Stent-assisted coil embolization (SAC) is used for complex wide-necked aneurysms but can expose stent struts to the arterial lumen, leading to thrombosis. Herein, we report two cases of delayed thromboembolic stroke post-SAC. Case 1: A 71-year-old woman had an acute ischemic stroke 2 months after Y-stent SAC for a basilar artery aneurysm, and aspirin was prescribed post-procedure. Diffusion-weighted imaging revealed multiple scattered infarcts of various sizes in the posterior circulation. Case 2: A 72-year-old woman experienced an acute ischemic stroke 3 years post-SAC for a right posterior communicating artery aneurysm. The stroke occurred after discontinuation of antiplatelet therapy. Diffusion-weighted imaging revealed scattered acute infarctions in the right middle and anterior cerebral artery territories. These two cases of delayed thromboembolic stroke after SAC might have been due to stent strut exposure in the arterial lumen and concurrent thrombosis.
The Asian Pacific Stroke Organization (APSO) and the Taiwan Stroke Society (TSS) are pleased to have this year's Asia Pacific Stroke Conference (APSC) in conjunction with the annual meeting of TSS in Kaohsiung, Taiwan. APSC, the flagship meeting of APSO, is held every year after receiving applications from member societies.
Therapeutic hypothermia improves outcomes in experimental stroke models, especially after ischemia-reperfusion injury. We investigated the clinical and radiological effects of therapeutic hypothermia in acute ischemic stroke patients after recanalization.A prospective cohort study at 2 stroke centers was performed. We enrolled patients with acute ischemic stroke in the anterior circulation with an initial National Institutes of Health Stroke Scale≥10 who had successful recanalization (≥thrombolysis in cerebral ischemia, 2b). Patients at center A underwent a mild hypothermia (34.5°C) protocol, which included mechanical ventilation, and 48-hour hypothermia and 48-hour rewarming. Patients at center B were treated according to the guidelines without hypothermia. Cerebral edema, hemorrhagic transformation, good outcome (3-month modified Rankin Scale, ≤2), mortality, and safety profiles were compared. Potential variables at baseline and during the therapy were analyzed to evaluate for independent predictors of good outcome.The hypothermia group (n=39) had less cerebral edema (P=0.001), hemorrhagic transformation (P=0.016), and better outcome (P=0.017) compared with the normothermia group (n=36). Mortality, hemicraniectomy rate, and medical complications were not statistically different. After adjustment for potential confounders, therapeutic hypothermia (odds ratio, 3.0; 95% confidence interval, 1.0-8.9; P=0.047) and distal occlusion (odds ratio, 7.3; 95% confidence interval; 1.3-40.3; P=0.022) were the independent predictors for good outcome. Absence of cerebral edema (odds ratio, 5.4; 95% confidence interval, 1.6-18.2; P=0.006) and no medical complications (odds ratio, 9.3; 95% confidence interval, 2.2-39.9; P=0.003) were also independent predictors for good outcome during the therapy.In patients with ischemic stroke, after successful recanalization, therapeutic hypothermia may reduce risk of cerebral edema and hemorrhagic transformation, and lead to improved clinical outcomes.
Objective To investigate the serum visfatin level in the subjects with type 2 diabetes mellitus (T2DM) and its influencing factors. Methods 47 T2DM patients were selected as T2DM group and 35 healthy subjects, as control group. Body height and weight, waist circumference (WC) and hip circumference (HC), blood pressure, and fasting levels of glucose, insulin, HbA_1c and visfatin were determined in T2DM and control group. Visfatin level was measured with enzyme-linked immunosorbent assay (ELISA). The HOMA-IR was calculated. The relationships of level of serum visfatin with BMI, WC, WHR, FPG, FIns, HOMA-IR, HbA_1c and blood lipids were analyzed. Results The visfatin level of T2DM group versus control group was increased significantly(98.48±22.37μg/L vs 70.43± 20.71μg/L,P0.01) and positively correlated with WC(r=0.307, P0.01), HC(r=0.297, P 0.01), WHR(r=0.242, P0.05), FPG(r=0.503, P0.01)and HbA_1c(r=0.464, P0.01). Multiple regression analysis showed that WC and FPG were independent related factors for influencing the serum visfatin level. Conclusions The fasting serum visfatin level is increased in T2DM patients, which may contribute, in part, to the pathogenesis of T2DM.
To assess the precise mechanisms of stroke in cancer patients, we analyzed the data for cancer patients with acute ischemic stroke registered from 6 centers in South Korea. Clinical features, risk factors, diffusion-weighted imaging lesion patterns, and laboratory findings including D-dimer levels were compared between patients with conventional stroke mechanisms (CSMs) and cryptogenic group.A total of 161 patients were included in this study: 97 (60.2%) patients in the CSM group and 64 (39.8%) in the cryptogenic group. Patients in the CSM group were older and vascular risk factors were more prevalent than in the cryptogenic group. Diffusion-weighted imaging patterns of multiple lesions involving multiple arterial territories were observed more frequently in the cryptogenic group than in the CSM group. In addition, levels of the D-dimer were higher in the cryptogenic group than in the CSM group (11.5+/-14.6 versus 3.6+/-10.3 microg/dL). In multivariate analysis, the diffusion-weighted imaging lesion pattern of multiple vascular territories (odds ratio, 11.2; 95% CI, 3.74 to 33.3), and D-dimer levels of >1.11 microg/dL (odds ratio, 10.6; 95% CI, 3.29 to 33.8) were associated independently with the cryptogenic group.Stroke outside of CSM occurred in a large number in cancer patients. In stroke patients with cancer, d-dimer levels and diffusion-weighted imaging lesion patterns may be helpful in early identification of non-CSMs (especially coagulopathy associated with cancer) and possibly in guiding preventive strategies for stroke.
A performance of forced arterial suction thrombectomy was not reported for the treatment of acute basilar artery occlusion. This study compared revascularization performance between intra-arterial fibrinolytic treatment and forced arterial suction thrombectomy with a Penumbra reperfusion catheter in patients with acute basilar artery occlusion.Fifty-seven patients with acute basilar artery occlusion were treated with intra-arterial fibrinolysis (n = 25) or forced arterial suction thrombectomy (n = 32). Baseline characteristics, successful revascularization rate, and clinical outcomes were compared between the groups.Baseline characteristics, the frequency of patients receiving intravenous recombinant tissue plasminogen activator, and mean time interval between symptom onset and femoral puncture did not differ between groups. The forced arterial suction thrombectomy group had a shorter procedure duration (75.5 minutes versus 113.3 minutes, P = .016) and higher successful revascularization rate (88% versus 60%, P = .017) than the fibrinolysis group. Fair outcome, indicated by a modified Rankin Scale 0-3, at 3 months was achieved in 34% of patients undergoing forced arterial suction thrombectomy and 8% of patients undergoing fibrinolysis (P = .019), and the mortality rate was significantly higher in the fibrinolysis group (25% versus 68%, P = .001). Multiple logistic regression analysis identified the forced arterial suction thrombectomy method as an independent predictor of fair outcome with adjustment for age, sex, initial NIHSS score, and the use of intravenous recombinant tissue plasminogen activator (odds ratio, 7.768; 95% CI, 1.246-48.416; P = .028).In acute basilar artery occlusion, forced arterial suction thrombectomy demonstrated a higher revascularization rate and improved clinical outcome compared with traditional intra-arterial fibrinolysis. Further clinical trials with the newer Penumbra catheter are warranted.