Chinese Journal of Stroke

Emergency Management of Acute Ischemic Stroke

KANG Hai, LIU Yuan-Yuan, WANG Lei, GUO Wei

2019, 14(12): 1197-1204. DOI: 10.3969/j.issn.1673-5765.2019.12.001

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Effect of Optimized Thrombolysis Treatment Workflow on In-hospital Delay and Prognosis in Acute Mild Ischemic Stroke

WANG Yao-Hui, ZHANG Chong-Yang, SUN Wei, LYU Zhe, LIU Wei-Bin

2019, 14(12): 1205-1208. DOI: 10.3969/j.issn.1673-5765.2019.12.002

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Objective To investigate the effect of optimized thrombolysis treatment workflow on door to needle time (DNT) and prognosis in acute mild ischemic stroke patients with intravenous thrombolysis. Methods Data of mild ischemic stroke patients receiving intravenous thrombolysis from July 2015 to June 2017 in the First Qinhuangdao Hospital were retrospectively collected. According to whether thrombolysis treatment workflow was optimized or not, all patients were divided into the optimization group and the control group. Door to needle time (DNT), NIHSS score at 7 days and mRS score at 3 months after thrombolysis of two groups were compared. Results A total of 57 mild ischemic stroke patients were included, with a mean age of 61.7±5.4 years old and 44 males (77.2%). There were 33 patients in optimization group and 24 patients in control group. The general information had no statistical difference between the two groups. DNT was shorter (68.7±19.1 vs 88.8±23.1 min, P =0.001), the percentage of patients with DNT ≤60 min was higher (42.4% vs 12.5%, P =0.015), the mRS score at 3 months was lower [0 (0-0.5) vs 0.5 (0- 2), P =0.017], and the rate of patients with mRS score ≤1 at 3 months was higher (87.9% vs 62.5%, P =0.024) in optimization group, compared with that in control group. Conclusions The optimized thrombolysis treatment workflow can shorten DNT, improve the rate of DNT ≤60 min, and improve 90-day prognosis in patients with acute mild ischemic stroke.

Intravenous Thrombolysis Combined with Endovascular Treatment for Hypoperfusion Cerebral Infarction Caused by Anterior Circulation Large Vessel Stenosis

ZHANG Xia, TONG Xu, ZHANG Bin

2019, 14(12): 1209-1213. DOI: 10.3969/j.issn.1673-5765.2019.12.003

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Objective To preliminarily observe the efficacy and safety of intravenous thrombolysis combined with endovascular treatment in patients with hypoperfusion cerebral infarction caused by anterior circulation large vessel stenosis. Methods Data of consecutive patients with hypoperfusion cerebral infarction caused by anterior circulation large vessel stenosis from Liaocheng Third People's Hospital between March 2017 and March 2019 were retrospectively analyzed. All enrolled patients received intravenous alteplase combined with endovascular treatment (including mechanical thrombectomy and/or intra-arterial thrombolysis and/or balloon angioplasty and/or stenting), and were followed up for 2 weeks, 1 month and 3 months after the procedure. Results A total of 40 patients successfully completed intravenous thrombolysis combined with endovascular treatment, with 24 (60%) males and a mean age of 70±4 (range 60-80) years old. The postoperative stenosis degree of target vessel significantly improved compared with that before operation (median: 18% vs 86%, P <0.01). The median scores of NIHSS and mRS at 2 weeks, 1 and 3 months after treatment were significantly lower than that before treatment (all P <0.05). Among 40 patients, only one (2.5%) patient had massive cerebral infarction and brain herniation, and another (2.5%) had symptomatic intracranial hemorrhage on the next day after operation. Conclusions Intravenous thrombolysis combined with endovascular treatment for hypoperfusion cerebral infarction caused by anterior circulation large vessel stenosis may be effective and safe.

The Value of Framingham Risk Score for Screening Carotid Vulnerable Atherosclerotic Plaques in the Asymptomatic Elderly

YAO Rong, ZHAO Xi-Hai, ZHOU Dan

2019, 14(12): 1214-1219. DOI: 10.3969/j.issn.1673-5765.2019.12.004

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Objective To investigate the value of Framingham risk score (FRS) in screening carotid vulnerable atherosclerotic plaques in the asymptomatic elderly (≥60 years old). Methods FRS of every subject was calculated and the MR imaging characteristics of carotid atherosclerotic plaques on 3D MR vessel wall imaging were evaluated. All patients were divided into vulnerable plaque group and non-vulnerable plaque group based on the imaging results. FRS was compared between the two groups. Univariate logistic regression was used to calculate the OR and 95%CI of FRS in determining carotid vulnerable plaques. The area under the curve (AUC) of receiver operating characteristic (ROC) was used to evaluate the ability of FRS in assessing carotid vulnerable plaques and determine the appropriate cut-off value. Results A total of 134 subjects were included in this study, with a mean age of 72.3±5.5 years old and 62 males (46.3%). 17 cases (12.7%) had carotid vulnerable plaques. The FRS in vulnerable plaques group was significantly higher than that in non-vulnerable plaques group [37.8% (27.4%- 60.0%) vs 16.6% (8.9%-27.4%), P =0.002]. In determining carotid vulnerable plaques, the OR of FRS per an increase of 10% was 1.556 (95%CI 1.204-2.011, P =0.001). ROC curve analysis showed that the AUC of FRS in determining the carotid vulnerable plaques was 0.732, and the appropriate cut-off value of FRS was 20%, with the sensitivity of 76.5% and specificity of 59.8%. Conclusions FRS can be preliminarily used to screen carotid vulnerable plaques. An advanced

imaging examination is needed to evaluate carotid vulnerable plaques for the asymptomatic elderly when FRS is higher than 20%.

Relationship between Body Mass Index and In-hospital Pneumonia in Acute Stroke Patients

SONG Yan-Li, XIA Wen-Jing, LIN Jie, XUE Bin, ZHI Kong-Liang, WU Yi-Ping

2019, 14(12): 1220-1224. DOI: 10.3969/j.issn.1673-5765.2019.12.005

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Objective To investigate the relationship between BMI and in-hospital pneumonia in acute stroke patients. Methods Data of acute stroke patients who consecutively admitted to Handan First Hospital from April 2017 to July 2018 were collected. Based on whether occurring in-hospital pneumonia, all the patients were divided into pneumonia group and no-pneumonia group. Multivariate analysis was performed to analyze the relationship between BMI and in-hospital pneumonia. Results A total of 1073 acute stroke patients were enrolled into the study, with a mean age of 62.95±11.45 years old and 677 males (63.1%). Of all, 56 (5.2%) patients suffered from in-hospital pneumonia. Multivariate analysis showed that age (1 year increase: OR 1.05, 95%CI 1.02-1.08, P =0.003), BMI <18.5 kg/m2 (OR 2.51, 95%CI 1.28-8.07, P =0.001), less fruit intake (OR 2.10, 95%CI 1.06-4.14, P =0.033), disturbance of consciousness (OR 8.65, 95%CI 4.13-18.12, P <0.001) and dysphagia (OR 3.40, 95%CI 1.67-6.94, P =0.001) were independent risk factors for in-hospital pneumonia. Conclusions BMI <18.5 kg/m2 was independent risk factors for in-hospital pneumonia in acute stroke patients.

The Effect of Dl-3-n-butylphthalide on Expressions of VEGF, Ang-2 Proteins and Angiogenesis in Intracerebral Hemorrhage Rats

TU E-Wen, LIU Qiu-Ting, TAN Li, ZENG Yan-Xiang, CHEN Qiong

2019, 14(12): 1225-1231. DOI: 10.3969/j.issn.1673-5765.2019.12.006

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Objective To investigate the possible neuroprotective effect and mechanism of dl-3-nbutylphthalide in intracerebral hemorrhage rats by observing the dynamic expression of vaseular endothelial growth factor (VEGF) and angiopoietin-2 (Ang-2) protein and the change of neovascularization in brain tissue of rats with intracerebral hemorrhage at different time points after giving different doses of dl-3-n-butylphthalide. Methods Male healthy SD rats were used to prepare cerebral hemorrhage models by injecting autologous blood, and were randomly divided into no-treatment intracerebral hemorrhage model group, the low-dose dl-3-n-butylphthalide group and medium-dose dl-3-n-butylphthalide group, and the sham-operated rats served as control group. Rats in the low and medium dose groups were given dl-3-n-butylphthalide in the dose of 10 mg/kg and 25 mg/kg (twice a day for both groups) respectively, while rats in the sham operation group and no-treatment intracerebral hemorrhage model group were given the same dose of soybean oil at the same time. The following indexes in all groups were assessed at 1, 3, 7 and 15 day after operation: neurological deficit, the expression of CD34, neovascularization and vascular field area, the expressions of VEGF and Ang-2 protein. The volume of hematoma in intracerebral hemorrhage rats were also measured. Results Compared with that in no-treatment model group, the expression of VEGF was up-regulated in the low-dose group at all time points and in the medium-dose group only at 7, 15 days after operation; the expression of Ang-2 protein was up-regulated and the neovascularization count was more in the low-dose and medium-dose group at all time points, and the neurological deficit score was lower in the low-dose group at 3 days after operation and were all lower in the medium-dose group at all time points, and all the above difference had statistical significance. Moreover, there were no significant difference in hematoma volume at 7 and 15 days after operation between the low-dose and medium-dose dl-3-n-butylphthalide groups and no-treatment model group. Conclusions Dl-3-n-butylphthalide can significantly alleviate neurological deficit in cerebral hemorrhage rats, with no increase in the risk of hematoma enlargement. The mechanism of dl-3- n-butylphthalide may be related to up-regulating the expressions of VEGF and Ang-2 protein and increasing the blood vessel density around hematoma.

Efficacy and Safety of Intravenous Thrombolysis Bridging Endovascular Therapy for Acute Ischemic Stroke

YUE Ting, LOU Ping, LU Qing-Shan

2019, 14(12): 1232-1236. DOI: 10.3969/j.issn.1673-5765.2019.12.007

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Objective To observe the clinical efficacy and safety of rt-PA intravenous thrombolysis bridging endovascular therapy in patients with acute ischemic stroke (AIS). Methods Data of AIS patients who receiving intravenous thrombolysis and endovascular treatment in the Department of Critical Care of the First Hospital of Zhengzhou from January 2017 to December 2017 were selected. According to the treatment method, the patients were divided into intravenous thrombolysis group and the bridging group. The intravenous thrombolysis group only received rt-PA intravenous thrombolysis, while the bridging group received rt-PA intravenous thrombolysis followed by endovascular treatment. The primary outcome was mRS score at 3 months, secondary outcome were the NIHSS score at 24 hours, 3 days and 30 days after the procedure. Safety outcome was the symptomatic intracranial hemorrhage and other bleeding from other sites within 2 days and all-cause death within 10 days. Results A total of 56 patients were included in this study, with a mean age of 60.77±12.72 years old and 35 (62.5%) males, 39 patients in intravenous thrombolysis group and 17 patients in the bridging treatment group. The rate of mRS ≤2 at 3 months in the bridging treatment group was higher than that in intravenous thrombolysis group (88.2% vs 56.4%, P =0.021). There was no statistical difference in NIHSS score at 24 hours, 3 days and 30 days after treatment. There were no statistical differences in the safety outcome between the two groups. Conclusions rt-PA intravenous thrombolysis bridging endovascular treatment can improve the prognosis of AIS patients at 3 months.

Emergency Management of Acute Stroke

GUO Wei

2019, 14(12): 1237-1237.

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