[Application of Rotarex catheter system in femoropopliteal artery stenosis accompanied with thrombosis]

OBJECTIVE

To evaluate the effectiveness and safety of Rotarex catheter system in treating femoropopliteal artery stenosis accompanied with thrombosis.

METHODS

From Jun. 2017 to Dec. 2019, the clinical data of 32 femoropopliteal artery stenosis accompanied with thrombosis cases treated with Rotarex catheter system were retrospectively analyzed. There were 23 males and 9 females aged from 50 to 89 years and the mean age was (70.7±10.3) years. Six cases had acute course of disease (≤2 weeks), 17 cases had subacute course of disease (>2 weeks, ≤3 months), and 9 cases had chronic course of disease (>3 months). Mean lesion length was (23.4±13.7) cm, mean occlusion length was (19.9±13.3) cm, and in-stent occlusion 7 cases. The superficial femoral artery (SFA) was involved in 13 cases, the popliteal artery (PA) was involved in 8 cases, and both SFA and PA were involved in the other 11 cases. All the cases were treated with Rotarex catheter system. When necessary, suction with large lumen catheter was enabled. Residual stenosis was treated with percutaneous transluminal angioplasty (PTA). Drug-coated balloon (DCB) was only used in patients with financial status, and stent was used only when it was necessary. Heparin was used for 24 h after procedures, and after that, antiplatelet agents were used. Doppler ultrasonography was taken during the followed-up.

RESULTS

Technical success was 100%, and mean procedure time was (107.4±21.5) min. 8F (1F≈0.33 mm) and 6F Rotarex catheter were used in 27 and 5 cases respectively. In 27 cases, forward flow was obtained immediately after debulking with Rotarex catheter, and in the other 5 cases, suction with large lumen catheters were used. PTA was used in all 32 cases. DCB were used in 8 cases, of which 4 were used in in-stent stenosis. Twelve cases were implanted stents. There were no perioperative deaths. The only one procedure related complication was distal embolism. We took out the thrombus with guiding catheter. In all cases, mean hospital stay were (4.6±1.5) d. The ankle brachial index increased from 0.32±0.15 to 0.86±0.10 after treatment (t=-16.847, P < 0.001). The Rutherford stages decreased significantly (Z=-4.518, P < 0.001). All the patients were followed up for 6.0-36.0 months, and the median time was 16.0 months. 2 cases stopped antiplatelet agents, which resulted in acute thrombosis. Another percutaneous mechanical thrombectomy and PTA were taken in one of them. Two cases died of cardiovascular disease during the follow-up, and no amputation was observed. Target lesion restenosis occurred in 7 cases during the follow-up, and target lesion revascularization (TLR) was taken in two of them.

CONCLUSION

In treating femoropopliteal artery stenosis accompanied with thrombosis, Rotarex catheter can remove thrombus effectively, and that can expose underlying lesions and reduce stent use and complications rates. It is a safe and effective method.

[Application of mechanical debulking in arteriosclerosis occlusive disease of lower extremity]

Objective: To evaluate the effect of mechanical debulking in treating arteriosclerosis occlusive disease of lower extremity. Methods: The clinical data of 52 arteriosclerosis occlusive disease of lower extremity cases treated with Rotarex mechanical debulking system from June 2017 to June 2020 at Department of Intervention Vascular Surgery,Peking University Third Hospital were retrospectively analyzed. There were 37 males and 15 females,aged(69.4±10.1)years(range:47 to 89 years).Lesion length was (21.6±12.9)cm(range:4 to 45 cm),occlusion length was (18.5±11.8)cm(range:4 to 45 cm).The lesion was located in iliac artery(IA) in 6 cases,femoral-popliteal artery(FPA) in 42 cases,and both IA and FPA in 4 cases. All the cases were treated with Rotarex mechanical debulking system. Residual stenosis more than 50% were treated with percutaneous transluminal angioplasty(PTA).Drug coated balloon was used in part of them,and stent was used only when it was necessary. The patient's operation, complications, postoperative target vessel restenosis and reoperation were collected. The paired sample t test and rank sum test was used for data comparison and the postoperative target vessel patency rate was analyzed by Kaplan-Meier survival curve. Results: All the 52 cases obtained technical success. Percutaneous transluminal angioplasty was used in all cases,and drug coated balloon were used in 11 cases. Twenty-six stents were implanted in 24 cases (2 cases implanted 2 stents).Nine stents were implanted in IA and 15 in FPA. The length of stents was (11.3±3.3)cm(range:6 to 23 cm).There were 3 procedure related complications: one of them was acute occlusion in an iliac lesion,and thrombectomy was applied urgently,and the result was good. And the other two were distal embolism. The thrombus were took out with guiding catheter. The hospital stay was (4.8±1.9)days. The ankle brachial index increased from 0.34±0.16 to 0.81±0.16 after treatment(t=-25.160,P<0.01).The Rutherford stages decreased from (M(IQR)) 3(1) to 1(1(Z=-6.825,P<0.01).The median followed up time was 19 months(range:6 to 42 months).Two cases stopped antiplatelet agents during follow-up and which result in acute thrombosis 2 weeks and 2 months later respectively. One of them was treated with percutaneous mechanical thrombectomy and the other one was not for gastrointestinal hemorrhage. Four cases died during follow-up,one case died of lung cancer,one died of abdominal infection,and the other 2 cases died of cardiovascular disease,and no amputation was observed. Target lesion restenosis(TLR) more than 50% occurred in 13 cases during the follow-up. All TLR were observed in FPA,and target lesion revascularization was taken in 3 of them. According to Kaplan-Meier survival curve analysis,half-year,1-year and 2-year cumulative patency rates of target vessels in this group was 94.2%,87.4% and 51.4%, respectively. And half-year and 1-year cumulative patency rates just in FPA cases was 92.9% and 84.3%, respectively. Conclusions: Percutaneous mechanical debulking using Rotarex catheter combining PTA can reduce the use of stents in femoral-popliteal artery. It is safe and effective in treating with arteriosclerosis obliterans of lower extremity.

[Significance of renal filtration fraction evaluation of renal artery stenting for atherosclerotic renal artery stenosis treatment]

OBJECTIVE

To investigate the significance of filtration fraction (FF) and renal artery stenting in the treatment of atherosclerotic renal artery stenosis.

METHODS

In the study, 42 cases of renal artery stenosis were treated with 52 renal artery stent implantation. Percutaneous transluminal renal angioplasty and stent (PTRAS) of the patients' health side kidney, ipsilateral kidney (renal) glomerular filtration rate (GFR), renal effective renal plasma flow effective renal plasma flow (ERPF), kidney filtration fraction changes of preoperative and postoperative serum creatinine (SCR) and the changes in the patients with blood pressure (SBP) and the changes after taking antihypertensive drugs were observed and analyzed.

RESULTS

The 52 cases of renal artery stent implantation were all successful. Preoperative ipsilateral GFR was significantly lower than that of normal side (t=-3.989, P=0.000); preoperative ipsilateral ERPF was significantly lower than the contralateral side (t=-4.926, P=0.000). On both sides, the overall FF values were equal (t=1.273, P=0.207). Postoperative ipsilateral renal GFR was increased, but there was no statistical difference (t=-1.411, P=0.164). Postoperative ipsilateral renal ERPF was increased significantly (t=-4.954, P=0.000), and FF lower (closer to the normal value (t=3.274, P=0.002). Postoperative side GFR was significantly reduced (t=2.569, P=0.000), the contralateral ERPF was significantly reduced (t=3.889, P=0.001), and FF had no significant change (t=-0.758, P=0.454). Postoperative side GFR was lower than that of the contralateral (t=-3.283, P=0.002) and postoperative side ERPF was still lower than that of the contralateral (t=-3.351, P=0.001), but on both sides, the FF values were equal (t=-0.361, P=0.719). Preoperative FF was relatively normal in the patients with kidney, and the postoperative FF value change was small (t=0.799, P=0.430); preoperative FF was significantly higher in the patients with kidney, and the postoperative FF value was lower than the preoperative (normal value, t=5.299, P=0.000). Postoperative overall serum creatinine was significantly decreased (t=2.505, P=0.016); but for the patients with unilateral renal artery stenosis, the changes in serum creatinine had no statistical difference (t=1.228, P=0.299); and for the patients with bilateral renal artery stenosis and serum creatinine compared with the preoperative, the changes were decreased significantly (t=2.518, P=0.030); postoperative blood pressure (SBP) was significantly decreased compared with that before operation (t=8.945, P=0.000); antihypertensive drugs taken were decreased significantly compared with the preoperative (t=5.280, P=0.000).

CONCLUSION

For the patients with renal artery stenosis, FF is a useful index to understand the pathophysiological process of renal ischemia. Whether preoperative FF is significantly increased or FF is relatively normal, should be regarded as the indications of renal artery stent implantation.

Differential gene expression profiling of oesophageal squamous cell carcinoma by DNA microarray and bioinformatics analysis

Differential gene expression profiling was carried out on primary tumour tissues and adjacent non-neoplastic tissues from patients with oesophageal squamous cell carcinoma (ESCC). RNA extracted from ESCC tissues and matched normal oesophageal epithelium of four ESCC patients was analysed using whole-genome microarrays. Bioinformatics analysis was also carried out to ascertain which genes and pathways may be important in the carcinogenesis of ESCC. A total of 570 genes were identified that differed significantly in expression: 303 genes were up-regulated and 267 genes were down-regulated in ESCC tissues compared with normal oesophageal epithelium. Gene ontology analysis showed that the primary molecular functions of these genes were related to the extracellular region, collagen and endopeptidase inhibitor activity. Pathway analysis revealed seven pathways or networks highly associated with the differential expression profile. Gene set analysis showed that the POD1_KO_UP gene set was significantly enriched, containing 15 matching genes. Thus, a large number of genes are involved in the carcinogenesis of ESCC and participate in various cell processes and pathways.

[Effects of short interval successive partial hepatectomy on ACP, AKP, HSC70/HSP68 and PCNA in rat liver]

In this paper, the models of 36-4-4 SISPH and 4-36-36-36 SISPH were used to analyze the changes of activity and content of ACP, AKP, HSC70/HSP68 and PCNA in rat liver. The results showed that the activities of 140 kD ACP and AKP in SISPH were increased following the increase of SISPH number of times, but that of 160 kD ACP and AKP were decreased following the increase of SISPH number of times. The content of PCNA in 4-36-36-36 SISPH were more than that in 36-4-4 SISPH, in contrast for HSC70/HSP68 in these two models. Therefore, the content and activities of ACP, AKP, HSC70/HSP68 and PCNA could be strongly effected by SISPH number of times and SISPH methods. Its mechanisms and physiological significance were discussed.

Minute esophageal granular cell tumor: a case report with immunohistochemical and ultrastructural examination

A small granular cell tumor (GCT) of the esophagus, which developed in a 44-year-old Japanese man and was removed by endoscopic polypectomy, is presented. Histopathologically, the tumor, located in the submucosa, was composed of uniform neoplastic cells with nuclei and abundant round or oval cytoplasm containing eosinophilic granules. An immunohistochemical examination showed positive reactions with S-100 protein, especially the beta subunit, and neuron specific enolase in the neoplastic cells. Electron microscopic observation revealed abundant electron-dense or light granules and myelin-like structures in the cytoplasm. These findings support the concept that esophageal GCT is derived from Schwann cells.