ABSTRACT
@#Background: Early neurological deterioration is a critical determinant of functional outcome in patients with acute minor ischemic stroke. This study aimed to identify clinical predictors of early neurological deterioration in patients with acute minor ischemic stroke. Methods: A total of 739 patients who experienced acute minor ischemic stroke symptoms between January 2014 and December 2018 were enrolled in this study. All patients were presented within a 4.5-hour time window of stroke symptom onset. Early neurological deterioration was defined as an increment of at least one point in motor power or total National Institute of Health Stroke Scale (NIHSS) score deterioration ≥ 2 points within 3 days after admission. Unfavorable functional outcome was defined as a modified Rankin Scale score of ≥ 2 at 90 days after stroke onset. Demographic characteristics, risk factors for vascular diseases, stroke severity, stroke subtypes, and neuroimaging parameters were analyzed. Regression analysis was used to determine clinical predictors of early neurological deterioration. Results: Of the 739 patients, 78 (10.5%) patients had early neurological deterioration. Among the 78 patients with early neurological deterioration, 61 (78.2%) had unfavorable functional outcome at 90 days after stroke onset. In contrast, 131 of the remaining 661 (19.8%) patients without early neurological deterioration had unfavorable functional outcome. Multivariate analysis identified hemorrhagic transformation (odds ratio, 3.8; 95% confidence interval, 1.4-10.5; P = 0.010), higher NIHSS score at admission (odds ratio, 1.4; 95% confidence interval, 1.1-1.7; P = 0.003), arterial stenosis (odds ratio, 2.0; 95% confidence interval, 1.2-3.5; P = 0.014) and occlusion (odds ratio, 2.6; 95% confidence interval, 1.4-4.8; P = 0.004) in the territory of stroke as significant predictors of early neurological deterioration. Conclusions: The results of this study suggest that hemorrhagic transformation, higher NIHSS score at admission, and arterial steno-occlusive lesions in the territory of stroke are independent predictors of early neurological deterioration in patients with acute minor ischemic stroke.
ABSTRACT
OBJECTIVE@#To observe the effects of "" acupuncture on cerebral blood flow in high-risk patients of cerebral ischemic stroke based on arterial spin labeling (ASL) and perfusion-weighted imaging (PWI), and to evaluate the clinical efficacy.@*METHODS@#A total of 180 patients with transient ischemic attacks (TIA) / minor ischemic stroke (MIS) were randomly divided into an acupuncture A group, an acupuncture B group and a medication group, 60 cases in each group. The patients in the acupuncture A group were treated with "" acupuncture at Baihui (GV 20), Fengfu (GV 16), Yamen (GV 15), Dazhui (GV 14), Shenzhu (GV 12), Zhiyang (GV 9), Mingmen (GV 4), Yaoyangguan (GV 3) and Jingjiaji (EX-B 2), once a day; the patients in the acupuncture B group were treated with identical acupoints but was given once every other day; the patients in the medication group were treated with oral administration of nimodipine tablets, 30 mg, three times daily. All the three groups were treated for four weeks. ASL and PWI, including relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), relative mean transit time (rMTT) and relative time to peak (rTTP), were conducted before and after treatment; the changes of the test indexes were compared before and after treatment. The clinical efficacy of the three groups was compared.@*RESULTS@#Compared before treatment, the numbers of ASL normal perfusion in the 3 groups were significantly increased after treatment (all 0.05). Compared before treatment, rCBV and rCBF in the 3 groups were significantly increased after treatment (all 0.05). The total effective rate was 88.3% (53/60) in the acupuncture A group, 73.3% (44/60) in the acupuncture B group and 90.0% (54/60) in the medication group; the total effective rate in the acupuncture A group was superior to that in the acupuncture B group (0.05).@*CONCLUSION@#"" acupuncture could effectively improve the hypoperfusion of cerebral blood flow in patients with high risk of cerebral ischemic stroke, reduce the incidence of severe CIS; acupuncture for once a day is better than once every other day.
Subject(s)
Humans , Acupuncture Therapy , Brain Ischemia , Cerebrovascular Circulation , Risk Factors , StrokeABSTRACT
Objective The present study aimed to evaluate the effects of isometric resistance training(IRT)conducted using handgrip exercise on blood pressure variability (BPV) and heart rate variability (HRV) in hypertensive patients with minor ischemic stroke (MIS).Methods One hundred and twenty-five hypertensive patients with MIS were included in the present study. Patients were randomized into two groups with random number table. Patients in the control group (n=60) were nursed in the routine care in department of neurology, while patients in the experimental group (n=65) received the IRT.The 24-hour ambulatory blood pressure-monitoring assessment was performed using validated oscillometric recorders (A&D TM- 2430, A&D Inc.,Tokyo,Japan).The 24- hour ambulatory electrocardiography measurement was performed using electrocardiocorder(PI200A-A, QunTian Inc.,Shanghai,China).The BPV ratio and the HRV ratio were assessed in the two groups. Results 24 hours after the intervention, intervention group 24 hours systolic blood pressure variation coefficient and diastolic blood pressure variation coefficient were(10.16 ± 1.95)％,(12.6 ± 7.15)％,the control group, respectively (12.92 ± 2.79)％, (17.38±4.49)％, two groups compare the difference was statistically significant (t=6.450, 4.435, P<0.05). Intervention group of normal sinus R- R period between the standard deviation, to the phase difference between adjacent R- R , root mean square value of the whole difference in more than 50 ms continuous period of percentage between normal R-R and triangle Index were (173.3±58.5) ms, (115.9±74.4), (54.8± 24.1)％, (53.3 ± 15.1).The control group was(128.7 ± 40.2)ms, (82.1 ± 35.2),(39.9 ± 17.1)％, (30.6 ± 14.9), and the difference between the two groups was statistically significant(t=-8.439--3.207, all P<0.05). Conclusions Isometric resistance training conducted using handgrip exercise could increase the HRV and decrease the BPV in hypertensive patients with MIS. These results indicated that the IRT may improve the life quality of hypertensive patients with MIS.
ABSTRACT
Objective To explore the efficacy and safety of intravenous thrombolysis or bridging therapy for acute minor ischemic stroke (MIS) with large artery occlusion. Methods Seventy-three acute MIS patients with large artery occlusion, who admitted to our hospital via stroke green channel within 4.5 h after onset from Sep. 2013 to Jun. 2018, were enrolled in this study, including 55 cases in intravenous thrombolysis group and 18 cases in bridging therapy group. The patients in the intravenous thrombolysis group underwent intravenous thrombolysis treatment with recombinant tissue plasminogen activator (rt-PA), and the patients in the bridging therapy group underwent thrombectomy within time window after intravenous thrombolysis. National Institutes of Health stroke scale (NIHSS) score at admission and modified Rankin scale (mRS) score at 90 days after treatment were evaluated in all patients. The mRS scoring 0-2 was good prognosis, and 3-6 was poor prognosis. Results There were no significant differences in the gender, age, medical history, smoking history, ratio of asymptomatic cerebral infarction, NIHSS score at admission, Glasgow coma scale score, Alberta stroke program early conputed tomography score, door-to-needle time or onset-to-needle time between the two groups (all P>0.05). The rates of good prognosis at 7 d and 90 d after treatment, incidence of symptomatic intracranial hemorrhage and mortality were not significantly different between the two groups (all P>0.05), while the incidence of systemic complications was significantly lower in the intravenous thrombolysis group than that in the bridging therapy group (23.6% [13/55] vs 44.4% [8/18]; χ2=2.434, P=0.019). Conclusion Intravenous thrombolysis and bridging therapy have similar clinical efficacy and safety in treatment of acute MIS with large artery occlusion; although the incidence of systemic complications in patients with bridging therapy is higher than that in patients treated with intravenous thrombolysis, the long-term effects are both good.
ABSTRACT
Objective To investigate the value of ABCD3-I score in predicting the outcome of acute minor ischemic stroke. Methods Totally 255 patients were valued by ABCD, ABCD2, ABCD3, ABCD3-I and ESSEN score then the clinical characters, outcome and early progression of these patients were investigated. Results Forty-eight patients had poor outcome after 90 days. Univariate logistic regression indicated that the differences of hypertension, diabetes, cardiovascular disease, stenosis of criminal artery, abnormal signal in diffusion weighted imaging (DWI) and other clinical symptoms between poor outcome group and good outcome group were statistically significant (P<0.05). The AUC of ABCD, ABCD2, ABCD3, ABCD3-I and ESSEN score in predicting outcome of acute minor stroke was 0.791 0, 0.798 3, 0.827 9, 0.930 0 and 0.735 9 respectively. There was difference among patients with different ABCD3-I scores both in outcome and early progression. Conclusion ABCD3-I score can predict the outcome of acute minor stroke and supply a new method for personalized treatment.