Colonic anastomotic leakage(AL)remains the most severe complication of colorectal surgery,significantly increasing morbidity,mortality,and healthcare burdens.The ideal solution-complete AL prevention without a defunct...Colonic anastomotic leakage(AL)remains the most severe complication of colorectal surgery,significantly increasing morbidity,mortality,and healthcare burdens.The ideal solution-complete AL prevention without a defunctioning stoma-has long eluded surgeons and patients.Hu et al proposed total enteric flow diversion using a modified ileostomy tube with an inflatable balloon,demonstrating its efficacy in completely preventing AL in porcine models.This innovation echoes the ancient legend of Yu the Great,a Chinese hero renowned for taming the Yellow River’s catastrophic floods.Unlike his father,who failed by merely building embankments to block water,Yu succeeded by dredging channels to redirect floods seaward.This paradigm of“diversion over obstruction”applies equally to AL prevention.Beyond Hu et al’s balloon technique,alternatives like the C-seal,the SafeHeal Colovac+anastomosis protection device and Tong et al’s biodegradable stent-based diverting techniques show promise in clinical trials.Key challenges remain:Diversion efficiency,device migration risks,and patient tolerance.We must accelerate such like breakthroughs in non-stoma diversion strategies to transform AL management.展开更多
BACKGROUND Mechanical thrombectomy is the most effective treatment for great cerebral artery embolization within a set time window.Typically,an arteriogram does not show the localization of the stent after release and...BACKGROUND Mechanical thrombectomy is the most effective treatment for great cerebral artery embolization within a set time window.Typically,an arteriogram does not show the localization of the stent after release and whether a thrombus is captured or not.Thus,improving the visualization of a stent in interventional therapy will be helpful for clinicians.AIM To analyze stent imaging findings to enhance clinicians’understanding of a special circumstance,wherein a Solitaire AB retrievable stent was visible during the imaging of a thrombus capture that improved the success rate of stent-based mechanical thrombectomy.METHODS This was a retrospective study with four acute ischemic stroke(AIS)patients who underwent stent-based mechanical thrombectomy.RESULTS Patient 1 was a 64-year-old man admitted after 5 h of confusion;angiography revealed basilar artery occlusion.We inserted a stent into the left posterior cerebral artery-P2 segment and visualized the expanded stent that successfully captured a thrombus.Patient 2 was a 74-year-old man admitted with confusion,which lasted approximately 3 h.Angiography revealed a left middle cerebral artery(MCA)-M1 segment occlusion.A stent was deployed in the distal M2 segment,and we could visualize the stent by capturing the thrombus.Patient 3 was a 74-year-old woman admitted after experiencing left hemiplegia for 3 h.We deployed a stent at the distal right MCAM2 segment,and the developing stent captured a large thrombus.Patient 4 was an 82-year-old man who presented with confusion for 3 h.A developing stent was placed in the distal left MCA-M1 segment,which captured a large thrombus and several fragmented thrombi.CONCLUSION To the best of our knowledge,this is the first report of stent imaging in patients with AIS.We demonstrated the usefulness and substantial potential of stent imaging in stent-based mechanical thrombectomy for AIS.展开更多
文摘Colonic anastomotic leakage(AL)remains the most severe complication of colorectal surgery,significantly increasing morbidity,mortality,and healthcare burdens.The ideal solution-complete AL prevention without a defunctioning stoma-has long eluded surgeons and patients.Hu et al proposed total enteric flow diversion using a modified ileostomy tube with an inflatable balloon,demonstrating its efficacy in completely preventing AL in porcine models.This innovation echoes the ancient legend of Yu the Great,a Chinese hero renowned for taming the Yellow River’s catastrophic floods.Unlike his father,who failed by merely building embankments to block water,Yu succeeded by dredging channels to redirect floods seaward.This paradigm of“diversion over obstruction”applies equally to AL prevention.Beyond Hu et al’s balloon technique,alternatives like the C-seal,the SafeHeal Colovac+anastomosis protection device and Tong et al’s biodegradable stent-based diverting techniques show promise in clinical trials.Key challenges remain:Diversion efficiency,device migration risks,and patient tolerance.We must accelerate such like breakthroughs in non-stoma diversion strategies to transform AL management.
基金The Clinical Research Project of The First Affiliated Hospital of Shenzhen University,No.20223357030 and No.20223357021the“Double-First Class”Application Characteristic Discipline of Hunan Province(Pharmaceutical Science).
文摘BACKGROUND Mechanical thrombectomy is the most effective treatment for great cerebral artery embolization within a set time window.Typically,an arteriogram does not show the localization of the stent after release and whether a thrombus is captured or not.Thus,improving the visualization of a stent in interventional therapy will be helpful for clinicians.AIM To analyze stent imaging findings to enhance clinicians’understanding of a special circumstance,wherein a Solitaire AB retrievable stent was visible during the imaging of a thrombus capture that improved the success rate of stent-based mechanical thrombectomy.METHODS This was a retrospective study with four acute ischemic stroke(AIS)patients who underwent stent-based mechanical thrombectomy.RESULTS Patient 1 was a 64-year-old man admitted after 5 h of confusion;angiography revealed basilar artery occlusion.We inserted a stent into the left posterior cerebral artery-P2 segment and visualized the expanded stent that successfully captured a thrombus.Patient 2 was a 74-year-old man admitted with confusion,which lasted approximately 3 h.Angiography revealed a left middle cerebral artery(MCA)-M1 segment occlusion.A stent was deployed in the distal M2 segment,and we could visualize the stent by capturing the thrombus.Patient 3 was a 74-year-old woman admitted after experiencing left hemiplegia for 3 h.We deployed a stent at the distal right MCAM2 segment,and the developing stent captured a large thrombus.Patient 4 was an 82-year-old man who presented with confusion for 3 h.A developing stent was placed in the distal left MCA-M1 segment,which captured a large thrombus and several fragmented thrombi.CONCLUSION To the best of our knowledge,this is the first report of stent imaging in patients with AIS.We demonstrated the usefulness and substantial potential of stent imaging in stent-based mechanical thrombectomy for AIS.
