| Background:Neurointerventional surgery is a treatment that can effectively reduce the recurrence and disability rate of ischemic stroke and decrease the recurrence rate of stroke in clinical practice,but it is prone to a series of clinical complications after surgery,such as hyperperfusion syndrome and intracranial hemorrhage.Cerebral hyperperfusion syndrome(CHS)is relatively common and has a relatively high rate of death and disability.Part Ⅰ:Objective:The clinical characteristics of CHS after interventional treatment were summarized and analyzed in order to accumulate more clinical information for the clinical definition of CHS.Methods:The clinical data of 101 patients who were admitted to the Department of Neurology of the First Affiliated Hospital of Guangzhou Medical University from February 2021 to February 2023 for cerebral artery stenting were collected,and the enrolled patients were divided into two groups,the anterior circulation group and the posterior circulation group,according to the location of stent implantation in the patients,and some of the runoff data were collected on magnetic resonance diffusion imaging in the two groups,respectively.In the anterior circulation group,a total of six trajectories(A1-A6)were made at the basal ganglia and centrum semiovale levels.The A3 trajectory was a vertical line starting from the midbrain aqueduct and making the midline of the left and right hemispheres;the A1 and A2 trajectories were straight lines with the midbrain aqueduct as the starting point and A3 as the reference line with an anterior-posterior angle of 45°;the A4 trajectory was a line connecting the ends of the A1 and A2 trajectories;the A5 trajectory was a straight line along the frontaloccipital lobe.A6 is the perpendicular line of A5(shown in the figure below).In the posterior circulation group,four trajectories(P1-P4)were made at the level of the pontine arm and the medulla oblongata.The imaging data and general clinical data of the two groups were summarized and analyzed to summarize the postoperative clinical manifestations,imaging manifestations and other clinical characteristics of CHS patients.Results:1.101 patients were enrolled in this study,with a mean age of 68 years,age range 41-90 years,of whom 60(59.4%)were male.101 patients,30 of whom presented with new clinical discomfort after surgery,and they did not present identically,including 15 patients with significant postoperative headache,17 patients with postoperative dizziness,4 patients with postoperative headache combined with All 101 patients had postoperative cranial MRI and cranial CT examinations,among which 10 patients showed cerebral edema and 7 patients showed cerebral hemorrhage.2.According to the site of stent implantation in the enrolled patients,they were divided into two groups: anterior circulation group and posterior circulation group.In both groups,the general clinical data of symptomatic patients were then compared with asymptomatic patients,respectively.In both groups,no significant differences were found between symptomatic and asymptomatic patients in terms of age,sex,history of previous stroke,history of diabetes,history of coronary heart disease,and history of chronic kidney disease(all P>0.05).3.In the anterior circulation group,there was a statistical difference between the pre-and post-surgical A1,A2,A3,and A6 trail differences between symptomatic patients and asymptomatic patients in both groups.The areas under the ROC curves of the pre-and post-surgical A1,A2,A3,and A6 trail differences were 0.999,0.926,0.852,and 0.952,respectively,corresponding to the Jorden index(best predictive value)of 0.575(sensitivity of 0.974,specificity of 1),0.395(sensitivity of 0.974,specificity of 0.895),0.645(sensitivity of 1,specificity of 0.842),0.795(sensitivity of0.974,specificity of 0.947),no statistical difference in the comparative analysis of the four ROC curves;in the posterior circulation group,symptomatic and asymptomatic patients with postoperative P2,P3 The area under the ROC curves of the postoperative P2,P3,and P2,P3,and P4 diameter differences before and after surgery were 0.858,0.864,0.054,0.000,and 0.224,respectively,and the corresponding Jorden indices(best predictive values)were 16.32(sensitivity 0.727,specificity0.969),16.32(sensitivity 0.727,specificity 0.969),0.000,and 0.224,respectively.degree of 0.969),14.39(sensitivity of 0.727,specificity of 0.906),0.095(sensitivity of 0,specificity of 0.250),0.41(sensitivity of 0,specificity of 0.969),0.41(sensitivity of 0.273,specificity of 0.062),and 0.41(sensitivity of 0.273,specificity of 0.062),respectively,with no statistical analysis of the postoperative P2 and P3 pathway ROC curves compared differences.4.In the anterior circulation group,there was no statistical difference between the A1-A6 tracings of the healthy and affected hemispheres before surgery,and there was a statistical difference between the A1,A3 and A6 tracings of the healthy and affected sides after surgery;in the posterior circulation,there was no statistical difference between the P1,P2,P3 and P4 tracings of the healthy and affected sides before and after surgery.5.In the anterior circulation subgroup,no statistically significant differences were seen in the A1-A6 diameter differences between the extracranial,intracranial,and middle cerebral artery groups before and after surgery.Conclusion:For the clinical presentation of patients presenting with CHS after surgery,the main conditions considered were dizziness and headache,headache on the operative side,mood changes such as postoperative irritability,and worse postoperative muscle strength than before.In the anterior circulation group,the difference between the A1,A2,A3 and A6 trajectories before and after the operation was measured by cranial magnetic resonance examination and may have a predictive effect on the development of CHS.In the posterior circulation group,measurement of the postoperative P2 diameter line,the postoperative P3 diameter line,and the pre-and postoperative P2,P3,and P4 diameter line differences may be useful in predicting the development of CHS.Part Ⅱ:Objective:To analyze the clinical characteristics of Cerebral hyperperfusion syndrome(CHS)in patients with cerebral infarction after cerebral artery stenting and to investigate the risk factors for the development of CHS.Methods:The clinical data of 101 patients with cerebral artery stenting who were admitted to the Neurology Department of the First Affiliated Hospital of Guangzhou Medical University from February 2021 to February 2023 were collected,and the enrolled patients were divided into a CHS group(n=30)and a non-CHS group(n=71)based on imaging means such as postoperative head CT scan,TCD,and new symptoms of patients after surgery,and the two groups The clinical data of the patients were retrospectively analyzed to further explore the risk factors for the development of CHS.Results:1.A total of 101 patients with cerebral artery stenting were included in this study,with an age range of 41 to 90 years.There were 60 males(59.4%),including 16 males and 14 females in the CHS group,with a mean age of 65 years,and 71 males and 27 females in the non-CHS group,with a mean age of 69 years.Univariate analysis revealed no statistically significant differences in age,gender,chronic kidney disease history,coronary heart disease history,stroke history,diabetes mellitus history,smoking and alcoholism history,posterior circulation artery stenting,and timing of surgery within 2 weeks between the two groups(P > 0.05).Univariate analysis suggested that the CHS group had a higher prevalence of hypertension,more strict cerebral artery stenosis,smaller residual artery stenosis,and poorer collateral circulation compensation than the non-Cerebral hyperperfusion syndrome group.Binary logistic regression analysis suggested that poor postoperative blood pressure control(OR=19.169;95% CI: 3.576-102.742;P<0.05),preoperative arterial stenosis(OR=1.12;95% CI: 1.026-1.224;P<0.05),and postoperative residual stenosis(OR=0.701;95% CI: 0.549-0.895;P<0.05))correlated with the development of CHS after cerebral artery stenting in patients.2.2.In the two subgroups of anterior and posterior circulation vessels,there was no statistically significant difference between CHS and non-CHS patients in terms of general clinical information such as gender,age,history of chronic kidney disease,history of coronary heart disease,history of stroke,and history of diabetes mellitus(P > 0.05).The results of univariate analysis suggested that in the anterior circulation subgroup,the CHS group had a higher rate of hypertension history,more severe degree of responsible arterial stenosis,greater rate of improvement in arterial stenosis and worse postoperative blood pressure control compared with the non-CHS group(all P < 0.05),and poor postoperative blood pressure control was suggested by binary logistic regression analysis(OR = 12.639;95% CI.1.371-116.547;P<0.05)and the degree of improvement in postoperative arterial stenosis(OR=1.322;95% CI: 1.184-1.483;P<0.05)were correlated with the development of CHS after cerebral artery stenting in patients.In the posterior circulation subgroup,the CHS group had more severe preoperative arterial stenosis,relatively greater improvement in postoperative residual arterial stenosis,and worse postoperative blood pressure control compared with the non-CHS group(all P<0.05),and a binary logistic regression analysis suggested that poor postoperative blood pressure control(OR=36.047;95% CI: 2.445-531.447;P< 0.01)was associated with the development of CHS after cerebral artery stenting.3.For the treatment of CHS,the mean duration of CHS symptoms was 5.6 days with mannitol + albumin and 4.6 days with mannitol only,with a statistical difference between the two groups.Conclusion:The results of this study suggest that poor postoperative blood pressure control,more severe degree of arterial stenosis on the operative side,and higher rate of residual postoperative arterial stenosis are independent risk factors for the development of CHS after cerebral artery stenting. |
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