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Zhang J, Huang X, Wang G, Wang X, Zhang T, Wang D, Qi L, Liang J, Li B, Chu J, Li K, Sun L, Song Y, Zhao W, Zheng M, Meng Y, Yin H, Wang W, Han J. Efficacy and Safety of Tirofiban Before Stenting for Symptomatic Intracranial Atherosclerotic Stenosis: A Randomized Clinical Trial. Neurology 2024; 102:e209217. [PMID: 38489544 DOI: 10.1212/wnl.0000000000209217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/21/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Acute stent thrombosis (AST) is not uncommon and even catastrophic during intracranial stenting angioplasty in patients with symptomatic high-grade intracranial atherosclerotic stenosis (ICAS). The purpose of this study was to investigate whether adjuvant intravenous tirofiban before stenting could reduce the risk of AST and periprocedural ischemic stroke in patients receiving stent angioplasty for symptomatic ICAS. METHODS A prospective, multicenter, open-label, randomized clinical trial was conducted from September 9, 2020, to February 18, 2022, at 10 medical centers in China. Patients intended to receive stent angioplasty for symptomatic high-grade ICAS were enrolled and randomly assigned to receive intravenous tirofiban or not before stenting in a 1:1 ratio. The primary outcomes included the incidence of AST within 30 minutes after stenting, periprocedural new-onset ischemic stroke, and symptomatic intracranial hemorrhage. The outcomes were analyzed using logistic regression analysis to obtain an odds ratio and 95% confidence interval. RESULTS A total of 200 participants (122 men [61.0%]; median [interquartile ranges] age, 57 [52-66] years) were included in the analysis, with 100 participants randomly assigned to the tirofiban group and 100 participants to the control (no tirofiban) group. The AST incidence was lower in the tirofiban group than that in the control group (4.0% vs 14.0%; adjusted odds ratio, 0.25; 95% CI 0.08-0.82; p = 0.02). No significant difference was observed in the incidence of periprocedural ischemic stroke (7.0% vs 8.0%; p = 0.98) or symptomatic intracranial hemorrhage between the 2 groups. DISCUSSION This study suggests that adjuvant intravenous tirofiban before stenting could lower the risk of AST during stent angioplasty in patients with symptomatic high-grade ICAS. TRIAL REGISTRATION INFORMATION URL: chictr.org.cn; Unique identifier: ChiCTR2000031935. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with symptomatic high-grade ICAS, pretreatment with tirofiban decreases the incidence of acute stent thrombosis. This study is Class II due to the unequal distribution of involved arteries between the 2 groups.
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Affiliation(s)
- Jun Zhang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Xin Huang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Guoqing Wang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Xianjun Wang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Tao Zhang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Dong Wang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Lifeng Qi
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Jiye Liang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Bing Li
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Jianfeng Chu
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Kai Li
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Lili Sun
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Yun Song
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Wei Zhao
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Meimei Zheng
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Yao Meng
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Hao Yin
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Wei Wang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Ju Han
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
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Sun L, Zhang J, Song Y, Zhao W, Zheng M, Zhang J, Yin H, Wang W, Meng Y, Tang J, Han J. Safety and Efficacy of Tirofiban in Rescue Treatment for Acute Intracranial Intraprocedural Stent Thrombosis. Front Neurol 2020; 11:492. [PMID: 32612569 PMCID: PMC7308481 DOI: 10.3389/fneur.2020.00492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/05/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: The incidence of acute intraprocedural stent thrombosis (AIST) during stenting of intracranial atherosclerotic stenosis (ICAS) has seldom been reported and evidence regarding the treatment of AIST is lacking. We aim to investigate the incidence of AIST during stenting of ICAS in our institute, assess the preliminary efficacy and safety of rescue treatment of tirofiban for these patients. Methods: From September 2016 to May 2019, all symptomatic ICAS patients who underwent intracranial stenting in our institute were prospectively registered into this study, of which patients with AIST were retrospectively reviewed to extract baseline characteristics, perioperative management, procedural details, angiographic, and clinical outcomes. Rescue treatment of tirofiban for AIST was assessed by recanalization of the culprit vessel and periprocedural death, hemorrhage, and ischemic stroke. Results: Acute intraprocedural stent thrombosis developed in 12 (6.2%) patients within 30 min after stent placement of 194 patients. All 12 cases were successfully recanalized with modified Treatment in Cerebral Ischemia (mTICI) 3 and Arterial Occlusive Lesion (AOL) 3 after rescue treatment of tirofiban alone. There was no perioperative death or any hemorrhagic complication. Three patients suffered perioperative ischemic stroke. Conclusions: We observed a non-negligible rate of AIST during intracranial stenting procedures for ICAS. Intra-arterial bolus followed by intravenous tirofiban infusion seems to be efficacious and safe for AIST during stent placement for ICAS, without increasing the rate of hemorrhagic complications and death.
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Affiliation(s)
- Lili Sun
- Department of Neurology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Jinping Zhang
- Department of Neurology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yun Song
- Department of Neurology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Wei Zhao
- Department of Neurology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Meimei Zheng
- Department of Neurology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Jun Zhang
- Department of Neurology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Hao Yin
- Department of Neurology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Wei Wang
- Department of Neurology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yao Meng
- Department of Neurology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Jiyou Tang
- Department of Neurology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Ju Han
- Department of Neurology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
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