Introduction and importance We report a rare case of subacute recurrent in-stent thrombosis after vertebral artery stenting of the left intracranial segment. Case presentation A 56-year-old man presented with V4 segment severe stenosis of the left vertebral artery. Stent (Apollo, 2.5 mm × 8 mm) implantation was performed for severe stenosis of the left vertebral artery. Approximately 48 h after operation, the patient developed dizziness and drowsiness. DSA showed stent thrombosis, which was treated by PTAS (Apollo, 2.5 mm × 13 mm), and the preoperative symptoms resolved. Two days later, symptoms of posterior circulation ischemia reappeared, DSA showed recurrence of stent thrombosis and CYP2C19 genotypic analysis showed intermediate metabolizers. Revision PTAS (Enterprise, 4.5 mm × 28 mm) was performed followed by administration of Ticagrelor instead of tirofiban. The patient showed good neurological outcomes. CTA performed both one week and four months after the operation showed that the blood flow of the left vertebral artery was unobstructed. Clinical discussion Endovascular therapy is an alternative treatment for severe intracranial vascular stenosis, and reocclusion is one of the serious complications. Conclusion our case report highlights that recurrent in-stent thrombosis maybe be caused by inadequate preoperative assessment and unsuitable therapeutic drug selection for the stents.
BackgroundThe incidence of esophagogastric junction adenocarcinoma (EJA) has increased in recent years, with surgical resection the main choice of treatment. The optimal length of the proximal margin for EJA is still under debate, and the impact of EJA survival and recurrence remains unclear. The aim of the present study was to investigate the influence of the optimal length of the proximal margin on EJA.MethodsFrom January 2011 to December 2015, 131 patients who had EJA with type II tumors were included and retrospectively analyzed. All patients underwent radical R0 resection. The proximal margin was measured promptly after resection, and the frozen-section pathological examination was negative for the margin.ResultsThere were 3 cases of Siewert type I EJA (2.9 %), 75 cases of Siewert type II EJA (57.9 %), and 53 cases (40.1%) of Siewert type III EJA. The median number of lymph nodes examined was 19 (range: 1–41), and the median number of positive lymph nodes was 2 (range: 0–18). Sixty-three patients underwent total gastrectomy (48.1%), and 68 underwent proximal gastrectomy (51.9%). The median follow-up time was 57.3 months: (range 1.9–174.1); 34 patients (26%) relapsed and 74 (56.5%) died. The 5-year overall survival rate of type II tumor patients was 68.2%, and that of type III tumor patients was 38.5% (P = 0.02). For patients with a proximal margin <2 cm, the median recurrence time was 41.6 months, whereas it was for 42.8 months for patients with proximal margin >2 cm (log–rank: 0.496). Our data analysis found that a proximal margin length of 2 cm was a prognostic variable for type II and type III tumors.ConclusionsThere are a number of factors associated with recurrence and overall survival at 5 years for patients who have EJA with type II and type III tumors, and a proximal margin >2 cm may indicate better prognosis.
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