Intravenous thrombolysis (IVT) and endovascular treatment (EVT) are currently the main treatments for reperfusion in acute ischemic stroke. Although the EVT recanalization rate has increased, unsuccessful recanalization is still observed in 10-30% cases. Superficial temporal artery-middle cerebral artery (STA-MCA) bypass is considered a rescue therapy in such cases, but in most centers it is not usually performed for acute ischemic stroke. Graft occlusion is rare following STA-MCA bypass, but it might lead to recurrent ischemic stroke. We hereby report on a patient with right MCA infarction and in whom EVT failed due to complete proximal internal carotid artery occlusion. He underwent an emergency STA-MCA bypass, resulting in a full recovery of his motor weakness. However, six months later, the patient experienced recurrent acute ischemic stroke due to bypass graft occlusion. His EVT failed again but revision bypass surgery, using STA remnant branch, was successful with full motor weakness recovery. We recommend a revision bypass surgery as a feasible therapeutic option for recurrent cerebral infarction caused by delayed STA graft occlusion.
Carotid Artery, Internal ; Cerebral Arteries* ; Cerebral Infarction ; Cerebral Revascularization ; Emergencies ; Graft Occlusion, Vascular ; Humans ; Infarction, Middle Cerebral Artery ; Reoperation ; Reperfusion ; Stroke* ; Transplants*

Primary stenting in femoropopliteal lesions of intermediate length has recently shown favorable outcomes. However, stent fractures are a concern after bare metal stent implantation. The incidence of stent fracture varies widely (ranging from 2% to 65%) depending on factors such as the treated lesions or stent type and may potentially lead to various complications. We reported a case of stent fracture with complete dislocation combined with recurrent in-stent reocclusion and aneurysm formation in a patient with occlusive disease of the femoropopliteal artery, which was successfully treated with self-expandable endovascular stent graft.
Aneurysm* ; Aneurysm, False ; Arteries* ; Blood Vessel Prosthesis ; Dislocations ; Graft Occlusion, Vascular ; Humans ; Incidence ; Stents*

PURPOSE: To analyze the long-term results of above-the-knee femoro-popliteal bypass (ATKFPB) with vein grafts compared with polytetrafluoroethylene (PTFE) grafts. METHODS: A database of patients with chronic atherosclerotic occlusive disease who underwent ATKFPB was retrospectively reviewed. Characteristics of patient and arterial lesion, and follow-up results were compared between vein grafts and PTFE grafts. Graft patency was determined by periodic examinations of duplex ultrasonography or CT angiograms. Graft patency and limb salvage rates were calculated using the Kaplan-Meier method. RESULTS: In total, 253 ATKFPBs (107 vein grafts; 146 PTFE grafts; critical limb ischemia, 32%) were performed on 228 patients (mean age, 68.5 years; male, 87.7%). No significant differences were observed between the two groups with respect to demographic characteristics, characteristics of arterial lesions, or distal runoff score. During the mean follow-up period of 41 months (range, 1-122 months), 14.5% patients died, and 94% of all limbs were available for follow-up. The primary patency rates were not significantly different between the two groups at 10 years after treatment (75% vs. 42%, P = 0.330). However, the primary-assisted patency rates (88% vs. 42%, P = 0.003) and secondary patency rates (91% vs. 49%, P = 0.013) were significantly higher in the vein grafts compared with the PTFE grafts. Graft occlusion developed more often in the PTFE grafts (5.6% vs. 20.5%, P = 0.001). When graft occlusion occurred, acute limb ischemia was significantly more frequent in the PTFE grafts than in the vein grafts (0% vs. 53%, P = 0.027). CONCLUSION: After ATKFPB, autologous vein grafts showed significantly better long-term results compared with PTFE grafts.
Extremities ; Follow-Up Studies ; Graft Occlusion, Vascular ; Humans ; Ischemia ; Limb Salvage ; Male ; Polytetrafluoroethylene* ; Retrospective Studies ; Transplants* ; Ultrasonography ; Veins*

Abnormal proliferation and migration of vascular smooth muscle cells (VSMCs) are the major cause of in-stent restenosis (ISR). Intervention proliferation and migration of VSMCs is an important strategy for antirestenotic therapy. Roscovitine, a second-generation cyclin-dependent kinase inhibitor, can inhibit cell cycle of multiple cell types. We studied the effects of roscovitine on cell cycle distribution, proliferation and migration of VSMCs in vitro by flow cytometry, BrdU incorporation and wound healing assay, respectively. Our results showed that roscovitine increased the proportion of G0/G1 phase cells after 12 h (69.57±3.65 vs. 92.50±1.68, P=0.000), 24 h (80.87±2.24 vs. 90.25±0.79, P=0.000) and 48 h (88.08±3.86 vs. 88.87±2.43, P=0.427) as compared with control group. Roscovitine inhibited proliferation and migration of VSMCs in a concentration-dependent way. With the increase of concentration, roscovitine showed increased capacity for growth and migration inhibition. Roscovitine (30 μmol/L) led to an almost complete VSMCs growth and migration arrest. Combined with its low toxicity and selective inhibition to ISR-VSMCs, roscovitine may be a potential drug in the treatment of vascular stenosis diseases and particularly useful in the prevention and treatment of ISR.
Animals ; Cell Cycle ; drug effects ; Cell Line ; Cell Movement ; drug effects ; Graft Occlusion, Vascular ; drug therapy ; metabolism ; pathology ; Muscle, Smooth, Vascular ; metabolism ; pathology ; Myocytes, Smooth Muscle ; metabolism ; pathology ; Protein Kinase Inhibitors ; pharmacology ; Purines ; pharmacology ; Rats

OBJECTIVETo observe the intervention effect of Leihong Granule (LG) in in-stent restenosis (ISR) after endovascular therapy for lower extremity arterial occlusive diseases (LEAOD).

METHODSRecruited 80 LEAOD patients who successfully underwent endovascular therapy (balloon dilation and stent implantation) were randomly assigned to two groups, the control group and the LG group, 40 in each group. Patients in the control group received basic treatment, while those in the LG group additionally took LG for 3 months. Plasma levels of IL-10, IL-18, CRP, and the intima-media thickness (IMT) of lower extremity artery were observed in the two groups between and after treatment. The rate of stent patency, ABI, intermittent claudication, rest pain, and the incidence of amputation the two groups were recorded and observed in the two groups.

RESULTSIn the control group, serum levels of IL-10, IL-18, CRP, and IMT were significantly higher one month after surgery than before surgery (P < 0.05). There was no significant difference in serum levels of IL-10, IL-18, CRP, or IMT between the two groups before surgery (P > 0.05). These indices were obviously lower in the LG group than in the control group after surgery (P < 0.05). Compared with the control group, the incidence rates of intermittent claudication and the rest pain at 6 months and 12 months after surgery significantly decreased (P < 0.05). The stent patency rate at 6 months and 12 months after surgery, and ABI were significantly higher than those of the control group (P < 0.05). There was no statistical difference in the amputation rate between the two groups (P > 0.05).

CONCLUSIONLG might effectively improve ischemic symptoms of affected limbs possibly through lowering the ISR rate after endovascular therapy for LEAOD through preventing immunosuppressive actions.

Aged ; Aged, 80 and over ; Arterial Occlusive Diseases ; therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Graft Occlusion, Vascular ; therapy ; Humans ; Interleukin-10 ; blood ; Interleukin-18 ; blood ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Phytotherapy ; Stents ; Treatment Outcome

OBJECTIVE: The current study retrospectively evaluated whether the percutaneous N-butyl cyanoacrylate (NBCA) seal-off technique is an effective treatment for controlling the angioplasty-related ruptures, which are irresponsive to prolonged balloon tamponade, during interventions for failed or failing hemodialysis vascular accesses. MATERIALS AND METHODS: We reviewed 1588 interventions performed during a 2-year period for dysfunction and/or failed hemodialysis vascular access sites in 1569 patients. For the angioplasty-related ruptures, which could not be controlled with repeated prolonged balloon tamponade, the rupture sites were sealed off with an injection of a glue mixture (NBCA and lipiodol), via a needle/needle sheath to the rupture site, under a sonographic guidance. Technical success rate, complications and clinical success rate were reported. The post-seal-off primary and secondary functional patency rates were calculated by a survival analysis with the Kaplan-Meier method. RESULTS: Twenty ruptures irresponsive to prolonged balloon tamponade occurred in 1588 interventions (1.3%). Two technical failures were noted; one was salvaged with a bailout stent-graft insertion and the other was lost after access embolization. Eighteen accesses (90.0%) were salvaged with the seal-off technique; of them, 16 ruptures were completely sealed off, and two lesions were controlled as acute pseudoaneurysms. Acute pseudoaneurysms were corrected with stentgraft insertion in one patient, and access ligation in the other. The most significant complication during the follow-up was delayed pseudoaneurysm, which occurred in 43.8% (7 of 16) of the completely sealed off accesses. Delayed pseudoaneurysms were treated with surgical revision (n = 2), access ligation (n = 2) and observation (n = 3). During the follow-up, despite the presence of pseudoaneurysms (acute = 1, delayed = 7), a high clinical success rate of 94.4% (17 of 18) was achieved, and they were utilized for hemodialysis at the mean of 411.0 days. The post-seal-off primary patency vs. secondary patency at 90, 180 and 360 days were 66.7 +/- 11.1% vs. 94.4 +/- 5.4%; 33.3 +/- 11.1% vs. 83.3 +/- 8.8%; and 13.3 +/- 8.5% vs. 63.3 +/- 12.1%, respectively. CONCLUSION: Our results suggest that the NBCA seal-off technique is effective for immediate control of a venous rupture irresponsive to prolonged balloon tamponade, during interventions for hemodialysis accesses. Both high technical and clinical success rates can be achieved. However, the treatment is not durable, and about 40% of the completely sealed off accesses are associated with developed delayed pseudoaneurysms in a 2-month of follow-up. Further repair of the vascular tear site, with surgery or stent-graft insertion, is often necessary.
Aged ; Aneurysm, False/etiology/therapy ; Angioplasty, Balloon/*adverse effects ; Arteriovenous Shunt, Surgical/*adverse effects ; Enbucrilate/*administration & dosage ; Ethiodized Oil/administration & dosage ; Female ; Graft Occlusion, Vascular/etiology/*therapy ; Humans ; Male ; *Renal Dialysis ; Retrospective Studies ; Rupture ; Survival Analysis ; Treatment Outcome ; Ultrasonography, Interventional ; Vascular Patency

BACKGROUND/AIMS: Chronic inflammatory status is a possible risk factor for vascular access dysfunction in hemodialysis (HD) patients, but susceptibility differences appear among individuals. Interleukin (IL)-6 is a well-known inflammatory cytokine with various polymorphisms. We examined whether IL-6 polymorphisms are associated with vascular access dysfunction in HD patients. METHODS: A total of 80 HD patients (including 42 diabetic patients) were enrolled. Polymorphisms in the IL-6 gene promoter (-634 C/G and -174 G/C) were studied using restriction length polymorphism polymerase chain reaction analysis. Vascular access patency was compared between the patient groups with respect to IL-6 polymorphisms. An additional 89 healthy individuals were enrolled in the control group. Plasma IL-6 levels were de termined by enzyme-linked immunosorbent assay. RESULTS: The GG genotype and G allele at position -634 in the IL-6 promoter were more frequently observed in HD patients than in controls. Furthermore, the distribution of the -634 polymorphism differed according to vascular access patency in non-diabetic HD patients. However, the G allele was not a significant risk factor for early access failure. No significant association appeared between the IL-6 -634 C/G polymorphism and plasma IL-6 levels. The C allele of the IL-6 -174 G/C polymorphism was not detected in our study population. CONCLUSIONS: The IL-6 -634 G allele appears with greater frequently in patients with end-stage renal disease and may be associated with vascular access dysfunction in non-diabetic HD patients.
Adult ; Aged ; Arteriovenous Shunt, Surgical/*adverse effects ; Asian Continental Ancestry Group/*genetics ; Case-Control Studies ; Chi-Square Distribution ; Enzyme-Linked Immunosorbent Assay ; Female ; Gene Frequency ; Genotype ; Graft Occlusion, Vascular/blood/ethnology/*genetics/physiopathology ; Humans ; Interleukin-6/blood/*genetics ; Kidney Failure, Chronic/blood/ethnology/genetics/immunology/*therapy ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Phenotype ; Polymerase Chain Reaction ; *Polymorphism, Genetic ; Promoter Regions, Genetic ; *Renal Dialysis ; Republic of Korea ; Time Factors ; Treatment Outcome ; Vascular Patency/*genetics

OBJECTIVE: We applied a modified pharmacomechanical thrombolysis (PMT) technique to endovascular treatment of thrombosed arteriovenous (AV) grafts without the use of any mechanical thrombectomy devices. The aim of this study was to evaluate the efficacy of the PMT technique in the treatment of thrombosed AV grafts by analyzing the long-term patency. MATERIALS AND METHODS: Eighty-two patients with thrombosed AV grafts were treated with the PMT technique. AV graft surveillance to detect failing/failed access was followed by endovascular treatment. RESULTS: The technical and clinical success rates were 95% and 95%, respectively. The total number of thrombolysis sessions was 279. A post-intervention primary patency rate was 45% and 22% at 12 and 24 months, respectively. The secondary patency rate was 96% and 91% at 12 and 24 months, respectively. No major complications were noticed. CONCLUSION: The modified PMT technique is effective in endovascular treatment of thrombosed AV grafts.
Adult ; Aged ; Aged, 80 and over ; Angiography ; Angioplasty, Balloon ; *Arteriovenous Shunt, Surgical ; Female ; Graft Occlusion, Vascular/*therapy ; Hemostatic Techniques ; Humans ; Male ; Middle Aged ; Polytetrafluoroethylene ; Proportional Hazards Models ; Radiography, Interventional ; Renal Dialysis ; Retrospective Studies ; Stents ; Thrombolytic Therapy/*methods ; Treatment Outcome ; Vascular Patency

OBJECTIVESTo study the revascularization techniques in the treatment of intracranial complex aneurysms and occlusive reasons of bypass vessel.

METHODSThe 20 complex intracranial aneurysms who underwent saphenous bypass treatment from November 2006 to November 2008 were retrospectively analyzed and the occlusive reasons were studied. Of the 20 patients, 12 were female and 8 were male, mean age was 54.5 years (ranged 27 - 65 years). The distribution of the lesions included 13 cavernous sinus aneurysms, 4 para-clinoid aneurysms, 2 supraclinoid aneurysms, and 1 basilar trunk aneurysm. Four aneurysms were giant (diameter > 25 mm), 12 aneurysms were large (15 - 25 mm), and 4 aneurysms were medium (10 - 15 mm) size.

RESULTSOne saphenous vein was occluded intraoperatively and one saphenous vein was occluded postoperatively. At discharge, 18 out of the 20 patients had Glasgow Outcome Scale (GOS) score of 4 or 5, 2 patients had score of 3, and 1 patient had score of 1. At 6 months follow up, 18 of 19 survivors had GOS score of 4 or 5 and 1 patient had score of 3.

CONCLUSIONSExtracranial-intracranial revascularization technique is a safe and effective method in the treatment of complex aneurysms. Mechanical and hemodynamic factors are two leading reasons for occlusion of bypass vessels. Long-term bypass vessels patent rate still needs further observation.

Adult ; Aged ; Cerebral Revascularization ; methods ; Female ; Follow-Up Studies ; Graft Occlusion, Vascular ; etiology ; prevention & control ; Humans ; Intracranial Aneurysm ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Saphenous Vein ; surgery ; Treatment Outcome

The Cabrol procedure is one of several techniques used for re-implantation of a coronary artery. After replacement of the ascending aorta and aortic valve using a composite graft, second Dacron tube grafts are used for anastomosis between the ascending aortic graft and the coronary arteries. Ostial stenosis is one of the complications associated with the Cabrol operation. However, there have been no reported cases of acute thrombosis of a Cabrol graft. Here we report a case with acute ST elevation myocardial infarction due to thrombotic total occlusion of a right Cabrol graft-to-right coronary artery (RCA) twelve days after surgery in a patient with Marfan syndrome. He was successfully treated with primary percutaneous coronary intervention (PCI).
Aorta ; Aortic Valve ; Constriction, Pathologic ; Coronary Vessels ; Graft Occlusion, Vascular ; Humans ; Marfan Syndrome ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Polyethylene Terephthalates ; Thrombosis ; Transplants