Ischemic stroke is a serious complication during the perioperative period of cardiac surgery. Endovascular mechanial thrombectomy is an effective treatment for acute ischemic stroke, especially for patients after cardiac surgery who cannot undergo intravenous thrombolysis. However, for this specific patients in the perioperative period of cardiac surgery, the proportion of mechanial thrombectomy is significantly lower than in non-cardiac surgery patients. The therapeutic effect of mechanial thrombectomy in this context is not yet fully clear and require extensive clinical research for further validation.
Endovascular thrombectomy is a first-line treatment option for acute large vessel occlusive ischemic stroke after strict selection, which is an effective method to improve the good prognosis rate of patients. More and more evidence-based medicine proves that balloon guide catheter (BGC) can shorten the reperfusion time, increase the rate of initial reperfusion, and reduce the risk of distal embolism due to it′s proximal blood flow occlusion, but the application of BGC in emergency endovascular thrombectomy is still limited. This review summarizes the clinical application progress of BGC to provide theoretical basis for it′s application in emergency endovascular thrombectomy.
Objective: To explore the predictive value of intraoperative flat CT scan for intracranial hemorrhage after mechanical thrombectomy in patients with acute anterior circulation large vessel occlusion (AAC-LVO). Methods: A total of 106 patients with AAC-LVO who underwent mechanical thrombectomy at The Second Affiliated Hospital of Bengbu Medical University was conducted from March 2020 to June 2023. Intraoperative flat CT scan was performed among above patients to record CT values, high-density sign and mass effect. According to whether occurred intracranial hemorrhage after surgery, those patients were divided into intracranial hemorrhage group (n=29) and non-intracranial hemorrhage group (n=77). Univariate and multivariate stepwise Logistic regression analyses were used to screen the influencing factors of intracranial hemorrhage after mechanical thrombectomy. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficacy of intraoperative flat CT scan for postoperative intracranial hemorrhage. Results: Logistic regression analysis showed that hypertension was a protective factor for patients with AAC-LVO who did not experience intracranial hemorrhage after mechanical (OR=0.340, 95%CI: 0.123-0.941; P=0.038). A high National Institutes of Health Stroke (NIHSS) score at admission (OR=1.068, 95%CI: 1.010-1.129; P=0.021), as well as intraoperative flat CT high-density sign (OR=9.942, 95%CI: 2.631-37.567; P=0.001), mass effect (OR=23.564, 95%CI: 7.266-79.421; P=0.000), and CT value ≥ 90 HU (OR=9.714, 95%CI: 1.982-47.605; P=0.005) were risk factors for postoperative intracranial hemorrhage. The ROC curve showed that the area under the curve (AUC) for intraoperative flat CT value ≥ 90 HU, mass effect and their combined prediction of postoperative intracranial hemorrhage were 0.82 (95%CI: 0.734-0.889, P=0.000), 0.75 (95%CI: 0.661-0.833, P=0.000) and 0.76 (95%CI: 0.668-0.838, P=0.000), with sensitivity were 75.86%, 58.62% and 58.62%, and specificity were 88.31%, 92.21% and 93.51%. The predictive efficiency was highest for CT value ≥ 90 HU (t=48.777, P=0.000; t=43.681, P=0.000). Conclusions: In patients with AAC-LVO undergoing mechanical thrombectomy, intraoperative flat CT high-density sign such as CT value ≥ 90 HU and mass effect can predict postoperative intracranial hemorrhage, and the predictive value of CT value ≥ 90 HU is relatively high.
Objective: To investigate the efficacy and safety of modified SWIM technique for mechanical thrombectomy in patients with acute ischemic stroke. Methods: Total 114 patients with acute ischemic stroke who underwent mechanical thrombectomy in The Third the People's Hospital of Bengbu from January 2021 to January 2024 were included. Modified SWIM technique (modified thrombectomy group, n=57) and conventional SWIM technique (conventional thrombectomy group, n=57) were given respectively. Vascular recanalization rate of the first thrombectomy, overall vascular recanalization rate, the number of thrombectomy, puncture-to-reperfusion time, near-term neurological deficits [National Institutes of Health Stroke Scale (NIHSS) at 14 d postoperatively] and long-term neurological prognosis [modified Rankin Scale (mRS) at 90 d postoperatively] were recorded, as well as symptomatic intracranial hemorrhage (sICH) rate and mortality. Results: The vascular recanalization rate of the first thrombectomy in modified thrombectomy group was higher than that in conventional thrombectomy group (χ2=5.054, P=0.025), the number of thrombectomy was less than (Z=2.014, P=0.044), and puncture-to-reperfusion time was shorter than (Z=2.630, P=0.009) conventional thrombectomy group. There was a statistically significant difference in NIHSS score between modified thrombectomy group and conventional thrombectomy group before and after surgery (F=5.185, P=0.025), and there was also a statistically significant difference in NIHSS score between the 2 groups at admission and 14 d after surgery (F=133.705, P=0.000). There was not an interaction between treatment factors and measurement times (F=3.148, P=0.079). The NIHSS score 14 d after surgery in modified thrombectomy group was lower than that in conventional thrombectomy group (t=2.969, P=0.004). The NIHSS score of modified thrombectomy group (t=10.286, P=0.000) and conventional thrombectomy group (t=6.428, P=0.000) were lower at 14 d after surgery than those at admission. There was a statistically significant difference in mRS score between modified thrombectomy group and conventional thrombectomy group before and after surgery (F=7.581, P=0.007), and there was also a statistically significant difference in mRS score between the 2 groups at admission and 90 d after surgery (F=277.328, P=0.000). There was an interaction between treatment factors and measurement times (F=10.471, P=0.002), and the effect of modified SWIM technique was better. Modified thrombectomy group had a better prognosis (mRS score ≤ 2) at 90 d after surgery than conventional thrombectomy group (χ2=4.267, P=0.039). There were no significant differences in the incidence of postoperative sICH rate (χ2=0.077, P=0.782) and the mortality (χ2=0.101, P=0.751) between 2 groups. Conclusions: The application of modified SWIM technique in mechanical thrombectomy has better efficacy and safety than conventional SWIM technique, and is worthy of clinical promotion.
Objective: To explore the clinical efficacy and changes in hemodynamic parameters before and after incomplete stent angioplasty with percutaneous transluminal angioplasty and stenting (PTAS) for severe intracranial atherosclerotic stenosis. Methods: A total of 52 patients with severe intracranial artery stenosis (> 70%) who underwent incomplete stent angioplasty with PTAS at Shijiazhuang People's Hospital in Hebei from February 2018 to February 2023 were selected. The residual stenosis rate after implantation of stent was evaluated, and neurological function was evaluated before and 6 months after surgery by modified Rankin Scale (mRS). The MeshLab software was used to analyze three-dimensional imaging data of arterial vessels, perform virtual repair of arterial stenosis approaching normal vessel diameter, and obtain hemodynamic parameters of each segment of the arterial wall and lumen before and after implantation of stent. Results: The residual stenosis rate after stent implantation was (15.34 ±6.12)%, which was better than the stenosis rate before stent implantation [(84.60 ±7.20)%; t=98.672, P=0.000]. The mRS score 6 months after surgery was (0.38 ±0.21) points, which was lower than before surgery [(1.21 ±0.43) points; t=24.124, P=0.000]. Compared with the hemodynamic parameters of each segment of the arterial wall before stent implantation, the dynamic pressure, total pressure, shear stress, shear rate, and cell Reynolds number of the proximal normal segment, stenotic and distal normal segment of the artery decreased after stent implantation (P=0.000, for all), also the dynamic pressure (P=0.000), total pressure (P=0.000), shear stress (P=0.000), shear rate (P=0.008), and cell Reynolds number (P=0.000) of the narrowed branch root decreased. Compared with the hemodynamic parameters related to the lumen of each segment of the artery before stent implantation, the dynamic pressure (P=0.000), total pressure (P=0.000), blood flow vElocity (P=0.000), vorticity (P=0.005), turbulence kinetic energy (P=0.000), turbulence intensity (P=0.000), turbulence dissipation rate (P=0.000), and turbulence Reynolds number (P=0.000) of the proximal normal segment of the artery decreased after stent implantation, while the cell Reynolds number increased (P=0.000). Excluding blood flow vElocity (P=0.138), the dynamic pressure, total pressure, vorticity, turbulence kinetic energy, turbulence intensity, turbulence dissipation rate, and turbulence Reynolds number of the root and segment of the artery decreased (P=0.000, for all). The dynamic pressure, total pressure, blood flow vElocity, vorticity, turbulence kinetic enery, turbulence intensity, turbulence dissipation rate, and turbulence Reynolds number of stenotic segment of the artery decreased (P=0.000, for all). The dynamic pressure (P=0.000), total pressure (P=0.000), blood flow vElocity (P=0.001), vorticity (P=0.000), turbulence kinetic energy (P=0.000), turbulence intensity (P=0.000), turbulence dissipation rate (P=0.000), and turbulence Reynolds number (P=0.000) of the distal normal segment decreased, while the cell Reynolds number increased (P=0.000). The hemodynamic parameters of the wall and lumen after virtual repair of artery stenosis were close to those after stent implantation. Conclusions: The use of incomplete stent angioplasty with PTAS for severe intracranial atherosclerotic stenosis can significantly alleviate clinical symptoms, improve hemodynamic parameters in each segment of the stenosis, reduce the damage of turbulent blood flow to the arterial wall, and lower the risk of plaque fragmentation, detachment, and embolism of distal brain tissue caused by complete dilation of the stenosis.
Objective: To investigate the efficacy and safety of mechanical thrombectomy in patients with acute progressive ischemic stroke with large vessel occlusion in the anterior circulation. Methods: From January 2020 to April 2023, 414 patients with acute progressive ischemic stroke with large vessel occlusion in the anterior cirulation in Hebei General Hospital were included.According to the time of onset and whether the patients underwent mechanical thrombectomy, the patients were divided into direct mechanical thrombectomy group (n=293), progressive stroke mechanical thrombectomy group (n=45), and standard medical treatment group (n=76).The modified Rankin Scale (mRS) and modified Thrombolysis in Cerebral Infarction (mTICI) were used to evaluate neurological prognosis and vascular recanalization.The incidence of symptomatic intracranial hemorrhage after treatment and 3-month all-cause mortality were recorded. Results: There was a statistically significant difference in neurological prognosis among the 3 groups (χ2=19.572, P=0.000).The rate of good prognosis in standard medical treatment group was lower than that progressive stroke mechanical thrombectomy group (Z=-2.829, P=0.005) and direct mechanical thrombectomy group (Z=-4.422, P=0.000), while there was no statistically significant difference in the rate of good prognosis between direct mechanical thrombectomy group and progressive stroke mechanical thrombectomy group (Z=-0.525, P=0.600).Logistic regression analysis showed that high National Institutes of Health Stroke Scale (NIHSS) score before treatment (OR=1.298, 95%CI: 1.216-1.385; P=0.000) and standard medical treatment (OR=7.572, 95%CI: 3.048-18.809; P=0.000) were the risk factors for poor prognosis, and direct mechanical thrombectomy was the protective factor for good prognosis (OR=0.431, 95%CI: 0.212-0.879; P=0.021).There was no statistically significant difference in the vascular recanalization rate between progressive stroke mechanical thrombectomy group and direct mechanical thrombectomy group (χ2=0.218, P=0.640).There was a statistically significant difference in the incidence of symptomatic intracranial hemorrhage after treatment among the 3 groups (χ2=6.575, P=0.037), and direct mechanical thrombectomy group was higher than that of standard medical treatment group (Z=-2.376, P=0.018).There was no statistically significant difference in the 3-month all-cause mortality (χ2=5.178, P=0.075). Conclusions: Mechanical thrombectomy is feasible in patients with acute progressive ischemic stroke with large vessel occlusion in the anterior circulation, and has a good efficacy and safety.
Objective: To explore the efficacy and safety of endovascular treatment (EVT) combined with eptifibatide in the treatment of acute ischemic stroke. Methods: This study enrolled the 102 acute ischemic stroke patients at 15 centers in China received EVT combined with eptifibatide from April 2019 to March 2020.The primary efficacy outcome was the reperfusion rate of blood vessels within 24 h after treatment [modified Thrombolysis in Cerebral Infarction (mTICI) grade ≥ 2b], while the secondary efficacy outcomes were the complete reperfusion (mTICI grade 3) rate of blood vessels within 24 h after treatment and the 3-month neurological function prognosis [modified Rankin Scale (mRS) score ≤ 2]; the incidence of symptomatic intracranial hemorrhage (sICH) within 48 h after treatment was the primary safety outcome, while the incidence of intracranial hemorrhage (ICH), parenchymal hemorrhage (PH), hemorrhagic infarction (HI), remote parenchymal hemorrhage (rPH), intraventricular hemorrhage (IVH), and subarachnoid hemorrhage (SAH) within 48 h, and 3-month mortality after treatment were secondary safety outcomes.Univariate and multivariate stepwise Logistic regression analyses were used to screen for the influencing factors of prognosis after EVT combined with eptifibatide for acute ischemic stroke. Results: The successful reperfusion (mTICI grade ≥ 2b) rate and complete reperfusion (mTICI grade 3) rate of blood vessels within 24 h after treatment were 86.27% (88/102) and 68.63% (70/102), respectively.The good prognosis (mRS score ≤ 2) rate at 3-month after treatment was 54.90% (56/102).The incidence of sICH within 48 h after treatment was 4.90% (5/102).The incidence of ICH was 19.61% (20/102), PH was 11.76% (12/102), HI was 5.88% (6/102), rPH was 1.96% (2/102), IVH was 3.92% (4/102), and there was no SAH within 48 h after treatment.The mortality rate at 3-month after treatment was 16.67% (17/102).Logistic regression analysis showed that an admission National Institutes of Health Stroke Scale (NIHSS) score of >15 was a risk factor for poor prognosis in patients with acute ischemic stroke after EVT combined with eptifibatide (OR=0.118, 95%CI: 0.046-0.307; P=0.000), while an Alberta Stroke Program Early CT Score (ASPECTS) of ≥ 6 was a protective factor for good prognosis (OR=5.871, 95%CI: 1.812-19.020; P=0.003). Conclusions: The combined regimen of eptifibatide and EVT studied in this trial was effective and safe.Optimal administration method and randomized controlled trial are need to be further justified.
Objective: To screen the prognostic influencing factors of patients with endovascular treatment for acute basilar artery occlusion (ABAO-EVT). Methods: The baseline, clinical and follow-up data of 215 patients with ABAO-EVT from October 2017 to August 2022 in The First Affiliated Hospital of University of Science and Technology of China, Linyi People's Hospital of Shandong and Maoming People's Hospital of Guangdong were retrospectively collected, including sex, age, stroke or transient ischemic attack (TIA), hypertension, diabetes, coronary heart disease, atrial fibrillation, smoking and drinking history, National Institutes of Health Stroke Scale (NIHSS) score, intravenous thrombolysis, first pass effect, times of embolectomy, extended Thrombolysis in Cerebral Infarction (eTICI), and modified Rankin Scale (mRS) score 90 d after operation.According to the 90 d mRS score, the patients were divided into 2 groups: good prognosis group (mRS score 0-3, n=93) and poor prognosis group (mRS score 4-6, n=122).Univariate and multivariate stepwise Logistic regression analyses were used to screen the neurological prognostic influencing factors of ABAO-EVT patients 90 d after operation. Results: Logistic regression analysis showed that the baseline NIHSS score increased was a risk factor for poor prognosis of ABAO-EVT patients (aOR=0.936, 95%CI: 0.907-0.965, P=0.000; aOR=0.940, 95%CI: 0.910-0.970, P=0.000), with the first pass effect (aOR=5.752, 95%CI: 2.875-11.508; P=0.000), eTICI grade 2c-3 (aOR=7.113, 95%CI: 3.665-13.805; P=0.000) were protective factors for good prognosis. Conclusions: Low baseline NIHSS score, first pass effect and reperfusion level of eTICI 2c-3 are all protective factors for good neurological prognosis of ABAO-EVT patients.
Objective: To analyze the prognosis and risk factors of the anterior and posterior circulation tandem lesions (TLs) patients after recanalization treatment. Methods: The general and clinical data of 42 patients with TLs who received recanalization treatment in Shijiazhuang People's Hospital from April 2019 to August 2022 were retrospectively collected.The prognosis of 90 d after surgery was evaluated by the modified Rankin Scale (mRS).Univariate and multivariate stepwise Logistic regression analyses were used to investigated the risk factors of poor prognosis of TLs. Results: According to mRS scores at the 90 d after surgery, the patients were divided into good prognosis group (mRS ≤ 2, n=21) and poor prognosis group (mRS > 2, n=21).The National Institutes of Health Stroke Scale (NIHSS) score at admission (Z=-2.916, P=0.004), time from onset to recanalization (Z=-2.048, P=0.041), mechanical thrombectomy times ≥ 3 (χ2=4.725, P=0.030) and the proportion of hematoma type hemorrhagic transformation (χ2=8.400, P=0.004) in the poor prognosis group were higher than those in good prognosis group.Logistic regression analysis showed that high NIHSS score at admission (OR=12.457, 95%CI: 2.066-75.120; P=0.006), mechanical thrombectomy times ≥ 3 (OR=9.387, 95%CI: 1.222-72.140; P=0.031) and postoperative hemorrhagic transformation (OR=7.237, 95%CI: 1.019-51.403; P=0.048) were risk factors of poor prognosis of TLs. Conclusions: Anterior and posterior circulation TLs patients with lower NHISS score at admission, mechanical thrombectomy times < 3 and without postoperative hemorrhagic transformation may have good prognosis.
Objective: To evaluate the long-term prognosis in patients with acute ischemic stroke due to large vessel occlusion presenting beyond the conventional time window (> 24 h) who received endovascular treatment (EVT) combined with best medical treatment (BMT), compared to those treated with BMT alone. Methods: This study included 158 patients from a prospective cohort of acute ischemic stroke due to large vessel occlusion were conducted at Tianjin Huanhu Hospital from November 2021 to July 2023.The 158 patients with anterior circulation large vessel occlusion were divided into received EVT combined with BMT (EVT group, n=70) and received BMT alone (BMT group, n=88).Long-term neurological prognosis was assessed using the modified Rankin Scale (mRS) 12 months after onset.Univariate and multivariate stepwise Logistic regression analyses were useded to investigated the risk factors of long-term neurological prognosis.Sensitivity analyses were performed using propensity score matching (PSM) and multiple imputation (MI). Results: Logistic regression analysis showed that EVT was a protective factor for good long-term neurological prognosis (mRS score ≤ 2; OR=3.110, 95%CI: 1.460-6.620, P=0.003), increasing age (OR=0.955, 95%CI: 0.924-0.987; P=0.007) and hypertension (OR=0.418, 95%CI: 0.187-0.936; P=0.034) were risk factors.In the sensitivity analyses of the primary outcome, both the PSM and MI datasets showed that the proportion of patients with a good long-term neurological prognosis was significantly higher in the EVT group compared to the BMT group (PSM: aOR=3.610, 95%CI: 1.370-9.550, P=0.010; MI: aOR=3.870, 95%CI: 1.780-8.440, P=0.000).The results were consistent with the main analysis. Conclusions: Compared to BMT group, EVT group patients with acute ischemic stroke due to large vessel occlusion presenting beyond the conventional time window was demonstrated a significantly better long-term neurological prognosis.
The concept of subjective cognitive decline (SCD) is currently receiving much attention, as SCD has a high risk of transitioning to mild cognitive impairment (MCI) and dementia.The ATN biomarker diagnostic framework can accurately diagnose SCD as preclinical Alzheimer's disease (AD), which is an important window for precise prevention and treatment of AD.Based on the present diagnostic paradigms of clinical diagnosis and biomarker diagnosis for SCD, it is important to have fine management during the diagnostic process and precise communication and support after diagnosis for SCD patients, including diagnostic management specification, interpretation and recommendation diagnostic of biomarker disclosure, patients health management, and possible treatment for specific underlying causes.Previous studies have shown heterogeneity between clinical research and practice, and many doctors still feel unfamiliar with the concept of SCD and lack a systematic understanding.SCD diagnosis can provide patients with a certain degree of certainty, but it may also bring uncertainty about the expected risk of disease, and there is an urgent need to provide guidance to clinical doctors.So far, there is still a lack of Chinese expert consensus on diagnostic management specification, biomarker disclosure, and patient management of SCD.Based on the systematic summary of the current domestic and international research on the SCD, the consensus is written and aimed to improve the diagnosis and treatment level of SCD, guide high-quality preclinical AD research and lay the foundation for further clinical translation.
Objective: To analyze stereo-electroencephalography (SEEG) data from patients with drug-resistant epilepsy (DRE) and explore the differences in graph theory indices of brain network between the epileptogenic zone (EZ) and the non-ictal zone (NIZ). Methods: Reviewed data from 11 patients who underwent SEEG implantation at Beijing Tiantan Hospital, Capital Medical University from August 2022 to December 2023.Based on the SEEG and structural imaging data, we calculated the epileptogenicity index and constructed epileptogenic map to differentiate the EZ from the NIZ.We then used Granger causality analysis to calculate functional adjacency matrices for both regions during interictal and epileptic periods, combining graph theory indices such as global efficiencies (Eglob), local efficiencies (Eloc), clustering coefficients (Cp), characteristic path length (Lp), normalized clustering coefficients (γ), normalized characteristic path length (λ), and small-world parameter (σ).We analyzed changes in the graph theory indices of patients in interictal and epileptic periods. Results: Compared with the interictal period, both γ (t=-3.730, P=0.005) and λ (t=-6.436, P=0.001) decreased in the NIZ during the epileptic period, while the differences of γ and λ in the EZ during the epileptic period were not statistically significant (P>0.05, for all).In terms of network efficiency, compared with the interictal period, Eglob (t=5.360, P=0.002; t=5.577, P=0.001) and Eloc (t=4.450, P=0.003; t=4.038, P=0.005) in both the EZ and NIZ increased during the epileptic period, while Lp decreased (t=-5.127, P=0.002; t=-3.912, P=0.005). Conclusions: During the epileptic period, both the EZ and NIZ exhibit increased synchronization across the whole brain network.Changes in graph theory indices, particularly the γ and λ may serve as the potential biomarkers for distinguishing the EZ and NIZ in epilepsy patients.
Objective: To investigate and compare the efficacy of neuroendoscopic surgery and craniotomy for spontaneous supratentorial intracerebral hemorrhage. Methods: A total of 65 patients with spontaneous supratentorial intracerebral hemorrhage who were admitted in Dongguan People's Hospital in Guangdong, received neuroendoscopic hematoma evacuation (n=19) or craniotomy hematoma evacuation (n=46) from December 2019 to December 2020.The hematoma clearance rate, rebleeding rate, operation time, intraoperative blood loss, postoperative intensive care unit (ICU) length of stay, postoperative tracheotomy rate and 30 d postoperative mortality were recorded.Glasgow Coma Scale (GCS) 7 d after surgery was used to evaluated the conscious, and modified Rankin Scale (mRS) 3 months after surgery was used to assess the neurological functional prognosis. Results: The hematoma clearance rate (t=2.393, P=0.020) and GCS score 7 d after surgery (t=3.445, P=0.001) in the neuroendoscopy group were higher than those in the craniotomy group, while the operation time (t=-13.318, P=0.000), intraoperative blood loss (t=-7.823, P=0.000), postoperative ICU length of stay (t=-4.183, P=0.000), postoperative tracheotomy rate (χ2=5.277, P=0.022), and mRS score 3 months after surgery (t=-2.493, P=0.015) were lower than those in craniotomy group. Conclusions: Neuroendoscopic surgery offers a higher hematoma clearance rate, less intraoperative blood loss, a shorter operation time and postoperative ICU length of stay, a lower postoperative tracheotomy rate, and improved postoperative conscious and neurological function prognosis, making it appropriate for clinical use.
