ABSTRACT
Objective To preliminarily investigate the safety and feasibility of intra-arterial cold saline infusion combined with intravascular reperfusion for acute ischemic stroke with large artery occlusion. Methods From March 2016 to March 2018, consecutive acute ischemic stroke patients with large artery occlusion within 8 h after onset admitted to the Department of Neurology, the People's Hospital of Longhua District, Shenzhen and recanalized successfully after endovascular treatment were enrolled. After recanalization, cold saline was infused through the guiding catheter via the ipsilateral guilty vessel (10 ℃, 33 ml/min for 30 min). Results A total of 20 patients were enrolled, including 15 males. Their median age was 67 years (interquartile range, 53-80 years). Fifteen patients were treated with thrombolysis. A median onset-to-needle time was 300 min (interquartile range, 260-360 min). During the infusion of cold saline, the lowest rectal temperature was only decreased 0. 1 ℃, but within 5 min after completion of perfusion, it returned to the temperature before perfusion. Complications associated with intra-arterial hypothermia were not observed. The median National Institutes of Health Stroke Scale score was significantly decreased from 21 (interquartile range 15-55) before needle to 15 (interquartile range 10-16; Z = -4. 549, P < 0. 001) at discharge. Conclusion Selective intra-arterial cold saline infusion combined with intravascular reperfusion for acute ischemic stroke with large artery occlusion is safe and feasible.
ABSTRACT
Objective To explore the optimal electrophysiologieal approach for detecting Riehe-Cannieu anastomosis(RCA),an anomalous anastomosis between the deep branch of ulnar nerve and the recurrent branch of the medial nerve in the palm of the hand,and to estimate its incidence. Methods One hundred subjects(56 male,44 female,mean age 37.8 years)without any hand motor or sensory dysfunction were selected randomly.The ulnar nerve was stimulated at both the elbow and wrist,and recordings were made from the abductor pollicis brevis,which is normally innervated by the medial nerve,to document any compound muscle action potentials(CMAP).CMAP recorded from both points during stimulation is an accepted indicator of RCA.Group A comprised 40 hands of 20 subjects,while group B included 160 hands of 80 subjects.Surface electrode stimulation was used in both groups.Surface and needle electrode recording was used in group A,while only needle electrode recording was used in group B.Results In group A,31 hands of 16 subjects were found to have RCA by means of surface electrode recording,but only 6 hands of 3 subjects were found to have RCA by means of concentric needle electrode recording.There was a difference of up t0 80.6% between results obtained by the 2 recording methods.In group B,35 hands of 20 subjects were found to have RCA.A total of 41 hands of 23 subjects among the 100 were found to have RCA when concentric needle electrode recording was used(20.5%incidence). Conclusion The type of recording electrode influences the accuracy of RCA examination.An accurate and reliable result can be obtained by using a concentric needle electrode.The abductor pollicis brevis can be anomalously innervated by the ulnar nerve because of RCA.When both the medial and ulnar nerve have been injured.RCA might result in anomalous clinical symptoms and electrophysiological findings.Thoroughly understanding this anomaly is of crucial importance in the clinical evaluation and diagnosis of medial or ulnar nerve injury,as well as to avoid mistakenly interpreting the electrophysiological data when Riche-Cannieu anastomosis is present.