Research advances in visualized microspheres / 介入放射学杂志

Microspheres are commonly used as embolic materials in vascular interventional operations.However,due to the limitation of materials,almost all microspheres cannot be detected by imaging equipment in vivo.The visualization of microspheres refers to the addition of various materials to the microspheres that enable the microspheres to be displayed on the images of imaging equipment.In order to optimize the embolization process and facilitate postoperative follow-up,a lot of visualized microspheres have been reported so far,such as X-ray visualized microspheres,MRI visualized microspheres,ultrasonic visualized microspheres,etc.Clinical experience has shown that these microspheres can provide true spatial distribution and real-time intraoperative feedback,which contributes to the optimization,personalization,and improvement of vascular embolization technology.This paper aims to make a comprehensive review about the recent advances in researches about the above mentioned visualized microspheres.

Adaptive sliding mode predictive control for robot-assisted vascular interventional surgery / 中国医学物理学杂志

The robustness of sliding mode control is utilized to improve the adaptability of the control system to changes in vascular mechanical properties of different patients.Adaptive sliding mode control is designed to adapt the controller to the needs of different virtual environment simulations through an adaptive mechanism,thereby weakening the chattering of sliding mode control.The extrapolation prediction algorithm is invoked under the adaptive sliding mode control to reduce the effects of delay on the control and improve force feedback transparency.The experimental results demonstrate that adaptive sliding mode predictive control can enhance system stability,force feedback control accuracy,and fidelity of force feedback control system for flexible surgical instruments.The study has important theoretical significance and practical value for the design of systems with flexible control objects and the improvement of force feedback fidelity.

Research on real-time detection system of catheter delivering force in vascular interventional robots / 生物医学工程学杂志

In existing vascular interventional surgical robots, it is difficult to accurately detect the delivery force of the catheter/guidewire at the slave side. Aiming to solve this problem, a real-time force detection system was designed for vascular interventional surgical (VIS) robots based on catheter push force. Firstly, the transfer process of catheter operating forces in the slave end of the interventional robot was analyzed and modeled, and the design principle of the catheter operating force detection system was obtained. Secondly, based on the principle of stress and strain, a torque sensor was designed and integrated into the internal transmission shaft of the slave end of the interventional robot, and a data acquisition and processing system was established. Thirdly, an ATI high-precision torque sensor was used to build the experimental platform, and the designed sensor was tested and calibrated. Finally, sensor test experiments under ideal static/dynamic conditions and simulated catheter delivery tests based on actual human computed tomography (CT) data and vascular model were carried out. The results showed that the average relative detection error of the designed sensor system was 1.26% under ideal static conditions and 1.38% under ideal dynamic stability conditions. The system can detect on-line catheter operation force at high precision, which is of great significance towards improving patient safety in interventional robotic surgery.

Application and development of shape memory polymers in endovascular therapy / 中国胸心血管外科临床杂志

@#As one of the stimulus-response polymeric intelligent materials, shape memory polymers have been widely applied in biomedicine due to their better biocompatibility, higher controllability, stronger deformation restorability and biodegradability compared with shape memory alloys and shape memory ceramics. This review will introduce the structural principles of shape memory polymers and summarize their applications in the treatment of vascular diseases, especially in endovascular therapy. At the same time, the related technical problems and the future of shape memory polymers are prospected. With the continuous development of processing technology and materials, it can be predicted that shape memory polymers will be more widely used in the medical field.

Percutaneous vascular intervention removal of foreign bodies in blood vessels / 中国介入影像与治疗学

Intravascular foreign bodies (IFB), most being iatrogenic foreign bodies, have become common clinical problems because of their adverse effect such as thrombogenesis, which may affect the function of important organs and even lead to death in some serious cases. It is necessary to remove IFB out in time. Percutaneous vascular intervention technologies have been widely used to remove IFB in recent years. The advancements of percutaneous vascular intervention technologies in application of removal IFB were reviewed in this article.

Trends in Lower Limb Amputation in Patients with Diabetic Foot Based on Vascular Intervention of Peripheral Arterial Disease in Korea: a Population-based Nationwide Study

BACKGROUND: Peripheral arterial disease (PAD) is known as the greatest risk factor affecting the amputation of diabetic foot. Thus, it is crucial to understand the epidemiology of PAD associated with diabetic foot and the relationship between PTA and amputation in predicting prognosis. However, no such multi-year data are available in Korea. Thus, the purpose of this study was to investigate trends of amputation involving diabetic foot based on vascular interventions for PAD in Korea. METHODS: This study was conducted using six-year data obtained from Health Insurance Review and Assessment Service from January 1, 2011 to December 31, 2016. Our study included data pertaining to diabetic foot, PAD, and vascular intervention codes (percutaneous transluminal angioplasty [PTA, M6597], percutaneous intravascular installation of stent-graft [PIISG, M6605], and percutaneous intravascular atherectomy [PIA, M6620]). We analyzed the number of vascular interventions and minor and major amputations each year. The relationship between annual amputation and vascular intervention was analyzed using χ² test. RESULTS: The overall number of vascular interventions increased from 253 (PTA, 111; PIISG, 140; and PIA, 2) in 2011 to 1,230 (PTA, 745; PIISG, 470; and PIA, 15) in 2016. During the same period, the number of minor amputations increased from 2,534 to 3,319 while major amputations decreased from 980 to 956. The proportion of minor amputations among patients who underwent vascular intervention was significantly increased from 19.34% in 2011 to 21.45% in 2016 while the proportion of major amputations among these patients was significantly reduced from 9.88% to 4.27%. In addition, the association between vascular intervention and amputation increased from 0.56 (spearman correlation coefficient) in 2011 to 0.62 in 2016. CONCLUSION: In diabetic foot patients, increase in vascular intervention resulted in a change in amputation pattern, showing statistically significant correlation.

Recent advance in drug eluting balloon in interventional treatment of ischemic cerebrovascular disease / 中华神经医学杂志

The interventional treatment of ischemic cerebrovascular disease has developed rapidly, but it also faces some difficulties, such as restenosis after simple balloon dilatation, in-stent restenosis and bleeding risk caused by anti-platelet therapy after stent angioplasty. The good results and bright prospects of drug eluting balloon (DEB) in treatment of coronary intervention provide a nice reference for the treatment of cerebral vascular intervention. As a new technology, DEB has the advantages of easily operation, short time of postoperative dual anti-platelet treatment, low risk of postoperative bleeding and no foreign matter left in the body. At present, only a few studies have attempted to do the cerebral vascular interventional therapy with DEB, and the results are encouraging. In this paper, the mechanism, mature experience in coronary arteries and clinical application of DEB are summarized to provide a new idea for interventional treatment of ischemic cerebrovascular diseases.

Research progress in robot-assisted vascular interventional therapy / 介入放射学杂志

Traditional vascular intervention relies on C-arm rotation and use of contrast to obtain imaging,which results in the loss of 3D-image information and increased burden on kidney.Moreover,interventional operators bear higher occupational hazard risk under longtime X-ray exposure and the heavy burden of lead protection apron.Robot-assisted vascular intervention system carries certain advantages,it can significantly reduce the X-ray exposure to operators,obtain precise localization of lesions as well as accurate and stable manipulation.While reducing the contact of the instruments with the vascular wall and the operation tremor,it can improve operator's comfortable sensation.This paper aims to make a detailed summary about the development of robot-assisted vascular intervention system and its clinical application.The future development directions of robot-assisted vascular intervention system is also discussed.

Effects of early administration of high-dose rosuvastatin on coronary microvascular function and short-term outcome in patients treated with primary percutaneous coronary intervention for acute myocardial infarction / 中国医师进修杂志

Objective To investigate effects of early administration of high-dose rosuvastatin(40 mg) on coronary microvascular function and short-term outcome in patients treated with primary percutaneous coronary intervention (PCI) for acute myocardial infarction(AMI). Methods Ninety-four consequent AMI patients treated with primary PCI were divided into rosuvastatin group (50 patients) and control group (44 group). The infarct-related artery flow of epicardium was classified in compliance with the TIMI criteria. Myocardial and microvascular perfusion was assessed using the TMPG. The incidence of the MACE and the cytotoxicity and hepatotoxicity of rosuvastatin was respectively recorded in 30 d follow-up period. Results Either patients in the rosuvastatin group or in the control group showed better TMPG immediately after PCI (P<0.05), compared with that before treatment. However, the post-PCI TMPG of the rosuvastatin group was obviously much better than that of control group (P<0.05). Compared with that in control group, the 30-day composite MACE rate was lower in rosuvastatin group and in the TMPG 3 patients of rosuvastatin group:12.0%(6/50) vs. 34.1%(15/44), P<0.05;11.1%(3/27) vs. 42.9%(6/14). There was no cytotoxicity and hepatotoxicity in two groups. Conclusions Early administration of high-dose rosuvastatin (40 mg) can improve coronary microvascular function and short-term outcome in patients treated with primary PCI for AMI, and it is efficient and safety.

Superselective intra-arterial infusion of fasudil for the treatment of symptomatic cerebral vasospasm:curative effect analysis / 介入放射学杂志

Objective To investigate the instant clinical efficacy of intra-arterial infusion of fasudil combined with routine anti-vasospasm for symptomatic cerebral vasospasm (SCVS). Methods The clinical data of 21 patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm, who were admitted to authors' hospital during the period from May 2010 and February 2014, were retrospectively analyzed. The lesions included Fisher gradeⅡ(n=2), gradeⅢ (n=16) and gradeⅣ (n=3). Endovascular embolization of the aneurysm was carried out within 48 hours after the confirmation of the diagnosis with total cerebral DSA;no bleeding occurred during the operation and routine anti-vasospasm therapy was given. Within 4-9 days after the onset of the disease, all 21 patients presented SCVS. Half dose systemic heparinization, superselective intra-arterial infusion of fasudil (30 mg fasudil+250 ml saline, lasting for 30 min) were adopted. Reexamination of angiography performed at 15 min after fasudil infusion was employed, and the results were evaluated with NIHSS score by comparing the preoperative findings. Results Imaging examination performed after the treatment showed that significant improvement was obtained in 15 patients and no obvious changes in 6 patients. Clinical symptoms were remarkably improved in 11 patients, partially improved in 4 patients and remained unchanged in 6 patients. The mean NIHSS score was improved from preoperative 28.6 to postoperative 21.2. Conclusion For the treatment of symptomatic cerebral vasospasm, superselective intra-arterial infusion of fasudil is effective and safe, and it has good clinical application value.

Research on value of 64-slice spiral computed tomography angiography in preoperative evaluation of spinal vascular intervention / 中国医学装备

Objective:To investigate the value of 64-slice spiral computed tomography (64SCT) in preoperative evaluation of spinal vascular intervention.Methods: Seventeen patients with spinal vascular malformations(SVM) scheduled for spinal vascular interventional therapy in our hospital between January 2012-December 2014 were collected, all received 64-detector spiral CT angiography (64-MDCTA) before surgery, image postprocessing technologies such as volume rendering (VR), maximum intensity projection(MIP) and multiplanar reconstruction(MPR) were applied to conduct three-dimensional reconstruction, the traveling case of spinal cord feeding artery was analyzed and were compared with DSA test results.Results: All of the 17 patients clearly showed the abnormality of spinal cord blood vessels and lesions scope, the SVM classification and lesions scope were exactly the same as that of DSA and intraoperative performance, the coincidence rate was 100%;1 case of patient was not shown fistula, the rest of the patients clearly shown the draining veins around the spinal cord, open position and flow tendency of radiculomedullary artery, the coincidence rates were 100.00%, 94.12%%, 100.00%.Conclusion: 64-MDCTA is important for SVM patients to preoperative evaluation of spinal vascular intervention, for it can fully and accurately reflect the open position and flow tendency of radiculomedullary artery, spatial relationship with the surrounding vessels, spinal cord and vertebral situation, should be widely applied.

Effects of endovascular embolization treatment on brain damage and recovery of neurological function in patients with posterior communicating artery aneurysm combined with oculomotor nerve palsy / 中华神经医学杂志

Objective To explore the effects of endovascular embolization treatment on brain damage and recovery of neurological function in patients with posterior communicating artery aneurysm combined with oculomotor nerve palsy.Methods Eighty-four patients with posterior communicating artery aneurysm combined with oculomotor nerve palsy,admitted to our hospital from January 2007 to January 2011,were chosen in our study; 42 of them used intravascular interventional therapy (group A)and other 42 used microsurgical treatment (group B); the operation time,intraoperative blood loss,time of postoperative recovery respiratory and postoperative extubation time between the groups were compared; and the levels of serum neuron specific enolase (NSE),glucose and lactic acid at the end of the operation,postoperative recovery of the oculomotor nerve palsy and postoperative complications at discharge of the hospital were observed and compared between the two groups.Results As compared with group B,group A had significantly shorter operation time and postoperative extubation time (P＜0.05),and significantly less intraoperative bleeding (P＜0.05); NSE,glucose and lactic acid levels in group A were significantly lower than those in group B at the end of the operation (P＜0.05); the incidence of cerebral vasospasm and cerebral edema in group A were obviously lower than that in group B (P＜0.05).The complete recovery of oculomotor nerve paralysis showed no significant difference between the two groups (P＞0.05).Conclusion As compared with microsurgical treatment,intravascular interventional therapy has good effects (no bleeding,rapid recovery and few complications) in patients with posterior communicating artery aneurysms combined with oculomotor nerve palsy.

Promoting interventional radiology in clinical practice of emergency medicine / 介入放射学杂志

Interventional radiology has lot of advantages in dealing with various emergencies. The technique is minimally-invasive,highly-effective and immediately-efficient,moreover,it integrates the diagnosis with the therapy perfectly. Besides,the interventional techniques applied in emergency medicine include not only the vascular interventions,such as embolization,embolectomy,etc,but also the nonvascular interventions,such as tracheal stent implantation,percutaneous vertebroplasty and so forth. However,importance has not been attached to the clinical use of interventional therapy in emergency medicine so far. It is imperative for us to promote the acceptance of interventional therapy in emergency medicine as well as to popularize the technique in clinical practice.

Clinical application of StarClose vascular closure device in the closing of femoral artery puncture site / 介入放射学杂志

Objective To present clinical experience in using StarClose vascular closure device in patients undergoing peripheral vascular interventions. Methods StarClose vascular closure devices were used in 78 patients receiving peripheral vascular interventions in order to close the femoral areriotomies, of which the device was repeatedly used at the same puncture site in 16. Successful hemostasis and vascular complications were observed. Successful hemostasis was defined as the blood oozing completely stopped within 2 min after StarClose deployment, while failure of hemostasis was defined as the blood kept oozing over 2 min after the procedure and manual compression was needed to stop bleeding. Results The mean procedure time for StarClose deployment was (30 ? 10)sec and the mean time for hemostasis was (12 ? 11)sec. Successful rate of hemostasis was 96%, and it was 100% in patients with repeated use of StarClose device. All the patients with successful hemostasis did not need to keep their body still in 2 h. after the surgery. No serious complications occurred. Slight blood oozing was seen in 3 patients 12 h after the procedure. The occurrence of mild complications was 3.2%. Conclusion StarClose vascular closure device can be used to close the femoral puncture site after peripheral vascular interventional procedures with safety and effectiveness, moreover, it can be repeatedly used at the same puncture site.