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Objective To observe the levels of serum interleukin-1β(1L-1β)and interleukin-1 receptor antagonist(IL-1Ra),the IL-1Ra/IL-1β ratio and the relationship between the levels of thern and the restenosis in patients with intra-and extra-cranial arteriostenosis after stent-assisted angioplasty.Methods Thirty-one patients with cerebral artery stenosis,admitted to our hospital from April 2003 to March 2006,were treated with stent-assistant angioplasty and followed up for 6-12 months.The relationship was analyzed between the restenosis of cerebral artery and both the levels of serum IL-1β,IL-1Ra and the IL-1 Ra/IL-1β ratio before and 1 h,1,3 and 5 d after stent-assisted angioplasty.Results The condition of 31 stents in 31 blood vessels of cerebral arteries was observed and followed up 6 to 12 months after the operation.Restenosis was noted in 6(19.3%)with 3 restenosis superior to 50% and 3 restenosis from 10%-30%.No obvious difference of the levels of serum IL-1β and IL-1Ra,the IL-1Ra/IL-1β ratio between restenosis group and non-restenosis group before the operation was found (P>0.05);IL-11β and IL-1Ra levels were positively correlated before the operation.The levels of serum IL-1β and IL-1Ra 1h,1,3 and 5 d after the operation were superior to those before the operation,respectively(P<0.05).The levels of serum IL-1β and IL-1Ra in the restenosis group showed no significant difference to those in the non-restenosis group 6 to 12 months alter the operation(P>0.05);however,the IL-1Ra/IL-1β ratio in the restenosis group was significantly lower than that in the non-restenosis group (P<0.05);positive correlation between the levels of IL-1β and IL-1Ra was observed.Conclusion The levels of serum IL-1β and IL-1Ra were associated with the inflammatory process after the operation and the immune maladjustment of IL-1β and IL-1Ra might be correlative to the restenosis,indicating that the IL-1Ra/IL-1β ratio might be an available index for monitoring the restenosis.
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Objective To discuss mechanism and control measures of stent fracture and restenosis after percutaneous transluminal angioplasty and stenting (PTAS) for symptomatic ostial vertebral/subclavian artery stenosis. Methods A retrospective analysis was performed on 3 patients with stent fracture after receiving PTAS for symptomatic ostial vertebral/subclavian artery stenosis.Simple radiographic, ultrasonographic and clinical follow-up examinations were estimated. Related articles on coronary stent fracture were gone over, consulting in the types, cumulative incidence and occurrence time of adverse events, risk factors and preventive measures. Results Stent fractures of 3 patients with symptomatic ostial vertebral /subclavian artery stenosis were associated with in-stent restenosis and occlusion. Two of the 3 patients treated with the balloon angioplasty and after balloon dilatation, and the patients exhibited relief of symptoms. One patient was only managed for vascular disease risk factors, and no developing recurrent symptoms were noted during the follow-up period.Conclusions Stent fracture might appear in patients performed PTAS for symptomatic ostial vertebral /subclavian artery stenosis, and regular check is needed. Individual treatment was emphasized in case of serious symptoms appeared.
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Objective To investigate the hemodynamic changes in patients with intracerebral hemorrhage (ICH) using CT perfusion (CTP) imaging and the relation between cerebral perfusion and the Scandinavian Stroke Scale (SSS) of the patients. Methods Forty-one patients with supratentorial ICH underwent plain CT scanning and CTP imaging at different times after ICH onset (from 5 h to 14 days). The impact of the time after ICH onset, hematoma volume, edema area, mean hlood pressure (MBP) and blood glucose on the hemodynamics of the patients was assessed, and the correlation between the SSS and the hemodynamic changes evaluated. Resnlts The cerebral blood flow in the edema area (CBF1), the peripheral area of the edema (CBF2, within 1 cm to the edema) and the distant cortical area from the hematoma (CBF3) showed significant differences (r=0.027, P=0.870) and fluctuated with time. CBF1 showed a positive linear relation with CBF2 (r=0.334, P=0.035), but neither of them was correlated to CBF3 (r=0.027, P=0.870;r=0.142, P=0.383). CBF1 also showed positive linear relations with relative cerebral blood volume (rCBV1) (r=0.803,P=0.000) and the peak time (PT1) (r=-0.52, P=0.752). The reduction of CBF1 was inversely correlated to the hematoma volume and the edema area (r=-0.501, P=0.001;r=-0.589, P=0.000), but not related with MBP or blood glucose (r=0.141, P=0.386;r=0.014, P=0.930). The area of ischemic injury (the ischemic area defined by CBF parameters-the hematoma area, edema area (r=0.449, P=0.003;r=0.645, P=0.000), but not to the MBP or blood glucose (r=-0.047, P=0.769;r=0.141,P=0.378). SSS was found to correlate to the volume and location of the hematoma and the reduction of CBF and CBV (r=-0.418, P=0.007;r=0.542, P=0.000;r=0.376, P=0.017;r=0.312, P=0.050), but not to the ischemic and edema area (r=-0.283, P=0.073;r=-0.163, P=0.308). Conclusion CBF is reduced in the edema area, peripheral area of the edema and the distant cortical area from the hematoma but showing different patterns of variation. Ischemic injury is present in the edema area around the hemotema, and its scope and severity is related with the hemotoma volume and the size of the edema area and may vary with time. The location and volume of the hematoma as well as the perfusion level in the edema area all affect the SSS of the patients.
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Objective To investigate the relation between compensation of collateral circulation and the severity of clinical neurologic deficit in patients with severe stenosis or occlusion of the internal carotid artery (ICA). Methods National Institutes of Health Stroke Scale (NIHSS) examination was performed in 52 patients with cerebral infarction caused by consecutive stenosis or occlusion of ICA during admission and digital subtraction angiography (DSA) was employed to evaluate the compensation of collateral circulation to analyze the results through statistical methods. Results DSA demonstrated occlusion oflCA in 18 patients, severe stenosis of unilateral ICA in 28, and severe stenosis of bilateral ICA in 6. Anterior communicating artery (ACoA) compensation was presented in 18 patients;posterior communicating artery (PCoA) compensation appeared in 8;both ACoA and PCoA compensations were showed in 12. Only 14 patients have no compensation by Willis circle. Significant differences of average ranks of the NIHSS were found in non Willis circle (35.75) and Willis circle (23.09) (P<0.05);while no significant differences were noted in ACoA (12.42) and PCoA (15.94) compensations (P>0.05). Conclusions Effective collateral circulation can be established spontaneously through multiple ways when occlusion or severe stenosis of ICA appears. The NIHSS scores and the compensation, the location of vessel occlusion are significantly correlative. It is extremely important to investigate the collateral circulation carefully through DSA before treatment intervention.
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Objective To study the cell toxicity of thrombin in astrocytes in vitro and the protective effect of hirudo extract liquid (HEL) on the injured astrocytes. Methods Astrocytes were isolated from Wistar rats' cerebral cortex and cultured in vitro, and observed under a phase contrast microscope for growth status. Cell activity was measured with MTT assay. The survival of astrocytes was investigated after exposed to a selected concentration of thrombin ranging from 0.1 to 100 U/mL or to HEL ranging from 0.25 to 4 mg/μL by observing cell morphology under an inverted phase-contrast microscope and measuring the lactate dehydrogenase (LDH) activity (a marker of cell death) in cell supernatant. Expressions of HSP70 and TGFβ-1 protein in astrocytes were investigated by immunohistochemistry. Results (1) Thrombin (1-100 U/mL) had toxicity on astrocytes in vitro in a dose-dependent manner (F=118.65, P=0.000). (2) HEL (0.25-4 mg/μL) could significantly reduce the cell toxicity of 10 U/mL thrombin in astrocytes (F=156.08, P=0.000). With the increasing concentration of HEL, the protection of HEL was accordingly enhanced, and it even increased the expressions of HSP70and TGFβ-1. Conclusions HEL could accelerate the proliferation of astrocytes, enhance the expressions of HSP70 and TGFβ-1 protein, so as to significantly depress the cell toxicity of thrombin to astrocytes.
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Objective To investigate the relationship between cortical watershed infarction and carotid artery stenosis and evaluate the stent insertion operation.Methods After 23 cortical watershed infarction patients diagnosed by CT or MRI received DSA detection,we performed stent insertion operationon 11 patients according to their requirements,and conservative treatment on the remaining 12 patients.All the patients underwent follow up for 6-12 months post-operatively.Results Among the 23 cortical watershed infarction patients,22 Were detected with carotid artery stenosis.Statistical analysis showed that the degree of carotid artery stenosis was associated With the elinical svmDtoms and the volume of steal phenomenon(P<0.05);further,the artery stenosis improvement was over 90%with the stent inserted;conversely,dizziness and steal phenomenon disappeared.The post procedure follow-up,ranging 6-12 months,showed that the patients with stent insertion got less new symptoms,steal phenomenon and artery stenosis,compared with the patients with conservation treatment(P<0.05).Conclusion Cortical watershed infarction is associated with carotid artery stenosis.The stent insertion iS useful for the treatment ofcarotid artery stenosis and prevention of cortical watershed infarction.