Chinese Journal of Stroke

Fill the Gap

WANG Yong-Jun

2019, 14(04): 303-304. DOI: 10.3969/j.issn.1673-5765.2019.04.001

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Sleep Disorders often Neglected in Stroke Patients

LIU Chun-Feng, LI Jie

2019, 14(04): 305-308. DOI: 10.3969/j.issn.1673-5765.2019.04.002

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Mechanical Thrombectomy versus Intravenous Thrombolysis for Acute Posterior Circulation Stroke

LUO Gang, HUANG Yi-Nuo, MO Da-Peng, SUN Zhong-Liang, MA Ning, GAO Feng, SONG Li-Gang, SUN Xuan, LIU Lian, HUO Xiao-Chuan, WANG Bo, JIA Bai-Xue, LI Xiao-Qing, XU Xiao-Tong, MIAO Zhong-Rong

2019, 14(04): 309-316. DOI: 10.3969/j.issn.1673-5765.2019.04.003

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Objective To compare the clinical outcome of endovascular treatment (EVT) and intravenous thrombolysis (IVT) alone for acute posterior circulation stroke. Methods Two cohorts of consecutive patients from Beijing Tian Tan Hospital from March 2012 to November 2016 were selected: EVT group were patients who underwent stent-retriever thrombectomy without IVT for acute vertebrobasilar occlusion; IVT group were patients with acute posterior circulation stroke treated with rt-PA IVT alone. The efficacy and safety outcome of the two groups were compared. The two groups were matched for age, sex, baseline NIHSS score, onset-to-treatment time and ischemic stroke subtype at 1:1 ratio. Ischemic stroke subtype was classified according to TOAST criteria. The baseline NIHSS score after matching was ≥10. The primary outcome was mRS score at 90 days, and the safety outcome was intracranial hemorrhage within 24 hours and all-cause mortality at 90 days. Results A total of 328 patients were included, with 69 cases in EVT group and 259 in IVT group.There were 55 patients in two matched groups. Stroke subtype in two groups were both mainly large artery atherosclerosis (LAA) stroke, with 63 cases (91.3%) in EVT group and 164 cases (63.3%) in IVT group. The rate of mRS ≤1 (30.9% vs 38.2%, adjusted OR 0.724, 95%CI 0.329-1.595, P =0.423) and mRS ≤2 at 90 days (38.2% vs 50.9%, adjusted OR 0.596, 95%CI 0.279-1.272, P =0.181) were both lower in EVT group than that in IVT group, but the differences were not statistically significant. There were also no significant differences in all-cause mortality at 90 days and symptomatic ICH within 24 hours between the two groups. Conclusions In acute posterior circulation stroke caused by large vessel occlusion, the outcome after intravenous thrombolysis alone or endovascular revascularization appeared similar. Further randomized clinical trials are needed to confirm this finding.

Effect of Sleep Phase Related Obstructive Sleep Apnea on Sleep Structure and Prognosis of Acute Ischemic Stroke Patients

CHEN Qin, LI Jie, MAO Cheng-Jie, SHEN Yun, FU Xiang, LIU Yu-Lu, LIU Chun-Feng

2019, 14(04): 317-326. DOI: 10.3969/j.issn.1673-5765.2019.04.004

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Objective To investigate the effect of REM and non-rapid eye movement (NREM) sleep related OSA on sleep structure and prognosis of acute ischemic stroke (AIS) patients. Methods Data of consecutive AIS patients with PSG examination in the Second Affiliated Hospital of Soochow University from Feburary 2011 to August 2018 were resepectively colleted.Collected data included the general information, emotion and cognition assessment, sleep scales, MRI and PSG findings, the NIHSS scores at 48 hours after admission and at discharge, and mRS scores at discharge and 3 months. According to overall AHI, AHI during REM (REM-AHI) and during NREM (NREM-AHI), they were divided into AIS group, AIS+REM-related OSA group and AIS+NREM-related OSA group. Univariate and multivariate analyses were used to analyze the effect of sleep phase related OSA on sleep architecture and prognosis of AIS patients. Results A total of 110 eligible patients were enrolled in this study, with 30 (27.3%) in AIS group,15 (13.6%) in AHI+REM-related OSA group and 65 (59.1%) in AHI+NREM-related OSA group. BMI was more higher in AIS+NREM-related OSA group than that in AIS group. The lesions of AIS group were mostly located in telencephalon, while the lesions of AIS+REM-related OSA group were located in brain stem, telencephalon and diencephalon. The time and proportion of NREM 1 were higher and the time and proportion of slow wave sleep (SWS) were shorter in AIS+NREMrelated OSA group than that in AIS group.Microarousal index, respiratory related microarousal index, spontaneous microarousal index were higher in AIS+NREM-related OSA group than that in AIS+REM-related OSA group. There was no difference in mRS score at 3 months.Logistic analysis results revealed that high NIHSS score on admission, the low level of education and high BMI were independent risk factors of poor prognosis of AIS patients. Conclusions Sleep structure of AIS can be disturbed by NREM-related OSA, with sleep characteristics of longer NREM1, shorter deep sleep (NREM 3 and 4) and fragmentation. These changes may result in worse prognosis of AIS.

Imaging Characteristic of Ischemic Stroke Patients with Cerebral Microbleeds

LI Ying, ZHAO Xing-Quan,ZHAO Liu-Zhuang, ZHOU Xiao-Mei, YUAN Jing-Lin

2019, 14(04): 327-330. DOI: 10.3969/j.issn.1673-5765.2019.04.005

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Objective To compare the incidence, amounts and distribution of cerebral microbleeds (CMBs) in cerebral hemorrhage patients and cerebral infarction patients. Methods Stroke patients with complete data from Department of Neurology of People Hospital of Beijing Daxing District from August 2017 to December 2018 were consecutively enrolled in this study. All subjects were divided into cerebral hemorrhage and cerebral infarction groups. The image data of MRI SWI of all the patients within two weeks of onset were collected, to analyze the incidence, amounts and distribution of CMBs of the two groups. Results A total of 234 patients were selected, including 79 cases of cerebral hemorrhage and 155 cases of cerebral infarction. 65 (82.3%) cerebral hemorrhage patients had CMBs, and 41/65 (51.9%) patients had the amount of CMBs >5; 73 (47.1%) cerebral infarction patients had CMBs, 21/73 (13.6%) patients had the amount of CMBs >5. and the difference between the two groups was statistically significant (P <0.001). In cerebral hemorrhage group, CMBs involved both lobes and deep brain tissue in 40 patients (50.6%); in cerebral infarction group, CMBs involved both lobes and deep brain tissue in 25 cases (16.1%), and the difference between the two groups was statistically significant (P <0.001). Conclusions The amount of CMBs >5 were more common in cerebral hemorrhage patients than in cerebral infarction patients. CMBs involving both cerebral lobe and deep brain tissue were also more common in cerebral hemorrhage patients than in cerebral infarction patients.

Influence Factors and Treatment Strategy for Pulmonary Infection in Patients with Spontaneous Cerebral Hemorrhage

WU Yong, LIU Qiang, YANG Hao, SHEN Song-Bo

2019, 14(04): 331-335. DOI: 10.3969/j.issn.1673-5765.2019.04.006

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Objective To investigate the influence factors of pulmonary infection (PI) in patients with spontaneous cerebral hemorrhage. Methods A retrospective analysis of clinical data of 228 patients with spontaneous cerebral hemorrhage in Huangshi Central Hospital from June 2015 to June 2018 were performed, to analyze the influence factors of PI in these patients. Results Of 228 patients with spontaneous cerebral hemorrhage, 100 cases (43.67%) had PI, and 148 pathogenic bacteria strains were isolated, including 128 strains (86.48%) of Gram-negative bacteria, 10 strains (6.76%) of Gram-positive bacteria and 10 strains (6.76%) of fungus. The single factor analysis results showed that age, smoking, dysphagia, GCS score, cerebral hemorrhage volume, airway invasive operation, nasal feeding, diabetes, lung diseases, hypoproteinemia were associated with PI after spontaneous cerebral hemorrhage (all P <0.05). The Logistic regression analysis showed that age ≥ 60 years,smoking,dysphagia, GCS score <8, bleeding volume ≥100 mL, airway invasive operation,nasal feeding, diabetes, lung disease, hypoproteinemia were independent risk factors of PI after spontaneous cerebral hemorrhage (P <0.05). Conclusions The incidence of PI after spontaneous cerebral hemorrhage is high, the strains of PI is mainly Gram-negative bacteria. PI occurrence is related with a variety of factors, especially age ≥60 years, smoking, dysphagia, GCS score <8, bleeding volume ≥100 mL, airway invasive operation, nasal feeding, diabetes, lung disease and hypoproteinemia. The patients with the above factors should be given more attention and timely intervention.

Effect of Butylphthalide on Executive Function of Patients with Mild Vascular Cognitive Impairment

BAI Yan-Yan, KONG Yu, ZHOU Guo-Qing, LU Qiang-Bin, ZHU Zu-Fu

2019, 14(04): 341-344. DOI: 10.3969/j.issn.1673-5765.2019.04.008

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Objective To evaluate the effect of butylphthalide on executive function in patients with mild vascular cognitive impairment (MVCI). Methods A total of 48 MVCI patients were included in this study, all of whom were divided into observation group (n =24) and control group (n =24). On the base of conventional therapy, Butylphthalide (200 mg, tid) was added to the observation group, and Vitamin E (100 mg, tid) was added to control group, with a treatment course of 90 days in each group. Executive function of patients were evaluated by the following tests: trail making test A and B (TMT-A and B), digit span test (including forward and backward), verbal fluency test (VFT) and clock drawing task. Executive function changes of two groups before and after treatment between the two groups were compared to evaluate the effect of butylphthalide on executive function in MVCI patients. Results The baseline cognition and executive function of two groups had no statistical difference. After treatment, the TMT-A [(53.65±0.88) vs (56.22±0.87)] and TMT-B [(174.95±1.99) vs (177.41±1.44)] scores in observation group were significantly lower than that in control group, the digit span forward and backward score [(5.05±1.22) vs (4.59±0.33)] and the VFT score [(13.29±0.88) vs (12.43±1.02)] in observation group were significantly higher than that in control group. There was no statistical difference in CDT between the two groups. Conclusions Butylphthalide can improve the executive function of patients with MVCI.

Post-stroke Sleep Disorders

WANG Ya-Li, PEI Shao-Fang, LIU Yi

2019, 14(04): 346-351. DOI: 10.3969/j.issn.1673-5765.2019.04.009

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Sleep disorders are a kind of common complications after stroke, which can affect the prognosis and life quality of stroke patients. The pathogenetic mechanism of poststroke sleep disorders (PSSD) is unclear, and PSSD occurrence may be related with lesion area, neurotransmitters and social psychological factors and etc. PSSD include two categories: respiratory related sleep disorders and non- respiratory related sleep disorders, and the former is more common. The therapy of PSSD includes pharmacotherapy and non-pharmacotherapy. Neurologists should pay more attention to PSSD, recognize PSSD as early as possible and give active intervention, to improve neurological function and life quality of patients.

Advance in Correlation of Obstructive Sleep Apnea Hypopnea Syndrome and Wake-up Stroke

FU Xiang,LI Jie, LIU Yu-Lu, WU Jia-Jing, LIU Chun-Feng

2019, 14(04): 352-356. DOI: 10.3969/j.issn.1673-5765.2019.04.010

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Due to the uncertain onset time, wake-up stroke (WUS) patients are usually excluded from thrombolytic therapy. There were still some differences in risk factors and pathogenesis between WUS and stroke occurring while awake. It's important to investigate the related risk factors and give timely intervention for WUS. Now many studies confirmed that OSAHS was one of the important risk factors of WUS, while the mechanism of OSAHS causing WUS is still unclear. This article reviewed the advance in the relationship between OSAHS and WUS.

Lancet: So Many Pharmacological Agents for Generalised Anxiety Disorder, How to Choose the Drugs?

YANG Zhong-Hua

2019, 14(04): 357-358. DOI: 10.3969/j.issn.1673-5765.2019.04.011

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Richard Traystman: Great Master in Experimental Stroke

John H.Zhang

2019, 14(04): 359-366. DOI: 10.3969/j.issn.1673-5765.2019.04.012

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Intracranial Carotid Artery Calcification and Endovascular Treatment

DING Ya-Rong

2019, 14(04): 378-380. DOI: 10.3969/j.issn.1673-5765.2019.04.016

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Advance in Aspiration Thrombectomy and Stent-retriever Thrombectomy for Acute Ischemic Stroke

WANG Peng, XU Cheng-Hua, YING Jiang-Xian, WANG Xin-Liang, WANG Zhi-Min

2019, 14(04): 381-384. DOI: 10.3969/j.issn.1673-5765.2019.04.017

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Stent thrombectomy is the preferred way in endovascular treatment (EVT) for acute ischemic stroke (AIS) recommended by current guidelines. Aspiration thrombectomy is another EVT technology widely applied in acute reperfusion therapy after stent-retriever thrombectomy. This article reviewed the advance in effect analysis of two technologies for AIS. Now stent thrombectomy is still the first-line technology in stroke EVT, with aspiration thrombectomy as a supplementary therapy. Some studies indicated that aspiration thrombectomy had some particular advantages such as the puncture-to-reperfusion time was much more relatively shorter. Future research will focus on the EVT technology selection according to stroke etiology and the location of vessel occlusion.

Advance in IL-33/ST2 Signal Pathway in Stroke

TIAN Xuan, PEI Lu-Lu, WANG Xiao, LIU Xin-Jing, XU Yu-Ming,SONG Bo

2019, 14(04): 385-388. DOI: 10.3969/j.issn.1673-5765.2019.04.018

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The IL-33/ST2 signal pathway is closely related to stroke. This signal pathway not only involves in the atherogenesis, but also in stroke occurrence and development, inflammation reaction after stroke and prognosis of stroke. This article reviewed the advance in role of IL-33/ST2 signal pathway in stroke, to provide ideas for future research and clinical practice.

Advance in Serum Biomarkers for Early Identification of Cerebral Infarction and Intracerebral Hemorrhage

ZHANG Xi, SU Jun-Hui, JIN Ling-Jing, TENG Fei

2019, 14(04): 389-394. DOI: 10.3969/j.issn.1673-5765.2019.04.019

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Cerebral infarction is caused by cerebrovascular stenosis or occlusion, while intracerebral hemorrhage is caused by cerebrovascular rupture. Although the two kinds of stroke present similar symptoms, their pathogenesis are different, which could lead to different expressions of some proteins and genes at the acute phase of stroke. Recently, some literature reported several serum biomarkers which could differentiate cerebral infarction and cerebral hemorrhage and the early diagnostic value of these biomarkers. This article reviewed the progress of serum biomarkers which could differentiate cerebral infarction and cerebral hemorrhage at the early stage, to provide a reference for early differential diagnosis of stroke.

Advance in Cerebral Watershed Infarction

XU Ming-Yang, YAN Bing-Chun, SU Pei-Qing

2019, 14(04): 395-399. DOI: 10.3969/j.issn.1673-5765.2019.04.020

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Cerebral watershed infarction (CWI) is defined as an ischemic lesion at the border zones between territories of two adjacent major arteries. CWI is a common type of cerebral infarction. This article reviewed the progress in high risk factors, pathogenesis, clinical types and features, imaging characteristics and treatment of CWI in recent years. The systematic and powerful evidence in risk factors and treatment of CWI now still lack, while more research in the other aspects have been done, and pathogenesis, imaging, clinical types and features of CWI are increasing clearer.

Advances in Recanalization of M2 Segment Occlusion in Middle Cerebral Artery

LIU Shu-Xin, LI Di

2019, 14(04): 400-403. DOI: 10.3969/j.issn.1673-5765.2019.04.021

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Compared with internal carotid artery (ICA) and middle cerebral artery (MCA) M1 segments, MCA M2 segments are more slender and tortuous. Recanalization methods for acute occlusion in MCA M2 segments include intravenous thrombolysis, arterial thrombolysis and mechanical thrombectomy. However, the safety and effectiveness of endovascular therapy still remained controversial. Current studies have shown that the recanalization rates of arterial thrombolysis and mechanical thrombectomy are higher than that of intravenous thrombolysis alone, while there is little difference in the prognosis at 90 days among the three treatment ways. In addition, due to relatively fewer studies, the impact of three treatment ways on hemorrhagic transformation remains inconclusive.

Application of Mobile Video Teaching in Training of Post-stroke Depression Assessment

LI Li-Jun, CHEN Qi,ZHANG Ning, WANG Chun-Xue

2019, 14(04): 404-406. DOI: 10.3969/j.issn.1673-5765.2019.04.022

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Objective To evaluate the effect of mobile video teaching model in the training of post-stroke depression assessment. Methods 28 interns from Department of Neuropsychiatry and Clinical Psychology of Beijing Tian tan Hospital were selected and randomly divided into control group and observation group. During the training of post-stroke depression assessment, the traditional teaching method was used in control group, and the mobile video teaching was used in observation group. After 4 weeks of internship, the clinical skills test was conducted to evaluate the teaching effect of the two groups, and a questionnaire survey was made in observation group. Results The score of observation group was much more higher than that of control group (92±3 vs 80±7, P =0.02). Conclusions In the clinical teaching process for interns, mobile video teaching can improve the teaching quality, promote the clinical operation skills of interns, and effectively motivate the learning initiative of interns.

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