ObjectiveTo summarize our experience in treating highrisk carotid stenosis. MethodsWe retrospectively analyzed the clinical characteristics, treatment, and outcomes of 24 patients with highrisk carotid stenosis in our department from January 2001 with emphasis on the application of carotid stents and shunting tubes. ResultsAll patients were successfully treated, with 11 patients undergoing carotid angioplasty and stenting (CAS) and 13 patients receiving carotid endarterectomy (CEA) and shunting. No death, stroke, and ischemic neurological deficit occurred in 30 days postoperatively. ConclusionSelective application of CAS and shunting in CEA can effectively reduce complications and improve therapeutic effects in patients with highrisk carotid stenosis.
Objective To construct recombinant adenovirus vector co-expressing human interleukin (hIL)-10 and green fluorescent protein (GFP) for study of the expression of genes of interest in vascular smooth muscle cells （VSMCs）. Methods hIL-10 cDNA was amplified from pUCm-T/hIL-10 cDNA using polymerase chain reaction (PCR), and cloned into shuttle plasmid pShuttle-IRES-hrGFP-1. Kanamycin resistance screeninged for recombinant plasmids, which were linealized with PmeⅠand transformed into BJ5183-AD-1 containing pAdEasy-1 by electroporation after determining the insert’s sequence correct by NotⅠ and XholⅠdigestion， sequencing and basic local alignment search tool (BLAST). Prepared recombinant adenovirus plasmids were transformed into XL10-Gold cells. Amplified plasmids were transfected to AD-293 cells for packaging after being linearized with PacⅠ. PCR was used to determine target gene; The titer of the recombinant adenovirus was measured. VSMCs were transfected by recombinant adenovirus and viewed under fluorescence microscope. hIL-10 concentration in transfected VSMCs supernant was measured by enzyme linked immune sorbent assay (ELISA). Results Recombinant shuttle plasmids contained interest gene. Recombinant adenovirus had 30 kb and 3 kb fragments after digestion with PacⅠ. PCR indicated that the recombinant adenovirus contained interest gene. The titer of recombinant adenovirus was 3×10１0 efu/ml. Transfected VSMCs had GFP expression and hIL-10 concentration in supernatant was 25 ng/106 cells. Conclusion The recombinant adenovirus co-expressing hIL-10 and GFP is successfully constructed and could effectively express in VSMCs, this lays the foundation for the gene therapy of vascular intimal hyperplasia.
Objective To study the diagnostic procedures and management of aortic stent graft infection. Methods Clinical data of 4 patients with aortic stent graft infection from 1998 to 2008 were analyzed retrospectively. Results Primary disease was thoracic endovascular aortic repair in 2 cases and endovascular aneurysm repair in another 2 cases. Constitutional symptoms and abscess information on imaging studies were presented in all patients. Salmonella choleraesuis was revealed in 2 cases. Surgical debridement, drainage and systematic antimicrobial therapies were given to 2 patients. The remaining 2 patients were managed with antimicrobial therapy only. During follow-up, there was no recurrence of infection. Conclusions Infection of aortic stent graft infection is a rare but potentially devastating complication. Radiologic studies can serve as important adjuncts in the diagnosis of endovascular graft infections. Several treatment options are available, some cases may be managed with conservative treatment.
ObjectiveTo analyze the causes and preventions of stent graft induced new entry (SINE) after thoracic endovascular aortic repair (TEVAR) for Stanford type B dissection, particularly from the standpoint of biomechanical behavior of stent graft. MethodsSINE was defined as the new tear caused by the stent graft itself, excluding those arising from natural disease progression or any iatrogenic injury from the endovascular manipulation. Twentytwo patients with SINE were retrospectively collected and analyzed out of 650 cases undergoing TEVAR for type B dissection from August 2000 to June 2008 in our center. An additional case included was referred to our center in 14 months after TEVAR performed in another hospital. ResultsTotally, there were 24 SINEs found in 23 cases, including SINE at the proximal end in 15 cases, at the distal end in 7, and at both in 1, and 6 patients died. The incidence was 3.4% ( 22/650) in our hospital, and the mortality was 26.1% (6/23). All 16 proximal SINEs was located at the greater curve of the arch and caused retrograde type A dissection. All 8 distal SINEs occurred at the dissected flap, and 5 of them caused enlarging aneurysm while 3 remained stable. All 23 cases had the endograft placed across the distal aortic arch during the primary TEVAR. ConclusionsSINE is not rare following TEVAR for type B dissection, and associates with a high substantial mortality. The stress yielded by the endograft seems to play a predominant role in its occurrence. It is of significance to take the stressinduced injury into account during both design and placement of the endograft.