ABSTRACT
Cerebrovascular diseases such as intracranial atherosclerosis, intracranial aneurysm and ischemic stroke have become the important causes of death and disability. The structural and functional changes of cerebrovascular, which are caused by various pathogenic factors, are the common pathophysiological basis of cerebrovascular diseases. At present, the etiology of cerebrovascular diseases has not been clarified. Growing evidence suggests that matrix metalloproteinases play an important role in the occurrence and development of cerebrovascular diseases. Blocking or inhibiting the expression of matrix metalloproteinases provides a new theoretical basis for non-invasive treatment of cerebrovascular diseases. This review discusses the relationship between matrix metalloproteinases and cerebrovascular diseases.
ABSTRACT
Objective To explore the influencing risk factors of perioperative technical complications and clinical prognosis of stent-assisted coiling (SAC) for acute (≤28 d) ruptured intracranial aneurysm (RIA). Methods Acute RIA patients, who received SAC treatment in Changhai Hospital of Naval Medical University (Second Military Medical University) between Jan. 2012 and Jun. 2018, were retrospectively enrolled. The clinical and imaging data were analyzed using univariable analysis and multivariate logistic regression analysis to identify the potential risk factors of perioperative technical complications and clinical prognosis. Results A total of 509 acute RIA patients (170 males and 339 females), who underwent SAC treatment and received 30-d follow-up, were included in this study. Perioperative ischemic complications occurred in 28 cases (5.5%), and multivariate regression analysis showed that the location of aneurysms at the bifurcation of blood vessels was an independent risk factor of ischemic complications (odds ratio [OR]＝4.108, P＝0.001). Perioperative hemorrhagic complications occurred in 25 cases (4.9%), and multivariate regression analysis showed that age60 years was an independent risk factor of hemorrhagic complications (OR＝3.574, P＝0.014). The modified Rankin scale (mRS) scores of 81 patients (15.9%) ranged from 3 to 5 at discharge, 27 patients (5.3%) died with mRS score of 6, and the poor prognosis (mRS score2) rate was 21.2% (108/509). Multivariate regression analysis showed that age≥80 years, Hunt-Hess 3-5 class, perioperative ischemic complications, perioperative hemorrhagic complications and poor Glasgow coma scale (GCS) score were independent risk factors of poor prognosis (all P0.01). Conclusion For the acute RIA patients treated with SAC, the location of aneurysms at the vascular bifurcation is an independent risk factor of perioperative ischemic complications; age60 years is an independent risk factor for hemorrhagic complications; and the patients with poor GCS score at admission have a poor prognosis at discharge, and perioperative ischemic and hemorrhagic complications are independent risk factors of poor prognosis.