Pub Date : 2017-11-25DOI: 10.3969/cjcnn.v17i11.1690
Zhi-tie Han, Xiu-li Wang, Hai Yuan, Xiao-dong Song
Objective To discuss the damage effect of Solitaire stent on tunica intima during thrombectomy, so as to evaluate the safety of thrombectomy. Methods Twelve healthy male New Zealand rabbits were randomly divided into 4 groups (3 rabbits in each group), including control group and 3 thrombectomy groups. Microcatheter was used instead of stent in control group. The other 3 groups underwent mimic thrombectomy for 1, 3 and 5 times in the same position, respectively. The procedure was performed at both sides of carotid artery of each rabbit. Immediately after operation, bilateral carotid arteries of each rabbit were removed, performed HE staining and examined the ultrastructure under microscope. Semi?quantitative analysis was used to evaluate the damage of carotid artery. Results During the model preparation, DSA showed the diameter of vascular wall was 2.10-2.90 mm, and there was no vascular spasm, bleeding, perforation or arterial dissection. Therefore, the model was successfully established. The difference of carotid artery damage among different groups was statistically significant ( F = 119.108, P = 0.000). Compared with control group, the carotid artery damage of 3 thrombectomy groups was more serious ( q = 3.136, P = 0.001; q = 7.463, P = 0.000; q = 10.682, P = 0.000). The carotid artery damage of the second and third thrombectomy group was more serious than the first group ( q = 3.330, P = 0.000; q = 8.160, P = 0.000). The carotid artery damage of the third thrombectomy group was more serious than the second group ( q = 4.830, P = 0.000). Optical microscope observation showed that with the increase of times of thrombectomy, carotid intimal injury was more extensive and intimal reaction was more severe. Scanning electron microscopy showed that with the increase of times of thrombectomy, the degree of carotid artery injury was increased. Conclusions Solitaire stent may injure tunica intima, and with the increase of times of thrombectomy, the damage to vascular wall will increase. DOI: 10.3969/j.issn.1672-6731.2017.11.008
目的探讨接龙支架在取栓过程中对血管内膜的损伤作用,评价取栓的安全性。方法12只健康雄性新西兰兔随机分为4组(每组3只),分别为对照组和取栓组。对照组采用微导管代替支架。其余3组在同一体位分别进行1、3、5次模拟取栓。手术在每只兔的颈动脉两侧进行。术后即刻取各组双侧颈动脉,行HE染色,显微镜下观察其超微结构。半吗?定量分析颈动脉损伤程度。结果DSA示血管壁直径2.10 ~ 2.90 mm,未见血管痉挛、出血、穿孔及动脉剥离。因此,模型建立成功。各组患者颈动脉损伤程度差异有统计学意义(F = 119.108, P = 0.000)。与对照组相比,3个取栓组颈动脉损伤更严重(q = 3.136, P = 0.001;q = 7.463, P = 0.000;q = 10.682, P = 0.000)。第二组和第三组取栓组颈动脉损伤较第一组严重(q = 3.330, P = 0.000;q = 8.160, P = 0.000)。取栓第三组颈动脉损伤较取栓第二组更严重(q = 4.830, P = 0.000)。光学显微镜观察显示,随着取栓次数的增加,颈动脉内膜损伤范围更广,内膜反应更严重。扫描电镜显示,随着取栓次数的增加,颈动脉损伤程度增加。结论接龙支架可损伤血管内膜,且随着取栓次数的增加,对血管壁的损伤也会增加。DOI: 10.3969 / j.issn.1672-6731.2017.11.008
{"title":"Damage effect of Solitaire stent on tunica intima during thrombectomy","authors":"Zhi-tie Han, Xiu-li Wang, Hai Yuan, Xiao-dong Song","doi":"10.3969/cjcnn.v17i11.1690","DOIUrl":"https://doi.org/10.3969/cjcnn.v17i11.1690","url":null,"abstract":"Objective To discuss the damage effect of Solitaire stent on tunica intima during thrombectomy, so as to evaluate the safety of thrombectomy. Methods Twelve healthy male New Zealand rabbits were randomly divided into 4 groups (3 rabbits in each group), including control group and 3 thrombectomy groups. Microcatheter was used instead of stent in control group. The other 3 groups underwent mimic thrombectomy for 1, 3 and 5 times in the same position, respectively. The procedure was performed at both sides of carotid artery of each rabbit. Immediately after operation, bilateral carotid arteries of each rabbit were removed, performed HE staining and examined the ultrastructure under microscope. Semi?quantitative analysis was used to evaluate the damage of carotid artery. Results During the model preparation, DSA showed the diameter of vascular wall was 2.10-2.90 mm, and there was no vascular spasm, bleeding, perforation or arterial dissection. Therefore, the model was successfully established. The difference of carotid artery damage among different groups was statistically significant ( F = 119.108, P = 0.000). Compared with control group, the carotid artery damage of 3 thrombectomy groups was more serious ( q = 3.136, P = 0.001; q = 7.463, P = 0.000; q = 10.682, P = 0.000). The carotid artery damage of the second and third thrombectomy group was more serious than the first group ( q = 3.330, P = 0.000; q = 8.160, P = 0.000). The carotid artery damage of the third thrombectomy group was more serious than the second group ( q = 4.830, P = 0.000). Optical microscope observation showed that with the increase of times of thrombectomy, carotid intimal injury was more extensive and intimal reaction was more severe. Scanning electron microscopy showed that with the increase of times of thrombectomy, the degree of carotid artery injury was increased. Conclusions Solitaire stent may injure tunica intima, and with the increase of times of thrombectomy, the damage to vascular wall will increase. DOI: 10.3969/j.issn.1672-6731.2017.11.008","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"819-824"},"PeriodicalIF":0.0,"publicationDate":"2017-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46652118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-25DOI: 10.3969/cjcnn.v17i11.1685
Ji Liu, Jia-Ling Wu
Stroke has become the leading common cause of disability and the second most common cause of death in China. Endovascular treatment emerged in recent years as a promising treatment method with a higher recanalization rate and better functional outcome in patients with acute ischemic stroke caused by large vessel occlusion. This paper selected 4 high-quality retrospective studies by Chinese scholars regarding endovascular treatment in patients with acute ischemic stroke, which were published in foreign journals during past 3 years, and focused on study methods and results. DOI: 10.3969/j.issn.1672-6731.2017.11.003
{"title":"Research progress of endovascular treatment of acute ischemic stroke: Chinese scholars' reports published abroad","authors":"Ji Liu, Jia-Ling Wu","doi":"10.3969/cjcnn.v17i11.1685","DOIUrl":"https://doi.org/10.3969/cjcnn.v17i11.1685","url":null,"abstract":"Stroke has become the leading common cause of disability and the second most common cause of death in China. Endovascular treatment emerged in recent years as a promising treatment method with a higher recanalization rate and better functional outcome in patients with acute ischemic stroke caused by large vessel occlusion. This paper selected 4 high-quality retrospective studies by Chinese scholars regarding endovascular treatment in patients with acute ischemic stroke, which were published in foreign journals during past 3 years, and focused on study methods and results. DOI: 10.3969/j.issn.1672-6731.2017.11.003","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"785-792"},"PeriodicalIF":0.0,"publicationDate":"2017-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44811374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-25DOI: 10.3969/CJCNN.V17I11.1693
X. Hao, Shicheng Yu, Hua Li, G. Cai
Objective To investigate the influence of body mass index (BMI) and abdominal girth index (AGI) on the location and etiology of ischemic stroke in order to determine whether they can predict the etiology and pathogenesis of ischemic stroke. Methods A total of 185 patients with acute ischemic stroke and 155 cases of normal controls matched in sex, age and past medical history were enrolled in this study. Their height and weight were measured to calculate BMI, and abdominal circumference was measured to calculate AGI. Oxfordshire Community Stroke Project (OCSP) and TOAST classification were carried out. Results BMI of overweight (BMI 24.00-27.90 kg/m 2 ) subgroup ( t = 2.060, P = 0.000) and obesity (BMI ≥ 28 kg/m 2 ) subgroup ( t = 2.315, P = 0.000) in patients with ischemic stroke was significantly higher than that in control group. AGI of abnomaly (AGI > 1 cm/kg) subgroup in patients with ischemic stroke was significantly higher than that in control group ( t = 1.021, P = 0.000). Based on OCSP classification, 185 patients with ischemic stroke were classified into 10 (5.41%) of total anterior circulation infarct (TACI), 81 (43.78%) of partial anterior circulation infarct (PACI), 56 (30.27%) of lacunar infarct (LACI) and 38 (20.54%) of posterior circulation infarct (POCI). Only the PACI ratio among different BMI subgroups had statistical significance ( H = 7.041, P = 0.011). PACI ratio in BMI 24.00-27.90 kg/m 2 subgroup was significantly higher than that in BMI 1 cm/kg subgroup was significantly higher (χ 2 = 11.461, P = 0.001), while SOE ratio was significantly lower ( χ 2 = 4.558, P = 0.033) than that in AGI ≤ 1 cm/kg subgroup. Conclusions BMI and AGI can influence the location and etiology of ischemic stroke, which can be used to predict the etiology and pathogenesis of ischemic stroke. DOI: 10.3969/j.issn.1672-6731.2017.11.011
目的探讨身体质量指数(BMI)和腹围指数(AGI)对缺血性脑卒中发病部位和病因的影响,以确定两者是否能预测缺血性脑卒中的病因病机。方法选取185例急性缺血性脑卒中患者和155例性别、年龄、既往病史相匹配的正常人作为研究对象。测量身高、体重,计算BMI,测量腹围,计算AGI。牛津郡社区中风项目(OCSP)和TOAST分类进行。结果缺血性脑卒中患者体重超重(BMI 24.00 ~ 27.90 kg/ m2)亚组(t = 2.060, P = 0.000)和肥胖(BMI≥28 kg/ m2)亚组(t = 2.315, P = 0.000)均显著高于对照组。缺血性脑卒中患者异常亚组AGI (AGI >.1 cm/kg)显著高于对照组(t = 1.021, P = 0.000)。根据OCSP分类,185例缺血性脑卒中患者分为完全前循环梗死(TACI) 10例(5.41%)、部分前循环梗死(PACI) 81例(43.78%)、腔隙性梗死(LACI) 56例(30.27%)、后循环梗死(POCI) 38例(20.54%)。各BMI亚组间PACI比值差异有统计学意义(H = 7.041, P = 0.011)。BMI 24.00 ~ 27.90 kg/ m2亚组PACI比值显著高于BMI 1 cm/kg亚组(χ 2 = 11.461, P = 0.001), SOE比值显著低于AGI≤1 cm/kg亚组(χ 2 = 4.558, P = 0.033)。结论BMI和AGI可影响缺血性脑卒中的发病部位和病因,可用于预测缺血性脑卒中的病因病机。DOI: 10.3969 / j.issn.1672-6731.2017.11.011
{"title":"Effect of body mass index and abdominal girth index on location and etiology of ischemic stroke","authors":"X. Hao, Shicheng Yu, Hua Li, G. Cai","doi":"10.3969/CJCNN.V17I11.1693","DOIUrl":"https://doi.org/10.3969/CJCNN.V17I11.1693","url":null,"abstract":"Objective To investigate the influence of body mass index (BMI) and abdominal girth index (AGI) on the location and etiology of ischemic stroke in order to determine whether they can predict the etiology and pathogenesis of ischemic stroke. Methods A total of 185 patients with acute ischemic stroke and 155 cases of normal controls matched in sex, age and past medical history were enrolled in this study. Their height and weight were measured to calculate BMI, and abdominal circumference was measured to calculate AGI. Oxfordshire Community Stroke Project (OCSP) and TOAST classification were carried out. Results BMI of overweight (BMI 24.00-27.90 kg/m 2 ) subgroup ( t = 2.060, P = 0.000) and obesity (BMI ≥ 28 kg/m 2 ) subgroup ( t = 2.315, P = 0.000) in patients with ischemic stroke was significantly higher than that in control group. AGI of abnomaly (AGI > 1 cm/kg) subgroup in patients with ischemic stroke was significantly higher than that in control group ( t = 1.021, P = 0.000). Based on OCSP classification, 185 patients with ischemic stroke were classified into 10 (5.41%) of total anterior circulation infarct (TACI), 81 (43.78%) of partial anterior circulation infarct (PACI), 56 (30.27%) of lacunar infarct (LACI) and 38 (20.54%) of posterior circulation infarct (POCI). Only the PACI ratio among different BMI subgroups had statistical significance ( H = 7.041, P = 0.011). PACI ratio in BMI 24.00-27.90 kg/m 2 subgroup was significantly higher than that in BMI 1 cm/kg subgroup was significantly higher (χ 2 = 11.461, P = 0.001), while SOE ratio was significantly lower ( χ 2 = 4.558, P = 0.033) than that in AGI ≤ 1 cm/kg subgroup. Conclusions BMI and AGI can influence the location and etiology of ischemic stroke, which can be used to predict the etiology and pathogenesis of ischemic stroke. DOI: 10.3969/j.issn.1672-6731.2017.11.011","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"840-845"},"PeriodicalIF":0.0,"publicationDate":"2017-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46798719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-25DOI: 10.3969/CJCNN.V17I11.1695
Kai-li Xian, Bao-xin Du
Small fiber neuropathy (SFN) is a kind of peripheral neuropathy in which the thinly myelinated A δ fibers and unmyelinated C fibers are predominantly affected, characterized by allodynia, analgesia, thermoanesthesia and/or autonomic nerve dysfunction. Nerve conduction velocity (NCV) detection can detect the pathological changes of large fibers (Aα and Aβ fibers) but not of small fibers, which lack of value in the diagnosis of SFN. Progress of the examinational and diagnostic methods for the neuropathological, neuroelectrophysiological and autonomic nerve functions of SFN in recent years were introduced in this paper. DOI: 10.3969/j.issn.1672-6731.2017.11.013
{"title":"Research progress of the diagnosis of small fiber neuropathy","authors":"Kai-li Xian, Bao-xin Du","doi":"10.3969/CJCNN.V17I11.1695","DOIUrl":"https://doi.org/10.3969/CJCNN.V17I11.1695","url":null,"abstract":"Small fiber neuropathy (SFN) is a kind of peripheral neuropathy in which the thinly myelinated A δ fibers and unmyelinated C fibers are predominantly affected, characterized by allodynia, analgesia, thermoanesthesia and/or autonomic nerve dysfunction. Nerve conduction velocity (NCV) detection can detect the pathological changes of large fibers (Aα and Aβ fibers) but not of small fibers, which lack of value in the diagnosis of SFN. Progress of the examinational and diagnostic methods for the neuropathological, neuroelectrophysiological and autonomic nerve functions of SFN in recent years were introduced in this paper. DOI: 10.3969/j.issn.1672-6731.2017.11.013","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"851-855"},"PeriodicalIF":0.0,"publicationDate":"2017-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46217755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To investigate the management of stenosis lesions during endovascular treatment for acute ischemic stroke. Methods A total of 36 acute ischemic stroke patients combined with intracranial/extracranial arterial stenosis were treated with endovascular treatment or bridging treatment. Time from aggravation on admission or in hospital stay to femoral artery puncture, from femoral arterypuncture to recanalization were recorded. Modified Thrombolysis in Cerebral Infarction (mTICI) was usedto assess the recanalization immediately after operation. Modified Rankin Scale (mRS) was used to evaluate prognosis at 90 d after operation. Occurrence rate of symptomatic intracranial hemorrhage and mortality were recorded. Results Among 36 patients, 13 patients (36.11%) underwent intravenous thrombolysis and then endovascular thrombectomy. In all patients, there were 21 (58.33%) with intracranial stenosis and 15 (41.67%) with extracranial stenosis, 16 (44.44%) with anterior circulation stenosis and 20 (55.56%) with posterior circulation stenosis. Stent thrombectomy was used in 25 patients (69.44% ), while balloon dilatation and/or stent implantation was used in 11 patients (30.56% ). For 21 patients with intracranial arterial stenosis, 4 were treated with balloon dilatation only, 9 with Wingspan self-expandable stents and 8 with Apollo balloon-expandable stents. Fifteen patients with extracranial arterial stenosis were treated with balloon dilatation and stent implantation. A total of 33 patients (91.67%) achieved recanalization (mTICI 2b-3 grade), 21 patients (58.33% ) had good outcomes (mRS ≤ 2 score), while symptomatic intracranial hemorrhage occurred in 2 patients (5.56%) and 5 (13.89%) died. There were no statistically significant differences in the rate of good prognosis, symptomatic intracranial hemorrhage and mortality between intracranial and extracranial arterial stenosis, anterior and posterior circulation stenosis (Fisher exact probability: P > 0.05, for all). Conclusions For acute ischemic stroke patients combined with intracranial/extracranial arterial stenosis, endovascular treatment is safe and effective. DOI: 10.3969/j.issn.1672-6731.2017.11.007
{"title":"Management of stenosis lesions during the period of endovascular treatment for acute ischemic stroke","authors":"Hong-xing Han, Qiyi Zhu, Jianbin Gong, Xianjun Wang, Yun-yong Liu, Zhenyu Zhao, Hao Wang","doi":"10.3969/cjcnn.v17i11.1689","DOIUrl":"https://doi.org/10.3969/cjcnn.v17i11.1689","url":null,"abstract":"Objective To investigate the management of stenosis lesions during endovascular treatment for acute ischemic stroke. Methods A total of 36 acute ischemic stroke patients combined with intracranial/extracranial arterial stenosis were treated with endovascular treatment or bridging treatment. Time from aggravation on admission or in hospital stay to femoral artery puncture, from femoral arterypuncture to recanalization were recorded. Modified Thrombolysis in Cerebral Infarction (mTICI) was usedto assess the recanalization immediately after operation. Modified Rankin Scale (mRS) was used to evaluate prognosis at 90 d after operation. Occurrence rate of symptomatic intracranial hemorrhage and mortality were recorded. Results Among 36 patients, 13 patients (36.11%) underwent intravenous thrombolysis and then endovascular thrombectomy. In all patients, there were 21 (58.33%) with intracranial stenosis and 15 (41.67%) with extracranial stenosis, 16 (44.44%) with anterior circulation stenosis and 20 (55.56%) with posterior circulation stenosis. Stent thrombectomy was used in 25 patients (69.44% ), while balloon dilatation and/or stent implantation was used in 11 patients (30.56% ). For 21 patients with intracranial arterial stenosis, 4 were treated with balloon dilatation only, 9 with Wingspan self-expandable stents and 8 with Apollo balloon-expandable stents. Fifteen patients with extracranial arterial stenosis were treated with balloon dilatation and stent implantation. A total of 33 patients (91.67%) achieved recanalization (mTICI 2b-3 grade), 21 patients (58.33% ) had good outcomes (mRS ≤ 2 score), while symptomatic intracranial hemorrhage occurred in 2 patients (5.56%) and 5 (13.89%) died. There were no statistically significant differences in the rate of good prognosis, symptomatic intracranial hemorrhage and mortality between intracranial and extracranial arterial stenosis, anterior and posterior circulation stenosis (Fisher exact probability: P > 0.05, for all). Conclusions For acute ischemic stroke patients combined with intracranial/extracranial arterial stenosis, endovascular treatment is safe and effective. DOI: 10.3969/j.issn.1672-6731.2017.11.007","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"812-818"},"PeriodicalIF":0.0,"publicationDate":"2017-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46222699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To evaluate the efficiency and safety of endovascular thrombectomy for acute ischemic stroke caused by acute large vessel occulsion. Methods A total of 41 patients with acute ischemic stroke caused by acute large vessel occulsion were treated with endovascular thrombectomy. Time from onset to admission, from admission to femoral artery puncture, from onset to recanalization were recorded. Modified Thrombolysis in Cerebral Infarction (mTICI) was used to assess the recanalization immediately after operation. National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the neurological function at 24 h after operation. Modified Rankin Scale (mRS) was used to evaluate clinical prognosis at 90 d after operation. Perioperative procedure-related complications and occurrence rate of symptomatic intracranial hemorrhage within at 90 d after operation were recorded. American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) Collateral Flow Grading System (ACG) was used to assess collateral compensation of anterior circulation. BATMAN score was used to assess collateral compensation of posterior circulation. Results Among 41 patients, 12 (29.27%) were treated with recombinant tissue-type plasminogen activator (rt-PA) intravenous thrombolysis. There were 32 patients (78.05%) achieved successful recanalization, including 20 patients (80%, 20/25) in anterior circulation and 12 (12/16) in posterior circulation, and no significant difference was seen between them (adjusted χ 2 = 1.424, P = 0.706). At 24 h after operation, 28 patients (68.29%) had better neurological function than preoperation (NIHSS decreasing ≥ 4 score), including 18 patients (72%, 18/25) with anterior circulation occlusion and 10 (10/16) with posterior circulation occlusion, and there was no significant difference between them (χ 2 = 0.407, P = 0.524). Eleven patients (26.83%) died within 90 d after operation, including 4 patients (16%, 4/25) with anterior circulation occlusion and 7 (7/16) with posterior circulation occlusion, and there was no significant difference between them (adjusted χ 2 = 2.130, P = 0.144). Among the 11 dead, 3 died of complicated pulmonary infection and respiratory failure, and 8 died of ischemic stroke. The other 30 patients were followed up for 3 months to one year, average (231.92 ± 95.36) d. At 90 d after operation, 14 patients (34.15%) had good outcome (mRS ≤ 2 score), including 10 patients (47.62%, 10/21) with anterior circulation occlusion and 4 (4/9) with posterior circulation occlusion, and there was no significant difference between them (adjusted χ 2 = 0.493, P = 0.483). Among 41 patients, 6 patients (14.63% ) had symptomatic intracranial hemorrhage, including 4 patients (16% , 4/25) with anterior circulation occlusion and 2 (2/16) with posterior circulation occlusion, and no significant difference was seen between them (adjusted χ 2 = 3.303, P = 0.856). Collateral compensation was
目的评价急性大血管闭塞致急性缺血性脑卒中血管内取栓术的有效性和安全性。方法对41例急性大血管闭塞致急性缺血性脑卒中患者行血管内取栓术。记录发病至入院时间、入院至股动脉穿刺时间、发病至再通时间。采用改良脑梗死溶栓(mTICI)评价术后立即再通情况。采用美国国立卫生研究院卒中量表(NIHSS)评价术后24 h神经功能。采用改良Rankin量表(mRS)评价术后90 d的临床预后。记录围手术期相关并发症及术后90 d内症状性颅内出血发生率。采用美国介入与治疗神经放射学会/介入放射学会(ASITN/SIR)侧支血流分级系统(ACG)评估前循环侧支代偿。采用BATMAN评分评估后循环侧支代偿。结果41例患者中12例(29.27%)采用重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓。再通成功32例(78.05%),其中前循环20例(80%,20/25),后循环12例(12/16),两者差异无统计学意义(校正χ 2 = 1.424, P = 0.706)。术后24 h, 28例(68.29%)患者神经功能优于术前(NIHSS评分降低≥4分),其中前循环闭塞18例(72%,18/25),后循环闭塞10例(10/16),两者差异无统计学意义(χ 2 = 0.407, P = 0.524)。术后90 d内死亡11例(26.83%),其中前循环闭塞4例(16%,4/25),后循环闭塞7例(7/16),两者差异无统计学意义(校正χ 2 = 2.130, P = 0.144)。11名死者中,3人死于并发肺部感染和呼吸衰竭,8人死于缺血性中风。其余30例患者随访3个月~ 1年,平均(231.92±95.36)d。术后90 d,预后良好(mRS≤2分)14例(34.15%),其中前循环闭塞10例(47.62%,10/21),后循环闭塞4例(4/9),两组间差异无统计学意义(校正χ 2 = 0.493, P = 0.483)。41例患者中有症状性颅内出血6例(14.63%),其中前循环闭塞4例(16%,4/25),后循环闭塞2例(2/16),两者差异无统计学意义(校正χ 2 = 3.303, P = 0.856)。对33例患者(前循环闭塞20例,后循环闭塞13例)进行侧支代偿评估。20例前循环闭塞患者中,14例(70%)侧支代偿良好,其中9例(9/14)术后90 d预后良好,6例(30%)侧支代偿较差,术后90 d预后良好,两者差异有统计学意义(Fisher精确概率:P = 0.014)。13例后循环闭塞患者中,3例(3/13)侧支代偿较好,术后90 d预后良好;10例(10/13)侧支代偿较差,其中1例(1/10)侧支代偿较好,术后90 d预后良好,两者差异有统计学意义(Fisher精确概率:P = 0.014)。结论血管内取栓是治疗急性大血管闭塞所致急性缺血性脑卒中有效、安全的方法。严格掌握适应证和术前评价,完善脑卒中急性抢救程序和治疗,可提高血管内取栓术的疗效。DOI: 10.3969 / j.issn.1672-6731.2017.11.005
{"title":"A single-center study on endovascular thrombectomy for acute ischemic stroke","authors":"Guangquan Zhang, Zhi-yong Ji, Huaizhang Shi, Shancai Xu, Jingtao Qi, Shiyi Zhu, Pei-quan Zhou","doi":"10.3969/cjcnn.v17i11.1687","DOIUrl":"https://doi.org/10.3969/cjcnn.v17i11.1687","url":null,"abstract":"Objective To evaluate the efficiency and safety of endovascular thrombectomy for acute ischemic stroke caused by acute large vessel occulsion. Methods A total of 41 patients with acute ischemic stroke caused by acute large vessel occulsion were treated with endovascular thrombectomy. Time from onset to admission, from admission to femoral artery puncture, from onset to recanalization were recorded. Modified Thrombolysis in Cerebral Infarction (mTICI) was used to assess the recanalization immediately after operation. National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the neurological function at 24 h after operation. Modified Rankin Scale (mRS) was used to evaluate clinical prognosis at 90 d after operation. Perioperative procedure-related complications and occurrence rate of symptomatic intracranial hemorrhage within at 90 d after operation were recorded. American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) Collateral Flow Grading System (ACG) was used to assess collateral compensation of anterior circulation. BATMAN score was used to assess collateral compensation of posterior circulation. Results Among 41 patients, 12 (29.27%) were treated with recombinant tissue-type plasminogen activator (rt-PA) intravenous thrombolysis. There were 32 patients (78.05%) achieved successful recanalization, including 20 patients (80%, 20/25) in anterior circulation and 12 (12/16) in posterior circulation, and no significant difference was seen between them (adjusted χ 2 = 1.424, P = 0.706). At 24 h after operation, 28 patients (68.29%) had better neurological function than preoperation (NIHSS decreasing ≥ 4 score), including 18 patients (72%, 18/25) with anterior circulation occlusion and 10 (10/16) with posterior circulation occlusion, and there was no significant difference between them (χ 2 = 0.407, P = 0.524). Eleven patients (26.83%) died within 90 d after operation, including 4 patients (16%, 4/25) with anterior circulation occlusion and 7 (7/16) with posterior circulation occlusion, and there was no significant difference between them (adjusted χ 2 = 2.130, P = 0.144). Among the 11 dead, 3 died of complicated pulmonary infection and respiratory failure, and 8 died of ischemic stroke. The other 30 patients were followed up for 3 months to one year, average (231.92 ± 95.36) d. At 90 d after operation, 14 patients (34.15%) had good outcome (mRS ≤ 2 score), including 10 patients (47.62%, 10/21) with anterior circulation occlusion and 4 (4/9) with posterior circulation occlusion, and there was no significant difference between them (adjusted χ 2 = 0.493, P = 0.483). Among 41 patients, 6 patients (14.63% ) had symptomatic intracranial hemorrhage, including 4 patients (16% , 4/25) with anterior circulation occlusion and 2 (2/16) with posterior circulation occlusion, and no significant difference was seen between them (adjusted χ 2 = 3.303, P = 0.856). Collateral compensation was","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"800-805"},"PeriodicalIF":0.0,"publicationDate":"2017-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46430871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-25DOI: 10.3969/cjcnn.v17i11.1694
F. Hu, Zun-sheng Zhang, Xinhong Yang
Parkinson's disease (PD) is a common neurodegenerative disease in the elderly, of which cognitive impairment is the most common non-motor symptom (NMS) affecting the life quality of patients. Cognitive impairment is associated with many factors, and white matter hyperintensity (WMH) is an important pathological change of cognitive impairment in PD. In this paper, we will explain the relationship between WMH and cognitive impairment in PD by the perspective of neuronal pathway, white matter volume change and diffusion tensor imaging (DTI), to provide a new direction for the early diagnosis of PD. DOI: 10.3969/j.issn.1672-6731.2017.11.012
{"title":"Research progress of relationship between white matter hyperintensity and cognitive impairment in Parkinson's disease","authors":"F. Hu, Zun-sheng Zhang, Xinhong Yang","doi":"10.3969/cjcnn.v17i11.1694","DOIUrl":"https://doi.org/10.3969/cjcnn.v17i11.1694","url":null,"abstract":"Parkinson's disease (PD) is a common neurodegenerative disease in the elderly, of which cognitive impairment is the most common non-motor symptom (NMS) affecting the life quality of patients. Cognitive impairment is associated with many factors, and white matter hyperintensity (WMH) is an important pathological change of cognitive impairment in PD. In this paper, we will explain the relationship between WMH and cognitive impairment in PD by the perspective of neuronal pathway, white matter volume change and diffusion tensor imaging (DTI), to provide a new direction for the early diagnosis of PD. DOI: 10.3969/j.issn.1672-6731.2017.11.012","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"846-850"},"PeriodicalIF":0.0,"publicationDate":"2017-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43320622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To investigate the effect of location of intracranial arterial stenosis on the safety of intracranial stenting. Methods A total of 73 patients with symptomatic intracranial atherosclerotic stenosis (ICAS) were divided into intracranial internal carotid artery (IICA, N = 18), middle cerebral artery (MCA)-M1 segment (MCA-M1, N = 11), intracranial vertebral artery (IVA, N = 27) and basilar artery (BA, N = 17). All of them underwent intracranial stenting. The improvement of intracranial arterial stenosis, cerebrovascular complications including perforating events, artery dissection, in-stent thrombosis, distal stent arterial embolism and cerebral hyperperfusion, and neurological complications including transient ischemic attack (TIA), ischemic stroke and intracranial hemorrhage were recorded. Modified Rankin Scale (mRS) was used to evaluate the prognosis 30 d after operation. Results A total of 73 stents were implanted in 73 patients (35 Apollo balloon-expandable stents and 38 Wingspan self-expandable stents). Among them, 10 cases (10/18) were treated with Apollo stents and 8 cases (8/18) with Wingspan stents in IICA group, 5 cases (5/11) were treated with Apollo stents and 6 cases (6/11) with Wingspan stents in MCA-M1 group, 16 cases (59.26%, 16/27) were treated with Apollo stents and 11 cases (40.74%, 11/27) with Wingspan stents in IVA group, and 4 cases (4/17) were treated with Apollo stents and 13 cases (13/17) with Wingspan stents in BA group. No significant difference was seen in stent type among 4 groups (χ 2 = 7.422, P = 0.201). The stenosis rate of IICA group after treatment [(10.94 ± 1.99)%] was significantly improved than before treatment [(90.89 ± 7.71)%; t = 69.545, P = 0.000]. The stenosis rate of MCA-M1 group after treatment [(10.37 ± 2.14)%] was significantly improved than before treatment [(87.64 ± 9.46)%; t = 26.000, P = 0.000]. The stenosis rate of IVA group after treatment [(11.02 ± 1.99)% ] was significantly improved than before treatment [(89.11 ± 7.97)%; t = 50.726, P = 0.000]. The stenosis rate of BA group after treatment [(10.99 ± 3.39)%] was significantly improved than before treatment [(91.35 ± 5.62)%; t = 69.545, P = 0.000]. In 73 patients, cerebrovascular complications occurred in 11 cases (15.07%), including 4 cases of perforating events, 4 cases of artery dissection, one case of in-stent thrombosis and 2 cases of distal stent arterial embolism. There were 3 cases (3/18) in IICA group, including 2 cases of artery dissection and one case of distal stent arterial embolism, and 8 cases (8/17) in BA group, including 4 cases of perforating events, 2 cases of artery dissection, one case of in-stent thrombosis and one case of distal stent arterial embolism. No cerebrovascular complications occurred in MCA-M1 group and IVA group. The difference among 4 groups was statistically significant ( H = 63.134, P = 0.000). Neurological complications occurred in 6 cases (8.22%), including 4 cases of TIA and 2 cases of i
目的探讨颅内动脉狭窄位置对颅内支架置入术安全性的影响。方法将73例有症状的颅内动脉粥样硬化性狭窄(ICAS)患者分为颅内颈内动脉(IICA, 18例)、大脑中动脉(MCA)-M1段(MCA-M1, 11例)、颅内椎动脉(IVA, 27例)和基底动脉(BA, 17例)。所有患者均行颅内支架置入术。记录颅内动脉狭窄的改善情况,脑血管并发症包括穿孔事件、动脉夹层、支架内血栓形成、远端支架动脉栓塞和脑高灌注,神经系统并发症包括短暂性脑缺血发作(TIA)、缺血性脑卒中和颅内出血。采用改良Rankin评分法(mRS)评价术后30 d的预后。结果73例患者共植入支架73个,其中阿波罗球囊可扩张支架35个,翼展自扩张支架38个。其中,IICA组阿波罗支架10例(10/18),翼展支架8例(8/18),ca - m1组阿波罗支架5例(5/11),翼展支架6例(6/11),IVA组阿波罗支架16例(59.26%,16/27),翼展支架11例(40.74%,11/27),BA组阿波罗支架4例(4/17),翼展支架13例(13/17)。4组患者支架类型比较差异无统计学意义(χ 2 = 7.422, P = 0.201)。IICA组治疗后狭窄率[(10.94±1.99)%]明显高于治疗前[(90.89±7.71)%];t = 69.545, P = 0.000]。MCA-M1组治疗后狭窄率[(10.37±2.14)%]较治疗前[(87.64±9.46)%显著改善;t = 26.000, P = 0.000]。IVA组治疗后狭窄率[(11.02±1.99)%]较治疗前[(89.11±7.97)%显著改善;t = 50.726, P = 0.000]。治疗后BA组狭窄率[(10.99±3.39)%]明显高于治疗前[(91.35±5.62)%];t = 69.545, P = 0.000]。73例患者发生脑血管并发症11例(15.07%),其中穿孔事件4例,动脉夹层4例,支架内血栓形成1例,支架远端动脉栓塞2例。IICA组3例(3/18),其中动脉夹层2例,支架远端动脉栓塞1例;BA组8例(8/17),其中穿孔事件4例,动脉夹层2例,支架内血栓形成1例,支架远端动脉栓塞1例。MCA-M1组和IVA组均未发生脑血管并发症。4组间差异有统计学意义(H = 63.134, P = 0.000)。发生神经系统并发症6例(8.22%),其中TIA 4例,缺血性脑卒中2例。IICA组缺血性卒中1例(1/18),BA组缺血性卒中5例(5/17),其中TIA 4例,缺血性卒中1例。MCA-M1组和IVA组均未发生神经系统并发症。4组间差异有统计学意义(H = 65.698, P = 0.003)。术后30 d, IICA组mRS 1分1例,BA组1例。术后30 d总预后良良率为97.26%(71/73)。结论颅内动脉狭窄的位置对颅内支架置入术围手术期脑血管及神经系统并发症的发生有较大影响,总体预后良好。DOI: 10.3969 / j.issn.1672-6731.2017.11.006
{"title":"Study on the effect of location of intracranial arterial stenosis on the safety of stenting","authors":"Yujie Sun, Jian Ding, Xian-jun Zhang, Naidong Wang, Yong Zhang","doi":"10.3969/CJCNN.V17I11.1688","DOIUrl":"https://doi.org/10.3969/CJCNN.V17I11.1688","url":null,"abstract":"Objective To investigate the effect of location of intracranial arterial stenosis on the safety of intracranial stenting. Methods A total of 73 patients with symptomatic intracranial atherosclerotic stenosis (ICAS) were divided into intracranial internal carotid artery (IICA, N = 18), middle cerebral artery (MCA)-M1 segment (MCA-M1, N = 11), intracranial vertebral artery (IVA, N = 27) and basilar artery (BA, N = 17). All of them underwent intracranial stenting. The improvement of intracranial arterial stenosis, cerebrovascular complications including perforating events, artery dissection, in-stent thrombosis, distal stent arterial embolism and cerebral hyperperfusion, and neurological complications including transient ischemic attack (TIA), ischemic stroke and intracranial hemorrhage were recorded. Modified Rankin Scale (mRS) was used to evaluate the prognosis 30 d after operation. Results A total of 73 stents were implanted in 73 patients (35 Apollo balloon-expandable stents and 38 Wingspan self-expandable stents). Among them, 10 cases (10/18) were treated with Apollo stents and 8 cases (8/18) with Wingspan stents in IICA group, 5 cases (5/11) were treated with Apollo stents and 6 cases (6/11) with Wingspan stents in MCA-M1 group, 16 cases (59.26%, 16/27) were treated with Apollo stents and 11 cases (40.74%, 11/27) with Wingspan stents in IVA group, and 4 cases (4/17) were treated with Apollo stents and 13 cases (13/17) with Wingspan stents in BA group. No significant difference was seen in stent type among 4 groups (χ 2 = 7.422, P = 0.201). The stenosis rate of IICA group after treatment [(10.94 ± 1.99)%] was significantly improved than before treatment [(90.89 ± 7.71)%; t = 69.545, P = 0.000]. The stenosis rate of MCA-M1 group after treatment [(10.37 ± 2.14)%] was significantly improved than before treatment [(87.64 ± 9.46)%; t = 26.000, P = 0.000]. The stenosis rate of IVA group after treatment [(11.02 ± 1.99)% ] was significantly improved than before treatment [(89.11 ± 7.97)%; t = 50.726, P = 0.000]. The stenosis rate of BA group after treatment [(10.99 ± 3.39)%] was significantly improved than before treatment [(91.35 ± 5.62)%; t = 69.545, P = 0.000]. In 73 patients, cerebrovascular complications occurred in 11 cases (15.07%), including 4 cases of perforating events, 4 cases of artery dissection, one case of in-stent thrombosis and 2 cases of distal stent arterial embolism. There were 3 cases (3/18) in IICA group, including 2 cases of artery dissection and one case of distal stent arterial embolism, and 8 cases (8/17) in BA group, including 4 cases of perforating events, 2 cases of artery dissection, one case of in-stent thrombosis and one case of distal stent arterial embolism. No cerebrovascular complications occurred in MCA-M1 group and IVA group. The difference among 4 groups was statistically significant ( H = 63.134, P = 0.000). Neurological complications occurred in 6 cases (8.22%), including 4 cases of TIA and 2 cases of i","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"806-811"},"PeriodicalIF":0.0,"publicationDate":"2017-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48782897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-25DOI: 10.3969/cjcnn.v17i11.1683
Yong Zhang, X. Zeng
How to get the best benefit from endovascular thrombectomy in acute ischemic stroke ZHANG Yong1, ZENG Xian⁃wei2 Department of Neurological Intervention, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China Department of Neurosurgery, Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong, China Corresponding author: ZHANG Yong (Email: bravezhang@126.com) ·专论·
{"title":"How to get the best benefit from endovascular thrombectomy in acute ischemic stroke","authors":"Yong Zhang, X. Zeng","doi":"10.3969/cjcnn.v17i11.1683","DOIUrl":"https://doi.org/10.3969/cjcnn.v17i11.1683","url":null,"abstract":"How to get the best benefit from endovascular thrombectomy in acute ischemic stroke ZHANG Yong1, ZENG Xian⁃wei2 Department of Neurological Intervention, the Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China Department of Neurosurgery, Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong, China Corresponding author: ZHANG Yong (Email: bravezhang@126.com) ·专论·","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"777-780"},"PeriodicalIF":0.0,"publicationDate":"2017-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43099919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-25DOI: 10.3969/cjcnn.v17i11.1684
X. Cao, Jun Wang, Z. Du, Xin-feng Liu, Yong-ping Liang, Hui Su
With the development of new technology and new materials, endovascular therapy has become the main treatment of intracranial aneurysms. The 70-year development of intracranial aneurysms endovascular therapy mainly includes 3 stages: firstly, the electric coagulation induced thrombosis of intracranial aneurysms in the period of 1940-1960; secondly, balloon embolization of intracranial aneurysms during 1970-1990; thirdly, coil embolization of intracranial aneurysms during the period from 1990 to the present. In recent years, the widespread use of flow diverter devices and intrasaccular flow disruptor have opened up a new direction for the treatment of intracranial aneurysms. DOI: 10.3969/j.issn.1672-6731.2017.11.002
{"title":"History and progress of endovascular treatment for intracranial aneurysms","authors":"X. Cao, Jun Wang, Z. Du, Xin-feng Liu, Yong-ping Liang, Hui Su","doi":"10.3969/cjcnn.v17i11.1684","DOIUrl":"https://doi.org/10.3969/cjcnn.v17i11.1684","url":null,"abstract":"With the development of new technology and new materials, endovascular therapy has become the main treatment of intracranial aneurysms. The 70-year development of intracranial aneurysms endovascular therapy mainly includes 3 stages: firstly, the electric coagulation induced thrombosis of intracranial aneurysms in the period of 1940-1960; secondly, balloon embolization of intracranial aneurysms during 1970-1990; thirdly, coil embolization of intracranial aneurysms during the period from 1990 to the present. In recent years, the widespread use of flow diverter devices and intrasaccular flow disruptor have opened up a new direction for the treatment of intracranial aneurysms. DOI: 10.3969/j.issn.1672-6731.2017.11.002","PeriodicalId":10113,"journal":{"name":"中国现代神经疾病杂志","volume":"17 1","pages":"781-784"},"PeriodicalIF":0.0,"publicationDate":"2017-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46026048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}