Fibrin networks, the structural framework of thrombi, undergo fatigue failure under pulsatile blood flow, posing risks of embolic events like stroke, pulmonary embolism. While fibrin's fracture behavior under monotonic loading has been intensively explored, its fatigue mechanism that governs thrombus embolization is understudied. Multiscale experiments, modeling of condensed fibrin networks, reveal a paradoxically low fatigue threshold despite high fracture energy. Mechanistically, cyclic loading induces irreversible α-to-β transitions in fibrin's molecular chains, causing molecular creep that dissipates strain energy, propagates cracks via rupture of stress-localized fibers. A multiscale continuum model quantitatively links this nanoscale mechanics to macroscale fatigue, providing an alternative mechanism of thrombus rupture as a molecular disorder driven by cumulative conformational damage. These findings reexamine widely adopted fibrous hydrogel design paradigms while bridging molecular structure characteristics to clinical thrombosis-a critical step toward predictive rupture risk assessment, targeted therapeutic strategies.

Objective: To compare the clinical benefits of classic endoscopic submucosal dissection (ESD) and hybrid ESD for the treatment of colorectal epithelium-derived tumors. Methods: The current investigation was a retrospective multicenter study of 418 patients who underwent ESD between January 2015 and April 2021 at Beijing Jishuitan Hospital. The patients were assigned to one of two groups based on the surgical procedure they underwent; a classic ESD group or a hybrid ESD group. The primary outcome was the rate of en bloc resection and complete resection. SPSS 26.0 was used for statistical analysis. Homogeneity of variance was assessed via Cochran's test. Normally distributed data with homogeneity of variance were analyzed via the t-test for independent samples. Non-normally distributed data and data with unequal variance were analyzed via the Kruskal-Wallis non-parametric test. Categorical data were analyzed via the Chi-square test or Fisher's exact test. Multivariable assessment was performed via logistic regression analysis. Results: The en bloc resection rates [89.4% (84/94) vs. 87.0% (194/223), χ2=0.34, P=0.558] and complete resection rates [85.1% (80/94) vs. 82.1% (183/223), χ2=0.33, P=0.510] were similar. Compared with classic ESD, procedures were shorter in the hybrid ESD group [22(7, 213) vs. 47(12, 680) min, Z=0.23, P<0.001], dissection was completed more rapidly [0.14(0.02, 0.32) vs. 0.10(0.02, 0.41) cm2/min, Z=0.08, P<0.001], and there was a higher rate of perforation (9.6% vs. 2.2%, χ2=2.67, P=0.006). Laterally spreading tumor granular type nodular mixed, non-granular type pseudo-depressed, flat-elevated type (odds ratio 2.826, P=0.012), and tumor location (odds ratio 6.970, P=0.005) were independently associated with complete resection in the hybrid ESD group. Conclusion: Classic ESD and hybrid ESD had similar en bloc and complete resection rates for colorectal epithelium-derived tumors, but hybrid ESD had shorter operation times. With respect to hybrid ESD, factors associated with failure of complete resection included lesion type and crossing tissue boundaries.

OBJECTIVE:To investigate the safety and effectiveness of balloon occlusion and intra-sac thrombin injection in the endovascular repair of ruptured abdominal aortic aneurysm. METHODS:From October 2019 to October 2022, the clinical data of 16 patients with rAAA treated with balloon occlusion technique and intra-sac thrombin injection combined with EVAR were retrospectively analyzed, including 13 males and 3 females, aged 42-85 years, with a median age of 70.5 years. The time of preoperative first aid (from hospital arrival to operation start), average operation time, stay in intensive care unit (ICU), average hospitalization time, success rate of surgical treatment, perioperative (30 d) mortality rate, incidence of complications, the maximum diameter and volume change of the aneurysm were observed and recorded. RESULTS:Among the 16 patients with ruptured abdominal aortic aneurysm, the technical success rate was 100.0% (16/16). One patient died of multiple organ dysfunction 6 hours after operation. The success rate of surgical treatment was 93.8% (15/16). The preoperative first aid time was (53.3±6.2) min, the average operation time was (89.9±17.1) min, the stay in the intensive care unit (ICU) was (1.7±0.8) d, and the average hospitalization time was (7.8±1.3) d. The intraoperative balloon occlusion time was (32.4±4.1) min. The postoperative renal function of all the patients had no significant deterioration compared with that preoperative. Abdominal compartment syndrome (ACS) occurred in 1 patient after operation, which improved after CT puncture and drainage. The median follow-up time was 36 months. During the follow-up period, 1 patient died of acute myocardial infarction 2 years after operation, and the remaining 14 patients survived. Among the 14 follow-up patients, 1 type Ⅱ endoleak occurred, and no other types of endoleak occurred. By the end of the follow-up, the maximum diameter of the aneurysm sac in 14 patients was significantly lower than that before operation [(44.6±8.0) mm vs.(66.0±15.5) mm, P < 0.001], and in 12 patients with CTA, the volume of the aneurysm sac was significantly shrunk than that before operation [(311.7±170.3) mm3 vs. (168.6±68.1) mm3, P < 0.05]. CONCLUSION:Balloon occlusion during endovascular repair is safe and effective in the treatment of ruptured abdominal aortic aneurysm; intraoperative thrombin injection of the aneurysm sac can significantly reduce the incidence of intraoperative and postoperative abdominal compartment syndrome and endoleak and, to a certain extent, improve the success rate of treatment.

OBJECTIVE:To assess the safety and efficacy of Neuroform Atlas stent used in treatment of unruptured wide-neck intracranial aneurysms.METHODS:Clinical data of 62 patients with unruptured wide-neck intracranial aneurysms undergoing Neuroform Atlas stent-assisted coiling from August 2020 to September 2021 were retrospectively analyzed. There were 64 aneurysms in those 62 patients. Among them, 25 aneurysms were located at the bifurcation of M1 segment on middle cerebral artery, 16 at the anterior communicating artery, 10 at the C7 segment of internal carotid artery, 5 at the C6 segment of internal carotid artery, 4 at the apex of basilar artery, 3 at the A3 segment of anterior cerebral artery, and 1 at the M2 segment of middle cerebral artery. All the patients underwent Neuroform Atlas stent-assisted coiling, including 49 patients with single stent assisted coiling and 15 patients with dual stents assisted coiling (14"Y"style and 1"X"style). After the procedure, the immediate DSA was performed to evaluate the status of aneurysm occlusion and the parent artery patency. The clinical follow-up was performed 3 months after the operation and evaluated based on the modified Rankin Scale(mRS).DSA image was reviewed at 6 months after operation and Raymond grading scale was used to assess the status of aneurysm occlusion and the parent artery patency.RESULTS:A total of 62 patients with 64 aneurysms were all achieved technical success(100%).The immediate post-procedural Raymond scale was assessed, including Raymond Ⅰ in 57 aneurysms(89.1%, 57/64), Raymond Ⅱ in 6 aneurysms(9.3%, 6/64) and Raymond Ⅲ in 1 aneurysm(1.6%, 1/64). The peri-procedural complications rate was 4.8%(3/62), 2 patients developed intraoperative thrombosis and 1 patient suffered from local subarachnoid hemorrhage. Among them, 55 patients obtained 3 months clinical follow-up after operation and all the patients had good outcomes (mRS≤2), 50 patients with 52 aneurysms were followed up with DSA 6 months after operation, including Raymond Ⅰ in 45 aneurysms(86.5%, 45/52), Raymond Ⅱ in 4 aneurysms(7.7%, 4/52) and Raymond Ⅲ in 3 aneurysms(5.8%, 3/52).CONCLUSION:Neuroform Atlas stent for the treatment of unruptured wide-neck intracranial aneurysms has high safety and good efficacy, and has its advantages over other traditional stents.

目的 观察颈动脉内膜斑块剥脱联合经股动脉途径顺行开通复合手术治疗Riles 1A型颈总动脉(CCA)闭塞的效果.方法 回顾性分析16例接受颈动脉内膜斑块剥脱联合经股动脉腔内途径顺行开通CCA闭塞病变复合手术的症状性Riles 1A型CCA闭塞患者,记录围手术期并发症;观察术后定期复查头颈部CT血管造影(CTA)、数字减影血管造影(DSA)有无CCA再狭窄,复查CT灌注成像(CTP)评估灌注情况,采用改良Rankin评分量表(mRS)评估临床预后.结果 对16例均顺利完成手术,技术成功率100％.术后1天1例少量基底核区渗血、1例切口血肿,经对症处理后恢复.术后2例出现无症状性支架内再狭窄,再狭窄部位均位于CCA开口部,均经再次支架成形术解除狭窄.随访期间无同侧短暂性脑缺血发作或卒中,中位mRS评分0分.结论 颈动脉内膜斑块剥脱联合经股动脉途径顺行开通复合手术治疗症状性Riles 1A型CCA闭塞安全、有效.

Objective:Pediatric nonsaccular aneurysms are rare but challenging lesions; pipeline embolization devices (PEDs) are their potential treatment option. In this study, we aimed to evaluate the safety and efficacy of PEDs for treatment of these aneurysms.Methods:We retrospectively selected pediatric patients with nonsaccular aneurysms treated using PEDs between June 2015 and July 2021 from our prospectively maintained database. For each patient, demographics, aneurysm characteristics, procedure details, and clinical and angiographic follow-up data were collected and summarized.Results:This study included 16 pediatric patients with 16 nonsaccular aneurysms treated with PEDs. A median clinical follow-up time of 1,376 days was achieved in 93.75% of the patients. The complication rate of the included patients was 25%, with two patients developing mass effect, one patient undergoing major ischemic stroke, and one patient experiencing stent foreshortening after the procedure. The complete occlusion rate of aneurysms without any neurologic sequelae was 93.33%, with a median angiographic follow-up period of 246 days. The mortality rate was 6.25%.Conclusions:The use of PEDs to treat pediatric nonsaccular aneurysms is feasible, with a high rate of complete occlusion of the aneurysm and favorable follow-up outcomes.

Purpose To evaluate the safety and effectiveness of intra-sac thrombin injection to remedy type II endoleaks (T2ELs) during endovascular aneurysm repair (EVAR). Materials and Methods 224 cases abdominal aortic aneurysm (AAA) were treated with EVAR. For the 52 cases of intra-operative type II endoleaks and 8 cases of ruptured AAAs, after the grafts were deployed, thrombin was injected into the aneurysm sac through a preset catheter. The occurrence of endoleaks post-EVAR were followed up with by Computed Tomography (CT) angiogram. The diameter and the volume of the aneurysm sac were also measured. Endpoints included incidence of T2ELs, AAA sac shrinkage and re-intervention rate and all-cause mortality. Results The overall technical success rate was 100%. Fifty-two patients were followed up with for 9-56 (median 24) months. No serious complications were observed during follow-up. The incidence of endoleak was 5.8% (3/52) during follow-up. The maximum diameter of the aneurysm decreased from 61.1 ± 14.2 mm to 53.7 ± 10.6 mm, 47.9 ± 8.3 mm and 43.7 ± 7.2 mm (87.9%, 78.4% and 71.5% of pre-EVAR) at the 6-month, 1-year and 2-year follow-up, respectively ( P < .05). The volume of the aneurysm sac shrank from 236.2 ± 136.2 cm 3 to 202.6 ± 114.1 cm 3 , 155.6 ± 68.4 cm 3 and 129.7 ± 52.4 cm 3 (85.8%, 65.9%, and 54.9% of pre-EVAR) at the 6-month, 1-year and 2-year follow-up, respectively ( P < .05). The rate of various endoleaks was 5.8% (3/52) and the re-intervention rate was 1.9% (1/52) in this research. Conclusions Clinical outcomes show that intra-sac injection of thrombin during EVAR is safe and may be effective in remedying small amount and low-velocity endoleaks and promoting shrinkage of the aneurysm sac.

目的 探讨Neuroform Atlas支架在双支架技术辅助弹簧圈栓塞治疗复杂颅内分叉部宽颈动脉瘤(wide-neck bifurcation aneurysm,WNBA)的安全性和有效性.方法 回顾性分析我院 2020 年 12 月到 2022 年 5 月采用Neuroform Atlas支架以双支架辅助栓塞(dual stent-assisted coiling,DSAC)治疗的 19 例复杂WNBA患者临床资料.19 例患者共 19 个WNBA,其中 5 个为破裂性动脉瘤.分布部位:10 个位于大脑中动脉M1分叉处、7个位于前交通动脉、2个位于基底动脉尖.其中18个动脉瘤采取"Y"型DSAC、1 个采取"X"型DSAC技术治疗.栓塞后复查脑血管数字减影血管造影(digital subtraction angiography,DSA),采取Raymond量表评估即刻栓塞效果和载瘤动脉情况.临床随访采用改良Rankin评分量表(modified Rankin Scale,mRS)评估患者术后 3 个月临床预后,影像学随访采取复查全脑血管DSA,评估患者术后 6 个月时动脉瘤闭塞情况和载瘤动脉通畅情况.结果 19 例患者手术步骤均成功,技术成功率为 100％.DSAC后复查DSA显示动脉瘤即刻闭塞情况:16 个为RaymondⅠ级(完全闭塞)、2 个为RaymondⅡ级(瘤颈残留)、1 个为RaymondⅢ级(瘤体残留).1 例患者出现围手术期并发症:为分支动脉内血栓形成,予替罗非班治疗后血流恢复,苏醒后无明显神经功能缺失.术后 3 个月时 18 例患者获临床随访,均预后良好(mRS≤2 分).术后 6 个月时 16 例患者获DSA影像随访:RaymondⅠ级 14 个、RaymondⅡ级 1 个、RaymondⅢ级 1 个.结论 Neuroform Atlas支架用于DSAC治疗WNBA技术成功率较高,有较低的围手术期并发症发生率和较高的动脉瘤闭塞率,较传统支架有一定优势,但其远期疗效还需进一步随访观察.

血栓栓塞性疾病的栓塞和出血风险并存已成为临床困境.疾病的多元化与药物更迭使抗栓治疗日益复杂和专业化,单一学科已不能胜任疑难病例的抗栓治疗.为更好地整合医疗资源,确保患者从规范化抗栓治疗中获益,北京大学第三医院突破学科间壁垒,组建了以心内科为主体,联合药剂科、检验科、神经内科、急诊科、消化科、心脏外科、呼吸科、介入血管外科、神经外科、风湿免疫科和血液科等12个科室参与的抗栓诊治专业团队,致力于制定合理的抗栓策略,着力解决临床血栓性疾病抗凝、抗血小板治疗中的关键问题,旨在探索一个"以心房颤动患者为中心"的多学科联合诊疗和精细化管理模式.

回顾性分析两例胎盘植入孕妇术后盆腔迟发性出血的发生及诊治经过，结合文献探讨胎盘植入的术前评估及围手术期处理经验。两例孕妇均行胎盘植入术前超声评估，考虑为穿透性胎盘植入，术中二次评估后行胎盘在位子宫次全切除术，术后病理证实为胎盘植入。术后2~3 d出现腹痛或肉眼血尿，超声检查提示手术区域血肿形成，并伴有血肿内活动性出血。急诊行子宫动脉栓塞术，术后病灶逐渐缩小。胎盘植入于子宫前壁下段，子宫下段与膀胱及腹膜与子宫颈的间隙可能有复杂的新生血管及吻合系统，子宫切除术后，仍有可能出现迟发性出血。胎盘植入术前除了进行严重程度的评估之外，还应重视胎盘局部状态及植入部位解剖学的评估，术后迟发性出血时可应用介入血管栓塞术治疗。

Background and Aim Distal cerebral circulation aneurysms (DCCAs) remain treatment challenges for neurointervention. The off-label use of the pipeline embolization device (PED) for these aneurysms remains controversial. This study aimed to evaluate the safety and efficacy of PED for DCCAs in a multicenter cohort of patients. Methods Between March 2016 and June 2021, we retrospectively analyzed the neurointerventional data on the clinical and radiological records of all patients undergoing PED treatment of DCCAs at three medical centers. Results A total of 53 consecutive patients with 53 DCCAs were treated with PED. The mean aneurysm size was 12.3 ± 5.7 mm. In total, 75.4% (40/53) were fusiform and 24.5% (13/53) were saccular. Of these, 17.0% (9/53) were recurrent aneurysms that were previously treated with endovascular or microsurgical approaches. The technical success rate was 100%, among which 81.1% (43/53) procedures were completed with a single PED, and the rest (10/53, 18.8%) required telescoping with two devices. Angiographic follow-up data were available for 51 patients, with a median follow-up time of 12 months. At the latest follow-up, 46/51 (90.2%) aneurysms showed complete obliteration, and 4/51 (7.8%) showed reduced filling. Periprocedural complications such as hemorrhage were observed in two patients with MCA aneurysms (3.8%, 2/53), and ischemic events occurred in six patients (11.3%, 6/53). The overall mortality and morbidity rates were 7% (4/53). Conclusions PED is a viable option for treating DCCAs, especially for recurrent aneurysms. Coverage of bifurcation branches and perforator may increase the risk of complications.

Stroke is the second leading cause of death globally and accounts for an estimated 5.5 million deaths each year worldwide. Revascularization of the carotid artery is one of the key procedures to reduce the incidence of stroke. Chronic total occlusion (TO) and near-total occlusion (NO) of the carotid artery are rare. Treatment for TO and NO is controversial with potential complications, including periprocedural stroke, intracranial hemorrhage, and carotid-cavernous fistula (CCF). There have been attempts to implement carotid artery endarterectomy (CEA) and endovascular treatment, but the success rates were far from satisfactory. For patients with TO, the success rate of revascularization is around 40% and 60%, respectively, for CEA and endovascular technique. For patients with NO, the morbidity and mortality rates are 3% and 9%, respectively.

Objective To explore the technical details and short-term effects of radiofrequency obliteration of varicose veins of lower extremities guided by combined venography and ultrasound. Methods Thirty-seven patients with varicose veins of lower extremities were treated with radiofrequency obliteration using Olympus Celon RFiTT® under combined guidance of venography and ultrasound. The indications included varicose veins of lower extremities and reflux of the great saphenous vein confirmed by ultrasound. The contraindications included deep vein thrombosis, cardiac pacemaker, severe cardio- and cerebrovascular diseases or coagulation disorders. Under ultrasound guidance, the saphenous vein around knee level was punctured using a 21G needle, and a 7F sheath was introduced. Through the sheath a venography was made, and an Olympus Celon ProCurve radiofrequency catheter was inserted and advanced to the great saphenous vein under road map, and the catheter tip was positioned at the point 2 cm below the sapheno-femoral junction. The swelling anesthesia was made under ultrasound guidance. Then the radiofrequency obliteration was performed with pressing of the treatment section. The venography was repeated to ensure optimal outcomes. If necessary the radiofrequency obliteration could be repeated once to twice. After that the superficial varicose veins were stripping by small incisions under local anesthesia. After operation, medical decompression stocking was utilized immediately and sustained for three months. The clinical data, intraoperative radiation dose, exposure time and short-term effects were retrospectively analyzed. Results After the operation, all the patients walked out of the operating room by themselves. The success rate of operation was 100%. The intraoperative radiation dose was 1.78-10.12 mGy (mean 6.56 mGy), and the exposure time was 61-448 s (mean 161 s). By 3 months follow-up, the symptoms were alleviated in all the 37 patients, and the occlusion rate was 100%. No complications such as skin burns, ecchymosis and deep venous thrombosis were found. Conclusion The short-term effects of radiofrequency obliteration using Olympus Celon RFiTT® system in a manner of twice fixed point followed by once reciprocating radiofrequency were satisfactory. Radiofrequency obliteration of great saphenous veins guided by venography and ultrasound has not only the advantages of minimal trauma and rapid recovery, but also the advantages of accurate location, exact effect and avoidance of complications.

Few studies have reported on simultaneous endovascular stenting for tandem posterior circulation (PC) stenoses and its long-term outcomes. Thus, our aim was to investigate the safety and efficacy of simultaneous stenting in patients with symptomatic tandem extra- and intracranial PC stenoses. From September 2014 to June 2018, 16 such patients with symptomatic stenoses who underwent simultaneous stent placement were analyzed. The primary outcome was occurrence of any stroke, TIA, or death within 30 days after the procedure. The secondary outcomes were technical success, clinical success, and the occurrence of in-stent restenosis ≥50% during follow-up. Technical success was defined as stent coverage of all tandem lesions and residual stenosis <30%. Clinical success was determined based on any occurrence of neurological events or death within 3 months after the procedure. All stents (19 intracranial and 14 extracranial) were placed with a technical success rate of 100%. One patient experienced a pontine ischemic stroke 2 days after the procedure and had recovered well at discharge. One patient experienced a minor complication of groin hematoma. The clinical success rate was 93.75% (15/16). During a median follow-up of 36.0 ± 11.0 months, two patients developed ISR ≥50% at the 1-year follow-up. None of the patients experienced stroke, TIA, or death after discharge during follow-up. Simultaneous stenting for symptomatic tandem extra- and intracranial PC stenoses is safe and feasible. Its impact on long-term stroke prevention is promising, and further study of a larger patient population is needed.

OBJECTIVE To summarize the preliminary experience of hybrid operation for the treatment of symptomatic long-segment chronic internal carotid artery occlusion (CICAO) without stump. METHODS Clinical data of 12 patients of symptomatic long-segment CICAO without stump undergoing hybrid operation treatment from July 2015 to December 2017 were retrospectively analyzed. The safety and efficacy of hybrid operation for the treatment of symptomatic long-segment CICAO without stump were preliminarily assessed. CICAO was defined as occlusion time being more than 4 weeks. The primary outcome was defined as any stroke (including ischemic or hemorrhagic) or deaths from any cause after hybrid operation within 30 days. The secondary outcome was defined as successful revascularization and occurrence of >50% in-stent restenosis during the follow-up period. RESULTS In this group, the symptomatic long-segment CICAO of 11 patients were successfully recanalized. Technical success rate was 91.7% (11/12). The main complication rate was 8.3% (1/12). This patient encountered iatrogenic internal carotid artery cavernous sinus fistula caused by micro-guide wire in the midway of the hybrid operation, the proximal segment of this internal carotid artery was ligated and the iatrogenic internal carotid artery cavernous sinus fistula disappeared in the following digital subtraction angiography image. No patient encountered hemorrhagic stroke and ischemic stroke. No death complications occurred. In this group 10 patients of them were followed up. The follow-up period ranged from 10 to 32 months [mean, (19±9) months]. During the follow-up period, 1 patients developed in-stent restenosis and improved after reoperation of percutaneous transluminal angioplasty by the right size balloon without stenting treatment. CONCLUSION Hybrid operation for the treatment of highly screened patients with symptomatic long-segment CICAO without stump is safe and effective, could reduce the incidence of complications and improve procedural success rate.

颈动脉支架成形术( carotid artery stenting ,CAS)治疗颈动脉重度狭窄引起的缺血性脑卒中已广泛开展. CAS 术后可出现脑高灌注综合征 ( hyper perfusion syndrome,HPS),是最危险的并发症之一, CAS术后1 .1％～6 .8％的患者可发生脑组织高灌注损伤,造成脑肿胀甚至脑出血[1]. 存在颈动脉极重度狭窄、对侧颈动脉重度狭窄或闭塞、侧支循环代偿差、合并难控性高血压等高危因素的患者,HPS发生率可高达14 .1％～56％[ 2 ]. HPS往往起病隐匿,如不及时发现及纠正,致残率和致死率均很高,如何降低有HPS高危因素患者术后HPS的发生风险是目前临床亟待解决的热点问题. 2015 年1 月 ～2018年6月我科对36例有HPS高危风险的颈内动脉狭窄行CAS ,现将围手术期的护理报道如下.

Objective:To evaluate the safety and efficacy of hybrid operation in the revascularization in symptomatic extracranial vertebral artery long-segment occlusion.Methods:From June 2018 to January 2020, five patients with symptomatic extracranial vertebral artery occlusion underwent hybrid operation revascularization in Peking University Third Hospital. The neurological score of 5 patients before and after operation was observed, and the neurological function of them was evaluated.Results:5 patients were revascularized successfully. There were no complications and no new-onset stroke or bleeding. For case 1 and case 3, endarterectomy combined with Fogarty catheter embolectomy was performed. For case 2, case 4, and case 5, endarterectomy combined with distal vertebral artery angioplasty and stenting was performed. In case 4, vertebral artery was occluded in one month follow-up, but the patient had no symptoms and no intervention was given.Conclusion:Hybrid operation may be an alternative treatment for symptomatic long-segment occlusion of extracranial vertebral artery with poor drug treatment, but the choice of operation methods and stent still needs further study.

OBJECTIVE To explore the risk factors, clinical characteristics, precaution and treatment of hyper perfusion syndrome (HPS) after carotid artery stenting (CAS). METHODS From September 2014 to March 2018, the clinical data of 226 patients with severe carotid stenosis (70%-99%) treated with carotid artery stenting (CAS)at Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, were analyzed retrospectively．Five of them developed HPS after CAS．The relationship between the clinical baseline data, imaging characteristics, perioperative management and HPS were assessed. RESULTS In this group, 5 patients of them (2.21%, 5/226) developed HPS after CAS, and 2 patients of them (0.88%, 2/226) were hyper perfusion induced intracranial hemorrhage (HICH). The 5 patients consisted of 4 men and 1 woman whose age ranged from 58 to 74 years. The symptoms of HPS occurred within 4 hours to 3 days after CAS. Among the 5 cases, the clinical manifestations were that 2 cases with headache, 1 case with delirium,1 case with hemiparesis of left limbs, and 1 case with coma(died ultimately).The main manifestations of case 1 and case 2 were headache in the frontal parietal temporal region of the operative side, accompanied by nausea and vomiting. The symptoms were relieved after blood pressure lowering treatment and mannitol dehydration. The main manifestations of case 3 were excitement and delirium. The symptoms were relieved by a small dose of sedatives, also with blood pressure lowering treatment and mannitol dehydration. The initial symptoms of case 4 were excitement and delirium, accompanied by mild headache of the operative side, and hemiplegia of the contralateral limb occurred within a short time. The main manifestation of case 5 was severe headache and went into deep coma within a short time. This patient died of massive cerebral hemorrhage ultimately. CONCLUSION HPS is an uncommon but serious complication after CAS. Improving our understanding and heightening vigilance of HPS is necessary. The earlier diagnosis, the earlier treatment.

目的 评估个体化选用支架的方法治疗不同类型的症状性重度颅内动脉粥样硬化性狭窄(intracranial atherosclerotic stenosis,ICAS)的安全性和有效性.方法 回顾性分析2016年1月～2018年3月北京大学第三医院介入血管外科症状性重度ICAS患者61例,根据症状性重度ICAS的不同类型采取个体化选用适应病变特点的颅内支架的方法治疗,观察主要终点事件(术后30 d内脑卒中事件及死亡)和次要终点事件(支架内再狭窄).结果 获得技术成功患者59例,技术成功率96.7％,支架置入术后狭窄率从(81.3±7.1)％降为(17.2±6.2)％,差异有统计学意义(P＜0.01).发生主要终点事件2例(3.3％),其中缺血性脑卒中1例,出血性脑卒中1例,无死亡患者.49例患者获得随访,随访6～29(17.0±7.0)个月,5例(10.2％)患者出现支架内再狭窄,其中2例为症状性再狭窄,予球囊成形术治疗.结论 采用个体化选用合适的颅内支架进行治疗不同类型ICAS的方法是安全有效的,可提高技术成功率,并降低并发症发生率.

目的 总结颈动脉蹼CT血管造影(computed tomography angiography,CTA)的特征,以提高临床和影像医师对此类病理结构的精确诊断.方法 回顾性分析2015年1月～2018年2月我院793例头颈部CTA检查的影像学资料,筛查颈动脉蹼,分析其影像学特征,包括发病部位、病变形态、是否导致动脉狭窄等.结果 8例颈动脉蹼,7例单侧,1例双侧;长度(2.40±0.73)mm,厚度(0.98±0.16)mm.无动脉蹼造成所在颈动脉的重度狭窄.结论 颈动脉蹼是发生于颈动脉窦或颈内动脉起始处后壁的一类少见的膜样结构,好发于女性,单侧多见,几乎不导致动脉重度狭窄;CTA对颈动脉蹼具有重要的诊断价值,仔细阅片对于准确诊断此类病变十分必要.