Intracranial arterial stenosis in young adults:risk factors,diagnosis and treatment

Intracranial artery stenosis(ICAS)in youth is an under-explored condition.ICAS is one of the leading causes of stroke in young people worldwide and confers a higher risk of stroke recurrence,leading to a poor prognosis for individuals and a great burden to society.The etiology and risk factors of ICAS in youth differ from those of older patients,thus resulting in a difference in the progression and prognosis of the disease.Even though the diagnosis of ICAS is lumen-based,it is sometimes difficult to identify in young patients based on imaging alone.Notably,novel vessel wall imaging techniques play an important role in determining the cause of stenosis and screening patients at high risk of recurrence.Moreover,pharmacologic regimens and risk factor control goals for ICAS in young adults are largely consistent with those in older patients.Thus,considering the poor prognosis,there is an urgent need for high-quality studies in the young ICAS population to analyze the high-quality observational data collected.

Safety and efficacy of coronary drug eluting stent for atherosclerotic stenosis of the small renal artery

Small diameter renal artery refers to the renal artery with the cross-section diameter less than 5 mm, the incidence of which is approximately 8%＇ Small diameter renal artery is common in patients with congenital multi-branch renal arteries, diabetes and multi-coronary artery lesions. Renal artery bare-mental stent （BMS） implantation is the standard treatment for ostial renal

An elevated platelet-to-lymphocyte ratio is associated with a higher risk of intracranial atherosclerotic stenosis

Background:Previous studies have shown that inflammation plays an important role in intracranial atherosclerotic stenosis(ICAS).The platelet-to-lymphocyte ratio(PLR)has recently emerged as a potential inflammatory biomarker.This study aimed to explore the association of the PLR with ICAS in a Chinese Han population.Methods:A total of 2134 participants(518 with ICAS,1616 without ICAS)were enrolled in this study.ICAS was defined as atherosclerotic stenosis>50%or the occlusion of several main intracranial arteries.Multivariable logistic regression analyses were used to assess the association of the PLR with ICAS.Additional subgroup analyses were performed according to age(<60 vs.≥60 years)and acute ischemic stroke.Results:Multivariate regression analysis showed that a high PLR was associated with a higher risk of ICAS in all participants(P<0.001).Compared with the lowest quartile,the fourth PLR quartile was significantly associated with ICAS(OR 1.705,95%confidence interval 1.278–2.275,P<0.001).In the subgroups stratified by age,an association between the PLR and ICAS was found in the late-life group(P<0.001),but not in the mid-life group(P=0.650).In the subgroups stratified by acute ischemic stroke,the relationship between an elevated PLR and a higher risk of ICAS remained unchanged(stroke group,P<0.001;non-stroke group,P=0.027).Conclusions:An elevated PLR was associated with a higher risk of ICAS in a Chinese Han population.The PLR might serve as a potential biomarker for ICAS in the elderly population.

Dynamic changes of renal cortical blood perfusion before and after percutaneous transluminal renal artery stenting in patients with severe atherosclerotic renal artery stenosis

Background:This study aims to observe the dynamic changes of renal artery(RA)disease and cortical blood perfusion(CBP)evaluated by contrast-enhanced ultrasound(CEUS)after percutaneous transluminal renal artery stenting(PTRAS)in patients with severe atherosclerotic renal artery stenosis(ARAS)and to analyze the relationship between CBP and prognosis.Methods:This was a single-center retrospective cohort study.A total of 98 patients with unilateral severe ARAS after successful PTRAS in Beijing Hospital from September 2017 to September 2020 were included.According to renal glomerular filtration rate(GFR)detected by radionuclide imaging at 12 months after PTRAS,all patients were divided into the poor prognosis group(n=21,GFR decreased by≥20%compared with baseline)and the control group(n=77,GFR decreased by<20%or improved compared with baseline).Renal artery stenosis was diagnosed by digital subtraction angiography,and renal CBP was evaluated by CEUS using TomTec Imaging Systems(Germany)before PTRAS,at 6 months and 12 months after discharge.The receiver operating characteristic(ROC)curve with area under the curve(AUC)was used to analyze the predictive value of CBP parameters,including area under ascending curve(AUC1),area under the descending curve(AUC2),rising time(RT),time to peak intensity(TTP),maximum intensity(IMAX),and mean transit time(MTT)for poor prognosis.Results:Among the 98 patients,there were 52 males(53.1%),aged 55–74 years old,with an average age of 62.1±8.7 years,and an average artery stenosis of 82.3±12.9%.The poor prognosis group was associated with significantly increased incidence of diabetes(76.2%vs.41.6%),and lower levels of GFR of the stenotic kidney(21.8 mL/min vs.25.0 mL/min)and total GFR(57.6 mL/min vs.63.7 mL/min)(all P<0.05),compared with the control group(P<0.05).In addition,the rate of RA restenosis was significantly higher in the poor prognosis group than in the control group(9.5%vs.0,χ^(2)=9.462,P=0.002).Compared with the control group,the poor prognosis group was associated with significantly decreased baseline AUC1 and AUC2,and extended duration of TTP and MTT(P<0.05).At 6 months and 12 months of follow-up,patients in the control group were associated with markedly increased AUC1,AUC2,and IMAX,and shorter duration of RT and MTT(P<0.05).The ROC curve showed that the predictive values of AUC1,AUC2,RT,TTP,IMAX,and MTT for poor prognosis were 0.812(95%CI:0.698–0.945),0.752(95%CI:0.591–0.957),0.724(95%CI:0.569–0.961),0.720(95%CI:0.522–0.993),0.693(95%CI:0.507–0.947),and 0.786(95%CI:0.631–0.979),respectively.Conclusions:Preoperative renal CBP in severe ARAS patients with poor prognosis is significantly reduced,and does not show significant improvement after stent treatment over the first year of follow-up.The parameter AUC1 may be a good predictor for renal dysfunction after PTRAS in severe ARAS patients.Trial Registration:ChiCTR.org.cn,ChiCTR1800016252.

Effect of Huanshuai Recipe Oral Liquid (缓衰口服液) on Renal Dysfunction Progression in Patients with Atherosclerotic Renal Artery Stenosis

Objective： To investigate the effect of Huanshuai Recipe Oral Liquid （缓衰口服液, HSR） on retarding the progression of renal dysfunction in patients with atherosclerotic renal artery stenosis （ARAS）. Methods： A total of 52 ARAS patients with the Chinese medicine （CM） syndrome of qi deficiency and blood stasis, phlegm and dampness retention were recruited and randomly assigned into the treatment group （36 cases） and the control group （16 cases）. Both groups received a basic treatment （high-quality low-protein diet, blood pressure control, lipid-lowering, correcting the acidosis, etc.）. In addition, the treatment group received 20 mL HSR and the control group received placebo, 3 times a day for 6 months. Renal function （serum creatinine, blood urea nitrogen and uric acid） and blood lipids （cholesterol, triglycerides and low density lipoprotein） were examined monthly. The estimated glomerular filtration rate （eGFR） and CM syndrome score were compared between groups. Results： After treatment, compared with the control group, the serum creatinine level, uric acid level and CM syndrome score of the treatment group were significantly decreased （P〈0.05 or P〈0.01）, and the eGFR in the treatment group were significantly increased （P〈0.05）. Conclusion： HSR can effectively improve the renal function and clinical symptoms of ARAS patients.