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Objective To study the process of single stent and double-stent thrombectomy at the Y-shaped bifurcation of the ideal internal carotid artery by finite element simulation, analyze the stent-thrombus-vessel interaction during the thrombectomy process based on the simulation results, and provide guidance for improving the effect of stent thrombectomy at the bifurcation. Methods The CAD software was used to build the model and the finite element analysis software was used to simulate the process of single stent and double-stent thrombectomy. Results Thrombectomy was unsuccessful in single stent model and successful in double-stent model, and the maximum stress of thrombus during embolus retrieval was twice that of single stent, the maximum strain was 1.12 times that of single stent, and the maximum contact pressure on the surface of vessel was approximately twice that of single stent. Conclusions Double Solitaire stents can effectively prevent thrombus displacement at the bifurcation and successfully retrieve the thrombus, but there is a risk of fracture due to the high stress level in the middle section of the thrombus. The contact pressure of the vessel on the anterior artery side is higher during thrombectomy, and the risk of vessel damage is greater. Therefore, it is necessary to optimize the design of the stent-retriever to improve its flexibility.
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Objective:To explore the correlation between serum microRNA(miR)-124 and miR-181c expression and the treatment outcome of Solitaire stent thrombectomy in patients with acute cerebral infarction and its influencing factors.Methods:Eighty-one patients with acute cerebral infarction performed Solitaire stent thrombectomyfrom June 2018 to October 2020 in the Affiliated Hospital of Jining Medical College were selected. The predictive value of miR-124, miR-181c expression in patients with acute cerebral infarction were analyzed.Results:In 81 patients, 21 patients with poor outcome(poor outcome group) and 60 patients with favorable outcome (favorable outcome group). The ratio of age ≥ 60 years in poor outcome group was higher than that in the favorable outcome group: 76.19% (16/21) vs. 46.67% (28/60), there was statistical difference ( χ2 = 5.46, P<0.05). The levels of miR-124, miR-181c before surgery and postoperative 1-day, 7-day in the favorable outcome group were higher than those in poor outcome group: 2.81 ± 0.82 vs. 2.24 ± 0.74, 3.01 ± 1.52 vs. 2.07 ± 1.04, 3.25 ± 1.67 vs. 1.86 ± 0.92; and the levels of miR-181c before surgery and postoperative 1-day, 7-day in the favorable outcome group were lower than those in the poor outcome group: 1.43 ± 0.59 vs. 1.79 ± 0.65, 1.35 ± 0.62 vs. 1.94 ± 0.79, 1.24 ± 0.60 vs. 2.16 ± 1.08, there were statistical differences ( P<0.05). The results of Logistic multivariate analysis showed that the age, the levels of miR-124, miR-181c before operation and postoperative 1-day, 7-day were influencing factors for the treatment outcome of Solitaire stent thrombectomy. The receiver operating characteristic (ROC) curve analysis showed that the area under the curve of miR-124, miR-181c on the postoperative 7-day were 0.806, 0.861, and were higher than those before operation and the postoperative 1-day, the diagnostic sensitivity were 71.43%, 76.19%, the specificity were 88.33%, 85.00%. Conclusions:The expression of miR-124 and miR-181c in the serum of acute cerebral infarction is related to the outcome of Solitaire stent thrombectomy, especially the expression level on the postoperative 7-day has better application value. It can be used to predict the outcome of surgery.
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Objective::To observe the effect of modified Tongqiao Huoxuetang combined with stent thrombectomy in treating acute cerebrovascular occlusion. Method::A total of 120 cases were randomly divided into control group and observation group, with 60 cases in each group. The control group received stent thrombectomy, while the observation group received modified Tongqiao Huoxuetang combined with stent thrombectomy. The clinical symptoms [health neural function defect scale stroke scale scores(NIHSS), activities of daily living(ADL), mini mental state examination(MMSE)], hemodynamic indexes [high-shear reduction viscosity(HSRV), medium-shear reduction viscosity(MSRV), low-shear reduction viscosity(LSRV), whole blood plasma viscosity(WBV)], vascular endothelial functions [serum nitric oxide synthase(NOS), endothelin-1(ET-1), vascular endothelial growth factor(VEGF)] were observed. The clinical efficacy and the incidence of adverse reactions were compared between two groups. The blood routine, urine routine, heart, liver and kidney function, incidence of cerebral hemorrhage in two groups were observed during the treatment. Result::There were 4 cases were shed in control group and 2 cases in observation group during the study period. The total effective rate in observation group was 94.8%(55/58), which was higher than 83.9% of the control group(47/56)(P<0.05). The NIHSS in observation group was lower than that in control group(P<0.05), whereas ADL and MMSE were higher than those in control group(P<0.05). The hemorheological indexes in observation group were lower than those in control group(P<0.05), NOS and VEGF in observation group were higher than those in control group(P<0.05), and ET-1 score was lower than that in control group(P<0.05). During the study period, the incidence of cerebral hemorrhage was 7.14%(4/56) in control group and 8.6%(5/58) in observation group, with no significant difference. Conclusion::Modified Tongqiao Huoxuetang combined with stent thrombectomy could significantly improve the clinical symptoms, hemorheology and vascular endothelial function of patients with acute cerebrovascular occlusion, and so is worthy of clinical promotion and application.
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Objective To preliminarily discuss the effect and safety of stent thrombectomy for acute middle cerebral artery M2 segment occlusion in patients with ischemic stroke. Methods From January 2014 to February 2019,19 consecutive acute ischemic stroke patients with acute middle cerebral artery M2 segment occlusion registered in Stroke Database of General Hospital of Eastern War Zone were enrolled retrospectively. They all receive stent thrombectomy. Of Lhe 19 patients, 12 were male and 7 were female;the age ranged from 48 to 83 years,with a median age of 69 ( 51,75) years;9 patients also had atrial fibrillation, 15 had hypertension,6 had diabetes,and 4had a history of coronary heart disease,and 2 had a history of stroke (the pre-onset modified Rankin scale [MRS] score 1) ;8 had a history of smoking;the National Institutes of Health Stroke Scale (NIHSS) scores on admission were 5 to 28,and the median score was 15 ( 11,22) ;the early CT scores (ASPECTS) of the Alberta Stroke Project were 3-10,and the median score was 8 (6,9);according to the etiological typing of Trial of Org 10172 in Acute Stroke Treatment (TOAST) ,9 were large atherosclerosis and 10 were cardiac embolism The NIHSS scores before and after thrombectomy, surgical methods, recanalization, and intracranial hemorrhage were analyzed, and the prognosis at 90 d after surgery was analyzed. The modified Thrombolysis in Cerebrovascular Infarction (mTICI) grade (mTICI) 2b-3 were successful recanalization; the MRS scores 0 -2 were clinical good prognosis, and the MRS scores 3 -6 were poor prognosis. Results The time from onset to puncture in 19 patients was 137-545min,a median time was 265 (184,347) min,and the time from puncture to recanalization was 75 (58,98) min;17 patients only used stent thrombectomy and 2 were also treated with a balloon recanalization. The median number of thrombectomy was 1 ( 1 ,2) times;the proportion of successful recanalization was 16/19, and 3 patients were mTICI grade 2a. The NIHSS scores were 1 to 30 at 24 h after surgery,and the median score was 17 (4,21). The NIHSS scores were 1 - 30 at discharge and the median score was 11 (2,15). Seven patients occurred intracranial hemorrhage, 1 of them was symptomatic intracranial hemorrhage; the other 12 did not have intracranial hemorrhage. Three of 19 patients died during the follow-up at 90d,including 1 herniation of brain, 1 diabetic nephropathy caused renal insufficiency,and 1 cerebral hemorrhage. The median MRS score was 2 (1,4) ,and the proportion of the good prognosis was 11/19 (including 10 successful recanalists) ,and the proportion of the poor prognosis was 8/19 (including 6 successful recanalists). Conclusion Preliminary analysis of the effect of stent thrombectomy in ischemic stroke patients with acute middle cerebral artery M2 segment occlusion is considered safe and effective, but the conclusion needs further verification.
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Objective To discuss the influencing factors of intracranial cerebral hemorrhage complicationin patients with acute ischemic stroke (AIS) after receiving Solitaire AB stent mechanical thrombectomy.Methods The clinical data of 32 AIS patients,who were treated with Solitaire AB stent thrombectomy during the period from June 2015 to October 2016 at authors' hospital,were retrospectively analyzed.The basic materials of patients,who developed intracranial hemorrhagic transformation (HT) after Solitaire AB stent thrombectomy,were analyzed and compared with the results of related studies published at home and abroad.Results Solitaire AB stent thrombectomy was successfully accomplished in all the 32 AIS patients.The postoperative fatality rate was 9.4％ (3/32).Three patients developed symptomatic intracranial HT after Solitaire AB stent thrombectomy,including artery occlusion in anterior circulation (n=1) and artery occlusion in posterior circulation (n=2),with the HT incidence being 9.4％ (3/32).Of the 3 patients,conservative treatment was adopted in 2 and ventricular external drainage with implantation of liquid storage bag through ventricular drilling-hole was carried out in one.Finally,2 patients died of HT and one patient recovered by conservative treatment.The percentage of HT death patients in all deaths was 66.7％ (2/3).Conclusion Intracranial HT is a fatal complication of embolectomy in AIS patients.In clinical practice,the indications of thrombectomy should be strictly observed,besides,intraoperative fine manipulation and sandardized perioperative management are also very important to reduce the incidence of bleeding complications.
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Objective To compare the therapeutic differences between stent-thrombectomy combined with urokinase thrombolysis and simple arterial urokinase thrombolysis in treating patients with acute cerebral infarction.Methods Arterial urokinase thrombolysis was carried out in 28 selected patients with acute cerebral infarction,admitted to our hospital in 2011 (urokinase group),while Solitaire AB stent-thrombectomy combined with arterial urokinase thrombolysis was carried out in 29 patients with acute cerebral infarction,admitted to our hospital in 2012 (combination group).Postoperative indices,including National Institutes of Health Stroke Scale (NIHSS),recanalization rate and intracranial hemorrhage incidence,were analyzed between the two groups.Results Recanaliztion rate of combination group was detailed as:middle cerebral artery in 20 patients,internal carotid artery in 3 patients,and vertebral-basilar artery in 4 patients,with a total recanalization rate of 93.1％.No postoperative hemorrhage was confirmed; two patients diagnosed as having internal carotid artery occlusion died.Recanaliztion rate of urokinase group was detailed as:middle cerebral artery in 15 patients,internal carotid artery in 3 patients,and vertebral-basilar artery in 0 patients,with a total recanalization rate of 64.2％; postopertive intracranial hemorrhage was noted in 5 patients and death in 8.For combination group,postoperative fourteen-day NIHSS scores decreased by 11.40±4.57 as compared with preoperative NIHSS scores; for urokinase group,postoperative fourteen-day NIHSS scores decreased by 11.40±4.57 as compared with preoperative NIHSS scores; significant differece was noted between the two groups (P＜0.05).Postoperative satisfactory rehabilitation (modified Rankin scale scores＜2) in combination group and urokinase group appeared in 20 and 17 patients,respectively,after 3 months of follow up.Conclusion The efficacy of stent-thrombectomy combined with arterial urokinase thrombolysis is superior to that of simple arterial urokinase thrombolysis in patients with acute cerebral infarction.
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Objective To evaluate the effectiveness of endovascular intervention in treating acute cerebral stroke.Methods Thirty-two patients with acute cerebral stroke (22 with middle cerebral artery occlusion and 10 with internal carotid artery occlusion),admitted to and treated with endovascular intervention in our hospital from January 2010 to October 2013,were chosen in our study;14 were performed arterial thrombolysis+mechanical fragrnengation and 18 were performed mechanical fragrnengation+ solitaireAB stent thrombectomy.Retrospective analysis was performed on the clinical data and treatment efficacy,and the prevention experience of complications was concluded.Results CTA showed that complete recanalization was noted in 18 patients and partial recanalization in 5,with a recanalization rate reaching 7 1％.Postoperative symptomatic intracerebral hemorrhage was noted in 2 patients (6％) and 1 (3.1％) had large area of cerebral infarction.One month after the treatment,MRI indicated decreased areas of infarction in all patients.NIHSS scores were 4-6 points of all patients;favorable prognosis was noted in 23 patients (72％).Nine patients had heavy neurological dysfunction,with limb muscle strength less than grade Ⅲ.Conclusion Endovascular intervention in treating acute cerebral stroke can get high recanalization rate,and achieve good clinical outcome.