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@#Objective To explore the difference of cerebral blood perfusion in patients with severe unilateral carotid artery stenosis by CTA,CTP and DSA combined assessment of circle of Willis (CoW) different mTICI compensatory grades.Methods Sixty-five patients with unilateral carotid artery stenosis≥70% were selected according to CTA,and CTP.Among them,33 patients were confirmed by carotid compression test to have compensated blood supply to the stenosis side through anterior communicating artery and/or posterior communicating artery (mTICI ≥2b),which was called as the well compensated CoW group.The other 32 cases were confirmed by neck compression test that there was no compensatory blood supply to the stenosis side,or inadequate compensation (mTICI ≤2a) was called the poor compensatory CoW group.All patients were given internal carotid artery stenting (CAS) for severe internal carotid artery (ICA) stenosis,and the residual stenosis was ≤30%.CTP examination was completed in all patients within 3 months after operation.The relative cerebral blood volume (rCBV),relative cerebral blood flow (rCBF),relative mean transit time (rMTT) and relative peak time (rTTP) of the middle cerebral artery blood supply area before and after operation were measured and calculated.The self-comparison of perfusion parameters before and after operation and the transverse comparison between the two groups.Results There were significant differences in rMTT,rTTP and slightly increased rCBV in the poor compensated CoW group before stenting than the well compensated CoW group(P<0.05),but the difference in rCBF was not significant (P=0.14).After stenting,there were no significant differences in rCBV,rCBF,rMTT,and rTTP between the two groups (P>0.05).There was only no significant difference in rCBF between the two groups before and after stenting (P>0.05).Conclusion For patients with severe unilateral carotid artery stenosis,different compensatory functions of Willis can significantly change the distribution of cerebral blood flow,providing a reference for the choice of carotid artery stent implantation.
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@#Objective To compare the differences of the result measuring infarct core and hypoperfusion with imSTROKE and RAPID software.Method This study collected medical imaging examination data from 611 patients with acute ischemic stroke,349 of them were examined by CTP and 262 of them were examined by PWI,DWI and ADC.The volumes of infarct core and hypoperfusion were respectively analyzed by RAPID and imSTROKE software.We used Bland-Altman analysis and intraclass correlation coefficient (ICC) as agreement assessment method between two software,and 25 ml,50 ml,70 ml set as the assessment point of accuracy for estimating infarct core volumes.45 ml,90 ml,125 ml set as the assessment point of accuracy for estimating infarct core volumes.Result The median volumes of hypoperfusion and infarct core are 68.20 ml and 29.18 ml with imSTROKE software,while the median volumes of hypoperfusion and infarct core are 68.55 ml and 29.53 ml with RAPID software.ICCs (95%CI) of the result measuring infarct core and hypoperfusion with imSTROKE and RAPID software are 0.9885 (0.9865~0.9902) and 0.9880 (0.9860~0.9898).Conclusion imSTROKE has high agreement with RAPID in the estimation of infarct core volumes and penumbra volumes.Both of them can be used to measure the volume of hypoperfusion and infarct core.
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@#Objective To explore the value of diffusion weighted imaging-Alberta stroke project early CT score (DWI-ASPECTS) in predicting early neurological deterioration (END) in the patients with acute anterior circulation cerebral infarction.Methods The data patients with acute anterior circulation cerebral infarction treated in the department of neurology of our hospital from October 01 2014 to June 30 2016 were retrospectively analyzed.According to the occurrence of END.The patients were divided into END group and non-END group.The differences of clinical variables between the two groups were analyzed and compared.ROC curve was used to evaluate the predictive value of DWI-ASPECTS score in the patients with acute anterior circulation cerebral infarction.Results The DWI-ASPECTS score of END group was significantly lower than that of non-END group (P<0.001).The DWI-ASPECTS (95%CI 0.466~0.8,95% CI 0.466~0.8 95% score 0.009) and the LDL-C (95% CI 1.006~2.316 score 0.047) were independent risk factors for END.ROC curve shows that when the DWI-ASPECTS is 7 as the cut-off point.The area under the curve is 0.769 (95%CI 0.715~0.818),the sensitivity is 61.54% and the specificity is 88.04%.Conclusion DWI-ASPECTS has a good predictive value in the patients with acute anterior circulation cerebral infarction.Which should be further verified by a large sample study.
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Objective To evaluate the efficacy of cerebral venous sinus pressure measurement with a microcatheter in guiding stent angioplasty for the treatment of venous sinus stenosis.Methods A total of 42 patients with idiopathic intracranial hypertension (IIH) complicated by localized venous sinus stenosis were enrolled in this study.Microcatheter venous sinus venography with DSA and venous sinus pressure measurement were performed in all patients.Of the 42 patients,the pressure difference between the distal end and the proximal end of venous sinus ＞12 mmHg was found in 32,for whom balloon dilatation together with stent angioplasty was carried out.The venous sinus pressure was measured again after the treatment.The improvement of postoperative clinical symptoms was evaluated.The occurrence of complications,the symptom relapse and the patency of venous sinus were checked up.Results Successful venous sinus stent angioplasty was achieved in all 32 patients.The symptoms of intracranial hypertension were remarkably relieved,and no procedure-related complications occurred.The postoperative pressure difference between the distal end and the proximal end of venous sinus was significantly different from the preoperative one (P＜0.05),and the pressure showed a parallel correlation with the pressure of lumbar puncture.One week after the treatment,the headache was strikingly rclieved although visual acuity showed no obvious improvement.The patients were followed up for 12 months,no recurrence of clinical symptoms was seen,and magnetic resonance venography (MRV) or DSA examination showed that venous sinus blood flow was unobstructed and no restenosis was detected.Conclusion For the treatment of IIH stenosis complicated by localized venous sinus stenosis,endovascular stent angioplasty is relatively safe and effective,and the cerebral venous sinus pressure measurement with a microcatheter is of clinical significance for the selection of suitable patients as well as for the evaluation of curative effect.
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Objective To evaluate the effect of different doses of aspirin on the platelet inhibition rate by thremboelastography.Methods One hundred and eighty patients with ischemic stroke or transient cerebral ischemic attack (TIA) were randomly divided into aspirin 100 mg/d group (60 patients),aspirin 200 mg/d group (60 patients) and aspirin 300 mg/d group (60 patients) according to the order of treatment.The platelet inhibition rate which arachidonic acid pathway induced was measured by thromboelastography and compared at different time points (before medication; 7 days,6 months,1 year after medication).Results There were significant differences in the platelet inhibition rate after medication at different time points compared with that before medication in three groups (P ＜ 0.05).After medication at different time points,the platelet inhibition rate of aspirin 100 mg/d group and aspirin 200 mg/d group was gradually decreasing.On the contrary,that of the aspirin 300 mg/d group showed gradually increasing.Cross-sectional comparison of the three groups at different time points showed that there was no significant difference in the platelet inhibition rate among three groups before medication,7 days,6 months after medication (P ＞ 0.05).However,there was significant difference at 1 year after medication (P ＜ 0.05).The platelet inhibition rate inaspirin 300 mg/d group [(93.8 ± 18.6)％] was higher than that in aspirin 200 mg/d group [(83.7 ± 11.2)％]and aspirin 100 mg/d group [(76.6 ± 12.8)％] (P ＜ 0.05).During medication there were 9 patients of less than 50％ platelet inhibition rate in aspirin 100 mg/d group,5 patients in aspirin 200 mg/d group,3 patients in aspirin 300 mg/d group,and 2 patients of peptic ulcer bleeding in aspirin 300 mg/d group.Conclusions The appropriate dose of aspirin (100,200,300 mg/d) can play a very good anti-platelet effect.Increasing the dose on the basis of 100 mg/d,the platelet inhibition rate shows no increase in the short-term (≤6 months),but in the long-term (1 year) there may be differences.It may be associated with less aspirin resistance and the relative increasing bleeding risk.