BACKGROUND & AIMS: An 18 month old girl with an angiographically measured ductus of 4.5 mm underwent transcatheter occlusion of the persistent arterial duct with a 17 mm Rashkind umbrella and an occluding spring coil. Severe intravascular haemolysis developed 20 hours later. Significant residual ductal leakage was noted and the residual duct measured 6 mm. Previous underestimation might have been related to ductal spasm as a catheter was placed across the duct before angiography. The haemolysis was abolished within 48 hours by a previously unreported approach of antegrade transcatheter closure of the residual duct by multiple spring coils.

背景与目标： 一名18个月大的女孩，其血管造影测量的4.5毫米导管，用17毫米的Rashkind伞和阻塞的弹簧线圈经导管闭塞了持续性动脉导管。20小时后出现严重的血管内溶血。注意到明显的残余导管泄漏，并且6毫米测量了残余导管。先前的低估可能与导管痉挛有关，因为在血管造影之前将导管穿过导管放置。通过先前未报道的通过多个弹簧线圈顺行经导管闭合残余导管的方法，在48小时内消除了溶血。

BACKGROUND & AIMS: BACKGROUND:Central retinal artery occlusion (CRAO) is a neurological and ophthalmologic emergency associated with poor visual recovery. There is a dilemma regarding the appropriate treatment, as formal guidelines are lacking. Despite being considered an ocular equivalent of cerebral infarction, the time window of intravenous (IV) thrombolysis administration for maximum efficacy and safety in CRAO remains uncertain. OBJECTIVE:To critically assess the current evidence regarding the safety and effectiveness of IV thrombolysis in the treatment of patients with CRAO. METHODS:The objective was addressed through the development of a critically appraised topic that included a clinical scenario, structured question, literature search strategy, critical appraisal, assessment of results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, and content experts in the fields of vascular neurology and ophthalmology. RESULTS:A recent patient-level meta-analysis was selected for critical appraisal. The study compared the visual recovery rates after IV thrombolysis in CRAO against the natural history of this illness and conservative therapies (ocular massage, anterior chamber paracentesis, and/or hemodilution). Time to thrombolytic therapy administration had a significant impact on visual recovery in CRAO (P<0.001). IV thrombolysis within the first 4.5 hours after symptom onset resulted in recovery of vision in 50.0% of the patients [95% confidence interval (CI), 32.4%-67.6%]. The rate of visual recovery was nearly 3 times higher than in the natural history cohort [odds ratio, 4.7 (95% CI, 2.3-9.6); P<0.001], with a 32.3% absolute risk reduction and a number needed to treat of 4.0 (95% CI, 2.6-6.6). There was no significant difference in the recovery rate after thrombolysis compared with the natural history cohort for those patients treated after 4.5 hours. No major hemorrhages occurred after alteplase administration in this meta-analysis. CONCLUSIONS:IV thrombolysis in CRAO seems to be safe and effective within the first 4.5 hours of symptom onset. A clinical decision based on this meta-analysis alone cannot be made due to several limitations. A randomized controlled clinical trial of early IV alteplase administration in CRAO is necessary to provide evidence-based therapeutic guidance.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:To describe the 15-year incidence of retinal vein occlusion (central retinal vein occlusion and branch retinal vein occlusion) and associated risk factors. METHODS:A population-based study where branch retinal vein occlusion and central retinal vein occlusion were detected at baseline (n = 4068, 1988-1990) and three 5-year follow-up examinations by grading 30 degrees color fundus photographs. RESULTS:The 15-year cumulative incidences of branch retinal vein occlusion and central retinal vein occlusion were 1.8% and 0.5%, respectively. Using a generalized estimating equation model, incident retinal vein occlusion was related to baseline age (odds ratio [OR] per 10 years, 1.70; 95% confidence interval [CI], 1.36-2.12), history of barbiturate use (OR, 5.30; 95% CI, 2.28-12.31), focal retinal arteriolar narrowing (OR, 2.45; 95% CI, 1.29-4.66), glaucoma (OR, 3.17; 95% CI, 1.50-6.69), serum ionized calcium level (OR per 0.4 mg/dL, 0.43; 95% CI, 0.23-0.79), serum phosphorus level (OR per 0.3 mg/dL, 1.15; 95% CI, 1.01-1.30), and serum creatinine level (OR for > or = 1.4 vs < 1.4 mg/dL, 1.61; 95% CI, 1.00-2.59). Migraine headache history was associated with branch retinal vein occlusion (OR, 1.99; 95% CI, 1.08-3.67). Diabetes history was associated with central retinal vein occlusion (OR, 6.35; 95% CI, 1.90-21.27). CONCLUSIONS:Incident retinal vein occlusion is not infrequent in the population, especially after age 65 years. The relationships of barbiturate use, serum creatinine level, serum ionized calcium level, and serum phosphorus level with incident retinal vein occlusion require further assessment in other large population-based studies.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To evaluate the predictive value of gestational age and maternal serum β-hCG concentration for the determination of the depth of trophoblastic invasion into the tubal wall. METHODS:This is a retrospective trial conducted on women with a diagnosis of ampullary pregnancy (71) who were submitted to salpingectomy. Serum β-hCG measurements were obtained at the initial admission of hospital. Histological investigation was performed by a single well-experienced pathologist who was blind to the clinical and laboratory characteristics of the patients. Ampullary pregnancy was classified histologically according to the depth of trophoblastic infiltration into tubal wall: trophoblast limited to the tubal mucosa (stage I), extended to muscularis layer (stage II) and complete tubal wall infiltration up to serosal layer (stage III). RESULTS:There was a significant difference in maternal serum β-hCG concentrations regarding the histological stages of trophoblastic invasion. The serum β-hCG concentrations that the best predicted for stage III trophoblastic invasion was 6,475 mIU/ml, with a sensitivity of 100 %, a specificity of 92 %. CONCLUSION:The depth of trophoblastic tissue infiltration into tubal wall is correlated with serum β-hCG levels, but not with gestational age. These findings may explain the reason for conservative management failure of EP in women with high β-hCG concentrations.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Previous studies have not distinguished patients with acute cervical internal carotid artery (ICA) occlusions from those with intracranial occlusions and often consider them together in the same cohort. OBJECTIVES:To evaluate the outcomes of patients with stroke from acute cervical ICA occlusion treated with intravenous thrombolysis or primary endovascular procedures and to identify early predictors of functional recovery among these patients. DESIGN:Retrospective study. SETTING:Academic hospital. PATIENTS:We studied patients with ischemic stroke who received intravenous thrombolysis or endovascular treatment for acute cervical ICA occlusion at St Mary's Hospital, Mayo Clinic, Rochester, Minnesota. We evaluated the associations of vascular risk factors, severity of stroke, arterial recanalization, presence of tandem occlusions, and collateral distal flow with functional recovery at 90 days after stroke. MAIN OUTCOME MEASURES:Favorable functional recovery (Modified Rankin Scale score, 0-2). RESULTS:We identified 21 patients (median age, 67 years; median National Institutes of Health Stroke Scale score at presentation, 13), of whom 13 patients received intravenous thrombolysis and 8 patients underwent primary endovascular treatment. Three patients who received intravenous thrombolysis underwent rescue endovascular treatment. Favorable functional recovery (Modified Rankin Scale score, 0-2) was observed in 7 patients who received intravenous thrombolysis and in 1 patient who underwent primary endovascular treatment. Good collateral distal flow and intracranial tandem occlusions were observed in 6 patients and 12 patients, respectively. Good collateral distal flow, observed more frequently in cigarette smokers, was associated with favorable functional recovery (odds ratio, 20; 95% CI, 2-242; P = .02). CONCLUSIONS:Intravenous thrombolysis should be administered as first-line treatment in patients with early acute cervical ICA occlusion. Treatment benefits are accentuated in patients with better collateral circulation.

背景与目标：

BACKGROUND & AIMS: PURPOSE:To analyze the repeatability of thickness measurements of the central macula, ganglion cell-inner plexiform layer (GC-IPL), and retinal nerve fiber layer (RNFL) using spectral-domain optical coherence tomography (SD-OCT) before and after treatment of macular edema in branch retinal vein occlusion (BRVO). METHODS:We analyzed patients with BRVO who visited our retinal clinic. The repeatability of the thickness measurements were compared using the intraclass correlation coefficient (ICC) and coefficient of variation (COV) of affected versus normal fellow eyes. RESULTS:The average thicknesses of the central macula, RNFL, and GC-IPL were 371.28 μm, 105.60 μm, and 61.88 μm, respectively, in affected eyes with macular edema before treatment, and the ICCs were 0.978, 0.919, and 0.705, respectively. The average thicknesses were 244.98 μm, 96.70 μm, and 82.70 μm, respectively, in affected eyes without macular edema after treatment, and the ICCs were 0.999, 0.975, and 0.928, respectively. After resolution of macular edema, the average thickness of the GC-IPL increased, whereas that of the central macula and RNFL significantly decreased (P < 0.05); all of the ICCs increased compared to pretreatment values. In normal fellow eyes, the average thicknesses were 250.98 μm, 93.50 μm, and 83.84 μm, respectively, and the ICCs were 0.996, 0.995, and 0.994, respectively. CONCLUSIONS:After treatment of macular edema, the repeatability and thickness of the GC-IPL increased, along with reduction in the central macular thickness. This resulted from auto-segmentation errors following macular contour changes and unstable gazes of the patients due to decreased visual acuities in BRVO with macular edema.

背景与目标：

BACKGROUND & AIMS: :End-expiratory occlusion test (EEOT) has been proposed as a preload responsiveness test that overcomes several limitations of pulse pressure (PPV) and stroke volume (SVV) variations. We compared the ability of EEOT versus SVV and PPV to predict fluid responsiveness during the increase of the vasomotor tone in a rabbit model of hemorrhage. Ten rabbits were anesthetized, paralyzed, and mechanically ventilated during basal load (BL), after progressive blood withdrawal (BW), and after volume replacement. Other two sets of data were obtained during vasomotor increase by phenylephrine (PHE) infusion in BL and BW. We estimated the change of stroke volume (∆SVEEOT) and aortic flow (∆AoFEEOT) during the EEOT. PPV and SVV were obtained by the variation of beat-to-beat PP and SV, respectively. Baseline PPV, SVV, ∆SVEEOT, and ∆AoFEEOT increased significantly after BW, with a decrease of aortic flow (P < 0.05). PHE induced a significant decrease of PPV and SVV, but without affecting ∆SVEEOT, and ∆AoFEEOT. We conclude that ∆SV and ∆AoF during EEOT kept the ability to predict fluid responsiveness during PHE infusion in a rabbit hemorrhage model. This result may suggest the advantage of EEOT with respect to SVV and PPV in predicting fluid responsiveness during vasomotor tone increase.

背景与目标： : 呼气末阻塞测试 (EEOT) 已被提议作为一种预载响应性测试，克服了脉压 (PPV) 和中风量 (SVV) 变化的几个限制。我们比较了EEOT与SVV和PPV在兔出血模型中血管舒缩张力增加期间预测液体反应性的能力。在基础负荷 (BL)，进行性抽血 (BW) 和容量置换后，将十只兔子麻醉，瘫痪和机械通气。在BL和BW中输注去氧肾上腺素 (PHE) 增加血管舒缩期间获得了其他两组数据。我们估计了EEOT期间中风量 (∆ sveeot) 和主动脉血流 (∆ aofeeot) 的变化。PPV和SVV分别通过节拍PP和SV的变化获得。基线PPV、SVV、 ∆ sveeot和 ∆ aofeeot在BW后显著增加，主动脉血流减少 (p  <  0.05)。PHE引起PPV和SVV的显着降低，但不影响 ∆ sveeot和 ∆ aofeeot。我们得出的结论是，EEOT期间的 ∆ sv和 ∆ aof在兔出血模型中保持了预测PHE输注期间液体反应性的能力。该结果可能表明EEOT相对于SVV和PPV在预测血管舒缩张力增加期间的液体反应性方面具有优势。

BACKGROUND & AIMS: OBJECTIVE:The aim of this study is to present our initial experience with the use of the retrograde popliteal artery access in patients with chronic total occlusions of superficial femoral artery (SFA). METHOD:From July 2012 to May 2014, a total of 28 patients (20 men, mean age 61.2 ± 11.5 years) with total occlusion of the SFA and good distal runoff were treated with percutaneous atherectomy, balloon angioplasty, and stenting (mean length 165.3 ± 57.5 mm, range 72-336 mm). All patients had severe claudication or critical limb ischemia, and most of the lesions were TransAtlantic Inter-Society Consensus classification type D (n = 21). RESULTS:Technical success was achieved in all cases. In majority (26, 92.8%) of the patients, endoluminal recanalization was possible from the popliteal access; SFA recanalization in the other 2 cases was obtained through the subintimal space. During a mean follow-up of 12.9 ± 2.5 months, claudication, severity, rest pain, and toe ulcers improved significantly. Ankle-brachial index changed from 0.54 ± 0.11 to 0.91 ± 0.2 at 1 year after intervention ( P < .001), and patency rates at 1, 6, and 12 months after interventions were 100%, 92.8%, and 85.7%, respectively. One pseudoaneurysm and 1 arteriovenous fistula were found in the popliteal region on duplex examinations. There were 2 in-stent restenosis and 3 occlusions during the 12-month follow-up. These occlusions were treated with reendovascular procedures. Our secondary patency rate was 96.4%. No stent fracture was observed. CONCLUSION:The retrograde popliteal artery approach under duplex guidance can be considered as safe, efficient, and the primary SFA recanalization strategy in carefully selected patients, with competitive immediate and mid-term results.

背景与目标：

BACKGROUND & AIMS: :Mycotic aneurysms (MA) are an uncommon complication of infectious endocarditis. Septic emboli are thought to be the precipitating event in their development, but the evidence for this is sparse. We present three cases in which septic embolic occlusion preceded MA development at the occlusion site, suggesting that documented angiographic emboli in patients with infectious endocarditis and bacteremia constitute a risk factor for MA formation. Two adult patients with a history of intravenous drug use and one child with congenital heart disease are described. They were all diagnosed with infectious endocarditis and developed neurological symptoms during their hospital course. Initial catheter-based cerebral angiograms demonstrated vascular occlusions, which were followed by the development of MA at the same sites within 1 month. Septic emboli, documented on cerebral angiogram, in patients with infectious endocarditis may precede the appearance of MA. Patients with angiographic occlusions in the setting of endocarditis warrant close follow-up.

背景与目标： : 霉菌性动脉瘤 (MA) 是感染性心内膜炎的罕见并发症。化脓性栓子被认为是其发展中的诱因，但证据很少。我们介绍了3例脓毒症栓塞闭塞先于MA在闭塞部位发展的病例，这表明感染性心内膜炎和菌血症患者的血管造影栓塞是MA形成的危险因素。描述了两名有静脉吸毒史的成年患者和一名患有先天性心脏病的儿童。他们都被诊断出患有感染性心内膜炎，并在住院期间出现神经系统症状。最初的基于导管的脑血管造影显示血管闭塞，随后在1个月内在相同部位发生MA。感染性心内膜炎患者在脑血管造影上记录的败血性栓子可能先于MA出现。心内膜炎背景下血管造影闭塞的患者需要密切随访。

BACKGROUND & AIMS: BACKGROUND:We examined guidewire and microcatheter utilization during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). METHODS:We examined device utilization in 2,968 CTO PCIs performed in 2,936 patients at 19 US and two international center between January 2016 and January 2019. RESULTS:The median number of antegrade guidewires used per case declined (5 in 2016 vs 3 in 2019) and was higher in higher complexity lesions (2 in J-CTO 0 vs. 8 in J-CTO 4 or 5 score). In antegrade-only procedures, the most frequently used guidewires were the Pilot 200 (Abbott Vascular, 37%), Fielder XT (Asahi Intecc, 25%) and Gaia third (Asahi Intecc, 18%), while the most commonly used microcatheters were the Turnpike Spiral (Vascular Solutions, 18%) and Turnpike (Vascular Solutions, 16%). Compared with 2012-2015, during 2016-2019 use of novel equipment such as the Gaia guidewires and the Turnpike microcatheters led to decreased use of Confianza Pro 12 (Asahi Intecc) wire and Corsair (Asahi Intecc) family of microcatheters. In retrograde cases, the guidewires most commonly used were the Sion (44%), Pilot 200 (27%) and Fielder FC (26%), while the Corsair/Corsair Pro, Turnpike LP (Vascular Solutions) and Caravel (Asahi Intecc) were the most frequently used microcatheters for collateral crossing (29%, 26% and 22%, respectively). CONCLUSIONS:The most commonly used guidewires during CTO PCI are polymer-jacketed guidewires and the most commonly used microcatheters are torquable microcatheters.

背景与目标：

BACKGROUND & AIMS: :Fifteen patients with laparoscopically diagnosed tubal pregnancy and constant or rising plasma beta-hCG levels were treated with prostaglandin F2 alpha and prostaglandin E2. Prostaglandin F2 alpha (5 mgms diluted in 10 cc of isotonic sodium solution) was injected transabdominally with a 22 gauge spinal needle during laparoscopy into the Fallopian tube. Prostaglandin E2 (500 micrograms ms) was given intramuscularly during three consecutive postoperative days. The treatment was defined as successful if plasma beta-hCG levels declined below the lower limit of detection and no further intervention other than prostaglandin application was required. The treatment was successful in eight patients. Six patients underwent laparotomy and salpingotomy because of rising beta-hCG levels. None of the treated patients displayed any adverse reactions following prostaglandin F2 alpha application. One patient underwent explorative laparotomy during the second postoperative day because of lower abdominal pain. During operation, no pathological change could be found. This patient was excluded from the study. In the group treated successfully (n = 8) seven out of eight patients had beta-hCG levels below 2500 mlU/ml preoperatively. In the unsuccessfully treated group (n = 6), four out of six patients had beta-hCG levels above 2500 mlU/ml preoperatively. Mean duration of beta-hCG decline to 10 percent of the maximum preoperative value was 15.8 +/- 8.64 days (mean +/- S.D.). Postoperatively, hysterosalpingography was performed in six out of eight successfully treated patients after three menstrual cycles (one patient had an intrauterine pregnancy, one patient refused written consent). The Fallopian tubes were patent bilaterally in all six patients.

背景与目标： : 用前列腺素f2α 和前列腺素e2治疗15例经腹腔镜诊断为输卵管妊娠且血浆 β-hCG水平持续或升高的患者。在腹腔镜检查期间，将前列腺素f2α (在10 cc的等渗钠溶液中稀释的5 mgms) 用22号脊柱针经腹注射到输卵管中。在术后连续三天肌肉注射前列腺素E2 (500微克ms)。如果血浆 β-hCG水平下降到检测下限以下，并且除前列腺素应用外不需要进一步干预，则治疗被定义为成功。八名患者的治疗成功。由于 β-hCG水平升高，六名患者接受了剖腹手术和输卵管切开术。在应用前列腺素f2α 后，治疗的患者均未显示任何不良反应。由于腹痛较低，一名患者在术后第二天接受了探索性剖腹手术。术中未见病理改变。该患者被排除在研究之外。在成功治疗的组中 (n = 8)，八名患者中有七名术前 β-hCG水平低于2500 mlU/ml。在未成功治疗组 (n = 6) 中，六名患者中有四名术前 β-hCG水平高于2500 mlU/ml。Β-hCG下降至最大术前值10% 的平均持续时间为15.8 +/- 8.64天 (平均值 +/-s.d.)。术后，在三个月经周期后，八名成功治疗的患者中有六名进行了子宫输卵管造影 (一名患者宫内妊娠，一名患者拒绝书面同意)。所有六名患者的输卵管均双侧未闭。

BACKGROUND & AIMS: OBJECTIVE:To determine the impact of oil-based versus water-based contrast on pregnancy and live birth rates ≤5 years after hysterosalpingography (HSG) in infertile women. DESIGN:A 5-year follow-up study of a multicenter randomized trial. SETTING:Hospitals. PATIENT(S):Infertile women with an ovulatory cycle, 18-39 years of age, and having a low risk of tubal pathology. INTERVENTION(S):Use of oil-based versus water-based contrast during HSG. MAIN OUTCOME MEASURE(S):Ongoing pregnancy, live births, time to ongoing pregnancy, second ongoing pregnancy. RESULT(S):A total of 1,119 women were randomly assigned to HSG with oil-based contrast (n = 557) or water-based contrast (n = 562). After 5 years, 444 of 555 women in the oil group (80.0%) and 419 of 559 women in the water group (75.0%) had an ongoing pregnancy (relative risk [RR] 1.07; 95% confidence interval [CI] 1.00-1.14), and 415 of 555 women in the oil group (74.8%) and 376 of 559 women in the water group (67.3%) had live births (RR 1.11; 95% CI 1.03-1.20). In the oil group, 228 pregnancies (41.1%) were conceived naturally versus 194 (34.7%) pregnancies in the water group (RR 1.18; 95% CI 1.02-1.38). The time to ongoing pregnancy was significantly shorter in the oil group versus the water group (10.0 vs. 13.7 months; hazard ratio, 1.25; 95% CI 1.09-1.43). No difference was found in the occurrence of a second ongoing pregnancy. CONCLUSION(S):During a 5-year time frame, ongoing pregnancy and live birth rates are higher after tubal flushing with oil-based contrast during HSG compared with water-based contrast. More pregnancies are naturally conceived and time to ongoing pregnancy is shorter after HSG with oil-based contrast. CLINICAL TRIAL REGISTRATION NUMBER:Netherlands Trial Register (NTR) 3270 and NTR6577(www.trialregister.nl).

背景与目标：

BACKGROUND & AIMS: :Traditional evaluation of cardiac function is too often limited by reliance on measurements with complex interdependence between cardiac properties and loading factors. Analysis by ventricular pressure-volume (P-V), -area (P-A), or -dimension (P-D) relations during inferior vena caval (IVC) occlusion independently quantifies ventricular properties and loading conditions, providing detailed information about cardiovascular dynamics. However, there has been no appropriate size of balloon catheter that can effectively occlude IVC of pediatric patients, hindering the application of P-V (P-A, or P-D) analysis to children with heart disease despite its potential benefit. To address this problem, we have developed a new balloon catheter for IVC occlusion in children. The catheter effectively occluded IVC in 92 pediatric patients with varying forms of heart disease who underwent cardiac catheterization, yielding end-systolic pressure-area relations. Thus a newly developed balloon catheter would contribute to establishing more accurate and detailed cardiovascular assessments in children with heart disease. Cathet Cardiovasc Intervent 2001;53:392-396.

背景与目标： : 传统的心脏功能评估常常受到依赖于心脏特性和负荷因素之间复杂相互依赖的测量的限制。通过下腔静脉 (IVC) 闭塞期间的心室压力-容量 (p-v)，-面积 (p-a) 或-尺寸 (p-d) 关系分析独立地量化了心室特性和负荷状况，提供了有关心血管动力学的详细信息。然而，没有合适尺寸的球囊导管可以有效地阻塞儿科患者的IVC，尽管它具有潜在的益处，但阻碍了对心脏病儿童进行p-v (p-a或p-d) 分析的应用。为了解决这个问题，我们开发了一种用于儿童IVC闭塞的新型球囊导管。在接受心脏导管插入术的92例患有不同形式心脏病的小儿患者中，该导管有效地阻塞了IVC，从而产生了收缩末期压力-面积关系。因此，新开发的球囊导管将有助于在心脏病儿童中建立更准确，更详细的心血管评估。导管心血管介入2001;53:392-396。

BACKGROUND & AIMS: :Intravitreal bevacizumab has been adopted as a well-established treatment modality for the treatment of macular edema associated with branch retinal vein occlusion. It is considered a safe and efficacious option for improving visual acuity. We present an interesting case of unilateral superotemporal branch retinal vein occlusion in a 55-year-old man who received two doses of intravitreal bevacizumab one month apart. Laboratory tests including complete hypercoagulability and thrombotic work-up were completed but the patient successively developed branch retinal artery occlusion. We reviewed cases in literature and combined possible etiologies. We report a previously unpublished case of retinal artery occlusion following the use of intravitreal bevacizumab. Several studies have shown evidence of systemic thromboembolic events after the use of intravenous and systemic bevacizumab; however, to the best of our knowledge, no case has been reported of retinal artery occlusion immediately after administration of intravitreal bevacizumab.

背景与目标： : 玻璃体内贝伐单抗已被用作治疗与视网膜分支静脉阻塞相关的黄斑水肿的公认治疗方式。它被认为是提高视力的安全有效的选择。我们介绍了一名55岁男子的单侧超颞支视网膜静脉阻塞的有趣病例，该男子相隔一个月接受了两剂玻璃体内贝伐单抗。完成了包括完全高凝状态和血栓形成检查在内的实验室检查，但患者相继出现视网膜分支动脉阻塞。我们回顾了文献中的病例，并结合了可能的病因。我们报告了使用玻璃体内贝伐单抗后先前未发表的视网膜动脉阻塞病例。几项研究表明，静脉和全身使用贝伐单抗后发生全身血栓栓塞事件的证据; 然而，据我们所知，尚未报道玻璃体腔注射贝伐单抗后立即发生视网膜动脉阻塞的病例。

BACKGROUND & AIMS: :Collaterals to occluded coronary arteries have been observed early after the onset of acute myocardial infarction (AMI). The pressure distal to the occluded segment of the culprit coronary artery (P(d)) is generated by collateral flow from the feeding coronary artery supplied by the systemic circulation. The aim of the study was to assess the relation between systemic blood pressure (BP) and P(d). Systemic BP and P(d) were measured simultaneously during intervention of totally occluded coronary arteries in 152 patients admitted for AMI. Patients were divided into groups by time from symptom onset to P(d) measurement. There was a significant positive correlation between P(d) and the systolic, diastolic, and mean BPs measured during the first 3 hours from symptom onset (n = 60; p <0.05, p <0.006, and p <0.005, respectively), from 3 to 12 hours (n = 56; p <0.02 for all), and >12 hours after symptom onset (n = 36; p <0.003 for all). The collateral flow, represented by calculated collateral flow index (mean 0.37 ± 0.14, median 0.36), was correlated with mean BP (p = 0.05) but not with diastolic or systolic BP (p = NS) in the overall study population. A direct relation was established during AMI between systemic BP and P(d) at all time intervals from symptom onset. Collateral flow index correlated with mean BP and was strongly associated with P(d) at all time intervals. In conclusion, the relation between P(d) and systemic BP suggests caution when administering therapy that may lower systemic BP during AMI before restoring flow in the occluded culprit artery, as it may compromise collateral pressure and exacerbate myocardial ischemia.

背景与目标： : 急性心肌梗死 (AMI) 发作后早期观察到闭塞的冠状动脉侧支。罪犯冠状动脉闭塞段远端的压力 (P(d)) 是由体循环提供的供血冠状动脉的侧支流动产生的。该研究的目的是评估全身血压 (BP) 与P(d) 之间的关系。在152例因AMI入院的患者中，在完全闭塞的冠状动脉介入期间同时测量了全身BP和P(d)。从症状发作到P(d) 测量，按时间将患者分为两组。P(d) 与症状发作后3小时 (n = 60; 分别为p <0.05，p <0.006和p <0.005)，3至12小时 (n = 56) 的收缩压，舒张压和平均BPs之间存在显着正相关; p <0.02) 和症状发作后> 12小时 (n = 36; p <0.003)。在整个研究人群中，以计算出的侧枝血流指数 (平均0.37 ± 0.14，中位数0.36) 表示的侧枝血流与平均BP (p = 0.05) 相关，但与舒张期或收缩期BP (p = NS) 无关。在AMI期间，从症状发作开始的所有时间间隔，系统性BP和P(d) 之间都建立了直接关系。在所有时间间隔内，侧支流动指数与平均BP相关，并且与P(d) 密切相关。总之，P(d) 与全身性血压之间的关系提示，在恢复闭塞的罪魁祸首动脉的血流之前，在AMI期间可能降低全身性血压的治疗时要谨慎，因为这可能会损害侧支压力并加剧心肌缺血。