The extracranial-intracranial (EC-IC) bypass surgery has been widely used in the treatment of cerebral ischemia,intracranial aneurysms,and other diseases for more than 40 years.In terms of treating atherosclerotic cerebral ischemia,the surgery is presumed to be helpful for the subgroup of hemodynamic compromise in prevention of subsequent stroke.However,two multicenter trials presented with high perioperative stroke rate and failed to demonstrate the profit of the surgery.1-3 On this point,one of the crucial issues currently is how to lower down the perioperative stroke rate,the centerpiece of which is early postoperative infarction (EPI).
Background:We sought to explore an optimal clinical nursing mode following a hybrid surgery for cerebral arteriovenous malformation.Methods:Patients with complex cerebral arteriovenous malformations seen in our neurosurgery department from January 2016 to December 2017 were prospectively enrolled.The hybrid surgery protocol included“angiographic diagnosis,surgical resection,and intraoperative angiographic evaluation”and“angiographic diagnosis and embolization,surgical resection,and intraoperative angiographic evaluation”.The patients were randomly stratified into intensive care group and routine care group.After surgery,intensive or routine care was provided,and the prognosis of patients was evaluated,with a subsequent comparative analysis.Results:A total of 109 cases were divided into the routine nursing group(n=54 cases)and intensive nursing group(n=55 cases).There were no significant differences between the two groups in baseline data before surgery.Postoperative lung infection in the intensive nursing group was significantly less frequent than those in the routine nursing group(5.5%vs.18.5%,P=0.039)with pulmonary infection and lower extremity venous thrombosis(5.5%vs.24.1%,P=0.006).The average hospital stay in the intensive nursing group was 14.4±5.78 days,which was significantly lower than that in the routine nursing group(19.3±6.38 days,P=0.013).At 3 months’follow-up after surgery,the Generic Quality of Life Inventory-74(GQOLI-74)dimension score and GQOLI-74 total score in the enhanced group were significantly better than those in the routine nursing group(P=0.017 and 0.023,respectively).Conclusions:Intensive postoperative nursing can improve the safety of patients after hybrid surgery,reduce the postoperative complications and the average length of hospital stay,and improve the quality of life of patients.
Objective Few studies have reported the surgical treatment of carotid in-stent restenosis(ISR),more data and longer follow-up are needed.We describe the surgical treatment of ISR by standard carotid endarterectomy(CEA)with stent removal,including long-term follow-up in 10 patients from our centre.Methods Ten patients from our centre who underwent CEA with stent removal for ISR were retrospectively analysed,including nine symptomatic and one asymptomatic ISR of at least 70%with mean age 67.3,the median time between carotid artery stenting and CEA was 17 months(range,2-54 months).results Standard CEA with stent removal was performed in all 10 patients without much technical difficulty(9 male and 1 female,mean age 67.3).Two cases were performed in hybrid operation room.There were a total of three complications that happened in three patients(30%)respectively.An asymptomatic dissecting aneurysm was formed on the petrous internal carotid artery in one patient who was followed up without intervention.In the second case,dissection occurred in the arterial wall distal to the site of the stent after stent removal revealed by intraoperative angiography,and another stent was implanted.The patient sustained temporary hypoglossal nerve dysfunction postoperatively.The third patient suffered cerebral hyperperfusion with complete recovery when discharged.No neurological complications occurred in other seven patients.After follow-up of 25 months(range,11-54 months),one patient died of rectal cancer without ischaemic attack and restenosis 4 years postoperation;in one patient occurred recurrent symptomatic restenosis(90%)1 year later;all other patients remained asymptomatic and without recurrent restenosis(>50%)by follow-up carotid ultrasound or CT angiography.conclusion It seems that CEA with stent removal is a reasonable choice,by experienced hand,for symptomatic ISR with higher but acceptable complications.The indication of stent removal for asymptomatic ISR needs further observation.
