Adult ; Central Nervous System Cysts ; diagnosis ; surgery ; Craniopharyngioma ; diagnosis ; surgery ; Female ; Humans ; Stroke ; diagnosis ; surgery

Brain Ischemia ; Endovascular Procedures ; Humans ; Stroke/surgery* ; Thrombectomy ; Treatment Outcome

Restoration of cerebral blood flow is particularly important for the treatment of ischemic cerebrovascular disease. It is notable that surgical approaches play a unique role in treating this devastating disease. Among them, mechanical thrombectomy facilitates rapid and effective recanalization of occluded intracranial large vessels causing ischemic stroke, which contributes to improvement of cerebral perfusion in the ischemic penumbra; decompressive craniectomy is an important therapeutic option for acute massive cerebral infarction, and the timing of surgery determines the final clinical outcomes; for carotid endarterectomy in carotid-artery stenosis, individualized surgical plan is important for the safety and effectiveness of the operation; in the surgical revascularization of Moyamoya disease, precise evaluation of clinical and radiological characteristics, optimal surgical strategies and accuracy of intraoperative judgment will yield maximal therapeutic effects; and hybrid surgery is feasible for the therapy of complex ischemic cerebrovascular diseases, such as extracranial/intracranial arteries tandem stenosis and symptomatic chronic total occlusion of carotid artery. This paper reviews recent technical and clinical advances in the surgical treatment of ischemic cerebrovascular disease.
Brain Ischemia ; surgery ; Carotid Artery, Internal ; surgery ; Carotid Stenosis ; surgery ; Endarterectomy, Carotid ; trends ; Humans ; Stroke ; surgery ; Treatment Outcome

BACKGROUNDCatheter ablation for atrial fibrillation (AF) has been demonstrated to be effective in a subsets of patients with AF. However, very few data are available in regard to patients with prior history of stroke undergoing catheter ablation. This study aimed to investigate the outcome of catheter ablation in AF patients with prior ischemic stroke.

METHODSBetween January 2008 and December 2011, of 1897 consecutive patients who presented at Beijing An Zhen Hospital for treatment of drug-refractory AF, 172 (9.1%) patients in the study population had a history of ischemic stroke. All patients underwent catheter ablation and were followed up to assess maintenance of sinus rhythm and recurrence of symptomatic stroke.

RESULTSAmong these 1897 patients, 1768 (93.2%) who had complete follow-up information for a minimum of six months were included in the final analysis. Patients in the stroke group (group I) and the no-stroke group (group II) were similar in regards to gender, body mass index (BMI), history of diabetes, type of AF, and left atrial size. The patients in group I were older than those in group II, and had a higher incidence of hypertension, chronic heart failure, lower left ventricular ejection fraction (LVEF), and higher CHADS2 scores. Six months after ablation, 107 (68.6%) patients in group I and 1403 (87.1%) in group II had discontinued warfarin treatment (P < 0.001). During a median follow-up of (633 ± 415) days, 65 patients in the group I and 638 in group II experienced AF recurrence, and five patients in group I and 28 in group II developed symptomatic stroke. The rates of AF recurrence and recurrent stroke were similar between group I and group II (41.7% vs. 39.6%, P = 0.611; 3.2% vs. 1.7%, P = 0.219; respectively).

CONCLUSIONCatheter ablation of AF in patients with prior stroke is feasible and efficient.

Aged ; Atrial Fibrillation ; surgery ; Catheter Ablation ; methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stroke ; surgery

The character and application status of interventional thrombectomy devices for acute ischemic stroke (AIS) are briefly introduced and the development trend is also analyzed.
Brain Ischemia ; drug therapy ; surgery ; Humans ; Stroke ; drug therapy ; surgery ; Thrombectomy ; instrumentation ; Thrombolytic Therapy ; instrumentation

Severe ischemic stroke carries a high rate of disability and death. The severity of stroke is often assessed by the degree of neurological deficits or the extent of brain infarct, defined as severe stroke and large infarction, respectively. Critically severe stroke is a life-threatening condition that requires neurocritical care or neurosurgical intervention, which includes stroke with malignant brain edema, a leading cause of death during the acute phase, and stroke with severe complications of other vital systems. Early prediction of high-risk patients with critically severe stroke would inform early prevention and treatment to interrupt the malignant course to fatal status. Selected patients with severe stroke could benefit from intravenous thrombolysis and endovascular treatment in improving functional outcome. There is insufficient evidence to inform dual antiplatelet therapy and the timing of anticoagulation initiation after severe stroke. Decompressive hemicraniectomy (DHC) <48 h improves survival in patients aged <60 years with large hemispheric infarction. Studies are ongoing to provide evidence to inform more precise prediction of malignant brain edema, optimal indications for acute reperfusion therapies and neurosurgery, and the individualized management of complications and secondary prevention. We present an evidence-based review for severe ischemic stroke, with the aims of proposing operational definitions, emphasizing the importance of early prediction and prevention of the evolution to critically severe status, summarizing specialized treatment for severe stroke, and proposing directions for future research.
Humans ; Ischemic Stroke/pathology* ; Brain Edema/surgery* ; Stroke/prevention & control* ; Brain/pathology* ; Brain Infarction/pathology* ; Treatment Outcome

To investigate the effect of controlled hypotension by urapidil on the predictive accuracy and diagnostic threshold of stroke volume variation (SVV) in hypertensive and non-hypertensive patients undergoing robotic hepatobiliary surgery.
 Methods: Eighty patients undergoing robotic hepatobiliary surgery under general anesthesia were divided into a hypertension group (n=25) and a non-hypertension group (n=38) according to whether or not essential hypertension was present (excluding some cases that didn't meet requirements). The pump speed was at 6.0-7.0 µg/(kg﹒min), and the range of hypotension was between 10%≤Δ systolic blood pressure (SAP)≤20%. Volume loading test was performed after artificial pneumoperitoneum was established in reverse-Trendelenburg position. Hemodynamic indexes including heart rate (HR), SAP, cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke volume index (SVI) and SVV were recorded before and after infusion. Then the receiver operating characteristic (ROC) curves of SVV was drawn to determine the accuracy and diagnosis of SVV in predicting volume status in hypertensive and non-hypertensive patients after anti-Trendelenburg posture and pneumoperitoneum.
 Results: In the patients with controlled hypotension by urapidil, the area under the ROC curve of SVV in the hypertension group was 0.974, the diagnostic threshold was 13.5%, the ROC curve of SVV in the non-hypertension group was 0.832, and the diagnostic threshold was 15.5%.
 Conclusion: SVV can accurately predict the volume status in the hypertension group and the non-hypertension group after controlled hypotension in the anti-Trendelenburg position and fixed pneumoperitoneal pressure, and the SVV diagnostic threshold in the non-hypertensive group is higher than that in the hypertensive group.
Biliary Tract Diseases ; surgery ; Blood Pressure ; Cardiac Output ; Fluid Therapy ; Hemodynamics ; Humans ; Hypotension, Controlled ; Liver Diseases ; surgery ; ROC Curve ; Robotic Surgical Procedures ; Stroke ; Stroke Volume

Anticoagulants ; Atrial Appendage/surgery* ; Atrial Fibrillation/complications* ; Brain Ischemia ; Cardiac Catheterization ; Female ; Humans ; Moyamoya Disease/surgery* ; Stroke ; Treatment Outcome

OBJECTIVETo evaluate the efficacy and safety of mechanical thrombectomy with the Solitaire AB device in recanalization of patients with acute ischemic stroke of posterior circulation.

METHODSThe clinical data of 17 consecutive patients with acute ischemic stroke of posterior circulation, treated with the Solitaire AB device from August 2011 to August 2015 in Department of Neurosurgery, the Military General Hospital of Beijing People's Liberation Army, were extracted and then retrospectively analyzed. There were 12 male and 5 female patients with a median age of 60 years (ranging from 44 to 75 years). Among them, 8 cases occluded in basilar artery, 4 cases occluded in vertebral artery and 5 cases occluded in vertebral plus basilar artery. Recanalization rate as well as complications after treatment were analysized. Also, neurological functions of the patients before and after treatment, measured by National Institute of Health stroke scale (NIHSS) score, were compared via t test and the clinical outcomes were assessed by modified Rankin score (mRS) at 90 days after treatment.

RESULTSFifteen patients resulted in successfully recanalization, and 2 cases failed both of whose onset to sheath time were above 7.5 hours. The NIHSS score at 7 days was 11±10, which was significantly decreased compared to the admission NIHSS score 17±5 (t=2.949, P=0.009). No symptomatic intracranial hemorrhage case was found after thrombectomy. At 90 days, one patient died(mRS 6), one patient seriously disabled (mRS 5), two patients moderately seriously disabled (mRS 4), four patients resulted in moderate outcome (mRS 3) and the other 9 patients achieved good outcome (mRS 0 to 2). The dead and seriously disabled cases were both due to failure in recanalization. Two moderately seriously disabled cases were probably attributed to their severe admission condition (NIHSS >20) and prolonged time (onset to sheath time >6 hours).

CONCLUSIONMechanical thrombectomy with the Solitaire AB device contributes to a high rate of recanalization with a low probability of complication and improves functional outcome in patients with acute ischemic stroke of posterior circulation.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Stroke ; surgery ; Thrombectomy ; Treatment Outcome

BACKGROUND: The optimal timing of surgery for infective endocarditis complicated by embolic stroke is unclear. We compared early versus delayed surgery in these patients. MATERIALS AND METHODS: Between 1992 and 2007, 56 consecutive patients underwent open cardiac surgery for the treatment of infective endocarditis complicated by acute septic embolic stroke, 34 within 2 weeks (early group) and 22 more than 2 weeks (delayed group) after the onset of stroke. RESULTS: The mean age at time of surgery was 45.7+/-14.8 years. Stroke was ischemic in 42 patients and hemorrhagic in 14. Patients in the early group were more likely to have highly mobile, large (>1 cm in diameter) vegetation and less likely to have hemorrhagic infarction than those in the delayed group. There were two (3.7%) intraoperative deaths, both in the early group and attributed to neurologic aggravation. Among the 54 survivors, 4 (7.1%), that is, 2 in each group, showed neurologic aggravation. During a median follow-up of 61.7 months (range, 0.4~170.4 months), there were 5 late deaths. Overall 5-year neurologic aggravation-free survival rates were 79.1+/-7.0% in the early group and 90.9+/-6.1% in the delayed group (p=0.113). CONCLUSION: Outcomes of early operation for infective endocarditis in stroke patients were similar to those of the conventional approach. Early surgical intervention may be preferable for patients at high risk of life-threatening septic embolism.
Embolism ; Endocarditis ; Follow-Up Studies ; Humans ; Infarction ; Neurologic Manifestations ; Stroke ; Survival Rate ; Survivors ; Thoracic Surgery