ABSTRACT
Asymptomatic cerebral artery stenosis (aCAS) is closely associated with cognitive impairment, which can lead to multiple cognitive domain impairments, thereby affecting the behavior and daily life of patients. This article reviews the main involved cognitive domains, injury mechanisms, and treatment in different types of aCAS, with the aim of increasing attention to aCAS, early clinical intervention, and delaying cognitive deterioration.
ABSTRACT
Objective:To investigate the predictors of outcome after endovascular therapy in patients with acute basilar artery occlusion (ABAO).Methods:Patients with ABAO received EVT in Bozhou People’s Hospital from May 2019 to September 2022 were included prospectively. The demographic data, clinical data, relevant parameters of periprocedural period and follow-up data were collected. The outcome evaluation was performed at 90 d after procedure. The modified Rankin Scale score ≤3 was defined as good outcome, and >3 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of good outcome after EVT. Results:A total of 42 patients with ABAO were included, 21 (50%) had a good outcome and 21 had a poor outcome. There were significant differences in the National Institutes of Health Stroke Scale (NIHSS), posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS), the time from onset to recanalization, the proportion of patients with successful recanalization, use of remedial treatment, and complications were statistically significant in both groups (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for other risk factors, the low NIHSS score (odds ratio [ OR] 0.756, 95% confidence interval [ CI] 0.615-0.903; P=0.008), less use of remedial treatment measures ( OR 0.170, 95% CI 0.033-0.884; P=0.035) and high pc-ASPECTS ( OR 4.274, 95% CI 1.418-12.882; P=0.010) were the independent predictors of good outcomes. Conclusions:Half of the patients with ABAO have a good outcome after EVT. Low NIHSS score, high pc-ASPECTS at admission and less use of remedial measures are the independent predictors of good outcomes in patients with ABAO.
ABSTRACT
ABSTRACT We describe two cases of surgical treatment of craniovertebral stenosis in preschool-aged brothers with Maroteaux-Lamy (MPS type VI) syndrome. The older brother was diagnosed with MPS during her second pregnancy. Literature describing familial cases of the disease and the treatment strategy in young children with MPS type VI and spinal canal stenosis is scarce. Based on the presented observations, indications, surgical treatment approaches, and perioperative management of patients with mucopolysac-charidosis are suggested. MPS type VI may have familial forms of the disease and the course of craniovertebral stenosis is similar in siblings. Surgical treatment of craniovertebral stenosis in these patients should be performed timely. We adhere to the point of view of early treatment of craniovertebral stenosis in patients with MPS before irreversible spinal cord dysfunction develops. Level of Evidence IV; Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease and Case series.
Resumo: Descreve-se dois casos de tratamento cirúrgico de estenose craniovertebral entre irmãos em idade pré-escolar com síndrome de Maroteaux-Lamy (MPS tipo VI). O irmão mais velho foi diagnosticado com MPS durante a segunda gravidez. A literatura que descreve casos familiares da doença e a estratégia de tratamento em crianças pequenas com MPS tipo VI e estenose do canal raquidiano é escassa. Com base nas observações apresentadas, foram sugeridas indicações, abordagens de tratamento cirúrgico e manejo perioperatório de pacientes com mucopolissacaridose. A MPS tipo VI pode apresentar formas familiares da doença e o curso da estenose craniovertebral é semelhante entre irmãos. O tratamento cirúrgico da estenose craniovertebral nesses pacientes deve ser realizado em tempo hábil. Adere-se ao conceito de tratamento precoce da estenose craniovertebral em pacientes com MPS antes que se desenvolva uma disfunção irreversível da medula espinhal. Nível de Evidência IV; Estudos Prognósticos - Investigando o Efeito de uma Característica de Paciente sobre o Resultado de uma Doença e de uma Série de Casos.
Resumen: Se describen dos casos de tratamiento quirúrgico de estenosis craneovertebral en hermanos de edad preescolar con síndrome de Maroteaux-Lamy (MPS tipo VI). Al hermano mayor se le diagnosticó MPS durante el segundo embarazo. La bibliografía que expone casos familiares de la enfermedad y la estrategia de tratamiento en niños pequeños con MPS tipo VI y estenosis del tubo vertebral es escasa. Sobre el fundamento de las observaciones presentadas, se sugieren indicaciones, enfoques de tratamiento quirúrgico y manejo perioperatorio de pacientes con mucopolisacaridosis. La MPS tipo VI puede presentar formas familiares de la enfermedad y el curso de la estenosis craneovertebral es semejante en los hermanos. El tratamiento quirúrgico de la estenosis craneovertebral en estos pacientes debe realizarse tempranamente. Se adhiere al planteamiento del tratamiento precoz de la estenosis craneovertebral en pacientes con MPS anticipándose al desarrollo de una disfunción irreversible de la médula espinal. Nivel de Evidencia IV; Estudios Pronósticos - Investigando el Efecto de una Característica del Paciente en el Resultado de la Enfermedad y Series de Casos.
Subject(s)
Humans , Child, Preschool , Spinal Stenosis , Mucopolysaccharidosis VI , Surgical Procedures, OperativeABSTRACT
Objective:A clinical case of rotational vertebral artery occlusion (bow hunter's syndrome, BHS) caused by left C 1 osteophyte was reported, and the epidemiological characteristics, diagnosis and treatment methods, and clinical outcomes of BHS were further analyzed. Methods:The clinical data, diagnostic methods, treatment options, and clinical outcomes of the above-mentioned BHS patient are described. The literature from 1978 to 2021 was retrieved, the BHS patients involved were taken as the research objects, and the data of onset age, gender, etiology, site of onset, diagnosis method, treatment method, and clinical outcomes of each selected patient were collected. The data were subdivided through systematic analysis.Results:A patient with rotational compression of the left vertebral artery associated with the left osteophyte of the atlas was presented. 3D-CT showed that the vertebral artery was compressed by the left osteophyte of the atlas. Dynamic digital subtraction angiography (dDSA) showed mild stenosis of the distal V2 segment of the left vertebral artery. When his head turned to the left, the distal V2 segment of the left vertebral artery was compressed and the blood flow was interrupted. After his head was in a neutral position, the blood flow was restored. Because the symptoms could not be relieved after conservative treatment, posterior C 1 osteophyte resection was used to decompress the vertebral artery, and the symptoms disappeared after the operation, and the short-term follow-up results were good. All of the 87 articles and 126 patients have been studied. The median age was 55.0 years (IQR: 43.5, 65.0 years) and the peak age of onset was 51 to 60 years old. The gender difference has been uncovered and the sex ratio was 1.9∶1 (male∶female). Among the 126 patients, 65 patients had vertebral artery occlusion or stenosis located in the C 1-C 2 segment; 66 patients involved the left vertebral artery, 45 patients involved the right vertebral artery, and 15 patients involved bilateral vertebral arteries. DSA was used to confirm BHS in 114 of 126 patients. The follow-up time was 0.25-114 months, with an average of 16.6 months. Thirty-six patients were treated conservatively, and 12 patients had residual symptoms; 33 patients underwent fusion surgery, and all patients' symptoms were relieved after surgery; 54 patients underwent simple decompression surgery, and 4 patients had residual symptoms after surgery; 4 patients received endovascular surgery, and their symptoms were relieved after surgery. Conclusion:Patients with BHS are rare clinically, often involving C 1-C 2 and the left vertebral artery is more likely to be involved. The peak age of onset was 51 to 60 years old. DSA is the gold standard for the diagnosis of BHS. For BHS caused by abnormal bone structure, intervertebral disc herniation, joint instability, etc., decompressive surgery of the vertebral artery or C 1-C 2 segment fusion is the most common treatment modality.
ABSTRACT
Objective:To evaluate the short-term efficacy and safety of Apollo stent in the treatment of symptomatic basilar artery stenosis.Methods:Patients with symptomatic basilar artery stenosis admitted to the Fourth Affiliated Hospital of China Medical University from January 2017 to May 2020 were selected and treated with Apollo stent implantation. The changes of clinical symptoms and the success rate of operation were evaluated. Postoperative complications included symptomatic intracranial hemorrhage, hyperperfusion, and new ischemic stroke, and follow-up results were evaluated 3 to 6 months later.Results:A total of 96 patients were included in this study, and all of them were confirmed by angiography to have severe basilar artery stenosis corresponding to the symptoms. Among them, 88 patients received stent implantation, with a success rate of 100%. Among the 88 patients, 86 received Apollo stent implantation, and 2 patients received self-Peng stent implantation. Among 86 patients with Apollo stent implantation, the lesions were located in the proximal segment in 73 cases (84.88%), in the middle segment in 10 cases (11.63%), and in the distal segment in 3 cases (3.49%). The degree of stenosis was (93.72±3.86)%, the length of stenosis was (8.50±2.65)mm, the residual stenosis rate was (1.76±4.87)%, and Mori type A lesions in 80 cases, type B lesions in 3 cases, and type C lesions in 3 cases. Among 86 patients with Apollo stent implantation, the incidence of perioperative neurological complications was 6.98%(6/86), including 1 case in the proximal part of the basilar artery (vascular rupture), 3 cases in the middle part of the basilar artery (perforating artery occlusion in 1 case, acute thrombosis artery occlusion in 2 cases), and 2 cases in the distal part (both acute vascular occlusion). Alteplase was injected into the microcatheter during the operation, and contact thrombolysis was performed. Immediately digital subtraction angiography (DSA) showed that the blood vessels were opened, and 1 case with neurological deficit was left. No hyperperfusion occurred in all patients. All patients were followed up for three months after operation. Among them, 58 patients had a good prognosis in the proximal segment of the basilar artery, 18 patients had a good prognosis in the middle segment, 4 patients had a good prognosis in the distal segment, and 6 patients had a bad prognosis (1 patient died). Postoperative stent restenosis occurred in 5 cases (5.81%), recurrent stroke in 3 cases (3.49%), and disabling stroke in 1 case (1.16%).Conclusions:Apollo stent is safe and effective in the treatment of symptomatic basilar artery stenosis, with good short-term prognosis, and long-term prognosis needs to be further studied.
ABSTRACT
Objective:To analyze the prehospital predictors of large-vessel occlusion (LVO) in acute ischemic stroke.Methods:This study recruited patients who had developed LVO for less than 24 hours and had a National Institute of Health Stroke Scale (NIHSS) score ≥ 8 and who received treatment in Lu'an People's Hospital from December 2018 to November 2020. The included patients were divided into LVO and LVO-free groups according to the presence of a large-vessel occlusion determined by magnetic resonance angiography, CT angiography, and digital subtraction angiography. Baseline data (sex, age, disease history, life history, and medication history), NIHSS subscale score, and blood pressure at admission were compared between LVO and LVO-free groups. The efficacy of the factors that were screened for predicting LVO in acute ischemic stroke were compared with the that of commonly used scales.Results:A total of 761 patients with acute ischemic stroke who had an NIHSS score ≥ 8 were included in the final analysis. Among them, 228 patients had an LVO and 533 patients had no LVO. There were significant differences in the proportions of patients with atrial fibrillation ( OR = 5.230, 95% CI = 3.400-8.043, P < 0.001) and systolic blood pressure ≤ 170 mmHg ( OR = 5.181, 95% CI = 3.327-8.068, P < 0.001) between the two groups. Conclusion:Atrial fibrillation and systolic blood pressure ≤ 170 mmHg are greatly associated with the presence of large-vessel occlusion in acute ischemic stroke.
ABSTRACT
Objective:To compare the effectiveness of first-line mechanical thrombectomy (MT) with other types of endovascular treatment (EVT) in patients with acute vertebrobasilar artery occlusion (VBAO).Methods:From May 2012 to December 2019, acute VBAO patients diagnosed by angiographic examinations were consecutively enrolled from Nanjing Stroke Registry. Patients were divided into first-line MT group who were treated with stent retriever and direct aspiration, and other types of EVT group who underwent intraarterial thrombolysis, tirofiban infusion, balloon dilation, and stent placement etc. Clinical characteristics at baseline with statistical trends ( P<0.1) between different groups were analyzed to calculate propensity scores, which were adjusted in binary Logistic regression for the relationship between first-line treatment and clinical outcome. Results:A total of 107 patients were enrolled in this study including 82 males and 25 females with average age 62 years old (35-82). The overall recanalization rate was 82.2% (88/107). During follow-up, 33.6% (36/107) and 37.1% (39/105) patients achieved good outcome (defined as modified Rankin Scale score 0-3) at 90 days and 1 year, respectively. The MT group received EVT earlier than the other types of EVT group (median year: 2017 vs. 2015, P=0.017), as well as higher proportion of atrial fibrillation history (21.6% vs. 0, P=0.002), higher baseline National Institution of Health Stroke Scale scores (median: 26 vs. 23, P=0.049), lower Glasgow Coma Scale scores (median: 6 vs. 7, P=0.027), and longer estimated occlusion to groin-puncture time (median: 367 min vs. 283 min, P=0.023). There were significant differences in the stroke etiologies between two groups ( P=0.002). The MT group had a lower ratio of rescue device treatment (28.4% vs. 54.5%, P=0.009). After propensity scores were adjusted, the recanalization rate of MT group was significantly higher than that in the other group [odds ratio (95% confidence interval [ CI]):5.201, 95 %CI 1.562-17.317, P=0.007]. No difference was noted regarding other clinical outcomes. Subgroup analysis indicated that recanalization rates in patients without atherosclerosis were different between intervention types [odds ratio (95 %CI): 7.859, 95 %CI 1.469-42.042, P=0.016], while the recanalization rates was comparable in population with atherosclerosis [odds ratio (95 %CI): 3.739, 95 %CI 0.613-22.812, P=0.153]. Conclusion:In acute VBAO patients, first-line MT is associated with higher recanalization rate compared with other types of EVT, especially in non-atherosclerosis patients.
ABSTRACT
Objective:To investigate the collateral circulation compensation model in patients with favorable prognosis of basilar artery occlusion/severe stenosis treated with drugs or endovascular therapy.Methods:Clinical data of patients with basilar artery occlusion/severe stenosis and good clinical outcome were retrospectively collected in the Department of Neurology, Sixth Medical Center of PLA General Hospital from January 2019 to January 2020. They were divided into intensive drug therapy group and combined endovascular therapy group. The number and ways of collateral compensation pathway described by digital substraction angiography (DSA) were analyzed, and the characteristics of the collateral compensation model were summarized. SPSS22.0 software was used for statistical analysis, and the constituent ratio (%) was used for statistical description of the enumeration data.Results:A total of 32 eligible patients were included, including 27 males and 5 females, with an average age 45-76 (59±10) years. The compensation model included posterior communicating artery-posterior cerebral artery (13 cases, 40.6%), posterior communicating artery-posterior cerebral artery-basilar artery (10 cases, 31.2%), cerebellar artery-anastomotic branches of superior cerebellar artery (8 cases, 25.0%), anterior choroid artery-anastomotic branches of posterior choroid artery (2 cases, 6.2%), collateral circulation not established (11 cases, 34.4%).In drug treatment group, collateral compensation was found in the majority (14/15), with mainly posterior communicating artery (10/14).Most patients in combined treatment group did not develop collateral compensation (10/17), anastomotic branches of PICA-SCA were the main routes (6/7).Conclusion:In patients with basilar artery occlusion/severe stenosis, favorable clinical outcome can be achieved in both groups of patients treated with intensive drug therapy or endovascular therapy.
ABSTRACT
Objective:To analyze the clinical efficacy and safety of stent implantation combined with drug therapy and drug therapy alone in patients with vertebral artery initial stenosis.Methods:A total of 112 patients with vertebral artery initial stenosis who were treated in Wuzhou Workers′ Hospital from January 2016 to June 2018 were selected and divided into drug group and stent + drug group according to random number table method, with 56 patients in each group. The drug group received drug therapy alone, and stent + drug group received stent implantation combined with drug therapy. The incidence of ischemic events in posterior circulation, the improvement of vascular stenosis rate and the improvement of neurological function injury were observed in the two groups after 12 months of treatment.Results:The success rate in the stent + drug group was 100.0%(56/56). The rate of vascular stenosis in the stent + drug group was lower than that in the drug group: (15.21 ± 3.74)% vs. (18.62 ± 4.27)% ; but the incidence of restenosis was higher than that in the drug group:26.79%(15/56) vs. 7.14%(4/56), the differences were statistically significant ( P<0.05). The total incidence of ischemic events in the posterior circulation after treatment in the stent + drug group was lower than that in the drug group: 8.93%(5/56) vs. 28.57%(16/56), and the difference was statistically significant ( χ2 = 7.092, P = 0.008). After treatment, the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) in the stent + drug group were lower than those in the drug group: (2.30 ± 0.36) scores vs. (3.75 ± 0.52) scores, (4.11 ± 0.51) scores vs.(6.14 ± 0.57) scores, and the differences were statistically significant ( P<0.05). Conclusions:The application of stent implantation combined with drug regimen in the treatment of patients with vertebral artery initial stenosis can effectively reduce the neurological damage of patients, andimprove the total effective rate, which is conductive to the improvement of patients′ quality of life, but the rate of stent restenosis is high.
ABSTRACT
Objective:To investigate the effect of magnetic resonance angiography (MRA) in evaluating the mouse model of vertebrobasilar dolichoectasia (VBD) induced by injection of elastase into cerebellomedullary cistern.Methods:Twenty-four male C57/BL6 mice were selected. The mice in the elastase group ( n=12) were injected in the cerebellomedullary cistern with 2.5 μl of phosphate buffer containing 25 mU elastase, and the mice in the saline control group ( n=12) were injected with the same volume of normal saline. MRA examination of the brains of living mice was performed 2 weeks after modeling. Successful modeling was defined as the basilar artery bending angle ≤170°, or the basilar artery bending length accounts for ≥10%, or the basilar artery deviated from the midline by more than 1 grade, or the percentage increase in artery diameter was ≥25%. Results:In the elastase group and the saline control group, 2 mice and 1 mouse did not wake up normally or died, respectively. The 11 surviving mice in the saline control group had no obvious vertebral artery and basilar artery abnormalities. The success rate of modeling in the 10 surviving mice in the elastase group was 80%, and the difference in the success rate between the two groups was statistically significant ( P<0.05). There were significant differences in mean basilar artery diameter (0.30 mm vs. 0.22 mm; P<0.05), mean basilar artery bending angle (115° vs. 170°; P<0.05), and proportion of mean basilar artery bending length (31% vs. 5%; P<0.05) of the surviving mice between the elastase group and the saline control group. Conclusion:MRA can better evaluate the mouse VBD model induced by elastase injection in the cerebellomedullary cistern.
ABSTRACT
Introduction: The atlas, the first cervical vertebra, supports the head. It is unique in that it fails to incorporate acentrum. Because it supports the skull, it was named after Atlas who, according to Greek mythology, supportedthe earth on his shoulders. Frequently bony spurs arise from the anterior and posterior margins of the groove forthe vertebral artery. These are sometimes referred to as Ponticles, and they occasionally convert the groove intoa foramen. More often the foramen is incomplete superiorly. Arcuate foramen also known as ponticulus posticus(Latin for “little posterior bridge”).Aims and Objectives: To study the proportion and various types of ponticuli.Materials and methods: Present study was conducted on 100 adult human atlas vertebrae, collected from thedepartment of Anatomy, Mysore Medical College and Research Institute, Mysuru.Observations and Results: Out of 100 atlas vertebrae examined, 20 atlas vertebrae showed ponticuli of varioustypes. 27 Ponticuli was observed in twenty (20) atlas vertebra as follows: a) Ponticulus posticus -15. b) Ponticuluslateralis -07. c) Ponticulus posterolateral -05. d) Complete Ponticulus -11. e) Incomplete Ponticulus -16.e) Bilateral Ponticulus -07. f) Unilateral Ponticulus -13. g) Right side -17 and Left side -10.Conclusion: Proper identification of this anomaly on preoperative lateral radiographs should alert the surgeonto avoid using the ponticulus as a starting point for a lateral mass screw in order to not injure the vertebralartery. It is also useful to surgeons who face regularly the patients complaining about the symptoms ofvertebrobasilar insufficiency like headache, vertigo, migraine.
ABSTRACT
OBJECTIVE: To evaluate the findings of magnetic resonance angiography (MRA) and transcranial Doppler ultrasound (TCD) in patients with a clinical diagnosis of vertebrobasilar insufficiency (VBI). METHOD: From our outpatient neurotology clinic, we selected patients (using the criteria proposed by Grad and Baloh) with a clinical diagnosis of VBI. We excluded patients with any definite cause for vestibular symptoms, a noncontrolled metabolic disease or any contraindication to MRA or TCD. The patients in the study group were sex- and age-matched with subjects who did not have vestibular symptoms (control group). Our final group of patients included 24 patients (study, n=12; control, n=12). RESULTS: The MRA results did not demonstrate significant differences in the findings between our study and control groups. TCD demonstrated that the systolic pulse velocity of the right middle cerebral artery, end diastolic velocity of the basilar artery, pulsatility index (PI) of the left middle cerebral artery, PI of the right middle cerebral artery, and PI of the basilar artery were significantly higher in the study group than in the control group, suggesting abnormalities affecting the microcirculation of patients with a clinical diagnosis of VBI compared with controls. CONCLUSION: MRA failed to reveal abnormalities in patients with a clinical diagnosis of VBI compared with controls. The PI of the basilar artery, measured using TCD, demonstrated high sensitivity (91%) and specificity (91%) for detecting clinically diagnosed VBI.
Subject(s)
Humans , Basilar Artery/diagnostic imaging , Vertebrobasilar Insufficiency/diagnostic imaging , Ultrasonography, Doppler, Transcranial/methods , Magnetic Resonance Angiography , Blood Flow Velocity , MicrocirculationABSTRACT
Objective@#To investigate the safety of argatroban in vertebral artery stenting and its effect on postoperative restenosis.@*Methods@#From January 2013 to September 2017, patients undergoing vertebral artery stenting in the Department of Neurology, Jinling Hospital were enrolled prospectively. They were divided into agatraban group and heparin group by random number table method. The argatroban group received argatroban anticoagulation during the procedure, and was continuously used for 5 d after procedure; while the heparin group underwent heparin anticoagulation during the procedure, and used saline as placebo after procedure. Clinical follow-up was performed at 1, 3, and 6 months after procedure. Digital subtraction angiography, CT angiography, or magnetic resonance angiography were performed at 6 months to evaluate the restenosis of the treated blood vessels. The primary endpoints included intraoperative safety, in-stent restenosis after procedure, and any clinical events that occurred during the follow-up period, including stroke, cardiovascular events, and death. Major safety events included bleeding from various organs, allergic reactions, liver dysfunction, and embolism events. Kaplan-Meier survival curve was used to evaluate the incidence of vascular events during the follow-up period.@*Results@#A total of 105 patients were enrolled in the analysis, including 53 in the argatroban group and 52 in the heparin group. During the periprocedural period, no hemorrhagic events, allergic reactions, liver dysfunction or embolism events occurred in both groups. There were no significant differences in preoperative vertebral artery stenosis degree, postoperative residual stenosis degree, and stenosis degree at 6 months after procedure between the two groups, but the increase of stent stenosis at 6 months after procedure in the agatroban group was significantly lower than that in the heparin group (13.56%±26.41% vs. 4.25%±15.76%; P=0.031). There was no significant difference in the incidence of stroke recurrence (P=1.000) and clinical events (P=0.739) between the two groups during the long-term follow-up period.@*Conclusions@#It is safe to use agatraban anticoagulant therapy in the vertebral artery stenting. Continuous use of agatraban anticoagulation after procedure may effectively reduce the increase of stent stenosis at 6 months after procedure.
ABSTRACT
Objective To investigate the predictors of death after endovascular mechanical thrombectomy (EMT) in patients with acute vertebrobasilar occlusive stroke (VBOS).Methods Patients with acute VBOS treated with EMT in Wuhan No.1 Hospital were enrolled retrospectively.The demographic and clinical data were collected.According to whether the patients died at 90 d after procedure,they were divided into survival group and death group.The demographic and clinical data were compared between the two groups.Multivariate logistic regression analysis was used to determine the independent risk factors for death at 90 d after EMT.Results A total of 47 patients were enrolled.The median age was 62 years,34 were males (72.3％),the median baseline National Institutes of Health Stroke Scale (NIHSS) score was 16,42 patients (89.4％) had recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] 2b/3 grade),and 12 (25.5％) died within 90 d after procedure.Univariate analysis showed that the baseline NIHSS score (26 [21-28]vs.12 [5-23];Z=-3.165,P=0.002),percentage of neutrophil (81.61％ ± 11.82％ vs.72.20％ ± 12.09％;t =-2.137,P =0.033),neutrophil/lymphocyte ratio (10.54 ±7.17 vs.4.98 ±3.57;t =-2.393,P=0.017),and incidence of sICH (25.0％ vs.2.9％;x2 =5.627,P=0.018) in the death group were significantly higher than those in the survival group,while the percentage of lymphocyte (12.00％ ± 9.04％ vs.20.67％ ±10.39％;t =-2.429,P=0.015) was significantly lower than that of the survival group.Multivariate logistic regression analysis showed that high baseline NIHSS score (odds ratio [OR] 1.243,95％ confidence interval [CI] 1.046-1.318;P =0.038),high neutrophil/lymphocyte ratio (OR 1.278,95％ CI 1.002-1.630;P =0.049) and symptomatic intracranial hemorrhage (OR 5.088,95％ CI 1.065-38.718;P =0.046) were the independent predictors for death.Conclusion High baseline NIHSS score,high neutrophil/lymphocyte ratio and symptomatic intracranial hemorrhage are the independent predictors for death within 90 d after EMT in patients with acute VBOS.
ABSTRACT
Objective@#To investigate the predictors of death after endovascular mechanical thrombectomy (EMT) in patients with acute vertebrobasilar occlusive stroke (VBOS).@*Methods@#Patients with acute VBOS treated with EMT in Wuhan No. 1 Hospital were enrolled retrospectively. The demographic and clinical data were collected. According to whether the patients died at 90 d after procedure, they were divided into survival group and death group. The demographic and clinical data were compared between the two groups. Multivariate logistic regression analysis was used to determine the independent risk factors for death at 90 d after EMT.@*Results@#A total of 47 patients were enrolled. The median age was 62 years, 34 were males (72.3%), the median baseline National Institutes of Health Stroke Scale (NIHSS) score was 16, 42 patients (89.4%) had recanalization (modified Thrombolysis in Cerebral Infarction[mTICI] 2b/3 grade), and 12 (25.5%) died within 90 d after procedure. Univariate analysis showed that the baseline NIHSS score (26 [21-28]vs. 12 [5-23]; Z=-3.165, P=0.002), percentage of neutrophil (81.61% ±11.82% vs. 72.20% ±12.09%; t=-2.137, P=0.033), neutrophil/lymphocyte ratio (10.54±7.17 vs. 4.98±3.57; t=-2.393, P=0.017), and incidence of sICH (25.0% vs. 2.9%; χ2=5.627, P=0.018) in the death group were significantly higher than those in the survival group, while the percentage of lymphocyte (12.00%±9.04% vs. 20.67%±10.39%; t=-2.429, P=0.015) was significantly lower than that of the survival group. Multivariate logistic regression analysis showed that high baseline NIHSS score (odds ratio [OR] 1.243, 95% confidence interval [CI] 1.046-1.318; P=0.038), high neutrophil/lymphocyte ratio (OR 1.278, 95% CI 1.002-1.630; P=0.049) and symptomatic intracranial hemorrhage (OR 5.088, 95% CI 1.065-38.718; P=0.046) were the independent predictors for death.@*Conclusion@#High baseline NIHSS score, high neutrophil/lymphocyte ratio and symptomatic intracranial hemorrhage are the independent predictors for death within 90 d after EMT in patients with acute VBOS.
ABSTRACT
Objective To investigate the feasibility of a model of vertebrobasilar dolichoectasia (VBD)in rats induced by injection of elastase into cisterna magna. Methods Forty male SD rats were randomly divided into elastase model group (n = 20) and saline control group (n = 20). The elastase model group was intracisternal injected with 0. 3 μl of elastase at a concentration of 1. 5 U/μl, and the saline control group was injected with 0. 3 μl of normal saline. All the animals were sacrificed at 28 d after model preparation.The degree of VBD was observed in both groups, and conventional HE and elastic fiber stain were performed. The tortuosity index and increased percentage of artery diameter were used to determine whether the model was successful. Results One and three rats died in the saline control group and the elastase model group, respectively. The diameter of the basilar artery in the elastase model group was significantly thicker than that in the saline control group (0. 452 ± 0. 062 mm vs. 0. 284 ± 0. 046 mm; t = 9. 113, P < 0. 001).None of the saline control groups showed morphological characteristics of VBD, and 15 in the elastase model group met the morphological characteristics of VBD. The success rate of model preparation was 88. 2％ (15/17 ). Histopathological examination showed that the structure of the vascular wall of was destroyed, the wall of the blood vessel was thinned, and internal elastic layer was discontinuous in the elastase model group; the saline control group had a clear wall structure, a uniform wall thickness, and a complete continuous elastic layer. Conclusion Injection of elastase into occipital cistern can successfully induce VBD in rats, which can be used to make a rat VBD model.
ABSTRACT
Objective:To observe the clinical effect of warm needling moxibustion plus Kai Qing Long Suo tuina therapy (opening the Qing Long lock,one type of'Eight and a Half Locks' tuina therapy) for cervical spondylosis of vertebral artery type (CSA).Methods:Sixty patients with CSA were randomly allocated into an observation group or a control group,with 30 cases in each group.The observation group was treated with warm needling moxibustion plus Kai Qing Long Suo tuina therapy,while the control group was treated with warm needling moxibustion alone.Warm needling moxibustion was conducted once every other day and tuina was conducted once a day,7-day treatments for one course.The clinical efficacy and vertebral artery blood flow was observed after one course of treatment.Results:After treatment,the total effective rate was 93.3％ in the observation group versus 80.0％ in the control group,and there was a significant difference between the two groups (P＜0.05).After treatment,the systolic blood flow velocity of vertebral artery increased in both groups,with statistical significance compared with that before treatment (both P＜0.05),and the blood flow velocity in the observation group was faster than that in the control group,with statistical significance between the two groups (P＜0.05).Conclusion:Both warm needling moxibustion plus Kai Qing Long Suo tuina therapy and warm needling moxibustion alone are both effective for CSA,can improve the systolic blood flow velocity of vertebral artery.The curative effect of warm needling moxibusiton plus Kai Qing Long Suo tuina therapy is better than that of warm needling moxibustion alone.
ABSTRACT
Objective To summarize the development and current status of the technology of extracranial vertebral artery stenting(VAS) in China based on published Chinese literatures. Methods Using computer retrieval and manual retrieval method,China National Knowledge Infrastructure (C N K I),Wanfang Database, Weipu, and Sinomed were searched. Data were collected form identified domestic literatures on VAS published until June 2018. Two researchers independently read and screened the articles according to inclusion and exclusion criteria, and then the data were checked by a third researcher. A comprehensive evaluation of VAS in China was performed according to regional distribution, department distribution, anesthesia type,stent use, surgical effect,clinical outcome, complications, medication and restenosis. Results (1) A total of 1 429 relevant literatures were retrieved and 178 articles with low overall quality were recruited,including 2 randomized controlled trials ( 100cases and follow-up > 1 year. The incidence rate of restenosis was 25.4% (430cases). Conclusions VAS technology has been widely used in China. However, VAS treatment should be completed by qualified hospitals with corresponding technical operation specifications. The guidance of VAS in China should be based on and further supported by rigorous clinical trials with high-quality research designs.
ABSTRACT
Objective To analyze and compare the intracranial and extracranial color doppler and hemodynamic parameters of severe intracranial vertebral artery stenosis (SIVAS) with different Mori classifications. Methods From January 2017 to June 2018,a total of 122 consecutive in-patients of symptomatic unilateral SI VAS were enrolled retrospectively in Xuanwu Hospital, Capital Medical University. Tliey were divided into Mori A,B,and C groups according to the criteria of Mori classifications by CT Angiography or DSA images. Characteristics of color doppler flow imaging (C D F I) in vertebral stenosis segment and blood flow parameters of spectrum doppler, including peak systolic velocity (PSV), end-diastolic velocity (E D V),mean flow velocity (M F V),resistance index (R I) and pulsatility index (PI) in both the stenosis segment and the proximal stenosis segment were detected and compared. Results Among 122 cases (122 branches),46 cases (46 branches) were Mori A type,55 cases (55 branches) were Mori B type and 21(21 branches) were Mori C type. There were no significant differences among different Mori types in ages,gender,lesion side,cerebrovascular disease risk factors such as hypertension,diabetes,hyperlipidemia and smoking and the incidence rate of posterior circulation infarction (all P > 0. 05). The average lesion length of Mori C group (16.0 ± 6.3 mm) was significant longer than that of Mori B group (7.0 ± 1.6 mm) and Mori A group (3.4 ± 0.8mm). The differences were statistically significant (F= 145. 297, P 0. 017). About 74. 1% (15) of Mori type C did not meet the hemodynamics criteria for severe stenosis. Conclusions Mori C type lesions of SIVAS differ from Mori A and B lesions in the local color imaging features, intracranial and extracranial hemodynamic parameters. Blood flow in Mori C type lesions can be manifested with low-velocity and high-resistance in extracranial segment and discontinuity in intracranial segment.
ABSTRACT
Objective To investigate the influencing factors of in-stent restenosis (ISR) following stenting for vertebral artery ostium stenosis (VAOS). Methods From January 2013 to December 2014, a total of 325 patients receiving stenting for severe vertebral artery stenosis (≥70%).which was diagnosed with color Doppler ultrasonography (CDUS) and confirmed by digital subtraction angiography (DSA) were retrospectively recruited. All patients were divided into the ISR group (116 cases) and the non-ISR group (209 cases). CDUS was utilized for periodical follow-up after the procedure. All vascular structure characteristics and related clinical information of the target vertebral artery were recorded. The Kaplan-Meier was used to calculate the accumulative ISR incidence and generate the survival curves. The Log-rank test (χ2 test or Fisher exact test) was used to compare the discrepancy in survival curves. Cox proportional risk regression model was used to analyze the possible influencing factors. Results (1) All patients were followed up for a median of 14 (6, 38) months. There was no significant difference between the two groups in age, gender, side of severe stenosis, diabetes mellitus, hypertension, smoking history, symptoms of posterior circulation and posterior circulation cerebral infarction (all P>0.05). (2) There was significant difference in stent type using of drug eluting stent (DES) or bare metal stent (BMS) between the two groups(48/68 vs. 125/84 , χ2 =10. 18, P = 0. 001). The stent diameter in the ISR group was significantly larger than that in the non-ISR group ([4. 5 ±0. 7]mm vs. [4. 3 ±0. 8]mm, t = -2. 52, P =0. 010). There was no significant difference in stent length between the two groups (P > 0. 05). (3) Compared with the non-ISR group, the ISR group had more prevalent tortuosity of vertebral artery (42. 2% [49/116] us. 26. 8% [56/209] , χ2 = 8.14) and larger original diameter of the vertebral artery before stenting ([3.5 ± 0. 6]mm vs. [3. 3 ± 0. 5]mm, t = - 2. 74). The differences were significantly (P 0. 05). (4) Further analyzed by Cox step-wise regression, DES (HR, 0. 58, 95 % CI 0. 39 -0. 86, P = 0. 01) and tortuosity of the target vertebral artery (HR, 1. 52, 95% CI 1. 02 -2. 28, P =0. 04) were influencing factors for ISR after VAOS stenting. While the ratio of postoperative diameter to preoperative original diameter was not significantly correlated with the occurrence of ISR (P >0. 05). (5) Kaplan-Meier survival curve analysis was performed on the cumulative incidence of ISR in patients with vascular tortuosity. There was no statistically significant difference in the cumulative incidence of ISR in patients with vertebral artery tortuosity using BMS (Log-rank χ2 = 1. 72, P = 0. 19), but DES (Log-rank χ2 = 8. 62, P = 0. 003). Conclusion DES could effectively reduce the incidence of ISR. Tortuosity of the target vertebral artery was a risk factor for ISR after stent implantation, especially when using DES.