Background Different feasible and safe thrombectomy and distal protection devices have been used in clinical practice. The efficiency and safety of adjunct thrombectomy using Diver CE device （Invatec, Italy） versus ...Background Different feasible and safe thrombectomy and distal protection devices have been used in clinical practice. The efficiency and safety of adjunct thrombectomy using Diver CE device （Invatec, Italy） versus Guardwire Plus device （Medtronic, USA） before percutaneous coronary intervention （PCI） were compared in patients with acute inferior ST-segment-elevation myocardial infarction （STEMI） for less than 12 hours, thrombolysis in myocardial infarction （TIMI） flow grade 0 to 1, and total occlusion of the proximal right coronary artery （≥3 mm in diameter） in a prospective randomized single-center study. Methods The primary end point was the magnitude of ST-segment resolution （STR） （〉70%） measured immediately, 90 minutes and 6 hours after PCI, myocardial blush grade and slow flow or no-reflow. Secondary end points were left ventricular end-diastolic volume （LVEDV）, left ventricle ejection fraction （LVEF） and major adverse cardiac events （MACEs） including death, myocardial infarction, target vessel revascularization and stroke at 30 days. Results A total of 122 patients were equally divided into Diver CE group and Guardwire Plus group, which were comparable by age （（60±14） years vs （60±13） years）, male （82% vs 84%）, diabetes （31% vs 28%）, previous coronary artery disease （25% vs 23%）, onset-to-angiogram （（350±185） min vs （345±180） min）, and use of glycoprotein lib/llia inhibitor （11% vs 13%）. The magnitude of ST-segment resolution was similar in the two groups as ST-segment resolution 〉70% （57% vs 59%; P〉0.05）. Similar slow flow/no-reflow rates were observed in the Diver CE group （8%） and the Guardwire Plus group （7%）. TIMI flow grade 3 was obtained in 95% vs 97% patients, respectively （P〉0.05）. Myocardial blush grade 3 was similar （70% vs 72%; P〉0.05）. Thirty-day clinical outcome was comparable （LVEF, 0.54±0.12 vs 0.53 ±0.11; death, 3% vs 3%; myocardial infarction, 2% vs 0%; and target ves展开更多
Hepatocellular carcinoma(HCC) with portal vein tumor thrombus(PVTT) is a disease that is not uncommon, but the treatments vary drastically between Eastern and Western countries. In Europe and America, the first line o...Hepatocellular carcinoma(HCC) with portal vein tumor thrombus(PVTT) is a disease that is not uncommon, but the treatments vary drastically between Eastern and Western countries. In Europe and America, the first line of treatment is systemic therapy such as sorafenib and the surgical treatment is not a recommend option. While an increasing number of studies from China and Japan have suggested that surgical treatment results in better outcomes when compared to transcatheter arterial chemoembolization(TACE), sorafenib, or other nonsurgical treatments, and two classification systems, Japanese Vp classification and Chinese Cheng's classification, were very useful to guide the surgical treatment. We have also found that surgical treatment may be more effective, as we have performed surgical treatment for HCC-PVTT patients over a period of approximately 15 years and achieved good results with the longest surviving time being 13 years and onward. In this study, we review the efficacy and principles of current surgical treatments and introduce our new, more effective surgical technique named "thrombectomy first", which means the tumor thrombus in the main portal vein, the bifurcation or the contralateral portal vein should be removed prior to liver resection. Thus, compression and crushing of PVTT during the operation could be avoided and new intrahepatic metastases caused by tumor thrombus to the remnant liver minimized. The new technique is even beneficial to the prognosis of Cheng's classification Types Ⅲ and Ⅳ PVTT. The vital tips and tricks for the surgical approach are described.展开更多
Deep vein thrombosis(DVT), which can lead to pulmonary embolism(PE), is a major contributor to the global disease burden and is the third most common cardiovascular pathology after coronary artery disease and stroke. ...Deep vein thrombosis(DVT), which can lead to pulmonary embolism(PE), is a major contributor to the global disease burden and is the third most common cardiovascular pathology after coronary artery disease and stroke. Venous thromboembolic disease, which encompasses the disease entities of DVT and PE, affects up to 10 million cases every year and represents a serious and potentially life-threatening condition. Standard anticoagulation therapy alone is ineffective at promoting deep venous system thrombus removal. Many patients develop postthrombotic syndrome(PTS) despite being on adequate anticoagulation therapy. Aggressive therapy for rapid thrombus removal is important to prevent the development of PTS. Besides impeding the onset of PTS, rapid clearance of the thrombus is also required in the treatment of phlegmasia cerulea dolens, an uncommon but life-threatening complication of acute DVT that can lead to arterial insufficiency, compartment syndrome, venous gangrene, and limb amputation. Manual aspiration thrombectomy(MAT) can provide rapid and effective therapy that could be compared to the open surgical thrombectomy approach with minimal risk of morbidity, mortality, or recurrence after surgery. Though many devices have been developed to date for pharmacomechanical thrombolysis, the cost of the treatment using these devices is very expensive. MAT is simple to perform, easy to learn, inexpensive, and rapid. This review will outline and dissect several studies and case reports, sourced from the Pub Med database, on the subject of the use of MAT in treating inferior vena cava thrombosis and lower extremity DVT, including in patients with compression of the iliac vein and phlegmasia cerulea dolens.展开更多
文摘Background Different feasible and safe thrombectomy and distal protection devices have been used in clinical practice. The efficiency and safety of adjunct thrombectomy using Diver CE device （Invatec, Italy） versus Guardwire Plus device （Medtronic, USA） before percutaneous coronary intervention （PCI） were compared in patients with acute inferior ST-segment-elevation myocardial infarction （STEMI） for less than 12 hours, thrombolysis in myocardial infarction （TIMI） flow grade 0 to 1, and total occlusion of the proximal right coronary artery （≥3 mm in diameter） in a prospective randomized single-center study. Methods The primary end point was the magnitude of ST-segment resolution （STR） （〉70%） measured immediately, 90 minutes and 6 hours after PCI, myocardial blush grade and slow flow or no-reflow. Secondary end points were left ventricular end-diastolic volume （LVEDV）, left ventricle ejection fraction （LVEF） and major adverse cardiac events （MACEs） including death, myocardial infarction, target vessel revascularization and stroke at 30 days. Results A total of 122 patients were equally divided into Diver CE group and Guardwire Plus group, which were comparable by age （（60±14） years vs （60±13） years）, male （82% vs 84%）, diabetes （31% vs 28%）, previous coronary artery disease （25% vs 23%）, onset-to-angiogram （（350±185） min vs （345±180） min）, and use of glycoprotein lib/llia inhibitor （11% vs 13%）. The magnitude of ST-segment resolution was similar in the two groups as ST-segment resolution 〉70% （57% vs 59%; P〉0.05）. Similar slow flow/no-reflow rates were observed in the Diver CE group （8%） and the Guardwire Plus group （7%）. TIMI flow grade 3 was obtained in 95% vs 97% patients, respectively （P〉0.05）. Myocardial blush grade 3 was similar （70% vs 72%; P〉0.05）. Thirty-day clinical outcome was comparable （LVEF, 0.54±0.12 vs 0.53 ±0.11; death, 3% vs 3%; myocardial infarction, 2% vs 0%; and target ves
基金Supported by Shanghai Pujiang Program,No.17PJD025Shanghai Natural Science Foundation,No.17ZR1418500
文摘Hepatocellular carcinoma(HCC) with portal vein tumor thrombus(PVTT) is a disease that is not uncommon, but the treatments vary drastically between Eastern and Western countries. In Europe and America, the first line of treatment is systemic therapy such as sorafenib and the surgical treatment is not a recommend option. While an increasing number of studies from China and Japan have suggested that surgical treatment results in better outcomes when compared to transcatheter arterial chemoembolization(TACE), sorafenib, or other nonsurgical treatments, and two classification systems, Japanese Vp classification and Chinese Cheng's classification, were very useful to guide the surgical treatment. We have also found that surgical treatment may be more effective, as we have performed surgical treatment for HCC-PVTT patients over a period of approximately 15 years and achieved good results with the longest surviving time being 13 years and onward. In this study, we review the efficacy and principles of current surgical treatments and introduce our new, more effective surgical technique named "thrombectomy first", which means the tumor thrombus in the main portal vein, the bifurcation or the contralateral portal vein should be removed prior to liver resection. Thus, compression and crushing of PVTT during the operation could be avoided and new intrahepatic metastases caused by tumor thrombus to the remnant liver minimized. The new technique is even beneficial to the prognosis of Cheng's classification Types Ⅲ and Ⅳ PVTT. The vital tips and tricks for the surgical approach are described.
基金supported by the Jiangsu Provincial Clinical Medical Science and Technology Projects--Research on Standardized Diagnosis and Treatment of Key Diseases(BL2014013)the Nanjing Science and Technology Development Plan Project(201803006)
文摘Deep vein thrombosis(DVT), which can lead to pulmonary embolism(PE), is a major contributor to the global disease burden and is the third most common cardiovascular pathology after coronary artery disease and stroke. Venous thromboembolic disease, which encompasses the disease entities of DVT and PE, affects up to 10 million cases every year and represents a serious and potentially life-threatening condition. Standard anticoagulation therapy alone is ineffective at promoting deep venous system thrombus removal. Many patients develop postthrombotic syndrome(PTS) despite being on adequate anticoagulation therapy. Aggressive therapy for rapid thrombus removal is important to prevent the development of PTS. Besides impeding the onset of PTS, rapid clearance of the thrombus is also required in the treatment of phlegmasia cerulea dolens, an uncommon but life-threatening complication of acute DVT that can lead to arterial insufficiency, compartment syndrome, venous gangrene, and limb amputation. Manual aspiration thrombectomy(MAT) can provide rapid and effective therapy that could be compared to the open surgical thrombectomy approach with minimal risk of morbidity, mortality, or recurrence after surgery. Though many devices have been developed to date for pharmacomechanical thrombolysis, the cost of the treatment using these devices is very expensive. MAT is simple to perform, easy to learn, inexpensive, and rapid. This review will outline and dissect several studies and case reports, sourced from the Pub Med database, on the subject of the use of MAT in treating inferior vena cava thrombosis and lower extremity DVT, including in patients with compression of the iliac vein and phlegmasia cerulea dolens.
