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Objective To observe the efficacy of tirofiban in the treatment of ischemic progressive stroke. Methods 300 patients who met the diagnostic criteria of ischemic progressive stroke were divided into the control group and tirofiban group. Patients in the control group received treatment of PA2S regiment, i.e., a combination of aspirin, clopidogrel, probucol and atorvastatin. Patients in the tirofiban group received extra tirofiban on the basis of PA2S therapy. National institute of health stroke scale (NIHSS) score was evaluated on patients in both group before the therapy and 3 days, 1 month, 6 months after the therapy respectively. Results For the control group, the average NIHSS score was 11.3±4.2,11.5±4.4,8.8±4.1,6.1±4.1 before therapy and at 3 days, 1 month, 6 months after the therapy. And for the tirofiban group, the average NIHSS score was 11.4±3.9, 10.8±3.6, 7.4±3.2, 4.4±3.0 at the corresponding period respectively. There were statistical differences between the two groups in the period of 1 month and 6 months after treatment with P<0.001. Conclusions Tirofiban hydrochloride can improve the degree of neurological deficit and outcome in patients with ischemic progressive stroke.
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Objective The double antiplatelet therapy with aspirin and clopidogrel is widely used in the progressive stroke patients.However, this therapeutic regimen is still lack of guideline confirmation .In this study, we aimed to observe the effects of cere-bral hemodynamics and platelet parameters of combined antiplatelet treatment with aspirin and clopidogrel on progressive stroke patients . Methods This retrospective study enrolled 82 patients with progres-sive stroke within 24 hours in the Nanjing Brain Hospital Affiliated to Nanjing Medical University from January 2014 to January 2016.All the patients were divided into two groups ( single antiplatelet group and combined antiplatelet group ) according to the antiplatelet therapy .Forty patients were included in the single antiplatelet group oral-ly took aspirin 0.1g once a day while in the combined antiplatelet group forty-two patients were included to take clopidogrel 75 mg once a day besides aspirin for 21 days and then kept aspirin only .All the patients were observed for 3 months.On the 1st and 7th day of ad-mission and 3 months after admission , the patients were examined for the terms of the grades of National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI), as well as the platelet parameters including plaletet count (PLT), thrombocytocrit (PCT), mean platelet volume ( MPV) and platelet distribution width ( PDW) .The thrombelastogram was done to test the plate inhibition rate . Meanwhile , the transcranial doppler examination was done to realize the cerebral hemodynamics . Results After 7 days'and 3 months'treatment, the grades of NIHSS of combined antiplatelet group were significantly decreased versus single antiplatelet group , while BI of the combined antiplatelet group was significantly increased ( P<0.05 ) .The inhibition rate induced through adenosine diphosphate pathway was higher in the combined antiplatelet group versus the single antiplatelet group (P=0.003) on the 7th day.PLT ( P=0.006) level in the combined antiplatelet group was higher than that in the single antiplatelet group , while MPV ( P=0.023) and PDW (P=0.017) were actually lower in the combined antiplatelet group than the single antiplatelet group after 7 days'treatment.After 3 months, PDW in the combined antiplatelet group was still lower than the single antiplatelet group (P=0.041).On the 7th day, Vs (P=0.046), Vm (P=0.039) in bilateral middle cerebral artery in the combined antiplatelet group were lower than the single anti -platelet group.After 3 months, the Vs (P=0.030), PI (P=0.041) in the combined antiplatelet group was further improved versus the single antiplatelet group . Conclusion The improved effects of combined antiplatelet treatment with aspirin and clopidogrel on the clinical symptoms, cerebral hemodynamics and platelet parameters were better than single antiplatelet treatment with aspirin .
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Objective The double antiplatelet therapy with aspirin and clopidogrel is widely used in the progressive stroke patients.However, this therapeutic regimen is still lack of guideline confirmation .In this study, we aimed to observe the effects of cere-bral hemodynamics and platelet parameters of combined antiplatelet treatment with aspirin and clopidogrel on progressive stroke patients . Methods This retrospective study enrolled 82 patients with progres-sive stroke within 24 hours in the Nanjing Brain Hospital Affiliated to Nanjing Medical University from January 2014 to January 2016.All the patients were divided into two groups ( single antiplatelet group and combined antiplatelet group ) according to the antiplatelet therapy .Forty patients were included in the single antiplatelet group oral-ly took aspirin 0.1g once a day while in the combined antiplatelet group forty-two patients were included to take clopidogrel 75 mg once a day besides aspirin for 21 days and then kept aspirin only .All the patients were observed for 3 months.On the 1st and 7th day of ad-mission and 3 months after admission , the patients were examined for the terms of the grades of National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI), as well as the platelet parameters including plaletet count (PLT), thrombocytocrit (PCT), mean platelet volume ( MPV) and platelet distribution width ( PDW) .The thrombelastogram was done to test the plate inhibition rate . Meanwhile , the transcranial doppler examination was done to realize the cerebral hemodynamics . Results After 7 days'and 3 months'treatment, the grades of NIHSS of combined antiplatelet group were significantly decreased versus single antiplatelet group , while BI of the combined antiplatelet group was significantly increased ( P<0.05 ) .The inhibition rate induced through adenosine diphosphate pathway was higher in the combined antiplatelet group versus the single antiplatelet group (P=0.003) on the 7th day.PLT ( P=0.006) level in the combined antiplatelet group was higher than that in the single antiplatelet group , while MPV ( P=0.023) and PDW (P=0.017) were actually lower in the combined antiplatelet group than the single antiplatelet group after 7 days'treatment.After 3 months, PDW in the combined antiplatelet group was still lower than the single antiplatelet group (P=0.041).On the 7th day, Vs (P=0.046), Vm (P=0.039) in bilateral middle cerebral artery in the combined antiplatelet group were lower than the single anti -platelet group.After 3 months, the Vs (P=0.030), PI (P=0.041) in the combined antiplatelet group was further improved versus the single antiplatelet group . Conclusion The improved effects of combined antiplatelet treatment with aspirin and clopidogrel on the clinical symptoms, cerebral hemodynamics and platelet parameters were better than single antiplatelet treatment with aspirin .
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Objective To discuss the artery effects of enhanced external counterpulsation for the progressive stroke patients.Methods Ninety-two progressive stroke patients who were treated in the Fourth People's Hospital of Shenzhen from August 2010 to February 2015 were selected and equally divided into the treatment group and the control group based on the random number table.The control group were received conventional therapy,and the treatment group were added treated with enhanced extemal counterpulsation therapy.Results All patients were successfully completed treatment,the C-reactive protein (CRP) and Endothelin-1 (ET-1) were presented decreased significantly after treatment (P＜ 0.05),and the C RP and ET-1 values in the treatment group were (2.09±2.11) mg/L,(13.98±6.30) mg/L,significantly lower than those of the control group((8.12±2.46) mg/L,(46.09± 11.02) mg/L;t =15.309,14.985;P＜0.05).After treatment,the FMD and NMD values in the treatment group were significantly increased from (5.26±1.34)％ to (11.93 ±2.13) ％,and from (13.20±5.33)％ to (22.98±8.34)％,in the control groupand were from (5.27±1.33)％ to (8.10±1.43) ％,and from (13.67±4.10)％ to (16.09±5.12)％ (t=16.934,21.787,8.443,12.345;P ＜0.05),and the value of FMD and NMD in treatment group were significantly higher than in the control group(t =7.982,9.113;P ＜ 0.05).The cardio ankle vascular index (CAVI) and brachial ankle pulse wave velocity (baPWV) values in the treatment group were significantly reduced after treatment,the difference was significant (P＜0.05),and compared with the control group the difference was also statistically significant (t =4.281,8.456;P＜ 0.05).Conclusion Enhanced external counterpulsation for the progressive stroke patients can effectively inhibit the expression of endothelin and inflammatory factors,improve endothelium-dependent relaxation of blood vessels,improve arterial elasticity,and thus play more effective treatment.
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Objective To study the correlation of the level of high-sensitivity C-reactive protein (Hs-CRP) in the acute phase of ischemic stroke and progressive stroke. Methods 101 patients with acute ischemic stroke were collected. Serum Hs-CRP of all patients were measured at 24 hours after admission , the onset of 48 hours, the onset of 72 hours by latex enhanced immune turbidity method. According to their serum Hs-CRP lev-els, the patients were divided into the group of Hs-CRP sustained growth (n = 35) and the group of non Hs-CRP sustained growth (n = 66). The NIHSS scores were assessed on two groups of patients , Logistic regression analysis was made to screen the related factors of Hs-CRP increase and the possible risky factors for progressive ischemic stroke. Results There was a significant difference of serum Hs-CRP level between the two groups (P <0.001). The incidence of progressive stroke in the group of Hs-CRP sustained growth was significantly higher than that in the group of non Hs-CRP sustained growth (χ2 = 32.710, P < 0.001). Logistic regression analysis showed blood glucose , white blood cell count , triglyceride level and NIHSS scores at admission were associated with sustained growth of Hs-CRP and the factors that they included Hs-CRP sustained growth , admission NIHSS scores, diabetes mellitus and pulmonary infection were regarded as independent risk factors. Conclusion The sustained growth of Hs-CRP in the acute phase of ischemic stroke is an independent predictor of progressive stroke.
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BACKGROUND: Neurological deterioration following acute lacunar infarction is not uncommon. Its association with poor clinical outcome is well-known, but little is known about what causes it. This study aimed to elucidate whether 3 stigmas of cerebral microangiopathy, a pathogenesis of lacunar infarction, are associated with neurological deterioration in patients with acute lacunar infarction. METHODS: Patients with acute lacunar infarction who were admitted within 24 hours of onset were identified using a prospective stroke registry. Patients who presented neurological deterioration within 7 days of hospitalization (progressive lacune group) were matched to 4 controls (non-progressive lacune group) for 'onset to arrival time'. Three stigmas of cerebral microangiopathy (leukoaraiosis, cerebral microbleeds, and silent lacunes) were measured using initial brain MRI, and their associations with neurological deterioration were analyzed. RESULTS: During 45 months, a total of 23 patients were identified and matched to 80 controls. Simple comparison of 2 groups showed that those 3 stigmas of cerebral microangiopathy were not significantly associated with neurological deterioration. Hyperlipidemia (p=0.18), history of transient ischemic attack or stroke (p=0.01), initial NIH stroke scale (p=0.07), white blood cell counts (p=0.16), and lesion volume (p=0.03) were possibly different (p's0.5). CONCLUSIONS: This study did not find a relationship between cerebral microangiopathy and neurological deterioration following acute lacunar infarction. The possibility of inadequate power should be noted.
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Humans , Brain , Cerebral Small Vessel Diseases , Hospitalization , Hyperlipidemias , Ischemic Attack, Transient , Leukocyte Count , Logistic Models , Prospective Studies , Stroke , Stroke, LacunarABSTRACT
@#Progressive stroke is a therapeutic challenge for clinical practice. Some factors, such as infection, hypotension, hyperglycaemia and fever were related with progressive stroke. The clinical features, imaging, laboratory examination could predict the development of progressive stroke. Treatment include anticoagulation, reduce fibrinogen，temperature，glucose，enlarge capacity，control brain edema, protective agent and surgery.