ABSTRACT
Objective To investigate the difference in infarction characteristics between large artery atherosclerosis and cardioembolism acute ischemic stroke (AIS). Methods A retrospective study was done on 99 AIS patients, who were admitted to Emergency Room of our hospital and underwent multi-modal computed tomography (CT) after admission and before treatment. Forty-six of 99 AIS patients had large artery atherosclerosis and 53 had cardioembolism. The NIHSS score and GCS score on admission, infraction core and ischemic penumbra volumes and the volume difference, and vascular occlusion rates of posterior circulation and large artery were compared between the two groups. Results Compared with the cardioembolism group, the NHISS score was significantly lower and the GCS score was significantly higher in the large artery atherosclerosis group (9.5 [2.0, 16.0] vs 15.0 [6.0, 24.0], Z=2.31, P0.05). The large artery occlusion rate and posterior circulation occlusion rate were both significantly different between the large artery atherosclerosis and cardioembolism groups (30.43% [14/46] vs 50.94% [27/53] and 36.96% [17/46] vs 9.43% [5/53]; χ2=11.82 and 6.77, both P<0.001). Conclusion The clinical symptoms, cerebral changes and intracranial large artery changes are different in AIS patients with large artery atherosclerosis and cardioembolism. Etiology evaluation based on clinical features and multi-modal CT examination can help to accurately assess the ischemic state of AIS patients.
ABSTRACT
Objective To investigate the clinical characteristics of the patients with acute ischemic stroke (AIS) caused by large artery atherosclerosis (LAA) or cardioembolism (CE) middle cerebral artery M1 segment occlusion, and to explore the difference of endovascular treatment. Methods The patients with AIS caused by M1 segment occlusion, who received endovascular treatment between Sep. 2014 and Feb. 2018 in our hospital, were recruited and assigned to LAA group and CE group. Clinical characteristics, treatment strategy, postoperative hemorrhage rate and prognosis were analyzed. Results Totally 134 patients were included, and 48 patients were in the LAA group and 86 patients were in the CE group. There were significant differences in the gender and age between the LAA and CE groups (male/female 39/9 vs 40/46, χ2＝ 15.363; average age [62.65±9.76] years vs [69.66±12.43] years, t＝－3.371; both P0.05). Compared with the CE group, the proportion of the patients with hypertension was significantly higher, and the National Institutes of Health stroke scale score on admission was significantly lower in the LAA group (70.8% [34/48] vs 51.2% [44/86], χ2＝4.900, P＝0.027; 13 [7, 16] vs 16 [13, 21], Z＝－3.603, P0.001). The proportion of the patients with angioplasty in the LAA group was 52.1% (25/48), which was significantly higher than the proportion in the CE group (4.7% [4/86], χ2＝38.121, P0.01). The incidence of postoperative intracranial hemorrhage was significantly lower in the LAA group than that in the CE gorup (10.4% [5/48] vs 32.6% [28/86], χ2＝8.136, P＝0.004). There were no significant differences in the incidence of symptomatic intracranial hemorrhage, endovascular recanalization rate, or good prognosis rate or mortality 3 months after operation between the two groups (all P0.05). Conclusion Compared with the patients with AIS due to LAA M1 segment occlusion, the CE patients have more severe symptoms and higher postoperative hemorrhage rate after endovascular treatment. The strategy of endovascular treatment is different in the two types of AIS, while there are no differences in prognosis and mortality after treatment.
ABSTRACT
Objective To explore the safety and clinical efficacy of Ginkgo biloba lactone injection combined with Alteplase intravenous thrombolysis in treatment of acute ischemic stroke.Methods Totally 87 patients were recruited and divided into control group and test group.The,patients in control group (39 cases) were given Alteplase 0.9 mg/kg for injection,intravenous bolus total dose 10％ was given within 1 min,then intravenous infusion of the remaining 90％ was given in 1 h,and given basic therapy after 24 h.The 48 cases in test group,which were immediately iv Ginkgo biloba lactone injection after intravenous thrombolysis,6 mL added into 250 mL saline,once daily for 14 d,and also were given basic therapy after 24 h.All NIHSS scores were recorded before treatment,14 d and 90 d after treatment,and the adverse events were recorded.The modified Rankin scale (mRS) score and BI index were performed at 14 and 90 d after admission.Patients in two groups were classified according to the TOAST classification,and the patients with large-arteryatherosclerosis and small-artery occlusion were analyzed.Results No intracranial hemorrhage occurred in the two groups.The NIHSS score and mRS score of test group were significantly lower than that of control group,and BI index was significantly increased 90 d after treatment.The NIHSS score and mRS score of test group were significantly lower than that of control group,and BI index was significantly increased90 d after treatment of patients with large-artery atherosclerosis.But there was no significant difference between test group and control group of patients with small-artery occlusion.Conclusion Ginkgo biloba lactone injection combined with rt-PA intravenous thrombolysis in the treatment of acute ischemic stroke has high safety,and can improve the prognosis of patients.
ABSTRACT
Objective To explore the association between rs7049105, rs647188, rs1333035 of chromosome 9p21 and the LAS among Chinese Han population of Changsha;to explore the association between rs7049105, rs647188, rs1333035 and the LAS among patients with evidence of cephalic and cervical vessel atherosclerosis. Methods The present study com?prised 229 LAS patients and 233 healthy controls. The 233 controls which we defined control group 1. In the controls, 150 (64.38%)controls with evidence of atherosclerosis were defined as control group 2, 83(35.62%)controls without evidence of atherosclerosis were defined as control group 3. The sample genotyping was detected using MALDI-TOF-MS. Results There was no polymorphism of rs647188 among case group and control group 1. There was no significant difference in the polymorphism distribution of rs7049105 and rs1333035 between the case group and control group 1 and 3 (P>0.05). There may be no significant different in the polymorphism distribution of rs7049105 between the case group and control group 2 . The rs1333035 was associated with risk of LAS among patients with evidence of cephalic and cervical vessel atherosclerosis (χ2=6.502,P=0.039). Conclusions The rs10757274 and rs7049105 polymorphism in the chromosome 9p21 may not be as?sociated with risk of LAS among Han population of Changsha. There may be no polymorphism of rs647188 among Han popu?lation of Changsha. The rs1333035 polymorphism may be associated with plaque rupture and thrombosis.
ABSTRACT
Based on the recently proposed Chinese ischemic stroke subclassification (CISS) system, intracranial branch atheromatous disease (BAD) is divided into large artery atherosclerosis (LAA) and penetrating artery disease (PAD). In the current retrospective analysis, we compared the general characteristics of BAD-LAA with BAD-PAD, BAD-LAA with non-BAD-LAA and BAD-PAD with non-BAD-PAD. The study included a total of 80 cases, including 45 cases of BAD and 35 cases of non-BAD. Subjects were classified using CISS system: BAD-LAA, BAD-PAD, non-BAD-LAA and non-BAD-PAD. In addition to analysis of general characteristics, the correlation between the factors and the two subtypes of BAD was evaluated. The number of cases included in the analysis was: 32 cases of BAD-LAA, 13 cases of BAD-PAD, 21 cases of non-BAD-LAA, and 14 cases of non-BAD-PAD. Diabetes mellitus affected more non-BAD-LAA patients than BAD-LAA patients (P=0.035). In comparison with non-BAD-PAD, patients with BAD-PAD were younger (P=0.040), had higher initial NIHSS score (P<0.001) and morbidity of ischemic heart disease (P=0.033). Within patients with BAD, the PAD subtype was associated with smoking (OR=0.043; P=0.011), higher low-density lipoprotein (OR=5.339; P=0.029), ischemic heart disease (OR=9.383; P=0.047) and diabetes mellitus (OR=12.59; P=0.020). It was concluded that large artery atherosclerosis was the primary mechanism of BAD. The general characteristics showed no significant differences between the CISS subtypes of LAA and PAD within BAD, as well as between the BAD and non-BAD within LAA subtype. Several differences between PAD subtypes of BAD and non-BAD were revealed.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Brain Ischemia , Pathology , China , Stroke , PathologyABSTRACT
Objective To investigate the risk factors of cerebral microbleeds (CMBs) in patients with acute isch?emic stroke of large-artery atherosclerosis. Methods One hundred twelve patients with acute ischemic stroke of large-ar?tery atherosclerosis admitted from July 2013 to January 2014 in Nanjing First Hospital affiliated to Nanjing Medical Uni?versity were enrolled. According to the results of MRI magnetic sensitive weighted imaging, the patients were divided into CMBs group or non-CMBs group. The history, general clinical data, serum biochemical results and MRI in both groups were enrolled. All the data were analyzed by the univariate and multivariate analysis. Results The results of univariate analysis showed that there were significant differences in age (61.620±11.479 vs. 70.620±11.185), serum uric acid (UA) level (278.920±69.512 vs. 353.460±111.206), serum creatinine (Cr) level (71.360±19.797 vs. 90.450±44.989), serum ho?mocysteine (Hcy) level (12.587±2.664 vs. 21.715±10.437) between the two groups (P<0.05). There were significant differ?ences in constituent ratio of Fazekas' s grade of periventricular hyperintensities and deep white matter hyperintensities between the two groups (P<0.05). The results of multivariate analysis showed that age (OR=0.963, 95%CI:0.905~1.025, P<0.05) and serum Hcy level (OR=1.487, 95%CI:1.219~1.813, P<0.05) were the independent risk factors for CMBs in patients with acute ischemic stroke of large-artery atherosclerosis. Conclusions Age and serum Hcy level are the inde?pendent risk factors for CMBs in patients with acute ischemic stroke of large-artery atherosclerosis.
ABSTRACT
Objective To investigate the relationship between apolipoprotein E ( ApoE ) gene polymorphism and cerebral infarction patients with different gender and etiological typing. Methods A total of 91 patients with cerebral infarction aged≥60 years ( cerebral infarction group) were enrolled. They were divided into either a large artery atherosclerotic (LAA) stroke group (n=37) or a small artery occlusion (SAO) stroke group (n=54) according to the Trial of Org 10172 in acute stroke treatment (TOAST) classification. A total of 105 age-,sex-,and residence-matched healthy subjects were enrolled as controls. A Nested Allele-Specific Multiplex Polymerase Chain Reaction Method was used to detect the ApoE gene polymorphism. The ApoE gene polymorphism of cerebral infarction of different gender and etiological typing were compared. Results ( 1 ) ApoE Genotypes of E2/2, E2/3, E2/4, E3/3, and E3/4 were detected,but the ApoE E4/4 was not detected. (2) There were no significant differences in the frequencies of ApoE genotypes and each gene carrier frequency between the cerebral infarction group and the control group (all P>0. 05). There was significant difference in ApoE genotype frequencies and each gene carrier frequency of the males between the cerebral infarction group and the control group (P0. 05). (3) There were no significant differences in the ApoE genotype frequency and gene carrier frequency among the LAA,SAO,and control groups. There was significant difference in the ApoE genotype frequency and gene carrier frequency in males between the LAA group and the control group (P>0. 01);the genotype frequencies of E2/3 and E3/E3 (6. 7% and 46. 7%),ε2,as well as theε3 carrier frequency (3. 3% and 73. 3%) of LAA were lower than those of the control group (13. 2%,79. 2%,6. 6%,and 89. 6%,respectively);the E3/4 genotype frequency andε4 carrier frequency of the LAA subtype were 46. 7% and 23. 3% respectively. They were all higher than 7. 5% and 3. 8% in the control group. However,there were no significant differences in males among the SAO group,the control group,and the 3 groups of females ( the LAA subtype,SAO subtypes,and the control group) (P>0. 05). Conclusion ε4 gene may be a risk factor for LAA in males. The association of ApoE gene polymorphism with cerebral infarction in females is not found.
ABSTRACT
OBJECTIVE: Arterial stiffness is a common change associated with aging and can be evaluated by measuring pulse wave velocity (PWV) between sites in the arterial tree, with the stiffer artery having the higher PWV. Arterial stiffness is associated with the risk of stroke in the general population and of fatal stroke in hypertensive patients. This study is to clarify whether PWV value predicts functional outcome of acute ischemic stroke. METHODS: One hundred patients were enrolled with a diagnosis of acute ischemic stroke and categorized into two groups: large-artery atherosclerosis (LAAS) or small vessel disease (SVD) subtype of Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Each group was divided into two sub-groups based on the functional outcome of acute ischemic stroke, indicated by modified Rankin Scale (mRS) at discharge. Poor functional outcome group was defined as a mRS > or = 3 at discharge. Student's t-test or Mann-Whitney U-test were used to compare maximal brachial-ankle PWV (baPWV) values. RESULTS: Twenty-four patients whose state was inadequate to assess baPWV or mRS were excluded. There were 38 patients with good functional outcome (mRS or = 3). The baPWV values were significantly higher in patients with poor outcome (2,070.05 +/- 518.37 cm/s) compared with those with good outcome (1,838.63 +/- 436.65) (p = 0.039). In patients with SVD subtype, there was a significant difference of baPWV values between groups (2,163.18 +/- 412.71 vs. 1,789.80 +/- 421.91, p = 0.022), while there was no significant difference of baPWV among patients with LAAS subtype (2,071.76 +/- 618.42 vs. 1,878.00 +/- 365.35, p = 0.579). CONCLUSIONS: Arterial stiffness indicated by baPWV is associated with the functional outcome of acute ischemic stroke. This finding suggests that measurement of baPWV predicts functional outcome in patients with stroke especially those whose TOAST classification was confirmed as SVD subtype.
Subject(s)
Humans , Aging , Arteries , Atherosclerosis , Classification , Diagnosis , Pulse Wave Analysis , Stroke , Vascular StiffnessABSTRACT
BACKGROUND AND PURPOSE: Remnant lipoproteins (RLPs) are products of partially catabolized chylomicrons and very-low-density lipoprotein, from which some triglycerides have been removed. These particles are smaller and denser than the parent particles and are believed to be strongly atherogenic. We explored the association between RLP cholesterol (RLP-C) and ischemic stroke, including stroke subtypes. METHODS: A cohort of 142 ischemic stroke patients (90 men and 52 women; age, 65.2+/-12.8 years, mean+/-SD) was enrolled; all had acute infarcts confirmed by diffusion-weighted MRI, and had fasting lipograms. A full stroke-related evaluation was conducted on each patient. An outpatient population of 88 subjects without a history of cerebrovascular or cardiovascular disease served as a control group. Serum RLP fractions were isolated using an immunoaffinity gel containing specific antiapolipoprotein (anti-apo)B-100 and anti-apoA-I antibodies. RLP-C values were considered to be high when they were in the highest quartile of all values in the study. RESULTS: High RLP-C values were more common in stroke patients than in control patients (31.0% vs. 14.8%, p=0.01), when 5.6 mg/dL (>75th percentile) was used as the cutoff value. Multivariable analyses indicated that RLP-C was a risk factor for stroke, with an odds ratio of 2.54 (p=0.045). The RLP-C level was higher in the large artery atherosclerosis subgroup (5.7+/-3.9 mg/dL) than in any other stroke subgroup (small vessel occlusion, 4.9+/-5.9 mg/dL; cardioembolism, 1.8+/-2.3 mg/dL; stroke of undetermined etiology, 3.1+/-2.9 mg/dL). CONCLUSIONS: We have found an association between high RLP-C levels and ischemic stroke, and in particular large artery atherosclerotic stroke.
Subject(s)
Humans , Male , Antibodies , Arteries , Atherosclerosis , Cardiovascular Diseases , Cholesterol , Chylomicrons , Cohort Studies , Fasting , Glycosaminoglycans , Lipoproteins , Odds Ratio , Outpatients , Parents , Risk Factors , Stroke , TriglyceridesABSTRACT
BACKGROUND: Carotid artery intima-media thickness (IMT) is an early structural marker of the atherosclerotic processes and an increased carotid IMT is a strong predictor of stroke. The measurement of carotid IMT is a useful non-invasive measure in risk stratification of ischemic stroke. The objective of the present study is to evaluate whether mea-surement of carotid IMT contributes to the prediction of large-artery atherosclesrotic cerebral infarction. METHODS: By TOAST classifications, 88 patients with ischemic stroke [67 with large-artery disease (LAD) and 21 with small-artery disease (SAD)] were selected from a stroke registry (2000.7~2001.7). Carotid IMT was defined as the mean of IMT measured by B-mode ultrasonography (12 MHz linear probe) at 10 sites of both distal common carotid arteries. The dif-ferences of carotid IMT were analyzed statistically between the LAD and SAD groups according to age or sex. RESULTS: The carotid IMT was 0.84+/-0.08 mm for the LAD and 0.77+/-0.04 mm for the SAD groups. There were no statistically significant differences (p > 0.05) of carotid IMT(total, age, sex) between the LAD and SAD groups. CONCLUSIONS: In this study, the carotid IMT was not associated with LAD as wells as SAD. However, with the increase in age, there is a tendency to increase the differences of carotid IMT between LAD and SAD groups.