n The intra-arterial thrembolysis could improved the prognosis of basilar artery occlusion.

Objective To investigate the efficacy and safety of carotid angioplasty and stenting for carotid stenosis in high-risk symptomatic NASCET-ineligible patients. Methods Twenty patients with symptomatic carotid stenosis at high risk ineligible for NASCET were treated with carotid angioplasty and stenting,12 of them were men,and 8 wre women,the patients ranged in age from 62 to76 years (mean age,69 years). Eleven patients had transient ischemic attack and 9 had cerebral infarction. Digital subtraction angiography showed that the degree of carotid stenosis in all patients was ＞ 70% (NASCET criteria). Among them,9 patients had unilateral carotid artery severe stenosis (2 had restenosis after endarterectomy),6 had bilateral carotid artery severe stenosis,5 had unilateral carotid artery occlusion with contralateral severe sentoses (1 had undergone cervical radiotherapy for nasopharyngeal carcinoma). The embolic protection devices,predilation,and self-expandable stents were used in all patients. Results The success rate of the procedure was 100%. The residual stenosis rate was ＜ 30%. The different levels of a transient decline in heart rates and blood pressure occurred in all the patients during the procedure. One patient was complicated with microembolic embolism. No ischemic stroke occurred in the remaining patients in the periprocedure. The postoperative examination with carotid ultrasound showed that the stenoses were improved significantly. No ipsilateral ischemic stroke and coronary ischemic events were observed at 1 and 3 months follow-up after the procedures. Conclusions Carotid artery stenting is less invasive,and the perioperative complications are fewer,The treatment of symptomatic carotid stenosis with high surgical risks is safe and effective.

Objective To investigate the clinical incidence of cerebral artery fenestration and its digital subtraction angiography (DSA) characteristics in order to improve the understanding of the clinical significance of the cerebral artery fenestration. Methods Whole cerebral angiography with DSA was employed in a total of 6 432 patients. The imaging material was retrospectively analyzed. The incidence of cerebral artery fenestration and the associated cerebral artery diseases were analyzed. Results Among the 6 432 patients, cerebral artery fenestration was detected in 283 with 296 fenestrations in total (4.60%, 296/6 432). The cerebral artery fenestration of internal carotid was seen in 19 cases with 21 fenestrations (9 on the left side and 12 on the right side), and the detection rate was 0.33%. The fenestration of anterior cerebral artery was found in 46 cases with 51 fenestrations (25 on the left side and 26 on the right side), and the detection rate was 0.79%. The fenestration of middle cerebral artery was found in 54 cases with 57 fenestrations (29 on the left side and 28 on the right side), and the detection rate was 0.89%. The fenestration of vertebral artery was revealed in 68 cases with 71 fenestrations (37 on the left side and 34 on the right side), and the detection rate was 1.10%. The fenestration of basilar artery was demonstrated in 95 cases with 95 fenestrations, and the detection rate was 1.37%. Besides, 17 fenestrations were accompanied with aneurysms and 5 fenestrations were complicated by arteriovenous malformations. Transient cerebral ischemia occurred in 37 cases with fenestrations, and ischemic symptoms were consistent with the blood supply region of the fenestration structures. Among the 37 cases , cerebral infarction at the distal region of the fenestration characteristics of the cerebral fenestrations is of great clinical significance for its diagnosis and for the selection of therapeutic scheme.

Objective To discuss the skills and effects of several endovascular mechanical techniques for the recanalization of subclavian artery total occlusion. Methods Endovascular mechanical recanalization of subclavian artery total occlusion was performed in 32 patients with symptomatic subclavian artery total occlusion. The re-open rate and the therapeutic results were observed and analyzed. Results Several endovascular mechanical techniques, including percutaneous transluminal angioplasty, were employed in treating 32 patients with subclavian artery total occlusion. After the procedure, the ischemic 8ymptoms of posterior circulation and/or upper extremity were markedly relieved. Conclusion It is safe and feasible using appropriate endovascular mechanical technique for re-canalizing the occluded subclavian artery.

Objective To evaluate the mechanism,prevention and prognosis of complications after stent angioplasty in the treatment of carotic artery stenosis. Methods[WT5”BZ] From 1997 to 2003,312 cases of carotid artery stenosis were treated by transluminal stent-assistant angioplasty. Results Procedure-related complication developed in 23 cases including 19 cases of transient mild complications such as transient arrhythmia and hypotension in 10 cases (3.2%) during deploying stent or balloon dilation,transient cerebral ischemia symptoms in 6 cases after balloon dilation,hypotension in 3 cases after the procedure. Severe complications occurred in 4 cases after the procedure,including embolus detachment,stent migration,carotic artery occlusion and fatal cerebral hemorrhage. Conclusion Although stent-assistant angioplasty are effective for treatment of carotid artery stenosis,severe complications could develop.

Objective To evaluate the terminal segment of the intracranial vertebral artery (tICVA) fine and atherosclerotic lesions using high-resolution MRI (HRMRI) in order to guide endovascular interventional therapy.Methods From October 2015 to October 2016,4 patients with bilateral tICVA diagnosed with digital subtraction angiography (DSA) and admitted to Xuanwu Hospital,Capital Medical University were analyzed retrospectively.At the same time,time of flight (TOF) and black blood imaging were used.The bilateral tICVA imaging features in 4 patients were analyzed.Congenital dysplasia of vertebral artery and atherosclerotic lesions were identified.Results DSA revealed that bilateral tICVA fine or occlusion.HRMRI evaluation of the vascular wall structure showed that vascular dysplasia in 4 cases were all located on the right sides,showing no obvious thickening of the wall thickness,and the diameter was less than 1/2 of the contralateral side.One patient had atherosclerotic stenosis on the left and 3 had occlusion,showing local wall thickening,plaque formation,and resulting in the narrowing of the corresponding lumen and even occlusion.Three of the patients were treated with endovascular intervention.Conclusion HRMRI is helpful to differentiate hypoplasia in terminal intracranial vertebral artery and atherosclerotic stenosis or occlusion,identifying the dominant side of the vertebral artery and providing image basis for endovascular treatment of vertebral artery.

Objective To investigate the feasibility and safety of endovascular recanalization of chronic occlusion of large intracranial artery.Methods From January 2009 to January 2017,the clinical and imaging data of 15 patients with chronic occlusion of large intracranial artery admitted to the Department of Interventional Neuroradiology,Xuanwu Hospital,Capital Medical University for endovascular recanalization were analyzed retrospectively.Twelve patients were V4 segment occlusion of vertebral artery and 3 were internal carotid artery occlusion.Preoperative whole brain digital subtraction angiography (DSA) was used to assess the occlusion length and location.High-resolution magnetic resonance imaging (MRI) was used to evaluate the nature of occlusion and the feasibility of recanalization.The intraoperative bilateral femoral artery sheath placement was conducted in 13 cases,one side was used for recanalization and stenting,and the other side was compensated by filling the distal occlusion of the artery through collateral circulation as the reference path map,and increased the feasibility of recanalization.According to the thrombolysis in cerebral infarction (TICI) grades after procedure,the forward flow after recanalization was systematically evaluated,and grade ≥2b was defined as the success of recanalization.Results The median time between the first onset of symptoms and recanalization was 50 (range,18-365) days.The occluded recanalization sites included intracranial segment of vertebral artery in 12 cases and intracranial segment of internal carotid artery in 3 cases.Recanalization was successful in 13 cases and recanalization failure of the intracranial segment of vertebral artery was in 2 cases.Recanalization was successful in 13 cases,and intracranial vertebral artery recanalization failed in 2 cases.Of the 13 patients of successful recanalization,the forward flow of angiography returned to grade TICI 3 in 12 cases after recanalization,and returned to TICI 2b in 1 case;the symptoms of 7 cases were improved,the symptoms of 4 cases did not have any change,and the symptoms of 2 patients aggravated after procedure and developed transient ischemic attack or stroke.After 11 patients were followed up for a median of 39 (3-89) months,the median mRS score was 1 (0-2).Conclusion For recanalization of chronic large intracranial artery occlusion,using preoperative high-resolution magnetic resonance imaging evaluation and intraoperative bilateral sheath placement technique may increase the patency rate and reduce the perioperative complications.

OBJECTIVETo study the prevention and treatment of HBV reinfection after liver transplantation.

METHODSTotal 19 cases of chronic fulminant hepatitis B, the end-stage of liver cirrhosis and liver carcinoma complicated with HBV cirrhosis. Were performed liver transplantation and given anti-viral drugs pre and post transplantation. Famciclovir was administered in 4 cases, lamivudine in 13 cases and lamivudine+HBIG in 2 cases. The serum HBVM and liver biopsy immunohistochemistry were performed.

RESULTSFour cases given famciclovir developed reinfection. Serum HBsAg, HBeAg and HBV DNA were positive in 3 cases. Liver biopsy immunohistochemistry showed HBsAg and HBeAg phenotype. Classical viral hepatitis in 1 case occurred, three cases died. In the lamivudin group 7 cases showed positive for HBsAg, 2 cases positive for HBV DNA, 4 cases HBsAg or HBcAg phenotype. One case showed positive for serum anti-HBc the other negative for HBVM, and liver biopsy immunohistochemistry was negative too.

CONCLUSIONSThese date suggest that anti-virus prevention and treatment in pre and post liver transplantation with HBV infected correlative disease is necessary, feasible and effective.

2-Aminopurine ; analogs & derivatives ; therapeutic use ; Adult ; Antiviral Agents ; Biopsy ; methods ; DNA, Viral ; analysis ; Drug Combinations ; Female ; Hepatitis B ; prevention & control ; Hepatitis B Surface Antigens ; blood ; Hepatitis B e Antigens ; blood ; Humans ; Immunoglobulins ; therapeutic use ; Lamivudine ; therapeutic use ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Postoperative Care ; methods ; Preoperative Care ; methods ; Recurrence

Adult ; Dura Mater ; blood supply ; Humans ; Intracranial Arteriovenous Malformations ; complications ; diagnosis ; Male ; Tinnitus ; etiology

OBJECTIVETo assess the value of stent-assistant angioplasty for intracranial vascular diseases.

METHODSThirteen patients with intracranial vascular diseases were treated consecutively by stent-assistant angioplasty for different purposes. Of these patients 7 had symptomatic intracranial artery stenosis, 3 intracranial wide-neck aneurysms, 2 intracranial pseudoaneurysms, and 1 bilateral transverse sinus stenosis. Clinical procedures and technical data of the patients were retrospectively analyzed.

RESULTSIn the 7 patients, the degree of intracranial artery stenosis reduced from 83% to 5%. Three months after the operation they exhibited good patency of stented lesions. Intracranial wide neck aneurysms (with 2 pseudoaneurysms) were successfully embolized with GDC in 5 patients. The patients with bilateral transverse sinus stenosis were implanted a self-expanded stent in the right transverse sinus. One patient failed because of the tortuous configuration of the left jugular bulb, but the patient's symptoms were improved quickly after the procedure.

CONCLUSIONStent-assistant angioplasty is a useful technique for selected intracranial vascular diseases, and it needs further investigation.

Adult ; Angioplasty, Balloon ; methods ; Cerebrovascular Disorders ; therapy ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome