Interventional procedures involving portal vein circulation: a review

Rapid development of diagnostic radiological methods during recent decades has been followed by development of new interventional procedures involving portal circulation. The majority of these interventions were developed for treatment of patients with symptoms secondary to portal hypertension (PH). Interventions involving portal vein circulation have an established position in the treatment of PH and other diseases, and further development of these methods can be expected.     

急性脑梗死血管再通研究进展

目前脑梗死患者的治疗仍然是神经科研究和关注的重点,早期的血管再通与患者良好预后明显相关。而目前针对急性脑梗死早期血管再通治疗的方法有多种,临床医师如何选择存在一定的困扰,本文结合指南就各血管再通治疗方法进行汇总分析,以帮助临床医师做出临床决策时进行参考。     

Clinical application of interventional techniques in the treatment of Budd-Chiari syndrome

Objective To evaluate the clinical value of various kinds of interventional techniques in the treatment of Budd-Chiari syndrome (BCS).Methods Multiple techniques such as recanalization of the inferior vena cava (IVC) under the guidance of marker and multi-angled fluoroscopy, recanalization of the hepatic vein with a transjugular approach, PTA, Z-expandable metallic stent (Z-EMS) implantation and modified TIPSS were used to treat 103 patients with BCS.Hesults Of 103 patients with BCS, 59 patients with obstruction of IVC were treated using recanalization of IVC. Seventeen patients with hepatic vein obstruction had their hepatic veins recanalized. The rest of the patients were given other methods of interventional treatment. Of all the subjects, 101 successfully underwent their procedures, with a success rate of 98.06% ; and only 2 failed to recanalization of the IVC. Fifty-three patients were treated using PTA for the first time, with a success rate of 100%. In the 48 patients undergoing Z-EMS implantation for the first time, the success rate was 95.8%. Five patients were treated with modified TIPSS. After these interventional treatments, the success rate was 100%. Two patients died 16 h and 72 h respectively after operation because of DIC and severe hemoptysis. SevenS-two patients were followed up for 1 -94 months (with a mean of 42. 3 months). The mean follow-up of a BCS patient treated with PTA was 52. 1 months, resulting in a primary patent rate of 59.4% and a restenosis rate of 40. 6%. The mean follow-up of BCS treated with stenting was 33.5 months, with a primary patent rate of 87.5% and a restenosis rate of 12. 5%. Eight patients died 7 -64 months after the interventional procedure.Conclusion Flecanalization of IVC or the hepatic vein transjugularly, PTA, Z-EMS implantation and modified TIPSS can be regarded as safe and effective micro-invasive methods in the treatment of BCS.     

Association of growth factors with arterial recanalization and clinical outcome in patients with ischemic stroke treated with tPA

Summary. Background: Growth factors (GF) such as vascular endothelial growth factor (VEGF), angiopoietin‐1 (Ang‐1) and granulocyte‐colony stimulating factor (G‐CSF) have been associated with greater efficacy of tissue plasminogen activator (tPA) in experimental studies. Objectives: To study the association of these GF with arterial recanalization and clinical outcome in patients with acute ischemic stroke treated with tPA. Methods: We prospectively studied 79 patients with ischemic stroke attributable to MCA occlusion treated with i.v. tPA within the first 3 h from onset of symptoms. Continuous transcranial color‐coded sonography (TCCS) was performed during the first 2 h after tPA bolus to assess early MCA recanalization. Hemorrhagic transformation (HT) was classified according to ECASS II definitions. Good functional outcome was defined as a Rankin scale score of 0–2 at 90 days. GF levels were determined by ELISA. Results: Mean serum levels of VEGF, G‐CSF and Ang‐1 at baseline were significantly higher in patients with early MCA recanalization (n = 30) (all P < 0.0001). In the multivariate analysis, serum levels of VEGF (OR, 1.03), G‐CSF (OR, 1.02) and Ang‐1 (OR, 1.07) were independently associated with early MCA recanalization (all P < 0.0001). On the other hand, patients with parenchymal hematoma (PH) (n = 20) showed higher levels of Ang‐1 (P < 0.0001). Ang‐1 (OR, 1.12; P < 0.0001) was independently associated with PH, whereas patients with good outcome (n = 38) had higher levels of G‐CSF (P < 0.0001). G‐CSF was independently associated with good outcome (OR, 1.12; P = 0.036). Conclusions: These findings suggest that GF may enhance arterial recanalization in patients with ischemic stroke treated with t‐PA, although they might increase the HT.     

A simplified procedure for intra-arterial thrombolysis with tissue-type plasminogen activator in peripheral arterial occlusive disease: primary and long-term results

One-hundred and fifty patients with thrombotic and 60 patientswith embolic occlusions of the superficial femoral and/or poplitealartery underwent a simplified IAT (intra-arterial thrombolysis)procedure. Ten mg rt-PA combined with 3000 IU Heparin were infusedover 6 h, thereafter the extent of thrombolysis was checkedfluoroscopically and the above mentioned treatment course repeatedup to four times if necessary. The IAT regimen employed didnot involve mechanical recanalization attempts; if completethrombolysis revealed an underlying stenosis, a PTA (percutaneoustransluminal angioplasty) was subsequently performed. IAT resultedin complete recanalization of 88 thrombotic occlusions (59%;95% confidence interval: 50.8%–66.8) and of 53 embolicocclusions (88%; 95% confidence interval: 77.1%–94.8%P <0.001). In a further 33 (22%) thrombotic and four (7%)embolic occlusions IAT reduced the length of the occluded segment.At discharge, 102 (67%) patient with thrombotic and 55 (92%)patients with embolic occlusions were clinically improved. Overall,untoward effects occurred in 60 patients (29%): 47 (22%) wereminor. Four patients (2%) suffered a systemic haemorrhage (threegastrointestinal, one macrohaematuria). The cumulative patencyrate was sign higher in patients with embolic occlusions throughoutfollow-up (82% vs 49% for thrombotic occlusions at 2 years,P <0.001). Although all amputations were carried out in patientswith thrombotic occlusions, follow-up mortality did not differsignificantly between patients with embolic and thrombotic occlusions.     

急性缺血性脑卒中血管内介入治疗的疗效分析

目的探讨急性缺血性脑卒中患者实施血管内介入治疗的效果。方法纳入本院(2015年10月～2018年10月接收的急性缺血性脑卒中患者(n=100)作为研究对象,均实施血管介入治疗,按随机数字表法分为实验组(n=50,实施硫酸氢氯吡格雷片+阿司匹林治疗)、对照组(n=50,实施阿司匹林治疗),比较两组治疗后血管再通率、并发症发生率、神经功能评分、临床总有效率情况。结果实验组治疗后血管再通率为76.00%,显著高于对照组56.00%,差异显著(P0.05)。实验组并发症发生率为12.00%,显著低于对照组28.00%,差异显著(P0.05)。实验组神经功能评分(4.52±1.35分)显著低于对照组(7.21±1.45分),差异显著(P0.05)。实验组临床总有效率为82.00%,显著高于对照组64.00%,差异显著(P0.05)。结论急性缺血性脑卒中患者实施血管内介入治疗的效果显著,既可提高血管再通率,改善神经功能缺损评分,还可降低并发症发生率,值得借鉴。     

Percutaneous coronary intervention of a circumflex chronic total occlusion using an epicardial collateral retrograde approach.

Antegrade disobliteration of a chronic total coronary occlusion (CTO) may be technically difficult in spite of the use of customized equipment. Retrograde approaches via intramyocardial septal or bypass grafts have been described. We report a successful Percutaneous intervention of a proximal circumflex CTO using a retrograde approach via an epicardial collateral.     

支架植入术对颈动脉狭窄患者血管再通及神经生化标志物的影响

目的 研究支架植入术对颈动脉狭窄患者血管再通及神经生化物的影响。方法 选取2016年1月~2020年1月我院收治的61例颈动脉狭窄患者,将患者采用随机数字表法分为手术干预组（n=30）和对照组（n=31）,对照组接受内科常规颈动脉狭窄手术治疗;手术干预组接受支架植入术治疗。对比两组患者治疗前和治疗四周后神经生化物[中枢神经特异蛋白（S100β）、人脑髓鞘碱性蛋白（MBP）、神经元特异性烯醇化酶（NSE）]、氧化应激因子[超氧化物歧化酶（SOD）,丙二醛（MDA）]、及认知功能评估;对比两组患者治疗期间出现的不良反应;对比两组患者治疗3、6个月后血管通畅情况。结果 治疗后,相比于对照组,手术干预组S100β、MBP、NSE显著更低（P<0.05）;治疗后,相比于对照组,手术干预组SOD显著更高,MDA显著更低（P<0.05）;治疗后,相比于对照组,手术干预组MOCA评分显著更高（P<0.05）。结论 支架植入术能够明显改善患者神经生化物、氧化应激因子和认知功能,提高术后血管再通率,且安全性较高。