Explantador de Cabrera: un nuevo dispositivo para explantar endoprótesis aórticas después de reparo endovascular de aneurisma de aorta, un estudio experimental ex vivo / Cabrera explanter: a new device to explant aortic stents after endovascular aortic aneurysm repair, an ex vivo experimental study

Introducción. Las complicaciones posteriores a la reparación endovascular de aneurisma (EVAR) pueden resolverse con técnicas endovasculares. Sin embargo, cuando está indicada, la explantación de una endoprótesis es un procedimiento complejo, que se asocia a lesiones vasculares o viscerales, con alta morbimortalidad, en pacientes con edad avanzada y múltiples comorbilidades, y por lo tanto, alto riesgo quirúrgico. No existen dispositivos producidos por la industria para explantar las endoprótesis aórticas, por lo que el objetivo de este trabajo fue desarrollar un dispositivo para la explantación de endoprótesis aórticas. Métodos. Se llevó a cabo un estudio experimental, en fase preclínica, para desarrollar un dispositivo para la explantación de endoprótesis aórticas, con pruebas en modelos 3D y en un modelo animal porcino cadavérico. Resultados. Es factible desarrollar un modelo experimental de un nuevo dispositivo para explantar endoprótesis aórticas, denominado explantador de Cabrera, y comprobar su funcionamiento en un modelo animal cadavérico. El uso del explantador de Cabrera limitó el daño de la pared aórtica por parte de la endoprótesis en un 100 % al momento de su explantación en un modelo experimental ex vivo. Conclusión. Usando una jeringa septo, el explantador de Cabrera es superior a la técnica estándar de explantación de una endoprótesis al limitar la lesión de la pared aórtica, al colapsar y liberar los ganchos de fijación suprarrenal de forma controlada y segura al interior de la luz aórtica y, posteriormente, extraerla de forma rápida y efectiva, conservando la mayor cantidad de aorta sana para la posterior reconstrucción aorto-ilíaca.

Introduction. Complications after endovascular aneurysm repair (EVAR) can be resolved with endovascular techniques; however, when indicated, stent explantation is a complex procedure, which is associated with vascular or visceral injuries, with high morbidity and mortality in patients, with advanced age and multiple comorbidities, and therefore high surgical risk. There are no devices produced by the industry to explant aortic endoprostheses, so the objective of this work was to develop a device for the explantation of aortic endoprostheses. Methods. An experimental study was carried out, in the preclinical phase, to develop a device for the explantation of aortic endoprostheses, with tests in 3D models and in a cadaveric porcine animal model. Results. It is feasible to develop an experimental model of a new device for explanting aortic endoprostheses, called Cabrera explanter, and verify its operation in a cadaveric animal model. The use of the Cabrera explanter limited damage to the aortic wall by the endoprosthesis by 100% at the time of explantation in an ex vivo experimental model. Conclusions. Using a septum syringe, the Cabrera explanter is superior to the standard stent explantation technique by limiting injury to the aortic wall, collapsing and releasing the adrenal fixation hooks in a controlled and safe manner into the aortic lumen, and subsequently, extract it quickly and effectively, preserving the greatest amount of healthy aorta for the subsequent aorto-iliac reconstruction.

Manejo endovascular de hemoptisis secundaria a pseudoaneurisma de la aorta torácica, mediante un abordaje proximal

Objetivo: Describir un caso clínico y una alternativa de manejo para el tratamiento de la hemoptisis secundaria a patología la aneurismática de la aorta torácica. Materiales y Métodos: Revisión de historia clínica y exámenes complementarios, disponibles en sistema digital del centro asistencial de origen. Resultados: Se presenta el caso de paciente masculino, 56 años, que cursó con cuadro de hemoptisis, posteriormente objetivado como secundario a un pseudoaneurisma de la aorta torácica. Entre sus antecedentes destaca, enfermedad aorto-ilíaca tratada mediante un bypass de aorta torácica. Se decidió la reparación endovascular, mediante un abordaje proximal, utilizando la arteria axilar. Discusión: Las indicaciones para el uso de la reparación torácica endovascular de la aorta (TEVAR) se están expandiendo ampliamente, incluyendo a pacientes previamente intervenidos o aquellos que antiguamente se consideraban con un riesgo prohibitivamente alto para una cirugía. La fístula aorto-bronquial, es una complicación rara, sin embargo, existe correlación entre su desarrollo y la cirugía de aorta torácica. La sospecha diagnóstica debe ser alta. La AngioTC, cumple un doble rol, tanto para el diagnóstico, como para la planificación preoperatoria, hecho fundamental para conseguir una terapia adecuada.

Objective: To describe a clinical case and a management alternative for the treatment of hemoptysis secondary to thoracic aortic aneurysm pathology. Material and Method: Review of clinical history and complementary examinations, available in the digital system of the health care center of origin. Results: We present the case of a male patient, 56 years old, presented with hemoptysis, later found to be secondary to a pseudoaneurysm of the thoracic aorta. History included aorto-iliac disease treated by thoracic aortic bypass. Endovascular repair was decided by a proximal approach using the axillary artery. Discussion: Indications for the use of TEVAR are expanding widely. Including previously operated patients or those formerly considered prohibitively high risk for surgery. Aortobronchial fistula is a rare complication, however, there is a correlation between its development and thoracic aortic surgery. Diagnostic suspicion should be high. AngioCT plays a dual role in diagnosis and preoperative planning, which is essential to achieve adequate therapy.

Implicancias de la inteligencia artificial en los métodos de imagen endovascular / Implications of Artificial Intelligence in Intravascular Imaging Methods

RESUMEN La angioplastia transluminal coronaria (ATC) es una de las principales estrategias de revascularización en pacientes con enfermedad coronaria aterosclerótica (ECA). Numerosos estudios respaldan la optimización de la ATC mediante métodos de imagen endovascular; sin embargo, estos métodos son subutilizados en la práctica clínica contemporánea y enfrentan desafíos en la interpretación de los datos obtenidos, por lo que la integración de la inteligencia artificial (IA) se vislumbra como una solución atractiva para promover y simplificar su uso. La IA se define como un programa computarizado que imita la capacidad del cerebro humano para recopilar y procesar datos. El aprendizaje de máquinas es una subdisciplina de la IA que implica la creación de algoritmos capaces de analizar grandes conjuntos de datos sin suposiciones previas, mientras que el aprendizaje profundo se centra en la construcción y entrenamiento de redes neuronales artificiales profundas y complejas. Así, se ha demostrado que la incorporación de sistemas de IA a los métodos de imagen endovascular incrementa la precisión de la ATC, disminuye el tiempo del procedimiento y la variabilidad interobservador en la interpretación de los datos obtenidos, promueve así una mayor adopción y facilita su utilización. El propósito de la presente revisión es destacar cómo los sistemas actuales basados en IA pueden desempeñar un papel fundamental en la interpretación de los datos generados por los métodos de imagen endovascular, lo que conduce a una mejora en la optimización de la ATC en pacientes con ECA.

ABSTRACT Percutaneous coronary intervention (PCI) is one of the primary revascularization strategies in patients with coronary artery disease (CAD). Several studies support the use of intravascular imaging methods to optimize PCI. However, these methods are underutilized in contemporary clinical practice and face challenges in data interpretation. Therefore, the incorporation of artificial intelligence (AI) is seen as an attractive solution to promote and simplify their use. AI can be defined as a computer program that mimics the human brain in its ability to collect and process data. Machine learning is a sub-discipline of AI that involves the creation of algorithms capable of analyzing large datasets without making prior assumptions, while deep learning focuses on the construction and training of deep and complex artificial neural networks. The incorporation of AI systems to intravascular imaging methods improves the accuracy of PCI, reduces procedure duration, and minimizes interobserver variability in data interpretation. This promotes their wider adoption and facilitates their use. The aim of this review is to highlight how current AI-based systems can play a key role in the interpretation of data generated by intravascular imaging methods and optimize PCI in patients with CAD.

Umbral crítico de administración en pacientes con trauma severo y reanimación endovascular: ¿Un concepto útil? / Critical Administration Threshold in severe trauma patients and endovascular resuscitation: A useful concept?

Introducción. Se describe la utilidad del umbral crítico de administración (CAT por su denominación en inglés) como herramienta para la reanimación hemostática en pacientes con trauma severo y oclusión endovascular aórtica. Métodos. Revisión retrospectiva de pacientes adultos con hemorragia por trauma, con o sin oclusión endovascular aórtica (REBOA), atendidos entre enero de 2015 y junio de 2020, en un centro de trauma nivel I en Cali, Colombia. Se registraron variables demográficas, severidad del trauma, estado clínico, requerimiento transfusional, tiempo hasta CAT+ y CAT alcanzado (1, 2 ó 3). Resultados. Se incluyeron 93 pacientes, se utilizó REBOA en 36 y manejo tradicional en 57. El grupo REBOA presentó mayor volumen de sangrado (mediana de 3000 ml, RIC: 1950-3625 ml) frente al grupo control (mediana de1500 ml, RIC: 700-2975ml) (p<0,001) y mayor cantidad de glóbulos rojos transfundidos en las primeras 6 horas (mediana de 5, RIC:4-9); p=0,015 y en las primeras 24 horas (mediana de 6, RIC: 4-11); p=0,005. No hubo diferencias estadísticamente significativas en número de pacientes CAT+ entre grupos o tiempo hasta alcanzarlo. Sin embargo, el estado CAT+ durante los primeros 30 minutos de la cirugía fue mayor en grupo REBOA (24/36, 66,7 %) frente al grupo control (17/57, 29,8 %; p=0,001), teniendo este mayor tasa de mortalidad intrahospitalaria frente a los pacientes CAT-. Conclusión. El umbral crítico de administración es una herramienta útil en la reanimación hemostática de pacientes con trauma y REBOA, que podría predecir mortalidad precoz.

Introduction. The objective is to describe the utility of the Critical Administration Threshold (CAT) as a tool in hemostatic resuscitation in patients with severe trauma and REBOA. Methods. Retrospective review between January 2015 and June 2020 of adult patients with hemorrhage secondary to trauma with or without REBOA in a level I trauma center in Cali, Colombia. Demographic variables, trauma severity, clinical status, transfusion needs, time to CAT+ and number of CAT achieved (1, 2 or 3) were recorded. Results. Ninety-three patients were included, in which REBOA was used in 36 and traditional management in 57. The REBOA group had a higher bleeding volume (3000 ml), IQR: 1950-3625 ml vs the control group (1500 ml, IQR: 700-2975 ml) (p<0.001) and a higher rate of PRBC units transfused in the first 6 hours (median 5, IQR: 4-9); p=0.015 and in the first 24 hours (median 6, IQR: 4-11); p=0.005. There were no statistically significant differences in the number of CAT+ patients between groups or time to CAT+. However, CAT+ status during the first 30 minutes of surgery was higher in the REBOA Group (24/36, 66.7%) vs. the control group (17/57, 29.8%; p=0.001), having this group a higher in-hospital mortality rate vs. CAT- patients. Conclusion. CAT is a useful tool in the hemostatic resuscitation of patients with trauma and REBOA that could predict early mortality.

Efficacy of partial and complete resuscitative endovascular balloon occlusion of the aorta in the hemorrhagic shock model of liver injury / 世界急诊医学杂志（英文）

@#BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) can temporarily control traumatic bleeding. However, its prolonged use potentially leads to ischemia-reperfusion injury (IRI). Partial REBOA (pREBOA) can alleviate ischemic burden; however, its security and effectiveness prior to operative hemorrhage control remains unknown. Hence, we aimed to estimate the efficacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic gun. METHODS: Twenty Landrace pigs were randomized into control (no aortic occlusion) (n=5), intervention with complete REBOA (cREBOA) (n=5), continuous pREBOA (C-pREBOA) (n=5), and sequential pREBOA (S-pREBOA) (n=5) groups. In the cREBOA and C-pREBOA groups, the balloon was inflated for 60 min. The hemodynamic and laboratory values were compared at various observation time points. Tissue samples immediately after animal euthanasia from the myocardium, liver, kidneys, and duodenum were collected for histological assessment using hematoxylin and eosin staining. RESULTS: Compared with the control group, the survival rate of the REBOA groups was prominently improved (all P<0.05). The total volume of blood loss was markedly lower in the cREBOA group (493.14±127.31 mL) compared with other groups (P<0.01). The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups (P<0.05). At 120 min, the S-pREBOA group showed higher alanine aminotransferase (P<0.05) but lower blood urea nitrogen compared with the cREBOA group (P<0.05). CONCLUSION: In this trauma model with liver injury, a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure, despite persistent hemorrhage. Extended tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures, and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.

A Case of Survival after Thoracic Endovascular Aortic Repair for Descending Thoracic Aortic Aneurysm Rupture and Aortoesophageal Fistula without Esophagectomy / 日本心臓血管外科学会雑誌

The patient was an 82-year-old woman. For dysphagia scrutiny, upper gastrointestinal endoscopy and biopsy of a submucosal tumor of the midthoracic esophagus were performed. The patient was urgently admitted to the Department of Gastroenterology for examination and treatment. After admission, enhanced CT showed a descending thoracic aortic aneurysm (DTA) pressing on the esophagus. On the third day of hospitalization, the patient suffered massive hematemesis and went into shock, and emergency thoracic endovascular aortic repair (TEVAR) was performed with resuscitation based on the diagnosis of esophageal perforation of the DTA. The patient was weaned from the ventilator by tracheotomy without cerebrospinal complications and left the intensive care unit on the seventh postoperative day. One month after surgery, a CT scan showed that the DTA had almost disappeared and that the esophageal compression had been released. The patient was managed with antibacterial therapy and nutritional support other than oral intake and was discharged home 7 months after surgery without stent graft infection or mediastinitis. The usefulness of TEVAR for ruptured descending thoracic aortic aneurysms has been reported in many cases. However, in patients with an aortoesophageal fistula (AEF), esophagectomy is required after TEVAR to control infection, and the mortality rate of this disease is high. We report a case in which infection were controlled by antibacterial therapy and nutritional management other than oral intake after TEVAR and the patient survived.

Urgent Thoracic Endovascular Aortic Repair for Retrograde Type A Acute Aortic Dissection with a Patent Ascending Aortic False Lumen / 日本心臓血管外科学会雑誌

We report a 49-year-old man with retrograde type A acute aortic dissection with patent false lumen in the ascending aorta. The patient successfully underwent urgent thoracic endovascular repair (TEVAR) to cover the primary entry on the onset (admission) day. The false lumen from the ascending aorta to the proximal descending thoracic aorta was completely thrombosed, gradually shrank, and finally disappeared. In conclusion, TEVAR for retrograde type A acute aortic dissection with a patent ascending false lumen is far less invasive than aortic replacement (with cardiopulmonary bypass, cardiac arrest, and circulatory arrest) and may be useful in selected patients with a primary entry located at least approximately 2 cm distal to the origin of the left subclavian artery.

A Case Report of a Ruptured Abdominal Aortic Aneurysm Associated with Thrombosed Acute Type B Aortic Dissection / 日本心臓血管外科学会雑誌

A 70-year-old man with no outpatient history visited the local doctor with complaints of weakness of the limbs and abdominal pain on the following day after vomiting on the previous night. He was suspected to have a ruptured abdominal aortic aneurysm from a simple CT scan of the abdomen, and was transported to our hospital for emergency treatment. After a contrast-enhanced CT scan at our hospital, a thrombosed type B aortic dissection and ruptured abdominal aortic aneurysm were diagnosed, and emergency surgery was performed on the same day. Although the dissection had extended to the abdominal aortic aneurysm, abdominal aortic endovascular repair (EVAR) was performed because it was a thrombosed type B aortic dissection. After admission to the intensive care unit (ICU), the patient showed intra-abdominal hypertension and oliguria. So, we performed an emergency decompressive laparotomy against abdominal compartment syndrome (ACS). He was discharged from the ICU on the 8th day and transferred to rehabilitation on the 38th day. We report a case of a ruptured abdominal aortic aneurysm associated with thrombosed acute type B aortic dissection that was successfully treated.

Neuroprotective therapy for acute ischemic stroke in the era of endovascular therapy / 国际脑血管病杂志

In recent years, endovascular therapy has become the most important progress in the field of the treatment of acute ischemic stroke caused by large vessel occlusion. However, the vascular recanalization shown by imaging after endovascular treatment cannot fully translate into effective tissue reperfusion and functional outcome, a phenomenon known as "futile recanalization". Combined neuroprotective therapy after vascular recanalization is expected to reduce the occurrence of futile recanalization and improve the outcome of patients. This article briefly summarizes the main application progress of commonly used neuroprotective therapies in clinical practice (edaravone dexborneol, glucocorticoids, hypothermia, and remote ischemic conditioning). It explores the trend and direction of combining endovascular therapy and neuroprotective therapy for patients with acute ischemic stroke caused by large vessel occlusion, and provides further reference and suggestions for intervention measures after endovascular therapy.

Predictive value of FLAIR vascular hyperintensity in patients with acute ischemic stroke underwent endovascular treatment / 国际脑血管病杂志

Endovascular treatment has become the standard treatment method for acute ischemic stroke caused by large vessel occlusion. The application of neuroimaging techniques for appropriate patient selection and prognosis prediction is of great significance for successful endovascular treatment. This article reviews the application progress of fluid-attenuated inversion recovery sequence vascular hyperintensity in patients with acute ischemic stroke underwent endovascular treatment.

Recent progress in hybrid surgery for tandem carotid artery stenosis / 介入放射学杂志

Clinically,tandem carotid artery stenosis(TCAS)is a relatively rare atherosclerotic disease,and with the development of interventional techniques,its treatment has become more and more minimally invasive,and the technical feasibility of hybrid surgery(HS)has been already confirmed for long time.In recent years,with the increasing of the number of patients and the deepening of research both at home and abroad,it has been found that the safety and effectiveness of HS for TCAS are still questionable,and it is particularly important to choose the appropriate treatment for such patients.This article aims to make a comprehensive review about the HS for TCAS,focusing on its surgical process,comparison of its surgical methods,and the current controversies over the treatment of TCAS,with the hope that clinicians can get a more comprehensive understanding about this surgical method.(J Intervent Radiol,2024,32:95-99)

Tubridge flow diverter for the treatment of ruptured intracranial aneurysms:clinical analysis of its safety and efficacy / 介入放射学杂志

Objective To investigate the efficacy and safety of Tubridge flow diverter(TFD)in the treatment of ruptured intracranial aneurysms.Methods The clinical data of 13 patients with aneurysmal subarachnoid hemorrhage,who received TFD treatment at the First Affiliated Hospital of Zhengzhou University between March 2019 and Jul 2022,were retrospectively collected.The perioperative materials and follow-up results were summarized and analyzed.Results Successful operation was accomplished in all the 13 patients(13 aneurysms in total).TFD and coil embolization were simultaneously performed in 10 patients(simultaneous treatment),spring coil filling followed by selective staged TFD placement was adopted in 2 patients(staged treatment),and pure TFD placement was employed in one patient.The incidence of perioperative complications was 15.4%(2/13),including asymptomatic ischemic event in one patient and extra-ventricular drainage-related postoperative bleeding in another patient,which caused death of the patient.The median follow-up time was 6.5 months,and 83.3%of patients(10/12)completed cerebral angiography reexamination with DSA.OKM grade D(complete occlusion of the aneurysm)was obtained in 8 patients(80%),and OKM grade C(residual aneurysm neck)in 2 patients.Conclusion For ruptured intracranial aneurysms,TFD implantation is a clinically feasible treatment with favorable safety and efficacy.

Endovascular treatment of ruptured internal carotid pseudoaneurysm with bleeding after radiotherapy for nasopharyngeal carcinoma / 介入放射学杂志

Objective To discuss the methods,efficacy,and safety of endovascular treatment for ruptured pseudoaneurysm hemorrhage of internal carotid artery(ICA)after radiotherapy for nasopharyngeal carcinoma(NPC).Methods The clinical data of 21 patients with ruptured pseudoaneurysm hemorrhage of ICA after radiotherapy for NPC,who were admitted to the Affiliated Union Hospital,Fujian Medical University of China,were retrospectively analyzed.The patient's surgical strategies were analyzed,the therapeutic results and the clinical and imaging follow-up results were summarized.Of the 21 patients,covered stent implantation was carried out in 8,stent-assisted coil embolization was employed in 6,and direct occlusion of parent artery was adopted in 7.Results Successful endovascular treatment was accomplished in all the 21 patients.Excellent hemostatic effect was obtained immediately after surgery.Aneurysm neck residue was observed in 2 patients,and aneurysm body residue was seen in one patients.Postoperative bleeding recurred in 5 patients,in 4 of them the bleeding stopped after once more occlusion of the parent artery,and one patient developed internal leakage after covered stent implantation and the bleeding stopped after balloon dilation,and this patient died of unknown cause one month later.One patient developed coma after covered stent implantation,CT scan demonstrated subarachnoid hemorrhage and brain swelling,and this patient showed no improvement after treatment and was self-discharged from hospital.ICA occlusion was seen in 3 patients during follow-up period,and 2 patients did not receive a postoperative follow-up visit.In the 19 patients who were followed up,the mRS score was 0 point(n=9),1 point(n=6),2 points(n=2),5 points(n=1),and 6 points(n=1).Conclusion For the ruptured pseudoaneurysm hemorrhage of ICA after radiotherapy for NPC,endovascular treatment is highly safe with reliable efficacy.The covered stent implantation carries good short-term efficacy,but there are also problems such as aneurysm recurrence,internal endoleak,etc.The direct occlusion of parent artery may have more reliable long-term efficacy.(J Intervent Radiol,2024,33:304-308)

Research progresses of 3D image fusion technology for guiding endovascular treatments of aortic lesions / 中国介入影像与治疗学

3D image fusion technology can fuse image data before and during interventional treatments with mediator of cone-beam CT and guide interventional operations,which might significantly improve the success rate of interventional treatment of aortic lesions and reduce radiation exposure,iodine contrast agent dosage and operation time,etc.The research progresses of 3D image fusion technology for guiding endovascular treatment of aortic lesions were reviewed in this article.

Ratio of postinterventional cerebral hyperdensities/venous sinus maximum density for predicting hemorrhagic transformation after endovascular treatment in patients with acute ischemic stroke / 中国介入影像与治疗学

Objective To observe the value of the ratio of cerebral hyperdensities(PCHD)/venous sinus maximum density for predicting hemorrhagic transformation(HT)after endovascular treatment(EVT)in patients with acute ischemic stroke(AIS).Methods Data of 79 AIS patients with PCHD immediately after EVT were retrospectively analyzed.The patients were divided into HT group(n=41)or non-HT group(n=38)based on the presence of HT or not.Clinical data and CT parameters were compared between groups.The value of the ratio of PCHD/venous sinus maximum density for predicting HT was evaluated.Results The maximum density of PCHD and the ratio of PCHD/venous sinus maximum density in HT group were both higher than those in non-HT group(both P＜0.001).Taken 87 HU as the best cut-off value of the maximum density of PCHD,the sensitivity,specificity and area under the curve(AUC)for predicting HT after EVT in AIS patients was 90.24%,71.05%and 0.79,respectively.Taken 0.94 as the best cut-off value of the ratio of PCHD/venous sinus maximum density,the sensitivity,specificity and AUC was 97.56%,71.05%and 0.81,respectively.No significant difference of AUC was found between the former and the latter(P＞0.05).Conclusion The ratio of PCHD/venous sinus maximum density immediately after EVT could be used to predict HT in AIS patients.

Efficacy analysis of the acute endovascular treatment in patients with symptomatic severe anterior intracranial atherosclerotic stenosis / 中国脑血管病杂志

Objective Observing the feasibility of acute endovascular treatment for patients with symptomatic anterior intracranial atherosclerotic severe stenosis.Method From Jun 2019 to Jun 2023,30 symptomatic anterior intracranial atherosclerotic severe stenosis cases were retrospectively collected in the Guangdong Hospital of Traditional Chinese Medicine to evaluate the risk stratification score and explore the safety and effectiveness of acute(≤72.0h)endovascular treatment.Endovascular treatment includes balloon dilation+self-expanding stent placement,balloon-mounted stent placement,and balloon dilation.From the clinical experience,the risk stratification score was based on the ABCD3-I score for transient ischemic attacks(TIA)and additional evaluation of cerebral watershed infarction to identify the risk of stroke progression or recurrence in acute stage of symptomatic intracranial artery stenosis.The score of 0-3 was defined as low-risk,4-7 as medium risk,and 8-13 as high-risk.The successful revascularization of blood flow is determined based on the residual stenosis≤50％and the extended thrombolysis in cerebral infarction(eTICI)＞2c.The information of patient receiving endovascular treatment was recorded,including age,sex,risk factors of cerebrovascular disease(hypertension,diabetes,hyperlipidemia,hyperhomocysteinemia,drinking history,smoking history),onset data(time from onset to endovascular treatment,symptoms,progression),diseased vessels,risk stratification score,National Institutes of Health Stroke Scale(NIHSS)score before and 90 days after surgery,modified Rankin scale(mRS)score 90 days after surgery,intraoperative cerebrovascular events(intracranial hemorrhage,occlusion of responsible vessels),and postoperative cerebrovascular events 90 days after surgery(intracranial hemorrhage,cerebral infarction,TIA and in-stent restenosis)and deaths.Results Among 30 patients with symptomatic anterior intracranial atherosclerotic severe stenosis,3 patients were excluded from the time interval between onset and endovascular treatment＞72.0 hours,1 patient needed long-term anticoagulant drugs due to other diseases,1 patient lost follow-up,3 patients coexisted with other cardiogenic cerebral embolism diseases,4 patients with non-atherosclerotic arterial stenosis,and 7 patients refused emergency endovascular treatment.11 patients were finally included.(1)All 11 patients were successfully treated with endovascular treatment,and 7 were males;age ranged from 52 to 76 years old,with a median age of 64 years old;there were 9 cases with hypertension,3 cases diabetes,7 cases hyperlipidemia,2 cases hyperhomocysteinemia(only 9cases performed the examination),2cases smoking history,1 case drinking history;time from onset to endovascular treatment is 4.0-72.0 h,with a median time of 12.0 h;there were 3 and 8 cases of infarction in the left and right hemispheres,respectively,with 4,3,and 2 cases accompanied with anterior-posterior watershed,medial watershed,and anlerior-medial-posterior watershed infarctions,and 1 case accompanied by posterior-medial,anterior-medial watershed infarctions.(2)Among the 1 1 patients,the risk stratification score was 10-13 points,with a median score of 11 points;preoperative NIHSS score ranged 0-11 points,with a median score of 7 points.(3)Among the 1 1 patients,10 lesions located in the middle cerebral artery and 1 in the C7 segment of the internal carotid artery;the preoperative stenosis rate was 70％to 99％,with a median stenosis rate of 86％;preoperative eTICI grading was 2a in 7 cases and 2b50 in 4 cases(with slow distal blood flow);9 cases received balloon dilation and self-expanding stent placement,1 case received balloon-mounted stent placement,and 1 case received balloon dilation treatment;the postoperative stenosis rate is 10％to 20％,with a median stenosis rate of 15％;there were 3 cases with postoperative eTICI grade 2c and 8 cases with grade 3.(4)Among the 11 patients,one experienced intracranial hemorrhage on the first day after surgery and one had a new cerebral infarction on the third day after surgery.Eight patients were followed up by imaging 90days after surgery,demonstrating 2 cases of in-stent restenosis;90 days post-surgery,NIHSS score was 0-20 points,with a median score of 2 points;after 90 days of surgery,the mRS score was 0-4 points,with a median score of 1 point.There were 8 patients with mRS score ≤ 2 and no death events occurred.Conclusions Preliminary analysis shows that acute endovascular treatment for symptomatic anterior intracranial atherosclerotic severe stenosis has certain effectiveness,but the safety needs to be further validated.The screening of high-risk patients using risk stratification scores still requires further exploration through large sample and multicenter studies.

Relationship between omentin-1,AQP4,and VILIP-1 levels and vascular recanalization after emergency endovascular treatment in patients with acute large vessel occlusion stroke / 中国医科大学学报

Objective To investigate the relationship between omentin-1,aquaporin 4(AQP4),and visinin-like protein 1(VILIP-1)levels and vascular recanalization after emergency endovascular treatment in patients with acute large vessel occlusion stroke(ALVOS)and their combined predictive efficacy.Methods In total,110 patients with ALVOS undergoing emergency endovascular treatment were categorized into a non-reopening group(23 patients)and a reopening group(87 patients)based on whether the blood vessels were re-opened after surgery.Clinical data and omentin-1,AQP4,and VILIP-1 levels were compared between the two groups.Factors influencing postoperative blood vessel reopening were analyzed,and nomograms were drawn to evaluate their predictive performance and calibration.Results Significant differences were observed in the proportion of patients with hypertension;preoperative NIHSS scores;emergency blood glucose;AQP4,VILIP-1,omentin-1,and platelet levels;time from onset to endovascular treatment;preoperative ASPECTS;and proportion of patients undergoing intravenous thrombolysis between the two groups(P＜0.05).Preoperative ASPECTS and omentin-1 levels were independent protective factors associated with postoperative vascular recanalization,whereas the time from onset to endovas-cular treatment,preoperative NIHSS scores,and AQP4 and VILIP-1 levels were independent risk factors associated with postoperative vascular recanalization(P＜0.05).The C-index of the nomogram for predicting postoperative vascular recanalization was 0.994,and the AUC of the nomogram for predicting postoperative vascular recanalization was 0.994,with a calibration degree of 0.975.Conclusion Omentin-1,AQP4,and VILIP-1 levels are important factors affecting vascular recanalization in patients with ALVOS after emergency endovascular treatment.Clinically,monitoring these levels may help to predict and evaluate early vascular recanalization fol-lowing treatment.

Effect of endovascular treatment on thrombosis of autogenous arteriovenous fistula / 中华肾脏病杂志

Objective:To investigate the effectiveness and safety of ultrasound-guided endovascular therapy for autogenous arteriovenous fistula (AVF) thrombosis.Methods:It was a single-center retrospective cohort study. Data of patients undergoing ultrasound-guided intravascular therapy due to AVF thrombosis in the First Hospital of Hebei Medical University from August 2018 to June 2021 were analyzed. According to different surgical procedures, the patients were divided into two groups. Patients treated with percutaneous transluminal angioplasty (PTA) + drilling thrombectomy were in group A, and patients treated with PTA only were in group B. After 1 year of follow-up, the surgical technique success rate, primary patency rate, secondary patency rate and complications were compared between the two groups.Results:A total of 152 patients were enrolled, including 74 in group A and 78 in group B. There were no significant differences in gender, age, proportion of patients with diabetes and hypertension, and thrombosis time of AVF between the two groups (all P>0.05). Compared with group B, the diameter and length of thrombus in group A were larger [13.0(9.0, 16.0) mm vs. 6.0(5.0, 6.5) mm, Z=-9.362, P<0.001; 12(8, 15) cm vs. 3(3, 4) cm, Z=-10.061, P<0.001], and the establishment time of AVF was longer [5(2, 7) years vs. 2(1, 5) years, Z=-2.698, P=0.007]. Among the overall patients, the success rate of surgery was 96.7% (147/152), and the success rate of surgery was 95.9% (71/74) in group A and 97.4% (76/78) in group B respectively, with no statistical difference ( χ2=0.004, P=0.952). Kaplan-Meier survival analysis showed that, overall, the primary patency rate at 3rd, 6th and 12th month after operation was 87.1%, 71.4% and 56.6%, and the secondary patency rate was 97.1%, 96.4% and 94.1%, respectively. The primary patency rate of group A at 3rd, 6th and 12th month was 82.4%, 66.7% and 53.6%, and the secondary patency rate was 95.7%, 94.2% and 89.7%, respectively. The primary patency rate of group B at 3rd, 6th and 12th month was 91.5%, 73.2% and 59.7%, and the secondary patency rate was 98.6%, 98.6% and 98.5%, respectively. There was no significant difference in the primary and secondary patency rate between group A and group B at 3rd, 6th and 12th month (all P>0.05). The duration of operation in group A was longer than that in group B [2.0(1.9, 2.0) h vs. 2.0(1.0, 2.0) h, Z=-5.181, P<0.001], but no serious complications occurred in both groups. Conclusion:The two surgical methods are effective, safe and reliable in the treatment of AVF thrombosis, and have high clinical application value.

Prompt recognition of renal malperfusion in type B aortic dissection and the prognosis after endovascular therapy / 中华胸心血管外科杂志

Objective:To analyze the imaging characteristics of Stanford B aortic dissection in aortic CT angiography, in order to explore the possible related factors of aortic dissection combined with renal malperfusion and to analyze the morphological changes in each involved vessel after TEVAR.Methods:From January 2018 to December 2019, totally 148 patients of Stanford B aortic dissection underwent TEVAR in our hospital. The preoperative aortic CTA was analyzed, and all cases complicated with renal malperfusion were determined according to the clinical manifestation, laboratory examination and imaging results. The differences of morphological features between the patients with and without renal malperfusion and the possible correlative factors were analyzed.The different ischemic types of the involved renal arteries were analyzed, and the morphological changes of the involved vessels before and after the operation of TEVAR were compared.Results:The logistic regression analysis showed that the concave configuration of the tear at the renal artery level was the independent risk factor for renal malperfusion (right kidney OR=5.319, P=0.032; left kidney OR=12.879, P=0.007). The diameter of renal artery was the independent protective factor for renal malperfusion (right kidney OR=0.464, P=0.018; left kidney OR=0.685, P=0.016). Compared with preoperative CTA, the diameter of the involved renal artery was significantly enlarged after TEVAR, no matter which type of ischemia. Most of the dynamic ischemia (15/16) was improved after TEVAR; while static and mixed ischemia only partially improved after TEVAR (static 22/36, mixed 11/19) . Conclusion:The concave configuration of the renal artery level, and the diameter of renal artery are associated with renal malperfusion.The malperfusion can be improved in most cases of dynamic ischemia type vessels, while only can be partially improved in static and mixed types vessles.

Superior vena cava syndrome and pulmonary artery stenosis in a patient with lung metastases of bladder cancer / 复旦学报（医学版）

Superior vena cava syndrome(SVCS)is a group of clinical syndromes caused by obstruction of the superior vena cava and its major branches from various causes.Pulmonary artery stenosis(PS)is a complication of lung cancer or mediastinal tumours.SVCS combined with PS due to pulmonary metastases from bladder cancer is extremely rare and has not been reported in the literature.Here we reported an old male patient with pulmonary metastases from bladder cancer presenting with swelling of the head,neck and both upper limbs.SVCS combined with PS was clarified by pulmonary artery computed tomography angiography(CTA)and digital subtraction angiography(DSA).Endovascular stenting was used to treat SVCS.Angiography also showed that PS had not caused pulmonary hypertension and did not need to be treated.The swelling of the patient's head,neck and upper limbs was gradually reduced after the procedure.