Blood blister-like aneurysms(BBAs)are fragile and difficult to treat.However,the optimal treatment has yet to be determined.Pipeline embolization devices and Willis covered stent implementation are still controversial...Blood blister-like aneurysms(BBAs)are fragile and difficult to treat.However,the optimal treatment has yet to be determined.Pipeline embolization devices and Willis covered stent implementation are still controversial strategies for treating BBA.Herein,we report a case of recurrent BBA successfully treated with a Willis covered stent.A long-term follow-up angiography after the procedure indicated complete occlusion of the aneurysm.This case demonstrates the safety and efficacy of applying the Wills cover stent in the treatment of recurrent BBA after Pipeline implantation.展开更多
Neurodegenerative diseases constitute a broad category of diseases caused by the degeneration of the neurons.They are mainly manifested by the gradual loss of neuron structure and function and eventually can cause dea...Neurodegenerative diseases constitute a broad category of diseases caused by the degeneration of the neurons.They are mainly manifested by the gradual loss of neuron structure and function and eventually can cause death or loss of neurons.As the global population ages rapidly,increased people are being diagnosed with neurodegenerative diseases.It has been established that the onset of Alzheimer’s disease(AD)is closely linked with increasing age and its major pathological features include amyloid-beta plaques(Aβ),Tau hyperphosphorylation,Neurofibrillary tangles(NFTs),neuronal death as well as synaptic loss.The involvement of microglia is crucial in the pathogenesis and progression of AD and exhibits a dual role.For instance,in the early stage of AD,microglia surface membrane proteins or receptors can participate in immunophagocytosis,and anti-inflammatory functions and act as a physical barrier after recognizing various ligands such as Aβand NFTs.However,in the later stage of the disease,membrane receptors on the surface of microglia can cause its activation to release a substantial quantity of pro-inflammatory factors.Which can amplify the neuroinflammatory response.The rapid decline of normal immune phagocytosis can result in the continuous accumulation of abnormal proteins,leading to neuronal dysfunction and destruction of the formed physical barrier as well as the neurovascular microenvironment.It can also increase the transformation of microglia from anti-inflammatory phenotype M2 to pro-inflammatory phenotype M1,induce severe neuronal injury or apoptosis,and aggravate the progression of AD.Due to few articles have focused on the AD-related membrane protein receptors on microglia,thus in this paper,we have reviewed several representative microglial membrane proteins or receptors about their specific roles and functions implicated in AD,and expect that there will be more in-depth research and scientific research results in the treatment of AD by targeted regulation of microglia membrane protein receptors in the future.展开更多
Background Although endovascular stenting is considered an effective and safe therapeutic option for symptomatic intracranial atherosclerotic disease(sICAD),an elevated rate of restenosis remains an important issue fo...Background Although endovascular stenting is considered an effective and safe therapeutic option for symptomatic intracranial atherosclerotic disease(sICAD),an elevated rate of restenosis remains an important issue for the conventional bare-metal stent(BMS).Recent evidence from observational studies suggests that applying drug-coated balloons(DCB)in sICAD may decrease restenosis occurrence.Additional large randomised studies are warranted to provide firmer evidence and to determine which patients would benefit most from DCB.Aim To design a randomised trial to examine DCB angioplasty(Taijieweiye intracranial paclitaxel-coated balloon catheter)versus BMS stenting(Wingspan intracranial stent system)in patients with sICAD.Design This is a multicentre,prospective,randomised,open-label,blinded end-point study to assess whether DCB angioplasty reduces the risk of restenosis compared with BMS stenting in sICAD patients with high-grade stenosis(≥70%-99%).Our goal is to randomly assign 198 eligible individuals at a 1:1 ratio to undergo DCB angioplasty(intervention group)or BMS stenting(control group).Outcome The primary efficacy outcome is restenosis at 6 months post treatment,that is,>50%stenosis in or within 5 mm of the treated segment and>20%absolute luminal loss.The primary safety outcome is stroke or death within 30 days post treatment.Discussion The DRug-coated Balloon for Endovascular treatment of sYmptOmatic intracraNial stenotic Disease trial aims to produce strong evidence on the efficacy and safety of DCB angioplasty as a promising therapeutic option for sICAD cases with high-grade stenosis.展开更多
Cardiovascular disease(CVD)remains a major cause of death and rising health care costs worldwide[1].Hyperlipidemia is an important,modifiable risk factor for CVD[2].Consequently,prevention and treatment of CVD have em...Cardiovascular disease(CVD)remains a major cause of death and rising health care costs worldwide[1].Hyperlipidemia is an important,modifiable risk factor for CVD[2].Consequently,prevention and treatment of CVD have emphasized targeting low-density lipoprotein cholesterol(LDL-C)[3].However,despite the efficiency of statins to reduce LDL-C concentration,the risk of recurrent cardiovascular events and mortality remains[4].Systemic inflammation has emerged as an important source of residual cardiovascular risk among patients receiving statin therapy[4].These contemporary data support the use of inflammation-inhibiting interventions as an effective strategy to further reduce cardiovascular risk.Diet is a highly modifiable lifestyle factor that has been shown to play a role in the regulation of systemic inflammation[5].Previous studies revealed that a higher dietary inflammatory potential was associated with an increased incidence of CVD and mortality in the general population[6].However,it is unclear whether this association persists in patients at-risk of or with established CVD who are already being treated with statins,a therapy whose mode of action includes decreasing inflammation[7].Evaluating the potential for residual risk due to diet is critical considering the large role inflammation plays in cardiovascular diseases.展开更多
In this study,we performed emergency stent angioplasty in a patient with basilar artery occlusion(BAO)at 21 hours after onset.Serial diffusion tensor tract imaging revealed that the ischaemic corticospinal tracts(CSTs...In this study,we performed emergency stent angioplasty in a patient with basilar artery occlusion(BAO)at 21 hours after onset.Serial diffusion tensor tract imaging revealed that the ischaemic corticospinal tracts(CSTs),which passed through pontine infarct,rapidly recovered to normal level even after delayed reperfusion.This case provided in vivo evidences that ischaemic white matter was still salvageable even after prolonged ischaemia.It also provided a new method(diffusion tensor tract imaging)and a novel therapeutic target(white matter)in the evaluation and treatment of acute BAO.展开更多
Background:Rebleeding can cause a catastrophic outcome after aneurysmal subarachnoid hemorrhage.A clinical+morphology nomogram was promoted in our previous study to assist in discriminating the rupture intracranial an...Background:Rebleeding can cause a catastrophic outcome after aneurysmal subarachnoid hemorrhage.A clinical+morphology nomogram was promoted in our previous study to assist in discriminating the rupture intracranial aneurysms(RIAs)with a high risk of rebleeding.The aim of this study was to validate the predictive accuracy of this nomogram model.Method:The patients with RIAs in two medical centers from December 2020 to September 2021 were retrospectively reviewed,whose clinical and morphological parameters were collected.The Cox regression model was employed to identify the risk factors related to rebleeding after their admission.The predicting accuracy of clinical+morphological nomogram,ELAPSS score and PHASES score was compared based on the area under the curves(AUCs).Results:One hundred thirty-eight patients with RIAs were finally included in this study,20 of whom suffering from rebleeding after admission.Hypertension(hazard ratio(HR),2.54;a confidence interval of 95%(CI),1.01-6.40;P=0.047),bifurcation(HR,3.88;95%CI,1.29-11.66;P=0.016),and AR(HR,2.68;95%CI,1.63-4.41;P<0.001)were demonstrated through Cox regression analysis as the independent risk factors for rebleeding after admission.The clinical+morphological nomogram had the highest predicting accuracy(AUC,0.939,P<0.01),followed by the bifurcation(AUC,0.735,P=0.001),AR(AUC,0.666,P=0.018),and ELAPSS score(AUC,0.682,P=0.009).Hypertension(AUC,0.693,P=0.080)or PHASES score(AUC,0.577,P=0.244)could not be used to predict the risk of rebleeding after admission.The calibration curve for the probability of rebleeding showed a good agreement between the prediction through clinical+morphological nomogram and actual observation.Conclusion:Hypertension,bifurcation site,and AR were independent risk factors related to the rebleeding of RIAs after admission.The clinical+morphological nomogram could help doctors to identify the high-risk RIAs with a high predictive accuracy.展开更多
Background:The neutrophil-to-lymphocyte ratio(NLR)is highly associated with stress responses to acute disorders and may be useful for differentiating hyperglycemia after stroke that is induced by stress or other cause...Background:The neutrophil-to-lymphocyte ratio(NLR)is highly associated with stress responses to acute disorders and may be useful for differentiating hyperglycemia after stroke that is induced by stress or other causes.This study aims to evaluate whether the NLR modifies the effect of hyperglycemia at admission on clinical outcome after thrombectomy.Methods:We retrospectively enrolled 343 patients that underwent endovascular thrombectomy for acute anterior circulation large-vessel occlusion between January 2019 and June 2022.NLR at admission was used to dichotomize patients into low-NLR and high-NLR groups according to its median value.The primary outcome was 90-day functional independence(modified Rankin Scale Score 0–2).Secondary outcomes were 24 h symptomatic intracranial hemorrhage and 90-day mortality.Results:Overall,hyperglycemia at admission decreased the likelihood of functional independence(adjusted odds ratio[OR]:0.34,95%confidence interval[95%CI]:0.19–0.60,p<0.001).There was a significant interaction between the NLR and hyperglycemia at admission on functional independence(p=0.024).Hyperglycemia at admission was negatively associated with functional independence in low-NLR patients(adjusted OR:0.18,95%CI:0.07–0.42,p<0.001),but not in high-NLR patients(adjusted OR:0.67,95%CI:0.30–1.48,p=0.320).Interactions between the NLR and hyperglycemia at admission on 24 h symptomatic intracerebral hemorrhage(p=0.734)and 90-day mortality(p=0.657)were not significant.Conclusions:The NLR modified the detrimental effect of hyperglycemia at admission on functional independence after thrombectomy.Low-NLR patients with hyperglycemia were at a high risk of poor outcomes,and might more likely benefit from aggressive glucose-lowering treatment.展开更多
Background:Carotid cavernous fistula is a rare complication that is typically associated with head trauma and skull base fractures.The traumatic bilateral carotid cavernous fistula are significantly rarer.Case present...Background:Carotid cavernous fistula is a rare complication that is typically associated with head trauma and skull base fractures.The traumatic bilateral carotid cavernous fistula are significantly rarer.Case presentations:We report a case of a 61-year-old man presenting with unilateral exophthalmos,swollen eyelids,conjunctival congestion,and edema etiologically associated with severe trauma.Thereafter,the patient demonstrated symptoms of contralateral oculomotor nerve injury caused by skull base fracture,such as ptosis of eyelid,dilated pupils,and eye movement disorder,and was diagnosed with bilateral carotid cavernous fistula.Conclusions:The patient recovered after undergoing endovascular embolization of bilateral cavernous sinus fistulas.The patient demonstrated the classic symptoms of an extremely rare condition known as bilateral carotid cavernous fistula,in only one eye.Reporting and analyzing this case will help us elucidate the underlying mechanisms of this disease.展开更多
文摘Blood blister-like aneurysms(BBAs)are fragile and difficult to treat.However,the optimal treatment has yet to be determined.Pipeline embolization devices and Willis covered stent implementation are still controversial strategies for treating BBA.Herein,we report a case of recurrent BBA successfully treated with a Willis covered stent.A long-term follow-up angiography after the procedure indicated complete occlusion of the aneurysm.This case demonstrates the safety and efficacy of applying the Wills cover stent in the treatment of recurrent BBA after Pipeline implantation.
基金This study was supported by grants from the Science and Technology Innovation Fund Project of Dalian(No.2021JJ13SN55).
文摘Neurodegenerative diseases constitute a broad category of diseases caused by the degeneration of the neurons.They are mainly manifested by the gradual loss of neuron structure and function and eventually can cause death or loss of neurons.As the global population ages rapidly,increased people are being diagnosed with neurodegenerative diseases.It has been established that the onset of Alzheimer’s disease(AD)is closely linked with increasing age and its major pathological features include amyloid-beta plaques(Aβ),Tau hyperphosphorylation,Neurofibrillary tangles(NFTs),neuronal death as well as synaptic loss.The involvement of microglia is crucial in the pathogenesis and progression of AD and exhibits a dual role.For instance,in the early stage of AD,microglia surface membrane proteins or receptors can participate in immunophagocytosis,and anti-inflammatory functions and act as a physical barrier after recognizing various ligands such as Aβand NFTs.However,in the later stage of the disease,membrane receptors on the surface of microglia can cause its activation to release a substantial quantity of pro-inflammatory factors.Which can amplify the neuroinflammatory response.The rapid decline of normal immune phagocytosis can result in the continuous accumulation of abnormal proteins,leading to neuronal dysfunction and destruction of the formed physical barrier as well as the neurovascular microenvironment.It can also increase the transformation of microglia from anti-inflammatory phenotype M2 to pro-inflammatory phenotype M1,induce severe neuronal injury or apoptosis,and aggravate the progression of AD.Due to few articles have focused on the AD-related membrane protein receptors on microglia,thus in this paper,we have reviewed several representative microglial membrane proteins or receptors about their specific roles and functions implicated in AD,and expect that there will be more in-depth research and scientific research results in the treatment of AD by targeted regulation of microglia membrane protein receptors in the future.
文摘Background Although endovascular stenting is considered an effective and safe therapeutic option for symptomatic intracranial atherosclerotic disease(sICAD),an elevated rate of restenosis remains an important issue for the conventional bare-metal stent(BMS).Recent evidence from observational studies suggests that applying drug-coated balloons(DCB)in sICAD may decrease restenosis occurrence.Additional large randomised studies are warranted to provide firmer evidence and to determine which patients would benefit most from DCB.Aim To design a randomised trial to examine DCB angioplasty(Taijieweiye intracranial paclitaxel-coated balloon catheter)versus BMS stenting(Wingspan intracranial stent system)in patients with sICAD.Design This is a multicentre,prospective,randomised,open-label,blinded end-point study to assess whether DCB angioplasty reduces the risk of restenosis compared with BMS stenting in sICAD patients with high-grade stenosis(≥70%-99%).Our goal is to randomly assign 198 eligible individuals at a 1:1 ratio to undergo DCB angioplasty(intervention group)or BMS stenting(control group).Outcome The primary efficacy outcome is restenosis at 6 months post treatment,that is,>50%stenosis in or within 5 mm of the treated segment and>20%absolute luminal loss.The primary safety outcome is stroke or death within 30 days post treatment.Discussion The DRug-coated Balloon for Endovascular treatment of sYmptOmatic intracraNial stenotic Disease trial aims to produce strong evidence on the efficacy and safety of DCB angioplasty as a promising therapeutic option for sICAD cases with high-grade stenosis.
基金National Natural Science Foundation of China(82311530048 and 82371298)Capital Health Research and Development of Special Fund(2024-2-2086)Talent Development Program of Beijing Shijitan Hospital(2024LJRCLS).
文摘Cardiovascular disease(CVD)remains a major cause of death and rising health care costs worldwide[1].Hyperlipidemia is an important,modifiable risk factor for CVD[2].Consequently,prevention and treatment of CVD have emphasized targeting low-density lipoprotein cholesterol(LDL-C)[3].However,despite the efficiency of statins to reduce LDL-C concentration,the risk of recurrent cardiovascular events and mortality remains[4].Systemic inflammation has emerged as an important source of residual cardiovascular risk among patients receiving statin therapy[4].These contemporary data support the use of inflammation-inhibiting interventions as an effective strategy to further reduce cardiovascular risk.Diet is a highly modifiable lifestyle factor that has been shown to play a role in the regulation of systemic inflammation[5].Previous studies revealed that a higher dietary inflammatory potential was associated with an increased incidence of CVD and mortality in the general population[6].However,it is unclear whether this association persists in patients at-risk of or with established CVD who are already being treated with statins,a therapy whose mode of action includes decreasing inflammation[7].Evaluating the potential for residual risk due to diet is critical considering the large role inflammation plays in cardiovascular diseases.
文摘In this study,we performed emergency stent angioplasty in a patient with basilar artery occlusion(BAO)at 21 hours after onset.Serial diffusion tensor tract imaging revealed that the ischaemic corticospinal tracts(CSTs),which passed through pontine infarct,rapidly recovered to normal level even after delayed reperfusion.This case provided in vivo evidences that ischaemic white matter was still salvageable even after prolonged ischaemia.It also provided a new method(diffusion tensor tract imaging)and a novel therapeutic target(white matter)in the evaluation and treatment of acute BAO.
基金the projects of National Natural Science Foundation of China(Grant Nos.82071296,81471210,and 81671129)"Major special projects in the 13th five-year plan"(Grant No.2016YFC1301800)+1 种基金"Major special projects in the 14th five-year plan"(Grant No.2021YFC2501100)The sponsors had no role in the design or conduct of this research.
文摘Background:Rebleeding can cause a catastrophic outcome after aneurysmal subarachnoid hemorrhage.A clinical+morphology nomogram was promoted in our previous study to assist in discriminating the rupture intracranial aneurysms(RIAs)with a high risk of rebleeding.The aim of this study was to validate the predictive accuracy of this nomogram model.Method:The patients with RIAs in two medical centers from December 2020 to September 2021 were retrospectively reviewed,whose clinical and morphological parameters were collected.The Cox regression model was employed to identify the risk factors related to rebleeding after their admission.The predicting accuracy of clinical+morphological nomogram,ELAPSS score and PHASES score was compared based on the area under the curves(AUCs).Results:One hundred thirty-eight patients with RIAs were finally included in this study,20 of whom suffering from rebleeding after admission.Hypertension(hazard ratio(HR),2.54;a confidence interval of 95%(CI),1.01-6.40;P=0.047),bifurcation(HR,3.88;95%CI,1.29-11.66;P=0.016),and AR(HR,2.68;95%CI,1.63-4.41;P<0.001)were demonstrated through Cox regression analysis as the independent risk factors for rebleeding after admission.The clinical+morphological nomogram had the highest predicting accuracy(AUC,0.939,P<0.01),followed by the bifurcation(AUC,0.735,P=0.001),AR(AUC,0.666,P=0.018),and ELAPSS score(AUC,0.682,P=0.009).Hypertension(AUC,0.693,P=0.080)or PHASES score(AUC,0.577,P=0.244)could not be used to predict the risk of rebleeding after admission.The calibration curve for the probability of rebleeding showed a good agreement between the prediction through clinical+morphological nomogram and actual observation.Conclusion:Hypertension,bifurcation site,and AR were independent risk factors related to the rebleeding of RIAs after admission.The clinical+morphological nomogram could help doctors to identify the high-risk RIAs with a high predictive accuracy.
基金Natural Science Foundation of Liaoning Province,Grant/Award Number:2022-NLTS.11-02。
文摘Background:The neutrophil-to-lymphocyte ratio(NLR)is highly associated with stress responses to acute disorders and may be useful for differentiating hyperglycemia after stroke that is induced by stress or other causes.This study aims to evaluate whether the NLR modifies the effect of hyperglycemia at admission on clinical outcome after thrombectomy.Methods:We retrospectively enrolled 343 patients that underwent endovascular thrombectomy for acute anterior circulation large-vessel occlusion between January 2019 and June 2022.NLR at admission was used to dichotomize patients into low-NLR and high-NLR groups according to its median value.The primary outcome was 90-day functional independence(modified Rankin Scale Score 0–2).Secondary outcomes were 24 h symptomatic intracranial hemorrhage and 90-day mortality.Results:Overall,hyperglycemia at admission decreased the likelihood of functional independence(adjusted odds ratio[OR]:0.34,95%confidence interval[95%CI]:0.19–0.60,p<0.001).There was a significant interaction between the NLR and hyperglycemia at admission on functional independence(p=0.024).Hyperglycemia at admission was negatively associated with functional independence in low-NLR patients(adjusted OR:0.18,95%CI:0.07–0.42,p<0.001),but not in high-NLR patients(adjusted OR:0.67,95%CI:0.30–1.48,p=0.320).Interactions between the NLR and hyperglycemia at admission on 24 h symptomatic intracerebral hemorrhage(p=0.734)and 90-day mortality(p=0.657)were not significant.Conclusions:The NLR modified the detrimental effect of hyperglycemia at admission on functional independence after thrombectomy.Low-NLR patients with hyperglycemia were at a high risk of poor outcomes,and might more likely benefit from aggressive glucose-lowering treatment.
基金supported by the Postdoctoral Program in Jiangsu Province(to Jingshan Liang,grant number:SBSH01).
文摘Background:Carotid cavernous fistula is a rare complication that is typically associated with head trauma and skull base fractures.The traumatic bilateral carotid cavernous fistula are significantly rarer.Case presentations:We report a case of a 61-year-old man presenting with unilateral exophthalmos,swollen eyelids,conjunctival congestion,and edema etiologically associated with severe trauma.Thereafter,the patient demonstrated symptoms of contralateral oculomotor nerve injury caused by skull base fracture,such as ptosis of eyelid,dilated pupils,and eye movement disorder,and was diagnosed with bilateral carotid cavernous fistula.Conclusions:The patient recovered after undergoing endovascular embolization of bilateral cavernous sinus fistulas.The patient demonstrated the classic symptoms of an extremely rare condition known as bilateral carotid cavernous fistula,in only one eye.Reporting and analyzing this case will help us elucidate the underlying mechanisms of this disease.
