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Objective To evaluate the value of Alberta Stroke Program Early CT Score on diffusion weight-ed imaging(DWI-ASPECTS)in predicting the leptomeningeal collateral circulation(LMA)compensation of isch-emic stroke with middle cerebral artery stenosis or occlusion after intravenous thrombolysis. Methods A total of 178 patients with ischemic stroke confirmed as severe middle cerebral artery stenosis or occlusion by imaging were enrolled in the study.All the patients were treated by rt-PA intravenous thrombolysis.The baseline clinical date, DWI-ASPECTS,mRS and NIHSS were collected. LMA was assessed by cranio-cervical CTA. Results Compared with the poor collateral circulation group,the triglyceride level and DWI-ASPECTS were significantly increased in good collateral circulation group(P<0.05).The proportion of hypertension,NIHSS score,mRS score in good col-lateral circulation group were significantly lower than those in the poor collateral circulation group(P < 0.05). Compared with the poor collateral circulation group,insula,the ASPECTS areas M1 to M4,M6 and insula showed significantly fewer infarctions in good collateral circulation group(P<0.05).ROC analysis showed the area under ROC curve(AUC)of DWI-ASPECTS to predict LMA compensation were 0.932,the cutoff point of DWI-ASPECTS was 7.5.the sensitivity and specificity were 81.% and 94.1%.Conclusions The tissue protective role of good lepto-meningeal collateralization seems to be more pronounced in cortical and subcortical areas M1 to M4,M6 and the in-sula.DWI-ASPECTS can effectively predict the collateral circulation compensation in patients with acute middle ce-rebral artery infarction.
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Objective To investigate the effectiveness and safety in patients with largeartery occlusive acute cerebral infarction who received multi-interventional modes mainly with mechanical thrombectomy and its related factors affecting prognosis. Methods The clinical data of 56 patients with large artery occlusive acute cerebral infarction were analyzed retrospectively. The clinical characteristics (gender,age,and underlying diseases),timing of treatment (time from ictus to puncture,time from puncture to recanalization), multi-interventional mode therapies (intra-arterial thrombolysis,thrombectomy,balloon dilation,and stenting, etc. ),and distribution of offending vessels were observed. The modified Thrombolysis in Cerebral Ischemia Scale (mTICI)grade was used to evaluate revascularization. The National Institute of Health Stroke Scale (NIHSS)score was used to observe the neurological function at 24 h before and after procedures. The modified Rankin scale (mRS)was used to evaluate the prognosis at 3 months after procedure. The safety of the treatment was evaluated with operative complications (mainly symptomatic intracranial hemorrhage)and mortality. The patients were divided into either a good prognosis group (n = 34;mRS≤2)or a poor prognosis group (n =22;mRS≥3)according to the prognosis at 3 months after procedure. They were analyzed with univariate analysis. The factors influencing the prognosis were further analyzed with multivariate logistic regression analysis. Results (1)The recanalization rate in 56 patients was 78. 6%(n = 44),in which basilar artery was the highest,reaching 93. 8% (15 / 16),middle cerebral artery was 87. 0% (20 / 23). The NIHSS score at 24 hours was 10 ± 7,it was lower than 16 ± 6 on admission. There was significant difference (t =6. 401,P <0. 01). At 3 months,34 patients (60. 7%)had good prognosis,4 (7. 1%)died,and 8 (14. 3%) had symptomatic intracranial hemorrhage. (2)Multiple factor analysis showed that the high level of recanalization was a protective factor for good prognosis (OR,0. 465,95% CI 0. 267 -0. 809,P =0. 007). Diabetes was an independent risk factor for poor prognosis (OR,5. 535,95% CI 1. 101 -27. 835, P = 0. 038). Conclusion Acute large artery occlusive cerebral infarction treated with the intra-arterial multi-interventional modes may quickly and effectively restore intracranial blood flow. It has the characteris-tics of high recanalization rate and good prognosis,and the higher the level of recanalization,the better the prognosis. Diabetes is an independent risk factor for poor prognosis.
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Objective To investigate the correlation between different blood pressure levels and carotid atherosclerotic plaque formation.Methods The population participated in stroke screening were selected from September 2012 to January 2013 in Dongying,Shandong province.The subjects met the diagnostic criteria of ideal blood pressure (systolic blood pressure [SBP] ＜ 120 mm Hg and diastolic blood pressure [DBP] ＜80 mm Hg,1 mm Hg =0.133 kPa),normotensive (SBP 120-129 mm Hg and/or DBP 80-84 mm Hg),and high-normal blood pressure (SBP 130-139 mm Hgand/or DBP 85-89 mm Hg)were selected.The questionnaires,physical examinations,blood biochemical tests,and neck vascular ultrasound examination were performed.The detection rates of carotid plaque among the normotensive,high-normal blood pressure and ideal blood pressure groups were compared.Multivariatelogistic regression analysis was used to identify the independent risk factors for carotid plaque.Results The proportions of men and diabetes,as well as the levels of body mass index (BMI) and fasting blood glucose (FBG) of the normotensive and high-normal blood pressure groups were significantly higher than those of the ideal blood pressure group (all P ＜0.05).The detection rates of carotid plaque of the normotensive,high-normal blood pressure and ideal blood pressure groups were 12.41％,38.14％ and 49.45％,respectively.The proportions of men and age,as well as the levels of SBP,FBG,and homocysteine (Hcy) of the carotid plaque formation group were significant higher than those of the non-carotid plaque formation group (all P ＜0.05).Multivariable logistic regression showed that age,SBP,FBG,and Hcy were the independent risk factors for carotid atherosclerotic plaque formation,while female gender was an independent protective factor.After adjusting the risk factors such as age,FBG,and Hcy,etc,the risk of plaque formation of the high-normal blood pressure group was significantly higher than that of the ideal blood pressure group (odds ratio 1.354,95％ confidence interval 1.028-1.783; P =0.031),while there was no significant difference between the normotensive group and the ideal blood pressure group.Conclusions High-normal blood pressure was significantly associated with the increased risk of carotid plaque formation,which was an independent risk factor for carotid plaque formation.