Endovascular recanalization for non-acute internal carotid artery occlusion using a new angiographic classification / 中华放射学杂志

Objective:To evaluate the safety and feasibility of endovascular recanalization for non-acute internal carotid artery occlusion (NA-ICAO), and to propose a new angiographic classification.Methods:From April 2015 to October 2019, 95 consecutive patients with symptomatic NA-ICAO who received endovascular recanalization were retrospectively analyzed in Beijing Tiantan Hospital, Capital Medical University. All the patients were divided into four groups according to DSA: type Ⅰ, petrous segments were distally reconstituted by collateral vessels; type Ⅱ, cavernous segments were distally reconstituted by collateral vessels; type Ⅲ, ophthalmic segments were distally reconstituted by collateral vessels; type Ⅳ, communicating segments were distally reconstituted by collateral vessels. Study data including clinical characteristics, surgical details, lesion classification, recanalization rate and perioperative complications. For the counting data, the χ 2 test was used to compare between groups. For the quantitative data, the ANOVA was used for the normal distribution data, otherwise the Kruskal-Wallis H test was used. The primary safety outcome was any stroke or death within 30 days. Results:Among the 95 patients, 67 (70.53%) had successful recanalization. The recanalization rates of type Ⅰ－Ⅳ were 92.31% (36/39), 81.82% (18/22), 47.83% (11/23) and 18.18% (2/11) respectively (χ2=29.557, P<0.001). And the complication rates of the four types were 5.13% (2/39), 13.64% (3/22), 21.74% (5/23) and 9.10% (1/11) respectively. The incidence of perioperative ischemic stroke was 2.11% (2/95). No other serious stroke and death occurred. Conclusions:Endovascular recanalization may be feasible and safe for carefully selected patients with NA-ICAO and therefore represents an alternative treatment. The patients with type Ⅰ and Ⅱ lesions had higher recanalization rates, while the patients with type Ⅳ lesions had significantly lower recalculation rate. The new angiographic classification is conducive to the selection of suitable patients and difficulty in grading.

A comparative analysis of bridging therapy versus direct endovascular treatment in acute ischemic stroke patients aged 80 years and over / 中华老年医学杂志

Objective:To compare the safety and therapeutic effect of bridging therapy versus direct endovascular treatment in patients with acute ischemic stroke(AIS)aged 80 years and over, who received the therapy within 4.5 h of onset.Methods:A total of 89 AIS patients aged 80 years and over receiving the endovascular therapy at our hospital from January 2016 to June 2019 were studied with versus without intravenous thrombolysis before endovascular therapy(the former as bridging therapy group, n=49; the latter as the direct endovascular treatment group, n=40). Baseline information including gender, the modified Rankin scale(mRS)score, medical history, smoking history, preoperative national institute of health stroke scale(NIHSS)score were collected.Clinical data related to the operation including the times from onset to hospital, door-to-puncture and door-to-recanalization, complications(symptomatic cerebral hemorrhage, mortality)and mRS at 90 d after treatment were compared between the two groups.Multiple logistic regression analysis was used to determine whether or not bridging therapy with intravenous thrombolysis was a prognostic factor.Results:There was no significant difference in baseline information between the two groups( P>0.05). The times from onset to hospital, door-to-puncture, door-to-recanalization had no significant difference between the two groups( P>0.05). There was no significant difference in the incidence of symptomatic cerebral hemorrhage and mortality within 90 d between the two groups(26.5% or 13 cases vs. 17.5% or 7 cases, 14.3% or 7 cases vs.7.5% or 3 cases, χ2=1.031 and 1.017, P=0.310 and 0.313). With different clinical outcomes as dependent variables, after adjusting factors such as gender, admission NIHSS and medical history, Logistic regression analysis showed that the bridging therapy with intravenous thrombolysis was not a prognostic factor( OR=0.795, 95% CI: 0.280~2.258, P=0.666). Conclusions:The bridging therapy is as safe and effective as the direct intravascular therapy for AIS patients aged 80 and over within 4.5 hours of onset.The intravenous thrombolysis should be given as soon as possible within time window.

The therapeutic effects of stent retriever-based thrombectomy on acute ischemia stroke in patients aged 80 years and over / 中华老年医学杂志

Objective To evaluate the safety and therapeutic effects of stent retriever-based thrombectomy (SRT) on acute ischemic stroke (AIS) in patients aged 80 years and older.Methods A cohort of 157 AIS patients hospitalized in Capital Medical University Affiliated Beijing Tiantan Hospital were selected for SRT from January 2016 to May 2017.Based on the age,all patients were divided into two groups:groups aged ＜ 80 years and ≥ 80 years.Baseline information including gender,the Modified Rankin Scale (mRS) score,past medical history,smoking history,preoperative National Institutes of Health Stroke Scale (NIHSS),the Alberta Stroke Program Early CT Scores (ASPECTS),intravenous thrombolysis and clinical outcomes were compared between two groups.The informations related to the operation,including time from onset to hospital,door-to-needle puncture time,door-to-recanalization time,SRT complications (symptomatic cerebral hemorrhage,mortality) and good outcome,were compared between two groups.Logistic regression analysis was used to determine whether the age of 80 years and over was a risk factor for adverse prognosis after SRT.Results There were 130 patients in the group ＜ 80 years of age,and 27 patients in the group ≥80 years.No significant differences were found in baseline information between the two groups (all P＞ 0.05).In addition,there were no significant differences in the proportions of the operative information,complications of SRT and the good outcome (all P＞0.05).Furthermore,advanced age (≥80 years) was not a risk factor for adverse outcome after SRT (OR =0.738,95％ CI:0.300-1.813).Conclusions Stent retriever-based thrombectomy is safe and beneficial for patients with acute ischemic stroke,even in patients aged 80 years and over.

Efficacy analysis of stenting in patients with internal carotid artery cavernous segment symptomatic stenosis / 中国脑血管病杂志

Objective To evaluate the safety,effectiveness,and middle or long-term efficacy of endovascular stenting of internal carotid artery stenosis at the cavernous segment. Methods Thirty-two patients underwent endovascular stenting at the cavernous segment of internal carotid artery from January 2012 to February 2015 were enrolled retrospectively. Angioplasty and stenting were conducted using Apollo or Winspan stent system. The improvement of internal carotid artery cavernous segment stenosis and perioperative safety and the results of the medium and long-term follow-up of the 2 kinds of stents were observed. Results All the 32 patients achieved technical success. The symptoms of cerebral ischemia of the patients were relieved significantly. The length of the stenosis at cavernous segment of the internal carotid artery was 4 to 13 mm (mean,7. 2 ±2. 9 mm). The stenosis rate from 82 ± 7% before treatment decreased to the 24 ± 7% . One patient had perioperative complication (4. 7%),26 of them were followed up with DSA,and 6 were lost to follow-up. The follow-up period ranged from 7 to 29 months (mean,16 ± 7 months). During the follow-up period,1 patient had intracerebral hemorrhage,1 had cerebral infarction,and none of them died. Four patients had in-stent restenosis,three of them used Winspan stents, and 1 used Apollo stents. Conclusion The patients should be screened strictly,particularly paying attention to the length of lesions. Endovascular stent angioplasty for the treatment of internal carotid artery cavernous segment stenosis is a safe and effective method.

The changes of oxygen extraction fraction and cerebral blood flow of brain parenchyma in patients with unilateral cerebral vessel stenosis: initial experience of the quantative measurements / 中华放射学杂志

Objective Using gradient-echo sampling of spin-echo (GESSE) sequence to study the change of oxygen extraction fraction (OEF) in patients with unilateral cerebral vessel stenosis and the relationship between OEF and cerebral blood flow (CBF). Methods Eight normal volunteers and 16 patients with unilateral cerebral vessel stenosis were enrolled in this study. Written informed consents were obtained from all subjects. Routine MRI, GESSE and arterial spin labeling (ASL) sequences were performed for all patients. Raw data from GESSE and VE-ASL sequences were transferred to PC to conduct postprocessing. To obtain quantitative OEF and CBF of the brain parenchyma, 6 ROIs were placed respectively in the anterior, middle and posterior part of both hemispheres. The relative CBF (rCBF) was defined as the ratio of CBF of ischemic hemisphere to that of contralateral hemisphere. T test was used for statistics. Results The mean value and normal range of OEF in the volunteers were 0. 318 ± 0. 023 and 0. 272-0. 364, respectively. In the 16 patients with unilateral cerebral vessel stenosis, 8 patients had ROIs with greater OEF in unilateral hemisphere than those in contralateral hemisphere. These cases presented multiple intracranial main arterial stenoses in digital subtraction angiography (DSA) or MR angiography (MRA) examination. The other 8 patients had normal OEF in all ROIs. And they only had single arterial stenosis in DSA or MRA. Set rCBF = 0. 50 as a dividing point, the mean OEF value was 0. 397 ±0. 010 in the patients with rCBF ＜ 0. 50. In the patients with rCBF ≥ 0. 5, the mean OEF value was 0. 325 ±0. 028. The difference between the two groups was statistically significant (t = - 8. 840, P = 0. 000).Conclusion Patients with chronic cerebral ischemia may present with various hemodynamic impairment.The more CBF decreases, the more OEF increases. Those with increased OEF tended to have more than one lesion in the major intracranial arteries.

Cerebral collateral magnetic resonance imaging / 中华神经科杂志

Objective To evaluate collateral flows using vessel encoded arterial spin labeling (VE-ASL) perfusion imaging. MethodsVE-ASL was achieved to assess the presence and function of collateral flow on patients with internal carotid artery (ICA) stenosis. The presence of the anterior and posterior collateral flow was demonstrated by flow patterns of the A1 segment and posterior communicating artery (PCoA).Distal function of collateral flow of stenotic hemisphere was categorized as adequate ( cerebral blood flow ≥10 ml · min-1·100 g-1 ) or deficient (cerebral blood flow < 10 ml · min-1· 100 g-1 ). The results were compared with magnetic resonance angiography (MRA) and intraarterial digital subtraction angiography (DSA) in crosstable by using Kappa values. The VE-ASL before and after ICA stent therapy were compared. ResultsThe Kappa values of the flow patterns of AI segment and PCoA between VE-ASL and MRA were 0. 746 and 0. 700. The Kappa value of the function of collaterals using VE-ASL and DSA was914. VE-ASL showed collateral flow via leptomeningeal anastomoses. VE-ASL changed significantly after ICA steat therapy. ConclusionVE-ASL reveals the presence and distal function of collateral flow, which helps to evaluate the efficacy of ICA steat therapy.

Comparison of Endarterectomy and Stenting for High-risk Carotid Atherosclerotic Stenosis / 中国微创外科杂志

Objective To compare the efficacy of carotid endarterectomy(CEA)and carotid artery stenting(CAS)for the treatment of high-risk atherosclerotic carotid artery stenosis.Methods We retrospectively studied the surgical outcomes of 58 patients with high-risk atherosclerotic carotid artery stenosis.Among the cases,32 received CEA and 26 underwent CAS.All of the patients were followed up with carotid ultrasonography,CTA or DSA in 30 days,6 months,and 1 year after the procedures,their neurological function was assessed meanwhile.Cumulative incidence of death,stroke,or myocardial infarction within 30 days after the surgical intervention and death or ipsilateral stroke events between 30 days and 1 year were set as the primary endpoint of the study.And the secondary endpoints were the CEA or CAS-correlated complications or severe restenosis within 1 year after the treatment.The outcomes of the two groups were compared.Results The primary endpoint occurred in 3 patients in the CEA group(9.4%)and 4 in the CAS group(15.4%)(?2=0.086,P= 0.769).And the secondary endpoint was found in 4 of the CEA group(12.5%)and 4 of the CAS group(15.4%)respectively(?2=0.000,P=1.000).Conclusions For the patients with high-risk carotid artery stenosis and coexisting conditions,CEA is as safe and effective as CAS.