Endovascular reconstruction of high cervical and long-segment carotid artery dissections with Leo plus stent.

PURPOSE: Endovascular reconstruction has emerged as a viable alternative for carotid artery dissections (CADs) that are unresponsive to antithrombotic therapy. However, high cervical and long-segment CADs pose challenges during endovascular treatment due to their distal location and tortuous anatomy. We presented our experiences using endovascular reconstruction with the Leo plus stent for this type of CAD. METHODS: We conducted a retrospective review of patients with high cervical and long-segment CADs treated using the Leo plus stent. We analyzed patient demographics, clinical presentations, procedural features, complications, and follow-up outcomes. RESULTS: A total of 17 patients (mean age, 48.1 years) with 17 CADs were identified. Seven of these dissections were accompanied by pseudoaneurysm. The mean length of the dissection was 5.7 cm, and the mean degree of stenosis was 92.3%. A single Leo plus stent was deployed in 15 patients, while another Wallstent carotid stent was used in 2 cases. All stents were successfully positioned in their intended sites. The average degree of residual stenosis was 22.2%. There were no perioperative complications. With a median follow-up duration of 29 months, no ischemic stroke events occurred. All but one Leo plus stent remained patent during follow-up, and all 7 pseudoaneurysms had disappeared at the last radiological assessment. CONCLUSION: Our experience in treating high cervical and long-segment CADs with the Leo plus stent demonstrates that this approach is practical, safe, and effective, as evidenced by long-term observations. The Leo Plus stent appears to be a suitable option for managing this type of CAD.

Clinical Outcomes of Diffuse Angiogram-Negative Subarachnoid Hemorrhage Versus Aneurysmal Subarachnoid Hemorrhage: A Propensity Score-Matched Analysis.

BACKGROUND: The outcome of diffuse angiogram-negative subarachnoid hemorrhage (dan-SAH) compared with aneurysmal SAH (aSAH) remains unclear. This study aimed to compare outcomes using propensity score matching. METHODS AND RESULTS: Sixty-five patients with dan-SAH and 857 patients with aSAH admitted between January 2018 and December 2022 were retrospectively reviewed. Propensity score matching resulted in matching 65 patients with dan-SAH to 260 patients with aSAH, and clinical outcomes were compared between the groups. Compared with patients with dan-SAH, patients with aSAH were more likely to experience rehemorrhage (8.8% versus 0%, P=0.027), death (11.2% versus 1.5%; odds ratios [OR] 8.04 [95% CI, 1.07-60.12]; P=0.042), or delayed cerebral ischemia (12.3% versus 3.1%; OR, 4.42 [95% CI, 1.03-18.95]; P=0.045). Multivariate analysis revealed that Hunt-Hess grade 4 to 5 (OR, 3.13 [95% CI, 2.11-4.64]; P<0.001), presence of intraventricular hemorrhage (OR, 3.58 [95% CI, 1.72-7.46]; P=0.001), and smoking (OR, 2.44 [95% CI, 1.12-5.28]; P=0.024) were independently associated with the incidence of unfavorable outcomes (modified Rankin scale score >2 at 3 months), whereas dan-SAH was not (OR, 0.66 [95% CI, 0.25-1.73]; P=0.40). CONCLUSIONS: Compared with patients with dan-SAH, patients with aSAH had higher rehemorrhage rates and in-hospital mortality, as well as a higher incidence of delayed cerebral ischemia. Unfavorable outcomes were associated with admission Hunt-Hess grade, the presence of intravenetricular hemorrhage, and smoking history, but there was no relation with the  pathogenesis of the hemorrhage (dan-SAH versus aSAH).

Does the presence of systemic artery-pulmonary circulation shunt during bronchial arterial embolization increase the recurrence of noncancer-related hemoptysis? A retrospective cohort study.

BACKGROUND: The presence of systemic artery-pulmonary circulation shunt (SPS) during the bronchial arterial embolization (BAE) procedure, has been inferred to be a potential risk factor for recurrence. The aim of this study is to reveal the impact of SPS on the recurrence of noncancer-related hemoptysis after BAE. METHODS: In this study, 134 patients with SPS (SPS-present group) and 192 patients without SPS (SPS-absent group) who underwent BAE for noncancer-related hemoptysis from January 2015 to December 2020 were compared. Four different Cox proportional hazards regression models were used to clarify the impact of SPSs on hemoptysis recurrence after BAE. RESULTS: During the median follow-up time of 39.8 months, recurrence occurred in 75 (23.0%) patients, including 51 (38.1%) in the SPS-present group and 24 (12.5%) in the SPS-absent group. The 1-month, 1-year, 2-year, 3-year and 5-year hemoptysis-free survival rates in the SPS-present and SPS-absent groups were 91.8%, 79.7%, 70.6%, 62.3%, and 52.6% and 97.9%, 94.7%, 89.0%, 87.1%, and 82.3%, respectively (P < 0.001). The adjusted hazard ratios of SPSs in the four models were 3.37 [95% confidence intervals (CI), 2.07-5.47, P < 0.001 in model 1], 1.96 (95% CI, 1.11-3.49, P = 0.021 in model 2), 2.29 (95% CI, 1.34-3.92, P = 0.002 in model 3), and 2.39 (95% CI, 1.44-3.97, P = 0.001 in model 4). CONCLUSIONS: The presence of SPS during BAE increases the recurrence probability of noncancer-related hemoptysis after BAE.

Comparison of Bronchial Artery Embolisation Versus Conservative Treatment for Bronchiectasis-Related Nonmassive Haemoptysis: A Single-Centre Retrospective Study.

OBJECTIVE: To compare the safety and effectiveness between bronchial artery embolisation (BAE) and conservative treatment for bronchiectasis-related nonmassive haemoptysis patients. MATERIALS AND METHODS: From January 2015 to December 2020, consecutive bronchiectasis-related nonmassive haemoptysis patients who underwent either BAE (n = 98) or conservative treatment (n = 118) were included. Treatment-related complications, length of hospital stays, clinical success rate, patient satisfaction, and recurrence-free survival rates were compared between groups. Prognostic factors related to recurrence were also analysed. RESULTS: During a median follow-up time of 44.8 months (range, 2.4-83.6 months), 34 and 66 patients in the BAE and conservative treatment groups suffered relapse. The 1-year, 2-year, 3-year and 5-year haemoptysis-free survival rates in the BAE and conservative treatment groups were 79.2%, 68.1%, 62.8%, and 57.6% and 64.0%, 52.8%, 44.1%, and 37.0%, respectively (P = 0.007). The minor complication rate after BAE was higher than that after conservative treatment (23/98 vs. 12/118, P = 0.008). BAE was associated with shorter hospital stays (5.0 vs. 7.0 days, P = 0.042) and higher patient satisfaction (88.8% vs. 74.6%, P = 0.008) than those for conservative treatment and with comparable clinical success rates (95.9% vs. 91.5%, P = 0.192). Treatment type, haemoptysis duration, and bronchiectasis severity were independently significant predictors of recurrence for these patients. CONCLUSIONS: BAE could be another option for bronchiectasis-related nonmassive haemoptysis patients. In the patients with longer duration and more severe bronchiectasis, BAE still appeared to have better long-term haemoptysis control than conservative therapy.

Higher Levels of Admission N-Terminal Pro-brain Natriuretic Peptide are Associated with Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage.

BACKGROUND: Delayed cerebral ischemia (DCI) greatly influences the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH). We aimed to determine whether higher levels of admission N-terminal pro-brain natriuretic peptide (NT-pro BNP) were related to neurogenic cardiac injury and predicted DCI occurrence in patients with aSAH. METHODS: We retrospectively reviewed consecutive patients with aSAH between January 2018 and April 2021 in our department. Patients with admission NT-pro BNP were included for analysis. The associations between admission NT-pro BNP levels and admission cardiac troponin T levels and electrocardiogram characteristics, as well as the incidence of DCI, were investigated. RESULTS: A total of 415 patients with aSAH were included, among whom DCI occurred in 53 (12.8%). The admission NT-pro BNP levels were positively correlated with the cardiac troponin T levels and were significantly higher in patients with abnormal electrocardiogram characteristics. The admission log NT-pro BNP levels were higher in patients with DCI than in those without DCI. Multivariable analysis revealed that admission log NT-pro BNP levels and modified Fisher scale were independent predictors of the incidence of DCI. Compared with the modified Fisher scale alone (area under the curve = 0.739), combining the modified Fisher scale with admission NT-pro BNP (area under the curve = 0.794) significantly improved the prediction accuracy for DCI (p < 0.001). CONCLUSIONS: Higher admission levels of NT-pro BNP correlated with neurogenic cardiac injury and predicted the occurrence of DCI in patients with aSAH. A combination of the modified Fisher scale and admission NT-pro BNP significantly improved the prediction accuracy for DCI.

Micro-guidewire electrocoagulation for the treatment of intracranial aneurysms that are inaccessible by microcatheterization: a case series and review of the literature.

BACKGROUND: The use of traditional endovascular techniques for aneurysms that are difficult to catheterize is challenging. We present our experience of using micro-guidewire electrocoagulation for the treatment of aneurysms that were inaccessible by a microcatheter. METHODS: Seven consecutive patients who underwent endovascular electrocoagulation for the treatment of aneurysms between January 2020 and May 2022 were retrospectively included. Patient demographics, treatment procedures, and follow-up outcomes were assessed. A review of the literature was also performed. RESULTS: All of the seven treated aneurysms were ruptured, and micro-guidewire electrocoagulation was only conducted if the microcatheter could not advance into the aneurysm or parent artery. After electrocoagulation for 1-4 min, all seven aneurysms disappeared on contrast angiography. Parent artery occlusion was observed in six cases, and post-procedure infarctions of the operating region were identified in three patients. The 3-month follow-up modified Rankin Scale score was 0 in all except one patient. Follow-up angiography was available in six patients, and complete obliteration of the aneurysm was observed in all of them. With a mean follow-up time of 13.6 months, there was no rebleeding in any of the cases. To date, there are only eight published cases of aneurysms treated using micro-guidewire electrocoagulation, and seven of them achieved total occlusion of the aneurysm without neurological deficits. CONCLUSIONS: Endovascular electrocoagulation is practicable and effective for the treatment of aneurysms that are inaccessible by a microcatheter during short-term observation. Studies on larger populations are needed to further confirm the safety and long-term outcomes for this technique.

Bronchial artery embolization for the management of frequent hemoptysis caused by bronchiectasis.

BACKGROUND: To retrospectively evaluate the effectiveness of bronchial artery embolization (BAE) compared with conservative therapy for the treatment of frequent hemoptysis caused by bronchiectasis. METHODS: From January 2015 to December 2019, consecutive patients who were admitted due to frequent (more than three times per year) bronchiectasis-related hemoptysis were retrospectively reviewed. Those who were treated with either BAE (n = 69) or conservative therapy (n = 47) were enrolled for analysis. The technical success, clinical success, and complications of the BAE procedure were evaluated. Long-term hemoptysis-free survival rates and clinical success were compared between patients in the BAE group and patients in the conservative group. A Cox proportional hazard regression model was used to identify the predictors of recurrent hemoptysis. RESULTS: The technical success rate was 100% for the BAE procedure, and clinical success was achieved in 92.8% (64 of 69) of cases. No major procedure-related complications occurred, and minor complications were observed in 16 cases (23.2%). The 1-, 2-, and 3-year hemoptysis-free survival rates were 88.3, 71.3, and 66.2%, respectively, for the BAE group and 31.9, 17.6, and 2.5%, respectively, for the conservative treatment group (P <  0.001). Multivariate analysis showed that BAE was a protective factor against recurrent hemoptysis in treated patients. In addition, the presence of cystic bronchiectasis was the only independent risk factor for rebleeding in the whole population and in the BAE group. CONCLUSIONS: BAE may provide an effective option for patients with frequent bronchiectasis-related hemoptysis, especially for those without cystic bronchiectasis.

Elevated N-terminal pro-brain-type natriuretic peptide at admission is associated with unfavorable outcomes after aneurysmal subarachnoid hemorrhage.

Cardiac injury and dysfunction following aneurysmal subarachnoid hemorrhage (aSAH) negatively impact the neurological outcomes. This study aimed to determine the association between N-terminal pro-brain-type natriuretic peptide (NT-pro BNP) levels at admission and neurological outcomes at six months in aSAH patients following endovascular treatment. Patients diagnosed with aSAH who underwent NT-pro BNP measurement at admission at our department between January 2018 and April 2021 were retrospectively analyzed. Neurological outcomes were evaluated based on the six-month modified Rankin Scale score. The associations between admission NT-pro BNP levels and neurological outcomes were investigated. In total, 471 patients were included in the analysis. The serum NT-pro BNP levels were significantly lower in patients with a favorable outcome than those with an unfavorable outcome. The area under the receiver operating characteristic curve (AUC) of NT-pro BNP was 0.687. The optimal cutoff value of serum NT-pro BNP level as a predictor of unfavorable outcome was 253.4 pg/mL. Multivariate analysis revealed that admission NT-pro BNP level of >253.4 pg/mL was significantly associated with unfavorable outcomes. After propensity score-matching, admission NT-pro BNP level of >253.4 pg/mL was an independent predictor of unfavorable outcomes. Admission NT-pro BNP level added a slight value to other clinical variables for the prediction of unfavorable outcomes (0.877 vs 0.871 in AUC, respectively; p = 0.084). In conclusion, higher admission NT-pro BNP levels were independently associated with six-month unfavorable outcomes in aSAH patients treated with endovascular treatment. However, it added only minor prognostic value to clinical information alone.

Development of a model to predict recurrence after bronchial artery embolization for non-cancer related hemoptysis.

BACKGROUND: Relapse after effective bronchial arterial embolization (BAE) for controlling hemoptysis is not uncommon. Studies reported diverse predictors of recurrence. However, a model to assess the probability of recurrence in non-cancer related hemoptysis patients after BAE has not been reported. This study was to develop a model to predict recurrence after BAE for non-cancer related hemoptysis. METHODS: The study cohort included 487 patients who underwent BAE for non-cancer-related hemoptysis between January 2015 and December 2019. We derived the model's variables from univariate and multivariate Cox regression analyses. The model presented as a nomogram scaled by the proportional regression coefficient of each predictor. Model performance was assessed with respect to discrimination and calibration. RESULTS: One-month and 1-, 2-, 3- and 5-year recurrence-free rates were 94.5%, 88.0%, 81.4%, 76.2% and 73.8%, respectively. Risk factors for recurrence were underlying lung diseases and the presence of systemic arterial-pulmonary circulation shunts. This risk prediction model with two risk factors provided good discrimination (area under curve, 0.69; 95% confidence interval, 0.62-0.76), and lower prediction error (integrated Brier score, 0.143). CONCLUSION: The proposed model based on routinely available clinical and imaging features demonstrates good performance for predicting recurrence of non-cancer-related hemoptysis after BAE. The model may assist clinicians in identifying higher-risk patients to improve the long-term efficacy of BAE.

A Nomogram to Predict Recurrence After Bronchial Artery Embolization for Hemoptysis Due to Bronchiectasis.

OBJECTIVE: To develop and validate a nomogram for predicting recurrent hemoptysis after successful bronchial arterial embolization (BAE) in patients with bronchiectasis. MATERIALS AND METHODS: From January 2015 to December 2019, a total of 251 patients were enrolled in this study. A nomogram was developed with the predictors of recurrent events, which were identified by univariate and multivariate Cox regression analyses. We evaluated nomogram discrimination by area under the receiver operating characteristic curve, calibration by the calibration curve, and clinical usefulness potential by decision curve analysis. RESULTS: The one-month, 1-year, 2-year, 3-year, and 5-year cumulative recurrence-free rates of patients were 98.4%, 90.5%, 82.8%, 77.7%, and 74.4%, respectively. Three predictive factors, namely sex, lung destruction, and systemic arterial-pulmonary circulation shunts, were applied to develop the nomogram. The model maintained good discrimination (area under the curve, 0.72; 95% confidence interval, 0.62-0.81), low prediction error (integrated Brier score, 0.129), and certain net benefits in terms of clinical usefulness. CONCLUSIONS: The proposed nomogram showed favorable predictive efficacy for hemoptysis recurrence after BAE in patients with bronchiectasis. Improved long-term outcomes are expected with close follow-up, a healthy lifestyle, and pulmonary rehabilitation for patients at risk of recurrence according to the model.

Effect of physical exercise on weight loss and physical function following bariatric surgery: a meta-analysis of randomised controlled trials.

OBJECTIVES: We performed a meta-analysis of all of the available randomised controlled trials (RCTs) to investigate whether physical exercise contributes to weight loss or physical function improvement in adults receiving bariatric surgery. METHODS: We searched PubMed, Embase, the Cochrane Library, OVID and the CINAHL up through May 2018. RCTs that assigned adults with obesity to either an exercise training group or a no-exercise group after bariatric surgery were included. The primary outcomes were weight loss and physical function. Study bias was assessed using the Cochrane risk of bias tool, and the quality of evidence was assessed using GRADEpro. RESULTS: A total of eight studies met the inclusion criteria (n=347 participants). Most of the studies carried a low risk of bias due to randomisation and blinding. Compared with those without exercise intervention after surgery, patients engaging in physical exercise were associated with greater weight loss (weighted mean difference (WMD) -1.94 kg; 95% CI -3.18 to -0.69; n=8) and longer 6 min walk distance (6MWD; WMD29.67 m; 95% CI 25.97 to 33.37; n=2) during follow-up. By subgroup analyses, the additional weight loss in exercise group was related to the starting time and type of exercise: patients engaging in exercise 1 year or more after surgery and patients received aerobic-resistance exercise experienced more weight loss. Besides, patients in exercise training group also had lower systolic blood pressure and resting heart rate after surgery. The quality of evidence for these outcomes was moderate to very low. CONCLUSIONS: Physical exercise after bariatric surgery provides 1.94 kg additional weight loss and 29.67 m longer 6MWD compared with surgery alone. Moreover, engaging in exercise 1 year or more after surgery, and a combined aerobic and resistance training programme may result in greater weight loss.

Effects of Diabetes Mellitus and Admission Glucose in Patients Receiving Mechanical Thrombectomy: A Systematic Review and Meta-analysis.

BACKGROUND: We performed a meta-analysis to evaluate the outcomes of acute ischemic stroke (AIS) in patients treated with mechanical thrombectomy (MT), according to diabetes mellitus and admission glucose level (AGL). METHODS: We systematically reviewed previous studies in PubMed that reported outcomes of MT in AIS patients and their relationships with diabetes mellitus or AGL. We used functional independence (modified Rankin score ≤ 2 at 3 months) as the primary end point. RESULTS: Data from 12,653 patients in 47 articles that evaluated the effect of diabetes mellitus or AGL on outcomes after MT were included. Compared with patients without a history of diabetes mellitus, patients with a diabetes mellitus history had significantly lower odds of functional independence in both the unadjusted meta-analysis (odds ratio [OR] 0.64; 95% confidence interval [CI] 0.54-0.75) and the multivariable analysis (OR 0.48; 95% CI 0.33-0.71). Similarly, higher AGL was associated with an unfavorable functional outcome in the unadjusted meta-analysis (pooled effect size - 0.38; 95% CI - 0.45 to - 0.31), and the adjusted OR (95% CI) per 1 mmol/L increase in AGL was 0.87 (0.83-0.92) for functional independence according to the combined multivariable results. Recanalization rate and symptomatic intracranial hemorrhage were neither related to AGL nor different in patients with or without diabetes mellitus. CONCLUSIONS: The present study confirms that a history of diabetes mellitus and high AGL are associated with unfavorable functional outcomes at 3 months after MT in AIS patients. However, the causal relationship between hyperglycemia and poor prognosis remains undetermined, and further investigations are required to ascertain whether AIS patients receiving MT could benefit from intensive glucose control.

Establishment of a canine model of acute pulmonary embolism with definite right ventricular dysfunction through introduced autologous blood clots.

PURPOSE: To establish a canine model of acute pulmonary embolism (PE) with right ventricular (RV) dysfunction using autologous blood clots and evaluate by echocardiography and contrast-enhanced Computed Tomography (CT). MATERIALS AND METHODS: Autologous blood clots formed in vitro were introduced sequentially into the pulmonary arteries of eight healthy mixed-breed dogs while monitoring pulmonary and systemic hemodynamic function. Blood clots were injected until the mean pulmonary artery pressure (MPAP) reached two-three times the baseline pressure, which was maintained up to 1 hour. The RV function was assessed by echocardiography and ECG-gated dual-source contrast CT. RESULTS: All animals survived the imaging procedure. The post-injection pulmonary angiograms showed extensive PE, and MPAP increased from 16.50±2.45 mmHg to 43.13±4.91 mmHg (P<0.001). On echocardiography, the RV fractional area change decreased from 42.06±3.36 to 27.96±3.54 (P<0.001), and the RV myocardial performance increased from 0.20±0.05 to 0.63±0.16 (P<0.001). On CT, the RV end-systolic volume increased from 11.11±1.81 ml to 24.71±4.60 ml (P<0.001), RV end-diastolic volume from 20.73±2.83 ml to 34.63±5.76 ml (P<0.001), and the four-chamber RV/left ventricular diameter ratio from 0.38±0.07 to 0.81±0.14 (P<0.001). CONCLUSION: Acute PE with RV dysfunction was established in a large animal model through controlled injection of autologous blood clots, which may be useful for developing and evaluating new therapeutic approaches for acute PE with RV dysfunction.