Objectives To assess the safety and efficacy of the combination of brachial artery (BA) cutdown with purse-string suture (PSS) for BA preclosure during fenestrated thoracic endovascular aortic repair (f-TEVAR).Methods We reviewed the consecutive data in our center from January 2022 to May 2023. Clinical data were analyzed retrospectively, including the baseline characteristics, procedural details, complications, and outcomes. Dichotomous data were summarized as absolute values and percentages. Continuous variables were presented as median values and interquartile ranges (IQRs). All patients underwent arterial cutdown with the PSS technique for BA preclosure. The technique was considered successful when complete hemostasis was achieved and confirmed by ultrasonography 24 h postoperatively. The patients were followed up 30 days postoperatively for access-related complications.Results Forty-eight patients who underwent f-TEVAR with 48 BA access sites were included [36 males and 12 females; median age: 62 (IQR: 30-78) years]. The median body mass index was 27.3 (IQR: 21.2-32.7) kg/m2. The median access establishing and closing times were 7.8 (IQR: 6-9.3) min and 3.7 (IQR: 2.5-5) min, respectively. The median operative time and length of stay were 75 (IQR: 63-87) min and 7 (IQR: 5-9) days, respectively. Although the success rate was 100%, partial numbness in the median nerve distribution was noted in 1 patient in the forearm. This resolved spontaneously and no permanent neurological problem was seen. No other access-related complications were noted, and the total complication rate was 2.1% (1/48).Conclusions BA preclosure with the PSS technique is safe and effective for left subclavian artery revascularization in Stanford B aortic dissection and can be another option for access closure during f-TEVAR.

Objective: The standard for computed tomography perfusion (CTP) assessment has not been well established in early acute ischemic stroke (AIS). We aimed to examine the prognostic factors for good outcomes in patients who received CTP, with an Alberta Stroke Program Early CT Score (ASPECTS) < 6 after endovascular thrombectomy (EVT) in the early time window (0-6 h).Methods: We retrospectively reviewed 59 patients who met the criteria from October 2019 to April 2021. Based on the modified Rankin Score (mRS) at 90 days, the patients were divided into a good outcome group (mRS 0-2) and a poor outcome group (mRS 3-6). Baseline and procedural characteristics were collected for unilateral and multivariate regression analyses to explore the influencing factors for good outcomes.Results: Of the 59 patients included, good outcomes were observed in 21 (35.6%). Multivariate logistic regression analysis showed that smaller ischemic core volume (odds ratio [OR]: 0.950; 95% CI: 0.908-0.994; P = 0.026), lower National Institutes of Health Stroke Scale (NIHSS) score (OR: 0.750; 95% CI: 0.593-0.949; P = 0.017) and shorter stroke onset to reperfusion time (ORT) (OR: 0.981; 95% CI: 0.966-0.996; P = 0.016) were independent predictors for good outcomes at 90 days.Conclusion: Smaller ischemic core volume based on CTP, lower NIHSS score and shorter ORT were significant independent predictors of good outcomes in patients with ASPECTS < 6 in the early time window after EVT.

BackgroundPatients with acute ischemic stroke (AIS) and a large core may benefit from endovascular treatment (EVT) in the early time window.PurposeTo examine the prognostic factors for good outcomes in patients with a large core (70–130 ml) after EVT.Materials and methodsWe retrospectively reviewed 40 patients who met the criteria from October 2019 to April 2021. Based on the modified Rankin Score (mRS) at 90 days, the patients were divided into a good outcome group (mRS 0–2) and a poor outcome group (mRS 3–6). Baseline and procedural characteristics were collected for unilateral and multivariate regression analyses to explore the factors that influence good outcomes. In particular, the infarct territories were quantified as subcortical infarct volume (SIV) and cortical infarct volume (CIV).ResultsOf the 40 patients included, good outcomes were observed in 11 (27.5%) patients. Younger age, smaller SIV and larger mismatch volume were noted in the good outcome group than in the poor outcome group (all P < 0.05). Multivariate logistic regression analysis showed that only a smaller SIV [odds ratio (OR) 0.801; 95% CI 0.644–0.996; P = 0.046] was an independent predictor for good outcomes. The receiver operating characteristic curve indicated a moderate value of SIV for predicting good outcomes, with an area under the receiver operating characteristic curve of 0.735 (95% CI 0.572–0.862; P = 0.007).ConclusionSubcortical infarct volume was a potential useful predictor of good outcomes in patients with a large core after EVT in the early time window.

This study aimed to compare a dual Proglide strategy versus a combination of one Proglide and dual Exoseal for large-bore access closure during percutaneous access endovascular aneurysm repair (pEVAR). We retrospectively analyzed 97 patients who underwent pEVAR at our center between January 2021 and February 2023. The patients were divided into two groups: dual Proglide (P + P) and one Proglide with dual Exoseal (P + E). The primary outcome measures were technical success and access-related vascular complications. Technical success was defined as achieving complete hemostasis without a bailout strategy. Postprocedural follow-up for access-related vascular complications was evaluated at 30 and 60 days using computed tomography angiography and ultrasonography. Severity was graded according to the Cardiovascular Interventional Radiological Society of Europe (CIRSE) Classification. Overall, a dual Proglide strategy was used in 46 patients (47.4

目的 探讨前循环急性缺血性脑卒中(AIS)患者支架取栓术首次成功再灌注(FPR)的影响因素.方法 回顾性分析2018年1月至2020年3月在南京医科大学第一附属医院接受Solitaire AB支架取栓治疗的前循环AIS患者临床资料.根据首次支架取栓后闭塞血管再通程度是否达到改良溶栓治疗脑梗死(mTICI)血流分级2c/3级且无需补救措施,将患者分为FPR组和非FPR组.采用单因素分析和多因素logistic回归法分析FPR相关影响因素.结果 共纳入215例患者,其中FPR组61例(28.4％),非FPR组154例(71.6％).单因素分析显示,FPR组患者平均穿刺至再通时间、90 d良好预后率均优于非FPR组(P＜0.05).多因素logistic回归分析显示,大脑中动脉闭塞(OR=0.387,95％CI=0.180～0.834,P=0.015)、术前静脉溶栓(OR =0.410,95％ CI=0.214～0.787,P=0.007)、取栓过程中使用中间导管(OR=0.405,95％CI=0.209～0.787,P=0.008)是FPR的独立预测因素.结论 FPR与大血管闭塞性AIS患者临床良好预后相关.支架取栓过程中大脑中动脉闭塞、使用中间导管及术前行静脉溶栓,会增加FPR可能性.

Objective This study aimed to develop and validate a nomogram to predict the risk of pancreatitis after percutaneous transhepatic biliary stent insertion (PTBS) in patients with malignant biliary obstruction (MBO). Materials and methods We enrolled 314 patients who underwent PTBS for MBO from March 2016 to July 2021 in this retrospective study. We used univariate analysis to identify potential risk factors, while a multivariate logistic regression model was employed to establish a nomogram for predicting the risk of pancreatitis. The discrimination and calibration of the nomogram were evaluated by estimating the area under the receiver operator characteristic curve (AUC) and by bootstrap resampling and visual inspection of the calibration curve. The clinical utility of the nomogram was assessed using decision curve analysis (DCA). Results After the procedure, 41 (13.1%) patients developed pancreatitis. Based on multivariate logistic regression analysis, young age ( OR = 2.57, 95% CI 1.16 to 5.69 ), stent insertion across the papilla ( OR = 6.47, 95% CI 2.66 to 15.70 ), and visualization of the pancreatic duct ( OR = 15.40, 95% CI 6.07 to 39.03 ) were associated with an elevated risk of pancreatitis. Importantly, the performance of the nomogram was satisfactory, with an identical AUC ( 0.807, 95% CI 0.730 to 0.883 ) and high-level agreement between predicted and observed probabilities as suggested in calibration curves. The DCA curve subsequently confirmed the clinical utility. Conclusion A predictive nomogram for pancreatitis after PTBS in patients with MBO was successfully established in the present study.