Temporary Strecker Stent for Management of Acute Dissection in Popliteal and Crural Arteries

Stent placement is a widely used bail-out treatment for dissection of peripheral arteries. Below the level of the superficial femoral artery permanent stenting is complicated by a high incidence of subacute thrombosis and restenosis. We present two cases of arterial occlusion due to acute iatrogenic dissection of the popliteal and distal fibular arteries. Successful treatment was achieved with a new bail-out procedure. Strecker stents were implanted to seal off the dissection flap. Stents were retrieved easily after 24 hr using a myocardial biopsy forceps. After stent retrieval the temporarily stented segments were patent and showed a larger lumen compared with segments treated by balloon dilatation alone. Temporary stenting is a simple and safe procedure and offers the advantage of tacking up dissection membranes and preventing recoil. Persistent presence of a metallic implant as a source of continued injury and stimulus for intimal proliferation is avoided.     

The strecker stent: Indications and results in iliac and femoropopliteal arteries

We have implanted more than 100 Strecker stents in the iliac and femoral arteries. In iliac arteries, follow-up is available from 8 to 48 months (mean 20 months) and in peripheral arteries, from 8 to 32 months (mean 19 months). In iliac and proximal femoral arteries there was a patency rate of 98% (mean 20 months after stent implantation) whereas in peripheral arteries the patency rate was 70.8% (mean 19 months after stent implantation). Besides careful selection of patients, anticoagulation is very important for successful stenting. Because of the excellent results of stents in iliac vessels there is a wide range of good indications, including primary stenting after recanalization of occlusions. In contrast, stent implantation in peripheral vessels should be restricted to special cases such as acute dissection or reocclusion after successful recanalization.     

Implantation of the Corinthian IQ stent into the femoropopliteal arteries using 6-F introducer sheaths in antegrade and crossover procedures: midterm results

The aim of this study was to evaluate the technical performance of the implantation of the Corinthian IQ stent into the femoropopliteal arteries using 6-F introducer sheaths. Thirty-three lesions (24 stenoses, 9 occlusions) in 32 patients (mean age 67 years) were stented. Selective stent implantation was performed after unsatisfactory percutaneous transluminal angioplasty result with an antegrade access in 21 patients and through a crossover sheath in 11 patients. A total of 36 stents were implanted. Stent delivery was successful in all cases (stent diameter 5 or 6 mm, stent length 11–38 mm). In none of the cases was stent dislodgement from the balloon observed. Stent placement was optimal without residual stenosis in 30 cases. In 1 case the stent was chosen too short requiring implantation of a second stent. In 1 patient distal embolization was observed which was treated with catheter embolectomy. Nine-month primary and secondary patency rates were 79±8.7 and 86±7.7%, respectively. Implantation of the Corinthian IQ stent into the femoropopliteal arteries using 6-F introducer sheaths is safe in antegrade and crossover procedures. Presented at ECR 2002.     

Percutaneous fenestration of aortic dissection: Salvage of an ischemic solitary left kidney

The false channel of a type III aortic dissection caused acute renal ischemia by compression of the origin of the left renal artery in a patient with status post-right nephrectomy. To relieve the ischemia and restore renal function, percutaneous balloon fenestration was performed successfully.     

Percutaneous transluminal atherectomy of the superficial femoral and popliteal arteries: Long-term results in 48 patients

Purpose Evaluate retrospectively the long-term primary patency of directional atherectomy (DA) in the femoropopliteal arteries.Materials and Methods DA was used alone in 59 patients (47%) or in combination with predilatation to allow passage of the device (43%) or after thrombolysis (10%) to treat 127 (93%) excentric atherosclerotic stenoses and nine (7%) occlusions of the femoropopliteal arteries. Forty-eight patients were followed by telephone interview, scheduled outpatient visits, color-flow Doppler evaluation, and angiography for 1–36 months (mean 16.9 months).Results Technical success (reduction of the stenosis or occlusion to less than 30% luminal diameter) was achieved in 110 lesions (80.3%) during 48 procedures in 37 patients. Mean luminal diameter was increased 54% with a concomitant increase in mean ankle/brachial indices of 0.33. According to Kaplan-Meier survival curves, patency at 12 and 24 months was 88% and 75%, respectively. When patients who retained patency but developed restenosis were excluded, the probability of patency at 12, 24, and 36 months was 76%, 58%, and 32%, respectively. Major and minor complications occurred in 15 (21.4%) procedures each for a total complication rate of 42.8%.Conclusion Based on our results, DA is an effective method for percutaneous treatment of atherosclerotic disease involving the femoropopliteal arteries. It has similar patency but a relatively high complication rate compared with PTA.     

128层螺旋CT支气管动脉三维成像解剖特征及临床意义

目的应用128层螺旋cT血管造影研究支气管动脉（BA）的三维解剖特征及其临床应用意义。方法对79例患者行胸部增强扫描,至少1支BA清晰显示病例,采用容积再现（VR）、薄层VR、多平面重组（MPR）、最大密度投影（MIP）、薄层MIP等后处理技术,通过薄层轴位图像及重建图像观察和分析BA的相关三维解剖学特征。结果79例患者中,BA共清晰显示189支,其中右侧99支,左侧90支;较为常见的是R,L,（59．4％,47／79）,R2L1（17．7％,14／79）;右BA主要起源于右肋间后动脉（80．O％,79／99）和胸主动脉（18．0％,18／99）。开口位于胸主动脉的右侧壁,右前侧壁及前壁,左BA主要起源于胸主动脉（92．O％,83／90）,开口位丁胸主动脉的前壁及前侧壁,BA左右共干起源的24支,开口于胸主动脉前壁,异位起源的9支（0．05％,9／189）。结论128层螺旋cT血管造影可清晰显示BA,有效评价BA的三维影像解剖特征,为临床诊断及治疗提供清晰的BA三维解剖资料。     

MRI in spontaneous dissection of vertebral and carotid arteries

Summary Fifteen patients were observed between 1987 and 1990: there were six with angiographically confirmed vertebral artery dissection, and 9 with carotid artery dissection. Results showed concordance of MRI and angiographic findings, in all cases but one. The dissected portion consistently showed a semilunar hyperintensity narrowing the residual eccentric signal void of the lumen when the artery was not completely occluded. In one angiographically occluded vessel, MR detected a small signal void within the hyperintensity, indicating that the artery was not completely occluded. The length of the dissected portion was clearly demonstrated by MR. Follow up MR and angiographic studies confirmed the regression of the dissection, and also allowed examination of the cerebral parenchyma.     

左右颈动脉支架植入术发生颈动脉窦综合征比较

目的 对比分析左右两侧颈内动脉分别行球囊扩张颈动脉支架植入术(CAS)时发生颈动脉窦综合征(CSS)的差异.方法 回顾性分析64例接受CAS术颈动脉狭窄患者,男36例,女28例,平均年龄62.7岁(49～75岁);右侧颈动脉狭窄36处、左侧颈动脉狭窄30处,2例患者为双侧狭窄;重度狭窄(＞70％)37处,狭窄伴溃疡(30％～70％)29处;共植入66枚支架.术中均选用Wallstent自膨式支架.结果 36处接受右侧CAS术治疗颈动脉狭窄中发生重度CSS 5处、中度19处、轻度12处,发生率分别为13.89％、52.78％、33.33％;30处接受左侧CAS术治疗颈动脉狭窄中发生重度CSS 3处,中度10处、轻度17处,发生率分别为10.00％、33.33％、56.67％.两组数据差异有统计学意义(P＜0.05).结论 CSS是CAS术时常见并发症,右侧颈动脉行CAS时CSS发生率高于左侧.     

Dissection of cranial arteries in the neck: correlation of MRI and arteriography

Summary Retrospective correlation of MRI and angiographic findings in nine patients with suspected cervical vascular dissections revealed MRI evidence of vessel abnormalities in eight patients, seven of whom proved to have arterial dissections. One patient whose MRI showed no abnormalities also proved to have a dissection, shown by angiography. Two patients had associated pseudoaneurysms not demonstrated by MRI. Five dissections involved the carotid arteries and three the vertebral arteries. Seven of the nine patients had associated transient neurologic deficits, while two had permanent deficits. Frank infarction of the brain was demonstrated by MRI in five cases. MRI findings suggestive of dissection included: (1) increased signal from the entire vessel; (2) a border of increased signal surrounding the lumen, with luminal narrowing; (3) poor or absent visualization of the vessel; and (4) significant compromise of the vessel lumen by adjacent abnormal increased signal tissue.     

非支气管性体动脉引起咯血的发病情况及介入栓塞疗效分析

目的 观察非支气管性体动脉(NBSA)引起咯血的发生率、与原发疾病的关系及行经导管动脉栓塞术(TAE)栓塞责任NBSA治疗咯血的效果.方法 对139例接受TAE治疗的咯血患者行系统的主动脉和锁骨下动脉造影.患者原发病为:肺结核66例(2例有胸廓改良术史、1例有肺叶切除术史、1例合并室间隔缺损),单纯性支气管扩张41例(其中1例有肺叶切除术史、1例有动脉导管未闭结扎术史),支气管肺癌15例,隐原性咯血7例,尘肺3例,支气管结石3例,支气管囊肿1例,脓胸1例,肺癌术后1例,慢性肺栓塞1例.对发现的责任NBSA行栓塞术,观察NBSA引起咯血的发生概率、责任NBSA分布情况及与原发病的关系.随访观察临床疗效和并发症.随访时间6个月至5年.结果 139例中73例(52.5%)咯血与出现病理性NBSA有关.共计181支责任NBSA,包括肋问后动脉88支、胸廓内动脉27支、膈下动脉21支、食管固动脉20支、胸外侧动脉9支、肩胛下动脉7支、肋颈干5支、甲状颈干4支.肺结核患者咯血的责任NSBA以肋间后动脉(75支)和锁骨下、腋动脉的分支(44支)为主,单纯性支气管扩张者以食管固有动脉(16支)和膈下动脉(17支)为主.本组患者TAE后,即刻止血 69例,包括1次以上支气管动脉栓塞术后支气管动脉(BA)已闭塞无效和复发的19例、BA正常的初治者4例.本组中除1例行锁骨下动脉造影术后出现同侧小脑梗死和1例行BA和胸廓内动脉栓寨术后发生呼吸衰竭外无其他严重并发症.获6个月以卜的随访60例.术后间断性痰中带血16例;11例复发,10例再次TAE后停止咯血8例、间断性痰中带血2例,1例外科肺叶切除后咯血停止;其余未再咯血,但1例术后8个月死于肿瘤进展,1例术后2周死于原呼吸衰竭加莺.结论 相邻病灶的刺激和肺血流灌注不良或缺失的心血管疾病可致相应的NBSA参与肺内供血并成为咯血的责任血管,系统的血管造影和完整的TAE可提高咯血的治疗效果.     

MR imaging-guided percutaneous angioplasty and stent placement in a swine model comparison of open- and closed-bore scanners

RATIONALE AND OBJECTIVES: The purpose of this study is to compare the feasibility and precision of renal artery angioplasty and stent placement using two different MR scanners. MATERIALS AND METHODS: MR imaging-guided angioplasty and stent placements were performed on seven pigs using 0.2 and 1.5 T scanners (Magnetom Open and Magnetom Sonata, Siemens Medical Solutions, Erlangen, Germany). For guidance of catheters, guide wires and stents susceptibility artifact-based tracking was used. The end point of each intervention was to position a stent in the renal artery with its proximal end at the level of the aortic wall. Procedure time and stent position were evaluated. RESULTS: Catheterization, angioplasty, and stent placement were feasible using MRI guidance at both 0.2 and 1,5 Tesla. At 1.5 T all catheter manipulations and interventions were performed in less than 30 minutes. At 0.2 T the interventions took up to 90 minutes. No significant difference in the stent deviation was noted between the two scanners. CONCLUSION: The use of a high-performance 1.5 T scanner helped to reduce the procedure time to half of that of a low-field system. Since no difference in stent placement precision was noted, a dedicated MR-stent might be mandatory for more precise stent placement.     

Percutaneous interventional reconstruction of the iliac arteries: primary and long-term success rate in selected TASC C and D lesions

We report the primary and long-term outcome of patients with selected TransAtlantic Inter-Society Consensus (TASC) C or D lesions of the iliac arteries after percutaneous interventional reconstruction. Between 1999 and 2001, 89 patients with peripheral arterial disease categorized as TASC C (n=37) and D (n=52) underwent percutaneous interventional reconstruction and stent implantation. Patients were followed for 1–62 months (mean 36 months). Patency rates were assessed by Duplex ultrasound and ankle–brachial index (ABI) measurement. The primary technical success rate was 96.9% with an overall complication rate of 5.6%. The ABI improved from an average of 0.51±0.15 before intervention to 0.79±0.16 on the day following intervention and to 0.81±0.17 within 3 years after intervention. Clinical improvement was observed in 97.3% of the patients in the TASC C group and in 88.5% in the TASC D group. Eighty of 89 patients (89.9%) remained patent at 3-year follow-up. In five patients the reintervention was successful. The secondary patency rate was 95.5%. The patency rates were similar in our selected TASC C and D patients to those so far published for TASC A and B, with low complication rates. Therefore, percutaneous intervention can be recommended for these patients.     

心脏临时起搏器在颅外颈动脉支架置入术中的应用观察

目的 观察心脏临时起搏器在颅外颈动脉支架围手术期防治血流动力学紊乱的有效性、安全性.方法 41例行颅外颈动脉支架术高危患者,共置入颈动脉支架47枚,术前经左侧股静脉安置心脏临时起搏器,起搏心率设定为60次/min,术中术后监测患者症状、血压心率变化、起搏器工作情况.结果 进行了球囊预扩张的25处颈动脉病变起搏器全部启动,25例患者出现一过性起搏器工作,持续工作最长时间1 d,1例伴发症状性低血压,低血压最长持续4 d.全部患者未出现相关并发症.结论 血流动力学紊乱是颅外颈动脉支架置入术围手术期常见的并发症,术前安置心脏临时起搏器可以快速、有效地纠正血流动力学紊乱,防止出现脑卒中等围手术期并发症,对于存在高危因素的患者,是值得推荐的方法.     

药物洗脱支架治疗多支慢性完全闭塞冠脉病变的中期疗效观察

目的探讨药物洗脱支架（DES）对多支慢性完全闭塞病变（CTO）冠心病患者的中期疗效和临床意义。方法选取2002年11月-2005年6月成功完成的多支CTO经皮冠状动脉介入治疗（PCI）置入DES的89例冠心病患者作为DES组,对照组为2000年11月-2003年6月成功置人裸金属支架（BMS）的多支CTO冠心病患者70例。分析比较两组临床资料、病变特征、PCI结果和住院期间主要不良心脏事件（MACE）,并记录出院后6个月临床随访时的MACE发生率。结果两组患者基础临床特征无统计学差异,仅DES组心肌梗死患者比例低于BMS组（29．2％vs45．7％）;两组患者CTO靶血管分布和PCI治疗情况无统计学差异;与BMs组比较,DES组CTO特征中≥15mm的靶病变数、平均支架数及平均支架长度均较高,而平均支架直径较低。两组患者住院期间均未发生MACE事件;6个月后随访DES组靶病变再血管化、靶血管再血管化、累积MACE率和总再狭窄率均低于BMS组,差异有统计学意义。结论DES在多支CTO患者PCI治疗中有较好的应用前景。     

MRI and MRA for evaluation of dissection of craniocerebral arteries: lessons from the medical literature

MR imaging and MR angiography have become first-line imaging techniques in assessment of the patient with suspected dissection of the carotid and vertebral arteries. This review describes the advantages of these two techniques for diagnosis and describes diagnostic pitfalls.     

颈动脉支架成形术治疗重度颈动脉狭窄25例效果分析

目的 评价颈动脉支架成形术(CAS)治疗重度颈动脉狭窄患者手术特点、安全性和围手术期处理.方法 2011年12月至2016年5月采用CAS术治疗25例颈动脉狭窄＞85％患者,术中针对病变狭窄特点应用远端脑保护装置,注重个体化手术细节和围术期处理方案,观察血运重建、脑保护装置内脱落栓子情况,控制并发症发生.术后随访1年观察患者缺血性脑 血管事件发生情况.结果 25例患者脑保护装置均通过重度狭窄后成功释放,球囊预扩张、支架释放后形态满意.北美症状性颈动脉内膜剥脱术试验研究(NASCET)方法检测显示,平均颈动脉狭窄程度由术前(91.0±3.1)％降至术后(21.0±5.1)％,保护伞均顺利回收,其中6个伞中发现脱落组织碎片.围术期未出现症状性脑出血、脑梗死、高灌注综合征、死亡等严重事件.25例患者随访1年,无短暂性脑缺血发作、脑卒中、死亡发生.结论 CAS术治疗重度颈动脉狭窄患者时需注意术中个体化细节管理及围术期处理,选择合适的脑保护装置,以确保手术成功率和安全性.部分重度狭窄患者的术后疗效更直观而迅速.     

Comparison of efficacy in crossing femoropopliteal artery occlusions with movable core and hydrophilic guidewires

Purpose Compare the recanalization rate of femoropopliteal occlusions between movable core wire guide (MG) and hydrophilic guidewire (HG).Methods Conventional PTA technique was used, followed by enclosed thrombolysis. The MG was used for all patients in the first 2 years, the HG in the following 2 years. Baseline characteristics were similar for the two groups of patients.Results Recanalization of 124 femoropopliteal occlusions was attempted. Technical success was achieved with the MG in 45 of 59 procedures; 42 procedures were clinically successful. Using the HG, technical success was achieved in 35 of 65 procedures; clinical success was achieved in 29 cases (p < 0.0048). At 1-year follow-up, 32 extremities improved after treatment with MG and 22 extremities after treatment with HG (p < 0.035).Conclusion The results suggest that the MG should be the first choice in recanalization of femoropopliteal occlusions.     

The erasme study: A multicenter study on the safety and technical results of the palmaz stent used for the treatment of atherosclerotic ostial renal artery stenosis

Purpose: To assess, in a multicenter setting, safety, technical results, and restenosis rate of the Palmaz stent for treatment of atherosclerotic ostial renal artery stenosis. Methods: Ten centers enrolled 106 patients (120 treated renal artery stenoses) in the study. Patient selection was based on unsuccessful percutaneous transluminal renal angioplasty (residual stenosis ≥ 20%) performed for treatment of ostial stenosis ≥ 50%, in patients with hypertension and/or impaired renal function. Safety was assessed by means of the complication rate, and technical results by the number of successful stent placements and occurrence of restenosis (>50%) at intraarterial angiographic follow-up. Results: Stent placement was successful (n = 112) or partially successful (n = 5) in 117 (98%) arteries. Complications occurred in 19 procedures; seven were of serious clinical significance. Angiographic follow-up was performed in 89 of 117 (76%) cases, at a mean of 8 months (range 2.5–18 months). Fifteen stents (16.9%) showed restenosis (at a mean of 8.5 months), of which 10 were successfully redilated. Conclusion: Renal artery stenting has a high technical success rate, a complication rate comparable to percutaneous transluminal renal angioplasty, and a low rate of restenosis at 8 months angiographic follow-up.     

Advances in stent-assisted management of intracranial occlusive disease and cerebral aneurysms

The use of stents in the intracranial circulation has been made possible by rapid developments in stent technology in recent years. Considerable improvements in stent design, delivery devices, and technique have expanded the use of stenting to the treatment of intracranial disorders. This article reviews the indications for endovascular stenting for cerebral aneurysms and intracranial atherosclerosis and describes the peri-procedure management and technique applied at the Department of Neurosurgery at the University at Buffalo.     

急性结肠梗阻支架置入对结直肠癌择期手术的作用

目的 探讨自膨胀金属支架(SEMS)置入对结直肠癌患者所致急性结肠梗阻择期手术的作用.方法 2001年4月-2010年12月,对急性结肠梗阻、拟择期手术的52例结直肠癌患者使用自膨胀金属支架治疗.收集患者的相关数据,包括技术和临床疗效、并发症、择期外科手术成功率及生存时间.结果 52例中除2例完全梗阻外,其余支架置...