Vertebral artery dissection is a rare pathology that can cause ischemic stroke in young people.Cervical massage,especially improper pulling manipulation,is a cause of vertebral artery dissection.We present a case of 3...Vertebral artery dissection is a rare pathology that can cause ischemic stroke in young people.Cervical massage,especially improper pulling manipulation,is a cause of vertebral artery dissection.We present a case of 32-year old woman who developed acute multiple posterior circulation ischemic cerebral infarctions as a result of left vertebral artery V4 segment dissection after receiving neck massage.She underwent emergency vertebral artery stent implantation at the site of the dissection.Symptoms were relieved the day after treatment.The patient recovered without adverse complications or endovascular restenosis in the following year.展开更多
Background Development of arterial dissection is thought to be an important key factor for bailout stenting in femoropopliteal disease. We aimed to evaluate the difference in dissection rate and outcomes between the t...Background Development of arterial dissection is thought to be an important key factor for bailout stenting in femoropopliteal disease. We aimed to evaluate the difference in dissection rate and outcomes between the treatment group with rotational atherectomy and with？out it. Methods From January 2011 to October 2016, we compared the angiography after balloon angioplasty （BA） of de-novo, femoropop？liteal, steno-occlusive lesions whether they were treated by rotational atherectomy prior to the BA or not. Fifty-nine lesions （8 occlusions; 3 involving popliteal segment; lesion length： 86.3 ± 66.8 mm） in 44 patients （29 males; mean age 66.9 ± 9.7 years） were enrolled for this review. Results Forty-two lesions were treated using rotational atherectomy, prior to BA while 17 were recanalized firstly by BA. Clinical and lesion characteristics were not different between the groups. However, the rate of significant arterial dissection （type C to F） was lower in the atherectomy group （88.2% vs. 42.9%; P = 0.001）. In multivariate analysis, use of the atherectomy device was the only risk factor for prevention of development of significant dissection （P = 0.013; OR = 0.12; 95% CI： 0.025？0.642）. Patients were treated either by the angioplasty alone, drug coated balloon or stent insertion. There was lower trend in target vessel revascularization and primary patency toward the atherectomy group （low rank P = 0.108 and 0.166）, however secondary patency was significantly better （low rank P = 0.001）. Conclusions Rotational atherec？tomy before BA reduced the rate of significant dissection and therefore, might be a valuable option for minimizing need of bailout stenting.展开更多
BACKGROUND:Spontaneous isolated superior mesenteric artery(SMA)dissection(SISMAD)is a rare cause of abdominal pain.The aim of the study is to investigate the role of a new parameter,the ratio of the SMA diameter to th...BACKGROUND:Spontaneous isolated superior mesenteric artery(SMA)dissection(SISMAD)is a rare cause of abdominal pain.The aim of the study is to investigate the role of a new parameter,the ratio of the SMA diameter to the superior mesenteric vein(SMV)diameter(SMA/SMV)based on non-enhanced computed tomography(CT),in the early diagnosis of SISMAD.METHODS:In a registry study from December 2013 to June 2021,97 abdominal pain SISMAD patients(SISMAD group)admitted to our hospital were enrolled.Meanwhile,the matched sex and age abdominal pain non-SISMAD patients at 1:2 were collected in reverse chronological order as the control group.Student’s t-test,Wilcoxon rank-sum test,and Chi-square test were used to compare differences between the SISMAD and control groups.Med Calc was used to generate receiver operating characteristic(ROC)curve.RESULTS:A total of 291 abdominal pain patients,including 97 SISMAD patients and 194 nonSISMAD patients,were included in the current study.The maximum SMA diameter,perivascular exudation,and SMA/SMV based on non-enhanced CT were significant between the two groups(all P<0.05).ROC curves showed that for the maximum SMA diameter,the area under the curve(AUC),cut-off,sensitivity,and specificity were 0.926,9.80,93.8%,and 79.4%,respectively.For SMA/SMV,its AUC,cut-off,sensitivity,and specificity were 0.956,0.83,88.7%,and 92.3%,respectively.The diagnostic efficiency of SMA/SMV was better than that of the maximum SMA diameter(P<0.05).The combined parameters of SMA/SMV and maximum SMA diameter had the best diagnostic efficiency(AUC=0.970).CONCLUSION:SMA/SMV may be a potential marker for SISMAD.展开更多
文摘Vertebral artery dissection is a rare pathology that can cause ischemic stroke in young people.Cervical massage,especially improper pulling manipulation,is a cause of vertebral artery dissection.We present a case of 32-year old woman who developed acute multiple posterior circulation ischemic cerebral infarctions as a result of left vertebral artery V4 segment dissection after receiving neck massage.She underwent emergency vertebral artery stent implantation at the site of the dissection.Symptoms were relieved the day after treatment.The patient recovered without adverse complications or endovascular restenosis in the following year.
文摘Background Development of arterial dissection is thought to be an important key factor for bailout stenting in femoropopliteal disease. We aimed to evaluate the difference in dissection rate and outcomes between the treatment group with rotational atherectomy and with？out it. Methods From January 2011 to October 2016, we compared the angiography after balloon angioplasty （BA） of de-novo, femoropop？liteal, steno-occlusive lesions whether they were treated by rotational atherectomy prior to the BA or not. Fifty-nine lesions （8 occlusions; 3 involving popliteal segment; lesion length： 86.3 ± 66.8 mm） in 44 patients （29 males; mean age 66.9 ± 9.7 years） were enrolled for this review. Results Forty-two lesions were treated using rotational atherectomy, prior to BA while 17 were recanalized firstly by BA. Clinical and lesion characteristics were not different between the groups. However, the rate of significant arterial dissection （type C to F） was lower in the atherectomy group （88.2% vs. 42.9%; P = 0.001）. In multivariate analysis, use of the atherectomy device was the only risk factor for prevention of development of significant dissection （P = 0.013; OR = 0.12; 95% CI： 0.025？0.642）. Patients were treated either by the angioplasty alone, drug coated balloon or stent insertion. There was lower trend in target vessel revascularization and primary patency toward the atherectomy group （low rank P = 0.108 and 0.166）, however secondary patency was significantly better （low rank P = 0.001）. Conclusions Rotational atherec？tomy before BA reduced the rate of significant dissection and therefore, might be a valuable option for minimizing need of bailout stenting.
基金supported by Clinical Scientific Research Fund of Zhejiang Medical Association(2021ZYC-A73)。
文摘BACKGROUND:Spontaneous isolated superior mesenteric artery(SMA)dissection(SISMAD)is a rare cause of abdominal pain.The aim of the study is to investigate the role of a new parameter,the ratio of the SMA diameter to the superior mesenteric vein(SMV)diameter(SMA/SMV)based on non-enhanced computed tomography(CT),in the early diagnosis of SISMAD.METHODS:In a registry study from December 2013 to June 2021,97 abdominal pain SISMAD patients(SISMAD group)admitted to our hospital were enrolled.Meanwhile,the matched sex and age abdominal pain non-SISMAD patients at 1:2 were collected in reverse chronological order as the control group.Student’s t-test,Wilcoxon rank-sum test,and Chi-square test were used to compare differences between the SISMAD and control groups.Med Calc was used to generate receiver operating characteristic(ROC)curve.RESULTS:A total of 291 abdominal pain patients,including 97 SISMAD patients and 194 nonSISMAD patients,were included in the current study.The maximum SMA diameter,perivascular exudation,and SMA/SMV based on non-enhanced CT were significant between the two groups(all P<0.05).ROC curves showed that for the maximum SMA diameter,the area under the curve(AUC),cut-off,sensitivity,and specificity were 0.926,9.80,93.8%,and 79.4%,respectively.For SMA/SMV,its AUC,cut-off,sensitivity,and specificity were 0.956,0.83,88.7%,and 92.3%,respectively.The diagnostic efficiency of SMA/SMV was better than that of the maximum SMA diameter(P<0.05).The combined parameters of SMA/SMV and maximum SMA diameter had the best diagnostic efficiency(AUC=0.970).CONCLUSION:SMA/SMV may be a potential marker for SISMAD.
