Feng Ling

Capital Medical University, Peping, Beijing, China

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Publications (206)224.76 Total impact

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    ABSTRACT: A retrocerebellar arachnoid cyst causing syringomyelia is extremely rare without tonsillar herniation. The authors present a 44-year-old woman with symptoms of foramen magnum compression and syringomyelia. Magnetic resonance imaging demonstrated a large retrocerebellar arachnoid cyst with a large cervicothoracic syrinx but no signs of tonsillar herniation or hydrocephalus. The patient underwent a foramen magnum decompression with C1 laminectomy, microsurgical fenestration of the cyst, and duraplasty. After successful reconstruction of CSF flow, the patient experienced a relief of symptoms and a significant reduction of the syrinx. The intraoperative findings support the theory of a piston mechanism in the development of syringomyelia. Additional arachnoidal adhesions may also obstruct the CSF flow around the craniocervical junction. We recommend the surgical treatment should consist of an adequate decompression of the foramen magnum, wide microsurgical arachnoidal debridement, and duraplasty with autologous grafts sutured in a watertight way.
    No preview · Article · Jan 2016 · Neurosurgical Review
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    ABSTRACT: Objective: To review the influencing factors of the early complication after carotid endarterectomy (CEA). Methods: Retrospective analysis of clinical data of 509 cases received CEA in Xuan Wu Hospital of Capital Medical University, Liaocheng People's Hospital and Dalian Central Hospital from January 2001 to December 2011. There are 422 male patients and 72 female patients among the 494 patients, 15 patients underwent CEA by stages. The patients were between 35-84 years old,and the mean age was (64±9) years. The complications within 30 days after CEA were analyzed, and find the risk factors for the major adverse events. Chi-square analysis was performed to analyze the correlation between the each variable of the basic characteristics of population, clinical features and intraoperative data and early adverse events after CEA. Logistic regression analysis was used to assess the relationship between a variety of factors and the postoperative complications within 30 days. Results: Technical complete rate of 98.6%, 7 cases of near-total occlusion patients could not been recanalized. Major complications in 30 days after CEA occurred in 20 cases (3.9%), including 6 cases of deaths (1.2%), 9 cases of cerebral infarction (1.8%) and 5 cases of cerebral hemorrhage (1.0%). Secondary complications occurred in 120 cases (23.6%). Univariate analysis showed modified Rankin scale (mRS) ≥ 3 on the incidence of early postoperative complication had significantly difference (χ(2)=20.517, P < 0.01), multivariate logistic regression analysis revealed that smoking (OR=2.667, 95% CI: 1.048-6.791, P=0.040) and mRS ≥ 3 (OR=8.690, 95% CI: 3.279-23.031, P=0.000) were the significant predictors of 30 days of the end event. Conclusion: The complications after CEA are uncommon, the security is proved. Smoking and mRS ≥ 3 can increase the risk of CEA.
    No preview · Article · Sep 2015 · Zhonghua wai ke za zhi [Chinese journal of surgery]
  • Xing-Wen Wang · Feng-Zeng Jian · Feng Ling
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    ABSTRACT: To report a rare fourth atlanto-axial joint. A cadaveric specimen of a young male adult from occiput to C4 was dissected for anatomical study of craniocervical region. A true fourth atlanto-axial joint was confirmed. Its morphological characteristics were described. The fourth atlantoaxial joint is rarely seen. The possible embryogenesis is discussed. This case raises an anatomical possibility of a new variant in this region. A unique case with an anatomically proven fourth atlantoaxial joint is reported. This anomaly can lead to misdiagnosis. CT scan coupled with MRI can facilitate accurate diagnosis.
    No preview · Article · Aug 2015 · European Spine Journal
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    ABSTRACT: Extracranial carotid artery aneurysm (ECAA) is an uncommon type of peripheral artery aneurysm. The treatment of this disease requires surgical intervention. Due to the limited number of large studies, the safety and efficacy of surgical and interventional management of ECAA is not well characterized. The optimum treatment has not been clearly defined. The present study reports four cases of ECAA. The patients received end‑to‑end anastomosis, carotid artery stents and balloon occlusion, respectively. These four cases demonstrate that ECAA may be successfully managed using end‑to‑end anastomosis. Furthermore, end‑to‑end anastomosis is a better intervention compared with endovascular treatment as it facilitates the removal of lesions under direct observation. The advantage of open surgery is the surgical repair of end‑to‑end anastomosis under direct observation. However, few studies have investigated the effect of the timing of resection of an aneurysm on patient outcome and the control of bleeding remains a challenge for surgeons. Therefore, the proximal and distal ends of aneurysm should be under direct observation during surgery.
    Preview · Article · Jul 2015 · Experimental and therapeutic medicine
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    ABSTRACT: To compare the incidence of retinal arterial embolism after carotid endarterectomy (CEA) or carotid artery stenting (CAS) as a treatment for carotid artery stenosis and to determine the risk factors for retinal artery embolization, this study included all consecutive severe carotid artery stenosis patients (70-99%), diagnosed by digital subtraction angiography, who underwent CEA or CAS between February 2014 and July 2014. The study included 61 patients in the CEA group and 71 patients in the CAS group. None of the patients developed a stroke or myocardial infarction or died within 7days of the surgery. A total of 15 patients exhibited retinal embolization including three patients who underwent CEA. None of these emboli caused symptoms. After undergoing CAS, 12 patients exhibited retinal embolization and one of the 12 patients suffered a decrease in visual acuity and visual field after CAS. The retinal embolization rate was 4.9% in the CEA group which was lower than the 16.9% rate in the CAS group (p=0.031). In addition, the retinal embolization rate in the ulcerated plaque group was higher than that in the non-ulcerated plaque group (p=0.007). Ulcerated plaques (odds ratio [OR] 5.043; 95% confidence interval [CI] 1.476-17.225; p=0.010) and CAS (OR 4.248; 95% CI 1.104-16.343; p=0.035) were independent predictors of retinal embolization. Although retinal embolization during CEA and CAS is common at our center, symptomatic embolization is not. The presence of ulcerated plaques and CAS were independent predictors of retinal embolization. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · May 2015 · Journal of Clinical Neuroscience
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    ABSTRACT: It is essential to collapse giant carotid-ophthalmic (OA) segment aneurysms for successful microsurgical clipping. We present a trapping-evacuation technique utilising hybrid operating theater capabilities to soften OA aneurysms. The patients were prepared for both microsurgical and endovascular procedures. After the majority of the aneurysm was exposed, a balloon was placed at the orifice of the aneurysm to fully block the blood flow. When the balloon was inflated, blood was evacuated from the aneurysm sac to eliminate the space occupying effect. Subsequently, the aneurysm neck was clearly exposed which greatly facilitated clip placement. A control angiogram was obtained prior to closing the wound to ensure complete aneurysm obliteration. After the establishment of a hybrid operating theater in our hospital, two aneurysms were successfully clipped using this technique. Although postoperative complications occurred in both patients, none of the events were related to the endovascular procedure or the trapping-evacuation technique. As a well-organized procedure designed for use in a hybrid operating theater, the current trapping-evacuation technique is an option for the surgical clipping of giant OA aneurysms. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · May 2015 · Journal of Clinical Neuroscience
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    ABSTRACT: The preservation of the facial nerve (FN) and acoustic function in large vestibular schwannoma (VS) surgery is challenging because of nerve course uncertainties and morphological deviations. Preoperative diffusion tensor tractography (DTT) has been proposed to predict the FN location. This study was conducted to evaluate the effectiveness of this technique for identifying the FN, cochlear nerve (CN) and trigeminal nerve (TN) in large VSs. The study included 23 consecutive patients with VS of Hannover classification T3b to T4b from November 2013 through May 2014. Diffusion tensor images and anatomical images were acquired. The DTT images of the cranial nerves were extracted before surgery for each patient to determine the relationships of these nerves with the tumor. The results were then validated during the tumorectomy. In 21 (91.30 %) patients, the location of the FN on the DTT images agreed with the intraoperative findings, including in 2 patients in whom the FN passed through the interface between the parenchyma and the cystic changes and in 3 patients with a membranoid FN. The CN or fibers of unclear function were observed on DTT images in four patients with functional hearing. One penetrating fiber of unknown function was effectively constructed. The TN was accurately detected on the DTT images for all patients. DTT effectively revealed the location of the FN, including cases in which the FN was membranoid or passed through the interface between an area exhibiting cystic changes and the tumor nodule. Fibers aside from the FN and the TN were revealed by DTT in patients who retained functional hearing. Penetrating fibers were also found using DTT. This technique can be useful during VS resection.
    Full-text · Article · May 2015 · Acta Neurochirurgica
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    ABSTRACT: Background: Patients with symptomatic stenosis of intradural arteries are at high risk for subsequent stroke. Since the SAMMPRIS trial, stenting is no longer recommended as primary treatment; however, the results of this trial, its inclusion criteria and its center selection received significant criticism and did not appear to reflect our experience regarding natural history nor treatment complications rate. As intracranial atherosclerosis (ICAS) is the most common cause for stroke in Asian countries, we are hereby proposing a refined prospective, randomized, multicenter study in an Asian population with strictly defined patient and participating center inclusion criteria. Methods: The China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis (CASSISS) trial is an ongoing, government-funded, prospective, multicenter, randomized trial. It recruits patients with recent TIA or stroke caused by 70%-99% stenosis of a major intracranial artery. Patients with previous stroke related to perforator ischemia will not be included. Only high-volume centers with a proven track record will enroll patients as determined by a lead-in phase. Patients will be randomized (1:1) to best medical therapy alone or medical therapy plus stenting. Primary endpoints are any stroke or death within 30 days after enrollment or after any revascularization procedure of the qualifying lesion during follow-up, or stroke in the territory of the symptomatic intracranial artery beyond 30 days. The CASSISS trial will be conducted in eight sites in China with core imaging lab review at a North American site and aims to have a sample size of 380 participants (stenting, 190; medical therapy, 190). Recruitment is expected to be finished by December 2016. Patients will be followed for at least three years. The trial is scheduled to complete in 2019. Conclusion: In the proposed trial, certain shortcomings of SAMMPRIS including patient and participating center selection will be addressed. The present manuscript outlines the rationale and design of the study. We estimate that this trial will allow for a critical reappraisal of the role of intracranial stenting for selected patients in high-volume centers.
    Full-text · Article · May 2015 · Interventional Neuroradiology
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    ABSTRACT: Anterior communicating artery (ACoA) aneurysms are well documented to have a higher rupture risk compared with aneurysms at other locations. However, the risk predicting factors for these aneurysms still remain unclear due to the complex arteries geometries and flow patterns involved. The authors introduce a comprehensive method to quantitatively illustrate the development of ACoA aneurysms using a computational fluid dynamics (CFD) approach. Seven ACoA aneurysms, which included 2 ruptured and 5 unruptured aneurysms, were employed. Patient-specific whole anterior circulation geometries were segmented to simulate the real circumstances in vivo. The energy losses (EL) and flow architectures of these 7 aneurysms were evaluated using an algorithm modality. Overall, the 2 ruptured aneurysms, along with 1 unruptured aneurysm that was defined as highly likely to rupture due to ACoA location and a bleb sitting at the top of the dome, had a significantly larger EL and more complex and unstable flow architecture than the others. Two aneurysms had a negative value of EL indicating that the geometries with aneurysms of the anterior communicating complex (ACC) had a smaller loss of energy than the geometries without aneurysms. Despite a small sample size resulting in a low statistical significance, EL may serve as a development predictor of ACoA aneurysms.
    No preview · Article · Mar 2015 · International Journal of Clinical and Experimental Medicine
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    ABSTRACT: Small side branches related brain infarction remains one of the major concerns for flow-diverter devices. However, among several factors, whether this high-profile stent would significantly block blood flow into small side branches remains unclear. The authors quantitatively evaluate blood flow reduction due to the deployment of flow-diverter devices using computational fluid dynamics approach. Thirty one patient-specific anterior inferior cerebellar artery geometries were employed. The flow-diverter device was hypothetically embedded into the basilar trunk, and to cover the anterior inferior cerebellar arteries. The blood flow reduction of each anterior inferior cerebellar artery following flow-diverter device deployment was calculated, with independent validations for both inflow and outflow conditions. Efficient diameters of the anterior inferior cerebellar arteries were calculated to evaluate any correlation with blood flow reduction after flow-diverter devices. The blood flow reduction ratio was shown to be 3.61±1.94%. There was moreover no significant difference of either inflow or outflow boundary conditions during the simulation. The results were calculated approximately as a modest linear correlation between the blood flow reduction ratio and the size of anterior anterior inferior cerebellar arteries which had a mean efficient diameter of 1.12±0.36mm (range from 0.31mm to 1.91mm), and the R(2) was 0.361. When covered by flow-diverter devices, the mechanical blood flow reduction in anterior inferior cerebellar arteries was found to be low with a maximum value estimated to be less than 8%. Therefore, mechanical blood flow reduction is probably not the leading factor contributing to small side branches related brain infarction. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Feb 2015 · Journal of Biomechanics
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    ABSTRACT: Endovascular surgery is advantageous in experimentally induced ischemic stroke because it causes fewer cranial traumatic lesions than invasive surgery and can closely mimic the pathophysiology in stroke patients. However, the outcomes are highly variable, which limits the accuracy of evaluations of ischemic stroke studies. In this study, eight healthy adult rhesus monkeys were randomized into two groups with four monkeys in each group: middle cerebral artery occlusion at origin segment (M1) and middle cerebral artery occlusion at M2 segment. The blood flow in the middle cerebral artery was blocked completely for 2 hours using the endovascular microcoil placement technique (1 mm × 10 cm) (undetachable), to establish a model of cerebral ischemia. The microcoil was withdrawn and the middle cerebral artery blood flow was restored. A reversible middle cerebral artery occlusion model was identified by hematoxylin-eosin staining, digital subtraction angiography, magnetic resonance angiography, magnetic resonance imaging, and neurological evaluation. The results showed that the middle cerebral artery occlusion model was successfully established in eight adult healthy rhesus monkeys, and ischemic lesions were apparent in the brain tissue of rhesus monkeys at 24 hours after occlusion. The rhesus monkeys had symptoms of neurological deficits. Compared with the M1 occlusion group, the M2 occlusion group had lower infarction volume and higher neurological scores. These experimental findings indicate that reversible middle cerebral artery occlusion can be produced with the endovascular microcoil technique in rhesus monkeys. The M2 occluded model had less infarction and less neurological impairment, which offers the potential for application in the field of brain injury research.
    No preview · Article · Dec 2014 · Neural Regeneration Research
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    ABSTRACT: Cerebral aneurysm (CA) is a life-threatening condition with a pathogenesis that remains unclear. Previous hypotheses have primarily been based on in vitro examinations of animal models. Therefore, we attempted to observe CA in living rats and to establish a multi-level evaluation system. The rat model was produced by deoxycorticosterone-acetate (DOCA; Sigma Aldrich, St. Louis, MO, USA) induced hypertension and a single injection of elastase into the basal cistern. The animals were assessed 35 days later. At the endpoint, we induced well-developed CA in 41.7% of the surviving rats. Using synchrotron radiation angiography (SRA), we observed the experimental aneurysms and their surrounding arteries dynamically in the living model. Further anatomical and histological analyses demonstrated the typical degenerative changes of the mural structure and a major infiltration of macrophages into the aneurysmal wall. In conclusion, we visualised well-developed experimental CA in living rats using SRA and demonstrated the associated degenerative histological changes and macrophage involvement; thus, we have provided an effective model for the study of dynamic multi-level changes associated with CA in a rat model.
    No preview · Article · Nov 2014 · Journal of Clinical Neuroscience
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    ABSTRACT: Objective The effects of growth hormone on cognitive dysfunction were observed in a controlled cortical impact (CCI) rat model and the underlying mechanism was explored. Method Three-month-old male SD rats were randomly divided into sham (n = 10), control (n = 10), and CCI groups (n = 40) The parameters were set as follows: striking speed, 3.5 m/s; impact depth, 1.5 mm; and dwell time, 400 msec. Eight and ten weeks post-injury, the GH levels were measured the water maze test and novel object recognition test were performed. CCI rats were divided into normal and decreased GH groups, and further randomly divided into two sub-groups (rhGH treatment and saline vehicle groups). All rats were tested for SYN, BDNF, and TrkB mRNA in the prefrontal cortex and hippocampus by RT-PCR. Results CCI rats 8 weeks post-injury had cognitive dysfunction regardless of the GH level (P<0.05). rhGH treatment improved cognitive function in CCI rats. There was a positive correlation between the expression of prefrontal BDNF and SYN mRNA in CCI rats after rhGH therapy and the water maze test score (r = 0.773 and 0.534, respectively; P<0.05). Furthermore, the expression of BDNF, TrkB, and SYN mRNA in the hippocampus was negatively correlated with the water maze test score (r = 0.602, 0.773, 0.672, and 0.783, respectively; P<0.05). There was a difference in the expression of hippocampal and prefrontal BDNF, TrkB, and SYN mRNA (P<0.05) Conclusion rhGH treatment had a positive effect on cognitive function, which was more evident in GH-deficient rats. The increased expression of hippocampal and prefrontal BDNF and TrkB mRNA is implicated in rhGH therapy to improve cognitive function. Changes in the expression of hippocampal SYN mRNA following rhGH therapy may also play a role in improving cognitive function.
    Preview · Article · Sep 2014 · PLoS ONE
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    ABSTRACT: Objective: To investigate the clinical incidence of cerebral artery fenestration and its digital subtraction angiography (DSA) characteristics in order to improve the understanding of the clinical significance of the cerebral artery fenestration.
    No preview · Article · Sep 2014
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    ABSTRACT: Objective: This retrospective study aimed to evaluate our initial experience with carotid endarterectomy in a Chinese population. Methods: Four hundred and thirty-three patients who underwent carotid endarterectomies at Xuan Wu Hospital Capital Medical University between January 1, 2001, and December 31, 2012, were reviewed. The postoperative 30-day complications were analyzed. Univariate and multivariate logistic regression analyses were used to analyze the factors associated with perioperative stroke and death. Results: The overall 30-day complication rates after surgery were 4.08% for death and stroke, 3.63% for cranial nerve injuries, and 3.63% for heart complications. The mean follow-up time was 32.99 months, and only 11 cases required restenosis, including two that were symptomatic (experiencing transient ischemic attacks). In the univariate analysis, a history of cerebral infarction was present preoperatively in 179 patients, of whom 12 (6.70%) had a postoperative stroke or died (P=0.021). Thirty-two patients had a modified Ranking score (mRS)≥ 3, and six (18.75%) of these patients had a postoperative stroke or died (P<0.001). In the multivariate logistic regression, female gender (OR: 4.669; 95% CI: 1.238-17.602; P=0.023), current smoking habits (OR: 3.826; 95% CI: 1.298-11.277; P=0.015), and an mRS ≥ 3 (OR: 1.540; 95% CI: 3.844-40.909; P<0.001) were independent risk factors for perioperative stroke and death. Conclusions: In our single-center study, carotid endarterectomies appeared to effectively prevent and treat the carotid artery stenosis that leads to stroke. Female gender, current smoking habits, and neurological deficits (mRS ≥ 3) increased the perioperative stroke and death rates.
    No preview · Article · Aug 2014 · Clinical Neurology and Neurosurgery
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    ABSTRACT: Objective: To investigate the effects of statins application on the prognosis of carotid artery stenting (CAS). Methods: A total of 1700 patients who successfully performed carotid artery stenting at the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from January 2001 to August 2012 were analyzed retrospectively. They were divided into either a statin group (n = 1224) or a non-statin group (n = 476) according to whether they took statins or not. The lipid-lowering target was to decrease the level of low-density lipoprotein cholesterol (LDL-C) to <2.1 mmol/L or decrease 40% of the basal level. The overall incidence of stroke, myocardial infarction and death at 30 day after procedure were observed in patients of both groups. The correlation between statins and the occurrence of adverse events, as well as the risk factors of complication were analyzed. Results: The technical success rate of stenting in this group was 100%. (1) Forty three patients (2.53%) had major adverse events within 30 days after procedure, including 34 strokes, 1 myocardial infarction, and 8 deaths. The major adverse event rate was 1.96% (24/1224) in the statin group, while it was 3.99% (19/476) in the non-statin group. There was significant difference (χ2 =5.731, P =0.017). The incidences of stroke in the two groups were 1.56% (19/1224) and 3.16% (15/476) respectively. There was significant different (P <0.05). (2)The perioperative administration of statins was a protective factor for the good prognosis of CAS (OR = 0.524, 95% CI 0.279 to 0.983; P = 0.044). The modified Rankin scale (mRS) score ≥3 (OR =3.025, 95% CI 1.353 to 6.763) was a risk factor for occurring complications in patients with carotid artery stenting within 30 days after procedure. Conclusion: The incidence of major adverse events of the statin group is lower than that of the non-statin group. Statin therapy may reduce the incidence of adverse outcome events.
    No preview · Article · Mar 2014 · Chinese Journal of Cerebrovascular Diseases

  • No preview · Article · Mar 2014 · Neural Regeneration Research
  • M. Li · L.-Q. Jiao · F. Ling · Y. Hua · M. Ye · Y.-F. Chen · Y.-B. Wang · Y. Ma
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    ABSTRACT: Objective: To analyze the risk factors of severe hemodynamic depression (HD) in carotid artery stenting (CAS) for the treatment of carotid stenosis. Methods: Eighty-five patients (70 males and 15 females) treated with CAS were analyzed retrospectively. They were divided into either a severe HD group (n = 18) or a non-severe HD group (n = 67) according to whether they had severe HD (blood pressure ≤90/60 mm Hg or heart rate ≤50/min) or not. The effects of all relevant factors on severe HD were observed, and Logistic regression analysis was used to define the independent risk factors for severe HD. Results: Multivariate Logistic regression analysis showed the hyperechoic plaques of color Doppler flow imaging (OR = 6.219,95% CI 1.163-33.266;P = 0.033) ,the distance from the most stenotic site to carotid bifurcation <1 cm (OR = 8.360,95% CI 1.372-50.930; P = 0.021), the baseline systolic pressure <120 mm Hg (OR = 6.384,95% CI 1.217-33.486; P = 0.028), and the dilatation of balloon diameter ≥5 mm (OR = 8.028,95% CI 1.462-44.091; P = 0.017) were the independent risk factors for severe HD after CAS. Conclusion: The hyperechoic plaques, distance from the most stenotic site to carotid bifurcation <1 cm, baseline systolic pressure <120 mm Hg,and dilatation balloon diameter ≥5 mm are the independent risk factors for severe HD after CAS.
    No preview · Article · Mar 2014 · Chinese Journal of Cerebrovascular Diseases
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    ABSTRACT: Objective: To evaluate the clinical efficacy of carotid artery stenting (CAS) for carotid restenotic lesions. Methods: Nineteen patients with carotid restenosis after carotid endarterectomy (CEA) or CAS at the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University were analyzed retrospectively. All the patients were males, aged 48 to 78 (mean 61.5 ± 8.6) years. 9 patients had restenosis after CAS, and 10 had restenosis after CEA. They were all diagnosed by DSA, and their restenoses were treated with CAS. Two days before and after procedure, they underwent color Doppler ultrasound examination. At 1, 3, 6, and 12 months after procedure, they were followed up at the outpatient department. Results: The stents of all the 19 patients were implanted successfully. No complications occurred. The residual stenosis rate was < 20%. The patients felt that their neurological deficit symptoms disappeared after procedure, and did not have any clinical symptoms at the follow-up period. No myocardial infarction, stroke and death were found during the follow up at each time point after the procedure. The reexamination of carotid artery with color Doppler flow imaging did not reveal restenosis. Conclusion: Carotid artery restenosis treated with CAS may be the safe and effective procedure.
    No preview · Article · Mar 2014 · Chinese Journal of Cerebrovascular Diseases
  • G. Sonh · L.-Q. Jiao · F. Ling

    No preview · Article · Mar 2014 · Chinese Journal of Cerebrovascular Diseases

Publication Stats

872 Citations
224.76 Total Impact Points

Institutions

  • 2003-2015
    • Capital Medical University
      • Department of Neurosurgery
      Peping, Beijing, China
  • 2002-2015
    • Xuanwu hospital
      Peping, Beijing, China
  • 2006-2011
    • Tongji University
      Shanghai, Shanghai Shi, China
  • 1999
    • Guiyang Medical University
      Kuei-yang, Guizhou Sheng, China