ABSTRACT
Objective:To investigate the clinical characteristics of acute ischemic stroke with anterior circulation large vessel occlusion caused by cardioembolism (CE) and large artery atherosclerosis (LAA) and the efficacy of endovascular treatment.Methods:Patients with acute ischemic stroke caused by large vessel occlusion in anterior circulation and received endovascular treatment in the Stroke Center of the 971 st Hospital of the PLA Navy from April 2014 to April 2021 were retrospectively enrolled. The etiological classification of stroke was CE or LAA. According to the modified Rankin Scale score at 90 d after onset, the patients were divided into good outcome group (0-2) and poor outcome group (>2). The demographic and clinical data between the groups were compared. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome. Results:A total of 106 patients were enrollded. Their age was 61.39±13.73 years and 70 (66.0%) were males. Seventy-four patients (69.8%) were in the CE group and 32 (30.2%) were in the LAA group. Sixty-six patients (62.3%) had good outcomes. Univariate analysis showed that there were significant differences in gender, age, smoking, systolic blood pressure, diastolic blood pressure, baseline National Institutes of Health Stroke Scale (NIHSS) score, time from onset to femoral artery puncture, time from puncture to vascular recanalization, and the number of retrieval attempts between the CE group and the LAA group (all P<0.05), and there were no significant differences in the incidences of poor outcome, hemorrhagic transformation, and symptomatic intracranial hemorrhage. There were significant differences in systolic blood pressure, diastolic blood pressure, baseline NIHSS score, time from onset to femoral artery puncture, and blood perfusion grade after treatment between the good outcome group and the poor outcome group (all P<0.05). Multivariable logistic regression analysis showed that higher systolic blood pressure (odds ratio [ OR] 1.046, 95% confidence interval [ CI] 1.014-1.078; P=0.004), higher baseline NIHSS score ( OR 1.117, 95% CI 1.037-1.203; P=0.003), longer time from onset to femoral artery puncture ( OR 1.008, 95% CI 1.001-1.015; P=0.019) and poor blood perfusion after treatment ( OR 8.042, 95% CI 1.532-42.215; P=0.014) were significantly and independently associated with the poor outcomes. Conclusions:Compared with LAA, CE do not increase the risks of hemorrhagic transformation and symptomatic intracranial hemorrhage. The safety and efficacy of the two are similar.
ABSTRACT
In addition to causing high disability and high fatality rates, ruptured intracranial aneurysms can also cause cognitive impairment. Although preventive surgical treatment can avoid intracranial aneurysm rupture and bleeding, patients may still have a certain degree of cognitive impairment, even in patients with good clinical recovery after surgery. There is no systematic review on the effect of different surgical methods on cognitive function, and the best surgical method is still inconclusive. This article reviews the cognitive impairment in patients with intracranial aneurysm, hoping to provide a basis for clinical treatment decisions.
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Objective To evaluate the safety and efficacy of endovascular treatment of posterior communicating artery (PCoA) aneurysms with fetal posterior cerebral artery (fPCA). Methods From January 2015 to December 2017,55 consecutive patients with PCoA aneurysm with fPCA (57 aneurysms) treated at the Department of Neurosurgery, First Hospital Affiliated to Naval Military Medical University were enrolled retrospectively. All aneurysms were treated with endovascular treatment, including 27 aneurysms treated with coils alone and 30 treated with stent-assisted embolizatioa The immediate degree of embolization after procedure was assessed according to the Raymond grade. Imaging follow-up was performed using DSA or MR angiography, and the clinical prognosis was followed up by the outpatient and/or telephone. The prognosis was assessed using the modified Rankin scale (MRS) score. Results Of the 55 patients ,41 (74. 5% ) had subarachnoid hemorrhage. Immediate post-operative angiography revealed that 21 aneurysms (36. 8% ) were Raymond grade 1,11 aneurysms (19. 3% ) were Raymond grade E ,and 25 aneurysms (43. 9% ) were Raymond grade HI. All the PCoAs were patent Three patients (5.5%) had perioperative complications, they were operation-related bleeding.no ischemic events occurred,and 3 patients died. Thirty-nine patients with 41 aneurysms were followed up with imaging, of which 26 (63. 4% ) were cured, 1 (2. 4% ) were improved,8 ( 19. 5% ) were stable, and 6 (14. 6% ) recurred ( all treated with coils alone). All PCoAs with fPCA remained patent during the follow-up. Of the 52 patients who were clinically followed up,2 died and the aneurysm of 1 ease reruptured one year after procedure. The follow-up MRS score was 0-2 in 47 cases (90.4% ) ,3 in 1 case,4 in 1 case,5 in 1 case,and 6 in 2cases. Conclusion Endovascular treatment of PCoA aneurysms with fPCA is feasible and effective.
ABSTRACT
Spontaneous recanalization after chronic occlusion of internal carotid artery (ICA) is a rare phenomenon, and its mechanism is not clear. This article reports a case of chronic occlusion of the extracranial segment of the right ICA. The right ICA occlusion was confirmed by the DSA and one year later, DSA showed the recanalization of occlusion ICA with tandem stenosis of the origin and the proximal petrosal segment. Carotid artery stenting was successfully performed, and postoperative angiography showed that the right ICA was patent and the stenosis was obviously improved. Therefore, drug therapy could be continued when artery lumen was completely normal or slightly narrow after spontaneous recanalization of chronic internal carotid artery occlusion;carotid endarterectomy or carotid artery stenting may be considered for tandem stenosis or severe stenosis with high risk of ischemic events.