Association between proteinuria and the development of malignant middle cerebral artery infarction: A retrospective cohort study

A disrupted blood-brain barrier (BBB) with extravasation of macromolecules plays a critical role in the development of malignant middle cerebral artery infarction (MMI). Proteinuria is considered a marker of generalized endothelial dysfunction, including BBB disruption. This study aimed to clarify whether proteinuria identified in the acute stage of stroke is associated with MMI development. Patients with infarctions involving the middle cerebral artery territory were reviewed. Urine samples collected within 8 hours after stroke were analyzed using urine dipsticks. Patients were divided into proteinuria (urine dipstick reading of 1 + to 4+) and nonproteinuria groups. MMI was present if either signs of uncal herniation or a progressive conscious disturbance were recorded along with a midline shift > 5 mm identified on follow-up computed tomography (CT). Among the 1261 patients identified between January 2010 and June 2019, 138 were eligible for final analyses. Patients in the MMI group had lower Alberta Stroke Program Early CT Scores (ASPECTS), higher National Institutes of Health Stroke Scale scores, and a greater proportion of proteinuria than those in the non-MMI group. Four multivariate logistic regression models were used to clarify the role of proteinuria in MMI development. In model 1, proteinuria was significantly associated with MMI after adjusting for age, sex, dyslipidemia and ASPECTS (OR = 2.987, 95% CI = 1.329–6.716, P = .0081). The risk of developing MMI in patients with proteinuria remained significant in model 2 (OR = 3.066, 95% CI = 1.349–6.968, P = .0075) after adjusting for estimated glomerular filtrate rate (eGFR) < 60ml/min/1.73 m² in addition to variables in model 1. In model 3, proteinuria was still significantly associated with MMI after adjusting for age, sex, dyslipidemia, ASPECTS, hypertension, diabetes, and atrial fibrillation (OR = 2.521, 95% CI = 1.075–5.912, P = .0335). In model 4, the risk of developing MMI in patients with proteinuria remained significant (OR = 2.579, 95% CI = 1.094–6.079, P = .0304) after adjusting for eGFR < 60ml/min/1.73 m² in addition to variables in model 3. Proteinuria is independently associated with MMI development. Proteinuria may be a clinically accessible predictor of MMI development.     

Repeated intracerebral hemorrhage after craniotomy for a distal middle cerebral artery aneurysm: A case report

Rationale:Distal middle cerebral artery aneurysms are very rare in the clinic, and craniotomy clipping is the better treatment after diagnosis. However, patients can also have repeated acute intracerebral hemorrhage after craniotomy for aneurysm, which has not been previously reported.Patient concerns:A 24-year-old male patient was admitted to our hospital with headache, nausea, and vomiting. He was well before, had no family history of cerebrovascular disease or hypertension, and had no history of trauma.Diagnoses:Computer tomography and digital subtraction angiography of the brain revealed intracranial hematoma and an aneurysm located at the M4 segment of the left middle cerebral artery.Interventions:The patient underwent 2 surgeries to treat the aneurysm, followed by 2 operations for acute cerebral hemorrhage.Outcomes:Despite repeated surgical treatments, the patient had a poor prognosis and eventually died of respiratory and circulatory failure after repeated brain bleeding.Lessons:Briefly, it is of great importance to consider the risk factors of cerebral hemorrhage, and provide individualized treatment and psychological counseling for patients with intracerebral hemorrhage.     

Solitaire FR支架机械取栓联合5F Navien导管抽吸技术治疗大脑中动脉急性闭塞的效果分析

目的探讨Solitaire FR支架机械取栓联合5F Navien导管抽吸技术治疗大脑中动脉急性闭塞的安全性和有效性。方法回顾性连续纳入2016年2月至5月首都医科大学宣武医院神经外科接受Solitaire FR支架机械取栓联合5F Navien导管抽吸技术治疗的大脑中动脉急性闭塞患者(发病6 h)11例的病例资料,记录患者年龄、性别、入院美国国立卫生研究院卒中量表(NIHSS)评分、脑梗死溶栓试验(TICI)分级、手术相关并发症、术后24 h NIHSS评分,术后90 d改良Rankin量表(mRS)评分。通过SPSS软件对治疗前后相关数据的差异进行分析。结果 11例大脑中动脉急性闭塞患者中,男7例,女4例,年龄44~78岁,平均(66±11)岁;术前及术后NIHSS评分分别为(18±3)、(8±4)分,治疗前后差异有统计学意义(t=5.327,P0.01);均成功实现闭塞大脑中动脉的再通。术后90 d随访,患者预后良好(mRS 0~2分)7例。无严重的M1段内导管操作的相关并发症。结论初步经验显示,Solitaire FR支架机械取栓联合5F Navien导管抽吸技术治疗大脑中动脉急性闭塞是一种安全有效的血管内机械取栓方法。     

双支架取栓治疗难治性颅内大动脉分叉处急性闭塞的疗效观察

目的探讨双支架取栓治疗难治性颅内大动脉分叉处急性闭塞的有效性及安全性。 方法回顾性分析盱眙县人民医院神经内科和江苏省人民医院介入放射科自2019年5月至2021年10月行双支架取栓治疗难治性颅内大动脉分叉处急性闭塞患者的临床及影像学资料，评估患者的血管再通情况、手术并发症及临床预后。比较患者术前及出院时美国国立卫生研究院卒中量表（NIHSS）评分，采用改良Rankin评分（mRs）评价患者术后90 d的临床预后。 结果本组共纳入11例患者，均为单支架取栓失败后改用双支架进行补救，9例（81.8%）患者成功再通（改良脑梗死溶栓分级为2b~3级），2例患者再通失败。4例患者术后发生症状性颅内出血。本组患者出院时NIHSS评分的中位数[12（2，20）分]较术前[16（8，21）分]明显降低，差异具有统计学意义（P=0.012）。术后随访90 d，2例患者死亡（mRs 6分），3例患者严重残疾（mRs 5分），1例患者重度残疾（mRs 4分），1例患者中等残疾（mRs 3分），4例患者良好（mRs≤2分）。 结论双支架取栓技术治疗难治性颅内大血管分叉处急性闭塞安全、有效，血管再通率高，可以作为单支架取栓不成功的补救措施。     

The association between white matter changes and development of malignant middle cerebral artery infarction: A case–control study

Disrupted blood–brain barrier (BBB) in patients with ischemic stroke plays a critical role in malignant middle cerebral artery infarction (MMI) development.Cerebral white matter changes (WMC), particularly in the deep subcortical area or in severe one, may be also underlain by disrupted BBB. It is unclear whether the presence of WMC with potential premorbid disruption of BBB makes patients susceptible to MMI. Therefore, this study aimed to clarify any putative relationship between the MMI and WMC in terms of their severity and locations.In this case–control study, patients with infarction in the middle cerebral artery territory were retrospectively reviewed. Brain magnetic resonance images were analyzed according to Fazekas scale, and identified WMC were divided into periventricular WMC (PV-WMC) and deep subcortical WMC (deep-WMC). Patients were scored as having WMC, PV-WMC, deep-WMC, severe PV-WMC, and severe deep-WMC according to the severity and locations. Patients were defined as having MMI if either a progressive conscious disturbance or signs of uncal herniation was recorded in combination with a midline shift >5 mm identified on the follow-up computed tomography.Among 297 patients admitted between July 2009 and February 2015, 92 patients were eligible for final analysis. Compared to patients without MMI, patients with MMI had a higher score of National Institutes of Health Stroke Scale, a larger infarct volume, and an increasingly greater proportion of severe PV-WMC, deep-WMC, and severe deep-WMC, respectively. After adjustment for sex, age, infarct volume, and history of hypertension, severe deep-WMC (odds ratio [OR] = 6.362, 95% confidence interval [CI] = 1.444–28.023, P = .0144) and severe PV-WMC (odds ratio = 5.608, 95% confidence interval = 1.107–28.399, P = .0372) were significantly associated with MMI development.MMI and WMC are significantly associated such that MMI development is more likely when PV-WMC or deep-WMC is more severe. We hypothesize that Fazekas scale-defined severe deep-WMC and PV-WMC may be considered as clinically approachable predictors of MMI development. These findings support that the WMC with potential premorbid disrupted BBB may make patients susceptible to MMI, and further prospective study should be conducted to clarify this hypothesis.     

大脑中动脉高密度征与磁敏感血管征对大脑中动脉闭塞评估的一致性

目的探讨CT平扫大脑中动脉高密度征(HMCAS)与磁敏感加权成像大脑中动脉(MCA)磁敏感血管征(SVS)的一致性。方法回顾性连续纳入150例发病6 h内前循环脑梗死急性期患者,均接受头部CT、MRI一站式检查,并记录患者基线情况。对CT及MRI进行分析,记录HMCAS、SVS存在情况,共有75例与DSA结果进行对照;HMCAS与SVS的一致性采用Kappa检验并行假设u检验。结果以DSA为参照标准,HMCAS和SVS对急性MCA主干闭塞的敏感度、特异度分别为42.4%(14/33)、36.4%(12/33)和92.9%(39/42)、90.5%(38/42);HMCAS与SVS的一致性检验值κ=0.804,u值为9.570(P0.05)。结论 MCA的HMCAS与SVS呈高度一致性,可为急性缺血性卒中的早期诊断、治疗方式的选择及溶栓后血管再通预测提供参考依据。     

Perfusion image guided mechanical thrombectomy combined with tirofiban successfully revascularize systemic lupus erythematosus related acute large vessel occlusion: A case report

Rationale:Systemic lupus erythematosus (SLE) is an important cause of stroke, more than a half the cases present as acute ischemic stroke. Thrombolysis is an effective choice in most cases, but for large vessel occlusion, mechanical thrombectomy is more effective. Here we reported a case of SLE-related stroke with left middle cerebral artery (MCA) occlusion, who was successfully treated by MT and tirofiban.Patient concern:A 38-year-old female suffered from right hemiplegia and aphasia for 8 hours. She was diagnosed with SLE 20 years ago, and neuropsychiatric SLE was considered 8 months before this onset. One month ago, glucocorticoids were discontinued by herself because of deterioration of bilateral femoral head osteonecrosis.Diagnosis:Left MCA occlusion was confirmed by computed tomography perfusion.Intervention:Immediate mechanical thrombectomy was performed and tirofiban was given to prevent re-occlusion of left MCA. Twenty fourhours later oral antiplatelet was given after intracranial hemorrhage was ruled out.Outcomes:Her neurological symptom improved several days later, and she was transferred to further rehabilitation. At 4 months follow-up she can live independently with mild hypophrasia. There was no further events of ischemic stroke in 1-year follow-up.Lessons:Mechanical thrombectomy is a highly effective and indispensable treatment for SLE related large vessel occlusion. In addition, tirofiban may reduce vessel reocclusion in special cases such as SLE and artery stenosis.     

Rheolytic mechanical thrombectomy for pulmonary artery thrombus in children with complex cyanotic congenital heart disease

Acute thrombosis of the pulmonary arteries (PA) can occur during operative or catheter based interventions. This may have serious consequences especially in patients with palliated single ventricle physiology. Traditional therapy for PA thrombosis includes use of local or systemic thrombolytic therapy and surgical thrombectomy. Percutaneous transcatheter mechanical thrombectomy can be broadly divided into three categories based on their mechanisms of action: (a) mechanical fragmentation of the embolus using guide‐wires, pigtail catheters, or balloons (flossing technique), (b) extraction using cup or basket devices, or (c) hydrodynamic fragmentation and aspiration of the embolus. Rheolytic thrombectomy using AngioJet system (Possis Medical, Minneapolis, MN) uses hydrodynamic thrombus fragmentation and aspiration technique, and provides an alternative solution in management of acute thrombosis. We report three patients with complex congenital heart disease of single ventricle physiology palliated by cavopulmonary anastomosis or central shunts and PA thrombosis treated with AngioJet system. © 2008 Wiley‐Liss, Inc.     

重组人促红细胞生长素治疗老年急性大脑中动脉缺血性脑卒中的研究

目的研究重组人促红细胞生长素(recombinant human erythropoietin,rhEPO)治疗老年急性缺血性脑卒中患者的有效性及安全性。方法入选74例年龄≥75岁的老年急性缺血性脑卒中患者,经磁共振弥散加权成像检查证实在大脑中动脉的范围内,将患者随机分为治疗组36例和对照组38例,患者入院后前3 d每日分别给予rhEPO或生理盐水静脉注射治疗。观察第1、3、7、20和30天美国国立卫生研究院卒中量表(NIHSS)评分和脑梗死体积变化,ELISA法检测损伤标记物S100B水平。结果与对照组比较,治疗组第20、30天NIHSS评分明显下降(P<0.05);第20天脑梗死体积明显降低[(46.5±32.3)cm~3 vs(89.6±68.9)cm~3,P<0.01];第3、7和20天血清S100B水平明显下降[(1.45±0.25)μg/L vs(1.58±0.13)μg/L,(1.41±0.20)μg/L vs(1.69±0.15)μg/L,(0.38±0.14)μg/L vs(0.78±0.26)μg/L,P<0.01]。结论老年急性缺血性脑卒中患者对静脉注射高剂量rhEPO治疗耐受性良好,并且可改善患者30 d后的临床预后。     

Predictors of intracranial hemorrhage after mechanical thrombectomy using a stent-retriever for anterior circulation ischemic stroke: A retrospective study

Intracranial hemorrhage (ICH) after mechanical thrombectomy (MT) is a potentially catastrophic complication. We aimed to identify predictors of hemorrhagic complications following MT using a stent-retriever (SR) for acute ischemic stroke (AIS) patients due to large vessel occlusion of anterior circulation. In consecutive AIS patients, the clinical and procedural variables were retrospectively analyzed. ICH was evaluated on computed tomography performed 24 hours following MT and dichotomized into asymptomatic ICH and symptomatic intracranial hemorrhage (SICH) depending on the presence of neurological deterioration. Using univariate and multivariate analyses, the predictors of ICH and SICH were identified. The optimal cutoff value for predicting SICH was determined by receiver operating characteristic (ROC) analysis. Among 135 patients, ICH was detected in 52 (38.5%), and 17 (12.6%) were classified as having SICH. We found that serum glucose level (odds ratio [OR] 1.016, P = .011) and number of SR passes (OR 2.607, P < .001) were significantly correlated with ICH. Independent predictors of SICH included the baseline Alberta stroke program early computed tomography score (ASPECTS) (OR 0.485, P = .042), time from stroke onset to groin puncture (OTP) (OR 1.033, P = .016), and number of SR passes (OR 2.342, P = .038). In ROC analysis, baseline ASPECTS ≤ 7, OTP > 280 minutes, and SR passes > 3 were the optimal cutoff values for predicting SICH. In conclusion, serum glucose level and SR pass serve as predictors for any form of ICH in large vessel occlusion-induced AIS patients undergoing MT. Moreover, patients with lower ASPECTS, prolonged OTP, and multiple SR passes are more vulnerable to SICH.     

双支架并联取栓术治疗急性基底动脉闭塞初步研究

目的初步探讨双支架取栓治疗急性基底动脉闭塞患者的可行性、有效性及安全性。方法回顾性分析采用Solitaire FR双支架并联取栓术治疗血栓负荷重的急性基底动脉闭塞所致脑梗死5例患者,统计手术时间,评价取栓后即刻血流再灌注、24 h神经功能改善及术后90天随访mRS评分。结果 5例患者均通过双支架并联取栓术获得闭塞血管良好再通,改良脑梗死溶栓分级(mTICI)为2b-3级,其中完全再通4例(mTICI 3级)。无明显与操作相关并发症,术后24 h NIHSS评分较术前减少10分。术后90天随访,2例患者预后良好,2例残疾,1例患者死亡。结论使用Solitaire FR双支架并联取栓术治疗血栓负荷重的部分后循环急性脑梗死患者是安全有效的。     

Endovascular treatment for acute basilar artery occlusion via persistent primitive hypoglossal artery: A case report

Introduction:Although their effectiveness and safety have not yet been established, endovascular treatments have recently been applied in the treatment of acute basilar artery occlusion. If not identified, persistent primitive hypoglossal artery, a rare variant of the posterior circulation, could be a barrier to the successful treatment of basilar artery occlusion.Patient concerns:An 83-year-old woman, who had been undergoing treatment for hypertension for 20 years, visited our hospital 3 hours after the onset of acute unresponsive mental deterioration. The patient was unresponsive to painful stimuli, and the pupils were equal and miotic.Diagnosis:Brain computed tomography angiography confirmed complete occlusion of the distal basilar artery and revealed a dilated branch arising from the right internal carotid artery at the C2 vertebral level.Interventions:Endovascular thrombectomy was performed directly via the right femoral artery. Complete recanalization was achieved via manual aspiration thrombectomy.Outcomes:Brain magnetic resonance imaging revealed multifocal cerebral infarctions in the bilateral thalamus, midbrain, and cerebellar vermis. The patient''s neurological symptoms gradually improved.Conclusions:This is a rare case of basilar artery occlusion that was successfully treated with mechanical thrombectomy through persistent primitive hypoglossal artery. It is important to consider the potential clinical implications of this rare vascular variant.     

Percutaneous mechanical thrombectomy and pharmacologic thrombolysis for renal artery embolism: case report and review of endovascular treatment

Renal artery embolism (RAE) is an uncommon event that is associated with a high rate of renal loss. We present a case of RAE to a solitary kidney that was treated with combined percutaneous rheolytic thrombectomy, intra-arterial thrombolysis, and supplemental renal artery stent placement.     

Free-floating and spinning thrombus of the basilar artery: A case report

Rationale:Free-floating thrombi in the intracranial artery are rare. We report a case of a free-floating and spinning thrombus caused by turbulent flow distal to the basilar artery stenosis. We compare thrombus changes in a series of images according to time and describe the approach to treatment and thrombosis resolution.</abstract>Patient concerns:A 55-year-old man presented to the emergency department on March 21, 2020, with left-sided weakness, bilateral limb ataxia, and a one-day history of dysarthria. Brain magnetic resonance imaging showed multifocal infarctions in the pons and cerebellum with severe basilar stenosis.Diagnoses:Digital subtraction angiography showed severe focal stenosis. A relatively large oval-shaped mobile thrombus was observed spinning due to turbulent flow at the distal portion of the stenosis.Interventions:We administered a combination antithrombotic regimen of warfarin and clopidogrel for 50 days.Outcomes:No thrombus was observed on the third follow-up digital subtraction angiography.Lessons:No previous study has directly observed a mobile thrombus in the intracranial artery using digital subtraction angiography. We used a combination antithrombotic strategy, which was effective after long-term, rather than short-term, use.     

改良大鼠大脑中动脉阻塞模型的建立

目的建立稳定、可靠的大鼠大脑中动脉阻塞(MCAO)改良模型。方法将60只SD雄性大鼠随机分为实验组和对照组,每组30只。实验组采用改良方法制作MCAO模型;对照组采用Longa传统方法制作模型。比较两组模型制作的成功率、脑梗死体积及模型稳定性。结果改良后的大鼠MCAO模型制作成功率和脑梗死体积分别为82·8%、(46±7)%,与对照组的89·3%、(48±7)%比较,差异无显著性(P>0·05)。实验组脑梗死体积变异系数为15·94%,对照组为16·21%,两组的模型稳定性相近。结论改良的大鼠MCAO模型是一种稳定性好、成功率高的脑缺血-再灌注模型。     

LVIS支架治疗大脑中动脉分叉部未破裂动脉瘤的临床效果分析

目的 评价LVIS(low profile visualized intraluminal support)支架治疗大脑中动脉(MCA)分叉部未破裂动脉瘤的安全性和有效性.方法 回顾性连续纳入2014年10月至2018年12月海军军医大学第一附属医院神经外科收治的所有LVIS支架治疗的MCA分叉部未破裂动脉瘤患者58例(58个MCA分叉部未破裂动脉瘤).收集患者的一般资料以及临床资料,一般资料包括年龄、性别和血管危险因素等;临床资料包括动脉瘤的基本特征(动脉瘤最大径、瘤颈大小、远近端载瘤动脉直径)、治疗结果、随访资料等.根据Raymond分级评价术后即刻栓塞程度,影像学随访采用DSA和(或)MR血管成像(MRA),临床预后采用门诊和(或)电话随访.术后6个月行DSA随访,此后间隔1~2年行MRA及临床随访.与术后即刻栓塞结果对比,影像学随访治愈为动脉瘤不显影,改善为显影较前减少,稳定为显影同前,复发为显影较前增多.采用改良Rankin量表(mRS)评分评估临床预后,预后良好为mRS评分≤2分,预后不良为mRS评分3~5分,死亡为mRS评分6分.结果 58例患者均成功实施LVIS支架辅助栓塞治疗,术后即刻造影显示,动脉瘤Raymond分级Ⅰ级26例(44.8%),Ⅱ级11例(19.0%),Ⅲ级21例(36.2%).围手术期并发症发生率为3.4%(2/58),包括1例操作相关出血并发症和1例血栓栓塞并发症.48例患者接受DSA随访[5~49个月,中位随访时间8.0(6.0,12.0)个月],其中37个(77.1%)动脉瘤治愈,3个(6.2%)改善,6个(12.5%)稳定,2个(4.2%)复发;1例发生支架内狭窄,2例分别为被LVIS支架覆盖的分支血管发生狭窄和闭塞,均无症状.58例患者完成了临床随访[5~49个月,中位时间9.0(6.0,15.8)个月],未发生出血及缺血事件.结论 LVIS支架可尝试用于MCA分叉部未破裂动脉瘤,但其对分支血管的影响还需要进一步研究.     

Solitaire AB型支架取栓治疗急性缺血性脑卒中患者的效果

目的评价Solitaire AB型支架取栓术治疗急性脑动脉闭塞患者的效果。方法回顾性分析2014年11月至2016年1月甘肃省庆阳市人民医院神经外科诊治的94例急性缺血性脑卒中(AIS)患者,根据治疗方法将患者分为Solitaire AB型支架取栓术组(A组)40例和常规微导管机械碎栓术组(B组)54例,术后随访3个月,比较2组患者手术前后神经功能指标。采用前向血流评定分级(TICI)、美国国立卫生研究院卒中量表(NIHSS)及改良Rankin量表问卷(MRS)评价治疗效果。采用SPSS 16.0统计软件对数据进行分析。根据数据类型,组间比较采用独立样本t检验或χ2检验,组内比较采用配对t检验。结果 2组患者同一时间点血清神经元特异性烯醇化酶(NSE)、中枢神经特异蛋白(S100β)、肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)水平差异均无统计学意义(P0.05);术后24 h,2组患者NSE、S100β、TNF-α及IL-6水平均较术前显著升高,术后72 h均较术前显著下降,差异有统计学意义(P0.05)。A组患者TICIⅢ级占70.00%(28/40)、TICIⅡ级17.50%(7/40),TICI 0~Ⅰ级12.50%(5/40),B组患者TICIⅢ级占57.41%(31/54)、TICIⅡ级25.93%(14/54),TICI 0~Ⅰ级16.67%(9/54),2组TICI分级比较差异无统计学意义(P=0.238)。2组患者同一时间点NIHSS评分比较差异无统计学意义(P0.05),但术后1周及术后2周2组患者NIHSS评分均较术前显著降低(P0.05)。术后3个月,2组患者预后良好率比较差异无统计学意义(80.00%vs 70.37%,P0.05)。结论 Solitaire AB型支架取栓术治疗AIS患者效果与常规机械碎栓的效果相差不大,但操作相对复杂,难度较高,临床医师需根据患者情况合理选择手术方法。     

吸烟与男性缺血性脑卒中患者大脑中动脉狭窄的关联性分析

目的探讨吸烟与男性大脑中动脉狭窄及缺血性脑卒中患者发病年龄的关系。方法连续收集广东省人民医院收住院的缺血性脑卒中并行全脑数字减影血管造影术检查的男性患者257例,根据是否吸烟分为吸烟组140例和非吸烟组117例,对比2组患者大脑中动脉M1段狭窄率及发病年龄。结果吸烟组大脑中动脉M1段狭窄发生率显著高于非吸烟组(49.3%vs 24.8%),发生缺血性脑卒中的年龄明显小于非吸烟组[(60.13±10.52)岁vs(65.26±11.77)岁,P<0.01]。吸烟组年龄≤60岁缺血性脑卒中发生率明显高于非吸烟组(50.7%vs 27.4%,P<0.01)。结论吸烟可能是男性患者大脑中动脉M1段狭窄的一个重要危险因素,且吸烟可能使男性患者更早发生缺血性脑卒中。     

Mechanical thrombectomy using the Solitaire stent in a left main coronary artery: A novel approach to coronary thrombus retrieval

The Solitaire stent is a self‐expanding nitinol, fully retrievable stent that was originally designed for applications in cerebral circulation. Expanded indications for its use in mechanical embolectomy during acute ischemic stroke have proven safe and effective. Herein, we describe a novel use of this stent to perform a mechanical thrombectomy of a large left main coronary artery thrombus. © 2016 Wiley Periodicals, Inc.     

Endovascular middle cerebral artery occlusion in rats as a model for studying vascular dementia

Vascular dementia (VaD), incorporating cognitive dysfunction with vascular disease, ranks as the second leading cause of dementia in the United States, yet no effective treatment is currently available. The challenge of defining the pathological substrates of VaD is complicated by the heterogeneous nature of cerebrovascular disease and coexistence of other pathologies, including Alzheimer’s disease (AD) types of lesion. The use of rodent models of ischemic stroke may help to elucidate the type of lesions that are responsible for cognitive impairment in humans. Endovascular middle cerebral artery (MCA) occlusion in rats is considered to be a convenient and reliable model of human cerebral ischemia. Both sensorimotor and cognitive dysfunction can be induced in the rat endovascular MCA occlusion model, yet sensorimotor deficits induced by endovascular MCA occlusion may improve with time, whereas data presented in this review suggest that in rats this model can result in a progressive course of cognitive impairment that is consistent with the clinical progression of VaD. Thus far, experimental studies using this model have demonstrated a direct interaction of cerebral ischemic damage and AD-type neuropathologies in the primary ischemic area. Further, coincident to the progressive decline of cognitive function, a delayed neurodegeneration in a remote area, distal to the primary ischemic area, the hippocampus, has been demonstrated in a rat endovascular MCA occlusion model. We argue that this model could be employed to study VaD and provide insight into some of the pathophysiological mechanisms of VaD.