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Objective:To investigate risk factors for decompressive craniectomy (DC) after endovascular therapy (EVT) in patients with acute anterior circulation ischemic stroke.Methods:Patients underwent EVT due to acute anterior circulation large vessel occlusion in Liaocheng Brain Hospital from January 2018 to January 2020 were retrospectively included. They were divided into DC group and non-DC group. Univariate and multivariate logistic regression analyses were used to determine risk factors for DC after EVT. Results:A total of 207 patients were enrolled, 126 were male (60.87%), and their age was 66.22±11.24 years old. The baseline National Institutes of Health Stroke Scale (NIHSS) score was 19.84±9.20, and the Alberta Stroke Program Early CT Score (ASPECTS) was 7.98±0.66. The immediate postoperative modified Treatment In Cerebral Ischemia (mTICI) blood flow grade in seven patients (5.80%) was ≤2a, 30 (14.49%) experienced hemorrhagic transformation (HT) after procedure, and 28 (13.5%) received DC. There were statistically significant differences between the DC group and the non-DC group in terms of past stroke history, preoperative NIHSS score and ASPECTS, vascular occlusion site, EVT time, immediate postoperative mTICI ≤2a, and HT (all P<0.05). Multivariate logistic regression analysis showed that atrial fibrillation (odds ratio [ OR] 3.202, 95% confidence interval [ CI] 1.335-9.796; P=0.011), previous stroke history ( OR 2.655, 95% CI 1.016-6.938; P=0.046), high preoperative NIHSS score ( OR 1.074, 95% CI 1.026-1.124; P=0.002), internal carotid artery occlusion ( OR 4.268, 95% CI 1.399-13.024; P=0.011), longer EVT time ( OR 1.010, 95% CI 1.003-1.016; P=0.003), mTICI grade ≤2a ( OR 5.342, 95% CI 1.565-18.227; P=0.007) and postoperative HT ( OR 3.036, 95% CI 1.024-9.004; P=0.045) were independent risk factors for DC. Conclusions:It is not uncommon for patients with acute anterior circulation ischemic stroke to need DC after EVT. Previous stroke history, atrial fibrillation, high baseline NIHSS score, internal carotid artery occlusion, prolonged blood EVT time, mTICI grade ≤2a and postoperative HT are independent predictors of needing DC after EVT.
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Objective To investigate the long -term angiography and clinical outcome of encephalo -duro-myo-synangiosis (EDMS) for the treatment of children w ith moyamoya disease. Methods The clinical and imaging data of before and after procedure in children w ith moyamoya disease treated w ith EDMS w ere analyzed retrospectively. Results A total of 21 children w ith moyamoya disease w ere enroled, including 13 females and 8 males, aged 4 to 16 years. The initial symptom: transient cerebral ischemic attack in 15 cases, ischemic stroke in 4 cases, and hemorrhagic stroke in 2 cases. Matsushima clinical classification: type Ⅰ in 8 cases, type Ⅱ in 7 cases, type Ⅳ in 3 cases, type Ⅴ in 1 case, and type Ⅵ in 2 cases. Suzuki stage: stageⅡ in 4 cases, stage Ⅲ in 11 cases, stage Ⅳ in 5 cases, and stage Ⅴ in 1 case. Ten children underw ent bilateral operation and 11 underw ent unilateral operation (a total of 31 sides). They w ere folow ed up for 13 to 91 months (mean 39.8 months). Three children had transient ischemic attack, 2 had cerebral infarction, 7 had facial edema, and none of them died during the perioperative period. The clinical symptoms w ere improved significantly in 14 sides (45.2%), good in 13 sides (41.9%), and general in 4 sides (12.9%) 1 year after operation. The proportion of children w ith modified Rankin Scale (mRS) score 0-2 after operation w as significantly higher than that before procedure (95 .2% vs.71.4%; χ2 = 4.29, P = 0.041). The middle meningeal artery and deep temporal artery participated in the blood supply of cerebral cortex in different degrees w ere observed by cerebral angiography again for 31 sides, excelent in 25 (80 .6%) and fair in 6 (19.4%). Conclusions The long-term angiography and clinical outcome in children w ith moyamoya disease treated w ith EDMS is good.
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Objective Colour ultrasound was used to detect the hemodynamic changes in patients with internal carotid artery kingking,in order to investigate the relationship between the carotid distortion angle and blood flow changes and to explore the assessment of severe internal carotid artery twist operation indications.Methods Forty-five patients with carotid artery kingking hospitalized in the Brain Hospital of Liaocheng were performed colour ultrasound to detect systolic blood flow velocity (PSV), end-diastolic velocity EDV) and to measure the angle of carotid artery kingking.Results According Metz classification, of the 45 patients, Ⅰ level 17 cases, Ⅱ level 17 cases, Ⅲ level 11 cases.With the decrease of carotid distortion angle,the influence on hemodynamics was more and more obvious, especially while the angle less than 30 degrees, the carotid artery blood flow was severely affected.The difference of PSV before and after Kinking was statistically significant in patientes of Metz Ⅲ level (Z=-2.934,P=0.003) and Metz Ⅱ level (Z=-3.053,P=0.002), but was statistically no significant in patientes of Metz Ⅰ level (Z=-0.382, P=0.702).There was a negative correlation between the ratio of the twist angle and PSV before kinking/PSV after kinking (rz =-0.842, P ＜0.05),that was, with the decrease of the twist angle, PSV before kinking/ PSV after kinking increase accordingly.Conclusion Kinking seriously affect the carotid artery blood flow dynamics.Ultrasound can accurately detect distortions arterial hemodynamics
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Objective To explore the effect and mechanism of atorvastatin on pulmonary hypertension (PAH) in chronic pulmonary heart disease.Methods Seventy eight patients with chronic pulmonary heart disease were randomly signed into treating group and observing group.Forty healthy people were picked up from people taking physical examination at the same stage as control group.Patients in observing group were given routine treatment,and patients in treating group were given atorvastatin (20 mg/d) supplement beside routine treatment.Pulmonary function,ultrasound cardiogram,plasma interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) were measured before and after 24 weeks of treatment.Results There were no difference in terms of forced expiratory volume in one second(FEV1),FEV1/forced vital capacity(FVC),pulmonary arterial pressure (PAP) and the levels of IL-6 and TNF-α between the observing group and treating group before treatment(P ＞ 0.05).While there were significant difference in terms of the serum levels of IL-6,TNF-α and PAP of treating group,observing group and normal control group at before treatment (IL-6:(106.61 ± 31.34) ng/L,(105.33 ± 30.16) ng/L,(73.81 ± 31.12) ng/L,F =67.17 ; TNF-α:(19.41 ± 10.21) ng/L,(18.25 ± 11.37) ng/L,(14.82 ± 4.33) ng/L,F =15.43 ; PAP:(58.33 ± 8.95) mmHg,(56.04 ± 8.57) mmHg,(15.88 ±7.01) mmHg,F =88.78;P =0.00),and these levels in observing and treating group were higher than those in normal control group(P ＜0.01).After 24 weeks treatment,the IL-6,TNF-α,PAP in the treating group were (73.90 ± 27.12) ng/L,(14.91 ± 5.35) ng/L and (45.96 ± 5.61) mmHg respectively,significantly lower than those in observing group ((103.00 ± 28.12) ng/L,(17.22 ± 7.17) ng/L and (53.11 ± 9.21) mmHg respectively; P =0.025,0.045 and 0.031 respectively).The pulmonary function indexes including FEV1 and FEV1/FVC in treating group were much better than those in observing group at 24 weeks treatment (FEV1:(57.85±10.31)％ vs.(43.9±31.33)％;FEV1/FVC:(57.83±10.38)％ vs.(47.97± 14.79) ％ ;P =0.001,0.024 respectively).Conclusion Atorvastatin can effectively improve the life quality and pulmonary function,decrease PAP of patients with chronic pulmonary heart disease,and the mechanism may be related to the inhibition of inflammation in pulmonary vessels.
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Objective To examine the barbiturate infusion for intractable intracranial hypertension and its effect on brain tissue oxygen ( PbtO2 ). Method 60 patients with intractable intracranial hypertension were divided into tow groups, experimental group and control group. PbtO2 and intracranial pressure (ICP) were continuous monitored. Follow-up was more than 3 months and the prognosis was compared between two groups. Results When pentobarbital administration began, the mean PbtO2 [ 72 h: (26. 7 ±6. 7)mmHg] at 24h, 48h and 72h in experimental group were significantly higher than that of control group [ 72 h: ( 21. 1 ± 7. 2) mmHg ] ( P < 0. 05 ). The mean ICP [ 5 d: (2. 48 ± 1.11 ) kPa ] in the third and fifth day of experimental group were lower than that of control group [ 5 d: (3. 12 ± 1.09 ) kPa ]. Prognosis of pentobarbital group was better than control group( P < 0. 05 ). Conclusions Pentobarbital can effectively reduce intracranial pressure in patients with refractory intracranial hypertension and improve brain tissue oxygen. PbtO2 is an ideal monitoring marker, and it can predict prognosis to a certain extent.
