BACKGROUND:The optimal threshold or range for systolic blood pressure (SBP) control in patients with successful reperfusion after endovascular thrombectomy for acute ischemic stroke (AIS) remains undefined. This study investigated whether SBP within the first 24 hours after successful reperfusion correlates with functional outcomes in AIS. METHODS:In this secondary analysis of the ENCHANTED2/MT trial, patients were categorized into two groups (120-140 mm Hg and 140-180 mm Hg, respectively) based on achieved SBP within 24 hours after randomization. The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included neurological deterioration at 7 days, major disability (mRS score of 3-5 at 90 days), hospitalization duration, and health-related quality of life assessed by the three-level EuroQoL 5-Dimension Self-Report Questionnaire (EQ-5D-3L) at 90 days. Safety outcomes included early neurological decline (END), 90-day mortality, symptomatic intracranial hemorrhage (sICH), and any intracranial hemorrhage (ICH). Treatment effects were expressed as ORs with 95% confidence intervals (CIs). RESULTS:A total of 611 patients (363 in the 120-140 mm Hg group and 248 in the 140-180 mm Hg group) were included. The mean (SD) age was 67 (12) years and 37.8% were female. After adjusting for confounders, the 120-140 mm Hg group was significantly associated with better functional outcomes (mRS: 2 (IQR 1-4) vs 2 (IQR 1-5); adjusted OR 1.54 (95% CI 1.10 to 2.17), P=0.013). Compared with the 140-180 mm Hg group, the 120-140 mm Hg group had lower rates of neurological deterioration at 7 days (adjusted OR 0.68 (95% CI 0.47 to 0.98), P=0.037) and 90-day mortality (47 (13.0%) vs 53 (21.4%); adjusted OR 0.48 (95% CI 0.27 to 0.86), P=0.013). There were no significant differences between groups in END, major disability at 90 days, hospitalization duration, EQ-5D-3L score, sICH, or ICH (all P>0.05). CONCLUSIONS:In patients with successful reperfusion after endovascular thrombectomy, an average SBP within 24 hours of 120-140 mm Hg was associated with a greater likelihood of functional independence compared with 140-180 mm Hg.

目的 探讨老年腔隙性脑梗死合并高血压患者认知功能障碍的影响因素及25-羟基维生素D对其预测价值.方法 回顾性分析219例老年腔隙性脑梗死合并高血压患者的临床资料及实验室检测结果,根据蒙特利尔认知评估量表评分将患者分为认知功能障碍组(132例)和认知正常组(87例).采用单因素分析及多因素Logistic回归分析法探讨老年腔隙性脑梗死合并高血压患者发生认知功能障碍的影响因素,并绘制受试者工作特征曲线分析25-羟基维生素D对老年腔隙性脑梗死合并高血压患者发生认知功能障碍的预测价值.结果 219例老年腔隙性脑梗死合并高血压患者发生认知功能障碍132例,发生率为60.27％.不同年龄、高血压病程、收缩压、血压控制效果、糖尿病、头颈动脉狭窄程度、25-羟基维生素D水平患者认知功能比较差异有统计学意义(P＜0.05或0.01).多因素Logistic回归分析显示,年龄(OR=1.841,95％CI为1.079～3.137,P=0.025)、高血压病程(OR=1.887,95％CI 为 1.199～2.968,P=0.006)、入院时收缩压(OR=1.740,95％CI 为 1.194～2.535,P=0.004)、血压控制不达标(OR=2.034,95％CI 为 1.106～3.741,P=0.022)、合并糖尿病(OR=1.840,95％CI 为 1.084～3.124,P=0.024)、头颈动脉中/重度狭窄(OR中度=1.804,95％CI中度为1.149～2.831,P中度=0.011;OR重度=1.985,95％CI重度为 1.293～3.050,P重度=0.002)、25-羟基维生素 D 水平(OR=1.887,95％CI为1.293～2.755,P=0.001)是老年腔隙性脑梗死合并高血压患者发生认知功能障碍的影响因素.受试者工作特征曲线显示,25-羟基维生素D水平预测老年腔隙性脑梗死合并高血压患者认知功能障碍的曲线下面积为0.891,最佳诊断点为66.08 nmol·L-1,此时灵敏度为77.01％,特异度为91.67％.结论 老年腔隙性脑梗死合并高血压患者认知功能障碍发生率较高,其影响因素较多,临床应早期综合评估并采取预防干预措施;25-羟基维生素D水平可作为此类患者发生认知功能障碍的辅助预测指标.

Objective To explore the correlation between serum lipoprotein（a）[Lp（a）],galectin3（GAL3）,visceral adipose-specific serine protease inhibitor（vaspin） and the outcome of Trevo stent thrombolectomy in patients with acute ischemic stroke in anterior circulation. Methods A total of 112 patients with circulating acute ischemic stroke admitted to the Department of Neurology,Nanyang Central Hospital from June 2019 to March 2022 were selected as the research objects. All patients were given Trevo stent thrombectomy. According to the modified Rankin Scale（mRS） score on the 14th day after Trevo stent thrombectomy,the patients were divided into the excellent outcome group（76 cases）and the poor outcome group（36 cases）. Serum Lp（a）,GAL3 and vaspin levels in the two groups were measured at admission,immediately after surgery,3 days,1 week and 2 weeks after surgery. Spearmen was used to analyze the correlation between serum Lp（a）,GAL3,vaspin and the outcome of Trevo stent thrombolectomy in patients with acute ischemic stroke in anterior circulation. Results The serum Lp（a）and GAL3 in the excellent outcome group were lower than those in the poor outcome group at 3 days,1 week and 2 weeks after Trevo stent thrombolectomy（t=7.725,10.602,9.578,2.888,5.875,9.45,P＜0.05）. Vaspin level was higher than that in the poor outcome group（t=23.416,14.754,8.428,P＜0.05）. Spearmen correlation analysis showed that the excellent outcome of Trevo stent thrombolectomy in patients with acute ischemic stroke in anterior circulation was positively correlated with serum Lp（a）and GAL3,and negatively correlated with vaspin level.Conclusion Serum Lp（a）,GAL3 and vaspin are correlated with the outcome of Trevo stent thrombolectomy in patients with acute ischemic stroke in anterior circulation. Those results can be referred to the monitoring of patients’ serum Lp（a）,GAL3 and vaspin for timely administration of appropriate clinical measures to improve the outcome of patients after thrombectomy.

目的 探究急性后循环供血区缺血性脑梗死患者血管再通术后24 h内Alberta卒中操作早期CT评分(Alberta stroke program early CT score,ASPECTS)联合血清血红素氧合酶-1(Heme oxygenase-1,HO-1)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)水平对患者短期不良预后的预测价值.方法 选取医院2019年1月-2020年1月收治的62例急性后循环供血区缺血性脑梗死患者,均行血管再通术;术后随访3个月,根据改良Rankin量表评分(Modified Rankin scale,mRS)进行神经功能评定,分为预后良好组、预后不良组,采用单因素分析比较2组术后24h内ASPECTS评分、血清HO-1,VEGF水平等可能影响患者短期不良预后的因素;采用Logistic回归分析急性后循环供血区缺血性脑梗死患者血管再通术后影响患者短期不良预后的危险因素,并绘制受试者工作特征(Receiver operating characteristic,ROC)曲线评估术后ASPECTS评分联合血清HO-1,VEGF水平对患者短期不良预后的预测价值.结果 根据随访3个月后mRS评分判定,62例患者中40例归为预后良好组,22例归为预后不良组.单因素分析中2组患者性别、年龄、体质量指数、是否吸烟、酗酒,高脂血症、糖尿病、冠心病、既往脑卒中、高血压病等既往病史、治疗前血压、术后24 h内血压、发病至入院时间、术后24 h内实验室检查指标(白细胞计数、血小板、血糖、血尿素、血肌酐、胱抑素C)水平均无明显差异(P＞0.05);预后良好组既往病史中心房颤动占比(12.50％)低于预后不良组(45.45％)(P＜0.05),术后24 h内NIHSS评分低于预后不良组(P＜0.05),术后24 h内ASPECTS评分高于预后不良组(P＜0.05).术后24 h内实验室检查指标中预后良好组血清HO-1水平高于预后不良组,VEGF水平低于预后不良组(P＜0.05).经Logistic回归分析显示,心房颤动史、术后24 h内NIHSS评分、术后24 h内ASPECTS评分、血清HO-1,VEGF水平是影响急性后循环供血区缺血性脑梗死患者血管再通术后短期不良预后的危险因素.ROC曲线分析显示,术后24 h内ASPECTS评分联合血清HO-1,VEGF水平预测急性后循环供血区缺血性脑梗死患者血管再通术后短期不良预后的敏感度、准确度、AUC分别为93.67％、84.36％、0.873,均高于血清HO-1水平、VEGF水平、ASPECTS评分单独预测.结论 术后24 h内ASPECTS评分、血清HO-1,VEGF水平与急性后循环供血区缺血性脑梗死患者血管再通术后短期不良预后密切相关,三者联合预测的准确性更好.

目的 探讨急性前循环串联闭塞卒中患者行机械取栓治疗中颅外颈动脉病变的治疗方案,评估其有效性和安全性.方法 回顾性分析2018年1月—2019年12月南阳市中心医院收治的18例行血管内治疗的颈内动脉颅外段伴同侧颅内动脉急性串联闭塞患者的临床资料.其中男性9例,女性9例,年龄为60～70岁.根据治疗方式的不同,将18例患者分为急诊支架组(11例)和急诊非支架组(7例).术中即刻血管再通情况根据脑梗死溶栓(TICI)分级判断,将卒中发生90d改良Rankin量表(mRS)评分0～2分定义为临床预后良好.结果 2组患者年龄、性别、术前美国国立卫生研究院卒中量表(NIHSS)评分、术前Alberta卒中项目早期CT(ASPECT)评分、病因分型、治疗方式、病变类型、血管闭塞部位等临床基线资料比较,差异均无统计学意义(均P＞0.05);急诊支架组和急诊非支架组的术后血管成功再通率(TICI分级为2b～3级)分别为72.7％和71.4％,组间差异无统计学意义(P＞0.05);2组术后症状性颅内出血率分别为9.1％和0,组间差异无统计学意义(P＞0.05);2组患者术后90 d改良mRS评分及90 d病死率比较差异无统计学意义(均P＞0.05);2组患者术后残余狭窄率差异有统计学意义(P＜0.05).结论 在急性前循环串联闭塞的血管内治疗中,急诊颈动脉颅外段支架置入术可能是有效和安全的.

Objective:To investigate the efficacy of different preferred thrombectomy strategies for embolic acute vertebrobasilar artery occlusion (AVBAO).Methods:Forty-four patients with embolic AVBAO who underwent endovascular treatment in Department of Neurology, Nanyang Central Hospital from January 2019 to June 2021 were included in the study. Patients were divided into stent-retriever thrombectomy group ( n=27) and aspiration thrombectomy group ( n=17) according to different preferred thrombectomy strategies. Modified Rankin scale (mRS) was used to evaluate the prognoses of these patients 90 d after surgery; the differences of clinical data, surgery-related characteristics, prognoses and complications between the two groups were compared. Results:There was no significant difference between the 2 groups in terms of time from onset to puncture, sites of target vessel occlusion, proportion of patients accepted intraoperative remedial measures, and successful recirculation rate of target vessels ( P>0.05). Compared with the aspiration thrombectomy group, the stent-retriever thrombectomy group had significantly decreased utilization rate of middle catheters, significantly increased retrieval attempts in thrombectomy, statistically lower re-recanalization rate of first-time thrombectomy on the target vessels, significantly longer time from puncture to re-recanalization, and significantly higher incidence of new embolism ( P<0.05). There was no significant difference between the 2 groups in incidences of vascular rupture and postoperative spontaneous intracerebral hemorrhage (sICH), and good prognosis rate 90 d after surgery ( P>0.05). Conclusion:For embolic AVBAO patients, similar recanalization and short-term good prognosis can be obtained by aspiration thrombectomy to those by stent-retriever thrombectomy; besides that, aspiration thrombectomy has advantages as shorter recanalization time, less new embolic complications and higher re-recanalization rate of first-time thrombectomy.

目的 比较颅内动脉粥样硬化疾病(ICAD)和栓塞两种病理机制导致的急性椎基底动脉闭塞(AVBO)患者临床特征及血管内治疗效果.方法 选取2019年1月至2021年11月在南阳市中心医院接受血管内治疗的116例AVBO患者,根据病理机制将其分为ICAD组72例和栓塞组44例.收集并比较患者术前资料(包括一般资料、临床资料)、术中血管造影检查结果〔闭塞位置、急性基底动脉闭塞侧支循环血管造影评分(ACGS-BAO)〕、术后即刻血管再通成功情况、围术期症状性颅内出血发生率和预后情况.结果 两组患者性别、年龄和有高血压史、糖尿病史、心房颤动史、卒中史、吸烟史者占比及美国国立卫生研究院卒中量表(NIHSS)评分、后循环Alberta卒中项目早期CT评分(ASPECTS)、基底动脉计算机扫描血管造影评分(BATMAN)、静脉溶栓率、发病至入院时间比较,差异无统计学意义(P>0.05);ICAD组患者格拉斯哥昏迷量表(GCS)评分低于栓塞组(P<0.05).两组患者血管闭塞位置比较,差异有统计学意义(P<0.05);ICAD组闭塞部位常见于椎动脉V4段、基底动脉中段,栓塞组闭塞部位常见于基底动脉上段.ICAD组患者ACGS-BAO高于栓塞组(P<0.05);两组患者术后即刻血管再通成功率、围术期症状性颅内出血发生率、预后良好率比较,差异无统计学意义(P>0.05).结论 ICAD可能是AVBO患者更常见的病理机制,病理机制为ICAD的AVBO患者术前GCS评分可能低于病理机制为栓塞者,且前者的闭塞位置常见于椎动脉V4段、基底动脉中段,后者的闭塞位置常见于基底动脉上段.两种不同病理机制的AVBO患者经血管内治疗后血管再通成功率和预后良好率相当.

目的 探讨颈内动脉颅外段伴同侧颅内动脉急性串联闭塞患者血管内治疗方法,评估其疗效和安全性.方法 回顾性分析2015年1月至2019年12月在南阳市中心医院接受血管内治疗的63例颈内动脉颅外段伴同侧颅内动脉急性串联闭塞患者临床资料.根据治疗方式不同,分为顺行再通组(n=41)和逆行再通组(n=22).采用改良溶栓治疗脑梗死(mTICI)血流分级判断术后血管再通程度,改良Rankin量表(mRS)评分评估术后90 d临床预后.结果 两组患者年龄、性别、伴高血压病、伴糖尿病、伴心房颤动、吸烟史、术前美国国立卫生研究院卒中量表(NIHSS)评分、术前Alberta卒中项目早期CT评分(ASPECTS)、脑卒中病因等差异均无统计学意义(均P>0.05).顺行再通组、逆行再通组分别有16例(39.0％)、15例(68.2％)接受急诊颈内动脉起始段支架植入(P=0.027),穿刺至再通时间分别为(138+55)min、(120+47)min(P<0.01),90 d恢复良好(mRS评分≤2分)分别有17例(41.5％)、15例(68.2％)(P=0.043),差异均有统计学意义.结论 血管内逆行再通治疗颈内动脉颅外段伴同侧颅内大血管急性串联闭塞,是一种安全有效的治疗选择.

目的 探讨急性脑梗死(acute cerebral infarction,ACI)患者血清微小RNA-493(microRNA-493,miR-493)表达水平及其与溶栓后预后的关系.方法 选取我院70例ACI患者作为研究组,70例健康体检者作为对照组,检测研究组阿替普酶静脉溶栓治疗前、治疗后3 d、7 d血清miR-493水平,并与对照组比较,比较研究组不同神经功能缺损程度患者治疗前血清血管生长因子、炎性因子及miR-493水平,分析血清miR-493与神经功能缺损程度、血清血管生长因子、炎性因子的相关性及与预测预后的价值.结果 研究组治疗前、治疗后3 d、7 d血清miR-493水平均低于对照组(P<0.05);治疗前血清miR-493水平与ACI患者神经功能缺损程度、血清血管内皮生长因子(VEGF)、血管生成素-2(Ang-2)、C反应蛋白(CRP)、白介素-6(IL-6)水平均呈负相关(P<0.05);研究组预后良好患者治疗前、治疗后3 d、7 d血清miR-493水平均高于预后不良患者(P<0.05);治疗前、治疗后3 d、7 d血清miR-493预测ACI患者溶栓治疗预后为不良的曲线下面积(AUC)分别为0.748、0.851、0.879,其中治疗后7 d血清miR-493预测的AUC最大,预测敏感度、特异度分别为73.68％、88.24％.结论 脑梗死急性期患者血清miR-493表达水平明显降低,且与患者溶栓后预后有关,在辅助临床预测患者预后方面具有一定价值.

This article was to analyze the factors influencing the prognosis of posterior circulation cerebral infarction (PCCI) patients, retrospectively. One hundred forty five patients diagnosed with PCCI in Nanyang Central Hospital between June 25, 2016 and October 14, 2019 were included and underwent cerebral vascular mechanical thrombectomy. The clinical data of those patients were collected. The patients were followed up for 3 months to observe the prognostic efficacy and explore the influencing factors for poor prognosis. The potential prognostic factors for PCCI patients after emergency endovascular mechanical thrombectomy were analyzed by univariate and multivariable logistic regression. The thermodynamic diagram was drawn to explore the associations between the prognostic factors. The risk of poor prognosis in PCCI patients receiving emergency endovascular mechanical thrombectomy was reduced by 0.552 time with every 1-point increase of the Alberta Stroke Program Early CT in posterior circulation score (odds ratio [OR] = 0.448, 95% confidence interval [CI]: 0.276-0.727). The risk of poor prognosis was increased by 0.827 time for each additional grade in the digital subtraction angiography-American Society of Intervention and Therapeutic Neuroradiology grading (OR = 1.827, 95% CI: 1.221-2.733, P = .003) and increased by 0.288 time for every 1-point increase in National Institutes of Health Stroke scale at 24 hours (OR = 1.288, 95% CI: 1.161-1.429). All P < .05. Alberta Stroke Program Early CT in posterior circulation score, digital subtraction angiography-American Society of Intervention and Therapeutic Neuroradiology grading, National Institutes of Health Stroke scale score at 24 hours were factors affecting the prognosis of PCCI patients undergoing emergency endovascular mechanical thrombectomy, which might provide evidence for endovascular treatment of PCCI.

Objective:This study aimed to explore the efficacy and safety of bridging therapy and direct thrombectomy in the treatment of acute posterior circulation ischemic stroke and analyze the prognostic factors.Methods:This observational study involved 67 patients with acute posterior circulation ischemic stroke in Nanyang City Central Hospital from January 2018 to December 2019. The patients, who comprised 52 males and 15 females aged 51-74 years old, were received the treatment of direct thrombectomy or bridging therapy. The patients were divided into two groups according to different treatment methods. Thirty-four patients who received direct mechanical thrombectomy were included in the direct thrombectomy group, and 33 patients who received intravenous alteplase thrombolysis combined with mechanical thrombectomy and bridging were included in the bridging treatment group. Digital subtraction angiography was used to evaluate the vascular recanalization rate immediately after the operation, and the incidence of intracranial hemorrhage was evaluated by CT 48 hours after the operation. The modified Rankin scale (mRS) was used to evaluate the neurological recovery of the patients before and on the 90th day after the operation. The mortality rate within 90 days after operation was determined. The effectiveness and safety of the two treatment options were evaluated by comparing the clinical baseline data of the two groups of patients and the above-mentioned observation indicators. Multivariate logistic regression analysis was performed to screen independent risk factors for mortality within 90 days after surgery.Results:The data from the two groups of patients were compared with clinical baseline data, such as age, gender distribution, preoperative National Institutes of Health stroke scale (NIHSS) score, etiology classification, onset time, and vascular occlusion location. The difference was not statistically significant (all P values>0.05). The proportion of patients with atrial fibrillation in the bridging treatment group and direct thrombus removal combination was 9.1%(3/33) and 32.4%(11/34), respectively, and the difference was statistically significant (χ 2=5.195, P<0.05). The proportion of patients in the bridging treatment group with good neurological function recovery (mRS class 0-2) 90 days after surgery was higher than that in the direct thrombus removal group (51.5%[17/33] and 29.4%[10/34], respectively), but no significant difference was observed between the groups (χ 2=3.401, P>0.05). The postoperative vascular recanalization rate (75.8% vs. 58.8%) and mortality within 90 days after the operation were determined (27.3%[25/33] vs. 29.4%[10/34]), and no significant difference was noted between the two groups ( P>0.05). One patient (3.03%) in the bridging treatment group had intracranial hemorrhage 48 hours after surgery, whereas no intracranial hemorrhage was observed in the direct thrombus removal group. The difference between the two groups was not statistically significant (χ 2=1.046, P>0.05). Multivariate logistic regression analysis suggested that the NIHSS score at admission was an independent risk factor for mortality within 90 days after surgery. Conclusions:Direct thrombectomy and bridging therapy have similar clinical efficacy and safety for acute posterior circulation ischemic stroke. The degree of neurological deficit at the onset has a certain correlation with the clinical prognosis.

Abstract Introduction: Dissecting aneurysms in the communicating segment of the internal carotid artery (ICA) is uncommon. Clinical evidence to support the use of endovascular treatment for dissecting aneurysms in the communicating segment of ICA has not been established. Patient concerns: A 48-year-old woman presented with complaints of sudden headaches with nausea and vomiting. Computed Tomography Head taken in another hospital showed subarachnoid hemorrhage. Diagnoses: Digital Subtraction Angiography examination of the head showed ruptured dissecting aneurysm in the communicating segment of ICA. Interventions: The patient underwent stent-assisted aneurysm embolization and acute thromboembolic complication occurred intra-operatively. Tirofiban was injected through the microcatheter and a Percutaneous Transluminal Angioplasty (PTA) balloon catheter was inserted in the stent. Following the treatment, a repeat digital subtraction angiography showed no aneurysm development and the right middle cerebral artery was unobstructed. The right ICA was observed for 30 minutes, and it remained patent. Outcomes: Seven hours after the procedure, the patient became drowsy, the right limb was paralyzed, and her speech was slurred. Magnetic resonance angiography and 3D time of flight showed severe stenosis of the right middle cerebral artery and anti-platelet drug was administered. At seven-month follow-up, the patient showed residual mild motor dysfunction of right hand and leg. Conclusion: For ruptured dissecting aneurysm in the communicating segment of ICA, endovascular treatment may be a suitable treatment. But there is a risk of acute thromboembolic complication during and after the procedure and hence requires careful monitoring.

Abstract Introduction: Mechanical thrombectomy (MT) has become part of the standard treatment for patients who have acute ischemic stroke due to large-vessel occlusion in the anterior cerebral circulation. But the safety and effectiveness of MT for posterior cerebral artery (PCA) is still controversial. Patient concerns: We report a 40-year-old man with a medical history of hypertension who was non-compliant with the treatment. He presented to the hospital with right extremity paralysis, aphasia, and left gaze paralysis due to the occlusion of left PCA P2 segment (National Institutes of Health Stroke Scale Score 16). Head computed tomography showed infarction area of left temporal lobe and occipital lobe. Diagnosis: A head computed tomography angiography examination showed left PCA P2 segment occlusion. Interventions: The patient underwent MT and subsequent angiography showed left PCA P2 segment occlusion was recanalized after MT. Outcomes: The patient's symptoms improved completely after MT. Conclusion: The clinical symptoms due to PCA P2 segment occlusion may be mistaken clinically for MCA stroke syndrome, which may lead to severe functional deficit. MT seems to be safe and effective in treating PCA P2 segment occlusion.

Objective:To explore the predictive value of posterior circulation acute stroke prognosis early CT score on CT angiography(CTA) posterior circulation acute stroke prognosis early CT(pc-ASPECTs) in the outcome of endovascular treatment for acute vertebrobasilar occlusion (AVBO).Methods:Thirty-five patients with AVBO diagnosed by preoperative CTA images from January 2018 to January 2020 in Nanyang Central Hospital were retrospectively analyzed. There were 25 males and 10 females, aged 34-84(62.40±13.46) years. All patients received endovascular treatment. Vascular recanalization was assessed using the blood flow grade after modified thrombolysis in cerebral infarction (mTICI) treatment; the modified Rankin Scale (mRS) score at 3 months after treatment was used to assess the clinical prognosis at 3 months after surgery. According to the prognosis of patients, they were divided into good and poor prognosis groups, and univariate analysis was conducted. Receiver operating characteristic (ROC) curve analysis was performed for the CTA pc-ASPECT score of the good prognosis group to determine the area under the curve and the optimal cut-off point. Multivariate logistic regression analysis was performed to identify independent predictors of the 3-month clinical outcome.Results:Among the 35 patients, 34 patients (97.1%) had successful recanalization, 22 patients (62.9%) had a good clinical prognosis, and 6 patients had intraoperative complications of distal embolization of the target vessel. The National Institute of Health stroke scale and CTA pc-ASPECT scores between the good and poor prognosis groups in univariate analysis (all P values<0.1), and were included into multivariate analysis. ROC analysis of the CTA pc-ASPECT score of the good prognosis group revealed an area under the curve of 0.930 (95% confidence interval [ CI]=0.850-1.000) and optimal cut-off value of 7.5 points (sensitivity=72.7% and specificity=100%). Multivariate logistic regression analysis showed that the CTA pc-ASPECT score ≥8 was an independent predictor of a good 3-month outcome after endovascular treatment of AVBO (odds ratio=23.850, 95% CI=2.005-283.704, P<0.05). Conclusions:The CTA pc-ASPECT score can independently predict the short-term clinical prognosis of patients with AVBO treated with endovascular treatment.

目的 分析超时间窗后循环缺血性脑梗死应用TREVO支架取栓再通的有效性及其对丝氨酸蛋白酶抑制剂(Vaspin)、认知功能的影响.方法 收集2016-01—2019-12南阳市中心医院超时间窗后循环缺血性脑梗死患者100例,根据随机数字表法分成观察组和对照组各50例.对照组采用人组织型纤溶酶原激活剂(rt-PA)进行静脉溶栓治疗,观察组采用TREVO支架取栓治疗.分析比较患者术前及术后72 h、90 d的NIHSS评分、MoCA评分、血清Vaspin水平,术后90 d mRS评分、并发症发生情况、复发率、病死率.结果 2组患者术后72 h、90 d相较术前NIHSS评分均降低,MoCA评分、血清Vaspin水平均升高,且观察组优于对照组.术后90 d观察组的并发症发生情况、复发率优于对照组,mRS评分≤2者占比观察组(58％)显著高于对照组(38％),2组患者术后90 d的病死率无明显差异(P>0.05).结论 TREVO支架取栓再通对超时间窗后循环缺血性脑梗死患者疗效显著,能够明显提高术后患者血清Vaspin水平,有效促进患者神经功能恢复,提高认知功能,改善预后.

目的 评价急性串联病变型椎基底动脉闭塞(VBO)患者血管内开通治疗的临床效果.方法 回顾性分析150例连续入组的急性VBO患者临床、技术及功能结局资料.根据血管病变类型,将患者分为串联病变组(n=33,VBO伴有椎动脉颅外段病变)、单纯栓塞组(n=33,VBO因心源性或不明原因栓塞)、颅内狭窄组(n=84,VBO因椎基底动脉颅内段狭窄基础上急性闭塞).对比分析3组患者临床结局、术中和术后并发症及血管开通情况等指标.靶血管成功再通定义为改良溶栓治疗脑梗死(mTICI)血流分级2b/3级.改良Rankin量表(mRS)评分评定术后3个月临床预后,0～2分为预后良好.结果 串联病变组、单纯栓塞组、颅内狭窄组靶血管再通率分别为100％(33/33)、97.0％(32/33)、98.8％(83/84),差异均无统计学意义(P>0.05);股动脉穿刺至血管再通中位时间分别为110(89.0～148.0)min、65(47.0～122.5)min、100(78.5～131.5)min,单纯栓塞组显著短于串联病变组、颅内狭窄组(P=0.004);术后90 d良好预后率分别为72.7％(24/33)、39.4％(13/33)、58.3％(49/84),串联病变组、颅内狭窄组高于单纯栓塞组(P=0.023).3组术中术后并发症比较,差异均无统计学意义(P>0.05).结论 血管内开通治疗急性串联病变型VBO安全有效,近期临床预后良好.

目的 探讨中间导管对急性基底动脉闭塞(acute basilar artery occlusion,ABAO)机械取栓的作用.方法 回顾性分析150例连续入组的ABAO患者的临床、技术及功能结局资料.根据机械取栓术中是否使用中间导管分为2组:中间导管组(n=52),常规取栓组(n=98).对比分析2组患者取栓次数、血管开通情况、术中并发症等相关指标.血管成功再通定义为改良脑梗死溶栓(mTICI)治疗后血流分级2b/3级.采用改良Rankin量表(mRS)评分评定术后3个月临床预后,0～3分为预后良好.结果 2组90 d良好预后率分别为:中间导管组50.00％(26/52),常规取栓组44.90％(60/98);血管再通率分别为:中间导管组98.08％(51/52),常规取栓组98.98％(97/98);中间导管组穿刺至血管再通时间中位数为77.0(64.25,77.00)min,明显短于常规取栓组92.5(63.00,132.50)min(P<0.05);前者取栓次数中位数1.0(1.0,2.0)明显小于后者2.0(1.0,3.0)(P<0.05);2组术中远端血管栓塞并发症情况比较差异无统计学意义(P>0.05).结论 急性基底动脉闭塞机械取栓术中应用中间导管辅助可降低靶血管穿刺至复流时间.

目的 探究基于双联抗方案治疗的脑梗死患者Solitaire AB支架介入对患者血管再通治疗效果、神经功能恢复情况、炎症反应的改善作用.方法 选取2018年3月至2020年12月河南省南阳市中心医院收治的急性脑梗死患者126例,按照随机数字表法分为研究组63例与对照组63例,研究组基于双联抗方案治疗实施Solitaire AB支架介入治疗,对照组基于双联抗方案治疗实施动脉溶栓.采用脑梗死溶栓分级评分(thrombolysis in cerebralinfaretion,TICI)对患者血管再通情况进行评价;在术前及术后第1、7天采用简易精神状态量表(the Mini-Mental State Examination,MMSE)对患者的神经功能进行评价;术前及术后第3、6个月采用改良Rankin量表(modified rankin scale,mRS)评估患者的远期神经功能恢复情况;术前、术后14d采用免疫比浊法检测高敏C反应蛋白(high-sensitive-CRP,hs-CRP),采用酶联免疫吸附法检测肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)及白细胞介素-6(interleukin-6,IL-6)水平;比较两组患者术后死亡及术后症状性出血、肺部感染等的发生情况.结果 研究组术后血管再通率高于对照组,差异有显著性(P<0.05);两组患者术后死亡及症状性出血、肺部感染的发生率差异无显著性(P>0.05).两组患者术后第1、7天MMSE评分均较术前增高,差异有显著性(P<0.05),且研究组术后第1、7d MMSE评分高于对照组,差异有显著性(P<0.05);两组患者术后3、6个月mRS评分均较术前降低,差异有显著性(P<0.05);且研究组术后3、6个月mRS评分低于对照组,差异有显著性(P<0.05).两组患者术后14d炎症因子水平均较术前降低,且研究组血清hs-CRP、TNF-α、IL-6水平显著低于对照组,差异有显著性(P<0.05).结论 对于脑梗死患者在双联抗方案基础上实施Solitaire AB支架介入对患者血管再通的治疗效果较高,且对神经功能恢复及炎性改善具有积极影响,安全性较好.