Objective:To investigate the feasibility and safety of submaximal balloon dilation and to perform small-diameter stent for symptomatic carotid artery severely stenosis before coronary artery bypass grafting(CABG).Methods:From January 2016 to December 2019, 30 patients of the Department of Neurointervention in Beijing Anzhen Hospital with symptomatic carotid artery stenosis(≥70%) and the left main trunk or triple-vessel of coronary artery disease were analyzed retrospectively. General information, clinical characteristics, and imaging data of all cases were collected. All patients underwent submaximal balloon dilation and small-diameter stent implantation. Preoperative comorbidities or risk factors included hypertension 23 cases(76.7%), diabetes 10 cases(33.3%), hyperglycemia 14 cases(46.7%), moking 13 cases(43.3%). Left main trunk disease 6 cases(20.0%), three-vessels disease 24 cases(80.0%), mitral regurgitation 1 case(3.3%), stable angina 25 cases(83.3%), myocardial infarction 8 cases(26.7%), cerebral infarction 24 cases(80.0%) and transient ischemia attack(TIA) 6 cases(20.0%) caused by ipsilateral carotid artery stenosis. The median National Institutes of Health Stroke Scale(NIHSS) score was 2(0-3), and the median modified Rankin Scale(mRS) score was 1(0-1) before the operation. The mean interval between carotid artery intervention and CABG was(23.4±8.2)days.Results:29 cases(96.7%, 29/30) underwent CAS-CABG operation successfully. In one case of carotid artery extreme tortuosity, the emboli protective device could not place the distal carotid artery. In the operative procedure, 27 cases(90.0%, 27/30) underwent with 3mm diameter balloon, only 3 cases(10.0%) with 3 mm balloon after pre-dilatation with 2 mm diameter balloon because of severely high-grade stenosis(99%). 25 cases(83.3%) with 7mm diameter stents and 5 cases(16.7%) with 6 mm diameter stents, including 22 cases(73.3%) with a closed-cell stent and 8 cases(26.7%) with an open-cell stent. In the perioperative period, the heart rate of two patients was lower than 50 BPM during operation and returned to normal after using atropine immediately. Another patient presented with chest tightness during interventional therapy. TNI elevation was examined urgently. After oxygen inhalation and intravenous infusion of Nitroglycerin, the patient's symptoms improved rapidly. No cardiac and cerebrovascular complications occurred during the perioperative period of CABG, no cardiac-related complications occurred within 30 days of follow-up, one case of TIA and 1 case of cerebral infarction. After intensive anti-platelet aggregation and lipid-lowering treatment, two patient's symptoms improved. There were no death cases in all patients during carotid artery interventional therapy, perioperative CABG and 30-day follow-up. Thirty days later, we performed a clinical follow-up of 23 cases, median 4.5(3.0-7.9) months, mRS Score Median 1(0-1). One patient presented with TIA, any patient had no symptoms of the cardiac or nervous system. Image follow-up of 17 cases, median 3.5(2.8-4.5) months, carotid artery ultrasound showed in-stent restenosis(stenosis rate>50%) in 1 case, the patient was asymptomatic restenosis, continue treatment of aggressive anti-platelet and lipid-lowering drugs.Conclusion:Submaximal balloon dilation and performing small-diameter stent for symptomatic carotid artery severely stenosis before CABG is safe and feasible, which could not only reduce the incidence of vagus reflex resulted in acute coronary syndrome during carotid artery stenosis intervention but also morbidity of acute ischemic stroke events during CABG.

Objective To explore the clinical efficacy of percutaneous vascular forming and stenting in patients with severe stenosis combined with cerebral infarction.Methods The clinical data of 74 patients with severe carotid stenosis combined with cerebral infarction,admitted to our hospital from January 2011 to January 2014,were analyzed;and according to the treatment methods,all patients were divided into operation group (percutaneous angioplasty and stenting,n=37) and non-operation group (conventional therapy,n=37).Follow-up was performed one,3 and 6 months after discharge,and the prognoses of these patients were evaluated with NIHSS and mini-mental state examination (MMSE).Results Before treatment,the rate of carotid artery stenosis,NIHSS scores and MMSE scores in the two groups showed no significant differences (P＞0.05).After treatment,stenosis rate of the operation group ([32.35±4.15]％) was significantly lower than that in the non-operation group ([72.32±7.72]％,P＜0.05).One month after treatment,the MMSE scores in the operation group (22.24±2.74) were significantly higher than those in the non-operation group (20.29±3.15,P＜0.05).Three months after treatment,the NIHSS scores in the operation group (7.05±1.35) were significantly lower than those in the non-operation group (8.89±1.76,P＜0.05).Conclusion Percutaneous vascular forming and stenting can help to achieve favorable outcome in patients with severe stenosis combined with cerebral infarction,which achieves better effect than conventional therapy.

Obj ective To observe the influence of carotid artery stenting (CAS)on the life quality and cognitive function of patients with severe carotid artery stenosis.Methods 64 carotid artery stenosis patients treated with CAS were collected. Mini -mental state examination (MMSE),activity of daily living scale (ADL),rapid verbal retrieve (RVR),digit span (DS),vi-sual retention test (VRT)and WHOQOL were applied for patients to assess efficacy at the time points of before operation and 3 ,12 months after operation.Results The success rate of CAS was 100%,and no complications such as embolism and internal carotid artery thrombosis were ob-served .The rate of carotid artery stenosis decreased after operation,while the carotid blood flow improved significantly.3 and 12 months after treatment,MMSE,VR and DS scores increased sig-nificantly,and ADL score decreased significantly,and the increased and decreased ranges at the time of 12 months after treatment were significantly larger than those at the time of 3 months after treatment.3 months after treatment,VRT right score and WHOQOL score increased,while VRT wrong score reduced significantly.Conclusion CAS can significantly improve the life quality and cognitive function of patients with carotid artery stenosis,so it is worthy of clinical application and popularization.

Obj ective To observe the influence of carotid artery stenting (CAS)on the life quality and cognitive function of patients with severe carotid artery stenosis.Methods 64 carotid artery stenosis patients treated with CAS were collected. Mini -mental state examination (MMSE),activity of daily living scale (ADL),rapid verbal retrieve (RVR),digit span (DS),vi-sual retention test (VRT)and WHOQOL were applied for patients to assess efficacy at the time points of before operation and 3 ,12 months after operation.Results The success rate of CAS was 100%,and no complications such as embolism and internal carotid artery thrombosis were ob-served .The rate of carotid artery stenosis decreased after operation,while the carotid blood flow improved significantly.3 and 12 months after treatment,MMSE,VR and DS scores increased sig-nificantly,and ADL score decreased significantly,and the increased and decreased ranges at the time of 12 months after treatment were significantly larger than those at the time of 3 months after treatment.3 months after treatment,VRT right score and WHOQOL score increased,while VRT wrong score reduced significantly.Conclusion CAS can significantly improve the life quality and cognitive function of patients with carotid artery stenosis,so it is worthy of clinical application and popularization.

Objective:To evaluate the safety and clinical efficacy of Neuroform EZ stent in the treatment of severe intracranial atherosclerotic stenosis (ICAS).Methods:A total of 36 patients with severe ICAS receiving Neuroform EZ stent angioplasty were retrospectively analyzed at Beijing Anzhen Hospital from July 2018 to January 2020. Digital subtraction angiography (DSA) before endovascular intervention confirmed the diagnosis. Follow-up information was reviewed by neurologists at 30 days and 6 months after the procedure. The primary endpoints were transient ischemic attack (TIA), ischemic or hemorrhagic stroke and death caused by any reason within 30 days.Results:The overall technical success rate was 100%. The median stenosis rate was reduced from 93.6%±4.5% to 18.8%±11.2% ( t=37.36, P<0.001).Primary endpoint event was not reported. During follow-up, one patient developed TIA and no death or ischemic stroke was observed. No in-stent restenosis at six months occurred. Conclusion:Neuroform EZ stent is safe and effective in patients with severe ICAS. However, perspective studies need to be operated for further validation via long-term follow-up.