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Objective To investigate the reversibility of ischemic core defined by CT perfusion imaging in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis within different time windows and influencing factors.Methods The data of AIS patients who received intravenous thrombolysis in the Department of Neurology of Lishui People's Hospital from May 2016 to December 2018 were retrospectively reviewed.All patients had finished multi-model CT imaging before thrombolysis and multi-model MRI examination 24-48 hours after thrombolysis.The baseline ischemic core volume (hypoperfusion area with relative cerebral blood flow (rCBF)＜30％) was quantitatively assessed based on CT perfusion images using MIStar software,and the final ischemic core volume was assessed based on diffusion weighted imaging acquired 24-48 hours after thrombolysis.The reversibility of ischemic core was defined as baseline ischemic core volume-the final infarct volume ≥5 ml.Then the clinical and imaging features of the patients between reversible group and irreversible group were compared,and the predictors of ischemic core reversibility were analyzed by binary Logistic regression analysis.Results Finally,97 patients were enrolled in the present study,of which 64 (66％) patients achieved successful recanalization,51 (53％) patients with reversible baseline ischemic core.For patients with recanalization,the incidence of reversibility was 76％ (26/34),71％ (17/24),2/5 and 0 (0/1) in patients with time window from onset to thrombolysis (ONT) ＜3.0 h,3.0-4.5 h,4.6-6.0 h,and ＞6.0 h,respectively.In the non-recanalization group,six patients were also showed with ischemic core reversibility,including 4 (4/12) in the ONT＜3.0 h group and 2 (2/12) in the ONT 3.0-4.5 h group.It was found that the reversible volume was positively correlated with baseline ischemic core volume (r=0.805,P＜0.001) by Spearman correlation analysis.Finally,binary Logistic regression analysis revealed that the history of hypertension,ONT and recanalization were independent predictors of reversible changes of baseline ischemic core.Conclusions The ischemic core defined by CT perfusion imaging (rCBF＜30％) was considerably inaccurate for patients with ONT＜6.0 h.If recanalization could be achieved within this time window,most of the patients would manifest with ischemic core reversibility,the predictors of which also included hypertension history and ONT.
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Objective@#To investigate the reversibility of ischemic core defined by CT perfusion imaging in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis within different time windows and influencing factors.@*Methods@#The data of AIS patients who received intravenous thrombolysis in the Department of Neurology of Lishui People′s Hospital from May 2016 to December 2018 were retrospectively reviewed. All patients had finished multi-model CT imaging before thrombolysis and multi-model MRI examination 24-48 hours after thrombolysis. The baseline ischemic core volume (hypoperfusion area with relative cerebral blood flow (rCBF)<30%) was quantitatively assessed based on CT perfusion images using MIStar software, and the final ischemic core volume was assessed based on diffusion weighted imaging acquired 24-48 hours after thrombolysis. The reversibility of ischemic core was defined as baseline ischemic core volume-the final infarct volume ≥5 ml. Then the clinical and imaging features of the patients between reversible group and irreversible group were compared, and the predictors of ischemic core reversibility were analyzed by binary Logistic regression analysis.@*Results@#Finally, 97 patients were enrolled in the present study, of which 64 (66%) patients achieved successful recanalization, 51 (53%) patients with reversible baseline ischemic core. For patients with recanalization, the incidence of reversibility was 76% (26/34), 71% (17/24), 2/5 and 0 (0/1) in patients with time window from onset to thrombolysis (ONT) <3.0 h, 3.0-4.5 h, 4.6-6.0 h, and >6.0 h, respectively. In the non-recanalization group, six patients were also showed with ischemic core reversibility, including 4 (4/12) in the ONT<3.0 h group and 2 (2/12) in the ONT 3.0-4.5 h group. It was found that the reversible volume was positively correlated with baseline ischemic core volume (r=0.805, P<0.001) by Spearman correlation analysis. Finally, binary Logistic regression analysis revealed that the history of hypertension, ONT and recanalization were independent predictors of reversible changes of baseline ischemic core.@*Conclusions@#The ischemic core defined by CT perfusion imaging (rCBF<30%) was considerably inaccurate for patients with ONT<6.0 h. If recanalization could be achieved within this time window, most of the patients would manifest with ischemic core reversibility, the predictors of which also included hypertension history and ONT.
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<p><b>OBJECTIVE</b>To evaluate the collateral flow in patients with ischemic stroke due to acute basilar artery occlusion by dynamic CT angiography and to predict the outcome after reperfusion therapy.</p><p><b>METHODS</b>Forty-five patients with stroke due to acute basilar artery occlusion undergoing reperfusion treatment in the Second Affiliated Hospital of Zhejiang University School of Medicine during January 2012 and August 2016 were retrospectively reviewed. Univariate and binary logistic regression model were used to identify the independent predictors of patient's outcome, and the receiver operating characteristic (ROC) curve was used to determine the optimal threshold of the posterior circulation collateral score (PC-CS) in predicting the prognosis of the patients.</p><p><b>RESULTS</b>Binary logistic regression analysis indicated that the baseline National Institutes of Health Stroke Scale (NIHSS) score (=0.886, 95%:0.802-0.979,<0.05) and PC-CS (=1.962, 95%:1.026-3.752,<0.05) were independent predictors of patient's outcome, and PC-CS 4.5 was the optimal threshold (AUC:0.837, sensitivity of 68.2%, specificity of 87.0%).</p><p><b>CONCLUSIONS</b>Dynamic CT angiography based on CT perfusion imaging can be used to evaluate collaterals in posterior circulation, and to predict clinical outcome after reperfusion therapy in patients with acute basilar artery occlusion.</p>
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<p><b>OBJECTIVE</b>To investigate the association of serum folate level with the severity of white matter hyperintensity (WMH) and presence of cerebral microbleeds (CMB).</p><p><b>METHODS</b>Clinical data of WMH patients from the second affiliated Hospital, Zhejiang University school of Medicine during July 2011 and February 2016 were retrospectively reviewed. According to Fazekas score based on T2-Flair images, patients were classified into mild WMH (0-3) and severe WMH (4-6). The presence of CMB was assessed on susceptibility weighted imaging (SWI). Binary logistic analysis was conducted to identify the independent predictors for severe WMH and the presence of CMB.</p><p><b>RESULTS</b>Two hundred and twenty eight patients with WMH were included, among whom 149(65.35%)had severe WMH. In patients with high folate (≥ 15.68 nmol/L), low folate (6.8-15.67 nmol/L) and folate deficiency (<6.8 nmol/L), the proportions of severe WMH were 52.88%, 73.33% and 89.47%, respectively. Binary logistic regression analysis revealed that compared with high folate group, severe WMH was more common in groups with low folate (=2.109, 95%:1.112-4.001,<0.05) and folate deficiency (=6.383, 95%:1.168-34.866,<0.05). Eighty-eight(48.09%) of 183 patients receiving SWI scan presented with CMB. Although the subjects with CMB had lower serum folate level than those without CMB(13.42 vs 16.51 nmol/L,<0.01), binary logistic regression analysis did not reveal the independent association between serum folate level and the presence of CMB after adjusting for hyperhomocysteinemia (>0.05).</p><p><b>CONCLUSIONS</b>Lower serum folate level is independently associated with severe WMH, but not with the CMB concurrence.</p>
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<p><b>OBJECTIVE</b>To investigate the effect of tirofiban on hemorrhagic transformation and neurological outcome in patients with acute cerebral infarct treated with endovascular therapy.</p><p><b>METHODS</b>One hundred and fifteen patients with acute cerebral infarct who received endovascular stent mechanical thrombectomy in the Second Affiliated Hospital, Zhejiang University School of Medicine during October 2013 and April 2017 were included in the study. Among 115 patients, 30 received tirofiban treatment. Hemorrhagic transformation and neurological outcomes were assessed using the ECASS Ⅱ criteria and modified Rankin scale (mRS), respectively. Unfavorable outcome was defined as mRS>2. Binary logistic regression model was used to analyze the independent predictors of hemorrhagic transformation and neurological outcome.</p><p><b>RESULTS</b>Binary logistic regression analysis showed that tirofiban treatment did not increase the risk of hemorrhagic transformation (=0.437, 95%:0.168-1.132,>0.05); baseline NIHSS (=1.136, 95%:1.014-1.273,<0.05), recanalization (=0.060, 95%:0.010-0.365,<0.01), hypertension (=4.233, 95%:1.320-13.570,<0.05) and onset to treatment time(=1.006, 95%:1.001-1.011,<0.05) were independently associated with unfavorable outcome, while such association was not observed in tirofiban treatment (=1.923, 95%:0.536-6.568,>0.05).</p><p><b>CONCLUSIONS</b>Tirofiban appears to be safe for patients with acute cerebral infarct receiving endovascular therapy.</p>
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Objective: To explore the safety and efficacy of intravenous thrombolysis therapy with tissue plasminogen activator ( tPA) in aged acute ischemic stroke patients. Methods:The patients treated with intravenous tPA were analyzed and divided into≥80-year group (n=16) and 0. 05). ② No significant difference was found in favorable prognosis between the two therapy groups 90 days after thrombolysis (P=0. 771), while very bad prognosis rate was higher in the≥80-year group than in the 0. 05). Conclusion:It is safe and effective for old patients to receive IV-tPA throm-bolysis therapy.
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Objective To investigate the prevalence of chronic kidney disease (CKD) in patients with acute stroke and the risk factors and prognostic characteristics in these patients.Methods A total of 270 consecutive hospitalized patients with acute stroke was recruited, and their CKD was evaluated transversally. Various risk factors and short-term prognosis of 53 patients with CKD whose National Institutes of Health Stroke Scale (NIHSS) scores were similar at admission among the 270 patients with stroke were compared to those of 106 patients without CKD. CKD was defined as glomerular filtration rate (GFR) ＜ 60 ml/(min·1.73 m2) and (or) random urinary albumin-to-creatinine ratios (ACR) ＞ 30 mg/g, and continued for more than 3 months. GFR was estimated according to the simplified Modification of Diet in Renal Disease (MDRD) equation, The modified Rankin Scale (mRS) was used to evaluate the shortterm prognosis. Results The prevalence of CKD in these patients was 19.6%, and most of them were early-and middle-stage CKD. The proportions of the histories of hypertension (81.13%), diabetes mellitus (33.96%), and stroke (45.28%) in patients with CKD were significantly higher than those in patients without CKD (64.15%, 18.86% and 27.36%,respectively, all P＜0.05). The mean levels of systolic pressure (151.74±20.98 mm Hg) and low density lipoprotein (3.03±0.96 mmol/L) in patients with CKD were significantly higher than those in patients without CKD (systolic pressure was 144.44±21.13 mm Hg, and low density lipoprotein was 2.75±0.76 mmol/L, all P＜0.05). In addition, the levels of erythrocytes sedimentation rate(median, 39 mm/h), high sensitive C-reactive protein (median,5.12 mg/L) and parathyroid hormone (81.01±26.78 pg/ml) were significantly higher than those in patients without CKD (they were 20 mm/h, 3.36 mg/L, and 46.95±24.63 pg/ml,respectively, all P＜0.05). There was a changing trend in low serum calcium and high serum phosphorus in patients with CKD. The proportion of the patients whose mRS score ≥ 3 at 3 months after the onset in patients with CKD was significantly higher than that in patients without CKD (66.03% vs 46.23%, P＜0.05). The mortality at 3 months (9.43%) also had an increasing tendency (P=0.073). Conclusions The prevalence of CKD was higher among the stroke population, and most of them were early-and middle-stage CKD. The stroke patients with CKD had more risk factors and worse prognosis than those without.