Abstract:Stroke is the first cause of death in China, with high disability and causing serious economic burden to the society and families. Moreover it is one of the most important reasons for returning to poverty due to illness. Investigation shows that the awareness of active treatment and control for various risk factors of cerebrovascular disease is increasing in China. With the development of stroke diagnosis and treatment technology, the mortality of patients with severe stroke is reducing. However, there is still a long way to go to curb the rapid increase of stroke incidence and to reduce the mortality of stroke.

Abstract:Stroke is the first cause of death in China, and ischemic stroke is the most common stroke and accounts for 70% of all new stroke cases. The treatment efficiency of acute ischemic stroke is closely related to the health of people in China. Bridging therapy has been proven safe and effective for acute ischemic stroke with anterior circulation large vessel occlusion. The incidence of symptomatic intracerebral hemorrhage is similar in the patients with bridging therapy and intravenous thrombolysis, suggesting that the complication is not due to intra-artery thrombectomy, but rather to intravenous thrombolysis. Thus it has become a research focus whether direct intra-artery thrombectomy is feasible for acute ischemic stroke, skipping intravenous thrombolysis. This paper discusses the related issues.

Abstract:To overcome the bottlenecks of treatment for stroke and comprehensively improve the treatment efficiency, we need to do three jobs:public health education, entering hospital in time, and specialized stroke treatment. Lack of public knowledge about stroke is the most important bottleneck restricting the treatment of stroke in China. Public health education is the foundation of treatment for stroke. Another bottleneck is whether the patients can enter a capable hospital in time. Optimizing the referral system, establishing a regional stroke network, and applying modern referral tools and information network can help the patients entering the target hospital in time. Specialized treatment of stroke refers to the quick access to professional treatment for stroke, which requires to avoid delay in hospital; and the effective strategy is to build and optimize the green channel for stroke treatment.

Abstract:Acute ischemic stroke (AIS) is the most common cerebrovascular disease with high morbidity, mortality and disability. The imaging evaluation of ischemic penumbra has great clinical implication for early diagnosis and reperfusion therapy of AIS. Here, we reviewed the evaluation methods, advangtages and disadvangtages of computed tomography (CT) and magnetic resonance imaging for ischemic penumbra, and discussed the advantages of one-stop multi-modal CT.

Abstract:Acute ischemic stroke (AIS) has the characteristics of high morbidity, disability and mortality. Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) for AIS in time window is an effective treatment recommended by domestic and overseas guidelines. However, intravenous thrombolysis has shortcomings, such as short time window, low recanalization rate and high risk of bleeding. Therefore, in recent years, studies on prolonging the time window, using low-dose rt-PA or a new generation of thrombolytic agent, and thrombolysis combined with anti-thrombotic therapy have been carried out worldwide. Based on the studies on intravenous thrombolysis, this paper discusses several issues, including extending time window, low-dose rt-PA thrombolysis, and new generation of thrombolytic agent.

Abstract:Cardiogenic stroke caused by atrial fibrillation is the most harmful type of stroke, causing great social burden. Prevention and treatment of cardiogenic stroke often require the joint decision by the cerebrovascular physicians and cardiologists. Within 14 d after onset, the early stage of stroke, is a high-risk period of stroke recurrence and also a high-risk period of cerebral hemorrhage. In this period, how to prevent stroke recurrence is an urgent problem to be solved. This paper summarizes the main ways of secondary prevention for cardiogenic stroke caused by atrial fibrillation and discusses the possibility of early secondary prevention.

Abstract:Objective To explore the value of intelligent early warning system in pre-and in-hospital connection in the treatment of stroke. Methods The clinical data of the patients with suspected stroke, who received treatment and pre-hospital warning with intelligent early warning system in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) between Nov. 2017 and Jun. 2018, were retrospectively analyzed. Pre-hospital warning was defined as 120 alerting stroke teams using software before transferring patients to the target hospital. According to the in-hospital treatment methods, the patients were divided into non-stroke group, conservative treatment group, thrombolysis group, thrombectomy group, bridging group and cerebral hemorrhage group. The efficiency in each link of the intelligent early warning system, the ability of emergency doctor diagnosing stroke, the ability of emergency doctor diagnosing severe stroke using gaze-face arm speech time (G-FAST) scale, the speed of first aid response of the attending physician and the door-in-to-door-out (DIDO) time in primary stroke center were evaluated in each group. Results A total of 248 patients were included in this study, including 24 non-stroke patients and 224 stroke patients (101 patients in the conservative treatment group, 23 patients in the thrombolysis group, 32 patients in the thrombectomy group, 22 patients in the bridging group and 46 patients in the cerebral hemorrhage group). The median primary screening time, early warning time and response time of 248 patients were 28.0 (13.0, 92.5), 11.0 (7.3, 15.3) and 19.0 (13.0, 35.0) s, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 6 pre-hospital emergency physicians diagnosing severe stroke using G-FAST scale were 84%, 71%, 83%, 72% and 79%, respectively. Eight patients with severe stroke underwent whole-process monitoring of pre-hospital treatment, and had a median transport time of 113 (82, 142) min and a median DIDO time of 84 (12, 125) min. Conclusion Intelligent early warning system can realize the automation of data acquisition for transfer time points, making the data more comprehensive and reliable. It is helpful to analyze the efficiency of emergency physicians, drivers, stroke teams and primary stroke center in pre-and in-hospital connection in the treatment of stroke, so as to shorten the pre-hospital treatment time and improve the pre-hospital treatment efficiency.

Abstract:Objective To explore the effect of informationized time tracking management mode on the speed of treatment of acute ischemic stroke (AIS). Methods From Aug. 2016 to Jun. 2018, a total of 475 AIS patients receiving intravenous thrombolysis and/or intravascular treatment in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) were divided into time tracking group (n=291) and non-time tracking group (n=184). The time indicators were compared between the two groups, including onset-to-door time (ODT), door-to-imaging time (DIT), imaging-to-needle time (INT), onset-to-needle time (ONT), imaging-to-puncture time (IPT), onset-to-puncture time (OPT), door-to-needle time (DNT) and door-to-puncture time (DPT). The correlations between ODT and DNT, and ODT and DPT were analyzed using Spearman correlation analysis in the non-time tracking group and the time tracking group. Results The DNT of the patients with intravenous thrombolysis was significantly shorter in the time tracking group than that in the non-time tracking group (27[23, 36] min vs 33[23, 43] min, Z=2.123, P<0.05). There was a significant negative correlation between ODT and DNT of the patients with intravenous thrombolysis in the non-time tracking group (r=-0.293, P=0.001), while there was no correlation in the time tracking group (r=-0.034, P=0.723). The ODT and OPT of the patients with endovascular treatment were significantly longer, and DIT was significantly shorter in the time tracking group than those in the non-time tracking group (246[113, 431] min vs 166[82, 299] min, 342[211, 519] min vs 277[142, 406] min and 18[14, 23] min vs 26[16, 34] min; Z=2.667, 2.182 and 4.077, all P<0.05). There was a significant negative correlation between ODT and DPT of the patients with endovascular treatment in the non-time tracking group (r=-0.234, P=0.024), while there was no correlation between ODT and DPT in the time tracking group. (r=-0.056, P=0.424). Conclusion The informationized time tracking management mode can improve the treatment efficiency of acute ischemic stroke and eliminate the influence of ODT on DNT and DPT.

Abstract:Objective To explore the impact of referral on intravascular treatment of acute ischemic stroke patients with large vessel occlusion (AIS-LVO), and to analyze the influence factors of prognosis. Methods We retrospectively analyzed the clinical data of the AIS-LVO patients who received intravascular treatment from Sep. 2013 to Feb. 2018 in Stroke Center of our hospital. The patients were divided into directly admitted group and referral group. The patients in the directly admitted group went directly to the Emergency of our hospital through the pre-hospital emergency medical service or other vehicles. The patients in the referral group were transferred from other hospitals to the Emergency of our hospital. The clinical features, curative effect and prognosis were analyzed between the two groups. Then the patients were divided into good prognosis group (modified Rankin scale score at 90 d after operation being 0-2) and poor prognosis group (>2). The clinical data and visit methods were analyzed between the good prognosis and poor prognosis groups, and logistic regression analysis was used to analyze the P<0.1 variables. Results A total of 316 patients were included, and the directly admitted group had 195 cases (61.7%) and the referral group had 121 cases (38.3%). Compared with the directly admitted group, the proportions of the patients with ischemic stroke and bridging therapy were significantly lower in the referral group (χ²=4.549, P=0.033; χ²=29.319, P<0.001). The onset-to-door time (ODT) and onset-to-recanalization time (ORT) were significantly longer in the referral group than those in the directly admitted group (239[168, 238] min vs 85[55, 170] min, Z=1.779, P<0.001; 397[306, 472] min vs 285[214, 364] min, Z=6.779, P<0.001). The short-term treatment efficiency and good prognosis rate were significantly worse in the referral group than those in the directly admitted group (52.9%[64/121] vs 64.1%[125/195], χ²=3.903, P=0.048; 46.3%[56/121] vs 57.9%[113/195], χ²=4.806, P=0.043). There were 169 cases (53.5%) in the good prognosis group and 147 cases (46.5%) in the poor prognosis group. Compared with the poor prognosis group, the patients were significantly younger, the proportion of the patients with hyperlipidemia was significantly lower and the proportion of the patients with bridging therapy was significantly higher in the good prognosis group ([64.2±12.8] years vs[69.9±11.9] years, t=4.095, P<0.001; 0.6%[1/169] vs 6.1%[9/147], χ²=7.848, P=0.005; 70.4%[119/169] vs 13.6%[20/147], χ²=102.975, P<0.001). Compared with the poor prognosis group, the proportion of directly admitted patients was significantly higher in the good prognosis (66.9%[113/169] vs 55.8%[82/147], χ²=4.086, P=0.043), and ODT and ORT were significantly shorter in the good prognosis group (106[59, 214] min vs 184[91, 281] min, Z=3.997, P<0.001; 308[226, 389] min vs 350[267, 453] min, Z=2.999, P=0.003). Logistic regression analysis showed that bridging therapy, direct visit and short ODT were independent predictors of good prognosis in AIS-LVO patients with intravascular treatment. Conclusion The prognosis of referral AIS-LVO patients with intravascular treatment is poorer compared with the directly admitted patients. Bridging therapy, direct visit and short ODT indicate good prognosis in AIS-LVO patients.

Abstract:Objective To explore the post-setting and clinical practice of stroke emergency nurse. Methods Through selecting stroke emergency nurses, systematic training and assessing stroke first-aid theory and skills, we set up a new post in our hospital called stroke emergency nurse and developed a series of duties and procedures of work. Results The stroke emergency nurses with undergraduate degree were required to have more than 2 years of work experience in the Emergency, Neurosurgery, Cerebrovascular Surgery, Interventional Operation Room, Rehabilitation Department, and those with college education were required to have more than 5 years of work experience. A total of 32 trainees participated in the training. The theoretical assessment scores increased from 73.75±11.73 before training to 84.31±8.63 after training, the assessment scores of thrombolytic drug use increased from 82.91±2.75 to 92.69±2.78, the assessment scores of simulated stroke test increased from 82.25±3.81 to 92.56±2.94, and the assessment scores of interventional nursing training increased from 82.44±3.59 to 92.00±2.93; and the differences were statistically significant (t=14.91, 21.09, 14.34 and 16.39; all P<0.01). The numbers of excellent, good, qualified and unqualified trainees in the theoretical examination of hyperacute and acute stroke before training were 4, 6, 17 and 5, respectively, and the numbers after training were 9, 14, 9 and 0, respectively; and the difference was statistically significant (χ²=12.585, P=0.006). Conclusion It is clinically effective and feasible to set up a post of stroke emergency nurse through clinical screening, theoretical training, and clinical training. However, the training and post promotion mechanism need to be further improved.

Abstract:Objective To explore the therapeutic effect of mechanical thrombectomy with stent-retriever for the anterior circulation distal vessel occlusion. Methods Consecutive cases with anterior circulation distal vessel occlusion treated with mechanical thrombectomy in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) from Sep. 2013 to May 2018 were enrolled. According to whether undergoing intravenous thrombolysis, the patients were divided into bridging group and direct thrombectomy group. The primary outcome was the neurological functional prognosis at 90 d after operation measured with modified Rankin Scale (mRS, mRS score ≤ 2 reflected good prognosis). The secondary outcomes were the rate of recanalization (modified thrombolysis in cerebral ischemia[mTICI] grade ≥ 2b), the National Institutes of Health stroke scale (NIHSS) score at 24 h after operation, complications and mortality. Results Totally 36 patients aged (68.3±13.6) years (ranging from 26 to 88 years) were included. There were 27 cases with middle cerebral artery (MCA) M2 segment occlusion, 5 cases with anterior cerebral artery (ACA) A1/A2 segment occlusion and 4 cases with MCA M2 segment accompanied with ACA A2 segment occlusion. The rate of recanalization of the occluded distal vessels was 91.7% (33/36) after mechanical thrombectomy with stent-retriever. The rate of good prognosis at 90 d after operation was 52.8% (19/36). The most common complication was vasospasm (33.3%, 12/36), followed by hemorrhagic transformation (16.7%, 6/36). The incidence of symptomatic intracranial hemorrhage was 5.6% (2/36) and the mortality was 8.3% (3/36). There were 14 cases in the brigding group and 22 cases in the direct thrombectomy group. The preoperative NIHSS score of the bridging group was significantly higher than that of the direct thrombectomy group (Z=3.025, P=0.002). While there were no significant differences in the NIHSS score at 24 h after operation, times of thrombectomy, the rate of recanalization, the rate of good prognosis at 90 d after operation, the incidence of hemorrhagic transformation or mortality between the bridging group and the direct thrombetomy group (all P>0.05). Conclusion The mechanical thrombectomy with stent-retriever for the anterior circulation distal vessel occlusion is likely safe and effective, and it is beneficial for vascular recanalization and good outcomes at 90 d.

Abstract:Objective To investigate the clinical characteristics of the patients with acute ischemic stroke (AIS) caused by large artery atherosclerosis (LAA) or cardioembolism (CE) middle cerebral artery M1 segment occlusion, and to explore the difference of endovascular treatment. Methods The patients with AIS caused by M1 segment occlusion, who received endovascular treatment between Sep. 2014 and Feb. 2018 in our hospital, were recruited and assigned to LAA group and CE group. Clinical characteristics, treatment strategy, postoperative hemorrhage rate and prognosis were analyzed. Results Totally 134 patients were included, and 48 patients were in the LAA group and 86 patients were in the CE group. There were significant differences in the gender and age between the LAA and CE groups (male/female 39/9 vs 40/46, χ²=15.363; average age[62.65±9.76] years vs[69.66±12.43] years, t=-3.371; both P<0.05). Compared with the CE group, the proportion of the patients with hypertension was significantly higher, and the National Institutes of Health stroke scale score on admission was significantly lower in the LAA group (70.8%[34/48] vs 51.2%[44/86], χ²=4.900, P=0.027; 13[7, 16] vs 16[13, 21], Z=-3.603, P<0.001). The proportion of the patients with angioplasty in the LAA group was 52.1% (25/48), which was significantly higher than the proportion in the CE group (4.7%[4/86], χ²=38.121, P<0.01). The incidence of postoperative intracranial hemorrhage was significantly lower in the LAA group than that in the CE gorup (10.4%[5/48] vs 32.6%[28/86], χ²=8.136, P=0.004). There were no significant differences in the incidence of symptomatic intracranial hemorrhage, endovascular recanalization rate, or good prognosis rate or mortality 3 months after operation between the two groups (all P>0.05). Conclusion Compared with the patients with AIS due to LAA M1 segment occlusion, the CE patients have more severe symptoms and higher postoperative hemorrhage rate after endovascular treatment. The strategy of endovascular treatment is different in the two types of AIS, while there are no differences in prognosis and mortality after treatment.

Abstract:Objective To explore the safety and effectiveness of stent angioplasty for acute intracranial large artery atherosclerosis occlusion. Methods We retrospectively analyzed the clinical data of 460 patients with acute ischemic stroke undergoing endovascular thrombectomy in our hospital from May 2013 to Feb. 2018. We selected the patients with stent angioplasty and evaluated the safety and effectiveness. Results Fifty-six patients were included in this study, and there were 36 cases (64.3%) with occlusion of the anterior circulation and 20 cases (35.7%) of the posterior circulation. Twenty patients underwent intravenous thrombolysis before operation, and the door-to-needle time was (39.9±13.2) min. All scaffolds were successfully released to the designated location with a technical success rate of 100% (56/56). Fifty-five patients (98.2%) achieved recanalization of modified thrombolysis in cerebral infarction grade 2b and 3, and one patient had failed recanalization. The National Institutes of Health stroke scale score was 2.0 (0.0, 6.0) at 7 d after operation, which was significantly improved compared with the preoperation one (12.5[6.0, 20.0], Z=-4.073, P<0.05). Intracranial hemorrhage occurred in 7 patients (12.5%) after operation, in which 2 patients (3.6%) had symptomatic intracranial hemorrhage. Thirty-nine patients (69.6%) received skull computed tomography perfusion (CTP) examination at 3-5 d after operation, and CTP showed that 33 cases (84.6%) had patency, 4 cases (10.3%) had reocclusion, and 2 cases (5.1%) had moderate stenosis; and 17 cases (30.4%) were not examined by CTP. Thirty-four patients (60.7%) had a good prognosis at 90 d after operation (modified Rankin scale score 0-2), 9 (16.1%) died, and 13 (23.2%) were lost. Conclusion Stent angioplasty is a safe and effective treatment method for acute intracranial large artery atherosclerosis occlusion. However, short-term stent reocclusion after operation should not be ignored.

Abstract:Objective To explore the application value of RAPID software based on computed tomography perfusion (CTP) in predicting the outcome of anterior circulation acute ischemic stroke patients with endovascular therapy, and to investigate the indicators influencing prognosis of the patients. Methods A retrospective analysis was done on the clinical data of patients with anterior circulation acute ischemic stroke. All patients underwent endovascular treatment in Changhai Hospital of Navy Medical University (Second Military Medical University) between Jan. 2017 and Feb. 2018, completed cerebral CTP examination and had image analysis results by RAPID software, and the postoperative endovascular reperfusion achieved a modified thrombolysis in cerebral infarction (mTICI) grade ≥ 2b. According the modified Rankin scale (mRS) score at 3 months after surgery, the patients were divided into good prognosis (mRS score ≤ 2) and poor prognosis (mRS score>2) groups. The age, National Institutes of Health stroke scale (NIHSS) score on admission and the image analysis results by RAPID software, including the volumes of hypoperfusion of time to maximum > 4 s, > 6 s, > 8 s, > 10 s (V_{Tmax > 4 s}, V_{Tmax > 6 s}, V_{Tmax > 8 s}, V_{Tmax > 10 s}), core volume of necrosis (V_CBF<30%), mismatch volume and the mismatch ratio (MMR), were compared between the two groups. Logistic regression analysis was used to investigate the prognostic predictors and obtain a prediction formula. Receiver operating characteristic (ROC) curve was used to evaluate the prediction value of the prediction formula. Results Totally 137 patients with anterior circulation acute ischemic stroke were included, including 92 patients in the good prognosis group and 45 in poor prognosis group. The age and NIHSS score on admission were significantly lower in the good prognosis group than those in the poor prognosis group (t=-4.21 and -4.06, both P<0.01). Compared with the poor prognosis group, the V_{Tmax > 6 s}, V_{Tmax > 8 s}, V_{Tmax > 10 s} and V_{CBF < 30%} were significantly smaller, and the MMR was significantly lower in the good prognosis group (Z=-3.11, -3.17, -3.38, -4.52 and -3.74, all P<0.01). Logistic regression analysis showed that young and small V_CBF<30% were independent predicting factors of good prognosis (odds ratio[OR]=0.904, 95% confidence interval[CI] 0.860-0.950; OR=0.976, 95% CI 0.964-0.988; both P<0.01). A prediction formula was obtained:Logit (P)=8.454-0.024×V_CBF<30%-0.101×age, and the area under the ROC curve of the prediction formula was 0.786 (95% CI 0.699-0.873, P<0.01). Conclusion The age and V_CBF<30% are independent factors influencing outcome of patients with anterior circulation acute ischemic stroke. RAPID software based on CTP can be used for preoperative screening of patients with anterior circulation acute ischemic stroke suitable for endovascular treatment, which is worthy of clinical promotion.

Abstract:Objective To investigate the clinical characteristics of stroke warning syndrome (SWS) and to explore the effectiveness of intravenous thrombolysis with alteplase. Methods Eleven patients with SWS, who received intravenous thrombolysis with alteplase in Stroke Center of our hospital between Sep. 2013 and Jan. 2018, were selected. The clinical features, imaging findings and therapeutic effects were analyzed. Results There were risk factors of cerebrovascular diseases in the 11 patients with SWS, in which 7 had hypertension, 4 had diabetes mellitus, 2 had hyperlipoidemia, and 1 had gout. In the classification of symptoms, 7 patients were pure motor type and 4 were motor-sense type. Magnetic resonance diffusion weighted imaging showed that 10 patients developed ischemic stroke. The infarction located in the posterior limb of internal capsule, putamen, globus pallidus, corona and pons. Head and neck computed tomography angiography examination found no large vascular stenosis in the patients. The modified Rankin scale scored 0-1 in 9 patients, 2 in 1 patient, and 3 in 1 patient. Conclusion Perforating artery disease is the main pathogenesis of SWS. Intravenous thrombolysis does not prevent SWS to ischemic stroke, but it improves the prognosis of the patients.

Abstract:Objective To investigate the related factors and clinical features of unexplained early neurological deterioration (END) of acute ischemic stroke (AIS) patients after intravenous thrombolysis. Methods A total of 258 AIS patients, who underwent intravenous thrombolysis treatment within 4.5 h of onset and were registered continuously in Stroke Center of our hospital between Jan. 2016 and Feb. 2018, were included in this study. The unexplained END was defined as the National Institutes of Health stroke scale (NIHSS) score increasing by more than 4 within 24 h of onset compared with that before thrombolysis, with no definite mechanism by imaging examination. The baseline and clinical data were compared between the unexplained END and non-END patients. The clinical features of the AIS patients with unexplained END were analyzed. Results Among the 258 patients enrolled in this study, 243 (94.2%) had no END and 15 (5.8%) had unexplained END. Compared with the patients without END, the proportion of diabetes mellitus in the patients with unexplained END was significantly higher and the door-to-needle time (DNT) was significantly longer (χ²=6.093, P=0.048; Z=2.055, P=0.040). The NIHSS score of 15 patients with unexplained END before thrombolysis was low (5[4, 9]). The most common type of trial of Org 10172 in Acute Stroke Treatment (TOAST) classification was small artery occlusion (11 cases, 73.3%). The most common infarction sites were posterior limb of internal capsule (6 cases, 40.0%) and ventromedial pons (6 cases, 40.0%). Conclusion Diabetes mellitus and long DNT may be the risk factors of unexplained END in the patients with AIS after intravenous thrombolysis. Unexplained END usually occurs in the AIS patinets with small artery occlusion and has lower NIHSS score; the common sites of infarction are posterior limb of the internal capsule and ventromedial pons.

Abstract:Objective To explore the prognostic influencing factors of acute cardiogenic ischemic stroke patients treated with alteplase intravenous thrombolysis. Methods Ninety-one patients with acute cardiogenic ischemic stroke, who received intravenous thrombolysis with alteplase in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) between Sep. 2013 and Sep. 2017, were included in this study. The modified Rankin scale (mRS) score at 3 months after thrombolysis was used as an prognostic indicator, and the patients with mRS score ≤ 2 were good prognosis group (n=54) and those with mRS score 3-6 were poor prognosis group (n=37). The age, gender, medical history, baseline National Institutes of Health stroke scale (NIHSS) score, baseline Glasgow coma scale (GCS) score and Alberta stroke program early computed tomograghy score (ASPECTS) before thrombolysis were analyzed in each group. Multivariate logistic regression analysis was used to analyze the prognostic influencing factors. Results The good prognosis rate was 59.3% (54/91) at 3 months after thrombolysis. There were significant differences in age ([66.57±13.46] years vs[75.95±6.06] years), incidence of patent foramen ovale (11.1%[6/54] vs 0.0%[0/37]), baseline NIHSS score (7.5[3.5, 13.0] vs 18.0[13.0, 22.0]), baseline GCS score (14.5[12.0, 15.0] vs 10.0[8.0, 14.0]), ASPECTS before thrombolysis (10.0[9.0, 10.0] vs 9.0[8.0, 10.0]) and incidence of symptomatic intracranial hemorrhage (SICH, 1.9%[1/54] vs 32.4%[12/37]) between the good and poor prognosis groups (t=3.964, χ²=4.401, Z=5.235, Z=4.079, Z=2.519, χ²=16.768; all P<0.05). Multivariate logistic regression analysis showed that age (odds ratio[OR]=3.236, 95% confidence interval[CI] 1.077-9.709, P=0.036), baseline NIHSS score (OR=2.874, 95% CI 1.074-6.329, P=0.034) and SICH (OR=9.346, 95% CI 1.017-83.333, P=0.048) were influencing factors for poor prognosis of acute cardiogenic ischemic stroke patients treated with intravenous thrombolysis. Conclusion The age, baseline NIHSS score and SICH are independent factors for poor prognosis of patients with acute cardiogenic ischemic stroke. The patients with elder age, more serious stroke or SICH may have a worse prognosis.

Abstract:Objective The explore the effect of blood pressure bundle management on prognosis of patients with acute ischemic stroke after intravenous thrombolysis. Methods A total of 286 acute ischemic stroke patients, who received intravenous thrombolytic therapy in Stroke Center of our hospital between Oct. 1, 2015 and Mar. 31, 2018, were included in this study. The patients who received blood pressure bundle management after intravenous thrombolysis were assigned to bundle group, and the patients without blood pressure bundle management were in control group. The baseline data, National Institutes of Health stroke scale (NIHSS) score on admission, blood pressure before thrombolysis, the incidence of symptomatic intracranial hemorrhage and the in-hospital mortality after thrombolysis, and the 90-d modified Rankin scale (mRS) score were compared between the two groups. Multivariate logistic regression analysis was used to explore the effect of blood pressure bundle management, NIHSS score, onset-to-needle time, and blood pressure on prognosis of patients. Results Of 286 patients with acute ischemic stroke, 161 patients were in bundle group, and 125 patients were in control group. There were no significant differences in age, gender, hypertension, diabetes mellitus, atrial fibrillation, NIHSS score on admission or blood pressure before thrombolysis between the two groups (all P>0.05). The incidence of symptomatic intracranial hemorrhage was significantly lower in the bundle group than that in the control group (2.48%[4/161] vs 8.00%[10/125], χ²=4.598, P=0.032). There was no significant difference in the in-hospital mortality between the two groups (3.73%[6/161] vs 3.20%[4/125], χ²=0.058, P=0.810). The 90-d good prognosis (mRS score 0-2) rate was significantly higher in the bundle group than that in the control group (62.11%[100/161] vs 49.60%[62/125], χ²=4.485, P=0.034). Successive variation of systolic blood pressure and successive variation of diastolic blood pressure were significantly lower in the bundle group than those in the control group ([13.37±4.92] mmHg[1 mmHg=0.133 kPa] vs[18.42±3.87] mmHg, t=2.437, P=0.025;[11.23±4.02] mmHg vs[15.48±5.16] mmHg, t=1.842, P=0.046). Multivariate logistic regression analysis showed that blood pressure bundle management (odds ratio[OR]=0.798, P=0.002) and successive variation of diastolic blood pressure ≤ 15 mmHg (OR=0.816, P=0.018) were independent predictors for good prognosis of acute ischemic stroke patients with intravenous thrombolysis. Conclusion Blood pressure bundle management can improve blood pressure variation of the patients with acute ischemic stroke after receiving intravenous thrombolysis, reduce the incidence of symptomatic intracranial hemorrhage and improve the prognosis of the patients.

Abstract:Stroke is a central nervous system disease that seriously affects the quality of life of the victims, with the second highest mortality among all the diseases in the world. At present, the main clinical treatment strategies for acute ischemic stroke are intravenous thrombolysis and mechanical thrombectomy, whereas these strategies do not protect patients from ischemia injury and functional disorder. Therefore, it is necessary to find neuroprotective methods to ameliorate ischemic injury and ischemic/reperfusion injury. This review summed up the current studies on the drugs which prevent and treat neurologic impairment after ischemic stroke, including ion channel blocker, antioxidant, anti-inflammatory agent, anti-apoptotic agent, analyzed the characteristics and advantages and disadvantages, and summarized several non-drug neuroprotective therapies.

Abstract:Objective To investigate the difference in infarction characteristics between large artery atherosclerosis and cardioembolism acute ischemic stroke (AIS). Methods A retrospective study was done on 99 AIS patients, who were admitted to Emergency Room of our hospital and underwent multi-modal computed tomography (CT) after admission and before treatment. Forty-six of 99 AIS patients had large artery atherosclerosis and 53 had cardioembolism. The NIHSS score and GCS score on admission, infraction core and ischemic penumbra volumes and the volume difference, and vascular occlusion rates of posterior circulation and large artery were compared between the two groups. Results Compared with the cardioembolism group, the NHISS score was significantly lower and the GCS score was significantly higher in the large artery atherosclerosis group (9.5[2.0, 16.0] vs 15.0[6.0, 24.0], Z=2.31, P<0.001; 13.52±2.69 vs 11.60±3.31, t=1.04, P=0.002). The volumes of infarction core and ischemic penumbra in the cardioembolism group were 1 (0, 22) mL and 64 (30, 126) mL, respectively, and were both significantly larger than those in the large artery atherosclerosis group (0[0, 1] mL and 10[0, 70] mL; Z=3.85 and 3.43, both P<0.01). However, the volume difference of ischemic penumbra and infraction core was not significantly different between the cardioembolism and large artery atherosclerosis groups (46[4, 103] mL vs 10[0, 64] mL, Z=1.92, P>0.05). The large artery occlusion rate and posterior circulation occlusion rate were both significantly different between the large artery atherosclerosis and cardioembolism groups (30.43%[14/46] vs 50.94%[27/53] and 36.96%[17/46] vs 9.43%[5/53]; χ²=11.82 and 6.77, both P<0.001). Conclusion The clinical symptoms, cerebral changes and intracranial large artery changes are different in AIS patients with large artery atherosclerosis and cardioembolism. Etiology evaluation based on clinical features and multi-modal CT examination can help to accurately assess the ischemic state of AIS patients.

Abstract:Objective To explore the effect of neuromuscular electrical stimulation combined with swallowing training for dysphagia after acute ischemic stroke. Methods A total of 104 patients with dysphagia after acute ischemic stroke receiving treatment in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) between Sep. 2013 and Sep. 2016 were retrospectively enrolled. According to the treatment method, the patients were divided into treatment group and control group. The 73 patients in the treatment group received neuromuscular electrical stimulation combined with swallowing training, and the 31 patients in the control group received conventional treatment. The change of water swallow test (WST) score, pulmonary infection incidence and gastric tube removal rate were compared between the two groups. Results There were no significant differences in gender, age, baseline WST score or hospital stay between the two groups (all P>0.05). The WST score after intervention was significantly lower in the treatment group than that in the control group ([1.39±0.85] vs[2.71±1.16], F=17.236, P<0.001). The decreased WST score was significantly higher in the treatment group than that in the control group ([2.60±0.89] vs[1.29±0.46], F=19.910, P<0.001). The incidence of pulmonary infection was significantly lower in the treatment group than that in the control group (20.55%[15/73] vs 64.52%[20/31], χ²=18.840, P<0.001). The removal rate of gastric tube was significantly higher in the treatment group than that in the control group (52.05%[38/73] vs 25.81%[8/31], χ²=6.078, P=0.014). Conclusion Neuromuscular electrical stimulation combined with swallowing training can improve swallowing function and reduce the incidence of pulmonary infection in the patients with dysphagia after acute ischemic stroke.

Abstract:Objective To investigate the pathogenesis of isolated ischemic stroke in basal ganglia using high resolution-magnetic resonance imaging (HR-MRI). Methods Fifteen consecutive patients with isolated ischemic stroke in basal ganglia, who received HR-MRI examination in our hospital between Jan. 2015 and Dec. 2016, were included in this study, and the clinical and imaging data were analyzed. Results Vascular evaluation results showed that 6 patients had normal middle cerebral artery, 4 had mild stenosis, 2 had moderate stenosis, and 3 had severe stenosis. HR-MRI examination showed that plaque formation of the middle cerebral artery in the lesion side was found in 10 patients, of which 7 patients had arc plaques and 3 had annular plaques. T₁ weighted imaging showed that the plaques of 8 patients were obviously enhanced, the plaque of 1 patient was moderately enhanced, and the plaque of 1 patient was not enhanced. Conclusion The etiology of isolated ischemic stroke in basal ganglia is complex. HR-MRI examination can clearly show the wall and plaque of the middle cerebral artery, providing evidence for etiological judgment.

Abstract:Objective To investigate the clinical characteristics of patients with cryptogenic stroke and patent foramen ovale (PFO). Methods The clinical features, imaging findings and therapeutic outcomes of 51 patients with cryptogenic stroke and PFO, who received treatment in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) between Sep. 2013 and Jan. 2018, were retrospectively analyzed. Results Of the 51 cases, 41 were male and 10 were female; and the mean age was (53.92±14.83) years (ranging from 21 to 84 years). Diffusion weighted imaging (DWI) showed that 46 patients developed new infarction including 20 cases (43.5%) of single lesion and 26 cases (56.5%) of multiple lesions, of which 15 cases (57.7%) involved single arterial territory and 11 cases (42.3%) involved two or more arterial territories (4 cases of bilateral anterior circulation, and 7 cases of both the anterior and posterior circulations). Thirty-seven patients underwent contrast-enhanced transcranial Doppler (cTCD) examination, which showed that 31 cases (83.8%) had microbubble sign (air microbubble emboli of 4 cases looked like raindrops or curtains). In 50 patients undergoing transesophageal echocardiography (TEE) examination, 49 cases (98.0%) were accompanied with PFO. Nine patients received intravenous thrombolysis. In secondary prevention, 18 patients received single antiplatelet therapy, 12 dual antiplatelet therapy, 8 anticoagulation therapy, and 13 PFO closure+single antiplatelet therapy. One patient with single antiplatelet therapy had recurrent ischemic stroke, 2 patients with dual antiplatelet therapy had recurrent ischemic stroke, and the patients with percutaneous closure of PFO had no recurrent stroke. Conclusion The infarction of cryptogenic stroke with PFO involves single or multiple arterial territories, cTCD and TEE have high positive diagnosis rate for PFO, and the patients with selective antithrombotic therapy and PFO closure have a low risk of recurrent stroke.