1.Comparison of the efficacy and safety of vedolizumab versus infliximab in Bio-naive patients with ulcerative colitis
Duidui YAO ; Feixue LI ; Jiaqi WU ; Xiaobing LIU ; Hongping WEN
China Pharmacy 2026;37(10):1307-1312
OBJECTIVE To compare the efficacy and safety of vedolizumab (VDZ) versus infliximab (IFX) in biologic-naive(Bio-naive) patients with moderate-to-severe active ulcerative colitis (UC), and to analyze the factors influencing efficacy. METHODS Clinical data were retrospectively collected from Bio-naive patients with moderate-to-severe active UC who received treatment in the Department of Gastroenterology at Shanxi Provincial People’s Hospital from June 2023 to June 2024. Based on the type of biologic agent administered, the patients were divided into the IFX group (41 cases) and the VDZ group (30 cases). Patients in the two groups received IFX (5 mg/kg) or VDZ (300 mg) for induction and maintenance of remission therapy. The two groups were compared regarding modified Mayo score, serological indicators (hemoglobin, albumin, platelet count, erythrocyte sedimentation rate, C-reactive protein), combined medication, efficacy-related indexes (clinical response rate/remission rate, and endoscopic response rate/remission rate), and the occurrence of adverse drug reactions (ADR). Based on Logistic regression model, univariate and multivariate analyses were conducted to identify potential factors influencing clinical remission at week 14 and endoscopic remission at week 38. RESULTS There were no statistically significant differences in clinical response rate/remission rate, or endoscopic response rate/remission rate between the two groups at weeks 14 and 38 ( P >0.05). However, at week 14 of treatment, the proportion of patients using concomitant corticosteroids in VDZ group was 26.67%, significantly higher than the 7.50% in IFX group ( P <0.05). There was no statistical significance in the overall incidence of ADR between the two groups ( P >0.05); all ADRs in the IFX group were grade 3 and led to treatment discontinuation (6 cases), whereas ADR in the VDZ group was grade 2 and did not interrupt therapy (1 case). Univariate and multivariate regression analyses revealed that disease type (relapsing) was significantly associated with clinical remission at week 14 of treatment, and a history of smoking was significantly associated with endoscopic remission at week 38 of treatment (the odds ratios were 0.08 for both, with 95% confidence intervals of 0.01-0.77 and 0.01-0.91 respectively, P <0.05). CONCLUSIONS For Bio-naive patients with moderate-to-severe active UC, VDZ and IFX demonstrate comparable efficacy in inducing and maintaining clinical remission and promoting mucosal healing, as well as overall safety. Although IFX can achieve faster control of inflammation in the early stage of the disease, it causes more severe ADR. Disease type (relapsing) and smoking history are identified as independent negative predictors for short-term clinical remission and long-term endoscopic remission, respectively.
2.Feasibility and safety of mechanical thrombectomy in the endovascular recanalization of non-acute symptomatic long-segment internal carotid artery occlusion
Lanqi LI ; Chao LI ; Mingchao SHI ; Dajiang XING ; Jie ZHOU ; Feixue YUE ; Kangjia SONG ; Shouchun WANG ; Wenbin ZHANG
Chinese Journal of Cerebrovascular Diseases 2025;22(10):665-676
Objective To explore the safety and feasibility of mechanical thrombectomy as the first-line endovascular strategy in patients with non-acute symptomatic long-segment internal carotid artery occlusion(ICAO)undergoing revascularization.Methods This study retrospectively and consecutively enrolled non-acute symptomatic long-segment ICAO patients treated in the Department of Neurology,First Hospital of Jilin University,between January 2019 and August 2023,with mechanical thrombectomy as the preferred endovascular modality.Baseline and clinical data were collected,including sex,age,stroke-related risk factors(hypertension,diabetes,dyslipidemia,coronary artery disease,prior stroke,smoking and alcohol use history),admission National Institutes of Health stroke scale(NIHSS)score,pre-operative modified Rankin scale(mRS)score,time from last symptom onset to femoral puncture,time from imaging confirmation to femoral puncture,high-resolution MRI,right-sided ICAO,stump morphology(absent,tapered,flat/blunt,irregular),distal backfilling patterns(above ophthalmic segment,cavernous/clinoid segment,below cavernous segment),pathogenesis(atherosclerosis,dissection),types of anesthesia(local,general),procedure time(time frame from femoral puncture to recanalization or final angiography),site of the original occlusion in successfully recanalized cases,surgical techniques(aspiration+balloon angioplasty,aspiration+balloon angioplasty+stent-retriever thrombectomy,aspiration+balloon angioplasty+stent placement,aspiration+balloon angioplasty+stent-retriever thrombectomy+stent placement),stent placement(yes/no),number of stents implanted,and number of cases with retrieved thrombus,observed indicators.Observed indicators including ratio of technical successful recanalization(immediately post-procedure most severely stenosed site stenosis rate<50%,expanded thrombolysis in cerebral infarction[eTICI]grade≥2c),intraoperative complications(distal embolization,symptomatic intracranial hemorrhage,arterial perforation)rate,perioperative mortality rate,30-day stroke recurrence,and 90-day mRS score.Compare the baseline data,clinical data and observational indicators of the patients with successful and unsuccessful recanalization.Base on the original occlusion site,successfully recanalized patients were subclassified into isolated extracranial,isolated intracranial,and tandem lesions patients,and their baseline characteristics and observation indicators were compared.Results(1)A total of 65 patients were enrolled(57 men,8 women;age 39-80 years;median 59[52,65]years)in this study.Technical success was achieved in 52cases(80%).Perioperative complications occurred in 4 patients(6.2%),with 3 distal embolization cases(4.6%),1(1.5%)developed symptomatic intracranial hemorrhage,and no arterial perforations were observed.There was no perioperative mortality.The 30-day stroke recurrence rate was 7.7%(5/65).90-day mRS scores ranged from 0 to 4,with a median of 1.0(0.0,1.5).(2)Baseline and clinical characteristics as well as outcome indicators did not differ significantly between patients with successful versus unsuccessful recanalization in the cohort undergoing mechanical thrombectomy for non-acute symptomatic long-segment intracranial carotid artery occlusion(all P>0.05).(3)Among successfully recanalized patients,17(32.7%)had isolated extracranial lesions,18(34.6%)had isolated intracranial lesions,and 17(32.7%)had tandem lesions.All cases in the extracranial lesions group had original lesion site at the origin of internal carotid artery(C1,17/17).The intracranial group most often had orginal lesion sites at the C4 segment(9/18),whereas tandem lesions predominantly involved C1 plus C4-C5(16/17).Among the three groups,patients with isolated intracranial lesions were younger(57[48,61]years vs.60[52,64],63[58,69]years,P=0.050),and had a lower proportion of right-sided ICAO(4/18 vs.11/17 vs.11/17,P=0.032),while patients with tandem lesions required a greater number of stents(2.0[1.0,2.0]vs.1.0[1.0,1.5],1.0[0.8,2.0],P=0.013).Significant differences were observed in the proportion of patients with retrieved thrombus decreased progressively from patients with isolated extracranial,isolated intracranial to tandem lesions(17/17 vs.17/18 vs.12/17,P=0.024).No significant differences were observed among lesion-site groups with respect to medical history,stump morphology,distal retrograde flow,procedural technique,procedure duration,anesthesia method,or outcome indicators(all P>0.05).Conclusions This study suggested that utilizing mechanical thrombectomy as the first-line endovascular therapy for non-acute symptomatic long-segment ICAO is safe and feasible.The original occlusive sites of non-acute symptomatic long-segment ICAO predominantly involve the cervical origin and the cavernous segment of the internal carotid artery.The conclusions of this study require further validation.
3.Feasibility and safety of mechanical thrombectomy in the endovascular recanalization of non-acute symptomatic long-segment internal carotid artery occlusion
Lanqi LI ; Chao LI ; Mingchao SHI ; Dajiang XING ; Jie ZHOU ; Feixue YUE ; Kangjia SONG ; Shouchun WANG ; Wenbin ZHANG
Chinese Journal of Cerebrovascular Diseases 2025;22(10):665-676
Objective To explore the safety and feasibility of mechanical thrombectomy as the first-line endovascular strategy in patients with non-acute symptomatic long-segment internal carotid artery occlusion(ICAO)undergoing revascularization.Methods This study retrospectively and consecutively enrolled non-acute symptomatic long-segment ICAO patients treated in the Department of Neurology,First Hospital of Jilin University,between January 2019 and August 2023,with mechanical thrombectomy as the preferred endovascular modality.Baseline and clinical data were collected,including sex,age,stroke-related risk factors(hypertension,diabetes,dyslipidemia,coronary artery disease,prior stroke,smoking and alcohol use history),admission National Institutes of Health stroke scale(NIHSS)score,pre-operative modified Rankin scale(mRS)score,time from last symptom onset to femoral puncture,time from imaging confirmation to femoral puncture,high-resolution MRI,right-sided ICAO,stump morphology(absent,tapered,flat/blunt,irregular),distal backfilling patterns(above ophthalmic segment,cavernous/clinoid segment,below cavernous segment),pathogenesis(atherosclerosis,dissection),types of anesthesia(local,general),procedure time(time frame from femoral puncture to recanalization or final angiography),site of the original occlusion in successfully recanalized cases,surgical techniques(aspiration+balloon angioplasty,aspiration+balloon angioplasty+stent-retriever thrombectomy,aspiration+balloon angioplasty+stent placement,aspiration+balloon angioplasty+stent-retriever thrombectomy+stent placement),stent placement(yes/no),number of stents implanted,and number of cases with retrieved thrombus,observed indicators.Observed indicators including ratio of technical successful recanalization(immediately post-procedure most severely stenosed site stenosis rate<50%,expanded thrombolysis in cerebral infarction[eTICI]grade≥2c),intraoperative complications(distal embolization,symptomatic intracranial hemorrhage,arterial perforation)rate,perioperative mortality rate,30-day stroke recurrence,and 90-day mRS score.Compare the baseline data,clinical data and observational indicators of the patients with successful and unsuccessful recanalization.Base on the original occlusion site,successfully recanalized patients were subclassified into isolated extracranial,isolated intracranial,and tandem lesions patients,and their baseline characteristics and observation indicators were compared.Results(1)A total of 65 patients were enrolled(57 men,8 women;age 39-80 years;median 59[52,65]years)in this study.Technical success was achieved in 52cases(80%).Perioperative complications occurred in 4 patients(6.2%),with 3 distal embolization cases(4.6%),1(1.5%)developed symptomatic intracranial hemorrhage,and no arterial perforations were observed.There was no perioperative mortality.The 30-day stroke recurrence rate was 7.7%(5/65).90-day mRS scores ranged from 0 to 4,with a median of 1.0(0.0,1.5).(2)Baseline and clinical characteristics as well as outcome indicators did not differ significantly between patients with successful versus unsuccessful recanalization in the cohort undergoing mechanical thrombectomy for non-acute symptomatic long-segment intracranial carotid artery occlusion(all P>0.05).(3)Among successfully recanalized patients,17(32.7%)had isolated extracranial lesions,18(34.6%)had isolated intracranial lesions,and 17(32.7%)had tandem lesions.All cases in the extracranial lesions group had original lesion site at the origin of internal carotid artery(C1,17/17).The intracranial group most often had orginal lesion sites at the C4 segment(9/18),whereas tandem lesions predominantly involved C1 plus C4-C5(16/17).Among the three groups,patients with isolated intracranial lesions were younger(57[48,61]years vs.60[52,64],63[58,69]years,P=0.050),and had a lower proportion of right-sided ICAO(4/18 vs.11/17 vs.11/17,P=0.032),while patients with tandem lesions required a greater number of stents(2.0[1.0,2.0]vs.1.0[1.0,1.5],1.0[0.8,2.0],P=0.013).Significant differences were observed in the proportion of patients with retrieved thrombus decreased progressively from patients with isolated extracranial,isolated intracranial to tandem lesions(17/17 vs.17/18 vs.12/17,P=0.024).No significant differences were observed among lesion-site groups with respect to medical history,stump morphology,distal retrograde flow,procedural technique,procedure duration,anesthesia method,or outcome indicators(all P>0.05).Conclusions This study suggested that utilizing mechanical thrombectomy as the first-line endovascular therapy for non-acute symptomatic long-segment ICAO is safe and feasible.The original occlusive sites of non-acute symptomatic long-segment ICAO predominantly involve the cervical origin and the cavernous segment of the internal carotid artery.The conclusions of this study require further validation.
4.The Distribution Characteristics of Pathogenic Bacteria in Inpatients with Diabetic Foot were Correlated with Different Wagner Grades
Feixue QIN ; Juankun HE ; Shi LIU ; Bin WEN ; Hong ZHU ; Jing LI ; Li GUI ; Xiaoyan CAO
Journal of Kunming Medical University 2025;46(2):67-73
Objective To study the pathogenic bacteria infection in hospitalized diabetic foot patients in the Third People's Hospital of Yunnan Province and its correlation with different Wagner grades,to understand the the characteristics of pathogenic bacteria and related risk factors in hospitalized diabetic foot patients in the Third People's Hospital of Yunnan Province,and to further provide theoretical guidance for anti-infection treatment of these patients.Methods A retrospective analysis was conducted on the demographic data,severity of foot ulcers,and related laboratory test results of 536 patients with diabetic foot who were detected to have bacterial infection in the Third People's Hospital of Yunnan Province from January 2019 to January 2023.Results Among the 536 diabetic foot patients,pathogenic bacteria were cultured from 268 cases(50.0%)of Gram-positive bacterial infections,214 cases(39.9%)of gram-negative bacterial infections,2 cases(0.4%)of fungal infections,and 52 cases(9.7%)of mixed bacterial infections.The main pathogens among gram-positive bacteria were Staphylococcus aureus,Staphylococcus epidermidis and Enterococcus faecalis.for Gram-negative bacteria,the main pathogens were Escherichia coli,Enterobacter cloacae and Klebsiella pneumoniae.There were 31 cases of multi-drug resistant bacteria,and the multi-drug resistance rate was(5.78%).Among Gram-positive bacteria,all multidrug-resistant strains were Staphylococcus aureus,while among Gram-negative bacteria,the multi-drug resistant strains included Acinetobacter baumannii(1 case),Klebsiella pneumoniae(2 cases),Proteus common(2 cases),Pseudomonas aeruginosa(5 cases),Proteus mirabilis(1 case)and Enterobacter cloacae(1 case).The 536 patients were divided into Wagner grade 1 and 2 groups(78 cases),Wagner grade 3 group(274 cases),and Wagner grade 4 and 5 groups(184 cases).There were 73 cases of single bacterial infections and 5 cases of mixed bacterial infections in Wagner grade 1 and 2 group,including 51 cases(65.4%)of gram-positive bacteria,21 cases(26.9%)of gram-negative bacteria and 1 case(1.3%)of fungi.There were 248 cases of single bacterial infections and 26 cases of mixed bacterial infections in Wagner3 group,with 144 cases(52.6%)of gram-positive bacteria,103 cases(37.6%)of gram-negative bacteria,and 1 case(0.4%)with fungi.In the Wagner grade 4 and 5 groups,there were 163 cases of single bacterial infections and 21 cases of mixed bacterial infection,with 73 strains(39.7%)of gram-positive bacteria,90 strains(48.9%)of gram-negative bacteria and 0 strain(0%)of fungi.The predominant infectious pathogens in Wagner grades 1,2 and 3 were gram-positive bacteria,while those in Wagner grades 4 and 5 patients were mainly gram-negative bacteria.There were statistically significant differences in white blood cell counts,neutrophil percentage,bacterial classification,length of hospital stay,erythrocyte sedimentation rate and albumin levels among diabetic foot patients with different Wagner grades(P<0.01).With the increase of Wagner grade,patients had higher white blood cell counts and hypersensitive C-reactive protein levels,longer hospital stays,and lower albumin levels;however,there were no statistically significant differences in age,sex,duration of diabetes,smoking history,alcohol consumption history and history of hypertension(P>0.05).Conclusion The bacterial infection situation in patients with diabetic foot ulcers is related to different Wagner grades.The higher the Wagner grades,the greater the likelihood of infection with gram-negative bacteria.Antibiotics can be reasonably selected according to the Wagner grades of patients upon admission,actively controlling infection,while also enhancing,shortening hospital stays,and reducing amputation rates,thereby improving the prognosis of diabetic foot patients.
5.Correlation Analysis of Drug Resistance Characteristics of Pathogenic Bacteria in Inpatients with Diabetic Foot Infection
Juankun HE ; Feixue QIN ; Bin WEN ; Shi LIU ; Jing LI ; Li GUI ; Hong ZHU
Journal of Kunming Medical University 2025;46(3):44-50
Objective To analyze the bacterial distribution characteristics,drug resistance characteristics and related risk factors of multidrug-resistant organisms(MDRO)in patients with diabetic foot infection(DFI)in some areas of Yunnan Province to provide empirical reference for clinical treatment.Methods Clinical data of 300 DFI patients admitted to the Department of Endocrinology of the Third People's Hospital of Yunnan Province from January 2019 to December 2023 were collected.Based on the results of drug sensitivity tests and matching of basic data,patients were divided into the MDRO group(n=60)and the non-MDRO group(n=240).A retrospective analysis was conducted on the distribution of pathogenic bacteria,drug resistance characteristics of MDRO and risk factors for MDRO infection in DFI patients.Results In 60 patients with MDRO infections,62 strains of MDRO were cultured,with 58 strains from single MDRO infections and 4 strains from mixed MDRO infections.Of the 60 patients,2 were cultured for 2 types of MDRO.Among the strains,there were 45 gram-positive bacteria(72.58%)which were all Staphylococcus aureus,17 strains of gram-negative bacteria(27.42%)mainly including Pseudomonas aeruginosa,Enterobacter cloacae and Klebsiella pneumoniae.Among common MDRO,Staphylococcus aureus showed complete resistance to penicillin G and oxacillin(100%),with high resistance to erythromycin and clindamycin(>80%),but no resistance to tigacycline vancomycin was observed.The resistance of Klebsiella pneumoniae and Enterobacter cloacae to cephalosporin antibiotics was obvious,and the resistance rate to imipenem and amikacin was low.Pseudomonas aeruginosa was 100%resistant to ticacillin/clavulanate potassium,imipenem,tigacycline and cotrimoxazole,but showed no resistance to cefepime,ciprofloxacin,gentamicin and amikacin.There were statistically significant differences between the two groups in regional distribution,duration of diabetic foot,lower extremity arterial disease,venous plasma glucose levels and glycosylated hemoglobin(P<0.05).Binary Logistic regression analysis showed that region and duration of diabetic foot disease were independent risk factors for MDRO infection in DFI patients(P<0.05).Conclusion In some areas of Yunnan Province,the distribution of MDRO in DFI patients is mainly gram-positive bacteria,with varying antibiotic sensitivities among different pathogens.Multiple factors lead to MDRO infections in DFI patients,which assists clinical practitioners in early identification of high-risk DFI patients with MDRO infections and provide empirical reference for clinical treatment.
6.Research progress on the impact of diabetes mellitus in male fertility
Feixue HAN ; Zhijie LI ; Ziwei TAN ; Zhuang WANG ; Zijie CHAI ; Sikai HUANG ; Xiaomin LI ; Geng AN
Chinese Journal of Reproduction and Contraception 2024;44(12):1304-1312
Diabetes mellitus is a global epidemic characterized by high incidence and mortality rates. It can lead to both acute and chronic systemic complications. Diabetes-induced male reproductive disorders have become a focal point of concern. Numerous studies have shown that hyperglycemia can impair male fertility through various pathways, including erectile and ejaculatory dysfunction, disruption of the hypothalamic-pituitary-gonadal axis, damage to the epididymis and testis, impaired semen quality, abnormalities in testicular and sperm glucose metabolism, and adverse effects on offspring health. The mechanisms involved include oxidative stress, inflammation, autophagy, apoptosis, epigenetic regulation, and mitochondrial damage. Interventions for male fertility impairment include diabetes treatment drugs, antioxidants, Traditional Chinese Medicine and acupuncture, mesenchymal stem cell therapy, exercise and physical training, as well as gut microbiota interventions. This article aims to review the current research on the relationship between diabetes and male fertility, explore the underlying mechanisms leading to male infertility, and identify potential interventions to improve male reproductive health, which holds significant clinical value.
7.Trend of blood pressure among children and adolescents and its correlation with pubertal development and nutritional status
HAO Zhihong, WEI Feixue, LI Qiaofeng, HAN Weifang, WANG Li
Chinese Journal of School Health 2024;45(12):1770-1774
Objective:
To explore the trend of blood pressure among children and adolescents and its correlation with pubertal development and nutritional status, so as to provide a scientific basis for developing prevention strategies targeting early stage hypertension.
Methods:
In September 2023, a multi stage random cluster sampling was used to select 20 241 primary and secondary school students aged 7-18 years from 57 schools in Jinzhong, whose height, weight, and blood pressure were measured. The Chi square test for trend was used to analyze the change trend in the detection rate of elevated blood pressure and hypertension in children and adolescents with the development of adolescence puberty, and the Logistic regression was used to analyze the correlation between elevated blood pressure and hypertension and nutritional status.
Results:
The prevalence of elevated blood pressure was 17.3% among children and adolescents. The middle and late pubertal groups had the highest prevalence (23.2% and 24.3%), followed by the early pubertal group (19.5%) and the prepuberty group (10.8%) ( χ 2 trend =372.86, P <0.01). The prevalence of hypertension was 14.8%, with the highest prevalence reported in the late pubertal group (22.4%), followed by the middle pubertal group (18.9%), and the early pubertal (13.0%)/prepuberty (12.2%) groups ( χ 2 trend =175.43, P <0.01). The prevalence of elevated blood pressure and hypertension increased with pubertal development, regardless of gender, region, or nutritional status ( χ 2 trend =9.21-771.90, P <0.01). Overweight and obesity were influencing factors of elevated blood pressure and hypertension among children and adolescents during all stages of pubertal development ( OR =1.2-2.8, P <0.01).
Conclusion
The prevalence of elevated blood pressure and hypertension among children and adolescents during pubertal development is high, showing an increasing trend with pubertal development.
8.Research progress on the impact of diabetes mellitus in male fertility
Feixue HAN ; Zhijie LI ; Ziwei TAN ; Zhuang WANG ; Zijie CHAI ; Sikai HUANG ; Xiaomin LI ; Geng AN
Chinese Journal of Reproduction and Contraception 2024;44(12):1304-1312
Diabetes mellitus is a global epidemic characterized by high incidence and mortality rates. It can lead to both acute and chronic systemic complications. Diabetes-induced male reproductive disorders have become a focal point of concern. Numerous studies have shown that hyperglycemia can impair male fertility through various pathways, including erectile and ejaculatory dysfunction, disruption of the hypothalamic-pituitary-gonadal axis, damage to the epididymis and testis, impaired semen quality, abnormalities in testicular and sperm glucose metabolism, and adverse effects on offspring health. The mechanisms involved include oxidative stress, inflammation, autophagy, apoptosis, epigenetic regulation, and mitochondrial damage. Interventions for male fertility impairment include diabetes treatment drugs, antioxidants, Traditional Chinese Medicine and acupuncture, mesenchymal stem cell therapy, exercise and physical training, as well as gut microbiota interventions. This article aims to review the current research on the relationship between diabetes and male fertility, explore the underlying mechanisms leading to male infertility, and identify potential interventions to improve male reproductive health, which holds significant clinical value.
9.Research Progress of HER2 Positive Colorectal Cancer
Yali QI ; Yani GOU ; Lijun DA ; Enxi LI ; Yating LIU ; Xiaxia PEI ; Feixue SONG
Cancer Research on Prevention and Treatment 2023;50(1):86-93
Epidermal growth factor receptor 2 (HER2) is an oncogene involved in tumour genesis and progression. It is expressed in 7% of patients with colorectal cancer (CRC) and is associated with drug resistance of epidermal growth factor receptor monoclonal antibodies. With the emergence of the therapeutic dilemma of CRC and the survival benefits of targeting HER2 for patients with breast cancer and gastric cancer, the significance of HER2 in CRC and the prognostic value of anti-HER2 therapy have been widely concerned, clinical researches on HER2-positive CRC have been continuously carried out. Currently, the diagnostic criteria for HER2 positive CRC have gradually been unified. HER2-targeting therapies such as monoclonal antibodies, tyrosine kinase inhibitors, antibody-drug coupling and HER2-related immunotherapy alone or in combination have shown good efficacy and brought significant survival benefits for HER2 positive CRC. This paper reviews the research progress of HER2 in CRC.
10.Safety and efficacy of endovascular treatment in patients with acute posterior circulation ischemic stroke over 24 hours from onset:a propensity score matched cohort study
Feixue YUE ; Chao LI ; Kangjia SONG ; Mingchao SHI ; Chao LI ; Jie ZHOU ; Wenbin ZHANG ; Shouchun WANG
Chinese Journal of Cerebrovascular Diseases 2023;20(12):816-824,836
Objective To explore the safety and efficacy of endovascular treatment(EVT)in patients with acute posterior circulation ischemic stroke over 24 hours from onset.Methods This retrospective study retrospectively analyzed patients with acute posterior circulation ischemic stroke who received EVT in the Department of Neurology,First Hospital of Jilin University from June 2018 to June 2023.The patient's gender,age and other related demographic information were collected.The related examination results of patients were collected,including admission rapid blood glucose,admission systolic blood pressure,admission diastolic blood pressure.The related risk factors of stroke of patients were collected,including previous transient ischemic attack,hypertension,diabetes,atrial fibrillation,and history of drinking,smoking history,etc.;other related indicators were collected,including intravenous thrombolysis,tandem lesions,awakening stroke,baseline National Institutes of Health stroke scale(NIHSS)score,and baseline posterior circulation Alberta stroke program early CT score(pc-ASPECTS),collateral circulation grade of American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology(ASITN/SIR),onset to EVT puncture time,the trial of org 10172 in acute stroke treatment(TOAST)classification and outcome indicators(efficacy indicators included 90 days Modified Rankin scale[mRS]score≤3 after EVT,successful recanalization[extended cerebral infarction thrombolytic recanalization class 2b-3];security indexes included symptomatic intracranial hemorrhage[sICH]within 24 h after EVT and 90 d mortality after EVT).According to the symptom onset to EVT puncture time,the patients were divided into two groups:≤24h group and>24h group.The patients with onset time>24 h and those with onset time≤24 h were matched at a ratio of 1:1 by propensity score matching(PSM).All patients were divided into poor prognosis group(mRS score>3)and good prognosis group(mRS score ≤ 3)according to mRS score at 90 days after EVT.Using univariate and multivariate Logistic regression was used to analyze the effect of onset time on clinical outcomes at 90 days after EVT.Results A total of 366 patients were enrolled in this study,including 284 males and 82 females.The median age was 61(55,68)years old,ranging from 25 to 91 years old.Before PSM,the>24h group had lower prevalence of atrial fibrillation(2.02%[2/99]vs.9.74%[26/267],P=0.025)and lower baseline NIHSS score(10.0[5.0,19.0]vs.14.0[10.0,35.0],P<0.01)and higher ASTIN/SIR collateral grade(P=0.018).After PSM,we did not find statistical difference between the two groups in baseline characteristics except for the onset to EVT puncture time.Before and after PSM,there was no significant difference in efficacy and safety between the onset time>24 h group and the onset time ≤24h group.Univariate binary Logistic regression analysis showed that hypertension(OR,0.613,95%CI 0.391-0.942,P=0.025),intravenous thrombolysis(OR,3.235,95%CI 1.316-9.237,P=0.010),baseline NIHSS score(OR,0.975,95%CI 0.957-0.988,P<0.01),baseline pc-ASPECTS(OR,1.281,95%CI 1.101-1.482,P=0.001)and sICH within 24 h after EVT(OR,0.070,95%CI 0.000-0.330,P<0.01)were significantly correlated with prognosis.Gender,age,hypertension,baseline NIHSS score,intravenous thrombolysis,baseline pc-ASPECTS,ASTIN/SIR collateral grade,onset time>24 h and sICH within 24 h after EVT were included in the multivariate binary Logistic regression analysis.The multivariate binary Logistic regression analysis showed that the onset time>24 h was not associated with poor prognosis 90 d after EVT(aOR,1.635,95%CI 0.936-2.893,P=0.087).Conclusion EVT for acute posterior circulation ischemic stroke more than 24 hours after onset is feasible under strict imaging screening,and its safety and efficacy are similar to those in patients with onset under 24 hours.


Result Analysis
Print
Save
E-mail