Objective To discuss the application of using transulnar approach(TUA),which is used as a complementary approach,after failure of transradial approach(TRA)in performing neurointerventional surgery,and to evaluate its clinical safety and feasibility.Methods A total of 189 consecutive patients,who were admitted to the Department of Neurointerventional Surgery,Affiliated Hospital of Binzhou Medical University of China from January to August of 2023 to receive treatment,were retrospectively collected.Of the 189 patients receiving neurointerventional surgery using TRA,23 adopted TUA puncture after failure of TRA puncture.The clinical data and the surgical materials were retrospectively collected.The diameter and depth of the radial artery and ulnar artery were measured by Doppler ultrasound before the operation.A 6 F catheter sheath was used to establish intraoperative manipulation access.After treatment,Doppler ultrasonography was used to assess the occurrence of arterial puncture-related complications and the patency of artery.The technical success rate and the puncture-related complications of TUA in neurointerventional surgery were calculated and analyzed.Results All the 23 patients underwent neurointerventional surgery.The preoperative mean ulnar artery diameter of the forearm and the depth of the ulnar radial artery measured by Doppler ultrasound were(2.1±0.3)mm and(5.6±1.0)mm respectively.The success rate of using TUA after failure of TRA for neurointerventional surgery was 91.3％(21/23)and no additional re-disinfection was required during the same procedure.In 2 patients,transfemoral artery approach(TFA)was used after failure of TUA.The causes of TUA failure included failure of guide wire insertion due to repeated puncturing(n=1)and failure of catheterization due to severe pain(n=1).Postoperative forearm angiography with manual-push injection method demonstrated that ulnar artery spasm occurred in S patients(34.8％).Postoperative re-examination of Doppler ultrasonography showed that no diminished pulse of the ulnar artery or hand ischemia was observed.One patient developed fat liquefaction at the puncture site,two patients developed hematoma around the puncture point,and one patient experienced transitory numbness around the puncture point.Thirty days after treatment,the follow-up check with Doppler ultrasonography showed that no ulnar artery occlusion was observed.Conclusion During the performance of neurointerventional surgery,the use of TUA after failure of TRA,which is used as a complementary approach,is clinically safe and feasible.However,because TUA carries several certain technical difficulties such as puncturing,catheterization,deeper position and smaller diameter of ulnar artery,diffuse arterial pulsation,etc.the operators need to go through a long learning curve before his or her puncturing success rate of ulnar artery can be surely improved.

Intracranial or extracranial artery stenosis is the major reason of ischemic stroke,which leads to insufficient cerebral blood flow perfusion and triggers cerebral dysfunction.The detection rate of unruptured intracranial aneurysm(UIA)combined with intracranial or extracranial artery stenosis is increasing with advances in diagnostic techniques for cerebrovascular disease.Due to the complexity of location and hemodynamic implications,there is no consensus on the treatment of UIA combined with intracranial or extracranial artery stenosis.This article summarized several types of UIA combined with intracranial or extracranial artery stenosis in terms of anatomical location,hemodynamics,and therapy strategies,aiming to provide references for clinical interventionalists.

Intracranial or extracranial artery stenosis is the major reason of ischemic stroke,which leads to insufficient cerebral blood flow perfusion and triggers cerebral dysfunction.The detection rate of unruptured intracranial aneurysm(UIA)combined with intracranial or extracranial artery stenosis is increasing with advances in diagnostic techniques for cerebrovascular disease.Due to the complexity of location and hemodynamic implications,there is no consensus on the treatment of UIA combined with intracranial or extracranial artery stenosis.This article summarized several types of UIA combined with intracranial or extracranial artery stenosis in terms of anatomical location,hemodynamics,and therapy strategies,aiming to provide references for clinical interventionalists.

Objective To investigate the protective effect of P-glycoprotein up-regulated by ulinastatin (UTI) on HK-2 cells during paraquat (PQ)-induced injury and its underlying mechanisms.Methods The research was divided into two parts.The first part of the research was divided into normal control group,PQ group,UTI+PQ group,UTI control group.The second part of the research was divided into negative virus group (including control group,PQ group,PQU+TI group,UTI group) and P-gp siRNA group (including control group,PQ group,PQU+TI group,UTI group).Negative virus group:the cells were transfected into the blank virus;siRNA P-gp group:the cells were transfected with P-gp siRNA virus.HK-2 cells were routinely cultured.After 800 μmol/L PQ treatment,the changes of P-gp protein levels in the HK-2 cells were determined by Western-blot (WB).Then,transfected lentivirus bringing P-gp silent gene,the cell viability was determined by CCK-8 assay,the expression of P-gp in the cells after transfection was detected by WB and the concentration of PQ in HK-2 cells were measured by high performance liquid chromatography (HPLC).Results Compared with the normal control group,the P-gp expression of PQ group had no significantly changes (P＞0.05).Compared with the PQ group,the P-gp expression of UTI +PQ group significantly increased (P＞0.05).Compared with the corresponding control siRNA group,the P-gp siRNA group had no significantly changes in cell viability (P＞ 0.05).and significantly decreased in P-gp expression.Compared with the corresponding control siRNA group,the P-gp siRNA group had no significantly changes in PQ concentration in HK-2 cell (P＞0.05),but compared with P-gp siRNA PQ group,the PQ concentration of P-gp siRNA PQ+UTI group significantly decrease(P＜0.05).Conclusion UTI significantly reduced the accumulation of PQ in HK-2 cells and increased the viability of HK-2 cells in vitro may be not by increased P-gp activity.UTI could significantly reduce HK-2 cell injury induced by PQ in vitro and improve the survival rate of HK-2 cells.It may not be related to the up regulation of P-gp expression.

Objective To investigate the protective effect of P-glycoprotein up-regulated by ulinastatin (UTI) on HK-2 cells during paraquat (PQ)-induced injury and its underlying mechanisms.Methods The research was divided into two parts.The first part of the research was divided into normal control group,PQ group,UTI+PQ group,UTI control group.The second part of the research was divided into negative virus group (including control group,PQ group,PQU+TI group,UTI group) and P-gp siRNA group (including control group,PQ group,PQU+TI group,UTI group).Negative virus group:the cells were transfected into the blank virus;siRNA P-gp group:the cells were transfected with P-gp siRNA virus.HK-2 cells were routinely cultured.After 800 μmol/L PQ treatment,the changes of P-gp protein levels in the HK-2 cells were determined by Western-blot (WB).Then,transfected lentivirus bringing P-gp silent gene,the cell viability was determined by CCK-8 assay,the expression of P-gp in the cells after transfection was detected by WB and the concentration of PQ in HK-2 cells were measured by high performance liquid chromatography (HPLC).Results Compared with the normal control group,the P-gp expression of PQ group had no significantly changes (P＞0.05).Compared with the PQ group,the P-gp expression of UTI +PQ group significantly increased (P＞0.05).Compared with the corresponding control siRNA group,the P-gp siRNA group had no significantly changes in cell viability (P＞ 0.05).and significantly decreased in P-gp expression.Compared with the corresponding control siRNA group,the P-gp siRNA group had no significantly changes in PQ concentration in HK-2 cell (P＞0.05),but compared with P-gp siRNA PQ group,the PQ concentration of P-gp siRNA PQ+UTI group significantly decrease(P＜0.05).Conclusion UTI significantly reduced the accumulation of PQ in HK-2 cells and increased the viability of HK-2 cells in vitro may be not by increased P-gp activity.UTI could significantly reduce HK-2 cell injury induced by PQ in vitro and improve the survival rate of HK-2 cells.It may not be related to the up regulation of P-gp expression.