Fluid-attenuated inversion recovery （FLAIR） vascular hyperintensity （FVH） is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the p...Fluid-attenuated inversion recovery （FLAIR） vascular hyperintensity （FVH） is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the present study was to assess a FVH score and explore its relationship with clinical outcomes. Patients with acute ischemic stroke due to middle cerebral artery M1 occlusion underwent magnetic resonance imaging and were followed up at 10 days （National Institutes of Health Stroke Scale） and 90 days （modified Rankin Scale） to determine short-term clinical outcomes. Effective collateral circulation indirectly improved recovery of neurological function and short-term clinical outcome by extending the size of the pial penumbra and reducing infarct lesions. FVH score showed no correlation with 90-day functional clinical outcome and was not sufficient as an independent predictor of short-term clinical outcome.展开更多
Integrity of the blood-brain barrier structure is essential for maintaining the internal environment of the brain.Development of cerebral infarction and brain edema is strongly associated with blood-brain barrier leak...Integrity of the blood-brain barrier structure is essential for maintaining the internal environment of the brain.Development of cerebral infarction and brain edema is strongly associated with blood-brain barrier leakage.Therefore,studies have suggested that protecting the blood-brain barrier may be an effective method for treating acute stroke.To examine this possibility,stroke model rats were established by middle cerebral artery occlusion and reperfusion.Remote ischemic postconditioning was immediately induced by three cycles of 10-minute ischemia/10-minute reperfusion of bilateral hind limbs at the beginning of middle cerebral artery occlusion reperfusion.Neurological function of rat models was evaluated using Zea Longa’s method.Permeability of the blood-brain barrier was assessed by Evans blue leakage.Infarct volume and brain edema were evaluated using 2,3,5-triphenyltetrazolium chloride staining.Expression of matrix metalloproteinase-9 and claudin-5 m RNA was determined by real-time quantitative reverse transcription-polymerase chain reaction.Expression of matrix metalloproteinase-9 and claudin-5 protein was measured by western blot assay.The number of matrix metalloproteinase-9-and claudin-5-positive cells was analyzed using immunohistochemistry.Our results showed that remote ischemic postconditioning alleviated disruption of the blood-brain barrier,reduced infarct volume and edema,decreased expression of matrix metalloproteinase-9 m RNA and protein and the number of positive cells,increased expression of claudin-5 m RNA and protein and the number of positive cells,and remarkably improved neurological function.These findings confirm that by suppressing expression of matrix metalloproteinase-9 and claudin-5 induced by acute ischemia/reperfusion,remote ischemic postconditioning reduces blood-brain barrier injury,mitigates ischemic injury,and exerts protective effects on the brain.展开更多
目的观察急性大脑中动脉闭塞患者机械取栓术中应用Penumbra抽吸导管逆向半回收Solitaire支架取栓的效果,探讨其临床应用价值。方法急性大脑中动脉闭塞患者19例,均采用Solumbra技术行机械取栓术,术中应用Penumbra抽吸导管逆向半回收Solit...目的观察急性大脑中动脉闭塞患者机械取栓术中应用Penumbra抽吸导管逆向半回收Solitaire支架取栓的效果,探讨其临床应用价值。方法急性大脑中动脉闭塞患者19例,均采用Solumbra技术行机械取栓术,术中应用Penumbra抽吸导管逆向半回收Solitaire支架取栓。术后即刻行头颅CT血管造影,采用改良脑梗死溶栓分级(modified thrombolysis in cerebral infarction score, mTICI)评估治疗效果,1次取栓未成功者立即再次取栓。比较术前、术后24 h及出院时美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale, NIHSS)评分;术后24-48 h复查头部CT平扫,观察颅内出血等并发症发生情况;术后随访24个月,记录症状改善或加重情况,评估有无动脉残余狭窄。结果 19例均成功实现大脑中动脉闭塞再通,1次取栓实现血管再通(mTICI≥2b/3级)15例,取栓2次3例,取栓3次1例,术后即刻mTICI 2b级3例、mTICI 3级16例。术后24-48 h头部CT平扫均未提示颅内出血。术后24 h时NIHSS评分[(10.3±3.9)分]低于术前[(15.2±4.8)分](P<0.05),高于出院时[(5.5±2.7)分](P<0.05)。术后随访3-24(11.3±5.7)个月,19例症状均明显改善,2例发生动脉残余狭窄者3个月后行支架植入术。结论急性大脑中动脉闭塞患者机械取栓术中应用Penumbra抽吸导管逆向半回收Solitaire支架取栓,可实现血流再通,有效改善临床症状,术后并发症发生率低。展开更多
目的分析颅内支撑导管联合Solitaire FR取栓支架(solitaire FR with intracranial support catheter for mechanical thrombectomy,SWIM)技术治疗急性大脑中动脉闭塞脑梗死的安全性、有效性。方法选取2019-05—2020-05湛江中心人民医院...目的分析颅内支撑导管联合Solitaire FR取栓支架(solitaire FR with intracranial support catheter for mechanical thrombectomy,SWIM)技术治疗急性大脑中动脉闭塞脑梗死的安全性、有效性。方法选取2019-05—2020-05湛江中心人民医院神经外二科收治的50例急性大脑中动脉闭塞脑梗死患者为研究对象,行SWIM技术取栓,回顾性分析其临床及影像学资料。结果50例患者血管再通率92.0%,其中血管完全再通40例,部分再通6例,未通4例。50例患者治疗后NIHSS评分(5.86±2.62)与治疗前(22.09±2.31)比较差异有统计学意义(P<0.05)。50例患者术后90 d mRS与术前比较,差异有统计学意义(t=4.01,P<0.05),其中术后mRS≤2者达60%。结论对急性大脑中动脉闭塞脑梗死患者采用SWIM技术治疗临床疗效良好,安全性高。展开更多
文摘目的探讨急性缺血性卒中接受重组组织型纤溶酶原激活剂(Recombinant Tissue Plasminogen Activator,rt-PA)静脉溶栓治疗后大脑中动脉再通患者的临床预后情况。方法回顾性分析2013年9月至2014年9月,于天津市环湖医院神经内科接受静脉溶栓治疗的急性缺血性卒中患者资料552例。入选患者按照0.9 mg/kg剂量标准,给予rt-PA静脉溶栓治疗。所有患者于溶栓前及溶栓后24 h进行头部MRA检查,采用TICI血管再通分级标准判断大脑中动脉的再通情况。其中根据溶栓后24 h MRA检查结果分为血管再通组(188例),血管未通组(364例)。溶栓前及溶栓后24 h的神经功能缺损评分及疗效判定,采用美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)。神经功能的预后评价,采用改良Rankin评分(modified Rankin Scale,mRS)。对2组患者溶栓后颅内出血(intracranial hemorrhage,ICH)、症状性颅内出血(symptomatic intracranial hemorrhage,SICH)的发生率、死亡率、神经功能缺损恢复及预后情况进行统计对比分析。结果血管再通组患者的恢复良好率和预后良好率均高于血管未通组,差异有统计学意义(P<0.05)。血管再通组患者未出现症状性颅内出血,有6例患者出现了非症状性颅内出血。血管再通组及血管未通组的颅内出血发生率、其他部位出血率和住院期间死亡率差异均无统计学意义(P>0.05)。结论研究结果表明,急性缺血性卒中患者在接受静脉溶栓治疗后,大脑中动脉再通的患者较未通患者神经功能缺损症状改善明显。静脉溶栓后,血管再通的患者临床预后获益更大。
文摘目的探讨多时相CT血管造影(multi-phase computed tomographic angiography,MP-CTA)评价大脑中动脉(middle cerebral artery,MCA)M1段闭塞所致急性脑梗死的侧枝血管循环状况及其与临床预后的相关性。方法采用Toshiba Aquilion ONE 320排动态容积CT对42例单侧大脑中动脉M1段闭塞所致的急性脑梗死患者进行一站式检查,对比分析单时相CTA-MIP、侧枝循环偏利现象、Alberta卒中项目早期CT评分(alberta stroke program early CT score,ASPECTS)对病灶侧枝血管及侧枝循环状况量化分级评估,结合临床随访结果分析MP-CTA侧支循环评分对预后的预测作用。结果1)入院时患者卒中严重程度与临床预后明显相关(P=0.001),入院时NIHSS评分越高,预后越差(P=0.000);2)相较于单时相CTA-MIP和偏利现象,ASPECTS评分与DSA一致性最高(κ=0.821,P=0.000),ASPECTS评分在ROC曲线下的面积分别为0.842(95%置信区间为0.707~0.976,P=0.001),诊断敏感度为93.55%,特异度为90.91%,约登指数为0.84;3)多时相ASPECTS侧枝循环量化分级预测临床预后明显优于单时相CTA-MIP评分(P=0.000)。结论多时相CTA的ASPECTS评分能较好地评价单侧大脑中动脉M1段闭塞致急性脑梗死患者的侧枝血管状态与预测临床预后。
基金supported by the National Natural Science Foundation of China,No.81371521
文摘Fluid-attenuated inversion recovery （FLAIR） vascular hyperintensity （FVH） is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the present study was to assess a FVH score and explore its relationship with clinical outcomes. Patients with acute ischemic stroke due to middle cerebral artery M1 occlusion underwent magnetic resonance imaging and were followed up at 10 days （National Institutes of Health Stroke Scale） and 90 days （modified Rankin Scale） to determine short-term clinical outcomes. Effective collateral circulation indirectly improved recovery of neurological function and short-term clinical outcome by extending the size of the pial penumbra and reducing infarct lesions. FVH score showed no correlation with 90-day functional clinical outcome and was not sufficient as an independent predictor of short-term clinical outcome.
基金supported by the National Natural Science Foundation of China,No.30960107the Natural Science Foundation of the Education Department of Sichuan Province of China,No.14ZA0223
文摘Integrity of the blood-brain barrier structure is essential for maintaining the internal environment of the brain.Development of cerebral infarction and brain edema is strongly associated with blood-brain barrier leakage.Therefore,studies have suggested that protecting the blood-brain barrier may be an effective method for treating acute stroke.To examine this possibility,stroke model rats were established by middle cerebral artery occlusion and reperfusion.Remote ischemic postconditioning was immediately induced by three cycles of 10-minute ischemia/10-minute reperfusion of bilateral hind limbs at the beginning of middle cerebral artery occlusion reperfusion.Neurological function of rat models was evaluated using Zea Longa’s method.Permeability of the blood-brain barrier was assessed by Evans blue leakage.Infarct volume and brain edema were evaluated using 2,3,5-triphenyltetrazolium chloride staining.Expression of matrix metalloproteinase-9 and claudin-5 m RNA was determined by real-time quantitative reverse transcription-polymerase chain reaction.Expression of matrix metalloproteinase-9 and claudin-5 protein was measured by western blot assay.The number of matrix metalloproteinase-9-and claudin-5-positive cells was analyzed using immunohistochemistry.Our results showed that remote ischemic postconditioning alleviated disruption of the blood-brain barrier,reduced infarct volume and edema,decreased expression of matrix metalloproteinase-9 m RNA and protein and the number of positive cells,increased expression of claudin-5 m RNA and protein and the number of positive cells,and remarkably improved neurological function.These findings confirm that by suppressing expression of matrix metalloproteinase-9 and claudin-5 induced by acute ischemia/reperfusion,remote ischemic postconditioning reduces blood-brain barrier injury,mitigates ischemic injury,and exerts protective effects on the brain.
文摘目的观察急性大脑中动脉闭塞患者机械取栓术中应用Penumbra抽吸导管逆向半回收Solitaire支架取栓的效果,探讨其临床应用价值。方法急性大脑中动脉闭塞患者19例,均采用Solumbra技术行机械取栓术,术中应用Penumbra抽吸导管逆向半回收Solitaire支架取栓。术后即刻行头颅CT血管造影,采用改良脑梗死溶栓分级(modified thrombolysis in cerebral infarction score, mTICI)评估治疗效果,1次取栓未成功者立即再次取栓。比较术前、术后24 h及出院时美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale, NIHSS)评分;术后24-48 h复查头部CT平扫,观察颅内出血等并发症发生情况;术后随访24个月,记录症状改善或加重情况,评估有无动脉残余狭窄。结果 19例均成功实现大脑中动脉闭塞再通,1次取栓实现血管再通(mTICI≥2b/3级)15例,取栓2次3例,取栓3次1例,术后即刻mTICI 2b级3例、mTICI 3级16例。术后24-48 h头部CT平扫均未提示颅内出血。术后24 h时NIHSS评分[(10.3±3.9)分]低于术前[(15.2±4.8)分](P<0.05),高于出院时[(5.5±2.7)分](P<0.05)。术后随访3-24(11.3±5.7)个月,19例症状均明显改善,2例发生动脉残余狭窄者3个月后行支架植入术。结论急性大脑中动脉闭塞患者机械取栓术中应用Penumbra抽吸导管逆向半回收Solitaire支架取栓,可实现血流再通,有效改善临床症状,术后并发症发生率低。
文摘目的分析颅内支撑导管联合Solitaire FR取栓支架(solitaire FR with intracranial support catheter for mechanical thrombectomy,SWIM)技术治疗急性大脑中动脉闭塞脑梗死的安全性、有效性。方法选取2019-05—2020-05湛江中心人民医院神经外二科收治的50例急性大脑中动脉闭塞脑梗死患者为研究对象,行SWIM技术取栓,回顾性分析其临床及影像学资料。结果50例患者血管再通率92.0%,其中血管完全再通40例,部分再通6例,未通4例。50例患者治疗后NIHSS评分(5.86±2.62)与治疗前(22.09±2.31)比较差异有统计学意义(P<0.05)。50例患者术后90 d mRS与术前比较,差异有统计学意义(t=4.01,P<0.05),其中术后mRS≤2者达60%。结论对急性大脑中动脉闭塞脑梗死患者采用SWIM技术治疗临床疗效良好,安全性高。
