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
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
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-hospital mortality was 0%. The overall 12-mo survival rate was 100%. All patients survived, and two of the eight patients had complications(the clot broke off during aspiration).CONCLUSION Aspiration therapy is feasible, safe, and beneficial for acute embolic SMA occlusion. Aspiration therapy has many benefits for reducing patients' death,resolving thrombi, and improving symptoms.展开更多
Objective:The study aimed to discuss the treatment of acute thromboembolic event(TE)during endovascular embolization of intracranial aneurysms.Methods:Between April 2013 and April 2019,158 patients with 167 intracrani...Objective:The study aimed to discuss the treatment of acute thromboembolic event(TE)during endovascular embolization of intracranial aneurysms.Methods:Between April 2013 and April 2019,158 patients with 167 intracranial aneurysms were treated with endovascular embolization in our hospital,in which 9 cases of acute TEs occurred during the embolization procedures.The clinical data,radiological findings and treatments of the 9 patients were reviewed and analyzed.Results:The TEs occurred at the aneurysmal neck in 3 patients,at distal part of the parent artery in 3,in the stent in 2,and at the proximal part of the parent artery in 1.Intra-arterial(IA)infusion of tirofiban were performed in 6 patients,mechanical thromboectomy(MT)with a stent in 2 patients,and combined use of the two methods in 1 patients.According to the modified Thrombolysis In Cerebral Infarction(mTICI)score,7 patients had recanalization of 2b/3a,1 patients had recanalization of 1,and 1 patients had recanalization of 0.At discharge,the mRS score was 0 in 3 patients,1 in 3 patients,and 2,3,4 in 1 patient each.6 months after the endovascular treatment,the mRS score was 0 in 5 patients,1 in 2 patients,and 3 in 1 patient.Conclusions:IA tirofiban and MT are effective remedies for the acute TE during endovascular embolization of intracranial aneurysm,reasonable selection of which may improve the prognosis of patients.展开更多
Objective The trial was designed to evaluate the safety and performance of the ev3 Protégé TM stent in the treatment of de novo or re-stenotic common and/or internal carotid artery stenoses with adjunctive u...Objective The trial was designed to evaluate the safety and performance of the ev3 Protégé TM stent in the treatment of de novo or re-stenotic common and/or internal carotid artery stenoses with adjunctive use of a CE-marked filter embolic protection device.Methods This study was a prospective multi-center, single-arm trial. Between June and October 2003, 77 patients were enrolled in 8 investigational centers throughout Europe. The primary endpoint was the incidence of Major Neurological Events (MANE) through one month. Other endpoints were the ability to properly place the stent, and primary patency and MANE after six months. Eligible for the study were patients with a de novo or restenotic target lesion located in the common and/or internal carotid artery (>70% stenosis for asymptomatic and >50% stenosis for symptomatic patients). The ev3 Spider (Embolic Protection Filter was used in 75 of 77 cases. Results In 76 out of the 77 patients (99%), the stent could be successfully implanted with a residual stenosis ≤30% as criterion. Of the 74 patients that had a carotid ultrasound at one month follow-up, none had a re-stenosis of the target lesion. There were three MANEs during or immediately after the procedure (3.9%), two were major and one was a minor stroke. There were eight severe complications (9.1%); six of these happened during or immediately after the procedure and were related to the procedure, none was related to the device. They are resolved without sequelae. No deaths have occurred.Conclusions The Protégé stent is safe and performs well in the treatment of carotid artery stenosis. The technical success rate for placement of the Protégé stent as assessed by the residual stenosis post implant was very high and all stents were successfully deployed. The incidence of MANE was comparable with that in other recent carotid stent studies and still lower than standard CEA.展开更多
The approval of commercial application transcatheter aortic valve replacement(TAVR)by the FDA in 2011 has revolutionized the management of high-risk surgical patients with severe aortic stenosis(AS).With TAVR being ex...The approval of commercial application transcatheter aortic valve replacement(TAVR)by the FDA in 2011 has revolutionized the management of high-risk surgical patients with severe aortic stenosis(AS).With TAVR being expanded to intermediate surgical risk patients in 2016,the number of patients undergoing TAVR has been increasing rapidly.In fact,since the very first human TAVR procedure in 2002,more than 300,000 TAVRs have been performed worldwide.[1,2]The technological advancements in the TAVR since its early days of clinical adaptation has made this procedure a routine practice in many institutions worldwide.However,one of the most feared complications,ischemic stroke,remains a major concern for clinicians and patients despite all the advancements in the procedure.展开更多
The aim of the current study is to report an inherently radiopaque drug-eluted beads(DEBs)as promising embolic materials for TACE techniques.Firstly,the synthesized radiopaque iodinated polycaprolactonepolyurethanes(I...The aim of the current study is to report an inherently radiopaque drug-eluted beads(DEBs)as promising embolic materials for TACE techniques.Firstly,the synthesized radiopaque iodinated polycaprolactonepolyurethanes(I-PCLUs)are synthesized by chain-extending method by using 4,4-′isopropylidinedi-(2,6-diiodophenol)(IBPA)as the radiopacifying agent.Then,doxorubicin(Dox)is introduced as a chemotherapeutic agent into I-PCLU beads via a double emulsification(W/O/W)method.The drug loading and controlled release behavior of two ratios of I-PCLU/Dox are found to be dependent upon the internal porous microstructure,and the radiopacity is well-retained after four weeks drug release.Besides,the I-PCLU/Dox beads exhibit positive in vitro anti-tumor effect.The in vivo intramuscular implantation and liver embolization results demonstrate that I-PCLU beads have good histocompatibility,occlusion effect and X-ray traceability.Furthermore,the drug-loaded I-PCLU beads are performed into a VX2 rabbit hepatocellular carcinoma(HCC)model using a micro-catheter,form embolization of hepatic arteries and inhibit the tumor growth after one week post-injection.Hence,this polymeric system provides a potential radiopaque chemoembolization candidate for HCC and other cancer therapies,which could bring opportunities to the next generation of multifunctional embolic agents.展开更多
BACKGROUND Testicular germ cell tumor(TGCT)is the most curable solid tumor and most common cancer among men 18-39 years.While cisplatin-based chemotherapy has significantly lengthened the survival of patients with TGC...BACKGROUND Testicular germ cell tumor(TGCT)is the most curable solid tumor and most common cancer among men 18-39 years.While cisplatin-based chemotherapy has significantly lengthened the survival of patients with TGCT,it is associated with a high rate of thromboembolic events(TEE).AIM To summarize our single-center experience highlighting patients who were diagnosed with TGCT and received platinum-based chemotherapy,with special attention to those patients who suffered a TEE.METHODS A retrospective analysis of the medical records and imaging studies of 68 consecutive individuals who were diagnosed with TGCT and received platinumbased chemotherapy at our Institution in a metropolitan community between January 1,2014 and December 31,2019.RESULTS A total of 19(28%)patients experienced a TEE following orchiectomy which occurred during chemotherapy in 13(68%)of these patients.Patients with a higher pathologic stage(stage III)were significantly(P=0.023)more likely to experience a TEE compared to patients who had a lower stage.Additionally,patients who were treated with 3 cycles of bleomycine,etoposide,and cisplatin and 1 cycle of etoposide and cisplatin or 4 cycles of etoposide and cisplatin were significantly 5(P=0.02)times more likely to experience a TEE compared to patients who were treated with only 3 cycles of bleomycine,etoposide,and cisplatin.CONCLUSION Due to numerous factors that predispose to a TEE such as large retroperitoneal disease,higher clinical stage,greater number of chemotherapy cycle,central venous catheter,cigarette smoking,and possible cannabis use,high-risk ambulatory patients with TGCT treated with cisplatin-based chemotherapy may benefit from prophylactic anticoagulation.Randomized studies to evaluate the safety and efficacy of prophylactic anticoagulants are warranted in this young patient population generally devoid of medical co-morbidities.展开更多
BACKGROUND Cholesterol crystal embolization(CCE)is a multisystemic and fatal disease with multiple clinical manifestations;however,there are few cases of idiopathic CCE.Here we report a patient with idiopathic CCE acc...BACKGROUND Cholesterol crystal embolization(CCE)is a multisystemic and fatal disease with multiple clinical manifestations;however,there are few cases of idiopathic CCE.Here we report a patient with idiopathic CCE accompanied by atheroembolic renal disease and blue toes who had a relatively good prognosis in the short-term due to early treatment with corticosteroids and statins.CASE SUMMARY A 76-year-old man complained of coldness,numbness and purple color change in his left foot for 7 d.He had a feeling of fatigue,constipation,foamy urine,poor appetite and sleep.He had a lacunar infarction for 5 years and hypertension for 9 mo.Laboratory results showed elevated eosinophils,cholesterol,uric acid,serum creatinine,urea and 24 h urine analysis revealed proteinuria.A renal biopsy revealed atheroembolic renal disease.Taken together,these findings strongly supported the diagnosis of idiopathic CCE and atheroembolic renal disease.CONCLUSION Atheroembolic renal disease and blue toes syndrome can be caused by idiopathic CCE,and early treatment with corticosteroids is effective but requires further investigation.展开更多
Objective:To analyze the safety and effectiveness of the ethylene-vinyl alcohol copolymer(EVOH)liquid embolic agent Squid(Emboflu,Switzerland)for the treatment of brain arteriovenous malformations.Materials and proced...Objective:To analyze the safety and effectiveness of the ethylene-vinyl alcohol copolymer(EVOH)liquid embolic agent Squid(Emboflu,Switzerland)for the treatment of brain arteriovenous malformations.Materials and procedures:Between April 2015 and July 2017,46 embolization treatments for brain arteriovenous malformations(BAVM)were performed in 25 patients using two Squid formulations(18 and 12).Six female and 19 male patients with a mean age of 34 years(range,9–62 years)were included.A total of 46 procedures were performed.The BAVMs were classified as Spetzler-Martin gradeⅡin 4 procedures,Ⅲin 27 procedures,and 1V in 15 procedures.Among the 25 patients,15 presented with hemorrhage,5 with seizures,and 5 with headache and neurology.The BAVMs were located in the temporal lobe in 5 patients,parietal lobe in 7 patients,frontal lobe in 3 patients,posterior fossa in 6 patients,basal ganglia in 3 patients,and parasagittal lobe in 1 patient.Results:The obliteration rate of the BAVMs ranged from 10%to 100%,with a mean of 33%.Most patients underwent their first or second embolization procedure.Four patients(8%)developed intracranial bleeding post procedure,with one death(2%).One patient(2%)experienced a seizure during the procedure;however,no intracranial bleeding was observed.Seven patients(15%)experienced perforations during catheter manipulation.One case(2%)of fractured catheter was recorded,but no significant complications were observed.The average volume of copolymer injected was 0.6 ml per nidus.Thirteen procedures used the Squid-12 formulation,29 procedures used the Squid-18 formulation,and 3 procedures used a combination of Squid-12 and-18 formulations.Conclusion:Squid is a safe and effective embolic agent for treating BAVMs.展开更多
To the Editor I have read the article entitled ＂Cognitive function and adherence to antieoagulation treatment in patients with atrial fibrillation＂ by Jankowska-Polafiska, et al., with great interest. The investigat...To the Editor I have read the article entitled ＂Cognitive function and adherence to antieoagulation treatment in patients with atrial fibrillation＂ by Jankowska-Polafiska, et al., with great interest. The investigators reported that cognitive impairment is an independent determinant of compliance with pharmacological therapy in elderly patients with atrial fibrillation （AF）.展开更多
OBJECTIVE: To investigate the anti-embolic effect of Taorenchengqi Tang(TRCQT), a formulas from Traditional Chinese Medicine, plus aspirin in rats with embolic stroke induced by selective occlusion of the middle cereb...OBJECTIVE: To investigate the anti-embolic effect of Taorenchengqi Tang(TRCQT), a formulas from Traditional Chinese Medicine, plus aspirin in rats with embolic stroke induced by selective occlusion of the middle cerebral artery(MCA). Possible side effects of hemorrhagic incident and other bleeding events and anti-platelet effect were also explored.METHODS: Ninety rats were randomly separatedinto 9 groups(n = 10): group 1 a sham-operated group(n = 10); groups 2 and 3 orally treated with an isovolumetric solvent(distilled water) for 1 and3 months, followed by thromboembolic occlusion(n = 10); groups 4 and 5 orally treated with aspirin(5 mg/kg) alone for 1 and 3 months, followed by thromboembolic occlusion(n = 10); groups 6 and 7orally treated with TRCQT(0.5 g/kg) alone for 1 and3 months, followed by thromboembolic occlusion(n = 10); groups 8 and 9 orally treated with TRCQT plus aspirin for 1 and 3 months, respectively followed by thromboembolic occlusion(n = 10). The ischemic stroke in rats was induced by selective MCA occlusion. One was orally administered. After the treatments, rats' brains were removed, sectioned and stained with triphenyltetrazolium chloride(TTC) for infarct volume measurement. The incidence of subarachnoid hemorrhage(SAH) and intracerebral hemorrhage(ICH) were observed. A potential gastric bleeding side effect was assessed by measuring hemoglobin(Hb), and prothrombin time(PT). Collagen-induced platelet activation and tail vein bleeding time were measured.RESULTS: Treatment with TRCQT alone or in combination with aspirin reduced infarct volume for 1(P < 0.05), and 3(P < 0.01) months without SAH and ICH incidences, and gastric bleeding. TRCQT treatment for 1 month was also not altered PT. Moreover, a concentration dependent inhibition of collagen-induced platelet activation, followed by increasing of tail vein bleeding time was observed after TRCQT treatment.CONCLUSION: Either TRCQT alone or TRCQT plus aspirin exhibits potent neuroprotective effect by reducing infarct volume without changing the status of SAH, ICH and gastric bleeding possibly via inhib-iting the platelet activation and increasing bleeding time.展开更多
Thromboembolism infrequently occurs in coronary arteries. In contrast to an in situ thrombosis, a thrombus is not fresh and floating. There has been no recommended treatment strategy for this rare condition, especiall...Thromboembolism infrequently occurs in coronary arteries. In contrast to an in situ thrombosis, a thrombus is not fresh and floating. There has been no recommended treatment strategy for this rare condition, especially for large thrombi in main arteries. Here, we report a modified stenting strategy to treat thromboembolism in the left main coronary artery.展开更多
Introduction: Venous thromboembolism (VTE) is a nosological group which mainly includes deep vein thrombosis (DVT) and pulmonary embolism (PE), it is frequently associated with high morbidity and mortality. We initiat...Introduction: Venous thromboembolism (VTE) is a nosological group which mainly includes deep vein thrombosis (DVT) and pulmonary embolism (PE), it is frequently associated with high morbidity and mortality. We initiated this study with the aim of studying VTE in a cardiological hospital environment in a regional hospital in Mali. Methodology: This was a descriptive study with prospective recruitment over 1 year from June 20, 2019 to June 20, 2020, covering patients hospitalized and followed in consultation in the cardiology department of the Ségou regional hospital in Mali. Results: We collected 31 cases of VTE out of 366 patients, representing a frequency of 8.47%. The sex ratio was 0.88. VTE risk factors were dominated by immobilization (29.03%), pregnancy and postpartum (16.12%), heart failure (16.12%). The reason for consultation was dyspnea (93.54%) followed by chest pain (83.87%). On admission the clinical manifestations were tachycardia (74.19%), tachypnea (90.32%), muffled heart sounds (70.96%), global heart failure syndrome (51.6%). According to VTE probability scores;51.61% of patients had an intermediate clinical probability according to the simplified Wells score for PE and 54.84% had an intermediate clinical probability for the simplified Geneva score for DVT. D-Dimers were only performed in 12 patients (38.70%) and were elevated in all. A chest CT angiogram showed PE in 90% of patients (n = 28/31). Venous Doppler ultrasound of the lower limbs showed venous thrombosis in 3 patients. Conclusion: Venous thromboembolism, although underdiagnosed, is common in our health structures. Prevention, particularly heparinoprophylaxis and early recovery in a hospital environment, remains the effective means of combating this condition.展开更多
Background We investigated differences in intracranial embolus distribution through communicating arteries in relation to supra-aortic vessel(SAV)patency.Methods For this experimental analysis,we created a silicone mo...Background We investigated differences in intracranial embolus distribution through communicating arteries in relation to supra-aortic vessel(SAV)patency.Methods For this experimental analysis,we created a silicone model of the extracranial and intracranial circulations using a blood-mimicking fluid under physiological pulsatile flow.We examined the sequence of embolus lodgment on injecting 104 frangible clot analogues(406 emboli)through the right internal carotid artery(CA)as SAV patency changed:(a)all SAV patent(baseline),(b)emboli from a CA occlusion,(c)emboli contralateral to a CA occlusion and(d)occlusion of the posterior circulation.The statistical analysis included a descriptive analysis of thrombi location after occlusion(absolute and relative frequencies).Sequences of occlusions were displayed in Sankey flow charts for the four SAV conditions.Associations between SAV conditions and occlusion location were tested by Fisher’s exact test.Two-sided p values were compared with a significance level of 0.05.Results The total number of emboli was 406(median fragments/clot:4(IQR:3-5)).Embolus lodgment was dependent on SAV patency(p<0.0001).In all scenarios,embolism lodging in the anterior cerebral artery(ACA)occurred after a previous middle cerebral artery(MCA)embolism(MCA first lodge:96%,100/104).The rate of ipsilateral ACA embolism was 28.9%(28/97)at baseline,decreasing significantly when emboli originated from an occluded CA(16%,14/88).There were more bihemispheric embolisations in cases of contralateral CA occlusion(37%,45/122),with bilateral ACA embolisms preceding contralateral MCA embolism in 56%of cases(14/25 opposite MCA and ACA embolism).Conclusions All emboli in the ACA occurred after a previous ipsilateral MCA embolism.Bihemispheric embolisms were rare,except when there was a coexisting occlusion in either CA,particularly in cases of a contralateral CA occlusion.展开更多
Current liquid embolic agents face several challenges,including poor biocompatibility and vascular recanali-zation.Herein,we propose an innovative liquid embolic agent composed of a coenzyme-based polymer(poly lipoic ...Current liquid embolic agents face several challenges,including poor biocompatibility and vascular recanali-zation.Herein,we propose an innovative liquid embolic agent composed of a coenzyme-based polymer(poly lipoic acid,PLA)and a biocompatible solvent(deep eutectic solvent,DES).The agent undergoes phase trans-formation to form a stable hydrogel in situ through solvent exchange with water,thereby enabling safe and effective embolization.First,DES is obtained by heating a mixture of choline chloride(ChCl)and glycerol(Gly).Subsequently,lipoic acid(LA)is incorporated into the DES and heated to produce the PLA/DES complex.Owing to the strong hydrogen bonding between the DES and PLA,the DES acts as a solvent while also inhibiting PLA depolymerization.Upon contact with blood,most of the DES exchange with water,whereas some amount of ChCl integrates within the PLA via strong hydrogen bonding.This hydrogen bonding not only prevents PLA depoly-merization but also reinforces the PLA network,resulting in a stable PLA hydrogel rather than depolymerized LA monomers.Furthermore,liquid-metal(LM)nanoparticles are incorporated to fabricate radiopaque PLA/LM/DES.PLA/LM/DES shows better in vitro hemocompatibility and cytocompatibility,milder inflammatory response in a rat model,and more effective and safer embolization in a rabbit model than a commercial embolic agent(Onyx).Thus,this work provides an innovative liquid embolic agent and broadens the biomedical ap-plications of DES.展开更多
Human immunodeficiency virus(HIV)is a highly adaptable and rapidly evolving virus,and the current population of people infected with HIV and diagnosed with acquired immune deficiency syndrome(AIDS)continues to grow.Al...Human immunodeficiency virus(HIV)is a highly adaptable and rapidly evolving virus,and the current population of people infected with HIV and diagnosed with acquired immune deficiency syndrome(AIDS)continues to grow.Although the lifespan of HIV-infected people(PWH)has been extended through control with antiretroviral therapy(ART),however,as the aging of PWH increases,this population is prone to new complications,including thromboembolic disease(TED).TED has been recognized as one of the most common cardiovascular diseases among PWH.展开更多
Hemoptysis is a severe complication of pulmonary hypertension (PH) with a low in- cidence of 6%-11%.^([1-4])Although occurring in all forms of PH,it is more commonly seen in pulmonary arterial hypertension (PAH),assoc...Hemoptysis is a severe complication of pulmonary hypertension (PH) with a low in- cidence of 6%-11%.^([1-4])Although occurring in all forms of PH,it is more commonly seen in pulmonary arterial hypertension (PAH),associated with congenital heart disease (PAH-CHD).^([5,6])Since enlarged bronchial arteries are a frequent source of pulmonary bleeding,the primary treatment focuses on bronchial artery embolization (BAE),especially for chronic thromboembolic pulmonary hypertension (CTEPH) patients^([7,8]).However,there is disagreement regarding medical therapy,which has received little attention in the recently published PH guidelines.^([5,6])展开更多
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
OBJECTIVE: To study whether recombinant adeno-associated virus (rAAV) mediated foreign gene, LacZ, could pass the blood brain barrier by intra-carotid artery delivery and express in vivo in ischemic brain of the foc...OBJECTIVE: To study whether recombinant adeno-associated virus (rAAV) mediated foreign gene, LacZ, could pass the blood brain barrier by intra-carotid artery delivery and express in vivo in ischemic brain of the focal embolic stroke rats to investigate a possibility of delivering foreign gene through carotid artery to treat acute ischemic stroke. METHODS: The carotid artery territory in 41 rats was embolized with or without arterial-like fibrin rich clots to make a model of focal embolic stroke rat. rAAV containing LacZ gene (rAAV-LacZ) was constructed in 293 cells by calcium phosphate cotransfection. The rats were assigned to one of the following treatments: 1 control (without embolism) groups, including PBS treated (n = 6), pLacZ treated (n = 6 ) and rAAV-LacZ treated (n = 6): 2 embolic groups, including embolism + PBS (n =7),embolism + pLacZ (n = 8) and embolism + rAAV-LacZ (n = 8). Brains were cryosectioned and kappa-Gal stain was performed at 2, 4, and 8 weeks, respectively, after transfection, and then infarct volume was measured and the percentage of LacZ staining-positive cells was calculated. RESULTS: In all the control groups and embolism + PBS treated animal, no kappa-Gal staining-positive cells were found, but in embolism + pLacZ (n = 8) and embolism+rAAV-LacZ groups a lot of kappa-Gal staining-positive cells were found. The expression cells were in the tissues around the infarction. The gene expression persisted only nearly four weeks in embolic group with pLacZ. In the embolic group with rAAV-LacZ the expression was very stable during the experiment course (eight weeks) and the percentage of the expressed cells was significantly higher than that of its contralateral areas at the same time points, respectively. CONCLUSIONS: The plasmid vector and rAAV could enter the brain through the ischemia-damaged blood barrier and foreign gene can be expressed in brain. The positive gene expression is mainly in the peripheral areas of the infarction. rAAV as a permanent expression vector may ultimately be used for gene therapy of human ischemia cerebravascular diseases.展开更多
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.
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.
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-hospital mortality was 0%. The overall 12-mo survival rate was 100%. All patients survived, and two of the eight patients had complications(the clot broke off during aspiration).CONCLUSION Aspiration therapy is feasible, safe, and beneficial for acute embolic SMA occlusion. Aspiration therapy has many benefits for reducing patients' death,resolving thrombi, and improving symptoms.
文摘Objective:The study aimed to discuss the treatment of acute thromboembolic event(TE)during endovascular embolization of intracranial aneurysms.Methods:Between April 2013 and April 2019,158 patients with 167 intracranial aneurysms were treated with endovascular embolization in our hospital,in which 9 cases of acute TEs occurred during the embolization procedures.The clinical data,radiological findings and treatments of the 9 patients were reviewed and analyzed.Results:The TEs occurred at the aneurysmal neck in 3 patients,at distal part of the parent artery in 3,in the stent in 2,and at the proximal part of the parent artery in 1.Intra-arterial(IA)infusion of tirofiban were performed in 6 patients,mechanical thromboectomy(MT)with a stent in 2 patients,and combined use of the two methods in 1 patients.According to the modified Thrombolysis In Cerebral Infarction(mTICI)score,7 patients had recanalization of 2b/3a,1 patients had recanalization of 1,and 1 patients had recanalization of 0.At discharge,the mRS score was 0 in 3 patients,1 in 3 patients,and 2,3,4 in 1 patient each.6 months after the endovascular treatment,the mRS score was 0 in 5 patients,1 in 2 patients,and 3 in 1 patient.Conclusions:IA tirofiban and MT are effective remedies for the acute TE during endovascular embolization of intracranial aneurysm,reasonable selection of which may improve the prognosis of patients.
文摘Objective The trial was designed to evaluate the safety and performance of the ev3 Protégé TM stent in the treatment of de novo or re-stenotic common and/or internal carotid artery stenoses with adjunctive use of a CE-marked filter embolic protection device.Methods This study was a prospective multi-center, single-arm trial. Between June and October 2003, 77 patients were enrolled in 8 investigational centers throughout Europe. The primary endpoint was the incidence of Major Neurological Events (MANE) through one month. Other endpoints were the ability to properly place the stent, and primary patency and MANE after six months. Eligible for the study were patients with a de novo or restenotic target lesion located in the common and/or internal carotid artery (>70% stenosis for asymptomatic and >50% stenosis for symptomatic patients). The ev3 Spider (Embolic Protection Filter was used in 75 of 77 cases. Results In 76 out of the 77 patients (99%), the stent could be successfully implanted with a residual stenosis ≤30% as criterion. Of the 74 patients that had a carotid ultrasound at one month follow-up, none had a re-stenosis of the target lesion. There were three MANEs during or immediately after the procedure (3.9%), two were major and one was a minor stroke. There were eight severe complications (9.1%); six of these happened during or immediately after the procedure and were related to the procedure, none was related to the device. They are resolved without sequelae. No deaths have occurred.Conclusions The Protégé stent is safe and performs well in the treatment of carotid artery stenosis. The technical success rate for placement of the Protégé stent as assessed by the residual stenosis post implant was very high and all stents were successfully deployed. The incidence of MANE was comparable with that in other recent carotid stent studies and still lower than standard CEA.
基金This work was supported by the Department of Anesthesiology and Pain Medicine and NIH grant UL1 TR001860 of the University of California Davis Health.
文摘The approval of commercial application transcatheter aortic valve replacement(TAVR)by the FDA in 2011 has revolutionized the management of high-risk surgical patients with severe aortic stenosis(AS).With TAVR being expanded to intermediate surgical risk patients in 2016,the number of patients undergoing TAVR has been increasing rapidly.In fact,since the very first human TAVR procedure in 2002,more than 300,000 TAVRs have been performed worldwide.[1,2]The technological advancements in the TAVR since its early days of clinical adaptation has made this procedure a routine practice in many institutions worldwide.However,one of the most feared complications,ischemic stroke,remains a major concern for clinicians and patients despite all the advancements in the procedure.
基金the financial support of the project from the National Natural Science Foundation of China(No.31500767)China Postdoctoral Science Foundation(2015M571300)+1 种基金the Joint Research Fund Liaoning-Shenyang National Laboratory for Materials Science(No.20180510037)the Fundamental Research Funds for the Central Universities(DUT19LAB27)。
文摘The aim of the current study is to report an inherently radiopaque drug-eluted beads(DEBs)as promising embolic materials for TACE techniques.Firstly,the synthesized radiopaque iodinated polycaprolactonepolyurethanes(I-PCLUs)are synthesized by chain-extending method by using 4,4-′isopropylidinedi-(2,6-diiodophenol)(IBPA)as the radiopacifying agent.Then,doxorubicin(Dox)is introduced as a chemotherapeutic agent into I-PCLU beads via a double emulsification(W/O/W)method.The drug loading and controlled release behavior of two ratios of I-PCLU/Dox are found to be dependent upon the internal porous microstructure,and the radiopacity is well-retained after four weeks drug release.Besides,the I-PCLU/Dox beads exhibit positive in vitro anti-tumor effect.The in vivo intramuscular implantation and liver embolization results demonstrate that I-PCLU beads have good histocompatibility,occlusion effect and X-ray traceability.Furthermore,the drug-loaded I-PCLU beads are performed into a VX2 rabbit hepatocellular carcinoma(HCC)model using a micro-catheter,form embolization of hepatic arteries and inhibit the tumor growth after one week post-injection.Hence,this polymeric system provides a potential radiopaque chemoembolization candidate for HCC and other cancer therapies,which could bring opportunities to the next generation of multifunctional embolic agents.
文摘BACKGROUND Testicular germ cell tumor(TGCT)is the most curable solid tumor and most common cancer among men 18-39 years.While cisplatin-based chemotherapy has significantly lengthened the survival of patients with TGCT,it is associated with a high rate of thromboembolic events(TEE).AIM To summarize our single-center experience highlighting patients who were diagnosed with TGCT and received platinum-based chemotherapy,with special attention to those patients who suffered a TEE.METHODS A retrospective analysis of the medical records and imaging studies of 68 consecutive individuals who were diagnosed with TGCT and received platinumbased chemotherapy at our Institution in a metropolitan community between January 1,2014 and December 31,2019.RESULTS A total of 19(28%)patients experienced a TEE following orchiectomy which occurred during chemotherapy in 13(68%)of these patients.Patients with a higher pathologic stage(stage III)were significantly(P=0.023)more likely to experience a TEE compared to patients who had a lower stage.Additionally,patients who were treated with 3 cycles of bleomycine,etoposide,and cisplatin and 1 cycle of etoposide and cisplatin or 4 cycles of etoposide and cisplatin were significantly 5(P=0.02)times more likely to experience a TEE compared to patients who were treated with only 3 cycles of bleomycine,etoposide,and cisplatin.CONCLUSION Due to numerous factors that predispose to a TEE such as large retroperitoneal disease,higher clinical stage,greater number of chemotherapy cycle,central venous catheter,cigarette smoking,and possible cannabis use,high-risk ambulatory patients with TGCT treated with cisplatin-based chemotherapy may benefit from prophylactic anticoagulation.Randomized studies to evaluate the safety and efficacy of prophylactic anticoagulants are warranted in this young patient population generally devoid of medical co-morbidities.
文摘BACKGROUND Cholesterol crystal embolization(CCE)is a multisystemic and fatal disease with multiple clinical manifestations;however,there are few cases of idiopathic CCE.Here we report a patient with idiopathic CCE accompanied by atheroembolic renal disease and blue toes who had a relatively good prognosis in the short-term due to early treatment with corticosteroids and statins.CASE SUMMARY A 76-year-old man complained of coldness,numbness and purple color change in his left foot for 7 d.He had a feeling of fatigue,constipation,foamy urine,poor appetite and sleep.He had a lacunar infarction for 5 years and hypertension for 9 mo.Laboratory results showed elevated eosinophils,cholesterol,uric acid,serum creatinine,urea and 24 h urine analysis revealed proteinuria.A renal biopsy revealed atheroembolic renal disease.Taken together,these findings strongly supported the diagnosis of idiopathic CCE and atheroembolic renal disease.CONCLUSION Atheroembolic renal disease and blue toes syndrome can be caused by idiopathic CCE,and early treatment with corticosteroids is effective but requires further investigation.
文摘Objective:To analyze the safety and effectiveness of the ethylene-vinyl alcohol copolymer(EVOH)liquid embolic agent Squid(Emboflu,Switzerland)for the treatment of brain arteriovenous malformations.Materials and procedures:Between April 2015 and July 2017,46 embolization treatments for brain arteriovenous malformations(BAVM)were performed in 25 patients using two Squid formulations(18 and 12).Six female and 19 male patients with a mean age of 34 years(range,9–62 years)were included.A total of 46 procedures were performed.The BAVMs were classified as Spetzler-Martin gradeⅡin 4 procedures,Ⅲin 27 procedures,and 1V in 15 procedures.Among the 25 patients,15 presented with hemorrhage,5 with seizures,and 5 with headache and neurology.The BAVMs were located in the temporal lobe in 5 patients,parietal lobe in 7 patients,frontal lobe in 3 patients,posterior fossa in 6 patients,basal ganglia in 3 patients,and parasagittal lobe in 1 patient.Results:The obliteration rate of the BAVMs ranged from 10%to 100%,with a mean of 33%.Most patients underwent their first or second embolization procedure.Four patients(8%)developed intracranial bleeding post procedure,with one death(2%).One patient(2%)experienced a seizure during the procedure;however,no intracranial bleeding was observed.Seven patients(15%)experienced perforations during catheter manipulation.One case(2%)of fractured catheter was recorded,but no significant complications were observed.The average volume of copolymer injected was 0.6 ml per nidus.Thirteen procedures used the Squid-12 formulation,29 procedures used the Squid-18 formulation,and 3 procedures used a combination of Squid-12 and-18 formulations.Conclusion:Squid is a safe and effective embolic agent for treating BAVMs.
文摘To the Editor I have read the article entitled ＂Cognitive function and adherence to antieoagulation treatment in patients with atrial fibrillation＂ by Jankowska-Polafiska, et al., with great interest. The investigators reported that cognitive impairment is an independent determinant of compliance with pharmacological therapy in elderly patients with atrial fibrillation （AF）.
基金Supported by Cathay General Hospital-Taipei Medical University(No.103CGH-TMU-06No.CGH-MR-A10308)+1 种基金Wan-Fang Hospital-Taipei Medical University(No.102TMUWFH-02-2)Taipei,Taiwan China
文摘OBJECTIVE: To investigate the anti-embolic effect of Taorenchengqi Tang(TRCQT), a formulas from Traditional Chinese Medicine, plus aspirin in rats with embolic stroke induced by selective occlusion of the middle cerebral artery(MCA). Possible side effects of hemorrhagic incident and other bleeding events and anti-platelet effect were also explored.METHODS: Ninety rats were randomly separatedinto 9 groups(n = 10): group 1 a sham-operated group(n = 10); groups 2 and 3 orally treated with an isovolumetric solvent(distilled water) for 1 and3 months, followed by thromboembolic occlusion(n = 10); groups 4 and 5 orally treated with aspirin(5 mg/kg) alone for 1 and 3 months, followed by thromboembolic occlusion(n = 10); groups 6 and 7orally treated with TRCQT(0.5 g/kg) alone for 1 and3 months, followed by thromboembolic occlusion(n = 10); groups 8 and 9 orally treated with TRCQT plus aspirin for 1 and 3 months, respectively followed by thromboembolic occlusion(n = 10). The ischemic stroke in rats was induced by selective MCA occlusion. One was orally administered. After the treatments, rats' brains were removed, sectioned and stained with triphenyltetrazolium chloride(TTC) for infarct volume measurement. The incidence of subarachnoid hemorrhage(SAH) and intracerebral hemorrhage(ICH) were observed. A potential gastric bleeding side effect was assessed by measuring hemoglobin(Hb), and prothrombin time(PT). Collagen-induced platelet activation and tail vein bleeding time were measured.RESULTS: Treatment with TRCQT alone or in combination with aspirin reduced infarct volume for 1(P < 0.05), and 3(P < 0.01) months without SAH and ICH incidences, and gastric bleeding. TRCQT treatment for 1 month was also not altered PT. Moreover, a concentration dependent inhibition of collagen-induced platelet activation, followed by increasing of tail vein bleeding time was observed after TRCQT treatment.CONCLUSION: Either TRCQT alone or TRCQT plus aspirin exhibits potent neuroprotective effect by reducing infarct volume without changing the status of SAH, ICH and gastric bleeding possibly via inhib-iting the platelet activation and increasing bleeding time.
文摘Thromboembolism infrequently occurs in coronary arteries. In contrast to an in situ thrombosis, a thrombus is not fresh and floating. There has been no recommended treatment strategy for this rare condition, especially for large thrombi in main arteries. Here, we report a modified stenting strategy to treat thromboembolism in the left main coronary artery.
文摘Introduction: Venous thromboembolism (VTE) is a nosological group which mainly includes deep vein thrombosis (DVT) and pulmonary embolism (PE), it is frequently associated with high morbidity and mortality. We initiated this study with the aim of studying VTE in a cardiological hospital environment in a regional hospital in Mali. Methodology: This was a descriptive study with prospective recruitment over 1 year from June 20, 2019 to June 20, 2020, covering patients hospitalized and followed in consultation in the cardiology department of the Ségou regional hospital in Mali. Results: We collected 31 cases of VTE out of 366 patients, representing a frequency of 8.47%. The sex ratio was 0.88. VTE risk factors were dominated by immobilization (29.03%), pregnancy and postpartum (16.12%), heart failure (16.12%). The reason for consultation was dyspnea (93.54%) followed by chest pain (83.87%). On admission the clinical manifestations were tachycardia (74.19%), tachypnea (90.32%), muffled heart sounds (70.96%), global heart failure syndrome (51.6%). According to VTE probability scores;51.61% of patients had an intermediate clinical probability according to the simplified Wells score for PE and 54.84% had an intermediate clinical probability for the simplified Geneva score for DVT. D-Dimers were only performed in 12 patients (38.70%) and were elevated in all. A chest CT angiogram showed PE in 90% of patients (n = 28/31). Venous Doppler ultrasound of the lower limbs showed venous thrombosis in 3 patients. Conclusion: Venous thromboembolism, although underdiagnosed, is common in our health structures. Prevention, particularly heparinoprophylaxis and early recovery in a hospital environment, remains the effective means of combating this condition.
文摘Background We investigated differences in intracranial embolus distribution through communicating arteries in relation to supra-aortic vessel(SAV)patency.Methods For this experimental analysis,we created a silicone model of the extracranial and intracranial circulations using a blood-mimicking fluid under physiological pulsatile flow.We examined the sequence of embolus lodgment on injecting 104 frangible clot analogues(406 emboli)through the right internal carotid artery(CA)as SAV patency changed:(a)all SAV patent(baseline),(b)emboli from a CA occlusion,(c)emboli contralateral to a CA occlusion and(d)occlusion of the posterior circulation.The statistical analysis included a descriptive analysis of thrombi location after occlusion(absolute and relative frequencies).Sequences of occlusions were displayed in Sankey flow charts for the four SAV conditions.Associations between SAV conditions and occlusion location were tested by Fisher’s exact test.Two-sided p values were compared with a significance level of 0.05.Results The total number of emboli was 406(median fragments/clot:4(IQR:3-5)).Embolus lodgment was dependent on SAV patency(p<0.0001).In all scenarios,embolism lodging in the anterior cerebral artery(ACA)occurred after a previous middle cerebral artery(MCA)embolism(MCA first lodge:96%,100/104).The rate of ipsilateral ACA embolism was 28.9%(28/97)at baseline,decreasing significantly when emboli originated from an occluded CA(16%,14/88).There were more bihemispheric embolisations in cases of contralateral CA occlusion(37%,45/122),with bilateral ACA embolisms preceding contralateral MCA embolism in 56%of cases(14/25 opposite MCA and ACA embolism).Conclusions All emboli in the ACA occurred after a previous ipsilateral MCA embolism.Bihemispheric embolisms were rare,except when there was a coexisting occlusion in either CA,particularly in cases of a contralateral CA occlusion.
基金the National Natural Science Foun-dation of China(22205264)the Guangdong-Hong Kong-Macao Uni-versity Joint Laboratory of Interventional Medicine Foundation of Guangdong Province(2023LSYS001)the Hundred Talents Program of Sun Yat-sen University.
文摘Current liquid embolic agents face several challenges,including poor biocompatibility and vascular recanali-zation.Herein,we propose an innovative liquid embolic agent composed of a coenzyme-based polymer(poly lipoic acid,PLA)and a biocompatible solvent(deep eutectic solvent,DES).The agent undergoes phase trans-formation to form a stable hydrogel in situ through solvent exchange with water,thereby enabling safe and effective embolization.First,DES is obtained by heating a mixture of choline chloride(ChCl)and glycerol(Gly).Subsequently,lipoic acid(LA)is incorporated into the DES and heated to produce the PLA/DES complex.Owing to the strong hydrogen bonding between the DES and PLA,the DES acts as a solvent while also inhibiting PLA depolymerization.Upon contact with blood,most of the DES exchange with water,whereas some amount of ChCl integrates within the PLA via strong hydrogen bonding.This hydrogen bonding not only prevents PLA depoly-merization but also reinforces the PLA network,resulting in a stable PLA hydrogel rather than depolymerized LA monomers.Furthermore,liquid-metal(LM)nanoparticles are incorporated to fabricate radiopaque PLA/LM/DES.PLA/LM/DES shows better in vitro hemocompatibility and cytocompatibility,milder inflammatory response in a rat model,and more effective and safer embolization in a rabbit model than a commercial embolic agent(Onyx).Thus,this work provides an innovative liquid embolic agent and broadens the biomedical ap-plications of DES.
基金supported by grants from Shenzhen Third People’s Hospital project(Nos.22240G1013,22250 G1013)HUI LAN Public Welfare(No.23250H1003)Henan Clinical Research Center of Infectious Diseases(AIDS)(Affiliated Infectious Diseases Hospital of Zhengzhou University,and Henan Infectious Diseases Hospital)2024 Open Subjects(No.KFKT202402).
文摘Human immunodeficiency virus(HIV)is a highly adaptable and rapidly evolving virus,and the current population of people infected with HIV and diagnosed with acquired immune deficiency syndrome(AIDS)continues to grow.Although the lifespan of HIV-infected people(PWH)has been extended through control with antiretroviral therapy(ART),however,as the aging of PWH increases,this population is prone to new complications,including thromboembolic disease(TED).TED has been recognized as one of the most common cardiovascular diseases among PWH.
基金supported by Liaoning Xingliao Talent Project (Grant No. XLYC2007020)。
文摘Hemoptysis is a severe complication of pulmonary hypertension (PH) with a low in- cidence of 6%-11%.^([1-4])Although occurring in all forms of PH,it is more commonly seen in pulmonary arterial hypertension (PAH),associated with congenital heart disease (PAH-CHD).^([5,6])Since enlarged bronchial arteries are a frequent source of pulmonary bleeding,the primary treatment focuses on bronchial artery embolization (BAE),especially for chronic thromboembolic pulmonary hypertension (CTEPH) patients^([7,8]).However,there is disagreement regarding medical therapy,which has received little attention in the recently published PH guidelines.^([5,6])
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ThisstudywassupportedbythegrantforKeyProjectofNationalNaturalScienceFoundationinChina (No39730170)andthegrantforGeneralProjectofNSFC (No 3 9770 810 )
文摘OBJECTIVE: To study whether recombinant adeno-associated virus (rAAV) mediated foreign gene, LacZ, could pass the blood brain barrier by intra-carotid artery delivery and express in vivo in ischemic brain of the focal embolic stroke rats to investigate a possibility of delivering foreign gene through carotid artery to treat acute ischemic stroke. METHODS: The carotid artery territory in 41 rats was embolized with or without arterial-like fibrin rich clots to make a model of focal embolic stroke rat. rAAV containing LacZ gene (rAAV-LacZ) was constructed in 293 cells by calcium phosphate cotransfection. The rats were assigned to one of the following treatments: 1 control (without embolism) groups, including PBS treated (n = 6), pLacZ treated (n = 6 ) and rAAV-LacZ treated (n = 6): 2 embolic groups, including embolism + PBS (n =7),embolism + pLacZ (n = 8) and embolism + rAAV-LacZ (n = 8). Brains were cryosectioned and kappa-Gal stain was performed at 2, 4, and 8 weeks, respectively, after transfection, and then infarct volume was measured and the percentage of LacZ staining-positive cells was calculated. RESULTS: In all the control groups and embolism + PBS treated animal, no kappa-Gal staining-positive cells were found, but in embolism + pLacZ (n = 8) and embolism+rAAV-LacZ groups a lot of kappa-Gal staining-positive cells were found. The expression cells were in the tissues around the infarction. The gene expression persisted only nearly four weeks in embolic group with pLacZ. In the embolic group with rAAV-LacZ the expression was very stable during the experiment course (eight weeks) and the percentage of the expressed cells was significantly higher than that of its contralateral areas at the same time points, respectively. CONCLUSIONS: The plasmid vector and rAAV could enter the brain through the ischemia-damaged blood barrier and foreign gene can be expressed in brain. The positive gene expression is mainly in the peripheral areas of the infarction. rAAV as a permanent expression vector may ultimately be used for gene therapy of human ischemia cerebravascular diseases.
