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Angiographic follow-up of cerebral aneurysms treated with Guglielmi detachable coils(GDCs): An analysis of 162 cases of 173 aneurysms

Minghua LI ; Bulang GAO ; Chun FANG ; Binxian GU ; Yingsheng CHENG ; Wu WANG ; Scotti GIUSEPPE

Journal of Interventional Radiology.2005;14(5):472-479.

Objective To evaluate the mid- and long-term radiological outcomes of cerebral aneurysms with GDCs embolization.Methods One hundred and sixty-two patients with 173 aneurysms embolized with GDCs underwent angiographic follow-up from 1 to 54 months post-operatively and were retrospectively reviewed. Three neuro-radiologists reviewed each angiogram and made a comparison between initial and follow-up angiograms. Morphological outcomes were evaluated as follows: unchanged; progressive thrombosis; and re-opening or re-growth. Results Of 173 aneurysms with GDC embolization, 142 aneutysms had total or nearly total occlusion, 23 subtotal occlusion and 8 partial occlusion shown on initial angiograms. The incidence of re-opening was 17.1% (13/76) in less than 3 months, and 6.2% (6/97) between 3 and 6 months postoperatively. Four aneurysms showed recurrency(2.3%) on second follow-up angiography in one year after procedure and one-year cumulative recurrent rate was 13.3% of 56 aneurysms with the third follow-up angiography in the post-operation period of 12 to 54 months, four showed a little enlargement and the cmnulative recurrent rate so far was 20.2% (35/173). Conclusions The direct and main causes for aneurysmal recurrence are incomplete and loosening packing. The first angiographic follow-up is recommended to be performed at 3 months or earlier after the procedure, especially in aneurysms with initial incomplete occlusion. Re-treatment with balloon- or stent-assisted coil embolization is recommended in re-opening aneurysms. (J Intervent Radiol,2005,14:472-479)

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Long-term follow-up of two interventional procedures for achalasia

Yingsheng CHENG ; Minghua LI ; Kezhong SHANG

Journal of Interventional Radiology.2005;14(2):171-174.

Objective To observed the long-term follow-up of the two types of interventional procedure for achalasia. Methods The study cohort was comprised of 140 patients of achalasia including 70 patients treated under fluoroscopy with pneumatic dilation (group A) and 70 with temporary partially covered metal stent dilation (group B). Results One hundred and forty dilations were performed on the 70 patients of group A with complications of chest pain (n=35), reflux (n=18), and bleeding (n=8); 38 atients of relapsing dysphagia during a 12-month follow-up, and 50 patients out of 60 of recurrent dysphagia during a 36-month follow-up. Seventy partially covered expandable metal stents were temporarily placed in the 70 patients of group B and withdrawn after 3-7 days via gastroscopy with complications of chest pain (n=28), reflux (n=15), and bleeding (n=9); 7 patients out of 70 exhibited dysphagia relapse during a 12-month follow-up, and 9 out of 58 patients exhibited dysphagia relapse during a 36-month follow-up. All the stents were inserted and withdrawn successfully. The follow-up in groups A-B lasted for 12-96 months. Conclusion Temporary partially covered metal stent dilation is one of the best methods of interventional procedure for achalasia in long-term follow-up. (J Intervent Radiol,2005,14:171-174)

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Prevention and Management of Liver Injury—The Regime of Long-Term Effects by Hepatic Arterial Chemoembolization

Maoquan LI

Journal of Interventional Radiology.1994;0(03):-.

Prevention and management of liver injury via hepatic arterial chemoemboliza- tion;and improvement of its curative effects,223 among 704 patients with more than three years survival after the treatment were assessed on liver tissue and vascularity and lives function.Hepatic clrrhosis(189/223,85.56%)were found rapidly and seriously on CT scan follow-up,Vascular occlusion(3.4%),localised stenosis(fringed duct wall,asymmetric and circumcrsent)were caused latrogenically and generalised stenosis(linear or serrated)could be found unavoidably via chemotherapeutic drugs,lipoidal and gelatine sponge.Collateral bran- ches were found originating from superior mesenteric artery etc.Liver dysfunction and portal hypertension(98/119,82.35%)were the common fatal causes.Acorrding to this assessment, authors expressed the opinoin on the resime of long-term effects by hepatic arterial chemoem- bolization.

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Interventional therapy for advanced cardiac carcinoma——Analysis of 42 cases

Qikang XIE

Journal of Interventional Radiology.1994;0(03):-.

The angiographic appearances and therapeutic effects of intra-arterial infusion chemotheropy of 42 patients with advanced cardiac carcinoma were analysed.148 intra-arterial infusion chemotherapies were performed for all patients of which all confirmed by pathology. The effective rate of treatment was 85.7% without complications.In this series,the angio- graphic manifestations including moderate hypervascularity and tumor staining(29 cases 69%). encasement of gastric wall arterioles(28 cases 67%),enlargement and staining of lymph nodes (21 cases 50%)and hepatic metastases(20 cases 47.6%)were shown.clinical significance of these signs and the affecting therapeutic factors were discussed.The results indicated that this therapeutic method is a safe rapid and effective palliative treatment for the advanced car- diae carcinoma.

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The repair of blunt popliteal artery injuries with two-points approach vascular stenting technique

Shan ZHONG ; Xiquan ZHANG ; Zhong CHEN ; Peng DONG ; Yequan SUN

Journal of Interventional Radiology.2017;26(4):309-312. doi:10.3969/j.issn.1008-794X.2017.04.006

Objective To explore the clinical effect of two-points approach vascular stenting technique (via both the femoral artery and posterior tibial artery of the affected side) in repairing blunt popliteal artery injuries.Methods The clinical data of eleven patients with blunt popliteal arterial injuries,who were treated with two-points approach vascular stenting technique during the period from March 2011 to March 2015 as single-approach stenting repair failed,were retrospectively analyzed.First,antegrade puncture of the femoral artery on the affected side with subsequent angiography was performed to evaluate the arterial injury,when the attempt to push the guide-wire to pass the injured arterial segment by twisting manipulation failed the puncture of posterior tibial artery was immediately carried out,then,a 4-French single-bend catheter together with a goose neck snare was inserted.Guide-wire capture technique was used to gasp the guide-wire in the injured artery segment,and then the guide-wire was pulled to pass through the injured artery segment.In this way,the guide-wire working circle was reliably established,and along the guide-wire the vascular stent was inserted and delivered to the right site to repair the injured artery.A 6-French guiding catheter was inserted to perform thrombus aspiration for eliminating the distal outflow obstruction caused by thrombus.Thrombolytic therapy with small dose of urokinase through a indwelling catheter was employed for the treatment of peripheral arterial thrombosis.Results The technical success rate was 100％.Angiography revealed that partial transection of artery was detected in 7 patients,and complete transection of artery in 4 patients.A total of 16 stents were implanted.No perioperative mortality or procedure-related complication occurred.All patients were followed up for 13-24 months,with a mean of (18.7±3.8) months.In-stent thrombosis occurred in 2 patients,which was treated with thrombolytic therapy and the blood flow recovered;severe in-stent stenosis (＞70％) was seen in 3 patients,in whom the blood flow returned to normal after balloon dilation therapy;mild in-stent stenosis (＜30％) was found in 6 patients,and no special treatment was given.During the follow-up period,no stent fracture,deformation,or displacement was seen,and no patient needed to have an amputation surgery.Conclusion In treating blunt popliteal artery injuries,two-points approach vascular stenting technique can effectively reduce the operation time,rapidly recover the blood flow of the injured popliteal artery,and shorten the time of limb ischemia.This technique has very satisfactory clinical shortterm effect.

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Endovenous laser obliteration versus traditional surgical ligation for the treatment of varicosis of lower extremity: a comparative study

Chunlong LI ; Lizheng YAO ; Wenhui LI ; Jun ZHU ; Haoguang WAN

Journal of Interventional Radiology.2017;26(4):305-308. doi:10.3969/j.issn.1008-794X.2017.04.005

Objective To compare the effectiveness and the influence on life quality of endovenous laser obliteration with those of traditional surgical ligation in treating varicosis of lower extremity.Methods By using numerical random grouping method,40 patients with varicosis of lower extremity were divided into traditional surgical ligation group (high ligation plus stripping,traditional group,n=20) and endovenous laser obliteration group (laser group,n=20).The curative effect and complications were compared between the two groups.According to the brief health survey (SF-36) scale,the influences of the two treatments on the life quality were evaluated.Results During the follow-up period,the differences in the curative effect and complications between two groups were not significant (P＞0.05).The life quality assessed by SF-36 scores in the laser group was better than that in the traditional group,the difference between the two groups was statistically significant (P＜0.05).Conclusion For the treatment of varicosis of lower extremity,endovenous laser obliteration is safe and effective,it carries less influence on the patient's life quality when compared with traditional surgical ligation therapy.

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Window-opening covered stent technology for the treatment of aortic dissection involving aortic arch:report of two cases

Yuanqing LIU ; Guotai SHENG ; Ming YANG

Journal of Interventional Radiology.2017;26(4):302-304. doi:10.3969/j.issn.1008-794X.2017.04.004

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Etiology analysis and prevention of cerebral ischemic complications occurring in perioperative period of interventional therapy for intracranial aneurysms: a report of 48 cases

Yanbing ZHANG ; Sheng GUAN ; Xinbin GUO ; Haowen XU ; Tao QUAN ; Zhen CHEN

Journal of Interventional Radiology.2017;26(4):291-295. doi:10.3969/j.issn.1008-794X.2017.04.001

Objective To analyze the etiology of cerebral ischemic complications occurring in perioperative period of interventional therapy for intracranial aneurysms,and to discuss its prevention and treatment.Methods From January 2011 to March 2015,a total of 1106 patients with intracranial aneurysms underwent interventional therapy at the First Affiliated Hospital of Zhengzhou University,China.Among the 1106 patients,48 patients developed cerebral ischemic complications;their clinical data and the imaging materials were retrospectively analyzed.The factors associated with complications,the effective therapeutic scheme and the clinical preventive methods were discussed.Three months after the treatment,the recovery of neurological function was assessed with modified Rankin Scale (mRS).Results The causes of ischemic complications were,in order of decreasing frequency,cerebral vasospasm/unable elimination of microemboli (n=19),thrombus (n=16),impaired blood flow of adjacent perforating or distal vascular branches caused by embolization (n=6),intra-procedural hypotension (n=4) and cerebral edema (n=3).Combined treatments,including integrated anticoagulation,anti-platelet aggregation,anti-vasospasm,medication of elevating blood pressure,endovascular intervention,etc.were adopted.The patients were followed up for 3 months.Thirty-four patients (70.8％) obtained a mRS of ≤2 (no serious sequelae),and mRS＞2 (poor prognosis) was seen in 14 patients (29.2％).Conclusion The etiology of cerebral ischemia occurring during interventional treatment of intracranial aneurysms is complicated.It is necessary to take useful measures such as individualized anticoagulation,anti-platelet aggregation,anti-vasospasm,etc.during perioperative period of interventional therapy.The procedure-related complications can be effectively treated with interventional therapy and reliably prevented by careful and skilled surgical manipulation.

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Advances in the research of hemodynamics of the pathogenesis of intracranial aneurysms

Dan ZHANG ; Caiying LI ; Bulang GAO ; Fangying JIA ; Chenguang KOU ; Cen WANG

Journal of Interventional Radiology.2017;26(4):378-382. doi:10.3969/j.issn.1008-794X.2017.04.023

Hemodynamics is a discipline that studies the effects of blood flow,blood flow volume and other factors on the arterial wall.Intracranial aneurysm is the main cause of death due to non-traumatic subarachnoid hemonhage,which has brought a heavy burden on society.Therefore,it is very important to make an intensive study of the pathogenesis of aneurysm.With the development of medical imaging technology and fluid mechanics software in recent years,it becomes possible to make the precise and scientific studies of the hemodynamics of intracranial aneurysms.In this paper,the hemodynamic factors inducing the formation of intracranial aneurysm that are proposed by medical experts at home and abroad are reviewed,and the hemodynamic mechanism is discussed.

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Endovascular treatment for subacute and chronic cerebrovascular occlusion: recent progress in research

Kaitao CHANG ; Tianxiao LI

Journal of Interventional Radiology.2017;26(4):373-377. doi:10.3969/j.issn.1008-794X.2017.04.022

Subacute and chronic cerebrovascular occlusion is an uncommon but an important cause for ischemic stroke.The main pathogenic mechanism is local hemodynamic disorder.Theoretically,the improvement of hemodynamic disorder can reduce the incidence of stroke as well as improve the prognosis.At present,there is still controversy over the optimal therapeutic plan.With the rapid development of interventional techniques,considerable progresses have been made in the endovascular treatment for subacute and chronic cerebrovascular occlusion,although some shortcomings still exist.This article aims to make a comprehensive review about the subacute and chronic cerebrovascular occlusion,focusing on its definition,damage,clinical status of its treatment,imaging evaluation,technical points of endovascular therapy,and procedure-related complications.

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