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Objective To analyze the causes and possible influencing factors of endovascular recanalization failure of chronic internal carotid artery occlusion (CICAO). Methods One hundred and three patients underwent endovascular recanalization of CICAO in Department of Interventional Meurology of Beijing Tiantan Hospital, Capital Medical University were selected from December 2012 to December 2019. The factors possibly related to failure (including sex, age, underlying disease, time from occlusion to recanalization, the shape of the stump and the position of the reflux) were analyzed. Univariate and multivariate Logistic regression analysis were used to screen for influence factors related to the failure of recanalization. Results In 103 cases there were 33 patients who failed in recanalization, the failure rate was 32.04%. One case (0.97%) occurred subarachnoid hemorrhage which induced severe headache during oberation. Logistic regression analysis showed that the stump of the occluded 1CA was non-pointed (OR = 3.037, 95% CI: 1.245-7.406; P = 0.015) and the reflux position of the distal ICA was above the cavernous sinus (OR = 3.118, 95% CI: 1.206-8.061; P = 0.019) were the risk factors for failure of successful rate after endovascular recanalization of CICAO. Of the 33 failure cases, 27 cases (81.82%) were due to guide wires failed to pass through the occlusion segment, which mainly occurred in C4-C5 segment (14 cases, 42.42%) and CI segment (11 cases, 33.33%); other 6 cases (18.18%) were due to dissection which mainly occurred in C4-C5 segment (5 cases, 15.15%). Conclusions The operation of CICAO is relatively safe and feasible. The stump condition and the position of distal reflux of the occluded internal carotid artery are the key in judging the difficulty of recanalization. [ABSTRACT FROM AUTHOR]

Objective To evaluate whether patients with acute basilar artery occlusion (BAO) tandem lesion could affect the clinical outcome after receiving endovascular treatment (EVT) in a high-volume stroke center. Methods A total of 187 consecutive patients with acute BAO receiving EVT from January 2012 to July 2018 were recruited in this study. The patients were categorized into 2 groups with (25 cases) or without (162 cases) tandem lesion. Preoperative Posterior Circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and Pons-Midbrairn Index (PMI) were used to evaluate the cerebral infarction range, and Post-Traffic Score and American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) grading were used to evaluate the posterior circulation collateral compensation after actue BAO. The main prognostic indicators were immediate postoperative vascular recanalization rate, functional independence and prognosis 90 d after treatment, and the main safety endpoints were intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH) incidence 7 d after surgery and mortality 90 d after treatment. Results In tandem group, the lesions were mainly located at the beginning of the basilar artery (including the intracranial segment of the vertebral artery) and at the distal end (P = 0.000), and the proportion of intracranial arterial stenosis was lower (P = 0.000). Among the 25 patients with tandem lesion, 21 took the Dirty-road route and 4 took the Clean-road route. The proportion of stent thrombectomy (P = 0.030) and intraoperative intravenous injection of tirofibana (P = 0.028) was lower, the proportion of stent implantation was higher (P = 0.005), the proportion of vascular recanalization after treatment was lower (P = 0.001), and the mortality rate was higher 90 d after treatment (P = 0.002). Univariate and multivariate Logistic regression analysis showed that acute BAO tandem lesion had a lower immediate vascular recanalization rate (OR = 0.050, 95%CI: 0.010-0.530; P = 0.012) and a higher mortality 90 d after treatment (OR = 17.320, 95%CI: 2.700-111.040; P = 0.003). Conclusions Tandem lesion seems to be associated with low rate of recanalization and high rate of mortality in patients with acute BAO. [ABSTRACT FROM AUTHOR]

Objective To screen the risk factors related to unfavorable prognosis and evaluate the predictive effect of four imaging scoring systems on the unfavorable prognosis in the patients with acute basilar artery occlusion (BAO) after endovascular thrombectomy. Methods From March 2012 to August 2018, a total of 57 patients with acute BAO were treated with endovascular thrombectomy, preoperative DWI Posterior Circulation Alberta Stroke Program Early CT Score (pc-ASPECTS), DWI Brain Stem Score (BSS), Posterior Circulation CTA (pc-CTA) and Basilar Artery CTA (BATMAN) were used. Thrombolysis in Cerebral Infarction (TICI) was used to evaluate the incidence of vascular recanalization. The incidence of symptomatic intracranial hemorrhage (sICH) was recorded within 36 h. The prognosis was evaluated by modified Rankin Scale (mRS) at 3 months. Univariate and multivariate backward Logistic regression analysis were used to screen the risk factors related to the unfavoriable prognosis in the patients with acute BAO after endovascular thrombectomy. Receiver operating characteristic curve (ROC) was used to calculate the area under the curve (AUC), and evaluate the predictive value of DWI pc-ASPECTS, DWI BSS, pc-CTA and BATMAN scores for prognosis. Results In 57 patients, 53 patients (92.98%) had successful recanalization, 2 (3.51%) had partial recanalization, 2 (3.51%) had no recanalization, 3 (5.26%) had sICH, 22 (38.60%) had good prognosis, 35 (61.40%) had poor prognosis, and 14 (24.56%) died. After univariate and multivariate backward Logistic regression analysis, higher NIHSS score on admission (OR = 0.879, 95%CI: 0.783-0.986; P = 0.028), higher DWI BSS score (OR = 0.348, 95%CI: 0.177-0.683; P = 0.002) and lower BATMAN score (OR = 1.549, 95% CI: 1.019-2.353; P = 0.040) were risk factors for unfavorable prognosis of patients with acute BAO after endovascular thrombectomy. ROC analysis of the four radiographic scoring systems showed that the AUC of DWI pc-ASPECTS, DWI BSS, pc-CTA and BATMAN score were 0.787 (95%CI: 0.658-0.884, P = 0.000), 0.861 (95%CI: 0.744-0.938, P = 0.000), 0.634 (95% CI: 0.496-0.757, P = 0.091) and 0.698 (95% CI: 0.562-0.813, P = 0.012), respectively. Conclusions Higher NIHSS score on admission, higher DWI BSS score and lower BATMAN score are risk factors for unfavorable prognosis of acute BAO treated with endovascular thrombectomy. [ABSTRACT FROM AUTHOR]

Acute progressive large vessel occlusive stroke (APLVO) is a special kind of acute ischemic stroke with large vessel occlusion (AIS-LVO). Adequate medical history inquiry, detailed imaging analysis and appropriate individualized treatment can lead to better therapeutic effect for APLVO patients. This article reviews the pathophysiological mechanism, clinical features, classification and treatment strategy of APLVO, which different from other causes of ischemic stroke. [ABSTRACT FROM AUTHOR]

Five randomized control clinical trials of N Engl J Med showed the efficacy of endovascular treatment (EVT) of acute ischemic stroke with large vessel occlusion (AIS-LVO) of anterior circulation. The "spring" of mechanical thrombectomy is coming. The international guideline changed and the treatment of AIS-LVO have been entering a new era. Mechanical thrombectomy became the one of milestones in the treatment of ischemic cerebrovascular events. The year of 2020 is the five years' anniversary since the "spring" of thrombectomy. What have we learned and where are we heading? To mark this anniversary year, this review takes you through the evolution of EVT from its tough beginnings to a way through the dark. [ABSTRACT FROM AUTHOR]

Platelet glycoprotein (GP) II b/III a receptor is the final common pathway of platelet aggregation and thrombosis, which can specifically and rapidly inhibit platelet aggregation. In recent years, more and more evidences support that tirofiban, a GP II b/III a receptor antagonist, can be used as a treatment option for thromboembolic diseases, but its application experience in clinical practice is still relatively insufficient. In order to apply tirofiban more reasonably and normatively in clinical practice, the Chinese Stroke Society organized a writing committee of well-known experts in the field of neurological intervention in China, and wrote the consensus of experts on the clinical application of tirofiban in atherosclerotic cerebrovascular diseases. It provides clinical experience and guidance for the application of tirofiban in the field of cerebrovascular disease, and guarantees the safe and effective use of drugs in medical behaviors. [ABSTRACT FROM AUTHOR]

Introduction: The risk of recurrent ischaemic events is related to platelet function, which is often assessed by thromboelastography (TEG). TEG has high interindividual variability.Objective: To identify causal variants associated with TEG parameters in patients who receive aspirin and clopidogrel after intra- or extracranial stenting.Methods: Patients who underwent stenting for extracranial or intracranial stenosis (70-99%) were recruited into the study. Blood samples were obtained for TEG to assess the platelet function before stenting. Aspirin- and clopidogrel-related genetic polymorphisms were determined by the MassARRAY method. Minor allele frequency and Hardy-Weinberg equilibrium (HWE) tests and linkage disequilibrium (LD) analysis were carried out. The influences of genetic polymorphism on TEG parameters were analysed by linear regression.Results: A total of 249 patients were included in this study. Twenty-two selected single nucleotide polymorphisms (SNPs) were genotyped, and no significant deviation from HWE was found for any SNP in the study patients. Four SNPs-rs2104543, rs12772169, rs1998591 and rs1042194-within CYP2C18 were in high LD, and the genetic polymorphisms had a significant impact on the TEG parameters maximal clot strength (MAThrombin) and ADP-induced platelet-fibrin clot strength (MAADP). Patients who carried the loss-of-function CYP2C19*2 (rs4244285) allele were also at risk of increased MAThrombin and MAADP.Conclusions: Testing for these polymorphisms may be valuable in the identification of patients at high risk of recurrent ischaemic events. Alternative treatments may be considered for these high-risk patients.Trial Registration Number: NCT01925872. [ABSTRACT FROM AUTHOR]

Background The major clinical presentation of severe subclavian artery stenosis is subclavian steal syndrome (SSS). At present, stent implantation has become a promising method for this disease. The aim of this article is to investigate the effectiveness and safeness of stent implantation in the treatment for symptomatic severe subclavian artery stenosis. Methods Clinical data of 20 patients with symptomatic severe subclavian artery stenosis treated via angioplasty and stenting from June 2012 to November 2012 were retrospectively analyzed. Results The procedure was technically successful in all of the 20 cases. Postoperative digital subtraction angiography (DSA) suggested the residual ratio of subclavian artery stenosis was < 20% . Straight - forward blood flow in vertebral artery, disappeared subclavian steal symptom and fluent blood flow in intracranial segment of ipsilateral vertebral artery were also seen. After procedure no stent-related complications were found. During the follow-up study from 10 days to 6 months, vessel ultrasound and computed tomography angiography (CTA) showed no in-stent restenosis, vessels with good form and fluent blood flow. Conclusion Percutaneous angioplasty and stenting is a minimally invasive, safe and effective method in the treatment for severe subclavian artery stenosis. [ABSTRACT FROM AUTHOR]

Objective: The sonographic diagnostic criteria for vertebral artery stenosis have not been fully investigated. The purpose of this study was to assess hemodynamic parameters at color Doppler imaging and to determine, with digital subtraction angiography as the reference standard, the optimal thresholds for evaluation of proximal vertebral artery stenosis., Materials and Methods: Among 653 patients with symptoms of ischemia of the posterior circulation, 247 subjects with normal arteries or stenosis of the proximal vertebral artery confirmed with digital subtraction angiography were included in the study. Peak systolic velocity at the origin of the vertebral artery (PSV(origin)) and in intervertebral segments of the vertebral artery (PSV(IV)), end-diastolic velocity at the origin and in the intervertebral segments of the vertebral artery, and the diameter of the vascular lumen were measured. The cutoff values for the diagnosis of < 50%, 50-69%, and 70-99% stenosis were determined with receiver operating characteristics analysis., Results: The optimal cutoff values of hemodynamic parameters in evaluation of stenosis of the proximal vertebral artery for < 50% stenosis were PSV(origin) >or= 85 cm/s, PSV(origin) / PSV(IV) >or= 1.3, and end-diastolic velocity at the origin >or= 27 cm/s; for 50-69% stenosis were PSV(origin) >or= 140 cm/s, PSV(origin) / PSV(IV) >or/= 2.1, and end-diastolic velocity at the origin >or= 35 cm/s; and for 70-99% stenosis were PSV(origin) >or= 210 cm/s, PSV(origin) / PSV(IV) >or= 4.0, and end-diastolic velocity at the origin >or= 50 cm/s. PSV(origin) was the most useful hemodynamic parameter, having accuracy of 94.5%, 96.2%, and 88.7% for the diagnosis of < 50%, 50-69%, and 70-99% stenosis., Conclusion: Color Doppler imaging is a reliable method for evaluation of vertebral artery stenosis. The results derived from this study can be used as a reference for establishing sonographic criteria for proximal vertebral artery stenosis.

Objective: To evaluate hemodynamic character and surgical effect of stenoses or occlusion of carotid artery system by perfusion-weighted MRI., Methods: Twenty-one patients with stenoses or occlusion of carotid artery system underwent surgical treatment. Two patients underwent endarterectomy, extracranial-intracranial arterial bypass to 10 patients, and percutaneous stent angioplasty to 9 patients., Results: Preoperative perfusion-weighted magnetic resonance (MR) revealed normal regional cerebral blood flow in all patients, with delayed time to peak in both middle cerebral artery distribution and border zone. Postoperative perfusion-weighted MR revealed normal time to peak in border zone, but abnormal in middle cerebral artery distribution. Evaluated by perfusion-weighted MR, it showed that surgical method can improve the hemodynamic disorder of this kind of disease. The early curative effect of endarterectomy and percutaneous stent angioplasty is better than extracranial-intracranial arterial bypass., Conclusions: Perfusion-weighted MR is a good method to evaluate hemodynamic character of stenoses or occlusion of carotid artery system. Surgical method is helpful to this kind of disease, and its curative effect can be evaluated impersonally and accurately by this new technique.

Objective: To discuss the benefits and complications of percutaneous transluminal stenting for stenosis of internal carotid artery (ICA)., Methods: 355 patients with ICA stenosis were included from 1997 to 2003. All of them took periprocedual anticoagulation treatment, cerebral vascular angiography and cervical Doppler sonography. 72 patients used cerebral protection of filter devices. Among the 283 patients without cerebral protection 202 patients (71.38%) underwent predilation, 66 patients (23.32%) underwent postdilation; and 3 patients underwent neither., Results: The heart rates of 25.0% of all the patients decreased. Dislocation of microemboli happened in 5 patients. 2 of them improved after treatment. 3 of them got dyskinesia of one side. 2 patients (0.56%) died of intracerebral hemorrhage (ICH). 256 patients (84.77%) turned for the better. 260 patients (73.34%) were followed up. Restenosis occurred in 11 patients (4.23%)., Conclusion: Percutaneous transluminal stenting for stenosis of internal carotid artery is safe if proper periprocedual treatment and operative procedure are taken. However, enough attention should be paid to the occurrence of ICH resulting from over-flow after operation.

Objective: To discuss the safety of intracranial stenting for refractory symptomatic intracranial artery stenosis., Methods: Forty-eight patients with symptomatic intracranial artery stenosis were treated by transluminal stent-assistant angioplasty. Of them, 40 cases were selected because they had recurrent TIAs or mild stroke despite of antiplatelet or anticoagulation therapy; 8 cases with high-grade stenosis after acute cerebral artery theromblysis. Lesions involved MCA (17/48); Basilar artery (8/48); intracranial vertebral artery (18/18); and distal ICA (5/18)., Results: For 46 of 48 cases the flexible coronary stent were successfully deployed. The average stenosis reduced from 83% to 5%, short-term follow-up showed good clinical improvement. Complications include vessel rupture (1/18); acute thrombosis within stent (1/48); perforation of cortical artery (1/18) and perforate vessel occlusion (1/18)., Conclusion: Stent-assistant angioplasty are effective for treatment of symptomatic intracranial stenosis, the higher rate of complications may be because of the limited experiences of this technique. it need further practise and long term follow-up study.

Objective: To test feasibility, safety and efficacy of combined intraarterial thrombolysis and intra-cerebral stent for acute ischemic stroke., Methods: From 2001-5 to 2002-8, 19 patients with acute onset of stroke were treated with intraaterial thrombolysis followed by intra-cerebral stent. 9 located in middle cerebral artery (MCA), 10 located in basal artery (BA). For each patient, intraarterial thrombolysis of MCA or BA was applied at first, stent angioplasty was applied at the stenosis left after the thrombolysis by using the stent for coronary artery., Results: All the 19 patients left stenosis after intraaterial thrombolysis, and the average stenosis was 85% in diameter. After the operation of stent, the images showed the vascular is smooth and had no stenosis left. The symptoms were disappeared or improved. Thrombus formation in the stent occurred on 1 patient 24 hours after the operation. TIA never occurred in the left 18 patients then. TCD follow up showed blood flow is normal., Conclusions: It is feasibility of intraaterial thrombosis followed by intra-cerebral stent. And it is valid for preventing occlusion again of the vessel and decreasing the rate of TIA occurring.