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Objective Toinvestigatetheriskfactorsforleukoaraiosis(LA)inpatientswithlarge arteryatherosclerosis(LAA).Methods Theclinicaldata(age,sex,hypertension,diabetes,smoking, serum lipid level,hyperhomocysteinemia,and numbers of stenosis or occluded cerebral arteries)of 312 patients with LAA classified by the modified stop stroke study trial of Org 10172 in acute stroke treatment (SSS-TOAST ) were analyzed retrospectively. The age-related white matter changes (age related white matter changes,ARWMC)scale was used to evaluate LA. All the 312 patients were divided into non-LA group(n=72)and LA group(n=240)according the T2 weighted magnetic resonance imaging (MRI) and fluid attenuated inversion recovery(FLAIR)sequence,and 3 groups according to the (age-related white matter changes,ARWMC)scores:mild LA,moderate LA,and severe LA groups. The patients with multiple risk factors were analyzed by the univariate and multivariate Logistic regression analyses. Results (1)Of the 312 patients with LA,227 were males (72. 8%). Their average age was 64 ± 11 years,and 240 of them (76. 9%)had LA. Multivariate Logistic regression analysis showed that age (OR,2. 911,95%CI 1. 647-5.146,P=0. 000),hypertension (OR,2. 583,95%CI 1. 373-4.857,P<0. 01),diabetes (OR,1. 882, 95%CI 1. 058-3. 348,P <0. 05),the numbers of stenosis or occlusion arteries (OR,1. 851,95%CI 1.018-3. 367,P<0. 05),and lacunar infarction (LI)(OR,1.493,95%CI 1. 202-1. 853,P<0. 01)were the risk factors for LA. (2)The comparison of the clinical data in patients with different severity in the LA group found that there were significant differences in age,hypertension,diabetes,the numbers of stenosis or occlusionarteries,andLIamongthe3groups(allP<0.05).Conclusion Age,hypertension,diabetes, the numbers of stenosis or occlusion arteries,and LI are the independent risk factors for patients with LAA,and it is associated with the severity of LA.
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The curative efficacy of percutaneous transluminal angioplasty and stenting (PTAS) in the treatment of patients with ischemia cerebrovascular disease caused by artery stenosis was explored. The clinical data of 111 patients with ischemia cerebrovascular disease receiving PTAS in Guangdong Province General Hospital from Aug. 2007 to Nov. 2009 were retrospectively analyzed. In total 132 stents were implanted in the 111 patients. The mortality and rate of neural and non-neural complications were assessed perioperatively. Outcomes [including the frequency of transient ischemic attack (TIA), stroke, or death from vascular diseases) were assessed after operation. NIHSS rating was performed in all cases before and at first week, 6th month and 12th month after the operation. The PTAS success rate was 100%. The degree of stenosis was reduced after PTAS. The total complication rate during perioperative period was 15.3% (the rate of neural complications was 3.6%). Sixty-seven patients were followed up. Three patients (4.48%) developed cerebrovascular events within 1 month, containing one case of TIA, one case of ipsilateral mild stroke and one case of contralateral mild stroke. No severe stroke or death was observed. During a follow-up period of 12 months 7 patients had cerebrovascular events (10.44%), including 2 cases of ipsilateral TIA (2.99%), 2 cases of ipsilateral mild stroke and 2 cases of contralateral mild stroke (2.99%), one case of severe stroke (1.49%). In 13 patients receiving DSA re-examination one year after PTAS, 2 patients (15.38%) had in-stent restenosis. NIHSS scores were obviously decreased during a follow-up period as compared with those pre-operation (P<0.05). It was concluded that PTAS could significantly alleviate the neural function deficit of the patients with ischemia cerebrovascular disease. The success rate of PTAS was high, and the rate of complications was lower and the clinical outcomes were satisfactory. PTAS is a safe and effective therapeutic method, though the long-term outcomes need further study.
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Objective To observe the prognostic factors of functional outcome of patients with cerebral infraction treated in stroke unit.Methods The data of patients with cerebral infractions treated in stroke unit in our hospital were prospectively collected from April 2004 to December 2005 continuously.All the patients They were fol lowed up either by their regular visits to our outpatient clinics or by phone interview.The modified Rankin scale(mRS)score was used as the index of primary outcome.The prognostic factors of the functional outcome were analyzed by monovariate and multivariate logistic regression.Results A total of 150 cases were collected,of whom 98 were with good outcome,52 cases with poor outcome.The multivariate logistic regression showed that the poor outcome was associated with aging,previous history of stroke,high NIHSS scores,complications,and time from onset of the disease to admission to stroke unit.Conclusion The results suggested that older age,having stroke history,higher NIHSS total scores,having complications and delayed hospitalized time were influence factors to functional outcome of cerebral infractions in stroke unit.
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Objective To investigate the visualization and quantitation of hemodynamic variables at carotid artery bifurcation in vivo by combining computational fluid dynamics(CFD)and vascular imaging. Methods A healthy volunteer underwent CT angiography of left carotid artery by SIEMENS multi-slice CT. Parameters of hemodynamics at this carotid bifurcation were calculated and visualized by combining vascular imaging post-processing and CFD.Results (1) The average range of flow velocity was 0.04～0.36 m/s. A region of high velocity was seen at medial wall of internal carotid artery (ICA) and medial wall of external carotid artery (ECA), respectively. The largest contiguous region of low velocity occurred at the carotid bulb. (2)The average range of absolute pressure, static pressure and dynamic pressure was 100 266.70～101 615.90 Pa, -1058.34～290.88 Pa, and 6.12～553.25 Pa, respectively. (3) The average range of wall shear stress (WSS) at the bifurcation was 0.59～5.35 Pa. There was a large region of low WSS at carotid bulb and posterior wall of ICA, with the lowest value of 0.25 Pa. Also there was a small region of low WSS at anterior and lateral wall of ECA.Conclusion CFD combined with vascular imaging can calculate and visualize the parameters of hemodynamics at carotid bifurcation in vivo individually. It is an interdisciplinary science of computer, radiology and hemodynamics and provides a new method to investigate the relationship of vascular geometry and flow condition with atherosclerotic pathological changes.