颅内静脉窦狭窄患者眼部表现及支架术后眼底改变的相关研究

目的 了解颅内静脉窦狭窄（cerebral venous sinus stenosis，CVSS）患者眼部特征，分析静脉窦支架置 入术后眼底改变情况，探讨与视盘水肿程度相关的可能因素。 方法 回顾性纳入2014年1月-2018年8月在首都医科大学附属北京天坛医院神经介入中心确诊，并 行静脉窦支架置入术的CVSS患者，收集患者一般资料、病程、视力、眼底检查、视野情况、颅内压、 DSA检查、静脉窦内压测定及患者术后的眼部变化等临床资料。总结CVSS患者的眼部特征和静脉窦 支架置入术后的眼底改变情况，应用Kendall’s tau-b相关分析探讨与视盘水肿程度相关的可能因素。 结果 共纳入125例CVSS患者，存在视功能损害者101例（80.8%），包括视物模糊、视力下降、视 物变形、阵发性黑蒙、视野缺损、复视等，其中65例（52.0%）眼部症状为首发症状，35例（28.0%）仅 表现出眼部症状。视盘水肿115例，共223只眼。视盘水肿等级中位值3（2～4）级（Fri sén分级）。部分 患者可见视盘周围出血、渗出、棉绒斑，视网膜皱褶及静脉迂曲扩张，视盘色淡或苍白等。视盘水 肿等级与颅内压正相关（Kendall’s tau-b=0.271，P =0.029），与病程负相关（Kendall’s tau-b=-0.261， P =0.002）。其中79例经内科治疗无效患者接受了静脉窦支架置入术，术后患者视盘水肿均有减轻， 术后1个月视盘水肿等级降为2（1～3）级；术后6个月时视盘水肿完全消退比例达94.4%（135/143）。 结论 对双眼视盘水肿患者要除外CVSS可能性；眼底检查是CVSS诊疗评估及判断颅内压情况的 一项重要无创检查，同时也是CVSS患者治疗后随访观察的必要检查。视盘水肿程度与颅内压正相关， 与病程负相关；静脉窦狭窄合并视盘水肿经内科治疗无效患者可考虑行静脉窦支架置入术治疗，促 进视盘水肿消退，减少视神经不可逆性损害。     

Results of retrograde open mesenteric stenting for acute thrombotic mesenteric ischemia

Objective

Acute mesenteric ischemia (AMI) is an emergent event with a high mortality rate; survivors have high rates of intestinal failure. Restoration of blood flow using endovascular or surgical revascularization is associated with better outcome in terms of survival rate and intestinal resection. Retrograde open mesenteric stenting (ROMS), which is a hybrid technique, combines two benefits: prompt blood flow restoration with an endovascular approach and inspection and resection of the small bowel. The aim of the study was to assess the results of ROMS in thrombotic AMI in a retrospective multicenter study.

Long-Term Effects on Preventing Stroke after Endovascular Treatment or Bypass Surgery for Intracranial Arterial Stenosis

Background: Intracranial arterial stenosis (ICAS) is an important cause of ischemic stroke worldwide due to its higher risk of recurrence with medical therapy. Although some large randomized studies failed to show the superiority of surgical treatment compared with medical therapy, the results of medical therapy are not sufficient. There are patients who still benefit from surgical treatment. This retrospective analysis aimed to evaluate the long-term efficacy of surgical therapy with percutaneous transluminal angioplasty and/or stenting (PTA/PTAS) or extracranial-intracranial (EC/IC) bypass surgery for patients with ICAS. Methods: Between October 2005 and December 2016, 55 ICAS patients were treated with PTA/PTAS or EC-IC bypass surgery. Their electronic medical records were retrospectively reviewed and analyzed. The primary outcome was all adverse events beyond 30 days after a revascularization procedure. Results: We performed 21 cases (35%) of PTA, 4 cases (7%) of PTAS, and 34 cases (58%) of EC-IC bypass surgery and the median follow-up duration was 66 months (range 1-144 months). The occurrence rate of the primary outcome was 10.2% and only 1 patient (1.8%) experienced ipsilateral disabling ischemic stroke beyond 30 days. The long-term functional independent survival rate was 83.6%. Conclusions: We demonstrated a long-term favorable outcome of combined surgical intervention for ICAS patients with PTA/PTAS and EC-IC bypass surgery, and the result was better than previously reported outcomes of medical therapy. Additional multicenter studies are required to draw firm conclusions on the efficacy of reduction of recurrent stroke in patients with ICAS.     

Transcatheter ductus arteriosus stenting in paediatric cardiology: Indications,results and perspectives

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