Carotid Artery Stenting for the Treatment of Fatal Acute Cerebral Infarction Associated with Aortic Dissection

Serum amyloid A is a potential predictor of prognosis in acute ischemic stroke patients after intravenous thrombolysis

Objectives

Inflammation shows a notable relationship to acute ischemic stroke's (AIS) occurrence and prognosis. However, existing research has confirmed that serum amyloid A (SAA) is an inflammatory biomarker. The aim of this paper was to investigate the association between SAA and the three-month clinical results of acute AIS patients after intravenous thrombolysis (IVT).

Methods

The evaluation of AIS patients with complete medical records was carried out by prospectively investigating patients hospitalized in our department between January 2020 and February 2023. The SAA levels were examined with the use of an immunosorbent assay kit that shows a relationship with the enzyme (Invitrogen Corp). Patients were dichotomized into favorable (mRS score of 0, 1 or 2) and unfavorable (mRS score of 3, 4, 5, or 6) results with the use of the modified Rankin Scale (mRS).

Results

A total of 405 AIS patients who were subjected to IVT therapy were prospectively covered. To be specific, 121 (29.88%) patients had an unfavorable prognosis during the follow-up for 3 months. On that basis, patients achieving unfavorable results gained notably greater SAA levels (39.77 (IQR 38.32-46.23) vs.31.23 (IQR 27.44-34.47), p < 0.001) during hospitalization in comparison to patients with a better result. In the analysis with multiple variates, SAA was adopted to achieve the independent prediction of the three-month unfavorable clinical results of acute AIS patients after IVT [OR:2.874 (95% CI, 1.764-4.321), p < 0.001]. When the fundamental confounding factors were regulated, the odds ratio (OR) of unfavorable prognosis after AIS patients undergoing IVT therapy was 4.127 (95% CI = 1.695-10.464, p = 0.032) for the maximum tertile of SAA in terms of the minimal tertile. With an AUC of 0.703 (95% CI, 0.649-0.757), SAA revealed a notably more effective discriminating capability in terms of CRP, NLR, EMR, and WBC. SAA as a predictor in terms of the prediction of three-month unfavorable results after AIS patients undergoing IVT therapy achieved specificity and sensitivity of 84.45% and 77.23%, as well as an optimal cut-off value (COV) of 37.39.

Conclusion

SAA level that is up-regulated during hospitalization is capable of serving as an effective marker in terms of the prediction of unfavorable three-month results in AIS patients after IVT.

Effect of Edaravone Combined with Anticoagulant Therapy on the Serum hs-CRP, IL-6, and TNF-α Levels and Activity of Daily Living in Patients with Acute Cerebral Infarction

Objective

To explore the effect of edaravone combined with anticoagulant therapy on the serum hs-CRP, IL-6, and TNF-α levels and the activity of daily living (ADL) in patients with acute cerebral infarction (ACI).

Methods

The clinical data of 84 ACI patients treated in our hospital from August 2020 to August 2021 were retrospectively analyzed, and they were divided into the routine group (n = 42) and the combined group (n = 42) according to the order of admission. Both groups were treated with routine clinical treatment, and the combined group was additionally treated with edaravone combined with anticoagulant therapy. Serum samples were collected from both groups after treatment. ELISA was used to detect the serum inflammatory factor levels, and the modified Barthel index score was used to evaluate the ADL of patients.

Results

Compared with the routine group, the combined group achieved obviously lower levels of PMA, CD62p, and serum inflammatory factors after treatment (P < 0.001), higher modified Barthel score after treatment (P < 0.001), lower plasma viscosity, platelet aggregation rate, and plasma fibrinogen level after treatment (P < 0.001), and higher clinical overall efficacy (P < 0.05).

Conclusion

Edaravone combined with anticoagulant therapy is a reliable method to enhance ADL and reduce the inflammatory response of ACI patients. This strategy greatly reduces the platelet-activating factor levels of patients and improves the comprehensive clinical efficacy, and its further research will help to establish a better solution for these patients.

[Use of temporary arterial shunt in surgery of dissection of the aorta and brachiocephalic arteries]

BACKGROUND

Unsolved problems of cerebral protection in operations on the aortic arch, especially in a combination with extension of dissection to the brachiocephalic arteries determine search for variants making it possible to carry out adequate cerebral perfusion.

AIM

To propose a new technique and initial experience of using cerebral perfusion through a temporary shunt from the basin of the left subclavian artery at the stage of prosthetic repair of brachiocephalic arteries.

PATIENTS AND METHODS

At the Department of Reconstructive Surgery and Aortic Root of A.N. Bakulev National Medical Research Centre of Cardiovascular Surgery, a total of 6 patients (5 men) with type A aortic dissection underwent a stage of restoration of brachiocephalic arteries with the use of a temporary arterial shunt. The mean age was 48±15 years. The patients had chronic aortic dissection involving brachiocephalic arteries, primary fenestration in the aortic arch. All were found to have signs of chronic cerebrovascular insufficiency (dizziness, loss of consciousness); 2 patients had a history of transitory focal impairments. All patients were subjected to prosthetic repair of the ascending portion, aortic arch and all brachiocephalic arteries in conditions of adaptive perfusion with the use of adaptive loop from arterial lines. Supracoronary reconstruction of the ascending aorta was performed in 4 patients, Bentall operation in 2 subjects, with all undergoing total aortic arch replacement according to the elephant trunk technique. Brachiocephalic arteries were repaired using a trifurcated vascular grafts.

RESULTS

Mean duration of cerebral perfusion along the temporary shunt amounted to 34±12 min. At all stages of operation, the level of haemoglobin oxygen saturation (rSO2) according to cerebral oximetry was within the reference values. All patients were discharged averagely on POD 12.

CONCLUSION

A novel technique of cerebral perfusion along a temporary shunt will make it possible to extend the capabilities of heart surgeons in complicated combined interventions on the aortic arch and brachiocephalic arteries.