Efficacy observation of long-time needle retaining at Baihui(GV20)combined with multidirectional point-toward-point needle insertion with needle shaking at Fengchi(GB20)for cervical vertigo / 针灸推拿医学（英文版）

Objective:To observe the clinical curative effect of long-time needle retaining at Baihui(GV20)combined with multidirectional point-toward-point needle insertion with needle shaking at Fengchi(GB20)for the treatment of cervical vertigo(CV)and its influence on the blood flow velocity of vertebrobasilar arteries. Methods:Seventy patients with CV were randomly divided into a treatment group(35 cases,1 dropout)and a control group(35 cases,2 dropouts)according to the random number table method.Those in the treatment group were treated with long-time needle retaining at Baihui(GV20)combined with multidirectional point-toward-point needle insertion with needle shaking at Fengchi(GB20),and those in the control group were treated with conventional acupuncture.The treatment was performed every other day,7 sessions as a treatment course,for a total of 2 courses.The clinical efficacy was compared between the two groups by observing changes in the evaluation scale for symptoms and functions of cervical vertigo(ESCV)and the mean blood flow velocity(Vm)of vertebrobasilar arteries. Results:The total effective rate and the cured plus markedly effective rate were 91.2%and 79.4%,respectively,in the treatment group,versus 78.8%and 54.5%in the control group,respectively,with a statistically significant difference in the cured plus markedly effective rate between the two groups(P<0.05).The ESCV score and the Vm of vertebrobasilar arteries in the two groups improved significantly after treatment.The Vm of the left vertebral artery(LVA),right vertebral artery(RVA),and basilar artery(BA)increased in patients with low and normal flow velocities(P<0.05),and the Vm of the LVA,RVA,and BA decreased in patients with a high flow velocity(P<0.05);the results in the treatment group were significantly better than those in the control group(P<0.05). Conclusion:Long-time needle retaining at Baihui(GV20)combined with multidirectional point-toward-point needle insertion with needle shaking at Fengchi(GB20)can significantly reduce the clinical symptoms of CV and regulate the blood flow rate of vertebrobasilar arteries bidirectionally,and thus is an effective therapy for CV.

Comorbidity Mechanism of Vertebrobasilar Dolichoectasia and Cerebral Small Vessel Disease Based on Collateral Disease Theory / 中国实验方剂学杂志

The comorbidities of vertebrobasilar dolichoectasia（VBD） and cerebral small vessel disease（CSVD） increase the poor prognosis of patients，and elucidating the mechanism underlying their comorbidities helps to explore effective treatment strategies. Therefore，based on the collateral disease theory and combining with the pathogenesis and research progress of traditional Chinese and Western medicine on the understanding of the two，this study proposes that both the disease locations are in the brain collaterals and the pathogenesis is deficiency in foundation and excess in symptoms. The main pathogenesis roots in the deficiency of original Qi and the emptiness of brain collaterals，which corresponds to the dysfunction of endothelial cells and neuro-endocrino-immune networks in modern medicine. The symptoms are cerebral blood stasis，occlusion of cerebral arteries and toxic lesion of cerebral arteries，corresponding to cerebrovascular atherosclerosis，hemodynamic changes，hypoperfusion and toxic metabolites-induced injury of white matter in modern medicine. Based on the collateral disease theory，exploring the common pathogenesis of the VBD and CSVD is expected to facilitate the establishment of TCM treatment scheme including the principles，methods and medicines，and improve the clinical prognosis of patients.

Recent advance in endovascular treatment of vertebrobasilar dolichoectasia / 中华神经医学杂志

Vertebrobasilar dolichoectasia is a rare and challenging disorder. Vertebrobasilar dolichoectasia is closely related to enzyme action and hemodynamic changes, and is characterized by ischemic stroke, neurological compression symptoms, hydrocephalus, and other clinical symptoms. With development of interventional techniques and materials in recent years, endovascular treatment of vertebrobasilar dolichoectasia has become the focus. This article summarizes the current endovascular treatment of vertebrobasilar dolichoectasia, aiming to provide references for clinicians.

Dynamic computed tomography angiography for noninvasive diagnosis of bow Hunter's syndrome: a case report

ABSTRACT The focus of this case report is to technically describe a noninvasive diagnostic evaluation of bow Hunter's syndrome using a dynamic computed tomography angiography protocol and discuss its advantages. In addition, we aimed to exemplify the quality of the study by presenting images of a 3D-printed model generated to help plan the surgical treatment for the patient. The dynamic computed tomography angiography protocol consisted of a first image acquisition with the patient in the anatomic position of the head and neck. This was followed by a second acquisition with the head and neck rotated to the side that triggered the symptoms, with technical parameters similar to the first acquisition. The acquired images were used to print a 3D model to better depict the findings for the surgical team. The dynamic computed tomography angiography protocol developed in this study helped visualize the vertebrobasilar arterial anatomy, detect vertebral artery stenosis produced by head and neck rotation, depict the structure responsible for artery stenosis (e.g., bony structure or membranes), and study possible complications of the disease (e.g., posterior cerebral circulation infarction). Additionally, the 3D-printed model better illustrated the findings of stenosis, aiding in surgical planning. In conclusion, dynamic computed tomography angiography for the evaluation of bow Hunter's syndrome is a feasible noninvasive technique that can be used as an alternative to traditional diagnostic methods.

Predictors of outcome after endovascular therapy in patients with acute basilar artery occlusion / 国际脑血管病杂志

Objective:To investigate the predictors of outcome after endovascular therapy in patients with acute basilar artery occlusion (ABAO).Methods:Patients with ABAO received EVT in Bozhou People’s Hospital from May 2019 to September 2022 were included prospectively. The demographic data, clinical data, relevant parameters of periprocedural period and follow-up data were collected. The outcome evaluation was performed at 90 d after procedure. The modified Rankin Scale score ≤3 was defined as good outcome, and >3 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of good outcome after EVT. Results:A total of 42 patients with ABAO were included, 21 (50%) had a good outcome and 21 had a poor outcome. There were significant differences in the National Institutes of Health Stroke Scale (NIHSS), posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS), the time from onset to recanalization, the proportion of patients with successful recanalization, use of remedial treatment, and complications were statistically significant in both groups (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for other risk factors, the low NIHSS score (odds ratio [ OR] 0.756, 95% confidence interval [ CI] 0.615-0.903; P=0.008), less use of remedial treatment measures ( OR 0.170, 95% CI 0.033-0.884; P=0.035) and high pc-ASPECTS ( OR 4.274, 95% CI 1.418-12.882; P=0.010) were the independent predictors of good outcomes. Conclusions:Half of the patients with ABAO have a good outcome after EVT. Low NIHSS score, high pc-ASPECTS at admission and less use of remedial measures are the independent predictors of good outcomes in patients with ABAO.

Asymptomatic cerebral artery stenosis and cognitive impairment / 国际脑血管病杂志

Asymptomatic cerebral artery stenosis (aCAS) is closely associated with cognitive impairment, which can lead to multiple cognitive domain impairments, thereby affecting the behavior and daily life of patients. This article reviews the main involved cognitive domains, injury mechanisms, and treatment in different types of aCAS, with the aim of increasing attention to aCAS, early clinical intervention, and delaying cognitive deterioration.

Animal models of vertebrobasilar dolichoectasia / 国际脑血管病杂志

Vertebrobasilar dolichoectasia (VBD) is a cerebrovascular variant disease. Researches have shown that further development of VBD may lead to severe disability and even death. The pathogenesis of VBD is still unclear, and there is no specific clinical prevention and treatment scheme. Therefore, establishing a stable and reliable animal model helps to further understand the pathophysiological mechanisms and potential therapeutic targets of VBD. This article reviews the establishment methods and research progress of the available VBD animal models.

Vertebrobasilar dolichoectasia and cerebral microbleeds / 国际脑血管病杂志

Vertebrobasilar dolichoectasia (VBD) is a disease characterized by the dilation, elongation, and tortuosity of the vertebrobasilar artery. Cerebral microbleeds (CMBs) are brain parenchymal injuries mainly caused by punctate microbleeds due to small vessel lesions. Recent studies have shown that VBD can increase the incidence rate of CMBs, but the correlation and pathophysiological mechanism of the two remain unclear. Multiple factors can induce VBD to accompany CMBs. A deep understanding of the causal relationship and related mechanisms between VBD and CMBs is helpful for the clinical prevention and treatment of such cerebrovascular diseases.

Correlation between residual cholesterol level and vertebrobasilar artery dilatation in elderly patients with acute cerebral infarction / 中华老年心脑血管病杂志

Objective To investigate the correlation between the residual cholesterol(RC)level and vertebrobasilar dilatation(VBD)in elderly patients with acute cerebral infarction(ACI).Methods A total of 325 elderly ACI patients admitted to Department of Neurology,Changzhou Second People's Hospital of Nanjing Medical University from January 2020 to July 2021 were recruited retrospectively.All of them underwent cranial MRI,CTA and biochemical test for plasma levels of TC,TG,LDL-C and HDL-C and other biochemical indicators.According to the imaging diagnostic criteria,they were divided into VBD group(52 cases)and non-VBD group(273 cases).Their clini-cal data were compared between the two groups,and the relationship between RC level and VBD was analyzed in the elderly ACI patients.Results Significant differences were observed in age,sex,hypertension,history of smoking and TC and RC levels between the VBD group and non-VBD group(P＜0.05,P＜0.01).Multivariate logistic regression analysis showed that after adjus-ting the potential confounding factors,age(OR=1.126,95％CI:1.065-1.191,P=0.000),male(OR=4.163,95％CI:11.173-10.120,P=0.002),and RC level(OR=1.270,95％CI:1.151-1.401,P=0.000)were independent risk factors for VBD in elderly ACI patients.Conclusion Age,male and RC level are independent risk factors for VBD in elderly ACI patients.High RC lev-el may increase the risk of VBD.

Value of vascular ultrasound examination in the diagnosis of subclavian artery stenosis combined with vertebral artery stenosis / 中国基层医药

Objective:To investigate the effectiveness of vascular ultrasound examination in the diagnosis of subclavian artery stenosis (ASA) combined with vertebral artery stenosis (VSA) and its effects on different types of steal syndrome.Methods:Seventy patients with ASA combined with VSA who received treatment in Zhuji People's Hospital from February 2018 to May 2022 were included in this study. All patients underwent digital subtraction angiography (DSA) and a vascular ultrasound examination. Taking the DSA examination results as the reference standard, the accuracy of vascular ultrasound examination in the classification of ASA and VSA and its consistency with the DSA diagnosis results were evaluated. The detection rate of subclavian artery steal was compared between DSA and vascular ultrasound examination was compared. The correlation between the degree of ASA and the severity of subclavian artery steal was analyzed.Results:The accuracy of vascular ultrasound examination in the diagnosis of different degrees of ASA was 84.62% (11/13), 89.66% (26/29), 95.24% (20/21), and 100.00% (7/7), respectively. The Kappa value, indicating the consistency of vascular ultrasound examination and DSA restults in the diagnosis of ASA, was 0.858 ( P < 0.05). There was a significant difference in the type of subclavian artery steal among patients with different degrees of ASA ( χ2 = 50.71, P < 0.01). The severity of subclavian artery steal was highly positively correlated with the severity of ASA ( r = 0.71, P < 0.001). Conclusion:Vascular ultrasound examination has high diagnostic accuracy for different degrees of ASA and VSA, has high consistency with DSA results, and can increase the detection rate of subclavian artery steal. Vascular ultrasound examination has certain advantages in the early screening and condition monitoring of ASA, VSA, and subclavian artery steal.

Surgical treatment of craniovertebral stenosis in two siblings with type vi mucopolysaccharidosis / Tratamento cirúrgico de estenose craneo-vertebral em dois irmãos com mucopolisacaredose tipo vi / Tratamiento quirúrgico de estenosis craneo-vertebral en dos hermanos con mucopolisacaridosis tipo vi

ABSTRACT We describe two cases of surgical treatment of craniovertebral stenosis in preschool-aged brothers with Maroteaux-Lamy (MPS type VI) syndrome. The older brother was diagnosed with MPS during her second pregnancy. Literature describing familial cases of the disease and the treatment strategy in young children with MPS type VI and spinal canal stenosis is scarce. Based on the presented observations, indications, surgical treatment approaches, and perioperative management of patients with mucopolysac-charidosis are suggested. MPS type VI may have familial forms of the disease and the course of craniovertebral stenosis is similar in siblings. Surgical treatment of craniovertebral stenosis in these patients should be performed timely. We adhere to the point of view of early treatment of craniovertebral stenosis in patients with MPS before irreversible spinal cord dysfunction develops. Level of Evidence IV; Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease and Case series.

Resumo: Descreve-se dois casos de tratamento cirúrgico de estenose craniovertebral entre irmãos em idade pré-escolar com síndrome de Maroteaux-Lamy (MPS tipo VI). O irmão mais velho foi diagnosticado com MPS durante a segunda gravidez. A literatura que descreve casos familiares da doença e a estratégia de tratamento em crianças pequenas com MPS tipo VI e estenose do canal raquidiano é escassa. Com base nas observações apresentadas, foram sugeridas indicações, abordagens de tratamento cirúrgico e manejo perioperatório de pacientes com mucopolissacaridose. A MPS tipo VI pode apresentar formas familiares da doença e o curso da estenose craniovertebral é semelhante entre irmãos. O tratamento cirúrgico da estenose craniovertebral nesses pacientes deve ser realizado em tempo hábil. Adere-se ao conceito de tratamento precoce da estenose craniovertebral em pacientes com MPS antes que se desenvolva uma disfunção irreversível da medula espinhal. Nível de Evidência IV; Estudos Prognósticos - Investigando o Efeito de uma Característica de Paciente sobre o Resultado de uma Doença e de uma Série de Casos.

Resumen: Se describen dos casos de tratamiento quirúrgico de estenosis craneovertebral en hermanos de edad preescolar con síndrome de Maroteaux-Lamy (MPS tipo VI). Al hermano mayor se le diagnosticó MPS durante el segundo embarazo. La bibliografía que expone casos familiares de la enfermedad y la estrategia de tratamiento en niños pequeños con MPS tipo VI y estenosis del tubo vertebral es escasa. Sobre el fundamento de las observaciones presentadas, se sugieren indicaciones, enfoques de tratamiento quirúrgico y manejo perioperatorio de pacientes con mucopolisacaridosis. La MPS tipo VI puede presentar formas familiares de la enfermedad y el curso de la estenosis craneovertebral es semejante en los hermanos. El tratamiento quirúrgico de la estenosis craneovertebral en estos pacientes debe realizarse tempranamente. Se adhiere al planteamiento del tratamiento precoz de la estenosis craneovertebral en pacientes con MPS anticipándose al desarrollo de una disfunción irreversible de la médula espinal. Nivel de Evidencia IV; Estudios Pronósticos - Investigando el Efecto de una Característica del Paciente en el Resultado de la Enfermedad y Series de Casos.

Arterial abnormalities and associated variations of the vertebrobasilar system on the brain base: apropos of a rare case / Anomalías arteriales y variaciones asociadas del sistema vertebrobasilar en la base del cerebro: un caso raro

SUMMARY: The presented case characterizes an association of primitive and definitive arteries with variations on the cadaveric brain base of a very old man. This case is found by the retrospective review of the data archive obtained during many years of cooperation of the author and co-authors. Fenestration of the (ectatic) basilar artery, partial and total duplication of some cerebellar arteries was associated with other variations of the vertebrobasilar and carotid systems. Although this is a case autopsied because of the myocardial infarction, the peculiarity of the case lies in the absence of the aneurysm based on the fenestration or dissection of one of the cerebral arteries.

RESUMEN: El caso presentado caracteriza una asociación de arterias primitivas y definitivas con variaciones sobre la base cerebral cadavérica de un anciano. Este caso se encuentra mediante la revisión retrospectiva de datos obtenidos durante muchos años de un trabajo de cooperación del autor y coautores. La fenestración de la arteria basilar (ectásica), la duplicación parcial y total de algunas arterias cerebelosas se asoció con otras variaciones de los sistemas vertebrobasilar y carotídeo. Si bien se trata de un caso de autopsia a causa de un infarto del miocardio, la peculiaridad del caso radica en la ausencia del aneurisma en base a la fenestración o disección de una de las arterias cerebrales.

Prehospital predictors of large-vessel occlusion in acute ischemic stroke / 中国基层医药

Objective:To analyze the prehospital predictors of large-vessel occlusion (LVO) in acute ischemic stroke.Methods:This study recruited patients who had developed LVO for less than 24 hours and had a National Institute of Health Stroke Scale (NIHSS) score ≥ 8 and who received treatment in Lu'an People's Hospital from December 2018 to November 2020. The included patients were divided into LVO and LVO-free groups according to the presence of a large-vessel occlusion determined by magnetic resonance angiography, CT angiography, and digital subtraction angiography. Baseline data (sex, age, disease history, life history, and medication history), NIHSS subscale score, and blood pressure at admission were compared between LVO and LVO-free groups. The efficacy of the factors that were screened for predicting LVO in acute ischemic stroke were compared with the that of commonly used scales.Results:A total of 761 patients with acute ischemic stroke who had an NIHSS score ≥ 8 were included in the final analysis. Among them, 228 patients had an LVO and 533 patients had no LVO. There were significant differences in the proportions of patients with atrial fibrillation ( OR = 5.230, 95% CI = 3.400-8.043, P < 0.001) and systolic blood pressure ≤ 170 mmHg ( OR = 5.181, 95% CI = 3.327-8.068, P < 0.001) between the two groups. Conclusion:Atrial fibrillation and systolic blood pressure ≤ 170 mmHg are greatly associated with the presence of large-vessel occlusion in acute ischemic stroke.

Short-term efficacy and safety of Apollo stent on symptomatic basilar artery stenosis / 中国医师杂志

Objective:To evaluate the short-term efficacy and safety of Apollo stent in the treatment of symptomatic basilar artery stenosis.Methods:Patients with symptomatic basilar artery stenosis admitted to the Fourth Affiliated Hospital of China Medical University from January 2017 to May 2020 were selected and treated with Apollo stent implantation. The changes of clinical symptoms and the success rate of operation were evaluated. Postoperative complications included symptomatic intracranial hemorrhage, hyperperfusion, and new ischemic stroke, and follow-up results were evaluated 3 to 6 months later.Results:A total of 96 patients were included in this study, and all of them were confirmed by angiography to have severe basilar artery stenosis corresponding to the symptoms. Among them, 88 patients received stent implantation, with a success rate of 100%. Among the 88 patients, 86 received Apollo stent implantation, and 2 patients received self-Peng stent implantation. Among 86 patients with Apollo stent implantation, the lesions were located in the proximal segment in 73 cases (84.88%), in the middle segment in 10 cases (11.63%), and in the distal segment in 3 cases (3.49%). The degree of stenosis was (93.72±3.86)%, the length of stenosis was (8.50±2.65)mm, the residual stenosis rate was (1.76±4.87)%, and Mori type A lesions in 80 cases, type B lesions in 3 cases, and type C lesions in 3 cases. Among 86 patients with Apollo stent implantation, the incidence of perioperative neurological complications was 6.98%(6/86), including 1 case in the proximal part of the basilar artery (vascular rupture), 3 cases in the middle part of the basilar artery (perforating artery occlusion in 1 case, acute thrombosis artery occlusion in 2 cases), and 2 cases in the distal part (both acute vascular occlusion). Alteplase was injected into the microcatheter during the operation, and contact thrombolysis was performed. Immediately digital subtraction angiography (DSA) showed that the blood vessels were opened, and 1 case with neurological deficit was left. No hyperperfusion occurred in all patients. All patients were followed up for three months after operation. Among them, 58 patients had a good prognosis in the proximal segment of the basilar artery, 18 patients had a good prognosis in the middle segment, 4 patients had a good prognosis in the distal segment, and 6 patients had a bad prognosis (1 patient died). Postoperative stent restenosis occurred in 5 cases (5.81%), recurrent stroke in 3 cases (3.49%), and disabling stroke in 1 case (1.16%).Conclusions:Apollo stent is safe and effective in the treatment of symptomatic basilar artery stenosis, with good short-term prognosis, and long-term prognosis needs to be further studied.

A case of bow hunter's syndrome and a systematic literature review / 中华骨科杂志

Objective:A clinical case of rotational vertebral artery occlusion (bow hunter's syndrome, BHS) caused by left C 1 osteophyte was reported, and the epidemiological characteristics, diagnosis and treatment methods, and clinical outcomes of BHS were further analyzed. Methods:The clinical data, diagnostic methods, treatment options, and clinical outcomes of the above-mentioned BHS patient are described. The literature from 1978 to 2021 was retrieved, the BHS patients involved were taken as the research objects, and the data of onset age, gender, etiology, site of onset, diagnosis method, treatment method, and clinical outcomes of each selected patient were collected. The data were subdivided through systematic analysis.Results:A patient with rotational compression of the left vertebral artery associated with the left osteophyte of the atlas was presented. 3D-CT showed that the vertebral artery was compressed by the left osteophyte of the atlas. Dynamic digital subtraction angiography (dDSA) showed mild stenosis of the distal V2 segment of the left vertebral artery. When his head turned to the left, the distal V2 segment of the left vertebral artery was compressed and the blood flow was interrupted. After his head was in a neutral position, the blood flow was restored. Because the symptoms could not be relieved after conservative treatment, posterior C 1 osteophyte resection was used to decompress the vertebral artery, and the symptoms disappeared after the operation, and the short-term follow-up results were good. All of the 87 articles and 126 patients have been studied. The median age was 55.0 years (IQR: 43.5, 65.0 years) and the peak age of onset was 51 to 60 years old. The gender difference has been uncovered and the sex ratio was 1.9∶1 (male∶female). Among the 126 patients, 65 patients had vertebral artery occlusion or stenosis located in the C 1-C 2 segment; 66 patients involved the left vertebral artery, 45 patients involved the right vertebral artery, and 15 patients involved bilateral vertebral arteries. DSA was used to confirm BHS in 114 of 126 patients. The follow-up time was 0.25-114 months, with an average of 16.6 months. Thirty-six patients were treated conservatively, and 12 patients had residual symptoms; 33 patients underwent fusion surgery, and all patients' symptoms were relieved after surgery; 54 patients underwent simple decompression surgery, and 4 patients had residual symptoms after surgery; 4 patients received endovascular surgery, and their symptoms were relieved after surgery. Conclusion:Patients with BHS are rare clinically, often involving C 1-C 2 and the left vertebral artery is more likely to be involved. The peak age of onset was 51 to 60 years old. DSA is the gold standard for the diagnosis of BHS. For BHS caused by abnormal bone structure, intervertebral disc herniation, joint instability, etc., decompressive surgery of the vertebral artery or C 1-C 2 segment fusion is the most common treatment modality.

Preferred thrombectomy strategies for acute embolic occlusion of the vertebrobasilar artery: a comparative study / 中华神经医学杂志

Objective:To investigate the efficacy of different preferred thrombectomy strategies for embolic acute vertebrobasilar artery occlusion (AVBAO).Methods:Forty-four patients with embolic AVBAO who underwent endovascular treatment in Department of Neurology, Nanyang Central Hospital from January 2019 to June 2021 were included in the study. Patients were divided into stent-retriever thrombectomy group ( n=27) and aspiration thrombectomy group ( n=17) according to different preferred thrombectomy strategies. Modified Rankin scale (mRS) was used to evaluate the prognoses of these patients 90 d after surgery; the differences of clinical data, surgery-related characteristics, prognoses and complications between the two groups were compared. Results:There was no significant difference between the 2 groups in terms of time from onset to puncture, sites of target vessel occlusion, proportion of patients accepted intraoperative remedial measures, and successful recirculation rate of target vessels ( P>0.05). Compared with the aspiration thrombectomy group, the stent-retriever thrombectomy group had significantly decreased utilization rate of middle catheters, significantly increased retrieval attempts in thrombectomy, statistically lower re-recanalization rate of first-time thrombectomy on the target vessels, significantly longer time from puncture to re-recanalization, and significantly higher incidence of new embolism ( P<0.05). There was no significant difference between the 2 groups in incidences of vascular rupture and postoperative spontaneous intracerebral hemorrhage (sICH), and good prognosis rate 90 d after surgery ( P>0.05). Conclusion:For embolic AVBAO patients, similar recanalization and short-term good prognosis can be obtained by aspiration thrombectomy to those by stent-retriever thrombectomy; besides that, aspiration thrombectomy has advantages as shorter recanalization time, less new embolic complications and higher re-recanalization rate of first-time thrombectomy.

Collateral circulation pathway in patients with basilar artery occlusion/severe stenosis: a single-center case series / 中华内科杂志

Objective:To investigate the collateral circulation compensation model in patients with favorable prognosis of basilar artery occlusion/severe stenosis treated with drugs or endovascular therapy.Methods:Clinical data of patients with basilar artery occlusion/severe stenosis and good clinical outcome were retrospectively collected in the Department of Neurology, Sixth Medical Center of PLA General Hospital from January 2019 to January 2020. They were divided into intensive drug therapy group and combined endovascular therapy group. The number and ways of collateral compensation pathway described by digital substraction angiography (DSA) were analyzed, and the characteristics of the collateral compensation model were summarized. SPSS22.0 software was used for statistical analysis, and the constituent ratio (%) was used for statistical description of the enumeration data.Results:A total of 32 eligible patients were included, including 27 males and 5 females, with an average age 45-76 (59±10) years. The compensation model included posterior communicating artery-posterior cerebral artery (13 cases, 40.6%), posterior communicating artery-posterior cerebral artery-basilar artery (10 cases, 31.2%), cerebellar artery-anastomotic branches of superior cerebellar artery (8 cases, 25.0%), anterior choroid artery-anastomotic branches of posterior choroid artery (2 cases, 6.2%), collateral circulation not established (11 cases, 34.4%).In drug treatment group, collateral compensation was found in the majority (14/15), with mainly posterior communicating artery (10/14).Most patients in combined treatment group did not develop collateral compensation (10/17), anastomotic branches of PICA-SCA were the main routes (6/7).Conclusion:In patients with basilar artery occlusion/severe stenosis, favorable clinical outcome can be achieved in both groups of patients treated with intensive drug therapy or endovascular therapy.

The influence of first-line endovascular treatment on clinical outcome in patients with acute vertebrobasilar artery occlusion / 中华内科杂志

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.

Expressions of c-Jun N-terminal kinase, matrix metalloproteinase-9 and macrophage marker MAC387 in rats with vertebrobasilar dolichoectasia and intervention effect of rosuvastatin / 中华神经医学杂志

Objective:To observe the expressions of c-Jun N-terminal kinase (JNK), matrix metalloproteinase-9 (MMP-9) and macrophage marker MAC387 in the blood vessels of rats with vertebrobasilar dolichoectasia (VBD), and to study the therapeutic effect and mechanism of rosuvastatin on VBD.Methods:Sixty male SD rats were randomly divided into sham-operated group, VBD model group and rosuvastatin intervention group ( n=20). Elastase at 0.3 uL (1.5 U/μL) was injected into the cisterna magna of rats in the latter two groups to establish VBD models; while same volume of saline solution was given to rats in the sham-operated group. Twenty-four h after model making, 5 mg/(kg.d) rosuvastatin (once/d, for 4 weeks) was administered intragastrically into rats in the rosuvastatin intervention group, and same volume of distilled water was administered intragastrically into rats in the other 2 groups. The degrees of extension and expansion of vertebrobasilar artery were measured and compared among the 3 groups. Western blotting was used to detect the expressions of JNK and MMP-9, and immunofluorescent staining was used to detect the MAC387 expression in the vertebrobasilar artery. Results:Fourteen rats in the VBD model group and rosuvastatin intervention group, respectively, had successful model making. As compared with the sham-operated group, the VBD model group and rosuvastatin intervention group had statistically increased basilar artery diameter and basilar artery tortuosity index ( P<0.05). The expressions of JNK, MMP-9 and MAC387 in the VBD model group and rosuvastatin intervention group were significantly increased as compared with those in the sham-operated group ( P<0.05); as compared with those in the VBD model group, the expressions of JNK, MMP-9 and MAC387 in the vertebrobasilar artery of rosuvastatin intervention group were significantly decreased ( P<0.05). Conclusion:Rosuvastatin can delay VBD progress, whose mechanism may be related to the inhibition of inflammatory response.

Elastase injection into the cerebellomedullary cistern to induce a model of vertebrobasilar dolichoectasia in mice and evaluation of magnetic resonance angiography / 国际脑血管病杂志

Objective:To investigate the effect of magnetic resonance angiography (MRA) in evaluating the mouse model of vertebrobasilar dolichoectasia (VBD) induced by injection of elastase into cerebellomedullary cistern.Methods:Twenty-four male C57/BL6 mice were selected. The mice in the elastase group ( n=12) were injected in the cerebellomedullary cistern with 2.5 μl of phosphate buffer containing 25 mU elastase, and the mice in the saline control group ( n=12) were injected with the same volume of normal saline. MRA examination of the brains of living mice was performed 2 weeks after modeling. Successful modeling was defined as the basilar artery bending angle ≤170°, or the basilar artery bending length accounts for ≥10%, or the basilar artery deviated from the midline by more than 1 grade, or the percentage increase in artery diameter was ≥25%. Results:In the elastase group and the saline control group, 2 mice and 1 mouse did not wake up normally or died, respectively. The 11 surviving mice in the saline control group had no obvious vertebral artery and basilar artery abnormalities. The success rate of modeling in the 10 surviving mice in the elastase group was 80%, and the difference in the success rate between the two groups was statistically significant ( P<0.05). There were significant differences in mean basilar artery diameter (0.30 mm vs. 0.22 mm; P<0.05), mean basilar artery bending angle (115° vs. 170°; P<0.05), and proportion of mean basilar artery bending length (31% vs. 5%; P<0.05) of the surviving mice between the elastase group and the saline control group. Conclusion:MRA can better evaluate the mouse VBD model induced by elastase injection in the cerebellomedullary cistern.