Background and Aims:Intermediate stage hepatocellular carcinoma (HCC) can be treated by transarterial chemoem-bolization (TACE).However,there appear to be side effects,such as induction of proangiogenic factors,e.g.va...Background and Aims:Intermediate stage hepatocellular carcinoma (HCC) can be treated by transarterial chemoem-bolization (TACE).However,there appear to be side effects,such as induction of proangiogenic factors,e.g.vascular endothelial growth factor (VEGF),which have been shown to be associated with a poor prognosis.This prospective study was designed to compare serum VEGF level response after TACE with different embolic agents in patients with HCC.Methods:Patients were assigned to one of three different TACE regimens:degradable starch microspheres (DSM) TACE,drugeluting bead (DEBDOX) TACE or Lipiodol TACE (cTACE).All patients received 50 mg doxorubicin/m2 body surface area (BSA) during TACE.Serum VEGF levels were assessed before TACE treatment,24 h post-treatment and 4 weeks later.Results:Twenty-two patients with 30 TACE treatments were enrolled.Compared to baseline VEGF levels,a marked increase was observed for 24 h post-TACE (164% of baseline level) and during the 4-week follow-up (170% of baseline level) only for the cTACE arm (p < 0.05).In contrast,the increase of serum VEGF levels were only 114% and 123% for DEBDOX and 121% and 124% for DSM,respectively.Conclusions:Conventional TACE using Lipiodol shows marked increase in blood levels of the proangiogenic factor VEGF,while DEBDOX and DSM TACE induce only a moderate VEGF response.展开更多
BACKGROUND Embolic superior mesenteric artery(SMA) occlusion is associated with high mortality rates. Delayed treatment often leads to serious consequences, including intestinal necrosis, resection, and even patient d...BACKGROUND Embolic superior mesenteric artery(SMA) occlusion is associated with high mortality rates. Delayed treatment often leads to serious consequences, including intestinal necrosis, resection, and even patient death. Endovascular repair is being introduced, which can improve clinical symptoms and prognosis and decrease the incidence of exploratory laparotomy. Many reports have described successful endovascular revascularization of embolic SMA occlusion. However,most of those reports are case reports, and there are few reports on Chinese patients. In this paper, we describe the technical and clinical outcomes of aspiration therapy using a guiding catheter and long sheath technique which facilitates the endovascular repair procedure.AIM To evaluate the complications, feasibility, effectiveness, and safety of endovascular treatment for the acute embolic occlusion of the SMA.METHODS This retrospective study reviewed eight patients(six males and two females)from August 2013 to October 2018 at Xuanwu Hospital, Capital Medical University. The patients presented with acute embolic occlusion of the SMA on admission and were initially diagnosed by computed tomography angiography(CTA). The patients who underwent endovascular treatment with a guiding catheter had no obvious evidence of bowel infarct. No intestinal necrosis was identified by gastrointestinal surgeons through peritoneal puncture or CTA. The complications, feasibility, effectiveness, safety, and mortality were assessed.RESULTS Six(75%) patients were male, and the mean patient age was 70.00 ± 8.43 years(range, 60-84 years). The acute embolic occlusion of the SMA was initially diagnosed by CTA. All patients had undertaken anticoagulation primarily, and percutaneous aspiration using a guiding catheter was then undertaken because the emboli had large amounts of thrombus residue. No death occurred among the patients. Complete patency of the suffering artery trunk was achieved in six patients, and defect filling was accomplished in two patients. The in-hospita展开更多
AIM To study tumor response, and tolerability of arterially directed embolic therapy(ADET) with polyethylene glycol embolics loaded with irinotecan for the treatment of colorectal cancer liver metastases(CRC-LM). Seco...AIM To study tumor response, and tolerability of arterially directed embolic therapy(ADET) with polyethylene glycol embolics loaded with irinotecan for the treatment of colorectal cancer liver metastases(CRC-LM). Secondary objectives were to monitor quality of life, time to progression and survival of patients.METHODS Patients were included in the study if they were affected by CRC-LM, refractory to systemic chemotherapy, treated with ADET using polyethylene glycol embolics, and had liver involvement < 50%. Tumor response, performance status(PS), tumor marker antigens, and quality of life(QoL) were monitored at 1, 3 and 6 mo after ADET. QoL was assessed with the Palliative Performance Scale(PPS).RESULTS We treated 50 consecutive CRC-LM patients with ADET using polyethylene glycol embolics. Their tumor response one month after ADET was: 28% of complete response(CR), 48% of partial response(PR), 8% stable disease(SD), and 16% of progression. Tumor response 3 mo after ADET was CR 24%, PR 38%, SD 19% and progression disease(PD) 19%. Tumor response 6 mo after ADET was CR 18%, PR 44%, SD 21% and PD 18%. QoL was 90% PPS at each time point. Median time to progression for patients who progressed was 2.5 mo(range 0.8-6). Median follow-up was 14 mo(0.8-25 range). ADETs were performed with no complications. Observed side effects(mild or moderate intensity) were: Pain in 32% of patients, increase of transaminase levels in 20% and fever in 14%, whereas 30% of patients did not complain any adverse event. CONCLUSION The treatment of unresectable CRC-LM with ADET using polyethylene glycol microspheres loaded with irinotecan was effective in tumor response and resulted in mild toxicity, and good QoL.展开更多
The distention of the colon without mechanical or anatomical obstruction, Acute Colonic Pseudo-obstruction (ACPO), is a common condition occurring in the critically ill. ACPO in the setting of an acute pulmonary embol...The distention of the colon without mechanical or anatomical obstruction, Acute Colonic Pseudo-obstruction (ACPO), is a common condition occurring in the critically ill. ACPO in the setting of an acute pulmonary embolism and embolic stroke is a rarity. A 76-year-old female with shortness of breath, left hemiparesis and right-sided paresthesias presented with acute pulmonary embolism and acute infarcts of the left caudate nucleus, thalamus and occipital lobe. Her hospitalization was complicated with persistent distention of the large bowel without dilation of the small bowel. Empiric antibiotics were initiated without improvement and laboratory studies including Clostridium difficile were negative. She underwent nasogastric decompression and two decompressive colonoscopies with a resolution of her symptoms. This case illustrates an example of acute abdominal distension, without underlying etiology, in the setting of acute embolism of the pulmonary and cerebral vasculature. Early identification and action with decompressive colonoscopy were key to preventing further bowel damage or rupture.展开更多
BACKGROUND While gelatin sponge particles and calibrated microspheres are commonly used as embolic materials in conventional transarterial chemoembolization(cTACE),direct comparisons between these embolic agents are r...BACKGROUND While gelatin sponge particles and calibrated microspheres are commonly used as embolic materials in conventional transarterial chemoembolization(cTACE),direct comparisons between these embolic agents are rare.AIM To compare the efficacy and safety of superselective cTACE using Embosphere®or Marine gel®in patients with early-stage hepatocellular carcinoma(HCC).METHODS This retrospective study included 70 patients with small(<4 cm)HCC who underwent cTACE with Embosphere®(n=33)or Marine gel®(n=37)as the embolic agent at a single center between March 2021 and July 2022.The radiologic images and clinical data were retrospectively reviewed,with an emphasis on tumor response,procedure-related complications,and local tumor recurrence.The primary index tumor was assessed on a 1-mo follow-up image,and local progression-free survival was obtained using the Kaplan-Meier method and was compared by the log-rank test.RESULTS The median tumor size of both groups was 1.5 cm,and 69 patients achieved a complete response one month after cTACE.The cumulative local recurrence rate at 12 mo was 15.5%in the Embosphere®group and 14.4%in the Marine gel®group.The local progression-free survival was not significantly different between the two groups(P=0.83).In the multivariate analysis,high serum alphafetoprotein was the only significant poor prognostic factor for local tumor progression(P=0.01).Postembolization syndrome occurred in 36.4%of the Embosphere®group and 35.1%of the Marine gel®group,and there were no cases of biloma,biliary duct dilation,or liver abscess in either group.CONCLUSION Calibrated gelatin sponge particles(Marine gel®)and calibrated microspheres(Embosphere®)have similar outcomes in terms of tumor response for superselective cTACE of small HCC.展开更多
Vascular embolic diseases are associated with blockage of blood supply to vital organs and thus are lethal.Aspiration thrombectomy is becoming the primary choice for revascularization in the treatment of vascular occl...Vascular embolic diseases are associated with blockage of blood supply to vital organs and thus are lethal.Aspiration thrombectomy is becoming the primary choice for revascularization in the treatment of vascular occlusions condition.As the power source in the aspiration thrombectomy procedure,the aspiration pump directly influences the outcome of the operation.This research surveyed the current technical developments of the aspiration pump in China through reviewing information obtained from the patent database and technical literatures,commented on the issues in the current patent designs,and gave suggestions for future design improvement.This study can be used as a reference for researchers and developers of medical devices besides the neurosurgeons.展开更多
Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus.It is the most common gynecological disorder,affecting up to 80%of women of reproductive age.Uterine fibroids can cause various ...Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus.It is the most common gynecological disorder,affecting up to 80%of women of reproductive age.Uterine fibroids can cause various symptoms such as abnormal uterine bleeding,pelvic pain,infertility,and pregnancy complications.The treatment options for uterine fibroids include medical therapy,surgical intervention,and minimally invasive techniques.AIM To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization(UAE).METHODS This prospective cohort study enrolled 87 women with symptomatic uterine fibroids who underwent UAE,and 87 women with the same symptoms who did not undergo UAE but received conservative management or other treatments.The two groups were matched for age,body mass index,parity,and baseline characteristics of uterine fibroids.The primary outcome was ovarian function that was evaluated by serum levels of follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),and anti-Müllerian hormone(AMH),as well as ovarian reserve tests,such as antral follicle count(AFC)and ovarian volume(OV).The secondary outcome was fertility that was evaluated based on the menstrual cycle,ovulation,conception,pregnancy,and delivery.The participants were followed-up for 36 months and assessed at 1,3,6,12,24,and 36 months after treatment.RESULTS The study found that the most common minor complication of UAE was postembolization syndrome in 73.6% of women,resolving within a week.No significant differences were observed between the UAE group and the control group in serum levels of reproductive hormones(FSH,LH,E2,AMH)and ovarian reserve indicators(AFC,OV)at any point up to 36 months post-treatment.Additionally,there were no significant differences in conception,pregnancy,or delivery rates,with the average time to conception and gestational age at delivery being similar between the two groups.Birth weights were also comparable.Finally,there was no significant correlation betwee展开更多
Background Non-adhesive liquid embolic agents are increasingly gaining importance in the embolization of cerebral arteriovenous malformations （AVMs）. We investigated the use of poly （N-isopropylacrylamide） （PNIPA...Background Non-adhesive liquid embolic agents are increasingly gaining importance in the embolization of cerebral arteriovenous malformations （AVMs）. We investigated the use of poly （N-isopropylacrylamide） （PNIPAM） as a non-adhesive embolic agent in swine rete mirabile. Methods The PNIPAM hydrogel was mixed with iohexol and embolization was performed in swine rete mirabile in 30 animals. The microcatheter was examined after embolization. Follow-up angiography was performed for embolic efficacy after embolization. Embolized retia were examined histopatholgically, and the alterations of inside rete and surrounding tissue were observed. Results The copolymer hydrogel was used for rete embolization in 30 swine, 28 swine survived the procedure, 2 swine died, 1 swine died of cerebrum infarction and the other died of embolic agent reflux into the occipital artery. The inside wall of the microcatheter was smooth, without copolymer adhering to it. Follow-up angiography was performed in 22 swine, there was no rete recanalization in 20 swine and partial rete recanalization in 2 swine because of the trunk embolization of ascending pharyngeal arteries. Histopatholgically, the copolymer was found diffused into vessels of 100-- 150 μm in diameter. In acute group, neutrophils scattered surrounding the copolymer and endothelial integrity was observed, without endothelial denuding and necrosis. In subacute and chronic groups, the copolymer was found inside retia, a few mononuclear cells and eosinocytes scattered inside and surrounding it. The muscular layer was loosened with most muscular nuclei degraded. Conclusion Experimental rete embolization with PNIPAM, made radiopaque with iohexol, is technically feasible in swine. Because of its properties, PNIPAM has great potential as a therapeutic non-adhesive embolic agent.展开更多
Objective Recent years have seen new evidence on the efficacy and safety of dual antiplatelet therapy for secondary stroke prevention.We updated a meta-analysis of randomised controlled trials evaluating dual antiplat...Objective Recent years have seen new evidence on the efficacy and safety of dual antiplatelet therapy for secondary stroke prevention.We updated a meta-analysis of randomised controlled trials evaluating dual antiplatelet versus monotherapy for patients with acute non-cardioembolic ischaemic stroke(IS)or transient ischaemic attack(TIA).Methods We searched PubMed and identified randomised controlled trials evaluating dual antiplatelet versus monotherapy for acute non-cardioembolic IS or TIA within 3 days of ictus up to May 2018.Risk ratio(RR)with 95%CI were calculated using random effects models.Clinical endpoints included stroke recurrence,composite vascular events and major bleeding.results 18 randomised controlled trials including 15515 patients were pooled in the meta-analysis.When compared with monotherapy among patients with acute IS or TIA,dual antiplatelet therapy reduced the risk of stroke recurrence(RR 0.69;95%CI 0.61 to 0.78;p<0.001)and composite vascular events(RR 0.72;95%CI 0.64 to 0.80;p<0.001).Dual therapy was associated with a significant increase in the risk of major bleeding(RR 1.77;95%CI 1.09 to 2.87;p=0.02)when all trial data were combined.However,when all previous trials before the completion of the POINT trial were analysed,dual antiplatelet versus monotherapy was not associated with a significant increase in the risk of major bleeding(RR 1.46;95%CI 0.77 to 2.75;p=0.25).Conclusions Among patients with acute noncardioembolic IS or TIA within 3 days of ictus,dual antiplatelet therapy was associated with a reduction in stroke recurrence,and composite vascular events,when compared with monotherapy.However,a significant increase in the risk of major bleeding was observed.展开更多
文摘Background and Aims:Intermediate stage hepatocellular carcinoma (HCC) can be treated by transarterial chemoem-bolization (TACE).However,there appear to be side effects,such as induction of proangiogenic factors,e.g.vascular endothelial growth factor (VEGF),which have been shown to be associated with a poor prognosis.This prospective study was designed to compare serum VEGF level response after TACE with different embolic agents in patients with HCC.Methods:Patients were assigned to one of three different TACE regimens:degradable starch microspheres (DSM) TACE,drugeluting bead (DEBDOX) TACE or Lipiodol TACE (cTACE).All patients received 50 mg doxorubicin/m2 body surface area (BSA) during TACE.Serum VEGF levels were assessed before TACE treatment,24 h post-treatment and 4 weeks later.Results:Twenty-two patients with 30 TACE treatments were enrolled.Compared to baseline VEGF levels,a marked increase was observed for 24 h post-TACE (164% of baseline level) and during the 4-week follow-up (170% of baseline level) only for the cTACE arm (p < 0.05).In contrast,the increase of serum VEGF levels were only 114% and 123% for DEBDOX and 121% and 124% for DSM,respectively.Conclusions:Conventional TACE using Lipiodol shows marked increase in blood levels of the proangiogenic factor VEGF,while DEBDOX and DSM TACE induce only a moderate VEGF response.
基金Supported by the National Key Research and Development Program of China,No.2017YFC1104100the Capital Health Research and Development of Special,No.2016-1-2012+1 种基金Beijing Hospital Authority Clinical Technological Innovation Project,No.XMLX201610Beijing Hospital Authority"Climb Peak"Talent Training Scheme,No.DFL20150801
文摘BACKGROUND Embolic superior mesenteric artery(SMA) occlusion is associated with high mortality rates. Delayed treatment often leads to serious consequences, including intestinal necrosis, resection, and even patient death. Endovascular repair is being introduced, which can improve clinical symptoms and prognosis and decrease the incidence of exploratory laparotomy. Many reports have described successful endovascular revascularization of embolic SMA occlusion. However,most of those reports are case reports, and there are few reports on Chinese patients. In this paper, we describe the technical and clinical outcomes of aspiration therapy using a guiding catheter and long sheath technique which facilitates the endovascular repair procedure.AIM To evaluate the complications, feasibility, effectiveness, and safety of endovascular treatment for the acute embolic occlusion of the SMA.METHODS This retrospective study reviewed eight patients(six males and two females)from August 2013 to October 2018 at Xuanwu Hospital, Capital Medical University. The patients presented with acute embolic occlusion of the SMA on admission and were initially diagnosed by computed tomography angiography(CTA). The patients who underwent endovascular treatment with a guiding catheter had no obvious evidence of bowel infarct. No intestinal necrosis was identified by gastrointestinal surgeons through peritoneal puncture or CTA. The complications, feasibility, effectiveness, safety, and mortality were assessed.RESULTS Six(75%) patients were male, and the mean patient age was 70.00 ± 8.43 years(range, 60-84 years). The acute embolic occlusion of the SMA was initially diagnosed by CTA. All patients had undertaken anticoagulation primarily, and percutaneous aspiration using a guiding catheter was then undertaken because the emboli had large amounts of thrombus residue. No death occurred among the patients. Complete patency of the suffering artery trunk was achieved in six patients, and defect filling was accomplished in two patients. The in-hospita
文摘AIM To study tumor response, and tolerability of arterially directed embolic therapy(ADET) with polyethylene glycol embolics loaded with irinotecan for the treatment of colorectal cancer liver metastases(CRC-LM). Secondary objectives were to monitor quality of life, time to progression and survival of patients.METHODS Patients were included in the study if they were affected by CRC-LM, refractory to systemic chemotherapy, treated with ADET using polyethylene glycol embolics, and had liver involvement < 50%. Tumor response, performance status(PS), tumor marker antigens, and quality of life(QoL) were monitored at 1, 3 and 6 mo after ADET. QoL was assessed with the Palliative Performance Scale(PPS).RESULTS We treated 50 consecutive CRC-LM patients with ADET using polyethylene glycol embolics. Their tumor response one month after ADET was: 28% of complete response(CR), 48% of partial response(PR), 8% stable disease(SD), and 16% of progression. Tumor response 3 mo after ADET was CR 24%, PR 38%, SD 19% and progression disease(PD) 19%. Tumor response 6 mo after ADET was CR 18%, PR 44%, SD 21% and PD 18%. QoL was 90% PPS at each time point. Median time to progression for patients who progressed was 2.5 mo(range 0.8-6). Median follow-up was 14 mo(0.8-25 range). ADETs were performed with no complications. Observed side effects(mild or moderate intensity) were: Pain in 32% of patients, increase of transaminase levels in 20% and fever in 14%, whereas 30% of patients did not complain any adverse event. CONCLUSION The treatment of unresectable CRC-LM with ADET using polyethylene glycol microspheres loaded with irinotecan was effective in tumor response and resulted in mild toxicity, and good QoL.
文摘The distention of the colon without mechanical or anatomical obstruction, Acute Colonic Pseudo-obstruction (ACPO), is a common condition occurring in the critically ill. ACPO in the setting of an acute pulmonary embolism and embolic stroke is a rarity. A 76-year-old female with shortness of breath, left hemiparesis and right-sided paresthesias presented with acute pulmonary embolism and acute infarcts of the left caudate nucleus, thalamus and occipital lobe. Her hospitalization was complicated with persistent distention of the large bowel without dilation of the small bowel. Empiric antibiotics were initiated without improvement and laboratory studies including Clostridium difficile were negative. She underwent nasogastric decompression and two decompressive colonoscopies with a resolution of her symptoms. This case illustrates an example of acute abdominal distension, without underlying etiology, in the setting of acute embolism of the pulmonary and cerebral vasculature. Early identification and action with decompressive colonoscopy were key to preventing further bowel damage or rupture.
文摘BACKGROUND While gelatin sponge particles and calibrated microspheres are commonly used as embolic materials in conventional transarterial chemoembolization(cTACE),direct comparisons between these embolic agents are rare.AIM To compare the efficacy and safety of superselective cTACE using Embosphere®or Marine gel®in patients with early-stage hepatocellular carcinoma(HCC).METHODS This retrospective study included 70 patients with small(<4 cm)HCC who underwent cTACE with Embosphere®(n=33)or Marine gel®(n=37)as the embolic agent at a single center between March 2021 and July 2022.The radiologic images and clinical data were retrospectively reviewed,with an emphasis on tumor response,procedure-related complications,and local tumor recurrence.The primary index tumor was assessed on a 1-mo follow-up image,and local progression-free survival was obtained using the Kaplan-Meier method and was compared by the log-rank test.RESULTS The median tumor size of both groups was 1.5 cm,and 69 patients achieved a complete response one month after cTACE.The cumulative local recurrence rate at 12 mo was 15.5%in the Embosphere®group and 14.4%in the Marine gel®group.The local progression-free survival was not significantly different between the two groups(P=0.83).In the multivariate analysis,high serum alphafetoprotein was the only significant poor prognostic factor for local tumor progression(P=0.01).Postembolization syndrome occurred in 36.4%of the Embosphere®group and 35.1%of the Marine gel®group,and there were no cases of biloma,biliary duct dilation,or liver abscess in either group.CONCLUSION Calibrated gelatin sponge particles(Marine gel®)and calibrated microspheres(Embosphere®)have similar outcomes in terms of tumor response for superselective cTACE of small HCC.
基金supported by the Natural Science Foundation of Shaanxi Province,China(2021JM-468)the China High Education Innovation Fund for Industry,Research and Development,Ministry of Education,China(Alibaba Cloud University Digital Innovation Program 2021ALA01002)+1 种基金the Open Research Grant from the Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application,China(2022KF02)the Key R&D grant from the Xianyang Municipal Science and Technology Bureau,China(L2022ZDYFSF051).
文摘Vascular embolic diseases are associated with blockage of blood supply to vital organs and thus are lethal.Aspiration thrombectomy is becoming the primary choice for revascularization in the treatment of vascular occlusions condition.As the power source in the aspiration thrombectomy procedure,the aspiration pump directly influences the outcome of the operation.This research surveyed the current technical developments of the aspiration pump in China through reviewing information obtained from the patent database and technical literatures,commented on the issues in the current patent designs,and gave suggestions for future design improvement.This study can be used as a reference for researchers and developers of medical devices besides the neurosurgeons.
基金Supported by Key Project of Medical Science Research in Hebei Province,China,No.20160005.
文摘Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus.It is the most common gynecological disorder,affecting up to 80%of women of reproductive age.Uterine fibroids can cause various symptoms such as abnormal uterine bleeding,pelvic pain,infertility,and pregnancy complications.The treatment options for uterine fibroids include medical therapy,surgical intervention,and minimally invasive techniques.AIM To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization(UAE).METHODS This prospective cohort study enrolled 87 women with symptomatic uterine fibroids who underwent UAE,and 87 women with the same symptoms who did not undergo UAE but received conservative management or other treatments.The two groups were matched for age,body mass index,parity,and baseline characteristics of uterine fibroids.The primary outcome was ovarian function that was evaluated by serum levels of follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),and anti-Müllerian hormone(AMH),as well as ovarian reserve tests,such as antral follicle count(AFC)and ovarian volume(OV).The secondary outcome was fertility that was evaluated based on the menstrual cycle,ovulation,conception,pregnancy,and delivery.The participants were followed-up for 36 months and assessed at 1,3,6,12,24,and 36 months after treatment.RESULTS The study found that the most common minor complication of UAE was postembolization syndrome in 73.6% of women,resolving within a week.No significant differences were observed between the UAE group and the control group in serum levels of reproductive hormones(FSH,LH,E2,AMH)and ovarian reserve indicators(AFC,OV)at any point up to 36 months post-treatment.Additionally,there were no significant differences in conception,pregnancy,or delivery rates,with the average time to conception and gestational age at delivery being similar between the two groups.Birth weights were also comparable.Finally,there was no significant correlation betwee
基金This work was supported by a grant from the National High Technology Research and Development Program of China (863 Program, No. 2002AA326100).
文摘Background Non-adhesive liquid embolic agents are increasingly gaining importance in the embolization of cerebral arteriovenous malformations （AVMs）. We investigated the use of poly （N-isopropylacrylamide） （PNIPAM） as a non-adhesive embolic agent in swine rete mirabile. Methods The PNIPAM hydrogel was mixed with iohexol and embolization was performed in swine rete mirabile in 30 animals. The microcatheter was examined after embolization. Follow-up angiography was performed for embolic efficacy after embolization. Embolized retia were examined histopatholgically, and the alterations of inside rete and surrounding tissue were observed. Results The copolymer hydrogel was used for rete embolization in 30 swine, 28 swine survived the procedure, 2 swine died, 1 swine died of cerebrum infarction and the other died of embolic agent reflux into the occipital artery. The inside wall of the microcatheter was smooth, without copolymer adhering to it. Follow-up angiography was performed in 22 swine, there was no rete recanalization in 20 swine and partial rete recanalization in 2 swine because of the trunk embolization of ascending pharyngeal arteries. Histopatholgically, the copolymer was found diffused into vessels of 100-- 150 μm in diameter. In acute group, neutrophils scattered surrounding the copolymer and endothelial integrity was observed, without endothelial denuding and necrosis. In subacute and chronic groups, the copolymer was found inside retia, a few mononuclear cells and eosinocytes scattered inside and surrounding it. The muscular layer was loosened with most muscular nuclei degraded. Conclusion Experimental rete embolization with PNIPAM, made radiopaque with iohexol, is technically feasible in swine. Because of its properties, PNIPAM has great potential as a therapeutic non-adhesive embolic agent.
文摘Objective Recent years have seen new evidence on the efficacy and safety of dual antiplatelet therapy for secondary stroke prevention.We updated a meta-analysis of randomised controlled trials evaluating dual antiplatelet versus monotherapy for patients with acute non-cardioembolic ischaemic stroke(IS)or transient ischaemic attack(TIA).Methods We searched PubMed and identified randomised controlled trials evaluating dual antiplatelet versus monotherapy for acute non-cardioembolic IS or TIA within 3 days of ictus up to May 2018.Risk ratio(RR)with 95%CI were calculated using random effects models.Clinical endpoints included stroke recurrence,composite vascular events and major bleeding.results 18 randomised controlled trials including 15515 patients were pooled in the meta-analysis.When compared with monotherapy among patients with acute IS or TIA,dual antiplatelet therapy reduced the risk of stroke recurrence(RR 0.69;95%CI 0.61 to 0.78;p<0.001)and composite vascular events(RR 0.72;95%CI 0.64 to 0.80;p<0.001).Dual therapy was associated with a significant increase in the risk of major bleeding(RR 1.77;95%CI 1.09 to 2.87;p=0.02)when all trial data were combined.However,when all previous trials before the completion of the POINT trial were analysed,dual antiplatelet versus monotherapy was not associated with a significant increase in the risk of major bleeding(RR 1.46;95%CI 0.77 to 2.75;p=0.25).Conclusions Among patients with acute noncardioembolic IS or TIA within 3 days of ictus,dual antiplatelet therapy was associated with a reduction in stroke recurrence,and composite vascular events,when compared with monotherapy.However,a significant increase in the risk of major bleeding was observed.
