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.

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

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流式细胞术监测血小板活化指导颅内支架介入术后病人抗血小板治疗的价值

目的 探讨流式细胞术监测血小板活化指导颅内支架介入治疗术后病人抗血小板治疗的价值。方法 选择2013年1月至2016年4月支架介入治疗术后病人1 792例，采集空腹静脉血，用20 μmol/L ADP激活5 min，应用流式细胞仪监测CD62P阳性率，范围控制在20.0%~50.0%。所有病人随访1年。结果 1792例中，无不良事件1691例，出血96例，再梗死5例。无不良事件组ADP激活后CD62P阳性率[（42.34±19.35）%]显著低于再梗死组[（83.64±6.41）%；P<0.05]，但是明显高于出血组[（11.32±3.96）%；P<0.05]。ADP激活后CD62P阳性率<20.0%有247例，20.0%~50.0%有1195例，>50.0%有345例。<20.0%组出血发生率明显增高（P<0.05），>50.0%组再梗死发生率明显增高（P<0.05）。20.0%~50.0%组不良事件发生率最低（P<0.05）。结论 应用20 μmol/L的ADP激活血小板5 min，采用流式细胞仪监测CD62P阳性率，可精准指导颅内支架介入治疗术后病人抗血小板治疗，其安全有效范围为20.0%~50.0     

A randomized pilot study of patients with tandem carotid lesions undergoing thrombectomy

Background and purposeThe optimal management of patients with tandem lesions (TL), or cervical internal carotid artery (c-ICA) steno-occlusive pathology and ipsilateral intracranial occlusion, who are undergoing endovascular thrombectomy (EVT) remains unknown. We sought to establish the feasibility of a trial designed to address this question.Materials and methodsThe Endovascular Acute Stroke Intervention (EASI) study was a single-centre randomized trial comparing EVT to medical therapy for large-vessel occlusion stroke. Patients with TL receiving EVT were randomly allocated to acute c-ICA stenting or no stenting. The primary outcome was the proportion of patients with a modified Rankin Scale (mRS) score of 0–2 at 90 days. Safety outcomes were symptomatic intracranial hemorrhage (sICH) at 24 hours and mortality at 90 days.ResultsOf 301 patients included in EASI between 2013 and 2018, 24 (8.0%) with TL were randomly allocated to acute stenting (n = 13) or no stenting (n = 11). Baseline characteristics were balanced. Eight (61.5%; 95% CI 35.5%–82.3%) and 7 (63.6%; 95% CI 35.4%–84.9%) patients, respectively, had a favorable outcome (mRS 0–2; P = 1.0). One non-stented patient had a symptomatic intracerebral hemorrhage.ConclusionsThis pilot trial of patients with TL undergoing EVT suggests that a sufficiently powered larger TL trial comparing acute c-ICA stenting to no stenting is feasible.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT02157532.     

Primary and Secondary Prevention of Ischemic Stroke and Cerebral Hemorrhage: JACC Focus Seminar

Stroke is a leading cause of permanent disability. Therefore, primary prevention of first stroke and secondary prevention of recurrent stroke are a high priority. Primary prevention of ischemic stroke includes lifestyle modification and diet, treatment of risk factors including hypertension, diabetes mellitus and lipid disorders, antiplatelet therapy for high vascular risk patients, and anticoagulation in atrial fibrillation. Secondary prevention of ischemic stroke includes additional carotid surgery or stenting in selected symptomatic patients, closure of patent foramen ovale after cryptogenic stroke, treatment of insulin resistance, and best medical treatment of intracranial stenosis. The most important preventive strategies in the primary and secondary prevention of cerebral hemorrhage include the treatment of hypertension, reduction in alcohol intake, and occlusion of the left atrial appendage in patients with atrial fibrillation and permanent contraindications for oral anticoagulation.