Evaluation of the efficacy of anti-platelet aggregation drugs in patients using thromboelastograph after percutaneous transluminal angioplasty and stenting / 中国脑血管病杂志

Objective: To detect the platelet inhibition of aspirin and Clopidogrel in patients after percutaneous transluminal angioplasty and stenting (PTAS) using a thromboelastograph (TEG) instrument in order to guide the individualized adjustment of anti-platelet aggregation drugs after PTAS. Methods: The clinical data of 65 patients with ischemic stroke or transient ischemic attack included from Nanjing Stroke Registry Program were analyzed retrospectively. Venous blood samples were collected at day 3 after PTAS. A TEG instrument was used to detect arachidonic acid (AA) -induced inhibition rate of platelet aggregation and adenosine diphosphate (ADP) receptor-induced inhibition rate of platelet aggregation. The AA pathway and ADP receptor-induced inhibition rate of platelet aggregation, as well as the response differences of the patients between aspirin and clopidogrel therapy were compared. Results: Circled digit oneThe inhibition rate (80 ± 28%) of aspirin for the AA pathway was significantly higher than that (53 ± 31%) of clopidogrel for the ADP receptor pathway (P < 0.01). Circled digit twoOf the 65 patients, the therapeutic effects in 45 (69.2%), 8 (12.3%), 7 (10.8%) and 5 (7.7%) patients were good, effective, low response, and ineffective in the aspirin group, and those in 19 (29.2%), 14 (21.5%), 23 (35.4%) and 9 (13.8%) were good, effective, low response, and ineffective in the clopidogrel group. Of those who had a good response to aspirin, 3 had no response to clopidogrel and 14 had low response to clopidogrel; of those who had a good response to clopidogrel, all responded well or effective to aspirin. Of those who had low response to clopidogrel, 4 had low response to aspirin, 5 had a good response to aspirin, and 14 had good results. The two efficacies had some relevance (χ2 = 33.311, P < 0.01). Circled digit threeA total of 53 patients had a good + effective response to aspirin, and 12 had low response + ineffective to aspirin, while 33 and 32 patients had good + effective and low response + ineffective to clopidogrel. There was significant difference in efficacy between the two drugs (χ2 = 15. 042, P < 0.01). Conclusion: Using TEG instrument to detect the inhibition rate of platelet aggregation in patients after PTAS is beneficial to guide the development of therapeutic scheme for individualized anti-platelet aggregation in clinical practice. The inhibitory effect of platelet aggregation of aspirin after PTAS is stronger than that of clopidogrel. The patients show differential responses to aspirin and clopidogrel therapy. Some patients who have low response to clopidogrel may respond well or may be effective to aspirin.

Clinical and Radiologic Features of Symptomatic Single Small Deep Cerebral Infarction

BACKGROUND: Small deep cerebral infarct can be associated with small-vessel occlusive disease, largevessel disease, low-flow or thrombo-embolic mechanism. This study is designed to investigate ralationship between symptomatic single small deep infarcts ahd vascular diseases. METHODS: We studied 154 patients who had symptomatic, small-sized(<20 mm), single, subcortical infarction(basal ganglia, corona rediata, centrum semiovale) who were admitted to our hospital from jund, 1996 to September, 1999. They were evaluated about the lesion site and vascular status of the carotid system and middle cerebral artery, using MRI, MRA and cervical duplex sonography or conventional angiography. RESULTS: Among 154 patients with single small deep infarction, 100 were related with small artery disease(64.9%), 38 with middle cerebral artery disease(26.7%) and 16 with carotid artery disease(10.4%). The basal ganglia or basal ganglia with corona radiata area were more frequently responsible lesion sites in both small artery disease(n=59, 59%) and middle cerebral artery disese(n=28, 73.7%) than in carotid artery disease(n=1, 6.3%). The centrum ovale or centrum ovale with corona radiata area were frequently involved lesion sites in carotid artery disease (n=10, 67.5%). CONCLUSION: Single small deep infarcts of th basal ganglia with corona radiata were mostly seen in the middle cerebral artery disease or small artery disease, and small deep infarcts of the centrum semiovale with corona radiata were usually assoicated with internal carotid artery disease. In occurrence of single small deep infarcts, middle cerebral artery disease was more frequent than carotid artery disease, which might be associated with intracranial occlusive disease known to be more common in Asians than in Caucasians.

Comparative study on transcranial color duplex sonography and angiography in detection of cerebral arterial stenosis / 临床神经病学杂志

Objective To evaluate the reliability of transcranial color duplex sonography(TCCD) in the detection of stenosis of the middle cerebral artery(MCA).Method 168 patients with cerebrovascular di sease were underwent both cerebral angiography and TCCD examination.Result 18 stenosis of the MCA were diagnosed by angiography, 15 of the 18 stenosis were detected by TCCD. But 2 MCA stenosis diagnosed by TCCD were not proved by angiography. TCCD diagnosed MCA stenosis with sensitivity(83%) and specificity(88%) respectively.Conclusion MCA stenosis diagnosed by TCCD was better than by transcranial Doppler(TCD).