Publications by authors named "Dapeng Mo"

75 Publications

Characteristics and Outcomes of the Idiopathic Intracranial Hypertension Treatment in Intrinsic and Extrinsic Stenosis: A Single-Center Experience in China.

Neurol Ther 2021 Sep 20. Epub 2021 Sep 20.

Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, the South Fourth Ring West Road, Fengtai district, Beijing, 100070, China.

Introduction: This study aimed to explore the precipitating factors and evaluate the impact of different stenosis types on treatment outcomes in patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis (VSS).

Methods: We recruited patients with IIH who presented with VSS, either intrinsic or extrinsic. We observed the clinical and laboratory findings, and we then compared the outcomes of stenting and medical treatment in different stenosis types.

Results: Among 145 patients with IIH and VSS, 59 were of the intrinsic type and 86 were of the extrinsic type. Patients in the intrinsic group were older (42 vs. 34 years old, P < 0.001) and presented with higher pre-op gradient pressure (15 mmHg vs. 12 mmHg, P < 0.001). There was no significant difference between groups regarding other precipitating factors (P > 0.05). Stenting was significantly associated with complete resolution of the headache and impaired vision both in intrinsic (adjusted OR 0.017, 95% CI 0.001-0.35, P = 0.011; adjusted OR 0.056, 95% CI 0.004-0.697, P = 0.025, respectively) and extrinsic types of stenosis (adjusted OR 0.072, 95% CI 0.015-0.343, P = 0.001; adjusted OR 0.241, 95% CI 0.062-0.931, P = 0.039, respectively). Meanwhile, stenting was significantly associated with improvement of the papilledema in extrinsic-type stenosis compared with medical treatment (adjusted OR 0.017, 95% CI 0.002-0.135, P < 0.001).

Conclusion: Stenting may provide substantial clinical improvement in patients with IIH regardless of intrinsic or extrinsic stenosis type in our patient population, as noted in other series.

Trial Registration: Clinical trial registration number ChiCTR-ONN-17010421.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40120-021-00281-0DOI Listing
September 2021

Novel Diffusion-Weighted Imaging Score Showed Good Prognostic Value for Acute Basilar Artery Occlusion Following Endovascular Treatment: The Pons-Midbrain and Thalamus Score.

Stroke 2021 Aug 30:STROKEAHA120032314. Epub 2021 Aug 30.

Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (L.L., Y.D., G.L., X.S., L.S., X.H., F.G., N.M., D.M., Z.M.).

Background And Purpose: Prognostic factors for outcome of endovascular treatment remains to be investigated in patients with acute basilar artery occlusion. We aimed to assess the prognostic value of a novel pretreatment diffusion-weighted imaging score: The Pons-Midbrain and Thalamus (PMT) score.

Methods: Eligible patients who underwent endovascular treatment due to acute basilar artery occlusion were reviewed. The PMT score was a diffusion-weighted imaging-based semiquantitative scale in which the infarctions of pons, midbrain, and thalamus were fully considered. The PMT score was assessed as well as the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score and Brain Stem Score. Good outcomes were defined as a modified Rankin Scale score of ≤3 at 90-day and successful reperfusion as Thrombolysis in Cerebral Infarction grades 2b/3. The associations between baseline clinical parameters and good outcomes were evaluated with logistic regression.

Results: A total of 107 patients with pretreatment magnetic resonance imaging were included in this cohort. The baseline PMT score (median [interquartile range], 3 [1-5] versus 7 [5-9]; <0.001) and Brain Stem Score (median [interquartile range], 2 [1-4] versus 3 [2-5]; =0.001) were significantly lower in good outcome group; the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score was higher in good outcome group without statistical significance. As a result of receiver operating characteristic curve analyses, the posterior circulation Acute Stroke Prognosis Early Computed Tomography Score showed poor prognostic accuracy for good outcome (area under the curve, 0.60 [95% CI, 0.49-0.71]; =0.081); The baseline PMT score showed significantly better prognostic accuracy for 90-day good outcome than the Brain Stem Score and National Institutes of Health Stroke Scale (area under the curve, 0.80 versus 0.68 versus 0.78, =0.003). In addition, favorable PMT score <7 (odds ratio, 22.0 [95% CI, 6.0-80.8], <0.001), Brain Stem Score <3 (odds ratio, 4.65 [95% CI, 2.05-10.55], <0.001) and baseline National Institutes of Health Stroke Scale <23 (odds ratio, 8.0 [95% CI, 2.5-25.6], <0.001) were associated with improved good outcome.

Conclusions: In patients with acute basilar artery occlusion following endovascular treatment, the pretreatment diffusion-weighted imaging based PMT score showed good prognostic value for clinical outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.120.032314DOI Listing
August 2021

Safety and Efficacy of Direct Angioplasty in Acute Basilar Artery Occlusion Due to Atherosclerosis.

Front Neurol 2021 19;12:651653. Epub 2021 Jul 19.

Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Endovascular treatment (EVT) is one of the promising treatment options in patients with intracranial atherosclerotic disease (ICAD)-related basilar artery occlusion (BAO). In this study, we compared the safety and efficacy of direct angioplasty (DA) with stent-retriever thrombectomy (SRT) with or without rescue treatment in ICAD-related BAO. We retrospectively evaluated 187 patients who underwent EVT for BAO from January 2012 to July 2018. We identified patients who underwent EVT due to ICAD-related BAO. Patients who accepted SRT with or without rescue treatment were classified into the SRT group. Patients treated with DA with or without stent placement were classified into DA group. Clinical and laboratory findings and outcomes were compared between groups. A total of 108 patients were enrolled, among them 77 underwent SRT and 31 underwent DA; 61 (79.2%) SRT group patients underwent angioplasty with or without stent placement. Compared with patients in the SRT group, those in the DA group experienced a significantly shorter procedure time [60 min (60-120 min) vs. 120 min (60-120 min); = 0.038] and a lower number of device passes [2 passes (1-2 passes) vs. 3 passes (2-4 passes); < 0.001]. No significant differences in balloon angioplasty (35.5 vs. 22.1%; = 0.150), emergent stent placement (64.5 vs. 57.1%; = 0.481), successful recanalization (93.5 vs. 85.7%; = 0.340), embolization in distal or new territory (3.2 vs. 9.1%, = 0.314), and reocclusion (22.6 vs. 9.1%; = 0.109) among DA and SRT groups were found. Additionally, no differences in symptomatic intracranial hemorrhage incidence [adjusted odds ratio (OR), 0.74; 95% CI, 0.06-9.44; = 0.815], functional independence (adjusted OR, 1.44; 95% CI, 0.50-4.16; = 0.497), and mortality rate (adjusted OR, 0.36; 95% CI, 0.06-2.04; = 0.247) were noted among groups. In certain patients with ICAD-related BAO, DA may shorten procedure time and reduce required device passes compared to SRT. In this study, DA was retrospectively found to be of similar safety and efficacy as SRT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2021.651653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8326335PMC
July 2021

Joint association of modifiable lifestyle and metabolic health status with incidence of cardiovascular disease and all-cause mortality: a prospective cohort study.

Endocrine 2021 Aug 3. Epub 2021 Aug 3.

China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Purpose: We aimed to identify the joint associations of modifiable lifestyle and metabolic factors with the incidences of cardiovascular disease and all-cause mortality.

Methods: We recruited 94,831 participants (men, 79.76%; median age, 51.60 [43.47-58.87]) without a history of cardiovascular disease from the Kailuan study during 2006 and 2007 and followed them until a cardiovascular disease event, or death occurred, or until December 31, 2017. Baseline metabolic health status was assessed using Adult Treatment Panel III criteria, and details of the lifestyles of the participants were recorded using a self-reported questionnaire. We used Cox proportional hazards models to evaluate the joint associations.

Results: During a median follow-up of 11.03 years, we recorded 6590 cardiovascular disease events and 9218 all-cause mortality. Participants with the most metabolic risk components and the least healthy lifestyle had higher risk of cardiovascular disease (hazard ratio 2.06 [95% confidence interval (CI) 1.77-2.39]) and mortality (HR 1.53 [95% CI 1.31-1.78]), than participants with fewer metabolic risk components and the healthiest lifestyle. Compared with those in participants with the healthiest lifestyle, the HRs for cardiovascular disease in participants with the least healthy lifestyle were 1.26 (95% CI 1.17-1.37), 1.16 (95% CI 1.03-1.31), and 1.07 (95% CI 0.90-1.27) for those with low, medium, and high metabolic risk, respectively.

Conclusion: Healthy lifestyle is associated with a lower risk of cardiovascular disease and there is no significant interaction between metabolic risk and a healthy lifestyle. Therefore, a healthy lifestyle should be promoted, even for people with high metabolic risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12020-021-02832-9DOI Listing
August 2021

Improvement of exhausted cerebral autoregulation in patients with idiopathic intracranial hypertension benefit of venous sinus stenting.

Physiol Meas 2021 Aug 27;42(8). Epub 2021 Aug 27.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.

To evaluate the cerebral autoregulation (CA) in idiopathic intracranial hypertension (IIH) patients with transfer function analysis, and to explore its improvement after venous sinus stenting.. In total, 15 consecutive IIH patients with venous sinus stenosis and 15 controls were recruited. All the patients underwent digital subtraction angiography and venous manometry. Venous sinus stenting was performed for IIH patients with a trans-stenosis pressure gradient ≥8 mmHg. CA was assessed before and after the operation with transfer function analysis, by using the spontaneous oscillations of the cerebral blood flow velocity in the bilateral middle cerebral artery and blood pressure.. Compared with controls, the autoregulatory parameters, phase shift and rate of recovery, were both significantly lower in IIH patients [(57.94° ± 23.22° versus 34.59° ± 24.15°, < 0.001; (39.87 ± 21.95) %/s versus (20.56 ± 46.66) %/s,= 0.045, respectively). In total, six patients with bilateral transverse or sigmoid sinus stenosis received venous sinus stenting, in whom, the phase shift significantly improved after venous sinus stenting (39.62° ± 20.26° versus 22.79° ± 19.96°, = 0.04).. The study revealed that dynamic CA was impaired in IIH patients and was improved after venous sinus stenting. CA assessment has the potential to be used for investigating the hemodynamics in IIH patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1088/1361-6579/ac172cDOI Listing
August 2021

Long-Term Outcome of Enterprise Stenting for Symptomatic ICAS in a High-Volume Stroke Center.

Front Neurol 2021 17;12:672662. Epub 2021 Jun 17.

Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

The Enterprise stent has been used for treating intracranial atherosclerotic stenosis (ICAS), but its long-term outcome remains unclear. The purpose of this study was to evaluate the long-term clinical efficacy of the Enterprise stent used for patients with symptomatic ICAS due to hypoperfusion. Patients with symptomatic ICAS due to hypoperfusion treated with the Enterprise stents from a high-volume stroke center were evaluated. The successful recanalization was defined as the Modified Thrombolysis In Cerebral Infarction (mTICI) ≥ 2b. The stroke and neurological death that occurred within 72 h after the procedure as well as long-term clinical and imaging outcomes were analyzed. Overall, 130 patients with 130 ICAS treated with the Enterprise stent were included in our study. The successful recanalization rate was 100%. The mean pre- and postprocedural stenosis was 82.9 ± 8.9% vs. 15.1 ± 8.4%. Periprocedural complications occurred in 5 (3.8%) patients within 72 h after the procedure. Clinical follow-up data were available in 125 (96.2%) patients (median, 24 months) and any stroke or neurological death was encountered in 6 (4.8%) patients. Angiographic follow-up data was obtained from 118 (90.8%) patients (median, 13.5 months). In addition, 1-year in-stent restenosis (>70%) was found in 17 (14.4%) patients, and among them, 4 (23.5%) patients were symptomatic. Deployment of Enterprise stent is safe for ICAS. The short-term and long-term outcomes were acceptable, but the efficacy of the Enterprise stent needs to be further evaluated in future studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2021.672662DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248485PMC
June 2021

Safety and Efficacy of Low-Dose Tirofiban Combined With Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischemic Stroke: A Matched-Control Analysis From a Nationwide Registry.

Front Neurol 2021 10;12:666919. Epub 2021 Jun 10.

Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Tirofiban administration to acute ischemic stroke patients undergoing mechanical thrombectomy with preceding intravenous thrombolysis remains controversial. The aim of the current study was to evaluate the safety and efficacy of low-dose tirofiban during mechanical thrombectomy in patients with preceding intravenous thrombolysis. Patients with acute ischemic stroke undergoing mechanical thrombectomy and preceding intravenous thrombolysis were derived from "ANGEL-ACT," a multicenter, prospective registry study. The patients were dichotomized into tirofiban and non-tirofiban groups based on whether tirofiban was administered. Propensity score matching was used to minimize case bias. The primary safety endpoint was symptomatic intracerebral hemorrhage (sICH), defined as an intracerebral hemorrhage (ICH) associated with clinical deterioration as determined by the Heidelberg Bleeding Classification. All ICHs and hemorrhage types were recorded. Clinical outcomes included successful recanalization, dramatic clinical improvement, functional independence, and mortality at the 3-month follow-up timepoint. Successful recanalization was defined as a modified Thrombolysis in Cerebral Ischemia score of 2b or 3. Dramatic clinical improvement at 24 h was defined as a reduction in NIH stroke score of ≥10 points compared with admission, or a score ≤1. Functional independence was defined as a Modified Rankin Scale (mRS) score of 0-2 at 3-months. The study included 201 patients, 81 in the tirofiban group and 120 in the non-tirofiban group, and each group included 68 patients after propensity score matching. Of the 201 patients, 52 (25.9%) suffered ICH, 15 (7.5%) suffered sICH, and 18 (9.0%) died within 3-months. The median mRS was 3 (0-4), 99 (49.3%) achieved functional independence. There were no statistically significant differences in safety outcomes, efficacy outcomes on successful recanalization, dramatic clinical improvement, or 3-month mRS between the tirofiban and non-tirofiban groups (all > 0.05). Similar results were obtained after propensity score matching. In acute ischemic stroke patients who underwent mechanical thrombectomy and preceding intravenous thrombolysis, low-dose tirofiban was not associated with increased risk of sICH or ICH. Further randomized clinical trials are needed to confirm the effects of tirofiban in patients undergoing bridging therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2021.666919DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225265PMC
June 2021

Cumulative Serum Uric Acid and Its Time Course Are Associated With Risk of Myocardial Infarction and All-Cause Mortality.

J Am Heart Assoc 2021 Jul 14;10(13):e020180. Epub 2021 Jun 14.

Department of Epidemiology and Health Statistics School of Public Health Capital Medical University Beijing China.

Background Serum uric acid (SUA) has been demonstrated as a risk factor for myocardial infarction (MI) and all-cause mortality; however, the impact of cumulative SUA (cumSUA) remains unclear. We aimed to investigate the association of cumSUA with MI risk and all-cause mortality, and to further explore the effects of SUA accumulation time course. Methods and Results The study enrolled 53 463 participants without a history of MI, and these participants underwent 3 examinations during 2006 to 2010. cumSUA from baseline to the third examination was calculated, multiplying mean values between consecutive examinations by time intervals between visits. Cox models estimated hazard ratios (HRs) and 95% CIs of MI and all-cause mortality for cumSUA quartiles, hyperuricemia exposure duration, and SUA accumulation time course. During a median follow-up of 7.04 years, 476 incident MIs and 2692 deaths occurred. In the fully adjusted model, a higher MI risk was observed in the highest cumSUA quartile (HR, 1.48; 95% CI, 1.10-1.99), in participants with longer hyperuricemia exposure duration (HR, 1.71; 95% CI, 1.06-2.73), and in participants with cumSUA≥median and a negative slope (HR, 1.58; 95% CI, 1.18-2.11). Similar associations persisted for all-cause mortality. Conclusions The risk of MI and all-cause mortality increased with higher cumSUA and was affected by the SUA accumulation time course. Early SUA accumulation contributed more to MI risk and all-cause mortality than later SUA accumulation with the same overall cumulative exposure, emphasizing the importance of optimal SUA control early in life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/JAHA.120.020180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403320PMC
July 2021

Thirty-Day and One-Year Outcomes of Endovascular Treatments for Severe Atherosclerotic Stenosis of Intracranial ICA: Results From a Single Center.

Front Neurol 2021 25;12:668868. Epub 2021 May 25.

Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Endovascular treatment for intracranial atherosclerotic stenosis (ICAS) has been developed. However, the intracranial internal carotid artery (ICA) presents a particular challenge due to the location and tortuous route, and the outcomes of endovascular treatment in patients with stenosis of the intracranial ICA still have not been reported. This article retrospectively investigated the 30-day and 1-year outcomes of tailored endovascular treatment for patients with severe intracranial ICA stenosis from a single center. Between June 2014 and December 2017, 96 consecutive patients with severe atherosclerotic stenosis (70-99%) of the intracranial ICA were managed with endovascular treatment in Beijing Tiantan Hospital. Three different kinds of treatments [angioplasty with balloon dilatation alone (BD group), balloon-mounted stent (BMS group), and self-expanding stent (SES group)] were performed according to the characteristics of the lesions. The primary endpoints included any stroke or death within 30 days and ipsilateral ischemic stroke afterwards within 1 year. Secondary endpoints included the revascularization success rate (residual stenosis <30%) and the restenosis rate (stenosis ≥ 50%) within 1 year. The 30-day death rate was 0, and the stroke rate of all patients was 7.3% (7/96). The stroke rate was higher in the BD group (15.8%) and SES group (9.8%) than in the BMS group (0%) ( = 0.047). Thirteen (13.5%) patients suffered at least one onset of ischemic stroke in the ipsilateral ICA territory within 1 year, and there was no significant difference among the three groups ( = 0.165). The overall revascularization success rate was 93.8%, and the revascularization success rate was significantly higher in the SES group (100%) than in the BD group (78.9%) ( = 0.006). The restenosis rate of all patients within 12 months was 20.8%, and there was no significant difference among the three groups. Patients with Mori type C target lesions were more likely to suffer stroke within 30 days (25%) and restenosis within 1 year (31.3%). Both the 30-day and 1-year outcomes of tailored endovascular treatments seemed to be acceptable in the treatment of symptomatic atherosclerotic stenosis of the intracranial ICA. However, this needs to be confirmed by further investigation, preferably in large multicenter randomized controlled clinical trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2021.668868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185297PMC
May 2021

Safety and efficacy of oral antiplatelet for patients who had acute ischaemic stroke undergoing endovascular therapy.

Stroke Vasc Neurol 2020 Nov 11. Epub 2020 Nov 11.

Neurointervention center, Beijing Tiantan Hospital, Beijing, China

Background And Purpose: To investigate the safety and efficacy of oral antiplatelet therapy (APT) for patients who had acute ischaemic stroke (AIS), receiving endovascular therapy (EVT).

Methods: Patients were divided into non-APT group and APT (single APT or dual APT (DAPT)) group. The safety and efficacy endpoints at 3-month follow-up were symptomatic intracranial haemorrhage (sICH), recanalisation rate, clinical outcome and mortality.

Results: Among 915 patients who had AIS, those in APT group (n=199) showed shorter puncture-to-recanalisation time, lower frequency of intravenous thrombolysis and more use of tirofiban compared with those in non-antiplatelet group (n=716) (p<0.05 for all). Oral APT was found to be associated with superior clinical outcome compared with non-APT (APT (44.2%) versus non-APT (41.1%)), adjusted OR=2.605, 95% CI 1.244 to 5.455, p=0.011). DAPT showed superior clinical outcome compared with non-APT (DAPT (56.5%) versus non-APT (41.1%), adjusted OR=5.405, 95% CI 1.614 to 18.102, p=0.006) and lower risk of mortality at 3-month follow-up (DAPT (4.8%) versus non-DAPT (17.7%), adjusted OR=0.008, 95% CI 0.000 to 0.441, p=0.019). There was no significant difference in sICH between the two groups.

Conclusions: Oral APT prior to undergoing EVT is safe and may accompany with superior clinical outcomes. DAPT may associate with superior clinical outcomes and lower risk of mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/svn-2020-000466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258061PMC
November 2020

Influence of coronavirus disease 2019 (COVID-19) on working flow, safety and efficacy outcome of mechanical thrombectomy for acute ischemic stroke with large vessel occlusion.

Interv Neuroradiol 2021 May 18:15910199211018093. Epub 2021 May 18.

NeuroIntervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Aim: The epidemic of COVID-19 has greatly affect the world health care system, particular measures have been taken not only to provide safety for health care providers but also to maintain the treatment quality. We evaluate the effect of COVID-19 epidemic to acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) received endovascular treatment (EVT) in our institution.

Methods: AIS patients with LVO who underwent EVT in the period of January 1st to April 30th between 2015 and 2020 from our stroke center. The baseline characteristics, working flow time, safety and efficacy outcome and the hospitalization status were retrospectively reviewed, compared and analyzed.

Results: There is significant decline in the number of AIS patients with LVO treated compared with the previous year (36 Vs 72 patients) during the epidemic period. The door to puncture time was significantly prolong (225 minutes versus 115 minutes) as well as the length of hospital stay with increase of the hospitalization costs ( < 0.05 for all). There is no significant difference on the safety and efficacy outcome, such recanalization rate, incidence of intracranial hemorrhage, functional independence and mortality during the epidemic ( > 0.05 for all).

Conclusions: Prolongation of the working time flow during the COVID-19 epidemic did not influence the safety and efficacy of EVT in AIS patients with LVO. However, special policy and particular measures in this circumstances is still need to evolve to improve the treatment quality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/15910199211018093DOI Listing
May 2021

Current status of aspiration thrombectomy for acute stroke patients in China: data from ANGEL-ACT Registry.

Ther Adv Neurol Disord 2021 12;14:17562864211007715. Epub 2021 Apr 12.

Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.

Background And Aims: Although noninferior to stent retriever (SR) as first-line approach for endovascular treatment (EVT) of acute large vessel occlusion (LVO) stroke, little is known about the current status of direct aspiration (DA) as first-line thrombectomy in China. This analysis of a prospective, nationwide registry (ANGEL-ACT) aimed to investigate the prevalence and comparative effectiveness of DA-first thrombectomy in a real-world practice in China.

Methods: All patients receiving thrombectomy were screened from a prospective cohort of LVO patients undergoing EVT at 111 hospitals in China between November 2017 and March 2019, and divided into two groups based upon which type of thrombectomy was attempted first ("DA-first" and "SR-first"). The following outcome measures were compared using logistic regression models with adjustment: successful recanalization after first-device alone and all procedures, use of rescue treatment, intracranial hemorrhage (ICH) within 24 h, and modified Rankin Scale (mRS) score at 90 days.

Results: A total of 1225 patients, 102 (8.3%) in DA-first group and 1123 (91.7%) in SR-first group, were included. Patients receiving DA-first had less often successful recanalization after first-device alone [30.4 66.4%; odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.15-0.37], more frequent rescue treatment (62.8 27.0%; OR = 4.55, 95% CI = 2.92-7.08) and ICH (35.4 22.1%; OR = 1.78, 95% CI = 1.12-2.83) than those receiving SR-first; however, no significant difference was found in successful recanalization after all procedures (84.3 90.3%;  = 0.18) and 90-day mRS (median: 3 3 points;  = 0.90) between both groups.

Conclusion: This real-world registry suggested that DA-first thrombectomy for acute stroke patients lagged behind in China during the study period. Far fewer DA-first than SR-first thrombectomies were performed, and DA-first was associated with lower first-device recanalization, more frequently requiring rescue treatment, and increased ICH risk.

Clinical Trial Registration: ClinicalTrials.gov, NCT03370939.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/17562864211007715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047968PMC
April 2021

Design and validation of a recognition instrument-the stroke aid for emergency scale-to predict large vessel occlusion stroke.

Aging (Albany NY) 2021 04 26;13(10):13680-13692. Epub 2021 Apr 26.

Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.

Background And Purpose: Rapidly recognizing patients with large-vessel occlusion stroke (LVOS) and transferring them to a center offering recanalization therapy is crucial of maximizing the benefits of early treatment. We therefore aimed to design an easy-to-use recognition instrument for identifying LVOS.

Methods: Prospective data were collected from emergency departments of 12 stroke-center hospitals in China during a 17-month study period. The Stroke Aid for Emergency (SAFE) scale is based on consciousness commands, facial palsy, gaze, and arm motor ability. Receiver operating characteristic analysis was used to obtain the area under the curve for the SAFE scale and previously established scales to predict LVOS.

Results: The SAFE scale could accurately predict LVOS at an accuracy rate comparable to that of the National Institutes of Health Stroke Scale (c-statistics: 0.823 versus 0.831, p = 0.4798). The sensitivity, specificity, positive predictive value, and negative predictive value for the SAFE scale were 0.6875, 0.8577, 0.6937, and 0.8542, respectively, with a cutoff point of 4. The SAFE scale also performed well in a subgroup analysis based on the patients' ages, occluded vessel locations, and the onset-to-door times.

Conclusions: The SAFE scale can accurately recognize LVOS at a rate comparable to those of other, similar scales.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18632/aging.202910DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202851PMC
April 2021

SOX9 Knockdown-Mediated FOXO3 Downregulation Confers Neuroprotection Against Ischemic Brain Injury.

Front Cell Dev Biol 2020 12;8:555175. Epub 2021 Mar 12.

Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Background: Evidence exists uncovering that SRY-box transcription factor 9 (SOX9) plays a role in ischemic brain injury (IBI). Thus, the current study was conducted to elucidate the specific role of SOX9 and the mechanism by which SOX9 influenced IBI.

Methods: The IBI-associated regulatory factors were searched by bioinformatics analysis. The rat model of IBI was generated using middle cerebral artery occlusion (MCAO) treatment. Neuronal cells were exposed to oxygen-glucose deprivation (OGD). The expressions of SOX9, forkhead box O3 (FOXO3), transcription of Cbp/p300-interacting transactivator with Glu/Asp-rich carboxy-terminal domain 2 (CITED2), and IκB kinase α (IKKα) in OGD-treated neuronal cells were characterized using reverse transcription quantitative polymerase chain reaction (RT-qPCR) assay. The interaction among CITED2, IKKα, and FOXO3 was identified by chromatin immunoprecipitation (ChIP) and dual luciferase reporter gene assays. Gain- and loss-of-function experiments were performed to verify the relationship among SOX9, FOXO3, CITED2, and IKKα and to investigate their functional effects on apoptosis and the inflammatory response of OGD-treated neuronal cells as well as neurological deficit and infarct area of the rat brain.

Results: SOX9, FOXO3, CITED2, and IKKα were highly expressed in OGD-treated neuronal cells. Silencing of SOX9 inhibited OGD-induced neuronal apoptosis and inflammatory response and reduced the neurological deficit and infarct area of the brain in the rats, which were caused by MCAO but were reversed by overexpressing FOXO3, CITED2, or IKKα.

Conclusion: Taken together, our study suggested that upregulation of SOX9 promoted IBI though upregulation of the FOXO3/CITED2/IKKα axis, highlighting a basic therapeutic consideration for IBI treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fcell.2020.555175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006459PMC
March 2021

Baseline and change in serum uric acid predict the progression from prehypertension to hypertension: a prospective cohort study.

J Hum Hypertens 2021 Mar 23. Epub 2021 Mar 23.

Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.

Evidence is lacking about the role of serum uric acid (SUA) in the progression from prehypertension to hypertension. Herein, we aimed to investigate the association of both baseline and dynamic change in SUA with the risk of hypertension developing from prehypertension. The study enrolled 11,488 participants with prehypertension during 2006-2010 from the Kailuan study. Change in SUA was assessed as % change of SUA from 2006 (baseline) to 2010. Participants were categorized into four groups by quartiles of baseline and change in SUA, separately. Multivariable logistic regressions were used to calculation the odds ratio (OR) and 95% confidence interval (CI). During a median follow-up of 7.06 years, 2716 (23.64%) participants developed hypertension from prehypertension. In the multivariable-adjusted model, the OR for hypertension comparing participants in the highest versus the lowest quartile of baseline SUA were 1.18 (95% CI, 1.02-1.36). Increased SUA over time was also associated with elevated risk of hypertension (OR in the highest quartile was 1.41 [95% CI, 1.23-1.62] versus the lowest quartile), especially in those with baseline SUA ≥ median (OR, 1.48; 95% CI, 1.21-1.81). Moreover, the addition of SUA to a conventional risk model had an incremental effect on the predictive value for hypertension (integrated discrimination improvement 0.30%, P < 0.0001; category-free net reclassification improvement 12.36%, P < 0.0001). Both high initial SUA and increased SUA over time can independently predict the progression from prehypertension to hypertension. Strategies aiming at controlling SUA level in prehypertensive subjects may impede the onset of hypertension.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41371-021-00522-7DOI Listing
March 2021

Thrombectomy Versus Combined Thrombolysis and Thrombectomy in Patients With Acute Stroke: A Matched-Control Study.

Stroke 2021 May 4;52(5):1589-1600. Epub 2021 Mar 4.

Department of Interventional Neuroradiology (X.T., B.J., X.Z., X.H., G.L., N.M., F.G., D.M., L.S., X.S., L.L., Y.D., X.L., B.W., G.M., Z.M.), Beijing Tiantan Hospital, Capital Medical University, China.

[Figure: see text].
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.120.031599DOI Listing
May 2021

Safety and Efficacy of Tirofiban for Acute Ischemic Stroke Patients With Large Artery Atherosclerosis Stroke Etiology Undergoing Endovascular Therapy.

Front Neurol 2021 11;12:630301. Epub 2021 Feb 11.

Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

To investigate the safety and efficacy of tirofiban in acute ischemic stroke (AIS) patients with large artery atherosclerosis (LAA) stroke etiology receiving endovascular therapy (EVT). In this multi-center prospective study, patients who were considered to have an indication received a low dose intra-arterial bolus (0.25-1 mg) of tirofiban. The safety and efficacy outcomes at 90-day follow-ups included symptomatic intracranial hemorrhage (sICH), recanalization rate, functional outcome, and mortality. Among the 649 AIS patients with LAA, those in the tirofiban group ( = 244) showed higher systolic blood pressure (BP) and NIHSS score on admission, puncture-to-recanalization time, lower frequency of intravenous thrombolysis and intra-arterial thrombolysis, higher frequency of antiplatelet, heparinization, mechanical stent retrieval, aspiration, balloon angioplasty, and more retrieval times compared with those in the non-tirofiban group ( = 405) (all < ). Tirofiban was found to be associated with superior clinical outcomes in anterior circulation stroke and major stroke patients [adjusted odds ratio (OR) = 2.163, 95% confidence interval (CI) = 1.130-4.140, = and adjusted OR = 2.361, 95% CI = 1.326-4.202, = , respectively] and a lower risk of mortality at 90-day follow-ups (adjusted OR = 0.159, 95% CI = 0.042-0.599, = and adjusted OR = 0.252, 95% CI = 0.103-0.621, = , respectively). There was no significant difference in sICH between the two groups. Tirofiban in AIS patients with LAA undergoing EVT is safe and may benefit the functional outcomes in anterior circulation and major stroke patients and showed a trend for reduced mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2021.630301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905208PMC
February 2021

Current Status of Endovascular Treatment for Acute Large Vessel Occlusion in China: A Real-World Nationwide Registry.

Stroke 2021 Apr 18;52(4):1203-1212. Epub 2021 Feb 18.

Department of Neurology, Hubei Third People's Hospital, China (X.P.).

Background And Purpose: The benefit of endovascular treatment (EVT) for large vessel occlusion in clinical practice in developing countries like China needs to be confirmed. The aim of the study was to determine whether the benefit of EVT for acute ischemic stroke in randomized trials could be generalized to clinical practice in Chinese population.

Methods: We conducted a prospective registry of EVT at 111 centers in China. Patients with acute ischemic stroke caused by imaging-confirmed intracranial large vessel occlusion and receiving EVT were included. The primary outcome was functional independence at 90 days defined as a modified Rankin Scale score of 0 to 2. Outcomes of specific subgroups in the anterior circulation were reported and logistic regression was performed to predict the primary outcome.

Results: Among the 1793 enrolled patients, 1396 (77.9%) had anterior circulation large vessel occlusion (median age, 66 [56-73] years) and 397 (22.1%) had posterior circulation large vessel occlusion (median age, 64 [55-72] years). Functional independence at 90 days was reached in 45% and 44% in anterior and posterior circulation groups, respectively. For anterior circulation population, underlying intracranial atherosclerotic disease was identified in 29% of patients, with higher functional independence at 90 days (52% versus 44%; =0.0122) than patients without intracranial atherosclerotic disease. In the anterior circulation population, after adjusting for baseline characteristics, procedure details, and early outcomes, the independent predictors for functional independence at 90 days were age <66 years (odds ratio [OR], 1.733 [95% CI, 1.213-2.476]), time from onset to puncture >6 hours (OR, 1.536 [95% CI, 1.065-2.216]), local anesthesia (OR, 2.194 [95% CI, 1.325-3.633]), final modified Thrombolysis in Cerebral Infarction 2b/3 (OR, 2.052 [95% CI, 1.085-3.878]), puncture-to-reperfusion time ≤1.5 hours (OR, 1.628 [95% CI, 1.098-2.413]), and National Institutes of Health Stroke Scale score 24 hours after the procedure <11 (OR, 9.126 [95% CI, 6.222-13.385]).

Conclusions: Despite distinct characteristics in the Chinese population, favorable outcome of EVT can be achieved in clinical practice in China. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03370939.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.120.031869DOI Listing
April 2021

Impact of the Perioperative Blood Pressure on Clinical Outcome after Thrombectomy in Acute Basilar Artery Occlusion.

J Stroke Cerebrovasc Dis 2021 Mar 9;30(3):105590. Epub 2021 Jan 9.

Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China. Electronic address:

Aim: Optimal blood pressure (BP) management in vertebrobasilar circulation stroke patients undergoing thrombectomy remains undetermined. We aimed to evaluate the impact of perioperative BP on clinical outcome after MT in acute basilar artery occlusion (BAO) patients.

Methods: We retrospectively analyzed all consecutive patients hospitalized with acute basilar artery occlusion administered endovascular treatment within 24 h from January 2012 to July 2018 in Beijing Tiantan Hospital. BP was measured at regular intervals during the first 24 h after stroke onset, during and after thrombectomy. The clinical outcomes assessed at 3-month follow up were functional independence (mRS score of 0-2) and mortality (mRS score of 6).

Results: Of the 187 treated patients, 157 were male; patient ages were 60±10 years. The median NIHSS on admission was 22. Totally in 179 patients had complete BP level assessment. In these individuals, univariate analysis revealed significant associations of postoperative Max SBP and Max MAP with mortality (all P < 0.05). Multivariate regression analysis also demonstrated that postoperative Max SBP (OR=0.964, 95% CI 0.941 to 0.987, P < 0.003) and Max MAP (OR=0.942, 95% CI 0.907 to 0.979, P < 0.002) were independent predictors of mortality.

Conclusions: In acute BAO patients administered thrombectomy, Max SBP between 120 and 160 mmHg may be associated with better outcome, with a trend of reduced risk of mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105590DOI Listing
March 2021

Clinical application values of neutrophil-to-lymphocyte ratio in intracranial aneurysms.

Aging (Albany NY) 2021 02 1;13(4):5250-5262. Epub 2021 Feb 1.

Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.

Inflammation plays an important role in the pathogenesis and growth of intracranial aneurysms (IAs). We investigated the clinical value of the neutrophil-to-lymphocyte ratio (NLR) as a marker of systemic subclinical inflammation in patients with IAs. Consecutive patients with IAs who underwent endovascular treatment (EVT) were enrolled in the study. The evaluation indicators were aneurysm size and rupture, a poor outcome at 3 to 6 months, and delayed cerebral ischemia (DCI) during hospitalization. In total, 532 patients with IAs underwent EVT (mean age, 54.0 years; 62.4% female). Among patients with ruptured IAs, those with a higher NLR had an increased risk of a poor outcome at 3 to 6 months and DCI during hospitalization than those with a lower NLR. A higher NLR was significantly more strongly associated with the size of unruptured aneurysms and aneurysm rupture than a lower NLR. The NLR and C-reactive protein concentration showed similar predictive ability for aneurysm size and treatment prognosis. The NLR was lower at discharge than admission for patients with ruptured IAs and DCI. An elevated NLR was significantly associated with the size of unruptured IAs, an increased risk of a poor outcome, and DCI in patients with ruptured IAs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18632/aging.202445DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7950281PMC
February 2021

Early Neurological Deterioration Despite Recanalization in Basilar Artery Occlusion Treated by Endovascular Therapy.

Front Neurol 2020 19;11:592003. Epub 2020 Nov 19.

Department of Neurology, Peking University Shougang Hospital, Beijing, China.

We aim to identify the risk factors of early neurological deterioration (END) despite successful recanalization and explore the association of END with 90-day outcomes in acute basilar artery occlusion (BAO) treated by endovascular therapy (EVT). A prospectively registered consecutive cohort of BAO patients with successful recanalization by EVT in a tertiary stroke center during a 6-year period was reviewed. END was defined as an National Institutes of Health Stroke Scale (NIHSS) score increase ≥4 points, or death, from baseline to 24 h after EVT. Multivariate logistic regression analysis was used to identify the risk factors of END. The 90-day outcomes between END and non-END groups were compared by Pearson's χ test. END was observed in 21 of 148 patients included in this study. Multivariate logistic regression analysis showed that patients with progressive or fluctuating symptoms had a higher risk of END than those with symptoms of acute attack (OR 5.52, 95% CI 1.73-17.63), and NIHSS score and puncture-to-recanalization time (PTR), as continuous variables, were also significantly associated with END. Using a generalized additive model with spline smoothing function, we observed a linear relationship between PTR (increased by 1 h) and END (OR 2.57, 95% CI 1.45-4.57), and a non-linear relationship between NIHSS score and END. Only when the NIHSS score was ≥23 points was it related to END (OR 0.7, 95% CI 0.6-0.9). In addition, patients with END had a lower proportion of 90-day favorable outcome (19.0 vs. 59.1%, < 0.01) and higher mortality (33.3 vs. 13.4%, = 0.048) than those with non-END. Mode of stroke onset, NIHSS score, and PTR may help to identify BAO patients with a higher risk of END after EVT. Moreover, END may affect the 90-day outcomes of these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2020.592003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7710936PMC
November 2020

Balloon-mounted stenting for ICAS in a multicenter registry study in China: a comparison with the WEAVE/WOVEN trial.

J Neurointerv Surg 2021 Oct 11;13(10):894-899. Epub 2020 Dec 11.

China National Clinical Research Center for Neurological Diseases, Beijing, China

Background: The outcome of deploying balloon-mounted stents for symptomatic intracranial atherosclerotic stenosis (ICAS) has not been fully investigated. In this study we evaluate the safety and long-term outcome of using balloon-mounted stents to treat symptomatic ICAS in comparison with the WEAVE/WOVEN study.

Methods: In a multicenter registry study of stenting for symptomatic intracranial artery stenosis in China, 159 patients treated with an intracranial balloon-mounted stent approved by the China Food and Drug Administration were evaluated. The morphological features of the lesions were categorized by Mori classification. The endpoints, including periprocedural and long-term clinical and radiological outcomes, were the same as those in the WEAVE/WOVEN study.

Results: In the present study the mean percent stenosis before and after stenting was 84.0% and 6.1%, respectively. The proportions of Mori A, Mori B, and Mori C lesions were 33.3%, 52.2%, and 14.5%, respectively. The 72-hour rates of stroke and mortality after the procedure were 0%. The 1-year rates of any stroke, ischemic stroke, hemorrhagic stroke, and death were 6.3% (10/159), 5.7% (9/159), 0.6% (1/159), and 0.6% (1/159), respectively. The 1-year rate of in-stent restenosis (ISR) was 23.4% (15/64). The rate of ISR in Mori C lesions (53.8%, 7/13) was significantly higher than that in Mori A (15.8%, 3/19) or Mori B lesions (15.6%, 5/32) (p=0.024).

Conclusions: The short-term and long-term outcomes of using a balloon-mounted stent for symptomatic ICAS with focal and non-angular lesions (Mori A and B type) and smooth arterial access were comparable to the results of the WEAVE/WOVEN trial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/neurintsurg-2020-016658DOI Listing
October 2021

Risk of Recurrence of Symptomatic Intracranial Atherosclerosis in Posterior Circulation Seen to Be Higher Than That in Anterior Circulation in Long-Term Follow-Up.

Front Neurol 2020 6;11:574926. Epub 2020 Nov 6.

Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Intracranial atherosclerotic stenosis (ICAS) is an important cause of ischemic stroke. In Asians, intracranial atherosclerotic disease leads to 33-50% of ischemic events. At present, treatment with medication vs. endovascular therapy (EVT) for symptomatic ICAS (sICAS) patients is still debatable. The clinical prognosis of patients who are not completely free of stroke symptoms despite regular medication and are not eligible for EVT for various reasons, is not yet investigated. To report the long-term recurrence rate of stroke in a cohort of symptomatic ICAS patients who intended to undergo EVT upon admission but could not for various reasons after digital subtraction angiography (DSA) evaluation. This is a retrospective analysis of consecutive sICAS patients in a single center from January 1, 2016 to August 31, 2017 who underwent DSA assessment alone and were not eligible for further EVT. Demographic information, risk factors related to cerebrovascular disease, clinical comorbidities, medication, imaging data, and long-term outcomes were reported. A total of 218 patients were included in the study; 42 (19.2%) patients had recurrence of stroke/transient ischemic attack (TIA) at the 1-year follow up. Patients were divided into two groups according to lesions in anterior circulation ( = 120) or posterior circulation ( = 98). There was a higher stroke/TIA recurrence rate in the posterior circulation than anterior circulation group (25.5 vs. 14.2%, = 0.035). Given the advanced age, higher prevalence of coronary heart disease, larger stenosis length, and poorer collateral circulation, the posterior circulation group showed a higher risk of recurrent stroke/TIA and death than the anterior circulation group [HR = 3.092, 95% CI (1.335-7.164), = 0.0084], after adjusting for all confounding factors in the COX regression model. Kaplan-Meier analysis showed that sICAS recurrence and mortality risk in the posterior circulation group was consistently higher than that in the anterior circulation group (log-rank-test, = 0.033). Patients with posterior circulation sICAS have higher recurrence risk than those with anterior circulation managed with medication alone. Further, posterior circulation lesion is an independent risk factor for recurrence in sICAS patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2020.574926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677522PMC
November 2020

Staged angioplasty versus regular carotid artery stenting in patients with carotid artery stenosis at high risk of hyperperfusion: a randomised clinical trial.

Stroke Vasc Neurol 2021 Mar 24;6(1):95-102. Epub 2020 Sep 24.

Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China

Background And Purpose: Hyperperfusion (HP) is a devastating complication associated with carotid artery stenting (CAS) or endarterectomy. The efficacy and safety of staged angioplasty (SAP) in patients with CAS at high risk of HP remains unclear. We sought to determine whether SAP is superior to regular CAS in patients with high risk of HP.

Methods: A randomised, multicentre open-label clinical trial with blinded outcome assessment (STEP) was conducted. Patients with severe carotid stenosis at high risk of HP were randomly assigned (1:1) to the SAP or regular CAS group. The primary endpoint was hyperperfusion syndrome (HPS) and intracerebral haemorrhage (ICH) within 30 days after the procedure.

Results: From November 2014 to January 2017, a total of 64 patients were enrolled in 11 centres. 33 patients were allocated to the SAP group and 31 to the regular CAS group. At 30 days, the rate of primary endpoint was 0.0% (0/33) in the SAP group and 9.7% (3/31) in the regular CAS group (absolute risk reduction (ARR), 9.7%; 95% CI -20.1% to 0.7%; p=0.11). As one of the secondary endpoints, the incidence of HP phenomenon (HPP) was lower in the SAP group than the regular CAS group (0.0% vs 22.6%, ARR,-22.6%; 95% CI -36.8% to -10.2%; p=0.04).

Conclusion: The rate of HPS and ICH was not significantly lower in SAP group; the extended secondary endpoint of HPP, however, significantly reduced, which suggested that SAP may be a safe and effective carotid revascularisation procedure to prevent HP.

Trial Registration Number: NCT02224209.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/svn-2020-000391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005890PMC
March 2021

Predictors of Futile Recanalization After Endovascular Treatment in Patients with Acute Ischemic Stroke in a Multicenter Registry Study.

J Stroke Cerebrovasc Dis 2020 Oct 30;29(10):105067. Epub 2020 Jul 30.

Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 009, West Road, the South Fourth Ring Road, Fengtai District Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; China National Clinical Research Center for Neurological Diseases Center of Stroke, Beijing, China; Beijing Institute for Brain Disorders, Beijing, China. Electronic address:

Background: Futile recanalization, defined as the early recanalization of an occluded artery failing to improve neurological outcome, remains a persistent concern in the endovascular treatment of acute ischemic stroke. We investigated the occurrence and predictors of futile recanalization after endovascular treatment in a nationwide multicenter stroke registry study.

Methods: The subjects consisted of eligible patients from the Acute Ischemic Stroke Cooperation Group of Endovascular Treatment registry study (2015-2017). Subjects with acute anterior large vessel occlusion who achieved successful angiographic recanalization (defined as modified Thrombolysis in Cerebral Infarction grades 2b or 3) by endovascular treatment were dichotomized into the futile-recanalization group (with a modified Rankin Scale score of 3-6) and the favorable-recanalization group (with a modified Rankin Scale score of 0-2) according to 90-day functional independence. Logistic regression analysis was performed to investigate predictors of futile recanalization.

Results: Futile recanalization was observed in 200 (49.6%) out of 403 patients. On multivariate analysis, older age (>74 vs. ≤74; odds ratio (OR), 2.41; 95% confidence interval (CI), 1.31-4.44; P=0.005), high baseline National Institutes of Health Stroke Scale score (>21 vs. ≤13; OR, 2.52; 95% CI, 1.21-5.28; P=0.014), delayed puncture to recanalization time (>80 vs. ≤80 min; OR, 2.75; 95% CI, 1.67-4.51; P=0.000), and the use of general anesthesia (OR, 1.90; 95% CI, 1.15-3.14; P=0.012) were positively associated with futile recanalization after mechanical thrombectomy.

Conclusions: The incidence of futile recanalization is common following endovascular treatment among Asian patients with anterior circulation occlusion. Advanced age, higher baseline National Institutes of Health Stroke Scale score, delayed puncture to reperfusion, and the use of general anesthesia are associated with lower functional independence 90 days post-treatment despite successful recanalization.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105067DOI Listing
October 2020

A Novel Endovascular Technique for Recanalization of Carotid Artery Chronic Total Occlusion: Staged Carotid Angioplasty and Stenting.

J Stroke Cerebrovasc Dis 2020 Oct 16;29(10):105131. Epub 2020 Jul 16.

Department of NeuroIntervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China. Electronic address:

Aim: Symptomatic carotid artery chronic total occlusion (SCACTO) can lead to neurocognitive function decline and carries a high risk or recurrent stroke. The treatment option is limited, endovascular intervention may be an alternative treatment but still controversial. To our knowledge, the staged carotid angioplasty and stenting (SCAS) did not previously reported. The purpose of this study was to report our experiences in this novel technique.

Methods: In 2017-2018, we attempted the staged carotid angioplasty and stenting (SCAS) approach in 13 patients who received SCACTO treatment. The SCAS approach involves two stages of intervention. The first stage involves initial recanalization and initial small-sized balloon angioplasty. The second stage, which is performed 4-6 weeks later, involves angioplasty and carotid stent placement.

Results: The success rate of SCAS was 76.9%. At the second stage, the lumen remained patent in all the patients. The mean spontaneous increase in lumen diameter after 4-6 weeks was 51.7%. The median length of the stent was 4.0 cm, and the median number of stents used was 1. One patient had a complication of dissection, with a complication rate of 7.6%.

Conclusions: SCAS is a novel technique in the endovascular treatment of SCACTO. It is a feasible and safe approach that could reduce the complication rate and number of carotid stents needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105131DOI Listing
October 2020

Endovascular Recanalization for Nonacute Intracranial Vertebral Artery Occlusion According to a New Classification.

Stroke 2020 11 25;51(11):3340-3343. Epub 2020 Aug 25.

Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China (F.G., X.S., N.M., D.M., Z.M.).

Background And Purpose: Endovascular recanalization for patients with nonacute intracranial vertebral artery occlusion remains clinically challenging. We aim to evaluate the feasibility and safety of endovascular recanalization for nonacute intracranial vertebral artery occlusion and propose a new angiographic classification.

Methods: Fifty patients with symptomatic atherosclerotic nonacute intracranial vertebral artery occlusion from January 2015 to December 2019 were analyzed, retrospectively. The rate of recanalization, peri-procedural complications, and follow-up results were evaluated. All patients were divided into 4 groups according to an angiographic classification.

Results: Among the 50 patients, 38 (76%) achieved successful recanalization. Any stroke or death within 30 days was 4% (2/50). From type I to type IV, the recanalization rate gradually decreased (94.1%, 76.9%, 70%, and 50%, respectively, =0.012), while the perioperative complication rate gradually increased (0.0%, 7.7%, 20%, and 50%, respectively, =0.001).

Conclusions: Endovascular recanalization may be feasible and safe for carefully selected patients with symptomatic atherosclerotic nonacute intracranial vertebral artery occlusion and, therefore, represents an alternative treatment, especially for type I and type II patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.120.030440DOI Listing
November 2020

Safety and Efficacy of Tirofiban During Mechanical Thrombectomy for Stroke Patients with Preceding Intravenous Thrombolysis.

Clin Interv Aging 2020 23;15:1241-1248. Epub 2020 Jul 23.

Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.

Purpose: Whether tirofiban is safe and effective for acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) with preceding intravenous thrombolysis (IVT) remains unclear. We aim to evaluate the safety and efficacy of tirofiban during MT for patients with preceding IVT.

Patients And Methods: Patients who underwent MT and preceding IVT were derived from the ANGEL registry and were dichotomized into tirofiban and non-tirofiban group according to whether rescue tirofiban was performed. The safety endpoints were sICH, total ICH and distal embolization. The efficacy endpoints were arterial recanalization, three-month functional independence (modified Rankin Scale [mRS]: 0-2) and mortality.

Results: We included 207 MT patients with preceding IVT from the entire registry. Among them, there were 55 in tirofiban group and 152 in non-tirofiban group, and 17 (8.2%) patients suffered sICH and 36 (17.4%) suffered ICH within 24 hours post-MT; 11 (5.3%) distal embolization of thrombus; 111 (53.6%) achieved functional independence and 34 (16.4%) died after three-month follow-up. No significant differences in safety outcomes on sICH, ICH and distal embolization of thrombus and efficacy outcomes on recanalization and long-term functional independence were found between tirofiban and non-tirofiban group for the entire cohort (p>0.05 for all groups). Tirofiban was correlated with long-term mortality reduction for patients underwent MT and preceding IVT (adjusted hazard ratio 0.28 [0.08-0.94], adjusted p=0.03).

Conclusion: In AIS patients who underwent MT and preceding IVT, rescue tirofiban was not correlated with increased risk of safety endpoints on sICH, ICH or distal embolization of thrombus, and might be associated with a lower risk of long-term mortality. Further study is needed to confirm the effect of early antiplatelet therapy with tirofiban for patients underwent MT and preceding IVT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/CIA.S238769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398880PMC
December 2020

Altered Granger Causal Connectivity of Resting-State Neural Networks in Patients With Leukoaraiosis-Associated Cognitive Impairment-A Cross-Sectional Study.

Front Neurol 2020 10;11:457. Epub 2020 Jun 10.

Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.

The purpose of this study was to provide an imaging reference for the measurement of disease progression, as well as to reveal the pathogenesis of leukoaraiosis (LA). Eighty-seven subjects were divided into three groups: LA patients with vascular dementia (LA-VaD) (20 subjects: 14 female, 6 male), LA patients with vascular cognitive impairment nondementia (LA-VCIND) (32 subjects: 14 male, 18 female), and normal controls (NC) (35 subjects: 14 male, 21 female). A multivariate Granger causality analysis (mGCA) was applied to the resting-state networks (RSNs) to evaluate the possible effective connectivity within the resting-state networks retrieved by independent component analysis (ICA) from resting-state functional magnetic resonance imaging (rs-fMRI) data. Ten RSNs were identified: the primary visual network, secondary visual network, auditory network, sensorimotor network, anterior default mode network, posterior default mode network, salience network, dorsal attention network, left working memory network, and the right working memory network. Using independent component analysis, significant average scores were found in the anterior default mode network, salience network, dorsal attention network, and right working memory network between LA-VAD and NC groups. The functional connectivity (FC) strength of the networks was different between the NC, LA-VCIND, and LA-VaD groups. Effective connectivity between RSNs was compensated by either increased or decreased effective connectivity changes in these three groups. The components of resting-state networks kept changing as the disease progressed. Meanwhile, the activation intensity increased at the early stage of LA and decreased as patients' cognitive impairment aggravated. Furthermore, the direction and strength of connections between these networks changed and remodeled differently. These suggest that the human brain compensates for specific functional changes at different stages.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fneur.2020.00457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325959PMC
June 2020

Analysis of Treatment Outcome After Endovascular Treatment in Different Pathological Subtypes of Basilar Artery Occlusion: a Single Center Experience.

Transl Stroke Res 2021 04 8;12(2):230-238. Epub 2020 Jul 8.

Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, No. 119, the South Fourth Ring West Road, Fengtai District, Beijing, 100050, China.

The current study aimed to evaluate whether patients with different pathologic subtypes of basilar artery occlusion (BAO) stroke could affect the clinical outcome after receiving endovascular treatment (EVT). A total of 187 consecutive patients with acute BAO receiving endovascular treatment (EVT) from January 2012 to July 2018 at the Beijing Tiantan Hospital were recruited in this study. The patients were categorized into three groups: embolism without vertebral artery (VA) steno-occlusion (group 1), in situ atherosclerotic thrombosis (group 2), and embolism from tandem VA steno-occlusion (group 3). Among the 187 patients, 4 patients with embolic combined with ICAS and 1 patient with tandem VA steno-occlusion combined with ICAS were excluded. Of the remaining 182 patients (153 men and 29 women; mean age, 60 years), 43 (23.6%) had embolism without vertebral artery (VA) steno-occlusion (group 1), 116 (63.7%) showed in situ atherosclerotic thrombosis (group 2), and 23 (12.6%) had embolism from tandem VA steno-occlusion (group 3). Overall, successful recanalization (modified thrombolysis in cerebral infarction grade 2b or 3) was achieved in 95.3%, 86.2%, and 60.9% in groups 1, 2, and 3, respectively. The favorable outcome (90-day modified Rankin scale score, 0-3) in the three groups was 51.2%, 52.6%, and 30.4%, respectively. Mortality was higher in group 3 (47.8%) as compared with groups 1 (16.3%) (p = 0.009) and 2 (17.2%) (p = 0.004). Embolism from tandem VA steno-occlusion (group 3) seems to be associated with a lower rate of recanalization and significantly higher rate of mortality as compared with another pathological mechanism of BAO.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12975-020-00833-wDOI Listing
April 2021
-->