Chinese Journal of Stroke

Imitation and Innovation

WANG Yong-Jun

2013, 8(11): 857-858.

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Parent Artery Reconstruction??New Era for Endovascular Treatment of Intracranial Aneurysms

LIU Jian-Min, YANG Peng-Fei

2013, 8(11): 859-861.

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Use of Stents in Repeat Endovascular Treatment of Post-embolization Recurrent Intracranial Aneurysms

ZHANG Zhao-Long, YANG Peng-Fei, FENG Hao, LI Qiang, FANG Yi-Bin, YANG Zhi-Gang, HUANG Qing-Hai, XU Yi, HONG Bo, ZHAO Wen-Yuan, LIU Jian-Min.

2013, 8(11): 862-867.

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Objective To evaluate the feasibility, effectiveness, and safety of recurrent aneurysm treatment with stent. Methods A retrospective review was conducted for 83 patients with recurrent intracranial aneurysms who underwent endovascular treatment with stent in Department of Neurosurgery, Changhai Hospital, between June 2006 and March 2013. Results For these 83 patients with recurrent aneurysms, 93 stents were deployed successfully, and 10 patients received dual stent placement. Among them, 33 patients were treated with stent placement alone and 50 patients received stent-assisted coil embolization. In the patients treated with stent placement alone, residual filling of contrast medium in the aneurysms was seen in 18 patients (54.5%) immediately after the stent placement. However, no obvious difference was seen in 15 patients (45.5%). Of the 50 aneurysms treated with stent-assisted embolization, complete occlusion was achieved in 11 aneurysms (22.0%); residual neck remained in 21 aneurysms (42.0%), and residual aneurysm was present in 18 aneurysms (36.0%). Procedure-related complication occurred in 2 patients. They both suffered vasospasm and was discharged with no deficit. The modified Rankin Scale (mRS) score at discharge was 0~2 in 82 patients (98.8%) and 3 in one patient (1.2%). Follow-up angiographies were available in 50 (60.2%) patients (ranging 2~52 months, median 11 months). The results of 20 patients treated by stent placement alone showed complete occlusion in 14 (70.0%), progressive occlusion in 3 (15.0%) and stable in 3 (15.0%). Follow-up of 30 patients treated by stent assisted coil embolization showed complete occlusion in 20 (66.7%), progressive occlusion in 3 (10.0%), stable in 3 (10.0%), minor recanalization in 2 (6.7%), major recanalization in 1 (3.3%) and rerupture in 1 (3.3%). The clinical follow-up (ranging 2~82 months, median 30 months) demonstrated no neurologic deterioration except the one suffering SAH, who received endovascular treatment again without neurologic deficit. Conclusion The treatment of recurrent intracranial aneurysms with stents can be successfully achieved with satisfactory midterm results.

Different Interventional Treatments of Large or Giant Intracranial Aneurysms:a Single Center Experience

CHEN Yan, YANG Peng-Fei, ZHOU Yu, HUANG Qing-Hai, HONG Bo, ZHAO Wen-Yuan, XU Yi, LIU Jian-Min.

2013, 8(11): 868-874.

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Objective To evaluate the clinic efficacy, complication and prognosis of different interventional modalities in the treatment of large and giant intracranial aneurysms. Methods Between January 2001 and December 2010, 134 patients with large and giant intracranial aneurysms treated by endovascular approaches in the Department of Neurosurgery of Changhai Hospital were retrospectively analyzed. Of the 134 patients, 11 had been treated by parent artery occlusion, 20 by coil embolization, 78 by stent-assisted coil, and the rest 25 patients by Tubridge. Patients were followed up for 6~44 months after the procedure. Angiographic results were evaluated with Raymond grading system, whereas clinical outcomes were evaluated with the modified Rankin Scale (mRS). Favorable prognosis rate when discharge, the cure rate, the recurrence rate and favorable prognosis rate when follow-up, complication incidence were compared. Results The rate of favorable prognosis in the parent artery occlusion group was 100%, coil embolization group was 70.0%, stent-assisted coil embolization group was 91% and flow-diverter device group was 100%; the differences between groups are statistically significant (P=0.0030). At the time of last follow-up, the cure rate of the parent artery occlusion group was 63.6%, coil embolization group was 5.6%, stent-assisted coil embolization group was 37.2% and flow-diverter device group was 72%; the differences between groups are statistically significant (P=0.0002). At the time of last follow-up, the recurrence rate of the parent artery occlusion group was 0%, coil embolization group was 83.3%, stent-assisted coil embolization group was 30.8% and flow-diverter device group was 0%; the differences between groups are statistically significant (P<0.0001). The last follow-up favorable prognosis rate of the parent artery occlusion group was 100%, coil embolization group was 75%, stent-assisted coil embolization group was 90% and flow-diverter device group was 100%; the differences between groups are statistically significant (P=0.0209). The complication incidence of the parent artery occlusion group was 27.3%, coil embolization group was 30%, stent-assisted coil embolization group was 14.1% and flow-diverter device group was 0%; however, there were no statistical differences in the complication incidence between the four groups (P=0.0650). Conclusion Endovascular treatment of large or giant intracranial aneurysms is very challenging. Coil embolization is often associated with a very high recurrence rate, stent-assisted coil embolization can reduce the recurrence rate, parent artery occlusion gets satisfied favorable prognosis and recurrence rate, but the complication incidence is relatively high, the preliminary clinical results of flow diverter device appear to be satisfactory.

Clinical and Imaging Features of Hypertrophic Inferior Olivary Degeneration Secondary to Pontine Hemorrhage

XING Yan*, ZOU Xin-Ying, ZHANG Jie, ZHANG Ming.

2013, 8(11): 875-880.

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Objective To investigate the clinical and imaging characteristics of hypertrophic inferior olivary degeneration (HOD) after pontine hemorrhage. Methods The clinical data of three patients with HOD secondary to pontine hemorrhage from December 2009 to March 2013 admitted to Aviation General Hospital and Beijing Tiantan Hospital were retrospectively analyzed. All cases were male who showed extrapyramidal symptoms such as non-autonomic hyperactivity of limbs, palatal myoclonus and walking instability and they all underwent computed tomography (CT) or magnetic resonance imaging (MRI) examination of the brain. Results Those three patients all had history of pontine hemorrhage, 2 cases caused by hypertensive, 1 case after trauma. There appeared clinical symptoms and imaging changes respectively in the 8th, 12th and 14th month after brain stem hemorrhage. Extrapyramidal symptoms were the main clinical manifestations in the 3 cases, with glossolalia accompanied by serious involuntary torsional jitter of torso and limbs in case 1 and only glossolalia with obvious palatal myoclonus in case 2. Case 3 showed the original dizzy and walking unsteadily relapsed after improvement. Bleeding occurred on bilateral pontine tegmentum in 2 cases and only unilateral in 1 case. The characteristics of the lesion site were ventrolateral isolated localized lesions in bilateral olive nucleus. Symptoms gradually ease in one week after oral diazepam combined with valproate in case 1 and oral clonazepam in case 2. For case 3 symptoms improved in two weeks after application of hormone therapy without no significant change of signs. Conclusion HOD can be caused by pontine hemorrhage. The possibility of secondary HOD should be considered if tremor jitter of limbs and other extrapyramidal symptoms appear during the pontine hemorrhage treatment in stable condition. Clonazepam and sodium valproate might play an effective role in controlling the symptoms and the effects of hormone therapy effect has not been definite.

Investigation of Ischemic Stroke Patients with Mild or Moderate Obstructive Sleep Apnea-hypopnea Syndrome Treated by Nasal Continuous Positive Airway Pressure

TANG Xiao-Mei, YU Feng-Chun, MENG Xiao-Mei,CHEN Xin-Ping, LIU Wei, FENG Hao, ZHU Jian.

2013, 8(11): 881-886.

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Objective To observe the clinical results of ischemic stroke patients with mild and moderate obstructive sleep apnea-hypopnea syndrome treated by nasal continuous positive airway pressure (nCPAP). Methods Sixty-two cases were selected from March 2008 to March 2010 who suffered acute ischemic stroke. After 90 days, thirty patients with mild or moderate obstructive sleep apnea-hypopnea syndrome were enrolled into the study by using polysomnography. Then they were divided into two groups by whether using nCPAP or not:one group (14 cases) accepted treatment with nCPAP, while the other group (16 cases) rejected it. The recurrence rate of stroke, apnea hypopnea index (AHI), blood pressure, body mass index (BMI), Epworth Sleepiness Score (ESS), Hospital Anxiety and Depression Scale (HAD) at the 6th, 12th, 18th, 24th month were measured. Results There were no significant differences between two groups in age, sex, diabetes mellitus,hypertension disease, AHI, systolic pressure, diastolic pressure, BMI, modified Rankin Scale score, ESS, HAD (P value >0.05). There are no recurrent ischemic strokes through two years of observation. The nCPAP group performs better than non-nCPAP group in reducing AHI (nCPAP group AHI:3.9±0.6, 3.8±0.5, 3.9±0.5, 3.8±0.5, non-CPAP group AHI:20.8±4.1, 21.7±4.5, 22.6±4.2, 26.8±6.1, t value 16.2, 15.9, 17.8, 15.0, P value <0.001) and ESS scores (nCPAP group 3.5±1.7, 2.6±1.5, 2.2±1.4, 2.1±1.1, t value 6.1, 8.8, 9.9, 10.0, all P values <0.001), improving the ratio of anxiety in 24th month (P=0.039), while there is subtle difference in the ratio of depression level in the 6th, 12th, 18th, 24th month (nCPAP group:14.3%, 14.3%, 14.3%,14.3%, non-CPAP group:18.8%, 18.8%, 18.8%, 18.8%, P value 1.0, 1.0, 1.0, 1.0) and there is subtle difference in BMI in the 6th, 12th, 18th, 24th month (nCPAP group:22.8±1.4, 23.1±1.4, 22.7±1.4, 22.6±1.4, non-CPAP group:23.3±1.4, 23.7±1.6, 23.5±1.6, 23.0±1.3, P value >0.05). Conclusion It proves that treatment with nCPAP can reduce AHI, decrease ESS scores, and improve the level of anxiety.

Effects of Low-frequency Ultrasound Combined with Urokinase Thrombolytic Therapy for Cerebral Infarction in Rats

SONG Yu-Qiang*, ZOU Hong-Li, JIANG Zhen-Po, TUO Miao, LIU Xian.

2013, 8(11): 887-892.

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Objective To observe the effect of low-frequency ultrasound combined with urokinase thrombolytic therapy for cerebral infarction in rats and the expression of matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1). Methods One hundred and sixty cerebral infarction models were divided into 4 groups, including urokinase treatment group, low-frequency ultrasound treatment group, urokinase plus low-frequency ultrasound treatment group and control group. Neurological Severity Score (NSS), cerebral infarction volume and the expressions of MMP-9 and TIMP-1 were measured. Results The NSS of each group before the treatment (urokinase treatment group 9.09±1.33, low-frequency ultrasound treatment group 9.16±1.23, urokinase plus low-frequency ultrasound treatment group 9.11±1.45 and control group 9.28±1.14) had no significant difference (F=0.04, P=0.99), but the NSS of three treatment groups after treatment (urokinase treatment group 6.38±1.11, low-frequency ultrasound treatment group 7.37±1.35, urokinase plus low-frequency ultrasound treatment group 5.08±1.31) after treatment were significantly lower than that of before (t=4.95, 3.10, 6.52, P<0.01). The infarct volume in each treatment group [urokinase treatment group (59.24±8.25)mm3, low-frequency ultrasound treatment group (76.36±9.48)mm3, urokinase plus low-frequency ultrasound treatment group (56.01±9.77)mm3] was significantly lower than that of control group [(94.90±11.09)mm3] (F=34.06, q=11.63, 6.04, 12.68; P<0.01). The hemorrhagic rate in group with urokinase (20%) was higher than that of group without urokinase (3.75%) (χ2=8.60, P<0.01). There were no significant differences between the group with low-frequency ultrasound and the group without low-frequency ultrasound in hemorrhagic rates (12.5% vs 11.25%, χ2=0.06, P=0.99). The expressions of MMP-9/TIMP-1 in three treatment groups were significantly higher than that of control group (F=33.44, 15.17, P<0.01; q=9.73, 3.84, 12.87; q=6.25, 4.33, 9.30; P<0.01). The expressions of MMP-9/TIMP-1 in urokinase plus low-frequency ultrasound treatment group were significantly higher than that of urokinase treatment group (q=3.14; 3.06; P<0.01). Conclusion Low-frequency ultrasound maybe enhance the effect of urokinase thrombolytic therapy for cerebral infarction in rats and have no increased hemorrhagic rate. The expressions of MMP-9 and TIMP-1 increasing after urokinase thrombolytic therapy or low-frequency ultrasound were found.

Endovascular Treatment of Intracranial Aneurysms

Liu Jian-Min

2013, 8(11): 893-893.

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