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Background: Symptomatic vertebral artery dissecting aneurysm (VADA) is a challenging disease with controversy on treatment strategy due to anatomic configuration and their nature. Moreover, the outcomes of reconstructive treatment have not been well established. Objective: To evaluate the safety and efficacy of reconstructive endovascular treatment (EVT) for symptomatic VADAs with Willis covered stent. Methods: We evaluated retrospectively 13 patients with symptomatic VADAs who treated with Willis covered stent, compared with stent-assisted coiling (SAC) on the characteristics, posttreatment course, angiographic and clinical follow-up outcomes at an average of 14.4 months (range, 3–48 months). Results: A total of 33 patients with symptomatic VADAs were reviewed, 23 of these patients with ruptured VADAs. The technical successful rate is 100% respectively in Willis covered stent (Group A) and SAC (Group B, n ​= ​20). The initial complete occlusion rate was significant higher in group A (100%) than group B (30%) (p ​ ​0.05). No obvious in-stent stenosis and no re-hemorrhage and delayed ischemic symptoms during the follow-up period. The final angiograms of all survived patients demonstrated the complete occlusion rate was higher in group A (100%) than group B (80%), but no significant statistical difference (p ​> ​0.05). Clinical outcomes were favorable in 31 (93.9%), severe disability occurred in one in group B, and only one death in group A. The final clinical outcomes were also not significant difference in the two groups (p ​> ​0.05). Conclusions: Our initial result demonstrated reconstructive EVT with Willis covered stent provides a viable approach for selected symptomatic VADAs involving the intracranial and extracranial segments, which is similar to favorable results with SAC. However, an expanded clinical experiences and larger cohort studies are needed.

The purpose of writing this paper. Through the in-depth understanding and value analysis of Mo Gao Grottoe at Dunhuang culture, as well as the analysis of the design of daily furniture — —according to hangers, the comparison of product types and the current situation of development, this paper tries to do a good job in the study of integrating Dunhuang cultural symbols with furniture design. How to write this paper. The first is to study the development of Dunhuang culture and the types of murals represented by Mogao Grottoes culture through historical literature exploration and research, and the second is to investigate and analyze the clothes hangers and compare the existing clothes hangers. Through these two methods, the shortcomings of existing hangers are found and the necessity of innovative design of hangers is put forward. The third is to integrate Dunhuang culture with clothes hanger through semiotics in order to better spread Dunhuang culture and let more people understand the depth of Chinese traditional culture. Fourth, through the method of computer-aided design, the product modeling, the determination of the scale, color collocation, design deliberation, refining and finally according to the semiotics and formal beauty law to come up with a computer-aided scheme. Write the conclusion of this paper. According to the interpretation and analysis of Dunhuang Mogao Grottoes culture combined with the current situation of social shortcomings of clothes hangers, the two are combined by semiotics research method to help people understand the connotation of Chinese traditional culture in their daily life.

Background: To investigate the efficacy of retrograde recanalization for chronic total occlusion (CTO) of femoral-popliteal artery in patients with peripheral arterial disease. Methods: In this single-center retrospective study, all patients who had undergone endovascular recanalization for femoral-popliteal CTOs at our center from June 2011 to October 2014 were included. Patients’ demographics, immediate and follow-up outcomes were analyzed. Results: A total of 205 patients with 238 CTOs were enrolled. In total, successful recanalization was achieved in 228 CTOs (95.8%). The antegrade procedure was successful in 196 CTOs. The retrograde procedure was successfully performed in 32 CTOs after failed antegrade procedure. Ankle-brachial index increased from 0.48±0.18 to 0.79±0.16 in antegrade group vs . 0.41±0.13 to 0.76±0.13 in retrograde group (P=0.438). Pulse score increased from 0.48±0.50 to 2.30±0.76 in antegrade group vs . 0.48±0.51 to 2.30±0.79 in retrograde group (P=0.771). At 12 and 24 months, primary patency rate was 86.2% (169/196) and 51.5% (101/196) in the antegrade group, and 75.0% (24/32) and 43.8% (14/32) in the retrograde group, respectively (P=0.346). Kaplan-Meier analysis showed limb salvage rates of 85.7% in the antegrade group vs . 78.1% in the retrograde group (P=0.198). Conclusions: Retrograde recanalization is effective for CTO of femoral-popliteal artery after the failure of an antegrade procedure; immediate outcomes and mid-term patency and limb salvage rate are comparable with that of antegrade procedure.

BACKGROUND: Diabetes mellitus (DM) is associated with increased prevalence and severity of atherosclerosis. This study aimed to assess the prevalence and location of atherosclerosis in intracranial and extracranial vessels in diabetic patients and to investigate their association with ischemic stroke subtype. METHODS: Diabetes patients (n=128) and nondiabetic patients (n=195) were enrolled. Brain MRI, MR angiography, and digital subtraction angiography (DSA) imaging findings in the two groups were retrospectively compared. The characteristics of atherosclerosis (prevalence, location, severity) and collateral flow in diabetic and nondiabetic patients and their association with stroke subtype were analyzed. RESULTS: Atherosclerosis in extracranial vessels was more common in diabetes patients than in nondiabetic patients (43.8% vs. 23.1%; P65 years (OR, 2.55; 95% CI, 1.24–5.22; P=0.011) were independent risk factors for lacunar infarct. Diabetes patients with symptomatic extracranial stenosis or occlusion, combined with good collateral circulation, had significantly higher risk of lacunar infarction than nondiabetic patients (47.8% vs. 30.5%; P=0.045). CONCLUSIONS: DM aggravates the severity of extracranial atherosclerosis. Lacunar stroke is relatively common in diabetic patients and could even be due to large artery disease (LAD).

To investigate factors predictive of thromboembolic occlusions and evaluate the efficacy of percutaneous aspiration thrombectomy (PAT) for infrainguinal thromboembolic occlusions in patients undergoing endovascular recanalization (EVR).In this single-center retrospective study, 23 patients who underwent PAT for thromboembolism during EVR and 237 patients who underwent successful EVR without thromboembolic occlusions (control group) were enrolled. Immediate posttreatment and follow-up outcomes between groups were compared. Multivariate analysis was performed to identify factors predictive of thromboembolic occlusions. Technical success of PAT was defined as achievement of30% residual stenosis and restoration of modified thrombolysis in myocardial infarction grade 3 flow.The technical success rate was 95.7% in the PAT group. After intervention, ankle brachial index (ABI), restoration of blood flow, and improvement in dorsal/plantar arterial pulse score showed no significant differences between the PAT and control groups. During follow-up, no significant differences were observed between groups in improvement of sustained ABI and maximum walking distance, ulcer healing, restenosis/occlusion and limb salvage rates, and pain relief in patients with critical ischemia. Stenosis greater than 90% with lesion occlusion (odds ratio, 12.891; 95% confidence interval, 1.676-99.161; P = .014) and intraluminal angioplasty (odds ratio, 18.423; 95% confidence interval, 2.408-140.942; P = .005) were associated with a high incidence of thromboembolism.Stenosis greater than 90% with lesion occlusion and intraluminal angioplasty may be factors predictive of thromboembolic occlusions. PAT is a safe and effective treatment for thromboembolism during infrainguinal arterial EVR.

The original version of this article unfortunately contained mistakes. The legends to Figs. 2-4 were incorrectly interchanged. The correct versions are given below. The original article has been corrected.

In recent years, with the use of mobile phone APPs, more and more people like to use tourism APPs when traveling, and the tourism industry also enters a new era of wireless tourism. College students are a huge tourist group. This paper will summarize an APP suitable for students’ tourism through the analysis of tourism APPs and tourist groups. This APP will make travel plans based on the student’s time, including travel time, travel residence, travel strategy, travel expenses, tour groups, etc. It also includes working with schools and local police to keep students safe. There should be such an APP for student travel to make it convenient for students to travel, enrich their university experience, and make student travel safer and more convenient.

The effects of crystal structure of Nickel on the interfacial phase and growth mechanism were clarified in Sn/Ni soldered joints by using polycrystal nickel and single crystal nickel substrate. It was found that the intermetallic compounds (IMCs) phase, Ni3Sn4, was formed at the interface of Sn/polycrystal nickel joints; while, it changed into NiSn4 when using single crystal nickel substrate. At the following thermal aging process, Ni3Sn4 and NiSn4 exhibited different behaviors: Ni3Sn4 grew faster than NiSn4 showing a much thicker layer. Kinetics analysis indicated that different diffusion mechanisms governed the IMCs layer growth, namely Ni3Sn4 was controlled by diffusion of the reaction elements, whereas NiSn4 was controlled by reaction rate.

Ni-W-Si intermetallic composite coatings consisting of primary tungsten dendrites and eutectic W/WSi2 were fabricated on 45 steel by laser cladding process using Ni-W-Si powder. The microstructure and composition of the coatings were characterized by SEM, XRD and EDS. The effect of the W content on the hardness and wear resistance of coatings was investigated. Results indicate that attributed to the high hardness and toughness of tungsten dendrites and fine and compact eutectic W/WSi2, coatings had high hardness being 950HV in maximum and the wear resistance was elevated to 4-8 times higher.

Rationale and Objectives To compare the clinical outcomes of retrograde transplantar arch angioplasty and conventional below-the-knee (BTK) anterograde recanalization. Materials and Methods One hundred twelve limbs in 96 patients underwent attempt at antegrade tibial angioplasty. Among 27 technical failures, retrograde trans-dorsal or -planter percutaneous transluminal angioplasty was attempted in 22 limbs. Ankle–brachial index (ABI), thrombolysis in myocardial infarction (TIMI) flow grade, and dorsal/plantar arterial pulse score improvement were compared immediately after the procedures between patients received successful anterograde angioplasty (anterograde angioplasty group [AAG], 85 limbs in 71 patients) and retrograde angioplasty (retrograde angioplasty group [RAG], 22 limbs in 20 patients). Target vessel restenosis and limb salvage were observed during follow-up. Results Primary technical success rate was 75.9% in the RAG (vs. 74.0% AAG, P > .05). ABI improved from 0.55 ± 0.21 to 0.93 ± 0.19 in the RAG (vs. 0.56 ± 0.14 to 0.89 ± 0.18 AAG, P > .05). TIMI flow grade demonstrated greater reperfusion of distal foot tissue in the RAG (2.3 ± 0.8 vs. 1.0 ± 0.8, P P > .05). Kaplan–Meier analysis after 24 months found limb salvage rates of 93.8% in the RAG and 96.5% in the AAG ( P > .05). Conclusions Retrograde transplantar arch angioplasty achieved better immediate blood flow and similar ABI improvement, primary patency rate, and limb salvage rate compared to conventional transtibial angioplasty for BTK occlusions. This could become a supplementary technique when anterograde angioplasty fails.

Our aim was to assess the reliability of detecting distal runoff vessels using contrast-enhanced MR angiography (CE-MRA) that were occult on digital subtraction angiography (DSA) for predicting the outcome of endovascular recanalization (ER). This retrospective analysis comprised 63 patients with diabetes (98 limbs) who underwent ER for infrapopliteal lesions. Before ER, they underwent CE-MRA and DSA for peripheral arterial disease; runoff vessels were detected with CE-MRA, but not with DSA. Immediate and follow-up postoperative outcomes were assessed. Univariate analysis was performed to identify variables associated with successful ER. Successful ER was achieved in 85.7 % of limbs, and runoff score was significantly lower than in failure limbs (5.1 ± 1.1 vs. 6.2 ± 1.3; P

This paper addresses the mechanical properties of ferrite steel resistance spot welds during quasi-static tensile test. The mechanical properties are described in terms of peak load. It was shown that the fusion zone size is the most important. The fusion zone size can control the solidification of the grain which controlling factor of spot weld peak load. The dendritic grain and equiaxial axial grains occurred in the microstructures of the welded specimens joined at various welding currents and electrode forces. The failure mechanism of resistance spot welds during tensile test was studied with the aid of thermography. The thermography gives visible data of temperature changes on the surface of specimen. In light of the failure mechanism, the simple model is proposed to ensure pull out failure mode.

Laser remelting of plasma sprayed Al 2 O 3 –TiO 2 coatings has been extensively investigated. However, little work on the microstructural evolution of laser-remelted Al 2 O 3 –TiO 2 coatings has been reported. This study presents a detailed microstructural investigation of laser-remelted Al 2 O 3 –TiO 2 coatings. Nanostructured feedstock has been reconstituted from nano-sized starting powders. A compound process of plasma spraying and laser remelting has been applied to fabricate the Al 2 O 3 –TiO 2 coatings on titanium alloy. The evolution of microstructures of laser-remelted Al 2 O 3 –TiO 2 coatings was investigated by X-ray diffractometer (XRD), scanning electron microscope (SEM), energy-dispersive spectrometer (EDS) and transmission electron microscope (TEM). Microstructural observations revealed microstructure correlation throughout the compound process. It was found the α-Al 2 O 3 in feedstock was transformed to γ-Al 2 O 3 after plasma spraying, which was completely transformed into stable α-Al 2 O 3 phase after laser remelting. Bi-modal microstructure features are found for the laser-remelted coatings. For nanostructured coating, the net structure of its remelted coating resembles that of its feedstock and as-sprayed coating. For conventional coating, the strip-like structure of its remelted coating also resembles that of its feedstock and as-sprayed coating.

in order to avoid signal collision when two or more tags send recognizable signals to the reader of underground coal mine personnel tracking system , the binary tree search algorithm along with algorithms which improved from them is discussed, an adaptive anti-collision algorithm is proposed .In the respects of time and space the algorithm shows obvious advantages than the binary tree search algorithm ,so the probability of collision reduces greatly and the problem of collision maybe effectively solved.

To investigate morphological characteristics used to predict recanalisation strategies in long-segment (10 cm) femoral chronic total occlusion (LSF-CTO) angioplasty.We retrospectively evaluated a range of morphological CTA and DSA features in patients who underwent recanalisation of LSF-CTO. The stage of CTO was classified into early (3-12 months) and late (12 months) according to estimated duration. Characteristics including stump morphology, lesion length and calcification, proximal side branches, collaterals circulation, runoff vessels and concomitant arterial occlusion were used as predictors, and multivariate logistic regression analysis was performed to identify variables associated with late-stage CTO and retrograde technique.A total of 119 patients with 137 CTOs in 137 limbs were enrolled. Overall, successful recanalisation was achieved in 122 CTOs (89.1%). Flush occlusion [odds ratio (OR) 2.958; 95% confidence interval (CI) 1.172-7.465; p = 0.022], large collateral (OR 2.778; 95% CI 1.201-6.427; p = 0.017) and TransAtlantic Inter-Society Consensus II class D (TASC D) lesion (OR 1.743; 95% CI 1.019-2.981; p = 0.042) were predictors for late-stage CTO. Flush occlusion (OR 75.278; 95% CI 10.664-531.384; p0.001) and large collateral (OR 23.213; 95% CI 3.236-166.523; p = 0.002) were associated with high likelihood for retrograde approach.Flush occlusion and large collateral were associated with a CTO at late-stage which may require retrograde recanalisation.• CTO morphological characteristics help estimate lesion duration and optimise recanalisation strategies. • Flush occlusion and large collateral is associated with late-stage CTO and retrograde recanalisation. • Application of anterograde and retrograde recanalisation for long-segment femoral CTO is effective.

ObjectiveTo investigate the effect of dl-3n-butylphthalide (NBP) on the protection of cerebral tissue and possible mechanism on ischaemia-reperfusion injury, and to find out whether NBP therapy can extend the reperfusion window in an experimental stroke model in rats.MethodsSeventy-two Sprague-Dawley rats were randomly divided into sham operation, ischaemia-reperfusion and ischaemia-reperfusion with NBP groups. Focal cerebral ischaemia was induced using the modified intraluminal thread method and maintained for 2, 3 or 4 h. The ischaemia-reperfusion group received reperfusion immediately after ischaemia-reperfusion. The NBP group received intraperitoneal injection of NBP immediately after ischaemia, followed by reperfusion. The sham operation group received only injection of physiological saline. The cerebral infarction volume and neurological deficit were analysed, and vascular endothelial growth factor (VEGF) expression in brain tissues was visualised by immunohistochemistry.ResultsNBP treatment caused a significant decrease in both infarction volume and neurological deficit compared with the ischaemia-reperfusion group at corresponding time points in each (p < 0.05). In the NBP group, the infarction volume and neurological deficit did not change with different ischaemia times. The expression of VEGF was significantly decreased in the ischaemia-reperfusion group compared with the sham group (p < 0.01), while this change was partly prevented in the NBP group (p < 0.01). The expression of VEGF in brain tissue in both the NBP and ischaemia-reperfusion groups gradually decreased when the ischaemic period was prolonged.ConclusionNBP treatment has a protective effect against cerebral ischaemia; this possible mechanism maybe related to the VEGF expression and may extend the reperfusion window for subsequent salvage of cerebral ischaemia by reperfusion.

Purpose To evaluate the efficacy of the Willis covered stent in the treatment of traumatic pseudoaneurysms of the internal carotid artery (ICA). Materials Thirty-eight patients with traumatic head and neck injury underwent angiography. We evaluated 14 delayed pseudoaneurysms in 13 patients who underwent angiography after treatment with the Willis covered stent. Prospective data on the technical success, initial and final angiographic results, mortality, morbidity, and final clinical outcome were analyzed immediately after the procedure, at the time of discharge from the hospital, at 3 months, 6 months, and 12 months after the procedures, and yearly thereafter. Results The Willis covered stent placement was successful in all 14 pseudoaneurysms. The initial angiographic results showed complete exclusion in 9 patients with 10 aneurysms (71.4% [95% confidence interval {CI}: 44-98%]) and incomplete exclusion in 4 patients. The angiographic follow-up (mean, 15 months [95% CI: 9-20 months]; range, 3-36 months) findings exhibited a complete exclusion in 12 patients with 13 aneurysms (92.9% [95% CI: 77-108%]) and an incomplete exclusion in 1 patient and maintained patency of the ICA in all patients. The clinical follow-up (mean, 20 months [95% CI: 14-27 months]) findings demonstrated full recovery (11 patients), symptom improvement (1 patient), or no change in the symptoms (1 patient). No procedure-related complications or deaths occurred during follow-up. Conclusion Treatment with the Willis covered stent provides a viable approach for patients with traumatic pseudoaneurysms of the ICA, maintaining patency of the ICA and thus leading to excellent clinical results. An expanded clinical experiences and a larger sample are needed.

Object Placement of covered stents has emerged as a promising therapeutic option for cerebrovascular diseases. However, the medium- and long-term efficacy and safety of covered stents in the treatment of these diseases remain unclear. The purpose of this study was to evaluate the medium-term clinical and angiographic outcomes of covered stent placement for the treatment of intracranial aneurysms. Methods The authors' institutional review board approved the study. Thirty-four patients (13 females and 21 males; mean age 41.9 years) with 38 intracranial aneurysms were treated with the Willis covered stent. Clinical and angiographic follow-up were performed at 3 months, at 6–12 months, and annually thereafter. The initial procedural and follow-up outcomes were collected and analyzed retrospectively. Results Forty-two covered stents were successfully implanted into the target artery in 33 patients with 37 aneurysms, and 1 covered stent navigation failed in 1 patient. A complete aneurysm exclusion was initially achieved in 24 patients with 28 aneurysms, and a minor endoleak occurred in 9 patients with 9 aneurysms. Postoperatively, 2 patients died of complications related to the procedure. Angiographic and clinical follow-up data are available in 30 patients. The angiographic follow-up (17.5 ± 9.4 months [mean ± SD]) exhibited complete occlusion in 28 patients with 31 aneurysms, and incomplete occlusion in 2 aneurysms, with an asymptomatic in-stent stenosis in 3 patients (10%). The clinical follow-up (26.7 ± 13 months [mean ± SD]) demonstrated that 16 patients (53.3%) experienced a full recovery, and 14 patients (46.7%) improved. No aneurysm rupture, thromboembolic events, or neurological deficits resulting from closure of a perforating vessel by covered stent placement occurred. Conclusions Endovascular reconstruction with the Willis covered stent represents a safe, durable, and curative treatment option for selected intracranial aneurysms, yielding an excellent medium-term patency of the parent artery and excellent clinical outcomes.

We designed a small randomized clinical trial to prospectively test the hypothesis that batroxobin is more effective than aspirin alone to prevent restenosis in patients with diabetes undergoing angioplasty of infrapopliteal arteries.After a successful angioplasty, a total of 52 diabetic patients with symptomatic infrapopliteal obstructions were randomized to either the treated group (n = 26) or the control group (n = 26). Patients in the treated group received 5 IU batroxobin through an intravenous drip once every alternate day, for a total of six doses. The primary end point was restenosis and reocclusion, which was documented by magnetic resonance angiography or duplex scanning at 12-month follow-up. The clinical symptoms relief and ankle-brachial index (ABI) were compared before and after the procedure, and during follow-up. Kaplan-Meier curves were constructed to evaluate restenosis or reocclusion-free, limb salvage, and amputation-free rates.Restenosis and reocclusion occurred in 22.0% and 34.5% lesions in the treated and the control group, respectively (p = 0.0307). Statistical differences were observed between the ABI before the angioplasty procedure(p0.05) and the ABI at the 12-month follow-up (p = 0.0094) of the two groups. Clinical symptoms improvement and tissue healing occurred in 23 and 19 patients in the batroxobin group and the control group, respectively (p = 0.0544). Twelve months after angioplasty, Kaplan-Meier analysis showed that the restenosis and reocclusion-free rate was 74.0% and 54.8%, the limb salvage rate was 96.2% and 92.3%, and the amputation-free rate was 84.6% and 84.6%, in the treated and control group, respectively.This pilot trial revealed that batroxobin usage was effective in preventing restenosis and reocclusion after infrapopliteal arterial angioplasty, and it might provide better clinical symptoms relief; however, it did not report preferable limb salvage or amputation-free rates.

Introduction L’embolisation endovasculaire des anevrysmes cerebraux de tres petite taille (ACPT) est controversee. Nous rapportons ici notre experience de l’embolisation par coils de ce type de lesions et decrivons la faisabilite et l’efficacite d’une telle intervention. Methode Nous avons revu les patients (n = 19) ayant beneficie d’un traitement endovasculaire d’ACPT dans notre institution. Les anevrysmes etaient situes au niveau du segment supraclinoide de l’artere carotide interne (ACI, n = 7), de la partie caverneuse de l’ICA (n = 3), de la communicante anterieure (n = 5), de l’artere vertebrale-artere cerebelleuse postero-inferieure (n = 2), de la bifurcation de l’artere cerebrale moyenne (n = 1), de l’artere pericalleuse (n = 1), et du segment P2 (n = 1). La classification pretherapeutique de la Federation Mondiale des Societes de Neurochirurgie etait de grade I dans 14 cas et de grade II dans 5 cas. Le traitement endovasculaire a inclu l’occlusion par coils, la mise en place de coils assistee par ballon, et la mise en place de coils associee a la mise en place d’un stent. Les taux d’occlusions ont ete subdivises en (1) occlusion complete ou quasi-complete quand la reduction du calibre luminal etait de 95-100%; (2) occlusion sub-complete quand il existait une stenose a 80-95%; et (3) partielle, quand la stenose etait Resultats Tous les patients ont ete embolises avec succes a l’aide de coils. Le controle angiographique immediat a demontre une occlusion totale (n = 5), sub-complete (n = 5) ou partielle (n = 6). Au cours d’un suivi compris entre 1 et 2 ans, l’occlusion de tous les anevrysmes a ete confirmee par angiographie. Aucune recidive ni compactage de coils n’est survenue. Aucune recidive hemorragique ni accident vasculaire cerebral n’est survenu. Conclusion L’embolisation par coils d’ACPT est faisable et efficace. Une occlusion subtotale ou partielle est susceptible d’evoluer vers une occlusion complete.

The Fe32Ni32Si16B18Nb2, Fe31Ni31Si18B18Nb2 and Fe30Ni30Si20B18Nb2, (at. %) alloys are synthesized using low purity of raw materials by high power CO2 laser cladding with synchronous powder feeding. X-ray diffraction results show that the coating has an amorphous structure with some crystalline phases on it. The microstructure of the coatings changes with different amounts of Si. It can be observed that black nanocrystalline grains embedded in the amorphous phase in the TEM image. The coating of Fe31Ni31Si18B18Nb2 alloy was annealed at different temperature for 30 minutes and the microstructure were investigated. The highest Vickers Hardness had exceeded 1300 in the coatings. The amount of Si is a critical factor for fabricating a Fe-Ni based amorphous composite coating.

Purpose: To compare the feasibility and efficacy of recanalizing below-the-knee (BTK) chronic total occlusions (CTOs) between patients with good or poor distal runoff based on magnetic resonance angiography (MRA) scans. Methods: Two hundred long-segment BTK CTOs in 171 limbs of 113 diabetic patients (58 men; mean age 69.8±1.9 years) were divided into good distal runoff (GDR: 119 lesions, 98 limbs) or poor distal runoff groups (PDR: 81 lesions, 73 limbs) based on baseline MRA findings. After angioplasty, modified thrombolysis in myocardial ischemia (mTIMI) grades and ankle-brachial index (ABI) were used to assess immediate outcomes. Regularly scheduled duplex or MRA imaging was performed in follow-up. The restenosis and limb salvage rates were compared. Results: The success rates were 93.3% and 87.7% in the GDR and PDR groups, respectively (p=0.21); subintimal angioplasty was more common in the PDR group (93.0% vs. 63.1%, p

Objectives To evaluate the efficacy of percutaneous aspiration thrombectomy (PAT) for infrainguinal arterial thromboembolism in patients undergoing endovascular recanalization (EVR) and to investigate the predictors for thromboembolic complications. Materials and Methods In total, 23 patients (23 limbs) who underwent PAT for thromboembolism (PAT group, PG) during EVR and 237 patients (302 limbs) who underwent successful EVR without thromboembolic complications (control group, CG) were enrolled. Immediate post-operation and follow-up outcomes were compared between the two groups. Multivariate analysis was performed to identify the predictors of thromboembolic complications. Technical success of PAT was defined as achievement of

To compare the clinical outcomes of retrograde transplantar arch angioplasty and conventional below-the-knee (BTK) anterograde recanalization.One hundred twelve limbs in 96 patients underwent attempt at antegrade tibial angioplasty. Among 27 technical failures, retrograde trans-dorsal or -planter percutaneous transluminal angioplasty was attempted in 22 limbs. Ankle-brachial index (ABI), thrombolysis in myocardial infarction (TIMI) flow grade, and dorsal/plantar arterial pulse score improvement were compared immediately after the procedures between patients received successful anterograde angioplasty (anterograde angioplasty group [AAG], 85 limbs in 71 patients) and retrograde angioplasty (retrograde angioplasty group [RAG], 22 limbs in 20 patients). Target vessel restenosis and limb salvage were observed during follow-up.Primary technical success rate was 75.9% in the RAG (vs. 74.0% AAG, P.05). ABI improved from 0.55 ± 0.21 to 0.93 ± 0.19 in the RAG (vs. 0.56 ± 0.14 to 0.89 ± 0.18 AAG, P.05). TIMI flow grade demonstrated greater reperfusion of distal foot tissue in the RAG (2.3 ± 0.8 vs. 1.0 ± 0.8, P.05). Primary patency rates at 12 and 24 months were 63.6% (14 of 22) and 45.5% (10 of 22) in the RAG and 52.9% (45 of 85) and 37.6% (32 of 85) in the AAG, respectively (P.05). Kaplan-Meier analysis after 24 months found limb salvage rates of 93.8% in the RAG and 96.5% in the AAG (P.05).Retrograde transplantar arch angioplasty achieved better immediate blood flow and similar ABI improvement, primary patency rate, and limb salvage rate compared to conventional transtibial angioplasty for BTK occlusions. This could become a supplementary technique when anterograde angioplasty fails.

We investigated immediate/late endoleaks and long-term patency following stent-graft placement for treatment of intracranial aneurysms located within the distal internal carotid artery (ICA) or vertebral artery (VA). Forty-five aneurysms in 41 patients receiving covered stents in three centres were followed. Outcome measures included aneurysm occlusion rate, endoleaks, late in-stent stenosis rate, clinical improvement, neurological deficiencies and death. Total aneurysm exclusion was achieved in 69.2% (n = 27), with 30.8% (n = 12) experiencing immediate residual endoleaks. Angiographic follow-up (mean 43.5 ± 14.3 months) revealed that 87.2% (n = 34) were completely occluded with only 12.8% (n = 5) showing residual endoleaks. Predictors of immediate endoleaks in our patient group were stent number (P = 0.023) and stent diameter (P = 0.022), while predictors of late endoleaks in our patient group were stent diameter (P = 0.035) and stent angulation (P = 0.021). Late in-stent stenosis rates were 18.0 ± 13.3 and 29.0 ± 18.5% compared with the period immediately following implantation at 2- and 6-year follow-ups respectively. Smoking (P = 0.017) and stent angulation (P = 0.020) were predictors of late in-stent stenosis. Treating intracranial aneurysms with Willis stent-grafts has an acceptable immediate and late occlusion rate and long-term stented artery patency rate. • Covered stents can be a treatment option for intracranial aneurysms. • Technical success for treating distal ICA and VA aneurysms can reach 97.6%. • However immediate and late endoleaks occur in 30.8 and 12.8% respectively. • The number, diameter and angulation of stents are possible predictors of endoleaks. • Smoking and stent angulation seem to predict late in-stent stenosis.

The current study evaluates the feasibility and safety of coil embolisation of the anterior communicating artery (ACoA) for the treatment of complicated anterior communicating arterial aneurysms (ACoAAs).Five patients presented with a subarachnoid haemorrhage caused by a ruptured ACoAA. The ACoAA morphologies were well defined by three-dimensional digital subtraction angiography (3D-DSA) and magnetic resonance angiography (MRA). Two of the ACoAAs were tiny (3 mm in diameter), and the remaining three ACoAAs were small (3-5 mm in diameter). All of the aneurysms were localised to the ACoA. The projection of the aneurysm dome was defined as being oriented superiorly or posteriorly in all five aneurysms. We performed a superselective catheterisation of each aneurysm, and we subsequently performed coil embolisation with balloon, stent or microcatheter assistance. Angiography and clinical follow-up occurred 3-6 months after the procedure. Clinical follow-up data were collected and retrospectively analysed, and patient responses were categorised as fully recovered, improved, unchanged or aggravated.All five patients with ACoAA were treated successfully using coil embolisation. In three patients, both the aneurysm sac and the ACoA were embolised using coils, and in two patients, only the ACoA was embolised. Acute angiography showed occlusion of the aneurysm and ACoA. Follow-up angiography confirmed complete occlusion of the aneurysm sac, and no ACoAA recurrence was detected in any of the patients. In clinical follow-up visits, none of the patients had haemorrhaged or had a stroke.Combined coil embolism of the aneurysm sac and the ACoA could be a feasible and safe method for the treatment of complicated ACoAAs without bilateral aplasia of the A1 segment.

We report the technical success rate and mid-term follow-up results after deploying stent-grafts to treat a cohort of patients with symptomatic complicated intra- or extracranial aneurysms (SCIEAs). This study was a retrospective review of 58 patients (39 male; mean age 40.4 ± 12.3 years) with 60 SCIEAs treated by 67 Willis covered stents at three medical centers in China between April 2005 and January 2010. The locations of the SCIEAs were as follows: Intracranial internal carotid artery (ICA) in 54 patients, extracranial ICA in one, intracranial vertebral artery (VA) in three and extra-cranial VA in two. Surgery was successful in 59 (98.3%) SCIEAs. Total exclusion was immediately achieved in 48 SCIEAs, and minor endoleaks were present in 11. Acute thrombosis occurred in two patients and hemorrhage in one. Follow-up angiography (mean 13.8 ± 8.9 months) revealed that 49 of 52 (94.2%) aneurysms were completely isolated, with mild in-stent stenosis in only two patients and in-stent occlusion in one patient. Willis stent-graft application is an alternative therapy to treat SCIEAs in either intra- or extracranial ICAs or VAs. In the case of a tortuous intracranial ICA or potential side branch coverage, however, it is still not a first choice.

Placement of covered stents has emerged as a promising therapeutic option for cerebrovascular diseases. However, the medium- and long-term efficacy and safety of covered stents in the treatment of these diseases remain unclear. The purpose of this study was to evaluate the medium-term clinical and angiographic outcomes of covered stent placement for the treatment of intracranial aneurysms.The authors' institutional review board approved the study. Thirty-four patients (13 females and 21 males; mean age 41.9 years) with 38 intracranial aneurysms were treated with the Willis covered stent. Clinical and angiographic follow-up were performed at 3 months, at 6-12 months, and annually thereafter. The initial procedural and follow-up outcomes were collected and analyzed retrospectively.Forty-two covered stents were successfully implanted into the target artery in 33 patients with 37 aneurysms, and 1 covered stent navigation failed in 1 patient. A complete aneurysm exclusion was initially achieved in 24 patients with 28 aneurysms, and a minor endoleak occurred in 9 patients with 9 aneurysms. Postoperatively, 2 patients died of complications related to the procedure. Angiographic and clinical follow-up data are available in 30 patients. The angiographic follow-up (17.5 ± 9.4 months [mean ± SD]) exhibited complete occlusion in 28 patients with 31 aneurysms, and incomplete occlusion in 2 aneurysms, with an asymptomatic in-stent stenosis in 3 patients (10%). The clinical follow-up (26.7 ± 13 months [mean ± SD]) demonstrated that 16 patients (53.3%) experienced a full recovery, and 14 patients (46.7%) improved. No aneurysm rupture, thromboembolic events, or neurological deficits resulting from closure of a perforating vessel by covered stent placement occurred.Endovascular reconstruction with the Willis covered stent represents a safe, durable, and curative treatment option for selected intracranial aneurysms, yielding an excellent medium-term patency of the parent artery and excellent clinical outcomes.

Background: The purpose of this study was to evaluate the feasibility, safety and efficacy of endovascular treatment of large or giant intracranial aneurysms with the Willis covered stent. Methods: Nineteen patients, each with a large or giant intracranial aneurysm, were treated with the Willis covered stent. Of these 19 aneurysms, 6 were giant and 13 were large; 18 were located in the cranial internal carotid artery and 1 in the vertebral artery. Results of the procedure, technical events and complications were recorded. Clinical and imaging follow-ups were performed at 3 and 6–12 months after the procedure. Results: Placement of Willis covered stent was successful in all patients. Complete aneurysm exclusion was achieved in 13 of the 19 aneurysms immediately after the procedure. No mortality or morbidity developed during the treatment or the follow-up period. During the follow-up period, complete aneurysm exclusion was achieved in 18 of the 19 patients; 11 aneurysms were totally involuted, 3 decreased to 25% of the original diameter, 4 decreased to 50% and 1 remained unchanged. Nine patients experienced full recovery, 9 improved and 1 was unchanged. No obvious in-stent stenosis was noted. Conclusions: Endovascular treatment of large or giant intracranial aneurysm with the Willis covered stent is feasible, safe and efficacious in selected cases. Endoleak is a frequent issue after initial covered stent placement, but can be eliminated or dramatically reduced to minimal endoleak by additional covered stent placement and/or balloon reinflation. Minor endoleak is likely to spontaneously resolve over time.

To compare the use of the Willis stent-graft versus coil embolization for complicated aneurysms in the cisternal segment of the internal carotid artery (ICA).Thirty-four patients (19 women; mean age 46.7+/-16.8 years, range 3-79) with 36 complicated aneurysms were treated either by Willis covered stents (n = 19) or by coil embolization (n = 17). Follow-up angiography was performed to investigate aneurysm recurrence, endoleak, and parent artery stenosis. Kaplan-Meier curves were constructed to compare the freedom from recurrence and parent artery stenosis rates in both groups. Clinical follow-up data were retrospectively analyzed and categorized as fully recovered, improved, unchanged, or worsened.In the covered stent group, total exclusion was immediately achieved in 13 aneurysms; there were 5 minor endoleaks and 1 delivery failure. In the patients treated with coil embolization, total/near-total occlusion was achieved in 7 aneurysms, subtotal in 8, and partial in 2. Acute thrombosis occurred in 1 patient in each group, while 1 patient experienced recurrent hemorrhage after embolotherapy. Follow-up angiography (mean 14.3+/-9.4, range 3-31) revealed that 16 aneurysms were completely isolated in the stent-graft group, with only 2 mild in-stent stenoses. Eighteen months after the procedure, Kaplan-Meier analysis showed recurrence-free rates of 93.3% and 50% for the stent-graft versus coil groups, respectively; freedom from parent artery stenosis was 87.5% and 100%. Symptoms were fully eliminated in 9 patients in each group; they were improved in 3 and 5, unchanged in 2 and 2, and worsened in 1 and 0, respectively, at the end of the follow-up period.Willis stent-graft application is an alternative to treat complicated aneurysms in the cisternal segment of the ICA. In the case of a tortuous parent artery or potential side branch coverage, however, it is still not a first choice therapy.

Objective: To determine the efficacy, safety and primary follow-up results of aguidewire looping technique for the treatment of infrapopliteal arteries. Materials and Methods: From October 2006 to May 2008, an intraluminalangioplasty of the infrapopliteal arteries was attempted in 200 consecutivepatients. Altogether, 417 infrapopliteal lesions, with lengths varying from 2 cm to32 cm, were treated as part of this study, including 305 lesions in the anterior tib-ial arteries, 89 in the posterior tibial arteries, and 23 in the peroneal arteries. The‘U’-shaped guidewire technique was attempted in 393 lesions from 361 limbs.The tip of a hydrophilic 0.035-inch guidewire was formed into a ‘U’ shape with theaid of a 4-Fr catheter and collateral branch vessel to recanalize the completelyoccluded long segment lesions.Results: A successful angioplasty with at least one artery recanalized directlyto the malleolar or dorsal foot was achieved in 322 limbs (89%). The looping tech-nique had a success rate of 90% (352 of 393 lesions). After the procedure, therest pain was relieved in 58 of 69 patients, while 207 of 245 limbs (85%) showedimprovement for intermittent claudication. Complete wound healing was noted in21 of 54 patients, while 20 of 54 patients showed an improvement in the woundsize or depth. A total of 38 major immediate procedure-related complicationswere noted, including retroperitoneal hematoma, distal emboli, and vessel rup-ture. Conclusion: The results of this study suggests that the guidewire looping tech-nique is a safe and effective method for the recanalization of the occluded lesionsin infrapopliteal vessels.ymptomatic lower limb ischemic disease is characterized by a malignantnatural history and is predominantly caused by diabetes mellitus. As aresult, a significant number of patients eventually require a limb amputa-tion. Although Dotter and Judkins (1) described three cases of percutaneous transluminalangioplasty (PTA) of the tibioperoneal trunk in their classic 1964 paper, and the numberof angioplasty procedures performed in iliac, femoral, and popliteal vessels has increasedseveral folds in the past decade, experience with dilatation of the infrapopliteal vesselshas been limited. Due to the recent developments in balloon catheters, there has been asignificant shift toward lower limb revascularization using endoluminal techniques overthe last five years (2). Stenotic lesions of the infrapopliteal arteries, either in isolation orin combination with iliac-femoral-popliteal axis disease, can be treated with PTA (3-5).However, direct endovascular access over the occlusive lesion with a straight tipguidewire is not always possible. We found that advanced guidewires with a U-shapedtip could effectively cross the long or multi-occlusive segment smoothly and go into theJian-bo Wang, MD, PhDJun-gong Zhao, MD, PhDMing-hua Li, MD, PhDYue-qi Zhu, MDJue Wang, MSPei-lei Zhang, MS

Background: The use of short balloons in the treatment of infrapopliteal arterial occlusive disease in diabetic patients often has a poor clinical outcome. Purpose: To retrospectively evaluate the safety and efficacy of a long over-the-wire (OTW) balloon as a primary percutaneous transluminal angioplasty (PTA) treatment for diabetic infrapopliteal severe limb ischemia. Material and Methods: Infrapopliteal PTA with a long OTW balloon was performed between April 2007 and March 2008 in 34 patients (53 limbs), including a total of 119 lesions. Patient age was 71.8±7.4 years. All patients had limb ischemic symptoms. Angiography was retrospectively analyzed, and every lesion categorized and classified according to its length and severity. The mean follow-up period was 7.4±2.6 months. Lower-limb magnetic resonance angiography (MRA) was performed every 3 months during follow-up, and clinical data were collected. Results: Altogether, 92% of patients were successfully treated. Ankle-brachial index (ABI) and transcutaneous oxygen tension (TcPO2) improved from 0.50±0.18 and 18.85±12.08 mmHg, respectively, before the procedure to 0.81±0.12 and 39.85±12.67 mmHg, respectively, after the procedure. At the end of follow-up, 29 patients had maintained a stable outcome. Five patients had symptom recurrence, and three of them underwent a second PTA. Two major amputations and four minor amputations were performed, with a 94% limb salvage rate and 59% patency rate. Conclusion: Infrapopliteal PTA with a long OTW balloon was feasible, with encouraging midterm outcome, in the treatment of severe limb ischemia in diabetic patients in this single-center case series. Further research is warranted to evaluate long-term outcome.

Endovascular embolization for very small cerebral aneurysms (VSCAs) is still controversial. We report our experience with endovascular coil embolization for these lesions and assess the feasibility and effectiveness.We conducted a review of our experience with endovascular treatment of a series of 19 patients with 20 VSCAs, located at the supraclinoid segment of the internal cranial artery (ICA) in seven, the cavernous ICA segment in three, the anterior communicating artery in five, vertebral artery-posterior inferior cerebellar artery in two, bifurcation of the middle cerebral artery in one, the pericallosal artery in one, and the P2 segment in one. The World Federation of Neurosurgical Societies classification before treatment was grade I in 14 patients and grade II in five patients. The strategy of endovascular treatment included coil occlusion, balloon-assisted coiling, and stent-assisted coiling. Occlusion rate was divided into (1) total/near total, occlusion rate 95-100%; (2) subtotal, occlusion rate 80-95%; and (3) partial, occlusion rate80%. Clinical outcome of patients with ruptured aneurysm was ascertained according to the Glasgow Outcomes Scale.All patients were successfully treated with coil embolization; immediate angiography determined occlusion of the aneurysm, including total occlusion in five, subtotal occlusion in nine, and partial occlusion in six. During 1-2 years of follow-up, all aneurysms were confirmed as complete occlusion by control angiography. No recurrence or coil compaction occurred. No rehemorrhage or ischemic stroke occurred.Endovascular coil embolization for VSCAs is effective and feasible. Initial subtotal or partial aneurysm occlusion might progress to total occlusion.