Search

Objective: To investigate the safety and effectiveness of catheter-based therapy (CBT) using AngioJet rheolytic thrombectomy (ART) device or large lumen catheter (LLC) in the oncological patients with inferior vena cava thrombosis (IVCT). Methods: This was a retrospective study including eligible patients with IVCT treated with CBT coupled with dose-reduced thrombolysis as the first-line treatment from February 1, 2015 to January 1, 2022. The baseline demographics, comorbidities, clinical characteristics, treatment details, course data were all reviewed. Results: A total of 33 patients (mean age 58.8 years, 57.6% male) was included, of whom 17 patients underwent ART and 16 underwent LLC aspiration, the technical success rates were 100%. All patients subsequently underwent catheter-directed thrombolysis relative to reduced-dose thrombolysis. At the end of catheter-directed thrombolysis, clinical success was achieved in 26 (78.8%) patients. In the subgroup analysis, ART seemed to receive a slightly higher rate of thrombus removal Grade III (47.1% vs 12.5%, p = .057). The symptoms of leg pain and swelling post-treatment were significantly improved in both groups (p < .001). Except for transient macroscopic hemoglobinuria occurring in patients with ART, none of all patients suffered from procedure-related adverse events and major complications. Minor complications such as bleeding events occurred in 6.1% (2/33) of patients. At the 6 month follow-up, the incidence of recurrent thrombosis and mild post-thrombotic syndrome (PTS) were 9.7% (3/31) and 6.5% (2/31). Conclusion: CBT is a safe and effective modality for the management of IVCT in the oncological patients, leading to high levels of technical and clinical success, symptoms alleviation, as well as a low incidence of minor complication, mild PTS and recurrence. Advances in knowledge statement: The available data and evidence of endovascular therapy (ET) on oncologic patients with IVCT remains insufficient. The purpose of present single center retrospective study including 33 oncological patients is to investigate the preliminary safety and efficacy of CBT using ART device or LLC. The results demonstrated that CBTs are safe and effective as an ET modality in majority of eligible patients with symptomatic acute cancer-associated IVCT, indicating high levels of technical and clinical success, symptoms alleviation, as well as a low prevalence of minor complication, mild post-thrombotic syndrome and recurrence. Furthermore, they have the advantages of accelerated reduction of thrombus burden in a moderate time, speedy restoration of blood flow, but at the risk of potentially increased economic cost. Notably, in the condition of parallel time and dosages of lytic agents, ART tends to achieve a slightly higher thrombus removal Grade III than LLCA.

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.

Background. Deep vein thrombosis (DVT) is the third most prevalent vascular disease worldwide. MicroRNAs (miRNAs) play regulatory roles in functions of endothelial progenitor cells (EPCs), which is becoming a promising therapeutic choice for thrombus resolution. Nevertheless, the role of miR-206 in EPCs is unclear. Methods. EPCs were isolated from the peripheral blood of patients with DVT. In DVT mouse models, DVT was induced by stenosis of the inferior vena cava (IVC). The levels of miR-206 and gap junction protein alpha 1 (GJA1) in EPCs and vascular tissues of DVT mice were detected by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The proliferation, migration, apoptosis, and angiogenesis were tested by cell counting kit-8 (CCK-8) assay, Transwell assay, flow cytometry analysis, and in vitro tube formation assay. The levels of autophagy-related proteins as well as the level of GJA1 in EPCs and vascular tissues were evaluated by western blotting. DVT formation in vivo was observed through hematoxylin-eosin (HE) staining. The expression of thrombus resolution markers, CD34 molecule (CD34) and matrix metallopeptidase 2 (MMP2), in the thrombi was measured by immunofluorescence staining. Results. miR-206 overexpression inhibited proliferation, migration, and angiogenesis and promoted apoptosis of EPCs, while miR-206 knockdown exerted an opposite effect on EPC phenotypes. Downregulation of GJA1, the target of miR-206, abolished the influence of miR-206 on EPC phenotypes. Furthermore, silencing of miR-206 suppressed the autophagy of EPCs via upregulating GJA1. miR-206 knockdown repressed thrombus formation, enhanced the homing ability of EPCs to the thrombosis site, and facilitated thrombus resolution in DVT mouse models. Additionally, miR-206 was upregulated while GJA1 was downregulated in vascular tissues of DVT mice. miR-206 knockdown elevated GJA1 expression in vascular tissues of DVT mice. The expression of miR-206 was negatively correlated with that of GJA1 in DVT mice. Conclusion. miR-206 knockdown upregulates GJA1 to inhibit autophagy of EPCs and then promote EPC proliferation, migration, and angiogenesis, thereby enhancing EPC homing to thrombi and facilitating thrombus resolution.

Purpose The present study aimed to investigate the preliminary safety and efficacy of rheolytic thrombectomy (RT) using an AngioJet Zelante DVT catheter or a Solent Omni catheter for acute proximal deep vein thrombosis (DVT). Material and methods We conducted a retrospective review of 40 patients who were treated with an AngioJet RT between January 2019 and January 2021, and then the patients were divided into the ZelanteDVT group (n = 17) and the Solent group (n = 23). Data on demographics, clinical characteristics, technical success, clinical success, complications, and early follow-up were analysed. Results No significant differences regarding demographics were detected (all p > .05). The technical success rates were both 100%. The ZelanteDVT group had a shorter duration of RT and a higher primary RT success than the Solent group (all p p = .010). The clinical success rates for the ZelanteDVT group and Solent group were 100% (17/17) and 95.7% (22/23), respectively, and these values were high in the two groups (p > .05). Apart from transient macroscopic haemoglobinuria occurring in all the patients during the first 24 hours post-RT, none of the patients in either group suffered other procedure-related adverse events or major complications. Minor complications included bleeding events in 21.7% (5/23) of the patients in the Solent group and one (5.9%) patient in the ZelanteDVT group (p > .05). At 6 months, the frequency of PTS was 5.9% (1/17) in the ZelanteDVT group and 17.4% (4/23) in the Solent group (p > .05). Conclusion Both catheters are safe and effective in managing patients with proximal DVT, thus leading to improved clinical outcomes with few complications. The ZelanteDVT catheter was more effective than the Solent catheter in thrombectomy, thus allowing for faster extraction of the DVT with a shorter run time and lower proportions of patients with adjunctive CDT.

ObjectiveThis study aimed to investigate the association between the left common iliac vein (CIV) compression degree and characteristics of first diagnosed left lower extremity deep vein thrombosis (DVT).Patients and methodsThis was a single-center retrospective observational study. Between January 2015 and June 2022, first diagnosed left lower extremity DVT patients with enhanced computed tomography of lower extremities were included. Patient demographics, comorbidities, risk factors, DVT characteristics, and CIV compression degree were collected and analyzed. Logistic regressions were performed to evaluate the odds ratio (OR) with a 95% confidence interval (CI) of iliofemoral or mixed DVT vs. compression percentage. The association between compression percentage and iliofemoral or mixed DVT was evaluated on a continuous scale with restricted cubic splines (RCS). The association between compression percentage and thrombus burden was evaluated using the Spearman test.ResultsA total of 196 (mean age, 61.8 ± 16.1 years; 86 males) patients were included. The median CIV compression percentage in iliofemoral or mixed DVT patients was significantly greater than in non-iliofemoral or non-mixed DVT, respectively (64.4 vs. 46.6%, p < 0.001; 67.8 vs. 54.8%, p = 0.004). CIV compression >50% was associated with significantly increased morbidity of iliofemoral DVT (adjusted OR, 2.96; 95% CI, 1.58–5.52; p = 0.001) or mixed DVT (adjusted OR, 2.39; 95% CI, 1.19–4.81; p = 0.014). RCS showed that a greater compression percentage was associated with a continuously increased OR of iliofemoral DVT (overall p = 0.003, non-linear p = 0.577) or mixed DVT (overall p = 0.020, non-linear p = 0.771). CIV compression percentage had a positive correlation with thrombus burden (rs = 0.284, p < 0.001).ConclusionA greater left CIV compression percentage may be associated with increasing likelihood of more proximal location and severe clot extent in first diagnosed left lower extremity DVT.

To investigate the safety and efficacy of the combination of radiofrequency ablation (RFA) and vertebroplasty versus single vertebroplasty in treating spinal metastases.The data of 35 patients with vertebral neoplastic lesions who received RFA combined with vertebroplasty (group A, 15 patients with 17 lesions) or single vertebroplasty (group B, 20 patients with 24 lesions) from March 2016 to June 2019 were retrospectively compared. The data of patients' Visual Analogue Scale (VAS) scores prior to the treatments, 1 week, 1 month, 3 months, and 6 months after the treatments, injected cement volume, ratios of cement leakage were compared between the two groups.All procedures were successfully done without severe complications. The VAS scores in group A were decreased more rapidly 1 week after the treatments and remained more stable at 6 months than that in group B (P 0.05). The cement injected in group A (5.95 ± 1.45 mL, range 4-9.5 mL) was significantly more than that in group B (4.09 ± 0.55 mL, range 3.1-5.5 mL) (P 0.05). The ratio of vascular cement leakage in group A was significantly lower than that in group B (P 0.05), while no statistical difference was found in the non-vascular cement leakage (P 0.05).Our study shows that the combination of RFA and vertebroplasty has a better analgesic effect with more injected cement and lower rates of venous cement leakage than single vertebroplasty.

The nano-carbon powders are often used as fillers to endow the shape memory polymers (SMPs) with electroconductivity. It has been found that the shape memory effects (SMEs) of SMPs filled with nano-carbon powder can be triggered both by temperature and by water. To reveal the driving mechanism of SMEs, a constitutive model for describing the thermally activated and moisture activated SMEs of these shape memory polymer composite (SMPCs) is developed here. Because both of the SMEs share the same driving mechanism, the variable moisture is incorporated into the framework of a thermo-mechanical modeling approach to disclose the effect of moisture on the thermoviscoelastic properties. The SMPCs are regarded as isotropic materials and the effect of carbon powder on the mechanical properties of the matrix is also considered in the paper. Because the complete recovery may not be reached even they are exposed to the stimulus environment long enough, the blocking mechanism is also considered here. This is the mainly new contribution compared to the early work. Using the method of parameter determination presented here, the effectiveness of the proposed hygro-thermo-mechanical constitutive model is confirmed by comparing the model results with the test data of uniaxial deformation from the literature.

To evaluate the age of caval thrombus that experimentally induced in swine by use of magnetic resonance imaging (MRI). Caval thrombus was experimentally created in 15 swine by autologous clot injection assisted with caval net knitting. Serial high-resolution MR images were obtained using magnetic resonance venography (MRV) and T1 high-resolution isotropic volume examination (THRIVE) sequences in a 3.0-T MR system at 1, 7, 14, 21, and 28 days post model creation. At each time point, three pigs were sacrificed and the thrombotic vena cava was processed for histopathological examinations respectively. Caval thrombus was successfully induced in 15 pigs in group A. The signal intensity (SI) change of caval thrombus on THRIVE was age-dependent, with a typical sign of circle or semi-circle hyper-intensity at 7-day-old model while SI of thrombus was lower than that of muscle from day 14 throughout day 28. The histo-pathological findings revealed that RBCs-rich thrombus at day 1 without blue-stained particles, RBCs layers with infiltration of inflammatory cells and sporadically distributed blue-stained particles at 7-day-old thrombus. At day 14, 21 and 28, blue-stained particles became richer, coupled with formation of granulation tissue and fibrous tissue. The swine model in the study is good for age evaluation of venous thrombosis. The peripheral circle or semi-circle hyperintensity on THRIVE indicates the young age of caval thrombus in swine.

The distinction of radiation-induced brain necrosis (RBN) and recurrent glioblastoma multiform (rGBM) remains a diagnostic challenge due to their similarly on routine follow-up imaging studies and also their clinical manifestations. Our purpose of this review article is to evaluate the role of advanced MR imaging techniques such as Perfusion-weighted imaging (PWI), Diffusion-weighted imaging (DWI) and Magnetic resonance spectroscopy (MRS) in the differentiation of RBN and rGBM and their complications together with our experience and knowledge gained during our neuroimaging practice.

Objective This study aimed to report a single centre management experience and mid term outcomes for symptomatic spontaneous isolated superior mesenteric artery dissection (SISMAD). Methods This was a retrospective observational study. Between 1 August 2012, and 30 June 2018, consecutive patients with symptomatic SISMAD were included. Patient demographics, clinical symptoms, comorbidities, risk factors, and dissection characteristics were obtained. The treatment regimens and clinical and follow up outcomes were reviewed and analysed. A chi square test, Fisher's exact test, or one way analysis of variance was used to compare variables between the groups. Binary logistic regression was used to determine predictive factors for failed conservative treatment. The cumulative rate of complete dissection remodelling was calculated using a Kaplan–Meier curve. Results Sixty-two patients (mean age, 56.0 ± 9.3 years) were included. Patients at risk of intestinal ischaemia or dissecting aneurysm rupture were considered to be high risk patients (Group 1, n = 16) and received primary endovascular treatment. The remaining patients were considered low risk (Group 2, n = 46) and received primary conservative treatment. Symptom relief was observed in 82.6% of patients in Group 2. Finally, failed conservative treatment was observed in 50% of the low risk patients. Dissection length ≥50 mm was an independent risk factor for failed conservative treatment (p = .019; OR 4.68, 95% CI 1.29–16.98). During a median follow up of 30.5 months (interquartile range, 17.5, 58.3), patients with stents had a higher complete dissection remodelling rate than those without stents. Conclusion This study found that conservative treatment showed satisfactory symptom resolution for low risk SISMAD patients. Endovascular stenting was associated with a high technical success and dissection remodelling rate. This treatment modality might be reserved for patients with high risk SISMAD or failed conservative treatment. In addition, a dissection length ≥50 mm was a risk factor for failed conservative treatment.

The management of acute massive pulmonary embolism (PE) patients who did not respond to systemic thrombolysis (ST) has not been well established. The present study aimed to investigate the safety and effectiveness of catheter-based therapies (CDT) in this condition. We conducted a retrospective study of PE patients after unsuccessful ST (UST) between January 2012 and January 2018. Massive PE was identified in 408 patients and treated with full-dose ST therapy. Thrombolysis at 36 h was judged to be unsuccessful in 52 patients. Four ineligible patients were excluded, and the remaining 48 patients underwent rescue CDT: 30 patients underwent thrombus fragmentation with a rotating pigtail catheter; 8 patients underwent Straub rotational thrombectomy; and 10 patients underwent AngioJet rheolytic thrombectomy. In total, 42 patients subsequently underwent CDT relative to reduced-dose thrombolysis. Pooled clinical success was achieved in 45 patients, and the time-to-clinical instability relief for CDT was short (i.e., 48 h). Clinical findings significantly improved with oxygen saturation and the shock index (p

Objectives: To investigate the safety and efficacy of a stent combined with a linear strand of 125I seeds to treat malignant cancer–associated venous obstruction. Methods: We retrospectively analyzed the data of 57 patients with malignant cancer–associated venous obstruction. Nineteen patients underwent the placement of a stent combined with a linear strand of 125I seeds (group A), and 38 patients underwent the placement of a bare stent (group B). The following parameters were compared between the 2 groups of patients: symptom relief rate, duration of venous patency, survival time, quality of life, and adverse events. Results: A total of 34 stents and 527 seeds were implanted in group A, while a total of 57 stents were implanted in group B. The surgery success rate was 96.5%, and no serious complication related to the surgery was reported. Symptoms of venous obstruction improved significantly after surgery. The score of group A decreased from 14.74 ± 0.562 points before surgery to 2.79 ± 1.357 points after surgery( P < .001), and the score of group B decreased from 13.79 ± 1.398 points before surgery to 5.55 ± 3.674 points after surgery ( P < .001). The patency rate of group A was significantly higher than that of group B at 1 to 6 months after surgery (100%, 84.2%, 68.4%, 63.2%, 36.8%, 21.1% vs 68.4%, 23.7%, 18.4%, 7.9%, 5.3%, 2.6%, respectively; P < .05). Before treatment, there was no statistically significant difference in the Karnofsky Performance Status (KPS) score between the groups ( P = .791). After 1 to 6 months of treatment, the KPS score was significantly higher in group A than in group B ( P = .013). The median patency duration in groups A and B was 125 days (95% CI: 80.018-169.982) and 35 days (95% CI: 20.501-49.499), respectively ( P < .001). The median survival time of group A was 155 days (95% CI: 110.406-199.594), and that of group B was 98 days (95% CI: 55.712-140.288; P = .325). Multivariate analysis showed that the implantation of a stent combined with a linear strand of 125I seeds and the KPS score (≥80 points) were independent factors of long-term patency after stent placement. Conclusions: The placement of a stent combined with a linear strand of 125I seeds is a safe and effective treatment for venous obstruction caused by malignant tumors. This treatment provides prolonged patency compared with the placement of bare stent, and while it does not significantly improve the survival time of patients, it can improve their quality of life.

Compared with amorphous shape memory polymers (SMPs), semicrystalline SMPs have more diverse shape memory effects (SMEs) which promotes their application in smart structures. To reveal the driving mechanism of the triple SMEs of semicrystalline SMPs, our study focuses on developing the constitutive model under the condition of finite deformation. In the paper, a thermo-mechanical constitutive model under consideration of the second law of thermodynamics is developed based on the theory of thermodynamics with internal state variables. The model can be used to describe the nonequilibrium response of the amorphous and semicrystalline components in the vicinity of the glass transition, melting, and crystallization. To verify the validity of model, numerical simulation is carried out for a thermo-mechanical shape memory cycle which can be divided into a two-step programing process and a two-step recovery process. The comparison between the model results and the test data shows good agreement.

To investigate the possible risk factors for proximal pulmonary embolism (PE) in patients with lower extremity deep vein thrombosis (LEDVT). A single-center, retrospective cohort study was conducted. Consecutive patients diagnosed with unilateral LEDVT and confirmed PE by computed tomography (CT) pulmonary angiography and indirect CT venography between September 2015 and January 2022 were included. Patient demographics, presentation of LEDVT, laboratory examination, thrombus characteristics, comorbidities and risk factors for LEDVT, and imaging findings were analyzed to determine the univariable and multivariable associations. The associations between thrombus location, stenosis, and proximal PE were assessed using a stratified analysis. A total of 115 eligible patients (60.08 ± 15.18 years, 59.1% male) were included. Of these patients, 40 (34.8%) were in the proximal PE group (proximal thrombus involved main or lobar pulmonary artery), and 75 (65.2%) were in the distal PE group (without main and labor pulmonary artery involvement). The univariable analysis showed that onset time of LEDVT symptoms ≤ 7 days ( P = .041), inferior vena cava (IVC) involvement ( P = .035), and severe iliac vein stenosis (IVS) (stenosis ratio > 61.3%) ( P = .010) were associated with the occurrence of proximal PE. Further multivariant analysis showed that IVC involvement was associated with an increased odds of proximal PE (OR: 4.45, 95% CI: 1.083 − 18.248, P = .038), whereas severe IVS (stenosis ratio > 61.3%) was associated with a decreased odds of proximal PE (OR: 0.294, 95% CI: 0.110-0.783, P = .014). Among patients with unilateral LEDVT, IVC involvement increased the risk of proximal PE; patients with severe IVS (stenosis ratio > 61.3%) had a lower risk of developing proximal PE compared with distal PE; and severe IVS seemed to be a protective factor for proximal PE.

Objective The objective of this study was to investigate the risk of acute kidney injury in elderly patients compared with nonelderly patients undergoing AngioJet rheolytic thrombectomy for treatment of acute deep vein thrombosis. Methods A retrospective review of all patients who underwent AngioJet rheolytic thrombectomy for the treatment of acute deep vein thrombosis between November 1, 2014 and August 1, 2022 was conducted. Their baseline demographics, comorbidities, clinical characteristics, procedural details, and postoperative course were reviewed. Results A total of 105 eligible patients were reviewed; 45 patients were in the elderly group, and 60 were in the nonelderly group. Except for age ( p 0.05). Transient macroscopic hemoglobinuria occurred in all patients during the first 24 h post-AngioJet rheolytic thrombectomy. The overall morbidity of acute kidney injury in the two groups was 11.4%, and the nonelderly group had a similar rate of acute kidney injury (8.3%) to the elderly group (15.6%). None of the 12 patients progressed to dialysis within the postoperative period, and the mean acute kidney injury recovery time of the elderly group was 5.86 ± 1.57 days, which was longer than the 3.60 ± .89 days of the nonelderly group ( p = 0.017). Conclusion The use of AngioJet rheolytic thrombectomy for the treatment of patients with acute deep vein thrombosis is associated with a potential risk of acute kidney injury, which seems to have a comparable rate in elderly and nonelderly patients. acute kidney injury in the elderly group tends to need a longer recovery time, which requires postoperative vigilance for this population.

Objective: To investigate the safety and effectiveness of catheter-based therapy (CBT) compared to conventional catheter-directed thrombosis (CDT) for non-oncological patients with inferior vena cava thrombosis (IVCT), as well to evaluate the differences between CBTs using AngioJet rheolytic thrombectomy (ART) and large lumen catheter aspiration (LLCA). Methods: This retrospective single-center study included eligible patients with IVCT treated with CBTs coupled with/without CDT or CDT alone as the first-line treatment between January 3, 2015 and January 28, 2022. The baseline demographics, comorbidities, clinical characteristics, treatment details, course data were all reviewed. Results: A total of 106 patients (128 limbs) were included, with 42 cases were treated with ART, 30 with LLCA, and 34 with CDT alone. Technical success rates were 100% (128/128), and 95.5% (84/88) limbs treated with CBT subsequently underwent CDT. The mean duration of CDT time and total infusion agent dosage in patients with CBTs were lower than those who underwent CDT alone ( P < .05). Similarities were observed in ART compared to LLCA ( P < .05). At the end of CDT, clinical success was achieved in 85.2% (75/88) of limbs treated with CBTs and 77.5% (31/40) of limbs with CDT alone, and 88.5% (46/52) in ART and 80.6% (29/36) in LLCA. The 12-month follow-up showed slightly lower incidences of recurrent thrombosis (7.7% vs 15.2%) and post-thrombotic syndrome (14.1% vs 21.2%), which persisted in patients who underwent ART compared to LLCA (4.3% vs 12.9% and 8.5% vs 22.6%). Patients who underwent CBTs tended to have lower minor complications (5.6% vs 17.6%) but were at higher risk of transient macroscopic hemoglobinuria (58.3% vs 0%) and recoverable acute kidney injury (11.1% vs 2.9%) compared to CDT alone. These findings were similar in ART compared to LLCA (2.4% vs 10.0%, 100% vs 0%, and 16.7% vs 3.3%, respectively). LLCA seemed to have more hemoglobin losses (10.50 ± 9.20 vs 5.57 ± 10. 42 g/L, P < .05). Conclusion: CBTs coupled with/without CDT are safe and effective in patients with IVCT, reducing the clot burden in a moderate time, restoring blood flow rapidly, minimizing thrombolytic drug requirement and lowering minor bleeding complication compared to CDT alone. ART and LLCA have comparable outcomes but with different adverse event profiles.

ObjectiveTo compare the efficacy and safety of AngioJet rheolytic thrombectomy (ART) and large-lumen catheter suction (LCS) in the treatment of inferior vena cava (IVC) filter related IVC-iliac vein thrombosis.MethodsThe clinical data and medical imaging materials of 65 cases were collected, which suffered acute inferior vena cava filter related IVC-iliac vein thrombosis and received percutaneous mechanic thrombectomy (PMT) from June 2016 to June 2020 in our center, including 32 cases of LCS group and 33 cases of ART group. The final thrombolysis rate, the incidence of complications, and the follow-up are evaluated.ResultsThe limb swelling was significantly relieved in patients with PMT after treatment. The peri-diameter difference of the limb in the LCS group before and after treatment was [(5.20 ± 2.03) vs. (2.17 ± 1.29) cm, P < 0.05], and that in the ART group before and after treatment was [(4.79 ± 2.23) vs. (1.74 ± 0.94) cm, P < 0.05]. The amount of postoperative recombinant tissue-type plasminogen activator (rt-PA) is reduced in ART group [(57.97 ± 21.25) in LCS group vs. (40.45 ± 20.89) mg in ART group, P < 0.05], and the thrombolysis rate was higher than that of the LCS group [(74.13 ± 19.74% in LCS group) vs. (84.58 ± 11.90% in ART group %), P < 0.05]. No serious complications occurred during the treatment.ConclusionBoth LCS group and ART group have good thrombosis clearance effects on the inferior vena cava filter related IVC-iliac vein thrombosis. ART can reduce the rt-PA dose, increase the thrombolysis rate and reduce the risk of bleeding during thrombolysis.

Objective Acute limb ischemia is one of the most common arterial emergencies. The data of mechanical revascularization using Solitaire AB device coupled with thromboaspiration for the treatment of popliteal and infrapopliteal acute limb ischemia are limited. The aim of this study was to review the preliminary safety and effectiveness. Methods We performed a single-center retrospective review of patients with popliteal and infrapopliteal acute limb ischemia treated with Solitaire AB device coupled with thromboaspiration from February 2019 to May 2020. Adjunctive balloon angioplasty was performed to correct coexisting atherosclerotic stenosis. Technical success was defined as successful deployment of the Solitaire AB device across the occlusive segment and successful retrieval without the use of adjunctive catheter-directed thrombolysis or balloon angioplasty. Clinical success was defined as the relief of symptoms related to acute limb ischemia. Follow-up outcomes were also reviewed. Results There were 15 consecutive patients who underwent 16 Solitaire AB devices. Technical success was achieved in 11 (73.3%) patients. Of the unsuccessful patients, double-stent retrievers were employed in 1 (6.7%) patient. Two patients who encountered residual clots in distal small arteries underwent adjunctive catheter-directed thrombolysis. An adjunctive balloon angioplasty was required in 1 (6.7%) patient. All patients had notable acute limb ischemia symptom relief after the procedures. Clinical success was achieved in 14 (93.3%) patients. Besides one patient encountered minor amputation, the major amputation was prevented in all patients. No device-related complications or distal embolization events were recorded during the procedures. At the follow-up of 12 months, all surviving patients remained symptom-free, the patency was achieved in 12 (80%) patients and the limb salvage was 100%. Conclusions Preliminary outcomes suggest that mechanical revascularization using Solitaire AB device coupled with manual thromboaspiration appears to be a rapid, safe, and effective modality that appears to reduce the requirement for catheter-directed thrombolysis. Advances in knowledge These findings may add a promising recanalization therapy for acute embolic occlusion of the acute limb ischemia secondary to popliteal and infrapopliteal arteries.

Purpose The present study aimed to investigate the preliminary safety and efficacy of rheolytic thrombectomy (RT) using AngioJet ZelanteDVT catheter or Solent Omni catheter for acute proximal deep vein thrombosis (DVT).Material and Methods We conducted a retrospective review of 40 patients who treated by AngioJet RT divided into ZelanteDVT group (n=17) and Solent group (n=23) from January 2019 to January 2021. Data of demographics, clinical characteristic, technical success, clinical success, complications, and early follow-up were analysed.Results No significant differences regarding demographics were detected (all p >.05). The technical success rates were both 100%. ZelanteDVT group had a shorter duration time of RT and a higher primary RT success than those of Solent group (all p significantly lower than that was 79.3% in Solent group (p =.010). The successful outcome for ZelanteDVT group and Solent group were 100% (17/17) and 95.7% (22/23), both high in the two groups (p >.05). Except for transient macroscopic hemoglobinuria occurred in all patients at the first 24 hours post-RT, none suffered other procedure-related adverse events or major complications in both groups. Minor complications presented as bleeding events occurred in 21.7% (5/23) patients of Solent group, and one (5.9%) patient in Zelante DVT group (p >.05). At 6-month, the frequency of PTS was 5.9% (1/17) in ZelanteDVT group compared with 17.4% (4/ 23) in Solent group (p >.05).Conclusion Both catheters are safe and effective for the management of patients with proximal DVT, leading to improved clinical outcomes with low complication. Zelante-DVT catheter offered more powerful thrombectomy over Solent catheter, allowing for faster extraction of the DVT with shorter run time and lower adjunctive CDT.

Background: The objective of this study is to establish a minimally invasive technique to create a stable carotid artery stenosis rabbit model. This article summarizes the specific methods and key points of this technology.Methods: The experiment studied a rabbit that was anesthetized through the vein. After the femoral artery was exposed, a minimally invasive needle was used to puncture the femoral artery, then the sheath was placed into the artery. We primarily put a catheter in the ascending aorta for angiography and then used a PT2 guidewire for super-selection. The PT2 guidewire was retained, and a balloon was placed in the right common carotid artery (CCA) through a guidewire to inflate it three times. Six rabbits in the 2- (2W) and 4-week (4W) groups were examined at 14 and 28 days, respectively. The rabbits in the control group received angiography at the beginning and 28 days later but without balloon injury. After angiography assessment, specimens of right CCA were dissected. Pathological and immunohistochemical examinations were performed on the collected specimens, and iFlow analysis was performed as well.Results: All the 18 animals which survived were observed. The rabbits in the 2W and 4W groups showed stenosis of the right CCA. Digital subtraction angiography showed the diameter was lower than that in the control group (1.04 ± 0.1, 0.71 ± 0.12, and 1.83 ± 0.08 mm in 2W, 4W, and control group, P < 0.05). Pathology also suggested carotid stenosis and obvious intimal hyperplasia. The results of immunohistochemistry showed that α-smooth muscle actin was highly expressed in the 2W and 4W groups, and the integrated optical density (IOD) value was higher than that in the control group (14,807.11 ± 1,822.3, 22,245.96 ± 1,212.82, and 6,537.16 ± 1,186.62 in the 2W, 4W, and control group, P < 0.05). Meanwhile, a cluster of differentiation 31 (CD31) was low expressed in the 2W and 4W groups, and the IOD value was lower than that in the control group (519.14 ± 44.4, 1,029.64 ± 98.48, and 1,502.05 ± 88.79 in the 2W, 4W, and control group, P < 0.05), which suggested endothelial damage and partial repair. The analysis by iFlow showed that the time-to-peak after balloon strain in the 2W and 4W groups were longer than that in the control group.Conclusion: We established a minimally invasive, effective, and safe method to establish a carotid artery stenosis rabbit model. The highlights of this technology were the application of minimally invasive methods, reducing surgical bleeding, infection, and related complications. This technology avoided the influence of tissue around CCA in the traditional carotid artery balloon injury model, which might lead to more accurate treatment outcomes.

In this article, a thermoviscoelastic constitutive model is introduced to describe the unidirectional continuous elastic fiber–reinforced shape memory polymer composites under the finite deformation. Although the shape memory polymers can be used in finite deformations, only a small strain can be applied on the carbon fiber for its small failure tensile strain (about 2%). Using the model, the effective strain of the carbon fiber for the unidirectional continuous carbon fiber–reinforced shape memory polymer composites can be derived. It is found that the carbon fiber–reinforced shape memory polymer composites with the fiber inclination angle in a typical range can be used in the finite deformation, without failure of the carbon fiber. Besides, a simplified buckling model is proposed to predict the fiber buckling under axial compression. It is calculated that the buckling critical stress is rather small. Therefore, it should be avoided in application. As for carbon fiber–reinforced shape memory polymer composites, the bending driving capacity is the crucial property in their applications. Hence, the shape memory effect of the carbon fiber–reinforced shape memory polymer composite beam under the finite deformation is also studied here. The findings can be used to provide guidance for the design and application of the carbon fiber–reinforced shape memory polymer composites and their structures.

The aim of this study was to assess factors associated with conservative management failure in patients with symptomatic isolated mesenteric artery dissection.Patients with symptomatic isolated mesenteric artery dissection who underwent conservative therapy as first line treatment between February 2010 and May 2018 were included in this retrospective study. Conservative management failure was defined as the persistence or aggravation of symptoms and signs, increasing aneurysmal dilation, or new appearance of a dissecting aneurysm after conservative management. Univariable and multivariable analyses were performed to identify risk factors for failure of conservative management.A total of 123 patients (115 men, 8 women, mean age, 53.7 ± 6.1 years) were included in this study. Conservative management was successful in 89 (72.4%) patients but failed in the remaining 34 (27.6%) patients. Of the 89 for whom conservative management was successful, all of the symptoms were eliminated (n = 81) or relieved (n = 8) within 3.8 ± 0.7 days after conservative management. All of the 34 patients in whom conservative management failed underwent successful endovascular stenting. Failure of conservative management was associated with type II IMADs as defined by the Sakamoto classification (meaning that there is an entry tear, but no re-entry, and still no thrombosis of false lumen, odds ratio: 33.76; 95% confidence interval 8.65-131.85; p .001) and with ≥90% luminal stenosis (odds ratio 40.70; 95% confidence interval: 3.76-440.07; p .01).Conservative management can be used successfully in most patients with symptomatic isolated mesenteric artery dissection. Risk factors for failed conservative treatment were type II IMADs and degree of luminal stenosis ≥90%.

Urban renewal has been an essential strategy for urban development in China. The decision to redevelop land in the process of urban renewal will help to optimize urban spatial layout, guide functional positioning, and improve the physical environment, to solve the urban land resource shortage problem and achieve sustainable development. This research aims to simulate the dynamic trend of land-use change by using the Cellular Automata (CA) model; with various complex settings, the actual urban renewal status, as well as three scenarios for future development, are simulated and analysed in the case study of Chongqing to assist and support stakeholders in making proper decisions for future urban planning. The study proposes a method to embed the rent gap theory, which states that when the value gap between the potential ground rent and actual ground rent is larger, the attractiveness of investing capital in land redevelopment is larger. In the process of CA simulation, the rent gap theory, as a transition rules of land-use change, can reflect the internal mechanism of urban development. When the location-based spatial characteristics are used, the macro-economic factors, such as GDP, interest rate and depreciation rates, can quantify the rent gap in the CA model. In addition, based on the background of China's "government-led" development, combined with the real situation, the endogenous and exogenous influencing factors of the policy are used as the quantitative factors of the rent gap theory and the second type of transition rule of land evolution, respectively, which can accurately reflect the urban development. The results show that the dynamics in the land redevelopment of Chongqing are well described by the model; additionally, the policy implications to manage the urban renewal are discussed in the research.

Thermal effect on size-dependent vibrational behavior of rotating microbeams made of functionally graded materials (FGMs) is investigated. It is assumed that the material properties of FGMs change smoothly through the thickness of the microbeam according to a power-law variation. Within the framework of Timoshenko beam theory (TBT) and Euler-Bernoulli beam theory (EBT), the governing equations and associated boundary conditions of rotating hinged-hinged, clamped-free, clamped-clamped and clamped-hinged microbeams are determined by using Hamilton's principle and modified couple stress theory. The axial nonlinear coupling deformation is taken into account to capture the centrifugal stiffening effect. An assumed-mode discretization approach is applied to solve these equations numerically. Convergence study and comparative examples are presented to verify the accuracy and reliability of the present model. A detailed numerical study is carried out to analyze the effects of dimensionless material length scale parameter, slenderness ratio, dimensionless angular velocity, temperature change and FG index on the vibrational behaviors of rotating FG microbeams. Numerical results indicate that the increasing value of temperature change leads to an increase in size dependency of rotating microbeams. The size dependency of rotating microbeams considerably differs from that of stationary microbeams. In addition, the gradient change in material properties greatly affects the size dependency of rotating FG microbeams.

Objective To evaluate perfusion alterations in skeletal muscle in a canine hind limb ischemia model using color-coded digital subtraction angiography (CC-DSA). Methods Twelve beagles underwent embolization at the branch of their left deep femoral artery. Right hind limbs were used as the control group. Angiography was performed before and immediately after embolization. Upon CC-DSA analysis, time to peak (TTP) was measured before embolization in both sides of the beagles' hind limbs at the middle iliac artery, and the distant, middle and proximal femoral artery. Regions of interest (ROI) peak and ROI peak time were symmetrically computed in proximal and distal thigh muscles before and immediately after embolization. The data were analyzed and compared using the Wilcoxon signed rank test. Results Before embolization, ROI peak in the proximal thigh was lower than in the ipsilateral distal thigh, whereas ROI peak time in the proximal thigh was longer than in the distal thigh. In the iliac femoral artery, there was no significant difference in ROI peak, ROI peak time, or TTP between right and left sides. After embolization, ROI peaks in proximal and distal skeletal muscles of the left hind limb were significantly lower than on the contralateral side. ROI peak time was significantly longer in the left proximal and left distal thigh compared to the contralateral side. There were no significant changes in ROI peak or ROI peak time in the right proximal and right distal thigh compared to pre-embolization values. Changes in ROI peak and ROI peak time were larger in the left proximal than in the left distal thigh. Conclusion CC-DSA provided real-time measurement of changes in vascular hemodynamics and skeletal muscle perfusion without increasing X-ray usage or contrast agent dose.

Given the substantial resource use and emissions generated from the building sector, China is seeking a more sustainable and greener mode of building construction. To grasp the characteristics of the embodied energy use of the building sector across provinces in China, a multidimensional framework is developed to examine the spatial and sectoral distributions through the whole supply chain using a multiregional input-output (MRIO) analysis and structural path analysis (SPA) as the underlying methods. The results show that from a regional perspective, Liaoning, Shandong, and Guangdong are identified as top contributors, while from a sectoral perspective, the manufacture of nonmetallic mineral products, smelting and pressing of metals, and transportation, storage, posts, and telecommunications are the largest energy suppliers. The upstream examination indicates that self-digestion is an obvious and dominant energy use behavior for most regions, while the relative importance of sectoral suppliers changes regularly with the increase in upstream stages. The energy capture that occurred in the cross-regional energy transfers indicates that Zhejiang and Hebei are the national leading net importer and net exporter of energy use in China's building sector, respectively.

To investigate the outcomes of stent thrombectomy combined with aspiration versus aspiration alone in acute mesenteric ischemia (AMI).This was a single-center, retrospective cohort study. Between May 1, 2012, and January 1, 2021, 41 patients (mean age, 73.8 years ± 7.9) with AMI who underwent stent thrombectomy plus aspiration (Group 1, n = 14) or aspiration alone (Group 2, n = 27) were included. The treatment regimens and clinical and follow-up outcomes of the patients were reviewed and analyzed. Group differences were compared using a χThe overall clinical success rate was 78.0% (32/41), and no significant differences were found between Group 1 and Group 2 (78.6% vs 77.8%, P = 1.00). Compared with Group 2, Group 1 was associated with a higher complete clearance rate (44.4% vs 78.6%, P = .04), less adjunctive local thrombolysis (48.1% vs 14.3%, P = .03), and a shorter length of hospital stay (10.7 days ± 9.0 vs 5.7 days ± 4.7, P = .03). The estimated survival rates at 1 month, 3 months, 6 months, 1 year, and 2 years were 73.2%, 72.5%, 71.4%, 65.3%, and 59.8%, respectively. No significant difference was found in the survival rate between the groups (log-rank test, P = .96). The recurrence rates for Group 1 and Group 2 were 8.3% (1/12) and 4.0% (1/25), respectively.Compared with aspiration alone, aspiration combined with stent thrombectomy showed a higher complete clearance rate, reduced adjunctive thrombolysis, and a shorter length of hospital stay.

BackgroundMechanical thrombectomy is the standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO) in the anterior circulation. This trial aimed to indicate whether Skyflow, a new thrombectomy device, could achieve the same safety and efficacy as Solitaire FR in the treatment of AIS.MethodsThis study was a prospective, multicenter, randomized, single blind, parallel, positive controlled, non-inferiority clinical trial. Patients with intracranial anterior circulation LVO within 8 hours from onset were included to receive thrombectomy treatment with either the Skyflow or Solitaire FR stent retriever. The primary endpoint was the rate of successful reperfusion (modified Treatment In Cerebral Infarction (mTICI) ≥2b) after the operation. The safety endpoints were the rate of symptomatic intracranial hemorrhage (sICH) and subarachnoid hemorrhage (SAH) at 24 hours after operation.ResultsA total of 95 and 97 patients were involved in the Skyflow group and Solitaire FR group, respectively. A successful reperfusion (mTICI ≥2b) was finally achieved in 84 (88.4%) patients in the Skyflow group and 80 (82.5%) patients in the Solitaire FR group. Skyflow was non-inferior to Solitaire FR in regard to the primary outcome, with the criterion of a non-inferiority margin of 12.5% (p=0.0002) after being adjusted for the combined center effect and the National Institutes of Health Stroke Scale (NIHSS) score. The rate of periprocedural sICH and SAH did not differ significantly between the two groups.ConclusionEndovascular thrombectomy with the Skyflow stent retriever was non-inferior to Solitaire FR with regard to successful reperfusion in AIS due to LVO (with a pre-specified non-inferiority margin of 12.5%).

Background Acute limb ischemia (ALI) is an important clinical event threatening both life and the affected limbs, but the optimal treatment for ALI remains undefined. The aim of this study was to compare the safety and effectiveness of thrombectomy approaches via either catheter-based thrombectomy (CBT) or catheter-directed thrombolysis (CDT). Methods A total of 98 patients (mean age 69.7 years, 60 male) who underwent endovascular intervention for ALI from January 2015 to July 2019 were included. Of these, 57 were treated with primary CBT via a large-bore catheter, an AngioJet catheter or Rotarex catheter, and/or underwent low-dose CDT, and 41 were treated with primary CDT. The safety and effectiveness of CBT compared to conventional CDT and other various endovascular techniques were evaluated. Results More Rutherford IIb patients were treated with primary CBT (68.4%) than CDT (26.8%; P P P P P > .05). Clinical success was estimated to be achieved in 98.2% of patients who underwent CBT, which is similar to the 97.6% estimated in those who underwent primary CDT (P = 1.000), and this finding was similar among the CBT subgroups. Patients who underwent CBT had a higher procedure-related distal embolization rate and economic cost than those who underwent primary CDT (P P = .059), especially minor complications (P = .036). The freedom from amputation at 6 and 12 months for CBT and CDT was assessed (93.0% vs 90.2% respectively, P = .625; 89.5% vs 82.9%, respectively, P = .34,). Comparable limb salvage was found for different techniques of large bore catheters, AngioJet catheters and Rotarex catheters. The Kaplan-Meier table analysis also showed similar limb salvage rates between groups. Conclusions Endovascular treatment of ALI with the use of catheter-based therapies is an effective modality that can reduce the requirement for thrombolysis, with expected reductions in hemorrhagic complications, but at the risk of remediable distal emboli and increased economic cost. It has a similar clinical outcome to conventional CDT alone. Different CBT techniques have comparable efficacy but different adverse event profiles.

To compare the safety of conventional transarterial chemoembolization (cTACE) vs drug-eluting bead TACE (DEB-TACE) in very early- and early-stage hepatocellular carcinoma (HCC).Data of patients with early- and very early-stage HCC treated with cTACE or DEB-TACE were evaluated retrospectively in this study. A total of 40 patients were included, 20 treated with cTACE and 20 with DEB-TACE. The cTACE and DEB-TACE groups were comprised of 80% and 75% males, while there were 20% females in cTACE group and 25% in Deb-TACE group respectively. The mean age of patients in cTACE group was 57.43 ​+ ​5.6 years, while it was 56.4 ​+ ​5.5 years in DEB-TACE group. All patients had liver status of Child-Pugh Class A and a score ≤ 7 in Child-Pugh class type B in very early- (stage 0) or early-phase (stage A) stages according to the Barcelona Clinic Liver Cancer (BCLC) system.The Child-Pugh class degradation in the cTACE group was slightly higher than that in the DEB-TACE group. Serious complications like peritumoral parenchymal ischemia were observed in 4 patients in the cTACE group and 5 in the DEB-TACE group. Localized bile duct dilation was seen in 2 patients in the cTACE group and 6 in the DEB-TACE group.No significant variation in serious complications between the two groups was established in localized bile duct dilatation. Other minor complications noted were liver failure, liver abscess, liver infarction, acute cholecystitis, biliary tree necrosis, and mortality. Further, no substantial variation in tumor response between the groups was reported immediately and 1-year post-procedural assessment. Conversion rate to other treatment modalities such as surgical resection, radiofrequency ablation (RFA), or swap between cTACE and DEB-TACE was substantially higher in the DEB-TACE group (40%) than in the cTACE group (10%) at the 1-year completion period of the study.In terms of tumor response, the DEB-TACE group showed a better response, to some extent, as an initial therapy for HCC in the early stages as compared to the cTACE group, and DEB-TACE also exhibited better clinical efficacy in patients with HCC.

To evaluate the effectiveness and safety of fluoroscopy-guided percutaneous high ligation (FPHL) combined with fluoroscopy-guided foam sclerotherapy (FGFS) to treat varicose veins of the great saphenous veins (GSVs).This was a retrospective study of 113 patients (mean age, 62.1 ± 10.8 years; 60 men) with varicose veins of the GSVs (133 limbs) that were treated with FPHL combined with FGFS between April 1 and October 31, 2019. Demographic and clinical data were collected from these patients before the FPHL procedure, after which FGFS was performed. The preterminal GSV was ligated percutaneously by a percutaneously-positioned polypropylene ligature under fluoroscopic guidance. The outcome of ligation was confirmed by venography. Then, foam sclerotherapy was performed under fluoroscopy. At 1-year follow-up, GSV occlusion was evaluated by ultrasound. The venous clinical severity scores (VCSSs) were compared between the preoperative and 1-year follow-up periods.The technical success rate was 100% (133 limbs). Complete 12-month follow-up was available for 112 limbs (84.2%) and 103 of these limbs (92.0%) remained occluded during this period. The VCSS improved from 4.71 ± 2.15 to 0.74 ± 0.60 (V = 6328, P.001). During follow-up, there were 16 limbs with thrombophlebitis and 38 limbs with saphenous junction pain; these events were alleviated within 2 weeks of the procedure. There was no deep venous thrombosis or other severe adverse events.FPHL combined with FGFS to treat varicose veins in the GSVs achieved an occlusion rate of 92% and improved the clinical symptoms within 1 year; this minimally-invasive procedure was safe and effective.

Transcatheter arterial embolization (TAE) for acute renal hemorrhage (RH) under coagulopathic conditions with N-butyl-2 cyanoacrylate (NBCA) is rarely described in the literature, and a consensus on the efficacy and safety of NBCA under this condition has not been reached. The present study aimed to evaluate the efficacy and safety of TAE using NBCA Glubran 2 in the treatment of acute RH under coagulopathic conditions.Eight patients who underwent TAE with NBCA Glubran 2 for acute RH under coagulopathic conditions were collected.NBCA Glubran 2 was employed as the sole embolic material in 6 patients. In the remaining 2 patients, NBCA Glubran 2 was employed for secondary embolization. Under coagulopathic conditions, both technical success and clinical success were achieved in treating acute RH with NBCA Glubran 2 in all patients. During a mean follow-up time of 30.1 months, neither persistent nor recurrent active hemorrhage required a repeated endovascular or surgical treatment for hemostasis. No Glubran 2-related complications occurred. In addition, there was no significant difference between the evaluated glomerular filtration rate level before and after one week of Glubran 2 embolization (P = 0.88; CI, -32.4 to 37.4).TAE with NBCA Glubran 2 may be a safe alternative treatment for the management of RH under coagulopathic conditions. In particular, this method appears to be a potentially attractive alternative when conventional embolic materials fail in patients with ongoing hemodynamic instability or even under severe coagulopathic conditions.