Regression of asymptomatic intracranial arterial stenosis by aggressive medical management with a lipid-lowering agent

OBJECTIVE: The incidence rate of stroke as a result of intracranial arterial stenosis (ICAS) is higher in Asian countries than in the West. We aimed to analyze the regression, lack of change, or progression of asymptomatic ICAS after the administration of rosuvastatin and associated factors.METHODS: The patients who had undergone computed tomography angiography (CTA) at our hospital and had been diagnosed with ICAS with no ischemic event in the stenosed vascular territory were included in the study. They were administered 20mg of rosuvastatin per day. After a follow-up period of at least 6 months after treatment, the patients were examined using CTA again and the clinical information and imaging results were analyzed.RESULTS: In total, 48 patients were diagnosed with asymptomatic ICAS. During the final follow-up examination, it was found that the stenotic lesion regressed in 30 patients, whereas it remained unchanged or progressed without any adverse effects in 18 patients. In univariate analysis, the regressed group showed significantly higher differences in the levels of total cholesterol and low-density lipoprotein (LDL) between their initial and final values (both, p=0.031 for both). In the multivariate analysis, a significantly higher difference in the levels of LDL between its initial and final measurement was seen in the regressed group (p=0.035, odds ratio(OR) 3.9).CONCLUSIONS: Rosuvastatin was found to have better lipid-lowering effects for total cholesterol and particularly LDL in patients whose ICAS had regressed. We concluded that rosuvastatin administration can be recommended for the treatment of patients with asymptomatic ICAS.

Study the Diagnosis Value of Transcranial Doppler Ultrasound for Intracranial Artery Stenosis in Patients with Cerebral Infarction / 现代生物医学进展

Objective:To study the diagnosis value of Transcranial Doppler ultrasound for intracranial artery stenosis in patients with cerebral infarction.Methods:A total of 140 patients with acute cerebral infarction,transient ischemic attack and posterior circulation ischemic attack in Department of Neurology,Xinjiang cardiovascular and cerebrovascular disease hospital from October 2014 to October 2016 were selected as research object,CT angiography (CTA) and TCD detection were performed in all patients.Used CTA examination results as the gold standard,the detection results of intracranial artery stenosis in two groups were compared,the diagnostic value of TCD and the diagnostic results of TCD to the degree of bilateral middle cerebral artery (MCA) stenosis were analyzed.Results:CTA diagnosis showed that 140 patients had a total of 105 patients with intracranial artery stenosis,in the anterior and posterior circulation vessel of 1155 intracranial segments,CTA detection showed that 249 vessels were narrow,TCD detection showed that 236 vessels were narrow.Com-pared with CTA,TCD was better in the diagnosis of patients (Kappa value＞0.75).The diagnostic sensitivity and positive predictive value of TCD for MCA were the highest,which were 91.26％ and 93.07％,the consistency was the best (Kappa value =0.917).CTA detection showed that 210 MCA vessels had 103 stenoses,mild stenosis 17,moderate stenosis 41,severe stenosis 45,TCD detection showed that the stenosis was 101,mild stenosis 16,moderate stenosis 40,severe stenosis 45.The Kappa test showed that the diagnostic results of TCD to the degree ofMCA stenosis was better consistency compared with CTA (Kappa value=0.884.Conclusion:TCD has a high diagnostic value for cerebral artery stenosis in patients with cerebral infarction,and it is consistent with the diagnosis of CTA.

Relationship of ambulatory pulse pressure and severity of intracranial arterial stenosis / 实用医学杂志

Objective To evaluated the relationship of ambulatory pulse pressure and severity intracranial arterial stenosis. Methods 165 ischemic stroke patients with intracranial arterial stenosis were selected as stenosis group. And 142 patients with no obvious intracranial arterial stenosis were selected as control group. All patients were given ambulatory blood pressure monitoring. 24 h average systolic pressure ,diastolic pressure and ambulatory pulse pressure were measured. Results Ambulatory pulse pressure of stenosis group[(73.02 ± 10.86)mmHg]was significantly higher than that of control group[(59.63±12.96)mmHg,P<0.01]. Ambulatory pulse pressure of mod-erated stenosis group[(69.73±9.3)mmHg,P < 0.05]was significantly higher than that of control group[(59.63± 12.96)mmHg,P<0.01]. Ambulatory pulse pressure of severe stenosis group[(77.36±7.94)mmHg]was signifi-cantly higher than that of moderate stenosis group[(69.73±9.3)mmHg,P < 0.05]. The level of ambulatory pulse pressure was independent risk factors of intracranial arterial stenosis(OR value:1.092). Conclusions Ambulatory pulse pressure is significantly related to the severity of intracranial arterial stenosis and is an independent risk factor for intracranial arterial stenosis.

Relationship of ambulatory pulse pressure and severity of intracranial arterial stenosis / 实用医学杂志

Objective To evaluated the relationship of ambulatory pulse pressure and severity intracranial arterial stenosis. Methods 165 ischemic stroke patients with intracranial arterial stenosis were selected as stenosis group. And 142 patients with no obvious intracranial arterial stenosis were selected as control group. All patients were given ambulatory blood pressure monitoring. 24 h average systolic pressure ,diastolic pressure and ambulatory pulse pressure were measured. Results Ambulatory pulse pressure of stenosis group[(73.02 ± 10.86)mmHg]was significantly higher than that of control group[(59.63±12.96)mmHg,P<0.01]. Ambulatory pulse pressure of mod-erated stenosis group[(69.73±9.3)mmHg,P < 0.05]was significantly higher than that of control group[(59.63± 12.96)mmHg,P<0.01]. Ambulatory pulse pressure of severe stenosis group[(77.36±7.94)mmHg]was signifi-cantly higher than that of moderate stenosis group[(69.73±9.3)mmHg,P < 0.05]. The level of ambulatory pulse pressure was independent risk factors of intracranial arterial stenosis(OR value:1.092). Conclusions Ambulatory pulse pressure is significantly related to the severity of intracranial arterial stenosis and is an independent risk factor for intracranial arterial stenosis.

Correlation between hemodynamic change of extracranial cerebral vessels evaluated by ultrasound and intracranial arterial stenosis / 中华超声影像学杂志

Objective By analyzing the correlation between Doppler spectrum of extracranial cerebral vessels ECV and intracranial arterial stenosis IAS to identify the value of hemodynamic change of ECV in predicting IAS Methods One hundred and four patients with moderate to severe IAS or intracranial arterial occlusion were enrolled in the case group while 32 patients without obvious cerebrovascular disease in the same period were enrolled in the control group Ultrasound examinations of ECV were performed for all patients the hemodynamic parameters of bilateral common carotid artery CCA internal carotid artery ICA and vertebral artery VA were recorded and compared between case and control group Results Compared with control group the ECV of patients with IAS had lower velocity and higher resistance index RI Of all the parameters end diastolic velocity EDV of ICA and EDV of VA were most accurate in predicting IAS with best cut off value of 21 3 cm/s 9 6 cm/s and accuracy of 76 1 % 81 0% respectively Conclusions The ECV of IAS patients tend to have lower velocity and higher RI Analysis of hemodynamic parameters of ECV might be useful in predicting IAS.

Value of endovascular stenting for symptomatic intracranial artery stenosis / 实用放射学杂志

Objective To evaluate the curative effect,safety,and medium-term effect of intracranial artery stenosis stent (ICASS) for the treatment of the symptomatic intracranial artery stenosis.Methods ICASS was performed in 21 cases with the symptomatic intracranial artery stenosis.The stenting success rate,the improvement rate of stenosis post-stenting and the incidence of complications were observed.The change of the scores of the Modified Rankin Scale (MRS)and National Institutes of Health Stroke Scale (NIHSS)between pre-and post-stenting (1 month,3 months,6 months,12 months and 2 years)and the occurrence of ischemic cerebrovascular events after stenting were compared and analyzed respectively.Results Except one case failed because of intracranial hemorrhage during the operation,other 20 patients were treated with endovascular stent plasty successfully,the total technical achievement ratio was 95.2%.The aver-age stenosis ratio decreased from (73.4±7.9)% to (13.7±9.2)%.The complications incidence was 4.8% within the peroperative. 9 patients were reviewed with DSA in 6 months,the average ratio of stenosis was (29.5 ±12.2)%,no patient was found with the restenosis.Compared with pre-stenting,the score of MRS and NIHSS at the follow-up duration of 3 months,6 months,12 months and 2 years post-stenting of patients were significant improved (all P < 0.05 ).During the follow-up period,2 patients were found with new transient ischemia attack (TIA),1 patient had non-targeted vascular CI without other target vascular therapy-related com-plications.Univariate analysis indicated that patients with elderly (≥ 75 years old),or hypertension,or diabetes,or dyslipidemia,or in the set of events to endovascular treatment for longer than 1 month,or with more than two independent risk factors for patients with underlying diseases treatment,or without systemic therapy,whom would be much more easily to reoccur the cerebrovascular events in post-operation(all P <0.05 ).Conclusion ICASS should be an effective and safe therapeutic method to the symptomatic intracra-nial arterial stenosis.The medium-term efficacy is significant.Serious complications might still be emerge with endovascular stent plasty,so close attention must be paid with.

Correlation between ambulatory aterial stiffness index and extracranial and intracranial arterial stenosis / 实用医学杂志

Objective To evaluate the relationship between ambulatory arterial stiffness index (AASI) and intracranial and extracranial arterial stenosis in 146 patients with ischemic cerebrovascular disease. Methods Degree of intracranial and extracranial arterial stenosis in 146 patients with ischemic cerebrovascular disease was assessed by CT angiography (CTA). Then all patients were divided into 4 groups according to the numbers of branches with stenosis: no stenosis group, 1 branch group, 2 branches group, and 3 and more than 3 branches group. Dynamic blood pressure was monitored to calculate the AASI. Results There was no significant difference of AASI among the extracranial arterial stenosis groups (P=0.614). AASI was positively correlated with the degree of intracranial artery stenosis (r=0.743, P<0.05), and with 3 and more intracranial artery branches stenosis (r=0.797, P<0.05). Conclusion AASI is closely correlated with the degree and numbers of branches of intracranial artery stenosis.

Perioperative complications of stent angioplasty for intracranial arterial stenosis：clinical analysis and therapeutic strategy / 介入放射学杂志

Intracranial artery stenosis is one of the main causes inducing transient ischemic attack (TIA) or cerebral ischemic stroke. Being a minimally-invasive and reliably-effective technique, intracranial artery stent angioplasty has brought about a new approach for the treatment of intracranial artery stenosis , and thus provides more opportunities to the patients who are not suitable for intracranial vascular bypass surgery. However, the higher occurrence of perioperative complications caused by stent angioplasty should be seriously taken into consideration by clinical physicians. In order to reduce the occurrence of complications , in this paper the perioperative complications of stent angioplasty for intracranial artery stenosis are analyzed , and the therapeutic strategies as well as the proper approaches are discussed.

Complications of stenting with Gateway-Wingspan system for symptomatic middle cerebral artery stenosis / 中国综合临床

Objective To investigate the safety of treatment of symptomatic middle cerebral artery stenosis with Gateway-Wingspan system by reviewing the data on complications.Methods Forty-seven patients with symptomatic middle cerebral artery stenosis treated with Wingspan system were respectively analyzed and emphasis was paid to cases with complications.Relevant data was collected such as characteristics of patients and lesions,selection of ballon and stent and radiographic information.Results Complications were found in 4 patients (8.5％),which were due to cerebral vasospasm,heperperfution syndrome,artery branch rupture and subacute stent thrombosis respectively.Two patients experienced symptomatic intracranial hemorrhage (4.3％)and one of them died (2.1％).The morbidity of severe complications was 6.4％.The success rate of stent implantation was 100％.Mean artery stenosis reduced from (83.5 ± 10.0)％ to (19.8 ± 9.2)％ after Wingspan stent implantation.Conclusion Middle cerebral artery stenting angioplsty greatly improved the stenosis with high technical success rate.However,the rates of cerebral vascular complications and symptomatic intracranial hemorrhage were relatively high in this study,which needs to be widely verified in practice.

Critical Appraisal of SAMMPRIS Study / 대한뇌졸중학회지

No abstract available.

The Roles of Drug-Fluting Stents in the Prevention and Treatment of Restenosis After Extracranial and Intracranial Stent Angioplasty / 国际脑血管病杂志

Now symptomatic extracranial and intracranial stenting usually uses bare metal stents, but the incidence of restenosis is higher.The studies of drug-eluting stems for the treatment of coronary atherosclerosis have suggested that the incidence of restenosis decreases significantly. Although extracranial and intracranial drug-eluting stem placement appears to be safe,further large,prospective,randomized,controlled trials are needed to demonstrate its safety and effectiveness.

Significance of Retinal Microvascular Changes in Patients with Ischemic Stroke

BACKGROUND: Retinal microvascular abnormalities reflect cerebral microvascular changes. However, there is few clinical data on the relationship between retinal microvascular changes and intracranial arterial stenosis or stroke subtypes. We examined the association between white matter changes (WMCs) or large artery stenosis and retinal microvascular changes, stroke subtypes. METHODS: We investigated demographic features, retinal microvascular changes, intracranial large arterial stenosis, WMCs and stroke subtypes in 100 acute ischemic stroke patients over 2 years who had taken retinal photography and underwent brain MRI with MR angiography. Retinal photography was evaluated for specific retinal microvascular change by grader using standardized protocol. Intracranial arterial stenosis was defined by MR angiography. WMCs were coded from 1 for normal to 8 for most severe degree. And we defined "White matter lesion" as grade 3 or more. Stroke subtypes were classified by TOAST criteria. RESULTS: Among the retinal microvascular changes, retinal hemorrhage, arteriovenous nicking, focal and generalized arteriolar narrowing and venous congestion were significantly correlated with intracranial large arterial stenosis. There was no relationship between the retinal microvascular changes and stroke subtypes. And only focal arteriolar narrowing was significantly correlated with WML. CONCLUSIONS: Retinal microvascular changes seen in patients with ischemic stroke were related to intracranial large arterial stenosis. We might suggest that the pathogenesis of retinal microvascular changes is related to that of large arterial atherosclerosis.

Stenting of Symptomatic Middle Cerebral Artery Stenosis: Case Report / 대한뇌혈관학회지

Percutaneous balloon angioplasty has been reported to be useful in the treatment of intracranial atherosclerotic arterial stenosis. However, arterial dissection with increased risk of acute closure and stroke has limited its widespread implementation. Stenting of the intracranial vasculature recently has been shown to be feasible in a variety of circumstance. However, stenting of middle cerebral artery has been limited because of difficulty with tracking stents across the carotid siphon. We report a case of successful percutaneous stenting of a symptomatic middle cerebral artery stenosis using a balloon-expandible flexible coronary stent.