ABSTRACT
Stroke has become the leading cause of death in China, and carotid atherosclerosis is an important risk factor for ischemic stroke. In current carotid atherosclerosis diagnosis and treatment guidelines, patients are stratified based on the degree of vascular stenosis. However, the presence of carotid atherosclerotic vulnerable plaques can cause ischemic stroke at any time, regardless of the degree of carotid stenosis. The development of MRI technology, especially the advent of high-resolution MRI, enables non-invasive assessment of carotid plaque structure and properties, and provides optimized treatment strategies for high-risk stroke population in the early stage to achieve the goal of prevention and treatment of stroke.
ABSTRACT
Stroke seriously endangers people's life and health because of its high prevalence, disability and recurrence rate. Among them, large vessel occlusive stroke (LVOS) has the worst outcome. Rapid recovery of cerebral perfusion is the key to improve the outcomes of patients with LVOS. As a new type of treatment, endovascular treatment can effectively recanalize the occluded blood vessels and extend the treatment time window. The level of collateral circulation determines the severity of symptoms, treatment choices, treatment effects and outcomes in patients with LVOS. This article summarizes the clinical factors related to collateral circulation compensation in patients with LVOS, and focuses on the application value of imaging technology in the evaluation of collateral circulation.
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Objective To investigate the change regulation of the serum ferritin level and its correlation with the clinical outcomes.Methods The patients with spontaneous intracerebral hemorrhage were enrolled.Their clinical data were collected.The serum ferritin levels were detected within 24 h after admission and on day 3,7,and 14,respectively.The modified Rankin Scale (mRS) were used to evaluate the clinical outcomes at day 90 after onset.mRS 0 to 2 was defined as good outcome and ＞ 2 was defined as poor outcome.Results A total of 32 patients with spontaneous intracerebral hemorrhage were enrolled,including 18 in the good outcome group and 14 in the poor outcome group.There were significant differences in age (66.33 ±12.57 years vs.76.50 ±6.55 years;t =-2.908,P =0.007),baseline National Institutes of Health Stroke Scale (NIHSS) scores (median [interquartile range];9.50 [4.75-11.25] vs.15.00 [11-20];Z=-3.499;P=0.001),diastolic blood pressure (82.16± 13.79 mmHg vs.94.76± 12.17mmHg,1 mmHg=0.133 kPa);t=-1.145,P=0.045),amount of bleeding (4.50 [2.75-9.00] mlvs.11.00 [7.50-15.00] ml;Z=-2.613,P=0.008],blood glucose (5.82±0.87 mmoFL vs.7.09±1.72 mmoFL;t =-2.548,P =0.020),and white blood cell count ([7.26 ± 2.36] × 109/L vs.[10.94 ±5.83] × 109/L;t =-2.440,P =0.021) between the good outcome group and the poor outcome group.The serum ferritin levels of the good outcome group were 139.81 ± 98.50 μg/L,181.77 ± 97.29 μg/L,198.17 ±96.63 μg/L,and 159.59 ±72.43 μg/L,respectively,within 24 h on admission and at day 3,7,and 14.There were no significant differences at each time point (F=1.397,P =0.251),and those of the poor outcome group were 226.07 ± 119.22 μg/L,297.36 ± 81.48 μg/L,305.45 ± 97.05 μg/L,and 307.74 ± 82.54 μg/L,respectively,and they increased progressively over time (F =4.245,P =0.044);at each time point,the good outcome group was significantly lower than the poor outcome group (within 24 hon admission:t =-2.242,P=0.033;at 3 days after onset:t =-3.234,P =0.003;at 7 days after onset:t =-3.149,P =0.004;at 14 days after onset:t =-3.628,P =0.001).Multivariate logistic regression analysis showed that the serum ferritin level within 24 h on admission (odds ratio 1.048,95％ confilence interval 1.004-1.095;P=0.034)and baseline NIHSS score (odds ratio 1.021,95％ confidence interval 1.004-1.039;P =0.016) were the independent risk factors for affecting the outcomes in patients with acute intracerebral hemorrhage.Conclusions The serum ferritin level increases in the poor-outcome patients with acute intracerebral hemorrhage.The increased serum ferritin level is an independent risk factor for poor outcome in patients with acute intracerebral hemorrhage.
ABSTRACT
Objectve To investigate the correlation between vertebral artery hypoplasia (VAH) and posterior circulation ischemic stroke (PCIS).Methods The patients who were diagnose as ischemic cerebral stroke and underwent brain magnetic resonance imaging and cervical three-dimensional contrast-enhanced magnetic resonance angiography from March 2012 to March 2014 were enrolled.VAH was defined as vertebral artery diameter ＜ 2 mm and thin or did not develop.They were divided into either an anterior circulation ischemic stroke (ACIS) group or a PCIS group according to the sites of disease.The clinical and imaging data were compared.Results A total of 137 patients were enrolled,including 96 patients (70.07％) with ACIS and 41 (29.93％) with PCIS.Thirty-seven patients were (27.01％) diagnosed as VAH,including 13 on the left and 24 on the right; 14 females and 23 males.The detection rate of females (29.17％) was higher than that of males (25.84％),but the difference was not statistically significant (x2 =0.175; P =0.676).There were significant differences in TOAST classificanon (x2 =6.710; P =0.035),combined with ischemic heart disease (14.6％ vs.61.5％ ; x2 =25.262,P ＜ 0.001) and VAH (58.5％ vs.13.5％ ; x2 =9.505,P ＜0.001) between the PCIS group and the ACIS group.Multivariable logistic regression analysis showed that VAH was independently correlated with PCIS (odds ratio 10.788,95％ confidence interval 3.863-30.131; P ＜ 0.001),and combined with ischemic heart disease was independently correlated with ACIS (odds ratio 0.082,95％ confidence interval 0.024-0.278; P ＜ 0.001).Conclusions VAH is not rare in patients with ischemic stroke.It may promote the occurrence of PCIS.