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Huijberts I, Pinckaers FME, van Zwam WH, Boogaarts HD, van Oostenbrugge RJ, Postma AA. Cerebral arterial air emboli on immediate post-endovascular treatment CT are associated with poor short- and long-term clinical outcomes in acute ischaemic stroke patients. J Neuroradiol 2023; 50:530-536. [PMID: 37331695 DOI: 10.1016/j.neurad.2023.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/30/2023] [Accepted: 06/11/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE To determine the incidence and predictors of cerebral arterial air emboli (CAAE) on immediate post-endovascular treatment (EVT) dual-energy CT (DECT) in acute ischaemic stroke (AIS) patients, and describe their association with clinical outcomes. METHODS EVT records from 2010 to 2019 were screened. Exclusion criteria included intracerebral haemorrhage on post-EVT DECT. In the affected middle cerebral artery (MCA)-territory, circular and linear (length ≥ 1.5*width) CAAE were counted. Clinical data were collected from prospective records. The modified Rankin Scale (mRS) at 90 days was the primary outcome. Multivariable linear, logistic, and ordinal regression were used to analyse the effect of (1) linear CAAE and (2) isolated circular CAAE. RESULTS Out of 651 EVT-records, 402 patients were included. In 65 patients (16%), at least one linear CAAE was found in the affected MCA-territory. 17 patients (4%) showed isolated circular CAAE. Multivariable regression showed an association between both the presence and the number of linear CAAE and the mRS at 90 days (presence: adjusted (a)cOR 3.10, 95%CI 1.75-5.50; number: acOR 1.28, 95%CI 1.13-1.44), NIHSS at 24-48 h (presence: aβ 4.15, 95%CI 1.87-6.43; number: aβ 0.88, 95%CI 0.42-1.34), mortality at 90 days (presence: aOR 3.34, 95%CI 1.51-7.40; number: aOR 1.24, 95%CI 1.08-1.43) and stroke progression (presence: aOR 4.01, 95%CI 1.96-8.18; number: aOR 1.31, 95%CI 1.15-1.50). Isolated circular CAAE were not significantly associated with any outcome measure. CONCLUSION CAAE were found frequently on post-EVT CT imaging. The presence and the number of linear CAAE, but not circular CAAE, are associated with unfavourable short- and long-term clinical outcomes.
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Affiliation(s)
- Ilse Huijberts
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, the Netherlands; Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
| | - Florentina M E Pinckaers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, the Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, the Netherlands.
| | - Wim H van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, the Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, the Netherlands
| | | | - Robert J van Oostenbrugge
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Neurology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, the Netherlands; School for Mental Health and Neuroscience (MHENS), Maastricht University, Maastricht, the Netherlands
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Ushimaru Y, Takahashi T, Yamashita K, Saito T, Tanaka K, Yamamoto K, Makino T, Kurokawa Y, Eguchi H, Doki Y, Nakajima K. Translation from manual to automatic endoscopic insufflation enhanced by a pressure limiter. Surg Endosc 2022; 36:7038-7046. [PMID: 35041055 DOI: 10.1007/s00464-022-09040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Optimal visualization and safety have always been essential in performing any type of endoscopic surgery. However, the safety of automatic gastrointestinal (GI) insufflation has yet to be thoroughly studied, especially when combined with manual insufflation. The current study aimed to verify whether the pressure limiter could lower GI endoluminal pressure during endoscopic procedures and affect the behavioral patterns of endoscopists. METHODS A preclinical blinded trial was conducted on endoscopists who had no knowledge regarding the presence of the pressure limiter that prevents a GI endoluminal pressure above 25 mmHg. Endoscopists in group A performed esophageal endoscopic submucosal dissection (ESD) with our insufflation device equipped with the pressure limiter, whereas those in group B performed the same procedure without the pressure limiter. During all procedures, endoluminal pressure was continuously monitored. The primary endpoint of the current study was to measure the endoluminal pressure with or without the pressure limiter during esophageal ESD, while the secondary endpoint was to evaluate the effect of the pressure limiter on intraesophageal pressure and perioperative outcomes during esophageal ESD. A questionnaire survey was conducted after each session. RESULTS A total of 79 endoscopists were included in this randomized control study. Group A had significantly lower endoluminal pressure than group B (10.6 ± 4.61 vs. 16.25 ± 7.51 mmHg, respectively; p < 0.05). Although two pigs in group B died from tension pneumothorax, none in group A died. Evaluation of lumen expansion, ease of aspiration, and visual field reproducibility were poorer in group A than in group B, although all fell within the acceptable range. Subjective evaluation of usability was divided into two categories, Excellent/Good and Poor/Bad, with no significant differences in any of the items. CONCLUSIONS This preclinical study showed that endoscopic treatment with an automatic insufflation system could be performed at lower endoluminal pressure with a pressure limiter, which had no adverse effects on the endoscopist's feels on endoscopic procedures with the device.
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Affiliation(s)
- Yuki Ushimaru
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Center of Medical Innovation and Translational Research, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suite 0912, Osaka, 565-0871, Japan
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kiyokazu Nakajima
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Center of Medical Innovation and Translational Research, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suite 0912, Osaka, 565-0871, Japan.
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
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Han D, Yan G, Wang Z, Jiang P, Liu D, Zhao K, Ma J. The Modelling, Analysis, and Experimental Validation of a Novel Micro-Robot for Diagnosis of Intestinal Diseases. MICROMACHINES 2020; 11:E896. [PMID: 32992512 PMCID: PMC7601751 DOI: 10.3390/mi11100896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 12/11/2022]
Abstract
Intestinal-related diseases all around the world are increasing nowadays, and gradually become stubborn diseases threatening human health, and even lives. Diagnosis methods have attracted more and more attention. This article concerns a non-invasive way, a novel micro-robot, to diagnose intestinal diseases. This proposed micro-robot is a swallowable device, 14 mm in diameter, like a capsule. In order to make it possible for the micro-robot to move forward, backward, or anchor itself at a suspicious lesion point in the intestine with different lumen diameter sections, two key mechanisms have been proposed. One is an expanding mechanism with two-layer folded legs for anchoring. The designed expanding mechanism could realize a large variable diameter ratio, upwards of 3.43. In addition, a pair of specific annular gears instead of a traditional pinion drive is devised not only saving limited space, but also reducing energy loss. The other mechanism is a telescoping mechanism, possessing a self-locking lead screw nut system, which is used to obtain axial motion of the micro-robot. Then, the kinematics and dynamics of the micro-robot are analyzed. After that, the following experiments, including force tests and locomotion tests, are constructed. A good match is found between the theoretical results and the experimental data. Finally, in vitro experiments are performed with a prototype to verify the safety and reliability of the proposed micro-robot in porcine intestine.
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Affiliation(s)
- Ding Han
- School of Electronic, Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; (G.Y.); (Z.W.); (P.J.); (D.L.); (K.Z.); (J.M.)
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Guozheng Yan
- School of Electronic, Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; (G.Y.); (Z.W.); (P.J.); (D.L.); (K.Z.); (J.M.)
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Zhiwu Wang
- School of Electronic, Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; (G.Y.); (Z.W.); (P.J.); (D.L.); (K.Z.); (J.M.)
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Pingping Jiang
- School of Electronic, Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; (G.Y.); (Z.W.); (P.J.); (D.L.); (K.Z.); (J.M.)
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Dasheng Liu
- School of Electronic, Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; (G.Y.); (Z.W.); (P.J.); (D.L.); (K.Z.); (J.M.)
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Kai Zhao
- School of Electronic, Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; (G.Y.); (Z.W.); (P.J.); (D.L.); (K.Z.); (J.M.)
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Jin Ma
- School of Electronic, Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; (G.Y.); (Z.W.); (P.J.); (D.L.); (K.Z.); (J.M.)
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai 200240, China
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Ghannam M, Beran A, Ghazaleh D, Ferderer T, Berry B, Banna MA, Mohl L, Streib C, Thacker T, Matos I. Cerebral Air Embolism after Esophagogastroduodenoscopy: Insight on Pathophysiology, Epidemiology, Prevention and Treatment. J Stroke Cerebrovasc Dis 2019; 28:104403. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/25/2019] [Accepted: 09/08/2019] [Indexed: 12/16/2022] Open
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