ABSTRACT Thrombolytic therapy alleviates pulmonary embolism (PE) symptoms rapidly but increases bleeding risk, with no consistent consensus on acute intermediate‐high risk PE. This study evaluated the efficacy and safety of low‐dose prolonged infusion thrombolysis for acute intermediate‐high risk PE to provide a safer clinical option. A total of 120 patients were collected and divided into anticoagulant (Group A, n = 58) and thrombolytic (Group B, n = 62) groups. Efficacy outcomes included pulmonary artery thrombus clearance rate, 30‐day all‐cause mortality, and 3–6 month pulmonary hypertension incidence; the primary safety outcome was treatment‐related bleeding. Both groups showed improved SBP, DBP, SpO₂, and RV/LV ratio (all p < 0.05) with no inter‐group differences, but Group B had higher thrombus clearance rate ([64.85 ± 17.47]% vs. [41.65 ± 16.19]%, p < 0.001), with similar 30‐day mortality (1.61% vs. 5.17%, p = 0.278). At 1 day, post‐treatment, Group B had higher D‐dimer (26.78 ± 16.57 μg/mL vs. 7.60 ± 7.23 μg/mL) and FDP (91.45 ± 97.37 μg/mL vs. 18.60 ± 26.34 μg/mL, all p < 0.001) but comparable FIB (p = 0.091); these differences persisted until discharge (all p < 0.05 for D‐dimer/FDP). Although the incidence of bleeding events in group B was numerically higher than that in group A (17.74% vs. 6.90%, p = 0.073), the difference between the two groups was not statistically significant. No fatal bleeding, intracranial hemorrhage, or recurrent pulmonary embolism occurred in either group. Group B had lower 3–6 month pulmonary artery systolic pressure (PASP) (30.70 ± 9.70 vs. 34.44 ± 10.04 mmHg, p = 0.045) and pulmonary hypertension incidence (27.87% vs. 54.55%, p = 0.004). Thrombus clearance rate correlated with treatment group (r = 0.57, p < 0.001), and D‐dimer (r = 0.42) and FDP (r = 0.32) levels at 1 day post‐treatment (both p < 0.001). Low‐dose prolonged infusion can effectively clear pulmonary artery thrombi in patients with acute intermediate‐high‐risk PE, which may be associated with a reduced incidence of pulmonary hypertension. Patients in the thrombolysis group showed significant dynamic changes in D‐dimer and FDP levels, which were significantly correlated with a higher thrombus clearance rate.

Accurate quantification of morphological features is essential for disease diagnosis, image-guided interventions, and robot-assisted surgeries. However, most existing methods are tailored for histopathological analysis and are inadequate for the real-time, autonomous navigation demands of surgical robotics, thereby limiting their intelligent functionalities. To address this, we propose a path-selectable, image-based morphological measurement method that facilitates vascular path planning and robotic navigation. The proposed method integrates edge detection, skeleton extraction, discrete point sorting, and multi-segment path reconstruction to extract outer contours and centerlines from 2D images. It enables users to interactively define paths of interest, within which four key morphological parameters, distance, tortuosity, angle, and diameter, are precisely quantified. By leveraging the multi-segment reconstruction process, the method enables accurate and continuous measurement across multiple vascular centerline segments. Validation experiments were conducted using a standard test model, with 50 repeated measurements performed at each measurement site for all parameters. The mean absolute error (MAE%) remained below 1%, and the coefficient of variation (CV%) was below 1.5%, demonstrating high accuracy and repeatability. The algorithm was further applied to clinical digital subtraction angiography (DSA) images, where it successfully extracted vessel centerlines and visualized key morphological features, indicating strong clinical adaptability. The proposed algorithm enables accurate and repeatable morphological measurements within user-specified paths on both standard models and clinical images. Compared to global image analysis, this path-selective approach offers enhanced flexibility and local precision, delivering robust technical support for preoperative planning and intraoperative navigation in robot-assisted surgical systems.

Objective: The objective of this study is to assess the feasibility of endovascular coiling combined with tissue glue embolism for the treatment of iliac arteriovenous fistula (AVF) secondary to deep vein thrombosis (DVT) of the lower extremities. In addition, we aim to summarize the treatment methods and enhance understanding of the disease. Methods: This research analyzes the clinical data and medical imaging materials of 20 cases with iliac AVF secondary to lower extremity DVT, ranging from December 2014 to December 2020, at our hospital. The patients underwent endovascular coiling and tissue glue embolism during their hospital stay. We collected and summarized the clinical and imaging data, evaluated the efficacy of treatment methods, assessed the incidence of complications, and conducted long-term follow-up observations. Results: All 20 surgeries were successful. Endovascular coiling combined with tissue glue embolism significantly relieved limb swelling. The diameter difference above the patella in patients before and after treatment was 9.38±3.58 versus 4.13±1.64 cm, P<0.001. No serious complications occurred during treatment, and no patients showed signs of AVF recurrence during follow-up after surgery. Conclusion: Endovascular coiling combined with tissue glue embolism can be used to treat iliac AVF secondary to DVT of the lower extremities, which has high clinical value and is safe. Clinical Impact For clinicians, AVF secondary to DVT is a complication that cannot be ignored. It also needs to be treated aggressively to improve patients’ quality of life. We presented a minimally invasive method to treat iliac arteriovenous fistula secondary to deep vein thrombosis of lower extremities, which is also an innovative intervention technique. Endovascular coiling combined with tissue glue embolism can achieve better embolic blockade in this type of iliac arteriovenous fistula. This will move the management of postoperative complications in the direction of minimally invasive.

OBJECTIVE:To investigate the expression levels of GAD1 and GAD2 in the peripheral blood of intracranial aneurysm (IA) patients and their correlation with the occurrence and development of IA. METHODS:Relevant IA datasets were retrieved from the Gene Expression Omnibus (GEO) database, and the limma package was employed to identify differentially expressed genes (DEGs) between IA wall tissues and superficial temporal artery wall tissues. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted on the identified DEGs. A total of 52 IA patients were enrolled in the IA group, and 34 healthy individuals were included in the healthy control (HC) group. Real-time quantitative polymerase chain reaction (qRT-PCR) was used to measure the expression levels of GAD1 and GAD2 in the peripheral blood of IA patients. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were utilized to evaluate the predictive value of GAD1 and GAD2 for IA. Enzyme-linked immunosorbent assay (ELISA) was performed to detect the levels of TNF-α, IL-6, and IL-1β in both groups. RESULTS:Bioinformatics analysis revealed that GAD1 and GAD2 were significantly upregulated in IA patients. GO enrichment analysis indicated that the biological processes involving DEGs primarily included the regulation of tumor necrosis factor production, negative regulation of cytokine production, T cell activation, and positive regulation of chemokine production. The main cellular components identified were the lysosomal membrane and neutrophil tertiary granules, while the molecular functions included cell adhesion cofactor activity. KEGG enrichment analysis demonstrated that the DEGs were predominantly involved in pathogenic Escherichia coli infection and the regulation of the actin cytoskeleton. qRT-PCR results showed that the expression levels of GAD1 and GAD2 in the peripheral blood of IA patients were significantly higher than those in the HC group (P < 0.05). ROC analysis revealed that the AUCs for GAD1 and GAD2 were 0.845 (95 % CI: 0.785-0.905) and 0.895 (95 % CI: 0.845-0.944), respectively. The levels of IL-6, IL-1β, and TNF-α in the peripheral blood of IA patients were significantly elevated compared to the HC group (P < 0.05). Pearson correlation analysis indicated that the levels of GAD1 and GAD2 were positively correlated with the levels of IL-6, IL-1β, and TNF-α (P < 0.05). CONCLUSION:GAD1 and GAD2 are upregulated in the peripheral blood of IA patients and are positively correlated with the levels of IL-6, IL-1β, and TNF-α. These findings suggest that GAD1 and GAD2 may play a role similar to IL-6, IL-1β, and TNF-α in the pathogenesis of IA, potentially contributing to vascular wall damage, dilation, and rupture, thereby inducing IA formation.

ObjectiveTo compare the efficacy and safety outcomes between percutaneous mechanical thrombectomy (PMT) and catheter-directed thrombolysis (CDT) as the first endovascular revascularization (EVR) strategy for arterial acute mesenteric ischemia (AMI) and identify risk factors for 30-day mortality.MethodsThis was a single-center retrospective study. Between May 2014 and March 2024, consecutive patients with arterial AMI who received EVR using PMT or CDT as the first strategy were included. The baseline characteristics, imaging information, procedure-related information, complications, and clinical outcomes of patients were analyzed and compared. Binary logistic regression analysis was used to identify potential risk factors for 30-day mortality with an odds ratio (OR) and 95% confidence interval (CI).ResultsForty-seven patients (PMT, n = 29; CDT, n = 18) were included. The mean age was 74.3 ± 7.6 years, and 66.0% were female. Successful revascularization was achieved in 89.4% of patients, and the 30-day mortality rate was 31.9%. There was no significant difference in successful revascularization, complications, and clinical outcomes between PMT and CDT as the first strategy. High plasma lactate (adjusted OR 1.73 per 1.0 mmol/L increase, 95% CI: 1.13–2.66; p = 0.012) and D-dimer (adjusted OR 1.73 per 1.0 mg/L increase; 95% CI: 1.20–2.50; p = .003) were associated with a high 30-day mortality rate.ConclusionsPMT and CDT were associated with high revascularization rates and few complications. High plasma lactate and D-dimer may be associated with high 30-day mortality.

The purpose of this study is to investigate the association between the aortomesenteric angle (AMA) and the occurrence and image characteristics of spontaneous isolated superior mesenteric artery dissection (SISMAD). This is a single-centre retrospective case-control study. Between January 1 2013 and December 13 2022, consecutive patients with computed tomography angiography (CTA) confirmed symptomatic SISMAD were included. Controls were selected with 1:1 matches in patients with CTA of the superior mesenteric artery but without SISMAD using propensity score matching for age, sex, and body mass index. Patient demographics, symptoms, and dissection characteristics were recorded. Logistic regression was performed to assess the association between AMA and SISMAD. The study also evaluated the association between AMA and SISMAD using restricted cubic splines (RCS). The associations between AMA and the characteristics of SISMAD were evaluated. One hundred and five SISMAD patients (mean age, 54.8 ± 8.9 years) were included, and most patients were male (87.6%). Univariable analysis revealed hypertension, hyperlipemia, and AMA (all p < .001) were associated with SISMAD. An increasing AMA (adjusted OR, 1.03 per 1 ° increase in angulation) and hypertension (adjusted OR, 3.52) were identified as risk factors for SISMAD. Compared with small AMA level (< 50°), intermediate (50–71°) (adjusted OR, 2.62; 95% CI, 1.23–5.58; p = .013) and large angle level (> 71°) (adjusted OR, 4.50; 95% CI, 2.07–9.82; p < .001) were significantly associated with SISMAD. No obvious associations between AMA and the SISMAD imaging characteristics were found. Greater AMA and hypertension were independent risk factors for SISMAD.

Background: False lumen changes (FLCs) are the main reference for the prognosis judgment and treatment plan selection for type IIa superior mesenteric artery dissection (SMAD). Methods: For this retrospective study, 55 patients with symptomatic type IIa SMAD were included. Computational fluid dynamics (CFD) analysis was used to explore the hemodynamic basis of FLCs. Correlation and multiple linear regression analyses were performed to identify clinical, morphological and hemodynamic factors associated with FLCs. Results: The FLCs of patients with successful conservative treatment ( n = 29) are significantly higher than those with failed conservative treatment ( n = 26) (58.5 ± 21.1% vs 10.9 ± 17.4%, p < 0.0001). Positive correlations were seen between FLCs and the morphological parameters false lumen length (FLL)/dissection entrance length (DEL) and FLL. In terms of hemodynamic parameters, negative correlations were seen between FLCs and time-averaged wall shear stress (TAWSS), vorticity, and high areas of TAWSS and vorticity, whereas positive correlations were seen between FLCs and oscillatory shear index (OSI), relative residence time (RRT), and high areas of OSI and RRT. Multiple linear regression analysis identified symptom duration (odds ratio [OR], 0.93; 95% CI, 0.91–0.96; p < 0.0001), FLL/DEL (OR, 1.30; 95% CI, 1.01–1.67; p = 0.044), and high RRT area (OR, 2.03; 95% CI, 1.48–2.78; p < 0.0001) as predictors of FLCs. Conclusion: The clinical predictor symptom duration, morphological factor FLL/DEL, and the hemodynamic factor high RRT area can serve as predictors of FLCs in patients with symptomatic type IIa SMAD.

OBJECTIVE:This paired meta-analysis aimed to compare the mortality and morbidity of endovascular revascularization (EVR) and open surgical revascularization (OSR) as the first strategy for arterial acute mesenteric ischemia (AMI). METHODS:This systematic review and meta-analysis were performed in accordance with the PRISMA statement. A systematic search strategy was performed to identify eligible studies using the following databases: PubMed, Embase, and Cochrane Library database from inception to December 31, 2023, with restriction to the English language. The end search date was January 2, 2024. The primary outcome was short-term mortality. Secondary outcomes included bowel resection, second-look laparotomy, and short bowel syndrome. The counterenhanced funnel plot and the Peters' test were used to assess bias. Outcomes were reported as odds ratio (OR) with a 95% confidence interval (CI) using the Mantel-Haenszel method. The GRADE classification was used to estimate the certainty of evidence. RESULTS:A total of 11 studies (1141 patients) comparing EVR vs OSR for arterial AMI were identified and analyzed. The mean patient age was 61.9 to 73.6 years and 45.1% of the patients were male. Compared with OSR, EVR as the first treatment may not decrease short-term mortality (OR, 0.79; 95% CI, 0.50-1.25; P = .31; very low certainty) and second-look laparotomy (OR, 1.00; 95% CI, 0.30-3.36; P = .99; very low certainty). However, EVR may be associated with decreased bowel resection (OR, 0.42; 95% CI, 0.20-0.88; P = .022; very low certainty) and short bowel syndrome (OR, 0.39; 95% CI, 0.21-0.75; P = .005; very low certainty). The metaregression revealed that the mortality regarding EVR vs OSR was not impacted significantly by thrombotic etiology (-0.002; 95% CI, -0.027 to 0.022; P = .85), whereas it was impacted significantly by publication year (0.076; 95% CI, 0.069-0.145; P = .031). CONCLUSIONS:Compared with OSR, EVR as the first treatment for arterial AMI may not decrease short-term mortality or second-look laparotomy. Future multicenter randomized controlled trials are needed urgently to confirm these results.

Objective: To identify risk factors for in-stent restenosis (ISR) in patients undergoing stent placement for superior mesenteric artery dissection (SMAD) and to determine the hemodynamic mechanism underlying ISR. Methods: For this retrospective study, patients with SMAD who had ISR after stent placement were included in the ISR group, and age- and sex-matched patients with SMAD who did not experience ISR after stent placement were included in the control group. Clinical, imaging, and hemodynamic data were assessed. Multivariable regression was used to identify independent ISR risk factors. Structural and fluid dynamics simulations were applied to determine the hemodynamic mechanism underlying the occurrence of ISR. Results: The study population included 26 patients with ISR and 26 control patients. Multivariate analysis demonstrated that stent-to-vascular (S/V) ratio (odds ratio [OR], 1.14; 95% confidence interval [CI]: 1.00–1.29; p=0.045), stent proximal position >10 mm away from the SMA root (OR, 108.67; 95% CI: 3.09–3816.42; p=0.010), and high oscillatory shear index (OSI) area (OR, 1.25; 95% CI: 1.02–1.52; p=0.029) were predictors of ISR. In structural and fluid dynamics simulations, a stent proximal position near the abdominal aorta (AA) or entering into the AA reduced the contact area between the proximal struts of the stent and the vascular wall, and alleviated the distal lumen overdilation. Conclusion: The S/V ratio, stent proximal position away from the SMA root (>10 mm), and high OSI area are independent risk factors for ISR in patients with SMAD undergoing stent placement. Deploying the proximal end of the stent near the AA or entering into the AA appears to improve the hemodynamic environment in the SMA lumen and ultimately reduce the risk of ISR. Clinical Impact In-stent restenosis is an uncommon but potentially catastrophic complication after stent placement for the management of superior mesenteric artery dissection. This study identified risk factors for in-stent restenosis and demonstrated that, as long as the stent can fully cover the dissection range, deploying the proximal end of the stent near the abdominal aorta or less entering into the abdominal aorta may reduce the risk of in-stent restenosis in this patient population.

Objectives: Atypical presentations, lack of biomarkers, and low sensitivity of plain CT can delay the diagnosis of superior mesenteric artery (SMA) abnormalities, resulting in poor clinical outcomes. Our study aims to develop a deep learning (DL) model for detecting SMA abnormalities in plain CT and evaluate its performance in comparison with a clinical model and radiologist assessment. Materials and methods: A total of 1048 patients comprised the internal (474 patients with SMA abnormalities, 474 controls) and external testing (50 patients with SMA abnormalities, 50 controls) cohorts. The internal cohort was divided into the training cohort (n = 776), validation cohort (n = 86), and internal testing cohort (n = 86). A total of 5 You Only Look Once version 8 (YOLOv8)-based DL submodels were developed, and the performance of the optimal submodel was compared with that of a clinical model and of experienced radiologists. Results: Of the submodels, YOLOv8x had the best performance. The area under the curve (AUC) of the YOLOv8x submodel was higher than that of the clinical model (internal test set: 0.990 vs 0.878, P =.002; external test set: 0.967 vs 0.912, P =.140) and that of all radiologists (P <.001). The YOLOv8x submodel, when compared with radiologist assessment, demonstrated higher sensitivity (internal test set: 100.0 % vs 70.7 %, P =.002; external test set: 96.0 % vs 68.8 %, P <.001) and specificity (internal test set: 90.7 % vs 66.0 %, P =.025; external test set: = 88.0 % vs 66.0 %, P <.001). Conclusion: Using plain CT images, YOLOv8x was able to efficiently identify cases of SMA abnormalities. This could potentially improve early diagnosis accuracy and thus improve clinical outcomes.

ObjectivesTo develop a novel and accurate nomogram to predict survival without amputation in patients with acute lower limb ischemia (ALLI) during the first year following endovascular therapy.\MethodsPatients with ALLI who underwent endovascular therapy in our department between January 2012 and September 2020 were screened and included in the research. The included patients were randomly divided into a training and validation cohorts, respectively. Univariate and multivariate analyses were used in the training cohort to identify independent risk factors for amputation-free survival(AFS). A nomogram was then developed according to the identified independent risk factors. The nomogram was then validated in the validation cohort.Results415 Chinese patients with 417 affected limbs were included in this study. Among these patients, 311 patients were classified into the training cohort and 104 patients were assigned to the validation cohort. Most patients were men (n =240) and the average age of patients was 71.43 (standard deviation 8.86) years old. After the univariate and multivariate analyses, advanced age (p < 0.001), history of smoking (p < 0.001), atrial fibrillation (p < 0.001), and insufficient outflow (p = 0.001) were revealed as independent risk factors for AFS during the first year. The nomogram yielded AUROC values of 0.912 (95% confidence interval [CI]: 0.873–0.950) and 0.889 (95% CI: 0.812–0.967) in the training and validation cohorts, respectively.ConclusionAdvanced age, history of smoking, atrial fibrillation, and insufficient outflow were independent negative predictors for AFS in ALLI patients treated by endovascular therapy. The novel nomogram offered an accurate prediction of AFS in ALLI patients.

PurposeThis study aimed to evaluate the feasibility of establishing an arterial acute mesenteric ischemia (AMI) model in canines using transcatheter autologous thrombus administration.Materials and methodsTen canines were divided into the experimental group (Group A, n = 5) and the sham group (Group B, n = 5). The canines in Group A received thrombus administration to the superior mesenteric artery (SMA) through a guiding catheter, while the canines in Group B received normal saline administration. Blood samples were collected and tested at baseline and 2 h after modelling. Canines in Group A underwent manual thromboaspiration after blood and intestine samples were collected. Ischaemic grades of intestinal mucosa were evaluated under light microscopes.ResultsThe AMI models were successfully conducted in all canines without procedure-related vessel injury or death. At the 2-h follow-up, the high-sensitivity C-reactive protein and D-dimer in Group A were significantly higher than in Group B (5.72 ± 1.8 mg/L vs. 2.82 ± 1.5 mg/L, p = 0.024; 2.25 ± 0.8 μg/mL vs. 0.27 ± 0.10 μg/mL, p = 0.005; respectively). The mean histopathologic intestinal ischaemic grade in Group A was significantly higher than in Group B (2.4 ± 0.5 vs. 0.8 ± 0.4, p < 0.001). After a median of 2 times of thromboaspiration, 80% (4/5) of the canines achieved complete SMA revascularisation.ConclusionThis experimental study demonstrated that establishing an arterial model in canines using endovascular approaches was feasible. The present model may play an important role in the investigation of endovascular techniques in the treatment of arterial AMI.

Objective:To investigate the influence of abducting upper limb posture on DSA image display of upper limb veins, and summarize the reasonable posture of upper limb phlebography.Methods:According to the different positions of the upper limbs, 93 patients with upper limb phlebography were divided into two groups: the control group in the conventional anatomical position and the experimental group in the abduction position. The difference of DSA imaging between the two positions was compared from various aspects, including artifacts, vascular filling status and position standardization.Results:The standard rate of forearm DSA in the experimental group was 60.00% higher than that in the control group, the incidence of artifacts in the experimental group was 67.67% lower than that in the control group, and the DSA complete filling rate of upper arm veins was 45.95% higher than that in the control group.Conclusions:Venography of upper limb in abducting position can fully show the true state of upper arm veins, reduce artifacts, and can replace the traditional anatomy position angiography.

BACKGROUND:The assessment of collaterals before endovascular thrombectomy (EVT) therapy play a pivotal role in clinical decision-making for acute stroke patients.OBJECTIVE:To investigate the correlation between hypoperfusion intensity ratio (HIR), collaterals on digital subtraction angiography (DSA), and infarct growth in acute stroke patients who underwent EVT therapy.METHODS:Patients with acute ischemic stroke (AIS) who underwent EVT therapy were enrolled retrospectively. HIR was assessed through magnetic resonance imaging (MRI) and was defined as the Tmax > 10 s lesion volume divided by the Tmax > 6 s lesion volume. Collaterals were assessed on DSA using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale. Good collaterals were defined as ASITN/SIR score 3-4 and poor collaterals were defined as ASITN/SIR score 0-2. Spearman's rank correlation analysis was used to evaluate the correlation between HIR, collaterals, infarct growth, and functional outcome.RESULTS:A total of 115 patients were included. Patients with good collateral (n = 59) had smaller HIR (0.29 ± 0.07 vs. 0.52 ± 0.14; t = 10.769, P < 0.001) and infarct growth (8.47 ± 2.40 vs. 14.37 ± 5.28; t = 7.652, P < 0.001) than those with poor collateral (n = 56).DISCUSSION:The ROC analyses showed that the optimal cut-off value of HIR was 0.40, and the sensitivity and specificity for predicting good collateral were 85.70% and 96.61%, respectively. With the optimal cut-off value, patients with HIR < 0.4 (n = 67) had smaller infarct growth (8.86 ± 2.59 vs. 14.81 ± 5.52; t = 6.944, P < 0.001) than those with HIR ≥ 0.4 (n = 48). Spearman's rank correlation analysis showed that HIR had a correlation with ASITN/SIR score (r = -0.761, P < 0.001), infarct growth (r = 0.567, P < 0.001), and mRS at 3 months (r = -0.627, P < 0.001).CONCLUSION:HIR < 0.4 is significantly correlated with good collateral status and small infarct growth. Evaluating HIR before treatment may be useful for guiding EVT and predicting the functional outcome of AIS patients.

Objective To analyze the demographic data,CT characteristics,treatment methods and follow-up results of patients with spontaneous isolated dissection of celiac artery(SIDCA)and to explore the selection of treatment strategy for SIDCA.Methods Medical records of 31 patients diagnosed as SIDCA were selected.The patients were divided into 2 groups,symptomatic group and asymptotic group.Demographic data,morbidity season,CT characteristics(type,distance of the entry site from the origin of the artery,dissection length,compression rate of the true lumen,branches involvement,organ ischemia,coexisting vasculopathy),treatment methods,and follow-up results were analyzed.Results Thirty-one patients were identified by CT contrast scan,22 were symptomatic and 9 were asymptomatic.22 patients were first diagnosed in cooler season,compared with 9 patients in warmer season(22 vs 9,Fisher's exact test,P=0.029).The difference between symptomatic and asymptomatic groups about branches involvement in patients was significant(8/14 vs 0/9,Fisher's exact test,P=0.007).Treatment included observation in 24,endovascular intervention in 6 patients and surgical repair in 1 patient.No patient required bowel resection.The mean follow-up period was 13.75 months.Except for 2 patients,the condition of the remaining patients improved or stabilized during follow-up.Conclusion The difference between symptomatic and asymptomatic groups about branches involvement in patients is significant.Initial conservative treatment may be adequate for patients without end organ malperfusion or aneurysm formation or aneurysm rupture in SIDCA.Additionally,during the cooler season,visceral artery should be observed carefully on abdominal contrast CT,especially in the patient with abdominal pain,to avoid misdiagnosis.

Background: The purpose of this study was to identify the signaling pathways and immune microenvironments related to elderly stroke patients. Methods: We downloaded the public transcriptome data (GSE37587) from the gene expression omnibus and divided the patients into young and old groups and identified differentially expressed genes (DEGs). Gene ontology function analysis, Kyoto encyclopedia of genes and genomes pathway analysis, and gene set enrichment analysis (GSEA) were performed. A protein-protein interaction network was constructed and hub genes were identified. Gene-miRNA, gene-TF, and gene-drug networks were constructed using the network analyst database. The immune infiltration score was evaluated using single-sample gene set enrichment analysis GSEA, its correlation with age was computed and visualized using R software. Results: We identified 240 DEGs, including 222 upregulated and 18 downregulated DEGs. Gene ontology enrichment was significantly enriched in response to the virus, type I interferon signaling pathway, cytological component, focal adhesion, cell-substrate adherents junction, and the cytosolic ribosome. GSEA identified the following mechanisms: heme metabolism, interferon gamma response, and interferon alpha response. Ten hub genes included interferon alpha-inducible protein 27, human leucocyte antigen-G, interferon-induced protein with tetratricopeptide repeats 2, 2’-5’-oligoadenylate synthetase 2, interferon alpha-inducible protein 6, interferon alpha-inducible protein 44-like, interferon-induced protein with tetratricopeptide repeats 3, interferon regulatory factor 5, myxovirus resistant 1, and interferon-induced protein with tetratricopeptide repeats 1. Quantitative analysis of immune infiltration showed that increased age was significantly positively correlated with myeloid-derived suppressor cells and natural killer T cells, and negatively correlated with immature dendritic cells. Conclusion: The present research could help us better understand the molecular mechanisms and immune microenvironment of elderly patients with stroke.

Spontaneous isolated superior mesenteric artery dissection (SISMAD) was considered to be a rare disease1 but has been increasingly reported.2 Most studies have focused on the characteristics or treatment of SISMAD, but the aetiology of SISMAD remains unknown.2 Some have suggested that a large aortomesenteric angle (AMA) may be associated with the occurrence of SISMAD,3–5 but the sample size was small3,5 or a control group was absent.3 This retrospective case control study aimed to further evaluate the association between AMA on a continuous scale and SISMAD risk.

Objective:To improve the visibility of some nerve interventional devices in X-ray fluoroscopy, and to provide convenience for neurointerventional surgeries.Methods:The Enterprise stent was placed into a body phantom, and dynamic imaging was performed using digital radiography (DR) mode, with simultaneous adjustment of parameter values to achieve the clearest image. A specialized fluoroscopy protocol was created to observe specific stent structural details. Subsequently, this protocol was applied to 96 patients who underwent general fluoroscopy at Nanjing First Hospital from May 2020 to July 2021, but had their intracranial stents for neurointerventional treatment not clearly display. The clarity, detail observation time, average radiation dose rate and visual comfort of the operator were compared between the two types of fluoroscopy.Results:The exclusive perspective mode was constructed. In all 96 cases, the use of specialized fluoroscopy for intracranial stent visualization during the intervention procedure was superior to general fluoroscopy. The average dose rate of exclusive fluoroscopy was higher than that of general fluoroscopy and the mean ± sd difference was 43.27 ± 36.29 μSv/h, and the average observation time of exclusive fluoroscopy was shorter than that of general fluoroscopy and the mean ± sd difference was 6.35 ± 3.96 sand the accumulate dose of exclusive fluoroscopy was decreased 1.1 ± 1.71 μSv. The observation comfort of operators under exclusive fluoroscopy was all better than that of general fluoroscopy.Conclusion:It is feasible to create a specialized fluoroscopy program, which is an effective means to observe specific structural details in neurointerventional surgery and can be used as a complement to general fluoroscopy.

Background: The purpose of this research was to establish a safe, effective, and simple nervous system aneurysm model. This method could quickly and stably establish an exact canine tongue aneurysm model. This paper summarizes the technique and key points of the method. Methods : Under the condition of anesthesia by inhaling isoflurane with a mask, we punctured the femoral artery of the canine, and the tip of the catheter was placed in the common carotid artery for intracranial arteriography. The positions of the lingual artery, external carotid artery, and internal carotid artery were identified. Then, the skin near the mandible was cut according to the positioning and separated layer by layer until the bifurcation of the lingual artery and external carotid artery was exposed. The lingual artery were then sutured with 2–0 silk sutures approximately 3 mm from the external carotid/lingual artery bifurcation. The final angiographic review showed that the aneurysm model was successfully established. Results : The lingual artery aneurysm was successfully established in all 8 canines. All canines obtained a stable model of nervous system aneurysm and confirmed by DSA angiography. Conclusion : We have established a safe, effective, stable and simple method to establish a canine nervous system aneurysm model with controllable size. In addition, this method has the advantages of no arteriotomy, less trauma, constant anatomical location, and low risk of stroke.

Objective : This study investigates the safety and efficacy of endovascular treatments on pregnancy-related iliofemoral deep vein thrombosis (DVT). Methods : We retrospectively reviewed data of 46 patients who had symptomatic pregnancy-related iliofemoral DVT and underwent endovascular treatment. The patients treated with catheter-directed thrombolysis (CDT) were classified as the CDT group. In contrast, those treated with CDT combined with pharmacomechanical thrombectomy (PMT) or angioplasty/stenting were classified as the pharmacomechanical catheter-directed thrombolysis (PCDT) group. Results : Based on the immediate post-operative clot burden reduction rate analysis of 46 patients: 22 cases were completely dissolved (lysis grades III), 12 were partially dissolved (lysis grades II), and 12 failed (lysis grades I). There was a statistically significant difference in the rate of clot burden reduction between the CDT group (n = 19) and the PCDT group (n = 27) ( p = 0.001). There was no statistically significant difference in the number of bleeding events between the two groups ( p = 0.989). At 24 months, cumulative venous patency in the CDT group was 50.0%, compared to 78.2% in the PCDT group. Furthermore, there was a statistically significant difference in Villalta score (p = 0.001) and venous severity scoring (VCSS score) (p = 0.005) between the two groups. Conclusions : CDT treatment combined with PMT or angioplasty/stenting is comparatively safe and effective for pregnant-related DVT patients. PCDT outperforms CDT in terms of immediate efficacy and reduces the incidence of post-thrombotic syndrome with better midterm outcomes.