Background: Coronary artery disease is highly prevalent in India with onset at a younger age. Coronary collateral circulation plays an important role in protecting myocardium from infarction, preserving myocardial con...Background: Coronary artery disease is highly prevalent in India with onset at a younger age. Coronary collateral circulation plays an important role in protecting myocardium from infarction, preserving myocardial contractility and reducing cardiovascular events. The objective of the present study is to assess the pattern of coronary collateral circulation in known cases of coronary artery disease with correlation to age, gender and degree of occlusion. Method: This is a retrospective study done on 200 preoperative angiograms in patients with coronary artery disease. Patients were classified according to age, gender and degree of obstruction in major vessels. Collateral vessels were graded according to the Rentrop classification. Patients with collaterals were further classified on the basis of intensity of collaterals into 3 groups: those with no collateralization (Grade 0), poor collateralization (Grade 1) and those with adequate collateralization (Grade 2 - 3). Results: Collateral development was seen in 175 (87.5%) angiograms. Collaterals were seen in 66% for left anterior descending (LAD), 44.5% for circumflex (LCx) and 70.5% for right coronary artery (RCA) block. Coronary collaterals between LAD and posterior descending artery (PDA) via ventricular septal branches were most common pathways. Adequate collaterals were seen in 53% males and 29.3% females (p 50 years and in 32% in cases with age p = 0.014) and 54.8% cases with arterial obstruction > 90%. Conclusion: Collateral circulation between LAD and PDA via ventricular septal branches is the commonest pathway to develop. Although prevalence of LAD occlusion is higher but collaterals develop more for RCA occlusion. Adequate collaterals develop more frequently in males, cases above 50 years and in vessels with >90% obstruction.展开更多
BACKGROUND Moyamoya disease(MMD)is a rare cause of acute stroke and transient ischemic attacks in children.We described clinical,diagnostic features and follow-ups of a young child with acute stroke.CASE SUMMARY We re...BACKGROUND Moyamoya disease(MMD)is a rare cause of acute stroke and transient ischemic attacks in children.We described clinical,diagnostic features and follow-ups of a young child with acute stroke.CASE SUMMARY We report a 4-year-old girl with left hemiparesis after an acute ischemic stroke.Her history was also significant for repeated left or right focal motor seizures,generalized tonic-clonic convulsions and transient ischemic attacks.Her magnetic resonance imaging and computed tomography(CT)of the brain and magnetic resonance angiography,CT angiography and venography on the cerebral vessels revealed evidence of bilateral fronto-parietal ischemic infarctions,occlusion of the right and left internal carotid arteries started at its bifurcation and non-visualization of right and left anterior and middle cerebral arteries.There was evidence of progression in angiography manifested as development of collaterals from the basal perforating vessels,increase in the extent of large intracranial arterial stenosis/occlusion and extensive collateral circulation with predominance from the posterior circulation.Physical and neurological evaluation and comprehensive laboratory investigations excluded an obvious comorbid disease or risk factor for the child’s condition.The diagnosis of MMD was highly suggested as a cause of the child’s steno-occlusive condition.She was treated symptomatically with levetiracetam,an antiepileptic medication.Aspirin was prescribed for secondary prevention.Her clinical manifestations were improved during the three years of follow-up.Revascularization surgery was postponed.CONCLUSION Up to our knowledge,this is the first report for MMD in a child in our country.The clinical improvement and the stabilization of the child’s condition over the 3 years of follow-up could be attributed to the rapid and extensive recruitment of collaterals and absence of risk factors or comorbidities.Revascularization surgery is highly recommended.展开更多
Objective To study the relationship between syndrome elements and anterior communicating artery(ACoA)opening in patients with symptomatic severe carotid artery stenosis/occlusion.Methods Thirty-six patients with sympt...Objective To study the relationship between syndrome elements and anterior communicating artery(ACoA)opening in patients with symptomatic severe carotid artery stenosis/occlusion.Methods Thirty-six patients with symptomatic severe carotid stenosis/occlusion were collected,including 26 patients with cerebral infarction and 10 patients with transient ischemic attack(TIA).Syndrome elements at five time points were collected.Computer tomography angiography(CTA)combined with magenic resonance angiograp(MRA)was used to evaluate the primary collateral circulation,and the prognosis and syndrome elements were statistically analyzed according to whether the ACoA was open or not.Results The ACoA was open more in the primary collateral circulation among patients with symptomatic severe carotid stenosis/occlusion.There was a statistically significant difference in national institute of health stroke scale(NIHSS)score improvement and good prognosis[the modified rankin scale(mRS)≤2]between the ACoA open group and the ACoA nonopen group on the 90th day(P<0.05).The proportion of patients with internal wind syndrome,blood stasis syndrome,Qi deficiency syndrome,and Yin deficiency syndrome in the ACoA non-open group was higher than that in the open group.Conclusion In the patients with severe carotid artery stenosis/occlusion,the group with presence of anterior communicating artery had better prognosis.The syndrome elements are more complex in the group without the presence of anterior communicating artery.The proportion of Qi deficiency syndrome was positively correlated with the non-opening of anterior communicating artery.The imaging evaluation of collateral circulation can provide guidance for syndrome differentiation and treatment.展开更多
Both open and closed loop self-expandable stents were used in carotid artery stenting（CAS） for carotid bifurcation stenosis. We sought to compare the efficacy of two types of stents in CAS. The data of 212 patients ...Both open and closed loop self-expandable stents were used in carotid artery stenting（CAS） for carotid bifurcation stenosis. We sought to compare the efficacy of two types of stents in CAS. The data of 212 patients treated with CAS（42 and 170 cases implanted with closed and open loop stents, respectively） for carotid bifurcation stenosis and distal filtration protection devices were retrospectively analyzed. Between closed and open loop stents, there were no significant differences in hospitalization duration, NIHSS score before and after the treatment, stenosis at 12 th month, and cumulative incidence of primary endpoint events within 30 days or from the 31 st day to the 12 th month; while there were significant differences in hemodynamic changes and rate of difficulty in recycling distal filtration protection devices. Use of open vs. closed loop stents for carotid bifurcation stenosis seems to be associated with similar incidence of complications, except for greater rate of hemodynamic changes and lower rate of difficulty in recycling the distal filtration protection devices.展开更多
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
目的观察替格瑞洛联合麝香保心丸对冠状动脉慢性完全闭塞(chronic total occlusion,CTO)患者血管内皮的再生作用。方法根据纳入排除标准选择2019年11月1日至2021年12月31日在医院心内科住院的60例经冠状动脉造影确诊为冠状动脉CTO的患者...目的观察替格瑞洛联合麝香保心丸对冠状动脉慢性完全闭塞(chronic total occlusion,CTO)患者血管内皮的再生作用。方法根据纳入排除标准选择2019年11月1日至2021年12月31日在医院心内科住院的60例经冠状动脉造影确诊为冠状动脉CTO的患者,按治疗方法分为两组,分别为常规组和观察组,每组30例。常规组给予常规治疗和替格瑞洛治疗,观察组在常规组基础上给予麝香保心丸治疗。比较两组治疗前和治疗12个月后血管炎症指数、血管内皮损伤和增殖标志物水平的变化,记录两组内皮舒张功能和侧支循环改善率。结果治疗前两组冠状动脉CTO患者的血管炎症指标、血管内皮损伤和增殖标志物比较差异均无统计学意义(P>0.05)。治疗后,观察组可溶性CD40配体(sCD40L)、高敏C反应蛋白(hs-CRP)、内皮素-1(ET-1)、血管性血友病因子(vWF)显著下降,与常规组相比,差异具有统计学意义(P<0.05);而内皮一氧化氮合酶(eNOS)、血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)和Jagged1蛋白均显著升高,与常规组相比,差异具有统计学意义(P<0.05);两组冠状动脉CTO患者的内皮舒张功能比较差异无统计学意义(P>0.05);观察组侧支循环良好率高于常规组(P<0.05)。结论替格瑞洛联合麝香保心丸治疗冠状动脉CTO患者可抑制血管炎症的表达,纠正其内皮功能障碍,促进内皮细胞增殖,改善冠状动脉CTO患者冠状动脉侧支循环。展开更多
目的:探讨多时相CTA侧支循环评分联合血浆D-二聚体与纤维蛋白原(FIB)的比值(D/F)在预测大脑中动脉闭塞急性缺血性脑卒中(AIS)患者预后中的价值。方法:选择2021年10月-2024年4月在本院确诊为大脑中动脉闭塞AIS的102例住院患者作为研究对...目的:探讨多时相CTA侧支循环评分联合血浆D-二聚体与纤维蛋白原(FIB)的比值(D/F)在预测大脑中动脉闭塞急性缺血性脑卒中(AIS)患者预后中的价值。方法:选择2021年10月-2024年4月在本院确诊为大脑中动脉闭塞AIS的102例住院患者作为研究对象,使用Toshiba Aqui-lion ONE 320排螺旋CT机进行头颅CT扫描。根据CT灌注成像原始图像中的动脉期、静脉期和静脉晚期定义多时相CTA。采用CTP脑灌注智能分析系统自动获得核心梗死体积和低灌注体积。采用Menon评分法(0~5分)对多时相CTA上侧支血管的情况进行评分。测量血浆D二聚体和FIB水平,计算两者比值(D/F)。根据治疗后3个月时改良Rankin量表(mRS)评分将患者分为预后良好组(45例)和预后不良组(57例)。采用t或χ^(2)检验对两组患者的一般资料、多时相CTA侧支循环评分、核心梗死体积和低灌注体积进行比较。采用多因素Logistic回归分析影响AIS患者预后的独立危险因素。采用受试者特征曲线(ROC)分析CTA侧支循环评分及对血浆D/F预测大脑中动脉闭塞AIS患者预后的效能结果:相较于预后良好组,预后不良组患者的糖尿病患病比例显著升高(P<0.05),多时相CTA侧支循环评分显著降低(P<0.001)血浆D/F显著升高(P<0.001)。Pearson相关性分析结果显示,AIS患者多时相CTA侧支循环评分与血浆D/F呈显著负相关(r=-0.350,P<0.001)。多时相CTA侧支循环评分和血浆D/F单独预测AIS患者预后不良的AUC分别为0.760(95%CI:0.668~0.851,P<0.001)、0.820(95%CI:0.741~0.899,P<0.001);两者联合时AUC为0.868(95%CI:0.801~0.935,P<0.001),相应的诊断敏感度为82.5%,特异度为77.8%。结论:多时相CTA侧支循环评分联合血浆D二聚体与纤维蛋白原的比值对大脑中动脉闭塞AIS患者的预后具有一定预测价值。展开更多
文摘Background: Coronary artery disease is highly prevalent in India with onset at a younger age. Coronary collateral circulation plays an important role in protecting myocardium from infarction, preserving myocardial contractility and reducing cardiovascular events. The objective of the present study is to assess the pattern of coronary collateral circulation in known cases of coronary artery disease with correlation to age, gender and degree of occlusion. Method: This is a retrospective study done on 200 preoperative angiograms in patients with coronary artery disease. Patients were classified according to age, gender and degree of obstruction in major vessels. Collateral vessels were graded according to the Rentrop classification. Patients with collaterals were further classified on the basis of intensity of collaterals into 3 groups: those with no collateralization (Grade 0), poor collateralization (Grade 1) and those with adequate collateralization (Grade 2 - 3). Results: Collateral development was seen in 175 (87.5%) angiograms. Collaterals were seen in 66% for left anterior descending (LAD), 44.5% for circumflex (LCx) and 70.5% for right coronary artery (RCA) block. Coronary collaterals between LAD and posterior descending artery (PDA) via ventricular septal branches were most common pathways. Adequate collaterals were seen in 53% males and 29.3% females (p 50 years and in 32% in cases with age p = 0.014) and 54.8% cases with arterial obstruction > 90%. Conclusion: Collateral circulation between LAD and PDA via ventricular septal branches is the commonest pathway to develop. Although prevalence of LAD occlusion is higher but collaterals develop more for RCA occlusion. Adequate collaterals develop more frequently in males, cases above 50 years and in vessels with >90% obstruction.
文摘BACKGROUND Moyamoya disease(MMD)is a rare cause of acute stroke and transient ischemic attacks in children.We described clinical,diagnostic features and follow-ups of a young child with acute stroke.CASE SUMMARY We report a 4-year-old girl with left hemiparesis after an acute ischemic stroke.Her history was also significant for repeated left or right focal motor seizures,generalized tonic-clonic convulsions and transient ischemic attacks.Her magnetic resonance imaging and computed tomography(CT)of the brain and magnetic resonance angiography,CT angiography and venography on the cerebral vessels revealed evidence of bilateral fronto-parietal ischemic infarctions,occlusion of the right and left internal carotid arteries started at its bifurcation and non-visualization of right and left anterior and middle cerebral arteries.There was evidence of progression in angiography manifested as development of collaterals from the basal perforating vessels,increase in the extent of large intracranial arterial stenosis/occlusion and extensive collateral circulation with predominance from the posterior circulation.Physical and neurological evaluation and comprehensive laboratory investigations excluded an obvious comorbid disease or risk factor for the child’s condition.The diagnosis of MMD was highly suggested as a cause of the child’s steno-occlusive condition.She was treated symptomatically with levetiracetam,an antiepileptic medication.Aspirin was prescribed for secondary prevention.Her clinical manifestations were improved during the three years of follow-up.Revascularization surgery was postponed.CONCLUSION Up to our knowledge,this is the first report for MMD in a child in our country.The clinical improvement and the stabilization of the child’s condition over the 3 years of follow-up could be attributed to the rapid and extensive recruitment of collaterals and absence of risk factors or comorbidities.Revascularization surgery is highly recommended.
基金We thank for the funding support from the Science&Technology Development Fund of Tianjin Education Commission for Higher Education(No.2017KJ150).
文摘Objective To study the relationship between syndrome elements and anterior communicating artery(ACoA)opening in patients with symptomatic severe carotid artery stenosis/occlusion.Methods Thirty-six patients with symptomatic severe carotid stenosis/occlusion were collected,including 26 patients with cerebral infarction and 10 patients with transient ischemic attack(TIA).Syndrome elements at five time points were collected.Computer tomography angiography(CTA)combined with magenic resonance angiograp(MRA)was used to evaluate the primary collateral circulation,and the prognosis and syndrome elements were statistically analyzed according to whether the ACoA was open or not.Results The ACoA was open more in the primary collateral circulation among patients with symptomatic severe carotid stenosis/occlusion.There was a statistically significant difference in national institute of health stroke scale(NIHSS)score improvement and good prognosis[the modified rankin scale(mRS)≤2]between the ACoA open group and the ACoA nonopen group on the 90th day(P<0.05).The proportion of patients with internal wind syndrome,blood stasis syndrome,Qi deficiency syndrome,and Yin deficiency syndrome in the ACoA non-open group was higher than that in the open group.Conclusion In the patients with severe carotid artery stenosis/occlusion,the group with presence of anterior communicating artery had better prognosis.The syndrome elements are more complex in the group without the presence of anterior communicating artery.The proportion of Qi deficiency syndrome was positively correlated with the non-opening of anterior communicating artery.The imaging evaluation of collateral circulation can provide guidance for syndrome differentiation and treatment.
文摘Both open and closed loop self-expandable stents were used in carotid artery stenting（CAS） for carotid bifurcation stenosis. We sought to compare the efficacy of two types of stents in CAS. The data of 212 patients treated with CAS（42 and 170 cases implanted with closed and open loop stents, respectively） for carotid bifurcation stenosis and distal filtration protection devices were retrospectively analyzed. Between closed and open loop stents, there were no significant differences in hospitalization duration, NIHSS score before and after the treatment, stenosis at 12 th month, and cumulative incidence of primary endpoint events within 30 days or from the 31 st day to the 12 th month; while there were significant differences in hemodynamic changes and rate of difficulty in recycling distal filtration protection devices. Use of open vs. closed loop stents for carotid bifurcation stenosis seems to be associated with similar incidence of complications, except for greater rate of hemodynamic changes and lower rate of difficulty in recycling the distal filtration protection devices.
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.
文摘目的观察替格瑞洛联合麝香保心丸对冠状动脉慢性完全闭塞(chronic total occlusion,CTO)患者血管内皮的再生作用。方法根据纳入排除标准选择2019年11月1日至2021年12月31日在医院心内科住院的60例经冠状动脉造影确诊为冠状动脉CTO的患者,按治疗方法分为两组,分别为常规组和观察组,每组30例。常规组给予常规治疗和替格瑞洛治疗,观察组在常规组基础上给予麝香保心丸治疗。比较两组治疗前和治疗12个月后血管炎症指数、血管内皮损伤和增殖标志物水平的变化,记录两组内皮舒张功能和侧支循环改善率。结果治疗前两组冠状动脉CTO患者的血管炎症指标、血管内皮损伤和增殖标志物比较差异均无统计学意义(P>0.05)。治疗后,观察组可溶性CD40配体(sCD40L)、高敏C反应蛋白(hs-CRP)、内皮素-1(ET-1)、血管性血友病因子(vWF)显著下降,与常规组相比,差异具有统计学意义(P<0.05);而内皮一氧化氮合酶(eNOS)、血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)和Jagged1蛋白均显著升高,与常规组相比,差异具有统计学意义(P<0.05);两组冠状动脉CTO患者的内皮舒张功能比较差异无统计学意义(P>0.05);观察组侧支循环良好率高于常规组(P<0.05)。结论替格瑞洛联合麝香保心丸治疗冠状动脉CTO患者可抑制血管炎症的表达,纠正其内皮功能障碍,促进内皮细胞增殖,改善冠状动脉CTO患者冠状动脉侧支循环。
文摘目的:探讨多时相CTA侧支循环评分联合血浆D-二聚体与纤维蛋白原(FIB)的比值(D/F)在预测大脑中动脉闭塞急性缺血性脑卒中(AIS)患者预后中的价值。方法:选择2021年10月-2024年4月在本院确诊为大脑中动脉闭塞AIS的102例住院患者作为研究对象,使用Toshiba Aqui-lion ONE 320排螺旋CT机进行头颅CT扫描。根据CT灌注成像原始图像中的动脉期、静脉期和静脉晚期定义多时相CTA。采用CTP脑灌注智能分析系统自动获得核心梗死体积和低灌注体积。采用Menon评分法(0~5分)对多时相CTA上侧支血管的情况进行评分。测量血浆D二聚体和FIB水平,计算两者比值(D/F)。根据治疗后3个月时改良Rankin量表(mRS)评分将患者分为预后良好组(45例)和预后不良组(57例)。采用t或χ^(2)检验对两组患者的一般资料、多时相CTA侧支循环评分、核心梗死体积和低灌注体积进行比较。采用多因素Logistic回归分析影响AIS患者预后的独立危险因素。采用受试者特征曲线(ROC)分析CTA侧支循环评分及对血浆D/F预测大脑中动脉闭塞AIS患者预后的效能结果:相较于预后良好组,预后不良组患者的糖尿病患病比例显著升高(P<0.05),多时相CTA侧支循环评分显著降低(P<0.001)血浆D/F显著升高(P<0.001)。Pearson相关性分析结果显示,AIS患者多时相CTA侧支循环评分与血浆D/F呈显著负相关(r=-0.350,P<0.001)。多时相CTA侧支循环评分和血浆D/F单独预测AIS患者预后不良的AUC分别为0.760(95%CI:0.668~0.851,P<0.001)、0.820(95%CI:0.741~0.899,P<0.001);两者联合时AUC为0.868(95%CI:0.801~0.935,P<0.001),相应的诊断敏感度为82.5%,特异度为77.8%。结论:多时相CTA侧支循环评分联合血浆D二聚体与纤维蛋白原的比值对大脑中动脉闭塞AIS患者的预后具有一定预测价值。
