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Objective:To evaluate the necessity, safety and efficacy of endovascular treatment for cerebral infarction caused by middle cerebral artery (MCA) stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery.Methods:The clinical and surgical data of patients with MCA atherosclerotic disease who underwent endovascular treatment in the First Affiliated Hospital of Zhengzhou University from January 2014 to October 2021 were retrospectively analyzed. A total of 6 patients with cerebral infarction caused by MCA stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery were selected. The preoperative and postoperative clinical imaging characteristics, perioperative complications and follow-up of these 6 patients were summarized and evaluated.Results:After the endovascular treatment, the imaging of the lenticulostriate artery in all the 6 patients was clearer than that before the operation, and the number of main trunks of the lenticulostriate artery shown by imaging in 2 patients was more than that before operation. The computer tomography perfusion of 6 patients after the endovascular treatment showed that perfusion in the supply area of the lenticulostriate artery was significantly improved compared with pre-operation. No stroke, transient ischemic attack (TIA) and death occurred during the perioperative period. The time of clinical follow-up was 360 (322, 495) days, and there were no stroke, TIA or death occurring in the corresponding artery. All the 6 patients underwent imaging follow-up, of which 3 patients underwent digital subtraction angiography and 3 underwent CT angiography. The lumen of the target vessels showed patency in all patients.Conclusions:With rigorous imaging evaluation, endovascular treatment may be safe and effective for cerebral infarction caused by MCA stenosis with hypoperfusion in the blood supply area of the lenticulostriate artery.
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Objective:To investigate the relationship between intracranial arterial remodeling and imaging markers in patients with cerebral small vessel disease (CSVD).Methods:One hundred and fifty-six patients with CSVD who were admitted to the Department of Neurology of the Second Affiliated Hospital of Zhengzhou University or the Public People′s Hospital of Xinzheng from January 2020 to May 2022 were selected, and their brain artery remodeling (BAR) score was calculated. The patients with BAR score≤-1 standard deviation (SD) were defined as individuals with constrictive remodeling of intracranial arteries, and the patients with BAR score≥1 SD were defined as individuals with dilated remodeling of intracranial arteries. Imaging markers of CSVD [white matter hyperintensities (WMHs), lacune, cerebral microbleeds, enlarged perivascular spaces, and cerebral atrophy] were quantified, total CSVD load was calculated and patients were divided into low load group (0-2 points, n=91) and high load group (3-4 points, n=65) according to the total CSVD load scores. The correlation between intracranial artery remodeling and various imaging markers of CSVD and total load was analyzed by using univariate analysis and binary Logistic regression analysis. A nomogram prediction model was established and a receiver operating characteristic curve (ROC) was drawn to assess the predictive value of intracranial artery remodeling on high total CSVD load. Results:Dilated intracranial arterial remodeling was an independent influence factor on severe WMHs ( OR=3.66, 95% CI 1.38-9.72, P=0.009), lacune ( OR=3.78, 95% CI 1.17-12.19, P=0.026), cerebral atrophy ( OR=3.11, 95% CI=1.10-8.81, P=0.033), and high total CSVD load ( OR=6.66, 95% CI=2.14-20.77, P=0.001). Age was an independent influencing factor for high total CSVD load ( OR=1.12, 95% CI 1.07-1.16, P<0.01). A nomogram prediction model for high total CSVD load with age and BAR score≥1 SD as dependent variables had a good effect (C-index=0.826) and calibration ( P=0.024). The best cut-off point of ROC curve was 0.50, with an area under the curve of 0.83 (95% CI 0.76-0.89, P<0.01), the sensitivity and specificity of 0.72 and 0.82. Conclusions:Patients with dilated intracranial arterial remodeling may have a heavier CSVD load. Dilated intracranial arterial remodeling may serve as a new biomarker for assessing CSVD, but the mechanism of the association needs further study.
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Objective:To investigate the efficacy and safety of encephalo-duro-arterio-synangiosis (EDAS) for intracranial atherosclerotic steno-occlusive disease (ICASD).Methods:Patients with symptomatic ICASD received EDAS treatment in the Department of Neurosurgery, the PLA General Hospital from January 2018 to January 2019 were retrospectively included. The baseline information, perioperative complications, primary endpoint events, and changes in modified Rankin Scale (mRS) scores before and after surgery were collected. The primary endpoint event was any stroke/death that occurred within 30 d after enrollment. The secondary endpoint events were any stroke/death, non-stroke bleeding (subdural or epidural bleeding), and clinical functional improvement after 30 d. The clinical functional improvement was defined as a decrease of ≥1 in the mRS score compared to before surgery.Results:A total of 40 patients were included, including 30 males and 10 females, aged 53.9±8.6 years old. The clinical symptoms were mainly limb weakness and dizziness. One case of ischemic stroke and one case of hemorrhagic stroke occurred during the perioperative period. The primary endpoint event incidence was 2.5%. The patients were followed up for 49.75±2.99 months after surgery. One patient died of cerebral hemorrhage 31 months after surgery, and one patient developed acute ischemic stroke 35 months after surgery. The postoperative mRS scores of 34 patients decreased compared to before surgery, and the clinical function improvement rate was 85%. The mRS score increased in 2 cases after surgery compared to before surgery and 4 cases had no change.Conclusion:EDAS can improve the clinical function of patients with symptomatic ICASD and reduce the incidence of long-term stroke.
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Abstract Moyamoya disease is a chronic occlusive cerebrovascular disease that is non-inflammatory and non-atherosclerotic. It is characterized by endothelial hyperplasia and fibrosis of the intracranial portion of the carotid artery and its proximal branches, leading to progressive stenosis and occlusion, often clinically manifesting as ischemic or hemorrhagic stroke with high rates of morbidity and mortality. On cerebral angiography, the formation of collateral vessels has the appearance of a puff of smoke (moyamoya in Japanese), which became more conspicuous with the refinement of modern imaging techniques. When there is associated disease, it is known as moyamoya syndrome. Treatments are currently limited, although surgical revascularization may prevent ischemic events and preserve quality of life. In this review, we summarize recent advances in moyamoya disease, covering aspects of epidemiology, etiology, presentation, imaging, and treatment strategies.
RESUMO A doença de moyamoya, ou doença cerebrovascular oclusiva crônica, é uma afecção não inflamatória e não aterosclerótica, caracterizada por hiperplasia endotelial e fibrose dos segmentos intracranianos das artérias carótidas internas e da porção proximal de seus ramos. Isso provoca estenose progressiva e oclusão, frequentemente manifestada clinicamente como isquemia cerebral ou hemorragia intracraniana, com alta morbimortalidade. A formação compensatória de vasos colaterais produz, na angiografia encefálica, um aspecto de nuvem de fumaça (moyamoya, em japonês). Quando existe doença subjacente que possa estar relacionada, a doença recebe o nome de síndrome de moyamoya. Embora a incidência esteja aumentando graças aos novos métodos diagnósticos, as estratégias terapêuticas ainda são limitadas. O diagnóstico precoce permite cirurgias de revascularização cerebral que podem evitar novos acidentes vasculares e melhorar a qualidade de vida. Nesta revisão são apresentados os avanços recentes sobre a doença de moyamoya, citando aspectos de epidemiologia, etiologia, apresentação, exames diagnósticos e tratamento.
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Objective:To evaluate the application value of transcranial Doppler in the detection of intracranial artery stenosis in patients with cerebral infarction.Methods:120 patients with cerebral infarction who received treatment in Zhuji Hospital of Traditional Chinese Medicine from December 2018 to December 2020 were included in this study. The patients underwent CT angiography and transcranial Doppler examination. The results of CT angiography and transcranial Doppler examination for screening intracranial artery stenosis at different locations were evaluated. Taking CT angiography results as the gold standard, the efficacy of transcranial Doppler examination for screening intracranial artery stenosis at different locations was determined. The consistency of transcranial Doppler examination versus CT angiography in screening intracranial necrosis at different locations was evaluated. Results:The sensitivity of transcranial Doppler examination in the detection of intracranial artery stenosis at bilateral middle cerebral arteries, anterior cerebral artery, posterior cerebral artery, basilar artery, bilateral vertebral arteries, and internal carotid artery (Siphon segment) was 89.47%, 91.18%, 85.00%, 90.62%, 81.82%, 96.55%, respectively. The specificity of transcranial Doppler examination in the detection of intracranial necrosis at bilateral middle cerebral arteries, anterior cerebral artery, posterior cerebral artery, basilar artery, bilateral vertebral arteries, and internal carotid artery (Siphon segment) was 87.30%, 95.35%, 91.25%, 94.32%, 96.33%, and 87.88%, respectively. The Kappa value for judging the consistency between transcranial Doppler examination and CT angiography in the detection of intracranial artery stenosis at bilateral middle cerebral arteries, anterior cerebral artery, posterior cerebral artery, basilar artery, bilateral vertebral arteries, and internal carotid artery (Siphon segment) was 0.766, 0.858, 0.758, 0.833, 0.800, and 0.852, respectively.Conclusion:Transcranial Doppler examination has high sensitivity and specificity in the detection of intracranial artery stenosis at different locations. Its screening results are highly consistent with those from CT angiography. Transcranial Doppler examination is of high clinical application value.
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Intracranial arterial dolichoectasia (IADE), also known as dilated cerebral artery disease, is manifested as an increase in the length and diameter of one or more intracranial arteries, the affected arteries being enlarged and dilated significantly, or even with winding and tortuosity. The diagnosis and prognostic evaluation of IADE are mainly based on the diameter and curvature of the intracranial artery. IADE can be manifested as ischemic stroke, transient ischemic attack, hydrocephalus, and hemorrhagic stroke. The review focuses on IADE, including the concept, diagnostic criteria, etiology, pathogenesis, pathology, clinical manifestations, treatment, and prognosis.
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Objective To investigate the feasibility,safety and efficacy of endovascular recanalization of the symptomatic occlusion of large intracranial artery in anterior circulation.Methods From October 2015 to December 2017,13 patients with symptomatic non-acute occlusion of large intracranial artery in anterior circulation were enrolled into this study and underwent endovascular recanalization.The initial procedural results,including the rate of successful recanalization and perioprocedural complications,and angiographic and clinical follow-up results were collected.The functional outcome was evaluated at discharge and 90 days.Results Recanalization was successful in 11 out of 13 patients.Perioperative complications occurred in 8 cases,including distal embolization in 7 cases (3 with symptom and 4 without),in which intracerebral hemorrhage associated with embolectomy was found in 1 case;and distal embolization concomitant with artery dissection in 1 case.At discharge,the symptoms of 10 out of 11 patients with successful recanalization were improved and 1 was unchanged;one of 2 patients with recanalization failure was aggravated and 1 was unchanged.After the procedure,1 patient with successful recanalization,but complicated with intracerebral hemorrhage associated with embolectomy was lost at follow-up,thus angiographic follow-up was available in the remaining 10 patients.Of the 10 patients,1 patient developed in-stent restenosis at 12 months and 9 patients had no hemodynamic stenosis/reocclusion.The clinical follow-up was available in 12 patients.No recurrence of TIA or stroke was found in 9 cases with successful recanalization except for 1 case who developed in-stent stenosis and suffered from TIA.At the follow-up of 90 days,l0 patients with successful recanalization showed good function (mRS∶0-2),2 patients with recanalization failure were deteriorated.Conclusions In strictly selected patients with symptomatic non-acute occlusion of large intracranial artery in anterior circulation,endovascular recanalization was feasible and safe,which may improve patients' symptoms in a short term and reduce the recurrence rate of stroke,but its definite efficacy needs to be confirmed by studies with larger sample and longer follow-up.
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INTRODUCCIÓN. La ruptura aneurismática ha sido responsable de hasta el 85 % de hemorragia subaracnoidea de origen no traumático, lo que ha producido altas tasas de morbimortalidad y altos costos hospitalarios, el diagnóstico oportuno y detallado de la localización y el tamaño del aneurisma ha determinado el manejo adecuado del paciente, ya sea invasivo o expectante. OBJETIVO. Analizar el comportamiento de una serie de casos de aneurismas intracraneales rotos y no rotos en cuanto a tamaño, localización sexo y edad. MATERIALES Y MÉTODOS. Estudio retrospectivo de la historia clínica única del informe radiológico de 155 pacientes diagnosticados de aneurisma intracraneal por panangiografía cerebral con sustracción digital como gold estánda que mejoró la calidad de imagen, en el Hospital de Especialidades Carlos Andrade Marín, periodo enero del 2015 a agosto de 2018. RESULTADOS. De los 155 pacientes con un total de 204 aneurismas intracraneales de los cuales (122; 204), accidentados y (82; 204), no accidentados, el 72,0% se presentó en mujeres. Los mayores porcentajes de ruptura de acuerdo con su localización, fueron: arteria comunicante posterior 34,0 %, arteria cerebral media 26,0 % y arteria comunicante anterior 15,0%. En cuanto a los aneurismas no accidentados, las localizaciones más frecuente fueron: arteria cerebral media 33,0%, arteria comunicante posterior 23,0% y segmento termino carotideo 12,0%. El 65% de aneurismas presentó roturas con diámetros iguales o mayores a 5 mm. La edad promedio de diagnóstico fue 56 años rango; 17 90. CONCLUSIÓN. Analizando los porcentajes de comportamiento de ruptura en cuanto a tamaño y localización de nuestra cohorte y comparándola con las referidas en la bibliografía revisada se pudo concluir que el comportamiento de ruptura aneurismática fue distinto dependiendo de la región poblacional estudiada.
INTRODUCTION. Aneurysmal rupture has been responsible for up to 85% of subarachnoid hemorrhage of non-traumatic origin, which has produced high morbidity and mortality and high hospital costs, the timely diagnosis, the detail of the location and size of the aneurysm has been adequate, either invasive or expectant. OBJECTIVE. Analyze the behavior of a series of cases of broken and unruptured intracranial aneurysms in terms of size, location, sex and age. MATERIALS AND METHODS. Retrospective study of the unique clinical history of the radiological report of 155 patients diagnosed with intracranial aneurysm by brain panangiography with digital subtraction as a gold standard that improved image quality, at the Carlos Andrade Marín Specialties Hospital, January 2015 to August 2018. RESULTS. Of the 155 patients with a total of 204 intracranial aneurysms of which (122; 204), injured and (82; 204), not injured, 72,0% occurred in women. The highest rupture percentages according to their location were: posterior communicating artery 34,0%, middle cerebral artery 26,0% and anterior communicating artery 15,0%. As for non-accident aneurysms, the most frequent locations were: 33,0% mean brain artery, 23,0% posterior communicating artery and 12,0% carotid segment. 65,0% of aneurysms presented ruptures with diameters equal to or greater than 5 mm. The average age of diagnosis was 56 years range; 17 - 90. CONCLUSION. Analyzing the percentages of rupture behavior in terms of size and location of our cohort and comparing it with those referred in the reviewed bibliography, it was concluded that the behavior of aneurysmal rupture was different depending on the population region studied.
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Humans , Female , Adult , Middle Aged , Aortic Rupture , Subarachnoid Hemorrhage , Intracranial Aneurysm , Cerebral Hemorrhage , Cerebrovascular Disorders , Intracranial Arterial Diseases , Rupture , Women , Indicators of Morbidity and MortalityABSTRACT
Objective To investigate the correlation betw een the cerebral w atershed infarction (WSI) types and cerebrovascular stenosis. Methods Patients w ith WSI diagnosed by MRI and diffusion -w eighted imaging w ere enroled. Color Doppler ultrasound w as used to conduct extracranial internal carotid artery (ICA) examination. Magnetic resonance angiography w as used to conduct intracranial vascular examination. The patients w ith WSI w ere divided into cortical w atershed infarction (CWSI), internal w atershed infarction (IWSI), and mixed-type w atershed infarction (MWSI). The correlation betw een the different types of WSI and cerebral vascular stenosis w ere analyzed. Results A total of 120 patients w ith WSI w ere enroled, including 18 w ith CWSI, 48 w ith IWSI, and 54 w ith MWSI. Ipsilateral vascular stenosis: 48 patients w ere in ICA (40.0%, 22 of them in the extracranial segment, 39 in the intracranial segment), 24 (20 .0%) w ere in the anterior cerebral artery, 86 (71.7%) w ere in the middle cerebral artery, 40 (33.3%) w ere in the posterior cerebral artery, 35 (29.2%) w ere in the vertebral basilar artery, and 36 (30.0%) w ere in ICA +MCA. There w ere significant differences in the detection rates of ipsilateral ICA, MCA and ICA + MCA stenosis among different types of WSI. Multivariate logistic regression analysis show ed that CWSI often accompanied by the ipsilateral ICA stenosis (odds ratio [ OR] 0.022; 95% confidence interval [ CI] 0.002 -0.230; P =0.001); IWSI often accompanied by the MCA stenosis ( OR 40.164; 95% CI 3.861 -417.810; P =0.002), w hile MWSI often accompanied by the ipsilateral MCA stenosis ( OR 9.586; 95% CI 2.776 -33.126; P <0.001) and ipsilateral ICA + MCA stenoses ( OR 7.481; 95% CI 2.541 -22.022; P <0.001). Conclusion There w ere significant differences in the incidence of the ipsilateral ICA, MCA, and ICA + MCA stenosis among the different types of WSI. CWSI often accompanied by the ipsilateral ICA stenosis, IWSI often accompanied by the ipsilateral MCA stenosis, and MWSI often accompanied by the ipsilateral ICA + MCA stenosis.
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Objective To investigate the correlation between the unilateral middle cerebral artery (MCA)stenosis ratio and cerebrovascular reserve(CVR) using computed tomography perfusion (CTP) and CO2 inhalation test in patients with unilateral middle cerebral artery stenosis.Methods CTP were performed in 31 patients who were diagnosed as unilateral middle cerebral stenosis before and after CO2 inhalation.The basal ganglia and radial dimension were selected as interested regions (thickness 8 mm).The value of cerebral blood flow (CBF) was measured and the mean CBF values of all interested regions in each MCA territory were harvested separately.Then the CVR of each MCA territory was calculated according to the following formula:CVR =(CBF after CO2 inhalation test-CBF before CO2 inhalation test)/ CBF before CO2 inhalation test × 100％.Patients were divided into two groups:the severe stenosis group and the moderate stenosis group.The association between the MCA stenosis ratio and the CVR values was investigated.Results In 31 patients,different changes of CBF were found in affected MCA territory after CO2 inhalation.CBF increased in 17 cases,unchanged in 2 cases and decreased in 12 cases.A decreased CVR was detected in 51.6％ of the patients(16/31) and more likely found in the severe stenosis group (13/19) than that in the moderate stenosis group(3/12,P =0.029).The degree of stenosis in MCA was also significantly correlated with the changes of CVR(r =0.423,P =0.018).Conclusions CVR is decreased in some patients with unilateral MCA stenosis and significantly correlates with the severity of stenosis in MCA.
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Objective To study the relationship between the degree of intracranial and extracranial arterial stenosis and the plasma level of homocysteine ( Hcy ) in patients with ischemic cerebrovascular disease .Methods 96 patients with ischemic cerebrovascular disease were checked by DSA .The distribution of stenosis in the studied cerebral arteries was analyzed .According to the degree of stenosis ,all 96 patients were divided into some groups ,at the same time Hcy level was detected ,and the correlation between Hcy level and intracranial and extracranial artefial stenosis were analyzed .Results 35 of the 96 patients had normal findings in angiography ,and 61 cases had occlusive lesions of different degrees .The mean plasma Hcy concentration in patients with intracranial and extracranial arterial stenosis was 19.26 (14.79~26.13)μmol/L,which was significantly higher than 11.60(8.8~15.11)μmol/L in the patients with no arterial stenosis (P<0.05).There was a significant positive correiation between Hcy level and cerebral artery stenosis degree(r=4.126,P<0.05).Conclusion The plasma Hcy level was positively correlated with intracranial and extracranial arterial stenosis in patients with ischemic cerebrovascular disease ,incidence and nar-row-degree of cerebral artery stenosis are all along with the increasing of Hcy level .
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Fundamento: el diagnóstico y tratamiento de las enfermedades vasculares encefálicas que afectan a las arterias cerebelares superiores, se dificulta por la gran variabilidad de estos vasos. Objetivo: caracterizar anatómicamente el patrón común y las variantes de la arteria cerebelar superior en el hombre adulto. Método: se realizó un estudio descriptivo en 50 encéfalos humanos obtenidos del Departamento de Medicina Legal del Hospital Docente Clínico Quirúrgico Amalia Simoni en Camagüey, se disecó macromicroscópicamente cada cerebelo y su sistema arterial. Resultados: la arteria cerebelar superior se originó como patrón común en la arteria basilar y como variante surgió a partir de la arteria cerebral posterior, se observó doble en nueve piezas a la derecha y ocho a la izquierda; siguió un trayecto clásico; bifurcada, de segmento prebifurcación corto y con ramificación difusa, de la que partieron las ramas colaterales perforantes y precerebelares, y las corticales como terminales. Algunas variantes presentaron relación anatómica con el trigémino en su trayecto, 21 derechas y 15 izquierdas. Conclusiones: como patrón común la arteria cerebelar superior tiene su origen en la basilar; de trayecto clásico; bifurcada, con segmento prebifurcación corto y ramificación difusa. Emite ramas perforantes, precerebelares y corticales. Las variantes incluyen origen en la cerebral posterior, relación con el trigémino y segmento prebifurcación largo.
Background: the diagnosis and treatment of vascular encephalic diseases that affect superior cerebellar arteries are really difficult because of the great variability of these vessels. Objective: to characterize anatomically the common pattern and the variants of the superior cerebellar artery in an adult man. Method: a descriptive study was conducted in 50 human brains obtained from the Department of Legal Medicine of the Amalia Simoni Clinical Surgical Teaching Hospital of Camagüey. Each brain and its arterial system were dissected macromicroscopically. Results: the superior cerebellar artery originated in the basilar artery as a common pattern; as a variant, it originated from the posterior cerebral artery. It was observed double in nine pieces to the right and in eight to the left; it fallowed a standard trajectory. It was bifurcate of short pre-bifurcation segment and with diffuse spread from which the perforans and pre-cerebellar collateral branches came out and the cortical branches as terminal. Some variants presented anatomic relation to the trigeminus in their trajectory, 21 were right and 15 were left. Conclusions: as a common pattern, the superior cerebellar artery has its origin in the basilar artery and a standard trajectory. It is bifurcate of short pre-bifurcation segment and diffuse spread. From it, perforans, pre-cerebellar, and cortical branches come out. Variants include origin in the posterior cerebral artery, relation to the trigeminus and long pre-bifurcation segment.
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Objective To explore the value of the diagnosis of middle cerebral artery (MCA) stenosis with transcranial Doppler ultrasound (TCD). Methods The clinical data in patients with ischemic cerebrovascular disease examined with digital subtract angiography (DSA)and TCD were analyzed retrospectively. DSA was used as a gold standard to analyze the sensitivity and specificity of the diagnosis of MCA stenosis with TCD. The normal and TCD blood flow velocity with different degrees of stenosis were compared. The best cut-off point of the TCD blood flow velocity of MCA at different degree of stenosis was calculated. Results DSA confirmed that 103 patients had MCA stenosis or occlusion, in which 12 were mild stenosis, 22 were moderate stenosis, 40 were severe stenosis, and 39 were occlusion. Compared to DSA, the sensitivity of TCD in detection of moderate and severe MCA stenosis or occlusion was 78. 8%, the specificity was 96. 0%, and the accuracy was 93. 0%, the missed diagnosis rate was 21. 2%, and the misdiagnosis rate was 4. 0%. As to the blood flow velocity, there was no significant difference between the mild stenosis and normal groups; while there was significant difference between the moderate stenosis and normal groups (P ＜0. 001). In addition, there was no significant difference in blood flow velocity between the moderate stenosis and severe stenosis groups. Determining the cut-off value of the best peak systolic velocity of the moderate stenosis was 163. 5 cm/s, while the best cut-off value of the mean velocity was 108. 5 cm/s. Conclusions TCD has certain advantages in the diagnosis of the MCA stenosis or occlusion, and it can be used as a safe and inexpensive screening means before DSA examination.
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More than 2 million strokes occur in china each year,most of which are caused by cerebrovascular stenosis. Atherosclerosis is the main reason for cerebrovascular stenosis. The effective treatment of intracranial atherosclerosis can significantly decrease the incidence of stroke. However,at present,about the treatment of intracranial atherosclerotic stenosis has not been standardized. This article reviews about the treatment methods for intracranial atherosclerotic stenosis in recent years and provides the basis for the development of standardized treatment of intracranial atherosclerotic stenosis.
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Intracranial atherosclerotic stenosis is one of the important causes of ischemic stroke. It is of vital importance to guide clinical treatment using imaging methods to diagnose intracranial artery stenosis and accurately assess the degree of stenosis. This article reviews the advantages and shortcomings,advances and clinical application values of diagnosing intracranial artery stenosis using transcranial Doppler ultrasound,transcranial color-coded duplex sonography,intravascular ultrasound,magnetic resonance angiography,computed tomography angiography,and digital subtract angiography,which will provide references for clinicians to select ideal checking tools.
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Objective To evaluate the relationship between stenosis of intra- or extra-cranial cerebral large artery and capsular warning syndrome(CWS). Methods Eleven consecutive CWS patients hospitalized during period of time from November 2008 to December 2009 were retrospectively analyzed.Result In these 11 patients with CWS, 5 patients had motor symptoms only, 4 patients had pure sensory symptoms, and 2 patients had sensorimotor symptoms. Ten patients underwent cervical contrast-enhanced MRA and intracranial MRA examination. The results showed no sign of arterial stenosis. Seven CWS patients eventually had strokes, 1 progressed to stroke despite receiving the therapy of antiplatelet and anticoagulation. All stroke lesions were located in the capsula interna. All the CWS patients had vascular risks: 7 were smoker, 8 had hypertension, 1 had diabetes mellitus, and 5 had hyperlipidemia. One patient had a history of previous stroke; no patient had a history of ischemic heart disease or atrial fibrillation. At follow-up(10. 2 ±3.4)mouths, the average modified Rankin scale score for all patients was 0. 73 ± 1.20.Conclusion CWS was not associated with stenosis of the intra and extra-cranial large cerebral arteries.CWS may be associated with small-vessel single-penetrator disease.
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Objective: To investigate the feasibility and safety of drug-eluting stenting for Wingspan in-stent restenosis Methods: Firebird drug-eluting stenting was used to treat two patients with Wingspan in-stent restenosis (localized restenosis >70% at vertebral artery V4 segment). One of them was a symptomatic case, and the other had contralateral vertebral artery occlusion and bilateral posterior communicating artery hypoplasia. The stents passed through the restenotic site, and they were released under the pressure of 911.93 to 1013.25 kPa, maintaining for 15 seconds. Results: All the stents were successfully released in place. Angiography showed that there was no significant residual stenosis immediately after the procedure. There was no discomfort in patients after the procedure. The patient's preoperative symptom of repeated vertigo attacks was disappeared. No clinical ischemic event occurred in the two patients after following up for more than 6 months. Six months after the restenting, DSA re-examination showed that there was no significant restenosis in one patient. Conclusion: Using drug-eluting stents for in-stent restenosis after Wingspan stenting is technically safe and feasible. However, selection criteria of patients and efficacy of a larger sample study will be needed.
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Objective To investigate the intracranial vascular stenosis and risk factors in different types of ischemic stroke. Methods 525 patients with ischemic stroke were assessed by a transcranial Doppler. Lipids including total cholesterol (CHO),low-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) were examined. Results Intracranial vascular stenosis in diabetic and non-diabetic groups of patients,hypertension and non-hypertension groups of patients showed significantly difference (P