scholarly journals Clinical Research of Combined Arteriovenous Approach Embolization on Complex Carotid-Cavernous Fistulas

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Li Xinxing ◽  
Zheng Jihui
Keyword(s):  
Carotid Artery ◽  
Clinical Research ◽  
Clinical Data ◽  
Relapse Rate ◽  
Clinical Symptoms ◽  
Curative Effect ◽  
Intraoperative Angiography ◽  
Occlusion Rate ◽  
Carotid Cavernous Fistulas

The objective of this study was to observe the curative effect of combined arteriovenous approach embolization on complex carotid-cavernous fistulas. The clinical data of 13 patients with complex carotid-cavernous fistulas treated with combined arteriovenous approach embolization in our department between January 2017 and January 2020 were analyzed retrospectively. All 13 patients received the combined arteriovenous approach embolization with coil combined with Onyx glue. The intraoperative angiography immediately showed that the fistula could be completely blocked, and the carotid artery was/got unobstructed. The patients had no clinical symptoms recurring during a follow-up period of 3-18 months, on average 9.1 ± 6.3 months. A combined arteriovenous approach embolization on complex carotid-cavernous fistulas is safe and effective since it can improve the occlusion rate and reduce the relapse rate.

scholarly journals Application of flow diverters in the treatment of aneurysms in the internal carotid artery bifurcation region

2020 ◽  
Vol 33 (4) ◽  
pp. 297-305
Author(s):  
Mostafa Mahmoud ◽  
Ahmed Farag ◽  
Mostafa Farid ◽  
Ahmed Elserwi ◽  
Amr Abdelsamad ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Case Reports ◽  
Therapeutic Option ◽  
Case Series ◽  
Flow Diversion ◽  
Occlusion Rate ◽  
Flow Diverters

Introduction The treatment of aneurysms in the internal carotid bifurcation region (ICABR), including aneurysms of the true internal carotid artery (ICA) terminus, those inclined on the proximal A1 or M1 segments or at the most distal pre-bifurcation (ICA) segment, is often challenging in microsurgical clipping and endovascular surgery. Few reports had discussed flow diversion as a therapeutic option for this group. Methods This was a retrospective study analysing flow diversion in treating ICABR aneurysms. Seven patients harbouring eight aneurysms in the ICABR were treated with flow diversion. Five aneurysms were inclined on the proximal A1 segment, and three were located at the most distal pre-bifurcation segment. Patients’ demographics, presentation, procedure technical description, angiographic and clinical follow-up were recorded. PubMed and Ovid MEDLINE were also reviewed for articles published in English, including case series or case reports, for ICABR aneurysms treated with flow diverters. Results All patients except one underwent angiographic follow-up. The Karman–Byrne occlusion scale was used to determine the occlusion rate. All six patients with documented angiographic follow-up had a class IV occlusion score. No permanent or transient neurological or non-neurological complications were encountered in this study. Conclusion Treating ICABR aneurysms using flow diversion is feasible, with a promising angiographic occlusion rate. Further studies are needed to analyse long-term clinical and angiographic results.

scholarly journals Dissection-related carotid-cavernous fistula (CCF) following surgical revascularization of chronic internal carotid artery occlusion: a new subtype of CCF and proposed management

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Ao-Fei Liu ◽  
Chen Li ◽  
Wengui Yu ◽  
Li-Mei Lin ◽  
Han-Cheng Qiu ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
Surgical Removal ◽  
Procedural Success ◽  
Carotid Cavernous Fistulas

Abstract Background The development of carotid-cavernous fistulas (CCFs) during surgical recanalization of chronic internal carotid artery occlusion (ICAO) may be secondary to severe ICA dissection rather than a focal tear of the cavernous ICA seen in typical traumatic CCFs. The purpose of this study is to investigate the causal relationship between the CCFs and severe ICA dissections and to characterize technical outcomes after treatment with stenting. Methods Five patients underwent treatment with self-expanding stents due to intraprocedural CCF and ICA dissection following surgical removal of ICAO plaque. The stents were telescopically placed via true channel of the dissection. Safety of the procedure was evaluated with 30-day stroke and death rate. Procedural success was determined by the efficacy of CCF obliteration and ICAO recanalization with angiography. Results All CCFs were associated with spiral and long segmental dissection from the cervical to cavernous ICA. After stenting, successful dissection reconstruction with TICI 3 was achieved in all patients, with complete (n = 4) or partial CCF (n = 1) obliteration. No patient had CCF syndrome, stroke, or death during follow-up of 6 to 37 months; but one patient had pulsatile tinnitus, which resolved 1 year later. Angiography at 6 to 24 months demonstrated CCF obliteration in all 5 patients and durable ICA patency in 4 patients. Conclusions Intraprocedural CCFs with spiral and cervical-to-cavernous ICA dissection during ICAO surgery are dissection-related because of successful obliteration after stenting for dissection reconstruction. Self-expanding stenting through true channel of the dissection, serving as implanting stent-autograft, may be an optimal therapy for the atypical CCF complication from ICAO surgery.

scholarly journals The biochemical markers associated with TCD to evaluate the curative effect after Carotid Artery Stenting

2020 ◽  
Author(s):  
Xiaofan Yuan ◽  
Jianhong Wang ◽  
Lei Guo ◽  
Duozi Wang ◽  
Shu Yang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Biochemical Markers ◽  
Control Group ◽  
Serum Concentrations ◽  
Curative Effect ◽  
Severe Stenosis ◽  
Blood Samples ◽  
Surrogate Outcome ◽  
Post Operation

Abstract Introduction：This study associated the expression of GFAP and S100B in serum with the imaging tools (TCD and DWI) to confirm these cerebral biochemical markers as surrogate outcome methods for evaluating the curative effect after CAS.Methods and materials：72 patients with unilateral carotid stenosis who underwent CAS were enrolled in the operation group. The blood samples of the operation patients were collected on four different time points: T1: the day before operation; T2: 1 day (24 hours) after operation; T3: 3 days (72 hours) after operation; T4: 30 days after operation. The operation patients were performed on the MRI after CAS to evaluate the post-operative lesion and received the TCD to monitor the changes of hemodynamics. 47 patients who were excluded for carotid artery stenosis by DSA were selected as the control group. The blood samples of patients in control group were collected at D1 (before DSA) and D2 (24 hours after DSA). The concentrations of GFAP and S100B in serum were measured with ELISA.Results：(1) The MFV (pre-operation, post-operation, 30 days follow-up: 47.65±17.24, 62.37±18.25, 70.29±16.89; P<0.05) and PI (pre-operation, post-operation, 30 days follow-up: 0.78±0.21, 0.98±0.19, 1.02±0.20; P<0.05) increased significantly in the ipsilateral MCA after CAS. And at 30 days follow-up, the CVR improved significantly (post-operation, 30 days follow-up: 27.47±12.13, 31.92±10.94; P<0.05). Patients with different degrees of stenosis, the more severe stenosis in carotid artery, the more obvious improvement of CVR at the 30 days follow-up. (2) After CAS, the serum concentrations of GFAP and S100B increased to the peak at 24 hour after operation (T2), and then decrease gradually (T2>T3>T4; P < 0.05). Furthermore, the serum concentrations of GFAP (r=0.71, P<0.05) and S100B (r=0.78, P<0.05) correlated positively with CVR at 30 days after CAS. (3) 29/72 patients (40.28%) were shown the emerging hyperintense in DWI after CAS.Conclusion：Our finding proven that the trend of GFAP and S100B in serum after CAS had a positive correlation to the improved hemodynamics which was verified by TCD. We recommend the biochemical markers (GFAP and S100B) associated with TCD to evaluate the curative effect after CAS.

scholarly journals Clinical Research Progress of Acupuncture and Massage Treatment in Pediatric Cerebral Palsy

2021 ◽  
Vol 4 (5) ◽  
Author(s):  
Lin Wang ◽  
Shijie Luo
Keyword(s):  
Cerebral Palsy ◽  
Clinical Research ◽  
Relevant Literature ◽  
Research Progress ◽  
Curative Effect ◽  
Disability Rate ◽  
Massage Treatment ◽  
The Many ◽  
Pediatric Cerebral Palsy

Pediatric cerebral palsy is a common refractory disease in pediatrics, which has not only a high disability rate, but also a significant impact on the growth and daily learning of children. At present, the clinical treatment of pediatric cerebral palsy is diversified, and the curative effect is different. Among the many therapies, acupuncture and massage have the characteristics of safety, economy, and efficiency, which has unique advantages in treating the disease. However, due to the irregularity of the acupoint selection experience and manipulation, the evaluation of clinical efficacy is different. Therefore, it is necessary to summarize, analyze and organize the clinical research of acupuncture and massage treatment of pediatric cerebral palsy, in order to provide guidance and reference for clinical and follow-up research. This paper sorts out the relevant literature, and reviews the treatment of pediatric cerebral palsy from the aspects of acupuncture and massage.

scholarly journals Percutaneous Total Endoscopic Resection of Partial Articular Processes for Treatment of Lateral Crypt Stenosis and Lumbar Spinal Stenosis: Technical Report and Efficacy Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Fujun Wu ◽  
Weijun Kong ◽  
Wenbo Liao ◽  
Jun Ao ◽  
Sheng Ye ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Clinical Symptoms ◽  
Surgical Site Infections ◽  
Efficacy Evaluation ◽  
Curative Effect ◽  
Single Segment ◽  
Vas Score ◽  
Lumbar Spinal

Objective. To observe the clinical curative effect of posterior total endoscopic precision decompression for the treatment of single-segment lateral crypt lumbar spinal stenosis (LSS). Method. A total of 27 patients with single-segment LSS satisfying the inclusion criteria were recruited from July 2013 to September 2015. There were 18 cases of unilateral stenosis of the L4-5 segments and 9 cases of unilateral stenosis of the L5-S1 segment. All patients were treated via the posterior approach with the precise lateral crypt decompression technique. Precise decompression was performed on the narrow areas causing clinical symptoms. Clinical efficacy was assessed at 3 days, 3 months, 6 months, and 2 years after surgery. Low-back pain and sciatic nerve pain assessed by visual analog scale (VAS) score and the functional Oswestry Disability Index (ODI) were used to evaluate lumbar function, and modified MacNab score criteria were used to investigate long-term efficacy. Result. All patients completed the operation successfully, and the follow-up time was 2 years. The VAS score of lumbago was lower after than before surgery (preoperative: 6.96±0.90; postoperative: 2.04±1.02, P<0.05). The VAS score of sciatica was also lower after than before surgery (preoperative: 7.19±0.88, postoperative: 1.93±0.92, P<0.05), and the ODI was improved at the last follow-up (29.62±4.26) % compared with before surgery (80.07±3.98) %. The MacNab efficacy evaluation showed improvement at the end of the follow-up period: 20 cases were excellent, 6 cases were good, and 1 case was satisfactory, with a good/excellent rate of 96%. No surgical site infections, iatrogenic nerve root injuries, epidural hematomas, or other complications occurred. Conclusion. Total endoscopic decompression of posterior facet arthrodesis for the treatment of single-segment lateral crypt LSS has the advantages of safety, reduced recurrence and trauma, and a satisfactory curative effect. This trial is registered with ChiCTR1800015628.

Treatment of 54 traumatic carotid-cavernous fistulas

1981 ◽  
Vol 55 (5) ◽  
pp. 678-692 ◽  
Author(s):  
Gérard Debrun ◽  
Pierre Lacour ◽  
Fernando Vinuela ◽  
Allan Fox ◽  
Charles G. Drake ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Oculomotor Nerve Palsy ◽  
Detachable Balloon ◽  
Content Type ◽  
Balloon Catheters ◽  
The One ◽  
Superior Portion ◽  
Carotid Cavernous Fistulas

✓ A series of 54 traumatic carotid-cavernous fistulas has been treated with detachable balloon catheters. The balloon was introduced through one of three different approaches: the endarterial route; the venous route through the jugular vein, the inferior petrosal sinus, and the cavernous sinus; or surgical exposure of the cavernous sinus; with occlusion of the fistula by a detachable balloon directly positioned in the cavernous sinus. Full follow-up review demonstrated that the carotid blood flow was preserved in 59% of cases. The most frequent complication was a transient oculomotor nerve palsy, which occurred in 20% of cases. In three cases where both the fistula and the carotid artery were originally occluded by the balloon, the superior portion of the fistula was later found not to be completely occluded, and these patients had intracranial ligation of the supraclinoid portion of the carotid artery. Three patients had hemiparesis, transient in two cases and permanent in the other. The results show that the fistula was totally occluded in 53 cases; in the one exception the patient became asymptomatic but had a minimal angiographic leak.

scholarly journals Vidinės miego arterijos kilpos ir linkiai. Cerebrovaskulinė liga

2010 ◽  
Vol 8 (2) ◽  
pp. 0-0
Author(s):  
Irena Bičkutė ◽  
Kęstutis Laurikėnas
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Clinical Case ◽  
Internal Carotid ◽  
Clinical Symptoms ◽  
District Hospital ◽  
Double Loop ◽  
Cerebrovascular Insufficiency

Irena Bičkutė1, Kęstutis Laurikėnas21Švenčionių rajono ligoninė,Partizanų g. 4, LT-18126 Švenčionys2Vilniaus universitetinė greitosios pagalbos ligoninė,Šiltnamių g. 29, LT-04130 VilniusEl paštas: [email protected] Smegenų išemijos ir vidinės miego arterijos linkio ryšys pirmą kartą literatūroje paminėtas 1951 metais. Tačiau iki šiol nėra iki galo aiški smegenų kraujotakos sutrikimų priežastis. Nagrinėtos galimos jos teorijos. Straipsnyje pateikiamas vidinės miego arterijos dvigubos kilpos ir pasikartojančios hemiparezės klinikinis atvejis. Po kilpos rezekcijos ligonis stebėtas trejus metus. Hemiparezė nesikartojo. Reikšminiai žodžiai: vidinė miego arterija, linkiai ir kilpos, chirurginis gydymas Internal carotid artery loops and kinks. cerebrovascular disease Irena Bičkutė1, Kęstutis Laurikėnas21Švenčionys District Hospital,Partizanų Str. 4, LT-18126 Švenčionys, Lithuania2Vilnius University Emergency Hospital,Šiltnamių Str. 29, LT-04130 Vilnius, LithuaniaE-mail: [email protected] In 1951, a relation between internal carotid artery tortuosity and cerebral ischaemia was first mentioned. Until now, the cause of cerebrovascular insufficiency is not clear enough. Probable theories of dyscirculation were discussed. A clinical case of internal carotid artery double loop related to repeated hemiparesis is presented. The three-year follow-up after loop resection did not show any clinical symptoms. Key words: internal carotid artery, kinks and loops, surgical treatment

scholarly journals Application and Discussion of Laparoscope in the Treatment of Gallbladder Carcinoma

2020 ◽  
Author(s):  
Di Wu ◽  
Yuxiang Chen ◽  
Yunfei Duan ◽  
Yunjie Lu ◽  
Donglin Sun
Keyword(s):  
Clinical Data ◽  
Gallbladder Carcinoma ◽  
Early Stage ◽  
Laparoscopic Technique ◽  
Curative Effect ◽  
Personal Reason ◽  
The Third ◽  
Long Term Prognosis

Abstract Background: To explore the clinical efficacy and long-term prognosis of laparoscopic technique in patients with gallbladder cancer.Methods: Retrospective analysis and summary of the clinical data of 50 patients with gallbladder carcinoma treated by laparoscope from January 2010 to November 2018 in the Third Affiliated Hospital of Soochow University.Results: The intraoperative or postoperative pathology of 43 cases were confirmed as the gallbladder carcinoma. Among them, 11 cases were confirmed as Tis stage, 12 cases as T1b stage, 20 cases as T2 stage and 7 cases as T3 stage. Follow up data of one patient was lost due to personal reason. During the follow-up period, no one at Tis stage died, two cases at T1b stage died, six cases at T2 stage died and six cases at T3 stage died. Conclusion: Laparoscope is a secure and feasible way in the treatment of gallbladder carcinoma at an early stage, but a large number of clinical data is still required to demonstrate its long-term curative effect.

Reconstruction of the Internal Carotid Artery After Treatment of Complex Traumatic Direct Carotid-Cavernous Fistulas With the Willis Covered Stent

Neurosurgery ◽  
2016 ◽  
Vol 79 (6) ◽  
pp. 794-805 ◽  
Author(s):  
Wu Wang ◽  
Ming-Hua Li ◽  
Yong-Dong Li ◽  
Bin-Xian Gu ◽  
Hai-Tao Lu
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Stent Placement ◽  
Internal Carotid ◽  
Covered Stent ◽  
Covered Stents ◽  
Complete Exclusion ◽  
Carotid Cavernous Fistulas

Abstract BACKGROUND: Endovascular treatment of complex traumatic direct carotid-cavernous fistulas (TDCCFs) is a challenge. OBJECTIVE: To evaluate the long-term efficacy of the Willis covered stent in endovascular treatment of complex TDCCFs, focusing on reconstruction and preservation of the internal carotid artery. METHODS: During the past 8 years, 25 patients with 27 TDCCFs who previously had unsuccessful treatment of fistulas with detachable balloons received endovascular treatment with Willis covered stents. The efficacy, complications, in-stent stenosis, angiographic, and clinical follow-up results were evaluated retrospectively between 6 and 88 months (mean, 43.8 months) after the stent placement. RESULTS: The technical success rate of stenting placement was 100%. Forty-four Willis covered stents were implanted into the target artery of 27 TDCCFs. Complete exclusion was achieved in 16 patients with 17 TDCCFs immediately after the stent placement, with transient endoleaks in 10 TDCCFs. Redilation was performed in 6 TDCCFs, and additional stents were implanted in the other 4 TDCCFs for endoleak exclusion. The initial angiographic results showed complete exclusion of fistulas with preservation of the internal carotid artery in 24 patients with 26 TDCCFs. One patient in whom complete occlusion initially was achieved subsequently experienced a delayed endoleak, which required placement of an additional stent. The angiographic follow-up results (mean, 30.3 months) demonstrated complete exclusion in all 27 TDCCFs, with patency of internal carotid artery in 23 patients. The clinical follow-up demonstrated a full recovery in 23 patients and improvement in 2 patients. CONCLUSION: The use of Willis covered stents was confirmed to be effective, safe, and a curative approach for endovascular treatment of complex TDCCFs and internal carotid artery reconstruction.

MIDTERM CLINICAL AND MAGNETIC RESONANCE IMAGING FOLLOW-UP OF LARGE AND GIANT CAROTID ARTERY ANEURYSMS AFTER THERAPEUTIC CAROTID ARTERY OCCLUSION

Neurosurgery ◽  
2007 ◽  
Vol 60 (6) ◽  
pp. 1025-1031 ◽  
Author(s):  
Anjob N. de Gast ◽  
Marieke E. Sprengers ◽  
Willem Jan van Rooij ◽  
Cristina Lavini ◽  
Menno Sluzewski ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Carotid Artery ◽  
Clinical Symptoms ◽  
Incidental Finding ◽  
Mass Effect ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Resonance Imaging

Abstract OBJECTIVE The purpose of this study was to evaluate aneurysm size and clinical symptoms midterm after therapeutic carotid artery occlusion in 39 patients with large or giant carotid artery aneurysms. METHODS Between January 1996 and August 2004, 39 patients with large or giant carotid artery aneurysms were treated with therapeutic carotid artery occlusion and had clinical and magnetic resonance imaging follow-up of at least 3 months (mean, 35.9 mo; median, 29 mo; range, 3–107 mo; 117 patient-yr). Initial clinical presentation was mass effect caused by the aneurysm in 32 (82%) of the 39 patients. Three patients presented with subarachnoid hemorrhage and one presented with epistaxis; two aneurysms were an incidental finding and one was additional to another ruptured aneurysm. RESULTS There were no early or late complications of therapeutic carotid artery occlusion. All aneurysms seemed to have thrombosed completely after carotid artery occlusion as observed on early and late magnetic resonance imaging and magnetic resonance angiographic follow-up studies. At the time of the most recent magnetic resonance imaging follow-up study, 29 (74%) of the 39 aneurysms involuted totally, two aneurysms decreased to 25% of the original diameter, two aneurysms decreased to 50%, and five aneurysms decreased to 75%. Two aneurysms remained unchanged in size after 49 and 58 months, respectively. At the most recent clinical follow-up evaluation, symptoms of mass effect were cured in 19 (60%), improved in 10 (31%), and remained unchanged in three (9%) of the 32 patients. CONCLUSION Therapeutic carotid artery occlusion was a simple, safe, and effective treatment for large and giant carotid artery aneurysms. Almost all aneurysms involute completely or substantially decrease in size. Alleviation of symptoms of mass effect was achieved in most patients.

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