Individualized antiplatelet therapy for non-cardiogenic ischemic stroke.

OBJECTIVE: This research aims to investigate the impact of individualized antiplatelet therapy guided by thromboelastography with platelet mapping (TEG-PM) on the clinical outcomes of patients with non-cardiogenic ischemic stroke. METHODS: Among a total of 1264 patients, 684 individuals diagnosed with non-cardiogenic ischemic stroke underwent TEG-PM testing. Based on the adjustment of antiplatelet medication, these patients were divided into individual and control groups. Within the individual group, in accordance with the TEG-PM test results, a Maximum amplitude (MA) value greater than 47mm was defined as high residual platelet reactivity (HRPR), while an MA value less than 31mm was defined as low residual platelet reactivity (LRPR). Patients with arachidonic acid (AA) less than 50% and adenosine diphosphate (ADP) less than 30% were classified as aspirin-resistant or clopidogrel-resistant. Treatment strategies for antiplatelet medication were subsequently adjusted accordingly, encompassing increment, decrement, or replacement of drugs. Meanwhile, the control group maintained their original medication regimen without alterations. RESULTS: The individual group included 487 patients, while the control group had 197. In the individual group, approximately 175 patients (35.9%) were treated with increased medication dosages, 89 patients (18.3%) with reduced dosages, and 223 patients (45.8%) switched medications. The results showed that the incidence rate of ischemic events in the individual group was lower than that of the control group (5.54% vs. 12.6%, P = 0.001), but no significant difference was observed in bleeding events. Cox regression analysis revealed age (hazard ratio, 1.043; 95% CI, 1.01-1.078; P = 0.011) and coronary heart disease (hazard ratio, 1.902; 95% CI, 1.147-3.153; P = 0.013) as significant risk factors for adverse events. CONCLUSION: Individualized antiplatelet therapy based on TEG-PM results can reduce the risk of ischemic events in patients with non-cardiogenic ischemic stroke without increasing the risk of bleeding events or mortality. Advanced age and coronary heart disease were identified as risk factors affecting the outcomes of individualized antiplatelet therapy.

Determination and pharmacokinetic analysis of ticarcillin disodium-clavulanate potassium for injection in rat plasma by UPLC-ESI-MS/MS.

OBJECTIVE: To establish a specific and rapid ultra-high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry (UPLC-ESI-MS/MS) method for measuring ticarcillin and clavulanate levels in rat plasma. METHODS: A Waters ACQUITY BEH C18 column (50 mm × 2.1 mm, 1.7 µm) and SCIEX QTRAP® LC-MS/MS System were used. Analyses were conducted to optimize the chromatographic and MS conditions, and the pharmacokinetic parameters of ticarcillin and clavulanate were assessed. RESULTS: Linear relationships were observed in the ranges of 10 to 10,000 ng/mL for ticarcillin R (r2 = 0.9967) 30 to 10,000 ng/mL for ticarcillin S (r2 = 0.9961), and 30 to 10,000 ng/mL for clavulanate (r2 = 0.9981). The average extraction recoveries of all compounds ranged from 86.9% to 96.4%. The pharmacokinetic parameters of the ticarcillin R and S isomers in rats were distinctive. The ticarcillin R and S isomers and clavulanate were rapidly absorbed in vivo. Ticarcillin S and clavulanate had similar elimination rates, whereas that of ticarcillin R was slower. CONCLUSION: A UPLC-ESI-MS/MS method was developed and validated for the determination of ticarcillin and clavulanate in rat plasma.

Effects of therapeutic hypothermia on cerebral tissue oxygen saturation in a swine model of post-cardiac arrest.

Since the introduction of therapeutic hypothermia (TH), trends have changed in the monitoring indicators used during and after cardiac arrest. During hypothermia, the cerebral metabolic rate of oxygen is reduced, which leads to uncertainty in regional cerebral tissue oxygen saturation (SctO2). The aim of the present study was to evaluate the effect of TH on changes in SctO2 using near-infrared spectroscopy. A total of 23 male domestic pigs were randomized into three groups: TH (n=9), normothermia (NT; n=9) and control (n=5). Animals in the control group underwent surgical preparation only. The animal models were established using 8 min of ventricular fibrillation and 5 min of cardiopulmonary resuscitation. In the TH group, at 5 min after resuscitation, the animals were cooled with a cooling blanket and ice packs for 24 h. SctO2 was recorded throughout the experiment. In all groups, The mean arterial pressure, arterial carbon dioxide partial pressure, arterial oxygen partial pressure, lactate, neuron-specific enolase (NSE) and S100B were measured at baseline and at 1, 3, 6, 12, 24 and 30 h after resuscitation. SctO2 significantly decreased after ventricular fibrillation, compared with the baseline. Following resuscitation, the SctO2 values gradually increased to 55.6±3.8% of baseline in the TH group and 51.2±3.5% in the NT group (P=0.039). Significant differences between the two groups were observed, starting at 6 h after cardiac arrest. Throughout the hypothermic period, NSE and S100B showed an increasing trend, then decreased during rewarming in the TH and NT groups. NSE and S100B showed greater improvement in the TH group compared with the NT group at 6 and 24 h after resuscitation. Following cardiac arrest, therapeutic hypothermia could increase SctO2 after resuscitation and could improve neurological outcome. In conclusion, SctO2 may be a feasible marker for use in the early assessment of brain damage during and after cardiac arrest.

Inosine triphosphate pyrophosphatase polymorphisms are predictors of anemia in Chinese patients with chronic hepatitis C during therapy with ribavirin and interferon.

BACKGROUND AND AIM: Polymorphisms of inosine triphosphate pyrophosphatase (rs1127354 and rs6051702) and interferon lambda 4 (IFLN4) (rs12979860) are indicators of anemia and/or sustained virological response (SVR) in patients with chronic hepatitis C on ribavirin/interferon. The study aims to investigate the associations of rs1127354, rs6051702, and rs12979860 with hemoglobin levels and SVR in patients on ribavirin/interferon. METHODS: Polymorphisms were detected by pyrosequencing. Levels of hemoglobin and hepatitis C virus (HCV) RNA were measured at weeks 2, 4, 12, 24, 36, 48, and 72 of treatment. RESULTS: A total of 351 patients (median age, 50 years; male, 71.2%) were recruited and had HCV genotypes 1b (55.8%) or 2a (37.0%). Vedian baseline hemoglobin and HCV RNA were 155 g/dL and 6.07 log10 IU/mL. Major allele homozygosity was observed in 76.3% for rs1127354 (CC), 70.9% for rs6051702 (AA), and 89.7% for rs12979860 (CC). At 4 weeks of ribavirin/interferon treatment, a more significant reduction in hemoglobin was observed with rs112754 CC than with AC/AA (P < 0.05). A decline ≥3 g/dL was more common in patients with the rs112754 CC than with the other two polymorphisms. No significant change was observed regarding rs6051702 and rs12979860 variants. In the multivariable analysis, rs1127354 AA/AC (vs CC) were independently associated with lower odds of hemoglobin decline of > 3 g/dL at 4 weeks (odds ratio, 0.21; 95% CI, 0.09-0.46; P < 0.0001). In 258 patients with 72-week outcome data available, rs1127354, rs6051702, and rs12979860 were not associated with SVR (all P > 0.05). CONCLUSION: rs1127354 polymorphisms are associated with hemoglobin levels in Chinese patients with chronic hepatitis C treated with ribavirin/interferon.

Cholecystokinin octapeptide inhibits the inflammatory response and improves neurological outcome in a porcine model of cardiopulmonary resuscitation.

Previous studies have demonstrated that cholecystokinin octapeptide (CCK8) induces hypothermia and inhibits the systemic inflammatory response in septic shock in rat and murine models. The present study aimed to ascertain whether CCK8 induced hypothermia and improved the neurological outcomes in a porcine model of cardiopulmonary resuscitation (CPR). Ventricular fibrillation was induced and left untreated for 10 min in 12 male Bama miniature pigs. Defibrillation was attempted after 5 min of CPR. At 5 min following resuscitation, the pigs were randomized and equally assigned into the CCK8 or the control group. CCK8 was continuously infused for 1 h at a dose of 44.4 µg/kg/h and a rate of 20 ml/h in the CCK8 group. Body temperature, hemodynamic measurements and post-resuscitation myocardial function were monitored in the first 4 h following CPR. Neuron specific enzyme (NSE), S100B protein, tumor necrosis factor (TNF)-α and interleukin (IL)-6 were measured at baseline and 4, 12 and 24 h following resuscitation. The neurological deficient score (NDS) was recorded and cerebral samples were collected for terminal deoxynucleotidyl-transferase-mediated dUTP nick end labelling assay and integrated optical density (IOD) analysis at 24 h following CPR. The results revealed that hypothermia was not induced by CCK8; however, post-resuscitation NSE, S100B, IL-6 and TNF-α were significantly decreased, and NDS and IOD were significantly improved in the CCK8 group compared with the control group (P<0.05). The present study revealed that in a porcine model of CPR, CCK8 does not induce hypothermia, but inhibits the inflammatory response and significantly improves neurological outcomes.

Clopidogrel and ischemic stroke outcomes by smoking status: Smoker's paradox?

BACKGROUND AND PURPOSE: Active smokers with myocardial infarction were shown to have enhanced benefit with clopidogrel compared with aspirin. Whether this "paradox" exists in ischemic stroke patients is unknown. We aimed to investigate whether smoking status has a differential impact on the efficacy of clopidogrel vs. aspirin in patients with non-cardioembolic strokes. METHODS: This single-center study retrospectively assessed 1792 non-cardioembolic ischemic stroke patients discharged from January 2013 to October 2014, and followed for 12months. Patients were categorized as current-smokers and never-smokers. Primary outcome was a composite of secondary ischemic stroke, myocardial infarction and all-cause death. Secondary outcome was secondary ischemic stroke. RESULTS: 1066 patients were current-smokers and 726 were never-smokers. Compared with never-smokers, current-smokers had significantly higher rates of ischemic stroke (4.3% vs. 1.2%; adjusted OR: 3.60, 95%CI: 1.50-8.64, p=0.004). Regarding the primary outcome, among smokers, rates showed a lower trend in clopidogrel vs. aspirin groups (3.7% vs. 6.4%; adjusted OR 0.57, 95%CI: 0.31-1.07, p=0.08), but no difference among never-smokers (2.1% vs. 1.0%; adjusted OR: 1.67, 95%CI: 0.47-5.89, p=0.42). Similarly, among smokers, trending lower rates for recurrent ischemic stroke were observed in clopidogrel vs. aspirin group (3.1% vs. 5.0%; adjusted OR: 0.60, 95%CI: 0.31-1.18, p=0.14); but no difference between the two groups among never-smokers (1.7% vs. 1.0%; adjusted OR 1.36, 95%CI: 0.36-5.52, p=0.65). CONCLUSIONS: Smoking is a major risk factor for recurrent stroke in our retrospective non-cardioembolic ischemic stroke cohort. Active-smokers trend toward better cardiovascular outcomes when on clopidogrel. This finding needs to be confirmed in a prospective cohort.

Remote Postconditioning Alone and Combined with Hypothermia Improved Postresuscitation Cardiac and Neurological Outcomes in Swine.

Objective. Previously, we demonstrated that remote ischemic postconditioning (RIpostC) improved postresuscitation myocardial and cerebral functions in rat. Here, we investigated the effects of RIpostC alone and combined with therapeutic hypothermia (TH) on cardiac and neurological outcomes after CPR in swine. Methods. Twenty-one pigs were subjected to 10 mins of VF and then 5 mins of CPR. The animals were randomized to receive RIpostC alone, or its combination with TH, or sham control. RIpostC was induced by 4 cycles of limb ischemia followed by reperfusion. TH was implemented by surface cooling to reach a temperature of 32-34°C. Results. During 72 hrs after resuscitation, lower level of cardiac troponin I and greater stroke volume and global ejection fraction were observed in animals that received RIpostC when compared to the control. RIpostC also decreased serum levels of neuron-specific enolase and S100B and increased neurologic alertness score after resuscitation. The combination of RIpostC and TH resulted in greater improvement in cardiac and neurological outcomes than RIpostC alone. Conclusion. RIpostC was conducive to improving postresuscitation myocardial and cerebral functions and reducing their organ injuries. Its combination with TH further enhanced its protective effects.

Interferon alpha (IFNα)-induced TRIM22 interrupts HCV replication by ubiquitinating NS5A.

TRIM22, a tripartite-motif (TRIM) protein, is upregulated upon interferon alpha (IFNα) administration to hepatitis C virus (HCV)-infected patients. However, the physiological role of TRIM22 upregulation remains unclear. Here, we describe a potential antiviral function of TRIM22's targeting of the HCV NS5A protein. NS5A is important for HCV replication and for resistance to IFNα therapy. During the first 24 h following the initiation of IFNα treatment, upregulation of TRIM22 in the peripheral blood mononuclear cells (PBMCs) of HCV patients correlated with a decrease in viral titer. This phenomenon was confirmed in the hepatocyte-derived cell line Huh-7, which is highly permissive for HCV infection. TRIM22 over-expression inhibited HCV replication, and Small interfering RNA (siRNA)-mediated knockdown of TRIM22 diminished IFNα-induced anti-HCV function. Furthermore, we determined that TRIM22 ubiquitinates NS5A in a concentration-dependent manner. In summary, our results suggest that TRIM22 upregulation is associated with HCV decline during IFNα treatment and plays an important role in controlling HCV replication in vitro.

Use of parenteral caffeinum natrio-benzoicum: an underestimated risk factor for HCV transmission in China.

BACKGROUND: Fuyu city in China has a high prevalence of hepatitis C virus (HCV) infection resulting in a high morbidity and mortality from chronic liver disease and hepatocellular carcinoma. This study was conducted to identify the risk factors for HCV infection in Fuyu city. METHODS: Recruitment of study subjects involved a cross-sectional survey using non-random, convenience sampling. Information on demographic variables, risk factors for HCV infection, clinical manifestations, behavioral practices and family history was collected by administering a questionnaire. Anti-HCV antibody was detected using Abbott ARCHITECT i2000SR. HCV infection was confirmed by HCV-RNA testing by the Roche Taqman HCV test. Univariate and multivariate analyses were performed to identify the factors associated with HCV infection. RESULTS: Out of 3,228 persons that participated in the survey, 3,219 were enrolled in the study. The prevalence of HCV infection was 42.1 % (1355/3219). Among 734 patients with chronic HCV infection whose HCV-RNA genotyping was performed, genotype 1b was the most common (58.0 %), followed by genotype 2a (40.2 %), while co-infection with genotypes 1b and 2a was detected in 1.8 % of the subjects. On univariate analysis, male gender, older age, parenteral caffeinum natrio-benzoicum and share syringes (PCNBSS), and nine other factors were significantly associated with HCV infection. After adjusting for potential confounders, male gender, old age, cigarette smoking, lower education level, history of blood transfusion, blood donation, prior dental surgery, and PCNBSS were found to be independently associated with HCV infection. CONCLUSIONS: The prevalence of HCV infection is likely to be high among residents in Fuyu and we observed that genotypes 1b and 2a dominated in the city. Our findings support the hypothesis that PCNBSS which became endemic in Fuyu city during 1970s-1980s is strongly associated with HCV positivity.

IL28B genetic variation is associated with spontaneous clearance of hepatitis C virus, treatment response, serum IL-28B levels in Chinese population.

BACKGROUND: The interleukin-28B gene (IL28B) locus has been associated with host resistance to hepatitis C virus (HCV) infection and response to PEG-IFN/RBV treatment in western populations. This study was to determine whether this gene variant is also associated with spontaneous clearance of HCV infection, treatment response and IL-28B protein production in Chinese patients. METHODS: We genotyped IL28B genetic variations (rs12980275, rs8103142, rs8099917 and rs12979860) by pyrosequencing DNA samples from cohorts consisting of 529 subjects with persistent HCV infection, 196 subjects who cleared the infection, 171 healthy individuals and 235 chronic HCV patients underwent IFN/RBV treatment. The expression of IL-28B were measured by ELISA and RT-PCR. RESULTS: We found that the four IL28B variants were in complete linkage disequilibrium (r2 = 0.97-0.98). The rs12979860 CC genotype was strongly associated with spontaneously HCV clearance and successful IFN/RBV treatment compared to the CT/TT. IL-28B levels in persistent HCV patients were significantly lower than subjects who spontaneously resolved HCV and healthy controls and were also associated with high levels of ALT (alanine aminotransferase) and AST (aspartate aminotransferase). IL-28B levels were also significantly lower in individuals carrying T alleles than CC homozygous. CONCLUSIONS: Thus, the rs12979860-CC variant upstream of IL28B gene is associated with spontaneous clearance of HCV, susceptible to IFN/RBV treatment and increased IL-28B levels in this Chinese population.

Dynamic functional reorganization of the motor execution network after stroke.

Numerous studies argue that cortical reorganization may contribute to the restoration of motor function following stroke. However, the evolution of changes during the post-stroke reorganization has been little studied. This study sought to identify dynamic changes in the functional organization, particularly topological characteristics, of the motor execution network during the stroke recovery process. Ten patients (nine male and one female) with subcortical infarctions were assessed by neurological examination and scanned with resting-state functional magnetic resonance imaging across five consecutive time points in a single year. The motor execution network of each subject was constructed using a functional connectivity matrix between 21 brain regions and subsequently analysed using graph theoretical approaches. Dynamic changes in topological configuration of the network during the process of recovery were evaluated by a mixed model. We found that the motor execution network gradually shifted towards a random mode during the recovery process, which suggests that a less optimized reorganization is involved in regaining function in the affected limbs. Significantly increased regional centralities within the network were observed in the ipsilesional primary motor area and contralesional cerebellum, whereas the ipsilesional cerebellum showed decreased regional centrality. Functional connectivity to these brain regions demonstrated consistent alterations over time. Notably, these measures correlated with different clinical variables, which provided support that the findings may reflect the adaptive reorganization of the motor execution network in stroke patients. In conclusion, the study expands our understanding of the spectrum of changes occurring in the brain after stroke and provides a new avenue for investigating lesion-induced network plasticity.

A longitudinal diffusion tensor imaging study on Wallerian degeneration of corticospinal tract after motor pathway stroke.

Wallerian degeneration of the corticospinal tract (CST) after motor pathway ischemic stroke can be characterized by diffusion tensor imaging (DTI). However, the dynamic evolution of the diffusion indices in the degenerated CST has not previously been completely identified. We investigated this dynamic evolution and the relationship between early changes of the diffusion indices in the degenerated CST and long-term clinical outcomes. DTI and neurological examinations were performed repeatedly in 9 patients with first-onset motor pathway subcortical infarction at 5 consecutive time points, i.e. within 1 week, at 2 weeks, 1 month, 3 months and 1 year. Using a region of interest method, we analyzed the ratios of the fractional anisotropy (rFA), mean diffusivity (rMD), primary eigenvalue (rlambda(1)) and transverse eigenvalue (rlambda(23)) between the affected and unaffected sides of the CSTs. We did not find any significant changes in the diffusion indices of the contralesional CSTs across time points. The rFA decreased monotonously during the first 3 months and then stabilized. The rMD increased after 2 weeks and stabilized after the third month. The rlambda(1) decreased during the first 2 weeks and then remained unchanged. The rlambda(23) increased during the first 3 months and then stabilized. We also found that the changes in the rFA between the first 2 time points were correlated with the NIHSS (P=0.00003) and the Motricity Indices (P=0.0004) after 1 year. Our results suggest that for patients with motor pathway stroke the diffusion indices in the degenerated CST stabilize within 3 months and that early changes in the rFA of the CST may predict long-term clinical outcomes.

[Distribution and risk factors of steno-occlusive lesions in patients with ischemic cerebrovascular disease].

OBJECTIVE: To investigate the distribution of atherosclerotic steno-occlusive lesions in Chinese patients with ischemic cerebrovascular disease and the risk factors for occlusive lesions of intracranial and extracranial arteries. METHODS: 583 consecutive patients with ischemic cerebrovascular disease, 449 males and 134 females, aged 18-86, 415 with cerebral infarction and 168 with transient ischemic attack (TIA), underwent angiography. The angiographic findings and relevant clinical; data were analyzed. RESULTS: Fifty of the 583 patients had normal findings in angiography and 527 had occlusive lesions of different degrees, among which 24.3% had only extracranial artery disease (EAD), 36.8% had only intracranial disease (IAD), and 38.9% had both EAD and IAD. In total the incidence of IAD was 75.6%, higher than that of EAD (63.2%). In the carotid TIA patients the percentage of IAD was significantly higher than that of the EAD (P = 0.005), and in the cerebral infarction patients the percentage of IAD was higher than that of the EAD, but now significantly. In the patients with TIA of vertebrobasilar artery the incidence of IAD was significantly higher than that of the EAD (P < 0.01). The proportion of pure IAD alone was high in patients aged < or =40 was 75.5% with the middle cerebral artery as the most frequently involved site, while the proportion of coexistence of IAD and EAD was high in the middle-aged and old-aged groups (39.4% and 48.0% respectively, P < 0.001) with the origin of internal carotid artery as the commonest site of lesions. Multivariable Logistic regression identified age, diabetes, hyperlipidemia, and coronary artery disease as the independent risk factors for EAD, and hypertension, diabetes, and hyperlipidemia for IAD. The patients with EAD were significantly elder and had an increased frequency of coronary artery disease compared with those with IAD. CONCLUSION: In general, the morbidity of IAD was higher that that of EAD in the Chinese patients with ischemic cerebrovascular disease, and presents symptoms of both extracranial and intracranial arteries; however, pure EAD is not uncommon. The distribution pattern of occlusive disease differs among different groups of patients. The patients with EAD are often elder and have an increased frequency of coronary artery disease.

Event-related potential N270 in detecting cognitive impairment in patients with transient ischemic attack.

Latency and amplitude of the visual P300 and N270 were examined in patients with transient ischemic attack (TIA) and in age-matched healthy control subjects to investigate the feasibility of N270 as a clinical examination method to evaluate the cognitive status of patients with TIA. Stimulus pairs with identical (match condition) or different (conflict condition) colors were randomly presented to subjects. Each pair consisted of two sequential stimuli (S1 and S2) that lasted for 300 ms; the onset interval between them was 700 ms. Thirty TIA patients without clinical dementia and 30 age-matched control subjects determined if the two stimuli in a pair had the same color. Subjects were required to press a button in the match condition and another button in the conflict condition. Event-related potentials (ERPs) were recorded from their scalp electrodes at the same time. N270 was evoked by the second stimulus (S2) of the conflict condition in either control subjects or patients. The patient group exhibited a delayed N270 than the control group. TIA patients as a group showed cognitive decline. N270 is an effective index to detect the cognitive impairment of TIA patients.

[Percutaneous transluminal stenting for stenosis of internal carotid artery: a report of 355 cases].

OBJECTIVE: To discuss the benefits and complications of percutaneous transluminal stenting for stenosis of internal carotid artery (ICA). METHODS: 355 patients with ICA stenosis were included from 1997 to 2003. All of them took periprocedual anticoagulation treatment, cerebral vascular angiography and cervical Doppler sonography. 72 patients used cerebral protection of filter devices. Among the 283 patients without cerebral protection 202 patients (71.38%) underwent predilation, 66 patients (23.32%) underwent postdilation; and 3 patients underwent neither. RESULTS: The heart rates of 25.0% of all the patients decreased. Dislocation of microemboli happened in 5 patients. 2 of them improved after treatment. 3 of them got dyskinesia of one side. 2 patients (0.56%) died of intracerebral hemorrhage (ICH). 256 patients (84.77%) turned for the better. 260 patients (73.34%) were followed up. Restenosis occurred in 11 patients (4.23%). CONCLUSION: Percutaneous transluminal stenting for stenosis of internal carotid artery is safe if proper periprocedual treatment and operative procedure are taken. However, enough attention should be paid to the occurrence of ICH resulting from over-flow after operation.

[Complications of stent-assistant angioplasty of symptomatic intracranial artery stenosis].

OBJECTIVE: To discuss the safety of intracranial stenting for refractory symptomatic intracranial artery stenosis. METHODS: Forty-eight patients with symptomatic intracranial artery stenosis were treated by transluminal stent-assistant angioplasty. Of them, 40 cases were selected because they had recurrent TIAs or mild stroke despite of antiplatelet or anticoagulation therapy; 8 cases with high-grade stenosis after acute cerebral artery theromblysis. Lesions involved MCA (17/48); Basilar artery (8/48); intracranial vertebral artery (18/18); and distal ICA (5/18). RESULTS: For 46 of 48 cases the flexible coronary stent were successfully deployed. The average stenosis reduced from 83% to 5%, short-term follow-up showed good clinical improvement. Complications include vessel rupture (1/18); acute thrombosis within stent (1/48); perforation of cortical artery (1/18) and perforate vessel occlusion (1/18). CONCLUSION: Stent-assistant angioplasty are effective for treatment of symptomatic intracranial stenosis, the higher rate of complications may be because of the limited experiences of this technique. it need further practise and long term follow-up study.

[Combined intraarterial thrombolysis and intra-cerebral stent for acute ischemic stroke institute of brain vascular diseases].

OBJECTIVE: To test feasibility, safety and efficacy of combined intraarterial thrombolysis and intra-cerebral stent for acute ischemic stroke. METHODS: From 2001-5 to 2002-8, 19 patients with acute onset of stroke were treated with intraaterial thrombolysis followed by intra-cerebral stent. 9 located in middle cerebral artery (MCA), 10 located in basal artery (BA). For each patient, intraarterial thrombolysis of MCA or BA was applied at first, stent angioplasty was applied at the stenosis left after the thrombolysis by using the stent for coronary artery. RESULTS: All the 19 patients left stenosis after intraaterial thrombolysis, and the average stenosis was 85% in diameter. After the operation of stent, the images showed the vascular is smooth and had no stenosis left. The symptoms were disappeared or improved. Thrombus formation in the stent occurred on 1 patient 24 hours after the operation. TIA never occurred in the left 18 patients then. TCD follow up showed blood flow is normal. CONCLUSIONS: It is feasibility of intraaterial thrombosis followed by intra-cerebral stent. And it is valid for preventing occlusion again of the vessel and decreasing the rate of TIA occurring.

[Stent-assisted angioplasty in treatment of symptomatic intracranial artery stenosis].

OBJECTIVE: To investigate the indications, safety and effectiveness of intracranial deployment of stents in treatment of systematic intracranial artery stenosis. METHODS: Stent-assisted angioplasty was performed upon 7 consecutive patients with symptoms of intracranial artery stenosis unresponsive to anticoagulant therapy and antiplatelet therapy. The lesions involved the middle cerebral artery in 3 cases, distal end of internal carotid artery in one case, basilar artery in one case, and intracranial section of vertebral artery in 2 cases. Short-term clinical and angiographic data were obtained. RESULTS: Symptoms of procedure-related intracranial hemorrhage and intracranial haematoma developed later were found in one patient. Emergency craniotomy was performed 5 hours after the stenosis-assisted angioplasty. The remaining patients experienced alleviation of symptoms without transient ischemic attack and apoplexy during the short-term follow-up. Angiography showed that the stenosis degree reduced from 83% to 5%. 0 - 3 months of follow-up by transcranial Doppler showed good patency of stented lesions. CONCLUSION: Stent-assisted angioplasty effectively treats atherosclerotic intracranial stenosis lesions. Long-term follow-up and further clinical/technical research are still needed.

[Experience with transluminal stent-assisted angioplasty for intracranial vascular diseases].

OBJECTIVE: To assess the value of stent-assistant angioplasty for intracranial vascular diseases. METHODS: Thirteen patients with intracranial vascular diseases were treated consecutively by stent-assistant angioplasty for different purposes. Of these patients 7 had symptomatic intracranial artery stenosis, 3 intracranial wide-neck aneurysms, 2 intracranial pseudoaneurysms, and 1 bilateral transverse sinus stenosis. Clinical procedures and technical data of the patients were retrospectively analyzed. RESULTS: In the 7 patients, the degree of intracranial artery stenosis reduced from 83% to 5%. Three months after the operation they exhibited good patency of stented lesions. Intracranial wide neck aneurysms (with 2 pseudoaneurysms) were successfully embolized with GDC in 5 patients. The patients with bilateral transverse sinus stenosis were implanted a self-expanded stent in the right transverse sinus. One patient failed because of the tortuous configuration of the left jugular bulb, but the patient's symptoms were improved quickly after the procedure. CONCLUSION: Stent-assistant angioplasty is a useful technique for selected intracranial vascular diseases, and it needs further investigation.