Objective To evaluate the changes of cerebral perfusion and hemodynamics in the patients with mono-carotid artery stenosis after stenting with the technique of DSA parametric imaging. Methods 15 patients with mono-carotid artery stenosis(the stenosis>75%) undergone carotid stenting were choosed. Digital subtraction imagines of diplo-carotid arteries were acquired before and after operation, then the imagines were processed by special soft ware in personal computer. The region of interest (ROI)were selected in the brain,internal carotid artery and superior sagittal sinus separately, the time-gray scale curves of the ROIs were drawn with the soft ware, from which,then acquired the following parameters from the time-gray scale curves,the largest gray values of brain in disordered side pre-and post-operation, and the parameters including peak value (PV), mean transit time (MTT) ,time to peak (TP), time of appearance to the peak , the max slope rate of the curve and relative time of cerebral circulation were also evalua-ted, respectively. The imaging speed was 7.5 pictures per second. The results were statistically evaluated by using matched-t test. Results Before the stenting, the values of the parameters peak value, the max slope rate of the curve,TP,MTT,relative time of cer-ebral circulation were 108.20±5.58 , 1.23±0.37 , (4.78±0.24)s , (8.20±0.42)s and(4.92±1.03)s , respectively; after the stenting , the values of the parameters above-mentioned were 114.20±7.58, 2.01±0.36, (4.14±0.40)s, (3.55±0.56)sand(4.18±0.89) s , respectively, the difference of the parame-ters above-mentioned pre-and post-operation were statisti-cally significant (t=5.97 , 8.00 , 0.21 , 10.21 , 10.12 and 4.14,P<0.05). Before and after operation, the values of time of appearance to the peak were (5.39±0.24) s and)(5.37±0.78) s , respectively , there was no statistical significance (t=0.21, P> 0.05). Conclusion DSA parametric imaging can be used to evaluate the changes of cerebral perfusion and hemodynamics before and after arterial stenting.

Objective To discuss the curative effect of unremitting pump infusion of microdose urokinase(100 000 u/24 h)into the cerebral venous sinus in treating thrombosis in cerebral venous sinus which had anatomical variation. Methods Mechanical disruption of the thrombus and unremitting pump infusion of microdose urokinase(100 000 u/24 h)into the cerebral venous sinus for 48-96 hours were employed in 9 patients with thrombosis in anatomically varied cerebral venous sinus.After the procedure the original disorder was actively treated and the anticoagulant therapy was continued for 6 months.A follow-up of 6-12 months(mean 10 months) was conducted. Results Recanalization of the previously occluded cerebral venous sinus was obtained in all 9 patients.The dose of urokinase was 100 000 u/24 h in 8 patients.For the remaining one patient the dose of urokinase was 100 000 u/24 h in the first 48 hours,then the dose Was increased to 250 000u/24 h. Excellent result was obtained in all patients.Conclusion Unremitting pump infusion of microdose urokinase into the cerebral venous sinus can effectively treat the thrombosis in anatomically varied cerebral venous sinus.

Objective To investigate the efficacy of treatment of intracranial venous sinus thrombosis using systemic anticoagulation combined with endovascular intervention.Methods From May 2014 to January 2017,the clinical data of 52 patients with cerebral venous sinus thrombosis diagnosed with DSA and treated with micro catheter thrombolysis at the Department of Neurology,the Second Hospital of Hebei Medical University were analyzed retrospective.The microcatheters were indwelled for 3-14 d.The dosage of urokinase ranged from 10-20 thousand U/h,13 patients were also treated with balloon dilatation,and 1 was also treated with stent-assisted treatment.The results of imaging data and 6-month telephone follow-up were analyzed.The prognosis was evaluated with the modified Rankin scale (mRS) and National Institutes of Health Stroke Scale (NIHSS).Results In 52 patients admitted to hospital,the whole brain DSA showed sagittal sinus thrombosis in 34 cases,transverse-sigmoid sinus transitional zone thrombosis in 31 cases,inferior sagittal sinus thrombosis in 2 cases,straight sinus thrombosis in 3 cases,and cortical vein thrombosis in 14 cases.Angiography before discharge showed complete patency of the venous sinus in 9 cases,most patency in 42 cases,partial patency in 1 cases,the symptoms were relieved,and neurological function scores were improved at discharge in 48 cases.There were no obvious changes in 3 cases,and 1 case aggravated.The mRS and NIHSS scores before and after treatment were compared.The difference was statistically significant (Z =5.45 and 3.03 respectively,all P ＜ 0.05).Forty-eight patients were followed up for 6 months by telephone,no symptoms related to venous sinus thrombosis were found.Three patients died,and 1 died of traumatic intracranial hemorrhage.Conclusions Endovascular intervention is an effective and safe treatment for intracranial venous sinus thrombosis.It can be used as an alternative treatment scheme of internal medicine for patients of ineffective anticoagulation.

Objective To observe the safety and efficacy of submaximal balloon dilation combined with Enterprise stent in the treatment of complex symptomatic intracranial atherosclerotic stenosis (ICAS).Methods Clinical data of 70 patients with complicated symptomatic ICAS treated in our hospital from February 2015 to September 2018 were retrospectively analyzed, and any stroke (cerebral infarction or transient ischemic attack [TIA] or cerebral hemorrhage), or death within 30 days were observed, as well as the recurrence of ischemic events and stent restenosis in the vascular supply area after 30 d of follow-up.Results Among the 70 patients, the success rate of operation was 100％; the preoperative stenosis rate was (81.4±10.2)％ and the postoperative stenosis rate was (18.3±6.4)％, with significant difference (P<0.05). Perioperative complications occurred in 4 patients (5.7％): two were subacute thrombosis in stent two d after operation; one had cerebral hemorrhage 10 h after operation, and one had perforator artery occlusion leading to pontine infarction. Nine patients (14.5％) had restenosis in stent during the follow-up period; symptomatic restenosis occurred in 3 (4.8％).Conclusion It is safe and effective to treat complex symptomatic ICAS with submaximal balloon dilatation combined with Enterprise stent, which can obviously decrease the incidences of postoperative complications and recent in-stent restenosis.

Objective:To investigate the safety and efficacy of interventional therapy with balloon predilation of different diameters in severe carotid artery stenosis.Methods:One hundred patients with symptomatic severe carotid artery stenosis admitted to our hospital from January 2018 to September 2018 were selected. These patients were randomly divided into 4 mm balloon predilation group and 5 mm balloon predilation group ( n=50). The surgical success rate, residual stenosis rate, changes of heart rate and blood pressure before and after surgery, and complications were compared between the two groups. Results:The success rate of surgery in both groups was 100%. The average preoperative vascular stenosis rate in the 4 mm balloon predilation group was (84.8±8.6)%, and postoperative residual stenosis rate was (12.2±6.2)%, with significant difference ( P<0.05); in the 5 mm balloon predilation group, the average preoperative vascular stenosis rate was (82.1±8.0)%, and the postoperative residual stenosis rate was (6.4±6.1)%, with significant difference ( P<0.05). The postoperative residual stenosis rate of the 5 mm balloon predilation group was significantly lower than that of the 4 mm balloon predilation group ( P<0.05). In the 4 mm balloon predilation group, systolic blood pressure decreased by (19.8±22.3) mmHg and heart rate decreased by (11.0±9.7) times/min; the systolic blood pressure decreased by (14.0±28.5) mmHg and heart rate decreased by (7.0±10.8) times/min in the 5 mm balloon predilation group; no significant differences were noted between the two groups in blood pressure and heart rate ( P>0.05). Complications was noted in 28 patients from the 4 mm balloon predilation group and 25 patients from the 5 mm balloon predilation group, without statistical difference ( P>0.05). Conclusion:The application of the two kinds of diameter balloon in the interventional treatment of severe carotid artery stenosis is safe and effective, and the short-term improvement efficay of 5 mm balloon predilation is better than that of 4 mm balloon predilation.