Angioplasty and stenting of atherosclerotic middle cerebral arteries with Wingspan: evaluation of clinical outcome, restenosis, and procedure outcome.

BACKGROUND AND PURPOSE: MCA is a common location of intracranial stenosis. It is relatively more peripherally located and of a smaller caliber, and could therefore be a site technically more challenging and risky for angioplasty and stenting. The study aimed to evaluate the clinical outcome, restenosis rate, and procedural safety of Wingspan stent placement for atherosclerosis in the MCA compared with stenosis in other arteries. MATERIALS AND METHODS: Patients who underwent Wingspan stent placement for symptomatic intracranial stenosis of ≥70% (or stenosis of ≥50% for recurrent ischemia despite medical therapy) were recruited prospectively and allocated into a study group (MCA stenosis, n=35) and a control group (other stenosis, n=25). Primary end points were the following: 1) all stroke or death rate at 1 year, and 2) significant in-stent restenosis rate at 1 year. Secondary end points were the following: 1) periprocedural complications within 24 hours, rate of TIA during the procedure, all stroke or death rate within 30 days; and 2) the inability to complete the procedure due to technical problems. RESULTS: Results of study group versus the control group were the following: degree of stenosis, 78.4 ± 10.9% versus 72.5 ± 11.2% (P value=.0456); diameter of stenosis, 0.6 ± 0.3 versus 1.0 ± 0.5 mm (P=.0017); all stroke or death rate at 1 year, 14.3% versus 12% (OR=1.22); in-stent restenosis rate at 1 year, 10% versus 10.5% (OR=1.05); periprocedural complication rate at 24 hours, 2.9% versus 4% (OR=0.70); TIA rate during the procedure, 8.6% versus 4% (OR=2.25); all stroke or death rate at 30 days, 5.7% versus 12% (OR=0.44); and technical failure rate, 2.9% versus 0%. CONCLUSIONS: In this study, there were no significant differences in procedural safety, patient outcome, and restenosis rates of stent placement between the group with MCA stenosis and the group with stenoses located at other sites.

Simple partial status epilepticus in Chinese adults.

Simple partial status epilepticus (SPSE) is uncommon compared with generalized tonic-clonic status epilepticus. We evaluated the clinical profile and predictors of poor outcome in a group of Chinese patients with this condition. We identified 32 patients above the age of 14 years with SPSE from a large urban hospital over an eleven-year period. Factors for poor outcome, defined as death or morbidity, were analyzed. The most common underlying causes were due to cerebrovascular disease (46.9%), CNS infection (15.6%), metabolic derangement (12.5%) and tumor (12.5%). At 30 days from the onset of seizures, 13(40.5%) patients had recovered fully and seven (21.9%) had died. Poor outcome was associated with the presence of an acute symptomatic injury.

Early computed tomography features in extensive middle cerebral artery territory infarct: prediction of survival.

BACKGROUND: To assess the predictive value of prognosis of different computed tomography (CT) features and National Institutes of Health Stroke Scale score (NIHSS) in acute extensive middle cerebral artery (MCA) infarct. METHODS: Fifty five patients with acute extensive MCA infarct had the CT performed within 24 hours of the onset of symptoms. A total of 11 CT features were analysed. The age distribution, presence of risk factors, presence of individual CT feature, the total CT score, and the NIHSS were correlated with the 30 day mortality. RESULTS: Single explanatory variable analysis showed NIHSS, presence of midline shift, midline shift of more than 1 cm, extent of infarct, presence of hydrocephalus, effacement of subarachnoid space/cella media, attenuation of corticomedullary differentiation, and total CT score were associated with the 30 day mortality. Both extent of infarct >67% and attenuation of corticomedullary differentiation gave a sensitivity and specificity of 93% and 95%, respectively, for the prediction of survival. Logistic regression analysis showed that the extent of infarct and NIHSS were the only independent predictors. CONCLUSIONS: CT features and admission NIHSS are important parameters for prediction of survival in extensive MCA infarct.

Multiple acute cerebral infarcts on diffusion-weighted imaging and risk of recurrent stroke.

Multiple acute cerebral infarcts (MACIs) detected by diffusion-weighted imaging (DWI) may indicate an unstable source of thromboembolism. The authors studied 119 consecutive acute ischemic stroke patients within 24 hours of onset with DWI. MACIs were present in 20 patients (16.8%). During the follow-up period, there were 15 recurrent strokes, 3 acute coronary syndromes, and 5 deaths. MACI was the only significant independent predictor for vascular events and death (odd ratio [OR]] = 4.34; p = 0.001) and stroke recurrence (OR = 5.93; p = 0.001).