Table of Content

20 November 2021, Volume 16 Issue 11

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The Future has Come: Current Status of Clinical Practice in Endovascular Treatment for Acute Ischemic Stroke in China

MIAO Zhong-Rong, HUO Xiao-Chuan

2021, 16(11):  1085-1090.  DOI: 10.3969/j.issn.1673-5765.2021.11.001

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Endovascular Treatment for Acute Ischemic Stroke

MIAO Zhong-Rong

2021, 16(11):  1091-1091. 

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vProgress of Automated Computed Tomography Perfusion in Endovascular Treatment for Acute Large Vessel Occlusion

SUN Da-Peng, HUO Xiao-Chuan, MA Gao-Ting, TONG Xu, ZHANG Xue-Lei, MIAO Zhong-Rong

2021, 16(11):  1092-1098.  DOI: 10.3969/j.issn.1673-5765.2021.11.002

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Automated CTP imaging is an kind of perfusion image method using automated perfusion processing software to interpret perfusion raw data. It can quickly, accurately and quantitatively evaluate the volume of core infarction and ischemic penumbra, evaluate collateral circulation and identify the type of occlusion vessels, and help doctors to select eligible patients with acute large vessel occlusion who can benefit from endovascular treatment. This article reviewed the specific significance of CTP parameters, and the progress of clinical application, the limitations and future development directions of automated CTP.

Endarterectomy by Stent Retriever during Mechanical Thrombectomy for Acute Intracranial Atherosclerosis Occlusion: A Case Report

HUO Xiao-Chuan, HE Hong-Wei, MIAO Zhong-Rong

2021, 16(11):  1099-1101.  DOI: 10.3969/j.issn.1673-5765.2021.11.003

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Association between Zinc Finger Homeobox 3 Gene Polymorphism and Outcomes in Different Ischemic StrokeSubtypes

CHENG Si, XU Zhe, ZUO Ying-Ting, LIU Yang, WANG An-Xin, SHI Yan-Feng, LI Hao, WANG Yong-Jun

2021, 16(11):  1102-1109.  DOI: 10.3969/j.issn.1673-5765.2021.11.004

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Objective To investigate the association between single nucleotide variants (SNVs) of zinc finger homeobox 3 (ZFHX3) and post-stroke outcomes in different stroke subtypes. Methods This study was based on the data of the Third China National Stroke Registry (CNSR- Ⅲ), a national multicenter prospective cohort study, which enrolled participants with firstever acute ischemic stroke or TIA from August 2015 to March 2018. Demographic information, diseases history and follow-up outcomes were collected. The outcomes included recurrent stroke and composite vascular events (stroke, myocardial infarction and vascular death) within 1-year

follow-up, and poor functional outcome (mRS>2) at 1 year. Three SNVs (rs7193343, rs879324,

rs12932445) were genotyped using competitive allele-specific PCR technique. For quantitative and qualitative data were analyzed using linear and logistic regression. Cox regression or logistic regression was used to determine the association between ZFHX3 gene polymorphisms and poststroke outcome. Results A total of 7674 eligible participants were included, with a mean age of 61.7±11.5 years old and 2438 females (31.77%). The SNVs rs879324 and rs12932445 (in high linkage disequilibrium, R 2=0.88) were associated with atrial fibrillation (AF), NIHSS at admission and stroke subtype. Three SNVs were all associated with 1-year composite vascular events in different stroke subtypes, even after adjusting for age, gender and AF. In cardioembolic stroke, T allele in rs7193343 was associated with recurrent stroke and composite vascular events within 1 year (aHR 1.92, 95%CI 1.21-3.05; aHR 1.95, 95%CI 1.26-3.01), A allele in rs879324 and C allele in rs12932445 were associated with composite vascular events within 1 year (aHR 1.58, 95%CI 1.10-2.27; aHR 1.66, 95%CI 1.16-2.38, respectively). In stroke of undemonstrated etiology, T allele in rs7193343 was associated with recurrent stroke and composite vascular events within 1 year (aHR 1.34, 95%CI 1.09-1.64; aHR 1.36, 95%CI 1.11-1.66). None of the 3 SNVs were found to be associated with poor functional outcome after adjusting for the confounding factors. Conclusions ZFHX3 variants were associated with recurrent stroke and composite vascular events within 1 year after onset in specific stroke subtypes, but not associated with poor functional outcome.



Safety of Intravenous Thrombolysis in Acute Ischemic Stroke Patients with Antithrombotic Therapy before Stroke Onset

ZHANG Xin-Miao, WANG Chun-Juan, YANG Xin, GU Hong-Qiu, JIANG Ying-Yu, WANG Yi-Long, ZHAO Xing-Quan, LI Zi-Xiao, WANG Yong-Jun

2021, 16(11):  1110-1114.  DOI: 10.3969/j.issn.1673-5765.2021.11.005

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Objective To investigate the effect of antithrombotic therapy before stroke onset on intravenous thrombolysis in patients with acute ischemic stroke (AIS). Methods The data of in-hospital AIS patients who received intravenous thrombolysis from a national, multi-center stroke registry of from January to December, 2018 were collected and retrospectively analyzed. All the patients were divided into observation group (with antithrombotic therapy before stroke onset) and control group (without antithrombotic therapy before stroke onset). Baseline information and in-hospital safety outcomes (symptomatic intracranial hemorrhage and all-cause death) were compared between the two groups, and multivariate logistic regression was used to analyze the correlation between pre-antithrombotic therapy and in-hospital safety outcomes. Results A total of 17 587 eligible patients in 1374 hospitals were included in this study, with 3313 patients (18.8%) in observation group and 14 274 patients (81.2%) in control group. Compared to

the control group, the observation group had higher age (67.7±11.1 years vs 64.8±12.2 years), less

males (63.6% vs 65.7%) and a higher proportion of vascular risk factors, and NIHSS >15 (16.1% vs 13.5%) on admission, with all statistical differences. The incidence of symptomatic intracranial hemorrhage (0.12% vs 0.07%, P =0.156) and all-cause death (1.72% vs 1.16%, P =0.010) in observation group were higher than those in control group. After multivariate adjustment, there was no statistical difference between the two groups in terms of symptomatic intracranial hemorrhage (HR 1.133, 95%CI 0.220-5.822, P =0.881) and in-hospital all-cause death (HR 0.912, 95%CI 0.612- 1.359, P =0.651). Conclusions There were no significant effects of antithrombotic therapy before stroke onset on short-term safety of intravenous thrombolytic therapy in AIS patients, without increasing the risk of symptomatic intracranial hemorrhage and in-hospital all-cause death.



Mechanical Prophylaxis for Venous Thromboembolism in Stroke Patients: A Meta-analysis

YANG Mu-Wei, LIU Gao, HE Yi-Xian, GUO Qing-Yuan, CAI En-Li

2021, 16(11):  1115-1122.  DOI: 10.3969/j.issn.1673-5765.2021.11.006

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Objective To evaluate the effectiveness of mechanical prophylaxis for venous thromboembolism (VTE) in stroke patients. Methods The database including PubMed, Embase, the Cochrane Library, Web of Science, CINAHL, CNKI, Wanfang Data, CBM from inception to February 2021 were retrieved to search for the randomized controlled trials (RCTs) on mechanical prophylaxis for VTE such as intermittent pneumatic compression (IPC) and compression stocking in stroke patients. The quality of the literatures was evaluated using Cochrane Collaboration's tool for assessing the risk of bias. Metaanalysis was performed using RevMan 5.3. Finally, the GRADE system was used to grade the evidence quality of results of incidence of VTE, deep venous thromboembolism (DVT) and pulmonary embolism (PE) and 30-day mortality. Results A total of 8 RCTs involving 5999 patients were included. The meta-analysis results showed that mechanical prophylaxis combined with conventional prevention could effectively reduce the incidence of VTE in stroke patients (RR 0.73, 95%CI 0.55-0.98, P =0.03). The combination of IPC pump and conventional prevention was better than conventional prevention alone in reducing the incidence of DVT (RR 0.53, 95%CI 0.31-0.93, P =0.03), while the effect of compression stocking

for preventing DVT was not obvious. The mechanical prophylaxis did not significantly reduce the

incidence of 30-day mortality or PE in stroke patients. The GRADE system evaluation showed that the evidence level of mechanical prophylaxis for VTE and IPC for DVT were low, and the level of mechanical prophylaxis for PE and 30-day mortality and compression stocking for DVT were moderate. Conclusions Mechanical prophylaxis can reduce the incidence of VTE in stroke patients, while not reduce the incidence of PE and 30-day mortality.



Development and Verification of Brain-Computer Interface Communication System Based on Steady-State Visual Evoked Potential for Patients with Post-stroke Language Disorder

WANG Lin-Lin, LI Xiao-Yang, YANG Chen, SHEN Xiao-Mei, MA Fei-Fei, LIU Xin-Yu, CHEN Xiao-Gang, ZHAO Xing-Quan, WANG Yong-Jun, GAO Xiao-Rong, JI Rui-Jun

2021, 16(11):  1123-1130.  DOI: 10.3969/j.issn.1673-5765.2021.11.007

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Objective To develop a steady state visual evoked potential-based brain computer interface communication system (SSVEP-BCI-CS), and improve the quality of life of patients with poststroke language disorder. Methods The theoretical framework of SSVEP-BCI-CS was designed, according to the clinical characteristics and needs of patients with post-stroke language disorder. 18 healthy volunteers were selected as the subjects. The system performance such as information transfer speed, accuracy and

recognition length were evaluated. National Aeronautics and Space Administration-task load index

(NASA-TLX) was used to evaluate the feasibility of this system. The gender differences in BCI performance and task load index were analyzed. Results SSVEP-BCI-CS was developed, including three modes of emergency call, instruction and typing. Occipital EEG were collected and decoded by spatio-temporal equalization dynamic window algorithm, with voice broadcast and screen feedback functions. The verification results show that the average information transfer speed of typing single task was 79.92±43.55 bits/min, and the accuracy was 94.00% (92.00%-97.00%); in the typing continuous task, the median output speed of Chinese characters was 1.79 (1.49-3.05) words/min; in instruction single task, the median output speed was 32.44 (11.73-38.64) instructions/min, the median accuracy was 95.65% (90.76%- 98.37%); in instruction continuous task, the average output speed was 23.66±9.50 instructions/min. The performance indexes of females were better than that of males. Conclusions All subjects can use this system to achieve the task of emergency call, instruction output and Chinese-English spelling. The system is expected to improve communication efficiency in patients with post-stroke language disorder.



Clinical Characteristics and 1-Year Prognosis of First-ever Cerebral Infarction Patients with Atrial Fibrillation in Xi'an

LU Qing-Li, WANG Jing, LIU Zhong-Zhong, LIU Pei, LIU Yan, CHANG Qiao-Qiao, LIN Xue-Mei, SHI Ya-Ling, WANG Fang, WU Song-Di

2021, 16(11):  1131-1136.  DOI: 10.3969/j.issn.1673-5765.2021.11.008

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Objective To investigate the clinical characteristics and 1-year prognosis of first-ever cerebral infarction patients with atrial fibrillation (AF) in Xi'an. Methods Based on the Xi'an Stroke Register database, the first-ever cerebral infarction patients admitted to four 3A-grade hospitals in Xi 'an from January to December 2015 were included in this retrospective analysis. The patients were divided into non-AF group and AF group. The difference in basic clinical characteristics and 1-year poor outcome including stroke recurrence, poor functional outcome (mRS 2-5) and all-cause death between the two groups were compared. Multivariate logistic regression model was used to analyze the influence of AF on 1-year prognosis in first-ever cerebral infarction patients. Results A total of 1564 patients were included, including 113 patients (7.2%) with AF and 1451 patients (92.8%) without AF. Compared to the non-AF group, the patients in AF group showed

elder age [(71.18±12.66) years vs (63.25±12.46) years, P <0.001], higher body mass index [24.0

(22.0-25.5) kg/m2 vs 23.4 (21.1-24.6) kg/m2, P =0.004], lower rate of current smoking (11.5% vs 26.6%, P =0.002), higher NIHSS score at admission [7 (3-12) vs 4 (2-6), P <0.001], higher rate of secondary pneumonia (17.7% vs 3.7%, P <0.001), more patients unable to walk within 48 hours after admission (54.0% vs 32.9%, P <0.001), higher rate of dysphasia (14.2% vs 6.4%, P =0.001), and lower LDL-C level (2.44±0.71 mmol/L vs 2.65±0.86 mmol/L, P =0.016), higher INR (1.21±0.52 vs 1.02±0.13, P <0.001) and lower platelet count [(164.91±47.55)×109/L vs (192.58±59.98)×109/L, P <0.001]. Multivariate logistic regression analysis showed that the risks of poor functional outcome (OR 2.25, 95%CI 1.10-5.23, P =0.022) and death (OR 3.28, 95%CI 1.48-7.28, P =0.004) within 1 year in AF group were significantly higher than that in non-AF group, but there was no statistical difference in recurrent stroke risk between the groups (OR 1.14, 95%CI 0.34-3.85, P =0.833). Conclusions The partial clinical characteristics of first-ever cerebral infarction patients with AF were significantly different from that of patients without AF in Xi'an, and the risk of 1-year poor functional outcome and death increased significantly. It was suggested to evaluate the risk of stroke in AF patients and standardize anticoagulant therapy in high-risk patients.



Clinical Characteristics of 25 Cases Series with Spinal Dural Arteriovenous Fistula

GAO Yu, FENG Xue-Dan, WANG Xiang-Bo, YAN He-Li, MA Hong-Mei, ZOU Can

2021, 16(11):  1137-1143.  DOI: 10.3969/j.issn.1673-5765.2021.11.009

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Objective To analyze the clinical characteristics of spinal dural arteriovenous fistula (SDAVF). Methods The clinical data of patients with SDAVF admitted to Beijing Fengtai You'anmen Hospital from January 2015 to December 2020 were collected and retrospectively analyzed. The general information, clinical manifestations, cerebrospinal fluid (CSF) examination, imaging features, treatment and prognosis were analyzed. The prognosis was evaluated using modified Aminoff and Logue score (ALS). Results A total of 25 eligible patients were included, with 21 males (84.0%) and a median age of 61 years (range: 40-75 years). The clinical manifestations included 25 cases (1 00.0%) of motor dysfunction, 22 cases (88.0%) of sensory dysfunction, 16 cases (64.0%) of urination and defecation dysfunction, 3 cases (12.0%) of back pain, 2 cases (8.0%) of dyspnea, dysarthria and dysphagia. CSF leukocytes was increased in 2/11 (18.2%) cases, and the protein was increased in 8/11 (72.7%)

cases. MRI showed long-segment lesions, which were located in thoracolumbar segment in 19

cases (76.0%), in sacral segment in 2 cases (8.0%), in cervical and craniocervical junction in 4 cases (16.0%). Flow void phenomena was found in 19/25 (76.0%) cases. Patchy or accompanied with linear enhancement was found in 11/18 (61.1%) cases, 5 of whom (45.5%) showed "piecemissing sign". The detection rate of fistula on CTA was 93.3% (14/15), and that of feeding artery was 80.0% (12/15). DSA showed single fistula in 23 cases (92.0%) and two fistulas in 2 cases (8.0%). All patients underwent fistulectomy or intravascular embolization. During a median follow-up of 5 months (range: 3-6 months), 4 cases (16.0%) were lost to follow-up. For 21 followed-up cases, 17 cases (81.0%) relieved, 3 cases (14.3%) did not improve, 1 case (4.8%) died. Conclusions SDAVF mostly occurred in thoracolumbar spinal cord, with the main clinical manifestations of progressive motor, sensory, urination and defecation dysfunction. SDAVF at the craniocervical junction can cause brain stem dysfunction, even life-threatening. The changes of CSF can be similar to inflammation. The "piece-missing sign " on contrast-enhanced MRI is helpful to the early identification of SDAVF. CTA can be used as a tool for screening SDAVF. The misdiagnosis rate of SDAVF is high. Early diagnosis and treatment can improve the prognosis.



Application of Personalized Cognitive Function Nursing and Training in Adult Patients with Moyamoya Diseaseafter Surgical Revascularization

ZHAO Dong-Hong, ZHANG Dong, XUE Rui, YUAN Qiao-Ling

2021, 16(11):  1144-1149.  DOI: 10.3969/j.issn.1673-5765.2021.11.010

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Objective To explore the effect of personalized cognitive function nursing and training in cognitive function recovery of adult patients with Moyamoya disease (MMD) who received surgical revascularization. Methods This study prospectively enrolled the adult MMD patients who underwent surgical revascularization in Beijing Tiantan Hospital between November 2018 and July 2020. All the patients were randomly divided into observation group and control group. The routine care were given in control group; and individualized cognitive function nursing and training based on routine nursing were given in observation group. The cognition scores of preoperative and postoperative 3-months between the two groups were compared, including Adult Webster’s Intelligence Scale (WAIS), the Chinese version of the Cambridge Prospective Memory Test (CAMPROMPT) and the Repeatable Battery of Neuropsychological State (RBANS) [including immediate memory(IM) and delayed memory (DM)].The ischemic and hemorrhagic events and prognosis were compared between the two group during the 3-month follow-up. The prognosis was evaluated by mRS, with

a score of 0-1 for normal neurological function, 2-3 for mild disability, and 4-5 points for severe

disability. Results A total of 140 adult patients with MMD were included, including 70 cases in control group and 70 cases in observation group. There were no statistical differences in baseline data and preoperative cognitive function score between the two groups. No significant difference in WAIS score (observation vs control: 98.11±11.16 points vs 95.27±14.83 points) was observed (P >0.05) between the two groups. The scores of CAMPROMPT (22.99±4.11 points vs 20.41±5.69 points, P =0.003), RBANS-DM (89.86±18.96 points vs 79.54±16.12 points, P =0.001) and RBANS-IM (84.43±12.35 points vs 79.61±15.93 points, P =0.048) were higher in observation group than those in control group. Conclusions The application of personalized cognitive function nursing and training in adult MMD patients after surgical revascularization was an important treatment method for promoting cognitive function recovery, especially for memory.



Characteristics of HR MR Vessel Wall Imaging of Culprit Artery after Recanalization in Yong and Elder Patients with Acute Middle Cerebral Artery Occlusion

HU Jian-Gang, LIAO Wen-Kai, ZHENG Yong, SONG Jian-Xun, YE Hua-Wei, HUANG Ju-Ke

2021, 16(11):  1150-1155.  DOI: 10.3969/j.issn.1673-5765.2021.11.011

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Objective To compare the characteristics of HR MR vessel wall imaging (HR-MRVWI) of culprit artery in young patients and middle-aged and elderly patients with acute middle cerebral artery (MCA) occlusion after recanalization. Methods This retrospective study enrolled the patients with acute MCA occlusion who underwent mechanical recanalization in Department of Neurosurgery of Shenzhen Bao'an People's Hospital from June 2015 to June 2018. The clinical data such as general information, laboratory examination, NIHSS score, HR-MRVWI, mRS score were collected. Taking 45 years as the age limit, the patients were divided into young group (≤45 years) and middle-aged and elderly group (>45 years). The degree of stenosis, vessel wall remodeling index, plaque thickness and enhancement rate of the culprit MCA at 4 weeks and 6 months after recanalization and 1-year prognosis between the two groups were compared. Good prognosis was defined as a mRS score of 0 to 3. Results A total of 30 patients were included, with 16 cases in young group and 14 cases in middle-aged and elderly group. There were no statistical differences in stenosis rate, remodeling

index, plaque thickness and enhancement rate of MCA between the two groups at 4 weeks after

recanalization. The degree of MCA stenosis [(37.47±0.04)% vs (60.00±0.26)%, P =0.024], plaque thickness (0.63±0.18 mm vs 1.56±0.35 mm, P =0.016) and enhancement rate [(0.35±0.17)% vs (0.57±0.24)%, P =0.043] of the young group were significantly lower than those of the middleaged and elderly group at 6 months. There were no statistical differences in the remodeling rate at 6 months and mRS scores at 1 year between the two groups. Conclusions Compared to the young patients, the degree of stenosis, plaque thickness and enhancement rate of culprit MCA were higher in the middle-aged and elderly patients, suggesting that age may be an important contributing factor for plaque progression.



Vinpocetine Injection Reduces Cerebral Ischemic Injury in Mice by Regulating Microglia Polarization

CHEN Qing-Fang, ZHAO Shun-Ying, WEN Shao-Hong, DONG Wen, LIU Wen-Qian, GONG Ting, CHEN Wen-Tao, LIU Xiang-Rong, WANG Yong-Jun

2021, 16(11):  1156-1163.  DOI: 10.3969/j.issn.1673-5765.2021.11.012

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Objective To study the effect of vinpocetine injection on the neurological function recovery and microglia polarization after permanent ischemia of distal middle cerebral artery(MCA) in mice. Methods Thirty six male C57BL/6J mice were randomly divided into permanent cerebral ischemia group (n =6), normal saline group (n =12), vinpocetine group (n =12) and sham group (n =6). The distal right MCA occlusion models were established by electrocoagulation in the first three groups. In the sham group, the distal of the MCA was exposed without electrocoagulation.Vinpocetine injection (4.55 mg/kg, 150 μL) or equal volume normal saline was injected via the caudal vein

20 minutes after ischemia for 5 minutes, and was administered continuously once a day for 14

days. Modified Garcia scores and rotarod test were performed to evaluate the sensory and motor neurological function of mice at 3, 7, 9, 11 and 14 days after the surgery. Neuron injury and Iba1 with CD16/32 (M1 microglia, pro-inflammatory) or CD206 (M2 microglia, anti-inflammatory) expression in cortex were evaluated by immunofluorescence staining at 14 days after ischemia. Results Vinpocetine injection improved modified Garcia scores at 11 and 14 days, quickened the running time and increased the speed of rotarod test at 14 days, compared with permanent cerebral ischemia group, with all statistical differences. Vinpocetine injection alleviate neuron injury compared to the permanent cerebral ischemia group (P =0.008) and normal saline treatment group (P =0.039). Vinpocetine injection decreased the expression of M1 microglia compared to the permanent cerebral ischemia group (P <0.001) and normal saline treatment group (P =0.038), and increased the expression of M2 microglia, compared to the other three groups (all P <0.001). Conclusions Vinpocetine injection may have protective effect against cerebral ischemia injury after permanent cerebral ischemia in mice by regulating microglia M1/M2 polarization from proinflammatory to anti-inflammatiory response.



A Case of Contrast-Induced Encephalopathy after Vertebral Artery and Renal Artery Stenting

JIANG Hua-Hua, SONG Wen-Feng

2021, 16(11):  1164-1168.  DOI: 10.3969/j.issn.1673-5765.2021.11.013

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A Case of Thalassemia and Moyamoya Syndrome

HUANG Meng-Xia, LIAO Bao

2021, 16(11):  1169-1171.  DOI: 10.3969/j.issn.1673-5765.2021.11.014

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The Value of FLAIR Hyperintense Vascular Sign in the Diagnosis and Treatment of Acute Ischemic Stroke

LU Ping, ZHAO Xing-Quan

2021, 16(11):  1172-1177.  DOI: 10.3969/j.issn.1673-5765.2021.11.015

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Head magnetic resonance FLAIR hyperintense vessel sign (HVS) is a FLAIR hyperintensity sign in the shape of dots or strips in the proximal middle cerebral artery, or linear or serpentine in the lateral fissure. HVS is associated with slow antegrade or retrograde blood flow in the collateral circulation due to intracranial large artery severe stenosis or occlusion. Current studies suggested that HVS can be a imaging marker of intracranial large vessel stenosis or occlusion, indicating the presence of good cerebral collateral circulation. For patients with acute ischemic stroke, baseline HVS-DWI mismatch can be used for screening eligible patients who would benefit from reperfusion therapy; However, the relationship between HVS and prognosis in patients who do not undergo reperfusion therapy is currently controversial. A variety of clinical factors, especially the time from onset to imaging, can affect the imaging of HVS, therefore, the imaging results should be judged comprehensively with reference to clinical features.

Mechanism of DNMT3A in Atherosclerosis

YAN Ran, SHANGGUAN Yi, QIU Xin, LI Zi-Xiao

2021, 16(11):  1178-1182.  DOI: 10.3969/j.issn.1673-5765.2021.11.016

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DNA methylase 3 alpha (DNMT3A) is an important DNA methylation enzyme. Recent studies have shown that it plays an important role in the regulation of atherosclerosis, which is the important pathological basis of cardiovascular and cerebrovascular diseases (CVD), such as coronary heart disease and ischemic stroke. Somatic DNMT3A mutation may affect the occurrence and development of atherosclerosis through several immune cells and mechanisms, and it is an important risk factor for CVD that has not been fully studied. This article focused on the mechanism of DNMT3A in CVD and its application prospect in the diagnosis and treatment of CVD.

Progress of Relationship between Ultrasound Biomarkers of Vulnerable Carotid Atherosclerotic Plaque and Cerebrovascular Disease

LI Yi, HE Wen

2021, 16(11):  1183-1188.  DOI: 10.3969/j.issn.1673-5765.2021.11.017

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Vulnerable carotid plaques are closely related to the occurrence of ischemic cerebrovascular events. Carotid ultrasound can not only quantify the degree of carotid stenosis, but also evaluate the vulnerability of carotid plaques. Three-dimensional ultrasound can quantitatively evaluate the volume of carotid plaques. Contrast-enhanced ultrasound can detect the density and distribution of intraplaque neovascularization. Shear wave elastography can evaluate plaque hardness which reflects the components of different parts of plaque. The development of carotid ultrasound makes it more widely applied in the diagnosis and treatment of ischemic stroke, and the evaluation of carotid artery hemodynamics and vessel wall more accurate, which are helpful to assess the risk of cerebrovascular events and take interventions timely.



Progress of Risk Factors for Perioperative Stroke in Noncardiac Surgery

QI Ying-Chun, CHEN Wen, CHENG Rui

2021, 16(11):  1189-1193.  DOI: 10.3969/j.issn.1673-5765.2021.11.018

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Perioperative stroke is one of the serious complications of noncardiac surgery. It can not only cause postoperative cognitive impairment, prolonged length of hospital stay and increased hospitalization costs, but also increase the disability rate and mortality. Recent studies have shown that the history of cerebrovascular disease, chronic atrial fibrillation and new-onset atrial fibrillation after surgery, general anesthesia, abnormal blood glucose, and the use of β blockers may be the risk factors for perioperative stroke in noncardiac surgery. This article reviewed the progress of these relevant risk factors, to help to timely identify and control these risk factors in noncardiac surgery, and reduce the risk of perioperative stroke and improve the prognosis of patients.

Current Status and Thoughts of Training of Clinical Practice for Physicians in Neurointensive Care

FENG Ya, GUI Ya-Xing, WANG Guo-Dong, FENG Yi, WU Yun-Cheng

2021, 16(11):  1194-1197.  DOI: 10.3969/j.issn.1673-5765.2021.11.019

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With the development of medical technology in neurology and increase of the number of stroke patients, the demand for neurointensive monitoring and management is increasing year by year. As a subspecialty of neurology, neurointensive care has the characteristics of intensive care. As a new subspecialty, neurointensive care medicine still has many problems, such as the development of discipline theory system, the ability of medical staff, especially the lack of systematic clinical training for medical staff. This article elaborated the current status of the training for physicians in neurointensive care in China, and put forward some problem-solving suggestions, to promote the development of discipline theory system and the clinical competence of physicians in neurocritical care.