Table of Content

20 November 2008, Volume 3 Issue 11

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Focus on October 29,2008

2008, 3(11):  789-790. 

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述评

Status and Prospects of Stroke Early Warning

2008, 3(11):  791-797. 

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论著

Long-term Outcome of Elective Stenting for Symptomatic IntracranialVertebrobasilar Stenosis

XU Xiao-Tong;JIANG Wei-Jian;DU Bin;et al.

2008, 3(11):  798-802. 

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Objective To examine long-term outcome of a largest case series to date after elective stenting of symptomatic atherosclerotic intracranial vertebrobasilar artery(VBA) stenosis.Methods During September 2001 till September 2007, elective stenting with a balloon-expandable stent was performed in 116 consecutive patients with atherosclerotic intracranial vertebrobasilarartery(VBA) stenosis ≥50% that resulted in qualifying stroke or TIA(Transient Ischemic Attack)event within 180 days.Results There were eight strokes within 30 days, and five strokes in the VBA territory after 30 days(mean of 1005 days). The annual stroke rate in the VBA territory (including any stroke and death within 30 days) was 4.0%Significantly higher stroke-free survivals in the vertebrobasilar territorywere found in stent success subgroup and VA stenosis patients.Conclusion Elective stenting can reduce the annual stroke risk and improve function outcome of patients with symptomatic atherosclerotic vertebrobasilar stenosis that compares favorably to medical therapy. The long-term outcome is associated with successful stent placement and stenotic site.

Hemodynamic Changes of Acute Ischemic Stroke Patients Treated with Intravenous rt-PA

XUE Shuang;WEI Kun;YANG Li-Hong;et al.

2008, 3(11):  803-807. 

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Objective To investigate cerebral hemodynamic change and outcomes of acute stroke patients receiving intravenous(IV) recombinant tissue plasminogen activator (rt-PA) in an ultra early stage by transcranial Doppler(TCD) .Methods Patients receiving standard IV rt-PA therapy (0.9-mg/kg dose, maximum 90 mg, 10% bolus, 90% continuous infusion) within the first 3 hours after the onset of acute stroke and fulfilling the criteria of the National Institute of Neurological Disorders and Stroke protocol, were performedby TCD before IV thrombolysis and subsequently at 24 hours, 3days, 2 weeks and 1month after the therapy.Results Totally 18 patients received IV rt-PA and TCD monitoring. The mean age of those patients was 64.6±8.84 years old and 15 of them were male. The mean score of the National Institutes of Health(NIH) Stroke Scale score was 11.4±2.8 [ranging from 6 to 16]. Before thrombolysis, TCDmonitoring showed that 1 patient was in Thrombolysis in Brain Ischemia(TIBI) flow grade 0, 3 in TIBI grade I, 8 patients in TIBI II, 3 patients in TIBI III, 2 patients in TIBI grade IV (serious middle cerebral artery stenosis) and 1 patient in TIBI V(lacuna infarction). The average time from the onsetto IV rtPA was 2.80±0.20h, ranging from 2 to 3 hours. Recanalization occurred in 2 patients during IV-tPA infusion , 1 patient within 1 hour after IV-tPA infusion and 4 patients within 24 hours. The artery occlusion recurred in 1 patient after 4 hours of recanalization. Others have no changes. Therewas a significant difference before and after thrombolysis(24h, 3d, 2 weeks, and 1 month) in NIH stroke scale and TIBI flow grade. Both are inverted correlativity.Conclusion TCD monitoring reveals that the change of cerebral blood flow has significant correlation with the changes of neurological function. To investigate cerebral hemodynamic change can help to study the pathogenesis and effect of treatment.

The Effects on Prognosis of Thrombolytic Therapy for Ultra-acute Ischemic Stroke by IV rt-PA at Different Doses

YAN Li-Rong;SUN Yu-Heng

2008, 3(11):  808-813. 

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Objective To investigate the effects of rt-PA on the prognosis of ultra-acute ischemic stroke, we analyzed the outcome of thrombolytic therapy by IV rt-PA at different doses.Methods 308 cases of ultra-acute ischemic stroke patients were divided by intention into two groups:thrombolytic therapy group and control group. For 221 patients in the thrombolytic therapy group: IV rt-PA were given at different doses: 0.9mg/kg for 92 patients(time window within 3hr in 68 cases, 3 to 4hr in 9 cases and 4 to 6hr in 15 cases) and 0.6-0.8mg/kg for 129 patients(time window within 3hr in 72 cases, 3 to 4hr in 24 cases and 4 to 6hr in 33 cases). The control group consist of 87 patients who were not administered by rt-PA. NIHSS score and Barthel Index were evaluated at baseline,24h after treatment and 90d prospectively. Neurological outcome was categorized as favorable(BI≥95)or unfavorable(BI≥95) at 90d after treatment. Intracranial hemorrhage included symptomatic intracranial hemorrhage(SIH) and asymptomatic intracranial hemorrhage(AIH). Vascular fatal events and re-stroke events were also recorded at the same time during the follow-up periods. Multivariable logistic regression was used to explore the independent prognostic factors.Results The independent factors for good outcome are baseline NIHSS(OR =2.067, 95%CI 1.201-3.556, P =0.009), Cornory Heart disease(OR =1.942, 95%CI 1.040-3.625, P =0.037)and thrombolytic therphy(rtPA 0.9mg/kg, OR =0.414, 95%CI 0.207-0.826, P =0.012; rtPA 0.6-0.8mg/kg,OR =0.261, 95%CI 0.137-0.497, P <0.001). The rate of symptomatic intracranial hemorrhage(SIH)in the thrombolytic therphy group were 3(3.3%) for rtPA 0.9mg/kg and 6(4.7%) for rtPA 0.6-0.8mg/kg. The difference is no significant.Conclusion Using IV rt-PA in ultra-acute ischemic stroke may have a good effect at our study.There is no statistic difference on prognosis between B group(rt-PA 0.6-0.8mg/kg ) and A group(rt-PA 0.9mg/kg). Accompanying history of atrial fibrillation and diabetes may affect prognosis.Thisshould be further studied by more strictly designed RCT.

Effect of Atorvastatin on Serum Matrix Metalloproteinase-9 (MMP-9) and Prognosis in Patients with Cerebral Infarction

FU Sheng-Qi;ZHANG Shu-Ling;FENG Lai-Hui;et al.

2008, 3(11):  814-818. 

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Objective To study the changes of serum matrix metalloproteinase-9 level and blood lipids level in patients with acute cerebral infarction after short treatment with atorvastatin, and study the effect of atorvastatin prognosis.Methods All 40 acute cerebral infarction patients were divided by random, double-blind, placebo contrasstive method into control group and atorvastain group (20mg/d of atorvastain for 7 days).The serum levels of MMP-9, lipids, aspartate aminotransferase(AST) and creatine kinase(CK) weredetected before and after treatment. All patients’ neurological function were evaluated by the National Institutes of Health Stroke Scale (NIHSS) score and the Barthel Index (BI) score at admission and 3 months after admission.Results 39 cases were involved in the study(control group=20, atorvastain group =19).The levels of serum MMP-9 were correlated significantly with severity and prognosis of cerebral infarction(P <0.01), but serum lipids were not correlated. The levels of serum MMP-9 in atorvastain group significantly decreased compared with those in control group(P <0.05). Deficit scales wereimproved at 3 months after treatment(P <0.01), but there were no statistical difference between atorvastain group and control group . AST and CK levels had no changes after treatment.Conclusion The levels of serum MMP-9 are associated with severity and can predict prognosis of acute cerebral infarction. Short treatment with atorvastain can rapidly and safely reduce the serum level of MMP-9, but there is no significant improvement in 3-month prognosis after cerebralinfarction.

Evaluation of Pyramidal Tract Injury in Acute Intracerebral Hemorrhage with MR Diffusion Tensor Tractography

ZHOU Jian;WANG Wei;ZHANG Xin-Jiang;et al

2008, 3(11):  819-823. 

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Objective To evaluate the relationship between pyramidal tract injury in acute intracerebral hemorrhage assessed by MR diffusion tensor tractography(DTT) techniques and motor rehabilitation.Methods Diffusion tensor imaging was performed on 30 patients with basal ganglia or thalamus hemorrhage within 2 weeks after upsets, and the integrity of the pyramidal tracts was assessed by DTT. Motor function rehabilitation was assessed with Barthel Index(BI) after 6 months from upsets.BI scores of the different groups were compared and the correlation was analyzed between the integrity of the pyramidal tracts and the BI scores.Results 7 cases were eliminated because of unsatisfied data and 23 cases were enrolled. BI scores had significant difference among the groups divided by DTT findings of the pyramidal tracts integrity(F =9.693, P <0.01). There was significant correlation between the integrity of the pyramidaltracts in acute stage and the BI scores after 6 months(r =0.733, P <0.01).Conclusion The DTT findings for pyramidal tract in acute intracerebral hemorrhage may be used to predict the motor outcome.

Study of Negative Emotion in Patients with Posterior Circulation Transient Ischemic Attack(TIA)

TAN Wei-Tang;LIU Tao;ZHANG Hong-Qiao;et al.

2008, 3(11):  824-826. 

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Objective To explore the negative emotion and its influential factors in patients with posterior circulation TIA for the guidance on mental intervention and the improvement of quality of patients’lives.Methods Totally, 257 posterior circulation TIA patients were investigated with Zung Self-Rating Anxiety Scale(SAS), Zung Self-rating Depression Scale(SDS) and Eysenck Personality Questionnaire(EPQ).Results The SAS and SDS scores differed significantly between the posterior circulation TIA patients group and the domestic normal group (all P <0.01).Conclusion Posterior circulation TIA patients were often accompanied with anxiety and depression,which were relevant to patients’ personalities.