Clinical outcomes in patients with renal artery stenosis treated with stent placement with embolic protection compared with those treated with stent alone

Purpose: To compare the clinical outcomes in patients with chronic renal insufficiency (CRI) and renal artery stenosis (RAS) following renal artery (RA) stent placement with and without embolic protection device (EPD) usage. Materials and Methods: Eighteen patients who had RA stent placement with EPD were matched to control patients (RA stent only). Blood pressure, number of hypertensive medications, and estimated glomerular filtration rate (eGFR) at 3 months before the procedure and after 12 months were determined. An increase of ≥ 20% in eGFR at 12 months from baseline was defined as "improvement," decrease of ≥20% as "deterioration," and an eGFR change between those values as "stabilization" at 12 months. Results: At 12 months, stage 4 patients treated with EPD had significantly higher eGFR than controls (P = .01). There was no statistical difference in blood pressure outcomes between the 2 groups. Conclusions: Patients with stage 4 CRI did significantly better with EPD than those treated without it.     

Bronchial compression due to stent placement in pulmonary artery in a child with congenital heart disease

Congenital heart disease, such as transposition of the great vessels (TGV), requires surgical procedures which can lead to important complications. We report on a case of bronchial obstruction following placement of a pulmonary artery stent in a 4-year-old boy who had undergone a Rastelli procedure to correct TGV, ventricular septal defect and pulmonary stenosis. There are many complications that can arise as a consequence of intravascular stents in heart surgery, as well as many causes of bronchial compression. However we have not found any report which describes bronchial compression as a direct consequence of endovascular stent.     

胰十二指肠切除术中放置与不放置胰管支撑管的比较

目的评价不同胰肠吻合方式在胰十二指肠切除术中的临床疗效,探讨不放置胰管支撑管的胰肠吻合的适用性。方法我院自2012年1月~2015年12月收治的87例可行胰十二指肠切除术患者,按随机分配方式分为胰管-空肠黏膜对黏膜端侧吻合+胰管支撑管外引流组(A组,43例)和胰腺-空肠端侧吻合不放置胰管支撑管组(B组,44例),比较两种不同胰肠吻合方式行胰肠吻合术的时间及术后住院时间、术后并发症的发生率。结果术中未放入胰管支撑管组的胰肠吻合时间(平均15.4min)明显小于术中放入胰管支撑管组(平均21.1min),差异有统计学意义(t=7.137,P0.05)。B组患者术后住院时间小于A组(t=2.408,P0.05,差异有统计学意义)。两组患者术后胰漏、腹腔出血、腹腔感染、胃潴留,差异无统计学意义(χ~2=0.181,0.322,0.603,0.001;P0.05)。结论胰十二指肠切除术不放置胰管支撑管可减少手术时间,降低术后住院天数,且术后并发症的发生率无显著差异,是安全可靠的。     

Cerebrospinal fluid pulsations in occult hydrocephalus due to ectasia of basilar artery

Summary The cerebrospinal fluid (CSF) pulsations were recorded in 4 patients with occult hydrocephalus, in whom the third ventricle was compressed by an ectatic basilar artery. Six patients with hydrocephalus without ectasia of the cerebral arteries were used as controls. Simultaneous intraventricular and lumbar pressure recordings were made.The variations in CSF pressure observed during respirator-breathing were of two kinds, i.e., those synchronous with respiration, and those small variations synchronous with the pulse, the latter having the shape of an arterial pressure pulse curve.The intraventricular pulse-synchronous pressure amplitude was almost significantly greater in the group with ectasia of the basilar artery (P<0.05). The ratio of the ventricular to the lumbar pulse amplitude was significantly greater in this group (P<0.01).The results suggest that pulsations from ectatic vessels adjacent to the ventricular system may contribute to the occurrence of occult normal pressure hydrocephalus.

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Liquorpulsationen bei unbemerktem Hydrozephalus infolge Ektasie der A. vertebralis

Zusammenfassung Die Liquorpulsationen werden bei 4 Patienten mit okkultem Hydrozephalus registriert, bei denen der 3. Ventrikel durch eine Ektasie der A. basilaris komprimiert war. Sechs andere Patienten mit Hydrozephalus, ohne Ektasie der Hirngefäße, dienten als Kontrollserie. Es wurden simultane intraventrikuläre und lumbale Druckmessungen durchgeführt.Während Respirator-Beatmung wurden zwei Veränderungen des Liquordruckes beobachtet, atemsynchrone Druckschwankungen und kleinere pulssynchrone Druckschwankungen. Die letzteren hatten das Aussehen einer arteriellen Pulsdruckkurve.Die intraventrikulären pulssynchronen Druckwellen waren in der Gruppe der Patienten mit Ektasie der A. basilaris fast signifikant höher (P<0,05). Die Relation zwischen der ventrikulären und der lumbalen Pulswellenhöhe war in dieser Gruppe signifikant größer (P<0,01).Die Ergebnisse lassen vermuten, daß die Pulsationen von ektatischen Hirngefäßen, die dem Ventrikelsystem nahegelegen sind, ursächlich zur Entstehung des okkulten Normaldruck-Hydrozephalus beitragen können.

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Pulsaciones del líquido cerebro-espinal en el hidrocéfalo occultó, a causa de ectasia de la arteria basilar

Resumen En 4 enfermos con hidrocefalia oculta, y en los que el tercer ventrículo estaba comprimido por una arteria basilar ectásica, se registraron las pulsaciones del líquido cerebro-espinal (L.C.R.). Se utilizaron como testigo 6 enfermos con hidrocefalia sin ectasia de las arterias cerebrales. Simultáneamente se registró la presión intraventricular y la lumbar.Las variaciones de la presión del L.C.R. observadas durante la respiración con mascarilla fueron de dos clases: aquellas que eran sínchronas con la respiración y las pequeñas variaciones síncronas con el pulso, éstas últimas tenian la curva de pulsaciones como la curva de la presión arterial.La amplificación de la presión síncrona pulso-intraventricular era sensiblemente mayor en el grupo con ectasia de la arteria basilar (P<0,05). La relación entre la amplificación de las pulsaciones ventriculares y las pulsaciones lumbares era sensiblemente mayor en este grupo (P<0,01).Estos resultados demuestran que las pulsaciones que provienen de los vasos ectásicos adyacentes al sistema ventricular contribuyen tal vez a la aparición de una hidrocefalia oculta con presión normal.

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Les pulsations du liquide cérébro-spinal chez une hydrocéphalie (ou hydropisie) occulte, dûe à une ectasie de l'artère basilaire

Résumé Les pulsations du liquide cérébro-spinal (=L.C.R.) ont été enregistrées chez 4 patients atteints d'hydrocéphalie occulte, et dont le troisième ventricule était comprimé par une artère basilaire ectasique. On a utilisé comme témoins 6 patients atteints d'hydrocéphalie sans ectasie des artères cérébrales. On a enregistré simultanément la pression intraventriculaire et la pression lombaire.Les variations de la pression du L.C.R. observées pendant la respiration avec masque furent de deux sortes: à savoir celles qui étaient synchrones de la respiration, et les petites variations synchrones avec le pouls, ces dernièrés ayant la forme d'une courbe de pulsation de pression artérielle.L'amplitude de la pression synchrone pouls-intraventriculaire était presque sensiblement plus grande dans le groupe avec ectasie de l'artère basilaire (P<0,05). Le rapport de l'amplitude des pulsations ventriculaires et des pulsations lombaires était sensiblement plus grand dans ce groupe (P<0,01).Ces résultats montrent que les pulsations provenant de vaisseaux ectasiques adjacents au système ventriculaire contribuent peut-être à l'apparition d'une hydrocéphalie occulte à «pression normale».

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Pulsazione del liquor cerebro-spinale nell'idrocefalo occulto dovuta ed ectasia dell'arteria basilare

Riassunto Gli AA. registrarono le pulsazioni del liquor cerebro-spinale (CSF) di 4 pazienti con idrocefalo occulto, nei quali il terzo ventricolo era compresso da un'ectasia dell'arteria basilare, servendosi per controllo di 6 pazienti con idrocefalo senza ectasia delle arterie basilari e ricorrendo alla registrazione simultanea della pressione endoventricolare e di quella lombare.Le variazioni della pressione del liquor osservate durante la respirazione erano di due tipi: quelle sincrone agli atti respiratori e le piccole variazioni sincrone al polso, le quali ultime avevano l'andamento della curva della pressione arteriosa.L'ampiezza della pressione endoventricolare polso-sincrona era notevolmente maggiore nel gruppo con ectasia dell'arteria basilare (P<0,05). Anche il rapporto dell'ampiezza ventricolare rispetto a quella lombare era notevolmente maggiore in questo gruppo (P<0,01).Da questi risultati si può dedurre che le pulsazioni dei vasi ectatici contigui al sistema ventricolare possono contribuire all'insorgere di un idrocefalo occulto con pressione liquorale normale.

     

Endovascular therapy for stenosis of the petrous or cavernous portion of the internal carotid artery: percutaneous transluminal angioplasty compared with stent placement

OBJECT: The effects of percutaneous transluminal angioplasty (PTA) and stent placement for stenosis of the petrous or cavernous portion of the internal carotid artery (ICA) were compared. METHODS: Twenty-four patients with symptomatic, greater than 60% stenosis of the petrous or cavernous portion of the ICA were treated using PTA or stent placement; 15 were treated with PTA and nine with stent insertion. Initial and follow-up results (> 3 months posttreatment) were compared in each group. Stenotic portions of the ICA were successfully opened in 13 of 15 patients in the PTA group, and in all nine patients in the stent-treated group. In one case in the PTA group stent delivery was attempted; however, the device could not pass through the vessel's tortuous curve, and PTA alone was performed in this case. Postoperatively, the mean stenotic ratio decreased from 72.1 to 29.6% in the PTA group, and from 75.6 to 2.2% in the stent-treated group. In four patients in the PTA group, stenoses greater than 50% were demonstrated on follow-up angiography performed at 3 to 6 months after PTA. In the stent-treated group, no restenosis was encountered, although in one case acute occlusion of the stent occurred; the device was recanalized with PTA and infusion of tissue plasminogen activator. This case was the only one of the 24 in which any neurological deficits related to the endovascular procedure occurred. Stent placement brought a greater gain in diameter than did PTA at the initial and late follow-up period; this gain was statistically significant. CONCLUSIONS: Stent placement is more effective than PTA for stenosis of the petrous or cavernous portion of the ICA from the viewpoint of initial and late gain in diameter.     

锁骨下动脉闭塞的血管腔内治疗

目的：探讨经皮血管内成形术(PTA)和血管内支架置放术治疗锁骨下动脉起始段闭塞的疗效。方法：应用经皮血管内成形术(PTA)和血管内支架安置术治疗5例锁骨下动脉起始段闭塞的病人。结果：5例手术均获成功。术后患肢动脉搏动恢复正常，多普勒测压双上肢血压压差由术前平均54mmHg降至术后9．6mmHg．术后随访1～3月；彩超提示支架无脱落及移位，病变部位血流通畅，椎动脉恢复为正常人颅血流。结论：PTA和血管内支架安置术是治疗锁骨下动脉起始段闭塞的一种微创、安全可行和疗效满意的方法。     

Treatment of spontaneous arterial dissections with stent placement for preservation of the parent artery

Summary Background. A wide variety of treatment regimens have been advocated for dissections involving the intracranial arteries. Recently, the stent can be used to exclude the aneurysm from the circulation and preserve the parent artery. We evaluated the safety and efficacy of stent angioplasty for intracranial arterial dissections.Methods. Ten patients with spontaneous dissections, nine vertebral artery and one internal carotid artery lesions underwent endovascular treatment using stent placement as primary treatment modality. One stent placement was attempted in five patients initially. Three patients were intentionally treated with two overlapping stents which completely covered the aneurysm orifice. Two tandem stents were used in one patient to allow spanning the entire length of the dissection. Stent-assisted coil embolization was performed in one patient.Results. Of the 10 patients in whom stenting was tried, the overall success in reaching the target lesion with stents was 90%. Of the 9 patients treated with stents, stent release and positioning were considered optimal in 7 patients (77.8%) and suboptimal in two. Lesions of 8 patients were improved or stable in angiographic follow-up. However, one pseudo-aneurysm was enlarged, and subsequently, was treated by proximal occlusion using coils. There were no instances of postprocedural ischaemic attacks, new neurological deficits, and no new minor or major strokes prior to patient discharge. All parent arteries of the patient who underwent the successful procedure were preserved. On the modified Rankin scale used for the follow up, all patients were assessed as functionally improved or of stable clinical status.Conclusions. The success in reducing dissection-induced stenosis or pseudo-aneurysm, the patency rate obtained at follow-up, and the lack of strokes (ischaemic or haemorrhagic) suggest that stent placement offers a viable alternative to complex surgical procedures or deconstructive procedures. The long-term efficacy and durability of stent placement for arterial dissection remains to be determined in a large series.     

Acute basilar artery occlusion in a patient with left subclavian artery occlusion due to first rib anomaly: case report

A previously healthy 22-year-old man presented with thoracic outlet syndrome manifesting as Raynaud's phenomenon in the left hand and embolic occlusion of the basilar artery. Three-dimensional computed tomography angiography showed that the left subclavian artery was occluded as it passed over the abnormal first rib. Retrograde propagation of the thrombus from the site of arterial occlusion and/or reflux of embolic material was suspected. Medical therapy was started. The patient underwent resection of the anomalous rib. Postoperative angiography demonstrated that the subclavian artery was recanalized with almost normal distal flow. The basilar artery was also recanalized. Thoracic outlet syndrome due to a first rib anomaly may cause stroke.     

Ectasia of the basilar artery with special reference to possible pathogenesis

The pattern of reticular fibers and some other microscopic features of all the major intracranial arteries were examined in two patients with ectatic basilar artery. In order to make a comparison possible the major cerebral arteries of 105 individuals with advanced atherosclerosis were also investigated. This series includes 40 patients with berry aneurysms. Defects in the elastic lamina and reticular fiber deficiency in the muscular layer were common pathologic features in patients with ectatic basilar artery and in those with berry aneurysm. In the ectatic basilar arteries these alterations were much more conspicuous. In the other atherosclerotic arteries sampled from patients having no malformations, the density of reticular fibers in the media was preserved. It is concluded that atherosclerosis may not have a basic role in the pathogenesis of arterial ectasias, but the severe reticular fiber deficiency in the media associated with extensive defects in the elastic lamina forms the morphologic basis of ectasias. Furthermore, the arterial ectasias and berry aneurysms are most probably different manifestations of the same underlying disorder.     

Successful cerebral artery stent placement for total occlusion of the vertebrobasilar artery in a patient suffering from acute stroke. Case report

A 64-year-old man suffering from crescendo brainstem symptoms due to acute total occlusion of the vertebrobasilar artery was successfully treated by cerebral artery stent placement. The total occlusion of a long segment of the vertebrobasilar artery was completely recanalized by implanting two flexible, balloon-expandable coronary stents. The patient's clinical outcome 30 days later was favorable. No complications occurred during or after the procedure. This therapeutic option may prove to be a useful means to revascularize an acute total occlusion of the vertebrobasilar artery.     

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目的：分析胰源性黄疸术前行直接胆道造影过程中发生并发症的原因，探讨其处理方法。方法：对1997～2002年收治的110例因胰腺疾病导致梗阻性黄疸病人术前行直接胆道造影发生急性胆道并发症的临床资料进行回顾性分析。结果：行PTCD检查42例，ERCP 59例，行两种检查者9例。总急性胆道并发症10例(9．09％)，PTCD组急性胆道并发症7例(13．73％)，急性胆管炎4例，胆道出血2例，胆汁性腹膜炎1例，死亡1例。ERCP组急性胆道并发症3例。结论：胰源性黄疸行直接胆道造影检查虽有一定的并发症发生，但合理的选择适应证，严格操作规范，对术后病人严密观察，积极的保守治疗可避免和治愈并发症。直接胆道造影和胆道引流应是胰源性黄疸术前安全有效的诊断和治疗方法。     

血管腔内裸支架成形术治疗自发性孤立性肠系膜上动脉夹层

目的探讨血管腔内裸支架成形术治疗自发性孤立性肠系膜上动脉夹层(SIDSMA)的安全性及有效性。方法回顾性分析经CTA及DSA确诊的15例SIDSMA患者的临床资料。按照Yun分型将SIDSMA分为4型。所有患者均接受SMA腔内裸支架成形术,术后予抗凝治疗2天及抗血小板治疗6个月。术后1、6、12个月及以后每年1次进行临床症状及CTA随访。结果15例患者中Ⅰ型1例,Ⅱa型11例,Ⅱb型3例。技术成功率100%,共植入裸支架22枚,其中行单个裸支架植入8例,双层裸支架重叠植入7例。随访时间5～51个月,平均(30.0±14.5)个月。随访期间未出现症状复发及与支架植入相关并发症;CTA提示SMA支架通畅,夹层重塑。1例患者于术后7个月死于急性心脏疾病。结论血管腔内裸支架成形术治疗SIDSMA是一种安全、有效的方法。     

Improved potential quality of intraoperative transcranial motor-evoked potentials by navigated electrode placement compared to the conventional ten-twenty system

Neurosurgical Review - Intraoperative neurophysiological monitoring of transcranial motor-evoked potentials (tcMEPs) may fail to produce a serviceable signal due to displacements by mass lesions....