Differentiation of stroke subtype classification by ASCO and modified TOAST / 中华神经科杂志

ObjectiveTo compare the differences in stroke subtype classification between ASCO and modified TOAST.MethodsAll 425 first-ever ischemic stroke patients were recruited and classified into different stroke subtypes according to the ASCO and modified TOAST criteria.Results Comparing ASCO grade 1 with modified TOAST,more patients were classified as atherosclerosis (60.2％ vs 57.9％ ; x2 =2.68,P=0.132) and fewer as small artery disease and cardiac disease subtype (13.4％ vs 14.8％ and 8.5％ vs 8.7％ ; x2 =1.30 and 0.00,P =0.238 and 1.000,respectively).ASCO grade 1 did not reduce the proportion of cause undetermined patients compared with modified TOAST ( 15.5％ vs 16.2％ ; x2 =0.09,P =0.795 ). Agreement was showed in every subtype categories between the two approaches.Agreement for atherosclerotic cause and small artery disease was very good ( all κ over 0.81 ),and for the cardiac disease subtype was good (κ: 0.61-0.80). Conclusion Agreement can be found in every subtype categories between ASCO and modified TOAST classification.ASCO grade 1 does not reduce the proportion of cause undetermined cases compared with modified TOAST,but the subtype categories characteristics of the two approaches should be considered in practice.

Clinical study on in-stent restenosis after middle cerebral artery wingspan stenting / 中国基层医药

Objective To observe long-term follow-up results of in-stent restenosis by digital subtraction angiography(DSA) method after angioplasty and stenting with the Gateway-Wingspan stenting system in middle cerebral artery(MCA).Methods Consecutive patients with ischemic stroke and Wingspan stent placement were enrolled into our study.The proportion of in-stent restenosis and ischemic stroke associated with restenosis were evaluated by DSA after 6 and 12 months of stent placement.Results 30 patients with stenosis/occlusion of MCA underwent Wingspan Stent successfully.All of the patients finished follow-up except two patients(6.7％ ) who died in the first three months after stenting.At the sixth months follow-up,in-stent restenosis was observed in 7 patients( 23.3％ ) with average (69.0 ± 9.8 )％ in-stent restenosis degree.However,no additional in-stent restenosis was found at the twelfth month,two patients among the 7 with in-tent restenosis were suffered with artery occlusion in stent.Conclusion In-stent restenosis after Wingspan stenting in middle cerebral artery was more common during the first six months,and 85.7％ with ischemic stroke.It was worthy of paying attention to prevent in-stent restenosis at the first six months after stenting.