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Ann Vasc Surg ; 2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31978482


BACKGROUND: Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis is one of the most important methods for deep venous thrombosis treatment. Spontaneous spinal subdural hematoma is a remarkably rare complication in the thrombolysis process with catastrophic consequences, as shown in this case report. METHODS: Percutaneous mechanical thrombectomy, percutaneous angioplasty, and catheter-directed thrombolysis were performed for the patient. Postoperatively, the patient was diagnosed with spontaneous spinal subdural hematoma and received a series of medical treatments and surgical interventions. RESULTS: The patient was still paraplegic and incontinent at the postoperative 7-month follow-up. CONCLUSIONS: Neurologic symptoms must be monitored carefully both during and after the thrombolysis procedure. The onset of spinal neurologic deficits in any patient must raise the suspicion that a spinal subdural hematoma has occurred. Surgical decompression beyond 24 hr may cause permanent neurological damage.

J Reconstr Microsurg ; 35(7): 499-504, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30836413


BACKGROUND: End-to-end, end-to-side, and side-to-side microvascular anastomoses are the main types of vascular bypass grafting used in microsurgery and neurosurgery. Currently, there has been no animal model available for practicing all three anastomoses in one operation. The aim of this study was to develop a novel animal model that utilizes the rat abdominal aorta (AA), common iliac arteries (CIAs), and the median sacral artery (MSA) for practicing these three types of anastomosis. METHODS: Eight adult Sprague-Dawley rats were anesthetized and then laparotomized. The AA, MSA, and bilateral CIAs were exposed and separated from the surrounding tissues. The length and diameter of each artery were measured. The relatively long segment of the AA without major branches was selected to perform end-to-end anastomosis. One side of the CIAs (or AA) and MSA were used for end-to-side anastomosis. The bilateral CIAs were applied to a side-to-side and another end-to-side anastomosis. RESULTS: Anatomical dissection of the AA, CIAs, and MSA was successfully performed on eight Sprague-Dawley rats; four arterial-to-arterial anastomoses were possible for each animal. The AA trunk between the left renal artery and right iliolumbar arteries was 15.60 ± 0.76 mm in length, 1.59 ± 0.15 mm in diameter, for an end-to-end anastomosis. The left CIA was 1.06 ± 0.08 mm in diameter, for an end-to-side anastomosis with the right CIA. The MSA was 0.78 ± 0.07 mm in diameter, for another end-to-side anastomosis with the right CIA or AA. After finishing end-to-side anastomosis in the proximal part of bilateral CIAs, the distal portion was juxtaposed for an average length of 5.6 ± 0.25 mm, for a side-to-side anastomosis. CONCLUSION: This model can comprehensively and effectively simulate anastomosis used in revascularization procedures and can provide more opportunities for surgical education, which may lead to more routine use in microvascular anastomosis training.

Anastomose Cirúrgica/educação , Microcirurgia/educação , Procedimentos Cirúrgicos Vasculares/educação , Animais , Masculino , Modelos Animais , Ratos , Ratos Sprague-Dawley
J Neurointerv Surg ; 11(8): 740-746, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30692214


INTRODUCTION: Acute basilar artery occlusion (BAO) can result in extremely high disability and mortality. Stent retrievers (SRs) can achieve a high recanalization rate for BAO, therefore improving favorable outcomes. However, the efficacy of a direct aspiration first pass technique (ADAPT) to treat BAO is unclear. Our aim was to compare the efficacy and safety of firstline ADAPT with that of firstline SR for patients with acute BAO. METHODS: Three databases were systematically searched for literature reporting outcomes on thrombectomy for acute BAO with both firstline ADAPT and firstline SR. The modified Newcastle-Ottawa scale was applied to assess bias risk. The random effects model was used. RESULTS: Of 50 articles, 5 cohort studies (2 prospective and 3 retrospective) were included in our research. 193 cases were treated with firstline ADAPT and 283 cases received firstline SR. Successful recanalization rate was significantly higher in the firstline ADAPT group (OR=2.0, 95% CI 1.1 to 3.5). Procedure time (mean difference=-27.6 min, 95% CI -51.0 to -4.3) and the incidence of new territory embolic event (OR=0.2, 95% CI 0.05 to 0.83) was significantly less in the firstline ADAPT group. No significant difference was observed between the firstline ADAPT and firstline SR groups for rate of complete recanalization, rescue therapy, any hemorrhagic complication, favorable outcomes, or mortality at 90 days. CONCLUSIONS: Our meta-analysis suggested that for patients with acute BAO, firstline ADAPT might achieve higher and faster recanalization, comparable neurological improvement and safety compared with firstline SR. Further studies are needed to confirm these results.

Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/cirurgia , Stents , Trombectomia/métodos , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/prevenção & controle , Trombectomia/instrumentação , Resultado do Tratamento
J Clin Neurosci ; 59: 112-118, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30401573


Drug-eluting stent (DES) is a potential endovascular treatment for patients with symptomatic intracranial atherosclerotic disease (sICAD). However, evidence regarding the treatment of ICAD with DES is lacking. We systematically searched Pubmed, Embase, Cochrane database (before 2017-12-21) for literature reporting the application of DES in the treatment of sICAD. The main outcomes were as follows: the incidence of any stroke or death within 30 days (perioperative complications), ischemic stroke in the territory of the qualifying artery beyond 30 days (long-term complications), in-stent restenosis rate (ISR) and symptomatic ISR during follow-up. Those studies with mean stenosis rate greater than 70% and less than 70% were defined as severe and moderate stenosis group, respectively. The random effect model was used to pool the data. Of 518 articles, 13 studies were eligible and included in our analysis (N = 336 patients with 364 lesions). After the implantation of DES, perioperative complications (mortality = 0) occurred in 6.0% (95%CI 2.0%-11.9%), long-term complications occurred in 2.2% (95%CI 0.7%-4.5%), ISR rate was 4.1% (95%CI 1.6%-7.7%) and the symptomatic ISR rate was only 0.5% (95%CI 0-2.2%). In addition, subgroup analysis showed that the perioperative complication rate in severe stenosis group [10.6% (95%CI 6.5%-15.7%)] was significantly (p < 0.01) higher than that in moderate stenosis group [1.0% (95%CI 0.3%-3.5%)]. In summary, endovascular DES implantation is a relatively safe and effective method compared with stents or medical management group in SAMMPRIS and VISSIT trials. However, a higher preoperative stenosis rate may imply a higher risk of perioperative complications. Further studies are needed.

Stents Farmacológicos , Arteriosclerose Intracraniana/terapia , Idoso , Stents Farmacológicos/efeitos adversos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Incidência , Arteriosclerose Intracraniana/complicações , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Resultado do Tratamento
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 47(6): 588-594, 2018 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-30900835


OBJECTIVE: To compare the efficacy of mechanical thrombectomy with transcatheter thrombolysis in the treatment of acute iliac femoral venous thrombosis. METHODS: The clinical data of 170 patients with acute iliac venous thrombosis treated in Ningbo No.2 Hospital from September 2015 to September 2017 were retrospectively reviewed. Among them, 94 cases were treated with AngioJet mechanical thrombolysis or additional thrombolysis for residual thrombus (PMT group) and 76 cases were treated with catheter-directed thrombolysis(CDT group). After thrombolytic treatment if there was stenosis of iliac vein, the transluminal angioplasty was also performed. The clearance of thrombus and safety were evaluated and compared between two groups. RESULTS: In PMT group there were 86 cases (91.5%) with grade Ⅲ, 5 cases (5.3%) with grade Ⅱ, 3 cases (3.2%) with grade Ⅰ clearance of thrombus; while in CDT group, there were 63 cases (82.9%) with grade Ⅲ, 7 cases (9.2%) with grade Ⅱ and 6 cases (7.9%) with grade Ⅰ clearance of thrombus (P>0.05). The differences of diameter of two lower extremities 15 cm above knee after treatment in PMT and CDT groups were (2.3±0.9) cm and (2.5±1.1) cm, respectively (P>0.05). The time of thrombolysis in group PMT was significantly shorter than that in group CDT[(2.6±1.2) d vs. (5.3±1.5) d, P<0.05]. The dosage of urokinase in PMT group was significantly lower than that in CDT group[(15.0±5.0)×105 U vs. (26.5±7.5)×105 U, P<0.05]. Hemoglobin decrease was observed in both groups, which was more significant in PMT group (P<0.01). During the following period, there was no significant difference in the incidence of recurrence and post-thrombosis syndrome in two groups (all P>0.05). CONCLUSIONS: Both PMT and CDT have good thrombus clearance effect in the treatment of acute iliac femoral venous thrombosis, however, PMT has the advantages of short thrombolytic time and less urokinase.

Cateterismo Periférico , Trombectomia , Terapia Trombolítica , Trombose Venosa , Fibrinolíticos/uso terapêutico , Humanos , Veia Ilíaca/patologia , Veia Ilíaca/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Trombose Venosa/cirurgia , Trombose Venosa/terapia
Chin Med J (Engl) ; 123(10): 1246-50, 2010 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-20529574


BACKGROUND: Hypertensive intracerebral hemorrhage (HICH) is a severe disease with high morbidity and mortality. Timely removal of the hematoma through surgical procedures may effectively reduce secondary injuries. However, there has long been a debate over the proper timing of such surgery. In this study, we explored the optimal operation time for HICH patients by observing the pathological changes in perihematomal brain regions during different stages of onset. METHODS: Twenty-five specimens of brain tissue, obtained from perihematomal region of HICH patients in different phases, were subjected to haematoxylin-eosin (HE) staining, terminal deoxynucleotidyl transferase-mediated deoxyuridine 5-triphosphate nick-end labeling (TUNEL) staining and Caspase-3, matrix metalloproteinases-9 (MMP-9) immunohistochemical staining. The changing roles of necrosis and apoptosis and the expression of MMP-9 and Caspase-3 positive cells were all observed using image analysis. RESULTS: The obvious expression of TUNEL positive cells was recognized within 6 hours of ICH onset, reaching its peak between 6 hours and 24 hours in the early phase. RESULTS: were highly consistent with Caspase-3 and MMP-9 positive cell counts. Necrosis was found 6 hours after ICH onset and aggravated after 12 hours. CONCLUSIONS: In the early phase, apoptosis was seen as a major modality of injury in the brain tissue of the perihematomal region and was strongly correlated with the expression of MMP-9 and Caspase-3. The results of the present study suggest that an operation performed as soon as possible after ICH onset may be optimal for preserving the nervous system function.

Apoptose/fisiologia , Hemorragia Intracraniana Hipertensiva/cirurgia , Idoso , Encéfalo/metabolismo , Encéfalo/patologia , Encéfalo/cirurgia , Caspase 3/metabolismo , Feminino , Humanos , Marcação In Situ das Extremidades Cortadas , Hemorragia Intracraniana Hipertensiva/metabolismo , Hemorragia Intracraniana Hipertensiva/patologia , Masculino , Metaloproteinase 9 da Matriz/metabolismo , Pessoa de Meia-Idade , Fatores de Tempo