Endovascular recanalization treatment of non-acute symptomatic internal carotid artery occlusion: a single center retrospective case series study / 国际脑血管病杂志

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.

A case of diffuse leptomeningeal glioneuronal tumor resembling meningitis / 中华神经科杂志

Diffuse leptomeningeal glioneuronal tumor (DLGNT) is a rare, low-grade neoplasm, which is newly categorized into the neuronal and mixed neuro-glial tumor in 2016. The most characteristic imaging findings are diffuse leptomeningeal thickening and enhancement with multiple minor cysts. This article described a case with DLGNT mimicking meningitis, whose cystic lesions were not obvious, with swollen multiple lobes cortex, gyri form cortical calcification and enhanced meninges. Meningeal irritation sign repeated attacks and the clinical symptoms gradually improved after steroid pulse therapy. The biopsy and immunohistochemistry staining were diagnosed as DLGNT. The imaging features and clinical data of this case were analyzed to improve the understanding of the disease in clinical practice.

Preliminary evaluation of carotid artery thrombosis by optical coherence tomography / 中华神经科杂志

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.

The effect of butylphthalide injection combined with interventional therapy on patients with acute anterior circulation large vessel occlusive stroke / 中华神经科杂志

Objective To investigate the effect of butylphthalide and sodium chloride injection on patients who received endovascular treatment for acute anterior circulation large vessel occlusive stroke.Methods A total of 173 patients were identified from February 2015 to December 2017 in the Department of Neurology of Jingling Hospital in this retrospective observational study.Propensity score-matching analysis was performed to balance differences in baseline characteristics between patients who received butylphthalide injection (butylphthalide group) and those who did not (control group).The modified Rankin Scale scores at 90 days were compared between the butylphthalide and control groups.Results A total of 144 patients who received endovascular treatment for acute anterior circulation large vessel occlusive stroke were finally analyzed,54 cases in the butylphthalide group and 90 cases in the control group.The proportion of good functional outcome at 90 days in the butylphthalide group was higher than that in the control group (63.0％ (34/54) vs 44.4％ (40/90);x2=4.633,P=0.031).Thirty-six pairs were matched successfully by the propensity score matching,36 patients in the butylphthalide group and 36 in the control group.There was no statistically significant difference in the 90-day functional outcome between the two groups (66.7％ (24/36) vs 44.4％ (16/36);x2=3.600,P=0.058).One hundred and fifteen patients were recanalized,47 cases in the butylphthalide group and 68 cases in the control group,and after the propensity score matching,30 pairs were analyzed.The proportion of good functional outcome at 90 days in the butylphthalide group was higher than that in the control group (73.3％ (22/30) vs 46.7％ (14/30);x2=4.444,P=0.035).Conclusion After propensity score-matching,butylphthalide and sodium chloride injection could improve 90-day functional outcome in patients with acute anterior circulation large vessel occlusive stroke and obtained recanalization by endovascular treatment while could not before propensity score-matching.

Neutrophil to lymphocyte ratio at admission for identification of large artery atherosclerosis and small vascular occlusion in patients with minor stroke / 国际脑血管病杂志

Objective To investigate the differential effect of neutrophil to lymphocyte ratio (NLR) at admission on large artery atherosclerosis (LAA) and small vessel occlusion (SVO) in patients with minor stroke.Methods Patients with first-ever acute ischemic stroke registered in Nanjing Stroke Registration System were enrolled retrospectively.Minor stroke was defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤3.Binary logistic regression was used to evaluate the independent relationship between NLR and LAA.Results A total of 417 patients with minor stroke were included,of which 242 were in a LAA group and 175 were in a SVO group.Univariate analysis showed that there were significant differences in leukocyte count,neutrophil count,lymphocyte count,NLR,glycosylated hemoglobin,highdensity lipoprotein cholesterol,onset to treatment time,and onset to NLR detection time between the patients of the LAA group and the SVO group (all P ＞0.05).Binary logistic regression analysis suggested that after adjusting for sex and high-density lipoprotein cholesterol,NLR (with the highest quartile as a reference,the first quartile:odds ratio [OR] 0.207,95％ confidence interval [CI]0.089-0.482;P ＞ 0.001;the second quartile:OR 0.277,95％ CI 0.122-0.625,P=0.002;the third quartile:OR 0.456,95％ CI 0.197-1.057;P =0.067),onset to NLR detection time (OR 1.216,95％ CI 1.038-1.424;P =0.015),and glycosylated hemoglobin (OR 1.414,95％ CI 1.142-0.751;P=0.002) were independently associated with LAA.The area under the ROC curve of NLR predicting the LAA was 0.611 in patients admitted within 7 d after onset,and was 0.673 in patients admitted within 24 h after onset.Conclusions The increased NLR was independently associated with the LAA in patients with minor stroke.Early NLR value may have higher predictive value for LAA.

Patients selection for endovascular therapy in acute ischemia stroke / 国际脑血管病杂志

Currently,intravenous tissue plasminogen activator within 4.5 hours of stroke onset is the only proven treatment for acute ischemic stroke.However,recanalization rate within 24 hours after the administration of intravenous tissue plasminogen activator is low,especially when the occlusion site involves a large intracranial artery.The low recanalization rate has prompted the development of endovascular therapy.Nevertheless,all treatment is binary,there is no best but most suitable treatment.In this article we review available researches on endovascular therapy and patients selection for endovascular therapy.

Effects of hydrogen-rich saline given during reperfusion on global cerebral ischemia-reperfusion injury in rats / 中华麻醉学杂志

ObjectiveTo evaluate the effect of hydrogen-rich saline given during reperfusion on global cerebral ischeraia-reperfusion (I/R) injury in rats.Methods Seventy-two adult male SD rats,aged 2.0-2.5 months,weighing 260-300 g,were randomly divided into 3 groups (n ＝ 24 each):sham operation group (group S),group I/R and hydrogen-rich saline group (group H).In groups I/R and H cerebral I/R was induced by occlusion of 4 vessels( cauterization of bilateral carotid arteries and 15 min occlusion of bilateral common carotid arteries).In group H intraperitoneal 0.6 mmol/L hydrogen-rich saline 5 ml/kg was injected at 6 h of reperfusion,while equal volume of normal saline was injected instead of hydrogen-rich saline.Eighteen rats of each group were sacririced at 24 h of reperfusion,and then the hippocampi were removed for determination of malondialdehyde (MDA),tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6)contents,and nuclear factor-κB (NF-κB) activity and activated caspase-3 expression.Another six rats of each group were sacrificed at 72 h of reperfusion,and then brain tissues were removed for microscopic examination and counting the number of uninjured pyramidal cells in hippocampal CA1 region.ResultsCompared with S group,the contents of MDA,TNF-α,IL-6 and NF-κB activity were significantly increased,activated caspase-3 expression was significantly up-regulated,uninjured pyramidal cells in hippocampal CA1 region were significantly decreased in I/R group( P < 0.05).Hydrogen-rich saline given during reperfusion attenuated the above-mentioned I/R-induced changes( P < 0.05 ).The histologic damage of the hippocampal CA1 region was significantly slighter in group H than group I/R.ConclusionHydrogen-rich saline given during reperfusion can reduce global cerebral I/R injury in rats through inhibition of lipid peroxidation,inflammatory response and apoptosis.