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Yang B, Ma Y, Wang T, Chen Y, Wang Y, Zhao Z, Chen D, Wang J, Xu X, Luo T, Hua Y, Ling F, Qureshi AI, Hong B, Jiao L. Carotid Endarterectomy and Stenting in a Chinese Population: Safety Outcome of the Revascularization of Extracranial Carotid Artery Stenosis Trial. Transl Stroke Res 2020; 12:239-247. [PMID: 32686047 DOI: 10.1007/s12975-020-00835-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/28/2022]
Abstract
Carotid endarterectomy (CEA) and carotid artery stenting (CAS) have been well-established as two effective treatment modalities for carotid artery stenosis, while their clinical outcomes in real-world China are still unknown due to lack of nationwide trials. We aimed to evaluate the safety outcome profile of CEA and CAS in Chinese patients with carotid artery stenosis. The Revascularization of Extracranial Carotid Artery Stenosis trial was a multicentre, prospective cohort study of CEA or CAS in treating patients with carotid artery stenosis. We included symptomatic or asymptomatic patients with carotid artery stenosis (≥ 50%). The primary endpoint was any stroke, myocardial infarction and/or death within 1 month post-procedure. Overall, 2719 cases (1543 CAS-treated patients and 1176 CEA-treated patients) were enrolled from 36 centres. The primary outcome was 4.3% (95% CI 3.2-5.6%) and 4.7% (95%CI 3.5-6.3%) in the symptomatic and asymptomatic patients, respectively. No significant difference in the primary outcome was found between CAS and CEA in both symptomatic (p = 0.338) and asymptomatic (p = 0.890) patients. High- versus low-volume centre significantly related to lower rate of primary outcome in CEA-treated patients (OR 2.54; 95%CI 1.19-5.44; p = 0.017) and asymptomatic patients (OR 2.54; 95%CI 1.42-4.54; p = 0.002). CEA and CAS decided by surgeons' discretion have comparable risks among patients with carotid artery stenosis in China. Both CEA and CAS should be avoided in asymptomatic patients until a consistently low complication rate is showed with centre-level audits. Medical treatment for patients with carotid stenosis in China needs to be improved. Trial registration: NCT01994187 ( ClinicalTrials.gov ).
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Affiliation(s)
- Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing, China
| | - Yanfei Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing, China
| | - Yinzhou Wang
- Department of Neurology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Zhenwei Zhao
- Department of Neurosurgery, Tangdu Hospital, Xian, Shanxi, China
| | - Dong Chen
- Department of Neurosurgery, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Jiyue Wang
- Department of Neurosurgery, Liaocheng Brain Hospital, Liaocheng, Shandong, China
| | - Xiaolin Xu
- Department of Neurology, Huanhu Hospital, Tianjin, China
| | - Tao Luo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yang Hua
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing, China
| | - Adnan I Qureshi
- Zeenet Qureshi Stroke Institute, St Cloud, MN and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Bo Hong
- Department of Neurosurgery, Changhai Hospital, No. 168, Changhai Road, Shanghai, China.
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing, China.
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Zhang X, Huang Z, Xie Y, Chen X, Zhang J, Qiu Z, Ma N, Xu G, Liu X. Lower levels of plasma adiponectin and endothelial progenitor cells are associated with large artery atherosclerotic stroke. Int J Neurosci 2015; 126:121-6. [PMID: 25469454 DOI: 10.3109/00207454.2014.994624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Both adiponectin and endothelial progenitor cells (EPCs) have been proposed recently with anti-atherosclerosis effects. However, their impacts on vascular outcomes in patients with large artery atherosclerosis (LAA) are unclear. This study aimed to investigate the relationship between adiponectin, EPCs and stroke with a case-control design. METHODS The study cohort included 127 patients (61.3 ± 11.0 years; 73.2% men) with LAA stroke and 58 control subjects (60.9 ± 9.2 years; 70.7% men) referred for adiponectin and EPCs levels testing. We collected demographic, clinical, angiographical features, and laboratory data. Influence of adiponectin and EPCs levels on cerebral atherosclerosis and LAA stroke was analyzed with regression models. RESULTS The levels of adiponectin and EPCs in atherosclerotic stroke patients were significantly lower compared with matched controls (p < 0.05). Logistic regression analysis identified that reduced levels of adiponectin and EPCs were closely correlated with cerebral atherosclerosis and LAA stroke. The associations remained significant after adjustment for age, sex and other confounders. Additionally, partial correlation analysis revealed a significant positive association between adiponectin and three subpopulations of EPCs levels (CD34(+)CD133(+)CD309(+)cells: r = 0.510, p = 0.001; CD34(+) CD133(-)CD309(+)cells: r = 0.262, p = 0.004; CD34(-)CD133(+)CD309(+)cells: r = 0.348, p < 0.001). CONCLUSIONS Adiponectin is positively correlated with EPCs levels, and both of them are independently associated with LAA stroke.
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Affiliation(s)
- Xiaohao Zhang
- a Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhixin Huang
- c Department of Neurology, Shenzhen Sixth People's Hospital (Nanshan Hospital), Shenzhen, China
| | - Yi Xie
- a Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Xiangliang Chen
- a Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Jun Zhang
- a Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhongming Qiu
- b Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, China
| | - Nan Ma
- a Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Gelin Xu
- a Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,b Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, China
| | - Xinfeng Liu
- a Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.,b Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, China
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Liu X, Zhang S, Liu M, Wang Y, Wu J, Dong Q, Zeng J, Huang Y, Wu J, Xu Y, Chen K, Zhang R, Li B, Liu Y, Peng B, Lu Z, Zhou H, Fan X, Shuai J, Xu G. Chinese guidelines for endovascular management of ischemic cerebrovascular diseases. INTERVENTIONAL NEUROLOGY 2014; 1:171-84. [PMID: 25187777 DOI: 10.1159/000351688] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Endovascular technology was initially applied in treating peripheral vascular disease and was further developed in managing coronary artery disease. During the latest two decades, it has been introduced into the arena of cerebrovascular diseases, which has garnered attention and research interests.
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Affiliation(s)
- Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Beijing
| | - Suming Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, Beijing
| | - Ming Liu
- Department of Neurology, West China Hospital, West China School of Medicine, Chengdu, Beijing
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Beijing
| | - Jiang Wu
- Department of Neurology, The First Affiliated Hospital of Jilin University, Bethune Medicine School, Jilin University, Changchun, PR China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University School of Medicine, Shanghai, PR China
| | - Jinsheng Zeng
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, PR China
| | - Yining Huang
- Department of Neurology, Peking University First Hospital, Peking University School of Medicine, Beijing
| | - Jian Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, School of Medicine, Zhengzhou University, Zhengzhou, PR China
| | - Kangning Chen
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, PR China
| | - Renliang Zhang
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Beijing
| | - Baomin Li
- Department of Neurology, No. 301 Hospital of People's Liberation Army, Beijing
| | - Yajie Liu
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, PR China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, School of Medicine, Sun Yat-sen University, PR China
| | - Huadong Zhou
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, PR China
| | - Xinying Fan
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Beijing
| | - Jie Shuai
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, PR China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Beijing ; on behalf of the Chinese Stroke Society
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Huang Z, Yin Q, Sun W, Zhu W, Li Y, Liu W, Xiao L, Duan Z, Cai Q, Liu D, Ma M, Liu X. Microbleeds in ischemic stroke are associated with lower serum adiponectin and higher soluble E-selectin levels. J Neurol Sci 2013; 334:83-7. [PMID: 23988228 DOI: 10.1016/j.jns.2013.07.2513] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/24/2013] [Accepted: 07/25/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cerebral microbleeds (CMBs) are the important indicators of cerebral small vessel disease. However, it is still unclear whether endothelial dysfunction is involved in CMBs. In this study, we performed a prospective study to investigate the correlation between sE-selectin (soluble E-selectin) or adiponectin and the prevalence of CMBs. METHODS We recruited 133 consecutive patients with first-ever ischemic stroke for this study. Finally, 126 patients were analyzed. The number and presence of CMBs were detected and evaluated on susceptibility-weighted magnetic resonance imaging within two weeks after symptom onset. We assessed the serum levels of adiponectin and sE-selectin for patients. RESULTS CMBs were detected in 63 subjects (50%) within 126 patients and more prevalent in mixed brain regions (55.6%). In binary logistic regression analysis, each 1SD-increase in adiponectin level was significantly conversely associated with the prevalence of CMBs after adjusting for age, sex and cardiovascular risk factors (OR = 0.55; 95% CI: 0.36-0.84); but sE-selectin was significantly positively associated with the prevalence of CMBs (OR = 1.09; 95% CI: 1.02-1.15). Furthermore, partial correlation analyses showed that sE-selectin remained significantly associated with and correlated conversely to adiponectin (r = -0.452, p = 0.001). CONCLUSIONS Endothelial injury may play a role in the pathogenesis of CMBs, and serum levels of adiponectin and sE-selectin were closely related to CMBs. Adiponectin might be protective for the prevalence of CMBs.
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Affiliation(s)
- Zhixin Huang
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing 21002, China; Department of Neurology, First Teaching Hospital of Fujian Medical University, Putian 351100, China
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Liu X. Beyond the time window of intravenous thrombolysis: standing by or by stenting? INTERVENTIONAL NEUROLOGY 2012; 1:3-15. [PMID: 25187761 PMCID: PMC4031767 DOI: 10.1159/000338389] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Intravenous administration of tissue plasminogen activator within 4.5 h of symptom onset is presently the 'golden rule' for treating acute ischemic stroke. However, many patients miss the time window and others reject this treatment due to a long list of contraindications. Mechanical embolectomy has recently progressed as a potential alternative for treating patients beyond the time window for IV thrombolysis. In this paper, recent progress in mechanical embolectomy, angioplasty, and stenting in acute stroke is reviewed. Despite worries concerning the long-term clinical outcomes and increased risk of intracranial hemorrhage, favorable clinical outcomes may be achieved after mechanical embolectomy in carefully selected patients even 4.5 h after stroke onset. Potential steps should be prepared and attempted in these patients whose opportunity for recovery will elapse in a flash.
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Affiliation(s)
- Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Epidemiology and the global burden of stroke. World Neurosurg 2012; 76:S85-90. [PMID: 22182277 DOI: 10.1016/j.wneu.2011.07.023] [Citation(s) in RCA: 362] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 06/24/2011] [Accepted: 07/16/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Stroke remains one of the most devastating of all neurological diseases, often causing death or gross physical impairment or disability. As numerous countries throughout the world undergo the epidemiological transition of diseases, trends in the prevalence of stroke have dramatically changed. METHODS All major international epidemiological articles published during the past 20 years addressing the global burden of stroke were reviewed. A focus was placed upon better defining current and future trends in surveillance, incidence, burden of disease, mortality, and costs associated with stroke internationally. RESULTS Despite the fact that various surveillance systems are used to identify stroke and its sequela around the world, it is clear that stroke remains one of the top causes of mortality and disability-adjusted life-years (DALYs) lost globally. Concerning trends include the increase of stroke mortality and lost DALYs in low- and middle-income countries. The global economic impact of stroke may be dire if effective preventive measures are not implemented to help decrease the burden of this disease. CONCLUSION The global burden of stroke is high, inclusive of increasing incidence, mortality, DALYs, and economic impact, particularly in low- and middle-income countries. The implementation of better surveillance systems and prevention programs are needed to help track current trends as well as to curb the projected exponential increase in stroke worldwide.
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