目的 探讨青年急性大血管闭塞性卒中(ALVOS)病因及血管内治疗的安全性和有效性.方法 回顾性分析2018年1月-2021年12月接受血管内治疗的40例青年ALVOS患者的临床资料,分析青年ALVOS的病因及接受血管内治疗的手术成功率和并发症发生情况,采用美国国立卫生研究院卒中量表(NIHSS)评分评估患者入院和出院时的神经功能.根据术后90 d时改良Rankin量表(mRS)评分将患者分为预后良好者(mRS评分≤2分)与预后不良者(mRS评分＞2分),比较预后良好与预后不良患者临床资料以及患者基线时与出院时NIHSS评分.结果 本研究共入组40例患者,其中男32例(80.0％),女8例(20.0％),年龄41.5(36.0,44.0)岁.按照急性卒中试验(TOAST)分型进行分类,大动脉粥样硬化(LAA)型18例(45.0％),心源性栓塞(CE)型12例(30.0％),其他原因(SOE)型8例(20.0％),不明原因(SUE)型2例(5.0％).38例患者经血管内治疗成功再通,2例再通失败,未发生手术相关严重并发症.术后6例患者出现症状性颅内出血.出院时NIHSS评分为2.0(0.3,7.5)分,低于基线时的12.0(6.3,15.8)分,差异有统计学意义(P＜0.05).术后90 d随访,29例患者预后良好(mRS评分0～2分),死亡5例(mRS评分6分).预后良好者、体质量指数(BMI)、手术时间、取栓次数、症状性颅内出血与预后不良者比较,差异有统计学意义(P＜0.05).结论 青年ALVOS病因以LAA型和颈动脉夹层常见,血管内治疗对各种病因引起的青年ALVOS安全、有效,BMI、手术时间、取栓次数、症状性颅内出血可能影响青年ALVOS患者血管内治疗的预后.

目的 评价血浆D-二聚体水平对接受脑动脉再通治疗的急性缺血性脑卒中(AIS)患者血管闭塞类型的预测价值.方法 回顾性分析2019年1月至2020年8月于南京医科大学第一附属医院接受脑动脉再通治疗的AIS患者临床资料.根据术中血管造影结果,将患者分为急性颅内动脉粥样硬化性狭窄(ICAS)所致大血管闭塞(LVO)(ICAS-LVO组)和非ICAS所致LVO(非ICAS-LVO组).所有患者均在到达急诊时接受血样采集,检测D-二聚体(D-D)水平.采用单因素和多因素logistic回归分析确定ICAS-LVO相关预测因子,与D-D相关性;受试者工作特征曲线(ROC)评价D-D水平预测ICAS-LVO的价值.结果 共纳入273例患者.其中79例(28.9％)患者诊断为ICAS-LVO.与非ICAS-LVO组患者相比,ICAS-LVO组患者更年轻,男性比例更高,有吸烟史者更多,伴心房颤动更少,美国国立卫生研究院卒中量表(NIHSS)评分基线值更低(均P<0.05).ICAS-LVO组患者血浆D-D水平显著低于非ICAS-LVO组患者(0.39 mg/L比1.20 mg/L,P<0.01).多因素logistic回归分析显示,较低D-D与ICAS-LVO呈显著正相关(OR=0.30,95％CI=0.18～0.47,P<0.01).基于ROC,血浆D-D预测ICAS-LVO的最佳临界值为0.84 mg/L,灵敏度为84.8％,特异度为67.5％,阴性预测值为91.6％,曲线下面积(AUC)为0.830.结论 基线低D-D水平是ICAS-LVO的独立预测因子,有助于神经介入医师预先制定血管再通治疗策略.

目的 探讨急性缺血性脑卒中(AIS)患者接受机械取栓后即刻行平板CT检查对术后出血的预测价值.方法 回顾性收集并分析2019年1月～2021年12月于我院接受机械取栓治疗并在术后立即行平板CT扫描的AIS患者临床资料.出血的观察时间窗为术后5～7 d,依据头颅CT平扫结果判断.采用受试者工作特征(ROC)曲线来评估平板CT对出血预测的准确性.结果 研究期间内共纳入108例患者,其中58例(53.7％)在平板CT上出现高密度征,另50例(46.3％)无高密度征.最终39例(36.1％)经随访影像学检查证实发生出血.平板CT高密度征患者发生出血比例显著高于无高密度征(58.7％比10.0％,P<0.001).平板CT高密度征预测出血的敏感度87.2％,阴性预测值90.0％.在所有平板CT高密度征患者中,发生出血的患者具有更高的CT值(125 HU比93 HU,P=0.001)和更高比例的高密度征占位效应(67.6％比12.5％,P<0.001).预测出血的CT值、占位效应和联合二者的ROC曲线下面积分别为0.74、0.78和0.83.结论 取栓术后即刻平板CT上的高密度征可以预测AIS的出血,具有较高的阴性预测值.在高密度征患者中,结合CT值和占位效应,平板CT预测高密度征进展为出血的能力得到进一步提高.

Objective:To investigate the effectiveness and safety of double stent-retriever thrombectomy in the treatment of acute intracranial macrovascular occlusion at bifurcation.Methods:The clinical and imaging materials of patients with acute intracranial macrovascular occlusion at the bifurcation treated with double stent-retriever thrombectomy from May 2019 to October 2021 in the Neurology Department of Xuyi County People's Hospital and Interventional Radiology Department of Jiangsu Provincial People's Hospital were retrospectively analyzed. The recanalization rate and complications were determined and the clinical outcomes were assessed. Also, neurological functions of the patients before treatment and discharge from hospital, measured by National Institute of Health stroke scale (NIHSS) score, were compared via Wilcoxon test and the clinical outcomes were assessed by modified Rankin score (mRs) at 90 d after treatment.Results:A total of 11 patients were treated with double stents after single stent thrombectomy failed, 9 patients resulted in successfully recanalization (modified thrombolysis in cerebrai infarction score of 2b to 3), and 2 patients failed. There were 4 patients with symptomatic intracranial hemorrhage occurred after operation. Compared with preoperative conditions, the NIHSS score discharge from hospital was markedly lower (12 vs 16, P=0.012). At 90 d, 2 patients died (mRs 6), 3 patients seriously disabled (mRs 5), 1 patient moderately seriously disabled (mRs 4), 1 patient resulted in moderate outcome (mRs 3) and the other 4 patients achieved good outcome (mRs 0-2).Conclusion:Double stent-retriever thrombectomy is safe and effective in the treatment of acute intracranial macrovascular occlusion at bifurcation with high vascular recanalization rate. It can be used as a rescue strategy for the failure of single stent thrombectomy.

Objective:To compare the clinical efficacies of endovascular treatments in patients with acute basilar artery occlusion (ABAO) caused by large-artery atherosclerosis (LAA) and cardioembolism (CE).Methods:From March 2018 to February 2021, 104 patients with ABAO accepted endovascular treatments in Department of Neurology and Department of Interventional Radiology, Xuyi County People's Hospital of Huaian City were enrolled; these patients were classified into either a LAA group or a CE group according to Trial of ORG 10172 in Acute Stroke Treatment classification (TOAST). The differences in general data, procedure information, and clinical efficacies were compared between the 2 groups. Univariate and multivariate Logistic regression analyses were used to identify the influencing factors for poor prognosis.Results:In these 104 patients, 51 patients (49.0%) were into the LAA group and 53 patients (51.0%) into the CE group. Ninety-six patients (92.3%) acquired successful revascularization, and 35 patients (33.7%) had good prognosis (modified Rankin scale scores of 0-2) 90 d after surgery. LAA group had significantly lower percentage of patients with atrial fibrillation, significantly lower baseline National Institutes of Health Stroke Scale scores, statistically higher percentages of patients with lower and middle basilar artery occlusion and patients accepted rescued stenting, and statistically longer procedure time ( P<0.05). There were no significant differences between the two groups in terms of successful recanalization percentage, symptomatic intracranial hemorrhage incidence, and prognosis 90 d after surgery ( P>0.05). Age ( OR=0.935, 95%CI: 0.891-0.981, P=0.006) and semiquantitative scores of basilar artery based on computed tomography angiography ( OR=1.520, 95%CI: 1.180-1.959, P=0.001) were independent influencing factors for poor prognosis. TOAST etiology (LAA/CE) was not an independent influencing factors for poor prognosis ( OR=1.175, 95%CI: 0.461-2.933, P=0.736). Conclusion:There are differences in risk factors, vascular occlusion sites, endovascular treatment, and procedure time between patients with ABAO caused by LAA and CE; however, no obvious difference in clinical outcomes is noted, and there was no obvious correlation between stroke etiology and prognoses.

Background Flat-panel computed tomography (CT) is an available imaging modality immediately after endovascular thrombectomy without transferring patients to the CT room. Purpose To determine the accuracy of flat-panel CT scans in differentiating hemorrhagic transformation (HT) from contrast exudation after thrombectomy in patients with acute ischemic stroke (AIS). Material and Methods From January 2019 to December 2021, consecutive patients with AIS who received an immediate flat-panel CT scan and follow-up neuroimaging after thrombectomy were enrolled in our study. The receiver operating characteristic curve was adopted to assess the discriminating accuracy of characteristics of flat-panel CT for HT. Results A total of 108 patients were enrolled in the study; 58 (53.7%) patients presented with hyperdense lesions on flat-panel CT. Patients with hyperdense lesions experienced a higher proportion of HT than patients without (58.7% vs. 10.0%; P < 0.001). Among all patients with hyperdensity on flat-panel CT, patients who experienced HT had higher average Hounsfield units (HUavg) (125 vs. 93; P = 0.001) and a higher proportion of mass effect (67.6 vs. 12.5; P < 0.001). The flat-panel CT differentiating HT from contrast exudation yielded a sensitivity of 87.2% and a negative predictive value of 90.0%. The area under the curve of HUavg, mass effect, and combination for differentiation of HT were 0.74, 0.78, and 0.83, respectively. Conclusion The hyperdensity on immediately post-thrombectomy flat-panel CT could differentiate HT from contrast exudation with an excellent negative predictive value. The ability of flat-panel CT in differentiating HT from contrast exudation was improved when combined with HUavg and mass effect.

目的:探讨依达拉奉治疗急性脑梗死患者的临床效果及对患者血清铁蛋白、氧化应激指标水平的影响.方法:选取2016年1月～2017年1月收治的82例急性脑梗死患者,采用随机数字表法分为试验组和对照组各41例,试验组采用基础治疗+依达拉奉,对照组给予基础治疗,对比两组患者的神经功能缺损评分(NIHSS)、血清神经元特异性烯醇化酶(NSE)、S-100β蛋白、基质金属蛋白酶-9(MMP-9)、一氧化氮(NO)、丙二醛(MDA)、超氧化物歧化酶(SOD)、铁蛋白(SF)及日常生活活动能力(ADL)评分.结果:治疗前,两组患者的NIHSS评分差异不具有统计学意义(P>0.05);治疗14 d、治疗28 d后,试验组患者的NIHSS评分均低于对照组,差异有统计学意义(P<0.05);治疗前,两组患者的血清SOD、MDA、NO、SF、NSE、S-100β蛋白、MMP-9水平差异不具有统计学意义(P>0.05);治疗7 d后,试验组患者的血清MDA、NO、SF、NSE、S-100β蛋白、MMP-9水平均低于对照组,差异有统计学意义(P<0.05),SOD水平高于对照组,差异有统计学意义(P<0.05);治疗前,两组患者的ADL评分差异不具有统计学意义(P>0.05);治疗后1个月、3个月,试验组患者的ADL评分均高于对应时间点的对照组,差异有统计学意义(P<0.05).结论:依达拉奉结合基础治疗急性脑梗死患者具有较好的临床效果,能显著促进患者神经功能恢复、降低血清SF水平、改善患者氧化应激水平及日常生活活动能力.