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Objectives: To evaluate the risk factors and safety of carotid angioplasty and stenting(CAS) for extracranial carotid stenosis in elderly patients and summarize CAS on the indication of elderly patients and the prevention of complications., Methods: The population characteristics, clinical features and vascular data of 60 elderly patients (≥ 75 years) treated between June 2001 and December 2010 were retrospectively analyzed. There were 57 male and 3 female. The median age of the patients was 78.8 years (range, 75 - 93 years ). The mean case history was 2.5 months with a range of 1 to 6 months. To summarize the prognosis of CAS according to the reduction of stenosis, NIHSS score, the incidence of early postoperative, 30 days adverse events and the follow-up status. Using χ(2) test as the statistical method., Results: The mean stenosis was reduced from 81% ± 17% preoperative to 18% ± 9% postoperative. NIHSS score was reduced from preoperative 22 ± 8 to postoperative 10 ± 4. The average follow-up period was 1.5 years (range from 3 months to 3 years), and the results showed no procedure-related death occurred. Ipsilateral stroke occurred in 1 case (1.7%) and restenosis (≥ 50%) occurred in 2 patients (3.3%). Diabetes (χ(2) = 23.96, P < 0.01)and cardiac insufficiency (χ(2) = 6.446, P < 0.05)had a respectively significant impact on the incidence of early postoperative complications., Conclusions: CAS can be effective in restoring carotid artery stenosis of elderly patients and preventing the occurrence of stroke. The elderly, diabetes, cardiac insufficiency are more likely to increase the postoperative risk of adverse events.

Objective: To discuss the efficiency and safety of carotid angioplasty stenting (CAS) in patients with contralateral carotid artery occlusion., Methods: From January 2001 to January 2010, 56 carotid artery stenosis patients with contralateral carotid artery occlusion were performed CAS and the feature and results of these cases were analyzed retrospectively. All the cases were confirmed to be carotid artery stenosis with contralateral carotid artery occlusion by digital subtraction angiography (DSA). The diameter stenosis rate was 72% ± 15%. CAS were performed with distal protection device in 56 cases., Results: The technique success rate of CAS were 100% in all the 56 patients with contralateral carotid artery occlusion and post-procedure stenosis rate descended to 13% ± 8%, and the symptoms of cerebral ischemia were all improved. Only 1 case occurred remote hemorrhage in the position of previous cerebral infarction in the side of CAS after the procedure, and recovered with light neurological deficit after the craniotomy to remove the hematoma. No ischemic complications or death occurred. During the following up of 6 months to 3 years, no cerebral ischemic symptoms reoccurred. The rechecking results of color Doppler of 47 cases and DSA of 2 cases showed no restenosis in-stent., Conclusions: CAS is safe and effective for the patients with contralateral carotid artery occlusion. Critical election of the case, operation of skilled doctors and scrupulous post procedure general management can decrease the rate of complication.

Objective: To investigate and evaluate the effectiveness and safety of the percutaneous transluminal angioplasty (PTA) and stent placement (SP) in the treatment of left subclavian steal syndrome (SSS)., Methods: From January 2007 to December 2009, 32 patients with left SSS were selected and the digital subtracted angiography (DSA) were used to evaluate before PTA and SP. Anticoagulation and antiplatelet therapy before and after interventional treatment were taken. Then the therapeutic effect was evaluated after the procedure immediately, in the third month and the sixth month post-operatively by transcranial doppler sonography (TCD)., Results: DSA was used to evaluate therapeutic effect after PTA and SP, the stenosis degree in average lumens diameter of the patients descended from 87.5% to 15.0%. The stenosis of subclavian steal artery was obviously improved and the contraflow of vertebral artery was disappeared without the stent's recovery and displacement by TCD. The mean systolic blood pressure difference between left and right upper limb was obvious lower than that before therapy [51.6 mmHg (1 mmHg = 0.133 kPa) vs 10 mmHg after 3 months]. No embolism and death was found., Conclusions: PTA and SP are effective in the treatment of SSS. Anticoagulation and antiplatelet therapy after interventional treatment has a good therapeutic effect. TCD is a cheap, sensitive and non-invasive method for evaluating SSS.

Objective: To study the feasibility, safety and validity of percutaneous angioplasty and stenting (PTAS) for symptomatic atherosclerotic stenosis of basilar artery., Methods: The results of treatment and follow-up of 40 cases with symptomatic atherosclerotic stenosis of basilar artery performed PTAS from August 2003 to December 2009 were studied retrospectively, who had either recurrent transient ischemic attacks (TIAs) or obvious ischemic symptoms and resistant to medical therapy., Results: PTAS were successfully performed in all the 40 cases and the post-operative average residual stenosis descended to 14% ± 11% from pre-operative 82% ± 14%. After operation the patients were administrated with antiplatelet drugs. After procedure the clinic symptoms and signs of ischemia were improved obviously in 38 cases and deteriorated in 2 cases whose CT scanning showed that the range of infarction in brain stem enlarged. The symptoms improved after treatment but 2 patients had neurological deficit. No hemorrhagic complications occurred in the group. During the follow-up for 2 months to 7 years, transcranial doppler ultrasonography in 26 cases demonstrated the blood flow was faster than normal in 2 cases, and digital subtraction angiography (DSA) in 6 cases showed restenosis in-stent in 1 case. The second stent was implanted because of the symptomatic restenosis. In another case the follow-up DSA showed occlusion of basilar artery in-stent but there was no ischemia of post circulation because the generation of anastomoses., Conclusions: PTAS is a feasible, safe and effective therapeutic method for the patients with symptomatic atherosclerotic stenosis of basilar artery. Further study in large number of patients is needed for long-term outcome.

Objective: To reconstruct and affix symptomatic giant and fusiform aneurysms of vertebrobasilar artery by using self-expandable stents in 5 cases with an average volume 5.5 mm × 5.0 mm × 60.0 mm., Methods: The clinical data of 5 patients who were suffered from giant and fusiform aneurysms of vertebrobasilar artery between October 2007 and October 2009 were retrospectively analyzed. Under instructing of digital subtraction angiography (DSA) images deployed the LEO and Neuroform stents for reconstructing and affixing the deferent 5 giant fusiform aneurysms of vertebrobasilar artery. And assisted embolized with 3 Orbit coils for a ruptured aneurysm to stop bleeding at the same time., Results: The operative procedures were succeeded in all five cases. The damaged signs and symptoms of posterior group of cranial nerves disappeared in 3 cases by following 3 to 26 months. Trigeminal neuralgia in one case was markedly improved but a hemiparesis. One case with subarachnoid hemorrhage (SAH) showed no relapse evidence. Follow up DSA images in 3 cases demonstrated one case with a more rule modality in the part of aneurysm affixed by stent and proximal part of aneurysm in which no covering by stent revealed a mild to expand after 26 months review. And the images of postoperative DSA following 1 month and 4 months in another 2 cases displayed the imaging enlargement of part of the original aneurysm body shrink and shape the rules than the previous view., Conclusions: The treatment of symptomatic huge fusiform vertebrobasilar aneurysms by using self-expandable stents is feasible, aneurysm growth is under control, short-term effects are positive.

Objectives: To discuss the possible cause of intracranial hemorrhage and treatment after carotid artery stenting (CAS) in patients with carotid artery stenosis., Methods: From January 2003 to August 2009, 403 patients with carotid artery stenosis that were performed CAS, intracranial hemorrhage occurred in 5 cases after the procedure. We analyzed the feature of these cases and perioperative management retrospectively to summarize the possible cause of intracranial hemorrhage and preventive measure., Results: Cerebral hemorrhage were found 30 min after CAS in 2 cases, 5 days in 2 cases and 3 days in 1 case. One patient was treated conservatively whose hemorrhage was about 2 ml, one was performed draining of ventricle and the other three cases were all performed craniotomy to remove the hematoma and to depress. The position of hemorrhage were all in the side of carotid artery stenosis, and in 2 cases of them the hemorrhage were at the region of previous cerebral infarction. One patient was cured conservatively, the one who was performed draining of ventricle died. Among the other three cases performed craniotomy, one recovered with light neurological deficit and two died of multiple organ failure., Conclusion: Intracranial hemorrhage is the most serious complication of CAS of carotid artery, and general measure should be taken to prevent it from occurring.

Objective: To study the feasibility, security and validity of percutaneous angioplasty (PTA) or percutaneous angioplasty and stenting (PTAS) for symptomatic stenosis of middle cerebral artery., Methods: The results of treatment and follow-up of 39 cases with symptomatic stenosis of middle cerebral artery who had either recurrent transient ischemic attacks (TIAs) or resistant to medical therapy and were performed PTA or PTAS were studied retrospectively., Results: Among the 39 cases with stenosis of middle cerebral artery (23 in left, 13 in right, 3 in bilateral side and 5 cases combining with stenosis of carotid artery) PTA were successfully performed in 9 cases and PTAS in 30 (whose post-operative residual stenosis were less than 10%). After operation the patients were administrated with antiplatelet drugs. The clinic symptom and sign of ischemia were improved obviously after operation. During the procedure the contrast could be seen outside the vessel in 2 cases, the patients had no obvious symptom of hemorrhage and got well rapidly. But in another case her consciousness changed 1 h after PTAS and the limbs could not move in right side. Emergency CT scan showed cerebral hemorrhage in left basic node area. The patient suffered language barrier and incomplete hemiplegy in right side. No complication was occurred in the others. During 5 to 60 months follow-up, the symptom of weakness in right arm reoccurred but lighter than before in only one case. TCD rechecked in 26 cases and demonstrated the blood beam speed was faster than normal in two case. DSA rechecked in 14 cases showed restenosis in-stent in the 2 cases and they were treated by medicine., Conclusions: PTA and PTAS is a feasible, safe and effective therapeutic method for the patients with symptomatic stenosis of middle cerebral artery. Further study in large number of patients is needed for long-term outcome.

Objective: To evaluate the operation method and prevention from complications of extracranial carotid stenosis., Methods: Three cases of carotid angioplasty and stenting for 271 patients with extracranial carotid stenosis were performed from October 2001 to June 2008. Before the operation, take Clopidogrel for 75 mg/d, Aspirin Delayed-Release Capsules for 100 200 mg/d, Simvastatin for 40 mg 1/night, for 5 - 10 d. Then treat continuous vein infusion Heparin 50 mg/d for 2 d. After the operation, continue antiplatelet and reduce blood fat therapy., Results: All 300 carotid stenting were successfully accomplished. DSA showed that the diameter of stenosed segment of carotid artery was markedly enlarged, and all clinical ischemia signs were improved remarkably. Seven cases suffered from complications in one week after operation and one died. Following up 3 - 24 months in 226 patients, restenosis were found in 5 cases, among which 45 patients were evaluated at follow-up by means of ultrasonic examination for 36 months or so, no restenosis was found. No ischemic attack occurred at follow-up., Conclusions: The satisfactory effect and safety are achieved in the therapy of carotid stenosis by carotid angioplasty and stenting. Correct intraoperative treatment and skilled techniques are the key points of success.