Lack of Relation Between Severity of Stroke and Severity of Extracranial Internal Carotid Artery Lesions in Taiwanese First-Ever Ischemic Stroke Patients

BACKGROUND AND PURPOSE: The authors attempt to determine whether hemodynamically significant extracranial internal carotid artery (ICA) lesions correlate with the severity of first-ever hemispheric ischemic stroke. METHODS: Carotid duplex was used to evaluate carotid arteries. The National Institutes of Health Stroke Scale was used to describe the severity of the stroke and was stratified as follows: 1-6 = mild, 7-15 = moderate, > 15 = severe. Duplex findings were categorized according to velocity criteria into < 50% stenosis if ICA peak systolic velocity (PSV) (cm/s) < 140 and > 50% stenosis if ICA PSV > 140 or ratio of ICA and common carotid artery in PSV > 2. No detectable flow at ICA was considered occlusion. Stroke subtype was classified according to TOAST criteria. RESULTS: Two hundred nineteen consecutive patients were enrolled, including 127 with mild, 65 with moderate, and 27 with severe stroke. The prevalence of ICA stenosis > 50% in each group was 3.6%, 1.4%, 0.9%, respectively. Two patients in the severe group had total ICA occlusion. The overall prevalence of significant ICA lesions was 6.8%. CONCLUSIONS: There is no positive correlation of stroke severity with the severity of duplex findings, which may be due to low prevalence of significant ICA lesions or other stroke mechanisms. Most of the patients had mild stroke, and the majority had ICA stenosis < 50%. Small-vessel occlusion tended to have mild severity of stroke. Intracranial artery lesions or other factors causing stroke in Taiwanese should be investigated. Given the low incidence of significant extracranial carotid disease in symptomatic Taiwanese stroke patients, routine screening of symptomatic Taiwanese for extracranial carotid artery disease does not provide enough information to determine stroke mechanism, and transcranial Doppler should be added to the screening tests.     

Association Between Total Cholesterol and 5 year Mortality in Patients with Carotid Artery Stenosis and Poststroke Functional Dependence

Background: Aggressive lipid-lowering treatment reduces the risk of cardiovascular events, but remains controversial in stroke patients. We investigate the influence of total cholesterol level on 5-year outcomes of ischemic stroke patients with high-grade internal carotid artery (ICA) stenosis and poststroke functional dependence.Methods: One-hundred and ninety-six acute ischemic stroke patients with high-grade ICA stenosis and modified Rankin Scale score ≥ 3 upon discharge were enrolled and prospectively observed for 5 years. Patients were divided into 2 groups according to total cholesterol level at admission: ≥200 mg/dL or <200 mg/dL. Demographic features, vascular risk factors, co-morbidities, and outcomes were compared between the 2 groups. Results: 117 (59.7%) patients had higher and 79 (40.3%) patients had lower total cholesterol levels. The prevalence of older age and atrial fibrillation was significantly higher in patients with lower total cholesterol; the prevalence of diabetes mellitus was higher in patients with higher total cholesterol. After adjusting for the established clinical predictors of adverse outcomes, the multivariate Cox regression revealed that lower total cholesterol level is a significant predictor of 5-year mortality (HR (hazard ratio)?=?1.88, 95% CI (confidence interval)?=?1.09-3.23, P?=?.023). Conclusions: Lower total cholesterol level is associated with increased risk of 5-year mortality in ischemic stroke patients with high-grade ICA stenosis and post-stroke functional dependence. Aggressive treatment of hyperlipidemia should be carefully considered in these patients although it could reduce the risk of atherosclerotic cardiovascular diseases and stroke recurrence in some stroke patients.     

Association between Ischemic Stroke and Vascular Shear Stress in the Carotid Artery

Background and Purpose

Vascular shear stress is essential for maintaining the morphology and function of endothelial cells. We hypothesized that shear stress in the internal carotid artery (ICA) may differ between patients with ischemic stroke and healthy control subjects.

Methods

ICA shear stress was calculated in 143 controls and 122 patients with ischemic stroke who had a normal ICA or an ICA with <50% stenosis. The stroke group included patients who presented with a first-ever or recurrent ischemic stroke but excluded cardioembolic stroke and uncertain etiologies. Of the 122 patients, 107 (87.7%) and 15 (12.3%) patients were categorized as first-ever and recurrent stroke, respectively.

Results

Carotid diameters were significantly larger, and both peak-systolic and end-diastolic velocities were significantly lower in patients with ischemic stroke than in controls (all p values <0.05). Mean values of peak-systolic and end-diastolic shear stress in both ICAs were significantly lower in patients with ischemic stroke in models that adjusted for age, sex, and vascular risk factors (p for trend <0.05). The ICA shear stress was lowest in patients with recurrent stroke or the subtype of small-vessel occlusion. Higher peak-systolic and end-diastolic shear stresses in both ICAs were independently and negatively associated with ischemic stroke after adjusting for potential confounders (all p values <0.05).

Conclusions

ICA shear stresses were significantly lower in patients with ischemic stroke than in control subjects. Future studies should attempt to define the causal relationship between carotid arterial shear stress and ischemic stroke.     

分期支架治疗颈内动脉次全闭塞伴对侧颈内动脉狭窄的疗效与安全性观察

目的 观察分期支架治疗颈内动脉次全闭塞伴对侧颈内动脉狭窄患者的疗效及安全性。
方法 回顾性分析2017年1-12月在西安交通大学第一附属医院神经内科连续住院的颈内动脉次全
闭塞伴对侧颈内动脉狭窄患者的临床资料。采用分期治疗的方法，一期使用小球囊扩张次全闭塞侧
颈内动脉，间隔2周后进行二期支架置入。观察手术技术成功率，手术成功指一期小球囊扩张后狭窄
率减小，局部无夹层，且二期支架置入位置良好，残余狭窄率≤30%，前向血流mTICI 3级；围手术期
并发症（包括高灌注综合征、脑梗死、TIA等）及死亡情况；随访1个月、3个月、6个月及3年的mRS评分，
以及心脑血管事件和全因死亡。
结果 共纳入7例颈内动脉次全闭塞患者，平均年龄63.0±3.4岁，男性6例；其中6例为左侧，6例合
并对侧颈内动脉狭窄≥50%。手术技术成功率100%（7/7），所有患者均未发生围手术期并发症及死
亡。1个月随访时1例患者mRS评分为1分，其他6例均为0分，其余时间点所有患者均为0分，3年随访时1
例患者于术后1年发生冠心病。
结论 分期支架治疗在颈内动脉次全闭塞伴对侧颈动脉狭窄患者中相对安全，并对颈内动脉狭窄
的改善明显。     

分期支架治疗颈内动脉次全闭塞伴对侧颈内动脉狭窄的疗效与安全性观察

目的 观察分期支架治疗颈内动脉次全闭塞伴对侧颈内动脉狭窄患者的疗效及安全性。方法 回顾性分析2017年1-12月在西安交通大学第一附属医院神经内科连续住院的颈内动脉次全闭塞伴对侧颈内动脉狭窄患者的临床资料。采用分期治疗的方法,一期使用小球囊扩张次全闭塞侧颈内动脉,间隔2周后进行二期支架置入。观察手术技术成功率,手术成功指一期小球囊扩张后狭窄率减小,局部无夹层,且二期支架置入位置良好,残余狭窄率≤30%,前向血流mTICI 3级;围手术期并发症（包括高灌注综合征、脑梗死、TIA等）及死亡情况;随访1个月、3个月、6个月及3年的mRS评分,以及心脑血管事件和全因死亡。结果 共纳入7例颈内动脉次全闭塞患者,平均年龄63.0±3.4岁,男性6例;其中6例为左侧,6例合并对侧颈内动脉狭窄≥50%。手术技术成功率100%（7/7）,所有患者均未发生围手术期并发症及死亡。1个月随访时1例患者mRS评分为1分,其他6例均为0分,其余时间点所有患者均为0分,3年随访时1例患者于术后1年发生冠心病。结论 分期支架治疗在颈内动脉次全闭塞伴对侧颈动脉狭窄患者中相对安全,并对颈内动脉狭窄的改善明显。     

颈动脉狭窄和缺血性脑血管病关系的研究

目的　探讨动脉粥样硬化所致的颈动脉颅外段狭窄与缺血性脑血管疾病的关系。方法　对214例脑梗死(CI)患者、26例短暂性脑缺血发作(TIA)患者、58例单纯高血压病(HBP)患者及43例正常健康人群,通过颈动脉彩色多普勒超声检测颈动脉颅外段的狭窄程度,并结合其病史进行对照研究。结果　CI、TIA患者的颈动脉颅外段狭窄率(分别为78.98%、57.69%)较HBP组(46.30%)和正常对照组(30.95%)明显升高(P <0.01,P <0.05),狭窄程度在1%~50%;CI各年龄组间狭窄程度无明显差异(P >0.05),但50岁以上的老年患者颈动脉狭窄率明显高于50 岁以下的患者(P <0.01);TIA与CI患者颈动脉狭窄度有症状侧重于无症状侧。结论　缺血性脑血管病与颈动脉狭窄程度有明显相关性。     

The Clinical Outcomes of 75 Consecutive Patients with Cervical Carotid Artery Stenosis Treated by Carotid Artery Stenting

Objective

The purpose of this study was to analyze the clinical outcome of 75 consecutive patients with cervical carotid artery stenosis and who were treated by carotid artery stenting (CAS) only.

Methods

From February 2003 to June 2008, there were 78 stents placed in 75 symptomatic patients (mean age : 67.3 years); 69 patients had carotid stenosis ≥70%, and 6 patients had asymptomatic stenosis ≥80%. No carotid endarterectomy (CEA) was performed during the same period. The patients were clinically followed-up for a mean of 20.1 months.

Results

The procedures were technically successful in all cases. Three (3.8%) patients had procedure-related complications. During the 30-day postprocedural period, there were no restenosis or major stroke. Minor stroke was noticed in 3 (3.8%) patients and 1 (1.3%) of the 75 patients suddenly expired 2 days after discharge. There were no new neurological symptoms that developed during the clinical follow-up period. The results of our series were not inferior to those the previously published in CAS studies, and in fact they were better.

Conclusion

Our results suggest that CAS may be safe and useful for the treatment of cervical carotid artery stenosis when it is used as the first line treatment in those institutions that lack enough experience with CEA.     

缺血性卒中患者血尿酸水平与颈动脉狭窄的关系

目的 研究缺血性卒中患者血尿酸（serum uric acid,SUA）与颈动脉狭窄之间的关系。方法 经脑血管造影术确诊有颈动脉狭窄的缺血性卒中患者112例,无狭窄者50例。根据造影结果,将颈动脉狭窄分轻度狭窄组45例、中度狭窄组39例和重度狭窄组28例。单侧颈动脉狭窄有62例,双侧颈动脉狭窄有50例。比较不同组别间SUA水平的差异以及SUA与颈动脉狭窄程度之间的关系。结果 颈动脉狭窄组SUA水平显著高于无狭窄组（343±111μmol/L vs 287±67μmol/L,P<0.01）;重度狭窄组SUA水平高于中度狭窄组和轻度狭窄组（408±112μmol/L vs 351±100μmol/L,P=0.025;408±112μmol/L vs 296±99μmol/L,P<0.01）;中度狭窄组SUA水平高于轻度狭窄组（P=0.017）;双侧颈动脉狭窄组SUA水平高于单侧狭窄组（378±128μmol/L vs 314±85μmol/L,P=0.003）。Logistic回归分析提示,SUA并非颈动脉狭窄与否的独立危险因素（P=0.239）;Spearman等级相关分析提示,SUA水平与颈动脉狭窄程度呈正相关（r=0.401,P<0.01）。结论 高血尿酸是颈动脉狭窄与否的重要但非独立危险因素,与颈动脉狭窄严重程度呈正相关。     

Association between gastrointestinal bleeding and 3-year mortality in patients with acute,first-ever ischemic stroke

The influence of gastrointestinal bleeding on clinical presentation and outcomes of patients with acute ischemic stroke remains controversial. We investigate the effect of gastrointestinal bleeding on the outcomes of patients with acute, first-ever ischemic stroke. We enrolled 934 patients with acute, first-ever ischemic stroke and followed up them for 3 years. Patients were divided into 2 groups according to the presence or absence of gastrointestinal bleeding during acute stroke stage. Clinical presentation, stroke risk factors, laboratory data, co-morbidities, and outcomes were recorded. Seventy-six (8.1%) patients had gastrointestinal bleeding at admission. The prevalence of old age, atrial fibrillation, and previous transient ischemic attack was higher in patients with gastrointestinal bleeding (P < 0.001, P = 0.038, and P = 0.018, respectively). Total anterior circulation syndrome occurred more frequently among patients with gastrointestinal bleeding (P < 0.001). The mean length of acute ward stay, initial impaired consciousness, and stroke in evolution were higher in patients with gastrointestinal bleeding (P < 0.001, P < 0.001, and P < 0.001, respectively). The occurrence of pneumonia and dependent functional outcome were higher in patients with gastrointestinal bleeding (P < 0.001 and P < 0.001, respectively). A multivariate Cox regression analysis revealed that gastrointestinal bleeding is a significant risk factor for 3-year all-cause mortality (hazard ratio = 2.76; 95% confidence interval = 1.61–4.72; P < 0.001). In conclusion, gastrointestinal bleeding is associated with increased risk of 3-year mortality in patients with acute, first-ever ischemic stroke. Prophylactic therapies for gastrointestinal bleeding might improve ischemic stroke outcome.     

脑梗死患者颅内和颈部动脉狭窄的分布及特点

目的：探讨脑梗死（CI）患者颅内和颈部动脉狭窄的分布及特点.方法：采用超高场强磁共振血管造影（3.0TMRA）测定186例CI患者颅内和颈部动脉,并与121例轻度头昏患者对照.结果：186例CI患者有动脉狭窄164例（88.17%）.狭窄动脉分布： ①颅内动脉狭窄率为83.54 %,颈部动脉狭窄率为51.83%.②前循环单一动脉狭窄60/164例（36.59%）,其中颅内50例,颈部10例;后循环动脉狭窄38/164例（23.17%）,其中颅内21例,颈部17例. ③合并前、后循环颅内和颈部两条以上动脉狭窄66/164例（40.24%）.46～60岁组患者以前循环动脉狭窄为主（54.05%）,其中主要为颅内大脑中动脉;〉60岁组前循环动脉狭窄比例相对有所减少（30.08%）,而后循环动脉狭窄（26.02%）和多发动脉狭窄（43.90%）明显增加（P〈0.05）.结论：46～60岁CI患者动脉狭窄以前循环颅内动脉为主,〉60岁CI患者后循环动脉狭窄和累及前后循环颅内和颈部动脉的多发动脉狭窄相对明显增加.     

动脉-动脉栓塞性缺血性卒中患者晨峰血压与颈动脉溃疡斑块的相关性研究

【摘要】 目的 在动脉-动脉栓塞性缺血性卒中患者中,探讨晨峰高血压与颈动脉溃疡斑块的相关性。 方法 连续入组120例经中国缺血性卒中亚型（Chinese Ischemic Stroke Subclassification,CISS）分型诊断为动脉-动脉栓塞性缺血性卒中患者,利用24 h动态血压监测以及颈动脉彩超分别监测晨峰血压及颈动脉溃疡斑块。利用Logistic回归模型,研究晨峰血压与颈动脉溃疡斑块的相关性。 结果 120例缺血性卒中患者的平均年龄为（62.6±12.8）岁,女性占36.8%。晨峰高血压组（n=48）溃疡斑块的检出率与无晨峰高血压组（n=72）相比,差异无显著性（31.3％ vs 30.6％,P=0.84）。进一步将溃疡斑块按照检出部位（出现在卒中病灶同侧颈动脉或对侧颈动脉）进行分类发现,晨峰高血压组病灶同侧溃疡斑块的检出率明显高于无晨峰高血压组（27.1% vs 19.4%,P=0.008）。多因素分析的结果显示,在调整了年龄、性别之后,晨峰高血压与病灶同侧溃疡斑块的相关性具有统计学意义[优势比（odds ratio,OR）：1.42;95%可信区间（confidence interval,CI）：1.09～4.22）］;进一步校正其他危险因素之后,两者相关性仍存在（OR 1.23;95%CI 1.02～3.46）。 结论 在动脉-动脉栓塞性缺血性卒中患者中,晨峰高血压与卒中病灶同侧颈动脉溃疡斑块的检出率具有相关性,提示过高的晨峰血压可能是颈动脉溃疡斑块脱落导致动脉-动脉栓塞型缺血性卒中发病的危险因素。     

正五聚蛋白3与缺血性卒中患者颈动脉狭窄的关系研究

目的 通过分析急性缺血性卒中患者血浆正五聚蛋白3（pentraxin 3,PTX3）和凝集素样氧化型低 密度脂蛋白受体-1（lectin-like oxidized low density lipoprotein receptor-1,LOX-1）与颈动脉狭窄的关系, 探索PTX3在颈动脉狭窄形成过程中的作用。 方法 前瞻性连续纳入2019年1-8月于首都医科大学附属北京友谊医院神经内科治疗的急性缺血 性卒中患者,收集患者的基线资料、头颅CTA、血脂、PTX3、LOX-1等检查结果。根据患者头颅CTA有无 颈动脉狭窄分为颈动脉狭窄组和无颈动脉狭窄组;以狭窄程度为标准,将颈动脉狭窄组患者分为严重 狭窄（≥50%）组和轻度狭窄（＜50%）组。采用单因素分析和多因素Logistic回归分析颈内动脉狭窄的 独立危险因素。 结果 共纳入102例患者,颈动脉狭窄组57例（55.9%）,无颈动脉狭窄组45例（44.1%）,颈动脉狭窄 组中轻度狭窄32例（56.1%）,严重狭窄25例（43.9%）;颈动脉狭窄组的缺血性脑血管病家族史比例、 LDL-C、PTX3及LOX-1水平均高于无颈动脉狭窄组（均P <0.05）;严重狭窄组的PTX3、LOX-1及LDL-C水 平均高于轻度狭窄组（均P <0.05）。多因素Logistic回归分析结果显示PTX3（OR 3.11,95%CI 2.11～4.58, P =0.007）、LOX-1（OR 5.47,95%CI 2.89～10.13,P =0.017）和LDL-C（OR 5.35,95%CI 2.45～10.65, P =0.021）水平升高是颈动脉狭窄发生的独立危险因素。 结论 血浆PTX3、LOX-1和LDL-C水平升高是颈动脉狭窄的独立危险因素。     

无症状性颈动脉狭窄患者不同治疗方式后的临床结局

目的 探讨无症状性颈动脉狭窄（asymptomatic carotid artery stenosis,ACAS）患者药物治疗和介入治疗后的临床结局。      

Association between pneumonia in acute stroke stage and 3-year mortality in patients with acute first-ever ischemic stroke

The influence of pneumonia in acute stroke stage on the clinical presentation and long-term outcomes of patients with acute ischemic stroke is still controversial. We investigate the influence of pneumonia in acute stroke stage on the 3-year outcomes of patients with acute first-ever ischemic stroke. Nine-hundred and thirty-four patients with acute first-ever ischemic stroke were enrolled and had been followed for 3 years. Patients were divided into two groups according to whether pneumonia occurred during acute stroke stage or not. Clinical presentations, risk factors for stroke, laboratory data, co-morbidities, and outcomes were recorded. The result showed that a total of 100 patients (10.7%) had pneumonia in acute stroke stage. The prevalence of older age, atrial fibrillation was significantly higher in patients with pneumonia in acute stroke stage. Total anterior circulation syndrome and posterior circulation syndrome occurred more frequently among patients with pneumonia in acute stroke stage (P < 0.001 and P = 0.009, respectively). Multivariate Cox regression revealed that pneumonia in acute stroke stage is a significant predictor of 3-year mortality (hazard ratio = 6.39, 95% confidence interval = 4.03–10.11, P < 0.001). In conclusion, pneumonia during the acute stroke stage is associated with increased risk of 3-year mortality. Interventions to prevent pneumonia in acute stroke stage might improve ischemic stroke outcome.     

特定温度模式与小动脉闭塞性缺血性卒中严重程度相关性的研究

目的 探讨寒冷和温暖两种不同温度模式下,气温与小动脉闭塞性缺血性卒中严重程度的相关性.方法 回顾性分析2018年1-12月于苏州大学附属第一医院神经内科住院治疗的小动脉闭塞性缺血性卒中患者的临床资料,记录患者住院当日平均温度、人口学特征、卒中严重程度(NIHSS评分)等资料,评估寒冷和温暖两种不同温度模式下卒中严重程度...     

多发颅内动脉粥样硬化性狭窄对轻型卒中和短暂性脑缺血发作早期卒中复发风险影响研究

目的 探讨多发颅内动脉狭窄对轻型缺血性卒中和TIA早期卒中复发的影响。 方法 纳入氯吡格雷用于急性非致残性脑血管事件高危人群的疗效（Clopidogrel in High -risk Patients with Acute Non-disabling Cerebrovascular Events,CHANCE）研究影像亚组1089例非心源性高危 TIA和轻型缺血性卒中患者。根据患者入院时MRA序列的检查结果分为无颅内动脉狭窄、单发颅内动 脉狭窄和多发颅内动脉狭窄3组。随访患者90 d卒中复发（缺血性和出血性卒中）事件。采用Cox回归 分析多发颅内动脉狭窄对轻型缺血性卒中和TIA患者90 d卒中复发风险的影响。 结果 无颅内动脉狭窄、单发颅内动脉狭窄和多发颅内动脉狭窄组分别有608例、298例和183 例患者;90 d卒中发生风险比例分别为5.43%、9.06%和18.03%。与无颅内动脉狭窄患者相比,伴 有颅内动脉狭窄（包含单发和多发颅内动脉狭窄）患者卒中复发风险显著高于非颅内动脉狭窄患者 （12.50% vs 5.40%,P＜0001）。其中,多发颅内动脉狭窄卒中复发风险最高（18.03%）,是无颅内动脉 狭窄患者的3.578倍（HR 3.578,95%CI 2.189～5.850）。 结论 多发颅内动脉狭窄是非心源性TIA和轻型卒中患者早期卒中复发的独立危险因素。     

颈动脉狭窄的诊断与治疗

目的 研究颈动脉狭窄的诊断与治疗方法。方法 选择短暂性脑缺血性发作(TIA)患者行全脑血管造影,了解血管病变部位和狭窄程度。颈动脉狭窄<50％者行颈动脉注射尿激酶治疗;颈动脉狭窄>50％者行颈动脉内膜剥脱手术或血管内支架置入治疗。结果 4年来58例TIA患者中,发现颈动脉狭窄16例,其中狭窄<50％者8例经尿激酶颈动脉注射治疗后,TIA终止;狭窄>70%者8例,其中1例动脉粥样硬化斑块性狭窄行颈动脉内膜剥脱术,5例动脉粥样硬化斑块性狭窄、1例多发性大动脉炎及1例颈动脉夹层动脉瘤均行自膨式支架置入治疗。7例患者8处病变共置入自膨式支架12枚,治疗效果良好,随访3～20个月无再狭窄发生。结论 颈动脉狭窄是TIA发作的重要原因,而颈动脉内膜剥脱术和支架置入是治疗颈动脉狭窄的有效手段。     

症状性颈动脉狭窄伴有同侧中动脉狭窄的介入治疗效果研究

目的   比较单纯颈动脉支架置入术治疗和联合颈动脉、大脑中动脉支架置入术治疗症状性颈动脉狭窄伴有中动脉狭窄的缺血性卒中或短暂性脑缺血发作（transient ischemic attack,TIA）患者短期终点事件发生率。 方法  回顾2010年1月～2013年12月采用血管内支架治疗症状性颈动脉狭窄伴有同侧大脑中动脉狭窄的缺血性卒中或TIA患者的临床资料。根据治疗情况将患者分为单纯颈动脉支架置入术治疗组和联合颈动脉、大脑中动脉支架置入术治疗组。比较两组术后90?d终点事件（包括同侧缺血性卒中复发、症状性脑出血及死亡风险）的发生率。 结果  共有21例患者纳入本研究,男性15例,女性6例,平均年龄（58.5±3.6）岁,其中16例患者进行了颈动脉支架治疗,5例患者进行了颈动脉联合中动脉支架治疗。颈动脉支架治疗组90?d终点事件发生3例（18.75%）,颈动脉联合中动脉支架治疗组发生1例终点事件（20%）,两组间差异无显著性（P=0.952）。两组发生的终点事件均为缺血性卒中复发,无症状性脑出血及死亡患者。 结论  对于伴有颈动脉及大脑中动脉狭窄的缺血性卒中或TIA患者,与单纯颈动脉支架治疗相比同时进行颈动脉及大脑中动脉支架治疗手术未减少术后90?d同侧缺血性卒中复发风险。