| Part1 Treatment of MRA-DWI mismatched patients with mild ischemic stroke caused by middle cerebral artery M1 segment occlusion:comparison of endovascular treatment and intravenous thrombolytic therapyBackground and objectiveAlthough the initial symptoms of mild ischemic stroke are slight,the recurrence rate is very high.If it is accompanied with large vessel occlusion at the same time,it will have a negative impact on the patient’s prognosis.Therefore,we cannot define mild stroke based on clinical symptoms alone,it will inevitably cover up the patient’s true condition.In contrast,imaging methods are more advantageous in assessing the prognosis of patients.Magnetic resonance angiography(MRA)-diffusion-weighted imaging(DWI)is not only simple and easy to operate,but also extremely useful for diagnosing ischemic penumbra after middle cerebral artery(MCA)occlusion.Moreover,it is helpful to judge the prognosis of patients.Therefore,we use routine one-stop CT-MRI evaluation for patients with acute ischemic stroke,which can timely analyze the relationship between occluded arteries displayed by MRA and infarcts displayed by DWIMild ischemic stroke caused by acute MCA M1segment occlusion is a disabling stroke,and reperfusion therapy should be given in time to improve the patient’s prognosis.At present,early reperfusion treatment methods for patients with mild stroke caused by acute MCA M1 segment occlusion mainly include intravenous thrombolysis and endovascular treatment.However,it is unclear which reperfusion therapy will benefit patients with mild stroke caused by acute MCA M1 segment occlusion.Therefore,this study is aimed to investigate the effect of different treatment regimens guided by MRA and DWI mismatch on the outcomes of patients with mild stroke caused by acute MCA M1 segment occlusion,and to provide base for further clinical workMethodFrom January 2013 to February 2018,the clinical data of patients with mild ischemic stroke caused by acute MCA M1 segment occlusion and admitted to the Department of Neurology,the Affiliated Hospital of Yangzhou University were analyzed retrospectively.Mild stroke was defined as the National Institutes of Health Stroke Scale(NIHSS)score<5,and the MRA-DWI mismatch was defined as MCA M1 segment occlusion confirmed by MRA and the DWI-Alberta Stroke Program Early Computed Tomography Score>6.According to the clinical decision,they were divided into endovascular treatment group and intravenous thrombolytic therapy group.The primary outcome measure was the modified Rankin Scale score at 90 days after onset,≤2 was defined as good outcome.The secondary outcome measure was the incidence of symptomatic intracranial hemorrhage(sICH)within 7 days after treatment and the mortality rate at 90 d.Multivariate logistic regression analysis was used to determine the independent effects of different treatment regimens on outcomes.ResultsA total of 38 patients were enrolled,19(50.00%)in the intravenous thrombolytic therapy group,and 19 in the endovascular treatment group(50.00%，including 5 patients with intratracheal thrombectomy after intravenous thrombolysis);27 patients had good outcomes(71.05%)and 11 had poor outcomes(28.95%).Except for total cholesterol level,there were no significant differences in demography,vascular risk factors,and all baseline clinical data between the endovascular treatment group and the intravenous thrombolytic therapy group.The rate of good outcome in the endovascular treatment group was significantly higher than that in the intravenous thrombolytic therapy group(89.47%vs.2.63%;P=0.029),and there was no significant difference between the incidence of sICH within 7 days(15.79%vs.5.26%:P=0.604)and 90-day mortality(0%vs.10.53%;P=0.486).The proportion of patients who underwent endovascular treatment in the good outcome group was significantly higher than that in the poor outcome group(62.96%vs.18.18%;P=0.029).Multivariate logistic regression analysis showed that endovascular treatment was an independent predictor of good outcome(odds ratio 0.103,95%confidence interval 0.015-0.714;P=0.021).ConclusionThis study initially showed that Endovascular treatment is an independent predictor of good outcome in patients with mild ischemic stroke caused by acute MCA M1 segment occlusion,and the two treatment did not show significant differences in terms of bleeding risk and mortality.Part2 Changes in Sleep Structure in Patients with Acute ischemic Mild Stroke and the Impact of Sleep Disorders on Patient PrognosisBackground and objectiveStroke-related sleep disorders(SSD)is a common complication after stroke,but it is often overlooked.Studies abroad have pointed out that the incidence of post-stroke sleep disorder(PSSD)is 44%-78%,especially in patients with acute stroke,and once the patients with acute ischemic stroke combined with sleep disorders will seriously affect their prognosis.Sleep-related breathing disorder(SDB)is the most common PSSD,with an incidence of about 50%-70%.Obstructive sleep apnea(OSA)is the most common SDB.It can reduce cerebral blood flow and impair the autoregulation of brain tissue in stroke patients,and the brain will be hypoxic during apnea,which will promote the deterioration of nerve function It will also change the sleep structure of stroke patients.The purpose of this study was to evaluate the changes in sleep in patients with acute mild ischemic stroke through polysomnography(PSG),and the effect of SDB on the sleep structure and prognosis of these patients,in order to provide evidence for future clinical work.MethodIn this study,patients with acute cerebral infarction confirmed by cranial magnetic resonance(MRI)from March 2019 to September 2019 were selected consecutively,and the National Institutes of Health Stroke Scale(NIHSS)score at admission was<77 patients with 5 points were selected as the case group,and 68 healthy persons matching the age and case group in the same period were selected as the control group.All patients underwent polysomnography(PSG)to analyze and compare general information,past history,cognitive function,sleep status,sleep structure changes,and apnea-hypopnea index hypopnea index,AHI).According to AHI,the cases were divided into sleep-related breathing disorder(SDB,AHI≥5 times/h)group and non-SDB(AHI<5 times/h)group.The effects of SDB on cognitive function,changes in sleep structure and prognosis of patients with cerebral infarction were evaluated to study the effect of different infarct sites on the sleep structure of patients.ResultsAmong the 77 cases,61(79.22%)were accompanied by SDB.Compared with the control group,the MMSE and MOCA scores of the case group were significantly lower(P<0.001),the PSQI score was significantly higher(P=0.004),and the total sleep time and sleep efficiency were significantly lower(P=0.007,P<0.001).Awake time after falling asleep was significantly lower(P=0.001),the proportion of stage 1 sleep was significantly higher(P = 0.003),and the proportion of stage 3 and REM sleep was lower(P=0.058,P=0.184).Compared with the control group and the non-SDB group,the proportion of stage 1 sleep increased significantly(P=0.001,P=0.008),and the proportion of stage 3 sleep decreased significantly(P=0.008,P=0.014).The 90-day prognosis of the SDB group was significantly lower than that of the non-SDB group(P=0.001),and AHI and the NIHSS score at admission were independent risk factors affecting the 90-day prognosis of patients with cerebral infarction(P=0.026,OR=1.122,95%CI:1.104-1.242),(P=0.002,OR=6.722,95%CI:2.029-22.265).Compared with non-SDB subgroup,SDB group is more common in the brainstem(29.51%vs 0,P=0.002).The effect of different infarct sites on sleep structure was not obvious,but compared with cerebral cortex,subcortex,and cerebellar infarction,patients with brainstem infarction had higher AHI and had statistical significance(P<0.05).ConclusionAcute ischemic stroke will affect the cognitive function and sleep structure of patients,and lead to the occurrence of SDB,and SDB after stroke can also cause sleep disorder in patients with stroke,and affect the prognosis of patients.The SDB group had a higher incidence in the brainstem,but different infarct sites had little effect on the sleep structure of the patients. |
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