Metastatic stage vs complications at radical nephrectomy with inferior vena cava thrombectomy

BackgroundTo investigate perioperative complication rates at radical nephrectomy (RN) according to inferior vena cava thrombectomy (IVC-T) status and stage (metastatic vs non-metastatic) within kidney cancer patients.Materials and methodsWe ascertained perioperative complication rates within the National Inpatient Sample database (2016–2019). First, log-link linear Generalized Estimating Equation function (GEE) regression models (adjusted for hospital clustering and weighted for discharge disposition) tested complication rates in IVC-T patients, according to metastatic stage. Subsequently, a subgroup analysis relied on RN patients with or without IVC-T. Here, multivariable logistic regression models tested complication rates in RN patients according to IVC-T status, after propensity score matching including metastatic stage.ResultsOf 26,299 RN patients, 461 (2%) patients underwent IVC-T. Of those, 252 (55%) were non-metastatic vs 209 (45%) were metastatic. Rates of acute kidney injury (AKI), transfusion, cardiac, thromboembolic and other medical complications in non-metastatic vs metastatic patients were 40 vs 40%, 25 vs 22%, 21 vs 23%, 19 vs 14% and 38 vs 40%, respectively (all p ≥ 0.2). Metastatic stage in IVC-T patients did not predict differences in complications in log-link linear GEE regression models (all p > 0.1). However, in logistic regression models with propensity score matching, relying on the overall cohort of RN patients, IVC-T status was associated with higher complication rates (all p < 0.001): AKI (Odds ratio [OR]:2.60; 95%-CI [95%-Confidence interval: 1.97–3.44), transfusions (OR:2.40; 95%-CI: 1.72–3.36), cardiac (OR:2.27; 95%-CI: 1.49–3.47), thromboembolic (OR:9.07; 95%-CI: 5.21–16.58) and other medical complications (OR:2.01; 95%-CI: 1.52–2.66).ConclusionsThe current analyses indicate that presence of concomitant IVC-T is associated with higher complication rate at RN. Conversely, metastatic stage has no effect on recorded complication rates.     

接受机械取栓治疗的急性脑梗死患者血栓特征研究进展

急性脑梗死是威胁我国人民健康的重大疾病,其致死率及致残率均较高,造成了沉重的社会负担。及时开通导致梗死的责任血管以恢复脑灌注是治疗该病的关键。机械取栓技术的应用使得患者的血栓组织能够被获取并得到研究。本文介绍了近年来通过机械取栓术获取的血栓的相关研究发现,以纤维蛋白为主的血栓是造成取栓困难的重要组织学原因,影像学方法可以在术前评估血栓特征。这些发现提示临床工作者可以积极开发新型血栓取出装置用于处理难治性血栓,并有必要探索精确便捷的血栓特征影像学评价方法,从而提高机械取栓疗效。     

SWIM技术治疗后循环大血管闭塞所致急性缺血性卒中的有效性和安全性观察

目的 观察SWIM技术治疗后循环大血管闭塞所致急性缺血性卒中的有效性及安全性。 方法 回顾性分析2017年2月-2018年11月于大连市中心医院采用SWIM技术治疗的后循环大血管闭 塞所致急性缺血性卒中患者的临床资料，评价该技术的疗效和安全性，并分析影响患者预后的因素。 观察指标为术后即刻成功再通（mTICI≥2b）、90 d良好预后（mRS评分≤2分），以及术后24 h任何颅内 出血、90 d全因死亡。 结果 共纳入35例患者，平均年龄66.1±12.1岁，男性26例（74.3%），基线NIHSS评分22（15～34）分。 术后即刻成功再通率为94.3%（33/35），90 d良好预后率为45.7%（16/35），24 h颅内出血率为17.1% （6/35），90 d全因死亡率为37.1%（13/35）。单因素分析显示，基线NIHSS评分较低（P =0.001）、基 线后循环ASPECTS评分较高（P =0.016）、发病至到院时间较短（P =0.039）、发病至再通时间较短 （P =0.047）、血管成功再通率较高（P =0.036）以及饮酒比例较低（P =0.042）与良好预后相关。 结论 使用SWIM技术治疗后循环急性缺血性卒中相对安全、有效。     

Revascularization of a thrombosed aortopulmonary shunt with the use of the AngioJet thrombectomy system.

We report the use of the AngioJet F140 rheolytic catheter to recannalize an acutely thrombosed aortopulmonary shunt in a 21-year-old female with palliated, complex congenital heart disease. After extracting the thrombus that filled the entire length of the shunt, three stents were placed at sites where the lumen was compromised by distortion or thrombus. Unobstructed flow was restored to the left pulmonary artery that persisted at 1-year follow-up.     

顺行和逆行取栓对静脉瓣膜及血管壁的影响

目的：比较顺行取栓与逆行取栓在猪腋静脉急性血栓形成对于其瓣膜功能和静脉壁形态的影响。方法：分别结扎猪的腋静脉的近远端,于结扎段内注入凝血酶原,放置６ｈ使形成血栓。随机分配为顺行取栓和逆行取栓组,对血栓段进行取栓。取栓后２４ｈ行取栓静脉插管逆行造影以评估瓣膜功能;切取此段静脉作ＣＤ８＾＋细胞免疫组化和苏木精－伊红（ＨＥ）染色以对比血管内膜及平滑肌的损伤程度。结果：逆行与顺行取栓在所有的例数中都成功地     

支架取栓术治疗急性缺血性脑卒中的 效果及不良事件发生率分析

〔摘 要〕 目的：探讨支架取栓术用于急性缺血性脑卒中患者治疗的效果及不良事件发生率。方法：2021 年 3 月 至 2022 年 5 月取南阳市中心医院收治的 110 例急性缺血性脑卒中患者作为研究对象，以计算机随机化方法分组，分 为对照组与观察组两组，各 55 例，对照组为静脉溶栓方案，观察组为支架取栓术方案，比较两组患者治疗后血管再 通情况、神经功能缺损程度、预后情况、不良事件发生情况。结果： 两组患者血管再通率、预后良好率相比，观察组 均高于对照组，差异均具有统计学意义（P ＜ 0.05）；治疗后，两组患者的美国国立卫生研究院脑卒中量表（NIHSS） 评分均低于治疗前，且观察组患者治疗后的 NIHSS 评分较对照组更低，差异均具有统计学意义（P ＜ 0.05）；观察 组患者不良事件发生率为 9.09 %，较对照组的 23.64 % 更低，差异具有统计学意义（P ＜ 0.05）。结论：急性缺血性 脑卒中者以支架取栓术方案治疗，相比于静脉溶栓方案，能提高血管再通率、预后良好率，以及能更好地改善神经功 能缺损程度，降低不良事件的发生率。     

Trombectomia percutânea reolítica no tratamento de tromboembolismo pulmonar de alto risco: experiência inicial de um centro

For years, the treatment of high‐risk pulmonary embolism (PE) was based on two well‐defined strategies: thrombolysis, whose benefits have been documented in randomized trials, and surgical embolectomy. However, mechanical reperfusion by percutaneous techniques is used in an increasing number of patients, and is a valid therapeutic option when there is a formal contraindication to thrombolysis, as rescue therapy when thrombolysis fails to improve hemodynamics, and/or when emergency surgical thrombectomy is unavailable or contraindicated.This article discusses the indications for the use of percutaneous techniques in PE, reports the initial experience of our center with the AngioJet® thrombectomy device (Possis Medical Inc, Minneapolis, MN, USA) and reviews the available evidence, the most recent recommendations and the main complications associated with this procedure.     

适合机械性取栓的急性栓塞性脑梗死动物模型的建立与评价

目的:建立并评价适合动脉内机械取栓的急性栓塞性脑梗死动物模型。方法:血流临时阻断凝血酶注入法制作急性栓塞性脑梗死模型,利用颅内动脉取栓装置行机械性取栓。应用数字减影血管造影(DSA)、磁共振弥散成像(DWI)、经颅多普勒及病理检查来评价模型建立的效果,比较模型建立前后表观弥散系数(ADC)、大脑中动脉流速(Vmca)变化情况。结果:DSA显示制模的成功率为83%。栓塞6 h DWI显示梗塞灶,24 h病理检查TTC染色可见梗死区。取栓后颈总动脉再通率为80%,栓塞前后、取栓前后Vmca的比较差异有统计学意义(P<0.05),取栓组与非治疗组6 h Vmca比较差异有统计学意义;取栓组ADC值呈上升趋势,非治疗组ADC值下降,两组24 h的比较差异有统计学意义(P<0.05)。结论:本研究所建立的模型稳定,重复性好,适用于颅内动脉取栓装置的实验研究和疗效评价。     

Brain CT perfusion improves intracranial vessel occlusion detection on CT angiography

Background and purpose

To evaluate whether brain CT perfusion (CTP) aids in the detection of intracranial vessel occlusion on CT angiography (CTA) in acute ischemic stroke.