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Objective To investigate the relation between endothelial repairing function and in-stent restenosis in patients with symptomatic middle cerebral arterial (MCA) stenosis after stent implantation.Method Sixty-six patients with symptomatic MCA stenosis underwent percutaneous stent implantation.Cranial CTA revealed that 23 patients had MCA restenosis (restenosis group) 1 year after stenting,including 14 cases with ＞50％ stenosis and 1 case with MCA occlusion,and 43 patients had no restenosis (non-restenosis group).The number of endothelial progenitor cells (EPC) was examined by flow cytometry,the adhesion function of EPC was tested by adhesion assay,the migration ability of EPC was tested by Transwell method and serum vascular endothelial growth factor (VEGF) levels were measured by ELISA.The relationship of endothelial repairing function with restenosis was analyzed.Results The MCA stent implantations were successfully performed in all patients.The EPC number (33.7 ± 4.6 vs.61.6 ± 6.4),adhesion activities (26.1 ± 7.5 vs.56.3-± 9.6),migration activities (12.0 ± 3.9 vs.21.4 ± 6.5) and serum VEGF level [(56.7 ± 14.6) vs.(89.6 ± 17.32) ng/L] in restenosis group were significantly lower than those in non-restenosis group (t =18.48,13.09,6.34 and 7.73,all P ＜ 0.05).Conclusion For patients with MCA stenosis after percutaneous stent implantation the increased risk of in-stent restenosis is associated with low level of EPCs and their migration ability,and low serum VEGF level.
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Objective To evaluate and explore the Patients with acute cerebral infarction P-selectin and C-reactive protein (CRP) clinical significance.Methods According to the degree of neurological deficit scores were divided into light group (38 cases),medium group (35 cases) and severe group (25 cases),30healthy subjects were selected as the control group,measured at different time levels of P-selectin and CRP.Results Light group,medium group,severe group admitted 24 h P-selectin levels were higher,the difference was statistically significant (P ＜ 0.05).Light group,medium group,severe group admission decreased after 3 d P-selectin levels were highest; mild group admitted 24 h,7 d P-selectin levels and medium-sized group and severe group differences were statistically significant (P ＜ 0.05).Light group,medium group,severe group admission 3 d P-selectin levels were statistically significant differences (P ＜ 0.05) among the three groups.Light group,medium group admitted 14 d P-selectin levels and heavy group differences were statistically significant (P ＜ 0.05).Light group,medium group,severe group admitted 24 h CRP levels were higher,the difference was statistically significant (P ＜ 0.05).Light group,medium group,severe group admitted 24 h,3 d,7 d,14 d CRP levels decreased,comparing the differences among the three groups were statistically significant (P ＜ 0.05) at the same time point.Linear correlation analysis showed that P-selectin hormone levels and CRP levels were positively correlated (r =0.493,P ＜ 0.05).Conclusions Serum P-selectin and C reactive protein may be involved in the pathological process of ACI.The changes of serum P-selectin and C reactive protein levels were contributed to judge severity of pathological changes,focus range and prognosis assessment.It is an important biochemical observational indicator,and it's worthy recommending in clinic.
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Objective To explore the influence of the cognitive function and related dangerous factors in patients lacunar infarction(LI) after carotid artery stenting (CAS).Methods Neuropsychological tests (MoCA and MMSE)were conducted in 43 patients with LI before CAS,1 month,6 months,1 year and 2 years after CAS and the scores were compared with those of 41 healthy cases.Results Compared with control group,in therapy group,MMSE scores before CAS,1 month and 6 months after CAS,MoCA scores before CAS(19.39 ±2.17) and 1 month after CAS(19.51 ± 1.99) and the scores of Cube Copying before CAS,Alternating Trail Making Test,attention and delayed recall before CAS,1 month after CAS and Clock Drawing before CAS,1 month and 6 months after CAS all lowered obviously.There were statistical differences(P＜ 0.05 or P ＜ 0.01).Compared with before CAS,in therapy group,MMSE scores and MoCA scores 6 months,1 year and 2 years after CAS,the scores of Alternating Trail Making Test 2 years after CAS,Cube Copying and Clock Drawing 1 year and 2 years after CAS and attention and delayed recall 6 months,1 year and 2 years after CAS all increased obviously.There were statistical differences (P ＜ 0.05 or P ＜ 0.01).In the follow-up of 2 years,the result of Logistic Regression Analysis showed that MoCA scores has correlation with age(OR =50.751,95％ CI 1.407 ～ 19.464; P =0.006),high blood pressure(0R=8.012,95％ CI1.212 ～27.550; P=0.042)and low levels of education(OR=11.586,95％ CI1.164～ 16.903 ; P =0.029) and no correlation with diabetes and CAS.Conclusion Cognitive impairment in patients with LI is improved 2 years after CAS,and visuospatial function,attention and delayed recall are significantly improved.But CAS is not independent protective factors for cognitive functions,and old age,low education levels and high blood pressure are independent risk factors for cognitive impairment in patients with LI.
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ObjectiveTo explore the characteristics of the cognitive changes in patients with lacunar infarction(LI) after carotid artery stenting(CAS).MethodsNeuropsychological tests were conducted in 43 patients with LI and carotid stenosis before and 1 month,6 months,12 months after CAS and the scores were compared with those of 41 healthy cases.ResultsCompared with control group,MMSE scores ( 26.33 ± 1.94),memory and executive function in therapy group lowered obviously.There was statistical difference (P＜ 0.05 or P＜ 0.01 ).Compared with before CAS,MMSE scores of 1 month (27.17±2.15),6 months (27.17 ±2.15),12 months (28.15±1.98) after CAS,memory and executive function in therapy group were all better obviously.There was statistical difference (P＜0.05 or P＜0.01).ConclusionIn acute stage of patients with LI (with in 1 week),most cognitive impairment was severe. Most cognition disorders was improved to normal level 12 months after CAS.The mechanism may be associated with the improvement of chronic cerebral insufficiency.
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Objective To explore the changes and the clinical relevance of plasma p-selectin (PS) and vascular endothelial cell function in patients with carotid stenosis (CS) before and after carotid artery stenting (CAS). Methods The plasma levels of PS, yon willebrand (vWF) and endothelin-1 (ET-1) before CAS and 1hour,6 hours,24 hours,2 months after CAS in 67 patients with carotid stenosis and 54 cases of TIA with negative result from cerebral angiography were measured. The patients of the therapy group were further divided into group A and group B according to complexity of CAS. The plasma levels of PS and vWF were determined by enzyme linked immunosorbent assay,and the level of ET-1 was measured by radioimmunoassay. Results The plasma levels of PS,vWF and ET-1 all increased in the patients group after CAS. In the therapy group,the level of PS reached peak value (29.23 ± 6.98) ng/ml 1 hour after CAS, and the levels of vWF and ET-1 reached peak value (119.63 ±16.75) %, (79.71 ± 9.78) ng/L 6 hour after CAS. In therapy group, there was significant difference in the levels of PS and ET-1 between each time points after CAS and before CAS (P＜0.05,P ＜0.01 respectively). There was significant difference in the level of vWF between 1 hour, 6 hours, 24 hours after CAS and before CAS (P ＜ 0.05 orP ＜ 0.01). There was significant difference in tihe levels of PS 1 hour after CAS and ET-1 at 6 hours after CAS (P ＜0.05) ,and in the level of vWF at 1 hour,6 hours after CAS between control group and therapy group (P ＜0.01).There was significant difference in the level of vWF at every time point after CAS (P ＜ 0.05 or P ＜ 0.01), and in the level of ET-1 at 1 hour,6 hours,24 hours between A group and B group(P ＜0.05 or P ＜0.01). Conclusions PS, vWF and ET-1 were activated to some extent and related to pathological changes degree and complexity of CAS. Monitoring these biological indexes after CAS maybe of great value in predicting risk, evaluating clinical therapy and judging prognosis.
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Objective To evaluate the mechanism,prevention and prognosis of complications after stent angioplasty in the treatment of carotic artery stenosis. Methods[WT5”BZ] From 1997 to 2003,312 cases of carotid artery stenosis were treated by transluminal stent-assistant angioplasty. Results Procedure-related complication developed in 23 cases including 19 cases of transient mild complications such as transient arrhythmia and hypotension in 10 cases (3.2%) during deploying stent or balloon dilation,transient cerebral ischemia symptoms in 6 cases after balloon dilation,hypotension in 3 cases after the procedure. Severe complications occurred in 4 cases after the procedure,including embolus detachment,stent migration,carotic artery occlusion and fatal cerebral hemorrhage. Conclusion Although stent-assistant angioplasty are effective for treatment of carotid artery stenosis,severe complications could develop.