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Objective:To investigate the predicting value of cardiac serum troponin I (cTnI) levels for the clinical outcome of patients with aneurismal subarachnoid hemorrhage (aSAH) after endovascular coil embolization.Methods:Patients with aSAH treated with endovascular coil embolization in the Department of Neurology, Fujian Provincial Hospital from January 2017 to December 2019 were enrolled retrospectively. The baseline data, clinical grade, serum cTnI and N-terminal-pro B-type natriuretic peptide (NT-proBNP) levels, electrocardiogram, aneurysm characteristics, endovascular treatment status, and complications of the patents were collected. The outcomes were evaluated by the modified Rankin Scale (mRS) at 90 d after onset. Poor outcome was defined as >2 points. Multivariate logistic regression analysis was used to identify the independent risk factors for poor outcomes. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of serum cTnI levels for poor outcomes. Results:A total of 316 patients were enrolled, among them, 256 had good outcomes (81.01%), 60 had poor outcomes (18.99%) and 13 died (4.11%). Forty-seven patients (14.87%) had elevated serum cTnI levels. The proportion of patients with elevated serum cTnI levels in the poor outcome group was significantly higher than that in the good outcome group (45% vs. 7.81%; P<0.001). Compared with the good outcome group, the Glasgow Coma Scale score of the poor outcome group was lower, and the Hunt-Hess grades and Fisher grades were higher ( P<0.001). The proportion of patients with elevated NT-proBNP levels and abnormal electrocardiogram in the poor outcome group (all P<0.001) were also significantly higher than those in the good outcome group. The proportion of receiving stent-assisted coil embolization, cerebrospinal fluid replacement and ventricular drainage, as well as the incidence of complicated with cerebral infarction, hydrocephalus, seizure and rebleeding in the poor outcome group were significantly higher than those in the good outcome group (all P<0.01). Multivariate logistic regression analysis showed that after adjusting for other confounding factors, Hunt-Hess grading 3-5 (odds ratio [ OR] 6.615, 95% confidence interval [ CI]2.158-20.278; P=0.001), Fisher grading 3-4 ( OR 3.719, 95% CI 1.479-9.352; P=0.005), cerebral infarction ( OR 15.814, 95% CI 4.978-50.235; P<0.001), rebleeding ( OR 13.324, 95% CI 2.092-84.881, P=0.006) and elevated serum cTnI levels ( OR 3.874, 95% CI 1.406-10.672; P=0.009) were significantly and independently associated with the poor outcomes, which could independently predict the poor outcomes after the onset of aSAH at 90 d. The area under the ROC curve for serum cTnI levels predicting poor outcomes was 0.747 (95% CI 0.666-0.828; P<0.001). The best cut-off value was 0.025 μg/L, the sensitivity and specificity were 60.0% and 87.9%, respectively. Conclusion:The elevated serum cTnI levels have certain predictive value for the poor outcomes of patients with aSAH after endovascular coil embolization.
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Objective To investigate the correlation between the location of ruptured intracranial vertebral artery dissecting aneurysm (VADA)and the outcome after endovascular treatment. Methods Thirty-six patients with ruptured intracranial VADA undergoing endovascular treatment were enrolled retrospectively. According to the relationship between VADA and the location of the opening of posterior inferior cerebellar artery(PICA),they were divided into 3 groups:proximal to PICA group (n=13), distal to PICA group (n=13),and PICA involvement group (n=10). The demographic data, vascular risk factors, clinical features, imaging features, endovascular treatment mode, postoperative complications, and differece of the good outcome rate(defined as the modified Rankin scale 0-2)after 6 months of treatment were compared.Results Seven patients in the proximal to PICA group received reconstructive endovascular treatment (RET), and 6 received endovascular internal trapping(EIT);the good outcome rate was 100%(13/13).Seven patients in the distal to PICA group received RET,6 were treated with EIT;the good outcome rate was 84.6%(11/13).Four patients in the PICA involvement group received RET,and 6 received EIT,and 2 of them received contralateral vertebral artery retrograde PICA stenting combined with VADA segment and proximal vertebral artery coil embolization;the good outcome rate was 60.0%(6/10). There were significant differences in the overall outcome good rate among the 3 groups (P<0.05). The good outcome rate in the PICA involvement group was significant lower than that in the proximal to PICA group,and significantly lower than that in the proximal to PICA combined with distal to PICA group(P<0.05).Multivariate logistic regression analysis showed that only Fisher grade 3-4 was the independent risk factor for poor outcome (odds ratio 28.0, 95% confidence interval 1.71-458.82; P=0.020). Conclusions The surgical options of endovascular treatment for ruptured intracranial VADA needs to evaluate the relationship between the location of dissecting aneurysms and the PICA origin. The risk of endovascular treatment in patients with intracranial VADA involving the origin of PICA is higher and it may affect the outcome.
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Objective To study the effects of Dengzhan Shengmai (DZSM) capsules on the autophagy in brains after cerebral Isch-emia-reperfusion in rats. Methods 50 Sprague-Dawley rats were divided into sham group (n=10), 3-methyladenine (3-MA) group (n=10), 3-MA-control group (n=10), DZSM group (n=10) and DZSM-control group (n=10). The middle cerebral arteries were occluded for 1 hour and re-perfused in all the rats except the sham group. The 3-MA and 3-MA-control groups were injected 3-MA or normal saline (NS) into the right lateral ventricle 1 hour before operation. The DZSM and DZSM-control groups accepted DZSM or NS by gavage daily for 3 days since 4 hours after reperfusion. The rats were assessed with Longa's score 3 days after operation, and the expression of microtubule-associat-ed protein 1 light chain 3 (LC3) and Beclin1 in the brain were detected with immunofluorescent labeling and Western blotting;and the level of reactive oxygen species (ROS) were detected with chemiluminescence in the DZSM and DZSM-control groups. Results The expression of LC3 and Beclin1 increased in the ipsilateral ischemic hemisphere, especially in the cortex and striatum surrounding the infarct core (P<0.001, compared with the sham group). The expression of LC3 and Beclin1 decreased in the 3-MA group compared with the 3-MA-control group (P<0.001), with the decrease of Longa's score (P<0.001). The expression of LC3-II and Beclin1 decreased in the DZSM group com-pared with the DZSM-control group (P<0.001), with the decrease of Longa's score (P<0.001) and level of ROS (P<0.001). Conclusion Inhi-bition of autophagy after focal cerebral ischemia-reperfusion plays a role in neuroprotection, which may be a way of DZSM to work.
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Objective To observe the effects of Dengzhan Shengmai capsule on β-amyloid protein (Aβ) deposition in the brain and learning and memory function in renovascular hypertensive rats (RHRSP).Methods Male Sprague-Dawley rats were randomly divided into four groups (5 rats per group):normal group,shamoperated group,hypertension with Dengzhan Shengmai capsule treatment group and hypertension with normal saline (NS) treatment group.Renovascular hypertensive models were created by clipping two-kidney.Dengzhan Shengmai capsules were dissolved in sterile 0.9％ NS and were administered (20 mg · kg-1 per day) by daily gavage for 4 weeks.In the NS group,hypertensive rats were given saline in the same volume.Immunofluorescent labeling and western blot were used to detect the expression of Aβ,NF-κB,IL-1β,TNF-α in the brain,respectively.Learning and memory function were detected by Morris water maze.Results RHRSP significantly increased Aβ deposition in the cerebral cortex and impaired memory function in rats.Dengzhan Shengmai capsule treatment significantly lowered the blood pressure compared with NS treatment((157.45±11.58) mmHgvs (197.76±10.12) mmHg).In addition,the levels of Aβ,NF-κB p65,IL-1β,TNF-α protein were significantly reduced,by Dengzhan Shengmai caspule treatment.The escape latency was shortened((24.64±4.57) s vs (37.17±3.87)s),while the frequency of passing through the platform quadrant(5.39±0.12 vs 3.05±0.28) and the dwell time((27.34±3.67) s vs (16.83±5.76)s) (all P＜0.01) in the platform quadrant were significantly increased by Dengzhan Shengmai capsule treatment.Conclusions Dengzhan Shengmai capsule may reduce Aβ deposition in brain and improve learning and memory function by anti-inflammatory effects in RHRSP.
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Objective To investigate the efficacy of endovascular stenting complicating other craniocervical artery stenosis (OCAS) in patients with atherosclerotic subclavian artery stenosis/occlusion (SASO).Methods The clinical data of receiving endovascular stenting therapy in patients with atherosclerotic SASO were analyzed retrospectively,including demographic characteristics,vascular risk factors,complicating OCAS,as well as stenting for SASO and follow-up results.Results A total of 65 patients with SASO were included in the study,47 of them were males and 18 were females (mean age of 64 ± 9 years).Forty-six patients (70.8％ ) complicated OCAS.The overall technical success rate was 95.4％,in which the patients with stenosis (n =58) were 98.1％ and those with complete occlusion (n =7) were 71.4％.The complications occurred in 4 patients.There were no intervention-related serious stroke and death.Mean follow-up was 24 ± 19 months,6 patients with restenosis and 10 with clinically relevant events were found.They mainly occurred in patients with OCAS.The first angioplasty patency rates were 94.5％,81.8％ and 81.8％,respectively at 12 and 24 months after procedure and at the end of follow-up.The survival rates of no clinically relevant events were 92.9％,74.6％ and 68.3％,respectively.Conclusions Endovascular stenting can safely and effectively treat the SASO patients complicating OCAS.Its overall clinical outcome may be affected to some extent by OCAS.
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Objective To summarize the clinical experience of endovascular intervention for intra-cranial aneurysms, especially in the respect of the technique and management of intra-operative complications. Method The clinical data of 60 patients with intra-cranial aneurysms treated with endovascular intervention in the past 3 years were analyzed. The relevant literature especially with regard to the practical technique described was reviewed so as to potentiall minimize and properly manage the intra-operative complications. Results A total of 69 sacciform aneurysms and one dissecting aneurysm located at left vertebral artery (VA) were detected by using digital subtraction angiography (DSA) in 60 patients. There were 65 saccular aneurysms obliterated with constructive approach, and five of them treated with stent-assisted technique and four of them treated with ballon-assisted technique. The VA dissecting aneurysm was obliterated with coils by deconstructive approach with complete occlusion of its parent vessel. There were a total of 53 complete occlusions of aneurysms accounted for 76.81% of 69 sacciform aneurysms in 51 patients ( 85 % ) and eight subtotal occlusion of aneurysms (95 % ～ 99 % occlusion) accounted for 13.56% of total sacciform aneurysms in five patients (8.47%) and four incomplete occlusion of aneurysms ( ＜ 95% occlusion) accounted for 6.78% of total sacciform aneurysms in three patients (5.08%), and one was failure in operation. The rupture of aneurysms occurred during operation in4 patients (6.78%). Two senile patients suffered from intra-opeartive symptomatic thromboembolisn. One patient had stent shifting and spring coil dislocated and moved into the M3 segment of the ipsilateral MCA. Vasospasm occurred in 15 patients during operation, and most of them received endovascular intervention 3 days after the initial ictus. The rate of good recovery was 93.3% at discharge from hospital (the modified Rankin Scales, mRS＜ 2). There were 55 patients followed up for up 24 months after discharge, and excellent recovery rate was found in 51 patients ( mRS ＜ 2), and 3 died.During the follow-up period, no aneurismal recanalization or rupture was noticed in all patients. Conclusions The endovascular intervention is a safe and effective approach to the intra = cranial aneurysms. Advances in the skill of technique and proper management will decrease the complications during operation and improve the prognosis of patients.
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Objective To summarize the clinical and imaging features of subarachnoid hemorrhage(SAH) and its complications and prognosis. Methods The clinical data of 502 cases of SAH were retrospectively analyzed and summarized. Results There were 84.3 % (423/496) patients sufferring from intense headache, dizziness or vertigo (13. 1%, 66/496 ), disturbance of consciousness ( 27. 5%, 138/496 ), partial neurologic impairment (58.2% ,292/496) ,meningeal irritation sign(72.5% ,364/496). The positive rate of digital subtraction angiogra-phy was 54.1% (93/172). Aneurysm was the common reason of SAH (20. 1%, 101/496). Prognosis in most pa-tients was better,but the old patients suffered from high mortality. Conclusions The cause and clinical manifesta-tion of SAH varies,cerebral angiography often could help find the cause of SAH. Most SAH patients recover well.
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Objective To determine the clinical characteristics of post ictal headache (PIH) and clinical risk factors associated with the occurrence of PIH in patients with localization related epilepsy.Methods The subjects were 47 patients with temporal lobe epilepsy (TLE),21 patients with occipital lobe epilepsy (OLE),and 29 patients with frontal lobe epilepsy (FLE).The subjects were directly asked whether headaches occurred just after seizures and its characteristics.Results The characteristics of PIH were:throbbing quality,which was exacerbated by coughing,vomiting,bending,and sudden head movement,accompanied by photophobia,phonophobia,and relieved by sleep.The incidence of PIH was 21 3% for TLE,61 9% for OLE,and 41 4% for FLE.The risk of PIH was significantly higher for OLE than for TLE or FLE,and for patients with generalized tonic clonic seizures.Younger onset age of epilepsy was also a risk factor for PIH.Conclusions PIH possess some characteristics similar to migraine.The occurrence of PIH may be related to the region of epileptic focus and the region of the spread of epileptic discharges.
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0.05), and significant difference was noticed after 14 day treatment as compared with pretreatment (P