Table of Content

20 April 2023, Volume 18 Issue 04

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DNA Methylation Bridging Stroke Risk Factors and Stroke

QIU Xin, LI Zixiao

2023, 18(04):  373-374.  DOI: 10.3969/j.issn.1673-5765.2023.04.001

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DNA Methylation and Stroke

LI Zixiao

2023, 18(04):  375-375. 

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Advances in Correlation between DNA Methylation and Non-Large Artery Atherosclerotic Stroke

JIANG Xiaoqing, WENG Jiaxu, ZHOU Hongyu, LI Zixiao, WANG Yongjun

2023, 18(04):  376-387.  DOI: 10.3969/j.issn.1673－5765.2023.04.002

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Ischemic stroke is determined by a variety of environmental and genetic risk factors. As a critical epigenetic regulatory mechanism, DNA methylation may be a heritable risk factor and potentially influence the occurrence and development of ischemic stroke. There are changes in DNA methylation levels of characteristic candidate genes in different etiological subtypes of ischemic stroke, which is important value in exploring the pathophysiological processes of different stroke subtypes. DNA methylation is a dynamic and reversible epigenetic change, and its pattern can change significantly with different stages of disease, suggesting that DNA methylation can be a potential biomarker and therapeutic target for ischemic stroke and its subtypes. This article reviewed the correlation between DNA methylation and non-large artery atherosclerotic stroke (cardioembolism, small-artery occlusion and other determined etiology), to provide new ideas for the diagnosis and treatment of ischemic stroke. 

Progress of the Relationship between DNA Methylation and Hyperlipidemia

HAN Ying, ZHOU Hongyu, LI Zixiao

2023, 18(04):  388-395.  DOI: 10.3969/j.issn.1673－5765.2023.04.003

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Hyperlipidemia is a major risk factor for cardiovascular disease, and blood lipid level can be hereditary and modifiable. Many studies have found correlation between DNA methylation and blood lipid levels, with specific genes involving this action process such as carnitine palmitoyl l transferase 1A (CPT1A) , adenosine triphosphate binding cassette transporter G1 (ABCG1) , sterol regulatory element-binding factor 1 (SREBF1) , tumor necrosis factor α-induced protein 3-interacting protein 1 (TNIP1) , and 3-β-hydroxysteroid-Δ-24-reductase (DHCR24). In addition, it has also been found that diet and environmental factors can influence blood lipid levels by altering the methylation levels of specific genes, and it is possible to identify lipid-lowering drugs targeting genes whose methylation level is correlated with blood lipid level. However, research findings on the relationship between DNA methylation and blood lipid level are inconsistent, and the causal relationship as well as the underlying mechanism between them remains unclear. Further research in the future is needed to explore the clinical value of DNA methylation in diagnosis and treatment of hyperlipidemia. 

Progress of the Relationship between DNA Methylation and Hypertension

HOU Yeye, ZHOU Hongyu, LI Zixiao

2023, 18(04):  396-403.  DOI: 10.3969/j.issn.1673－5765.2023.04.004

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Hypertension is one of the most common modifiable risk factors for ischemic stroke. As a highly heterogeneous disease with multifactorial causes, environmental and genetic factors play pivotal roles in occurrence and progression of hypertension. Gene–environment interactions, that is to say that epigenetic modification may mediate the relationship between genetic and environmental factors and ischemic stroke, whereas the exact mechanism is still unclear. These epigenetic modifications include DNA methylation, histone modification, chromatin remodeling and so on. DNA methylation, as a crucial component of epigenetics, is a well-studied epigenetic mechanism. DNA methylation regulates gene expression and is also influenced by environmental factors. This article reviewed the progress of DNA methylation in the pathophysiological processes, risk factors, and environmental factors related to hypertension. The potential mechanism of hypertension-related DNA methylation and stroke risk was also discussed, highlighting the potential use of DNA methylation as a new target and approach for diagnosing and treating hypertension, and preventing ischemic stroke.

DNA Methylation and Hyperhomocysteinemia

WENG Jiaxu, ZHOU Hongyu, LI Zixiao

2023, 18(04):  404-409.  DOI: 10.3969/j.issn.1673－5765.2023.04.005

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DNA methylation is a process catalyzed by DNA methyltransferases (DNMTs) , which is dependent on S-adenosyl-L-homocysteine (SAH) , a substrate related to the metabolism of Hcy. It is an epigenetic mechanism that regulates gene expression, and is critical for maintaining cellular homeostasis. A number of studies have shown that hyperhomocysteinemia (HHcy)  may regulate DNA methylation status by regulating the methionine-homocysteine cycle (M-H cycle) , which is involved in multiple pathological process of atherosclerosis formation such as dysfunction of endothelial cells, proliferation and metastasis of damaged smooth muscle cells (SMCs) , and lipid metabolism, then can influence the occurrence and prognosis of cardiovascular diseases.



The Association between Stress Hyperglycemia and Early Prognosis after Successful Recanalization with Thrombectomy in Acute Anterior Circulation Large Artery Occlusion

CHEN Liujing, ZHU Kaiqi, CAI Xueli

2023, 18(04):  410-417.  DOI: 10.3969/j.issn.1673-5765.2023.04.006

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Objective  To investigate the association between stress hyperglycemia and early neurological prognosis after successful recanalization with thrombectomy in acute anterior circulation large artery occlusion. 
Methods  Patients with acute anterior circulation large artery occlusion after successful recanalization with thrombectomy in Lishui Municipal Central Hospital were enrolled in this retrospective analysis. Patients were divided into low stress hyperglycemia ratio (SHR) group and high SHR group according to median of SHR. Successful recanalization was defined as modified thrombolysis in cerebral infarction (mTICI) 2b to 3. Primary outcome was poor functional outcome at discharge (defined as a mRS score of 4-6) and secondary outcome was malignant cerebral edema (MCE) within 72 hours after thrombectomy. The association between SHR and mRS increase at discharge was analyzed by ordinal logistic regression, and the association of SHR with poor functional outcome and MCE was analyzed by multivariate logistic regression. 
Results  A total of 312 patients were enrolled in the final analysis, with 156  patients in each group. The median SHR was 0.953 (0.817-1.100) , intravenous thrombolysis accounted for 48.1%, median admission NIHSS score was 14 (11-18) , 74 patients developed MCE within 72 hours, and 196 patients had poor functional outcome at discharge. Compared to the low SHR group, the high SHR group had higher admission NIHSS score (16 vs. 14, P=0.031) , higher proportion of MCE within 72 hours (33.3% vs. 14.1%, P<0.001) and poor functional outcome at discharge (72.4% vs. 53.2%, P<0.001) . The multivariate logistic regression showed that high SHR was an independent predictive factor for mRS increase (OR 1.910, 95%CI 1.257-2.904, P=0.002) , poor functional outcome at discharge (OR 2.064, 95%CI 1.223-3.482, P=0.007) and MCE within 72 hours (OR 2.746, 95%CI 1.532-4.922, P=0.001) . Subgroup analysis based on basal diabetes and long-term glucose control level showed that high SHR was associated with poor functional outcome at discharge (OR 2.132, 95%CI 1.175-3.868, P=0.013) and MCE within 72 hours (OR 3.079, 95%CI 1.540-6.155, P=0.001) in non-diabetes patients, and high SHR was associated with poor functional outcome at discharge (OR 1.925, 95%CI 1.082-3.424, P=0.026) and MCE within 72 hours (OR 2.869, 95%CI 1.459-5.642, P=0.002) in patients with glycosylated hemoglobin (HbA1c) ≤ 6.5% . Interaction test and subgroup analysis showed that high SHR was strongly associated with poor functional outcome at discharge in patients with age ≤ 80 years old (OR 2.074, 95%CI 1.165-3.690, P=0.013) , TC>3.81 mmol/L (OR 2.763, 95%CI 1.267-6.026, P=0.011) , admission ASPECTS score of 8-10 (OR 1.865, 95%CI 1.023-3.401, P=0.042) , admission NIHSS score ≤ 14 (OR 2.926, 95%CI 1.400-6.115, P=0.004), time from stroke onset to recanalization of 6-12 h (OR 2.088, 95%CI 1.062-4.103, P=0.033) and large artery atherosclerotic stroke subtype (OR 4.151, 95%CI 1.880-9.169, P<0.001) . 
Conclusions  High stress hyperglycemia ratio was associated with MCE within 72 hours and poor functional outcome at discharge in patients with acute anterior circulation large artery occlusion after successful recanalization with thrombectomy.

Relationship between Intracranial Atherosclerotic Stenosis and Cognition

SI Qianqian, CHENG Anqi, FAN Xiaoyuan, ZHANG Xiaoqian, LI Mingli, FENG Feng, LIU Caiyan, XU Weihai

2023, 18(04):  418-427.  DOI: 10.3969/j.issn.1673-5765.2023.04.007

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Objective  To evaluate the cognitive function changes in patients with intracranial atherosclerotic stenosis (ICAS) . 
Methods  The patients diagnosed with ICAS (stenosis>50%) in Department of Neurology of Peking Union Medical College Hospital from December 2021 to December 2022 were consecutively enrolled in this study. Based on the presence or absence of previous ischemic stroke or transient ischemic attacks (TIA) caused by ICAS, they were classified into symptomatic or asymptomatic ICAS group. The healthy people matched for age and education were included in the control group. Global cognition and four cognitive domains (including memory, executive function, language function, visuospatial function) were evaluated in all the subjects. The differences in traditional cerebrovascular risk factors and cerebrovascular disease burden, brain atrophy and apolipoprotein E (ApoE) genotype were compared among the three groups, to screen the possible cognitive influencing factors. The global cognition and average Z-score of each cognitive domain were compared among the groups by covariance analysis controlling the confounders. 
Results  A total of 170 patients with ICAS, including 103 patients with asymptomatic ICAS [52 males, mean age of (55.86±11.78) years] and 67 patients with symptomatic ICAS [44 males, mean age of (57.49±10.75) years], and 91 controls [39 males, mean age of (56.21±9.70) years] were included in this study. Compared with patients with asymptomatic ICAS, patients with symptomatic ICAS had a higher incidence of posterior circulation stenosis (40.3% vs. 22.3%, P=0.016) , especially vertebral artery stenosis (22.4% vs. 9.7%, P=0.028) , as well as higher incidence of white matter hyperintensities (Fazekas grade≥2) (40.3% vs. 16.5%, P=0.001) and medial temporal lobe atrophy [medial temporal atrophy (MTA) grade≥2] (17.9% vs. 5.8%, P=0.020) . 
After adjusting for age, gender, education years, cerebrovascular risk factors (hypertension, diabetes, hyperlipidemia, coronary heart disease and smoking) , white matter hyperintensities and medial temporal lobe atrophy, patients with asymptomatic and symptomatic ICAS had  lower MoCA score (25.79±0.30 vs. 27.15±0.36, P=0.017; 24.18±0.39 vs. 27.15±0.36, P<0.001) and Z-score of language function (0.60±0.12 vs. 1.10±0.14, P=0.030; 0.02±0.15 vs. 1.10±0.14, P<0.001) compared with the controls; patients with symptomatic ICAS had lower MoCA score (24.18±0.39 vs. 25.79±0.30, P=0.003) and Z-score of language (0.02±0.15 vs. 0.60±0.12, P=0.006) and executive function (-0.45±0.15 vs. 0.12±0.11, P=0.006) than those with asymptomatic ICAS. 
Conclusions  Patients with symptomatic or asymptomatic ICAS  presented with  declined global cognition and language function, and patients with symptomatic ICAS also showed declined executive function. The patients with symptomatic ICAS had more severe cognition decline, independent of traditional cerebrovascular risk factors, white matter hyperintensities, and medial temporal lobe atrophy. 

Construction and Verification of Short-term Malnutrition Prediction Model for Patients with Acute Ischemic Stroke without Basal Metabolic Diseases

ZHANG Lan, SHEN Xiaofang, JIN Jin, XU Ji, ZHANG Jing

2023, 18(04):  428-433.  DOI: 10.3969/j.issn.1673-5765.2023.04.008

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Objective  To analyze the influencing factors of short-term malnutrition in patients with acute ischemic stroke (AIS) without basal metabolism disease, and construct a clinical prediction model of short-term malnutrition in AIS. 
Methods  The AIS patients without basal metabolism diseases from Department of Neurology of Suzhou Ninth People’s Hospital from March 2019 to June 2021 were retrospectively included as the modeling cohort. The mini-nutritional assessment short-form (MNA-SF) , BMI and albumin (Alb) were used to evaluate for nutrition condition at 2 weeks after admission. The malnutrition was defined as the MNA-SF score < 8, BMI < 18.5 kg/m2 and Alb < 35.0 g/L, then the patients were divided into malnutrition group and non-malnutrition group. A prediction model was constructed based on the variables screened by multivariate logistic regression analysis. The discrimination was evaluated by ROC curve, and the calibration was evaluated by goodness of fit test. AIS patients without underlying metabolic diseases in Department of Neurology of Suzhou Ninth People’s Hospital from August 2021 to June 2022 were selected as the validation cohort of the model. 
Results  The modeling cohort included 924 AIS patients, with the mean age of 55.0±14.3 years and 544 males (58.9%) .72 cases (7.8%) of malnutrition were screened at 2 weeks after admission. Multivariate analysis showed that advanced age (OR 2.059, 95%CI 1.132-3.743, P=0.018) , drinking history (OR 1.747, 95%CI 1.076-2.835, P=0.024) , nutritional risk at admission (OR 2.951, 95%CI 1.485-5.859, P=0.002) , no nutritional support in hospital 
(OR 1.870, 95%CI 1.065-3.284, P=0.029) , low admission Caiteng's grade (OR 0.226, 95% CI 0.079-0.652, P=0.006) , and high admission NIHSS score (OR 1.556, 95%CI 1.057-2.289, P=0.025) were independent influencing factors of short-term malnutrition in AIS patients without underlying metabolic diseases. According to the influencing factors, the prediction model equation is: logit (P) = 0.722 × age + 0.558 × drinking history + 1.082 × nutritional risk at admission + 0.626 × no nutritional support in hospital－1.483 × Caiteng grade + 0.442 × NIHSS score + 0.479－31.187. The AUC of this model for predicting short-term malnutrition was 0.863 (95% CI 0.811-0.914) . The sensitivity and specificity of the maximum Youden index (0.703) were 87.50% and 83.90%, respectively. Goodness of fit test χ2=2.754, P=0.498. The validation cohort included 126 AIS patients without underlying metabolic diseases. The sensitivity, specificity and accuracy of the validation cohort-based model for predicting malnutrition were 86.96%, 83.50% and 84.13%, respectively. 
Conclusions  Advanced age, drinking history, nutritional risk at admission, no nutritional support in hospital, low Caiteng grade and high NIHSS score at admission were the influencing factors of short-term malnutrition in AIS patients without underlying metabolic diseases. The clinical prediction model based on the above indicators has good prediction performance. 

Effects of Home Occupational Therapy Based on Person-Environment-Occupation Model on Functional Prognosis of Stroke Patients with Hemiplegia

BAI Min, YANG Ting, ZHOU Yan, MA Teng, LI Xueping

2023, 18(04):  434-439.  DOI: 10.3969/j.issn.1673-5765.2023.04.009

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Objective  To investiage the effects of home occupational therapy based on person-environment-occupation (PEO) model on upper limb function, activity of daily living and quality of life in stroke patients with hemiplegia. 
Methods  This study prospectively enrolled the patients with hemiplegia after stroke from Department of Rehabilitation Medicine of Nanjing Pukou People's Hospital (Formerly Nanjing Pukou Central Hospital) from January 2020 to December 2020. The patients were randomly divided into observation group and control group. The Wechat group was established in both groups.  The rehabilitation video updated regularly in the control group, and the personalized PEO-based video updates for each patient were performed in observation group. The Fugl-Meyer assessment upper extremity scale (FMA-UE) for upper limb motor function, Barthel index (BI) and stroke-specific quality of life (SS-QOL) were assessed in both groups at discharge, and at 3, 6 and 12 months after discharge. 
Results  A total of 60 patients were eventually included, with a mean age of 63.10±6.83 years old and 30 males, and 30 patients in each group. ①Comparison within a group: for observation group, the BI score (57.00±7.83 vs. 53.17±8.36, P<0.001) and FMA-UE score
 (47.23±6.66 vs. 45.47±6.63, P<0.001) at 3 months after discharge were higher than those at discharge; the BI score (57.33±7.58 vs. 53.17±8.36, P<0.001) and FMA-UE score (47.23±6.66 vs. 45.47±6.63, P<0.001) at 6 months after discharge were higher than those at discharge; the FMA-UE score (46.57±6.39 vs. 45.47±6.63, P<0.001) at 12 months after discharge was higher than that at discharge. For control group, the BI score (51.00±6.87 vs. 54.00±7.59 , 
P<0.001) and FMA-UE score (43.67±6.99 vs. 45.60±6.96, P<0.001) at 6 months after discharge were lower than those at discharge; the BI score (48.50±6.45 vs. 54.00±7.59, P<0.001), FMA-UE score (41.97±6.61 vs. 45.60±6.96, P<0.001) and SS-QOL scores (152.77±8.11 vs. 158.43±10.07, P<0.001) at 12 months after discharge were lower than those at discharge. ②Comparison between two groups:the BI score (57.33±7.58 vs. 51.00±6.87, P=0.010) and FMA-UE score (47.23±6.66 vs. 43.67±6.99, P=0.048) at 6 months after discharge, and the BI score (55.67±6.92 vs. 48.50±6.45, P<0.001) , FMA-UE score (46.57±6.39 vs. 41.97±6.61, P=0.008) and SS-QOL scores (159.10±10.66 vs. 152.77±8.11, P=0.012) at 12 months after discharge in observation group were higher than those in the control group. 
Conclusion  The PEO-based home occupational therapy can obviously improve upper limb function, activity of daily living and quality of life in stroke patients with hemiplegia. 

Risk factors of Cerebral Microbleeds in Patients with Symptomatic and Atherosclerotic Cerebral Small Vessel Disease

LIU Yang, WANG Rui, ZHANG Xiang, SUN Huiling, MA Yinghu

2023, 18(04):  440-449.  DOI: 10.3969/j.issn.1673-5765.2023.04.010

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Objective  To analyze the risk factors of cerebral microbleeds (CMBs) in patients with symptomatic and atherosclerotic cerebral small vessel disease (CSVD) , and differences in clinical characteristics of CMBs in different locations.
Method  The clinical data of patients with symptomatic and atherosclerotic CSVD from Changji Traditional Chinese Medicine Hospital of Xinjiang between March 2017 and October 2018 were retrospectively analyzed. According to having CMBs diagnosed by SWI or not, the patiens were divided into CMBs group and non-CMBs group. Binary logistic regression analysis was used to determine the risk factors for CMBs, and the correlation of CMBs number classification and independent risk factors was analyzed. In addition, according to the location of CMBs, the differences of clinical characteristics in different location subgroups were compared: lobar and non-lobar region subgroups, deep white matter and non-deep white matter subgroups, infratentorial region and non-infratentorial region subgroups. 
Results  A total of 144 CSVD patients were included, with 42 patients (29.2%) with CMBs. CMBs were located in lobar region in 18 cases, deep brain region in 23 cases and infratentorial region in 9 cases. Logistic regression analysis showed that lower apolipoprotein B (OR 0.308, 95%CI 0.099-0.957, P=0.042) and higher fasting blood glucose level (OR 1.128, 95%CI 1.015-1.254, P=0.026) , 
low and middle grade of diastolic pressure, more lacunar cerebral infarcts and lacunar lesions of presumed vascular origin were independent risk factors for CMBs. The grade of CMBs was negatively correlated with the level of apolipoprotein B (r = ﹣0.212, P= 0.011) , positively correlated with the grade of lacunar cerebral infarcts (r = 0.378, P< 0.001) and the grade of lacunar lesions of presumed vascular origin (r = 0.411, P< 0.001) . Compared to the non-lobar region subgroup, lobar region subgroup had the higher BMI (24.4 vs. 23.5, P=0.045) , left ventricular ejection fraction (61.0% vs. 60.0%, P=0.012) and lower heart rate (75.0 beat per minute vs. 83.0 beat per minute, P=0.017) , and educational level distribution also had statistical difference between the two groups (P=0.004) . Compared to the non-deep white matter region subgroup, deep white matter region subgroup had a higher male proportion (78.3% vs. 47.4%, P=0.038) and more lacunar cerebral infarcts (P=0.002) . 
Conclusion  Low apolipoprotein B level and high fasting blood glucose level, low and middle level of diastolic pressure, more lacunar cerebral infarcts and lacunar lesions of presumed vascular origin were independent risk factors for CMBs. The grade of CMBs was negatively correlated with the level of apolipoprotein B, and positively correlated with lacunar cerebral infarcts number and the grade of lacunar lesions of presumed vascular origin. BMI, left ventricular ejection fraction, heart rate and educational level were correlated with lobar CMBs, while gender and lacunar cerebral infarcts number were correlated with deep white matter CMBs.  

Effect of Collateral Status on Futile Recanalization after Endovascular Treatment in Patients with Acute Anterior Circulation Large Vessel Occlusive Cerebral Infarction

WEI Na, LIU Xin, NIE Ximing, YAN Hongyi, WEN Miao, YANG Zhonghua, LIU Liping

2023, 18(04):  450-455.  DOI: 10.3969/j.issn.1673-5765.2023.04.011

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Objective  To assess the impact of collateral circulation status on clinical outcomes at 3 months after endovascular treatment in patients with acute anterior circulation large vessel occlusive cerebral infarction, and analyze risk factors for futile recanalization. 
Methods  This study was based on the Registration Study for Critical Care of Acute Ischemic Stroke after Recanalization (RESCUE-RE) database. The pretreatment collateral status was evaluated using the DSA-based American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral flow grading system, then patients were divided into two groups: poor (grade 0-1) and good (grade 2-4) collateral circulation groups. Futile recanalization was defined as poor outcome (mRS score of 3-6) at 90 days after surgery despite successful angiographic recanalization (mTICI grade 2b or 3) . Multivariate logistic regression analysis was performed to identify predictors of futile recanalization. 
Results  Of 748 patients included in the study, 323 (43.2%) had poor collateral circulation, and 374 (50.0%) had futile recanalization. Univariate comparisons showed a higher proportion of atrial fibrillation history (27.6% vs. 18.4%, P=0.003) , diabetes mellitus (26.9% vs. 16.0%, P<0.001) and 90-day poor outcome (55.4% vs. 45.9%, P=0.010) in the poor collateral circulation group. Multivariate logistic regression analysis showed that poor collateral status (OR 1.75, 95%CI 1.19-2.57, P=0.004) , advanced age (OR 1.03, 95%CI 1.02-1.05, P<0.001) , high baseline NIHSS score (OR 1.09, 95%CI 1.05-1.14, P<0.001) , low ASPECTS score (OR 0.79, 95%CI 0.68-0.92, P=0.003) , and general anesthesia (OR 2.58, 95%CI 1.71-3.89, P<0.001) were independent risk factors for futile recanalization. 
Conclusions  Poor collateral status is associated with futile recanalization after endovascular treatment in acute anterior circulation large vessel occlusive cerebral infarction. In clinical practice, collateral status should be taken as an evaluation factor for thrombectomy in acute ischemic stroke. 

 A Comparative Study on the Efficacy and Safety of Bridging Therapy and Direct Endovascular Therapy for Acute Posterior Circulation Large Vessel Occlusive Cerebral Infarction

GUAN Qiaochu, XIE Ziyi, LYU Weiping, NI Huanyu, LI Jingwei, ZHOU Junshan, YUN Wenwei, LI Xiaobo, ZHANG Qingxiu, XU Yun

2023, 18(04):  456-462.  DOI: 10.3969/j.issn.1673-5765.2023.04.012

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Objective  To investigate the safety and efficacy of bridging therapy and direct endovascular therapy in patients with acute posterior circulation large vessel occlusive cerebral infarction. 
Methods  In this retrospective multicenter study, all the clinical data were collected from the arterial thrombectomy data of patients with acute posterior circulation large vessel occlusive cerebral infarction of 4 medical centers in Jiangsu Province of the Epidata database from January 2020 to December 2021. The patients were divided into bridging treatment group (intravenous thrombolysis with alteplase before emergency endovascular treatment) and direct endovascular treatment group. The baseline characteristics and prognosis after treatment were compared between the two groups. The efficacy evaluation indexes were mRS score (score of 0-2 for good prognosis and 3-6 for poor prognosis) and vascular mortality at 90 days after surgery. The main safety indexes were symptomatic intracerebral hemorrhage (sICH) , reperfusion injury and contrast leakage within 48 hours after surgery. Multivariate logistic regression was used to analyze the independent risk factors for the prognosis after thrombectomy in post circulation. 
Results  A total of 125 eligible patients were enrolled, with 28 in bridging treatment group and 97 in direct endovascular treatment group. At admission, alanine aminotransferase (ALT) [13.9 (11.3-23.2) U/L vs. 20.0 (13.0-27.8) U/L, P=0.024] in bridging treatment group was lower than that in direct thrombectomy group. The time from onset to hospital [120 (82.5-180.0) min vs. 270 (180.0-360.0) min, P<0.001], the time from onset to endovascular treatment [232 (180.0-363.8) min vs. 334 (255.0-443.5) min, P<0.013], the time from puncture to perfusion [67.5 (44.3-95.0) min vs. 90 (60.0-137.5) min, P=0.009], the time from onset to perfusion [348.5 (272.5-421.3) min vs. 460 (335.0-577.5) min, P=0.002] in bridging treatment group were shorter than those in direct thrombectomy group. The time from admission to arterial puncture was longer in bridging treatment group [117.5 (70.0-160.0) min vs. 60 (25.0-120.0) min, P=0.002] than that in direct thrombectomy group. The proportion of good prognosis at 90 days in bridging treatment group was higher than that in direct thrombectomy group (57.1 % vs. 28.9 %, P=0.006) . The proportion of sICH (7.1 % vs. 17.5 %, P=0.178) , reperfusion injury (25.0 % vs. 41.2 %, P=0.118) , contrast leakage (10.7 % vs. 15.5 %, P=0.528) and 90-day vascular mortality (28.6 % vs. 43.3 %, P=0.161) in bridging treatment group was lower than those in  direct thrombectomy group, without statistical  differences. 
Conclusions  Bridging therapy can significantly improve the 90-day clinical prognosis of patients with acute posterior circulation large vessel occlusive cerebral infarction, and the efficacy was significantly better than that of direct endovascular therapy, without increasing the risk of sICH. 

Risk Factors for Intracranial Aneurysm Rupture Using Metabolomics and Cytokine Profiling Analysis

LIU Qingyuan, JIANG Pengjun, WANG Shuo, WU Jun

2023, 18(04):  463-471.  DOI: 10.3969/j.issn.1673-5765.2023.04.013

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Objectives  To investigate the metabolite and cytokine biomarkers related to intracranial aneurysm rupture using the metabolomics and cytokine profiling analysis. 
Methods  The patients undergoing surgery for single intracranial aneurysm from January 2020 to January 2022 were prospectively enrolled in this study. The aneurysm tissues and serum samples of patients were collected. According to intracranial aneurysm state at admission, all patients were divided into the ruptured aneurysm group and unruptured aneurysm group. The targeted metabolomics was used to detect the abnormal metabolites in aneurysm tissue and serum, and the 46-cytokine profiling analysis was used to detect the abnormal cytokines. The Spearman correlation analysis was used to analyze the correlation of these metabolites and cytokines with aneurysm rupture in aneurysm tissues and serum. Receiver operating characteristic (ROC) curve was used to evaluate the clinical value of these risk factors for aneurysm rupture, and multivariate logistic regression analysis was used to determine the risk factors for aneurysm rupture. 
Results  This study included 25 cases with ruptured aneurysm and 31 cases of unruptured aneurysm. The targeted metabolomics and cytokine profiling analysis found 43 metabolites and 5 cytokines related to aneurysm rupture (all P<0.05) . Enrichment analysis showed that these metabolites and cytokines are mainly lipids and lipid analogs, which involve the signaling pathways related with inflammation. The levels of serum oleic acid [22.0 (12.9-23.5) μmol/mL vs. 41.5 (40.5-43.8) ] μmol/mL, P<0.001] and IL-1 receptor antagonist [398.6 (356.6-730.1) pg/mL vs.  1589.5 (1580.3-1595.5) pg/mL, P<0.001] decreased in ruptured aneurysm group compared to that in unruptured aneurysm group, while the levels of arachnoid acid [59.9 (26.7-76.6) μmol/mL vs. 12.7 (10.7-16.9) μmol/mL, P<0.001], IL-1β [28.8 (28.8-157.5) pg/mL vs. 46.7 (17.2-61.1) pg/mL, P=0.010], monocyte chemoattractant protein (MCP-1) [7.9 (3.0-15.3) pg/mL vs. 0.7 (0.5-1.1) pg/mL, P<0.001], IL-6 [9.8 (3.9-15.3) pg/mL vs. 2.8 (2.6-3.0) pg/mL, P<0.001] and TNF-α [141.9 (37.1-555.7) pg/mL vs. 345.1 (307.8-384.5) pg/mL, P=0.006] increased in ruptured aneurysm group compared to that in unruptured aneurysm groups. The correlation analysis showed that the expression levels of oleic acid (r2=0.554, P<0.001) , arachnoid acid (r2=0.527, P<0.001) and IL-1β (r2=0.592, P<0.001) in serum and aneurysm tissue had a positive correlation. The ROC curve analysis showed that the levels of oleic acid, arachnoid acid and IL-1β in serum and aneurysm tissue had a good diagnosis value for aneurysm rupture (AUC>0.7) . Multivariate logistic regression analysis showed that serum oleic acid (OR 0.74, 95% CI 0.60-0.87, P=0.001) was an independent risk factor for aneurysm rupture.  
Conclusions  The levels of  oleic acid and IL-1 receptor antagonist decreased, and the levels of arachnoid acid, IL-1β, MCP-1 and TNF-α increased in serum and aneurysm tissue in patients with ruptured intracranial aneurysm, compared to that in patients with unruptured aneurysm. The decreased level of serum oleic acid was an independent risk factor for intracranial aneurysm rupture.   



Predictors of Hemodynamic Depression Requiring Vasoactive Agent after Carotid Artery Stenting

XIA Liping, ZHENG Wenling, ZOU Yuntao, FENG Leyan, JIA Yuqin

2023, 18(04):  472-477.  DOI: 10.3969/j.issn.1673-5765.2023.04.014

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Objective  To determine the predictors of hemodynamic depression (HD) requiring vasoactive agent following carotid artery stenting (CAS). 
Methods  Patients who underwent unilateral CAS in Department of Neurology, Weifang Hospital of Traditional Chinese Medicine between February 2017 and December 2021 were enrolled in this retrospective study. Patient vital sign records within 24 hours post-CAS were analyzed. The HD was defined as sustained systolic blood pressure <90 mmHg (1 mmHg=133.3 Pa) or heart rate <50 beats per minute requiring vasoactive agent after CAS. The patients were divided into HD group (n=42) and non-HD group (n=88) according to having HD or not. The multivariate logistic regression analysis was used to identify independent risk factors of HD following CAS. 
Results  A total of 130 patients were included in this study, and HD occured in 42 pationts
(32.3%) . Univariate analysis showed that the HD group had a lower proportion of diabetes mellitus (28.57% vs. 48.86%, P=0.034), lower level of fasting blood glucose
[(5.46±1.71) mmol/L vs. (6.69±2.06) mmol/L, P<0.001], higher proportion of hyperechoic plaques (7.14% vs. 3.41%, P=0.043) and the distance from carotid bifurcation to maximum vascular stenosis (MVS) ≤ 10 mm (71.43% vs. 47.73%, P=0.021), and a higher use rate of open-cell stent (85.71% vs. 56.82%, P=0.024), compared to the non-HD group. Multivariate logistic regression analysis showed that hyperechoic plaques (OR 3.28, 95%CI 1.45-9.36, P=0.021) and the distance from carotid bifurcation to MVS≤ 10 mm (OR 3.10, 95%CI 1.23-8.11, P=0.028) were independent risk factors for HD requiring vasoactive agent after CAS, while diabetes mellitus (OR 0.25, 95% CI 0.07-0.91, P=0.031) and high fasting blood glucose level (OR 0.18, 95%CI 0.02-0.51, P=0.024) could provide protection against HD following CAS. 
Conclusions  The hyperechoic plaques and the distance from carotid bifurcation to MVS≤10 mm were independent risk factors for HD requiring administration of vasoactive agent after CAS. 

A Case of Recurring Arterial and Venous Thrombosis due to JAK2 Mutation

JIANG Jiwei, LI Zixiao, DONG Kehui, LI Wenyi, ZOU Xinying, XU Jun, GONG Xiping

2023, 18(04):  478-483.  DOI: 10.3969/j.issn.1673-5765.2023.04.015

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The Application of Near Infrared Spectroscopy in Diagnosis and Treatment of Cerebrovascular Diseases

WANG Shiyao, XU Yawen, ZHANG Bingwei

2023, 18(04):  484-489.  DOI: 10.3969/j.issn.1673-5765.2023.04.016

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Bedside monitoring of cerebral oxygenation in patients with cerebrovascular diseases is of great value for the diagnosis, treatment and prognosis of cerebrovascular diseases. As a novel brain imaging technology, near infrared spectroscopy (NIRS) has the advantages of low price, good convenience and non-invasiveness. It has gradually become the focus of cerebrovascular disease research. This article introduced the basic principle of NIRS, the application of NIRS in early recognition of acute cerebral infarction, efficacy evaluation of reperfusion after infarction, and prediction of malignant cerebral edema secondary to large cerebral infarction, and also the application prospect of NIRS in monitoring the hemorrhage near cerebral cortex. For patients with subarachnoid hemorrhage, NIRS may play a great potential role in monitoring delayed cerebral ischemia and predicting postoperative functional outcome by dynamical monitoring cerebral oxygen saturation. Finally, based on the advantages and disadvantages of NIRS, we looked forward to the clinical scenarios suitable for NIRS application in the future. Further NIRS research in cerebrovascular disease will make accurate pre-hospital and in-hospital real-time dynamic assessment of cerebrovascular disease possible. 

Progress of Intracranial and Extracranial Vascular Parameters Evaluation in Moyamoya Disease

LUO Wanxian, HE Yiqing, LI Yingjia

2023, 18(04):  490-494.  DOI: 10.3969/j.issn.1673-5765.2023.04.017

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Moyamoya disease (MMD) is characterized by progressive stenosis and occlusion of the terminals of bilateral internal carotid artery, the initial segment of middle cerebral artery and anterior cerebral artery, which leads to cerebral ischemia and hemorrhage due to fragile vessels rupture after ischemia. The blood flow of different segments of intracranial and extracranial vessels can influence each other, and the detection of blood flow parameters in specific segments can reveal the progression of disease,  which can guide clinical decision making. It is important for diagnosis and treatment of MMD to understand and master blood flow changes of different segments and progression of MMD. This article reviewed the correlation of different  extracranial and intracranial vascular parameters, collateral circulation and clinical prognosis of MMD, providing reference for the diagnosis and treatment of ischemic and hemorrhagic cerebrovascular diseases caused by intracranial artery stenosis or occlusion.