Abstract:In June 2021, National Health Commission and other 9 ministries decided to implement the Project to Reduce Millions of New Disabilities for prevention and treatment of stroke (Million Disability Reduction Project), and jointly formulated Comprehensive Plan for Strengthening Stroke Prevention and Treatment to Reduce Millions of New Disabilities. Million Disability Reduction Project is an important part of efforts for national stroke prevention and treatment, is the key job in cerebrovascular disease control in China in the future, and needs to be actively promoted by all levels of medical institutions according to their own conditions. This article elaborates on the background and significance of the project and the job that needs to be focused on, so as to comprehensively understand and recognize the meaning of the Million Disability Reduction Project, better guide the development of the related jobs in the future, and reduce the disability rate, social risk and family burden of stroke.

Abstract:China is a country with the highest morbidity of stroke in the world. Although the Stroke Prevention and Control Project Committee of the National Health Commission has made great efforts in recent 10 years, the situation of stroke prevention and control is still grim. Poor national medical literacy, complex medical environment, unbalanced distribution of stroke centers and unbalanced stroke treatment levels in different hospitals often lead to the failure of timely hospitalization or diagnosis and treatment of stroke. Construction of regional stroke alliance is urgent and plays a significant role in exploring the hierarchical diagnosis and treatment of stroke, setting up emergency aid and transform mode, standardizing stroke work process, carrying out clinical practice and health education, and improving the stroke diagnosis and treatment levels of regional stroke centers at all levels, especially in grass-root hospitals. At present, different forms of regional stroke alliances have been established around the country, which not only give play to the advantages of stroke centers, but also improve the diagnosis and treatment of stroke, win the golden rescue time, and comply with the construction strategies of National Medical Association and specialty alliances. Although initial benefits have been achieved, there is still a long way to go. Further plan is needed to improve the regional stroke alliance and establish a regional efficient and intelligent "1-h golden treatment circle of stroke", so as to strive for the early "inflection point" of stroke prevention and treatment.

Abstract:Vascular recanalization therapy is the major treatment strategy for acute ischemic stroke with large vessel occlusion (AIS-LVO). Time window for mechanical thrombectomy has been proven to be within 6 h after stroke onset. Screening of patients who are to undergo mechanical thrombectomy 6-24 h or beyond 24 h after onset remains controversial. In this review, we summarize the current status of mechanical thrombectomy in AIS-LVO patients with extended time window of 6-24 h or beyond 24 h, and analyze the feasibility and evaluate the strategies for extending the time window of thrombectomy.

Abstract:Objective To investigate the status and homogeneity of pre-hospital warning and in-hospital green channel process management of patients with acute ischemic stroke in tertiary first-class hospitals in different administrative regions of China.Methods Convenience sampling method was conducted among experts in the field of interventional therapy of cerebrovascular diseases in China. Then, the ALICE questionnaire (Chinese version of questionnaire on the status of intravascular treatment of cerebrovascular diseases-ALICE study) was sent to them by WeChat Mini Program (the online survey tool Sojump) or e-mail. The survey contents included the basic information of the hospital, the treatment status of cerebrovascular diseases (acute ischemic stroke, intracranial aneurysm, arteriovenous malformation and non-stenotic carotid plaque) and patient transfer system. The status of green channel process management in 7 administrative regions (North, Northeast, East, Central, South, Southwest and Northwest) of China and the saved time of door-to-treatment after optimizing the management strategies were analyzed.Results A total of 142 questionnaires were distributed, 11 incomplete questionnaires were excluded, and 131 valid questionnaires were collected. The 131 neurointerventional physicians were from 126 tertiary first-class hospitals. Hospitals with more than 100 cases of mechanical thrombectomy every year accounted for 31.0% (39/126). Direct admission by ambulance was the main mode of care for emergency acute ischemic stroke patients (53%[35%, 70%]). There were slight differences in the pre-hospital warning mechanism, emergency pre-examination, space layout between CT machine and catheter operation room, general anesthesia protocol and preparation for mechanical thrombectomy among the hospitals in different administrative regions, showing no significant differences (all P > 0.05). Anesthesiologists in a callable state throughout the day, optimization of the imaging procedure, position optimization or functional integration of CT machine and advance warning mechanism could shorten the time of door-to-treatment by 21 (19, 30), 20 (15, 30), 20 (12, 25) and 19 (10, 23) min, respectively.Conclusion There is a high homogeneity of in-hospital green channel treatment process for acute ischemic stroke among the tertiary first-class hospitals in different administrative regions of China. Avoiding unnecessary steps, planning a reasonable stroke green channel and parallel-management can greatly improve the rescue and treatment efficiency.

Abstract:Objective To analyze the effect of standard stroke treatment procedures of Changhai Hospital on treatment time of patients with acute ischemic stroke (AIS) caused by large vessel occlusion.Methods A total of 876 consecutive patients with large vessel occlusion AIS who underwent endovascular treatment in Neurovascular Center of our hospital from Sep. 10, 2013 to Dec. 31, 2019 were retrospectively selected; 66 patients without complete data were excluded and 810 were finally included. The patients who received the standard stroke treatment procedures (implemented from Jun. 22, 2018) were assigned to study group (n=335), and the patients who did not received were assigned to control group (n=475). The door-to-needle time (DNT), door-to-puncture time (DPT), puncture-to-recanalization time (PRT), successful recanalization (modified thrombolysis in cerebral infarction grade ≥ 2b) rate and good prognosis (modified Rankin scale score ≤ 2) rate 90 d after operation were compared between the 2 groups.Results There were no significant differences in gender, age or National Institutes of Health stroke scale score on admission between the 2 groups (all P > 0.05). The proportion of patients treated with intravenous thrombolysis+endovascular treatment was significantly lower in the study group than that in the control group (14.3%[48/335] vs 31.2%[148/475], P < 0.001). In the patients treated with intravenous thrombolysis+endovascular treatment, the DNT, DPT and PRT were significantly shorter in the study group than those in the control group (34.2[28.1, 60.4] min vs 53.5[27.0, 72.2] min, 76.5[55.9, 106.4] min vs 97.0[68.9, 151.1] min, and 45.0[37.3, 90.4] min vs 78.0[55.4, 109.3] min, all P < 0.01). There were no significant differences in the good prognosis rate 90 d after operation or successful recanalization rate between the 2 groups (66.7%[32/48] vs 57.4%[85/148] and 91.7%[44/48] vs 93.2%[138/148], both P > 0.05). In the patients treated with endovascular treatment alone, the DPT and PRT were significantly shorter in the study group than those in the control group (67.0[50.1, 109.0] min vs 87.0[60.8, 150.0] min and 48.0[43.5, 80.8] min vs 74.0[60.3, 100.6] min, both P < 0.001). There were no significant differences in the good prognosis rate 90 d after operation or successful recanalization rate between the 2 groups (54.7%[157/287] vs 52.3%[171/327] and 93.0%[267/287] vs 91.1%[298/327], both P > 0.05).Conclusion The standard stroke treatment procedures in our hospital can significantly shorten the DNT, DPT and PRT in treating the patients with large vessel occlusion AIS, without reducing the successful recanalization rate and 90 d good prognosis rate.

Abstract:Objective To investigate the embolism causes, and the imaging and clinical characteristics of patients with embolic stroke of undetermined source (ESUS), and analyze the differences of acute ischemic stroke with large vessel occlusion (AIS-LVO) caused by large artery atherosclerosis and cardioembolism.Methods A total of 127 patients, who were admitted to Department of Emergency of our hospital from Jan. 2018 to Dec. 2019 with anterior circulation AIS-LVO suggested by multimodal computed tomography (CT) and underwent endovascular treatment, were retrospectively included. Twenty-nine patients had ESUS, 40 had large artery atherosclerosis and 58 had cardioembolism. The scores of National Institutes of Health stroke scale (NIHSS) and Glasgow coma scale (GCS) on admission, the volumes of infarction core and ischemic penumbra, Alberta Stroke Program early computed tomography score (ASPECTS) and hypoperfusion intensity ratio (HIR) were compared among the 3 groups. Multivariate logistic regression model was used to evaluate the differential value of imaging features for ESUS and large artery atherosclerosis.Results There were significant differences in the NIHSS and GCS scores on admission, infarction core volume, ASPECTS and HIR between the ESUS, large artery atherosclerosis and cardioembolism groups (all P < 0.05). The results of multiple comparison showed that the GCS score on admission in the ESUS group was significantly lower than that in the large artery atherosclerosis group, and the infarction core volume and HIR were significantly higher than those in the large artery atherosclerosis group (all P < 0.05); there were significant differences in the NIHSS and GCS scores on admission, infarction core volume, ASPECTS and HIR between the large artery atherosclerosis group and cardioembolism group (all P < 0.05); while there were no significant differences in the NIHSS and GCS scores on admission, infarction core volume, ischemic penumbra volume, ASPECTS or HIR between the ESUS group and cardioembolism group (all P > 0.05). Multivariate logistic regression analysis showed that HIR had independent predictive value for ESUS in patients with anterior circulation AIS-LVO (odds ratio=9.757 0, 95% confidence interval 1.203 4-79.107 2, P=0.03).Conclusion Compared with the AIS-LVO caused by large artery atherosclerosis, the imaging characteristics of ESUS are more similar to those of AIS-LVO caused by cardioembolism, suggesting that most ESUS may be caused by cardioembolism. HIR has guiding value for the judgment of the etiology of anterior circulation AIS-LVO.

Abstract:Objective To investigate the predictive value of hypoperfusion intensity ratio (HIR) on the prognosis of patients with acute ischemic stroke with large vessel occlusion (AIS-LVO) of anterior circulation after endovascular thrombectomy.Methods The data of anterior circulation AIS-LVO patients treated with endovascular thrombectomy in Neurovascular Center of our hospital from Jan. to Dec. 2019 were retrospectively analyzed. The patients were divided into good collateral circulation (HIR < 0.4) group and poor collateral circulation (HIR ≥ 0.4) group. The clinical data of the 2 groups were compared. According to the modified Rankin scale (mRS) score 90 d after operation, the patients were divided into good prognosis (mRS score ≤ 2) group and poor prognosis (mRS score 3-6) group. The clinical and imaging data of the 2 groups were compared. The influencing factors of the prognosis 90 d after operation were determined by multivariate logistic regression analysis.Results Totally 120 patients were included, including 41 patients in the good collateral circulation group and 79 in the poor collateral circulation group; and 68 in the good prognosis group and 52 in the poor prognosis group. The patients in the poor collateral circulation group were older, and had larger core infarction volume, higher baseline National Institutes of Health stroke scale (NIHSS) score and lower Alberta Stroke Program early computed tomography score (ASPECTS) compared with the patients in the good collateral circulation group, with significant differences (all P < 0.05). The patients in the poor prognosis group were older, with more females, and had higher baseline NIHSS score, larger core infarction volume, lower ASPECTS and successful vascular recanalization rate, and higher incidence of postoperative sICH and HIR compared with the patients in the good prognosis group, with significant differences (all P < 0.05). Multivariate logistic regression analysis showed that age > 80 years (odds ratio[OR]=2.290, 95% confidence interval[CI]1.077-4.869, P=0.031) and HIR ≥ 0.4 (OR=2.974, 95% CI 1.060-8.342, P=0.038) were independent predictors of poor prognosis of patients with anterior circulation AIS-LVO 90 d after endovascular thrombectomy.Conclusion HIR is a reliable measure of collateral circulation before operation. Advanced age and HIR ≥ 0.4 are independent predictors of poor prognosis of patients with anterior circulation AIS-LVO 90 d after endovascular thrombectomy.

Abstract:Objective To explore the predictive value of posterior circulation-Alberta Stroke Program early computed tomography score(pc-ASPECTS) based on cerebral computed tomography perfusion(CTP) for prognosis of patients with acute ischemic stroke caused by vertebral and basilar artery occlusion(VBAO-AIS).Methods The data of 56 patients with VBAO-AIS who received endovascular treatment in the Neurovascular Center, Changhai Hospital, Naval Medical University(Second Military Medical University) from Jan. 2019 to Dec. 2020 were retrospectively analyzed. All patients underwent emergency multimodal computed tomography(CT) examination, and the pc-ASPECTSs based on non-contrast computed tomography(NCCT), CTP and RAPID-CTP were obtained. The modified Rankin scale(mRS) score 3 months after treatment was used to evaluate prognosis(mRS score ≤ 3 indicated good prognosis). Receiver operating characteristic(ROC) curve and multivariate logistic regression analysis were used to evaluate the prognostic value of pc-ASPECTS based on NCCT and each parameter of CTP and RAPID-CTP.Results Among the 56 patients, 29 had good prognosis and 27 had poor prognosis. The pc-ASPECTSs based on NCCT and each parameter of CTP and RAPID-CTP were significantly higher in the good prognosis group than those in the poor prognosis group(all P<0.05). The sensitivities of CTP cerebral blood volume(CBV) pc-ASPECTS and RAPID-CBV pc-ASPECTS in predicting prognosis were 89.7% and 79.3%, the specificities were 74.1% and 81.5%, and the area under curve values were 0.861(95% confidence interval[CI]0.760-0.963) and 0.861(95% CI 0.764-0.958), respectively. Binary multivariate logistic regression analysis showed that NCCT pc-ASPECTS ≥ 8, CTP CBV pc-ASPECTS ≥ 7, CTP mean transit time(MTT) pc-ASPECTS ≥ 5, RAPID-CBV pc-ASPECTS ≥ 8, and RAPID-cerebral blood flow(CBF) pc-ASPECTS ≥ 7 were independent factors in predicting good prognosis of VBAO-AIS patients 3 months after endovascular treatment(all P<0.05).Conclusion pc-ASPECTS based on each parameter of CTP is a useful prognostic marker of VBAO-AIS patients. In particular, CBV pc-ASPECTS has a high predictive value for the prognosis of VBAO-AIS patients 3 months after endovascular treatment.

Abstract:Objective To compare the efficacy and safety of intravenous thrombolysis in acute ischemic stroke (AIS) with different etiology types.Methods AIS patients who received intravenous thrombolysis with alteplase in our center from Jan. 2016 to Dec. 2020 were retrospectively included, and the clinical data were collected. According to the classification of Trial of Org 10172 in Acute Stroke Treatment (TOAST), the patients were divided into large artery atherosclerosis (LAA) group, small artery occlusion (SAO) group, cardioembolism (CE) group, stroke of other determined etiology (SOE) group and stroke of undetermined etiology (SUE) group. The early effective rate 24 h after treatment, good prognosis rate 90 d after treatment and hemorrhagic transformation rate were compared among different etiology groups. Multivariate logistic regression analysis was used to explore whether TOAST classification was an influencing factor of prognosis 90 d after intravenous thrombolysis.Results A total of 538 AIS patients were enrolled, including 140 (26.0%) patients in the LAA group, 233 (43.3%) in the SAO group, 98 (18.2%) in the CE group, 58 (10.8%) in the SUE group and 9 (1.7%) in the SOE group. It was effective in 210 (39.0%) AIS patients 24 h after intravenous thrombolysis, including 56 (40.0%) patients in the LAA group, 85 (36.5%) in the SAO group, 41 (41.8%) in the CE group, 26 (44.8%) in the SUE group and 2 (22.2%) in the SOE group, showing no significant difference (P=0.596). There were 443 (82.3%) AIS patients with good prognosis (modified Rankin scale score of 0-2) 90 d after treatment, including 108 (77.1%) patients in the LAA group, 201 (86.3%) in the SAO group, 82 (83.7%) in the CE group, 45 (77.6%) in the SUE group and 7 (77.8%) in the SOE group, showing no significant difference (P=0.147). Thirty-six (6.7%) AIS patients had hemorrhagic transformation after treatment, including 10 (7.1%) patients in the LAA group, 11 (4.7%) in the SAO group, 11 (11.2%) in the CE group, 3 (5.2%) in the SUE group and 1 (11.1%) in the SOE group, showing no significant difference (P=0.209). Multivariate logistic regression analysis showed that TOAST classification was not a prognostic factor of AIS patients 90 d after intravenous thrombolysis.Conclusion There are no significant differences in the efficacy or safety of intravenous thrombolysis in AIS patients with different etiology types.

Abstract:Objective To investigate the efficacy and safety of intravenous thrombolysis in patients with acute ischemic stroke manifested as repeated transient ischemic attack (TIA).Methods A total of 111 acute ischemic stroke inpatients with repeated TIA who were admitted to Neurovascular Center of our hospital from Aug. 1, 2013 to Sep. 11, 2019 were retrospectively included. The patients were divided into intravenous thrombolysis group (57 cases) and non-intravenous thrombolysis group (54 cases treated with standard antiplatelet drugs alone). National Institutes of Health stroke scale (NIHSS) score 7 d after treatment was used to evaluate the early efficacy (NIHSS score decreased by ≥ 0 indicated effective). Modified Rankin scale (mRS) score 90 d after treatment was used to evaluated the long-term prognosis (mRS score ≤ 2 indicated good prognosis). Heidelberg classification was used to evaluate the hemorrhagic transformation after treatment.Results There were no significant differences in age, gender, hypertension, diabetes mellitus, ABCD2 (age, blood pressure, clinical features, duration of symptoms, diabetes mellitus) score, or TIA times and NIHSS score before treatment between the 2 groups (all P>0.05). After treatment, the recurrence times of TIA was significantly lower in the intravenous thrombolysis group than that in the non-intravenous thrombolysis group (0[0, 2] vs 0[0, 18], P=0.028). The proportion of patients whose NIHSS score decreased by ≥ 0 7 d after treatment was significantly higher in the intravenous thrombolysis group than that in the non-intravenous thrombolysis group (98.2%[56/57] vs 90.7%[49/54], P<0.001). There were no significant differences in the positive rate of magnetic resonance diffusion weighted imaging (DWI) 7 d after treatment, good prognosis rate 90 d after treatment or incidence of asymptomatic intracranial hemorrhage between the 2 groups (all P>0.05). No symptomatic intracranial hemorrhage or death occurred in the 2 groups.Conclusion Intravenous thrombolysis can improve the early neurological function of patients with acute ischemic stroke manifested as repeated TIA, and the long-term efficacy is similar to that of standard drug treatment.

Abstract:Objective To investigate the efficacy and safety of step-by-step endovascular treatment strategy for patients with acute ischemic stroke (AIS) caused by intracranial atherosclerosis-large vessel occlusion (ICAS-LVO) of anterior circulation.Methods The clinical data of patients with anterior circulation ICAS-LVO-related AIS who underwent emergency step-by-step endovascular treatment in our center from Jan. 1, 2018 to Dec. 31, 2019 were retrospectively analyzed. According to the step-by-step treatment methods, the patients were divided into glycoprotein Ⅱb/Ⅲa inhibitor (tirofiban) infusion group (GPI group), GPI+ballon angioplasty (BA) group and GPI+BA+rescue stenting (RS) group. The rate of successful recanalization (modified thrombolysis in cerebral infarction grade ≥ 2b) immediately after operation, incidence of symptomatic intracranial hemorrhage after operation, and good prognosis (modified Rankin scale score ≤ 2) rate and mortality 90 d after operation were evaluated.Results Totally 69 patients (53 males and 16 females), aged 30-86 years, were included in this study, including 20 patients in the GPI group, 14 in the GPI+BA group and 35 in the GPI+BA+RS group. There were no significant differences in baseline data, such as gender, age, hypertension, diabetes mellitus, coronary heart disease, smoking or drinking, among the 3 groups (all P>0.05), except for the history of ischemic stroke or transient ischemic attack and National Institutes of Health stroke scale score before operation. Sixty-eight (98.6%) patients had immediate successful recanalization. After operation, the reocclusion rate of responsible vessels was 6.7% (4/60), and the incidence of symptomatic intracranial hemorrhage was 4.3% (3/69). Sixty-seven patients were followed up 90 d after operation, and 2 were lost. The good prognosis rate was 64.2% (43/67), and the mortality was 9.0% (6/67). There were no significant differences in the 90 d good prognosis rate, 90 d mortality, incidence of symptomatic intracranial hemorrhage or reocclusion rate of responsible vessels among the 3 groups (all P>0.05).Conclusion For patients with AIS caused by ICAS-LVO, the step-by-step endovascular treatment strategy is safe and effective.

Abstract:Objective To investigate the recanalization techniques for acute ischemic stroke with large vessel occlusion (AIS-LVO) caused by intracranial atherosclerotic stenosis (ICAS) and their clinical efficacy.Methods A total of 264 patients with AIS-LVO caused by ICAS who underwent endovascular treatment in Neurovascular Center, Department of Neurosurgery, the First People's Hospital of Changzhou (the Third Affiliated Hospital of Soochow University) from Jan. 2019 to Mar. 2021 were retrospectively included. All of them were treated with at least 1 method such as mechanical thrombectomy, ADAPT (a direct aspiration first-pass technique) technology, balloon dilatation and/or stent implantation within 6 or 8 h after onset. The clinical data analyzed included age, gender, past history, vessel occlusion site, collateral circulation, intervention methods, immediate postoperative recanalization (modified thrombolysis in cerebral infarction[mTICI]grade ≥ 2b indicated successful recanalization), National Institutes of Health stroke scale (NIHSS) score on admission and at discharge, and prognosis 90 d after operation (modified Rankin scale score ≤ 2 indicated good prognosis).Results Among 264 patients with AIS-LVO caused by ICAS, 229 had anterior circulation lesions and 35 had posterior circulation lesions, with NIHSS scores of 16 (12, 19) and 25 (22, 32) on admission and 8 (6, 11) and 10 (8, 12) at discharge, respectively. The immediate postoperative successful recanalization rate was 91.3% (241/264), including 68 (25.8%) patients with mTICI grade 2b and 173 (65.5%) with grade 3. The incidence of symptomatic intracranial hemorrhage 24 h after operation was 9.1% (24/264). The good prognosis rate was 55.7% (147/264) 90 d after operation, and the mortality was 10.6% (28/264). One hundred and thirty-two patients underwent mechanical thrombectomy alone and 108 patients were treated with mechanical thrombectomy+rescue stenting, and the good prognosis rates 90 d after operation were 58.3% (77/132) and 50.9% (55/108), respectively; there were no significant differences in the baseline data (such as age and gender), immediate postoperative successful recanalization rate or good prognosis rate 90 d after operation between the 2 groups (all P>0.05).Conclusion For patients with AIS-LVO caused by ICAS, mechanical thrombectomy can be the preferred endovascular treatment technique, and rescue techniques such as balloon dilatation and stent implantation are safe and effective.

Abstract:Objective To explore the feasibility and safety of carotid artery stenting during the procedure of emergency endovascular treatment in patients with carotid artery tandem lesions, and to analyze the effect of emergency carotid artery stenting on prognosis.Methods A total of 131 consecutive patients with carotid artery tandem lesions, who met the inclusion and exclusion criteria and underwent emergency endovascular treatment within 24 h of the onset in our division from May 2015 to Apr. 2021, were retrospectively included. They were divided into stenting group (93 cases) and non-stenting group (38 cases) according to whether undergoing carotid artery stenting during the procedure of emergency endovascular treatment. The baseline data, good prognosis (modified Rankin scale score ≤ 2) rate and mortality 90 d after operation, acute reocclusion rate and incidence of symptomatic intracranial hemorrhage (sICH) were compared between the 2 groups. According to the prognosis 90 d after operation, the patients were divided into good prognosis group (67 cases) and poor prognosis group (64 cases). The influencing factors of prognosis 90 d after operation were analyzed by univariate analysis, and the independent influencing factors of good prognosis were determined by multivariate logistic regression analysis.Results Compared with the non-stenting group, the patients in the stenting group were older, with higher proportion of diabetes mellitus, had a lower National Institutes of Health stroke scale (NIHSS) score on admission and a higher rate of good prognosis 90 d after operation, showing significant differences (all P < 0.05); and there were no significant differences in mortality 90 d after operation, incidence of sICH after operation or reocclusion rate (all P>0.05). Compared with the poor prognosis group, the patients in the good prognosis group were younger, had a lower NIHSS score on admission, fewer hyperdense area on C-arm computed tomography (CT) after operation, lower incidence rates of intracranial hemorrhage and sICH and a higher stenting rate, showing significant differences (all P < 0.05). Multivariate logistic regression analysis showed that younger age (odds ratio[OR]=0.931, 95% confidence interval[CI] 0.886-0.979, P=0.005), no sICH (OR=0.069, 95% 0.008-0.628, P=0.018) and no postoperative hyperdense area on C-arm CT (OR=0.187, 95% CI 0.060-0.589, P=0.004) were independent factors in predicting good prognosis of patients with carotid artery tandem lesions after emergency endovascular treatment, and no stenting was an independent factor in predicting poor prognosis (OR=4.583, 95% CI 1.476-14.228, P=0.008).Conclusion Carotid artery stenting during the procedure of emergency endovascular treatment is safe and feasible in patients with carotid artery tandem lesions. Emergency carotid artery stenting is an independent factor in predicting good prognosis.

Abstract:Objective To evaluate the efficacy and safety of mechanical thrombectomy of intracranial artery combined with carotid stent implantation in the treatment of acute ischemic stroke caused by tandem lesions of internal carotid artery.Methods A total of 55 patients with acute ischemic stroke caused by tandem lesions of internal carotid artery treated in Department of Neurosurgery of Liaocheng People's Hospital (Brain Hospital) from Jan. 2019 to Dec. 2020 were retrospectively included. Among them, 43 patients (distal-to-proximal group) were treated with mechanical thrombectomy for the occluded lesion of intracranial artery, followed by stent implantation for the severe stenotic/occluded lesions of initial internal carotid artery, and 12 patients (proximal-to-distal group) were treated with stent implantation for the severe stenotic/occluded lesions of initial internal carotid artery, followed by mechanical thrombectomy for the occluded lesion of intracranial artery. Onset-to-puncture time, National Institutes of Health stroke scale (NIHSS) scores on admission, and 24 h and 7 d after operation, the success rate of 1-time thrombectomy during operation, puncture-to-recanalization time, rate of successful recanalization immediately after operation (modified thrombolysis in cerebral infarction grade ≥ 2b), incidence of postoperative symptomatic intracranial hemorrhage, and good prognosis (modified Rankin scale score ≤ 2) rate and mortality 90 d after operation were compared between the 2 groups.Results All patients successfully received mechanical thrombectomy of intracranial artery and stent implantation of initial internal carotid artery. The success rate of 1-time thrombectomy in the distal-to-proximal group was significantly higher than that in the proximal-to-distal group (67.4%[29/43] vs 33.3%[4/12], P < 0.05), and the puncture-to-recanalization time was significantly shorter than that in the proximal-to-distal group ([68.77±17.65] min vs[100.08±38.38] min, P < 0.05). There were no significant differences in the onset-to-puncture time, NIHSS scores on admission, 24 h and 7 d after operation, successful recanalization rate immediately after operation, incidence of postoperative symptomatic intracranial hemorrhage, or good prognosis rate and mortality 90 d after operation between the 2 groups (all P>0.05).Conclusion Mechanical thrombectomy of intracranial artery combined with carotid stent implantation is safe and effective in the treatment of acute ischemic stroke caused by tandem lesions of internal carotid artery. The distal-to-proximal strategy has a higher success rate of 1-time thrombectomy than the proximal-to-distal strategy, and can achieve successful recanalization much faster.

Abstract:Objective To evaluate the efficacy and safety of endovascular treatment for acute ischemic stroke with large vessel occlusion (AIS-LVO) in the posterior circulation.Methods The data of 82 patients with posterior circulation AIS-LVO who received endovascular treatment in Linyi People's Hospital from Dec. 2019 to Dec. 2020 were retrospectively analyzed. Vascular recanalization was evaluated by modified thrombolysis in cerebral infarction (mTICI) grade, and the mTICI grade ≥ 2b indicated successful vascular recanalization. Modified Rankin scale (mRS) was used to evaluate the prognosis 90 d after operation, and the mRS score ≤ 2 indicated good prognosis and 3-6 indicated poor prognosis. The incidence of symptomatic intracranial hemorrhage (sICH) after operation and mortality 90 d after operation were recorded. Multivariate logistic regression analysis was used to determine the independent influencing factors of the prognosis 90 d after endovascular treatment.Results Totally 71 AIS patients were included, and 61 (85.9%) of them had immediate postoperative mTICI grade ≥ 2b, including 23 grade 2b and 38 grade 3. sICH occurred in 6 (8.5%) patients after operation. Thirty (42.3%) patients had a good prognosis, 41 (57.7%) had a poor prognosis, and 20 (28.2%) died 90 d after operation. Compared with the poor prognosis group, the proportion of patients with drinking and preoperative National Institutes of Health stroke scale (NIHSS) score were significantly lower, the proportion of patients with consciousness before operation and proportion of patients with posterior communicating artery opening were significantly higher, and puncture-to-recanalization time was significantly shorter in the good prognosis group (all P < 0.05). Multivariate logistic regression analysis showed that preoperative NIHSS score (odds ratio[OR]=1.116, 95% confidence interval[CI] 1.010-1.232, P=0.030), puncture-to-recanalization time (OR=1.019, 95% CI 1.005-1.034, P=0.008) and posterior communicating artery opening (OR=0.285, 95% CI 0.103-0.787, P=0.015) were independent influencing factors for prognosis of patients with posterior circulation AIS-LVO 90 d after endovascular treatment.Conclusion Endovascular treatment is safe and effective in patients with posterior circulation AIS-LVO, and it can improve the clinical outcome of some patients.

Abstract:Objective To investigate the impact of perioperative blood pressure management on the prognosis of successful recanalization patients with anterior circulatory acute ischemic stroke with large vessel occlusion (AIS-LVO).Methods Consecutive patients with anterior circulation AIS-LVO who achieved successful recanalization (thrombolysis in cerebral infarction grade ≥ 2b) after endovascular treatment (EVT) in Neurovascular Center of our hospital from Mar. 2018 to Jun. 2019 were retrospectively enrolled. The influencing factors of good prognosis (modified Rankin scale score ≤ 2) were analyzed by univariate analysis, and the variables with P < 0.1 were included for multivariate logistic regression analysis to understand the prognostic value of mean systolic blood pressure (mSBP) in the first 24 h after EVT. According to the first 24 h mSBP after EVT, the patients were divided into 3 groups:low mSBP (100- < 120 mmHg[1 mmHg=0.133 kPa]) group, medium mSBP (120-140 mmHg) group and high mSBP (>140-160 mmHg) group. The good prognosis rate and mortality 3 months after EVT and the incidence of symptomatic intracranial hemorrhage (sICH) 24 h after EVT were compared among the 3 groups. Then the patients were divided into low to medium mSBP group (100-140 mmHg) and high mSBP group (>140-160 mmHg) for prognosis analysis.Results A total of 238 patients were included, including 161 (67.65%) with good prognosis and 77 (32.35%) with poor prognosis 3 months after EVT. The age, National Institutes of Health Stroke scale (NIHSS) scores before and 24 h after EVT, preoperative infarction core volume (brain tissue volume of cerebral blood flow < 30%) and first 24 h mSBP after EVT were significantly lower in the good prognosis group than those in the poor prognosis group, while preoperative Alberta Stroke Program early computed tomography score (ASPECTS) was significantly higher than that in the poor prognosis group (all P < 0.05). Multivariate logistic regression analysis showed that the preoperative ASPECTS (odds ratio[OR]=1.338, 95% confidence interval[CI] 1.081-1.657, P=0.007), NIHSS score 24 h after EVT (OR=0.838, 95% CI 0.785-0.894, P < 0.001) and first 24 h mSBP after EVT (OR=0.966, 95% CI 0.937-0.996, P=0.031) were independent prognostic factors. With the increase of mSBP, the mortality 3 months after EVT and the incidence of sICH 24 h after EVT were both significantly increased (P=0.001, 0.032), while the good prognosis rate 3 months after EVT was slightly decreased without significant difference (P=0.060). The good prognosis rate 3 months after EVT was significantly higher in the low to medium mSBP group than that in the high mSBP group (P=0.04), the incidence of sICH 24 h after EVT was significantly lower than that in the high mSBP group (P=0.01), while there was no significant difference in mortality 3 months after EVT between the 2 groups (P=0.19).Conclusion The mSBP in the first 24 h after EVT is an independent prognostic factor for anterior circulation AIS-LVO patients with successful recanalization. Active control of the mSBP ≤ 140 mmHg in the first 24 h after EVT is recommended, and if the risk of hemorrhagic transformation is high, it may be controlled at 120 mmHg or below.

Abstract:Objective To investigate the application and effectiveness of health management network platform in the health management of discharged stroke patients with hypertension.Methods The data of 818 acute stroke patients with hypertension treated in Neurovascular Center of our hospital from Oct. 2018 to Dec. 2020 were collected. The patients were assigned to control group or observation group. The patients in the control group received routine health management:the health risks were assessed and individualized health profiles were established during hospitalization, routine discharge instructions were given at discharge, and tailored lectures on stroke and outpatient follow-up were conducted 1, 3, 6 and 12 months after discharge. The patients in the observation group received individualized health management intervention for 12 months using the health management network platform together with the routine health management. The medication adherence, blood pressure management, life style and rehabilitation exercise were compared between the 2 groups within 12 months after discharge.Results A total of 512 stroke patients with hypertension met the inclusion and exclusion criteria, of which 488 patients completed the follow-up, including 183 patients in the control group and 305 in the observation group. There were no significant differences in gender, age or stroke risk factors between the 2 groups (all P>0.05). Compared with the control group, the management of blood pressure within 12 months after discharge was not improved in the observation group (P=0.135), but the medication adherence, life style and rehabilitation exercise were significantly improved (all P < 0.01).Conclusion As a new supporting care platform for stroke patients, health management network platform can effectively improve the quality of health management of stroke patients with hypertension after discharge.

Abstract:Objective To explore the association between perceived control and cognitive function in patients with acute ischemic stroke (AIS).Methods Convenience sampling method was used to select 437 AIS patients from Jul. to Nov. 2020. Among them, 231 patients were from Neurovascular Center, Changhai Hospital, Naval Medical University (Second Military Medical University) and 206 were from Stroke Center, Air Force Hospital of PLA Eastern Theater Command. Demographic and sociological data and AIS-related data were collected using the self-made general data and disease-related data questionnaires. Cognitive function was assessed using Montreal cognitive assessment, Changsha version. Perceived control was assessed by perceived control in health care questionnaire. The association between perceptive control and cognitive function was analyzed by hierarchical regression analysis.Results Among the 437 AIS patients, 286 (65.4%) were male and 151 (34.6%) were female, aged from 45 to 92 years, with an average age of (64.8±9.6) years. The National Institutes of Health stroke scale (NIHSS) score was 3 (1, 7) on admission, and 329 (75.3%) patients had the first onset of AIS. The average score of cognitive function of the 437 patients was 19.6±6.2, which was generally at a low level. The average score of perceived control was 78.8±22.8, which was generally at a middle level. After adjusting the severity of AIS, age, gender and education level, the analysis results of hierarchical regression model showed that perceived control was associated with cognitive function in AIS patients (β=0.11, P=0.014).Conclusion Low perceived control is an important factor related to low cognitive function in AIS patients. Improving perceived control is a potential intervention method for cognitive impairment in AIS patients.

Abstract:Objective To explore the application of case-oriented objective structured clinical examination (OSCE) in the training and assessment of stroke emergency nurses.Methods From Jun. 2018 to Jun. 2019, 71 stroke emergency nurses were enrolled in this study. The rescue ability of stroke emergency nurses in the stroke green channel was evaluated by OSCE based on practical cases, stroke emergency process and occupation ability requirements in the emergency rooms. Six stations were set up for the evaluation, including preliminary assessment of acute ischemic stroke (AIS), nursing operation, patient transfer from emergency inquiries to computed tomography (CT) room, cooperation between nurses and imaging technicians before and after CT and multi-mode CT examination, use of intravenous thrombolytic drugs, and disease observation and education in the process of intravenous thrombolysis. The score rate in each station, coefficient of difficulty and degree of distinction were calculated after the examination, and the student feedback on the examination was assessed by a questionnaire.Results The examination score of 71 stroke emergency nurses was 78.6-95.8, with an average of 82.9±3.2. The coefficient of difficulty was 0.17 and the degree of distinction was 0.36. The average score rate of the 6 stations was 86.1%, and the second station had the highest score rate (92.2%) and the fifth station had the lowest score rate (74.3%). Most examinees believed that this examination mode was in line with clinical practice (97.2%, 69/71), could reflect the clinical thinking ability (95.8%, 68/71) and the comprehensive ability (95.8%, 68/71) in AIS first aid, and was worthy of clinical promotion (98.6%, 70/71).Conclusion The case-oriented OSCE mode can objectively reflect the comprehensive ability of stroke emergency nurses in AIS first aid, and has been recognized by examinees.