Alcohol consumption may be a risk factor for cerebrovascular stenosis in acute ischemic stroke and transient ischemic attack.

BACKGROUND: Atherosclerosis are well established risk factors for ischemic stroke, however the association between alcohol consumption and atherosclerosis is controversial. This study aims to explore the potential correlation between alcohol consumption and cerebral stenosis in patients with acute ischemic stroke and transient ischemic attack (TIA). METHODS: Nine hundreds and eighty-eight patients with first acute ischemic stroke attack or TIA were recruited retrospectively. Alcohol consumption was classified into five consumption categories (non-drinkers, occasional drinkers, < 140 g per week [mild drinkers], 140-279 g per week [moderate drinkers], ≥ 280 g per week [heavy drinkers]). Computed tomography angiography (CTA) and digital subtraction angiography (DSA) were utilized to assess the carotid and cerebral artery in all patients. Five-step scale for degree of stenosis was applied: normal (0, 0 points), mild (< 50%, 1 point), moderate (50-69%, 2 points), severe (70-99%, 3 points), and occlusion (100%, 4 points). RESULTS: The carotid and cerebral artery stenosis scores were positively correlated with moderate alcohol consumption (B = 1.695, P < 0.001). Compared with nondrinkers, moderate alcohol consumption had significant increasing risk of moderate carotid and cerebral artery stenosis (OR = 4.28, 95% CI: 1.47-12.49, P = 0.008) and severe stenosis (OR = 4.24, 95% CI: 1.55-11.64, P = 0.005) and occlusion (OR = 3.87, 95% CI: 1.65-9.06, P = 0.002). Compared with nondrinkers, heavy alcohol consumption patients had significant higher risk of carotid and cerebral artery occlusion (OR = 2.71, 95% CI: 1.36-5.41, P = 0.005). CONCLUSIONS: Higher alcohol consumption may associate with higher risk and more severity of carotid and cerebrovascular stenosis.

New evidence for fractional pressure ratio prediction by pulsatility index from transcranial Doppler in patients with symptomatic cerebrovascular stenosis disease.

Background: The pulsatility index (PI) derived from transcranial Doppler (TCD) assessment may represent the cerebral resistance and altered cerebral blood flow. The purpose of this study was to assess the performance of the TCD PI in correlation with wire-based fractional pressure ratio (FPR). Methods: This study included 33 patients with symptomatic atherosclerotic lesions of the extracranial and intracranial large arteries, specifically the internal carotid artery, middle cerebral artery (MCA), vertebral artery (VA) V4 segment, and basilar artery (BA), all of which exhibited luminal stenosis ranging from 50% to 70%. TCD was performed prior to angiography in order to determine the flow distal to the lesion. We performed cerebrovascular angiography with a pressure wire to measure the FPR of vessels with stenotic lesions. Bland-Altman analysis and ordinal least square (OLS) linear regression were used to quantify the correlation between PI and FPR. Results: A total of 42 TCD data points were analyzed. At the TCD locations distal to the lesions, the correlation coefficients were no less than 0.90%, with almost all P values <0.001, which indicated very strong positive correlations; the exception to this was the distal TCD for MCA segment lesions (r=0.897; P=0.015) and VA V4 segment (r=0.964; P=0.036). The Bland-Altman plot demonstrated a small difference (0.003) between the distal TCD PI and the FPR, with an acceptable 95% confidence interval [95% confidence interval (CI): 0.06-0.12]. Conclusions: The PI obtained through TCD assessment distal to the stenotic lesion exhibited a correlation with the FPR computed using pressure wire measurements.

Moyamoya disease presenting with symptomatic ischemic stroke during new-generation tyrosine kinase inhibitor treatment: two illustrative cases.

Tyrosine kinase inhibitors (TKIs) have been widely used to treat chronic myeloid leukemia. Nilotinib and ponatinib, which are second- and third-generation TKIs, have been reported to cause cerebrovascular arterial complications. Here, we present two cases of moyamoya disease presenting with symptomatic ischemic stroke during new-generation TKI treatment. We judged that new-generation TKI treatment was a factor in symptomatic ischemic stroke of unknown moyamoya disease in both cases. Noninvasive examinations using magnetic resonance imaging or carotid ultrasonography should be performed before and during new-generation TKI treatment in order to prevent symptomatic ischemic stroke.

LC-MS/MS based metabolomic analysis of serum from patients with cerebrovascular stenosis.

Cerebrovascular stenosis (CVS) is the main cause of ischemic stroke, which greatly threatens human life. Hence, it's important to perform early screenings for CVS. Metabolomics is an emerging omics approach that has great advantages in disease screening and diagnosis. Therefore, we aim to elucidate the correlation between CVS and metabolomics, which can aid in conducting CVS screening at an early stage. Patients with CVS in Beijing Hospital were included in the study. A total of 36 participants, including 18 patients diagnosed with CVS and 18 healthy individuals, were recruited at Beijing Hospital between May 2022 and October 2021. The serum samples were analyzed for liquid chromatography-tandem mass spectrometry (LC-MS/MS). Then, multivariate statistical methods, including principal component analysis (PCA), partial least squares-discriminant analysis (PLS-DA) and orthogonal partial least squares-discriminant analysis (OPLS-DA) were performed. Differential metabolites were obtained and demonstrated by volcano plot and heatmap. The study recruited 36 participants, including 18 patients with CVS and 18 healthy participants. A total of 150 metabolites were identified. Multivariate statistical analysis revealed significant differences between patients and healthy participants. Furthermore, 30 serum metabolites levels differed significantly between two groups. Differential metabolites were enriched in phenylalanine, tyrosine, and tryptophan biosynthesis; primary bile acid biosynthesis, and other pathways. This study identified differential metabolites in patients with CVS and elucidated the relevant metabolic pathways. Thus, these findings aid in the study of the pathogenesis of CVS and its early diagnosis. DATA AVAILABILITY STATEMENT: The datasets generated for this study are available on request to the corresponding author.

Relations between antinuclear, antineutrophil cytoplasmic, anticardiolipin antibodies and degree of neurological deficit, cerebrovascular stenosis in cerebral infarction patients.

Objective: To investigate the correlation of antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA) and anticardiolipin antibody (ACA) with the degree of the neurological defect and cerebrovascular stenosis in patients with cerebral infarction. Methods: Clinical data of 99 patients with acute cerebral infarction (ACI) admitted to the Department of Neurology of Baoding First Central Hospital from June 2020 to December 2021 were retrospectively analyzed, and their ANA, ACA, ANCA, neurological deficit (NIHSS) scores as well as cerebrovascular stenosis were detected and assessed. Moreover, the correlation between the positive expression rates of ANA, ANCA, ACA and the degree of the neurological deficit, as well as the location and degree of cerebrovascular stenosis, were analyzed. Results: All patients had ANA, ACA, ANCA antibodies with positive rates of 68.69%, 70.71%, 69.70%, and mild, moderate, and severe cerebrovascular stenosis with incidence rates of 28.28%, 32.32%, and 39.39% respectively; Moreover, their incidence of mild, moderate, and severe neurological deficits were 15.15%, 44.44%, and 40.40%, respectively. Statistically significant differences could be observed in the degree of cerebrovascular stenosis and neurological deficit between the ANA, ACA and ANCA antibody positive group and the negative group (p<0.05). ANA, ACA, ANCA antibody positive was moderately positively correlated with cerebrovascular stenosis rate and NIHSS score (0.40

A novel computational fluid dynamic method and validation for assessing distal cerebrovascular microcirculatory resistance.

BACKGROUND AND OBJECTIVE: The non-invasive assessment of microcirculatory resistance could improve the treatment of cerebrovascular stenosis. This study aimed to validate a novel computational strategy for determining the reference value of microcirculatory resistance in patients with cerebrovascular stenosis. METHODS: We reconstructed a patient-specific 3-dimensional model of the extracranial-intracranial arteries. A computational strategy incorporating patient-specific pressure-wire measurements was developed to estimate the blood flow rate and microcirculatory resistance. Throughout the computational fluid dynamics (CFD) simulation, the boundary conditions were adjusted according to the developed algorithm. Pearson correlation and Bland-Altman analyses were used to quantify the correlation and agreement between CFD calculations and transcranial Doppler (TCD) assessment. RESULTS: A strong correlation was found between the CFD-based and invasive distal pressure measurements (P<0.0001). Meanwhile, the CFD and TCD-based flow measurements were highly correlated (r = 0.853; P = 0.001). Furthermore, there was a correlation between the mean velocity measured by CFD and the mean velocity measured by TCD (r = 0.777; P<0.001). Good agreement was observed between the mass flow by CFD simulation and volumetric flow by TCD (P = 0.0266, mean difference: -0.7814 mmHg, limits of agreement, -4.0905 - 2.5276). However, the mean velocities from CFD simulation were in less agreement with those from the TCD assessment (P = 0.3992, mean difference, -0.0485; limits of agreement, -0.6141 - 0.5170). Results of the CFD simulation indicate that the flow resistance varies greatly between individuals. CONCLUSIONS: The computational strategy of incorporating patient-specific pressure-wire measurements may serve as an effective approach to evaluate the actual reference values of microcirculatory resistance. In addition, an individualized assessment of non-invasive flow resistance is necessary for the accurate determination of non-invasive cerebrovascular pressure.

New-generation tyrosine kinase inhibitor-associated asymptomatic cerebrovascular stenosis: two illustrative cases.

New-generation tyrosine kinase inhibitors (TKIs), nilotinib and ponatinib, for chronic myelogenous leukemia (CML) have been reported to cause symptomatic cerebral ischemia. Herein, we report two patients with asymptomatic cerebral artery stenosis associated with these TKIs, as a previously unreported finding. Both patients were in their 40 s and administered new-generation TKIs without vascular risk factors. New-generation TKIs for CML can cause major cerebrovascular stenosis without any symptoms. Examining the neck and intracranial arteries using magnetic resonance angiography and carotid ultrasonography may prevent future cerebral infarctions associated with these TKIs.

Diffuse Cerebral Vasospasm After Removal of a Posterior Fossa Hemangioblastoma in a 62-Year-Old Woman.

BACKGROUND: The development of diffuse cerebral vasospasm after the removal of a brain tumor is extremely rare. We report a case of cerebral vasospasm after the removal of a posterior fossa hemangioblastoma. CASE DESCRIPTION: A 62-year-old woman presented with a 1-month history of vertigo and nausea. Neurologic examination revealed that she was alert, with no paresis, and a mild left-sided cerebellar ataxia. Contrast-enhanced magnetic resonance imaging showed a cystic lesion with a strongly enhancing nodule, measuring 20 × 26 mm in diameter, in the cerebellar dorsal vermis. Angiography revealed that the lesion had feeding arteries from the left posterior inferior cerebellar artery. A diagnosis of hemangioblastoma was suspected and surgery was performed. On the first postoperative day, paresis of the right-sided extremities occurred. Diffusion-weighted imaging showed a high-intensity area in the medial side of the left frontal lobe. Magnetic resonance angiography indicated diffuse cerebrovascular stenosis. Considering these findings to be caused by vasospasm, we started the treatment used for vasospasm secondary to aneurysmal subarachnoid hemorrhage. Magnetic resonance angiography on the 13th postoperative day revealed an improvement in the cerebrovascular stenosis. In this case, it appears that the cause of vasospasm was intraoperative spillage of the contents of the cyst. CONCLUSIONS: Although the occurrence of diffuse cerebral vasospasm after the removal of brain tumors in the posterior fossa is rare, this complication should be noted as a potential postoperative complication after tumor removal; this should lead to earlier diagnosis and treatment and a potentially better prognosis.

Distribution of cerebral artery stenosis and risk factors in ethnic Zhuang and Han patients with ischemic stroke in Guangxi province.

Previous studies have demonstrated differences in the distribution of intracranial and/or extracranial atherosclerosis (I-ECAS) by region and race. Despite this, few studies have examined the distribution of arterial stenosis in ischemic stroke patients of the Zhuang population in Guangxi, China. We therefore aimed to investigate the distribution of cerebrovascular stenosis in ischemic stroke patients across different ethnicities in Guangxi province. A total of 1,101 patients were divided into 2 groups according to their ethnicity: the Zhuang group and Han group. All patients underwent 64-slice spiral computed tomographic angiography (CTA) scanning to document the presence of intracranial or extracranial stenosis. Results showed that: (I) intracranial atherosclerosis (ICAS) a higher incidence of ECAS (51.1% vs. 48.9%); (II) I-ECAS was the most common lesion type, followed by ICAS; (III) Zhuang patients had a higher rate of ECAS ( 20.2% vs. 15.2%, P=0.047) and a lower rate of I-ECAS (35.8% vs. 42.3%, P=0.041) than that of the Han group. Furthermore, Zhuang patients had a higher percentage of stenosis in the posterior circulation (23.0% vs. 13.1%, P<0.001) and a lower percentage of stenosis in the anterior circulation (29.3% vs. 41.5%, P<0.001) than Han patients; (IV) large artery atherosclerosis (LAA) was the most commonly identified cause of stroke, and the Zhuang group had a lower proportion of LAA than the Han group (47.7% vs. 55.4%; P=0.020); (V) smoking and drinking were independent risk factors for ICAS; older age, male gender, and drinking were independent risk factors for ECAS; older age, male gender, hypertension, and drinking were independent risk factors for I-ECAS; age, hypertension, diabetes, hyperlipidemia, smoking, and drinking were independent risk factors for LAA. These outcomes indicate that there are ethnicity differences in the distribution of cerebrovascular stenosis in Guangxi. The variability in the risk factors involved may explain the variation in the distribution of cerebral atherosclerosis between ethnic groups.

[Association between soluble receptor for advanced glycation end products (sRAGE) and coronary and cerebral atherosclerosis].

Objective: To investigate the Association between soluble receptor for advanced glycation end products (sRAGE) and coronary and cerebral atherosclerosis. Methods: A total of 232 consecutive patients who synchronously undertook coronary angiography and craniocerebral CT angiography (or total cerebral angiography) were included between May 2018 and December 2018 in Beijing Tiantan Hospital, Capital Medical University in this study. Patients were divided into the control group (without coronary artery disease (CAD) and cerebrovascular stenosis (CVS), n=55), CAD group (n=118), CVS group (n=11), concomitant CAD and CVS group (CAD+CVS, n=48). Plasma sRAGE level was measured by enzyme-linked immunosorbent assay (ELISA) and compared among the four groups. The relationship between sRAGE and Gensini Score (GS) and cerebrovascular stenosis severity was assayed. sRAGE levels were compared among low, middle and high GS group as well as between extracranial and intracranial arteries stenosis. Results: The levels of sRAGE in CAD group (1.96 µg/L) were higher than those in the control group (1.66 µg/L, P=0.025) or the CVS group (1.53 µg/L, P=0.013). However, no significant difference in sRAGE level was found between the groups of CAD and CAD+CVS (1.89 µg/L, P>0.05). Meanwhile, sRAGE was positively associated with GS in the entire study population (r=0.153, P=0.023) or in the diabetic patients (r=0.242, P=0.017). The sRAGE leves in both middle GS and high GS groups were higher than those in low GS group (P<0.05). No association between sRAGE and CVS severity and vascular count. Additionally, no significant difference in levels of sRAGE was found between extracranial (1.84 µg/L) and intracranial arteries stenosis (1.66 µg/L, P=0.523). Conclusion: Plasma sRAGE level is positively associated withseverity of CAD, but its association with cerebral atherosclerosis needs further studies.

Vessel wall magnetic resonance imaging findings and surgical treatment in nilotinib-associated cerebrovascular disease: A case report.

Nilotinib, a second-generation tyrosine kinase inhibitor, is considered as one of the most effective drugs for the treatment of chronic myeloid leukemia (CML); however, the use of nilotinib has been reported to be associated with vascular adverse events, such as peripheral arterial occlusive disease and ischemic heart disease. Moreover, there are few reports on cerebral vascular disease associated with nilotinib use. We herein describe the case of a 55-year-old male patient with CML, who presented with cerebral infarction and severe cerebrovascular stenosis that developed during nilotinib treatment. The patient was diagnosed with cerebral infarction and severe stenosis of the intracranial arteries associated with nilotinib use. Vessel wall magnetic resonance imaging (VW-MRI) revealed diffuse concentric thickening of the vessel wall, unlike ordinary patterns of atherosclerosis. The patient underwent direct revascularization (superficial temporal artery to middle cerebral artery bypass) and was successfully treated without recurrence. Based on this rare case, VW-MRI may be used to detect the morphological changes of the intracranial arteries that are associated with nilotinib use. Moreover, surgical revascularization may improve the prognosis of nilotinib-associated cerebrovascular diseases, such as severe stenosis or occlusion of the main trunk of the cerebral arteries, that cause brain ischemia.

The Impact of Variational Primary Collaterals on Cerebral Autoregulation.

The influence of the anterior and posterior communicating artery (ACoA and PCoA) on dynamic cerebral autoregulation (dCA) is largely unknown. In this study, we aimed to test whether substantial differences in collateral anatomy were associated with differences in dCA in two common types of stenosis according to digital subtraction angiography (DSA): either isolated basal artery and/or bilateral vertebral arteries severe stenosis/occlusion (group 1; group 1A: with bilateral PCoAs; and group 1B: without bilateral PCoAs), or isolated unilateral internal carotid artery severe stenosis/occlusion (group 2; group 2A: without ACoA and with PCoA; group 2B: with ACoA and without PCoAs; and group 2C: without both ACoA and PCoA). The dCA was calculated by transfer function analysis (a mathematical model), and was evaluated in middle cerebral artery (MCA) and/or posterior cerebral artery (PCA). Of a total of 231 non-acute phase ischemic stroke patients who received both dCA assessment and DSA in our lab between 2014 and 2017, 51 patients met inclusion criteria based on the presence or absence of ACoA or PCoA, including 21 patients in the group 1, and 30 patients in the group 2. There were no significant differences in gender, age, and mean blood pressure between group 1A and group 1B, and among group 2A, group 2B, and group 2C. In group 1, the PCA phase difference values (autoregulatory parameter) were significantly higher in the subgroup with patent PCoAs, compared to those without. In group 2, the MCA phase difference values were higher in the subgroup with patent ACoA, compared to those without. This pilot study found that the cross-flow of the ACoA/PCoA to the affected area compensates for compromised dCA in the affected area, which suggests an important role of the ACoA/PCoA in stabilizing cerebral blood flow.

Vascular stenosis in a child with visual pathway glioma treated with bevacizumab: a case report and review of literature.

BACKGROUND: Bevacizumab (BVZ) is a vascular endothelial growth factor inhibitor that has been widely accepted since its introduction into the cancer pharmacopoeia. Anecdotal reports suggested improvements in vision in children with visual pathway glioma. CASE PRESENTATION: We report a boy with visual pathway glioma whose vision had deteriorated significantly on vincristine and carboplatin, to the point that he was registered blind. Following bevacizumab therapy, there was a dramatic improvement in vision with reduction in tumour volume. However, following 20 doses of BVZ given over 19 months, he developed a significant cerebrovascular stenosis. CONCLUSION: The BVZ-induced cerebrovascular diseases in children are extremely rare but potentially serious. Importantly, stenosis has not been previously described in literature.

Clinical features and the degree of cerebrovascular stenosis in different types and subtypes of cerebral watershed infarction.

BACKGROUND: Whether there are differences in pathogenesis among different types and subtypes of cerebral watershed infarction (WSI) is controversial since they have been combined into a single group in most previous studies. METHODS: We prospectively identified 340 supratentorial WSI patients at Beijing Chao-Yang Hospital, Capital Medical University, China and classified them based on diffusion-weighted imaging(DWI) templates. Baseline characteristics, clinical courses and neuroradiological features were compared among patients with different types and subtypes of WSI. RESULTS: We identified 92 patients with cortical watershed infarction (CWI), 112 with internal watershed infarction (IWI) and 136 with mixed-type infarction. Compared with CWI patients, more IWI patients had critical stenosis of internal carotid artery (ICA) (P < 0.001). For the CWI group, patients with anterior watershed infarction (AWI) were more prone to critical ICA stenosis than those with posterior watershed infarction (PWI) (P = 0.011). For the IWI group, critical ICA stenosis was more prevalent in patients with partial IWI (P-IWI) than in those with confluent IWI (C-IWI) (P = 0.026). IWI patients were more frequently found to have clinical deterioration during the first 7 days of hospitalization and a poor prognosis at the 90th day than in CWI patients (P = 0.003 and P = 0.014, respectively). CONCLUSIONS: IWI, especially the P-IWI subtype, is associated with hemodynamic impairment (HDI), whereas CWI has a weaker correlation with ICA steno-occlusion. Furthermore, IWI patients are more prone to poor prognosis.

Clinical impact of preoperative brain MR angiography and MR imaging in candidates for liver transplantation: a propensity score-matching study in a single institution.

OBJECTIVES: To investigate the prevalence of cerebrovascular stenosis and white matter lesions on preoperative magnetic resonance angiography (MRA) and magnetic resonance imaging (MRI) in liver transplantation candidates. METHODS: This retrospective study included 1,460 consecutive patients with liver cirrhosis (LC) who underwent MRA with/without brain MRI for pretransplantation evaluation. These patients were matched with 5,331 controls using propensity scores, and the prevalences of significant cerebrovascular stenosis and white matter lesions were compared. RESULTS: A matched analysis of 1,264 pairs demonstrated that the prevalence of significant stenosis was comparable between LC patients and controls (2.2% vs. 1.4%, P = 0.143). LC and most of LC-related parameters were not associated with stenosis. Significant white matter lesions were more common in LC patients (2.8% vs. 1.3%, P = 0.036). A high Model for End-Stage Liver Disease (MELD) score (OR 1.11, CI 1.03-1.20, P = 0.008, for infarction; OR 1.1, CI 1.04-1.16, P = 0.001, for haemorrhage) and stroke history (OR 179.06, CI 45.19-709.45, P < 0.001) were predictors of perioperative stroke. CONCLUSIONS: LC patients and control subjects demonstrated similar cerebrovascular stenosis prevalences, whereas white matter lesions were more common in LC patients. A high MELD score and stroke history contribute as predictors of perioperative stroke. KEY POINTS: • Routine preoperative MR imaging in liver transplantation candidates may not be necessary. • Liver cirrhosis patients and control subjects had similar prevalences of significant cerebrovascular stenosis. • Liver cirrhosis and cirrhosis-related parameters were not correlated with significant cerebrovascular stenosis. • Significant white matter lesions were more frequent in liver cirrhosis patients.

Acetazolamide-augmented dynamic BOLD (aczBOLD) imaging for assessing cerebrovascular reactivity in chronic steno-occlusive disease of the anterior circulation: An initial experience.

The purpose of this study was to measure cerebrovascular reactivity (CVR) in chronic steno-occlusive disease using a novel approach that couples BOLD imaging with acetazolamide (ACZ) vasoreactivity (aczBOLD), to evaluate dynamic effects of ACZ on BOLD and to establish the relationship between aczBOLD and dynamic susceptibility contrast (DSC) perfusion MRI. Eighteen patients with unilateral chronic steno-occlusive disease of the anterior circulation underwent a 20-min aczBOLD imaging protocol, with ACZ infusion starting at 5 min of scan initiation. AczBOLD reactivity was calculated on a voxel-by-voxel basis to generate CVR maps for subsequent quantitative analyses. Reduced CVR was observed in the diseased vs. the normal hemisphere both by qualitative and quantitative assessment (gray matter (GM): 4.13% ± 1.16% vs. 4.90% ± 0.98%, P = 0.002; white matter (WM): 2.83% ± 1.23% vs. 3.50% ± 0.94%, P = 0.005). In all cases BOLD signal began increasing immediately following ACZ infusion, approaching a plateau at ~ 8.5 min after infusion, with the tissue volume of reduced augmentation increasing progressively with time, peaking at 2.60 min (time range above 95% of the maximum value: 0-4.43 min) for the GM and 1.80 min (time range above 95% of the maximum value: 1.40-3.53 min) for the WM. In the diseased hemisphere, aczBOLD CVR significantly correlated with baseline DSC time-to-maximum of the residue function (Tmax) (P = 0.008 for the WM) and normalized cerebral blood flow (P = 0.003 for the GM, and P = 0.001 for the WM). AczBOLD provides a novel, safe, easily implementable approach to CVR measurement in the routine clinical environments. Further studies can establish quantitative thresholds from aczBOLD towards identification of patients at heightened risk of recurrent ischemia and cognitive decline.

Risk factors for perioperative ischemic stroke in patients with atherosclerotic cerebrovascular stenosis undergoing percutaneous transluminal angioplasty and stenting / 临床麻醉学杂志

Objective To explore the predictors of perioperative ischemic stroke following percutaneous transluminal angioplasty and stenting.Methods We retrospectively evaluated data on 416 percutaneous transluminal angioplasty and stenting (PTAS) procedures at (334 males,82 females,aged 40-85 years,falling into ASA Ⅰ-Ⅲ) a single institution.Logistic regression was used to analyze the role of clinical,angiographic and hemodynamic variables on periprocedural ischemic strokes.Results Among 328 patients underwent PTAS for the treatment of extracranial stenosis,10 patients (3.0％) had perioperative ischemic stroke.Among the 88 stenting for intracranial stenosis,6 patients (6.8 ％) had perioperative ischemic stroke.Multivariable predictors of perioperative ischemic stroke for stenting for extracranial stenosis were the presence of untreated intracranial artery stenosis (OR =9.44,95％CI 2.36-37.71,P=0.001) and intraoperative absolute minimal SBP＜90 mm Hg (OR=9.13,95％CI 1.35-61.76,P =0.023).The independent predictors of perioperative ischemic stroke following PTAS for intracranial stenosis included the patients' increasing age (OR =1.25,95 ％ CI 1.04-1.51,P=0.021),presence of calcific plaques (OR=11.02,95％CI 1.11-109.25,P=0.040) and untreated intracranial artery stenosis (OR =44.81,95％ CI 1.99-1 011.84,P =0.017).Conclusion For patients with extracranial stenosis,suffering from the presence of untreated intracranial artery stenosis and intraoperative absolute minimal SBP＜90 mm Hg are the independent risk factors for perioperative ischemic stroke.The patients' increasing age,presence of calcific plaques and untreated intracranial artery stenosis were the independent risk factors for this complication in patients with intracranial stenosis.

Heat shock protein 70 and antibodies to heat shock protein 60 are associated with cerebrovascular atherosclerosis.

OBJECTIVES: Heat shock proteins (Hsps) are produced by all cells, including vascular, to ensure stress protection. Damaged cells release Hsps in their local environment and systemic circulation. The aim of this study was to investigate the involvement and prognostic utility of serum Hsp60 and Hsp70, and the respective antibodies anti-Hsp60 and anti-Hsp70 in subjects with advanced atherosclerosis resulting in high degree of cerebrovascular stenosis. DESIGN AND METHODS: Ultrasound Doppler examination of carotid arteries was used to discriminate between control and cerebrovascular atherosclerosis subjects. Twenty eight subjects without carotid obstruction were selected as controls. Fifty patients with obstruction of cerebrovascular blood flow were evaluated for the degree of stenosis of cerebral arteries by digital subtraction angiography. In parallel, serum concentrations of Hsp60, Hsp70, anti-Hsp60 and anti-Hsp70 were measured by ELISA kits. RESULTS: Anti-Hsp60 was significantly higher (P=0.003) in the atherosclerosis group than in the control group (23.62ng/L vs. 15.28ng/L, respectively, expressed as median). Circulating Hsp70 was lower in the atherosclerosis than in the control group (P=0.048), with respective median values of 0.00µg/L vs. 0.22µg/L. Concentrations of Hsp60 and anti-Hsp70 did not differ significantly between the control and atherosclerosis group. CONCLUSIONS: Higher circulating anti-Hsp60 is associated with advanced cerebrovascular atherosclerosis as a consequence of the autoimmunity part of the inflammation and bursting of atherosclerosis. Higher levels of Hsp70 observed in the control group could be protective in the development of atherosclerotic changes.

Clinical Characteristics of Patients with Cerebral Infarction Complicated with Metabolic Syndrome / 中华高血压杂志

Objective To explore clinical characteristics of patients with cerebral infarction(CI) complicated with metabolic syndrome(MS) and their correlation with severity of cerebrovascular stenosis. Methods A total of 585 cases with CI were retrospectively studied. The patients were catogorized in to groups with and without MS according to NCEP-ATPⅢ diagnostic criteria. Severity of cerebrovascular were evaluated by CT. ResultsTwo hundred ninty cases(49.6%) complicated with MS showed higher body mass index (BMI), waist circumference, blood pressure, serum total cholesterol(TC), triglyceride (TG), uric acid (UA), fasting blood glucose (FBG), two hours postprandial blood glucose (2 h PBG), glucosylated hemoglobin A1c(HbA1c), and lower high-densitylipoprotein-cholesterol(HDL-C) than those without MS. Larger size and multiple infarcts and more serious score of neurological deficit were shown in patients complicated with MS. Severity of cerebrovascular disease disclosed by CT was positively related to levels of waist circumferene, blood pressure, TC, TG, HbA1c, FBG and 2 h PBG while in versely related to the levels of HDL-C (r=-1.23, P

Stent Placement for Cerebrovascular Stenosis: Complications and Management / 国际脑血管病杂志

Stenting is one of the effective approaches in the treatment of cerebrovascular stenosis. It may reduce the risk of ischemic stroke in patients with symptomatic and asymptomatic cerebrovascular stenosis. With the increasing number of stenting procedures in the treatment of cerebrovascular stenosis, various complications have received attention. This article reviews some common complications and their management.