Baseline blood pressure does not modify the effect of intravenous thrombolysis in successfully revascularized patients.

Background: Studies indicate a trajectory relationship between baseline blood pressure (BP) and outcome in patients with acute ischemic stroke (AIS) eligible for both intravenous thrombolysis (IVT) with alteplase and endovascular treatment (EVT). We determined whether baseline BP modified the effect of IVT in successfully revascularized AIS patients who participated in the Direct Intra-Arterial Thrombectomy to Revascularize AIS Patients With Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals (DIECT-MT) trial. Methods: The association of baseline systolic BP, trichotomized as high (141-185 mmHg), middle (121-140 mmHg), and low (91-120 mmHg), and the outcomes of any intracerebral hemorrhage (ICH), symptomatic ICH (sICH), and mortality and functional outcome on the modified Rankin scale at 90 days were explored. Logistic regression models determined the interaction between clinical outcomes and baseline systolic and diastolic BP, and mean arterial pressure (MAP), at 10 mmHg intervals. Data are reported as odds ratios (OR) and 95% CI. Results: A post-hoc analysis of DIRECT-MT, in 510 of the 656 randomized participants with successful revascularization underwent MT. The overall adjusted common OR of IVT and baseline BP on any ICH, sICH, and 90-day mortality and functional outcome were 0.884 (95%CI 0.613-1.274), 0.643 (95%CI 0.283-1.458), 0.842 (95%CI 0.566-1.252), and 1.286 (95%CI 0.772-2.142), respectively. No significant interaction between baseline blood pressure and intravenous thrombolysis with clinical outcome was observed. Conclusions: In patients with baseline SBP under 185 mmHg, baseline blood pressure does not alter the risk of hemorrhagic transformation and clinicaloutcome in successfully revascularized patients, regardless of intravenous alteplase usage. Future studies are needed to confirm our findings. Registration: URL: http://www.clinicaltrials.gov, Identifier: NCT03469206.

Microcatheter Looping Technique Facilitates the Embolization of Complex Intracranial Aneurysms with an Acute Angle Branch Incorporated into the Sac.

OBJECTIVE: Intracranial aneurysms with an acutely angled parent vessel are difficult to enter using conventional techniques. This study examined efficacy, safety, and technical aspects of intraluminal, intra-aneurysmal, and in vitro microcatheter looping techniques (MLTs). METHODS: MLTs were used to treat intracranial aneurysms with an incorporated acute angle branch in 29 consecutive patients after failed treatment with conventional techniques. The MLT was adopted based on specific morphologic traits of aneurysms and parent vessels. Narrow-necked aneurysms were generally treated with coiling alone, whereas wide-necked aneurysms and giant aneurysms were treated with stent-assisted coiling. RESULTS: Technical success was achieved in 28 of 29 cases (96.6%). In vitro MLT was used in 12 patients, intraluminal MLT was used in 14 patients, and intra-aneurysmal MLT was used in 3 patients. Immediate total occlusion was achieved in 8 patients, near-total occlusion was achieved in 8 patients, and subtotal occlusion was achieved in 13 patients. CONCLUSIONS: The MLT may provide access to an incorporated, acutely angled arterial branch that is difficult to enter using a conventional coiling technique. The in vitro MLT is potentially safer than intraluminal and intra-aneurysmal MLTs because the loop is very stable and requires less manipulation.

Risk assessment of hyperperfusion induced intracranial hemorrhage after stenting in patients with severe carotid stenosis / 中国脑血管病杂志

Objective To assess the risk of hyperperfusion induced intracranial hemorrhage (HICH) after carotid artery stenting (CAS) in patients with symptomatic severe carotid stenosis.Methods From June 2009 to June 2015,the clinical data of 210 patients with symptomatic severe carotid stenosis (70％-99％) treated with CAS at Department of Neurosurgery,Changhai Hospital,the Second Military Medical University,were analyzed retrospectively.Seven of them (3.3 ％) developed HICH after operation.The relationship between the clinical baseline and imaging characteristics and HICH were assessed.All patients received the evaluation of cerebral CT perfusion examination.The time to peak (TTP) index of cerebral blood flow was defined as the TTP ratio of the affected and contralateral sides,t test was used to conduct the comparison of measurement data,and Poisson test was used to conduct the comparison of the enumeration data.Results There was significant difference in the TTP index between the HICH group and non-HICH group (1.15 ± 0.10 vs.1.30 ± 0.15,t =4.461,P ＜ 0.01).The receiver operating characteristic (ROC)curve analysis results suggested that the TTP index ＞ 1.22 could be used as a risk factor for predicting HICH (sensitivity 100％,specificity 75.9％).Conclusion Under the condition of prompting the preoperative TTP index ＞ 1.22,the risk of HICH may be higher after CAS in patients with severe carotid stenosis.