BACKGROUND： Due to collateral circulation and cerebrovascular reserve, arterial stenosis and reduced cerebral blood flow may not necessarily indicate impaired cerebral peffusion. Therefore, according to degree of ste...BACKGROUND： Due to collateral circulation and cerebrovascular reserve, arterial stenosis and reduced cerebral blood flow may not necessarily indicate impaired cerebral peffusion. Therefore, according to degree of stenosis and clinical symptoms, interventional surgery to relieve arterial stenosis in transient ischemic attack （TIA） patients with major intracranial stenosis is imprudent. Rather, cerebral perfusion and reserve capacity are direct indicators for the assessment of degree and presence of cerebral ischemia. OBJECTIVE： To evaluate cerebral perfusion and reserve in TIA patients with major intracranial stenosis or occlusion using magnetic resonance-perfusion-weighted imaging （MR-PWl） data prior to and following diamox administration. DESIGN, TIME AND SETTING： A self-comparative, neuroimaging observation was performed at the Neurological Department and Radiological Center of the First Affiliated Hospital of Jinan University between December 2007 and April 2009. PARTICIPANTS： Seven acute TIA patients, who were admitted to the Neurological Department of the First Affiliated Hospital of Jinan University between December 2007 and April 2009, were enrolled in the present study. Magnetic resonance imaging confirmed that no acute cerebral infarction happened, nor did bleeding exist. Magnetic resonance angiography, transcranial Doppler ultrasound, and/or digital subtraction angiography confirmed the presence of major intracranial arterial stenosis. Clinical symptoms corresponded to blood supplying regions of the arterial stenosis. METHODS： Baseline MR-PWI was performed on seven patients with intracranial stenosis or occlusion. Two grams of acetazolamide （diamox） were orally administered after 2 days. A second PWl was performed after 2 hours to compare cerebral perfusion parameters prior to and following diamox administration. MAIN OUTCOME MEASURES： PWI results of cerebral perfusion prior to and following diamox administration. RESULTS： The baseline PWl from five patients indicated decreased cerebral perfusion areas. Following oral administration of diamox, cerebral perfusion significantly decreased in those areas. Moreover, new areas of decreased cerebral perfusion were observed in two out of the five patients. In one patient, no significant decrease in cerebral perfusion was found. In another patient, baseline PWl indicated decreased cerebral perfusion in the left hemisphere. However, normal perfusion was observed in both cerebral lobes following diamox administration. CONCLUSION： TIA patients with intracranial stenosis, who are diagnosed by PWI and exhibited decreased cerebral perfusion and reserve, might require further treatment such as intervention by angioptasty.展开更多
BACKGROUND： If changes of hemodynamics in internal or external cranial artery and stenosis of atherosclerosis are found eady, patients with transient ischemic attack （TIA） may be treated at an eady phase so as to p...BACKGROUND： If changes of hemodynamics in internal or external cranial artery and stenosis of atherosclerosis are found eady, patients with transient ischemic attack （TIA） may be treated at an eady phase so as to prevent and decrease the onset of cerebral infarction. Carotid Doppler can analyze carotid canal wall, hemodynamic properties and stenosis, and changes of plaque morphology; however, transcranial Doppler （TCD） can evaluate vascular stenosis and occlusion and judge collateral circulation in cranium through detecting velocity and direction of blood flow. Can the association of them increase the diagnostic rate of TIA？ OB3ECTIVE： To evaluate the effect of the association of carotid Doppler and TCD on TIA in internal carotid artery. DESIGN： Contrast observational study SETTING： Department of Neuroelectrophysiology, Central People＇s Hospital of Huizhou PARTICIPANTS： A total of 54 patients with TIA in internal carotid artery were selected from the Department of Neurology of Huizhou Central People＇s Hospital from May 2004 to June 2005. There were 35 males and 24 females aged 46-81 years. The clinical situation was asthenia of single limb, hemiplegia, anaesthesia of single upper or lower limb, hemianesthesia, sensory disorder and aphasia. The symptoms lasted for less than 2 hours. All cases were diagnosed with CT, and those who had pathological changes of acute cerebral infarction and history of cardiac disease were excluded. Additionally, 50 healthy subjects who were regarded as control group were selected from the Department of Neurology of Huizhou Central People＇s Hospital. There were 30 males and 20 females aged 45-80 years. All subjects were consent. METHODS： HD15000 color Doppler ultrasound （Philips Company, USA） and Muliti-DopX2 TCD （DWL Company, Germany） were used to detect hemodynamics, stenosis and distribution of atherosclerosis in carotid artery and internal carotid artery. Evaluation of marker： Stenosis was calculated by the ratio between the minimal cavity and vascular sectional area at the maximal site of plaque （mild： stenosis 〈 50%; moderate and severe： stenosis t〉 50%）. With TCD, the following results were regarded as stenosis： blood velocity of average envelope 〉 120 cm/s （diagnostic criteria of vascular stenosis of basilar artery： blood velocity of average envelope 〉 80 cm/s）, increase and segmental property of blood flow, and murmu of turbulent flow and vessel. MAIN OUTCOME MEASURES： Positive rate of atherosclerosis and incidence of stenosis with carotid Doppler and TCD. RESULTS： All 54 TIA patients and 50 healthy subjects were involved in the final analysis. ① Results of carotid Doppler： Atherosclerosis and stenosis were obvious in experimental group. Positive rate of atherosclerosis was 85% （46/54） and incidence of stenosis of carotid artery was 41% （22/54）, which were higher than those in control group [52% （26/54）, 41% （22/54）, x^2 = 13.42, 10.90, P 〈 0.01]. ② Results of TCD： In experimental group, positive rate of atherosclerosis at base of skull was 89% （48/54） and incidence of stenosis of internal cranial artery was 48% （26/54）, which were higher than those in control group [62% （31/50）, 0, x^2 = 10.28, 32.00, P 〈 0.01]. Stenosis of artery was mainly involved in middle cerebral artery, initial segment and crotch of carotid artery. CONCLUSION： The association of carotid Doppler and TCD can increase clinically diagnostic rate of TIA and provide bases for apposition and intensity of TIA lesion.展开更多
Objective:To investigate the effect of cold weather on carotid artery stenosis and occlusion.Methods:We conducted a retrospective observational study,in which 145 patients with carotid artery stenosis and occlusion we...Objective:To investigate the effect of cold weather on carotid artery stenosis and occlusion.Methods:We conducted a retrospective observational study,in which 145 patients with carotid artery stenosis and occlusion were enrolled[115 men and 30 women;the mean age was 61.08 years(95%CI 59.27-62.88)].Patients were divided into the low-temperature group(n=98)(≤12℃)and the non-low temperature group(n=47)(>12℃).Clinical characteristics,blood pressure,National Institutes of Health Stroke Scale(NIHSS),blood fat,and blood viscositys were compared between the two groups.Correlation between NIHSS and mean daily temperature was analyzed.Results:There was no significant difference in the systolic and diastolic blood pressure between the two groups(P>0.05).The NIHSS score was slightly higher in the non-low temperature group compared to that of the low-temperature group(U=2984,P<0.01).Glycemia,cholesterol level,prothrombin time,fibrinogen,and International Normalized Ratio did not show any significant difference(P>0.05).Correlation analysis showed a very low positive and statistically significant correlation between ambient temperature and NIHSS score(r=0.18,P=0.029).Conclusion:Cold weather does not impact blood pressure,blood cholesterol,and coagulation factors of patients with carotid artery stenosis and occlusion.The neurological deficit is more severe in the non-low ambient temperature group.A potential relationship exists between ambient temperature and the level of neurological impairment.展开更多
Objective:To explore the effect of atorvastatin calcium on the carotid atherosclerotic plaque, serum lipid level, and cerebral hemodynamic indicators in patients with transient ischemic attack (TIA).Methods:A total of...Objective:To explore the effect of atorvastatin calcium on the carotid atherosclerotic plaque, serum lipid level, and cerebral hemodynamic indicators in patients with transient ischemic attack (TIA).Methods:A total of 80 patients with TIA and carotid atherosclerotic plaque who were admitted in our hospital and confirmed by the ultrasound were included in the study and randomized into the treatment group and the control group (n = 40). The patients in the two groups were given TIA routine treatments and aspirin. On this basis, the patients in the treatment group were given atorvastatin calcium. The carotid ultrasound before treatment and 6 months after treatment in the two groups was performed to compare the atherosclerotic plaque area and IMT. The serum lipid level and cerebral hemodynamic parameters were detected. Results:IMT and carotid plaque area after treatment in the treatment group were significantly reduced when compared with before treatment (P<0.05). IMT and carotid plaque area after treatment in the treatment group were significantly lower than those in the control group (P<0.05). The comparison of TC, TG, LDL, and HDL levels before treatment between the two groups was not statistically significant (P>0.05). TC, TG, and LDL levels after treatment were significantly reduced when compared with before treatment (P<0.05), while HDL level was significantly elevated when compared with before treatment (P<0.05). TC, TG, and LDL levels after treatment in the treatment group were significantly lower than those in the control group (P<0.05), while HDL level was significantly higher than that in the control group (P<0.05). The average blood velocity and average blood flow volume of cerebral circulation after treatment in the treatment group were significantly higher than those in the control group (P<0.05), while the cerebrovascular characteristic resistance and peripheral resistance were significantly lower than those in the control group (P<0.05).Conclusions:Atorvastatin calcium in the treatment of TIA can significantly reduce the serum lipid level, alleviate or stabilize the carotid atherosclerotic plaque, and improve the cerebral hemodynamic indicators, with a significant efficacy.展开更多
Background:Previous single-center studies have demonstrated that drug-coated balloons(DCBs)may reduce restenosis rates,which is an important factor affecting the prognosis for intracranial interventional therapy.Howev...Background:Previous single-center studies have demonstrated that drug-coated balloons(DCBs)may reduce restenosis rates,which is an important factor affecting the prognosis for intracranial interventional therapy.However,currently available cardiac DCBs are not always suitable for the treatment of intracranial atherosclerotic stenosis(ICAS).This study aimed to evaluate the safety and efficacy of a novel DCB catheter designed for patients with severely symptomatic ICAS.Methods:This prospective,multicenter,single-arm,target-value clinical trial was conducted in 9 Chinese stroke centers to evaluate the safety and efficacy of a novel DCB catheter for treating symptomatic severe ICAS.Primary metrics and other indicators were collected and analyzed using SAS version 9.4(SAS Institute,Cary,NC,USA).Results:A total of 155 patients were enrolled in this study.The preliminary collection of follow-up data has been completed,while data quality control is ongoing.Conclusion:Results of this study demonstrated the patency rate,safety,and effectiveness of a novel on-label paclitaxel DCB designed for the treatment of ICAS.Ethics and dissemination:This study,involving human participants,was reviewed and approved by the Ethics Committee of Drugs(Devices)Clinical Experiment at Henan Provincial People’s Hospital(reference number:2020-145-03)and other research centers participating in the clinical trial.The results of this study will be presented at international conferences and sent to peer-reviewed journals for publication.Standard protocol items:The Recommendations for Interventional Trials checklist was used when drafting the study protocol.Trial registration number:Registered with the Chinese Clinical Trial Registry on June 11,2021(Chi CTR2100047223).展开更多
目的探究颈动脉支架植入术(CAS)后缺血性脑卒中患者脑组织灌注、神经影像学及相关因子变化。方法选取2021-01—2022-12邢台市第三医院收治的80例缺血性脑卒中患者为研究对象,分为CAS组和颈动脉内膜剥脱术(CEA)组各40例,对比2组患者治疗...目的探究颈动脉支架植入术(CAS)后缺血性脑卒中患者脑组织灌注、神经影像学及相关因子变化。方法选取2021-01—2022-12邢台市第三医院收治的80例缺血性脑卒中患者为研究对象,分为CAS组和颈动脉内膜剥脱术(CEA)组各40例,对比2组患者治疗前后脑组织灌注情况[峰值时间(TTP)、平均通过时间(MTT)、脑血流量(CBF)、脑血容量(CBV)]、颈动脉狭窄及血管内皮生长因子(VEGF)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)等情况。结果治疗后2组患者TTP、MTT均降低,CBF、CBV均升高,CAS组较CEA组变化更显著(P<0.05)。治疗后2组患者颈动脉狭窄处血管内径测量结果均较治疗前增加,CAS组较CEA组变化更为显著(P<0.05)。治疗后2组患者VEGF、hs-CRP、TNF-α、IL-6水平均呈先升高后降低的趋势,治疗后1 d及7 d CEA组患者VEGF、hs-CRP、TNF-α、IL-6水平均高于CAS组(P<0.05)。结论CAS可改善缺血性脑卒中患者术后脑组织灌注及颈动脉狭窄处血管内径,对患者的相关因子水平影响较小,具有较好的治疗效果。展开更多
基金Medical Scientific and Technological Research Foundation of Guangdong Province, No. 2007332 2009360the Natural Science Foundation of Guangdong Province, No. 9451063201002951
文摘BACKGROUND： Due to collateral circulation and cerebrovascular reserve, arterial stenosis and reduced cerebral blood flow may not necessarily indicate impaired cerebral peffusion. Therefore, according to degree of stenosis and clinical symptoms, interventional surgery to relieve arterial stenosis in transient ischemic attack （TIA） patients with major intracranial stenosis is imprudent. Rather, cerebral perfusion and reserve capacity are direct indicators for the assessment of degree and presence of cerebral ischemia. OBJECTIVE： To evaluate cerebral perfusion and reserve in TIA patients with major intracranial stenosis or occlusion using magnetic resonance-perfusion-weighted imaging （MR-PWl） data prior to and following diamox administration. DESIGN, TIME AND SETTING： A self-comparative, neuroimaging observation was performed at the Neurological Department and Radiological Center of the First Affiliated Hospital of Jinan University between December 2007 and April 2009. PARTICIPANTS： Seven acute TIA patients, who were admitted to the Neurological Department of the First Affiliated Hospital of Jinan University between December 2007 and April 2009, were enrolled in the present study. Magnetic resonance imaging confirmed that no acute cerebral infarction happened, nor did bleeding exist. Magnetic resonance angiography, transcranial Doppler ultrasound, and/or digital subtraction angiography confirmed the presence of major intracranial arterial stenosis. Clinical symptoms corresponded to blood supplying regions of the arterial stenosis. METHODS： Baseline MR-PWI was performed on seven patients with intracranial stenosis or occlusion. Two grams of acetazolamide （diamox） were orally administered after 2 days. A second PWl was performed after 2 hours to compare cerebral perfusion parameters prior to and following diamox administration. MAIN OUTCOME MEASURES： PWI results of cerebral perfusion prior to and following diamox administration. RESULTS： The baseline PWl from five patients indicated decreased cerebral perfusion areas. Following oral administration of diamox, cerebral perfusion significantly decreased in those areas. Moreover, new areas of decreased cerebral perfusion were observed in two out of the five patients. In one patient, no significant decrease in cerebral perfusion was found. In another patient, baseline PWl indicated decreased cerebral perfusion in the left hemisphere. However, normal perfusion was observed in both cerebral lobes following diamox administration. CONCLUSION： TIA patients with intracranial stenosis, who are diagnosed by PWI and exhibited decreased cerebral perfusion and reserve, might require further treatment such as intervention by angioptasty.
文摘BACKGROUND： If changes of hemodynamics in internal or external cranial artery and stenosis of atherosclerosis are found eady, patients with transient ischemic attack （TIA） may be treated at an eady phase so as to prevent and decrease the onset of cerebral infarction. Carotid Doppler can analyze carotid canal wall, hemodynamic properties and stenosis, and changes of plaque morphology; however, transcranial Doppler （TCD） can evaluate vascular stenosis and occlusion and judge collateral circulation in cranium through detecting velocity and direction of blood flow. Can the association of them increase the diagnostic rate of TIA？ OB3ECTIVE： To evaluate the effect of the association of carotid Doppler and TCD on TIA in internal carotid artery. DESIGN： Contrast observational study SETTING： Department of Neuroelectrophysiology, Central People＇s Hospital of Huizhou PARTICIPANTS： A total of 54 patients with TIA in internal carotid artery were selected from the Department of Neurology of Huizhou Central People＇s Hospital from May 2004 to June 2005. There were 35 males and 24 females aged 46-81 years. The clinical situation was asthenia of single limb, hemiplegia, anaesthesia of single upper or lower limb, hemianesthesia, sensory disorder and aphasia. The symptoms lasted for less than 2 hours. All cases were diagnosed with CT, and those who had pathological changes of acute cerebral infarction and history of cardiac disease were excluded. Additionally, 50 healthy subjects who were regarded as control group were selected from the Department of Neurology of Huizhou Central People＇s Hospital. There were 30 males and 20 females aged 45-80 years. All subjects were consent. METHODS： HD15000 color Doppler ultrasound （Philips Company, USA） and Muliti-DopX2 TCD （DWL Company, Germany） were used to detect hemodynamics, stenosis and distribution of atherosclerosis in carotid artery and internal carotid artery. Evaluation of marker： Stenosis was calculated by the ratio between the minimal cavity and vascular sectional area at the maximal site of plaque （mild： stenosis 〈 50%; moderate and severe： stenosis t〉 50%）. With TCD, the following results were regarded as stenosis： blood velocity of average envelope 〉 120 cm/s （diagnostic criteria of vascular stenosis of basilar artery： blood velocity of average envelope 〉 80 cm/s）, increase and segmental property of blood flow, and murmu of turbulent flow and vessel. MAIN OUTCOME MEASURES： Positive rate of atherosclerosis and incidence of stenosis with carotid Doppler and TCD. RESULTS： All 54 TIA patients and 50 healthy subjects were involved in the final analysis. ① Results of carotid Doppler： Atherosclerosis and stenosis were obvious in experimental group. Positive rate of atherosclerosis was 85% （46/54） and incidence of stenosis of carotid artery was 41% （22/54）, which were higher than those in control group [52% （26/54）, 41% （22/54）, x^2 = 13.42, 10.90, P 〈 0.01]. ② Results of TCD： In experimental group, positive rate of atherosclerosis at base of skull was 89% （48/54） and incidence of stenosis of internal cranial artery was 48% （26/54）, which were higher than those in control group [62% （31/50）, 0, x^2 = 10.28, 32.00, P 〈 0.01]. Stenosis of artery was mainly involved in middle cerebral artery, initial segment and crotch of carotid artery. CONCLUSION： The association of carotid Doppler and TCD can increase clinically diagnostic rate of TIA and provide bases for apposition and intensity of TIA lesion.
文摘Objective:To investigate the effect of cold weather on carotid artery stenosis and occlusion.Methods:We conducted a retrospective observational study,in which 145 patients with carotid artery stenosis and occlusion were enrolled[115 men and 30 women;the mean age was 61.08 years(95%CI 59.27-62.88)].Patients were divided into the low-temperature group(n=98)(≤12℃)and the non-low temperature group(n=47)(>12℃).Clinical characteristics,blood pressure,National Institutes of Health Stroke Scale(NIHSS),blood fat,and blood viscositys were compared between the two groups.Correlation between NIHSS and mean daily temperature was analyzed.Results:There was no significant difference in the systolic and diastolic blood pressure between the two groups(P>0.05).The NIHSS score was slightly higher in the non-low temperature group compared to that of the low-temperature group(U=2984,P<0.01).Glycemia,cholesterol level,prothrombin time,fibrinogen,and International Normalized Ratio did not show any significant difference(P>0.05).Correlation analysis showed a very low positive and statistically significant correlation between ambient temperature and NIHSS score(r=0.18,P=0.029).Conclusion:Cold weather does not impact blood pressure,blood cholesterol,and coagulation factors of patients with carotid artery stenosis and occlusion.The neurological deficit is more severe in the non-low ambient temperature group.A potential relationship exists between ambient temperature and the level of neurological impairment.
文摘Objective:To explore the effect of atorvastatin calcium on the carotid atherosclerotic plaque, serum lipid level, and cerebral hemodynamic indicators in patients with transient ischemic attack (TIA).Methods:A total of 80 patients with TIA and carotid atherosclerotic plaque who were admitted in our hospital and confirmed by the ultrasound were included in the study and randomized into the treatment group and the control group (n = 40). The patients in the two groups were given TIA routine treatments and aspirin. On this basis, the patients in the treatment group were given atorvastatin calcium. The carotid ultrasound before treatment and 6 months after treatment in the two groups was performed to compare the atherosclerotic plaque area and IMT. The serum lipid level and cerebral hemodynamic parameters were detected. Results:IMT and carotid plaque area after treatment in the treatment group were significantly reduced when compared with before treatment (P<0.05). IMT and carotid plaque area after treatment in the treatment group were significantly lower than those in the control group (P<0.05). The comparison of TC, TG, LDL, and HDL levels before treatment between the two groups was not statistically significant (P>0.05). TC, TG, and LDL levels after treatment were significantly reduced when compared with before treatment (P<0.05), while HDL level was significantly elevated when compared with before treatment (P<0.05). TC, TG, and LDL levels after treatment in the treatment group were significantly lower than those in the control group (P<0.05), while HDL level was significantly higher than that in the control group (P<0.05). The average blood velocity and average blood flow volume of cerebral circulation after treatment in the treatment group were significantly higher than those in the control group (P<0.05), while the cerebrovascular characteristic resistance and peripheral resistance were significantly lower than those in the control group (P<0.05).Conclusions:Atorvastatin calcium in the treatment of TIA can significantly reduce the serum lipid level, alleviate or stabilize the carotid atherosclerotic plaque, and improve the cerebral hemodynamic indicators, with a significant efficacy.
基金funded by The Henan Province Young and Middle-aged Health Science and Technology Innovation Young Talent Training Project(,Grant/Award Number:YXKC20200041)National Health Commission Capacity Building and Continuing Education Project(Grant/Award Number:GWJJ2023100101)
文摘Background:Previous single-center studies have demonstrated that drug-coated balloons(DCBs)may reduce restenosis rates,which is an important factor affecting the prognosis for intracranial interventional therapy.However,currently available cardiac DCBs are not always suitable for the treatment of intracranial atherosclerotic stenosis(ICAS).This study aimed to evaluate the safety and efficacy of a novel DCB catheter designed for patients with severely symptomatic ICAS.Methods:This prospective,multicenter,single-arm,target-value clinical trial was conducted in 9 Chinese stroke centers to evaluate the safety and efficacy of a novel DCB catheter for treating symptomatic severe ICAS.Primary metrics and other indicators were collected and analyzed using SAS version 9.4(SAS Institute,Cary,NC,USA).Results:A total of 155 patients were enrolled in this study.The preliminary collection of follow-up data has been completed,while data quality control is ongoing.Conclusion:Results of this study demonstrated the patency rate,safety,and effectiveness of a novel on-label paclitaxel DCB designed for the treatment of ICAS.Ethics and dissemination:This study,involving human participants,was reviewed and approved by the Ethics Committee of Drugs(Devices)Clinical Experiment at Henan Provincial People’s Hospital(reference number:2020-145-03)and other research centers participating in the clinical trial.The results of this study will be presented at international conferences and sent to peer-reviewed journals for publication.Standard protocol items:The Recommendations for Interventional Trials checklist was used when drafting the study protocol.Trial registration number:Registered with the Chinese Clinical Trial Registry on June 11,2021(Chi CTR2100047223).
文摘目的探究颈动脉支架植入术(CAS)后缺血性脑卒中患者脑组织灌注、神经影像学及相关因子变化。方法选取2021-01—2022-12邢台市第三医院收治的80例缺血性脑卒中患者为研究对象,分为CAS组和颈动脉内膜剥脱术(CEA)组各40例,对比2组患者治疗前后脑组织灌注情况[峰值时间(TTP)、平均通过时间(MTT)、脑血流量(CBF)、脑血容量(CBV)]、颈动脉狭窄及血管内皮生长因子(VEGF)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)等情况。结果治疗后2组患者TTP、MTT均降低,CBF、CBV均升高,CAS组较CEA组变化更显著(P<0.05)。治疗后2组患者颈动脉狭窄处血管内径测量结果均较治疗前增加,CAS组较CEA组变化更为显著(P<0.05)。治疗后2组患者VEGF、hs-CRP、TNF-α、IL-6水平均呈先升高后降低的趋势,治疗后1 d及7 d CEA组患者VEGF、hs-CRP、TNF-α、IL-6水平均高于CAS组(P<0.05)。结论CAS可改善缺血性脑卒中患者术后脑组织灌注及颈动脉狭窄处血管内径,对患者的相关因子水平影响较小,具有较好的治疗效果。
