Objective: To explore the predictive effect of microvascular permeability surface (PS) on spontaneous hemorrhagic transformation (HT) in acute ischemic stroke patients. Methods: A retrospective analysis was performed on 43 patients with acute ischemic stroke who underwent CT perfusion imaging (CTPI). Neither arterial thrombolysis nor intravenous thrombolysis was carried out in these patients. The patients were divided into HT group (n=20) and control group (n=23) according to whether HT occurred within 2 weeks after the onset of stroke detected with CT or MRI. Mann-whitney U test was used to compare the differences of CTPI parameters, including PS, cerebral blood volume (CBV) and cerebral blood flow (CBF) between the affected and contralateral areas in HT group, and CTPI parameters of the affected area were also compared between HT and control groups. ROC curve was used to analyze the efficiency of PS value to predict HT. Results: In HT group, PS (Z=-5.410, P<0.001) and CBV (Z=-3.517, P<0.001) of the affected area were higher than those of contralateral area, while CBF (Z=-2.245, P=0.024) of the affected area was lower than that of contralateral area. PS (Z=-5.065, P<0.001) and CBV (Z=-3.458, P=0.001) of the affected area in HT group were higher than those in control group, while there was no statistical difference of CBF (Z=-1.729, P=0.084) of the affected area between HT and control group. ROC analysis showed that the AUC was 0.952 for predicting HT in acute ischemic stroke patients with the threshold of PS as 0.032 4 ml/(100 ml•min). The sensitivity, specificity and accuracy was 90.00%, 82.60% and 86.05%, respectively. Conclusion: PS value can be used to predict HT in patients with acute ischemic stroke, therefore being helpful to appropriate treatments in clinic.

OBJECTIVETo investigate the endovascular treatments for the ruptured aneurysms located at anterior communicating artery complex (ACoAC).

METHODSThe data of patients with ruptured ACoAC aneurysms treated in Department of Neurosurgery, First Affiliated Hospital to Fourth Military Medical University from May 2013 to December 2014 was retrospectively analyzed. Sixty-six cases were recruited including 50 male and 16 female patients. The patients aged from 31 to 69 years old, averaging (51±8) years. The Hunt-Hess grade at admission were 13 cases with grade Ⅰ, 36 cases with grade Ⅱ, 11 cases with grade Ⅲ, and 6 cases with grade Ⅳ. The most diameter of aneurysms sac: 14 cases less than or equal to 3 mm, 36 cases more than 3 mm but less than or equal to 7 mm, and 16 cases more than 7 mm. The height diameter/neck width ratio: 8 cases with absolute wide neck, 50 cases with relatively wide neck, and 8 cases with narrow neck. There were 28 cases underwent single micro-catheter embolization, 18 cases underwent double micro-catheters embolization, 14 cases underwent stent-assisted embolization and 6 cases underwent balloon-assisted embolization. The patients were followed up for 6 to 12 months and evaluated by modified Rankin score (mRS) and digital subtraction angiography (DSA). The ratio of total embolization, recurrence rate, and time from operation to reexamination of four groups managed by different endovascular treatment were compared by χ(2) test or F test.

RESULTSSixty cases were totally embolized, 3 cases subtotally embolized, 3 cases incompletely embolized. Mild hemiparalysis and aphasia occurred in 2 cases, and 1 case died of infarction induced by subarachnoid haemorrhage. The mRS at six months after operation were 0 in 31 cases, 1 in 22 cases, 2 in 8 cases, 3 in 2 cases, 4 in 2 cases, 6 in 1 case. All the included cases reexamined the DSA at averaging (7.5±1.0) month post-operatively and 4 cases recurred. There were not significant differences of the ratio of total embolization, recurrence rate, time from operation to reexamination among four groups (all P>0.05).

CONCLUSIONThe endovascular treatment maybe an ideal management for ruptured ACoAC aneurysms.

Adult ; Aged ; Aneurysm, Ruptured ; therapy ; Catheters ; Embolization, Therapeutic ; Female ; Humans ; Intracranial Aneurysm ; therapy ; Male ; Middle Aged ; Postoperative Period ; Recurrence ; Retrospective Studies ; Stents ; Treatment Outcome