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@#Objective To establish a nomogram model based on cystatin C (Cys-C) to predict the risk of large-artery atherosclerosis (LAA) by analyzing the risk factors of LAA and to evaluate its effectiveness. Methods A retrospective observational study performed on clinical data of 800 patients with acute ischemic stroke (AIS) in the Department of Neurology,Affiliated Hospital of Xuzhou Medical University,from January 2019 to January 2022.Patients were randomly assigned (2∶1 ratio) to the training set (n=546) and the validation set (n=254). The independent risk factors of LAA were determined by logistic regression analysis. A nomogram model of the risk of LAA was established and the model was verified internally and externally. The nomogram was evaluated based on discrimination,calibration,and clinical efficacy using the concordance statistic (C-statistic),calibration plot and decision curve analysis (DCA),respectively. Results Univariate and multifactor logistic regression analysis screening showed hypertension,diabetes,cystatin c,low-density lipoprotein (LDL),homocysteine (HCY),and hypersensitive C-reactive protein (hs-CRP) as independent correlated predictors of LAA,and the prediction model constructed from this,and the ROC curve was plotted with an area under the training set curve of 0.800 (0.762-0.838),with a diagnostic threshold of 0.6224,corresponding to a sensitivity of 68.3% and a specificity of 79.2%,and a validation set curve with an area under the curve of 0.838 (0.786-0.890) and a diagnostic threshold of 0.5901,corresponding to a sensitivity of 79.5% and a specificity of 78.5%,with a well-fitted calibration curve. Conclusion The nomogram model established has a good degree of differentiation and accuracy. It has a good performance in predictive ability,which is simple,intuitive and individualized to screen high-risk groups and has a certain predictive value for the occurrence of LAA patients,and can improve their prognosis through various preventive measures at an early stage.
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@#Objective To explore the relationship between the total burden of cerebral small vessel disease (CSVD) and the progression of large artery atherosclerosis (LAA) cerebral infarction in acute stage.Methods One hundred and forty-three patients with acute LAA cerebral infarction were collected.The CSVD total load score (0~4 points) was calculated according to MRI and CSVD total load scale.According to the progress of the disease in the acute phase,the patients were divided into two groups:non progressive cerebral infarction group (NPCI) and progressive cerebral infarction group (PCI).The baseline data,CSVD sub items and total load scores were compared between two groups.Logistic regression analysis was used to analyze the relationship between CSVD total load score and the progression of LAA type cerebral infarction.Results There was significant difference in CSVD total load score between PCI group and NPCI group (P<0.05).In group PCI,smoking history,diabetes history,baseline diastolic blood pressure,fasting blood glucose,vascular lacuna,moderate and severe WMH,CMBs and CSVD total load score were all higher than those in NPCI group (P<0.05),and LDL-C level was lower than that in NPCI group (P<0.05).Logistic regression analysis showed that fasting blood glucose,moderate and severe WMH and CSVD total load score were independent risk factors for the progression of LAA cerebral infarction in acute stage (P<0.05).Conclusion The severity of CSVD in patients with LAA type cerebral infarction is closely related to the progress of the disease in acute phase.
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Objective:To compare the clinical efficacies of endovascular treatments in patients with acute basilar artery occlusion (ABAO) caused by large-artery atherosclerosis (LAA) and cardioembolism (CE).Methods:From March 2018 to February 2021, 104 patients with ABAO accepted endovascular treatments in Department of Neurology and Department of Interventional Radiology, Xuyi County People's Hospital of Huaian City were enrolled; these patients were classified into either a LAA group or a CE group according to Trial of ORG 10172 in Acute Stroke Treatment classification (TOAST). The differences in general data, procedure information, and clinical efficacies were compared between the 2 groups. Univariate and multivariate Logistic regression analyses were used to identify the influencing factors for poor prognosis.Results:In these 104 patients, 51 patients (49.0%) were into the LAA group and 53 patients (51.0%) into the CE group. Ninety-six patients (92.3%) acquired successful revascularization, and 35 patients (33.7%) had good prognosis (modified Rankin scale scores of 0-2) 90 d after surgery. LAA group had significantly lower percentage of patients with atrial fibrillation, significantly lower baseline National Institutes of Health Stroke Scale scores, statistically higher percentages of patients with lower and middle basilar artery occlusion and patients accepted rescued stenting, and statistically longer procedure time ( P<0.05). There were no significant differences between the two groups in terms of successful recanalization percentage, symptomatic intracranial hemorrhage incidence, and prognosis 90 d after surgery ( P>0.05). Age ( OR=0.935, 95%CI: 0.891-0.981, P=0.006) and semiquantitative scores of basilar artery based on computed tomography angiography ( OR=1.520, 95%CI: 1.180-1.959, P=0.001) were independent influencing factors for poor prognosis. TOAST etiology (LAA/CE) was not an independent influencing factors for poor prognosis ( OR=1.175, 95%CI: 0.461-2.933, P=0.736). Conclusion:There are differences in risk factors, vascular occlusion sites, endovascular treatment, and procedure time between patients with ABAO caused by LAA and CE; however, no obvious difference in clinical outcomes is noted, and there was no obvious correlation between stroke etiology and prognoses.
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@#Objective To investigate the clinical features and prognosis of anterior circulation cerebral infarction secondary to cervical artery dissection.Methods Sixty one patients with cervical artery dissection (CAD) secondary to anterior circulation cerebral infarction treated in Department of Neurology of North Jiangsu People’s Hospital from January 2016 to December 2020 were included consecutively.And 67 patients with large artery atherosclerosis (LAA) cerebral infarction complicated with moderate to severe carotid artery stenosis who were hospitalized at the same time were enrolled for comparison.The clinical data and prognosis between the two groups were compared.Results Unifactorial analysis showed that the average age of CAD cerebral infarction group was younger,the incidence of head and neck pain and monocular amaurosis was higher,the proportion of massage trauma fatigue history was higher,the incidence of hypertension and smoking history was higher in LAA cerebral infarction group.The comparison of the two hematologic examinations showed that the erythrocyte count was higher in the CAD cerebral infarction group,and the D-dimer,cholesterol,glycated hemoglobin,and uric acid values were higher in the LAA cerebral infarction group.Binary logistic regression analysis showed that the history of massage trauma fatigue was more correlated with CAD cerebral infarction,while older age and smoking history were more correlated with LAA cerebral infarction.The improvement of NIHSS scores during hospitalization in the CAD cerebral infarction group was more significant than that in the LAA cerebral infarction group,and the difference was statistically significant.There were no significant differences in 90 day prognosis,mortality,and reinfarction rate within 6 months between the two groups.Conclusion The correlation between the history of massage trauma and fatigue and CAD cerebral infarction was greater,and the correlation between the older age and smoking history and LAA cerebral infarction was greater.The improvement of NIHSS score in CAD cerebral infarction group during hospitalization was more obvious than that in LAA cerebral infarction group,which was statistically significant.There were no significant differences in 90 days prognosis,mortality and 6 month reinfarct rate between the two groups.
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@#Objective In this study,the clinical data of single-center acute posterior circulation stroke patients were analyzed to compare the efficacy of TOAST classification for large artery atherosclerosis (LAA) and cardioembolism (CE) stroke patients after intravascular treatment difference.Methods Patient data comes from the advanced stroke center of the First Affiliated Hospital of Shihezi University School of Medicine,Xinjiang,China.According to the TOAST classification,the 98 people included were divided into LAA group and CE group.The mTICI score was used to evaluate vascular recanalization,the 90 day mRS score was used to evaluate the prognosis,the incidence of intracranial hemorrhage conversion within 72 hours and 90 day mortality Assess the safety of intravascular treatment.Results Among the 98 patients included in the study,79 were LAA stroke patients and 19 were CE patients.Compared with CE patients,LAA stroke patients are younger (60.08±12.64 vs 71.05±10.42,P=0.001),have a higher prevalence of hyperlipidemia (55.7% vs 22.1%,P=0.014),and preoperative systolic blood pressure higher (149.25±21.24 vs 134.79±22.83,P=0.010),lower NIHSS score (17.3 vs 22.2,P=0.025),better collateral circulation (ASITN/SIR score of 2~4 ratio,63.3% vs 21.1 %,P=0.002),the angioplasty rate is higher (31.6% vs 5.3%,P=0.040).However,the EVT recanalization rate (87.5% vs 84.2%,P=1.000) of the two groups of patients,the 90 day neurological function recovery rate (mRS score 0~2) (58.2% vs 36.8%,P=0.093),The incidence of postoperative intracranial hemorrhage transformation (1.3% vs 0%,P=1.000) and the 90 day stroke-related mortality (20.3% vs 42.1%,P=0.091) were not statistically significant.Conclusion s Although there were differences in baseline clinical data and clinical characteristics of EVT treatment between LAA and CE in posterior circulation,there was no significant difference in prognosis.
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@#Objective To explore the relationship between the total burden of cerebral small vessel disease (CSVD) and the long-term outcome in patients with large artery atherosclerosis (LAA) cerebral infarction.Methods Patients with LAA cerebral infarction who were hospitalized from June 2016 to January 2018 were retrospectively analyzed.The total burden of CSVD was evaluated according to MRI findings,the total score was 0~4.The severity of the disease was assessed by the National Institutes of Health Stroke Scale (NIHSS).The modified Rankin scale was used to evaluate the prognosis of patients at 90 days and one-year after the onset.The mRS score 0~2 was defined as good prognosis and>2 was defined as poor prognosis.Results At 90 days after onset,72 patients had good prognosis and 60 patients had poor prognosis.At one-year followed up,88 patients had good prognosis and 60 patients had poor prognosis.At baseline,63 were in the CSVD 0~1 group and 85 were in the CSVD 2~4 group.There were significant differences in the age,proportion of hypertension,NIHSS score and mRS score at 90 days and one-year after the onset between the 2 groups(P<0.05).It was found that the total burden of CSVD was an independent risk factor for poor prognosis of long-term neurological function in patients with LAA cerebral infarction at 90 days and one-year after onset.Conclusions The total burden of CSVD was associated with the long-term outcome in patients with LAA cerebral infarction.
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@#Objective To analyze and summarize the clinical and imaging characteristics of the patients with convexal subarachnoid hemorrhage complicated (cSAH) with acute cerebral infarction,and also to discuss the etiology,mechanisms and prognosis of this disease.Methods Data from eight patients diagnosed as cSAH with acute cerebral infarction were analyzed.The clinical representation,imaging features,therapy and prognosis were observed.Results Eight patients had a mean age of 58 years (range,43~68 years),and half of them were male.The main cause is large artery atherosclerosis,and this disease also can be observed in amyloid cerebrovascular disease,cardiogenic embolism,cancer radiotherapy,moyamoya disease and unknown cause.Clinical onset of the disease is characterized by conscious disturbance,headache,limb movement and sensation disorder,aphasia and limb convulsion.All patients were presented with continuous or transient limb movement and/or sensation disorder.Six cSAH cases were associated with ipsilateral acute cerebral infarction,and the other two cSAH cases with contralateral acute cerebral infarction.Six cases were presented with internal carotid artery stenosis or occlusion.All patients received timely symptomatic and etiological treatment.Antiplatelet treatments were given for three patients with large artery atherosclerosis stroke and anticoagulation therapy was initiated for patient with cardioembolic stroke.All patients had a favorable outcome (90 days modified Rankin scale score≤2),and no recurrence occurs.Conclusion cSAH with acute cerebral infarction is characterized by various clinical manifestations and different etiologies.The most common cause is large artery atherosclerosis stenosis or occlusion.cSAH can not only occur at the same side of the infarct territory,but also at the opposite side of infarction.The patients generally can obtain good outcome after the early symptomatic and etiological treatment.
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Objective To explore the effect of fetal-type posterior cerebral artery (tPCA) on short-term outcomes and degrees of severity of acute large artery atherosclerosis (LAA) stroke.Methods A total of 689 patients with LAA stroke were consecutively collected from Nanjing Stroke Registry Program (August 2013 to December 2016) and stroke database of Yijishan Hospital of Wannan Medical College (January 2017 to December 2017) according to the strict inclusion criteria.Patients were divided into fPCA group (n=185) and non-fPCA group (n=504) according to the results of 3D-time of flight-MR angiography and maximum intensity projection.National Institutes of Health Stroke Scale (NIHSS) was used to assess the degrees of severity of stroke and mild stroke was defined as NIHSS scores ≤ 7.There-month modified Rankin scale (mRS) was used to evaluate the short-term stroke outcomes,and favorable functional outcome was defined as MRS score ≤ 1.The correlation between fPCA and LAA stroke was analyzed and the independent risk factors of LAA stroke were identified.Results There were no significant differences in gender,age,hypertension,diabetes,and hyperlipidemia between fPCA group and non-fPCA group (P＞0.05).Multivariable Logistic regression analysis showed that there was no significant association of fPCA with severity and short-term outcomes in patients with acute LAA stroke in either anterior or posterior circulation (P＞0.05);however,age was an independent risk factor for severe stroke and unfavorable stroke outcome (P＜0.05).Conclusion fPCA is a common variant of cerebral circulation,but has no significant influence in severity and short-term outcome of LAA stroke.
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Objective To compare the safety and effectiveness of intravenous thrombolysis treatment in large artery atherosclerosis (LAA) and cardioembolic (CE) strokes in patients with acute anterior circulation ischemic stroke.Methods Two hundred and thirty-eight patients with acute anterior circulation ischemic stroke, admitted to and treated with intravenous thrombolysis in our hospital from January 2017 to June 2018 were chosen in our study. These patients were divided into either a LAA group (n=158) or a CE group (n=80) according to etiological subtypes. The differences in baseline data and outcomes 90 d after the onset between the two groups were compared. Baseline data of patients in the good outcome group and the poor outcome group were compared and independent risk factors for poor outcome were determined by multivariate Logistic regression analysis.Results As compared with the patients from the LAA group, patients from the CE group had older age and higher proportion of patients combined with atrial fibrillation, with significant differences (P<0.05); there were no statistically significant differences in the good outcome rate, mortality rate and incidence of symptomatic intracranial hemorrhage between the two groups (P>0.05). Among the 238 patients, 112 were into the good outcome group and 126 were into the poor outcome group; as compared with patients from the poor outcome group, patients from the good outcome group had younger age, and lower National Institute of Health Stroke Scale (NIHSS) scores and lower levels of fasting blood glucose before and after thrombolysis, with statistically significant differences (P<0.05); multivariate Logistic regression analysis showed that older age (odds ratio [OR]=1.040, 95％ confidence interval [CI]: 1.010-1.071,P=0.008) and higher NIHSS scores 24 h after thrombolysis (OR=1.259, 95％CI: 1.175-1.350,P=0.000) were independently associated with poor outcome.Conclusion The outcomes of intravenous thrombolysis in patients with acute anterior ischemic stroke are only associated with age and severity of stroke, and not associated with TOAST etiological subtypes; intravenous thrombolysis for cardiogenic stroke is safe and effective.
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Objective To investigate the clinical characteristics of the patients with acute ischemic stroke (AIS) caused by large artery atherosclerosis (LAA) or cardioembolism (CE) middle cerebral artery M1 segment occlusion, and to explore the difference of endovascular treatment. Methods The patients with AIS caused by M1 segment occlusion, who received endovascular treatment between Sep. 2014 and Feb. 2018 in our hospital, were recruited and assigned to LAA group and CE group. Clinical characteristics, treatment strategy, postoperative hemorrhage rate and prognosis were analyzed. Results Totally 134 patients were included, and 48 patients were in the LAA group and 86 patients were in the CE group. There were significant differences in the gender and age between the LAA and CE groups (male/female 39/9 vs 40/46, χ2＝ 15.363; average age [62.65±9.76] years vs [69.66±12.43] years, t＝－3.371; both P0.05). Compared with the CE group, the proportion of the patients with hypertension was significantly higher, and the National Institutes of Health stroke scale score on admission was significantly lower in the LAA group (70.8% [34/48] vs 51.2% [44/86], χ2＝4.900, P＝0.027; 13 [7, 16] vs 16 [13, 21], Z＝－3.603, P0.001). The proportion of the patients with angioplasty in the LAA group was 52.1% (25/48), which was significantly higher than the proportion in the CE group (4.7% [4/86], χ2＝38.121, P0.01). The incidence of postoperative intracranial hemorrhage was significantly lower in the LAA group than that in the CE gorup (10.4% [5/48] vs 32.6% [28/86], χ2＝8.136, P＝0.004). There were no significant differences in the incidence of symptomatic intracranial hemorrhage, endovascular recanalization rate, or good prognosis rate or mortality 3 months after operation between the two groups (all P0.05). Conclusion Compared with the patients with AIS due to LAA M1 segment occlusion, the CE patients have more severe symptoms and higher postoperative hemorrhage rate after endovascular treatment. The strategy of endovascular treatment is different in the two types of AIS, while there are no differences in prognosis and mortality after treatment.
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Objective To investigate the difference in infarction characteristics between large artery atherosclerosis and cardioembolism acute ischemic stroke (AIS). Methods A retrospective study was done on 99 AIS patients, who were admitted to Emergency Room of our hospital and underwent multi-modal computed tomography (CT) after admission and before treatment. Forty-six of 99 AIS patients had large artery atherosclerosis and 53 had cardioembolism. The NIHSS score and GCS score on admission, infraction core and ischemic penumbra volumes and the volume difference, and vascular occlusion rates of posterior circulation and large artery were compared between the two groups. Results Compared with the cardioembolism group, the NHISS score was significantly lower and the GCS score was significantly higher in the large artery atherosclerosis group (9.5 [2.0, 16.0] vs 15.0 [6.0, 24.0], Z=2.31, P0.05). The large artery occlusion rate and posterior circulation occlusion rate were both significantly different between the large artery atherosclerosis and cardioembolism groups (30.43% [14/46] vs 50.94% [27/53] and 36.96% [17/46] vs 9.43% [5/53]; χ2=11.82 and 6.77, both P<0.001). Conclusion The clinical symptoms, cerebral changes and intracranial large artery changes are different in AIS patients with large artery atherosclerosis and cardioembolism. Etiology evaluation based on clinical features and multi-modal CT examination can help to accurately assess the ischemic state of AIS patients.
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The term,cerebral small vessel disease (CSVD),describes a syndrome of neuroimaging,pathological,and associated clinical features caused by small intracranial vascular lesions.Recent studies have found different MRI features of CSVD in patients with ischemic strokes caused by large artery atherosclerosis (LAA),significantly influencing the stroke outcomes.This paper reviews the effects of CSVD on clinical outcomes of cerebral infarction patients caused by LAA and their mechanisms.
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Objective To explore the safety and clinical efficacy of Ginkgo biloba lactone injection combined with Alteplase intravenous thrombolysis in treatment of acute ischemic stroke.Methods Totally 87 patients were recruited and divided into control group and test group.The,patients in control group (39 cases) were given Alteplase 0.9 mg/kg for injection,intravenous bolus total dose 10％ was given within 1 min,then intravenous infusion of the remaining 90％ was given in 1 h,and given basic therapy after 24 h.The 48 cases in test group,which were immediately iv Ginkgo biloba lactone injection after intravenous thrombolysis,6 mL added into 250 mL saline,once daily for 14 d,and also were given basic therapy after 24 h.All NIHSS scores were recorded before treatment,14 d and 90 d after treatment,and the adverse events were recorded.The modified Rankin scale (mRS) score and BI index were performed at 14 and 90 d after admission.Patients in two groups were classified according to the TOAST classification,and the patients with large-arteryatherosclerosis and small-artery occlusion were analyzed.Results No intracranial hemorrhage occurred in the two groups.The NIHSS score and mRS score of test group were significantly lower than that of control group,and BI index was significantly increased 90 d after treatment.The NIHSS score and mRS score of test group were significantly lower than that of control group,and BI index was significantly increased90 d after treatment of patients with large-artery atherosclerosis.But there was no significant difference between test group and control group of patients with small-artery occlusion.Conclusion Ginkgo biloba lactone injection combined with rt-PA intravenous thrombolysis in the treatment of acute ischemic stroke has high safety,and can improve the prognosis of patients.
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Objective To explore the association between rs7049105, rs647188, rs1333035 of chromosome 9p21 and the LAS among Chinese Han population of Changsha;to explore the association between rs7049105, rs647188, rs1333035 and the LAS among patients with evidence of cephalic and cervical vessel atherosclerosis. Methods The present study com?prised 229 LAS patients and 233 healthy controls. The 233 controls which we defined control group 1. In the controls, 150 (64.38%)controls with evidence of atherosclerosis were defined as control group 2, 83(35.62%)controls without evidence of atherosclerosis were defined as control group 3. The sample genotyping was detected using MALDI-TOF-MS. Results There was no polymorphism of rs647188 among case group and control group 1. There was no significant difference in the polymorphism distribution of rs7049105 and rs1333035 between the case group and control group 1 and 3 (P>0.05). There may be no significant different in the polymorphism distribution of rs7049105 between the case group and control group 2 . The rs1333035 was associated with risk of LAS among patients with evidence of cephalic and cervical vessel atherosclerosis (χ2=6.502,P=0.039). Conclusions The rs10757274 and rs7049105 polymorphism in the chromosome 9p21 may not be as?sociated with risk of LAS among Han population of Changsha. There may be no polymorphism of rs647188 among Han popu?lation of Changsha. The rs1333035 polymorphism may be associated with plaque rupture and thrombosis.
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Based on the recently proposed Chinese ischemic stroke subclassification (CISS) system, intracranial branch atheromatous disease (BAD) is divided into large artery atherosclerosis (LAA) and penetrating artery disease (PAD). In the current retrospective analysis, we compared the general characteristics of BAD-LAA with BAD-PAD, BAD-LAA with non-BAD-LAA and BAD-PAD with non-BAD-PAD. The study included a total of 80 cases, including 45 cases of BAD and 35 cases of non-BAD. Subjects were classified using CISS system: BAD-LAA, BAD-PAD, non-BAD-LAA and non-BAD-PAD. In addition to analysis of general characteristics, the correlation between the factors and the two subtypes of BAD was evaluated. The number of cases included in the analysis was: 32 cases of BAD-LAA, 13 cases of BAD-PAD, 21 cases of non-BAD-LAA, and 14 cases of non-BAD-PAD. Diabetes mellitus affected more non-BAD-LAA patients than BAD-LAA patients (P=0.035). In comparison with non-BAD-PAD, patients with BAD-PAD were younger (P=0.040), had higher initial NIHSS score (P<0.001) and morbidity of ischemic heart disease (P=0.033). Within patients with BAD, the PAD subtype was associated with smoking (OR=0.043; P=0.011), higher low-density lipoprotein (OR=5.339; P=0.029), ischemic heart disease (OR=9.383; P=0.047) and diabetes mellitus (OR=12.59; P=0.020). It was concluded that large artery atherosclerosis was the primary mechanism of BAD. The general characteristics showed no significant differences between the CISS subtypes of LAA and PAD within BAD, as well as between the BAD and non-BAD within LAA subtype. Several differences between PAD subtypes of BAD and non-BAD were revealed.
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Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Encéphalopathie ischémique , Anatomopathologie , Chine , Accident vasculaire cérébral , AnatomopathologieRÉSUMÉ
Objective To investigate the risk factors of cerebral microbleeds (CMBs) in patients with acute isch?emic stroke of large-artery atherosclerosis. Methods One hundred twelve patients with acute ischemic stroke of large-ar?tery atherosclerosis admitted from July 2013 to January 2014 in Nanjing First Hospital affiliated to Nanjing Medical Uni?versity were enrolled. According to the results of MRI magnetic sensitive weighted imaging, the patients were divided into CMBs group or non-CMBs group. The history, general clinical data, serum biochemical results and MRI in both groups were enrolled. All the data were analyzed by the univariate and multivariate analysis. Results The results of univariate analysis showed that there were significant differences in age (61.620±11.479 vs. 70.620±11.185), serum uric acid (UA) level (278.920±69.512 vs. 353.460±111.206), serum creatinine (Cr) level (71.360±19.797 vs. 90.450±44.989), serum ho?mocysteine (Hcy) level (12.587±2.664 vs. 21.715±10.437) between the two groups (P<0.05). There were significant differ?ences in constituent ratio of Fazekas' s grade of periventricular hyperintensities and deep white matter hyperintensities between the two groups (P<0.05). The results of multivariate analysis showed that age (OR=0.963, 95%CI:0.905~1.025, P<0.05) and serum Hcy level (OR=1.487, 95%CI:1.219~1.813, P<0.05) were the independent risk factors for CMBs in patients with acute ischemic stroke of large-artery atherosclerosis. Conclusions Age and serum Hcy level are the inde?pendent risk factors for CMBs in patients with acute ischemic stroke of large-artery atherosclerosis.
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OBJECTIVE: Arterial stiffness is a common change associated with aging and can be evaluated by measuring pulse wave velocity (PWV) between sites in the arterial tree, with the stiffer artery having the higher PWV. Arterial stiffness is associated with the risk of stroke in the general population and of fatal stroke in hypertensive patients. This study is to clarify whether PWV value predicts functional outcome of acute ischemic stroke. METHODS: One hundred patients were enrolled with a diagnosis of acute ischemic stroke and categorized into two groups: large-artery atherosclerosis (LAAS) or small vessel disease (SVD) subtype of Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Each group was divided into two sub-groups based on the functional outcome of acute ischemic stroke, indicated by modified Rankin Scale (mRS) at discharge. Poor functional outcome group was defined as a mRS > or = 3 at discharge. Student's t-test or Mann-Whitney U-test were used to compare maximal brachial-ankle PWV (baPWV) values. RESULTS: Twenty-four patients whose state was inadequate to assess baPWV or mRS were excluded. There were 38 patients with good functional outcome (mRS or = 3). The baPWV values were significantly higher in patients with poor outcome (2,070.05 +/- 518.37 cm/s) compared with those with good outcome (1,838.63 +/- 436.65) (p = 0.039). In patients with SVD subtype, there was a significant difference of baPWV values between groups (2,163.18 +/- 412.71 vs. 1,789.80 +/- 421.91, p = 0.022), while there was no significant difference of baPWV among patients with LAAS subtype (2,071.76 +/- 618.42 vs. 1,878.00 +/- 365.35, p = 0.579). CONCLUSIONS: Arterial stiffness indicated by baPWV is associated with the functional outcome of acute ischemic stroke. This finding suggests that measurement of baPWV predicts functional outcome in patients with stroke especially those whose TOAST classification was confirmed as SVD subtype.
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Humains , Vieillissement , Artères , Athérosclérose , Classification , Diagnostic , Analyse de l'onde de pouls , Accident vasculaire cérébral , Rigidité vasculaireRÉSUMÉ
Objective To investigate the relationship between apolipoprotein E ( ApoE ) gene polymorphism and cerebral infarction patients with different gender and etiological typing. Methods A total of 91 patients with cerebral infarction aged≥60 years ( cerebral infarction group) were enrolled. They were divided into either a large artery atherosclerotic (LAA) stroke group (n=37) or a small artery occlusion (SAO) stroke group (n=54) according to the Trial of Org 10172 in acute stroke treatment (TOAST) classification. A total of 105 age-,sex-,and residence-matched healthy subjects were enrolled as controls. A Nested Allele-Specific Multiplex Polymerase Chain Reaction Method was used to detect the ApoE gene polymorphism. The ApoE gene polymorphism of cerebral infarction of different gender and etiological typing were compared. Results ( 1 ) ApoE Genotypes of E2/2, E2/3, E2/4, E3/3, and E3/4 were detected,but the ApoE E4/4 was not detected. (2) There were no significant differences in the frequencies of ApoE genotypes and each gene carrier frequency between the cerebral infarction group and the control group (all P>0. 05). There was significant difference in ApoE genotype frequencies and each gene carrier frequency of the males between the cerebral infarction group and the control group (P0. 05). (3) There were no significant differences in the ApoE genotype frequency and gene carrier frequency among the LAA,SAO,and control groups. There was significant difference in the ApoE genotype frequency and gene carrier frequency in males between the LAA group and the control group (P>0. 01);the genotype frequencies of E2/3 and E3/E3 (6. 7% and 46. 7%),ε2,as well as theε3 carrier frequency (3. 3% and 73. 3%) of LAA were lower than those of the control group (13. 2%,79. 2%,6. 6%,and 89. 6%,respectively);the E3/4 genotype frequency andε4 carrier frequency of the LAA subtype were 46. 7% and 23. 3% respectively. They were all higher than 7. 5% and 3. 8% in the control group. However,there were no significant differences in males among the SAO group,the control group,and the 3 groups of females ( the LAA subtype,SAO subtypes,and the control group) (P>0. 05). Conclusion ε4 gene may be a risk factor for LAA in males. The association of ApoE gene polymorphism with cerebral infarction in females is not found.
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Objective To discuss influencing factors of recurrent ischemic stroke in patients with large artery atherosclerosis. Methods A total of 200 cases with cerebral infarction were divided into recurrent group and non-re-current group. Influencing factors of recurrent ischemic stroke in patients with large artery atherosclerosis were ana-lyzed by analyzing clinical data. Results Multiple-factor analysis showed that age, high level of LDL-C, diabetes mel-litus, aspirin resistance and poor compliance to antiplatelet drug were risk factors of recurrent ischemic stroke in pa-tients with large artery atherosclerosis (P<0.05 or P<0.01). Conclusion Age, high level of LDL-C, diabetes mellitus, as-pirin resistance and poor compliance to antiplatelet drug are risk factors of recurrent ischemic stroke in patients with large artery atherosclerosis.
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BACKGROUND AND PURPOSE: Remnant lipoproteins (RLPs) are products of partially catabolized chylomicrons and very-low-density lipoprotein, from which some triglycerides have been removed. These particles are smaller and denser than the parent particles and are believed to be strongly atherogenic. We explored the association between RLP cholesterol (RLP-C) and ischemic stroke, including stroke subtypes. METHODS: A cohort of 142 ischemic stroke patients (90 men and 52 women; age, 65.2+/-12.8 years, mean+/-SD) was enrolled; all had acute infarcts confirmed by diffusion-weighted MRI, and had fasting lipograms. A full stroke-related evaluation was conducted on each patient. An outpatient population of 88 subjects without a history of cerebrovascular or cardiovascular disease served as a control group. Serum RLP fractions were isolated using an immunoaffinity gel containing specific antiapolipoprotein (anti-apo)B-100 and anti-apoA-I antibodies. RLP-C values were considered to be high when they were in the highest quartile of all values in the study. RESULTS: High RLP-C values were more common in stroke patients than in control patients (31.0% vs. 14.8%, p=0.01), when 5.6 mg/dL (>75th percentile) was used as the cutoff value. Multivariable analyses indicated that RLP-C was a risk factor for stroke, with an odds ratio of 2.54 (p=0.045). The RLP-C level was higher in the large artery atherosclerosis subgroup (5.7+/-3.9 mg/dL) than in any other stroke subgroup (small vessel occlusion, 4.9+/-5.9 mg/dL; cardioembolism, 1.8+/-2.3 mg/dL; stroke of undetermined etiology, 3.1+/-2.9 mg/dL). CONCLUSIONS: We have found an association between high RLP-C levels and ischemic stroke, and in particular large artery atherosclerotic stroke.