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Ji Z, Ling Y, Chen P, Meng Y, Xu S, Wu P, Wang C, Ilyasova T, Sun B, Shi H. Time correlation of success recanalization for endovascular recanalization of medically refractory non-acute intracranial arterial occlusions. Front Surg 2023; 9:1074514. [PMID: 36684327 PMCID: PMC9852846 DOI: 10.3389/fsurg.2022.1074514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/14/2022] [Indexed: 01/09/2023] Open
Abstract
Background and purpose The management of patients with symptomatic non-acute atherosclerotic intracranial artery occlusion (sNAA-ICAO), which is a special subset with high morbidity and a high probability of recurrent serious ischemic events despite standard medical therapy, has been clinically challenging. A number of small-sample clinical studies have discussed endovascular recanalization for sNAA-ICAO and the lack of a uniform standard of operation time. The purpose of this study was to investigate the time correlation of successful recanalization. Methods From January 2013 to August 2021, 69 consecutive patients who underwent endovascular recanalization for sNAA-ICAO were analyzed retrospectively in the First Affiliated Hospital of Harbin Medical University. The technical success rate, periprocedural complications, and rate of TIA/ischemic stroke during follow-up were evaluated. Results The overall technical success rate was 73.91% (51/69), and the rate of perioperative complications was 37.68% (26/69). The percentage of patients with perioperative symptoms was 27.53% (19/69). The rate of serious symptomatic perioperative complications was 8.70% (6/69). After adjusting for age, sex, and BMI, the effect of the time from the last symptom to operation on successful recanalization was 0.42 (IQR, 0.20, 0.88, P = 0.021), before the inflection point (51 days). Conclusions Endovascular recanalization for sNAA-ICAO is technically feasible in reasonably selected patients. The perioperative safety is within the acceptable range. Before 51 days, the last symptoms to operation time, for every 10 days of delay, the probability of successful recanalization is reduced by 57%.
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Affiliation(s)
- Zhiyong Ji
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yeping Ling
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Pingbo Chen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuxiao Meng
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shancai Xu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Pei Wu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chunlei Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tatiana Ilyasova
- Department of Internal Diseases, Bashkir State Medical University, Ufa, Russian Federation
| | - Bowen Sun
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huaizhang Shi
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China,Correspondence: Huaizhang Shi
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Sakes A, Lageweg M, van Starkenburg RIB, Sontakke S, Spronck JW. Crossing Total Occlusions Using a Hydraulic Pressure Wave: Development of the Wave Catheter. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:851927. [PMID: 35434702 PMCID: PMC9010673 DOI: 10.3389/fmedt.2022.851927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/23/2022] [Indexed: 11/23/2022] Open
Abstract
With the ongoing miniaturization of surgical instruments, the ability to apply large forces on tissues for resection becomes challenging and the risk of buckling becomes more real. In an effort to allow for high force application in slender instruments, in this study, we have investigated using a hydraulic pressure wave (COMSOL model) and developed an innovative 5F cardiac catheter (L = 1,000 mm) that allows for applying high forces up to 9.0 ± 0.2 N on target tissues without buckling. The catheter uses high-speed pressure waves to transfer high-force impulses through a slender flexible shaft consisted of a flat wire coil, a double braid, and a nylon outer coating. The handle allows for single-handed operation of the catheter with easy adjusting of the input impulse characteristic, including frequency (1–10 Hz), time and number of strokes using a solenoid actuator, and easy connection of an off-the-shelf inflator for catheter filling. In a proof-of-principle experiment, we illustrated that the Wave catheter was able to penetrate a phantom model of a coronary Chronic Total Occlusion (CTO) manufactured out of hydroxyapatite and gelatin. It was found that the time until puncture decreased from 80 ± 5.4 s to 7.8 ± 0.4 s, for a stroke frequency of 1–10 Hz, respectively. The number of strikes until puncture was approximately constant at 80 ± 5.4, 76.7 ± 2.6, and 77.7 ± 3.9 for the different stroke frequencies. With the development of the Wave catheter, first steps have been made toward high force application through slender shafts.
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Affiliation(s)
- Aimee Sakes
- Department of BioMechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Delft, Netherlands
- *Correspondence: Aimee Sakes
| | - Menno Lageweg
- Department of Electronic and Mechanical Support Division (DEMO), Delft University of Technology, Delft, Netherlands
| | - Remi I. B. van Starkenburg
- Department of Electronic and Mechanical Support Division (DEMO), Delft University of Technology, Delft, Netherlands
| | - Saurabh Sontakke
- Department of Precision and Microsystems Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Delft, Netherlands
| | - Jo W. Spronck
- Department of Precision and Microsystems Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Delft, Netherlands
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Zhang C, Guo S, Xiao N, Wu J, Li Y, Jiang Y. Transverse microvibrations-based guide wires drag reduction evaluation for endovascular interventional application. Biomed Microdevices 2018; 20:69. [PMID: 30094504 DOI: 10.1007/s10544-018-0315-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
When conducting endovascular interventional surgery, doctors usually experience high viscous resistance resulting from direct contact with blood when operating the guide wire in blood vessels, which reduces the operational efficiency. Improper operation can cause vascular injuries and greatly reduce surgical safety, sometimes leading to the death of the patient. This paper presents a new method that applies transverse microvibrations at the proximal end of a conventional passive guide wire to reduce viscous resistance. The effect of the proposed method in reducing the viscous resistance in the fluid is studied. The influences of the tube diameter, medium density, and applied vibration frequency on the viscous force are investigated. Finally, for endovascular therapy, a mathematical model of the viscous force of the guide wire based on the proposed method is established in the environment of human blood vessels to predict the magnitude of the viscous force exerted on the guide wire and analyze the drag reduction effect of the proposed method. The effectiveness of the proposed method in drag reduction and its feasibility in improving surgical safety are experimentally demonstrated. The experimental results indicate that the proposed method can assist the doctor during complicated and variable operation conditions.
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Affiliation(s)
- Chaonan Zhang
- Key Laboratory of Convergence Medical Engineering System and Healthcare Technology, Ministry of Industry and Information Technology, Beijing Institute of Technology, Beijing, 100081, China
| | - Shuxiang Guo
- Key Laboratory of Convergence Medical Engineering System and Healthcare Technology, Ministry of Industry and Information Technology, Beijing Institute of Technology, Beijing, 100081, China. .,Intelligent Mechanical Systems Engineering Department, Kagawa University, Takamatsu, 761-0396, Japan.
| | - Nan Xiao
- Key Laboratory of Convergence Medical Engineering System and Healthcare Technology, Ministry of Industry and Information Technology, Beijing Institute of Technology, Beijing, 100081, China.
| | - Jiaqing Wu
- Key Laboratory of Convergence Medical Engineering System and Healthcare Technology, Ministry of Industry and Information Technology, Beijing Institute of Technology, Beijing, 100081, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Engineering Technology Research Center for Interventional Neuroradiology, and Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 10050, China
| | - Yuhua Jiang
- Department of Interventional Neuroradiology, Beijing Engineering Technology Research Center for Interventional Neuroradiology, and Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 10050, China
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Gao P, Wang Y, Ma Y, Yang Q, Song H, Chen Y, Jiao L, Qureshi AI. Endovascular recanalization for chronic symptomatic intracranial vertebral artery total occlusion: Experience of a single center and review of literature. J Neuroradiol 2018; 45:295-304. [PMID: 29408529 DOI: 10.1016/j.neurad.2017.12.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 11/29/2017] [Accepted: 12/08/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The optimal treatment of chronic symptomatic total occlusion of the intracranial vertebral artery (ICVA) remains undefined. We report a single-center experience of endovascular recanalization for patients with chronic symptomatic ICVA occlusion who were refractory to medical therapy. METHODS From Jan 2009 to Jan 2017, we retrospectively reviewed 14 consecutive patients presenting with recurrent symptoms attributed to the chronic ICVA occlusion. We searched previous literature using PubMed databases during the same period as comparison. RESULTS Eleven patients out of 14 presented initial symptoms to intervention less than 90days. The occlusion course was extrapolated on simultaneous two-vessel injection angiography or high-resolution MR imaging (HRMRI) in 13 cases. Nine patients had the occlusion beyond the origin of posterior inferior cerebellar artery (PICA) and 5 had the occlusion proximal to the PICA origin. The technical success rate of recanalization was 85.7% (12/14). Two patients (14.3%, 2/14) had peri-procedural complications: 1 developed TIA and 1 presented with perforator occlusion syndrome. Using the keyword-based search, we identified 6 studies at the same period. A total of 34 patients underwent recanalization with the successful recanalization rate at 94.1%, peri-procedural complication rate at 17.6% and mortality at 2.9%, respectively. CONCLUSION Our single-center study illustrated the feasibility and safety of ICVA recanalization. Great care should be taken as revascularization is of high risk. When patient selection, occlusion course and stage as well as neuroimaging evaluation are considered, endovascular recanalization may be a useful therapeutic modality.
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Affiliation(s)
- Peng Gao
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, 100053 Beijing, China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 100053 Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 100053 Beijing, China
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, 100053 Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 100053 Beijing, China
| | - Yanfei Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 100053 Beijing, China
| | - Liqun Jiao
- Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, 100053 Beijing, China.
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