Objective To evaluate the effect of surgical treatment in ischemic cerebrovascular disease using perfusion-weighted magnetic resonance imaging (PWI) technique.Methods The clinical and imaging data of 24 patients with ischemic cerebrovascular disease were analyzed retrospectively. Cerebral perfusion was compared before and after operation by PWI.Results In our series, there were 9 cases of stenosis or occlusion of unilateral internal carotid artery (ICA), 8 cases of unilateral stenosis or occlusion of middle cerebral artery (MCA), 5 cases of multiple stenoses of intra- or extracranial artery system, 2 cases of moyamoya disease. PWI revealed 1 case of normal regional cerebral blood flow (rCBF) and mean transit time (MTT), 15cases of normal rCBF with increased MTT, and 8 cases of decreased rCBF with increased MTT. 23 patients received surgical treatment. There were 13 patients performed by stent angioplasty, 4 patients by endarterectomy, and 6 patients by STA-MCA bypass surgery. Cerebral perfusion improved in 19 cases (82.6%), which included 12 cases (92.3%) performed with stent angioplasty, 4 cases (100%) with endarterectomy and 3 cases (50%) with STA-MCA bypass surgery.Conclusions Being a new type of examination, PWI is helpful to evaluate the status of cerebral perfusion. Surgical methods are effective in treatment of ischemic cerebrovascular disease.

Objective To investigate the effect of the training scheme of microvascular anastomosis in different time courses. Methods A total of 31 neurosurgeons were trained with different training schemes of microvascular anastomosis with ultrashort time course (n = 9;4 h),medium time course (n =12;12 h),and long time course (n = 10,300 h)were selected respectively,including 22 neurosurgeons from the top three hospitals and 9 from other levels of hospitals. Before training,the average median time of working in a department of neurosurgery was 6 (range,0 to 19)years. After training,the trainees accepted the assessments,such as performing the rat common carotid artery end to end anastomosis under a surgical microscope. Their completion time,anastomosis quality score,and proportion of vascular patency after anastomosis were compared. The measurement data of normal distribution used the single factor analysis of variance. The skewed distribution used rank sum test. The comparison of count data used Fisher exact test. Results The trainees who participated in the ultrashort time course training,the time of completion of carotid end - end anastomosis was 78 ± 37 min,the anastomosis quality score was 8. 1 ± 2. 8,and 2 vessels were patent;the trainees who participated in the medium time course training,the anastomosis time was 69 ± 20 min,the anastomosis quality score was 15. 8 ± 6. 8,and 10 vessels were patent;the trainees who participated in the long time course training,the anastomosis time was 34 ± 7 min,the anastomosis quality score was 23. 5 ± 1. 3,and 10 vessels were patent. There were significant differences in the completion of anastomosis time among the 3 groups of trainees (F = 9. 50,P = 0. 001). The completion time of the long time course group was shorter than that of the medium time course group and the ultrashort time course group. There were significant differences. There were significant differences in the anastomosis quality score among the 3 groups (F = 26. 870,P = 0. 000). As for the number of the patent vessels,there were significant differences between the medium and long time course groups and the ultrashort time course group (P < 0. 01 ). Conclusion If the vascular anastomosis skills of the trainees achieve relative proficiency and stability,they need to choose the long time course training.

Objective To evaluate the feasibility,safety and efficacy of percutaneous transluminal stenting angioplasty for severe complicated stenosis of vertebrobasilar system. Methods From November 2003 to February 2006,5 candidates underwent percutaneous transluminal stenting for severe complicated stenosis of vertebrobasilar system. Results Four out of 5 candidates,had occlusion of unilateral vertebral artery (VA),1 had severe bilateral proximal segmental stenosis of VA. There were 4 with severe proximal segmental stenosis of the VA associated with multiple segmental stenosis of intracranial VA and basilar artery (BA),and 1 with multiple segmental severe stenosis of intracranial VA and BA. Stenosis rate ranges from 80% ～95% with involved length from 10-20 mm. Technical success was achieved in all of the patient (100%),and residual stenosis rate was less than 20%. All the symptoms due to vertebrobasilar blood supply insufficiency disappeared. Follow-up with DSA 6-12 months later demonstrated no restenosis; showing satisfactory short term efficacy. Conclusions Percutaneous transluminal stenting for vertebrobasilar blood supply insufficiency is a safe and efficacious option with favorable short term outcome,especially with furthermore prevention of stroke.

Objective To evaluate the short-term and long-term effects in patients of carotid artery subtotal or complete occlusion after carotid endarterectomy ( CEA) using vascular ultrasound. Methods A total of 107 consecutive patients were diagnosed as carotid artery occlusive disease with DSA and treated with CEA at Beijing Xuanwu Hospital,Capital Medical University from January 2005 to January 2014 were enrolled retrospectively. Sixty-three of them had subtotal occlusion ( the carotid artery stenosis rate 95% to 99%) and 44 had complete occlusion. The occurrence of perioperative complications of all patients was documented. The follow-up study used outpatient follow-up and telephone tracking. The patients of surgical recanalization were followed up with ultrasound at 1 week, 3, 6, 12, and 24 months after procedure. The clinical prognosis, restenosis, vascular structure and hemodynamic changes of the patients after CEA were documented. Results (1) Of the 107 patients,86 (80. 4%) achieved recanalization after procedure and 21 (19. 6%) did not. The incidence of stroke and death was 4. 7% (5 cases) within 30 days after procedure,among them the incidence of subtotal occlusion group was 4. 8% ( n=3 cases) and the complete occlusion group was 4. 5% (2 cases). (2) Within one week after procedure,the peak systolic velocity ( PSV) ,end diastolic velocity ( EDV) ,and pulsatility index ( PI) of the ipsilateral middle cerebral artery in the recanalization patients increased significantly (120 ± 39 cm/s vs 60 ± 17 cm/s,50 ± 18 cm/s vs 33±11cm/s,and0.96±0.20vs0.67±0.14,respectively).Thereweresignificantdifferences(allP<0. 01). Carotid artery ultrasound showed that the local vessel diameters of the original lesions in the recanalization patients were widened as compared with preoperation (4. 4 ± 1. 1 and 3. 6 ± 1. 0 mm). There was significant difference (P<0. 01). (3) Sixty-nine patients with recanalization were followed up for 1 to 60 months( the median time was 12 months) . One to six months after procedure,the patency rate of the patients was 95. 6%(n=66),>6 to 12 months was 94. 2%(n=65),>12 to 24 months was 94. 2%(n=65),and more than 2 years was 91. 3%(n=63). Conclusion Vascular ultrasound can conduct short-term and long-term follow-up for carotid artery occlusive disease after CEA. The degree of blood flow improvement should be identified and restenosis should be found in time after procedure.

Objective To analyze the correlations of vascular structure, hemodynamic changes and surgical recanalization of carotid endarterectomy ( CEA) for the treatment of subtotal or complete occlusion of carotid artery. Methods A total of 107 patients with carotid artery occlusive disease diagnosed at Beijing Xuanwu Hospital,Capital Medical University received CEA therapy from January 2005 to January 2014 and were enrolled retrospectively. According to the findings of introperative ultrasound,they were divided into either a recanalization group (n=86) or a non-recanalization group (n=21). Preoperative and intraoperative carotid artery diameter and blood flow velocity were compared and analyzed with carotid ultrasonography. Intraoperative detected vascular abnormalities, residual vascular stenosis rate, blood flow velocity and pulsatility index of the ipsilateral middle cerebral artery ( MCA) were documented. Results (1) The peak systolic velocity (PSV) (82 ± 32 cm/s and 60 ± 17 cm/s),mean velocity (MV) (50 ± 19 cm/s and 42 ±13cm/s),and pulsatility index (PI) (0. 97 ± 0. 25 and 0. 67 ± 0. 14) on the ipsilateral MCA in patients of carotid artery recanalization before and after procedure were significantly higher than those during the procedure. There were significant differences (all P=0. 000). In patients failed to recanalize,the intraoperative and preoperative PSV,EDV,and MV of MCA were 46 ± 20 cm/s and. 63 ± 21 cm/s,24 ± 13 cm/s and 34 ± 12 cm/s, and 32 ± 16 cm/s and 44 ± 15 cm/s,respectively. They were reduced more significantly during the procedure than those after procedure. There were significant differences ( all P=0. 000 ) . But there was no significant difference in PI (0. 70 ± 0. 18 and 0. 67 ± 0. 15) compared with that before procedure (P=0. 317). (2) The diseased vascular diameter of the recanalization group was significantly widened (0. 6 ± 0. 4 mm vs. 3. 4 ± 0. 9 mm,P=0. 000) compared with before procedure. The overall recanalization rate was 80. 4% (86/107). Intraoperative ultrasound revealed that 13 patients had mild abnormal vascular structures among the recanalized patients. The non-recanalized patients had significantly abnormal vascular structure. Conclusion Intraoperative carotid ultrasound in combination with transcranial Doppler (TCD) for monitoring cerebral blood flow may effectively identify the carotid structure and the degree of cerebral hemodynamic improvement,and timely guide the secondary repair.

Objectives To analyze the incidence of cranial nerve injury in patients after receiving carotid endarterectomy ( CEA) in a single-center and to investigate its correlation with surgical experiences. Methods The clinical data of patients underwent CEA at Beijing Xuanwu Hospital, Capital Medical University from January. 2001 to December 2013 were analyzed retrospectively. Cranial nerve injury was assessed at day 7 after procedure according to the clinical symptoms,and they were followed up at 1,3,6, and 12 months. The incidence of permanent cranial nerve injury was evaluated. The incidences of permanent cranial nerve injury were further analyzed at two time periods ( from January 2001 to September 2011 and from October 2011 to December 2013 ) . Results ( 1 ) A total of 598 consecutive patients treated with CEA were enrolled,and 15 (2. 5%) of them had cranial nerve injury,including 2 (0. 3%) facial nerve injury,7 (1. 2%) hypoglossal nerve injury,and 6 (1. 0%) vagus nerve injury. Only 1 case (0. 2%) did not recover completely at 6 months after procedure. ( 2 ) The patients with cranial nerve injury were 10 (3. 2%,10/308) and 5 (1. 7%,5/290) respectively from January 2001 to September 2011 and from October 2011 to December 2013). There was no significant difference (P < 0. 05). Conclusion The incidence of cranial nerve injury was low after CEA,and most patients could recover completely. The increased surgical experiences did not show the reduction of cranial nerve injury rate evidently after CEA.

Objective To evaluate the correlations of vascular structures,hemodynamic changes and recanalization before receiving carotid endarterectomy ( CEA) in patients with subtotal or complete occlusion of carotid artery using color Doppler flow imaging (CDFI) and transcranial Doppler (TCD) ultrasonography. Methods A total of 107 patients were diagnosed as subtotal ( stenosis rate 95% to 99%) or complete occlusion of carotid artery with DSA and treated with CEA at Beijing Xuanwu Hospital, Capital Medical University from January 2005 to January 2014 were enrolled retrospectively. The mean age of patients was 61 ± 9 years. According to the findings of DSA,they were divided into either a carotid artery subtotal occlusion group (n=63) or a complete occlusion group (n=44). The vascular diameter,the locations of the lesions ( internal carotid artery or common carotid artery) ,the lumen echo characteristics,and whether internal-external artery collateral circulation patent or not at different stages in patients of both groups were documented. Results The lumen diameter of distal segment was significant wider in patients of the complete occlusion group compared with the subtotal occlusion group (4. 1 ± 1. 1 mm vs. 3. 2 ± 0. 8 mm). There was significant difference between the 2 groups (P <0. 01). There was no significant difference between the location of occlusion and the recanalization rate (P=0. 460). The recanalization rate of the lumen homogeneous echo ( hypoecho and echodense) filling patients (94. 1% vs. 86. 7%) was significantly higher than that of the patients of heterogeneity echo. In patients with complete occlusion of internal carotid artery,the recanalization of CEA would increase when the internal-external collateral arteries were patent. For general comparison,the recanalization rate of the subtotal occlusion group was significantly higher than that of the complete occlusion group (P<0. 01). Conclusion The carotid artery diameter normal or broadening ,the homogeneous echo in the occlusive lumen and the internal-external collateral arteries patency are closely associated with the recanalization rate. The preoperative ultrasonography has great value for the assessment of recanalization of carotid artery occlusive disease after CEA.

Objective To investigate the clinical incidence of cerebral artery fenestration and its digital subtraction angiography (DSA) characteristics in order to improve the understanding of the clinical significance of the cerebral artery fenestration. Methods Whole cerebral angiography with DSA was employed in a total of 6 432 patients. The imaging material was retrospectively analyzed. The incidence of cerebral artery fenestration and the associated cerebral artery diseases were analyzed. Results Among the 6 432 patients, cerebral artery fenestration was detected in 283 with 296 fenestrations in total (4.60%, 296/6 432). The cerebral artery fenestration of internal carotid was seen in 19 cases with 21 fenestrations (9 on the left side and 12 on the right side), and the detection rate was 0.33%. The fenestration of anterior cerebral artery was found in 46 cases with 51 fenestrations (25 on the left side and 26 on the right side), and the detection rate was 0.79%. The fenestration of middle cerebral artery was found in 54 cases with 57 fenestrations (29 on the left side and 28 on the right side), and the detection rate was 0.89%. The fenestration of vertebral artery was revealed in 68 cases with 71 fenestrations (37 on the left side and 34 on the right side), and the detection rate was 1.10%. The fenestration of basilar artery was demonstrated in 95 cases with 95 fenestrations, and the detection rate was 1.37%. Besides, 17 fenestrations were accompanied with aneurysms and 5 fenestrations were complicated by arteriovenous malformations. Transient cerebral ischemia occurred in 37 cases with fenestrations, and ischemic symptoms were consistent with the blood supply region of the fenestration structures. Among the 37 cases , cerebral infarction at the distal region of the fenestration characteristics of the cerebral fenestrations is of great clinical significance for its diagnosis and for the selection of therapeutic scheme.

Objective To analyze the influencing factors of having clinical meaningful recanalization (CMR)after revascularization therapy in acute phase of ischemic stroke. Methods A total of 267 consecutive patients with ischemic stroke admitted to the Department of Neurology,Xuanwu Hospital, Capital Medical University and received intravenous thrombolysis or endovascular intervention in acute stage from March 2011 and March 2015 were enrolled retrospectively. CMR was used as a primary endpoint event. They were divided into either a CMR group (n = 92)or a non-CMR group (n = 175)according to whether they had CMR. The baseline data of the patients in both groups were compared by using the Rank sum test and Pearson Chi-Square test. A multivariate logistic regression model was established to analyze the independent influencing factor of CMR. Results The median (interquartile range)age of 267 patents was 60 (51 -69)years,and 69 of them were females (25. 8%);the median (interquartile range)time from onset to treatment was 250 (195 -305)min,and the median (interquartile range)NIHSS score was 10 (6 -15). The baseline NIHSS score,body mass index,blood glucose level,and proportion of diabetes of the CMR group were significantly lower than those of the non-CMR group (all P≤0. 05). The results of multivariate logistic regression analysis showed that the baseline NIHSS (OR,0. 93,95% CI 0. 88 -0. 98;P = 0. 01),intravenous thrombolysis (with respect to endovascular intervention)(OR,0. 35, 95% CI 0. 17 -0. 73;P = 0. 01),and baseline blood glucose (OR,0. 87;95% CI 0. 77 -0. 98;P =0. 02)were the independent negative predictors of CMR. Conclusion The baseline NIHSS,intravenous thrombolysis (with respect to endovascular intervention),and high blood glucose are the negative influencing factors for achieving CMR in the acute phase of ischemic stroke,suggesting blood sugar intervention and endovascular intervention in acute phase may contribute to the improvement of clinical prognosis.

Objective To strengthen the training effect of the neuro-interventional surgeons using staged target teaching method. Methods A total of 39 neurosurgeons from all over the country were trained at the Department of Interventional Radiology,Xuanwu Hospital,Capital Medical University from March 2012 to March 2013. In the one-year training period,the training was divided into 4 stages (each stage for 3 months). All the learning contents were phased to focus on teaching and set the target at each stage,which had a clear purpose. Questionnaires were sent to the refresher doctors at 6 months and 12 months after they returned to their original work in order to obtain the conditions about their independent work after training. Results All the 39 neurosurgeons achieved their desired goal from theory to practical operation. They mastered the holistic treatment principles of ischemic cerebrovascular disease and were familiar with and mastered the whole brain DSA and stenting techniques. At the fourth stage,as an operator, everyone had finished at least 5 extracranial artery stentings. The recovered questionnaires after the end of training showed that 95. 8%(23/24)neurosurgeons were able to perform whole brain DSA independently and held≥5 surgeries monthly;87. 5%(21/24)neurosurgeons could complete stenting independently (1 patient/month). Conclusion The staged target teaching method is a practical and effective teaching means for special technical training of neurointervention.