Objective:To explore the value of blood-brain barrier permeability (BBBP) parameters based on CT perfusion (CTP) in predicting delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH) within 24 hours of admission.Methods:Totally 69 patients underwent whole-brain CTP within 24 h after aneurysm rupture from July to November 2020 in Yijishan Hospital of Wannan Medical College. The volume transfer constant (K trans) reflecting BBBP, the time to drain (TTD) and transit time to the center of the impulse response function (TMax) reflecting cerebral perfusion were obtained. Patients were divided into DCI and non-DCI groups. Quantitative and qualitative CTP parameters, clinical data were compared between the two groups. On the basis of univariate analysis, the multivariate logistic regression analysis was used to determine the independent risk factors of DCI using the stepwise regression method. The predictive efficiency of clinical data and CTP parameters were evaluated by ROC analysis. Results:Twenty-one of 69 aSAH patients developed DCI. Whole brain average values of K trans (mK trans) in the DCI group [(0.67±0.16)ml/(100 ml·min)] were significantly higher than those in the non-DCI group [(0.41±0.15)ml/(100 ml·min), t=-6.454, P<0.001]. mK trans in the diffused hypoperfusion patients [(0.61±0.18)ml/(100 ml·min)] was significantly higher than that in the normal perfusion group [(0.36±0.15)ml/(100 ml·min), P<0.001] and localized hypoperfusion group [(0.43±0.16)ml/(100 ml·min), P<0.001]. Multivariate logistic regression analysis showed mK trans (OR=1.13, 95%CI 1.05-1.21, P=0.001), World Federation of Neurosurgery Scale (OR=5.35, 95%CI 1.12-25.65, P=0.036) and modified Fisher Score (OR=5.32, 95%CI 1.02-27.80, P=0.048) were significantly independent predictors of DCI. ROC curve analysis revealed that mK trans produced the highest AUC of 0.875 (95%CI 0.78-0.97), with a threshold of 0.545 ml/(100 ml·min) had sensitivity of 85.7%, specificity of 79.2% and Youden index of 64.9% for prediction of developing DCI. Conclusion:It is feasible to evaluate cerebral perfusion and BBBP status and predict the risk of developing DCI in aASH patients who admitted within 24 h after aneurysm rupture using whole-brain CTP.

To analyze the structural specificity of Shenque (CV 8) in terms of vascular biology from the three aspects of structure, tissue and molecular anatomies. On structural anatomy Shenque (CV 8) possessed defined vascular structure and was the only acupoint directly affected vascular intima. The basis of the specific therapeutic effects was owing to its relation with vessel and abundant microcirculation. Endothelial cells and microvascular endothelial cells were the tissue basis of the starting of therapeutic specificity. Molecular anatomy involved in the functions of transient receptor potential vanilloid family (TRPV) pathway and neuronal peptide secretion of endothelial cells in the structural function of the point. The "restoringfor collapse" effect of salt-partition moxibustion at Shenque (CV 8) was analyzed based on the local biological specificity of blood vessels. The mechanisms were concluded as effectively targeting the dysfunction of microvascular endothelial cells and acquiring the maximum quantity of moxibustion by repeated warm-heat stimulation. The vascular biological structural features of Shenque (CV 8) may contribute to direct therapeutic effects on endothelial cells by the point.