Collateral circulation is a significant factor that limits the damage to the cervical spinal cord. Impaired circulation in the artery of cervical enlargement is significant in extension of perifocal ischemia. The appearance of early arteriovenous shunting in the region of a primary spinal cord injury (contusion focus) by angiography is pathognomonic. The data obtained open a perspective for the endovascular treatment of spinal cord injury.
Case of endovascular treatment of a patient with tandem left internal carotid artery (ICA) and middle cerebral artery (MCA), which was a complication of carotid endarterectomy, are presented. The rupture at the location of the suture in the bulb of the ICA during endovascular intervention required implantation of a graft-stent and subsequent removal of the hematoma in the neck soft tissues.A 51 year old man in the residual period of ischemic stroke in the left carotid basin with elements of sensory speech disorders, with subtotal stenosis in the bulb of the left ICA, stenosis 35 % in the bulb of the right ICA and severe hypoplasia of the A1-segment of the left anterior cerebral artery underwent left-side carotid endarterectomy. The next morning after surgery, 1 hour after awakening, a right-sided hemiparesis progressing to hemiplegia, total aphasia. The level of consciousness deteriorated to the sopor. A computer tomography was performed immediately. New ischemic lesions were not identified. Cerebral angiography revealed the occlusion from the mouth of the left ICA, occlusion in the M1-segment of the left MCA. Thrombospiration from MCA and ICA was performed with Sofia Plus distal approach catheter. The MCA was recanalized in one pass (mTICI 3), but the patency of the left ICA was not recovered. The anti-embolic device SpiderFX was introduced and opened in the C2-segment of the left ICA. Then, a slow inflation of the Submarine 5 × 20 mm balloon catheter was performed in the left ICA bulb. At a pressure of 4.0 atm, the balloon opened like an hourglass, indicating a rough rigid stenosis in the ICA bulb. At a pressure of 4.5 atm, the balloon fully opened. Immediately after balloon deflation, intense contrast extravasation is determined at the level of the ICA bulb. Inflation of the balloon at a pressure of 4 atm was performed again. Intubation of the trachea of the patient was performed. Intravenous administration of 300 mg acetylsalicylic acid was initiated. The balloon catheter is deflated and withdrawn from vessels, the carotid stent Protégé 8–6×40 mm was implanted into the left ICA bulb and the left common carotid bifurcation segment. The bloodstream above the stent is not determined, but extravasation through the stent cells at the level of the former defect is determined. Stent graft Graftmaster 4×15 mm was implanted into the carotid stent at the level of the defect in the ICA. Stent graft was additionally opened in its lower part by a 5×20 mm balloon-catheter. Thrombaspiration from the left ICA was performed again. Patency of the ICA and intracranial arteries was totally restored – mTICI3, stenosis in the left ICA bulb was completely eliminated. The patient’s neurological status was restored to baseline. A large hematoma in the soft tissues of the neck to the left was determined. Only “old” ischemic foci in the left temporal lobe were determined on brain CT, a large hematoma laterally and anteriorly to the carotid artery was determined in the soft tissues of the left side of the neck on computer tomography. Ticagrelor was added to aspirin therapy. Hematoma was removed surgically. The postoperative period was unremarkable. The patient was discharged from the clinic in good condition with an level modified Rankin scale 1.In the presented case, the friendly work of different profiles specialists avoided the devastating consequences of such a relatively rare complication of carotid endarterectomy as cerebral arteries tandem thrombosis. The availability of graft-stents in access to interventional neuroradiologists is extremely important in such cases.
The most important economic tndexof the operation of an industrial enterprise is the output per man-shift, which is governed by the interaction of various production characteristics. In investigation of its origins, we must take account of the inflnence of as many as possible of these characteristics (parameters) and their interrelations, and establish definite laws for the aggregate of analyzed enterprises. This will enable us to elucidate the most important parameters and establish their individual and collective quantitative influence on the output per manshift.We studied the choice of parameters on the basis of file results of the productive and economic activities of the pits of the "Donetskugol' "comblnein1966-1967. We made observations of 170 pit-years. As a result of our research, we decided to analyze the following parameters over their ranges of variation: the maximum depth of the workings H meters (133-1033), the mean dynamic thickness oftheseam m meters (0.53-2.14), the mean active number of faces n (2o25.8), the mean face length I meters (88.6-268.8), the mean monthly advance of the face v meters (20.9-60.1), the relative contributions (weights) of faces with roof control by total caving, K 0 (0-1.0), the volume of workings per 1000 tons of target product, L w meters (5.0-54.9), the extent of supported workings per 1000 tom of target product, Lsu p meters (30.3-140.9), the extent of repairs to workings per 1000 tons of target product, L r meters (1.6-89.8), the relative weight of conveyerized inclined workings, K c (0.0-1.0), and the amount of rock removed from the pit per 1000 tons of target product, Q tons (52-868.0). The output per man-shift (o.m.s.) of preoextraction workers varied from 14.8 to 58.2 tons/month.The dependence of the o.m.s, on these parameters was found by multiple correlation methods, which enable us to establish the law of relation between the parameters and to solve the problem of the form and closeness of the correlation" which is basic in determining the laws concerned.In investigations of the economic multiple correlation indices, we used predominantly linear relations of the type:where y is the index under review, b i are regression coefficients, x i are the parameters, a is the independent term, and i = 1, 2 ..... n.Ithas beenshown [1, 2] that a linear relation for the o.m.s, does not give a correct representation of the essential features of the phenomenon, because the principal pairwise relations have clearly nonlinear characters.Calculations carried out with a program for the , involving computation of the mean values of the parameters (y, xi), the root-mean-square deviations (Oy, Oxi), the coefficients of pairwise (ryxi) and partial (r~xi) correlation, the patrwise (~yxi) and multiple (I) correlation ratios, and the coefficients of pa~wlse and multiple regression on the scale of the prototype (a i, b i, ci) revealed that for these relations there are both linear, hyperbolic, and parabolic types of correlation.
One case of successful treatment of the common femoral artery pseudoaneurysm with usage of modified technique of pseudoaneurysm neck sealing with Angio-Seal with retrograde access percutaneously is presented.A 52-year-old man was admitted in the recovery period of ischemic stroke in the left carotid basin. A total subtraction cerebral angiography was performed, which revealed severe stenosis in the bulb of the left internal carotid artery with ulcerated contour and severe stenosis in the ostium of the left vertebral artery. Hemostasis was performed by compression. A pressure dressing was applied for a day. The puncture site was without any problems on the next day. The patient received double antiplatelet therapy 5 days before endovascular surgery. Before surgery, palpation in the right inguinal region determines a rounded painful compaction. Carotid stenting on the left side, stenting of the left vertebral artery and control angiography of arteries of the right lower limb were performed by left-side femoral access. Pseudoaneurysm in the bifurcation of the right common femoral artery with a narrow neck was verified. Attempts to cure it by manual compression under angiographic control and ultrasound control were unsuccessful.After 6 days, endovascular treatment of pseudoaneurysms of the right common femoral artery with closure of the pseudoaneurysm neck was performed. The right common femoral artery was catheterized with left radial access with diagnostic catheter on a hydrophilic wire 0.035ʺ. This wire was carefully advanced into pseudoaneurysm through a defect in the common femoral artery and subsequently served as a marker. The pseudoaneurysm was punctured with miniaccess needle, then the 0.018ʺ wire passed through the pseudoaneurysm neck into the femoral artery retrogradly, focusing on the “marker” wire. A 6F radial introducer is introduced along 0.018ʺ wire. Further, this access was used to close the pseudoaneurysm neck with the Angio-Seal Closure Device 6F according to the standard method. In a control angiograms, a pseudoaneurysm did not contrast, arteries are passable without stenosis and signs of dissection. Hemostasis at the site of puncture of the radial artery was performed with a hemostatic bracelet. The patient was discharged from the clinic to continue treatment in a rehabilitation neurological center.This technique of endovascular treatment of postcatheterization pseudoaneurysms of the common femoral artery is quite simple, causing minimal discomfort for the patient. The closure is immediate and angiographically controled. The use of radial access instead of contralateral femoral access for introducing of a “marker” wire and angiographic control reduces the risk of local complications at the access site.
Цель работы-улучшить результаты каротидного стентирования за счет оптимизации выбора метода и инструментов противоэмболической защиты и дизайна каротидного стента в зависимости от характеристик атеросклеротической бляшки и морфологии сонных артерий. Материалы и методы. В эндоваскулярном центре Днепропетровской областной клинической больницы имени И.И. Мечникова за последние 15 лет выполнено 479 каротидных стентирований экстракраниальных сегментов сонных артерий у 411 пациентов в возрасте от 41 до 82 лет. Все операции проведены с использованием разных типов противоэмболических систем защиты (дистального, проксимального или их сочетания) и дизайна каротидных стентов. Результаты. Установлены высокая эффективность и низкий уровень осложнений каротидного стентирования. Послеоперационная смертность составила 0,73 %. Интраоперационные эмболические осложнения отмечены в 0,73 % наблюдений, реперфузионный синдром-в 1,7 %, местные осложнения в месте пункции бедренной артерии-в 1,95 %. Ипсилатеральный ишемический инсульт развился в 2 (0,49 %) случаях в течение первых 30 дней наблюдения после каротидного стентирования и в 4 (0,97 %)-в течение 5 лет. Выводы. Эндоваскулярные методы в лечении стенозов экстракраниальных отделов внутренних сонных артерий являются эффективными и ассоциируются с небольшим риском осложнений, который можно уменьшить за счет дифференцированного выбора инструментов и методов противоэмболической защиты, дизайна каротидных стентов с учетом характеристик атеросклеротической бляшки и морфологии сонных артерий. Ключевые слова: каротидное стентирование, противоэмболическая защита, дизайн стен-та. *Conflict of Interest Statement (We declare that we have no conflict of interest). *Заява про конфлікт інтересів (Ми заявляємо, що у нас немає ніякого конфлікту інтересів). *Заявление о конфликте интересов (Мы заявляем, что у нас нет никакого конфликта интересов). *No human/animal subjects policy requirements or funding disclosures. *Жодний із об'єктів дослідження (людина/тварина) не підпадає під вимоги політики щодо розкриття інформації фінансування. *Ни один из объектов исследования не подпадает под политику раскрытия информации финансирования. *Date of submission-01.09.17 *Дата подачі рукопису-01.09.17 *Дата подачи рукописи-01.09.17 *Date of acceptance-13.09.17 *Дата ухвалення-13.09.17 *Дата одобрения к печати-13.09.17
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