RESUMEN
Objective:To compare the effects of intensive and standard blood pressure control on the outcomes of patients with acute ischemic stroke in the anterior circulation who have successfully recanalized after endovascular therapy (EVT).Methods:A multicenter, open-label, blinded-endpoint, randomized controlled design was used. Patients with anterior circulation stroke received EVT and successfully recanalized in Nanjing First Hospital, Nanjing Medical University and several branch hospitals from July 2020 to October 2022 were prospectively included. They were randomly divided into the intensive blood pressure control group (target systolic blood pressure [SBP] 100-120 mmHg) or the standard blood pressure control group (target SBP 121-140 mmHg). The blood pressure of both groups needs to achieve the target within 1 h and maintain for 72 h. The primary outcome endpoint was outcome at 90 d, and the good outcome was defined as a score of 0-2 on the modified Rankin Scale. Secondary outcome endpoints included early neurological improvement, symptomatic intracranial hemorrhage (sICH) within 24 h, and death and serious adverse events within 90 d.Results:A total of 120 patients were included, including 63 in the intensive blood pressure control group and 57 in the standard blood pressure control group. There was no statistically significant difference in baseline characteristics between the two groups. The SBP at 72 h after procedure was 122.7±8.1 mmHg in the intensive blood pressure control group and 130.2±7.4 mmHg in the standard blood pressure control group, respectively. There were no significantly differences in the good outcome rate (54.0% vs. 54.4%; χ2=0.002, P=0.963), the early neurological improvement rate (45.2% vs. 34.5%; χ2=1.367, P=0.242), the incidence of sICH (6.3% vs. 3.5%; P=0.682), mortality (7.9% vs. 14.0%; χ2=1.152, P=0.283) and the incidence of serious adverse events (12.7% vs. 15.8%; χ2=0.235, P=0.628) at 90 d between the intensive blood pressure control group and the standard blood pressure control group. Conclusion:In patients with anterior circulation stroke and successful revascularization of EVT, early intensive blood pressure control don’t improve clinical outcomes and reduce the incidence of sICH.
RESUMEN
Objective:To analyze the clinical characteristics of acute ischemic stroke (AIS) patients with negative cerebral CT perfusion (CTP) and influencing factors for their prognoses.Methods:A retrospective analysis was performed; 448 patients with AIS admitted to Department of Neurology, Sixth Affiliated Hospital of Nantong University from January 2020 to June 2021 were enrolled. CTP images of these patients were processed by RAPID software, and they were divided into CTP-negative group and CTP-positive group according to cerebral infarction core and ischemic penumbra volumes. The clinical data were compared between patients from CTP-negative group and CTP-positive group and between patients from CTP-negative and CTP-positive subgroups accepted thrombolytic therapy. According to the prognoses 3 months after discharge, CTP negative patients were divided into poor prognosis group and good prognosis group. Independent influencing factors for poor prognosis in negative CTP patients were analyzed by univariate and multivariate Logistic regressions.Results:(1) In these 448 patients, 154 (34.4%) were with negative CTP and 294 (65.6%) were with positive CTP; compared with the CTP-positive group, the CTP-negative group had significantly younger age, significantly higher percentage of patients with diabetes, significantly lower percentage of patients with atrial fibrillation, statistically higher baseline systolic blood pressure, and significantly lower baseline National Institutes of Health Stroke Scale (NIHSS) scores, early neurological deterioration (END) incidence, modified Rankin scale (mRS) scores 3 months after discharge, and proportion of patients with poor prognosis ( P<0.05); significant differences in distributions of responsible circulations for the lesions and etiological classification (TOAST) were noted between the 2 groups ( P<0.05). Of the 448 patients, 270 received thrombolytic therapy, including 101 CTP-negative patients and 169 CTP-positive patients; compared with the CTP-positive subgroup, the CTP-negative subgroup had significantly younger age, significantly lower percentage of patients with atrial fibrillation, statistically higher baseline systolic blood pressure, and significantly lower baseline NIHSS scores, END incidence, mRS scores 3 months after discharge, and proportion of patients with poor prognosis ( P<0.05). (2) Of the 154 CTP negative patients, 31 had poor prognosis and 123 had good prognosis. Univariate Logistic regression analysis showed that baseline blood glucose, fasting blood glucose, glycosylated hemoglobin (HbA1C), baseline NIHSS scores and fibrinogen were the influencing factors for prognoses of CTP negative patients, with significant differences ( P<0.05). Multivariate Logistic regression analysis found that NIHSS ( OR=0.827, 95% CI: 0.743-0.920, P<0.001) and HbA1 C ( OR=0.763, 95% CI: 0.609-0.956, P=0.019) were independent influencing factors for poor prognosis of CTP-negative patients. Conclusion:AIS patients with negative CTP have milder neurological impairment, better prognosis, and higher safety of receiving intravenous thrombolysis than those with positive CTP; AIS patients with negative CTP enjoying high baseline NIHSS scores and HBA1c have poor prognosis.
RESUMEN
Objective:To evaluate the efficacy and safety of reperfusion therapy in patients with wake-up stroke (WUS) under the guidance of "tissue-window" by comparing with patients with non-WUS who received reperfusion therapy within "time-window".Methods:Two hundred and thirty-five acute ischemic stroke patients admitted to our hospital from January 2018 to December 2019 were enrolled in our study. Patients with non-WUS received reperfusion therapy within "time-window"; patients with WUS accepted multimodal CT examination at Emergency right after admission, Mistar software was used to reconstruct CT perfusion imaging (CTP) images, and reperfusion therapy was given to these patients after the judgement of "tissue-window". The differences of clinical data, prognoses, and safety indexes were compared between patients with WUS and non-WUS.Results:In these 235 patients, 45 patients were with WUS and 190 were with non-WUS. As compared with patients with non-WUS, those with WUS had significantly lower percentages of patients with hypertension history and patients accepted intravenous thrombolysis ( P<0.05). In 153 patients accepted intravenous thrombolysis, 23 patients were with WUS and 130 were with non-WUS; the time from admission to intravenous thrombolysis in WUS patients was significantly longer than that in non-WUS patients ( P<0.05); the clinical data, prognoses, and safety indexes showed no significant differences between these patients with WUS and non-WUS ( P>0.05). In 82 patients accepted bridging thrombectomy and direct thrombectomy, 22 patients were with WUS and 60 were with non-WUS; the clinical data, prognoses, and safety indexes showed no significant differences between these patients with WUS and non-WUS ( P>0.05). Conclusion:By comparing with patients with non-WUS who received reperfusion therapy within "time-window", reperfusion therapy is effective and safe for WUS patients under the guidance of multimodal CT "tissue-window".
RESUMEN
Objective To compare the rate of intraplaque hemorrhage between symptomatic and asymptom-atic vertebral artery stenosis groups using high-resolution magnetic resonance imaging(HR-MRI).Methods The patients diagnosed with PCI and with vertebral artery stenosis using HR-MRI were enrolled retrospectively. They were divided into symptomatic and asymptomatic groups according to whether they were detected with PCI by the re-sponsible vertebral artery stenosis before examination. All patients underwent 3D time of flight magnetic resonance angiography(3D TOF MRA)to detect the stenosis location of vertebral artery and the stenosis rate at the narrow-est. T1-weighted fat-suppressed images were positioned on the atherosclerotic plaque that the signal 150% higher than the surrounding muscle was confirmed to be intraplaque hemorrhage. Statistical significance was assessed by chi-square test or Student′s unpaired t test.Results A total of 60 patients were included in this study,28 patients in the symptomatic group and 32 patients in the asymptomatic group.The rate of vertebral artery stenosis in asymp-tomatic group was higher than symptomatic group,but there was no statistical significance[(72 ± 33)% vs.(65 ± 28)%,P=0.383];the number of intraplaque hemorrhage in symptomatic group was significantly higher than that in the asymptomatic group(9 vs.2,P=0.024).Conclusions There is a higher rate of intraplaque hemorrhage in symptomatic vertebral artery stenosis group than asymptomatic group.Intraplaque Hemorrhage could be one of risk factor of acute ischemic cerebral disease.
RESUMEN
Objective To determine the association between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) and early neurological deterioration (END) in patients with acute ischemic stroke (AIS).Methods Two hundred and fifty-five AIS patients diagnosed by MR imaging were recruited between January 2011 and July 2015.The levels of serum Lp-PLA2 and high-sensitivity C-reactive protein (hs-CRP) were assessed right after hospitalization.END was defined as any increase in National Institutes of Health Stroke Scale (NIHSS) scores ≥ 2 in the first 72 h after stroke onset,and the patients were accordingly divided into END group and non-END group.Risk factors associated with END and their clinical data were analyzed by Logistic regression analysis.Results END was observed in 72 of the 255 patients (28.23％).The percentage of female (58.3％ vs.31.3％),smoking ratio (58.3％ vs.31.3％),diabetes mellitus ratio (73.6％ vs.16.9％),prior stroke ratio (44.4％ vs.25.1％),NHISS scores (8 [3] vs.3 [2]),serum Lp-PLA2 level (230.31 ±75.57 μg/L vs.87.60±28.45 μg/L) and hs-CRP level (20.08±8.05 mg/L vs.6.73±3.48 mg/L) in the END group were significantly higher than those in the non-END group (P＜0.05).Multiple Logistic regression analyses indicated that END was positively associated with diabetes mellitus (OR=4.903,95％CI:1.363-17.695,P=0.015),Lp-PLA2 level (OR=1.032,95％CI:1.013-1.043,P=0.000) and hs-CRP level (OR=1.229,95％CI:1.087-1.391,P=0.001) in patients with acute ischemic stroke.Conclusion Serum Lp-PLA2 may predict END in Chinese patients with acute ischemic stroke.
RESUMEN
Objective To evaluate the safety and effect of the use of micro coils in endovascular embolization of anterior communicating artery aneurysms. Methods The clinical data of 27 consecutive patients with anterior communicating artery aneurysm, who were admitted to Yancheng Municipal Third People’s Hospital to receive endovascular embolization treatment with micro coils, were retrospectively analyzed. One patient had multiple anterior communicating artery aneurysms. The efficacy and safety of endovascular micro-coil embolization of anterior communicating artery aneurysm were evaluated by the occlusion rate of aneurysm, the prognosis of the patients, the complications, the neurological function, etc. Results Successful embolization treatment of anterior communicating artery aneurysm was achieved in all 27 patients. Dual catheter technique was employed in 3 patients, stent-assisted technique was used in 3 patients, and the technical success rate was 100%. Dense embolization was obtained in 21 patients, and residual aneurysm neck was observed in 6 patients. The unobstructed parent artery was reserved in all patients, no hemorrhage due to ruptured aneurysm or dropping of steel coil was found. One patient developed recurrent hemorrhage and died two days later. Mild recurrence was seen in one patient six months after the treatment. The modified Rankin scal (mRS) score showed that 0-1 point was seen in 24 patients, 2 points in one patient, and 4 point in one patient. Conclusion The anterior communicating artery aneurysm can be safely and effectively cured when appropriate endovascular embolization technique is used.
RESUMEN
Objective:To investigate the correlation between plasma homocysteine (Hcy) concentration and transient ischemic attack (TIA) and traditional vascular risk factors.Methods:The plasma Hcy concentrations of 112 patients with TIA and 62 controls were measured by fluorescenee polarization immunoassay.Hcy concentrations and related risk factors were analyzed.Results:The risk of TIA was increased significantly in plasma Hcy concentration 10.0 to 14.9 μmol/L group(OR=2.450,95% CI 1.091 to 5.502) and≥15.0 μmol/L group(OR=5.169,95% CI 2.096 to 12.746) compared with plasma Hcy concentration＜10.0 μmol/L group.Using TIA as the dependent wariable,various vascular risk factors (including plasma Hcy concentration) as the independent variable,logistic regression was analyzed.The result showed that the risk of TIA was increased significantly in plasma Hcy concentration＞10.0 μmol/L group compared with plasma Hcy concentration＜10.0 μmol/L group(OR=3.150,95% CI 1.380 to 7.192).Conclusions:Plasma Hcy concentration is an independent risk factor for TIA.