Corrosion of tungsten coils after peripheral vascular embolization therapy: influence on outcome and tungsten load.

The purpose of this study was to evaluate coil corrosion and the long-term outcome after peripheral vascular embolization therapy performed with tungsten coils. We studied 14 patients who received tungsten coils on an average of 26 months prior to follow-up. The protocol included plain radiography and contrast-enhanced magnetic resonance angiography to investigate corrosion of tungsten coils and recanalization of the embolized vessels. Whole blood, hair, and urine tungsten levels were assayed when available. Corrosion of tungsten coils was detected in 9 of 14 patients by plain radiography. No evidence of recanalization of the embolized vessel and no adverse clinical effects of tungsten resorption were detected. Blood levels of tungsten were elevated in 6 of 14 patients and urine levels of tungsten were elevated in all 12 patients tested. Tungsten coil corrosion and elevated tungsten levels in blood, hair, and urine were found in most patients, although no adverse clinical effects of tungsten resorption were detected. Since the overall effect of high tungsten blood levels remains unclear, its use as an implant should be avoided.     

通用介入器械治疗输卵管阻塞的临床应用

目的:探讨使用通用介入器械治疗输卵管阻塞的临床价值。方法:使用5F单弯导管、血管鞘、超滑导丝等简易器械介入治疗输卵管阻塞38例共71条阻塞的输卵管。结果:阻塞的输卵管71条中,再通67条,再通率94.36％(67/71)。29例1次治疗后再通,9例2-3次治疗后再通。全部病例随访2年,24例妊娠,总妊娠率63.15％(24/38)。结论:通用介入器械介入治疗输卵管阻塞安全、有效、操作简单、费用低,效果理想。     

输卵管再通术联合中医治疗输卵管阻塞性不孕

目的　评价介入性输卵管再通术与中医药联合应用在治疗输卵管阻塞性不孕症方面的临床疗效。方法　对 38例输卵管阻塞性不孕病人的 76条输卵管,在DSA监视下,用Cook公司FTC-900输卵管再通系列器材进行输卵管阻塞再通术,手术前、后均辅以中医药侧穹隆封闭、灌肠治疗。结果　76条阻塞的输卵管中有 71条获得疏通,有效率为 93. 4%;术后随访半年, 38例不孕病人中有 25人受孕,受孕率为 67. 3%; 13例未受孕者中,有 8例出现输卵管的再阻塞。结论　输卵管再通术与中医药联合应用,简便安全,输卵管疏通率、术后受孕率均高于单纯行输卵管再通术或中医药治疗的病例,值得推广应用。     

指腹揉捏法用于3例PICC导管血栓性堵塞再通的应急处理

报道3例PICC导管外露端因血栓性堵管经尿激酶溶栓未通后,应用指腹揉捏法进行再通的应急处理全过程。前期对导管堵塞性质评估判断,确定为血栓性栓塞。先进行尿激酶溶栓,再通无效后实施指腹揉捏法,实施前要做好各方面充分准备和告知,实施过程中要掌握方法操作技巧,减少感染和导管损伤。再通成功导管通畅后要有针对性的做好护士维护指导和患者的护管教育。指腹揉捏法可以作为药物溶栓再通失败后应急处理的一种方法,高再通率能继续保障PICC导管顺利使用。     

Extracorporeal double filtration plasmapheresis in acute atherothrombotic brain infarction caused by major artery occlusive lesion

Extracorporeal double filtration plasmapheresis (EDFP) can quickly lower plasma viscosity and fibrinogen concentration. EDFP has the potential to improve cerebral microcirculation in acute ischemic stroke and ultimately to salvage penumbral tissue. However, no evidence is available to show that EDFP can increase cerebra blood flow (CBF). Therefore, we investigated whether EDFP could increase CBF by quantitative CBF measurements and documented the clinical effects of EDFP in acute ischemic stroke. EDFP was performed ten times in seven patients diagnosed as having acute atherothrombotic brain infarction caused by major artery occlusive lesion. They also fulfilled one of the following entry criteria: 1) diffusion/perfusion mismatch demonstrated by MRI on admission; 2) a hemispheric syndrome, but only a small lesion on diffusion weighted MRI (<25% of MCA territory); or 3) progressing stroke. Exclusion criteria were 1) contraindication of heparin or 2) spontaneous improvement of symptoms. Time from stroke onset to EDFP varied from 5 hr to 7 days. Plasma viscosity was quickly lowered by EDFP without affecting RBC counts, Hb, or Hct in all patients. Positron emission tomography (PET) with 15-O labeled H2O measurements revealed a significant CBF increase from 36.4 +/- 8.3 ml/100 g/min to 40.7 +/- 6.8 ml/100 g/min in the affected hemisphere (P=0.048). Definite CBF improvement was also demonstrated by single photon emission computed tomography (SPECT) in one of two patients who had severe stenosis of the middle cerebral artery. Furthermore, this patient showed remarkable improvement of hemiplegia immediately following EDFP (NIHSS score: 18 to 13). In conclusion, EDFP can increase CBF in ischemic brain tissue in acute atherothrombotic brain infarction. Further clinical studies should focus on the efficacy of EDFP on outcome of patients with this stroke subtype.     

心肌肌钙蛋白I在急性心肌梗死溶栓治疗中的临床意义

目的观察急性心肌梗死 (AMI)溶栓后血管再通和未通者与未溶栓者血清肌钙蛋白的动态变化。方法定量测定 93例 AMI患者的心肌肌钙蛋白 I(c Tn I) ,以 >10 0 ng/ L作为阳性判定值。结果溶栓再通者 c Tn I峰值较未通组与未溶栓组显著增高 (P<0 .0 5 ) ,且峰值增大 ,峰值时间提前 8小时 ,再通组 c Tn I恢复正常时间平均为 (13 0± 3 8)小时 ,较未通者提前 60小时。结论溶栓后动态测定血清c Tn I浓度、峰值时间 ,可作为判断溶栓成功的指标之一。     

Coronary artery stenting with high-pressure post-dilation followed by adjunctive thrombolysis after failed coronary angioplasty for acute myocardial infarction: Report of three cases

We successfully implanted coronary stents into refractory reoccluded lesions after failed coronary angioplasty in three patients with acute myocardial infarction (AMI). Lesion location was the proximal left anterior descending coronary artery in two patients and the dominant right coronary artery in one patient. The reference diameters of the lesions were 3.64, 3.33, and 3.50 mm, respectively. A stent with a luminal diameter of 3.0 mm was implanted in all patients. Poststenting dilation of the stent was performed at high pressure (18 atm), and urokinase was administered immediately thereafter. Heparin was administered for 24 h with maintenance of activated coagulation time within 180–200 s. Warfarin was then administered to keep the international normalized ratio within 2.5–3.5. Luminal diameters immediately after stenting were 3.14, 2.89, and 3.26 mm, and those at 1 month after stenting were 3.09, 2.81, and 3.12 mm, respectively, indicating good patency. Our experience in these cases suggests that coronary stenting can be applied after unsuccessful coronary angioplasty in selected patients with AMI. The present report includes informative reference data on diameter, postdilation, adjunctive thrombolytic agent administration, and adequate anticoagulation therapy in coronary stenting in this acute application.     

ST 段抬高型心肌梗死患者梗死相关动脉自发再通的相关因素

目的：观察急性ST段抬高型心肌梗死（STEMI）梗死相关动脉（IRA）自发再通（SR）患者的凝血功能指标,对其是否与SR相关进行分析。方法：连续入选STEMI且符合入选条件者共153例,根据急诊冠状动脉造影术中IRA血流分级,将其分为SR组51例,未自发再通（NSR）组102例。于患者入院时抽取静脉血,检测血小板功能参数、凝血常规、D-二聚体、肝肾功能等指标,分析两组患者的一般临床资料、检验指标、冠脉造影等资料特点。结果：两组在冠心病危险因素、肝肾功能、血小板功能参数、D-二聚体等方面差异无统计学意义（P〈0．05）。SR组梗死前心绞痛检出率显著高于NSR组（45．10％ vs 526．47％,P〈0．05）,部分凝血活酶时间（P1阿）高于NSR组[（24．26±3．55）s vs（22．93±3．49）s;P〈0．051。Pearson相关分析结果提示,梗死前心绞痛、PTT与IRA的SR有较强相关。结论：梗死前心绞痛、PTT水平的延长可以作为冠脉自发再通的预测指标。     

逆行开通技术治疗下肢动脉闭塞性病变

目的 探讨在介入治疗下肢动脉闭塞性病变导丝无法顺行通过闭塞段时改用逆行开通技术的临床意义.方法 回顾性分析27例下肢动脉闭塞性病变患者,男17例、女10例,年龄32～89岁,平均(70±12)岁.27例中下肢动脉硬化性闭塞症18例、糖尿病足7例、血栓闭塞性脉管炎2例.按Fontaine分期,Ⅱ期6例、Ⅲ期11例、Ⅳ期10例.在导丝无法顺行开通真腔、进入内膜下无法重返真腔或穿出血管外后,采用经足背动脉、胫后动脉穿刺或切开显露及利用足踝部胫后动脉、腓动脉、足背动脉的侧支血管进行逆行开通闭塞血管,再进行球囊扩张术和支架植入术.结果 27例手术均获得成功,血管开通后患者下肢缺血症状即刻得到改善.仅3例出现穿刺处血肿、1例足背动脉切开后足趾麻木,无严重围手术期并发症.术后5d平均踝肱指数由术前的0.37±0.11增加到0.85±0.12.结论 逆行开通技术可以作为常规正向开通技术治疗下肢动脉闭塞性病变失败时的一种补救方法,可以明显提高介入手术的成功率.     

非急性颅外段颈内动脉闭塞再通可行性 及开通失败的预测因素研究

目的：分析非急性颅外段颈内动脉闭塞再通可行性及影响开通的因素,并建立一个可预测闭塞再通 失败的模型。方法：纳入自2015年1月到2021年9月我中心经全脑血管造影确诊的动脉粥样硬化性颅外 段颈内动脉闭塞并接受血管内闭塞再通治疗的患者83例,分析血管开通失败的因素（性别、年龄、既往史、 发病到开通的时间、颈内动脉闭塞残端的角度、是否眼动脉返流）,分析是否开通与相关自变量的多因素 Logistic回归分析,建立一个可预测颈内动脉闭塞开通失败的模型。结果：在83例患者中,成功开通48例, 手术的总体成功率为57.8%。多因素回归分析显示,颈内动脉闭塞开通失败的影响因素包括：年龄（OR 1.159,95%CI 1.041～1.328）、高血压（OR 6.213,95%CI 1.204～46.540）、冠心病（OR 0.025,95%CI 0.001～ 0.254）、糖尿病（OR 0.157,95%CI 0.014～1.108）、颈内动脉闭塞残端角度（OR 0.082,95%CI 0.008～ 0.550）、眼动脉未返流至海绵窦段（OR 0.002,95%CI 0～0.021）。将Logistic多因素回归分析得出的危险因 素纳入预测模型并绘制列线图,该模型的ROC曲线下面积（AUC值）为0.947（95%CI 0.898～0.996）。结 论：非急性颅外段颈内动脉闭塞再通技术上可行。男性、年龄越高、无冠心病、无糖尿病、颈内闭塞角度是 钝角、眼动脉无返流是开通失败的预测因子。