Background and purpose:Despite successful recanalization following endovascular mechanical thrombectomy (EVT) in patients with large-vessel occlusive stroke, a subset of patients continues to experience poor outcomes. This study aims to analyze the association between core infarct growth rate and patient prognosis, and to examine the interaction between infarct growth rate (IGR) and hypoperfusion intensity ratio (HIR). Methods:We retrospectively analyzed 142 patients with acute anterior circulation occlusion who achieved successful recanalization following EVT, defined as modified Thrombolysis in Cerebral Infarction (mTICI) grade 2b or 3. Patients were stratified into good (modified Rankin Scale [mRS] 0-2) and poor (mRS 3-6) prognosis groups based on 3-month mRS scores. IGR was calculated as the infarct core volume divided by the time from symptom onset to imaging. Infarct core volume was delineated as the volume of brain tissue with relative cerebral blood flow <30%, quantified using software based on perfusion imaging. HIR was defined as the ratio of tissue volume with Tmax > 10 s to that with Tmax > 6 s on CT perfusion imaging. Multivariate logistic regression was used to identify independent predictors of clinical outcome, and receiver operating characteristic curves were generated to evaluate their prognostic value. Results:Among the 142 patients, 91 achieved a good outcome (mRS 0-2), whereas 51 had a poor outcome (mRS 3-6). The cohort included 103 males (72.5%), with a median age of 68 (IQR: 58-74) and a median baseline NIHSS of 13 (IQR: 9-15). Multivariate analysis identified hypertension (odds ratio [OR] = 5.14, 95% CI: 1.15-22.87), baseline NIHSS score (OR = 1.25, 95% CI: 1.07-1.46), IGR (OR = 1.10, 95% CI: 1.01-1.21), HIR (OR = 380.71, 95% CI: 6.29-23,037.59), and cystatin C levels (OR = 26.65, 95% CI: 2.19-324.55) as independent predictors of poor outcome. HIR was the primary determinant of IGR, with higher HIR significantly associated with accelerated infarct growth (adjusted OR = 18.75, 95% CI: 2.45-143.54; p = 0.005). Conclusion:Hypertension, baseline NIHSS score, IGR, HIR, and cystatin C levels are independent predictors of poor functional outcome despite successful recanalization. Among these, HIR demonstrated strong discriminatory power in identifying patients with rapid versus slow infarct progression.

Cystatin C (CysC) is a cysteine protease inhibitor and previous studies have demonstrated that increasing endogenous CysC expression has therapeutic implications on brain ischemia, Alzheimer's disease, and other neurodegenerative disorders. Our previous reports have demonstrated that the autophagy pathway was activated in the brain after experimental subarachnoid hemorrhage (SAH), and it may play a beneficial role in early brain injury (EBI). This study investigated the effects of exogenous CysC on EBI, cognitive dysfunction, and the autophagy pathway following experimental SAH. All SAH animals were subjected to injections of 0.3 ml fresh arterial, nonheparinized blood into the prechiasmatic cistern in 20 s. As a result, treatment with CysC with low and medial concentrations significantly ameliorated the degree of EBI when compared with vehicle-treated SAH rats. Microtubule-associated protein light chain-3 (LC3), a biomarker of autophagosomes, and beclin-1, a Bcl-2-interacting protein required for autophagy, were significantly increased in the cortex 48 h after SAH and were further up-regulated after CysC therapy. By ultrastructural observation, there was a marked increase in autophagosomes and autolysosomes in neurons of CysC-treated rats. Learning deficits induced by SAH were markedly alleviated after CysC treatment with medial doses. In conclusion, pre-SAH CysC administration may attenuate EBI and neurobehavioral dysfunction in this SAH model, possibly through activating autophagy pathway.

Scalp arteriovenous fistula (SAVF) is a rare complication of thread-lift sutures for facial rejuvenation.This article reports a 23-year-old female patient who suffered from entotic sounds in left ear after thread lifting. Then, the entotic sounds was gradually aggravated with palpitations. The cerebral angiography showed a high flow scalp arteriovenous fistula in the left temporal region, which got satisfactory result by endovascular embolization with coil and medical glue. There was no recurrence of the fistulas after one year of follow-up.

目的 探讨前循环大血管闭塞患者接受机械取栓术后闭塞血管复流程度与治疗前外周静脉血中性粒细胞和淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)的关系.方法 回顾性分析2016年6月至2022年3月苏州大学附属第一医院接受机械取栓治疗的前循环大血管闭塞性急性缺血性脑卒中(acute ischemic stroke,AIS)患者的临床资料.根据改良脑梗死溶栓分级(modified thrombolysis in cerebral infarction,mTICI)评估术后闭塞血管的复流程度,将所有成功复流患者分为部分复流组(mTICI=2b级)及完全复流组(mTICI=3级).比较两组患者的基本临床资料、疾病特征、介入治疗及预后的相关数据,多因素logistic分析术后复流程度的影响因素.结果 共纳入患者214例,其中部分复流65例,完全复流149例.单因素分析结果显示,两组患者的术前NLR、闭塞血管位置、血栓负荷量、穿刺至再通时间、取栓次数、术后90 d预后良好率差异均有统计学意义(均P＜0.05).与部分复流患者相比,完全复流患者的NLR更低、闭塞血管更多位于大脑中动脉、血栓负荷量更低、手术时间更短、取栓次数更少以及临床预后更好.多因素logistic回归分析显示,NLR与低血栓负荷是前循环AIS患者术后完全复流的独立影响因素.结论 机械取栓术前低NLR和低血栓负荷量的前循环AIS患者,术后更容易达到完全复流.

Background Alteplase before thrombectomy for patients with large vessel occlusion stroke raises concerns regarding an increased risk of intracranial hemorrhage (ICH), but the details of this relationship are not well understood. Methods This was a secondary analysis of the DIRECT-MT trial. ICH and its subtypes were independently reviewed and classified according to the Heidelberg Bleeding Classification. The effects of alteplase before thrombectomy on ICH and ICH subtypes occurrence were evaluated using logistic regression. Clinical and imaging characteristics that may modify these effects were exploratorily tested. Results Among 591 patients, any ICH occurred in 254 (43.0%), including hemorrhagic infarction type 1 in 12 (2.1%), hemorrhagic infarction type 2 in 127 (21.7%), parenchymal hematoma type 1 in 34 (5.8%), parenchymal hematoma type 2 in 50 (8.6%), and other hemorrhage types (3a-3c) in 24 (4.1%). Similar ICH frequencies were observed with combined alteplase and thrombectomy versus thrombectomy only (134/292 (45.9%) vs 120/299 (40.1%); OR 1.27, 95% CI 0.91 to 1.75, P=0.16), but patients treated with alteplase had a higher parenchymal hematoma rate (51/287 (17.8%) vs 33/297 (11.1%); OR 1.75, 95% CI 1.08 to 2.85, P=0.024). In the adjusted model, difference in parenchymal hematoma occurrence between groups remained significant (adjusted OR 1.71, 95% CI 1.00 to 2.92, P=0.049). Patients with history of diabetes (P interaction =0.048), hypertension (P interaction =0.02), antiplatelet therapy (P interaction =0.02), anticoagulation therapy (P interaction =0.04), and statin administration (P interaction =0.02) harbored a higher ICH rate when they received combination therapy. Conclusions Our data showed that in the DIRECT-MT trial, alteplase did not increase overall ICH for large vessel occlusion patients treated with thrombectomy, but it increased the parenchymal hematoma rate.

目的 基于多模式影像对比研究颈部动脉超声(CDU)、CT血管成像(CTA)与数字减影血管造影(DSA)诊断锁骨下动脉狭窄的一致性,以DSA为金标准,旨在寻找锁骨下动脉不同狭窄程度的血流动力学参数.方法 回顾性连续纳入2018年1月―2021年12月于苏州大学附属第一医院卒中中心就诊的患者179例,1周内均行CDU、主动脉弓上CT血管造影(CTA)及数字减影血管造影(DSA)检查,至少一项检查提示锁骨下动脉狭窄.分析179例患者双侧锁骨下动脉的狭窄程度.以DSA诊断为金标准评估CDU及CTA诊断锁骨下动脉狭窄程度,分别对CDU及CTA进行狭窄程度的Kappa一致性分析.以DSA为金标准进行狭窄程度分级,采用ROC曲线分析,确定轻度狭窄(<50%)、中度狭窄(50%～69%)和重度狭窄(70%～99%)的血流速度(PSV,EDV)以及血流速度比值(PSVOR/PSVDIS)的最佳截断值.结果 (1)Kappa一致性分析:CTA与DSA有较高的一致性(κ=0.777),CDU与DSA有很好的一致性(κ=0.813);(2)以DSA为标准:CDU诊断锁骨下动脉狭窄段的收缩期峰值流速(PSV)、舒张期末流速(EDV)以及狭窄段与狭窄远段收缩期峰值流速比值(PSVOR/PSVDIS)分别为:轻度狭窄:PSV<252 cm/s,EDV<21 cm/s,PSVOR/PSVDIS<1.9;中度狭窄:252 cm/s≤PSV<339 cm/s,21 cm/s≤EDV<39 cm/s,1.9≤PSVOR/PSVDIS<4.0;重度狭窄:PSV≥339 cm/s,EDV≥39 cm/s,PSVOR/PSVDIS≥4.0.结论 CDU能够无创、实时动态评估锁骨下动脉狭窄程度并分析血流动力学改变,为临床精准治疗提供分层管理依据.

BACKGROUND:Mitochondrial autophagy, the elimination of damaged mitochondria through autophagy, contributes to neuron survival in cerebral ischemia. Long non-coding RNAs (lncRNAs)/microRNAs (miRNAs)/mRNAs are important regulatory networks implicated in various biological processes, including cerebral ischemia-reperfusion (I/R) injury. Therefore, this work clarifies a novel RGD1564534-mediated regulatory network on mitochondrial autophagy in cerebral I/R injury.METHODS:Differentially expressed lncRNAs in cerebral I/R injury were predicted by bioinformatics analysis. Expression of RGD1564534 was examined in the established middle cerebral artery occlusion (MCAO) rats and oxygen glucose deprivation/reoxygenation (OGD/R)-exposed neurons. We conducted luciferase activity, RNA pull-down and RIP assays to illustrate the interaction among RGD1564534, miR-101a-3p and Dusp1. Gain- or loss-of-function approaches were used to manipulate RGD1564534 and Dusp1 expression. The mechanism of RGD1564534 in cerebral I/R injury was evaluated both in vivo and in vitro.RESULTS:RGD1564534 was poorly expressed in the MCAO rats and OGD/R-treated cells, while its high expression attenuated nerve damage, cognitive dysfunction, brain white matter and small vessel damage in MCAO rats. In addition, RGD1564534 promoted mitochondrial autophagy and inhibited NLRP3 inflammasome activity. RGD1564534 competitively bound to miR-101a-3p and attenuated its binding to Dusp1, increasing the expression of Dusp1 in neurons. By this mechanism, RGD1564534 enhanced mitochondrial autophagy, reduced NLRP3 inflammasome activity and suppressed the neuron apoptosis induced by OGD/R.CONCLUSION:Altogether, RGD1564534 elevates the expression of Dusp1 by competitively binding to miR-101a-3p, which facilitates mitochondrial autophagy-mediated inactivation of NLRP3 inflammasome and thus retards cerebral I/R injury.

Objective:To investigate the poor prognostic factors of posterior circulation stroke (PCS) after complete reperfusion by mechanical thrombectomy.Methods:39 patients with PCS treated with mechanical thrombectomy (MT) from January 2017 to September 2020 were included and retrospectively analyzed. Complete reperfusion in occlusive vessels was defined as modified thrombolysis in cerebral infarction (mTICI) grade 3. 90 d modified Rankin score (mRS) > 2 was defined as a poor outcome. The baseline data and treatment-related indicators were included in the multivariate analysis, and the receiver operating characteristic (ROC) curve was used to determine the best cut-off value.Results:39 patients with complete reperfusion (mTICI 3) were included in this study. Poor outcome was observed in 20 (51.3%) of these patients. Stepwise Logistic regression analysis showed that lower NIHSS score (OR = 1.21, 95%CI = 1.037-1.414, P = 0.016) and posterior communicating artery (PcomA) patency (OR = 0.052, 95%CI = 0.005-0.557, P = 0.014) were independent predictors of favourable 90 d outcome. Based on the analysis of ROC curve, the area under the curve of NIHSS score at admission was 0.762, cut-off value was 20, sensitivity was 70.0%, specificity was 84.2%.Conclusions:High NIHSS score and PcomA occlusion at admission are poor prognostic factors of PCS treated with mechanical thrombectomy after complete reperfusion.

目的 筛选机械取栓(MT)治疗大血管闭塞性急性缺血性脑卒中(AIS-LVO)获得首过效应(FPE)的预测因素.方法 回顾性分析207例接受MT治疗的AIS-LVO患者,根据获得FPE与否分为FPE组(n=66)和非FPE组(n=141);比较组间一般资料、手术资料及术后情况,并将其中P＜0.1者纳入logistic回归分析,筛选FPE预测因素;构建列线图模型,分析其预测效能.结果 2组患者年龄、美国国立卫生研究院卒中量表(NIHSS)评分、艾伯塔卒中项目早期CT评分(ASPECTS)、血栓负荷评分(CBS)、闭塞位置、手术方式、手术时间、症状性颅内出血(sICH)率及预后差异均有统计学意义(P均＜0.05).年龄、高血压、ASPECTS、CBS、闭塞位置及手术方式均为MTFPE的独立预测因素;据此构建的列线图模型预测MT治疗AIS-LVO FPE的效能中等,其一致性指数为0.759[95％CI(0.629,0.889)].结论 根据AIS-LVO患者年龄、高血压、ASPECTS、CBS、闭塞位置及手术方式可预测MT FPE.

Objectives The aim of this study is to identify the peri-procedural risk factors and outcomes of hemodynamic instability (HI) after carotid artery stenting (CAS). Methods A single-center, retrospective study was performed in 168 patients who underwent CAS procedure between September 2017 and September 2020. The presence of HI, as defined by hypertension (systolic blood pressure >160 mmHg), hypotension (systolic blood pressure <90 mmHg), and/or bradycardia (heart rate <60 bpm), was recorded. Long-period HI was defined as persistent HI lasting more than 24 h. Patient demographics, comorbidities, peri-procedural variables, and risk factors were recorded. Clinical outcomes including cerebral hyperperfusion syndrome, hemorrhage, transient ischemic attack (TIA), stroke, myocardial infarction, and mortality within 30 days of the procedure were evaluated. Logistic regression was used to analyze the independent risk factors of long-period HI following CAS. Results Among 168 patients (mean age, 68.2 ± 8.3 years; 81.5% male), the frequency of post-procedural long-period HI was noted in 42 patients (25.0%). Male was prone to experience HI (odds ratio, 9.156, p = 0.021). Aggressive inflation pressure (>7 atm) and 5 mm balloon for pre-dilatation were risk factors of long-period HI (OR, 7.372, p = 0.035; OR, 3.527, p = 0.023). Intraoperative peak blood pressure and larger-sized stents remained independent predictors for the development of HI (OR, 1.043, p = 0.027, and OR, 1.973, p = 0.015). Patients with prolonged HI were more likely to suffer TIA and stroke compared to other patients and significant difference was found in the occurrence of TIA ( p < 0.05). Non-significance was found in mortality rate and other outcomes. Conclusions CAS-induced HI occurs in a considerable percentage while several peri-procedural variables are determined as independent predictors to develop long-period HI. Patients with prolonged HI are associated with increased risk of neurologic events and thus standardized intervention as well as management of long-period HI are of critical importance during clinical process.

The treatment of complex cerebrovascular diseases (CCVDs) at the skull base, such as complex intracranial aneurysms, carotid-cavernous sinus fistulas, and intracranial artery traumatic injuries, is a difficult clinical problem despite advances in endovascular and surgical therapies. Covered stents or stent graft insertion is a new concept for endovascular treatment that focuses on arterial wall defect reconstruction, differing from endovascular lesion embolization or flow diverter therapies. In recent years, covered stents specifically designed for cerebrovascular treatment have been applied in the clinical setting, allowing thousands of patients with CCVDs to undergo intraluminal reconstruction treatment and achieving positive results, even in the era of flow diverters. Since there is no unified reference standard for the application of covered stents for treating CCVDs, it is necessary to further standardize and guide the clinical application of this technique. Thus, we organized authoritative experts in the field of neurointervention in China to write an expert consensus, which aims to summarize the results of covered stent insertion in the treatment of CCVDs and propose suitable standards for its application in the clinical setting. Based on the contents of this consensus, clinicians can use individualized intraluminal reconstruction treatment techniques for patients with CCVDs.

ObjectiveAcute ischemic stroke is common in elder patients. This study investigates whether using the balloon-guided catheter (BGC) would improve the effect of stent thrombectomy (Solitaire FR With Intracranial Support Catheter for Mechanical Thrombectomy, SWIM) for patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO).MethodThe data of 209 patients with AIS-LVO underwent SWIM were collected retrospectively from January 2017 to June 2021. These patients were divided into two groups based on whether they used of BGC or not. The propensity score matching (PSM) analysis was used to compare the differences in the first pass effect (FPE), successful recanalization, embolus escape rate, symptomatic intracranial hemorrhage (sICH), 90-day clinical favorable outcome, 90-day all-cause mortality, and complications in the patients treated with SWIM combined with balloon-guided catheter or conventional catheter.ResultsAmong the 209 patients, 44 patients were treated with BGC and 165 patients were not. After matching, a total of 111 patients were included. The results showed that there was no statistical difference in FPE (35.1% in non-BGC group compared to 24.3% in BGC group, matched RR, 0.59; 95% CI, 0.24–1.44), successful recanalization (89.2 vs. 91.9%, matched RR, 1.37; 95%CI, 0.34–5.51), embolus escape (6.8 vs. 8.1%, matched RR, 1.22; 95%CI, 0.28–5.40), sICH (8.1 vs. 13.5%; matched RR, 1.77; 95%CI 0.50–6.24), 90-day clinical favorable outcome (48.7 vs. 54.1%, matched RR, 1.11; 95%CI 0.51–2.46), 90-day all-cause mortality (17.6 vs. 21.6%, matched RR, 1.29; 95%CI 0.48–3.47), and the incidence of complications (6.8 vs. 5.4%, matched RR, 0.79 95%CI 0.15–4.27). These results indicate that using SWIM as the first-line treatment for patients with AIS-LVO, there is no statistical significance in FPE, final successful recanalization, distal emboli, sICH, procedural time, 90-day favorable outcome, 90-day mortality, and complications with or without BGC.ConclusionBalloon-guided catheter does not affect the result of using SWIM as the first-line treatment for patients with AIS-LVO. Our results will guide daily practice, with the adoption of the use of a guided catheter without a balloon.

目的 评价前循环急性缺血性脑卒中(AIS)伴恶性肿瘤患者接受机械取栓治疗的有效性和安全性,分析影响机械取栓术预后的因素.方法 回顾性分析2016年6月至2021年9月在苏州大学附属第一医院接受机械取栓治疗的前循环AIS患者临床资料.根据患者病史分为肿瘤组与非肿瘤组.评估两组患者基线资料、取栓术后症状性颅内出血发生率和90 d改良Rankin量表(mRS)评分等指标.再将肿瘤组患者分为预后良好(术后90 d mRS评分≤2分)和预后不良(mRS评分＞2分).采用单因素和多因素logistic分析影响AIS伴恶性肿瘤患者机械取栓治疗预后的因素.结果 共入组219例患者(肿瘤组24例,非肿瘤组195例).肿瘤组、非肿瘤组分别成功复流23例(95.8％)、183例(93.8％),差异无统计学意义(P=1.00);术后出血转化率(52.2％比41.5％,P=0.331)、症状性颅内出血发生率(17.4％比12.0％,P=0.503)、90 d预后良好率(39.1％比42.1％,P=0.787)差异均无统计学意义.logistic回归分析显示,静脉溶栓后桥接机械取栓治疗是肿瘤组患者术后90 d临床预后不良的影响因素.与非肿瘤组相比,肿瘤组桥接治疗后有更高的症状性颅内出血发生率(36.4％比10.9％,P=0.044).结论 机械取栓治疗前循环AIS伴恶性肿瘤患者安全、有效.直接机械取栓治疗AIS伴恶性肿瘤患者比桥接治疗有更低的症状性颅内出血发生率和更好的预后.

Objective: To evaluate the efficacy and safety of hybrid revascularization by carotid endarterectomy and endovascular intervention in the treatment of chronic internal carotid artery occlusion (ICAO). Methods: We performed a retrospective analysis of patients who received hybrid treatment for symptomatic chronic ICAO between December 2016 and December 2018. Fifty-six patients with long-segment ICAO were enrolled and divided into the short duration (1-3 months) and long ICAO duration (>3 months) groups, and their clinical and angiographic data were analyzed. Results: The mean duration was 106.8 +/- 36.1 days from the date of ICAO diagnosis to revascularization. Totally, 10 patients (17.8%, n = 56) in the short duration group while no patients in the long duration group failed recanalization (n = 7). Perioperative complications included intraoperative thromboembolism in 1 (1.8%) patient and subarachnoid hemorrhage in 2 (3.6%) patients. Early phase postoperative hypertension was noted in 11 (19.6%) patients and cervical hemorrhage in 1 (1.8%) patient. No severe neurological deficits occurred. Overall, the 6-month modified Rankin score, Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores in patients with successful recanalization significantly improved versus the baseline (P < 0.05). After successful recanalization, the long duration group demonstrated more stents for revascularization compared with the short duration group (P < 0.05). Five (10.8%) patients had recurrent transient ischemic attack, and 1 (2.2%) patient developed stroke in the successful revascularization group during 6 months of follow-up. ICA restenosis occurred in 5 (8.9%) patients and re-occlusion was noted in 1 (1.8%) patient. Conclusions: Hybrid operation may be feasible and effective for patients with symptomatic chronic complete ICAO according to our limited data. The original occlusion site from the carotid bifurcation and the duration of ICAO should be considered as independent indicators for successful recanalization as well as perioperative outcomes.

Objective:To evaluate the relationship between the type of vertebral artery steal and posterior circulation ischemia by carotid Doppler ultrasonography (CDU) in the case of moderate to severe subclavian artery stenosis or occlusion.Methods:A total of 163 patients with moderate to severe subclavian artery stenosis or occlusion confirmed by CDU and digital subtraction angiography (DSA) at the Stroke Center of the First Affiliated Hospital of Soochow University from January 2017 to July 2020 were retrospectively enrolled. All patients underwent cranial magnetic resonance imaging (MRI) and National Institute of Health Stroke Scale (NIHSS) score evaluation. According to the type of vertebral artery steal on the affected side of patients examined by CDU, 163 patients were divided into type Ⅰ (latent type; 51 cases), type Ⅱ (partial type; 70 cases), and type Ⅲ (complete type; 42 cases) cases. CDU was used to assess the type of blood steal and compared with DSA findings to analyze the correlation between different degrees of subclavian artery stenosis and the type of vertebral artery steal, and the incidence of cerebral infarction in patients with different types of vertebral artery steal.Results:The results of CDU and DSA in evaluating the types of vertebral artery steal were: type Ⅰ (51 vs 0); type Ⅱ (70 vs 53); type Ⅲ (42 vs 42). Among 46 patients with moderate subclavian artery stenosis, 36 (78.3%, 36/46), 10 (21.7%, 10/46), and 0 were evaluated by CDU as having type Ⅰ, type Ⅱ, and type Ⅲ blood steal, respectively. Among 83 patients with severe stenosis of SA, 15 (18.1%, 15/83), 60 (72.3%, 60/83), and 8 (9.6%, 8/83) were evaluated by CDU as having type Ⅰ, type Ⅱ, and type Ⅲ blood steal, respectively. All 34 patients with SA occlusion were evaluated by CDU as having type Ⅲ blood steal. The degree of subclavian artery stenosis was not completely consistent, but positively correlated, with the type of vertebral artery steal (rs=0.802, P＜0.001). All patients with type Ⅰ showed transient ischemic attack (TIA), the incidence of cerebral infarction was 0 (0/51), and the NIHSS score was <10. The incidence of cerebral infarction in type Ⅱ patients was 28.6% (20/70), and those with an NIHSS score ≥10 accounted for 4.3% (3/70). The incidence of cerebral infarction in type Ⅲ patients was 52.4% (22/42), and those with an NIHSS score ≥10 accounted for 16.7% (7/42). There was a significant difference in the incidence of cerebral infarction in type Ⅰ~Ⅲ patients (H=33.337, P＜0.001).Conclusion:With the development of the type of blood steal from the affected vertebral artery, the incidence of cerebral infarction gradually increases. CDU allows for early, noninvasive, real-time, dynamical, and accurate evaluation of subclavian artery blood steal syndrome, so as to provide a basis for clinical individualized treatment.

目的 探讨在超声检查血管烟雾病(MMD)患者颅内外血管的特征性改变.方法 选取我院诊断为MMD患者87例作为研究组,另纳入同期排除心脑血管疾病者53例作为对照组.比较两组间颈内动脉(ICA)管径及血流动力学参数的差异;计算Youden指数,确定最佳界值;比较研究组内重度狭窄或闭塞的ICA管径及血流动力学参数的差异.结果 ①MMD患者双侧ICA管径及血流动力学参数与对照组差异具有统计学意义;②ICA管径能更有效预测MMD,当预测界值为3.15 mm时,获得最大Youden指数;③研究组中闭塞患者ICA管径及PSV、EDV较重度狭窄减低,RI升高.结论 脑颈血管一体化评估可作为MMD的初步筛查手段.

Objective:To evaluate the diagnostic value of carotid Doppler ultrasound (CDU) in evaluating the hemodynamic changes of severe intracranial stenosis of the internal carotid artery (ICA).Methods:We retrospectively reviewed 171 patients who underwent CDU at Stroke Center, the First Affiliated Hospital of Soochow University with severe intracranial stenosis or occlusion of unilateral ICA confirmed by CTA and/or DSA from January 2018 to December 2019 as a study group. Meanwhile, 99 patients who underwent CDU in the same period with dizziness as the main complaint and without obvious stenosis of intracranial and external large blood vessels (confirmed by CTA and/or DSA) were used as a control group. The diameter (D), peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) of the affected side, healthy side, and control sides of the study group at a distance of 20 mm from the beginning of ICA were recorded. Differences of D, PSV, EDV, and RI of bilateral ICA between the study group and control group were calculated. Using CTA and/or DSA as the gold standard, Logistic regression and ROC curve analysis were used to analyze the parameters of extracranial hemodynamics and combined parameters to evaluate the diagnostic value of ICA for severe intracranial stenosis.Results:In the study group, 109 of 171 patients showed high resistance flow spectrum with increased systolic peak and decreased diastolic peak. CTA and/or DSA confirmed ICA severe intracranial stenosis or occlusion after occlusion of the ophthalmic artery. The 62 CDU patients showed a diastolic or reversed unimodal or oscillating flow spectrum, and CTA and/or DSA confirmed ICA occlusion before occlusion of the ophthalmic artery. Compared with the healthy side of the study group and the left side of the control group, D, PSV, and EDV in the affected side of study group were significantly decreased, with EDV being most obvious [EDV: (11.89±6.95) cm/s vs (36.14±11.93) cm/s, (29.27±9.69) cm/s], while RI was significantly increased [(0.81±0.06) vs (0.59±0.07), (0.64±0.07)], and the differences were statistically significant (P＜0.001). Compared with the left side of the control group, D, PSV, and EDV in the healthy side of study group were all increased, with EDV being most obvious, while RI was significantly decreased (D: P=0.029; PSV: P=0.011; EDV and RI: P＜0.001).When combining RI ≥0.74 in the ICA on one side, D difference ≥1.1 mm, EDV difference ≥ 15.7cm/s, and RI difference ≥0.13 in the ICA on both sides, the area under the ROC curve was 0.990, and the sensitivity (92.7%) and specificity (98.0%) for diagnosing severe intracranial stenosis in the ICA were the best.Conclusion:After severe stenosis or occlusion of major branches of the ICA (e.g, the middle cerebral artery and anterior cerebral artery) was excluded, CDU, in combination with TCD and/or TCCD, can effectively evaluate the severe intracranial stenosis of the ICA through the bilateral waveform and hemodynamic parameters of ICA extracranial segment, i.e, RI and differences of D, EDV, and RI, and provide a hemodynamic basis for clinical diagnosis.

Objective:To evaluate the efficacy and safety of reperfusion therapy in patients with wake-up stroke (WUS) under the guidance of "tissue-window" by comparing with patients with non-WUS who received reperfusion therapy within "time-window".Methods:Two hundred and thirty-five acute ischemic stroke patients admitted to our hospital from January 2018 to December 2019 were enrolled in our study. Patients with non-WUS received reperfusion therapy within "time-window"; patients with WUS accepted multimodal CT examination at Emergency right after admission, Mistar software was used to reconstruct CT perfusion imaging (CTP) images, and reperfusion therapy was given to these patients after the judgement of "tissue-window". The differences of clinical data, prognoses, and safety indexes were compared between patients with WUS and non-WUS.Results:In these 235 patients, 45 patients were with WUS and 190 were with non-WUS. As compared with patients with non-WUS, those with WUS had significantly lower percentages of patients with hypertension history and patients accepted intravenous thrombolysis ( P<0.05). In 153 patients accepted intravenous thrombolysis, 23 patients were with WUS and 130 were with non-WUS; the time from admission to intravenous thrombolysis in WUS patients was significantly longer than that in non-WUS patients ( P<0.05); the clinical data, prognoses, and safety indexes showed no significant differences between these patients with WUS and non-WUS ( P>0.05). In 82 patients accepted bridging thrombectomy and direct thrombectomy, 22 patients were with WUS and 60 were with non-WUS; the clinical data, prognoses, and safety indexes showed no significant differences between these patients with WUS and non-WUS ( P>0.05). Conclusion:By comparing with patients with non-WUS who received reperfusion therapy within "time-window", reperfusion therapy is effective and safe for WUS patients under the guidance of multimodal CT "tissue-window".

目的 探讨对机械取栓成功后颅内靶血管残余重度狭窄患者行择期动脉支架植入治疗的可行性.方法 对4例成功机械取栓后颅内靶血管残余重度狭窄患者行择期动脉支架植入术.结果 取栓术后4例闭塞血管均成功复流,靶血管均残余≥70％的重度狭窄,但可维持稳定前向血流.2例取栓术后72 h内MRI显示脑梗死面积较大,分别于取栓后48天和27天行支架植入;2例脑梗死面积小且神经功能恢复良好,分别于取栓术后12天和4天行支架植入.支架释放后4例血流均通畅,未见并发症,术后90天改良Rankin评分(mRS)均≤2;末次随访时支架位置均良好,血管通畅.结论 对于机械取栓成功后靶血管残余重度狭窄,根据取栓后脑梗死面积及神经功能恢复情况择期植入动脉支架是相对安全有效的治疗方案.

目的 比较不同卒中分型急性基底动脉闭塞(BAO)患者机械取栓的临床疗效和安全性.方法 回顾性纳入2017年4月至2019年4月在苏州大学附属第一医院总院接受机械取栓治疗的29例急性BAO患者.采用中间导管联合Solitaire FR支架行机械取栓,评价急性BAO机械取栓可行性、血管再通率、90 d预后良好率和手术相关并发症.结果 29例急性BAO患者中TOAST分型为心源性脑栓塞(CE)型19例(CE组),大动脉粥样硬化性脑卒中(LAA)型9例(LAA组),病因不明栓塞1例.26例(89.7％)闭塞血管成功再通(mTICI分级2b/3级),其中CE组、LAA组分别为17例(89.5％)、8例(88.9％)(P＞0.05),病因不明1例.CE组、LAA组患者发病至医院就诊时间分别为(203.6±99.2) min、(353.8±210.8) min(P＜0.05),分别有2例、3例接受补救性支架植入(P＞0.05),取栓次数分别为(1.6±0.9)次、(2.0±1.4)次(P＞0.05).术后90 d预后良好率(改良Rankin量表评分≤2分)为48.3％(14/29),其中CE组、LAA组分别为52.6％(10/19)、33.3％ (3/9) (P＞ 0.05),病因不明1例恢复良好.手术相关并发症包括异位栓塞、出血转化.结论 机械取栓治疗急性BAO安全可行.CE患者和LAA患者90 d预后良好率无差异,但CE患者发病至医院就诊时间较短于LAA患者.