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Objective:To evaluate the short-term efficacy and safety of Apollo stent in the treatment of symptomatic basilar artery stenosis.Methods:Patients with symptomatic basilar artery stenosis admitted to the Fourth Affiliated Hospital of China Medical University from January 2017 to May 2020 were selected and treated with Apollo stent implantation. The changes of clinical symptoms and the success rate of operation were evaluated. Postoperative complications included symptomatic intracranial hemorrhage, hyperperfusion, and new ischemic stroke, and follow-up results were evaluated 3 to 6 months later.Results:A total of 96 patients were included in this study, and all of them were confirmed by angiography to have severe basilar artery stenosis corresponding to the symptoms. Among them, 88 patients received stent implantation, with a success rate of 100%. Among the 88 patients, 86 received Apollo stent implantation, and 2 patients received self-Peng stent implantation. Among 86 patients with Apollo stent implantation, the lesions were located in the proximal segment in 73 cases (84.88%), in the middle segment in 10 cases (11.63%), and in the distal segment in 3 cases (3.49%). The degree of stenosis was (93.72±3.86)%, the length of stenosis was (8.50±2.65)mm, the residual stenosis rate was (1.76±4.87)%, and Mori type A lesions in 80 cases, type B lesions in 3 cases, and type C lesions in 3 cases. Among 86 patients with Apollo stent implantation, the incidence of perioperative neurological complications was 6.98%(6/86), including 1 case in the proximal part of the basilar artery (vascular rupture), 3 cases in the middle part of the basilar artery (perforating artery occlusion in 1 case, acute thrombosis artery occlusion in 2 cases), and 2 cases in the distal part (both acute vascular occlusion). Alteplase was injected into the microcatheter during the operation, and contact thrombolysis was performed. Immediately digital subtraction angiography (DSA) showed that the blood vessels were opened, and 1 case with neurological deficit was left. No hyperperfusion occurred in all patients. All patients were followed up for three months after operation. Among them, 58 patients had a good prognosis in the proximal segment of the basilar artery, 18 patients had a good prognosis in the middle segment, 4 patients had a good prognosis in the distal segment, and 6 patients had a bad prognosis (1 patient died). Postoperative stent restenosis occurred in 5 cases (5.81%), recurrent stroke in 3 cases (3.49%), and disabling stroke in 1 case (1.16%).Conclusions:Apollo stent is safe and effective in the treatment of symptomatic basilar artery stenosis, with good short-term prognosis, and long-term prognosis needs to be further studied.
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Objective To investigate whether apathy during the acute stage of stroke was related to glycated hemoglobin and homocysteine(Hcy) and functional disability,and to elucidate possible factors that are related to poststroke apathy (PSA).Methods Totally 298 patients with acute cerebral infarction who met the inclusion and exclusion criteria were recruited from the Fourth Affiliated Hospital of China Medical University.The control group of 298 volunteers was recruited from medical center in our hospital during the same period.The apathy scale (AS) was used to assess PSA within 2 weeks after stroke.Patients with an AS score≥ 14 points were defined as PSA,and the patients were divided into apathy group (A group) and non-apathy group (NA group) according to AS score.Modified Rankin Scale (mRS) was used to assess functional disability.Functional disability in daily living activities was assessed with the Barthel Index(BI).Serum levels of Hcy,glycated hemoglobin A1C (HbA1 c),lipid series and fibrinogen of patients were determined.Results The prevalence of PSA in patients was significantly higher than the control group (P ＜ 0.01).In the case group,A group had an older age,higher mRS score,higher Hcy level,lower educational level,lower BI score,and lower HbA1C level than the NA group(P ＜0.05).In the A group,the mRS score was positively correlated with the AS score(B =1.508,P =0.003),serum Hcy level was positively correlated with the AS score(B =0.170,P =0.013),the HbA1C level was negatively correlated with the AS score(B =-0.872,P =0.031).Conclusions The serum Hcy level,HbA1C level and functional disability are closely related to apathy during the acute stage of ischemic stroke.
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Objective To explore risk factors of different locational leukoaraiosis in elderly patients with cerebral infarction.Methods Patients were collected who aged 60 to 85 with cerebral infarctions came to the Fourth Affiliated Hospital of China Medical University and took cerebral magnetic resonance imaging (MRI) [fluid-attenuated inversion recovery (FLAIR), T1, and T2].The patients were divided into periventricular white matter changes (PVWMCs) and deep white matter changes (DWMCs), and scored by Fazekas scale, respectively.We registered past medical history, medical systems and neurological examination, blood lipids, regular blood test, and resting blood pressure measurements in the morning.Univariate analysis was used to choose risk factors which ~fected white matter changes.After that, rank multivariate logistic regression analysis was used to test risk factors of PVWMCs and DWMCs, respectively.Results There were significant age differences in both PVWMCs and DWMCs, the degree of risk was associated with age.Conclusions PVWMCs and DWMCs risk factors vary, and we should take control of risk factors actively for the elderly in order to reduce the harm arising from WMC.
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@# Objective To explore the relationship between apathy and lesion location and serum homocysteine during the acute stage of ischemic stroke. Methods 152 patients with acute cerebral infarction were recruited. 152 volunteers from medical center were as control group. The Apathy Scale (AS) was used to assess poststroke apathy (PSA). National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of stroke. Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) was used to evaluate the lesion location. Modified Fazekas Scale was used to assess leukoaraiosis. The serum levels of homocysteine of patients were determined. Results The prevalence of PSA was significantly higher in the patients than in the control group (P<0.001). Multivariate logistic regression demonstrated that frontal lesion (P=0.001), basal ganglia lesion (P=0.006), pons lesion (P=0.002) and higher homocysteine level (P<0.001) significantly related with PSA. Conclusion Frontal lesion, basal ganglia lesion, pons lesion and higher homocysteine level may be predictors for apathy in acute stage of ischemic stroke.
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Objective To explore the relationship between apathy and lesion location and serum homocysteine during the acute stage of ischemic stroke. Methods 152 patients with acute cerebral infarction were recruited. 152 volunteers from medical center were as control group. The Apathy Scale (AS) was used to assess poststroke apathy (PSA). National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of stroke. Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) was used to evaluate the lesion lo-cation. Modified Fazekas Scale was used to assess leukoaraiosis. The serum levels of homocysteine of patients were determined. Results The prevalence of PSA was significantly higher in the patients than in the control group (P<0.001). Multivariate logistic regression demon-strated that frontal lesion (P=0.001), basal ganglia lesion (P=0.006), pons lesion (P=0.002) and higher homocysteine level (P<0.001) signifi-cantly related with PSA. Conclusion Frontal lesion, basal ganglia lesion, pons lesion and higher homocysteine level may be predictors for apathy in acute stage of ischemic stroke.
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@#Objective To investigate the relationship of serum levels of macrophage migration inhibitory factor (MIF), matrix metallo-proteinase-9 (MMP-9), hypersensitive C-reactive protein (hs-CRP) with the severity of acute cerebral infarction (ACI). Methods 101 pa-tients with ACI were envolved and divided into 3 groups according to the scores of National Institute of Health Stroke Scale (NIHSS):mild group (group A, n=38, NIHSS score<4), moderate group (group B, n=36, NIHSS score 4-15) and severe group (group C, n=27, NIHSS score>15). Meanwhile, 44 non-ACI inpatients with atherosclerosis were included as control group (group D). Their serum MIF and MMP-9 were detected with ELISA, and hs-CRP with immunoturbidimety. Results The levels of serum MIF, MMP-9 and hs-CRP ranged from more to less as groups C, B, A and D (P<0.05). There was positive correlation of MIF with MMP-9 (r=0.301, P<0.01) and hs-CRP (r=0.309, P<0.001). Conclusion Serum MIF, MMP-9 and hs-CRP levels increased with the severity in ACI patients, which may be prediction of athero-sclerotic plaque instability.
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ObjectiveTo investigate the risk factors related with the prognosis of patients with acute cerebral infarction after intravenous thrombolysis by alteplase in 90 days.MethodsForty patients with acute cerebral infarction treated by intravenous thrombolysis with aheplase were selected and assigned into good outcome group [modified Rankin scale (mRS) 0-1 score] and poor outcome group (mRS 2-6 scores) according to mRS at 90 days.The risk factors were compared between two groups.ResultsPoor outcome group(22 cases) comparing with good outcome group (18 cases),the values of age[ (64.64±11.30) years vs.(58.94±10.47) years ],onset to therapy time(OTT) [(376.73±316.32)min vs.( 176.00±59.74) min],National Institutes of Health stroke scale (NIHSS) score before thrombolysis [ ( 16.73±8.46)scores vs. (11.22±5.20) scores],maximum of systolic blood pressure (SBPmax) in the first 24 hours after thrombolysis[ ( 186.59±24.79 )mm Hg ( 1 mm Hg =0.133 kPa) vs.( 169.00±23.04) mm Hg] and systolic blood pressure variability (SBPV)[(17.11±3.90) mm Hg vs.(13.33±4.97) mm Hg] had significant differences (P＜ 0.05).ConclusionThe values ofage,OTT,NIHSS score before thrombolysis,SBPmax and SBPV in the first 24 hours after thrombolysis are related with the prognosis of patients with acute cerebral infarction after intravenous thrombolysis by altcplase in 90 days.
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@#Objective To observe expression and significance of inflammatory factor during perioperative and follow-up periods after endovascular stents in patients with cerebral arterial stenosis.Methods 54 patients diagnosed as cerebral arterial stenosis by digital substraction angiography (DSA) were selected as the stent group and treated with endovascular stents; another 32 subjects had the same disease but not accepted stenting were considered as the control group. Interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) contents were measured at different time points during perioperative and follow-up periods in the two groups. Stage A represented as day one before angiography or catheterization; stage B as 6 hours postoperatively (stent group) or 6 hours after diagnostic angiography (control group); stages C～I as 12, 24, 48, 72 hours, 1 and 6 months after stent insertion (stent group) or the same time points after angiography (control group).Results Contents of IL-6 and hs-CRP of the stent group were similar as the control group in the stage A ( P>0.05), but significantly higher than that of the control group during stages B～I ( P<0.01～0.05). Among 54 patients of the stent group, 21 cases had restenosis 6 months postoperatively (38.89%). Contents of IL-6 and hs-CRP of the patients were similar as those without restenosis in stages A～F postoperatively ( P>0.05), but significantly higher than that of the cases without restenosis in stages G and I postoperatively ( P<0.01～0.05).Conclusion Endovascular stents can increase the contents of IL-6 and hs-CRP of patients with cerebral arterial stenosis; in addition, high expression of them is the risk factor of post-stent restenosis during follow-up period.