| Part OneObjectives To summarize the published articles on the treatment of non-acute internal carotid artery occlusion(NAICAO)with intravascular recanalization,and to systematically evaluate the efficacy and safety of the procedure.Methods The literature on endovascular recanalization of NAICAO was obtained by searching Pubmed and Embase databases.Reports consistent with the study criteria were included.The data of success recanalization rate,the incidence of complications,the incidence of perioperative adverse events and the cumulative mortality rate,the incidence of recurrent stroke were extracted.Heterogeneity test and/or meta-regression were performed before combining the effect indicator,and the causes of heterogeneity were analyzed and processed.The effect indicators of the single-arm study were combined,and the indicators with two-group comparison were compared and analyzed.The above summary results were subjected to publication bias analysis and correction to determine whether the combined results were reliable.Results The combined result showed that the overall successful 1 recanalization rate was 76%with 95%CI(0.66,0.85)and perioperative complication rate was 6.3%,with 95%CI(3.8%;10.3%).Long-term follow-up of cumulative mortality and cumulative recurrent stroke were obtained between the success and failure recanalization groups,with a ratio of 13%to 31%and 3.6%to 13.3%,and the adjusted RR values were 0.95,95%CI(0.32,1.08)and 0.57,95%CI(0.343,0.945),respectively.Conclusion Endovascular recanalization in patients with symptomatic NAICAO is technically safe and feasible with a high success recanalization rate.The risk of recurrent stroke was significantly lower in the success group than that of the failure group,and the all-cause mortality rate also decreased but without statistical significance.Part twoObjectives To evaluate the success rate,safety and efficacy of intravascular recanalization in the treatment of non-acute carotid occlusion(NACO),and to establish a multivariate predictive model for the success rate of endovascular occlusion for endovascular treatment.Methods In the cohort study,the clinical and surgical data of patients with non-acute carotid occlusion treated in our department were collected.The survival information of patients was obtained by follow-up.According to the outcome of the procedure,the patients were divided into successful recanalization group and non-recanalization group.Logistic multivariate analysis was used to explore the risk factors leading to the primary outcomes.COX risk proportional regression was used to compare the risk ratio of outcome events between the two groups and a prediction model by the Nomogram plot established to predict the success rate of intravascular recanalization.Results A total of 59 patients were included in the study.62 procedures were performed,the success recanalization rate was 75.81%,and the main complications during the perioperative period were 6.45%.The average follow-up time was 36.53±3.92 months.The incidence of primary outcome events in the two groups was 6.52%and 23.08%,respectively,and the independent risk factors for primary outcome events were carotid occlusion and diabetes.There was a significant difference in the incidence of major outcome events between the success recanalization group and the failure group,RR=0.16,95%CI(0.04,0.71).The prediction model proposed in this study was verified of having good sensitivity and specificity to predict the success recanalization rate.Conclusion Successful recanalization significantly reduced the risk of recurrent TIA and stroke.Compared with symptomatic carotid stenosis with CAS,intravascular recanalization of carotid occlusion did not increase the risk of perioperative complications.Our prediction model can be used to predict the accuracy success rate of recanalization according to the preoperative imaging characteristics of patients.Part threeObjectives To develop a model by using of the rat’s abdominal aorta and common iliac arteries(CIAs)for practicing end-to-end,end-to-side and side-to-side anastomosis that commonly used in cerebrovascular surgery.Methods Adult SD rats were anesthetized and then laparotomized.The abdominal aorta and bilateral common iliac arteries were exposed and fully separated from the surrounding tissues.The lengths and diameters of abdominal aortic and common iliac arteries of each segment were measured.The relatively long segment abdominal aorta without major branches was selected to perform end-to-end anastomosis.One side of the common iliac artery and the sacral median artery were used for end-to-side anastomosis.The bilateral common iliac arteries were applied to end-to-side and side-to-side anastomosis.The patency of each anastomotic lumen was checked by "milking test"technique.Results Anatomical separation of the abdominal aorta and common iliac artery was successfully performed on 12 Sprague-Dawley rats and each rat can be provided with 4 vascular anastomoses.The abdomen aorta trunk between left renal artery and right iliolumbar arteries was 15.6 ± 2.50mm in length,1.6 ± 0.26mm in diameter,for side-to-side anastomosis.The left common iliac artery was 9.0 ± 1.52mm in length,1.0±0.16mm in diameter,cut off at its origin and then for end-to-side anastomosis with the right common iliac artery.After finishing end-to-side anastomosis in the proximal part of bilateral common iliac artery,the distal part could be juxtaposed for an average length of 5.1±0.36mm,for a side-to-side anastomosis.The median sacral artery was 0.8±0.08mm in diameter,performed end-to-side anastomosis with the right common iliac artery with fish-mouthing incision of its stump.Conclusion This model can comprehensively and effectively simulate anastomosis that used in cerebral revascularization procedures,and it is suitable for neurosurgeons to carry out microsurgical anastomosis training in inermediate level. |
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