Objective To evaluate the value of ischemia modified albumin (IMA) in the diagnosis of coronary heart disease (CHD) and the correlation between IMA levels and the pathological scope of coronary atherosclerosis .Methods A total of 88 coro-nary heart disease(CHD) patients diagnosed by coronary arteriongraphy (CAG) were selected ,including stable angina pectoris (16 cases)(SA group) and acute coronary syndrome (72 cases)(ACS group) .ACS group was further divided into 3 groups :unstable an-gina pectoris(30 cases)(UA group) ,non-ST-elevation myocardial infarction (19 cases) (NSTEMI group) ,ST-elevation myocardial infarction(23 cases) (STEMI group) .According to the results of CAG ,CHD patients were divided into 3 groups:1 vessel lesion group ,2 vessels lesion group and 3 vessels lesion group ,and 60 healthy physical cases were selected as control group .Results IMA in the CHD group was significantly higher than in control group (P<0 .05) .IMA in the ACS group was higher than SA group (P<0 .05) .IMA in the NSTEMI group and STEMI group were significantly higher than UA group (P<0 .05) .IMA levels and the degree of coronary atherosclerosis were significantly positively correlated (P<0 .05 ,r=0 .570) .When the cut-off value of IMA was 80 .10 U/mL ,the area under the curve was 0 .869 ,the specificity was 98 .4% and the sensitivity was 65 .9% .Logistic regression a-nalysis showed that IMA was an independent predictor of CHD .Conclusion IMA has a high negative predictive value in the diag-nosis of CHD ,there was a significantly positive correlation between IMA level and the pathological scope of coronary atherosclero-sis .

Objective To investigate the preliminary experience of mechanical thrombectomy with a tri-axial system of the Solitaire AB stent through a Neuro delivery catheter to treat intracranial large artery occlusion. Methods A tri-axial system was used to deliver the Solitaire AB stent through a Neuro delivery catheter to provide intracranial aspiration in close proximity to the stent. This technique was used in 1 case of acute middle cerebral artery occlusion and 1 case of acute basilar artery occlusion. Results Successful revascularization was achieved in these 2 cases. Thrombolysis in cerebral infarction (TICI)score was 3. The clot length of acute middle cerebral artery occlusion was 3 cm and the modified Rankin Scale (mRS)score of this case was 3 at 90 days follow-up. Another patient with acute bilateral vertebral occlusion was revealed successful recanalization by angiography. Conclusion The results suggest that this technique of a tri-axial system used of the Solitaire stent through a Neuro delivery catheter can effectively retrieve clots from the occlusive artery and minimize the chance of antegrade blood flow dislodging the thrombus.

Objective To investigate the effect of hyperglycemia at admission in patients with acute ischemic stroke on endovascular treatment outcome.Methods From May 2012 to December 2016,200 consecutive patients with acute ischemic stroke (excluding patients with diabetes mellitus) underwent endovascular mechanical thrombectomy at the Department of Neurosurgery,the First People's Hospital of Changzhou were enrolled retrospectively.They were divided into either a hyperglycemia group (hyperglycemia was defined as glucose ＞7.8 nmol/L at admission,n =57) or a non-hyperglycemia group (n =143) according to the blood glucose levels at admission.The neurological function of the patients was evaluated by the National Institutes of Health Stroke Scale (NIHSS) at admission and discharge.The modified thrombolysis in cerebral infarction (mTICI) grade was used to evaluate the degree of recanalization.The modified Rankin scale (mRS) was used to evaluate the prognosis of the patients at 90 d after procedure.The general information of the patients were analyzed,including sex,age,past history,hospitalization time,onset to recanalization time (ORT),TOAST classification of cerebral infarction,and recanalization.The endovascular treatment outcomes of both groups were compared.Results (1) There were no significant differences in TOAST classification,age,hypertension history,atrial fibrillation history,stroke history,coronary heart disease history,ORT,NIHSS at admission between the patients of the two groups (all P ＞ 0.05).(2) There were no significant differences in days of hospitalization,mTICI grade,and number of thrombectomy between the patients of the two groups (P ＞0.05).(3) The discharge mortality and incidence of in-hospital neurological deterioration in the patients of the hyperglycemia group were 28.1％ (16/57) and 31.6％ (18/57) respectively,while those in the non-hyperglycemia group were 14.7％ (21/143) and 18.2％ (26/143) respectively.There were significant differences between the two groups (P =0.028 and 0.039 respectively).Conclusion Hyperglycemia at admission may have adverse effects on the prognosis in patients after receiving mechanical thrombectomy.

Objective To investigate the efficacy of endovascular treatment (EVT) in acute cardioembolic large vessel occlusion (LVO) of anterior circulation and its influencing factors.Methods The clinical data of 83 patients with acute cardioembolic LVO of anterior circulation treated with EVT during June 2014 to June 2016 were analyzed retrospectively.The neurological outcomes in these patients were evaluated by National Institutes of Health Stroke Scale (NIHSS) on admission;cerebral vascular re-canalization after procedure was classified according to thrombolysis in cerebral infarction (TICI) grading;the recovery of neurological outcomes was classified by modified Rankin scale (mRS) at discharge.According to the mRS scores at discharge,these patients were divided into two groups:good curative effect group and poor curative effect group.Single factor analysis was performed on all clinical parameters that might influence the surgical outcomes;in addition,the influencing factors of surgical outcomes were analyzed by multiple factor Logistic regression analysis.Results Eighty-one patients (97.59％) had good re-canalization (TICI grading 2b-3) after EVT;41 patients (49.40％) had better curative effect (mRS scores ≤3 at discharge),and 42 patients (50.60％) had poor curative effect (mRS scores ≥4 at discharge);postoperative hemorrhagic transformation appeared in 26 patients,and 16 patients (19.28％) accepted decompressive craniectomy resulting from massive cerebral infarction,severe encephaledema or hemorrhagic transformation,and had poor curative effect.The single factor analysis showed that the differences of NIHSS scores on admission,occlusion site,angiographic re-canalization,time from the symptom onset to the vessel re-canalization and whether hemorrhagic transformation after operation between the good curative effect group and poor curative effect group were statistically significant (P＜0.05);multiple factor Logistic regression analysis showed that NIHSS scores on admission,angiographic re-canalization,time from the symptom onset to the vessel re-canalization and whether hemorrhagic transformation after procedure were significantly correlated to the treatment efficacy (OR=1.171,95％CI:1.028-1.333,P=0.017;OR=3.623,95％CI:0.931-14.095,P=0.063;OR=l.012,95％ CI:1.003-1.021,P=0.008;OR=3.146,95％CI:0.875-11.309,P=0.079).Conclusions Endovascular thrombectomy is an effective approach for cardioembolic acute anterior circulation stroke.Furthermore,the influential factors of surgical treatment are NIHSS scores on admission,angiographic re-canalization,time from the symptom onset to the vessel re-canalization and whether hemorrhagic transformation after procedure.

Objective To investigate the effectiveness and feasibility of endovascular treatment (EVT) in acute large vessel occlusion (LVO) of anterior circulation,and explore its influencing factors.Methods The clinical data of 302 patients with acute LVO of anterior circulation treated with EVT in our hospital from October 2010 to December 2016 were analyzed retrospectively.Collateral blood flow classification (American Society of Interventional and Therapeutic Radiology/Society of Interventional Radiology collateral circulating grading),interventionaI treatment methods,thrombolysisin cerebral infarction (TICI) grading,and National Institutes of Health Stroke Scale (NIHSS) scores before and after treatment were recorded.Incidence and mortality rate of intraoperative and postoperative symptomatic intracranial hemorrhage (sICH) were recorded.The recovery of neurological outcomes was classified by modified Rankin scale (mRS) 90 d after treatment:patients with mRS scores≤2 were divided into a good prognosis group,and those with 3 ≤mRS scores ≤ 6 were divided into a poor prognosis group.Single factor analysis was performed on all clinical parameters that might influence the surgical outcomes;in addition,the influencing factors of prognosis were further analyzed by multivariate Logistic regression analysis.Results (1)After the operation,ASITN/SIR grading 0-2 was noted in 201 patients,ASITN/SIR grading 3-4 was noted in 101 patients.Two hundred sixty-nine patients (89.0％) had good re-canalization (TICI grading 2b-3) after EVT:66.2％ patients were TICI grading 3,22.8％ patients were TICI grading 2b,5.6％ patients were TICI grading 2a,and 5.4％ patients were TICI grading 1-0.The NIHSS scores on discharge (8.4±3.9) were lower than those on admission (16.8+4.7);sICH rate was 10.9％.(2) On 90 d of follow-up,149 patients (49.3％) enjoyed good prognosis,and 153 patients (50.7％) had poor prognosis;and the mortality was 8.3％.(3) Single factor analysis showed that the differences in age,associated atrial fibrillation,NIHSS scores on admission,times of thrombectomy,and collateral circulating grading between good prognosis group and poor prognosis group were statistically significant (P＜0.05);multivariate Logistic regression analysis showed that NIHSS scores on admission and time from symptom onset to vessel recanalization were prognostic risk factors (OR=1.162,95％CI:1.018-1.329,P=0.016;OR=1.008,95％CI:1.003-1.019,P=0.007).Conclusion EVT is an effective and safe approach for acute LVO of anterior circulation.