Objective:To explore the relationship between the rupture of small intracranial aneurysms and their anatomical features, and establish the prediction model for assessing the risk score of the rupture of aneurysms to provide references for the intervention of small intracranial aneurysms.Methods:Data of 182 cases with small intracranial aneurysms were analyzed retrospectively, which was confirmed by computed tomography angiography or digital subtraction angiography in Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2015 to May 2020. In this study, 62 males and 120 females, aged 31-83 (56.85±11.51) years were included. The patients were divided into rupture aneurysm group (95 cases) and unruptured group (87 cases). Univariate analysis was used to analyze the clinical features and imaging anatomical data. Multivariate logistic regression analysis was used to analyze the independent risk factors for ruptured intracranial aneurysms, and the prediction model for assessing the risk score of aneurysm rupture was established.Results:Univariate analysis showed that statistically significant differences in aneurysm location, morphology, asci of aneurysm, inflow angle, and aspect ratio(AR)value existed between the two groups (all P values<0.05). Multivariate logistic regression analysis disclosed that asci of aneurysm, inflow angle>117.75°, and AR value>1.65 were the independent risk factors for the rupture of intracranial aneurysms (all P values<0.01). The area under the receiver operator characteristic curve of aneurysm rupture risk score ( R) based on the logistic prediction model was 0.812(95% confidence interval 0.750-0.874, P<0.01), R=2 was the best cut-off value, sensitivity was 72.6%, and specificity was 78.2%. Conclusions:Patients with small unruptured intracranial aneurysms have two or more imaging anatomical characteristics, such as aneurysm located in the posterior communicating segment of the internal carotid artery or anterior communicating artery, irregular shape, with capsule, inflow angle>117.75°, and AR value>1.65, are high-risk groups of aneurysm rupture.

目的 研究探讨载药微球(Drug-eluting beads,DEB)在肝动脉化疗栓塞术(Transcatheter arterial chemoem-bolization,TACE)治疗原发性肝癌(Primary hepatic carcinoma,PHC)中的临床效果及价值.方法 选取60例郑州市中心医院于2017年1月-2019年12月收治的PHC患者,应用计算机随机排序的方式将上述呢如患者平均分为对照组(30例,应用TACE进行治疗)和研究组(30例,采用DEB-TACE进行治疗),对比患者术后1个月、术后3个月肝功能情况及肿瘤直径,病情控制率及并发症发生率.结果 研究组患者术后1个月肝功能中ALB(Albumin,白蛋白)、ALT(Alanine aminotransferase,血清谷丙转氨酶)、AST(Aspartate aminotransferase,谷草转氨酶)、TBIL(total bilirubin,总胆红素)、AchE(Acetylcholinesterase,乙酰胆碱酯酶)及肿瘤直径改善情况较对照组更为明显,有统计学意义(P＜0.05),而3个月后患者上述各指标水平差异缩小至无统计学意义(P＞0.05).在病情控制率方面,研究组患者控制率达到100.00％,明显高于对照组的83.33％,有统计学意义(P＜0.05);同时在并发症发生率方面,研究组(23.33％)略低于对照组(33.33％),但不具有统计学意义(P＞0.05).结论 通过对PHC患者采用DEB-TACE治疗,能够在保证其安全性的条件下提升近期临床疗效,同时在病情控制上较常规TACE治疗表现更佳.通过将该手术治疗用于PHC患者,能有效改善其生存状态,增加其生存率,帮助其尽早地回归家庭和社会,可在各大医院进行推广.

目的 观察SilverHawk斑块切除系统在治疗股腘动脉支架内再狭窄中的临床疗效.方法 回顾性分析34例股腘动脉支架内再狭窄患者的临床及随访资料,其中15例采用斑块切除术治疗(切除组),19例采用普通球囊血管成形术治疗(POBA组).术后观察两组患者临床症状改善情况,记录手术前后踝肱指数(ABI)及最小管腔直径(MLD)的变化,采用Kaplan-Meier生存函数分析术后靶血管通畅率.结果 两组手术治疗成功率均为100％.术后6、12个月切除组ABI(0.81±0.07、0.79±0.08)与POBA组(0.68±0.12、0.51±0.11)比较P均<0.05.术后12个月切除组MLD[(3.10±0.89)mm]与POBA组[(1.74±0.94)mm]比较P<0.05.术后12个月切除组靶血管一期通畅率(66.7％)高于POBA组(31.6％),P<0.05.结论 SilverHawk斑块切除系统在治疗股腘动脉支架内再狭窄病变方面具有理想的近中期临床效果,且安全有效.

目的 探讨SilverHawk斑块切除系统治疗膝下动脉硬化闭塞的临床效果.方法 采用SilverHawk斑块切除系统治疗34例(39条患肢)膝下动脉硬化闭塞患者,观察治疗效果及随访结果.结果 患者围手术期无死亡.39条患肢中,31条(28例患者)顺行开通成功,8条(6例)逆行开通成功,治疗成功率100％(39/39),技术成功率92.31％(36/39).术后1周患者跛行距离、趾肱指数(TBI)及踝肱指数(ABI)均高于术前(P均＜0.05).术后随访2～46个月,平均(23.63±9.71)个月,溃疡愈合率90.00％(9/10);4条坏疽患肢中,1条膝下截肢.术后6、12、24个月患肢一期通畅率分别为87.18％(34/39)、82.05％(32/39)及71.79％(28/39),二期通畅率分别为94.87％(37/39)、92.31％(36/39)和84.62％(33/39).结论 采用SilverHawk斑块切除系统治疗膝下动脉硬化闭塞效果良好.

Extracranial carotid artery pseudoaneurysms (ECAPs) are rare vascular lesions that, if untreated, can lead to severe neurologic deficits and significant mortality. Although conservative therapy, surgical ligation or reconstruction, and endovascular techniques can be curative, the literature demonstrates that the best therapy remains controversial and consensus is lacking. We report a case of a 53-year-old patient who developed a giant ECAP on the left side of her neck, which had been presented for 10 years and was successfully treated by covered stent-assisted open surgery. During the 6 months of follow-up, computed tomography angiography confirmed complete occlusion of the ECAP and patency of the carotid artery. In addition to this report, a brief review of the literature is presented.

目的 观察颈动脉内膜剥脱术联合腔内技术治疗慢性颈内动脉长段闭塞的临床效果.方法 颈内动脉长段闭塞患者21例,均采用颈动脉内膜剥脱术联合腔内技术(Fogarty导管取栓、闭塞段球囊扩张、支架置入)治疗.观察围术期一般情况.通过临床症状改善情况及脑血流动力学指标(脑血流量、脑血容量、脑血流平均通过时间)(采用CT灌注成像检测)评价术后效果.术后3、6、12、24个月,采用影像学检查评估颈内动脉通畅情况;术前、术后3个月,采用改良Rankin量表(mRS)评分评价神经功能缺损情况和残障程度.结果 21例患者均成功开通闭塞血管,围手术期无新发脑梗死或死亡,并发症发生率为19.04％.术后临床症状均得到不同程度缓解.与术前比较,术后脑血流动力学指标脑血流量、脑血容量均升高,脑血流平均通过时间缩短(t分别为13.86、3.96、11.98,P均<O.05).16例(76.19％)获得影像学随访的患者中,13例(81.25％)管腔通畅,1例出现靶血管支架内闭塞,2例出现靶血管狭窄.术后3个月mRS评分2分者3例,1分者5例,0分者13例,提示总体神经功能恢复良好.结论 颈动脉内膜剥脱术联合腔内技术是治疗慢性颈内动脉长段闭塞的有效手段,短期随访结果满意,安全性好.

Objective To compare the hemostatic safety and efficacy of a new butterfly femoral artery compression device (FACD) with those of manual compression (MC) in patients undergoing percutaneous peripheral endovascular interventions via femoral artery. Methods A total of 283 patients, who received percutaneous endovascular interventions via femoral artery during the period from September 2016 to December 2017, were enrolled in this study. After endovascular intervention, 167 patients received FACD to make hemostasis (FACD group), and 116 patients received MC hemostasis (MC group) . The patient's comfortableness, time used for hemostasis (min), limb immobilization time (h), and the incidence of vascular complications in both groups were analyzed. Results All 283 patients were included in analysis, the results indicated that the hemostatic success rates in FACD group and MC group were 96.4％ (161/167) and 94.0％ (109/116) respectively, the difference between the two groups was not statistically significant (P>0.05) . The postoperative Kolcaba Comfort Scale score of FACD group was (85.0 ±11.2) points, which was remarkably higher than (58.4±11.7) points of MC group (P<0.05), the time used for hemostasis in FACD group was (9.2 ±2.2) min, which was strikingly shorter than (18.5 ±2.9) min in MC group (P <0.05) . The limb immobilization time in FACD group was (10.4±2.4) hours, which was obviously shorter than (23.1±4.1) hours in MC group (P <0.05) . The incidence of vascular complications in FACD group was 3.6％, which was dramatically lower than 9.5％ in MC group (χ2=4.206, P=0.04) . Conclusion The use of the new butterfly FACD can promptly, safely and effectively stop bleeding of femoral artery puncture site. The new butterfly FACD is superior to MC in shortening hemostatic time and limb immobilization time, in reducing incidence of vascular complications, as well as in improving patient's comfortableness degree.

Objective To analyze the clinical effects of Viabahn covered stents and bare metal stents in treatment of femoral and popliteal arteriosclerosis. Methods The clinical data of 75 patients ( 75 limbs) with femoral and popliteal arteriosclerosis obliterans receiving endovascular surgery from January 2016 to January 2017 were retrospectively analyzed. There were 35 patients in the Viabahn covered stents group and 40 in the bare metal stents group. The condition of vascular recanalization was compared between the two groups and the factors which affected the primary patency rate were also analyzed. Results All the patients ( 75 limbs in 75 cases) were operated successfully. The follow-up time was 24 months. In the Viabahn covered stents group, the primary patency rates were97. 14％, 91. 43％, 80. 00％ and 68. 57％ 3, 6, 12 and 24 months after surgery, and the secondary patency rates were 100. 00％, 97. 14％, 91. 43％ and 85. 71％ respectively. In the bare metal stents group, the primary patency rates were 90. 00％, 75. 00％, 52. 50％ and 42. 50％ 3, 6, 12 and 24 months after surgery, and the secondary patency rates was 97. 50％, 92. 50％, 87. 50％ and 80. 00％ respectively. Log-rank test showed that there were a significant differences in the primary patency rates between the two groups ( χ2= 5. 318, P = 0. 021), but there were no significant difference in the secondary patency rates ( χ2= 0. 536, P = 0. 464). Smoking, hyperlipidemia and diabetes were the independent risk factors of primary patency rates ( P = 0. 007, 0. 003, 0. 063). Conclusion Viabahn covered stent is more effective than bare metal stent in the treatment of femoral popliteal arteriosclerosis.

患者 男性,49 岁. 因 "发现右下腹部搏动性包块 4年"于2017年11月16日入院.患者20年前有右大腿枪弹伤史,行伤口"清创缝合"后愈合良好.发现包块后于当地医院诊断为"右股动静脉瘘(arteriovenous fistula,AVF)"并已行"右股动脉造影并覆膜支架植入术"治疗,术后症状无明显缓解. 入院查体示右下肢较对侧粗,右下腹部可触及6 cm× 8 cm 搏动性包块,搏动频率与心率一致,可触及震颤,能闻及吹风样杂音. 实验室检查梅毒螺旋体抗体阴性、 血沉、C反应蛋白等均在正常范围.

目的： 评价应用 TurboHawk 斑块切除系统联合药物涂层球囊（DCB）治疗股腘动脉硬化闭塞性疾病的安全性和有效性。 方法： 2016 年 4 月—2017 年 10 月，对 17 例股腘动脉硬化闭塞性疾病患者应用 TurboHawk 斑块切除系统联合 DCB 治疗。17 例患者平均年龄（66.9±10.5）岁；其中男 14 例，女 3 例；股腘动脉狭窄病变 13 例，闭塞性病变 4 例；术前 Rutherford 分级 2~5 级；术前踝肱指数（ABI）为 0.49±0.18。 结果： 17 例患者的血管病变全部经腔内开通成功，其中 1 例股动脉穿孔患者行补救性覆膜支架植入术，另 1 例远端栓塞患者经股动脉切开球囊导管取栓后血流恢复通畅，技术成功率 88.2%。术后 ABI为 0.99±0.27，明显高于术前（P=0.03）。术后 3、6 个月一期通畅率分别为 94.1%，88.2%，二期通畅率 100%。 结论： TurboHawk 斑块切除系统联合药物涂层球囊治疗股腘动脉硬化闭塞性疾病安全有效，早期效果满意。

目的:探讨复合手术治疗慢性症状性颈内动脉闭塞的安全性及临床应用价值.方法:回顾性分析2016年12月—2018年3月应用复合手术治疗的9例颈内动脉闭塞患者的临床资料,其中男7例,女2例;中位年龄58岁.比较手术前后临床症状的变化并进行随访,记录手术前后改良Rankin量表(mRS)评分及大脑血流MR灌注(PWI)指标(CBF、TTP、MTT)变化.结果:9名患者均成功开通闭塞血管,技术成功率100％.术后临床症状均获得缓解,围手术期无新发脑卒中,无死亡患者;术后2例(22.2％)出现高灌注表现,经保守治疗后症状消失;术后PWI指标较术前均明显改善.9名患者均获得随访,中位随访时间8个月;1例患者靶血管6个月时出现再闭塞,表现为短暂性脑缺血发作频发,保守治疗后症状稍缓解;余8例病情均好转,mRS评分较术前改善均≥1分;术后3、6个月再闭塞率为0％、11.1％,提示总体通畅良好.

Objective To explore the value of retrograde recanalization technique in treatment of TASCⅡ C/D femoropopliteal arteriosclerosis obliterans.Methods Totally 36 patients with TASCⅡ C/D femoropopliteal arteriosclerosis obliterans were retrospectively analyzed.Preoperative and postoperative ankle brachial index (ABI) and intermittent claudication were compared,as well as postoperative vascular patency rate and complications were analyzed.Results The retrograde recanalization technique were successfully performed in all 36 patients.The walking distance and ABI of 7 days,and 3,6,12 months postoperation were increased significantly compared with preoperation (all P＜0.05).The postoperative vascular patency rate of 3,6 and 12 months was 97.22％,91.67％ and 72.22％,respectively.There was no death nor amputation during the follow-up period,and the incidence of perioperative complications was 11.11 ％ (4/36).Conclusion Retrograde recanalization technique can be used to treat TASC Ⅱ C/D femoropopliteal arteriosclerosis obliterans when anterograde access failed.