Collateral circulation plays a vital role in sustaining blood flow to the ischaemic areas in acute,subacute or chronic phases after an ischaemic stroke or transient ischaemic attack.Good collateral circulation has sho...Collateral circulation plays a vital role in sustaining blood flow to the ischaemic areas in acute,subacute or chronic phases after an ischaemic stroke or transient ischaemic attack.Good collateral circulation has shown protective effects towards a favourable functional outcome and a lower risk of recurrence in stroke attributed to different aetiologies or undergoing medical or endovascular treatment.Over the past decade,the importance of collateral circulation has attracted more attention and is becoming a hot spot for research.However,the diversity in imaging methods and criteria to evaluate collateral circulation has hindered comparisons of findings from different cohorts and further studies in exploring the clinical relevance of collateral circulation and possible methods to enhance collateral flow.The statement is aimed to update currently available evidence and provide evidence-based recommendations regarding grading methods for collateral circulation,its significance in patients with stroke and methods under investigation to improve collateral flow.展开更多
Background:High on-treatment platelet reactivity (HTPR) has been suggested as a risk factor for patients with ischemic vascular disease.We explored a predictive model of platelet reactivity to clopidogrel and the rela...Background:High on-treatment platelet reactivity (HTPR) has been suggested as a risk factor for patients with ischemic vascular disease.We explored a predictive model of platelet reactivity to clopidogrel and the relationship with clinical outcomes.Methods:A total of 441 patients were included.Platelet reactivity was measured by light transmittance aggregometry after receiving dual antiplatelet therapy.HTPR was defined by the consensus cutoff of maximal platelet aggregation >46% by light transmittance aggregometry.CYP2C19 loss-of-function polymorphisms were identified by DNA microarray analysis.The data were compared by binary logistic regression to find the risk factors.The primary endpoint was major adverse clinical events (MACEs),and patients were followed for a median time of 29 months.Survival curves were constructed with Kaplan-Meier estimates and compared by logrank tests between the patients with HTPR and non-HTPR.Results:The rate of HTPR was 17.2%.Logistic regression identified the following predictors of HTPR:age,therapy regimen,body mass index,diabetes history,CYP2C19^*2,or CYP2C19^*3 variant.The area under the curve of receiver operating characteristic for the HTPR predictive model was 0.793 (95% confidence interval:0.738–0.848).Kaplan-Meier analysis showed that patients with HTPR had a higher incidence of MACE than those with non-HTPR (21.1% vs.9.9%;χ^2 = 7.572,P = 0.010).Conclusions:Our results suggest that advanced age,higher body mass index,treatment with regular dual antiplatelet therapy,diabetes,and CYP2C19^*2 or CYP2C19^*3 carriers are significantly associated with HTPR to clopidogrel.The predictive model of HTPR has useful discrimination and good calibration and may predict long-term MACE.展开更多
文摘Collateral circulation plays a vital role in sustaining blood flow to the ischaemic areas in acute,subacute or chronic phases after an ischaemic stroke or transient ischaemic attack.Good collateral circulation has shown protective effects towards a favourable functional outcome and a lower risk of recurrence in stroke attributed to different aetiologies or undergoing medical or endovascular treatment.Over the past decade,the importance of collateral circulation has attracted more attention and is becoming a hot spot for research.However,the diversity in imaging methods and criteria to evaluate collateral circulation has hindered comparisons of findings from different cohorts and further studies in exploring the clinical relevance of collateral circulation and possible methods to enhance collateral flow.The statement is aimed to update currently available evidence and provide evidence-based recommendations regarding grading methods for collateral circulation,its significance in patients with stroke and methods under investigation to improve collateral flow.
文摘Background:High on-treatment platelet reactivity (HTPR) has been suggested as a risk factor for patients with ischemic vascular disease.We explored a predictive model of platelet reactivity to clopidogrel and the relationship with clinical outcomes.Methods:A total of 441 patients were included.Platelet reactivity was measured by light transmittance aggregometry after receiving dual antiplatelet therapy.HTPR was defined by the consensus cutoff of maximal platelet aggregation >46% by light transmittance aggregometry.CYP2C19 loss-of-function polymorphisms were identified by DNA microarray analysis.The data were compared by binary logistic regression to find the risk factors.The primary endpoint was major adverse clinical events (MACEs),and patients were followed for a median time of 29 months.Survival curves were constructed with Kaplan-Meier estimates and compared by logrank tests between the patients with HTPR and non-HTPR.Results:The rate of HTPR was 17.2%.Logistic regression identified the following predictors of HTPR:age,therapy regimen,body mass index,diabetes history,CYP2C19^*2,or CYP2C19^*3 variant.The area under the curve of receiver operating characteristic for the HTPR predictive model was 0.793 (95% confidence interval:0.738–0.848).Kaplan-Meier analysis showed that patients with HTPR had a higher incidence of MACE than those with non-HTPR (21.1% vs.9.9%;χ^2 = 7.572,P = 0.010).Conclusions:Our results suggest that advanced age,higher body mass index,treatment with regular dual antiplatelet therapy,diabetes,and CYP2C19^*2 or CYP2C19^*3 carriers are significantly associated with HTPR to clopidogrel.The predictive model of HTPR has useful discrimination and good calibration and may predict long-term MACE.
