Objective To explore the prognostic value of hyperdense artery sign(HAS)in elderly patients with acute anterior LVO in anterior circulation undergoing mechanical thrombectomy.Methods A single-center retrospective analysis was conducted on 109 patients with acute LVO of anterior circulation admitted in our department from January 2019 to December 2022.According to their preoperative plain CT scans,they were divided into HAS positive(39 patients)and HAS negative(70 patients)groups.Baseline features,surgical indicators,complications and outcomes were compared between the two groups.Results The patients with HAS had significantly larger proportions of atrial fibrillation and symptomatic intracranial hemorrhage than those without the sign(53.8％vs 31.4％,20.5％vs 5.7％,P＜0.05).The rate of 90-day good prognosis was a little higher in the HAS positive group than the negative group,though no statistical difference(48.7％vs 38.6％,P＞0.05).Male,stroke history,SBP,NIHSS at admission,HAS positivity,revasculiza-tion,and symptomatic intracranial hemorrhage were independent influencing factors for favorable prognosis in the patients(P＜0.05,P＜0.01).Conclusion The presence of HAS is a prognostic marker for patients with acute LVO in anterior circulation undergoing mechanical thrombectomy,and it is associated with a higher risk of symptomatic intracranial hemorrhage.

Objective To explore the prognostic value of hyperdense artery sign(HAS)in elderly patients with acute anterior LVO in anterior circulation undergoing mechanical thrombectomy.Methods A single-center retrospective analysis was conducted on 109 patients with acute LVO of anterior circulation admitted in our department from January 2019 to December 2022.According to their preoperative plain CT scans,they were divided into HAS positive(39 patients)and HAS negative(70 patients)groups.Baseline features,surgical indicators,complications and outcomes were compared between the two groups.Results The patients with HAS had significantly larger proportions of atrial fibrillation and symptomatic intracranial hemorrhage than those without the sign(53.8％vs 31.4％,20.5％vs 5.7％,P＜0.05).The rate of 90-day good prognosis was a little higher in the HAS positive group than the negative group,though no statistical difference(48.7％vs 38.6％,P＞0.05).Male,stroke history,SBP,NIHSS at admission,HAS positivity,revasculiza-tion,and symptomatic intracranial hemorrhage were independent influencing factors for favorable prognosis in the patients(P＜0.05,P＜0.01).Conclusion The presence of HAS is a prognostic marker for patients with acute LVO in anterior circulation undergoing mechanical thrombectomy,and it is associated with a higher risk of symptomatic intracranial hemorrhage.

Objective:To investigate the safety of early antiplatelet therapy for non-cardioembolic mild stroke patients with thrombocytopenia.Methods:Data of acute ischemic stroke patients with baseline National Institutes of Health Stroke Scale(NIHSS)score≤3 and a platelet count<100×109/L were obtained from a multicenter register.Those who required anticoagulation or had other contraindications to antiplatelet therapy were excluded.Short-term safety outcomes were in-hospital bleeding events,while the long-term safety outcome was a 1-year all-cause death.The short-term neurological outcomes were evaluated by modified Rankin scale(mRS)score at discharge.Results:A total of 1868 non-cardioembolic mild stroke patients with thrombocytopenia were enrolled.Multivariate regression analyses showed that mono-antiplatelet therapy significantly increased the proportion of mRS score of 0-1 at discharge(OR=1.657,95%CI:1.253-2.192,P<0.01)and did not increase the risk of intracranial hemorrhage(OR=2.359,95%CI:0.301-18.503,P>0.05),compared with those without antiplatelet therapy.However,dual-antiplatelet therapy did not bring more neurological benefits(OR=0.923,95%CI:0.690-1.234,P>0.05),but increased the risk of gastrointestinal bleeding(OR= 2.837,95%CI:1.311-6.136,P<0.01)compared with those with mono-antiplatelet therapy.For patients with platelet counts≤75×109/L and>90×109/L,antiplatelet therapy significantly improved neurological functional outcomes(both P<0.05).For those with platelet counts(>75-90)×109/L,antiplatelet therapy resulted in a significant improvement of 1-year survival(P<0.05).For patients even with concurrent coagulation abnormalities,mono-antiplatelet therapy did not increase the risk of various types of bleeding(all P>0.05)but improved neurological functional outcomes(all P<0.01).There was no significant difference in the occurrence of bleeding events,1-year all-cause mortality risk,and neurological functional outcomes between aspirin and clopidogrel(all P>0.05).Conclusions:For non-cardioembolic mild stroke patients with thrombocytopenia,antiplatelet therapy remains a reasonable choice.Mono-antiplatelet therapy has the same efficiency as dual-antiplatelet therapy in neurological outcome improvement with lower risk of gastrointestinal bleeding.

Objective To investigate the safety, reliability and effectiveness of supra - aortic artery stenting angioplasty via transradial access in treating supra-aortic artery occlusion or stenosis. Methods The clinical data of 325 consecutive patients with supra-aortic artery occlusion or stenosis, who were admitted to authors' hospital during the period from January 2012 to January 2016 to receive stenting angioplasty, were retrospectively analyzed. According to patient's own will, the 325 patients were divided into transradial access group (n=52) and transfemoral access group (n=273). The results of the puncturing, the operative results, the duration of operation, the amount of intraoperative blood loss, the postoperative complications, the time of postoperative rest in bed, the average time of hospitalization of both groups were recorded. Results No statistically significant differences in the success rate of puncturing, the success rate of operation and the amount of intraoperative blood loss existed between the two groups (P＞0. 05). In 73. 1％ of patients (38/52) of the transradial access group the duration of operation was ≤30 min, while only in 43. 2％ of patients (118/ 273) of the transfemoral access group the duration of operation was ≤30 min, the difference between the two groups was statistically significant (P＜0. 000 1). After the operation, in transradial access group puncture point bleeding was seen in 8 patients and hematoma at the puncture site in one patient, the complication rate was 17. 3％ (9/52), while in transfemoral access group puncture point bleeding was observed in 23 patients, hematoma at the puncture site in 7 patients, pain of puncture site in one patient, and cerebral hemorrhage in one patient, the total complication rate was 11. 7％ (32/273); but the difference between the two groups was not statistically significant (χ2=1. 236, P=0. 266). Patients in the transradial access group could get out of bed immediately after the operation. No statistically significant difference in the average time of hospitalization existed between the two groups (P＞0. 05). Conclusion In performing endovascular stenting angioplasty for supra-aortic artery occlusion or stenosis, both transradial access and transfemoral access are safe, reliable and effective. Transradial access can be used as a replacement of transfemoral access. (J Intervent Radiol, 2018, 27:207-210)

Objective To investigate the effects of X-ray beam hardening from contrast agent on CT values on CTA images.Methods The 20 mL syringes were numbered 1 to 26.The syringe 1,4,7,23 and 20 were filled with 1 mL,0.8 mL,0.6 mL,0.4 mL and 0.2 mL of iodine contrast medium (300 mg I/mL),respectively,and then mixed each of them with 0.9％ NaC1 solution to get a total of 20 mL solution in each syringe.The rest of 26 syringes were filled with 20 mL of 0.9％ NaC1 solution,as the experimental group to simulate carotid artery CTA examination.Matched 26 numbered syringes were filled with 20 mL 0.9％ NaC1 solution respectively,as control group to simulate plain scan.CT scans were performed,CT values were measured,and then the difference of CT values of 0.9 ％ NaCl solution in two groups was analyzed statistically.Results The mean,maximum and minimum CT values of saline in the experimental group vs control group were (-0.139±10.322) HU vs (5.585±2.939) HU,14.6 HU vs 9.7 HU,-23.8 HU vs-2.4 HU,respectively,and the differences were significant (t=2.695,P＜0.05).The CT values of saline around the high concentrations of iodine solution showed a large fluctuation range.Conclusion The X ray beam hardening effects caused by high concentration of iodine contrast on carotid artery CTA phase,may cause significant fluctuations of CT values.

Objective To investigate the relationship between acute cerebral infarction(CI)and matrix metalloproteinase-9(MMP-9)serum level and polymorphism(C-1562T)in Han population.Methods One hundred and one patients with acute CI from the department of neurology of Taizhou Hospital were included and 114 healthy persons were selected from physical examination as the control group.Serum MMP-9 level was measured by enzyme-linked immunosorbent assay(ELISA).At the same time.genotype was determined by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP)for the common C-1562T functional promoter polymorphism of the MMP-9 gene.The serum MMP-9 level and genotype frequencies of the MMP-9 gene between the patients and the control group were analyzed.Results The genotype frequencies of the MMP-9 gene C-1562T polymorphism of the two groups were in Hardy-Weinberg equilibrium.The results of individual polymorphisms analysis showed that the frequencies of CT and TT genotypes in the C-1562T polyporphismin were of no significant difference between the patients group with CI(13.9%)and the control group(13.2%).The frequencies of-1562T allele was of no statistical difference between the CI group(6.9%)and the control group(7.5%).But serum levels of MMP-9 in CI patients group((138.9±121.8)ng/ml)were significantly higher than in the control group((18.4±4.6)ng/ml,t=9.93,P=0.00).Conclusions Serum level of MMP-9 obviously is increased after ischemic stroke in 48 hours.But genetic polymorphism in MMP-9 promoter(C-1562T)has no definite relationship with MMP-9 genetic expression and CI in the Han population of China.Therefore,the relationship between genetic polymorphism in MMP-9 promoter(C-1562T)and ischemic stroke needs further investigation.

Objective:To investigate the effect ofLeech Capsule on stability ofcarotid plaque and expression ofplatelet membrane glycoprotein in patients with cerebral arteriosclerosis.Methods:203 patients with cerebral arteriosclerosis which with unstable carotid plaque were divided into two groups.There were 101 patients in observation group which were treated by conventional therapy and Leech Capsule, and 102 patients in control group which were treated only by conventional therapy.Then comparison analysis ofIMT, plaque area, unstable plaque number and positive rates ofPAC-1 and CD62P were made before and after treatment with two groups.Results:After treatment, the IMT, plaque area, unstable plaque number and positive rates ofPAC-1 and CD62P in observation group were significantly lesser than those in control group.In observation group, all parameters after treatment were significantly lesser than those before treatment, but in control group there were no significant difference in IMT and positive rates ofCD62P between after treatment and before treatment.In addition, there were no obvious adverse reactions after treatment by leech capsule.Conclusion:Leech Capsule was an effective drug for stabilizing carotid plaque and depressing the level ofplatelet activation, and it had few adverse reaction.It was worth further spreading.