ABSTRACT
Objective To investigate the relationship between intracranial atherosclerotic plaque stability and stroke recurrence risk.Methods Forty-eight patients with acute ischemic stroke caused by intracranial atherosclerosis in Guangdong Province Hospital of TCM were analyzed retrospectively.After the Essen Stroke Risk Scale (ESRS) was used to assess the risk factors for the patients,they were divided into either an ESRS ≥3 group (n=21 in the high-risk recurrence group) or an ESRS <3 group (n=27 in the low-risk recurrence group).Both groups of patients underwent high-resolution MR imaging (HR-MRI) examinations of the intracranial guilty vessels (basilar artery or unilateral middle cerebral artery).According to the signal intensity of HR-MRI on the T1-weighted imaging,T2-weighted imaging,and T1 fat suppression sequences,the intracranial atherosclerotic stable plaques and unstable plaques were distinguished.The stabilization of intracranial atherosclerotic plaques was compared in patients of both groups.Results There were significant differences in the age and incidences of hypertension,diabetes mellitus,and unstable plaques in patients of both groups (P<0.05).Further multivariate logistic regression analysis of the four factors showed that the age,hypertension,diabetes,and intracranial atherosclerotic unstable plaques were the high-risk factors for recurrent ischemic stroke (ORs,87.114,159.423,8.942,and 11.551,respectively;95%CIs 4.218-1 799.078,3.235-7 855.957,1.054-75.857,and 1.011-132.043,respectively;all P<0.05).Conclusion In addition to the traditional risk factors such as age,hypertension,and diabetes,the intracranial atherosclerotic unstable plaque is an independent risk factor for high-risk recurrence of ischemic stroke.
ABSTRACT
Objective To investigate the roles of Xenon-CT cerebral blood flow perfusion imaging in cerebral revascularization before surgery and efficacy evaluation.Methods The clinical data of 15 patients with symptomatic cerebral artery stenosis/occlusion of anterior circulation were analyzed retrospectively.Eight patients were treated with endovascular stenting,1 was treated with internal carotid endarterectomy,and 6 were treated with superficial temporal artery-middle cerebral artery bypass grafting.The regional cerebral blood flow (rCBF) detected by Xenon CT within 2 weeks before and after procedure and the modified Ranking scale (mRS) scores at 6 months after procedure were compared.Results (1) The mean rCBF value of 12 patients with abnormal blood perfusion of target vessels before procedure was 30±10 ml/(100 g·min) and that was 32±14 ml/(100 g·min) after procedure.Compared with before procedure,the difference was statistically significant (P0.05).(2) The postoperative mRS score was decreased in 8 cases and stable in 7 cases.Compared with before procedure,there were significant differences in mRS scores after procedure in 15 cases (P<0.05).During the follow-up period,none of the patients had new neurological impairment.Conclusion Revascularization can improve the presence of hemodynamic disorders in patients with symptomatic anterior circulation cerebral artery stenosis or occlusion of the target blood vessels in the distal local cerebral perfusion and neurological deficit symptoms.The patients with abnormal perfusion of preoperative Xenon-CT cerebral blood flow perfusion imaging may be more beneficial than those with normal perfusion.
ABSTRACT
Objective To investigate the relation between the balloon occlusion test ( BOT) and the anatomy of the circle of Willis ( CW) , and to explore the role of balloon occlusion test in the treatment of internal carotid artery permanent occlusion. Methods Selected the clinical data of 49 patients (52 sides) who had BOT in our hospital from October 2009 to June 2015,and analyzed the relationship be-tween the occurrence rate of anterior communicating artery ( AcoA) / posterior communicating artery ( PcoA) and the positive rate of BOT retrospectively. Results The occurrence rate of the AcoA was 97. 9%, and the occurrence rate of PcoA in one side was 82. 7%. Negative rate BOT accounted for 92. 3% and AcoA occurred in all, while the positive rate accounted for 7. 7%, including 2 cases of right superior ar-teria cerebri anterior combined with ipsilateral PcoAs absence, 1 case of left superior arteria cerebri anterior combined with ipsilateral PcoAs absence, and 1 case of AcoA and PcoAs absence. Conclusion Before the permanent occlusion of the internal carotid artery, it’ s necessary to clarify the redistribution of the compensatory way of blood flow in the AcoA-absent cases. Implementing permanent occlusion for cases with complete circle of Willis would cause less ischemic risk.
ABSTRACT
Objective To investigate the clinical manifestations, angiographic features and clinical significance of kinking of extracranial internal carotid artery (ICA). Methods The clinical and radiological data of 21 patients with kinking of extracranial ICA were retrospectively reviewed in our hospital from April 2003 to July 2007. Fisher exact test was performed. Results Of the 21 patients, 7 hod no clinical symptoms, the other 14 showed manifestations of cerebral iachemia with varying degree. One of the characteristic clinical manifestations that neck rotation or specific positions of head and neck might induce the occurrence of clinical symptoms was found in 5 cases. The whole-brain coverage DSA accurately showed the location of kinking of extracranial ICA and the degree of vascular stenosis. In patients with α < 66%, 80% > α≥ 66% and α≥ 80%, clinical symptoms were found in 3 out of 5,7 out of 10 and 4 out of 6 patients, respectively. Fisher exact test revealed that the positive rates of clinical symptoms in three groups had no significant difference (P > 0. 05). Conclusion Kinking of extracranial ICA is a frequent vascular morphologic variation, and it is also a kind of potential disease. The whole-brain coverage DSA is a relatively reliable method to detect this variation.
ABSTRACT
Objective To evaluate the short-term outcome of local intraarterial thrombolysis in patients with acute ischemic stroke of the anterior circulation. Methods 24 patients with acute ischemic stroke of the anterior cir-culation within 8 hours were treated by local intraarterial thrombolysis. Arterial recanalization was divided into total, partial and occlusive respectively according to angiography. Evaluation of clinical outcome was performed on the 30th day after thrombolysis,and was classified as good for Modified Rankin Scale (MRS) scores of 0 to Ⅲ and poor for MRS scores of Ⅳ to Ⅵ. Results Total recanalization was obtained in 54.2 % of patients, partial recanalization in 25.0%. Clinical outcome was good in 15 patients (62.5%). Cerebral hemorrhage occurred in 4 patients (16.7%). Four patients died (16.7%). Conclusion Local intraarterial thrombolysis is an effective method for treatment of a-cute iachemic stroke of the anterior circulation. It needs further practice and long-term follow-up study on safety and long-term efficacy.