Objective To explore the value of ultrafast pulse wave velocity(UFPWV)technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis(HT)patients with euthyroidism.Methods Conventional ultrasoun...Objective To explore the value of ultrafast pulse wave velocity(UFPWV)technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis(HT)patients with euthyroidism.Methods Conventional ultrasound and UFPWV for carotid artery were prospectively performed in 91 HT patients with euthyroidism(HT group)and 81 healthy subjects(control group).Clinical data and ultrasonic parameters were compared between groups.Spearman correlation analysis was performed to observe the correlations of carotid pulse wave velocity in end of systole(PWV-ES)with clinical indexes and other ultrasonic parameters in HT group.Multiple stepwise linear regression analysis was used to screen the independent impact factors of increased carotid PWV-ES in HT group.Results Significant differences of thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TgAb),total cholesterol(TC),low density lipoprotein and neutrophil-lymphocyte ratio(NLR)were found between groups(all P<0.05).The carotid PWV-ES in HT group was significantly higher than that in control group(P<0.05),while no significant difference of carotid artery intima-media thickness(CIMT)nor carotid pulse wave velocity in beginning of systole(PWV-BS)was found between groups(both P>0.05).Carotid PWV-ES in HT group was positively correlated with patients'age,body mass index,TPOAb,TC,triglyceride,NLR and CIMT(r=0.217—0.707,all P<0.05).Patients'age,TPOAb and NLR were all independent impact factors of increased carotid PWV-ES in HT patients with euthyroidism(all P<0.05).Conclusion UFPWV technique could be used to evaluate changes of carotid artery elasticity in HT patients with euthyroidism,among which PWV-ES was relatively sensitive.展开更多
Objective BACKGROUND Spontaneous closure of direct traumatic carotid cavernous fistulas (TCCFs) is rare. A few cases have been reported in literature to be related to diagnostic cerebral angiography and orbital venogr...Objective BACKGROUND Spontaneous closure of direct traumatic carotid cavernous fistulas (TCCFs) is rare. A few cases have been reported in literature to be related to diagnostic cerebral angiography and orbital venography. Several mechanisms have been postulated, including irritation of the vessels from contrast media, compression of the carotid artery and reduced blood pressure from general anesthesia. In our own series of about 400 patients at Ramathibodi Hospital, the incidence is approximately 1.75%.CASE PRESENTATION We present a case, which spontaneous closure occurred during attempted endovascular embolization. A 45-year-old woman with left TCCF was referred to our hospital for endovascular treatment. Cerebral angiogram revealed a small-hole fistula at the posterosuperior wall of C2-3 segment of the LICA. Transarterial balloon failed due to the small size of the fistula and acute retroangulation of the balloon attached microcatheter. Transarterial GDC coil placement into the first venous pouch was then attempted for two times, but was unsuccessful. During repositioning of the microcatheter for a third attempt, spontaneous closure of the fistula was observed and confirmed by control angiogram. CONCLUSION Spontaneous closure of direct traumatic carotid cavernous fistulas may occur during endovascular procedures, which can be caused by dissection of the venous pouch by the microcatheter or coils during manipulation, irritation of the vascular walls from the contrast media and decreased blood pressure from general anesthesia.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
Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas (CCF) and their complications such as pseudoaneurysms. Methods: Over a five-year period, 22 patients with traumatic direct...Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas (CCF) and their complications such as pseudoaneurysms. Methods: Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coil embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stent management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% (4/22). A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% (8/22). Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.展开更多
Objective Intracranial internal carotid artery dissection is a rare case. The purpose of this study was to report the treatment of intracranial internal carotid dissection and the radiologic and clinical result.Materi...Objective Intracranial internal carotid artery dissection is a rare case. The purpose of this study was to report the treatment of intracranial internal carotid dissection and the radiologic and clinical result.Material And Method A 67 year-old female patient admitted for lower leg fracture at the outside university hospital. After 6 days later, she presented with left hemiparesis, verbal disturbance and visual disturbance. She transferred to our hospital and evaluated with MRI and Angiography. Angiography show stenosis with ulceration and pseudoaneurysm at the internal carotid artery. The stenosis rate was 63%. At the lesion, ophthalmic artery was poor visualized. Results The intracranial lesion was treated with angioplasty and stenting. After stenting, angiography showed good ophthalmic artery flow. Patients improved visual acuity just after stenting. Conclusions Intracranial angioplasty and stenting will be a good treatment option in a highly selected case.展开更多
Objective Introduction When we perform transvenous embolization of carotid cavernous fistula, we selectively occluded the venous outflow to the retrograde cortical venous drainage and retrograde ophthalmic venous drai...Objective Introduction When we perform transvenous embolization of carotid cavernous fistula, we selectively occluded the venous outflow to the retrograde cortical venous drainage and retrograde ophthalmic venous drainage as the initial steps before the rest of the cavernous sinus. The rationale is to prevent re-diversion of flow into the ophthalmic veins and cortical veins in a subtotally occluded carotid cavernous fistula.Method From 1997 to 2004, a total of 46 patients with carotid cavernous fistula were treated by transvenous embolization using the proposed selective occlusion strategy. There were 6 direct and 40 dural cartoid cavernous fistulae. The embolic agents were Guglielmi detachable coils and fibered platinum coils. Transvenous embolization routes included inferior petrosal sinus (IPS) alone (32 patients), IPS and intercavernous sinus (9 patients), and superior ophthalmic vein (5 patients).Result The follow-up period ranged from 4 months to 7 years. One patient developed retinal hemorrhage due to ophthalic vein thrombosis one week after the embolization procedure. Two patients had transient ophthalmoplegia and 2 patients had symptomatic recurrence of the carotid cavernous fistula during the follow-up. Clinical cure was achieved in 44 patients (96%).Conclusion The sequential occlusion strategy offers a safe and effective method in the transvenous embolization of carotid cavernous fistula.展开更多
目的分析急性脑梗死(acute cerebral infarction,ACI)患者小而密低密度脂蛋白(small dense low-density lipoprotein,sd-LDL)及脂蛋白(a)水平与颈动脉斑块稳定性的关系。方法回顾性选取2020年2月至2024年2月河北省人民医院收治的老年AC...目的分析急性脑梗死(acute cerebral infarction,ACI)患者小而密低密度脂蛋白(small dense low-density lipoprotein,sd-LDL)及脂蛋白(a)水平与颈动脉斑块稳定性的关系。方法回顾性选取2020年2月至2024年2月河北省人民医院收治的老年ACI患者160例,所有患者行颈部彩色多普勒超声检查,依据颈动脉斑块情况分为无斑块组43例、稳定斑块组56例和不稳定斑块组61例,另取同期河北省人民医院健康体检者40例作为对照组,比较4组临床资料、sd-LDL、脂蛋白(a)水平,评估sd-LDL、脂蛋白(a)水平对不稳定斑块的预测价值。结果与无斑块组比较,稳定斑块组和不稳定斑块组美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)显著升高,不稳定斑块组总胆固醇显著升高,高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)显著降低,对照组NIHSS评分、总胆固醇、三酰甘油、LDL-C显著降低,HDL-C显著升高,差异有统计学意义(P<0.05);与稳定斑块组比较,不稳定斑块组NIHSS评分、LDL-C、sdLDL、脂蛋白(a)显著升高,HDL-C显著降低,对照组脂蛋白(a)显著降低,差异有统计学意义(P<0.05)。Pearson相关性分析显示,sd-LDL、脂蛋白(a)水平与NIHSS评分、总胆固醇、三酰甘油、LDL-C呈显著正相关(P<0.05,P<0.01),与HDL-C呈显著负相关(P<0.01)。二元logistic回归分析显示,NIHSS评分、LDL-C、sd-LDL、脂蛋白(a)是ACI患者颈动脉不稳定斑块形成的危险因素,HDL-C是保护因素(P<0.01)。ROC曲线结果显示,sd-LDL、脂蛋白(a)及联合检测对颈动脉斑块稳定性预测的ROC曲线下面积分别为0.830、0.847、0.921,联合检测的敏感性高于sd-LDL、脂蛋白(a)单项指标检测(93.44%vs 88.52%、86.89%,P=0.000)。结论血浆sd-LDL、脂蛋白(a)水平与ACI患者颈动脉斑块稳定性具有一定关联性,可作为临床相关参考指标。展开更多
文摘Objective To explore the value of ultrafast pulse wave velocity(UFPWV)technique for evaluating changes of carotid artery elasticity in Hashimoto thyroiditis(HT)patients with euthyroidism.Methods Conventional ultrasound and UFPWV for carotid artery were prospectively performed in 91 HT patients with euthyroidism(HT group)and 81 healthy subjects(control group).Clinical data and ultrasonic parameters were compared between groups.Spearman correlation analysis was performed to observe the correlations of carotid pulse wave velocity in end of systole(PWV-ES)with clinical indexes and other ultrasonic parameters in HT group.Multiple stepwise linear regression analysis was used to screen the independent impact factors of increased carotid PWV-ES in HT group.Results Significant differences of thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TgAb),total cholesterol(TC),low density lipoprotein and neutrophil-lymphocyte ratio(NLR)were found between groups(all P<0.05).The carotid PWV-ES in HT group was significantly higher than that in control group(P<0.05),while no significant difference of carotid artery intima-media thickness(CIMT)nor carotid pulse wave velocity in beginning of systole(PWV-BS)was found between groups(both P>0.05).Carotid PWV-ES in HT group was positively correlated with patients'age,body mass index,TPOAb,TC,triglyceride,NLR and CIMT(r=0.217—0.707,all P<0.05).Patients'age,TPOAb and NLR were all independent impact factors of increased carotid PWV-ES in HT patients with euthyroidism(all P<0.05).Conclusion UFPWV technique could be used to evaluate changes of carotid artery elasticity in HT patients with euthyroidism,among which PWV-ES was relatively sensitive.
文摘Objective BACKGROUND Spontaneous closure of direct traumatic carotid cavernous fistulas (TCCFs) is rare. A few cases have been reported in literature to be related to diagnostic cerebral angiography and orbital venography. Several mechanisms have been postulated, including irritation of the vessels from contrast media, compression of the carotid artery and reduced blood pressure from general anesthesia. In our own series of about 400 patients at Ramathibodi Hospital, the incidence is approximately 1.75%.CASE PRESENTATION We present a case, which spontaneous closure occurred during attempted endovascular embolization. A 45-year-old woman with left TCCF was referred to our hospital for endovascular treatment. Cerebral angiogram revealed a small-hole fistula at the posterosuperior wall of C2-3 segment of the LICA. Transarterial balloon failed due to the small size of the fistula and acute retroangulation of the balloon attached microcatheter. Transarterial GDC coil placement into the first venous pouch was then attempted for two times, but was unsuccessful. During repositioning of the microcatheter for a third attempt, spontaneous closure of the fistula was observed and confirmed by control angiogram. CONCLUSION Spontaneous closure of direct traumatic carotid cavernous fistulas may occur during endovascular procedures, which can be caused by dissection of the venous pouch by the microcatheter or coils during manipulation, irritation of the vascular walls from the contrast media and decreased blood pressure from general anesthesia.
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.
文摘Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas (CCF) and their complications such as pseudoaneurysms. Methods: Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coil embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stent management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% (4/22). A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% (8/22). Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.
文摘Objective Intracranial internal carotid artery dissection is a rare case. The purpose of this study was to report the treatment of intracranial internal carotid dissection and the radiologic and clinical result.Material And Method A 67 year-old female patient admitted for lower leg fracture at the outside university hospital. After 6 days later, she presented with left hemiparesis, verbal disturbance and visual disturbance. She transferred to our hospital and evaluated with MRI and Angiography. Angiography show stenosis with ulceration and pseudoaneurysm at the internal carotid artery. The stenosis rate was 63%. At the lesion, ophthalmic artery was poor visualized. Results The intracranial lesion was treated with angioplasty and stenting. After stenting, angiography showed good ophthalmic artery flow. Patients improved visual acuity just after stenting. Conclusions Intracranial angioplasty and stenting will be a good treatment option in a highly selected case.
文摘Objective Introduction When we perform transvenous embolization of carotid cavernous fistula, we selectively occluded the venous outflow to the retrograde cortical venous drainage and retrograde ophthalmic venous drainage as the initial steps before the rest of the cavernous sinus. The rationale is to prevent re-diversion of flow into the ophthalmic veins and cortical veins in a subtotally occluded carotid cavernous fistula.Method From 1997 to 2004, a total of 46 patients with carotid cavernous fistula were treated by transvenous embolization using the proposed selective occlusion strategy. There were 6 direct and 40 dural cartoid cavernous fistulae. The embolic agents were Guglielmi detachable coils and fibered platinum coils. Transvenous embolization routes included inferior petrosal sinus (IPS) alone (32 patients), IPS and intercavernous sinus (9 patients), and superior ophthalmic vein (5 patients).Result The follow-up period ranged from 4 months to 7 years. One patient developed retinal hemorrhage due to ophthalic vein thrombosis one week after the embolization procedure. Two patients had transient ophthalmoplegia and 2 patients had symptomatic recurrence of the carotid cavernous fistula during the follow-up. Clinical cure was achieved in 44 patients (96%).Conclusion The sequential occlusion strategy offers a safe and effective method in the transvenous embolization of carotid cavernous fistula.
文摘目的分析急性脑梗死(acute cerebral infarction,ACI)患者小而密低密度脂蛋白(small dense low-density lipoprotein,sd-LDL)及脂蛋白(a)水平与颈动脉斑块稳定性的关系。方法回顾性选取2020年2月至2024年2月河北省人民医院收治的老年ACI患者160例,所有患者行颈部彩色多普勒超声检查,依据颈动脉斑块情况分为无斑块组43例、稳定斑块组56例和不稳定斑块组61例,另取同期河北省人民医院健康体检者40例作为对照组,比较4组临床资料、sd-LDL、脂蛋白(a)水平,评估sd-LDL、脂蛋白(a)水平对不稳定斑块的预测价值。结果与无斑块组比较,稳定斑块组和不稳定斑块组美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)显著升高,不稳定斑块组总胆固醇显著升高,高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)显著降低,对照组NIHSS评分、总胆固醇、三酰甘油、LDL-C显著降低,HDL-C显著升高,差异有统计学意义(P<0.05);与稳定斑块组比较,不稳定斑块组NIHSS评分、LDL-C、sdLDL、脂蛋白(a)显著升高,HDL-C显著降低,对照组脂蛋白(a)显著降低,差异有统计学意义(P<0.05)。Pearson相关性分析显示,sd-LDL、脂蛋白(a)水平与NIHSS评分、总胆固醇、三酰甘油、LDL-C呈显著正相关(P<0.05,P<0.01),与HDL-C呈显著负相关(P<0.01)。二元logistic回归分析显示,NIHSS评分、LDL-C、sd-LDL、脂蛋白(a)是ACI患者颈动脉不稳定斑块形成的危险因素,HDL-C是保护因素(P<0.01)。ROC曲线结果显示,sd-LDL、脂蛋白(a)及联合检测对颈动脉斑块稳定性预测的ROC曲线下面积分别为0.830、0.847、0.921,联合检测的敏感性高于sd-LDL、脂蛋白(a)单项指标检测(93.44%vs 88.52%、86.89%,P=0.000)。结论血浆sd-LDL、脂蛋白(a)水平与ACI患者颈动脉斑块稳定性具有一定关联性,可作为临床相关参考指标。
