Not long after Director Li Lishan hung up the phone, he pushed the patient to the obstetrics building.

"The patient, 77 years old, had sudden loss of movement of the right limb with slurred speech for 2 hours, and had a history of hypertension and atrial fibrillation. Treatment is not standardized. Denial of trauma and family history of cerebrovascular disease, no obvious abnormalities on CT, cerebral ischemia was ruled out, NIHSS score was 19, and anterior circulation infarction. TOAST classification, cardiac cerebral embolism. Cardiac emboli intravenous thrombolysis may not be very effective, so it will be sent to you directly. As soon as Director Li Lishan saw Yuntian, he didn't care about the surprise of his family, and reported the patient's situation to Yuntian one by one.

"Heart embolism!" Yun Tian frowned.

NIHSS refers to a stroke rating scale developed by the National Institutes of Health in the United States, which evaluates the patient's condition through the patient's clinical performance, and the higher the score, the more severe the patient's stroke.

The patient's score of 19 points is already a very obvious and serious score value.

TOAST typing, on the other hand, is a method to determine the source of emboli based on the results of the examination.

"Doctor, can I have surgery? Can I still have surgery in my father's condition?" Although the patient's family did not trust the too handsome and young Yuntian at first.

However, Director Li Lishan's attitude has been very clear, at this time, the patient's condition is critical, and the family can no longer care about doubting Yuntian.

Instead, he asked anxiously.

"For anterior circulation infarction of about two hours, thrombectomy can be done. But let's look at the imaging situation first. Yun Tian explained with a frown.

Yuntian had a feeling that the treatment of this patient would not go too smoothly.

But it can't grasp the crux of the problem.

Judging from the patient's condition, it must be a very ordinary anterior circulation infarction.

He also inquired in detail about the patient's various conditions, and carefully ruled out the possible contraindications of arterial thrombectomy.

before the surgery is ready to begin.

"You go get busy, according to the convention, the preoperative consent form is mine. Director Li Lishan patted Yuntian on the shoulder and prepared to start the surgical process.

The operation began to enter the preparation process, and Leng Chengye also rushed over.

Yesterday I had one less operation and three more hours of rest, and Leng Chengye's condition today is obviously much better.

"You go brush your hands, and I'll do the preoperative preparations. Finally relieved. Leng Chengye began to clean up the things in the operating room, and said to Yuntian with emotion.

Yun Tian stared at the patient's CT film and remained silent.

"What's wrong? CT can still see that the flower is coming?Is there a flower like tears?" Leng Chengye laughed.

"No, let's do an imaging first!" Yun Tian finally put down the patient's film in his hand and began to brush his hands in the locker room.

Yun Tian came out after brushing his hands, and just saw Director Li Lishan rushing to the consent form for the operation in his hand after raising sheep.

"Liu Qingya's family has signed and can be operated on. Although Director Li raised the surgical consent form in his hand, he still pressed the walkie-talkie outside the disposal room in accordance with the procedure.

Said solemnly to Yuntian

Road.

Both the disposal room and the cāo) workshop are fully equipped with surveillance and video equipment.

Director Li's words and actions will be recorded.

It is also a kind of protection for the surgeon.

Yun Tian nodded and began to perform femoral artery puncture.

When the aorta is about to be reached, Yuntian performs an aortogram.

As the contrast agent enters, the aortic arch becomes apparent.

"This, this, how can this be?" Leng Chengye was dumbfounded, looking at the image on the screen, and stammered speechless.

On the screen, the aorta twists and turns, almost forming a piece.

This is typically a tortuosity of the aorta for the type three arch W

Visually, it is not possible to pass through the stenosis segment of the aorta with microwires and microcatheters.

"What should I do, do you want to quit?" had never encountered such a situation, and Leng Chengye was completely dumbfounded.

Judging from the degree of roundabout rotation of the aorta at this time, even if Yun Tian has super high skills to pass through. It is also uncertain that the surgery will be completed.

After all, there is a high probability that the patient has an embolism in the middle cerebral artery above the m section.

The distal end requires an extremely delicate maneuver to release the stent and drag the thrombus.

After opening, it is absolutely impossible for the stent to pass through such a tortuous and narrow blood vessel!

That's why Leng Chengye proposed to withdraw.

In such a situation, it is impossible to complete the operation.

"Exit first. Yun Tian nodded, and the poetic cold Chengye walked first, and the micro guidewire that was halfway through withdrew.

Either circumferential or femoral artery access must pass through the aortic segment.

This is the only way to go through interventional surgery for cerebrovascular embolization.

Now this passage of life is blocked.

There is no possibility of interventional surgery.

Plus the patient is a cardiac emboli.

The effect of intravenous thrombolysis is very poor, and what awaits the patient is either a serious infarction or even life-threatening.

So Leng Chengye's face was a little ugly, this was the first time Leng Chengye and Yuntian had encountered a helpless patient since they had interventional surgery!

has been with Yuntian for almost 4 months, and Leng Chengye has not experienced this feeling of weakness for a long time!

At this time, I felt it again, and I felt a little unacceptable!

"Boss, is there no other way? You can think of a way!" Leng Chengye completely forgot that he was once a Massachusetts Neurology Star.

When encountering difficulties, the previous decisions seemed to have disappeared, but it was the first time to beg Yuntian to find a way.

Yuntian was silent and did not answer.

Leng Chengye could only start withdrawing the microwires by appointment.

"I'm going to talk to the patient's family. Yuntian motioned Leng Chengye to continue the work at hand, and he stepped down, took off his surgical gown and lead suit, opened the door of the disposal room directly, and walked out.

"The aorta looks like this, it doesn't seem to be possible. You pick a few pictures that are clearer, and I'll go with you and explain them to the patient. Director Li Lishan patted Yuntian on the shoulder to show comfort.

and said that he was willing to communicate with Yuntian to the patient.

reach

Director Shao Li Lishan believes that he has decades of experience in the emergency department, and he still has some experience in handling the doctor-patient relationship.

Seeing the young and handsome surgeon walking out so quickly, a trace of worry flashed on the faces of the patient's family, and then a wry smile flashed on their faces, and they walked over to Yuntian and Li Lishan.

"Dr. Yun, is the operation done so quickly? I thought it would take at least two or three hours!" said the patient's family with a pretended relaxation.

"No, there is no way to complete the operation! Your father's aortic arch is severely stenotic and circuitous, and the microguidewire cannot pass through at all. Yun Tian shook his head, directly breaking the patient's self-deception.

"This, that," the patient's family member was speechless.