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1.
Radiologia (Engl Ed) ; 64(2): 103-109, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35504675

RESUMO

OBJECTIVE: To determine the safety and efficacy of angioplasty with a retrievable stent in treating vasospasm secondary to subarachnoid hemorrhage (SAH) due to an aneurysm. METHODS: We retrospectively analyzed prospectively collected data from consecutive patients undergoing endovascular angioplasty with a retrievable stent to treat vasospasm related to SAH due to an aneurysm in four neurointerventional radiology departments between January 2018 and July 2019. We included patients aged >18 years with vasospasm >50% of the internal carotid artery (ICA), anterior cerebral artery (ACA), and / or middle cerebral artery (MCA) secondary to SAH due to an aneurysm treated with endovascular angioplasty with a retrievable stent. The variables used to measure safety were complications of the procedure and clinical complications. The variables used to measure radiological efficacy were improvement in the degree of stenosis after endovascular treatment and improvement or normalization of cerebral circulation time CTT). RESULTS: We included 16 angioplasty procedures with retrievable stents in 13 patients, in which 33 arterial segments were treated (10 ICA, 15 MCA, and 8 ACA). We observed no complications of the procedure in any patients and no clinical complications in patients who were not intubated. All but one of the patients who had delayed CTT at the beginning of the procedure showed improvements in CTT. The mean improvement in the degree of stenosis was 18% ± 11.65% in the ICA, 30.67% ± 18.45% in the MCA, and 28.38% ± 15.49% in the ACA. No statistically significant associations were observed between endovascular treatment variables and the degree of improvement in stenosis. CONCLUSION: Angioplasty with a retrievable stent is a safe and efficacious treatment for vasospasm secondary to SAH due to an aneurysm, improving CTT and stenosis.


Assuntos
Aneurisma Intracraniano , Hemorragia Subaracnóidea , Vasoespasmo Intracraniano , Angioplastia/efeitos adversos , Constrição Patológica/complicações , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/terapia , Estudos Retrospectivos , Stents/efeitos adversos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/terapia , Vasoespasmo Intracraniano/cirurgia , Vasoespasmo Intracraniano/terapia
2.
Contrast Media Mol Imaging ; 2022: 4107491, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35517991

RESUMO

Objective: To demonstrate the advantage of our newly designed magnetic ureteric stenting retrieval device over traditional nonmagnetic ureteric stents and other retrieval devices without cystoscopy intervention on clinical application and cost-related outcomes. Patients and Methods. A total of 333 patients were recruited into two study groups: magnetic-end ureteral stent (Group A) and conventional ureteral stent (Group B). The effects were evaluated by Ureteral Stent Symptom Questionnaire (USSQ) scores, complications of the indwelling stent, visual analog scale (VAS) pain scores at stent removal, and cost-analysis outcomes between the magnetic ureteric stenting retrieval device and traditional double-J ureteral stent (DJUS) removed by cystoscopy. Results: The VAS of the pain score of patients undergoing magnetic stent removal with the retrieval device was 2 ± 0.97, whereas that of patients undergoing conventional ureteral stent removal with cystoscopy was 5.76 ± 1.53 (p < 0.001). The removal of magnetic stents by a retrieval device proved to be less painful than cystoscopy-mediated stent removal (p < 0.001). Obviously, the total cost for the magnetic stent removal was much lower than the conventional ureteral stent removal, although the magnetic stent costs more than the conventional ureteral stent. The improved magnetic stent used in our study showed a remarkable cost saving of 705/111 USD Chinese Yuan (CNY) per patient when compared with the conventional ureteral stent. Conclusion: We reported the integrated design features of the improved magnetic stent in the world, which was granted a patent in China. USSQ scores and rate of complications in the magnetic stent were as equally acceptable as a conventional stent. Furthermore, successful stent insertion rate reached 100% by both the antegrade and retrograde approaches, and no failure case of magnetic stent removal was reported in our study.


Assuntos
Ureter , Humanos , Fenômenos Magnéticos , Dor/etiologia , Estudos Prospectivos , Stents/efeitos adversos , Ureter/cirurgia
3.
Chirurgia (Bucur) ; 117(2): 175-179, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35535778

RESUMO

Introduction: Anastomotic fistulas after surgery for esophageal cancer, remain a challenge for both the surgeon and the gastroenterologist. The aim of the study is to highlight the role of esophageal stenting in the management of leaks after esophagectomy for malignancies. Materials and Methods: We reviewed the available literature on the endoscopic treatment of esophageal anastomotic leaks, especially articles on endoscopic stenting in the management of this complication. Pubmed and ClinicalKey databases were searched using keywords such as esophageal anastomotic leaks, fully covered self-expanding metal stents, esophageal neoplasm. The relevant literature has been reviewed and included in the article. Results and Conclusions: The insertion of self-expanding stents in the fistulas of the esophageal anastomosis, represents an efficient method of treatment both for the closure of the fistula and in the control of sepsis. The morbidity and mortality associated with this method of treatment may be significant.


Assuntos
Doenças do Esôfago , Neoplasias Esofágicas , Neoplasias Gástricas , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Doenças do Esôfago/complicações , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Humanos , Estudos Retrospectivos , Stents/efeitos adversos , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
5.
BMJ Case Rep ; 15(4)2022 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-35387786

RESUMO

A man in his mid-30s was admitted with a thunderclap headache. He was conscious and hypertensive. A decade earlier, severe hypertension had been diagnosed and extensively investigated without revealing an underlying cause. Brain imaging showed subarachnoid haemorrhage caused by a ruptured pericallosal aneurysm. Endovascular occlusion was attempted, but as the sheath could not pass the aortic arch, it was converted to surgical aneurismal clipping. Intraoperative blood pressure measurement revealed a peak-to-peak gradient of 100 mm Hg across the aortic arch and an ankle/brachial index of 0.46 (normal range 0.9-1.2). Aortic coarctation was suspected, and angiographic imaging and echocardiography confirmed the diagnosis. Subacute direct stenting was performed, which normalised the peak-to-peak gradient and ankle/brachial index. To minimise the risk of severe complications, early diagnosis of aortic coarctation is important and can be facilitated by ankle/brachial index and echocardiography in the suprasternal view.


Assuntos
Aneurisma Roto , Coartação Aórtica , Hipertensão , Hemorragia Subaracnóidea , Aneurisma Roto/complicações , Aorta Torácica , Coartação Aórtica/diagnóstico , Coartação Aórtica/diagnóstico por imagem , Humanos , Hipertensão/etiologia , Masculino , Stents/efeitos adversos , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia
6.
Medicine (Baltimore) ; 101(10): e29042, 2022 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-35451416

RESUMO

RATIONALE: Lower extremity arteriosclerosis obliterans (ASO) disease is caused by the formation of atherosclerotic plaque in the femoral artery, which causes the stenosis and occlusion of lower legs, and then leads to chronic limb ischemia. Stent intervention is the most common treatment for ASO in the lower extremities, although there is a risk of overstretching or fracturing the stent, resulting in stent rupture. We provide a unique method for treating stent rupture. PATIENT CONCERNS: A 79-year-old male presented with intermittent claudication of the left lower limb for 6 months. Five years ago, a stent was placed in the lower extremity femoral artery. According to the examination, the stent suffered a modest torsional fracture. DIAGNOSIS: The case was diagnosed with lower extremity ASO. INTERVENTIONS: We performed a combination of femoral endarterectomy and interventional surgery. OUTCOMES: Blood flow was restored after the hybrid operation has been used to treat arterial stenosis in the lower limbs. CONCLUSION: Integrating vascular interventional surgeries can shorten surgical procedures time and increase success rates.


Assuntos
Reestenose Coronária , Artéria Femoral , Idoso , Constrição Patológica/complicações , Constrição Patológica/cirurgia , Reestenose Coronária/complicações , Artéria Femoral/cirurgia , Humanos , Isquemia/etiologia , Extremidade Inferior/irrigação sanguínea , Masculino , Stents/efeitos adversos , Resultado do Tratamento , Grau de Desobstrução Vascular
7.
Kyobu Geka ; 75(5): 382-386, 2022 May.
Artigo em Japonês | MEDLINE | ID: mdl-35474204

RESUMO

Thoracic endovascular aortic repair (TEVAR) has been widely used in recent years as a treatment for thoracic aortic aneurysm, but open surgery may be required for various complications that cannot be controlled by endovascular treatment alone. It is often a more challenging operation. A 78-year-old man underwent two debranch TEVAR (zone 1) for thoracic aortic aneurysm eight years before, and he received TEVAR (zone 0) again with the Najuta stent graft for re-expansion of aneurysm due to typeⅠa endoleak two years before. Since the aneurysm continued to expand and the aortic valve stenosis progressed after that, we performed total arch replacement (TAR) and aortic valve replacement (AVR). The Najuta stent graft could be removed manually. As the debranched graft had to be cut off at sternotomy, selective cerebral perfusion (SCP) was initiated at normal body temperature. It should be noted that SCP at normal body temperature may require more perfusion than hypothermic SCP. TAR was performed in combination with frozen elephant trunk, and postoperative computed tomography (CT) confirmed the disappearance of endoleak. One year has passed since the operation, but the aneurysm has not re-expanded.


Assuntos
Aneurisma da Aorta Torácica , Procedimentos Endovasculares , Idoso , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular/efeitos adversos , Endoleak/etiologia , Procedimentos Endovasculares/métodos , Humanos , Masculino , Stents/efeitos adversos
8.
Medicina (Kaunas) ; 58(4)2022 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-35454371

RESUMO

Background and Objectives: Endoscopic ultrasound-guided gastroenteric anastomosis (EUS-GEA) using lumen-apposing metal stents (LAMS) is emerging as a minimally invasive alternative to surgery across several indications. The aim of this survey is to investigate the perceived feasibility of this technique nationwide, within a working group skilled in interventional endosonography. Materials and Methods: Endoscopists were asked to answer to 49 items on a web-based questionnaire about expertise, peri- and intra-procedural aspects in the three main settings of EUS-GEA performance, budget/refund, and future perspectives. Statistical analysis was performed through SPSS® (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.). Results: Sixty endosonographers belonging to forty Italian centers were I-EUS app users and were all invited to participate. In total, 29 participants from 24 Italian centers completed the survey. All the participants were endosonographers with a broad range of experience both in the field of EUS (only 10.3% with more than 20 years of experience) and duodenal stenting (only 6.9% placed more than 10 stents in 2020), whereas 86.2% also performed ERCP. A total of 27.6% of participants performed EUS-GEA (3.4% more than 20 during their career); on the other hand, 79.3% of participants routinely performed drainage of peri-pancreatic fluid collections, 62.1% performed biliary drainage, and 62.1% performed gallbladder drainage with LAMS. A total of 89.7% of participants thought that EUS-GEA could be useful in their daily clinical practice, with 100% concluding that this procedure will need to be performed in referral centers in the near future; however, in 55.2% of cases, organizational obstacles may occur and affect the diffusion of the procedure. With regard to indications: 44.8% of participants performed the procedure with palliative intent for malignant indication (96.6% pancreatic adenocarcinoma), and 13.6% also for benign indication. A total of 20.7% of participants experienced adverse events (none severe or fatal, 66.6% moderate). A total of 62.1% of participants considered the procedure technically challenging, although 82.8% considered the risk of adverse events acceptable when considering the benefit. Conclusions: To our knowledge, this is the first survey assessing the perceived feasibility of EUS-guided anastomoses after its advent. There are currently wide variations in practice nationwide, which demonstrate a need to define technical, qualitative, and peri-procedural requirements to carry out this procedure. Therefore, a standardization of these requirements is needed in order to overcome the technical, economical, and organizational obstacles relative to its diffusion.


Assuntos
Colestase , Endossonografia , Stents , Ultrassonografia de Intervenção , Adenocarcinoma , Anastomose Cirúrgica , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colestase/etiologia , Colestase/terapia , Endossonografia/métodos , Estudos de Viabilidade , Humanos , Neoplasias Pancreáticas , Stents/efeitos adversos , Inquéritos e Questionários , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos
9.
Sci Rep ; 12(1): 6918, 2022 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-35484182

RESUMO

The purpose of this clinical study was to investigate the efficacy and safety of airway stent implantation and transarterial infusion chemotherapy in the sequential treatment of severe airway stenosis caused by esophageal cancer. Data of patients with advanced esophageal cancer complicated by severe airway stenosis treated with airway stent implantation and transarterial infusion chemotherapy were retrospectively analyzed. Furthermore, dyspnea, clinical efficacy, adverse reactions, and survival of patients were evaluated. 71 patients were included in this study. There were 28 patients with grade III dyspnea and 43 patients with grade IV dyspnea before airway stent implantation, and 34 patients with grade I dyspnea, 35 patients with grade II dyspnea and 2 patients with grade III dyspnea after airway stent implantation. After airway stent implantation and 1-3 courses of transarterial infusion chemotherapy, 11, 41 and 19 patients had complete response, partial response and stable response respectively. Total disease control rate (DCR) and objective response rate (ORR) were 100.0% and 73.2%, respectively. During the follow-up, 32 patients died of organ failure, 24 patients died of tumor-related respiratory failure, and 10 patients died of gastrointestinal bleeding. The median survival time of all patients was 8 months, and the 1-year survival rate was 40.8%. Airway stent implantation combined with arterial infusion chemotherapy is safe and effective for sequential treatment of esophageal cancer with severe airway stenosis.


Assuntos
Neoplasias Esofágicas , Stents , Constrição Patológica/etiologia , Dispneia/etiologia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/tratamento farmacológico , Humanos , Estudos Retrospectivos , Stents/efeitos adversos
10.
Molecules ; 27(8)2022 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-35458670

RESUMO

There is little known about the prognostic value of serum microRNAs (miRs) in diabetic patients with symptomatic internal carotid artery disease (ICAS) who underwent stent supported angioplasty (PTA) for ICAS. The present study aimed to investigate expression levels of selected miRs for future major adverse cardiac and cerebral events (MACCE) as a marker in diabetic patients following ICAS-PTA. The expression levels of 11 chosen circulating serum miRs were compared in 37 diabetic patients with symptomatic ICAS and 64 control group patients with symptomatic ICAS, but free of diabetes. The prospective median follow-up of 84 months was performed for cardiovascular outcomes. Diabetic patients, as compared to control subjects, did not differ with respect to age (p = 0.159), distribution of gender (p = 0.375), hypertension (p = 0.872), hyperlipidemia (p = 0.203), smoking (p = 0.115), coronary heart disease (p = 0.182), lower extremities arterial disease (LEAD, p = 0.731), and miRs expressions except from lower miR-16-5p (p < 0.001). During the follow-up period, MACCE occurred in 16 (43.2%) diabetic and 26 (40.6%) non-diabetic patients (p = 0.624). On multivariate Cox analysis, hazard ratio (HR) and 95% Confidence Intervals (95%CI) for diabetic patients associated with MACCE were miR-134-5p (1.12; 1.05-1.21, p < 0.001), miR-499-5p (0.16; 0.02-1.32, p = 0.089), hs-CRP (1.14; 1.02-1.28; p = 0.022), prior myocardial infarction (8.56, 1.91-38.3, p = 0.004), LEAD (11.9; 2.99-47.9, p = 0.005), and RAS (20.2; 2.4-167.5, p = 0.005), while in non-diabetic subjects, only miR-16-5p (1.0006; 1.0001-1.0012, p = 0.016), miR-208b-3p (2.82; 0.91-8.71, p = 0.071), and hypertension (0.27, 0.08-0.95, p = 0.042) were associated with MACCE. Our study demonstrated that different circulating miRs may be prognostic for MACCE in diabetic versus non-diabetic patients with symptomatic ICAS. Higher expression levels of miR-134 were prognostic for MACCE in diabetic patients, while higher expression levels of miR-16 were prognostic in non-diabetic patients.


Assuntos
Estenose das Carótidas , MicroRNA Circulante , Diabetes Mellitus , Hipertensão , MicroRNAs , Artérias Carótidas , Estenose das Carótidas/complicações , Estenose das Carótidas/cirurgia , MicroRNA Circulante/genética , Humanos , MicroRNAs/genética , Estudos Prospectivos , Fatores de Risco , Stents/efeitos adversos , Resultado do Tratamento
11.
J Am Heart Assoc ; 11(7): e023276, 2022 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-35377181

RESUMO

Background Stent thrombosis (ST) remains a significant medical issue. In particular, longer-term mortality and clinical predictors after ST occurrence have yet to be elucidated. Methods and Results This was a multicenter, retrospective, observational study. A total of 187 definite ST cases from January 2008 to December 2017 were enrolled, and the long-term clinical outcomes were investigated. The primary outcome measure was the cumulative mortality after ST occurrence. In addition, independent predictors of mortality were assessed. Among the stent types causing ST, bare-metal stent, first-generation drug-eluting stent, second-generation drug-eluting stent, and third-generation drug-eluting stent comprised 31.0%, 19.3%, 36.9%, and 6.4% of cases, respectively. Median duration from stent implantation to ST was 680.5 (interquartile range, 33.8-2450.5) days. Cumulative mortality was 14.6%, 17.4%, 21.2%, 24.4%, and 33.8% at 1, 2, 3, 5 and 10 years, respectively. The cumulative mortality did not significantly differ by type of stent, and mortality of late ST was higher than that of early ST and very late ST; however, it did not reach statistical significance after the multivariate analysis. Independent predictors of mortality were hemodialysis (hazard ratio [HR], 7.80; 95% CI, 3.07-19.81; P<0.001), culprit lesions in the left main trunk (HR, 8.14; 95% CI, 1.71-38.75; P=0.008), culprit lesions in the left coronary artery (HR, 2.77; 95% CI, 1.10-6.96; P=0.030), and peak creatine kinase (HR, 1.017; 95% CI, 1.011-1.022; P<0.001). Conclusions The 10-year cumulative mortality after ST reached 33.8%. Close follow-up is thus mandatory for patients with ST, especially with hemodialysis, culprit lesions in the left main trunk and left coronary artery, and high peak creatine kinase.


Assuntos
Trombose Coronária , Stents Farmacológicos , Intervenção Coronária Percutânea , Trombose , Trombose Coronária/etiologia , Stents Farmacológicos/efeitos adversos , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Estudos Retrospectivos , Fatores de Risco , Stents/efeitos adversos , Trombose/epidemiologia , Resultado do Tratamento
12.
J Med Life ; 15(2): 222-227, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35419099

RESUMO

The hybrid method of treating thoracic aortic pathology is devoid of the disadvantages of traditional open surgery and, at the same time, has a broader range of applications than the endovascular method. From 2014 to 2019, we researched 122 patients with thoracic aortic pathology treated with the hybrid method (open surgery with thoracic endovascular aortic repair (TEVAR) at the National M. Amosov Institute of Cardiovascular Surgery National Academy of Medical Science of Ukraine. In the general group, 34 patients had a descending aortic aneurysm without dissection or rupture; 71 patients had an aortic dissection (10 - acute, 9 - subacute, 52 - chronic), penetrating aortic ulcer (PAU) - 7, thoracoabdominal aneurysm (Crawford I-II) - 4, isolated aortic arch aneurysm - 2, residual enlargement aorta after previous ascending aortic grafting causing type A acute aortic dissection (TAAD) - 3, primary aortic thrombosis - 1. Patients admitted as elective surgery candidates had switched aortic arch vessels (debranching) in the first stage and TEVAR in the second stage. For emergencies (aortic rupture with uncontrolled bleeding, malperfusion syndrome), TEVAR operation was performed first. Long-term results of treatment after three and six months are satisfactory. The hybrid technique of aortic arch treatment using modern minimally invasive technologies can eliminate the pathology in the most dangerous segment of the main artery of the body, providing a reasonable level of hospital mortality - 4.2%, and a small number of neurological complications.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/efeitos adversos , Humanos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Stents/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
13.
J Med Life ; 15(2): 252-257, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35419100

RESUMO

Carotid artery stenosis is responsible for up to 12% of all ischemic strokes. The prevalence of bilateral carotid artery stenosis is nearly 8-39% among patients with stroke, and its management is still controversial. This study aimed to report the treatment results of bilateral carotid artery stenosis with simultaneous bilateral angioplasty and stenting (sbCAS) in a single institution during the last 10 years. 315 patients underwent carotid stenting in the Scientific-Practical Center of Endovascular Neuroradiology, NAMS of Ukraine during 2010-2020. 39 (12.4%) patients (mean age 57.9±2.1 - 28 men) underwent sbCAS. Primary clinical endpoints (stroke, myocardial infarction, or death) and secondary endpoints (hemodynamic depression (HD) - hypotension (<90 mmHg) or bradycardia (<60 bpm) and hyperperfusion syndrome (HPS) were evaluated. All sbCAS were technically successful, and a reduction of stenosis was noted in each case. There were two periprocedural neurological complications, one transient ischemic attack (TIA), and one minor stroke with the Modified Rankin Scale (mRS) - 3 at discharge. No myocardial infarction (MI) or death during hospitalization was noted. 28 patients (71.8%) had HD, and 2 (5.1%) had HPS. All patients except those with periprocedural stroke were discharged or transferred to another hospital without neurological deterioration. sbCAS is an effective and relatively safe procedure for carefully selected patients with bilateral carotid stenosis. Patients with bilateral carotid stenosis should be carefully examined, and the best treatment strategy should be assessed using a multidisciplinary approach taking into account the possibility of sbCAS.


Assuntos
Estenose das Carótidas , Infarto do Miocárdio , Acidente Vascular Cerebral , Angioplastia/efeitos adversos , Angioplastia/métodos , Estenose das Carótidas/complicações , Estenose das Carótidas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Estudos Retrospectivos , Fatores de Risco , Stents/efeitos adversos , Acidente Vascular Cerebral/complicações , Resultado do Tratamento
14.
Eur Rev Med Pharmacol Sci ; 26(6): 1846-1851, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35363332

RESUMO

OBJECTIVE: The aim of this study was to investigate the technical success and in-hospital outcomes of endovascular thrombectomy (ET) in acute ischemic stroke (AIS) patients performed by interventional cardiologists. PATIENTS AND METHODS: ET for AIS provides fast, effective and safe recanalization. Insufficient number of catheter laboratories for stroke interventions and experienced interventional neurologists are limiting the widespread application of such a promising treatment method. RESULTS: 123 patients with AIS and eligible for ET were evaluated retrospectively. 65 patients were female (52.8%) and the mean age of the patients was 71.5 ± 11.9 years. Most of the patients had a middle cerebral artery (MCA) occlusion (112 patients, 91%). Successful recanalization (thrombolysis in cerebral infarction grading 2b or higher) was achieved in 109 patients (88.6%). Access site complication was observed only in 3 patients (2.4%). Intracranial bleeding was observed in 17 patients (13.8%) and only 8 of them were symptomatic (6.5%). In-hospital death occurred in 19 patients (15.4%). The initial National Institutes of Health Stroke Scale (NIHSS) was 16.8±3.3 (median 18) which improved significantly to 10.4±7.2 (median 11) at 24 hours (p<0.001). Dramatic neurologic improvement was observed in 60 of 123 patients (48.8%). The modified rankin score of the patients was significantly lower at discharge compared to admission (4.2±0.7 vs. 2.9±2, p<0.001). CONCLUSIONS: ET in AIS can be performed safely with high success rates by trained interventional cardiologists within the stroke team. Until the number of stroke centers is sufficient, endovascular treatment of AIS can be supported by experienced interventional cardiologists.


Assuntos
Isquemia Encefálica , Cardiologistas , Procedimentos Endovasculares , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Isquemia Encefálica/terapia , Cateteres/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Mortalidade Hospitalar , Humanos , Laboratórios , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents/efeitos adversos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/cirurgia , Trombectomia/efeitos adversos , Resultado do Tratamento
15.
Zhonghua Nei Ke Za Zhi ; 61(5): 537-542, 2022 May 01.
Artigo em Chinês | MEDLINE | ID: mdl-35488604

RESUMO

Objective: To evaluate whether underdilated stent could reduce the occurrence of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation. Methods: A total of 197 patients with decompensated liver cirrhosis, who had underwent TIPS creation at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively, including 110 males and 87 females with age 25-79 (54±11) years old. Uncovered and covered stents with 8 mm diameter were implanted in all subjects, and then dilated by balloon catheters with 6 mm or 8 mm diameter. The patients were divided into two groups, including underdilated group (6 mm, n=105) and control group (8 mm, n=92).Kaplan-Meier curves were used to illustrate cumulative rate of HE, and the differences were assessed with the log-rank test. Multivariate analyses with a Cox regression model were conducted to explore the risk factors for HE. Results: During a median follow-up period of 29 (12-54) months, 16 (15.2%) patients developed HE in the underdilated group and 27 (29.3%) patients in the control group. There was a significant difference in the cumulative rate of HE (P=0.014), but no statistical differences were found in terms of variceal rebleeding, shunt dysfunction and survival between the two groups (P=0.608, P=0.659, P=0.968). In multivariated analysis, group assignment (underdilated vs. control, HR=0.291, 95%CI 0.125-0.674, P=0.004) was identified as an independent risk factor for HE after TIPS creation. Conclusion: Underdilated TIPS could reduced the risk of HE compared with completely dilated TIPS, with comparable risk of variceal rebleeding, shunt dysfunction and mortality. And it is worthy of applying this technique to a large sample of patients in clinical practice.


Assuntos
Encefalopatia Hepática , Derivação Portossistêmica Transjugular Intra-Hepática , Adulto , Idoso , Feminino , Encefalopatia Hepática/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Estudos Retrospectivos , Fatores de Risco , Stents/efeitos adversos
16.
Med Sci Monit ; 28: e935697, 2022 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-35466284

RESUMO

BACKGROUND Cerebral hypoperfusion syndrome (CHS) includes a spectrum of clinical symptoms, ranging from focal neurologic deficit to intracerebral hemorrhage. CHS was initially described as a complication of carotid endarterectomy but also occurs following carotid artery stenting. This retrospective study included 320 patients treated with carotid artery stenting at 4 general hospitals in Zhejiang Province between June 2019 and June 2021 and aimed to establish a risk score for CHS. MATERIAL AND METHODS Through retrospective case analysis, a risk model and scoring model for CHS were established and evaluated. RESULTS Poor integrity of the circle of Willis, preoperative cerebrovascular resistance, mean transit time, peak time at CTP, and preoperative cerebral circulation time were significant in the univariate analysis and were entered into the regression equation to establish the logistic and additive scoring model for predicting the risk of CHS after carotid stenting. The area under the receiver operating characteristic (ROC) curve of the logistic scoring system for the early warning risk of CHS after carotid stenting was 0.964 (95% confidence interval [CI] [0.931-0.996]), and the area under the ROC curve of the CHS early risk additive scoring model after carotid stenting was 0.968 (95% CI [0.936-1.000]), The Hosmer-Lemeshow test chi-square values were 0.037 (P=0.848) and 2.671 (P=0.102). CONCLUSIONS Two methods of scoring risk for CHS were developed from a retrospective analysis of 320 patients treated with carotid artery stenting at 4 general hospitals in Zhejian Province between June 2019 and June 2021.


Assuntos
Estenose das Carótidas , Transtornos Cerebrovasculares , Endarterectomia das Carótidas , Artérias Carótidas/cirurgia , Estenose das Carótidas/complicações , Circulação Cerebrovascular , Transtornos Cerebrovasculares/etiologia , Endarterectomia das Carótidas/efeitos adversos , Hospitais Gerais , Humanos , Estudos Retrospectivos , Fatores de Risco , Stents/efeitos adversos , Síndrome
17.
Anatol J Cardiol ; 26(4): 298-304, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35435841

RESUMO

BACKGROUND: Silent cranial embolism due to carotid artery stenting has been demonstrated to cause dementia, cognitive decline, and even ischemic stroke. The purpose of this study was to compare the periprocedural asymptomatic cranial embolism rates of different stent designs used for extracranial carotid stenosis with diffusion-weighted magnetic resonance imaging. METHODS: A total of 507 consecutive patients who underwent carotid artery stenting at our center from December 2010 to June 2020 (mean age, 66.4 ± 9.5) were analyzed retrospectively. The patients were divided into 3 groups as open-cell stent (334 patients), closed-cell stent (102 patients), and hybrid-cell stent (71 patients) groups. Diffusionweighted magnetic resonance imaging was performed for the patients before and after carotid artery stenting and compared. The diffusion limitations of 3 stent groups on cranial diffusion-weighted magnetic resonance imaging were compared with one another. RESULTS: Periprocedural asymptomatic same-side microembolism, which was the primary endpoint of our study, was detected in 58 (17.4%) patients in the open-cell stent group, 6 (5.9%) patients in the closed-cell group, and 8 (11.3%) patients in the hybrid cell group, and overall in 72 (14.2%) patients. On diffusion-weighted magnetic resonance imaging, periprocedural asymptomatic same-side cranial embolism was found to be statistically significantly higher in the open-cell group compared to the other two groups (P=.011). CONCLUSIONS: The result of this study showed us that the rate of same-side cranial embolism detected on cranial diffusion-weighted magnetic resonance imaging after carotid artery stenting performed with open-cell stent was higher than those of the carotid artery stenting procedure performed with closed-cell and hybrid-cell stents.


Assuntos
Cardiologia , Embolia , Acidente Vascular Cerebral , Idoso , Artérias Carótidas , Hospitais , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Stents/efeitos adversos , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Turquia/epidemiologia
18.
Ann Med ; 54(1): 953-961, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35412414

RESUMO

OBJECTIVES: The large-cell Niti-S stent is useful for multiple stenting in patients with malignant hilar biliary obstruction (MHBO). Recently, a novel uncovered self-expandable metallic stent (USEMS) (a Niti-S large-cell SR slim delivery system) was developed. In this study, we aimed to evaluate the efficacy of this USEMS slim delivery system in MHBO patients. MATERIALS AND METHODS: Outcomes related to USEMS placement, the clinical course, and the period to recurrent biliary obstruction (RBO) were evaluated in MHBO patients who received multiple USEMSs with the Niti-S large-cell SR slim delivery system. RESULTS: Twenty-two MHBO patients underwent the placement of multiple USEMSs, including the novel slim-delivery stent. Six patients had a past history of upper gastrointestinal reconstruction (Billroth I: 1, Billroth II: 4, Roux-en-Y: 1). The number of USEMSs placed in each patient was 2-6. Three procedures were reinterventions. The new slim delivery system was placed as the first stent in ten patients and as an additional stent in the remaining patients. Seven patients were drained using only Niti-S large-cell SR slim delivery stents. The technical and clinical success rates were both 100%. CONCLUSIONS: Placing multiple USEMSs in patients with a past history of abdominal surgery or in reintervention is difficult. Although difficult cases were included in this study, stent-in-stent placement with the novel Niti-S large-cell SR slim delivery system was useful in treating MHBO patients. In addition, this novel stent might be the first choice for MHBO patients.KEY MESSAGESEndoscopic multistenting for MHBO is challenging. In addition, reintervention or multistenting for MHBO patients with a past history of abdominal surgery becomes more difficult.The novel Niti-S large-cell SR slim delivery USEMS is useful as an additional stent because the delivery system is thin and suitable for a 0.025 guidewire. In addition, the novel stent is of the braided type and has a large mesh. Therefore, the novel stent is expected to have strong radial force and can be used as the first SEMS.The Niti-S large-cell SR slim delivery stent is long enough to be used in patients with upper gastrointestinal reconstruction. Although this study included patients with reintervention or a past history of upper gastrointestinal reconstruction, the technical success rate of multiple stenting for MHBO patients was 100%. The slim-delivery stent might overcome several difficulties of endoscopic multistenting.


Assuntos
Neoplasias dos Ductos Biliares , Colestase , Stents Metálicos Autoexpansíveis , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/cirurgia , Colestase/etiologia , Colestase/cirurgia , Humanos , Estudos Retrospectivos , Stents Metálicos Autoexpansíveis/efeitos adversos , Stents/efeitos adversos , Resultado do Tratamento
19.
Pan Afr Med J ; 41: 94, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35465380

RESUMO

In our current practice, the use of JJ probes has become extremely frequent. However, incrustation and fragmentation of JJ leads are still relatively common and sometimes complicate removal. A 61-year-old woman with a history of hysterectomy ten years ago, she had a double J endo-ureteral stent for preoperative identification of the right ureter. The patient has forgotten the double J stent. She currently has right lower back pain and urinary tract symptoms of urinary. Uroscan revealed a very important right hydronephrosis, a fully calcified right double J stent with a calcification of 6 cm at the level of the lower loop. She had, at first, a cystotomy allowing the extraction of the lower part of the calcified stent and secondly a pyelotomy to extract the rest of the double J stent. The operative follow-up was simple. The use of a double J probe to divert the urinary tract is an effective and generally well tolerated technique. Regular monitoring prevents complications.


Assuntos
Calcinose , Ureter , Calcinose/etiologia , Calcinose/cirurgia , Cistotomia , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Stents/efeitos adversos , Ureter/cirurgia
20.
In Vivo ; 36(3): 1053-1058, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35478131

RESUMO

BACKGROUND/AIM: Chemotherapy offers a clear benefit in terms of survival rates of stage IV metastatic colorectal cancer (CRC) patients, but this advantage might be mitigated by the theoretical risks of short- and mid-term complications in the cases of contextual self-expandable metal stent (SEMS) positioning, which might also affect survival rates. MATERIALS AND METHODS: We reviewed all available literature from Medline and Scopus databases to study the role of chemotherapy with or without the simultaneous administration of targeted therapy in increasing the risk of the complications after SEMS positioning and, eventually, in affecting the survival rates. RESULTS: Thirteen retrospective studies and 1 randomized controlled trial (RCT) were eligible for the present analysis. The study group consisted of a total of 682 patients. A total of 305 patients were treated with conventional chemotherapy, 212 with conventional chemotherapy also containing targeted therapy, and 165 with no chemotherapy administration. Chemotherapy administration did not increase the rate of SEMS-related complications and these complications did not affect the overall survival rates. CONCLUSION: Chemotherapy administration is not associated with a higher risk of SEMS-related complications and a reduction in the survival rates.


Assuntos
Neoplasias Colorretais , Obstrução Intestinal , Neoplasias Colorretais/tratamento farmacológico , Humanos , Obstrução Intestinal/etiologia , Cuidados Paliativos , Stents/efeitos adversos , Resultado do Tratamento
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