Subacute Recanalization and Reocclusion in Patients with Acute Ischemic Stroke Following Endovascular Treatment

Objective  To determine the rate of subacute recanalization and reocclusion and its effect on clinical outcomes among patients with ischemic stroke treated with endovascular treatment. Subacute recanalization and reocclusion occurring hours after completion of the intravenous or intra-arterial thrombolysis for acute ischemic stroke has been reported in anecdotal cases. Methods  We performed cerebral angiography at 24 h to determine the status of occlusion after endovascular treatment (compared with immediate post-procedure angiogram) in a series of patients with ischemic stroke treated with endovascular treatment. Clinical and radiological evaluations were performed before and 24 h, and prior to discharge or 1–3 months after treatment. We performed multivariate analysis to evaluate the effect of subacute recanalization on clinical outcome graded using modified Rankin scale (mRS). Favorable outcome was defined by mRS of 0–2. Results  A total of 56 patients (mean age 66 ± 14 years; 22 were men) were analyzed. Subacute recanalization was observed in 16 (29%) patients and consisted of additional recanalization in 8 patients with early recanalization. Subacute recanalization was associated with a trend toward a higher rate of favorable outcome (Wald chi-square 3.3, P = 0.19) after adjusting for other covariates. Subacute recanalization was not associated with either neurological deterioration or symptomatic intracranial hemorrhage. Subacute reocclusion was observed in 5 (9%) patients. Subacute reocclusion was associated with a trend toward higher rate of neurological deterioration within 24 h (Wald chi-square 2.1, P = 0.15) after adjusting for other covariates. Conclusion  We found that new or additional recanalization occurs in one-fourth of the patients within 24 h of endovascular treatment and is not associated with any adverse consequences. Subacute reocclusion occurs infrequently after endovascular treatment.     

Complete recovery following intra-arterial tenecteplase administration in a woman with acute ischemic stroke

A 23-year-old woman, who underwent a percutaneous transluminal mitral commissurotomy for a tight mitral stenosis, developed an acute ischemic stroke involving the proximal right middle cerebral artery territory. She had a dense left hemiplegia with a National Institutes of Health Stroke Scale score of 12. She was emergently treated within 1 hour with intra-arterial tenecteplase and made a dramatic recovery. Intra-arterial tenecteplase is an attractive option for treating acute ischemic stroke with proximal or major vessel occlusion.     

Recanalization of Completely Thrombosed Non-Giant Saccular Aneurysm Mimicking as De Novo Aneurysm

Partial thrombosis of giant aneurysms is not uncommon however, complete angiographic occlusion occurs less frequently. In the case of non-giant aneurysms, complete thrombosis and recanalization has been rarely reported. A 31-year-old man presented to the emergency department with sudden bursting headache. Brain computed tomography (CT) revealed diffuse subarachnoid hemorrhage on the left side. Both CT angiography (CTA) and digital subtraction angiography showed suspicion of small left anterior choroidal artery aneurysm. We performed surgical exploration. In the operation field, anterior choroidal artery aneurysm of 2 × 2 mm with broad neck and friable appearance was observed. Because we could not clip without sacrificing the anterior choroidal artery, we performed wrapping only. Follow up CTA after 7 months demonstrated 4 mm right internal carotid artery bifurcation aneurysm. The patient underwent aneurismal neck clipping. During the operation, 9 × 13 mm sized thrombosed aneurysm was detected and completely clipped. We initially thought this aneurysm to be a de novo aneurysm however, it was an aneurysm that had recanalized from a completely thrombosed aneurysm. This case report provides an insight into the potential for complete thrombosis and recanalization of non-giant aneurysms.     

前循环串联病变的血管再通顺序对急性缺血性卒中短期预后的影响

目的:探讨前循环串联病变血管再通顺序对急性缺血性卒中(AIS)患者短期预后的影响。方法:回顾性队列研究。纳入2018年1月—2019年6月中国医科大学附属第四医院神经内科因前循环串联病变导致AIS并行血管内介入治疗的40例患者的临床资料,其中男36例、女4例,年龄39～78岁。根据不同的再通顺序将患者分为2组：A组26...     

子宫输卵管碘油造影在女性不孕症诊治中的作用

目的探讨子宫输卵管造影术(HSG)在不孕症中的诊断与治疗作用。方法选择病例853例进行分析,其中原发性不孕症353例,继发性不孕症490例,输卵管吻合术后10例。结果造影能显示输卵管阻塞的部位、范围、程度及子宫畸形情况。结论子宫输卵管造影术(HSG)是测定输卵管是否通畅的一种初筛方法,且具有分离轻度粘连的治疗作用。     

彩色多普勒超声在中央型血栓诊断与介入治疗中的应用价值

目的 探讨彩色多普勒超声（CDUS）在急性中央型血栓诊断中的价值及在介入治疗中的意义。方法 回顾性分析2014年1月至2016年1月蚌埠医学院第一附属医院收治的32例急性中央型血栓患者的临床资料,所有患者入院后先行下肢CDUS检查,DSA进一步明确诊断后,在滤器保护下借助超声引导穿刺腘静脉为入路行深静脉置管溶栓术,观察下肢肿胀消退情况并复查CDUS,评估血管再通情况。结果 本组32例患者入院超声检查与DSA结果一致,均诊断为急性中央型血栓,经溶栓治疗,下肢肿胀均较治疗前显著缓解,平均管腔直径狭窄率（38.28±2.37）%较术前（90.19±2.58）%降低,差异有统计学意义（P<0.05）,治疗有效率达100%。结论 CDUS在急性中央型血栓诊断中敏感性高,同时具有无创、可反复的优点,可作为诊断该疾病的首选方法之一,在超声引导下穿刺行置管溶栓及疗效评价中具有明显优势。     

用自制器械行选择性输卵管造影和再通术

报告用自制器械行子宫输卵管选择性造影及再通术45例,插管成功率95.5%。近端输卵管阻塞再通率80%。随访结果:15例患者正常受孕,受孕率33.3%,其中继发不孕症受孕率50%,原发不孕症受孕率17.4%。近端阻塞再通术后受孕率54.5%,远端积水或阻塞患者受孕率15%。显示选择性输卵管造影及再通术是治疗女性不孕症的有效方法;本手术最佳适应证为继发不孕、近端输卵管阻塞患者;自制器械价廉、安全。     

中心静脉导管堵塞再通的时效探讨

目的 探讨中心静脉导管堵管后再通的时间窗.方法 通过体外模拟中心静脉堵管分4h(A组及a组)、8h(B组及b组)、12h(C组及c组)、24 h(D组及d组)、48 h(E组及e组)10组用尿激酶1000 U/ml进行负压溶栓,观察其效果.结果 相同的堵管时间条件下,两种不同的静脉导管所需要的再通时间比较差异无统计学意义(P＞0.05).PICC组中4h与8h、8h与12h之间比较差异具有统计学意义(P＜0.05),而12h组与24 h间比较差异无统计学意义(P＞0.05).CVC管中4h与8h之间比较差异无统计学意义(P＞0.05),8h与12h、12h与24 h组间比较差异具有统计学意义(P＜0.05).结论 中心静脉导管堵管后再通成功率以及所需时间与堵管时间密切相关,中心静脉堵管发生回血返流应及时冲管,正压封管,发生堵管后及时进行再通的操作.     

介入性输卵管再通术治疗输卵管阻塞132例临床观察

目的:探讨介入性输卵管再通术诊治输卵管阻塞的临床效果。方法:采用回顾性分析的方法,对132例不孕症病人使用美国COOK公司生产的输卵管再通器械(包括DBH-100双球囊导管和FTC-550型同轴导管导丝)在X线监测下介入治疗,向导管内注射造影剂观察输卵管通畅情况并术后指导受孕,电话回访3～9个月。结果:132例患者共计264条输卵管梗阻介入术后复通率为81.82%,3个月后妊娠53例,妊娠率为40.15%。导通的输卵管间质部峡部梗阻患者32例,共64条输卵管,输卵管壶腹及伞端梗阻76例共152条输卵管,壶腹部及远端梗阻的患者中有24例导通后造影剂进入盆腔后显示弥散不良,术后受孕最短时间为2个月,最长为7个月,平均5.5个月。结论:介入性输卵管再通术是诊治输卵管阻塞的一种安全有效的方法,为不孕症的临床诊治提供了一种新疗法,可以推广应用。