Chinese Journal of Stroke

Wisdom

WANG Yong-Jun

2018, 13(06): 535-537. DOI: 10.3969/j.issn.1673-5765.2018.06.001

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Risk Assessment and Prescription Principle for Stroke Primary Prevention

HE Li

2018, 13(06): 538-541. DOI: 10.3969/j.issn.1673-5765.2018.06.002

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Effect of Statin Use During Hospitalization on Short-term Stroke Recurrence in Acute Ischemic Stroke with Chronic Kidney Disease in Chinese Population

LYU Wei, JIANG Yong, ZHANG Xin-Miao, JING Jing, MENG Xia, ZHOU Mai-Geng

2018, 13(06): 542-549. DOI: 10.3969/j.issn.1673-5765.2018.06.003

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Objective We investigated the effect of statin use during hospitalization in reducing short-term stroke recurrence of patients with acute ischemic stroke and chronic kidney diseases (CKD). Methods Data of first-ever ischemic stroke patients without a history of pre-stroke statin use was derived from the China National Stroke Registry (CNSR). Patients were stratified according to estimated glomerular filtration rate (eGFR): normal renal function [eGFR≥90 ml/(min·1.73 m2)], mild CKD [60 ml/(min·1.73 m2)≤eGFR<90 ml/(min·1.73 m2)] and moderate CKD [eGFR<60 ml/(min·1.73 m2)]. Multi-factors logistic regression analysis was used to evaluate the association between statin use during hospitalization and stroke recurrence with different renal functions at 3-month follow-up. Results Among 5951 patients included, 2595 (43.6%) patients were on statin use during hospitalization after stroke. Compared with non-statin group, statin use during hospitalization was associated with decreased stroke recurrence in patients with mild CKD [odds ratios (OR) 0.69, 95% confidence interval (CI) 0.50-0.95, P =0.02] and moderate CKD (OR 0.48, 95%CI 0.28-0.83, P =0.009) at 3-month follow-up, respectively. Whereas in patients with normal renal function, no significant benefit from statin therapy was detected (OR 0.80, 95%CI 0.60-1.06, P =0.12). Conclusion Statin use during hospitalization was associated with decreased stroke recurrence in ischemic stroke patients with mild and moderate CKD at 3-month follow-up, but not in patients with normal renal function in Chinese population. Further studies are needed to confirm this finding.

A Comparative Study of High and Low Frequency Repetitive Transcranial Magnetic Stimulation in Treatment of Upper Limb Spasticity after Stroke

QIN Yin, LIU Yue, GUO Xiao-Ping, ZHANG Chang-Long, ZHANG Yin-Xin, WU Ji-Wei, HU Zhi-Hong, LIU Min-Hua, ZHENG Ying, LIU Xiao-Ying

2018, 13(06): 550-555. DOI: 10.3969/j.issn.1673-5765.2018.06.004

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Objective To investigate the clinical efficacy and differences of repetitive transcranial magnetic stimulation (rTMS) for high-frequency and low-frequency stimulation in the treatment of stroke upper limb spasticity. Methods A total of 60 patients from department of neurology and physiotherapy with spasticity were randomized to receive 10 Hz (n =20), 1 Hz (n =20) or sham (n =20) rTMS. The high-frequency rTMS group and the low-frequency rTMS group were given rTMS for 40 days in the ipsilesional and contralesional primary motor cortex. The stimulation frequency of the high-frequency rTMS was 10 Hz and the stimulation intensity was 80% motor threshold (MT). The stimulation frequency of the low-frequency rTMS was 1 Hz, 90% MT; the sham stimulation group received sham stimulation. All of participants received conventional rehabilitation. All the treatments were performed once a day, 5 times per week, and continued for 8 weeks. The modified Ashworth scale (MAS), upper extremities motor function test of Fugl-Meyer movement assessment (U-FMA) and modified Barthel index (MBI) were performed before and 8 weeks after treatment. Results After treatment, there was a significant improvement of MAS U-FMA and MBI scores after treatment in three groups (P <0.01). The MAS,U-FMA and MBI scores of the low-frequency group and high-frequency group were more obviously improved than that of the control group (P <0.05), but there was no significant difference between the low frequency group and the high frequency group (P >0.05). Conclusion Low-frequency stimulation of the contralesional and high-frequency stimulation of the ipsilesional M1 area can both effectively improve the clinical symptoms and motor function of the spastic patients. There was no significant difference for their clinical efficacy.

Construction and Application of Optimized Clinical Nursing Pathway of Acute Thrombolytic Therapy during#br# Treatment of Patients with Acute Ischemic Stroke based on Time-dependent Analysis

WU Xue-Ying, LIU Ying, LI Xiang-Dong, LIU Yang, YANG Sha, WANG Ying

2018, 13(06): 556-561. DOI: 10.3969/j.issn.1673-5765.2018.06.005

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Objective To establish a clinical nursing pathway of acute thrombolytic therapy during treatment of patients with acute ischemic stroke (AIS) in emergency room, and to investigate its feasibility and effects. Methods The clinical nursing pathway of acute thrombolytic therapy in AIS patients were established by consulting literatures, case review and qualitative interviews with emergency department medical staff. Nursing intervention was performed on patients with AIS during acute thrombolytic therapy in emergency room. Treatment time points and therapeutic effects were compared between the experimental group and the control group. Results There were statistical differences in three timing indexes between two groups (P <0.05). They were receiving new patients to computed tomography (CT) scan time, CT results to needle time and door to needle time, which were obvious better in experimental group than the control group. Conclusion Optimized clinical nursing pathway of acute thrombolytic therapy can reduce treatment time of patients with AIS and improve prognosis, which is worthwhile to be promoted.

Efficacy and Safety Study on Low Molecular Heparin in the Prevention for Venous Thromboembolism Prophylaxis after Spontaneous Intracerebral Hemorrhage

NI Jie, QIAN Jian, WANG Lu-Na, WANG Fang, SHA Du-Juan

2018, 13(06): 562-566. DOI: 10.3969/j.issn.1673-5765.2018.06.006

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Objective To assess the efficacy of low molecular weight heparin (LMWH) for deep vein thrombosis (DVT) in patients with spontaneous intracerebral hemorrhage (sICH) during early stage. Methods One hundred and four patients with sICH were enrolled in our study: LMWH group (n =51) and control group (n =53). The patients of LMWH group were injected hypodermically with LMWH (Enoxaparin Sodium Injection, 0.4 ml/d) from day 4th to day 10th after admittance. While the patients in control group received intermittent pneumatic compression (IPC). The LPA and the anticoagulant factor Xa level were detected on admission day and the treatment of low molecular heparin for the 7th day in all patients, and whether the patient had bleeding signs were observed. Results No hematoma enlargement were observed in both groups. After treatment, the serum level of LPA were significantly lower in LMWH group than that of the control group (11.74±5.30 ng/ml vs 26.81±5.12 ng/ml, P <0.05). The level of anti-Xa were significantly higher in LMWH group than that of the control group (25.96±7.97 ng/ml vs 8.06±1.32 ng/ml, P <0.05). Conclusion The hospitalized patients with acute sICH were the crowd with high risk of DVT. LMWH in doses of 0.4 ml once daily during acute phase in patients with sICH is safe and efficient.

Clinical Value of Multimode CT in the Assessment of Isolated Posterior Circulation Ischemia Vertigo

YANG Chao-Ping, RUI Han-Chen, FAN Gui-Mei, ZHANG Li-Hua

2018, 13(06): 567-572. DOI: 10.3969/j.issn.1673-5765.2018.06.007

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Objective To explore the clinical value of multimode computed tomography (CT) in the assessment of isolated posterior circulation ischemia vertigo. Methods The 320-slice whole-brain computed tomography perfusion (CTP), head and neck computed tomography angiography (CTA) were performed in 30 patients with clinical diagnosed isolated posterior circulation ischemia vertigo. The intracranial and extracranial arteries of the posterior circulation and the whole brain perfusions were observed. Results Vascular lesions were found in 25 patients (83.33%), among which, 70 vessels were vertebrobasilar stenosis, 9 vessels were vertebral artery circuity, and 4 were vertebral artery hypoplasia. Abnormal perfusions were found in 22 patients (73.33%), time to peak (TTP) and mean transit time (MTT) were prolonged in 20 and 17 patients respectively, and cerebral blood flow (CBF) and cerebral blood volume (CBV) were reduced in 16 and 13 patients respectively. Responsible artery stenosis was found in all of the patients with abnormal perfusions, and 15 of which were moderate/severe stenosis. TTP and MTT of the affected side significantly were prolonged compared with the contralateral side (P <0.05), but no significant difference of CBV nor CBF was detected between the affected side and the contralateral side. Perfusion abnormalities associated with the degree of responsible artery stenosis. Positive incidence of CTP abnormalities was higher in patients with moderate/severe vascular stenosis than in those with mild/none vascular stenosis (P <0.05). Conclusion Multimode CT is effective to assess the brain vessels and perfusions of patients with isolated posterior circulation ischemia vertigo.

Preventive Effects of Omeprazole Against Stress Ulcer Bleeding for Post-stroke Patients: A Meta Analysis

LIU Yong-Hui, ZENG Pei-Pei, GAO Yu-Guang

2018, 13(06): 573-578. DOI: 10.3969/j.issn.1673-5765.2018.06.008

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Objective To evaluate the preventive effects of omeprazole against stress ulcer bleeding (USB) for post-stroke patients, and compare their effectiveness between Histamine-2 receptor antagonists (H2RA). Methods Cochrane, PudMed, Embase, CNKI, WangFang and VIP were searched systematically. Case-control studies of omeprazole protects against SUB for post stroke patients were included, and the articles were performed Meta analysis by RevMan 5.2 software. Results A total of 17 case-control studies (1739 cases) were included. The results of meta-analysis were as followed: Prophylactic use of omeprazole could decrease the incidence of SUB for post-stoke patients [odds ratio (OR) 0.01, 95% confidence interval (CI) 0.06-0.14, P <0.00001]; and the treatment effectives of USB with omeprazole was better than H2RA (OR 0.24, 95%CI 0.15-0.38, P <0.00001). The use of omeprazole could decrease the mortality of post-stroke patients (OR 0.17, 95%CI 0.09-0.33, P <0.0001). Conclusion Evidence indicates that prophylactic use of omeprazole can decrease the incidence of SUB and mortality among post-stoke patients, and the effectiveness is better than H2RA.

The Role of Statin in Primary Prevention of Ischemic Stroke

ZHOU Mu-Ke, GUO Yi-Jia, DONG Shu-Ju, HE Li

2018, 13(06): 580-585. DOI: 10.3969/j.issn.1673-5765.2018.06.009

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Statin is one of safe and well-tolerant prescriptions in lipid-lowering drugs, and widely used in patients with atherosclerotic cardiovascular and cerebrovascular diseases. Many studies have identified the effective role of statin in reducing the incidence and severity of stroke and improving functional outcomes in stroke patients. This article is aim to review the evidence of statin for the primary prevention of ischemic stroke, providing reference for standard clinical practice.

Practice of Acute Ischemic Stroke Related Guidelines in Primary Hospitals — A Long Way to Go

WANG Jian-Hong, YANG Shu, GUO Fu-Qiang

2018, 13(06): 586-590. DOI: 10.3969/j.issn.1673-5765.2018.06.010

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Diagnosis and treatment of acute ischemic stroke (AIS) is a systematic project, and AIS related guidelines can provide guidance for clinical practice. The primary hospitals may face different problems during applying the guidelines to practice. This paper summarized and evaluated the common problems including AIS emergency assessment and transfer, imaging evaluation, intravenous thrombolysis and antithrombotic therapy, and endovascular treatment in primary hospitals.

Secondary Prevention of Ischemic Stroke in Community

ZHAO Jia-Ju, WU Bo

2018, 13(06): 591-593. DOI: 10.3969/j.issn.1673-5765.2018.06.011

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With the development of diagnosis and management of stroke, the mortality of ischemic stroke is gradually decreased, however, the recurrence rate of cerebral vascular disease remains very high. Therefore, the secondary prevention is particularly important. Community physician play the key role in decreasing cerebral vascular events recurrence through scientific and standard management of patients with ischemic stroke. This paper is to review the characters and relevant problems of secondary prevention medications for ischemic stroke patients in community.

Chinese Expert Consensus on Endovascular Treatment for Symptomatic Intracranial Atherosclerotic Stenosis 2018

Chinese Stroke Association, Chinese Interventional Neuroradiology Society, Intervention Group of Committee of

2018, 13(06): 594-604. DOI: 10.3969/j.issn.1673-5765.2018.06.012

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Lancet N: Practical Diagnoistic Tool for Cerebral Amyloid Angiopath Related Lobar Hemorrhage

YANG Zhong-Hua

2018, 13(06): 605-605. DOI: 10.3969/j.issn.1673-5765.2018.06.013

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Short Story about Stroke: Face Arm Speech Test-FAST by Ford Changed the World of Stroke

John H.Zhang

2018, 13(06): 606-611. DOI: 10.3969/j.issn.1673-5765.2018.06.014

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