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| 1 | Stenting for symptomatic intracranial arterial stenosis in China:1-year outcome of a multicentre registry study显示文摘background and purpose A multicentre prospective registry study of individually tailored stenting for a patient with symptomatic intracranial atherosclerotic stenosis(ICAS)combined with poor collaterals in China showed that the short-term safety and efficacy of stenting was acceptable.However,it remained uncertain whether the low event rate could be of a long term.We reported the 1-year outcome of this registry study to evaluate the long-term efficacy of individually tailored stenting for patients with severe symptomatic ICAS combined with poor collaterals.Methods Patients with symptomatic ICAS caused by 70%-99% stenosis located at the intracranial internal carotid,middle cerebral,intracranial vertebral or basilar arteries combined with poor collaterals were enrolled.Balloon-mounted stent or balloon plus self-expanding stent were selected based on the ease of vascular access and lesion morphology determined by the operators.The primary outcome was the rate of 30-day stroke,transient ischaemic attack and death,and 12-month ischaemic stroke within the same vascular territory,haemorrhagic stroke and vascular death after stenting.results From September 2013 to January 2015,300 patients(ages 58.3±9.78 years)were recruited.Among them,159 patients were treated with balloon-mounted stent and 141 with balloon plus self-expanding stent.During the 1-year follow-up,25 patients had a primary end point event.The probability of primary outcome at 1 year was 8.1%(95% CI 5.3% to 11.7%).In 76 patients with digital subtraction angiography follow-up,27.6%(21/76)had re-stenosis≥50% and 18.4%(14/76)had re-stenosis≥70%.No baseline characteristic was associated with the primary outcome.Conclusion The event rate remains low over 1 year of individually tailored stenting for patients with severe symptomatic ICAS combined with poor collaterals.Further randomised trial of comparing individually tailored stenting with best medical therapy is needed. | Ning Ma Yong Zhang Jie Shuai Changchun Jiang Qiyi Zhu Kangning Chen Li Liu Baomin Li Xiangqun Shi Lianbo Gao Yajie Liu Feng Wang Yongli Li Tieyan Liu Hongbo Zheng Dapeng Mo Feng Gao Yilong Wang Yongjun Wang Lei Feng Zhongrong Miao | 2018 | Stroke & Vascular Neurology2018，3，3： | 29 |
| 2 | An Integrated Analysis of Risk Factors of Cognitive Impairment in Patients with Severe Carotid Artery Stenosis显示文摘Objective To investigate cognitive dysfunction in patients with carotid artery stenosis(CAS) and potential risk factors related to cognitive-especially memory-dysfunction. Methods Forty-seven patients with carotid artery stenosis were recruited into our study cohort. The Mini-Mental State Examination(MMSE) and the Montreal Cognitive Assessment(MoCA) were adopted to assess cognitive function, the Wechsler Memory Scale(WMS) to assess memory function, high-resolution MRI and enhanced ultrasound to evaluate carotid plaques, and computed tomography perfusion(CTP) imaging to evaluate intracranial blood perfusion. Single-factor analysis and multiple-factor regression analysis were used to analyze potential risk factors of cognitive impairment. Results Mini-Mental State Examination test results showed that 22 patients had cognitive impairment, and MoCA test results showed that 10 patients had cognitive impairment. Analysis of various risk factors indicated that the average memory quotient of female patients was higher than that of males(P = 0.024). The cognitive and memory performance of those with an educational background above high school were significantly better than those of participants with high school or lower(P = 0.045). Patients with abnormal intracranial perfusion performed worse on the MMSE test(P = 0.024), and their WMS scores were significantly lower(P = 0.007). The MMSE scores and the memory quotients were significantly lower in patients with a history of cerebral infarction(MMSE, P = 0.047, memory quotient score, P = 0.018). Conclusion A history of cerebral infarction and abnormal cerebral perfusion are associated with decline in overall cognitive function and memory in patients with carotid stenosis. Being female and having an educational background above high school may be protective factors in the development of cognitive dysfunction. | LUO Ru Tao WANG Pei Jiong DENG Xiao Feng ZHOU Shu Jie ZHAO Meng QIAN Jing ZHANG Dong WANG Rong ZHANG Yan | 2018 | Biomedical and Environmental Sciences2018，31，11： | 17 |
| 3 | Endoscopic management of esophageal stenosis in children:New and traditional treatments显示文摘Post-esophageal atresia anastomotic strictures and postcorrosive esophagitis are the most frequent types of cicatricial esophageal stricture. Congenital esophageal stenosis has been reported to be a rare but typical disease in children; other pediatric conditions are peptic, eosinophilic esophagitis and dystrophic recessive epidermolysis bullosa strictures. The conservative treatment of esophageal stenosis and strictures(ES) rather than surgery is a well-known strategy for children. Before planning esophageal dilation, the esophageal morphology should be assessed in detail for its length, aspect, number and level, and different conservative strategies should be chosen accordingly. Endoscopic dilators and techniques that involve different adjuvant treatment strategies have been reported and depend on the stricture's etiology, the availability of different tools and the operator's experience and preferences. Balloon and semirigid dilators are the most frequently used tools. No high-quality studies have reported on the differences in the efficacies and rates of complications associated with these two types of dilators. There is no consensus in the literature regarding the frequency of dilations or the diameter that should be achieved. The use of adjuvant treatments has been reported in cases of recalcitrant stenosis or strictures with evidence of dysphagic symptoms. Corticosteroids(either systemically or locally injected), the local application of mitomycin C, diathermy and laser ES sectioning have been reported. Some authors have suggested that stenting can reduce both the number of dilations and the treatment length. In many cases, this strategy is effective when either metallic or plastic stents are utilized. Treatment complications, such esophageal perforations, can be conservatively managed, considering surgery only in cases with severe pleural cavity involvement. In cases of stricture relapse,even if such relapses occur following the execution of well-conducted conservative strategies, surgical stricture resection and anastomosis or esophageal substitution are the only remaining options. | Luigi Dall rsquo Oglio Tamara Caldaro Francesca Foschia Simona Faraci Giovanni Federici di Abriola Francesca Rea Erminia Romeo Filippo Torroni Giulia Angelino Paola De Angelis | 2016 | World Journal of Gastrointestinal Endoscopy2016，8，4： | 16 |
| 4 | Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis显示文摘Spinal nerve roots have a peculiar structure, different from the arrangements in the peripheral nerve. The nerve roots are devoid of lymphatic vessels but are immersed in the cerebrospinal fluid(CSF) within the subarachnoid space. The blood supply of nerve roots depends on the blood flow from both and peripheral direction(ascending) and the spinal cord direction(descending). There is no hypovascular region in the nerve root, although there exists a so-called water-shed of the bloodstream in the radicular artery itself. Increased mechanical compression promotes the disturbance of CSF flow, circulatory disturbance starting from the venous congestion and intraradicular edema formation resulting from the breakdown of the blood-nerve barrier. Although this edema may diffuse into CSF when the subarachnoid space is preserved, the endoneurial fluid pressure may increase when the area is closed by increased compression. On the other hand, the nerve root tissue has already degenerated under the compression and the numerous macrophages releasing various chemical mediators, aggravating radicular symptomsthat appear in the area of Wallerian degeneration. Prostaglandin E1(PGE1) is a potent vasodilator as well as an inhibitor of platelet aggregation and has therefore attracted interest as a therapeutic drug for lumbar canal stenosis. However, investigations in the clinical setting have shown that PGE1 is effective in some patients but not in others, although the reason for this is unclear. | Shigeru Kobayashi | 2014 | World Journal of Orthopedics2014，5，2： | 15 |
| 5 | Biliary complications in liver transplantation: Impact of anastomotic technique and ischemic time on short- and long-term outcome显示文摘AIM: To elucidate the impact of various donor recipient and transplant factors on the development of biliary complications after liver transplantation.METHODS: We retrospectively reviewed 200 patients of our newly established liver transplantation(LT) program, who received full size liver graft. Biliary reconstruction was performed by side-to-side(SS), end-to-end(EE) anastomosis or hepeaticojejunostomy(HJ). Biliary complications(BC), anastomotic stenosis, bile leak, papillary stenosis, biliary drain complication, ischemic type biliary lesion(ITBL) were evaluated by studying patient records, corresponding radiologic imaging and reports of interventional procedures [e.g., endoscopic retrograde cholangiopancreatography(ERCP)]. Laboratory results included alanine aminotransferase(ALT), gammaglutamyltransferase and direct/indirect bilirubin with focus on the first and fifth postoperative day, six weeks after LT. The routinely employed external bile drain was examined by a routine cholangiography on the fifth postoperative day and six weeks after transplantation as a standard procedure, but also whenever clinically indicated. If necessary, interventional(e.g., ERCP) or surgical therapy was performed. In case of biliary complication, patients were selected, assigned to different complication-groups and subsequently reviewed in detail. To evaluate the patients outcome, we focussed on appearance of postoperative/post-interventional cholangitis, need for rehospitalisation, retransplantation, ITBL or death caused by BC.RESULTS: A total of 200 patients [age: 56(19-72), alcoholic cirrhosis: n = 64(32%), hepatocellular carcinoma: n = 40(20%), acute liver failure: n = 23(11.5%), cryptogenic cirrhosis: n = 22(11%), hepatitis B virus /hepatitis C virus cirrhosis: n = 13(6.5%), primary sclerosing cholangitis: n = 13(6.5%), others: n = 25(12.5%) were included. The median follow-up was 27 mo until June 2015. The overall biliary complication rate was 37.5%(n = 75) with anastomotic strictures(AS): n = 38(19%), bile leak(BL): n = 12(6%), biliary drain complication: n = 12(6%); papillary stenosis(PS): n = 7(3.5%), ITBL: n = 6(3%). Clinically relevant were only 19%(n = 38). We established a comprehensive classification for AS with four grades according to clinical relevance. The reconstruction techniques [SS: n = 164, EE: n = 18, HJ: n = 18] showed no significant impact on the development of BCs in general(all n < 0.05), whereas in the HJ group significantly less AS were found(P = 0.031). The length of donor intensive care unit stay over 6 d had a significant influence on BC development(P = 0.007, HR = 2.85; 95%CI: 1.33-6.08) in the binary logistic regression model, whereas other reviewed variables had not [warm ischemic time > 45 min(P = 0.543), cold ischemic time > 10 h(P = 0.114), ALT init > 1500 U/L(P = 0.631), bilirubin init > 5 mg/d L(P = 0.595), donor age > 65(P = 0.244), donor sex(P = 0.068), rescue organ(P = 0.971)]. 13%(n = 10) of BCs had no therapeutic consequences, 36%(n = 27) resulted in repeated lab control, 40%(n = 30) received ERCP and 11%(n = 8) surgical therapy. Fifteen(7.5%) patients developed cholangitis [AS(n = 6), ITBL(n = 5), PS(n = 3), biliary lesion BL(n = 1)]. One patient developed ITBL twelve months after LT and subsequently needed retransplantation. Rehospitalisation rate was 10.5 %(n = 21) [AS(n = 11), ITBL(n = 5), PS(n = 3), BL(n = 1)] with intervention or reinterventional therapy as main reasons. Retransplantation was performed in 5(2.5%) patients [ITBL(n = 1), acute liver injury(ALI) by organ rejection(n = 3), ALI by occlusion of hepatic artery(n = 1)]. In total 21(10.5%) patients died within the follow-up period. Out of these, one patient with AS developed severe fatal chologenic sepsis after ERCP.CONCLUSION: In our data biliary reconstruction technique and ischemic times seem to have little impact on the development of BCs. | Stefan Kienlein Wenzel Schoening Anne Andert Daniela Kroy Ulf Peter Neumann Maximilian Schmeding | 2015 | World Journal of Transplantation2015，5，4： | 14 |
| 6 | Multiple hypointense vessels on susceptibility-weighted imaging predict early neurological deterioration in acute ischaemic stroke patients with severe intracranial large artery stenosis or occlusion receiving intravenous thrombolysis显示文摘background and purpose Early neurological deterioration(END)is a common feature in patients with acute ischaemic stroke(AIS)receiving thrombolysis.This study aimed to investigate whether the presence of multiple hypointense vessels(MHVs)on susceptibility-weighted imaging(SWI)could predict END in patients with the anterior circulation AIS treated with recombinant tissue plasminogen activator(r-tPA).Methods This was a retrospective study focusing on AIS patients suffering from symptomatic stenosis or occlusion of the middle cerebral artery or internal carotid artery with r-tPA treatment.We collected clinical variables and initial haematological and neuroimaging findings.MHVs were measured on SWI performed after intravenous thrombosis and were defined as the presence of a greater number of veins or veins of a larger diameter with greater signal loss on SWI than those of the contralesional haemisphere.The degree of hyperintensity of MHVs was classified into four grades:none,subtle,moderate and extensive.END was defined as an increase in the National Institutes of Health Stroke Scale score by 2 points during the first 48 hours after the onset of symptoms.Multivariate logistic regressions were conducted to investigate the predictors of END.results The study included 61 patients(51 males and 10 females)with a mean age of 62.4±12.6 years.Thirty-five(57.4%)patients presented with MHVs:8(13.1%)were graded as subtle MHVs,while 23(37.7%)and 4(6.6%)were graded as moderate or extensive MHVs,respectively.Twenty patients(32.8%)presented with END.Logistic regression analysis showed that compared with patients without MHVs,moderate MHVs(adjusted OR 5.446,95%CI 1.360 to 21.800;p=0.017)and extensive MHVs(adjusted OR 15.240,95%CI 1.200 to 193.544;p=0.036)were significantly associated with END.Conclusions MHVs might be a useful predictor of END in AIS patients with symptomatic large artery stenosis or occlusion after r-tPA treatment. | Yong-Lin Liu Han-Peng Yin Dong-Hai Qiu Jian-Feng Qu Huo-Hua Zhong Zhi-Hao Lu Fang Wang Man-Qiu Liang Yang-Kun Chen | 2020 | Stroke & Vascular Neurology2020，5，4： | 14 |
| 7 | Endovascular treatment of extracranial vertebral artery stenosis显示文摘Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation,with a low complication rate and good long-term results.In patients with severe tortuosity of the vessel,stent placement is a real challenge.The new coronary balloon-expandable stents may be preferred.A large variability of restenosis rates has been reported.Drug-eluting stents may be the solution.After a comprehensive review of the literature,it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible,but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management. | Burak Kocak Bora Korkmazer Civan Islak Naci Kocer Osman Kizilkilic | 2012 | World Journal of Radiology2012，4，9： | 13 |
| 8 | Predicting asymptomatic coronary artery stenosis by aortic arch plaque in acute ischemic cerebrovascular disease:beyond the cervicocephalic atherosclerosis?显示文摘Background:Asymptomatic coronary artery stenosis(ACAS)≥50%is common in patients with acute ischemic cerebrovascular disease(AICVD),which portends a poor cardiovascular and cerebrovascular prognosis.Identifying ACAS>50%early may optimize the clinical management and improve the outcomes of these high-risk AICVD patients.This study aimed to investigate whether aortic arch plaque(AAP),an early atherosclerotic manifestation of brain blood-supplying arteries,could be a predictor for ACAS>50%in AICVD.Methods:In this cross-sectional study,atherosclerosis of the coronary and brain blood-supplying arteries was simultaneously evaluated using one-step computed tomography angiography(CTA)in AICVD patients without coronary artery disease history.The patients were divided into ACAS≥50%and non-ACAS≥50%groups according to whether CTA showed stenosis≥50%in at least one coronary arterial segment.The AAP characteristics of CTA were depicted from aspects of thickness,extent,and complexity.Results:Among 118 analyzed patients with AICVD,29/118(24.6%)patients had ACAS≥50%,while AAPs were observed in 86/118(72.9%)patients.Increased AAP thickness per millimeter(adjusted odds ratio[OR]:1.56,95%confidence interval[CI]:1.18-2.05),severe-extent AAP(adjusted OR:13.66,95%CI:2.33-80.15),and presence of complex AAP(adjusted OR:7.27,95%CI:2.30-23.03)were associated with ACAS≥50%among patients with AICVD,independently of clinical demographics and cervicocephalic atherosclerotic stenosis.The combination of AAP thickness,extent,and complexity predicted ACAS≥50%with an area under the receiver-operating characteristic curve of 0.78(95%CI:0.70-0.85,P<0.001).All three AAP characteristics provided additional predictive power beyond cervical and intracranial atherosclerotic stenosis for ACAS≥50%in AICVD(all P<0.05).Conclusions:Thicker,severe-extent,and complex AAP were significant markers of the concomitant ACAS≥50%in AICVD,possibly superior to the indicative value of cervical and intracranial atherosclerotic stenosis.As an integral part of atherosclerosis of brain blood-supplying arteries,AAP should not be overlooked in predicting ACAS≥50%for patients with AICVD. | Xin Ma Qi Kong Chen Wang Gary Rajah Yu-Chuan Ding Yu-Ren Zhang Xiang-Ying Du | 2019 | Chinese Medical Journal2019，，8： | 13 |
| 9 | Association between large artery atherosclerosis and cerebral microbleeds:a systematic review and meta-analysis显示文摘Objective:The aim of this systematic review and meta-analysis was to provide evidence that biomarkers of large artery atherosclerosis,including arterial stenosis and greater carotid intima-media thickness(cIMT),may serve as clinical markers of subclinical haemorrhage-prone cerebral small vessel disease,reflected by cerebral microbleeds(CMBs).Methods:We searched PubMed,MEDLINE,Web of Science,EMBASE and the Cochrane Library to identify relevant studies published before 1 July 2016.The association between arterial stenosis and CMBs was estimated by the OR and 95%CI.The association of cIMT and CMBs was calculated using the standardised mean difference(SMD).Heterogeneity and publication bias were explored.Results:8 studies including a total of 7160 participants were pooled in the meta-analysis.6 of the included studies were cross-sectional,except that 2 were prospective.We found a significant association between arterial stenosis>50%and the presence of CMBs(OR 1.95,95%CI 1.13 to 3.36,I2=56.1%).A fixed-effects model suggested that patients with CMBs were more likely to have a greater cIMT(SMD 0.20,95%CI 0.11 to 0.28,I2=24.7%).Conclusions:This systematic review and metaanalysis found that there is a relationship between large artery atherosclerosis and CMBs.Future studies are needed to confirm the impact of atherosclerosis on the CMBs,which may have potential therapeutic implications. | Lingling Ding Yuehui Hong Bin Peng | 2017 | Stroke & Vascular Neurology2017，2，1： | 13 |
| 10 | Bilateral medial medullary infarction with distal stenosis of hypoplastic vertebral artery显示文摘To the Editor:Bilateral medial medullary infarction(MMI)is a rare stroke subtype.[1]usually leads to quadriplegia,sensory disturbance,hypoglossal palsy,bulbar paralysis,etc.[2]We encountered a patient with rapidly progressive tetraparesis and diffusion-weighted imaging(DWI)exhibited a“heart appearance”sign in the bilateral ventral medulla.Computed tomography angiography(CTA)demonstrated that the left vertebral artery(VA)was hypoplastic and there was an atherosclerotic stenosis in the V4 segment. | Jie-Ping Lu Yan Wu Fang Xiao Huai-Yu Li Qi-Qiang Tang | 2019 | Chinese Medical Journal2019，，8： | 13 |
| 11 | Is there any relation between ischemic cerebrovascular disease and extracranial internal carotid stenosis?显示文摘Isthereanyrelationbetweenischemiccerebrovasculardiseaseandextracranialinternalcarotidstenosis?WangYuqi王玉琦,GuoDaqiao郭大乔andFuWe... | 王玉琦 郭大乔 符伟国 | 1998 | Chinese Medical Journal1998，，6： | 12 |
| 12 | Rationale and study design for one-stop assessment of renal artery stenosis and renal microvascular perfusion with contrast-enhanced ultrasound for patients with suspected renovascular hypertension显示文摘Background:Renal artery stenosis (RAS) is always associated with abnormalities in renal microvascular perfusion (RMP).However,few imaging methods can simultaneously evaluate the degree of luminal stenosis and RMP.Thus,this study will aim to evaluate the feasibility of using contrast-enhanced ultrasound (CEUS) for assessing both RAS and RMP to achieve a one-stop assessment of patients with suspected renovascular hypertension. Methods:This will be a single-center diagnostic study with a sample size of 440.Patients with chronic kidney disease (CKD) and suspected of having resistant hypertension will be eligible.Patients with Stages 1–3 CKD will undergo CEUS and computed tomography (CT) angiography (CTA).Values obtained by CEUS and CTA for diagnosing low-grade (lumen reduced by <60%) and high-grade (lumen reduced by ≥60%) RAS will be compared.Moreover,all patients will also undergo radionuclide imaging.The diagnostic value for RAS will be assessed by the receiver operating characteristic curve,including the accuracy,sensitivity,specificity,positive predictive values,negative predictive values,and area under the ROC.Pearson correlation analysis will be performed to assess the association between CEUS findings for RMP and glomerular filtration rate measured by a radionuclide imaging method. Conclusion:The data gathered from this study will be used to evaluate the feasibility of expanding clinical applications of CEUS for evaluation of patients with suspected renovascular hypertension. | Jun-Hong Ren Na Ma Si-Yu Wang You-Jing Sun Yue-Wei Zhang Fa-Jin Guo Yong-Jun Li Tian-Hui Li Hu Ai Wen-Duo Zhang Peng Li Wei-Hua Ma | 2019 | Chinese Medical Journal2019，，1： | 12 |
| 13 | Concurrent intracranial and extracranial artery stenosis and the prognosis of transient ischaemic symptoms or imaging-negative ischaemic stroke显示文摘Background and purpose Transient ischaemic attack(TIA),transient symptoms with infarction(TSI)and diffusion-weighted imaging(DWI)-negative acute ischaemic stroke(AIS)share similar aetiologies but are considered to have a rather benign prognosis.We intended to investigate the association between intracranial atherosclerotic stenosis(ICAS),extracranial atherosclerotic stenosis(ECAS)and the prognosis of patients with TIA,TSI and DWI-negative AIS.Methods Clinical and imaging data of eligible participants were derived from the Chinese Intracranial Atherosclerosis study,according to symptom duration,acute infarction on DWI and discharge diagnosis.Based on the severity and location of arterial atherosclerosis,we categorised the study population into four groups:no or<50% ICAS and no ECAS;≥50% ICAS but no ECAS;no or<50%ICAS with ECAS;and concurrent≥50% ICAS and ECAS.Using multivariable Cox regression models,we analysed the relationship between the severity and distribution of large artery atherosclerosis and the prognosis of TIA,TSI and DWI-negative AIS.Results A total of 806 patients were included,67.3% of whom were male.The median age of the study participants was 63 years.Patients in the concurrent≥50% ICAS and ECAS subgroup had both a significantly higher 1-year recurrence rate(adjusted HR 3.4(95%CI 1.15 to 10.04),p=0.027)and a higher risk of composite vascular events(adjusted HR 3.82(95%CI 1.50 to 9.72),p=0.005).Conclusions Concurrent ICAS and ECAS is associated with a higher possibility of 1-year recurrent stroke or composite vascular events.Large artery evaluation is necessary to assess patients with transient ischaemic symptoms or DWI-negative AIS.Progress in shortening the time interval between symptom onset and large vessel evaluation is needed. | Yue Suo Jing Jing Yuesong Pan Weiqi Chen Hongyu Zhou Hao Li Yuehua Pu Liping Liu Xingquan Zhao Yilong Wang Xia Meng Yongjun Wang | 2021 | Stroke & Vascular Neurology2021，6，1： | 10 |
| 14 | Stroke mechanisms and outcomes of isolated symptomatic basilar artery stenosis显示文摘background While diffuse atherosclerotic disease affecting the posterior circulation has been described extensively,the prevalence,natural history and angiographic characteristics of isolated symptomatic basilar artery stenosis(ISBAS)remain unknown.Methods We reviewed our prospective institutional database to identify patients with≥50% symptomatic basilar artery(BA)stenosis without significant atherosclerotic burden in the vertebral or posterior cerebral arteries.Stroke mechanism,collateral circulation,and degree and length of stenosis were analysed.The primary outcome was time from index event to new transient ischaemic attack(TIA),acute ischaemic stroke(AIS)or death.Other outcome variables included modified Rankin Scale(mRS)score on discharge and last follow-up.results Of 6369 patients with AIS/TIA,91(1.43%)had ISBAS.Seventy-three(80.2%)patients presented with AIS and 18(19.8%)with TIA.Twenty-nine(31.9%)were women and the median age was 66.8±13.6 years.The mean follow-up time was 2.7 years.The most common stroke mechanism was artery-to artery thromboembolism(45.2%),followed by perforator occlusion(28.7%)and flow-dependent/hypoperfusion(15.1%).The percentage of stenosis was lower in patients who had favourable outcome compared with those with mRS 3-6 on discharge(78.3±14.3 vs 86.9±14.5,p=0.007).Kaplan-Meier curves showed higher recurrence/death rates in patients with≥80% stenosis,mid-basilar location and poor collateral circulation.Approximately 13% of patients with ISBAS presented with complete BA occlusion.Conclusion ISBAS is an uncommon(1.43%)cause of TIA and AIS.Men in their 60s are mostly affected,and artery-to artery embolism is the most common stroke mechanism.Mid-basilar location,≥80% stenosis and poor collateral circulation are important factors associated with worse prognosis. | Edgar A Samaniego Amir Shaban Santiago Ortega-Gutierrez Jorge A Roa David M Hasan Colin Derdeyn Biyue Dai Harold Adams Enrique Leira | 2019 | Stroke & Vascular Neurology2019，4，4： | 10 |
| 15 | How to identify which patients with asymptomatic carotid stenosis could benefit from endarterectomy or stenting显示文摘Offering routine carotid endarterectomy(CEA)or carotid artery stenting(CAS)to patients with asymptomatic carotid artery stenosis(ACS)is no longer considered as the optimal management of these patients.Equally suboptimal,however,is the policy of offering only best medical treatment(BMT)to all patients with ACS and not considering any of them for prophylactic CEA.In the last few years,there have been many studies aiming to identify reliable predictors of future cerebrovascular events that would allow the identification of patients with high-risk ACS and offer a prophylactic carotid intervention only to these patients to prevent them from becoming symptomatic.All patients with ACS should receive BMT.The present article will summarise the evidence suggesting ways to identify these high-risk asymptomatic individuals,namely:(1)microemboli detection on transcranial Doppler,(2)plaque echolucency on Duplex ultrasound,(3)progression in the severity of ACS,(4)silent embolic infarcts on brain CT/MRI,(5)reduced cerebrovascular reserve,(6)increased size of juxtaluminal hypoechoic area,(7)identification of intraplaque haemorrhage using MRI and(8)carotid ulceration.The evidence suggests that approximately 10%-15%of patents with asymptomatic stenosis might benefit from intervention;this will become more clear after publication of ongoing studies comparing stenting or endarterectomy with best medical therapy.In the meantime,no patient should be offered intervention unless there is evidence of high risk of ipsilateral stroke,from modalities such as those discussed here. | Kosmas I Paraskevas Frank J Veith J David Spence | 2018 | Stroke & Vascular Neurology2018，3，2： | 10 |
| 16 | Infliximab induces remission in cryptogenic multifocal ulcerous stenosing enteritis:First case显示文摘We present the case of a 29-year-old patient with a history of abdominal pain and vomiting.Based on wireless video capsule findings he was previously diagnosed with ileal Crohn's disease at a different institution,although the clinical and radiological picture was not typical and the response to corticosteroids was poor.We performed a single-balloon enteroscopy showing a short,ulcerous stenosis 50 cm proximal from Bauhin's valve.The endoscopic and clinical histopathological findings were compatible with cryptogenic multifocal ulcerous stenosing enteritis(CMUSE).High dose corticosteroids were again started,without effect.The monoclonal tumor necrosis factor-α(TNF-α) antibody infliximab was added to the medical therapy.After induction therapy,both clinical and endoscopic amelioration was obtained.Larger case studies are needed to confirm the efficacy of TNF-α inhibition in steroid refractory CMUSE. | De Schepper Heiko Macken Elisabeth Van Marck Veerle Spinhoven Maarten Pelckmans Paul Moreels Tom | 2013 | World Journal of Gastroenterology2013，19，10： | 10 |
| 17 | Endoscopic management of Crohn's strictures显示文摘Symptomatic intestinal strictures develop in more than one third of patients with Crohn's disease(CD) within 10 years of disease onset. Strictures can be inflammatory, fibrotic or mixed and result in a significant decline in quality of life, frequently requiring surgery for palliation of symptoms. Patients under the age of 40 with perianal disease are more likely to suffer from disabling ileocolonic disease thus may have a greater risk for fibrostenotic strictures. Treatment options for fibrostenotic strictures are limited to endoscopic and surgical therapy. Endoscopic balloon dilatation(EBD) appears to be a safe, less invasive and effective alternative modality to replace or defer surgery. Serious complications are rare and occur in less than 3% of procedures. For non-complex strictures without adjacent fistulizaation or perforation that are less than 5 cm in length, EBD should be considered as first-line therapy. The aim of this review is to present the current literature on the endoscopic management of small bowel and colonic strictures in CD, which includes balloon dilatation, adjuvant techniques of intralesional injection of steroids and anti-tumor necrosis factor, and metal stent insertion. Short and long-term outcomes, complications and safety of EBD will be discussed. | Talat Bessissow Jason Reinglas Achuthan Aruljothy Peter L Lakatos Gert Van Assche | 2018 | World Journal of Gastroenterology2018，24，17： | 10 |
| 18 | Palliation of malignant esophageal obstruction and fistulas with self expandable metallic stents显示文摘AIM: To evaluate the efficacy of self expandable metallic stents (SEMS) in patients with malignant esophageal obstruction and fistulas. METHODS: SEMS were implanted in the presence of fluoroscopic guidance in patients suffering from advanced and non-resectable esophageal, cardiac and invasive lung cancer between 2002 and 2009. All procedures were performed under conscious sedation. All patients had esophagus obstruction and/or fistula. In all patients who required reintervention, recurrence of dysphagia, hemorrhage, and fistula formation were indications for further endoscopy. Patients' files were scanned retrospectively and the obtained data were analyzed using SPSS 13.0 for Windows. The χ 2 test was used for categorical data and was analysis of variance for noncategorical data. Patients' long-term survival was assessed using the Kaplan-Meier method. RESULTS: Stents were successfully implanted in 90 patients using fluoroscopic guidance. Reasons for stent implantation in these patients were esophageal stricture (77/90, 85.5%), external pressure (8/90, 8.8%) and tracheo-esophageal fistula (5/90, 5.5%). Dysphagia scores (mean ± SD) were 3.37 ± 0.52 before and 0.90 ± 0.43 after stent implantation (P = 0.002). Intermittent, nonmassive hemorrhage due to the erosion caused by the distal end of the stent in the stomach occurred in only one patient who received implementation at cardioesophageal junction. Mean survival following stenting was 134.14 d (95% confidence interval: 94.06-174.21).CONCLUSION: SEMS placement is safe and effective in the palliation of dysphagia in selected patients with malignant esophageal strictures. | Ahmet Dobrucali Erkan Caglar | 2010 | World Journal of Gastroenterology2010，16，45： | 9 |
| 19 | Update on the natural history of intracranial atherosclerotic disease: A critical review显示文摘Intracranial atherosclerotic disease (ICAD) contributes to a significant number of ischemic strokes. There is debate in the recent literature concerning the impact of the location of stenosis in ICAD on outcome. Some reports have suggested that disease processes and outcomes vary by vessel location, potentially altering the natural history and indications for intervention. Here we have performed a comprehensive, critical review of the natural history of ICAD by vessel in an attempt to assess the differences in disease specific to each of the vascular territories. Our assessment concludes that only minor differences exist between patients with different vessels affected in vessel-specific ICAD. We have found that middle cerebral artery disease confers a lower mortality than vessel-specific ICAD in other intracranial vessels, asymptomatic disease follows a more benign course than symptomatic disease, andthat plaque progression or the detection of microemboli on transcranial Doppler may predict poor outcome. Given the expanding indications for treatment of ICAD and rapidly developing endovascular techniques to confront this disease, a thorough understanding of the natural history of ICAD aids the interventional neuroradiologist in determining when to treat and how to predict outcome in this patient population. | Ricardo J Komotar Christopher P Kellner Daniel M Raper Dorothea Strozyk Randall T Higashida Philip M Meyers | 2010 | World Journal of Radiology2010，2，5： | 8 |
| 20 | Decrease of Glomerular Filtration Rate may be Attributed to the Microcirculation Damage in Renal Artery Stenosis显示文摘Background: The decrease ofglomenllar filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis (RAS). But the gap between artery stenosis and the glomerular filtration ability is still unclear. Methods: Patients with selective renal artery angiogram were divided by the degree of renal artery narrowing, level of estimated glomerular filtration rate (eGFR), respectively. The different levels ofeGFR, renal microcirculation markers, and RAS severity were compared with each other, to determine the relationships among them. Results: A total of 215 consecutive patients were enrolled in the prospective cohort study. Concentrations of microcirculation markers had no significant difference between RAS group (RAS ≥ 50%) and no RAS group (RAS 〈 50%) or did not change correspondingly to RAS severity. The value ofeGFR in RAS group was lower than that in the no RAS group, but it did not decline parallel to the progressive severity of RAS. The microcirculation markers presented integral difference if grouped by different eGFR level with negative tendency, especially that plasma cystatin C (cysC) and urinary microalbumin to creatinine ratio (mACR) increased with the deterioration ofeGFR, with strong (r= -0.713, P 〈 0.001 ) and moderate (r = -0.580, P 〈 0.001 ) correlations. In the subgroup analysis of severe RAS (RAS 〉 80%), the levels of plasma cysC and urinary mACR demonstrated stronger negative associations with eGFR, (r = -0.827, P 〈 0.001) and (r= -0.672, P 〈 0.001 ) correlations, respectively. Conclusions: Severity of RAS could not accurately predict the value of eGFR, whereas microcirculation impairment may substantially contribute to the glomerular filtration loss in patients with RAS. | Hao-Jian Dong Cheng Huang De-Mou Luo Jing-Guang Ye Jun-Qing Yang Guang Li Jian-Fang Luo Ying-Ling Zhou | 2015 | Chinese Medical Journal2015，，6： | 8 |
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