Résumé
The patient is a 55-year-old woman. Enhanced contrast computed tomography (CT) was conducted to comprehensively assess the renal deformity, revealing a severe stenosis in proximity to the celiac artery (CA) and the point of origin of the superior mesenteric artery (SMA), as well as dilatation of the inferior mesenteric artery (IMA), an aneurysm of the left colic artery (LCAA), and a limbal aneurysm of the splenic flexure arcades. To address the LCAA, coil embolization was performed, and a two-stage bypass of the SMA was carried out to enhance blood flow to the visceral arteries, leading to IMA dilation amelioration.
Résumé
Objective To investigate the relationship between the expression of plasma miRNA-195 in pa-tients with severe coronary artery stenosis and its coronary collateral circulation. Methods One hundred and nine-ty patients with selective coronary angiography in our hospital from March 2000 to May 2017 were enrolled,who were divided into poor collateral circulation group(n = 90)and good collateral circulation group(100 cases)ac-cording to the Rentrop classification.Plasma miRNA-195 and VEGF levels were compared between the two groups. The relationship between plasma miRNA-195 and VEGF was analyzed,and also the relationship between plasma miRNA-195 and Gensini points.Results(1)Plasma miRNA-195 and VEGF levels in good collateral circulation group were significantly higher than those in poor collateral circulation group(P<0.05).(2)There was a positive correlation between plasma miRNA-195 and VEGF in patients with coronary heart disease(r=0.628,P=0.022). (3)There was a positive correlation between plasma miRNA-195 and Gensini score in patients with coronary heart disease(r = 0.765,P = 0.013). Conclusion MiRNA-195 may be involved in the production of neovasculariza-tion by regulating VEGF in the formation of collateral circulation in patients with severe coronary artery stenosis, which can be used as a biomarker for predicting the formation of collateral circulation for clinical reference.
Résumé
[Objective] To investigatethe correlation between blood flow signal on three dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) and short-term outcome in patients with symptomatic middle cerebral artery (MCA) severe stenosis or MCA occlusion.[Methods] We retrospectively reviewed consecutive patients with symptomatic MCA severe stenosis or MCA occlusion.General information,clinical data and cranial imaging data were collected.Characteristics of blood flow signal on 3D-TOF-MRA for each patient were analyzed,which included:(1) blood flow signal of MCA distal to stenosis/occlusion lesion;(2) laterality of posterior cerebral artery (PCA).The correlation between characteristics of blood flow signal and short-term outcome was analyzed.[Results] Three hundred and twenty-eight patients were included in this study.There were 154 patients with symptomatic MCA severe stenosis and the rest of them had symptomatic MCA occlusion.Poor blood flow signal of distal MCA independently correlated with poor shortterm outcome in patients with severe MCA stenosis.[Odds Ratio (OR) 0.32,95％ Confident Interval (CI) 0.14～0.72].PCA laterality was not related with short-term outcome in these patients (OR,2.28,95％ CI,0.85～6.15).PCA laterality independently correlated with poor short-term outcome in patients with MCA occlusion.(OR,3.54,95％ CI,1.32～ 9.78).Blood flow signal of distal MCA was not related with short-term outcome in these patients (OR,0.58,95％ CI,0.22～1.48).[Conclusion] Blood flow signal on 3D-TOF-MRA correlates with short-term outcome in patients with symptomatic MCA severe stenosis or occlusion but the characteristics differs between severe MCA stenosis and occlusion patients.Anterograde blood flow (blood flow signal of MCA distal to stenosis lesion) for patients with severe MCA stenosis and retrograde blood flow (PCA laterality) for patients with MCA occlusion correlates with shot-term outcome.
Résumé
Objective To investigate the influence of collateral circulation recruitment on cognitive functions in patients with severe unilateral stenosis or unilateral occlusion of the internal carotid artery by using TCD.Methods A total of 176 patients with severe unilateral stenosis or unilateral occlusion of the internal carotid artery were enrolled and were divided into a single vessel collateral group(n=80,45.5 ％),a multiple vessel collateral group(n=74,42.1％) and a no collateral group(n=22,12.5 ％).In order to study the influence of single vessel collateral circulation on cognitive functions,the single vessel collateral group was further divided into an anterior communicating subgroup(AcoA),a posterior communicating subgroup(PcoA),an ocular artery subgroup(OA),and a normal control subgroup.All patients and 34 normal controls(NC) received MoCA,and scores for the overall assessment and individual domains were analyzed.Results Compared with the control group (26.3± 1.1,4.7 ± 0.5,2.0 ± 0.0,3.6 ± 1.0),the multiple vessel collateral group,the single vessel collateral group and the no collateral group had lower overall scores (24.2 ± 1.7,21.9 ± 2.3,19.0 ± 2.4),lower executive/visuospatial function(3.9 ± 0.7,3.2 ± 0.8,2.4 ± 0.6),lower abstraction (1.7 ± 0.5,1.6±0.5,1.3±0.5),and lower delayed recall(2.9±0.8,1.9±0.8,1.6±0.5)(F=80.52,63.21,12,48.99,all P＜0.05);both collateral groups had lower scores in subtraction and attention (4.6±0.6 vs.5.2±0.7,4.3±0.7 vs.5.2±0.7);the no collateral group had lower scores in orientation(4.7±0.7 vs.5.7±0.5)(P＜0.05).Compared with the multiple vessel collateral group,both the single vessel collateral group and the no collateral group had lower overall scores(21.9±2.3 vs.24.2 ± 1.7,19.0± 2.4 vs.24.2 ± 1.7),executive/visuospatial function (3.2 ± 0.8 vs.3.9 ± 0.7,2.4±0.6 vs.3.9±0.7),subtraction and attention(4.6±0.6 vs.5.1±0.5,4.3±0.7 vs.5.1±0.5) (all P＜ 0.05);the no collateral group had lower scores in abstraction (1.3 ± 0.5 vs.1.7 ± 0.5),delayed recall(1.6 ± 0.5 vs.2.9 ± 0.8) and orientation (4.7 ± 0.7 vs.5.7 ± 0.5) (all P ＜ 0.05).Compared with the single vessel collateral group,the no collateral group had lower overall scores(19.0 ±2.4 vs.21.9±2.3),executive/visuospatial function(2.4±0.6 vs.3.2±0.8)and orientation(4.7± 0.7 vs.5.7 ± 0.6) (all P ＜0.05).In single vessel collateral patients,the AcoA subgroup had higher MoCAscores than the PcoA subgroup(22.9± 1.7 vs.21.2±2.7) (P＜0.05),and the AcoA subgroup had higher scores in delayed recall than the OA subgroup(2.2±0.8 vs.1.7±0.6) (P＜ 0.05).Conclusions Severe unilateral stenosis or unilateral occlusion in the internal carotid artery can result in cognitive impairment,especially in executive/visuospatial function,abstraction,delayed recall,subtraction and attention.However,collateral circulation can protect cognitive function in patients with unilateral internal carotid artery stenosis or occlusion and multiple vessel collateral circulation is more effective than single vessel collateral circulation,and AcoA is more effective than either PcoA or OA,but the difference between PcoA and OA is not significant.
Résumé
Objective To determine the occurrence and baseline predictive factors of early neurological deterioration ( END) among mild ischemic stroke patients.Methods Mild ischemic stroke patients admitted in the hospital were prospectively enrolled.Univariate and multivariate Logistic recession analyses were used to analyze the demographic data, risk factors of ischemic stroke, clinical, brain imaging and laboratory data.Risk factors of END were identified.Results From June 2012 to August 2013, a total of 319 patients with mild ischemic stroke were enrolled, 45 patients (14.1%) of them experienced END.Univariate analysis showed that baseline NIHSS ( U=3522.000,P=0.000), baseline systolic blood pressure (t=2.871,P=0.004), proportion of symptomatic large artery severe stenosis or occlusion (χ2 =52.564,P=0.000) and proportion of large artery atherosclerosis among TOAST subtypes (χ2 =47.287,P=0.000) in END group were significantly higher than those in non-END group. Multivariate logistic regression analysis showed that baseline systolic blood pressure>142 mmHg (1 mmHg=0.133 kPa) (OR=3.954, 95%CI:1.693-9.236, P=0.001), symptomatic large artery severe stenosis or occlusion (OR=3.170, 95%CI:1.170-8.583, P=0.023) and baseline NIHSS (OR=2.038, 95%CI:1.359-3.057, P=0.001) were associated with END.Conclusions About 14.1% of the mild ischemic stroke patients can occur END.Baseline systolic blood pressure>142 mmHg, symptomatic large artery severe stenosis or occlusion and higher baseline NIHSS were the independent risk factors of END.
Résumé
Objective To analyze the clinical effect of intravascular intervention for treating the severe stenosis of bilateral renal arteries (BRASS).Methods A total of 40 patients with BRASS admitted in Fuwai Hospital from September 2008 to December 2010 were retrospectively analyzed.These patients,23 males and 17 females,aged from 21 to 76 years with average age of (59.75 ± 17.59) years,with luminal narrowing over 70％ in bilateral renal arteries,met the criteria of BRASS evidenced by angiography of renal arteries,and were subjected to renal artery interventional therapy. The etiological factors included arteriosclerosis (34 cases),Takayasu arteritis (3 cases) and congenital fibromuscular dysplasia (3 cases).After percutaneous endovascular intervention,the therapeutic effects were evaluated by lowering the systemic blood pressure and serum creatinine level in 12-month follow-up in average after operation. The data were analyzed with SPSS 13.0 statistical software.ResultsAmong the 80 reual arteries in 40 patients,18 arteries were treated with percutaneous transluminal balloon angioplasty (PTBA),while the other 62 arteries were treated with percutaneous transluminal renal artery stenting (PTRAS).Mter endovascular intervention,the mean systolic blood pressure decreased from ( 165.0 ± 27.0) mm Hg to ( 135.7 ± 25.3 ) mm Hg on the second day after operation ( P ＜ 0.01 ) ; and the mean diastolic blood pressure decreased from ( 88.9 ±15.1 ) mm Hg to (74.8 ± 13.2) mm Hg on the second day after operation ( P ＜ 0.01 ).Accordingly,the kinds of anti-hypertension drug used decreased from ( 3.1 ± 0.9 ) to ( 2.3 ± 1.2) ( P ＜ 0.01 ).Only one patient died suddenly 3 months after intervention,and one died of acute myocardial infarction 7 months after operation.The other 38 patients were followed up for 12 months.At last,the mean systolic blood pressure of patients decreased from ( 165.0 ±27.0) mm Hg to ( 133.53 ± 15.94) mm Hg and the mean diastolic blood pressure decreased from (88.9 ± 15.1 ) mm Hg to (77.37 ± 13.47 )mm Hg. Of all 38 patients,2 were cured (5.3％),27 were improved (71.1％) and 9 failed to treatment (23.7％).Of all 38 patients,76.4％ got hypertension lowered.Moreover,renal function (Scr) was improved in 2 patients (6.3％ ),steady in 21 patients ( 65.6％ ),declined in 9 patients ( 28.1％ ) resulted in azotemia stage.Of 38 patients,71.9％ patients got overall benefit from endovascular intervention in respect of renal function improved.Conclusions The procedure of PTBA or PTRAS offered a minimally invasive,relatively safe and effective technique for BRASS patients to decrease blood pressure and stabilize renal function.
Résumé
ObjectiveTo research collateral pathways and collateral grading through digital subtract angiography(DSA) and their relation to clinical prognosis.MethodsCollateral pathways and collateral grading of 49 cases suffered from severe internal carotid artery (ICA) stenosis (70% -99% ) were assessed through DSA.Incidence of stroke,TIA or cerebral hemorrhage were observed in the following 12 months.Results①In all the subjects,no collateral pathway exist in 9 cases(18.9%),and primary and secondary collateral pathways occurred in 39(79.6% ) and 25(51.0%)cases.Pathway is not related to clinical prognosis.②There were 9 ,15 and 25 cases in 0 grade,1 -2 grade and 3 -4 grade collateral circulation and the complication ratio is 44.4%,50.66% and 24.00% respectively.Incidence of ischemic cerebrovascular disease is significantly higher in 3 - 4 grade patinets than those in 0 and 1 - 2 grade pation(x2 =4.856,3.242;all P ＜ 0.05 ).ConclusionsCollateral levels but not pathway were correlated with clinical prognosis in patients with severe stenosis of internal carotid artery.
Résumé
Objective To evaluate the recent curative effect of the angioplasty of vertebrobasilar system TIA patients.Methods 26 patients of vertebrobasilar system TIA after accepting angioplasty were analyzed retrospectively and were followed-up during 6 months to 9 months with average(7?0.25)months.We analyzed the short-period curative effect of the angioplasty and risk factors.Results 26 patients were accepted angioplasty of 31 vessels,with achievement ratio of technique being 100%,mean preoperative stenosis(82.50?9.95)% reducing to(4.2?3.8)%.1 patient appeared transient ischemic attacked following-up for 6~9months.The symptom disappeared in 24 patients.2 patients relapsed.One was related to take medicine irregularly,the other was related to the hypertension.Conclusion The recent curative effect of angioplasty to vertebrobasilar system TIA patients was satisfactory,but long-ferm efficacy needs to be observed in the further.