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Table of Content

    20 July 2017, Volume 12 Issue 07
    Inflection Point
    WANG Yong-Jun
    2017, 12(07):  573-574.  DOI: 10.3969/j.issn.1673-5765.2017.07.001
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    Endovascular Treatment of Acute Phase Ischemic Stroke: Is Spring Really Coming?
    MIAO Zhong-Rong
    2017, 12(07):  575-578.  DOI: 10.3969/j.issn.1673-5765.2017.07.002
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    Study on the Difference of Response to Endovascular Recanalization Treatment of Large Vessel Occlusion: Intracranial Atherosclerosis versus Cardioembolism
    ZHOU Teng-Fei, ZHU Liang-Fu,LI Tian-Xiao, et al.
    2017, 12(07):  579-583.  DOI: 10.3969/j.issn.1673-5765.2017.07.003
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    Objective To investigate the clinical characteristics and the difference of response of endovascular treatment in patients with acute large artery occlusion caused by intracranial atherosclerotic disease (IAD) and cardioembolism (CE) reason. Methods A retrospective analysis of data of patients with acute ischemic stroke with large artery occlusion who received endovascular treatment in our center was performed. The clinical characteristics, ways of endovascular treatment, vascular recanalization status, peri-operational complications and post-operation improvement of neurological functions were compared. Results A total of 46 patients who received endovascular treatment were categorized to CE group (n =22) and underlying IAD group (n =24). Prevalence of male (75% vs 36%, P =0.008), tobacco (33% vs 9%, P =0.046) in IAD group were higher than CE group, and the prevalence of AF was significantly higher than IAD group (0% vs 82%, P <0.001). The prevalence of acute angioplasty with or without stenting was higher in IAD group (67% vs 27%, P =0.008). There were no significant difference in rate of final recanalization, procedure complications and post-operation improvement of neurological functions. Conclusion Clinical risk factors and treatment strategy for acute arterial occlusions due to IAD may differ from those due to CE. Endovascular recanalization treatment in patients with acute large artery occlusion caused by IAD always needs the combination of angioplasty.

    Observational Study on Thrombectomy in Acute Middle Cerebral Artery Occlusion  
    HAN Zhi-An,DING Ming-Xiang, LIU Tian-Zhu, et al.
    2017, 12(07):  584-587.  DOI: 10.3969/j.issn.1673-5765.2017.07.004
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    Objective To explore optimization of treatment method of intra-arterial thrombectomy and its clinical effects in acute middle cerebral artery occlusion. Methods Patients with acute middle cerebral artery (MCA) occlusion who underwent thrombectomy by using Solitaire stent were taken as study subjects. The involved lesions characteristics, endovascular treatment methods, recanalization status and post-surgery improvement of neurological function were analyzed retrospectively. Results A total of 77 patients with acute middle cerebral artery (MCA) occlusion who underwent thrombectomy by using Solitaire stent in Dept. of Cerebral Vascular Intervention, Zhongshan People’s Hospital during Jan. 2014 and August, 2016 were enrolled into study consecutively. The occluded arteries included M1 segment of MCA (M1-MCA, Right n =27, Left n =25), inferior division of MCA (MCA-ID, n =10), and superior division of MCA (MCA-SD, n =15). Residual luminal stenosis after thrombectomy was found in 26 cases, among which stent implantation (n =17), balloon dilatation (n =6) or regional thrombolysis (n =3) were carried out ultimately. Successful recanalization was achieved in all patients (n =77), in which 48 patients showed good clinical outcome (62.34% ) at 90 d after surgery with modified Rankin Scale (mRS) score <2. Postoperative intracranial hemorrhage occurred in 6 patients (7.79%), and decompressive craniectomy were carried out in 5 patients (6.49%) with acute cerebral swelling . Conclusion This study suggests that thrombectomy by using Solitaire stent can achieve satisfactory recanalization rate in patients with MCA occlusion and good prognosis at month 3.

    Study on Clinical Efficacy and Safety of Endovascular Embolization of Ruptured Tiny Intracranial Aneurysms
    WU Zhi-Lin, ZHANG Jin-Zhao, HU Shi-Feng, et al.
    2017, 12(07):  588-591.  DOI: 10.3969/j.issn.1673-5765.2017.07.005
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    Objective To explore the key technique of endovascular embolization of ruptured tiny intracranial aneurysms, and evaluate the clinical efficacy and safety of this treatment. Methods A retrospective analysis of clinical data of patients with subarachnoid hemorrhage was performed to rupture tiny intracranial aneurysm which was treated by endovascular embolization in Yunfu People’s Hospital during April, 2014 and October 2016, and to evaluate the clinical efficacy, intraoperative complications and the prognosis. Results All 23 patients were treated with endovascular coil embolization under the general anesthesia. Among which, 17 of them were only with coil and 6 were with stent-assisted embolization. There were complete embolization in 19 cases (82.61%), aneurysm neck residue in 4 cases (17.39%) and all parent arteries were normal. Aneurysm were followed up for 6-30 months, and no bleeding recurred was found. The parent artery in one (4.35%) case was occluded by a bit of protruding coil and restored to normal after planting Enterprise stent. One (4.35%) with residual aneurysm neck recurred after 1 year and was successfully treated with stent-assisted endovascular embolization. Among 23 patients, the mRS scale scores in 21 cases were 0 at 6 months after procedure, and 2 cases were 2. Conclusion Endovascular embolization for the treatment of ruptured tiny intracranial aneurysms is safe and effective, and the result of short-term follow-up is good.

    Enterprise Stent in Treatment of Symptomatic Complex Intracranial Atherosclerotic Stenosis
    LIU Lian, MA Ning, MO Da-Peng, et al.
    2017, 12(07):  592-597.  DOI: 10.3969/j.issn.1673-5765.2017.07.006
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    Objective To assess the feasibility and efficacy of Enterprise stent using in treatment of Symptomatic Complex Intracranial Atherosclerotic Stenosis (ICAS). Methods The data of 24 patients with symptomatic severe stenosis of a major intracranial artery refractory to aggressive medical therapy were treated by undersized balloon angioplasty and Enterprise stent deployment from January 2014 to June 2016 were collected. All the lesions were considered as complex ICAS, i.e. with tortuous access, long (>15 mm) lesions and/or arterial bifurcations, or with concurrent aneurysms near the stenotic lesion. The primary outcome was defined any stroke (including ischemic or hemorrhagic), transient ischemic attack (TIA) or deaths after stenting procedure within 30 days. The secondary outcome was successful revascularization; occurrence of >50% in-stent restenosis; or occurrence of TIA or stroke attributable to the target vessel during the follow-up. Results Of the 24 patients included, the 30-day stroke, TIA or death was 4.2% (1/24), which presented as asymptomatic subarachnoid hemorrhage (SAH). There was no ischemic complications occurred during or after procedures (0%) in this cohort. The procedural success rate of 100 %, and stenosis was reduced from (87.1±9.3)% to (17.5±8.7)%. Four concurrent aneurysms were embolized simultaneously. Eighteen patients underwent imaging follow-up and 6 patients (33.3%) developed in-stent restenosis (ISR) during 6-month angiographic follow-up. Among which, 3 patients had symptomatic restenosis and underwent in-stent ballon angioplasty. Conclusion In this study, undersized balloon angioplasty followed by Enterprise stent deployment appears technically feasibility with a relatively low rate of complications for the treatment of ICAS. Stent with catheter-delivery might promote the procedural safety.

    The Effect Analysis of Community-based Rehabilitation and Risk Factors Self-management for Stroke Patients in Urban of Beijing
    RU Xiao-Juan, JIANG Bin, ZHANG Hui, et al.
    2017, 12(07):  598-603.  DOI: 10.3969/j.issn.1673-5765.2017.07.007
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    Objective To evaluate the effectiveness of a community-based rehabilitation based on conductive education and self-management measures of risk factors in improving awareness, behavior and functional recovery of stroke survivors. Methods Two communities were selected as either the intervention or control community in Dongcheng District. A 3-month community-based rehabilitation treatment plan and 6-month risk factors self-management program, based on modern rehabilitation theory, conductive education and risk factor self-management for stroke survivors, was successively implemented among 109 patients in intervention community. The effects before and after the intervention were evaluated through comparing stroke survivors in intervention community with themselves and 110 stroke survivors in control community. Results After 3-month rehabilitation treatment, median Fugel-Meyer assessment (FMA) score for stroke survivors in intervention community was enhanced from 57.0 (30.0-81.5) to 70.5 (40.5-92.0) (P <0.001), median Barthel index (BI) score from 90 (65-95) to 95 (75-100) (P <0.001) and mean score of function activity questionnaire (FAQ) was decreased from (11.6±8.3) to (10.1±8.4) (P <0.001). After 6-month self-management, the stroke risk factors awareness (P <0.001), warning awareness (P <0.001), rehabilitation awareness (P <0.001), blood glucose control (P =0.033) and adherence to rehabilitation

    (P <0.001) in intervention community were significantly higher than that in control community. Conclusion Community-based rehabilitation treatment and risk factors self-management program may improve awareness, behavior and functional recovery of stroke survivors.

    Expression of Adenosine Monophosphate-activated Protein Kinase in Cultured Rat Astrocytes
    SHI Zhong-Fang, XU Li-Xin, YAN Xu, et al.
    2017, 12(07):  604-608.  DOI: 10.3969/j.issn.1673-5765.2017.07.008
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    Objective To explore the way of adenosine monophosphate-activated protein kinase (AMPK) forming into heterotrimer in astrocytes through detecting the expression of AMPK α1, α2, β1, β2, γ1 and γ2 subunits in cultured rat astrocytes. Methods Primary cultured astrocytes derived from the cerebral cortex of one-day-old Wistar rats. The purity of cell culture was assessed by immunofluorescence staining for anti-glial fibrillary acidic protein (GFAP) and S100β antibody. The expression of AMPK subunits were detected through reverse transcription polymerase chain reaction (RT-PCR) in cultured astrocytes. Results Immunofluorescence staining revealed that over 95% of cells were GFAP and S100β- positive, and the monolayer cultures of astrocytes were presented as uniform shapes under the phase contrast microscopic. The results from RT-PCR showed that the five subunits including AMPK α1, α2, β1, γ1 and γ2 were found in the cultured astrocytes. The expression of AMPK α2, β1 and γ1 subunits were relatively high, and AMPK α1 and γ2 subunit expression were very weak. Conclusion AMPK heterotrimer is composed of α2, β1 and γ1 subunits in astrocytes, and plays a key role in the regulation of energy metabolism in astrocytes.

    Risk Factors Analysis for Symmetrical Distribution of Carotid Atherosclerotic Vulnerable Plaque
    MI Dong-Hua, ZHAO Xi-Hai, GONG Xi-Ping, et al.
    2017, 12(07):  609-613.  DOI: 10.3969/j.issn.1673-5765.2017.07.009
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    Objective To investigate the risk factors affecting the symmetrical distribution of carotid atherosclerotic plaques. Methods A total of 81 patients with ischemic stroke patients were prospectively enrolled consecutively as the research subject, whom were performed with more comparative sequence, black blood and carotid artery high resolution magnetic resonance imaging (MRI). According to the results of MRI, the patients were divided into 3 groups with no high risk vulnerable plaque group (n =40), unilateral high risk vulnerable plaque group (n =26) and bilateral high risk vulnerable plaque group (n =15). The clinical data of age, sex, hypertension, diabetes, current smoking history, blood pressure value, pulse pressure, BMI index and blood lipid level etc. were recorded. Logistic regression analysis was used to analyze the risk factors for carotid artery vulnerable plaque formation. Results Single factor analysis showed that there were statistically significant differences in hypertension history, current smoking history, BMI and systolic pressure in three groups (P <0.05). Multi-factors Logistic regression analysis showed that current smoking history (OR 3.136, 95%CI 1.122-8.766, P =0.03) was an independent factor for the occurrence of high risk vulnerable plaque and its symmetrical distribution. Conclusion There is correlation between current smoking history and the symmetrical distribution of carotid plaque. Smoking cessation might be good for the stability of plaque.

    Relationship of Serum Interleukin-33 and Carotid Atherosclerosis Plaque Vulnerability
    LU Fei
    2017, 12(07):  614-618.  DOI: 10.3969/j.issn.1673-5765.2017.07.010
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    Objective To explore the relationship of serum interleukin-33 (IL-33) and carotid atherosclerosis plaque vulnerability. Methods According the result of carotid artery ultrasound, patients with ischemic stroke were divided to vulnerable plaque group, stable plaques group and non-plaque group. The clinical data were compared among groups. Logistic dichotomy regression analysis was used to analyze the influential factors for plaque stability of carotid arthrosclerosis. Pearson correlation analysis was used to analyze the correlation between serum IL-33 and related factors. Results A total of 133 patients with ischemic stroke were enrolled into study, among which, there were 52 cases of vulnerable plaque, 45 cases of stable plaques and 36 cases of non-plaque. There were significant difference in age, 2 h plasma glucose (2 h PG), hemoglobin A1c (HbA1c), intimamedia thickness (IMT) and level of serum IL-33. The age, 2 h PG, HbA1c, IMT of non-plaque group were lower than that of vulnerable plaque group and stable plaques group, and the serum IL-33 of non-plaque group was higher than that of vulnerable plaque group and stable plaques group. Logistic regression analysis result showed that relatively higher age, 2 h PG, HbA1c, IMT and relatively lower IL-33 were independent risk factors for carotid atherosclerosis vulnerable plaque. Pearson correlation analysis result showed that, serum IL-33 level negatively correlated with IMT (r =-0.336, P =0.000), and had no correlation with age, 2 h PG and HbA1C. Conclusion Serum IL-33 can effectively response the carotid atherosclerosis plaque instability, is a reliable serological index for clinical prediction of vulnerable plaques.

    Progress of Mechanism and Treatment of Fat Embolism Stroke
    HUO Kang, YUAN Xing-Yun, CHEN Chen, et al.
    2017, 12(07):  620-623.  DOI: 10.3969/j.issn.1673-5765.2017.07.011
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    Cerebral fat embolism (CFE) is a rare clinical embolization stroke. In recent years, with the continuous development of plastic surgery, the incidence rate of CFE presents an increasing tendency year by year, which gradually draws people’s attention. This paper reviewed the mechanism of CFE and fat embolism stroke with common clinical features, imaging features and treatment methods , aiming at improving the awareness of early recognition and early diagnosis so as to provide assistance in further appropriate treatment.

    JAMA: Should General Anesthesia be Chosen in Endovascular Treatment for Acute Ischemic Stroke?
    YANG Zhong-Hua
    2017, 12(07):  624-625.  DOI: 10.3969/j.issn.1673-5765.2017.07.012
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    Stroke Treatment —— A Story before Using Stenting in Embolus Removal
    John H.Zhang
    2017, 12(07):  626-627.  DOI: 10.3969/j.issn.1673-5765.2017.07.013
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    A Case Report on Application of Willis Covered Stent in Treatment of Blood Blister-like Aneurysm
    YU Jia, DENG Jian-Ping, ZHAO Zhen-Wei
    2017, 12(07):  628-631.  DOI: 10.3969/j.issn.1673-5765.2017.07.014
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    A Case Report on Combined Multiple Technologies in Treatment of Acute Internal Carotid Artery Occlusion
    CHANG Wan-Sheng, YIN Ji-Jun, LIN Feng, et al.
    2017, 12(07):  632-635.  DOI: 10.3969/j.issn.1673-5765.2017.07.015
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    A Case Report on Reversible Cerebral Vasoconstriction Syndrome with Convexity Subrachnoid Hemorrhage as Major Manifestation
    YANG Xin-Guang, HE Yi-Hua, XIE Long-Chang, et al.
    2017, 12(07):  636-639.  DOI: 10.3969/j.issn.1673-5765.2017.07.016
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    Staged Carotid Artery Angioplasty and Stenting for Patients with High-grade Carotid Stenosis with High Risk of Developing Hyperperfusion Injury:A Retrospective Analysis of 44 Cases
    MO Da-Peng
    2017, 12(07):  640-641.  DOI: 10.3969/j.issn.1673-5765.2017.07.017
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    Retrograde Semi-Retrieval Technique——Modified Solumbra Technique for Thrombectomy
    WEI Ming, LI Hong
    2017, 12(07):  642-645.  DOI: 10.3969/j.issn.1673-5765.2017.07.018
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    The endovascular treatment of acute ischemic stroke has become a standard therapeutic technique. The combination of multiple neuro-endovascular devices provides more possibilities for the improvement of thrombectomy technique. We will describe a modified retrieval technique by using a distal intracranial catheter (DIC) for the semi-retrieval of stent retriever during the thrombectomy procedure. The retrograde semi-retrieval technique involves completely unfolding of the stent retriever by pulling a Navien catheter and the partial resheath of a retrievable stent forming a tapered configuration by pushing the Navien catheter, which led to a embedding of thrombi into the strut, a securing of the clot within the stent, and a shorter distance for the clot to travel. This technique may lessen the occurrence of thrombus fragmentation and the injury of vessel wall. The retrograde semi-retrieval technique is an optional thrombectomy technique that may improve the efficiency of this procedure in the treatment of acute ischemic stroke.

    Effects of Music Intervention on Mood and Cognitive Disorders in Post-stroke Patients
    SHEN Zhao-Bo, SHEN Dong-Chao, WANG Chun-Xue
    2017, 12(07):  646-649.  DOI: 10.3969/j.issn.1673-5765.2017.07.019
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    Music intervention is a rising interdisciplinary subject integrating music, medicine and psychology. Studies found that music intervention could significantly improve the mental state of patients after onset of stroke, increase their attention and words and expressions memory, improve their ignorance symptoms, and trigger tiny neurological dissection changes of the recovery area of the brain. Although music intervention has promising prospect in improving post-stroke mood and cognitive disorder, there are only few studies which mainly focus on short-term postintervention effect. Whether there are long-lasting effect and whether it could improve the future daily life still require long-term follow-up.

    Advances in Diagnosis and Treatment of Pregnancy-Related Stroke
    XU Yu-Zhen, ZHAO Yu-Wu
    2017, 12(07):  650-653.  DOI: 10.3969/j.issn.1673-5765.2017.07.020
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    Although the morbidity of pregnancy-related strokes are relatively low, it brings a greater morbidity and mortality to both the mother and the child. The pathology mechanism of pregnancy-related strokes is complicated. Diagnosis requires brain imaging with computerized tomography or magnetic resonance imaging, and magnetic resonance imaging is the preferred imaging examination for the pregnancy-related strokes. Management follows the general management principles for strokes including antiplatelet therapy, anticoagulant therapy, thrombolytic therapy and surgical treatment, etc.

    Posterior Circulation and Cognitive Dysfunction
    FU Xiu-Juan, XIAO Zhe-Man, YIN Hao, et al.
    2017, 12(07):  654-658.  DOI: 10.3969/j.issn.1673-5765.2017.07.021
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    In contrast with the traditional view that the posterior circulation had no impact on cognitive function, recent studies had shown that posterior circulation stroke could also cause different degrees of cognitive dysfunction. Recent studies had revealed that the cerebellum may be involved in the regulation of cognition and emotion. The brainstem stroke mainly led to the executive function and attention disorders. The thalamus stroke usually caused a wide range of neuropsychological change. The occipital lobe stroke usually accompanied with other posterior cerebral artery area lesions, and played a role in the formation of vascular dementia. This paper is to review research progress of association between cognitive dysfunction and posterior circulation.

    Application of Problem-based Learning and Wechat in Standardized Resident Training in Neurosur-gery
    JIANG Tao
    2017, 12(07):  659-661.  DOI: 10.3969/j.issn.1673-5765.2017.07.022
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    Objective To investigate the role of problem-based learning (PBL) associated with Wechat in standardized neurosurgical resident training, compared with traditional lecture-based learning (LBL) method. Methods Twenty residents in Beijing Tiantan Hospital, Capital Medical University were randomized into two groups. Taking Children moyamoya disease (MMD) as an example, the control group adopted the LBL method and the study group adopted the PBL combined with wechat. After the course, examination scores and self-evaluation were taken as evaluation criteria. Results There was no significant difference in theoretical examination score. However, retrieval ability (P =0.012), teamwork ability (P =0.046) and innovation ability (P =0.002) of PBL and Wechat group was higher than LBL group. Conclusion PBL associated with Wechat teaching method could better improve the retrieval ability, teamwork ability and innovation ability of resident in learning about MMD. It is worthwhile to be popularized in neurosurgical resident education.

    Analysis on Employment Situation of Neurology Postgraduate
    MENG Shi-Jiao, WANG Lei, REN Yi,et al.
    2017, 12(07):  662-664.  DOI: 10.3969/j.issn.1673-5765.2017.07.023
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    Objective To investigate the employment status of neurological postgraduates and analyze how to improve the quality of postgraduate employment. Methods The neurological postgraduates in Beijing Tiantan hospital, Capital Medical University from 2011 to 2015 were taken as study subjects. Fisher's exact test was used for precise analysis of the data of employment. Results From 2011 to 2015, there were 69 neurological postgraduates in Beijing Tiantan hospital. The average rate of employment, working in medical system and stay in Beijing were 100% (69/69), 85.5% (59/69) and 79.7% (55/69) respectively, and maintained at a high level. Conclusion The further measures of a high quality postgraduate employment direction can be facilitated by ensuring the graduate student enrollment and training quality, enhancing core competitiveness, improving the postgraduate employment consciousness and playing a role of mentors.