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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Humans , Basilar Artery/diagnostic imaging , Vertebrobasilar Insufficiency/diagnostic imaging , Ultrasonography, Doppler, Transcranial/methods , Magnetic Resonance Angiography , Blood Flow Velocity , MicrocirculationABSTRACT
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.
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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.
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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.
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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.
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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.
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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.
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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.
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Objective To investigate the clinical application of Tongqiao-Huoxue decoction for the treatment of vertebrobasilar artery insufficiency vertigo with stasis orifice type. Methods According to the random table method, 93 vertebrobasilar artery insufficiency vertigo patients with stasis orifice type were divided into the control group (n=46) and the treatment group (n=47). The patients in the control group were treated with fluoguizine hydrochloride, while the patients in the treatment group were treated with Tongqiao-Huoxue decoction on the basis of control group. Two groups were treated for 4 weeks. The clinical total effective rate of two groups of patients after treatment was compared. The LVA mean blood flow velocity, RVA mean blood flow velocity, BA mean blood flow velocity, total blood viscosity, plasma viscosity, erythrocyte aggregation index, fibrinogen, TC, TG, LDL-C and HDL-C were detected respectively before and after treatment. In addition, the adverse reaction incidence of two groups of patients were observed. Results The total effective rate of treatment group was 93.6% (44/47), while the total effective rate of control group was 78.3% (36/46). The difference between two groups was statistically significant (χ2=4.559, P=0.033). After treatment,the LVA mean blood flow velocity (38.34 ± 3.72 cm/s vs. 29.73 ± 3.11 cm/s, t=12.096), RVA mean blood flow velocity (41.12 ± 4.05 cm/s vs. 34.11 ± 3.86 cm/s, t=8.541),BA mean blood flow velocity (48.92 ± 5.24 cm/s vs. 40.75 ± 4.63 cm/s, t=7.962), HDL-C (2.13 ± 0.64 mmol/L vs. 1.54 ± 0.53 mmol/L, t=4.836) of treatment group were significantly higher than the control group (P<0.05), while the total blood viscosity, plasma viscosity, erythrocyteaggregation index, fibrinogen, TC, TG, LDL-C of treatment group were significantly lower than the control group (t value were 5.457, 8.875, 3.661, 6.549, 3.838, 6.369, 5.201, all Ps<0.05). No serious adverse reactions occurred during the treatment of the two groups. Conclusions The clinical curative effect of Tongqiao-Huoxue decoction for the treatment of vertebrobasilar artery insufficiency vertigo with stasis orifice type is significantly, and it can increases blood flow to the brain, improve hemorheology and lipid levels. It has the high security of the forward curative effect.
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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.
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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.
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Vertebrobasilar dolichoectasia (VBD) is a rare posterior circulation vascular variant disease.Studies have shown that VBD has an effect on the outcome of ischemic stroke.This article reviews the relationship between VBD and ischemic stroke.
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Objective:To evaluate the clinical efficacy of acupuncture plus tuina in treating cervical vertigo (CV).Methods:One hundred CV patients were randomized into an observation group and an acupuncture group by the random number table,with 50 cases in each group.The acupuncture group received acupuncture at Xiang Ba Zhen (eight acupoints on the nape);the observation group received tuina treatment in addition to the Xiang Ba Zhen acupuncture.The two groups were both treated once every other day for 10 sessions in total.The two groups were examined by transcranial cerebral Doppler (TCD) before and after the treatment,and their therapeutic efficacies were evaluated.Results:After the treatment,the mean velocity (Vm) of vertebral artery (VA) and basilar artery (BA) showed significant improvement in both groups (all P＜0.001);there were significant differences in the Vm of VA and BA between the two groups (both P＜0.05).The total effective rate was 100.0％ in the observation group versus 82.0％ in the acupuncture group,and the difference was statistically significant (P＜0.01).Conclusion:Xiang Ba Zhen acupuncture as a monotherapy or used together with tuina can improve CV,but Xiang Ba Zhen plus tuina can produce a more significant efficacy.
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Objective:To observe the curative effect of cervical chiropractic for cervical spondylosis of vertebral artery type (CSA) and to explore its possible mechanism.Methods:Sixty CSA patients were randomly divided into two groups.Thirty patients in the treatment group were treated with chiropractic manipulation for cervical vertebrae,once every other day,7 treatments in total.The other 30 patients in the control group received oral administration of flunarizine hydrochloride,10 mg per night,for 14 d.Cervical vertigo and functional assessment scale and transcranial cerebral Doppler (TCD) were measured before treatment and 7 days after treatment.Results:The total effective rate was 96.7％ in the treatment group and 83.3％ in the control group.The curative rate was 66.7％ in the treatment group and 20％ in the control group.The differences between the two groups in the total effective rate and the curative rate were statistically significant (both P＜0.05).The scores of cervical vertigo symptom and functional assessment after treatment in both groups were significantly higher than those before treatment (both P＜0.01);the difference between the two groups was statistically significant (P＜0.05).After treatment,the maximum systolic velocity (Vs),the maximum diastolic velocity (Vd),the mean velocity (Vm),the pulsatility index (PI) and the vascular resistance index (RI) in both groups were significantly improved compared with those before the treatment (all P＜0.01);there were significant differences between the two groups (all P＜0.05).Conclusion:Cervical chiropractic is an effective method for CSA,and its curative effect is better than that of flunarizine hydrochloride alone.Its mechanism may relate to correcting cervical instability.