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Quantitative digital subtraction angiography (DSA) analysis can obtain pixel time density curves through changes in contrast agent concentration, and calculate the corresponding parameters of the contrast agent in the area of interest, achieving semi quantitative analysis of patient hemodynamic, used to evaluate the reperfusion status of intravascular therapy in patients with acute ischemic large vessel occlusion stroke. With the widespread application of artificial intelligence technology, especially deep learning algorithms in medical image processing, it is expected to further excavate the DSA images, which can comprehensively evaluate cerebral vascular diseases in multiple phases, angles, and directions.
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Objective:To explore the prognostic prediction value of quantitative digital subtraction angiography (DSA) parameters in patients with acute anterior circulation ischemic stroke undergoing mechanical thrombectomy, and whether the clinical values vary by stroke etiology.Methods:This study was a post hoc analysis of the Multicenter Prospective Captor Trial. Patients with acute anterior circulation large-vessel occlusion and successful recanalization from April 2018 to July 2019 were screened. Post-processing analysis was performed on the DSA imaging sequence after recanalization, and 4 regions of interest (ROI) were selected in the target vessel: ROI1 (the proximal of the internal carotid artery-C2 segment), ROI2 (the starting point of the internal carotid artery-C7 segment), ROI3 (the end of the middle cerebral artery-M1 segment), and ROI4 (the end of the middle cerebral artery-M2 segment). Time to peak (TTP) was defined as the time at contrast concentration of selected ROI reached its maximum. Relative TTP (rTTP) was calculated by subtracting the TTP of ROI1 from the TTP of distalis ROIs. Successful recanalization was defined as modified Thrombolysis In Cerebral Infarction (mTICI) grade≥2b. Favorable outcomes at 3 months were defined as the modified Rankin Scale score≤2. According to the modified Rankin Scale score, the patients were divided into good prognosis group and poor prognosis group. The differences in clinical characteristics, postoperative hemodynamic parameters, and other data were compared between patients with good and poor prognoses. Univariate and multivariate Logistic regression was used to analyze factors related to a good prognosis. Finally, the prognostic prediction value of hemodynamic parameters was analyzed in patients with different Trial of Org10172 in Acute Stroke Treatment etiological classifications.Results:A total of 245 patients were collected, of which 161 patients [age 69 (60, 76) years, 92 (57.1%) male] were finally included in the analysis, including 36 cases of large artery atherosclerosis (LAA) stroke, 76 cases of cardiogenic embolism (CE), and 49 cases of other causes of stroke. Seventy-one (44.1%) patients had favorable outcomes at 3 months. The post-operative hemodynamic analysis indicated that patients with favorable outcomes ( n=71) had a higher proportion of mTICI grade 3 [54/71 (76.1%) vs 41/90 (45.6%),χ 2=15.26, P<0.001] and lower rTTP 31 [means TTP ROI3-TTP ROI1;0.33 (0.23, 0.54) s vs 0.47 (0.31, 0.65) s, Z=-2.71, P=0.007] than patients with unfavorable outcomes ( n=90). The mTICI score and rTTP 31 were respectively included in multivariate Logistic regression models. It was shown that mTICI grade 3 (adjusted OR=5.97, 95% CI 2.49-14.27, P<0.001) and rTTP 31 (adjusted OR=0.24, 95% CI 0.06-0.99, P=0.048) were significantly associated with favorable outcomes, and the area under the receiver operating characteristic curve of the models had no statistically significant difference ( P=0.170). Subgroup analysis showed that rTTP 31 was significantly associated with the prognosis of patients with LAA stroke ( OR=0, 95% CI 0-0.25, P=0.014), while mTICI grade was associated with the prognosis of patients with CE ( OR=3.91, 95% CI 1.40-10.91, P=0.009) and other etiologies ( OR=7.35, 95% CI 1.92-28.14, P=0.004). Conclusions:In patients with acute anterior circulation ischemic stroke and successful recanalization, both mTICI score and rTTP 31 had significant predictive value for favorable outcomes at 3 months. Moreover, rTTP 31 was significantly associated with the prognosis of patients with LAA stroke, while mTICI score was significantly related to the prognosis of patients with CE and other causes of stroke.
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Objective:To investigate the safety and effectiveness of Neuroform Atlas stent-assisted coiling in the endovascular treatment of intracranial aneurysms.Methods:This was a retrospective, single-center observational study of 77 patients who underwent endovascular treatment of intracranial aneurysms using the Neuroform Atlas device at the Department of Neurology, People′s Liberation Army General Hospital from July 2020 to May 2022. There were 34 males and 43 females, with a median (range) age of 59 (23-81) years. The degree and effect of aneurysm embolization were evaluated by modified Raymond grading post procedure and after 6 months. Complications occurring during the perioperative period were recorded. Vaso computed tomography was performed immediately after the operation to assess stent opening and adherence. Digital subtraction angiography was performed 6 months after discharge and the aneurysm was classified as cured, stable, or recurrent.Results:A total of 87 Atlases were successfully released in 77 cases. Angiography performed immediately after the embolization revealed 19 (24.7%) modified Raymond grade Ⅰ, 10 (13.0%) grade Ⅱ, and 48 (62.3%) grade Ⅲa cases. Three perioperative complications were observed including thrombotic events in 2 cases and stent migration in 1 case. A follow-up angiogram was available for 47 aneurysms, and showed that modified Raymond grade Ⅰ occlusion was achieved in 38 (80.9%) cases, grade Ⅱ in 2 (4.3%) cases, and grade Ⅲa in 7 (14.9%) cases. At the 6-month follow-up, 38 patients were cured and 7 were stable, whereas 2 patients experienced a recurrence of aneurysm. Stenosis of the parent artery occurred in 3 (6.4%) cases, including 2 at the head and 1 inside the stent.Conclusions:The results of this preliminary study suggest that Neuroform Atlas stent-assisted coiling has a high occlusion rate and low incidence of complications in the endovascular treatment of aneurysms. However, the effectiveness of this procedure for large aneurysms and long-term outcomes require further investigation.
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Objective:The study aimed to investigate the association between lesion location and post-stroke depression (PSD) in acute ischemic stroke patients.Methods:In this case-control study, acute ischemic stroke patients were recruited from the Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), between September 2020 and June 2021. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, the patients were divided into the PSD and non-PSD groups. The 24-item Hamilton Rating Scale (HAMD) was used to evaluate the severity of depression. The Student′s t-test, Mann-Whitney test, and Chi-square test were used to compare the clinical baseline characteristics of PSD and non-PSD groups. Voxel-based lesion-symptom mapping (VLSM) was applied to investigate the association between lesion location and depression occurrence and severity. Results:A total of 70 and 173 patients were admitted to the PSD and non-PSD groups, respectively. The mean age of patients was 59 years (23-86). There were 153 males and 90 females. Univariate analysis showed a significant difference only in Hamilton Anxiety ( P=0.025) and Depression ( P<0.001) scores between the PSD and non-PSD groups. VLSM analysis identified clusters within the anterior cingulate gyrus ( Z=-3.05, P<0.001), left hippocampus ( Z=-3.15, P<0.001), and left lingual lobe ( Z=-3.08, P<0.001) where lesions were significantly associated with PSD. Additionally, the severity of PSD was associated with damage in the anterior cingulate gyrus ( Z=-3.64, P<0.001), left hippocampus ( Z=-3.51, P<0.001), left lingual lobe ( Z=-4.18, P<0.001), and pericalcarine cortex ( Z=-3.65, P<0.001). Conclusion:VLSM demonstrated that lesion location could be used to predict the occurrence of PSD in patients with acute ischemic stroke.
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Objective:To investigate the value of cellular immune status before initial 131I treatment for predicting treatment response in young and middle-aged patients with papillary thyroid cancer (PTC). Methods:From March 2018 to April 2019, 150 young and middle-aged patients with PTC (46 males, 104 females, age (40.0±9.8) years) who underwent total thyroidectomy and neck lymph node dissection in the Affiliated Hospital of Qingdao University were enrolled retrospectively. All patients underwent radioablation 1-2 months after operation, and the serum lymphocyte subsets (CD3 + , CD4 + , CD8 + , CD4/CD8) as well as natural killer (NK) cells were detected 1 d before the initial 131I treatment. Patients were divided into excellent response (ER) group and non-ER group according to the response of 6-12 months after 131I treatment. Clinicopathological characteristics, preablative stimulated thyroglobulin (psTg), initial 131I dose and lymphocyte subsets that might affect the response to 131I treatment were analyzed (independent-sample t test, Mann-Whitney U test, χ2 test, multiple logistic regression analysis). ROC curve analysis was used to evaluate the predictive value of significant factors for non-ER. Results:Of 150 patients, 84 cases were in ER group (56.00%), and 66 cases (44.00%) were in non-ER group. Age ( z=-2.86, P=0.004), M stage ( χ2=13.64, P<0.001), psTg ( z=-8.94, P<0.001), initial 131I dose ( z=-7.60, P<0.001), CD4 + ( t=2.50, P=0.014), CD4/CD8 ( z=-2.22, P=0.027) of the two groups were significantly different. Multivariate analysis showed that psTg (odds ratio ( OR)=1.27, 95% CI: 1.16-1.40, P<0.001) and CD4/CD8 ( OR=0.39, 95% CI: 0.15-0.99, P=0.048) were independent factors for predicting 131I treatment response. The cut-off values of psTg and CD4/CD8 for predicting non-ER were 6.78 μg/L and 1.67, respectively. Conclusions:Cellular immune status before initial 131I treatment may predict treatment response in young and middle-aged patients with PTC. It indicates non-ER response when Tg is higher than 6.78 μg/L and CD4/CD8 is lower than 1.67.
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Objective:To investigate the influencing factors, periprocedural complications, and long-term outcomes of successful recanalization after endovascular treatment in patients with non-acute symptomatic internal carotid artery occlusion.Methods:Patients with non-acute internal carotid artery occlusion received endovascular treatment in the Nanjing Stroke Registration System between January 2010 and December 2021 were retrospectively enrolled. Clinical endpoint events were defined as successful vascular recanalization, periprocedural complications (symptomatic embolism and symptomatic intracranial hemorrhage), neurological function improvement, and recurrence of ipsilateral ischemic events. Multivariate logistic regression analysis was used to investigate the independent influencing factors of successful vascular recanalization. Cox proportional hazards regression analysis was used to investigate the correlation between endovascular treatment outcomes and neurological function improvement, as well as ipsilateral ischemic cerebrovascular events. Results:A total of 296 patients were included, of which 190 (64.2%) were successfully recanalized. Multivariate logistic regression analysis showed that symptoms manifest as ischemic stroke (odds ratio [ OR] 3.353, 95% confidence interval [ CI] 1.399-8.038; P=0.007), the time from the most recent symptom onset to endovascular therapy within 1 to 30 d ( OR 2.327, 95% CI 1.271-4.261; P=0.006), proximal conical residual cavity ( OR 2.853, 95% CI 1.242-6.552; P=0.013) and focal occlusion (C1-C2: OR 3.255, 95% CI 1.296-8.027, P=0.012; C6/C7: OR 5.079, 95% CI 1.334-19.334; P=0.017) were the independent influencing factors for successful vascular recanalization. Successful recanalization did not increase the risk of symptomatic intracranial hemorrhage within 7 d after procedure (3.2% vs. 0.9%; P=0.428). The median follow-up time after procedure was 38 months. Cox proportional hazards regression analysis showed that after adjusting for confounding factors, successful recanalization was significantly associated with postprocedural neurological improvement (hazard ratio 1.608, 95% CI 1.091-2.371; P=0.017), and significantly reduced the risk of recurrence of long-term ischemic events (hazard ratio 0.351, 95% CI 0.162-0.773; P=0.010). Conclusion:In patients with non-acute internal carotid artery occlusion, successful endovascular recanalization can effectively reduce the risk of long-term ischemic events without increasing the risk of symptomatic intracranial hemorrhage.
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Background@#and Purpose The optimal management of patients with acute basilar artery occlusion (BAO) is uncertain. We aimed to evaluate the safety and efficacy of endovascular thrombectomy (EVT) compared to medical management (MM) for acute BAO through a meta-analysis of randomized controlled trials (RCTs). @*Methods@#We performed a systematic review and meta-analysis of RCTs of patients with acute BAO. We analyzed the pooled effect of EVT compared to MM on the primary outcome (modified Rankin Scale [mRS] of 0–3 at 3 months), secondary outcome (mRS 0–2 at 3 months), symptomatic intracranial hemorrhage (sICH), and 3-month mortality rates. For each study, effect sizes were computed as odds ratios (ORs) with random effects and Mantel-Haenszel weighting. @*Results@#Four RCTs met inclusion criteria including 988 patients. There were higher odds of mRS of 0-3 at 90 days in the EVT versus MM group (45.1% vs. 29.1%, OR 1.99, 95% confidence interval [CI] 1.04–3.80; P=0.04). Patients receiving EVT had a higher sICH compared to MM (5.4% vs. 0.8%, OR 7.89, 95% CI 4.10–15.19; P<0.01). Mortality was lower in the EVT group (35.5% vs. 45.1%, OR 0.64, 95% CI 0.42–0.99; P=0.05). In an analysis of two trials with BAO patients and National Institutes of Health Stroke Scale (NIHSS) <10, there was no difference in 90-day outcomes between EVT versus MM. @*Conclusion@#In this systematic review and meta-analysis, EVT was associated with favorable outcome and decreased mortality in patients with BAO up to 24 hours from stroke symptoms compared to MM. The treatment effect in BAO patients with NIHSS <10 was less certain. Further studies are of interest to evaluate the efficacy of EVT in basilar occlusion patients with milder symptoms.
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Objective:To investigate the correlation between the lipocalin-2 (LCN-2) level and white matter hyperintensities (WMHs) in patients with ischemic stroke.Methods:Consecutive patients with ischemic stroke admitted to the Department of Neurology, Jinling Hospital, Medical School of Nanjing University from September 2021 to November 2021 and whose duration from onset to hospitalization <14 d were prospectively enrolled. Enzyme-linked immunosorbent assay was used to detect the serum LCN-2. Fazekas scale was used to assess the severity of periventricular and subcortical WMHs. A total WMHs score ≥3 was defined as severe WMHs. Multivariate logistic regression analysis was used to determine the correlation between serum LCN-2 level and WMHs. Results:A total of 179 patients were enrolled, including 122 males (68.2%), aged 64.7±11.6 years. The median serum LCN-2 level was 387.1 g/L, and 86 patients (48.0%) had severe WMHs. Serum LCN-2 in the severe WMH group was significantly higher than that in the non-severe WMH group (505.3±342.4 g/L vs. 367.8±224.5 g/L; t=3.110, P=0.002). Multivariable logistic regression analysis showed that after adjusting for the relevant confounding factors, there was a significant correlation between higher serum LCN-2 and severe WMHs (odds ratio 2.32, 95% confidence interval 1.17-4.63; P=0.017) and higher total WMHs score (odds ratio 1.62, 95% confidence interval 1.12-2.35; P=0.011). Conclusion:Higher serum LCN-2 level is associated with severe WMHs in patients with ischemic stroke.
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Objective:To explore independent predictors for poor outcome at 3 months in elderly patients with acute cerebral infarction(ACI)treated with intravenous thrombolysis(IVT), and to develop a nomogram-based predictive model.Methods:This was a retrospective cohort study.Clinical, laboratory and imaging data of 346 elderly patients with ACI treated with IVT from January 2016 to April 2021 in our hospital were collected.Poor outcome was defined as a modified Rankin Scale(mRS)score >2 at 3 months after the stroke.Logistic regression analysis was used to screen for independent factors predicting poor outcome in elderly ACI patients treated with IVT, and a corresponding nomogram model was developed using the R software.The ROC curve, calibration plots and decision curve analysis were used to evaluate discrimination, calibration and clinical application value of the nomogram model.Results:Among 346 candidates, 109 developed a poor outcome, representing a rate of 31.5%.Logistic regression analysis showed that symptomatic hemorrhagic transformation( OR=15.647, 95% CI: 8.913-27.454), stroke severity(moderate stroke, OR=3.322, 95% CI: 1.414-7.811; moderate-severe stroke, OR=8.169, 95% CI: 4.102-16.258; severe stroke, OR=9.653, 95% CI: 5.440-17.121), stroke-associated pneumonia( OR=2.239, 95% CI: 1.134-4.420), and heart failure( OR=2.758, 95% CI: 1.424-5.336)were independent predictors for poor outcome at 3 months in elderly ACI patients treated with intravenous thrombolysis(all P<0.05). With the area under curve(AUC-ROC)value at 0.85(95% CI: 0.80-0.89), the nomogram model, which was composed of the above four predictors, demonstrated good discrimination.On the calibration plot, the mean absolute error was 0.020, indicating that the model had good calibration.Decision curve analysis revealed that the model had good clinical application value. Conclusions:The nomogram model composed of symptomatic hemorrhagic transformation, stroke severity, stroke-associated pneumonia and heart failure may predict poor outcome at 3 months in elderly ACI patients treated with IVT, with high prediction accuracy and high clinical application value.
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Objective:To validate the predictive function of Field Assessment Stroke Triage for Emergency Destination (FAST-ED) score on large vessel occlusion (LVO) in Chinese population.Methods:The information about the patients who had the disease onset within 24 hours, were treated in the Emergency Department of Jinling Hospital, and diagnosed as ‘acute ischemic stroke’ was collected. Via the emergent brain computed tomography angiography or digital subtraction angiography, the patients were divided into LVO group and non-LVO group. The scores of FAST-ED were calculated according to the National Institutes of Health Stroke Scale (NIHSS) scores and compared with Rapid Arterial oCclusion Evaluation (RACE), 3-item Stroke Scale (3I-SS), Cincinnati Stroke Triage Assessment Tool (C-STAT), and Prehospital Acute Stroke Scale (PASS) scores. Moreover, the patients were further divided into anterior and posterior circulation lesion groups to explore whether the FAST-ED scale can differ the anterior or posterior circulation effectively.Results:Three hundred and eighty-one patients were eventually included, among whom 284 were diagnosed as LVO, and 97 were diagnosed as non-LVO. Receiver operating characteristic curves showed that cut-off value of 4 optimized the scale (sensitivity: 0.76, specificity: 0.69, area under the curve: 0.78). The area under the curve of FAST-ED score(0.78) showed no statistically significant difference with NIHSS (0.79), RACE (0.77), 3I-SS (0.78) and C-STAT scores (0.75), and exhibited statistically significant difference with PASS score (0.74; 95% CI 0.69-0.78, P=0.01). FAST-ED score showed no statistically significant difference in predicting anterior and posterior circulation lesions. Conclusions:FAST-ED score can predict LVO in a rather accurate manner. It can predict anterior and posterior circulation lesions with similar effectiveness. So FAST-ED is able to be a prehospital screening tool and make assistance to the prehospital treatment.
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Objective:To investigate the preoperative diagnostic value of 99Tc m-methoxyisobutylisonitrile (MIBI) planar imaging and SPECT/CT imaging for primary hyperparathyroidism (PHPT), and analyze the relevant factors affecting the imaging results. Methods:From June 2016 to September 2019, a total of 62 patients (15 males, 47 females, age range: 27-80 years) confirmed as PHPT by postsurgical pathology in Affiliated Hospital of Qingdao University were retrospectively enrolled. The diagnostic efficacies of 99Tc m-MIBI planar imaging and SPECT/CT imaging were compared using χ2 test. The differences of preoperative serum parathyroid hormone (PTH), Ca and the maximum diameter of lesion between the positive and negative groups of planar imaging were analyzed using independent-sample t test and Mann-Whitney U test. The region of interest (ROI) method was applied to calculate the uptake ratio of lesions to normal tissues at the early phase (T/Ne) and delayed phase (T/Nd) in positive cases of planar imaging. Pearson or Spearman correlation analysis was used to evaluate the correlation of T/Ne, T/Nd with preoperative serum PTH, Ca and the maximum diameter of lesion. The receiver operating characteristic (ROC) curves of preoperative serum PTH, Ca and positive planar imaging were drawn and the cut-off values were obtained. Results:The sensitivity of planar imaging and SPECT/CT imaging was 69.35%(43/62) and 87.10%(54/62) respectively ( χ2=5.729, P=0.017). The preoperative serum PTH, Ca levels and the maximum diameter of lesion in patients with positive planar imaging (253.32(107.00, 331.70) ng/L, 2.78(2.51, 2.87) mmol/L, (2.01±0.88) mm) were higher than those with negative planar imaging ((111.86±44.29) ng/L, (2.59±0.21) mmol/L, (1.42±0.55) mm; z values: -2.802, -1.978, t=3.300, all P<0.05). T/Ne was positively correlated with preoperative serum PTH ( rs=0.511, P<0.001) and the maximum diameter of lesion ( r=0.381, P=0.012), and T/Nd was positively correlated with preoperative serum PTH ( rs=0.538, P<0.001), Ca ( rs=0.348, P=0.022) and the maximum diameter of lesion ( r=0.463, P=0.002). The area under the ROC curve between preoperative serum PTH, Ca and planar imaging was 0.725 and 0.646, respectively. Preoperative serum PTH had a better predictive value with the optimal cut-off value of 150.4 ng/L. Conclusions:Preoperative serum PTH, Ca and the maximum diameter of lesion are positively correlated with 99Tc m-MIBI uptake in PHPT patients with positive planar imaging results. When preoperative serum PTH is lower than 150.4 ng/L, planar imaging is prone to false negative. SPECT/CT imaging has a significant value in preoperative diagnosis and the combination of PTH and CT can improve the positive rate.
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Objective:To evaluate the characteristics of carotid plaque and the immediate outcomes after carotid artery stenting (CAS) in diabetic and non-diabetic patients by optical coherence tomography (OCT).Methods:Patients underwent CAS and OCT before and after operation in the Department of Neurology, Jinling Hospital from January 2014 to March 2019 were enrolled retrospectively. The clinical features, the characteristics of carotid plaque on OCT and the immediate outcomes after CAS were compared between diabetic group and non-diabetic group. The risk factors of stent malapposition were analyzed.Results:A total of 46 patients were enrolled. Their age was 64.02±8.32 years and 41 were males (89.1%). There were 20 patients (43.5%) in the diabetes group and 26 (56.5%) in the non-diabetes group. The proportions of atherosclerotic plaque with thin fibrous cap (40.0% vs. 7.7%; χ2=5.166, P=0.023), plaque rupture (55.0% vs. 23.1%; χ2=4.945, P=0.026) and macrophage infiltration (60.0% vs. 30.8%; χ2=3.930, P=0.047) in the diabetic group were significantly higher than those in the non-diabetic group. Multivariate logistic regression analysis showed that older age (odds ratio [ OR] 1.208, 95% confidence interval [ CI] 1.033-1.413; P=0.018), coronary heart disease ( OR 15.953, 95% CI 1.142-222.952; P=0.040), alcohol consumption ( OR 6.192, 95% CI 1.098-34.923; P=0.039) and lower systolic blood pressure ( OR 0.944, 95% CI 0.894-0.997; P=0.037) were independently associated with stent malaposition. Conclusion:Compared with the non-diabetic patients, carotid plaque in diabetic patients may be more unstable. Older age, coronary heart disease, alcohol consumption and lower systolic blood pressure were associated with stent malaposition after carotid stenting. OCT can reveal the characteristics of carotid plaque and the immediate outcomes after CAS, which can provide strong evidence for treatment decision.
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Objective:To identify the morphological features and clinical significance of intra-vascular thrombus in carotid stenosis using optical coherence tomography (OCT).Methods:Twelve patients with carotid artery thrombosis detected by OCT assessment in Jinling Hospital between January 2017 and January 2020 were included. Serial area measurements within the athero-thrombotic target lesion were performed to evaluate the OCT-thrombus score, length, area and volume. The clinical data and plaque morphological features were also assessed.Results:Among the 12 patients demonstrating thrombus on OCT, eight patients presented with white thrombus, two patients presented with red thrombus, and another two patients displayed both white thrombus and red thrombus. OCT-thrombus scores were 1-32. The OCT-thrombus score was correlated to the OCT-thrombus volume ( ρ=0.739, P=0.006) and the thrombus length ( ρ=0.932, P<0.001). All lesions were presented with fibrous cap disruption, and 10 lesions were presented with thin-cap fibroatheroma. In view of the OCT findings, all patients received carotid balloon angioplasty and stent implantation. During an average follow-up of 14.2 months, none of the 12 patients had fatal stroke or recurrent ischemic stroke. Conclusions:OCT can be used to assess intra-carotid thrombus and its more detailed morphological characteristics, offering more possibilities in quantitative analysis of thrombus burden.
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Objective:To compare the effectiveness of first-line mechanical thrombectomy (MT) with other types of endovascular treatment (EVT) in patients with acute vertebrobasilar artery occlusion (VBAO).Methods:From May 2012 to December 2019, acute VBAO patients diagnosed by angiographic examinations were consecutively enrolled from Nanjing Stroke Registry. Patients were divided into first-line MT group who were treated with stent retriever and direct aspiration, and other types of EVT group who underwent intraarterial thrombolysis, tirofiban infusion, balloon dilation, and stent placement etc. Clinical characteristics at baseline with statistical trends ( P<0.1) between different groups were analyzed to calculate propensity scores, which were adjusted in binary Logistic regression for the relationship between first-line treatment and clinical outcome. Results:A total of 107 patients were enrolled in this study including 82 males and 25 females with average age 62 years old (35-82). The overall recanalization rate was 82.2% (88/107). During follow-up, 33.6% (36/107) and 37.1% (39/105) patients achieved good outcome (defined as modified Rankin Scale score 0-3) at 90 days and 1 year, respectively. The MT group received EVT earlier than the other types of EVT group (median year: 2017 vs. 2015, P=0.017), as well as higher proportion of atrial fibrillation history (21.6% vs. 0, P=0.002), higher baseline National Institution of Health Stroke Scale scores (median: 26 vs. 23, P=0.049), lower Glasgow Coma Scale scores (median: 6 vs. 7, P=0.027), and longer estimated occlusion to groin-puncture time (median: 367 min vs. 283 min, P=0.023). There were significant differences in the stroke etiologies between two groups ( P=0.002). The MT group had a lower ratio of rescue device treatment (28.4% vs. 54.5%, P=0.009). After propensity scores were adjusted, the recanalization rate of MT group was significantly higher than that in the other group [odds ratio (95% confidence interval [ CI]):5.201, 95 %CI 1.562-17.317, P=0.007]. No difference was noted regarding other clinical outcomes. Subgroup analysis indicated that recanalization rates in patients without atherosclerosis were different between intervention types [odds ratio (95 %CI): 7.859, 95 %CI 1.469-42.042, P=0.016], while the recanalization rates was comparable in population with atherosclerosis [odds ratio (95 %CI): 3.739, 95 %CI 0.613-22.812, P=0.153]. Conclusion:In acute VBAO patients, first-line MT is associated with higher recanalization rate compared with other types of EVT, especially in non-atherosclerosis patients.
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Objective:To evaluate the efficacy of endovascular stenting of various types of venous sinus stenosis in idiopathic intracranial hypertension (IIH).Method:Clinical, radiological, and manometric data before and after stenting in venous sinus stenosis were retrospectively analyzed in 99 IIH patients who were refractory to medical therapy or rapidly progressed between July 2004 to July 2019. The follow-up period was between 2.3 months to 11 years.Results:Our study enrolled 21 men (21.2%)and 78 women (78.8%) with average body mass index (BMI) 19.2-40.6(27.0±4.4) kg/m2 and median age 37 years. Before stent placement, the mean transverse sinus stenosis gradient was 1-59(26±8) mmHg. Patients with extrinsic stenosis were younger than those with intrinsic and mixed stenosis. In all cases, stenting was effective for papilledema. Fifty patients complained of headaches. Pulsatile tinnitus in twenty-eight patients completely alleviated after stenting. In one patient, replacement of stent did not improve symptoms, and a subsequent CSF diversion procedure was performed and effective.Conclusion:Irrespective of the type of stenosis, stenting of venous sinus stenosis is an effective treatment for IIH. Patients with persistent papilledema post-stenting and elevated transverse pressure pre-stenting should be followed closely as high risk of stenting failure may occur and further diversion procedure is needed.
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Background@#and Purpose Paroxysmal atrial fibrillation (PAF) underlying acute stroke frequently evades detection by standard practice, considered to be a combination of routine electrocardiogram (ECG) monitoring, and 24-hour Holter recordings. We hypothesized that nurse-led in-hospital intermittent monitoring approach would increase PAF detection rate. @*Methods@#We recruited patients hospitalised for stroke/transient ischemic attack, without history of atrial fibrillation (AF), in a prospective multi-centre observational study. Patients were monitored using a smartphone-enabled handheld ECG (iECG) during routine nursing observations, and underwent 24-hour Holter monitoring according to local practice. The primary outcome was comparison of AF detection by nurse-led iECG versus Holter monitoring in patients who received both tests: secondary outcome was oral anticoagulant commencement at 3-month following PAF detection. @*Results@#One thousand and seventy-nine patients underwent iECG monitoring: 294 had iECG and Holter monitoring. AF was detected in 25/294 (8.5%) by iECG, and 8/294 (2.8%) by 24-hour Holter recordings (P<0.001). Median duration from stroke onset to AF detection for iECG was 3 days (interquartile range [IQR], 2 to 6) compared with 7 days (IQR, 6 to 10) for Holter recordings (P=0.02). Of 25 patients with AF detected by iECG, 11 were commenced on oral anticoagulant, compared to 5/8 for Holter. AF was detected in 8.8% (69/785 patients) who underwent iECG recordings only (P=0.8 vs. those who had both iECG and 24-hour Holter). @*Conclusions@#Nurse-led in-hospital iECG surveillance after stroke is feasible and effective and detects more PAF earlier and more frequently than routine 24-hour Holter recordings. Screening with iECG could be incorporated into routine post-stroke nursing observations to increase diagnosis of PAF, and facilitate institution of guideline-recommended anticoagulation.
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Insomnia, as the most common sleep disorder in the population, is often accompanied by depression, anxiety and other mental diseases, which can lead to impaired social and occupational functions as well as decreased quality of life. There is growing evidence that insomnia may be a risk factor for stroke. On the other hand, the incidence of insomnia in stroke patients is significantly higher than that in the general population. Correctly understanding the bidirectional relationship between insomnia and stroke can make clinicians pay more attention to insomnia and its treatment, and increase clinical benefit in patients with stroke and insomnia.
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Ischemic stroke has high mortality and disability. For the acute phase of cerebral infarction, endovascular treatment can make patients obtain more significant clinical benefits within the time window. With the widespread application of endovascular treatment for acute ischemic stroke, neurologists need to understand the indications and contraindications of endovascular treatment, understand common methods, and properly handle surgical complications
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Objective To investigate the response to 131I therapy and to explore the influence factors in postoperative differentiated thyroid carcinoma (DTC) patients with negative preablative stimulated thyroglobulin (psTg) and iodine-positive lymph node after the first radioablation.Methods From May 2016 to October 2018,108 DTC patients (28 males,80 females,age:(45.7±10.4) years) with negative psTg who underwent 131I treatment for the first time in the Affiliated Hospital of Qingdao University were retrospectively enrolled.All patients had iodine-positive lymph nodes,which were showed by SPECT/CT imaging 5-6 d after 131I treatment.The treatment response was evaluated at 6-24 month after 131I treatment.Patients were divided into excellent response (ER) group and non-excellent response (non-ER) group according to the response to the first 131I treatment.Independent-sample t test,x2 test and Mann-Whitney U test were used to analyze differences of factors (e.g.age,gender,extraglandular infiltration) between the 2 groups,and then multivariate logistic regression was performed to find the influence factors for treatment response.The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of the iodine-positive lymph node size in 131I treatment response.Results A total of 82 patients (75.93％,82/108) achieved ER,and 26 (24.07％,26/108) was non-ER patients.There were significant differences in age (t=-2.540,P=0.016),extraglandular infiltration (x2 =5.764,P=0.016),T stage (x2=19.857,P＜0.001),N stage (x2 =14.145,P =0.001),risk stratification of recurrence (x2 =11.487,P=0.003),ultrasound results before 131I treatment (x2 =44.819,P＜0.001),dose of the first 131 I treatment (U =780.0,P =0.018),size (long diameter) of iodine-positive lymph node (U=184.0,P＜0.001),and psTg level (U=776.0,P=0.037) between ER and non-ER groups.Multivariate logistic regression showed that age,size of iodine-positive lymph node and ultrasound results before 131I treatment were closely related to 131I treatment response.The odds ratio (OR) values (95％ CI) were 1.123 (1.025-1.231),4.275 (1.893-9.653) and 260.86 (8.123-8376.764),respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value for non-ER were 100％ (26/26),70.73％ (58/82),77.78％ (84/108),52.00％ (26/50) and 100％ (58/58) respectively when the cut-off value of iodine-positive lymph node size was 5.5 mm.Conclusion The response of some DTC patients with negative psTg and iodine-positive lymph node after the first radioablation were non-ER.Age,ultrasound results before 131I treatment and size of iodine-positive lymph node are sensitive indicators for predicting clinical outcome in DTC patients with negative psTg and iodine-positive lymph node after the first radioablation.
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Objective:To explore the value of intravascular optical coherence tomography (OCT) in evaluating carotid atherosclerotic stenosis, and compare the morphological characteristics of symptomatic and asymptomatic carotid atherosclerotic plaques.Methods:Patients diagnosed as carotid atherosclerotic stenosis and performed OCT in the Department of Neurology, Jinling Hospital, Medical School of Nanjing University from January 2017 to November 2019 were enrolled retrospectively. Digital subtraction angiography (DSA) and OCT were used to determine the degree of stenosis of the diseased vessels, and the plaque characteristics observed by OCT were recorded. Symptomatic carotid atherosclerotic stenosis is defined as a history of transient ischemic attack, amaurosis fugax, or stroke related to the blood supply area of the diseased vessel within 6 months before the carotid artery examination. The baseline clinical and imaging data of the symptomatic group and the asymptomatic group were compared. Multivariate logistic regression analysis was used to determine the independent risk factors for symptomatic carotid atherosclerotic stenosis. Results:A total of 56 patients were enrolled. DSA and OCT had good consistency in carotid artery diameter measurement ( r=0.93, P<0.001). When the OCT technique was used to evaluate the plaque properties, the consistency of inter-observer ( κ=0.96, P<0.001) and intra-observer ( κ=0.96, P<0.001) was higher. The proportions of patients with type Ⅵ plaque (66.7% vs. 34.5%; P=0.016) and macrophage infiltration (51.9% vs. 24.1%; P=0.032) in the symptomatic group were significantly higher than those in the asymptomatic group, while the proportion of patients with fibrotic plaque was significantly lower than that in the asymptomatic group (40.7% vs. 69.0%; P=0.034). Multivariate logistic regression analysis suggested that type Ⅵ plaques (odds ratio 13.798, 95% confidence interval 1.38-137.675; P=0.025) and macrophage infiltration (odds ratio 5.856, 95% confidence interval 1.405-24.406; P=0.015) were the independent risk factors for symptomatic carotid atherosclerotic stenosis. Conclusions:OCT can be used to evaluate the degree of vascular stenosis and plaque characteristics in patients with carotid atherosclerotic stenosis. The detection rate of complex plaques in patients with symptomatic carotid atherosclerotic stenosis is significantly higher. Type Ⅵ plaque and macrophage infiltration are the independent risk factors for symptomatic carotid atherosclerotic stenosis.