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【Objective】 To observe the safety and effectiveness of endovascular treatment for mild stroke patients with acute anterior circulation large vessel occlusion. 【Methods】 The retrospective study enrolled 38 mild stroke patients with anterior circulation large vessel occlusion who received endovascular thrombectomy (EVT) at The First Affiliated Hospital of Xi’an Jiaotong University between January 2018 and August 2021. Vascular recanalization rate after endovascular treatment (mTICI≥2b), procedural complications, NIHSS score at discharge, and the rate of good modified Rankin Score (mRS≤2) at 90d were observed. 【Results】 The average age of the 38 patients was 62.89±12.41 years, and there were 21 males (55.3%). The vascular recanalization rate post EVT was 100%, while with three cases of thrombosis escape (7.9%) and one case (2.6%) of sICH of 24 h post EVT. The average NIHSS at discharge was 1 (0-1) point, which significantly decreased compared to the average baseline NIHSS 4 (4-5) points (P<0.01). The 90 d followed-up rate was 89.47%, and among all the followed-up patients, 91.2% of them had mRS≤2. Imaging follow-up showed good vascular flow and no in-stent restenosis. 【Conclusion】 Endovascular treatment for acute anterior circulation large vessel occlusion in mild stroke is safe and effective.
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Objective:To investigate the correlation between the level of serum 25-hydroxyvitamin D [25(OH)D] and infarction volume in patients with acute ischemic stroke (AIS) with internal carotid artery system (anterior circulation).Methods:A prospective cohort study was conducted. Patients with AIS admitted to the department of emergency of Beijing Boai Hospital from October 2017 to September 2019 were enrolled. Nutritional risk screening 2002 (NRS 2002) were assessed in all cases within 24 hours after enrollment. Fasting venous blood was collected for biochemical analysis, including albumin (ALB), homocysteine (HCY), uric acid (UA), hypersensitive C-reactive protein (hs-CRP), etc. Serum 25(OH)D level was detected by electrochemiluminescence immunoassay. Magnetic resonance imaging (MRI) was performed to calculate the volume of cerebral infarction. According to the volume of cerebral infarction, the patients were divided into small volume (≤ 1 cm 3) group, medium volume (1 cm 3 < infarct volume < 20 cm 3) group and large volume (≥20 cm 3) group. The differences of serum 25(OH)D and other indicators in each group were compared; the influencing factors of infarct volume were analyzed by Logistic regression; and the goodness of fit of regression model was tested by Hosmer-Lemeshow (HL). Results:A total of 224 patients with AIS were enrolled, 92 in small volume group, 90 in medium volume group and 42 in large volume group, and there was no significant difference in serum 25(OH)D level among small, medium and large volume groups [μg/L: 13.21 (7.47, 19.33), 11.20 (7.00, 15.07), 9.19 (6.30, 17.10), H = 4.994, P = 0.082]. There were 124 patients with AIS in anterior circulation, 45, 56 and 23 patients in the small, medium and large volume groups, respectively, with the increase of the cerebral infarction volume, the serum 25(OH)D level in small, medium and large volume groups decreased gradually, and the difference was statistically significant [μg/L: 13.22 (9.00, 19.65), 10.41 (6.72, 14.92), 8.30 (4.70, 11.30), H = 11.068, P = 0.004]. In addition, with the increase of the cerebral infarction volume, the older the patients with AIS in anterior circulation [years old: 63.0 (54.0, 75.5), 76.0 (63.0, 84.0), 82.0 (67.5, 85.0), H = 14.981, P = 0.001], the higher the nutritional risk ratio (35.6%, 53.6%, 73.9%, χ2 = 9.271, P = 0.010), the higher the serum hs-CRP level [mg/L: 1.91 (0.92, 3.40), 4.10 (1.73, 22.42), 19.74 (4.02, 68.81), H = 21.477, P < 0.001], and the lower the ALB level (g/L: 42.30±12, 38.11±5.06, 35.14±5.49, F = 19.347, P < 0.001). After adjusting for age, gender, atrial fibrillation, nutritional risk, hs-CRP and other confounding factors, serum 25(OH)D was an independent protective factor for the infarct volume of AIS in anterior circulation [odds ratio ( OR) = 0.962, P = 0.040], For every 10 μg/L decrease of 25(OH)D, the risk of one grade increase in infarction volume was increased by 47.7% respectively (goodness of fit: χ2 = 5.357, P = 0.719). Conclusion:The low serum 25(OH)D level was associated with the increase of infarct volume in the anterior circulation cerebral infarction, and early detection of serum 25(OH)D level can help risk stratification of AIS patients.
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Background: Pterional approach is most accepted and most common approach for clipping of intracranial anterior circulationaneurysms. This approach imparts good exposure of anterior and middle skull base. However the Pterional approach haspotential adverse effects, such as long operative time, excessive blood loss, long hospital stay, and temporal muscle atrophy.Supraorbital keyhole via eyebrow incision is a minimal invasive approach for anterior circulation aneurysm surgery. This approachhas advantages of less operative time, less blood loss, less brain retraction, short hospital stay and no temporal muscle atrophy.Objective: Objective of this study to emphasize the advantages and limitations of supra orbital key hole approach for anteriorcirculation aneurysm surgery based on our institutional experience.Material and Methods: Between September 2017 and February 2020, total 16 patients with anterior circulation aneurysmswere operated by suprorbital keyhole craniotomy approach. All patients included were ≥18 years of age with Subarachnoidhemorrhage grade 1, grade 2, grade 3 on modified fischer scale. Intra operative and postoperative parameter noted andanalyzed over a period of 3 months follow up.Results: There were good cosmetic results with less approach related complications. We achieved good recovery (4/5) onGlasgow outcome scale score 4 or 5 were achieved in 87.5% of the patients in follow period of 3 months.Conclusion: Supra orbital key hole approach is not a standard approach for all kind of anterior circulation aneurysms, it can beapplied for small sized aneurysms with SAH grade up to 3 on modified fischer scale. An thorough pre-op work up, experience,skilled hand are prerequisites for supra orbital keyhole approach in aneurysm surgery. Selection of this approach should bebased on aneurysms morphology, size of aneurysm, grade of SAH, brain edema, and the surgeon’s experience.
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Introduction: Stroke is a global health problem. In this study we evaluated the risk factors, clinical features and their correlation with Magnetic Resonance Imaging (MRI) brain including Magnetic Resonance Angiogram (MRA) and Carotid Verteberal (CV) Doppler findings in patients presenting with acute ischemic stroke. Material and methods: Seventy five patients of the age group 20 to 80 years admitted with acute ischemic stroke were enrolled for the study. A detailed history, clinical examination and blood investigations were done. MRI, MRA and CV Doppler were done in all patients. Serum Homocysteine levels and Anti-nuclear antibody assay (ANA) by Immunofluorescence (IF) were done in selected patients. Statistical analysis was done using SSPS version 16.0 for microsoft windows. Results: In this study, there were more males than females. The mean age was 59 years. Young stroke population (<40 years) was 5%. Anterior circulation was predominantly involved than posterior circulation. Right Middle Cerebral Artery was the most common artery involved. There was positive correlation for clinical presentation and area of infarct and for areas of infarct and the vessels involved. Most common clinical presentations were weakness and slurring of speech. There were 3% intracranial anomalies. 56% had significantly elevated levels of homocysteine. 24% had ANA- IF positivity. Recurrence of stroke was seen in 17%; National Institute of Health Stroke Scale (NIHSS) score was higher in patients with recurrent stroke and right hemisphere infarcts. Conclusion: There was positive correlation for clinical presentation and area of infarct and for areas of infarct and the vessels involved.
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Aim: The aim of the study is to analyze the usefulness of lamina terminalis fenestration (LTF) in hydrocephalus secondary tosubarachnoid hemorrhage while performing surgical interventions for anterior circulation aneurysm and to know the limitationsof this procedure in patients who undergo clipping of these aneurysms.Materials and Methods: A total of 81 aneurysms in 78 patients were included in this study from the year 2001 to 2018. Patientsin the age range of 12–80 years were included. Male-female ratio was 1:1.1. Until February 2011, LTF was done for 9 patientswho had any degree of hydrocephalus as an adjuvant to clipping of the anterior circulation aneurysms. After March 2011, insteadof LTF, intraoperative ventricular tapping was done in patients with hydrocephalus.Results: Among the 9 cases who had undergone LTF, two patients developed frontoparietal subdural hygromas with masseffect. From March 2011 till date after stopping LTF, only 2 of 47 patients required ventriculoperitoneal shunt who ultimatelydeveloped chronic hydrocephalus.Conclusion: LTF can lead to potential complications such as subdural hygromas due to poor absorption in blood cloggedsubarachnoid spaces. This procedure must be adopted with caution as it has its own limitations.
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Objective To investigate the MRI manifestations and analyze the prognostic factors of patients with anterior circulation minor stroke and nonGminor stroke in Qinghai plateau.Methods 41 6 cases of the first admission,including 1 9 2 patients with minor stroke and 224 patients with nonGminor stroke.MRI and MRA examinations of the head were completed in all patients within 72 h of admission.Patients were followed up for one year to observe the recurrence of stroke,and the quality of life was evaluated with the help of modified Rankin Scale (MRS)scores.Results (1)MRA showed that 36.98% of the minor stroke and 58.93% of the nonGminor stroke had the stenosis of the responsible artery at the infarction site.The difference was significant (χ2＝ 1 9.94,P＜ 0.00 1 ).(2 )MRI showed that the initial infarction sites of minor stroke and nonGminor stroke were different (χ2＝4.47 ,P＜0.005 ).(3 )The recurrence rate was 10.42% in minor stroke and 12.05% in nonGminor stroke.There was no significance between the two groups (χ2＝ 0.28,P＞0.05).(4) Among patients with poor prognostic outcomes (whose MRS≥3),there were 1 9 cases of minor stroke and 6 1 cases of nonGminor stroke,and the difference was significant (χ2＝20.00,P＜0.0 1 ).Conclusion LesionGrelated vascular stenosis in patients with minor stroke is mild and the primary infarction is more common in isolated subcortical or deep white matter.The stenosis is severe in patients with nonGminor stroke,and the infarct lesion is often subcortical with or without cortical or deep white matter.There is no difference in recurrence risk between minor stroke and nonGminor stroke.The prognosis of minor stroke is better than that of nonGminor stroke.
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Objective To investigate the prognostic influence factors of Solitaire stent thrombectomy in patients with acute anterior circulation macrovascular occlusion. Methods From March 2015 to March 2017,222 consecutive patients with acute anterior circulation macrovascular occlusion admitted to the Department of Neurosurgery,the 101stHospital of People′s Liberation Army and the Nanjing Jinling Hospital were enrolled retrospectively.They were all confirmed by DSA and were treated with Solitaire stent thrombectomy. According to the modified Rankin Scale(mRS) scores at 90 d after treatment,they were divided into a good prognosis group (0-2,n=120) and a poor prognosis group (3-6,n =102). The baseline data and clinical data of the two groups of patients were analyzed,including the risk factors for cardiocerebrovascular diseases,baseline National Institutes of Health Stroke Scale (NIHSS) score,occlusion sites (internal carotid artery or middle cerebral artery occlusion),collateral compensatory,onset to puncture time, operation time,onset to recanalization median time,recanalization status,preoperative Alberta stroke programme early CT score(ASPECTS),and symptomatic cerebral hemorrhage,and then further multivariate logistic regression analysis was conducted for the prognostic factors of patients. Results (1) The rate of good prognosis was 54.1% (120/222).There were no significant differences in patients′ age,NIHSS at admission,ASPECTS at admission,sex,hypertension,occlusion site,and rate of good collateral branches in both groups(all P<0.05).There were no significant differences in other baseline data (all P >0. 05). (2) Onset to puncture time and onset to successful recanalization median time of the patients in good prognosis group was lower than that of the poor prognosis group (182 [138,230]min vs.236[170,305]min, 237[175,269]min vs.288[223,367]min).The proportion of successful recanalization was higher than that of the poor prognosis group (98.3% [118/120] vs.78.4% [80/102]).The proportion of postoperative symptomatic intracerebral hemorrhage was lower than that of the poor prognosis group (2.5% [3/120] vs.21.6% [22/102]).There was significant difference between the two groups (all P <0.01). There was no significant difference in operative time between the two groups (P >0.05). (3)In the single factor analysis,the parameter of P <0.05 was used as an independent variable,and prognosis was used as a dependent variable,multivariate logistic regression analysis showed that the increased age (OR,1.096,95% CI 1.050-1.144),history of hypertension (OR,8.401,95% CI 2.960-23.845),increased baseline NIHSS score (OR,1.071,95% CI 1.007-1.138),prolonged onset to successful recanalization time (OR,1.019,95% CI 1.003-1.035),symptomatic intracerebral hemorrhage after procedure (OR,18.110,95% CI 4.656-70.434) were all the risk factors for poor prognosis(all P<0.05);higher ASPECTS score at admission(OR,0.641,95% CI 0.451-0.911) and successful recanalization (OR,0.127,95% CI 0.024-0.664) were all the protective factors of good prognosis (all P<0.05). Conclusions Higher ASPECTS at admission and successful recanalization were the protective factors of poor prognosis of Solitaire stent thrombectomy in patients with acute anterior circulation macrovascular occlusion.Increased age,history of hypertension,increased baseline NIHSS score,prolonged onset to successful recanalization time,and symptomatic intracerebral hemorrhage after procedure were the risk factors for poor prognosis of Solitaire stent thrombectomy in patients with acute anterior circulation macrovascular occlusion.
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Objective To investigate the relationship between the onset of cerebral infarction in anterior and posterior circulation and the "three high" risk factors in Guangzhou communities. Methods From Jan. 2014 to Jan.2016,367 patients from Guangzhou communities were diagnosed with new cerebral infarction by head diffu-sion weighted imaging(DWI).The data were divided into two groups of anterior and posterior circulation,and uni-variate and multivariate methods were used to analyze the relationship between the "three high" and other risk factors and the onset of cerebral infarction in anterior and posterior circulation.The data of anterior circulation cere-bral infarction were further divided into two subgroups of lacunar and non-lacunar infarction,and the same statisti-cal methods were employed to analyze differences of risk factors between the two subgroups. Results The frequen-cies of hypertension(P = 0.040)and large atherosclerotic infarction(P = 0.012)were significantly higher,and the serum high-density lipoprotein(HDL)level(P = 0.045)was significantly lower in posterior circulation than those in anterior circulation,respectively;and the onset of posterior circulation cerebral infarction was more associ-ated with the incidence of hypertension(OR = 1.767,P = 0.035)and the decrease of HDL(OR = 0.380,P =0.021). In anterior circulation,the levels of systolic blood pressure(SBP)(P = 0.011)and diastolic blood pres-sure(DBP)(P=0.000),as well as the frequency of large atherosclerotic infarction(P=0.000)in non-lacunar infarction subgroup were significantly higher than those in lacunar infarction subgroup respectively,and the onset of non-lacunar infarction was more closely related to increased SBP levels(OR=1.045,P=0.001). Conclusions Among the"three high"risk factors,the onset of posterior circulation cerebral infarction is more closely related to the incidence of hypertension and the decrease of HDL.In anterior circulation,and the onset of non-lacunar infarc-tion is more closely related to the increased levels of DBP and SBP,especially to the elevated levels of SBP.
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Objective To compare the treatment effect of surgically clipping anterior circulation aneurysms by lateral supraorbital approach and supraorbital keyhole approach for guiding the selection of surgical approach for anterior circulation aneurysms.Methods The clinical data of 80 patients diagnosed as anterior circulation aneurysms due to spontaneous subarachnoid hemorrhage from January 2011 to January 2016 were retrospectively analyzed,including the operation time,craniotomy time,cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge,GOS scores at discharge were compared between the two groups and the literatures were reviewed.Results The operation time and craniotomy time of the lateral supraorbital approach were less than those of the supraorbital keyhole approach,and the differences between the two groups were statistically significant (P＜0.05);the cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge and GOS scores at discharge had no statistical differences between the two groups (P＞0.05).Conclusion The lateral supraorbital approach has the advantages of shorter operation time and craniotomy time,providing a better surgical field during operation,less intraoperative traction and less postoperative complications,and can serve as an alternative scheme for the supraorbital keyhole approach in clipping anterior circulation aneurysms.
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Objective To compare the treatment effect of surgically clipping anterior circulation aneurysms by lateral supraorbital approach and supraorbital keyhole approach for guiding the selection of surgical approach for anterior circulation aneurysms.Methods The clinical data of 80 patients diagnosed as anterior circulation aneurysms due to spontaneous subarachnoid hemorrhage from January 2011 to January 2016 were retrospectively analyzed,including the operation time,craniotomy time,cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge,GOS scores at discharge were compared between the two groups and the literatures were reviewed.Results The operation time and craniotomy time of the lateral supraorbital approach were less than those of the supraorbital keyhole approach,and the differences between the two groups were statistically significant (P＜0.05);the cranial closure time,estimated intraoperative blood loss,HCT change before and after surgery,early ambulation time,postoperative hospitalization days,GCS scores at admission and discharge and GOS scores at discharge had no statistical differences between the two groups (P＞0.05).Conclusion The lateral supraorbital approach has the advantages of shorter operation time and craniotomy time,providing a better surgical field during operation,less intraoperative traction and less postoperative complications,and can serve as an alternative scheme for the supraorbital keyhole approach in clipping anterior circulation aneurysms.
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OBJECTIVE: To evaluate the efficacy of balloon guiding catheter (BGC) during thrombectomy in anterior circulation ischemic stroke. METHODS: Sixty-two patients with acute anterior circulation ischemic stroke were treated with thrombectomy using a Solitaire stent from 2011 to 2016. Patients were divided into the BGC group (n=24, 39%) and the non-BGC group (n=38, 61%). The number of retrievals, procedure time, thrombolysis in cerebral infarction (TICI) grade, presence of distal emboli, and clinical outcomes at 3 months were evaluated. RESULTS: Successful recanalization was more frequent in BGC than in non-BGC (83% vs. 66%, p=0.13). Distal emboli occurred less in BGC than in non-BGC (23.1% vs. 57.1%, p=0.02). Good clinical outcome was more frequent in BGC than in non-BGC (50% vs. 16%, p=0.03). The multivariate analysis showed that use of BGC was the only independent predictor of good clinical outcome (odds ratio, 5.19: 95% confidence interval, 1.07–25.11). More patients in BGC were successfully recanalized in internal carotid artery (ICA) occlusion with small retrieval numbers (<3) than those in non-BGC (70% vs. 24%, p=0.005). In successfully recanalized ICA occlusion, distal emboli did not occur in BGC, whereas nine patients had distal emboli in non-BGC (0% vs. 75%, p=0.001) and good clinical outcome was superior in BGC than in non-BGC (55.6% vs. 8.3%, p=0.01). CONCLUSION: A BGC significantly reduces the number of retrievals and the occurrence of distal emboli, thereby resulting in better clinical outcomes in patients with anterior circulation ischemic stroke, particularly with ICA occlusion.
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Humans , Carotid Artery, Internal , Catheters , Cerebral Infarction , Multivariate Analysis , Stents , Stroke , ThrombectomyABSTRACT
OBJECTIVE:To study clinical effect of argatroban for progressive stroke patients of different cerebral ischemic ranges. METHODS:A total of 116 progressive stroke patients selected from neurology department of our hospital during Feb. 2015-May 2016 were divided into anterior circulation (ischemia) group (n=60),posterior circulation (ischemia) group (n=50) and lacunar(cerebral infarction)group(n=6)according to cerebral ischemic ranges. They all received routine treatment combined with argatroban,and given continuous intravenous infusion of argatroban 60 mg/d on the day and 2nd day of disease aggravation, and then continuous intravenous infusion of argatroban 5th day after relieving,3 h/time,bid,7 d as a treatment course. NIHSS scores,modified RANKIN (mRS) scores,APTT and ADR were compared among 3 groups. RESULTS:Forteen days after treat-ment,NIHSS scores and mRS scores of 3 groups were decreased significantly compared to before treatment,with statistical signifi-cance (P0.05). No obvious ADR was found in 3 groups. CONCLUSIONS:Argatroban shows significant therapeutic efficacy for progressive stroke of different ischemic ranges with good safety;especially for the patients with anterior circulation ischemics stroke,the effect is quick and anticoagulant effect is significant.
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Objective To explore the Efficacy and safety of intravenous thrombolysis with different doses of rt-PA in the treatment of acute anterior circulation cerebral infarction with atrial fibrillation.Methods Retrospective analysis of 61 cases of patients with anterior circulation of cerebral infarction with atrial fibrillation from October 2009 to October 2014 in the First Affiliated Hospital of Xiamen University, the incidence within 4.5 hours of intravenous thrombolysis,and divided into two groups by rt-PA usage,19 cases in adequate group,received 0.9 mg/kg rt-PA intravenous thrombolytic therapy,42 cases in low dose group, received 0.6 mg/kg rt-PA intravenous thrombolysis.Before and after thrombolysis 1,7 and 30 days,NIHSS score was measured, the indexes of coagulation were observed at before thrombolysis and 1,7 days after thrombolysis,,CT scans were performed at 1, 7, and 14 days after thrombolysis,and Rankin (MRS) scores were compared at 90 days after thrombolysis.Results NIHSS 1,7,30 days scores of 2 groups were significantly decreased after thrombolysis(P<0.05),there was no statistically significant at at each time point after thrombolysis.Plasma prothrombin time increased significantly at 1 day and 7 days after thrombolysis,fibrinogen was significantly lower,compared with the low dose group, the difference was significant (P<0.05).There was no significant difference between the two groups in clinical outcome and mortality.The rate of mucosal bleeding in low dose group was lower than that in adequate group (P<0.05).Conclusion Low-dose rt-PA group intravenous thrombolysis with anterior circulation of atrial fibrillation is more safe,can reduce the risk of bleeding, reduce neurological deficits and improve the quality of life of patients.
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BACKGROUND AND PURPOSE: Little is known about the factors associated with in-hospital mortality following total anterior circulation stroke (TACS). We examined the characteristics and comorbidity data for TACS patients in relation to in-hospital mortality with the aim of developing a simple clinical rule for predicting the acute mortality outcome in TACS. METHODS: A routine data registry of one regional hospital in the UK was analyzed. The subjects were 2,971 stroke patients with TACS (82% ischemic; median age=81 years, interquartile age range=74–86 years) admitted between 1996 and 2012. Uni- and multivariate regression models were used to estimate in-hospital mortality odds ratios for the study covariates. A 6-point TACS scoring system was developed from regression analyses to predict in-hospital mortality as the outcome. RESULTS: Factors associated with in-hospital mortality of TACS were male sex [adjusted odds ratio (AOR)=1.19], age (AOR=4.96 for ≥85 years vs. <65 years), hemorrhagic subtype (AOR=1.70), nonlateralization (AOR=1.75), prestroke disability (AOR=1.73 for moderate disability vs. no symptoms), and congestive heart failure (CHF) (AOR=1.61). Risk stratification using the 6-point TACS Score [T=type (hemorrhage=1 point) and territory (nonlateralization=1 point), A=age (65–84 years=1 point, ≥85 years=2 points), C=CHF (if present=1 point), S=status before stroke (prestroke modified Rankin Scale score of 4 or 5=1 point)] reliably predicted a mortality outcome: score=0, 29.4% mortality; score=1, 46.2% mortality [negative predictive value (NPV)=70.6%, positive predictive value (PPV)=46.2%]; score=2, 64.1% mortality (NPV=70.6, PPV=64.1%); score=3, 73.7% mortality (NPV=70.6%, PPV=73.7%); and score=4 or 5, 81.2% mortality (NPV=70.6%, PPV=81.2%). CONCLUSIONS: We have identified the key determinants of in-hospital mortality following TACS and derived a 6-point TACS Score that can be used to predict the prognosis of particular patients.
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Humans , Male , Comorbidity , Heart Failure , Hospital Mortality , Mortality , Odds Ratio , Prognosis , Risk Factors , StrokeABSTRACT
Objective To research the clinical characteristics of cerebral infarction involving the anterior and posterior circulation in the same time. Methods Collected the clinical data of 11 patients with cerebral infarction involving the anterior and posterior circulation in the same time, who was confirmed by clinical and radiographic examination. Results In the majority of 11 patients, they had multiple risk factors in the same time. By Chinese Ischemic Stroke Subclassification (CISS) criteria, there were 3 patients with large-artery atherosclerotic brain infarction (aortic arch atherosclerosis and intracranial and extracranial large arteries atherosclerosis coexist), 3 patients with cardiogenic stroke, 3 patients with undetermined etiology (intracranial and extracranial large arteries atherosclerosis and cardiogenic stroke maybe coexist), 2 patients with other etiologies(1 patient with Moyamoya disease, 1 patient with polycythemia vera). There were multiple vascular stenosis in the 3 patients with large artery atherosclerosis, and the posterior communicating artery was open. Conclusions Cerebral infarction involving the anterior and posterior circulation in the same time is rare, cardiogenic stroke is more often, the relevant examinations should be perfect to definite the rare cause.
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Objective To investigate the distribution characteristics and risk factors of intracranial atherosclerotic stenosis ischemic stroke. Methods We retrospectively collected 342 consecutive patients with first-ever ischemic stroke. Clinical data was collected including demographics, the presence of risk factors,MRI with MRA and other routine admis?sion laboratory tests. Results Intracranial atherosclerotic stenosis (ICAS) was located most frequently in MCA (47.0%), Extracranial internal carotid artery was the most common affected artery (65.0%) among extracranial atherosclerotic steno? sis (ECAS). MetS (OR=1.586,95%CI:1.232~2.268), ApoB/ApoA1 ratio (OR=1.926,95%CI:1.051~4.288), were as?sociated with ICAS (vs ECAS), whereas hypertension (OR=3.603,95%CI:1.675~12.485), MetS (OR=2.268,95%CI:1.274~6.103), HbA1c (OR=2.015,95%CI:1.182~5.613) and ApoB/ ApoA I ratio (OR=1.948,95%CI:1.157~4.285) were related to ICAS (vs NCAS). Hypertension (OR=2.437,95%CI:1.492~3.505,P=0.005), Hcy (OR=2.437,95%CI:1.492~3.505,P=0.005) and HbA1c (OR=1.769,95%CI:1.034~3.121, P=0.005) were the independent risk factors re?lated to posterior circulation strokes (vs anterior circulation strokes ) in ICAS strokes. Conclusions The occurrence of ICAS may be more frequent than that of ECAS in ischemic stroke. Posterior circulation ICAS strokes seems to be close?ly associated with metabolic derangement.
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OBJECTIVE: Chronic subdural hematoma (CSDH) is a rare complication of unruptured aneurysm clipping surgery. The purpose of this study was to identify the incidence and risk factors of postoperative CSDH after surgical clipping for unruptured anterior circulation aneurysms. METHODS: This retrospective study included 518 patients from a single tertiary institute from January 2008 to December 2013. CSDH was defined as subdural hemorrhage which needed surgical treatment. The degree of brain atrophy was estimated using the bicaudate ratio (BCR) index. We used uni- and multivariate analyses to identify risk factors correlated with CSDH. RESULTS: Sixteen (3.1%) patients experienced postoperative CSDH that required burr hole drainage surgery. In univariate analyses, male gender (p<0.001), size of aneurysm (p=0.030), higher BCR index (p=0.004), and the use of antithrombotic medication (p=0.006) were associated with postoperative CSDH. In multivariate analyses using logistic regression test, male gender [odds ratio (OR) 4.037, range 1.287-12.688], high BCR index (OR 5.376, range 1.170-25.000), and the use of antithrombotic medication (OR 4.854, range 1.658-14.085) were associated with postoperative CSDH (p<0.05). Postoperative subdural fluid collection and arachnoid plasty were not showed statistically significant difference in this study. CONCLUSION: The incidence of CSDH was 3.1% in unruptured anterior circulation aneurysm surgery. This study shows that male gender, degree of brain atrophy, and the use of antithrombotic medication were associated with postoperative CSDH.
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Humans , Male , Aneurysm , Arachnoid , Atrophy , Brain , Drainage , Hematoma, Subdural , Hematoma, Subdural, Chronic , Incidence , Logistic Models , Multivariate Analysis , Retrospective Studies , Risk Factors , Surgical InstrumentsABSTRACT
Objective To discuss the predictable factors for the occurrence of intra-operative aneurysm rupture(IAR).Methods A total of 84 patients with 101 aneurysms treated by neurosurgical clipping from September 2009 to September 2014 were retrospectively analyzed.The statistic analysis was performed for the risk factors of IAR such as aneurysm location,aneurysm sac,dome/neck ratio,direction,pre-operative Hunt-Hess Scale,history of hypertension and operation time.Results Eighteen cases (21.4％) occurred LAR (18 (17.8％) of aneurysms) during the operations,2 patients (2.4％) died.Statistic analysis revealed that preoperative Hunt-Hess scale (P =0.042),history of hypertension (P =0.038),aneurysm sac (P =0.012),dome/neck ratio(P=0.027),direction (P =0.010) and operation time (P =0.002) were the predictable factors for the occurrence of IAR,while the location of aneurysm was not included (P =0.199).Conclusion The IAR may be the result of the synthesis of various factors in the occurrence of intracranial aneurysms clipping.Hypertension history,Hunt-Hess scale,direction,aneurysm sac,operation time and dome/neck ratio 1.78-2.89 are the predictable factors for the occurrence of IAR and the combination of various factors leads to the occurrence of IAR.
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A totel of 120 patients with CT or MRI proved as acute cerebral infarction group of anterior circulation and 90 non-infarction patients as the control group were studied. The diameter,inter median thickness( IMT) ,peak systolic velocity ( PSV ) , end diastolic velocity ( EDV ) , early shrinkage acceleration time ( AT ) , resistance index ( RI) ,and pulsatility index( PI) of carotid artery,and whether there was arteriosclerotic plaque or stenosis,and the properties of plaque were examined with color Doppler ultrasound. In acute cerebral infarction group of anterior cir-culation,the IMT was thicker that in the control group(P<0. 01). The incidence of the film thickness,moderate-se-vere stenosis and instable carotid artery plaque in infaiction group of anterior circulation were obviousely higher than those in the control group(P<0. 01). Arterial complete or incomplete occlusion was observed in severe cases. The blood flow parameters showed that the PSV and EDV of common carotid and internal carotid in acute cerebral in-farction group of anterior circulation were lowerer than those in the control group. RI and PI of internal carotid in a-cute cerebral infarction group of anterior circulation were higher than those in the control group(P<0. 05),while AT was lower than those in the control group.
ABSTRACT
Objective To study the ideal patient's head positioning for the anterior circulation aneurysms microsurgery. Method We divided the study in two parts. Firstly, 10 fresh cadaveric heads were positioned and dissected in order to ideally expose the anterior circulation aneurysm sites. Afterwards, 110 patients were submitted to anterior circulation aneurysms microsurgery. During the surgery, the patient's head was positioned accordingly to the aneurysm location and the results from the cadaveric study. The effectiveness of the position was noted. Results We could determine mainly two patterns for head positioning for the anterior circulation aneurysms. Conclusion The best surgical exposure is related to specific head positions. The proper angle of microscopic view may minimize neurovascular injury and brain retraction. .
Objetivo Estudar o posicionamento da cabeça para a cirurgia de aneurismas cerebrais da circulação anterior. Método Dividimos o estudo em duas partes. Inicialmente, dez cabeças de cadáveres frescos foram posicionadas e dissecadas de modo a expor, de maneira ideal, os principais sítios de aneurismas na circulação anterior do cérebro. Posteriormente, 110 pacientes foram submetidos a microcirurgia para clipagem de aneurismas cerebrais da circulação anterior. Durante as cirurgias, as cabeças foram posicionadas de acordo com a localização específica de cada aneurisma e o resultado obtido no estudo dos cadáveres. Cada paciente teve sua posição avaliada quanto a sua eficácia. Resultados Obtivemos basicamente dois padrões de posicionamento da cabeça para cirurgias de aneurismas cerebrais da circulação anterior. Conclusão A melhor exposição cirúrgica está relacionada à posição específica da cabeça para cada localização aneurismática. O ângulo de visão microscópica adequado minimiza lesões neurovasculares e a excessiva retração cerebral. .