Table of Content

20 August 2022, Volume 17 Issue 08

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Explore, Discover, Create, Opportunity—Dual Antiplatelet Therapy Strategy Guided by Gene

WANG Anxin, XU Qin, XIA Xue, MENG Xia, XIE Xuewei, WANG Yongjun

2022, 17(08):  797-801.  DOI: 10.3969/j.issn.1673-5765.2022.08.001

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Having the Second Chance, What is the Next? 

DONG Yi, DONG Qiang

2022, 17(08):  802-806.  DOI: 10.3969/j.issn.1673-5765.2022.08.002

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CHANCE 2 Pioneered Gene-guided Antiplatelet Therapy for Stroke

ZHANG Liang, HUANG Li'an, XU Anding

2022, 17(08):  807-812.  DOI: 10.3969/j.issn.1673-5765.2022.08.003

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Dual Antiplatelet Therapy for Acute Minor Ischemic Stroke Patient Carrying Extensive Metabolizers Based on Rapid CYP2C19 Genotyping: A Case Report

KONG Xiaotong, LIU Peifang, CAI Hanlu, WANG Yu, WANG Lihua

2022, 17(08):  814-816.  DOI: 10.3969/j.issn.1673-5765.2022.08.004

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Dual Antiplatelet Therapy for Acute Minor Ischemic Stroke in Loss-of-function Carriers Based on Rapid CYP2C19 Genotyping: A Case Report

FENG Bo, ZHAO Caijun, CHANG Liguo

2022, 17(08):  817-820.  DOI: 10.3969/j.issn.1673-5765.2022.08.005

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Effects of Aspirin Combined with Clopidogrel on the Expression of RAGE and sRAGE during the Convalescence of Cerebral Ischemia in Mice

WEN Shaohong, LIU Xiangrong, ZHAO Shunying, DONG Wen, CHEN Qingfang, CHEN Wentao, LI Zixiao, WANG Chunjuan

2022, 17(08):  821-828.  DOI: 10.3969/j.issn.1673-5765.2022.08.006

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Objective  To explore the effects and mechanisms of aspirin combined with clopidogrel (ASA+CPG) on the expression of receptor for advanced glycation end products (RAGE) and soluble receptor for advanced glycation end products (sRAGE) in the convalescent stage of distal middle cerebral artery occlusion-reperfusion model in mice.
Methods  60 male C57BL/6J mice were randomly divided into sham operation group, vehicle group and ASA+CPG group, 20 mice per group. A model of transient cerebral ischemia was performed by occluding the distal middle cerebral artery (ischemia for 60 minutes, then restore to reperfusion). 100 μL suspension of aspirin (12 mg/kg, 0.3 mg per mouse), clopidogrel (12 mg/kg, 0.3 mg per mouse) and water were administered by gavage at the onset of reperfusion, once a day for 21 days. The neurological function of mice was evaluated on day 1, 3, 5, 7, 9, 11, 14 and 21 after ischemia. Samples were harvested 21 days after ischemia. The serum sRAGE expression level was detected by enzyme-linked immunosorbent assay (ELISA). Immunoblotting was used to evaluate RAGE expression in brain tissues. Real-time quantitative PCR was applied to detect the mRNA expression levels of CD16, CD32, CD11b, inducible nitric oxide synthase (iNOS), CD206, arginase 1 (Arg1), transforming growth factor β (TGF-β), chitinase-like 3 (Chil3/Ym1/2) and RAGE. RAGE, neuronal nuclei (NeuN) and glial fibrillary acidic protein (GFAP) were labelled by immunofluence  to observe the colocalization of RAGE with neurons and astrocytes.
Results  The vibrissae touch score at day 3, neurological function total score at day 3 and day 9 in ASA+CPG group were better than those in vehicle group (P=0.0067, 0.0140, 0.0406). At 21 days after  ischemia, the level of serum sRAGE in ASA+CPG group was higher than that in  vehicle group (1.099±0.541 ng/mL vs. 0.319±0.341 ng/mL, P=0.0120). The mRNA expression levels of iNOS (1.250±0.318 vs. 1.843±0.301, P=0.0164) and RAGE (2.105±0.300 vs. 2.732±0.249, P=0.0071) in ASA+CPG group decreased compared with vehicle group. RAGE colocalized with neurons but not with astrocytes in peri-infarct area of ischemic mice. The number of RAGE+NeuN+ cells in ASA+CPG group was less than that in vehicle group (328.798±35.183 vs. 814.437±165.758 per square millimeter, P=0.0012).
Conclusions  Combined treatment with aspirin and clopidogrel plays cerebral ischemia protective effect by down-regulate RAGE and up-regulate sRAGE expression to alleviate inflammatory response.



LEI Yancheng, LIU Zhu, WANG Jinpeng, ZHANG Hao, YANG Wenfang, XIAO Shunxi, YANG Huijie, MO Haizhen, CHEN Yan

LEI Yancheng, LIU Zhu, WANG Jinpeng, ZHANG Hao, YANG Wenfang, XIAO Shunxi, YANG Huijie, MO Haizhen, CHEN Yan

2022, 17(08):  829-833.  DOI: 10.3969/j.issn.1673-5765.2022.08.007

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Objective  To study the correlation between the monocyte/high density lipoprotein cholesterol ratio (MHR) and the degree of intracranial atherosclerotic stenosis (ICAS) in high altitude area.
Methods  Patients with acute cerebral infarction in high altitude area (2260-4480 m) in Qinghai People's Hospital from June 2017 to June 2021 were included in this retrospective study. According to the degree of cerebral artery stenosis on DSA imaging, all the patients were divided into 5 groups: no stenosis group, mild stenosis group (≤50%), moderate stenosis group (50%-70%), severe stenosis group (≥70%) and occlusion group (100%). The baseline clinical data, laboratory tests results and MHR were collected. Logistic regression model was used to analyze the risk factors for cerebral artery stenosis.
Results  A total of 349 patients were included. There were 69 patients without stenosis, 78 patients with mild stenosis, 41 patients with moderate stenosis, 84 patients with severe stenosis and 77 patients with occlusion. Multivariate logistic regression analysis showed that old age and high MHR were independent risk factors for mild stenosis (OR 1.061, 95%CI 1.027-1.097, P<0.001; OR 1.041, 95%CI 1.009-1.074, P=0.011), moderate stenosis (OR 1.057, 95%CI 1.017-1.099, P=0.005; OR 1.082, 95%CI 1.045-1.119, P<0.001), severe stenosis (OR 1.096, 95%CI 1.057-1.137, P<0.001; OR 1.096, 95%CI 1.062-1.131, P<0.001) and occlusion (OR 1.036, 95%CI 1.001-1.072, P=0.046; OR 1.101, 95%CI 1.067-1.136, P<0.001), compared to no stenosis; increased monocyte count was an independent risk factor for moderate stenosis (OR 1.684, 95%CI 1.569-2.725, P=0.027), severe stenosis (OR 3.529, 95%CI 1.541-5.766, P=0.002) and occlusion (OR 5.446, 95%CI 4.453-6.917, P=0.002).
Conclusions  Old age, high MHR and increased monocyte count were associated with intracranial atherosclerotic stenosis in patients with acute cerebral infarction in high altitude area.







Emergent Management of Anterior Circulation Tandem Occlusion with Large Core Infarction

LIU Chengchun, TANG Chunhua, HUANG Shuhan, WU Ya, LI Xiaoshu, LI Wei, ZHANG Meng

2022, 17(08):  834-839.  DOI: 10.3969/j.issn.1673-5765.2022.08.008

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Objective  To evaluate the safety and efficacy of endovascular of in treating anterior circulation tandem occlusion with large core infarction.
Methods  The clinical and imaging data of the patients with anterior circulation tandem occlusion and large core infarction who were admitted to Daping Hospital, Army Military Medical University from March 2018 to May 2020 were retrospectively analyzed. The preoperative evaluation, surgical approach, operation technique, perioperative management, surgical outcomes and prognosis of the patients were analyzed.
Results  A total of five patients were included, with 4 males and age range 61-71 years old. Of the 5 cases, the initial and terminal segment occlusion of internal carotid artery (ICA) was in one patient, and ICA initial segment occlusion combined with ipsilateral middle cerebral artery (MCA) occlusion was in four patients. All of them underwent distal-to-proximal revascularization by applying the Solitaire stent-retriever half-release protection (Sharp) technique. Two patients underwent ipsilateral ICA stenting immediately after MCA recanalization; in the other two patients, ICA stenting was performed after MCA recanalization and a long time of reperfusion observation; and one patient only underwent balloon dilation of carotid artery after recanalization. All 5 patients got successful recanalization of the occluded vessels without symptomatic intracranial hemorrhage or distal thrombotic events. The time from stroke onset to recanalization was 637.2±172.2 (451-814) minutes, and the time from recanalization to ICA stent implantation was 152.5±92.2 (59-270) minutes. Two patients died from postoperative hyperperfusion (edema), and the other three patients all had a good prognosis (mRS 3) at 90 days after surgery.
Conclusions  Patients with anterior circulation tandem occlusion and large core infarction may benefit from acute endovascular treatment. To reduce the risk of postoperative hyperperfusion, appropriate "reperfusion precondition" time is necessary, then dealing with intracranial lesion, while the optimal precondition time is still uncertain.




Coagulation Characteristics in Patients with Wake-up Stroke

DANG Meijuan, ZHAO Lili, LI Tao, LI Ye, WANG Xiaoya, LU Ziwei, LU Jialiang, FENG Yuxuan, YANG Yang, ZHANG Guilian

2022, 17(08):  840-844.  DOI: 10.3969/j.issn.1673-5765.2022.08.009

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Objective To compare the difference of coagulation function between wake-up stroke (WUS) patients and non-WUS patients, in order to further clarify the pathophysiological mechanism of WUS. Methods Patients with first-ever acute ischemic stroke (AIS) within 72 hours from symptom onset who were admitted to the Second Affiliated Hospital of Xi'an Jiaotong University between January 2018 and May 2020 were included in this retrospective study. Sex- and age-matched (±5 years old) inpatients without stroke history during the same period were selected as the control group. According to having WUS or not, the patients with AIS were divided into WUS subgroup and non-WUS subgroup. The differences of coagulation function were compared between AIS group and control group and between WUS group and non-WUS group. Binary logistic regression analysis was used to evaluate the relationship between coagulation function and WUS. Results A total of 342 AIS patients and 342 controls were included, with 67 WUS patients (19.6%) and 275 non-WUS patients (80.4%) in AIS patients. Compared with control group, activated partial thromboplastin time (APTT) [23.2 (20.7-26.3) s vs. 24.0 (21.6-26.8) s, P=0.019] and thrombin time [18.4 (17.9-19.1) s vs. 18.9 (18.3-19.4) s, P<0.001] were shorter and D-dimer [270.0 (170.0-460.0) ng/mL vs. 220.0 (137.5-352.5) ng/mL, P<0.001], fibrinogen [287.0 (243.8-331.0) g/L vs. 255.0 (221.0-292.3) g/L, P<0.001], and fibrin degradation product [1.1 (0.6-1.6) μg/mL vs. 0.7 (0.4-1.1) μg/mL, P<0.001] were higher in patients with AIS. Among AIS group, compared with non-WUS patients, WUS patients were more inclined to have higher NIHSS scores at admission [3 (2-6) vs. 2 (1-4), P=0.005] and higher percentage of taking statins [94.0% vs 84.0%, P=0.034]. The APTT in WUS subgroup was longer than that in non-WUS subgroup [24.8 (21.5-27.5) s vs. 22.9 (20.5-25.9) s, P=0.004], and the other coagulation parameters had no statistical differences between the two subgroups. Logistic regression analysis showed that APTT prolongation was independently associated with WUS (OR 2.082, 95%CI 1.156-3.751, P=0.015). Conclusions The WUS patients had longer APTT than non-WUS patients, which indicated that WUS patients had worse intrinsic coagulation function.



The Impact of Blood Glucose Fluctuation on Delayed Cerebral Ischemia and 30-day Mortality in Aneurysm Subarachnoid Hemorrhage

WU Qian, TAO Liyuan, CHEN Siqi, ZHONG Lianmei, LIU Liping, MI Donghua

2022, 17(08):  845-850.  DOI: 10.3969/j.issn.1673-5765.2022.08.010

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Objective To clarify the relationship of blood glucose fluctuation and delayed cerebral ischemia and 30-day mortality in aneurysmal subarachnoid hemorrhage (aSAH) patients. Methods The data of aSAH patients were collected and retrospectively analyzed. Continuous 14-day fasting blood glucose level was collected and patients were divided into four groups: stable (Day 1, <7 mmol/L; Day 2-14, all <10 mmol/L), unstable (Day 1, <7 mmol/L; Day 2-14, at least once ≥10 mmol/L), well-controlled (Day 1, ≥7 mmol/L; Day 2-14, all <10 mmol/L) and bad-controlled (Day 1, ≥7 mmol/L; Day 2-14, at least once ≥10 mmol/L). Univariate and multivariate analysis were used to analyze the impact of glucose fluctuation on delayed cerebral ischemia and 30-day all-cause mortality. Results A total of 341 patients were included, with 212 cases in stable group, 23 in unstable group, 62 in well-controlled group and 44 in bad-controlled group. The incidence of delayed cerebral ischemia among the four groups as follows: the highest incidence was 39.13% in unstable group, then 29.55% in bad-controlled group, 17.92% in stable group and the lowest was 17.74% in well-controlled group, with statistical difference (P=0.043). 30-day all-cause mortality as follows: the highest mortality was 15.91% in bad-controlled group, then 13.04% in unstable group, 6.45% was in well-controlled group, and the lowest was 1.42% in stable group, with statistical difference (P<0.001). Logistic regression analysis showed that unstable and bad-controlled blood glucose were risk factors of delayed cerebral ischemia occurrence (OR 6.032, 95%CI 1.941-18.747, P=0.002; OR 2.889, 95%CI 1.247-6.691, P=0.013) and 30-day all-cause mortality (OR 14.033, 95%CI 1.971-99.921, P=0.008; OR 19.723, 95%CI 3.597-108.143, P=0.001) in aSAH patients. Conclusions The unstable and bad-controlled blood glucose levels in aSAH patients were associated with delayed cerebral ischemia and 30-day mortality.



Effect of A2 Segment Configuration of Anterior Cerebral Artery on Clipping of Anterior Communicating Aneurysms via Left Pterional Approach

SONG Xulin, CHEN Laizhao, WEI Minggui

2022, 17(08):  851-856.  DOI: 10.3969/j.issn.1673-5765.2022.08.011

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Objective To compare the surgical effect, operation procedure and intraoperative exposure of craniotomy clipping for anterior communicating aneurysms with of different spatial configurations superior blood supply on the left side, and to explore the related surgical indications. Methods The data of patients with left superior anterior communicating aneurysms receiving neurosurgical clipping in the Second Hospital of Shanxi Medical University from January 2013 to December 2021 were retrospectively analyzed. According to the positional relationship between the running direction of A2 segment of anterior cerebral artery (ACA) and the coronary plane, aneurysms were divided into four types: horizontal type, the angle between ACA and the coronary plane was less than 22.5°; longitudinal type, the angle between ACA and the sagittal plane was less than 22.5°; right anterior left posterior type, the right ACA in front and the angle between ACA and the coronary plane was between 112.5°-157.5°; right posterior left anterior type, the left anterior cerebral artery in front and the angle between ACA and the coronary plane was between 22.5°-67.5°. The operation time, clipping pattern (simple clipping or complex clipping), clipping results(complete clipping or not) , aneurysm recurrence from 3 months to 1 year and GCS score at 1 year after operation were compared between horizontal type and longitudinal type, between right anterior left posterior type and right posterior left anterior type. Results A total of 50 patients were included in the study, including 8 cases of horizontal type, 12 cases of longitudinal type, 16 cases of right anterior left posterior type, and 14 cases of right posterior left anterior type. There were no statistical differences in all the clinical indexes between horizontal type and longitudinal type. There were no statistical differences in the baseline data between right anterior left posterior type and right posterior left anterior type, while the operation time in right anterior left posterior type was shorter than that in right posterior left anterior type (85.1±19.2 min vs.102.1±57.5 min, P=0.032), and there were no statistical differences in the aneurysm recurrence rate and prognosis between the two groups. Conclusions For patients with left superior anterior communicating aneurysms, the operation time in right anterior left posterior type (based ACA) was shorter than that in right posterior left anterior type, and there was no statistical difference in prognosis indexes between the two groups; there were no statistical differences in operation and prognosis indexes between horizontal type and longitudinal type.



The Protective Effect of Adiponectin on Rats with Cerebral Ischemia-reperfusion through PI3K/PKB Signaling Pathway

HE Junfang, LIU Xinping, LYU Xuehai, WAGN Bin

2022, 17(08):  857-862.  DOI: 10.3969/j.issn.1673-5765.2022.08.012

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Objective To investigate the protective effect of adiponectin (ADPN) through PI3K/PKB signaling pathway in rats with cerebral infarction. Methods The SD rats were randomly divided into sham operation group, middle cerebral artery occlusion (MCAO) model group, ADPN treatment group and PI3K/PKB inhibitor (LY294002) group, with 15 rats in each group. The rat MCAO model was constructed by thread occlusion method, and all the rats were given reperfusion 1.5 hours after ischemia. The following treatments were given 2 hours after successful ischemia-reperfusion: the rats in the ADPN treatment group were given intravenous injection of ADPN (180 μg/100 g), the rats in the inhibitor group were given intravenous injection of ADPN (180 μg/100 g) + LY294004 (0.03 mg/100 g), and the other two groups were given the corresponding volume of 0.9% normal saline (0.09 mL/100 g). The cerebral infarct area, brain water content of rats in each group were detected 24 hours after ischemia-reperfusion. And neurological function deficit was assessed by Longa 5-point. The expression levels of PI3K, PKB, p-PKB and ADPN protein were detected by western blotting, the levels of MDA and SOD were detected by enzyme linked immunosorbent assay (ELISA). Results Compared with the sham operation group, the area of cerebral infarction, brain water content, neurological function deficit score and MDA level in MCAO model group increased (all P<0.001), and the expression levels of SOD, ADPN, PI3K and p-PKB protein decreased (all P<0.001). Compared with MCAO model group, the area of cerebral infarction, brain water content, neurological deficit score and MDA level in ADPN treatment group decreased (all P<0.001), and the expression levels of SOD, ADPN, PI3K and p-PKB protein increased (all P<0.001). Compared with ADPN treatment group, the area of cerebral infarction, brain water content, neurological function deficit score and MDA level in inhibitor group increased (all P<0.001), and the expression levels of SOD, ADPN, PI3K and p-PKB protein decreased (all P<0.001). Conclusions ADPN has a protective effect on cerebral ischemia-reperfusion injury, which may be related to activation of PI3K/PKB signal pathway and inhibition of oxidative stress.



Chinese Experts Consensus on Endovascular Treatment for Symptomatic Intracranial Atherosclerotic Stenosis 2022

Chinese Stroke Association, Chinese Interventional Neuroradiology Society

2022, 17(08):  863-888.  DOI: 10.3969/j.issn.1673-5765.2022.08.013

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Endovascular Treatment for Acute Ischemic Stroke Three Times in a Patient: A Case Report and Literature Review

NI Ruilong, CAO Li, ZHAO Yuwu, DENG Jiangshan

2022, 17(08):  889-893.  DOI: 10.3969/j.issn.1673-5765.2022.08.014

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Acute Ischemic Stroke in a Boy with Atrial Septal Defect

HUANG Xiaofeng, HAO Xinqing, LIANG zhanhua, LEI Yang

2022, 17(08):  894-896.  DOI: 10.3969/j.issn.1673-5765.2022.08.015

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Complication of Acute Coronary Syndrome Presenting with Neck Pain during Endovascular Treatment of Acute Ischemic Stroke

CHEN Zhengping, HUANG Tingting, YANG Deyu, LIU Shudong, ZHAO Libo, LI Qianlu

2022, 17(08):  897-900.  DOI: 10.3969/j.issn.1673-5765.2022.08.016

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The Application of Susceptibility Weighted Imaging in Cerebral Hemorrhage

MA Xiaodan, XIA Wanhong, ZHANG Yingkui

2022, 17(08):  901-904.  DOI: 10.3969/j.issn.1673-5765.2022.08.017

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Progress of Non-motor Dysfunction after Cerebellar Stroke

MU Haoyue, JIANG Ruixuan, WANG Yan, JU Yi, ZHAO Xingquan

2022, 17(08):  905-910.  DOI: 10.3969/j.issn.1673-5765.2022.08.018

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At present, the new understanding of non-motor function of cerebellum is based on the comprehensive evidence of neuroanatomy, neuroimaging and clinical research. In clinical practice, the understanding of this aspect for doctors is insufficient, so they often ignore the symptoms of non-motor function impairment of patients with cerebellar stroke. This article mainly discussed the research progress of non-motor dysfunction after cerebellar stroke from the aspects of anatomy, mechanism, and clinical manifestations including cognition, language, emotion and other non-motor function.



A Standardized Scheme of Collection, Storage and Transportation of Whole Blood Samples of Cerebrovascular Disease

CHEN Yu, WANG Di, LI Guanzhang, ZHAO Zheng, LI Yiying

2022, 17(08):  911-914.  DOI: 10.3969/j.issn.1673-5765.2022.08.019

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With the advent of the era of precision medicine and big data, the construction of a standardized clinical sample database has become an important prerequisite for the basic and transformational research of cerebrovascular diseases. Cerebrovascular disease whole blood samples are unstable, batch effect is strong, difficult to transport, so how to standardize the collection, preservation and transportation of whole blood samples has become a key issue in the construction of cerebrovascular disease clinical sample database. Based on the scheme of International Standardization Organization, the center for biological sample database of cerebrovascular diseases in Beijing Tiantan Hospital Affiliated to Capital Medical University developed the standard framework for the whole process of collection, preservation and transportation of whole blood samples of cerebrovascular diseases in China. The solution realizes the standard, normative, timely and reliable collection and management of whole blood samples, and can provide technical support for clinical diagnosis and treatment, disease research and drug development of cerebrovascular diseases.