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Objective:To investigate the influence of collateral circulation evaluated by CT perfusion (CTP) imaging in infarction progression and clinical prognoses of patients with acute large-artery occlusion of the anterior circulation before and after thrombectomy.Methods:One hundred and ten patients with acute large-artery occlusion of the anterior circulation within 24 h of onset, admitted to our hospital from May 2018 to September 2019, were chosen in our study; all patients completed thrombectomy; their clinical data were analyzed retrospectively. Regional leptomeningeal collateral-temporally fused maximum intensity projection (rLMC-tMIP) was used to evaluate the collateral circulation based on 4D-CT angiography (4D-CTA). According to the core infarct volume in CTP imaging and the diffusion weighted imaging (DWI) results of MR within one week of surgery, the progressive infarct volume was calculated. Modified Rankin scale (mRS) was used to evaluate the prognoses of these patients 3 months after surgery.Results:(1) There were 56 patients with good collateral circulation and 54 patients with poor collateral circulation. Age ( OR=0.951, 95%CI: 0.910-0.993, P=0.023), cardiac dysfunction ( OR=0.116, 95%CI: 0.018-0.731, P=0.022), baseline fasting blood glucose ( OR=0.788, 95%CI: 0.646-0.961, P=0.019), wakefulness stroke ( OR=0.093, 95%CI: 0.023-0.380, P=0.001), and site of vascular occlusion ( OR=7.604, 95%CI: 2.650-21.821, P=0.000) were independent influencing factors for collateral circulation. (2) Scores of rLMC-tMIP ( 95%CI: -2.947- -1.474, P=0.000), volume of ischemic penumbra ( 95%CI: 0.065-0.126, P=0.000), scores of edema in the brain tissues ( 95%CI: 2.952-7.600, P=0.000), hemorrhage transformation ( 95%CI: 8.966-23.114, P=0.000), and 24 h NIHSS scores ( 95%CI: 0.606-1.248, P=0.000) were independent influencing factors for volume of progressive infarction. (3) There were 59 patients having good prognosis and 51 patients having poor prognosis. Hemorrhage transformation ( OR=0.019, 95%CI: 0.001-0.275, P=0.004) and progressive infarction volume ( OR=0.824, 95%CI: 0.756-0.897, P=0.000) were independent influencing factors for prognoses of patients with acute large-artery occlusion of the anterior circulation after thrombectomy. Conclusion:The scores of rLMC-tMIP based on 4D-CTA can well predict the infarction volume in patients with acute large-artery occlusion of the anterior circulation within 24 h of onset, which can effctively evaluate the clinical prognoses of the patients.
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Objective:To analyze the efficacy and safety of dual antiplatelet therapy guided by thromboelastography (TEG).Methods:One hundred and nine patients with ischemic cerebrovascular diseases, admitted to and accepted dual antiplatelet therapy in our hospital from August 2020 to April 2021, were enrolled in this study. TEG test was completed 3-5 d after treatment, and clopidogrel gene test was completed during hospitalization. According to the results of adenosine diphosphate (ADP) inhibition rate in TEG, they were divided into high-efficiency group, moderate efficiency group and low efficiency group. No medication change was recommended for patients in the high-efficiency group, but medication changes were recommended for patients in the moderate efficiency group and low efficiency group; differences of National Institutes of Health Stroke Scale (NIHSS) scores, efficacies and safety were recorded in these 3 groups after drug adjustment.Results:The proportion of patients with coronary heart disease in moderate efficiency group was statistically higher than that in high-efficiency group and low efficiency group ( P<0.05). Six patients in the high-efficiency group switched to use aspirin and cilostazol; 28 in the moderate efficiency group and 14 patients in the low efficiency group were disinclined to change their medications and continued to use aspirin+clopidogrel. In patients from the high-efficiency group, the overall incidence of new stroke and in-stent restenosis in patients without changing medications (1/39) was lower than that in patients with changing medications (1/6); in patients from the moderate efficiency group, that in patients without changing medications (6/28) was higher than that in patients with changing medications (1/9); in patients from the low efficiency group, that in patients without changing medications (3/14) was higher than that in patients with changing medications (0/13). In patients with slow metabolism from high-efficiency group, the overall incidence of new stroke and in-stent restenosis in patients without changing medications (2/3) was higher than that in patients with changing medications (1/2). Conclusions:Dual antiplatelet therapy guided by TEG can reduce clinical adverse events without increasing the risk of bleeding. For patients with ADP inhibition rate>70% and clopidogrel genotype (slow metabolism), clopidogrel replacement can further improve efficacy.
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Objective To investigate the efficacy and safety of endovascular recanalization 6-24 h after onset in patients with acute basilar artery occlusion,and explore the related factors for their prognoses.Methods Clinical data of 37 patients with acute basilar artery occlusion,received endovascular recanalization in our hospital from January 2016 to July 2019,were retrospectively collected;23 patients were into group of onset-to-puncture time (OPT)＞6 h (6-24 h),and 14 patients were into group of OPT ≤ 6 h (0-6 h).Statistical methods were used to compare the postoperative symptomatic intracranial hemorrhage rate,good prognosis rate (modified Rankin scale [mRS] scores ≤ 3) and mortality 3 months after onset between the two groups;clinical data between the subgroups with good and poor prognoses in patients of group of OPT＞6 h were compared.Results The postoperative symptomatic intracranial hemorrhage rate,and good prognosis rate and mortality of patients from group of OPT＞6 h were 30.4％,47.8％ and 43.5％,respectively;and there were no statistically significant differences as compared with those in patients from group of OPT≤6 h (35.7％,35.7％,and 42.9％,P＞0.05).Scores of scales based on preoperative CTA images (posterior circulation-Alberta stroke program early CT scale [pc-ASPECTS],scale of posterior circulation on CTA [pc-CTA],and scale of basilar artery on CTA [BATMAN]) showed significant differences between the good prognosis subgroup and poor prognosis subgroup in patients fiom group of OPT＞6 h (P＜0.05).Conclusion Endovascular recanalization 6-24 h after onset is effective in patients with acute basilar artery occlusion,and the safety does not obviously decrease;scores of pc-ASPECTS,pc-CTA and BATMAN may be related to the clinical prognoses.
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Objective To assess whether degrees of leukoaraiosis (LA) severity is associated with prognoses of patients with acute anterior circulation large-artery occlusive stroke after mechanical thrombectomy.Methods Clinical data of patients with acute anterior circulation large-artery occlusive stroke who underwent mechanical thrombectomy in our hospital from January 2016 to August 2017 were collected. The subjects were divided into non-to-moderate LA group and severe LA group according to preoperative degrees of LA severity; the baseline data, successful reperfusion rate, and symptomatic intracranial hemorrhage rate within 24 h of surgery, good prognosis rate 90 d after surgery (modified Rankin scale [mRS] scores≤2) and mortality 90 d after surgery were analyzed. According to the prognoses, the patients were divided into good prognosis group and poor prognosis group; univariate regression analysis and multivariate Logistic regression analysis were used to evaluate the relations of degrees of LA severity with prognoses 90 d after surgery.Results In these 146 patients, 100 patients were into the non-to-moderate LA group and 46 patients were into the severe LA group. As compared with patients in the non-to-moderate LA group, patients in the severe LA group had significantly older age (70.50 [59.75, 79.75] yearsvs. 79 [73, 82] years), significantly higher baseline NIHSS scores (20 [16, 25])vs. 22 [18, 28]), significantly higher rate of symptomatic intracranial hemorrhage 24 h after surgery (11.0％ [11/100])vs. 26.1％ [12/46]), statistically higher mortality rate 90 d after surgery (14.0％[14/100]) vs. 14.0％ [14/46]), significantly lower successful reperfusion rate (97.0％ [97/100]vs. 84.8％ [39/46]), and statistically lower good prognosis rate (54.0％ [54/100]vs. 21.7％ [10/46],P<0.05). Among the 146 patients, 64 had good prognosis and 82 had poor prognosis; univariate analysis showed that as compared with than those from the good prognosis group, patients from the poor prognosis group had significantly older age (70.50 [59.75, 79.75] years oldvs. 79 [73, 82] years old) and statistically higher baseline NIHSS scores (20 [16, 25]vs. 22 [18, 28]), and significantly higher proportion of central source embolism by TOAST etiology classification (68.8％ [44/64]vs. 76.8％[63/82]) and proportion of severe LA (15.6％ [10/64]vs. 43.9％ [36/82],P<0.05); multivariate Logistic regression analysis showed that severe LA (OR=3.109, 95％CI: 1.241-7.788,P=0.015), age, baseline NIHSS scores, and TOAST etiology classification were all independent risk factors for poor prognosis 90 d after surgery (P<0.05). ConclusionSevere LA may be associated with poor prognosis of patients with acute anterior circulation large-artery occlusive stroke after mechanical thrombectomy.
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Acute basilar artery occlusion (ABAO) has a high rate of disability and mortality, and the key to its treatment is to start reperfusion therapy as early as possible. A number of retrospective studies have found that the good prognosis rate of endovascular treatment of ABAO is related to number of infarction locus, extent of ABAO, vascular occlusion and collateral circulation. Screening patients through imaging evaluation before endovascular treatment may further improve the rate of favorable outcome. This article reviews research progress on the correlation between imaging evaluation before endovascular treatment of ABAO and clinical prognoses.
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Cerebral collateral circulation can improve cerebral blood flow and protect neurons in ischemic stroke, which provides valuable time for reperfusion therapy and is closely related to the prognoses of patients with acute ischemic stroke. With the continuous emergence and development of new techniques for vascular reperfusion therapy in acute phase, it is urgent to establish a scheme for individualized evaluation of collateral circulation to guide clinical decision-making. Collateral circulation based on multi-mode imaging evaluation can provide guidance for clinical individualized diagnoses and accurate treatments more quickly and effectively to improve the clinical prognoses of patients. In order to provide guidance for the reperfusion treatment of acute ischemic stroke and effectively evaluate the clinical prognoses of patients, the authors summarize the research progress on correlation between collateral circulation and prognoses of ischemic stroke based on multi-mode imaging evaluation in recent years.
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Objective To observe the clinical efficacy of Xingnaojing combined with butylphthalide in the treatment of vascular dementia (VD). Methods One hundred and twenty VD patients admitted to First People's Hospital of Tongxiang from August 1st 2014 to December 1st 2017 were enrolled, all the patients were given routine treatment according to their disease conditions, 53 cases were treated by intravenous drip of butylphthalide and sodium chloride injection (100 mL containing butylphthalide 25 mg and sodium chloride 0.9 g), 100 mL once, 2 times each day (single-use group); another 67 patients were treated with Xingnaojing 20 mL added into 200 mL glucose solution intravenous drip, once a day, on the basis of the treatment in the single-use group (combined group), and both groups were treated for 4 weeks. The changes of mini-mental state examination (MMSE) and activity of daily life (ADL) scores, clinical efficacy and adverse reactions were observed before and after treatment in the two groups. Results The MMSE and ADL scores in both groups were higher after treatment than those before treatment, and the MMSE and ADL scores in the combined group were significantly higher than those in the single-use group (MMSE scores: 26.77±1.30 vs. 25.64±2.81, ADL: 74.77±3.30 vs. 59.23±4.21, both P < 0.05); the clinical efficacy of the combined group was significantly higher than that of the single-use group [97.0% (65/67) vs. 81.1% (43/53), P < 0.05], however, there was no significant difference in the incidence of adverse reactions between the combined group and the single-use group [7.5% (5/67) vs. 7.6% (4/53), P > 0.05 ]. Conclusions After treatment of VD with the combination of Xingnaojing and butylphthalide, the cognitive function and daily living ability of the patients are improved to some extent, the combined treatment is more effective than the single application of butylphthalide, and no obvious adverse reaction occurs during the therapeutic course.
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Objective To evaluate the efficacy and safety of endovascular thrombectomy for acute ischemic stroke due to basilar artery occlusion,and analyze the correlation between baseline clinical features and prognoses.Methods The clinical data of 27 patients with acute stroke due to basilar artery occlusion,admitted to and underwent emergency endovascular thrombectomy in our hospital from February 2016 to March 2017,were analyzed retrospectively.The re-canalization rate and complications were determined and the clinical outcomes were assessed.The correlation between clinical features and prognoses were analyzed.Results Successful re-canalization was achieved in 24 out of 27 patients (88.9 ％),and the mean time from onset to re-canalization was (418.92±223.96) min.Symptomatic intracerebral hemorrhage (SICH) was observed in 2 patients (7.4 ％) and mortality in the first 3 months was 29.6％ (8/27).At 3-month follow up,14 patients (51.8 ％) showed good prognosis (modified Rankin scale [mRS] scores≤＜2) and 13 had poor prognosis.Baseline NIHSS scores (23[12.5,33.8] vs.35[23,39]) and posterior circulation-Alberta Stroke Program Early CT Scale scores (9 [8,10] vs.7 [4,9]) between patients with good prognosis and poor prognosis were significantly different (Z=-2.043,P=0.041;Z=-2.387,P=0.017).Conclusions Endovascular thrombectomy can contribute to a high re-canalization rate and safety.Baseline clinical severity and collateral circulation compensation are associated with clinical prognosis.
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Objective To compare the efficacy and safety of direct thrombectomy and bridging therapy for acute large-vessel occlusion in anterior circulation stroke.Methods A retrospective study was performed on clinical data of 146 patients with anterior circulation large-vessel occlusion stroke who accepted direct thrombectomy in our hospital from March 2016 to July 2017;85 patients were in direct thrombectomy group and 61 patients were in bridging therapy group.The clinical characteristics,procedural complications and clinical outcomes between the two groups were compared.Results There were no significant differences between the two groups in age,gender,baseline National Institutes of Health Stroke Scale (NIHSS) scores,percentages of patients with hypertension,diabetes and atrial fibrillation,baseline blood glucose,platelet count,creatinine level,baseline systolic blood pressure,stroke etiology,occlusion site,and anesthesia methods (P＞0.05).There were no significant differences between the two groups in admission-to-CT time,admission-to-puncture time,puncture-to-re-canalization time,and admission-to-re-canalization time (P＞0.05).The successful reperfusion rate (91.8％ vs.95.1％),incidence of symptomatic intracranial hemorrhage (11.8％ vs.21.3％),favorable outcome rate 90 d after treatment (41.2％ vs.47.5％),and mortality (20.0％ vs.18.0％) were not significantly different between the two groups (P＞0.05).Conclusion The efficacy and safety of direct thrombectomy and bridging therapy are similar for acute large-vessel occlusion in anterior circulation stroke.
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Objective To evaluate the effect of anesthesia selection on endovascular treatment for anterior circulation major vessel occlusion stroke. Methods The clinical data of patients undergoing endovascular treatment in our hospital from January 2016 to August 2016 were retrospectively reviewed. The patients were divided into general anesthesia group and conscious sedation group. Comparison of the differences in time, symptomatic intracranial hemorrhage, and 90-day functional outcome between the two groups was made. Results A total of 73 patients were included in the analysis, 34 (46.6％) in the general anesthesia group, and 39 (53.4％) in the conscious sedation group. The baseline clinical data were balanced in both groups. There was no statistically significant difference in door-to-puncture time, puncture-to-recanalization time and onset-to-recanalization time between the two groups. The postoperative systolic blood pressure was significantly decreased in the general anesthesia group ((126.29 ± 20.07) vs (139.95 ± 21.22) mmHg (1 mmHg=0.133 kPa), t=2.81, P=0.01), whereas the rate of successful reperfusion (modified thrombolysis in cerebral infarction ≥ 2b) (94.1％(32/34) vs 87.2％(34/39), χ2=0.33, P=0.57), symptomatic intracranial hemorrhage rate (17.6％(6/34) vs 10.3％(4/39), χ2=0.33, P=0.57) and good outcome (modified Rankin Scale (mRS) score≤2) at 90 days (41.2％(14/34) vs 53.8％(21/39),χ2=1.17, P=0.28) did not show statistically significant difference between the two groups. Conclusions The selection of general anesthesia or conscious sedation had no significant effect on the outcome of endovascular treatment for anterior circulation major vascular occlusion stroke. The results of the study still need to be verified by large-scale randomized controlled trial.
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Objective To study the effectiveness and safety of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis therapy for acute ischemic stroke in patients with atrial fibrillation (AF).Methods A total of 94 patients treated with intravenous rt-PA thrombolysis within 4.5 hours after cerebral stroke onset were analyzed and divided into two groups:a non-AF group (n =64) and an AF group (n =30).Another 30 acute ischemic stroke patients with AF without thrombolytic therapy were selected as a control group.The prognosis of the three groups was compared.The National Institute of Health Stroke Scale (NIHSS) was used for comparison among the three groups before therapy and 7 days after therapy.The incidences of intracerebral hemorrhage (ICH) and symptomatic ICH (SICH) were recorded.The patients were followed up for 90 days and their clinical outcomes were assessed by using the modified Rankin scale (mRS).Results There were no significant differences in the NIHSS scores among three groups before treatment (P ＞ 0.05).The NIHSS scores were significantly lower in the AF and non-AF groups 7 days after thrombolysis therapy than those before thrombolysis therapy (P ＜0.05 and P ＜0.01),and no significant difference in the NIHSS scores was found in the control group before and after therapy (P ＞ 0.05).The incidence of ICH was significantly higher in the AF group than in the non-AF group (26.7％ vs.9.4％,P ＜ 0.05).No significant difference in the incidence of SICH was found between the AF and non-AF groups (13.3％ vs.6.3％,P ＞ 0.05).The favorable prognosis rate was higher in the AF and nonAFgroups than in control group (40.0％ vs.16.7％,P＜0.05; 45.3％ vs.16.7％,P＜0.01).No significant difference in very unfavorable prognosis rate was found between the AF and non-AF groups (20.0％ vs.18.8％,P ＞0.05).Conclusions It is effective and safe of rt-PA thrombolysis therapy for acute ischemic stroke patients with AF.