Risk Factor For Cerebral Infarction Research Articles

Small dense low-density lipoprotein cholesterol is strongly associated with NIHSS score and intracranial arterial calcification in acute ischemic stroke subjects

Intracranial artery calcification (IAC) is an important risk factor for cerebral infarction and a key biomarker for intracranial artery stenosis. Small dense low-density lipoprotein cholesterol (sd-LDL-c) was independently associated with increased cardiovascular events and coronary calcification. Our study assessed whether sd-LDL-c is an independent factor for IAC in acute ischemic stroke (AIS) patients. This cross-sectional study involved a total of 754 patients with AIS (mean age: 65 ± 13.2 years). All the patients had received brain computed tomography angiography (CTA) examination to evaluate IAC. Serum sd-LDL-c levels and other biochemical parameters were analyzed. Admission NIHSS score and mRS score at discharge were collected. After 60-days 85 patients died during hospitalization and follow-up. Partial correlation analysis showed that serum sd-LDL-c levels were associated with admission NIHSS score and IAC score after adjusted age and gender. Logistic regression analysis showed that serum sd-LDL-c levels independently predicted NIHSS scores (β = 1.537, 95%CI: 0.134-2.878, p = 0.042) and IAC scores (β = 1.355, 95%CI: 0.319-2.446, p = 0.015). The average level of sd-LDL-c in patients who died was also significantly increased compared to survival patients (1.04 ± 0.59 vs 0.88 ± 0.44 mmol/L, p = 0.017). However, multivariate logistic regression analysis showed serum sd-LDL-c levels could not predict all-cause mortality and prognosis in AIS patients. Our study found that sd-LDL-c as a strong atherogenic lipid particle can independently predict admission NIHSS scores and the severity of cerebral artery calcification in AIS patients. However, its prognostic value in AIS patients still needs further study in the future.

Impact of aneurysm shape and neck configuration on cerebral infarction during microsurgical clipping of intracranial aneurysms.

Cerebral infarction is a significant cause of morbidity and mortality related to microsurgical clipping of intracranial aneurysms. The objective of this study was to determine the impact of aneurysm shape and neck configuration on cerebral infarction after aneurysm surgery. The authors retrospectively reviewed consecutive cases of ruptured and unruptured aneurysms treated with microsurgical clipping at their institution between 2010 and 2018. Three-dimensional reconstructions from preoperative computed tomography and digital subtraction angiography were used to determine aneurysm shape (regular/complex) and neck configuration (regular/irregular). Morphological and procedure-related risk factors for cerebral infarction were identified using univariate and multivariate statistical analyses. Among 243 patients with 252 aneurysms (148 ruptured, 104 unruptured), the overall cerebral infarction rate was 17.1%. Infarction tended to occur more often in aneurysms with complex shape (p = 0.084). Likewise, aneurysms with an irregular neck had a significantly higher rate of infarction (37.5%) than aneurysms with regular neck configuration (10.1%, p < 0.001). Aneurysms with an irregular neck were associated with a higher rate of intraoperative rupture (p = 0.003) and temporary parent artery occlusion (p = 0.037). In the multivariate analysis, irregular neck configuration was identified as an independent risk factor for infarction (OR 4.2, 95% CI 1.9-9.4, p < 0.001), whereas the association between aneurysm shape and infarction was not significant (p = 0.966). Irregular aneurysm neck configuration represents an independent risk factor for cerebral infarction during microsurgical clipping of both ruptured and unruptured aneurysms.

Relationship between apolipoprotein E gene polymorphism and cerebral infraction in Chinese type 2 diabetes mellitus patients

Objective To investigate the relationship between apolipoprotein E (APOE) gene polymorphism and cerebral infraction (CI) in Chinese type 2 diabetes mellitus (T2DM) patients. Methods This study included 245 samples of T2DM patients without cerebral infraction (CON group) (Male/Female, 128/117) and 270 samples of T2DM patients with cerebral infraction (CI group)(Male/Female, 145/125) from the department of endocrinology and neurology utilizing real-time fluorescence quantitative PCR technique. The t test and χ2 test were used to compare the differences between the two groups. Results Patients with a history of hypertension in the CI group (84.12%) were significantly higher than those in the CON group (70.42%) (χ2=15.91, P<0.05).The systolic blood pressure (142.78±20.52)mmHg of the CI group was significantly higher than that of the CON group (133.89±18.58)mmHg (t=-5.16, P<0.05).Compared with CON group, the frequency of genotypes of e2/e3 and e3/e4 in CI group was significantly higher, while the frequency of e3/e3 genotype was significantly lower (χ2=11.48, P<0.05); the allele frequency of APOE e4 was higher while e3 was lower in CI group than that in CON group (χ2=7.00, P<0.05). Logistic regression analysis showed that hypertension history (OR=1.95, P<0.05), high systolic blood pressure (OR=1.02, P<0.05), APOE genotypes of e2/e3 (OR=2.08, P<0.05) and e3/e4 (OR=1.85, P<0.05) were independent risk factors for cerebral infarction in T2DM patients. Conclusion The polymorphism of APOE gene may be related to cerebral infraction in Chinese T2DM patients. Key words: Diabetes mellitus, type 2; Diabetic angiopathies; Brain infarction; Apolipoprotein E4; Polymorphism, genetic

Analysis of features of carotid artery color doppler ultrasonography in diabetes mellitus patients complicated with cerebral infarction

Objective To analyze the changes of carotid artery ultrasound in diabetes mellitus patients complicated with cerebral infarction. Methods From March 2017 to June 2018, 55 type 2 diabetes patients complicated with cerebral infarction in the Second People's Hospital of Yuhang District were selected as study group.Another 50 diabetes patients without cerebral infarction were selected as simple group, and 60 healthy people were selected as control group.The carotid artery colour doppler check was implemented, the carotid artery ultrasound media thickness(IMT) index and carotid plaques were compared in three groups. Results The IMT index in the study group was (1.84±0.23), which was significantly higher than (1.32±0.21) in the control group (t=12.674, P<0.05). The IMT index of the simple group was (1.59±0.19), which was significantly lower than that of the study group (t=6.037, P<0.05). Compared with the control group, the IMT index of the simple group was significantly higher (t=7.009, P<0.05). The detective rate of carotid unstable plaque in the study group was 85.37%(35/41), which was significantly higher than 11.54%(3/26) in the control group (χ2 =21.371, P<0.05). The detective rate of carotid unstable plaque in the simple group was 45.95%(17/37), which was significantly lower than that in the study group (χ2=19.118, P<0.05). The detective rate of carotid unstable plaque between the control group and the simple group had statistically significant difference (χ2=18.342, P<0.05). Conclusion The IMT index of carotid artery in diabetes patients complicated with cerebral infarction is high, and the unstable plaque examination rate is high, which are the risk factors for cerebral infarction in patients with diabetes.To do a good job in carotid atherosclerosis for diabetic patients, and give active treatment, can prevent cerebral infarction. Key words: Diabetes mellitus; Brain infarction; Arteriosclerosis; Carotid arteries; Ultrasonography, doppler, color

Association Between the Polymorphism of Aldehyde Dehydrogenase 2 Gene and Cerebral Infarction in a Hakka Population in Southern China.

Genetic factors play an important role in determining the susceptibility to ischemic stroke. Herein, we examined the association of an aldehyde dehydrogenase 2 (ALDH2) gene polymorphism with cerebral infarction. Patients with cerebral infarction (n = 963) and healthy controls (n = 921) were included. Genotyping was performed using gene chip platform analysis, and Sanger sequencing was used to confirm ALDH2 genotypes. The risk prediction of ALDH2 polymorphisms for cerebral infarction was examined under three genetic modes of inheritance. For males, ALDH2*2/*2 genotype was a significant risk factor for cerebral infarction in the co-dominant model (age-, smoking-, and drinking-adjusted OR 1.514, 95% CI 1.005-2.282, p = 0.047) and the recessive model (age-, smoking-, and drinking-adjusted OR 1.601, 95% CI 1.078-2.379, p = 0.020). However, for females, ALDH2*2/*2 genotype was a protective factor for cerebral infarction in the co-dominant model (age-, smoking-, and drinking-adjusted OR 0.450 95% CI 0.215-0.941, p = 0.034) and the recessive model (age-, smoking-, and drinking-adjusted OR 0.440, 95% CI 0.214-0.903, p = 0.025). Further, logistic regression analysis revealed that age, smoking, hypertension, hyperlipidemia, and hypercholesterolemia were significant risks for the presence of cerebral infarction. In conclusion, these findings support an association of ALDH2 gene polymorphisms with ischemic stroke in a Chinese Hakka population. In particular, homozygote ALDH2*2/*2 may be a risk factor for cerebral infarction in males, but contribute to reduced risk for cerebral infarction in females.

Decreased Serum Exosomal miR-152-3p Contributes to the Progression of Acute Ischemic Stroke.

The current study aims to investigate the expression and potential role of exosome-derived miR-152-3p in acute ischemic stroke (AIS) patients. Exosomes were isolated from AIS patients and healthy controls. The level of exosome miR-152-3p was examined using RT-PCR. Receiver operating characteristic (ROC) curves were used to assess exosome miR-152-3p as a biomarker, and the area under the curve (AUC) was reported. Our data showed that the expression of serum exosome miR-152-3p in patients with AIS was significantly lower than in healthy controls. In contrast to those with NIHSS score < 7, the level of exosome miR-152-3p was significantly reduced in AIS patients with NIHSS score ≥ 7, indicating that the decrease of exosome miR-152-3p level is significantly related to the severity of endothelial injury. Moreover, the lowest level of exosome miR-152-3p was found in large-artery atherosclerosis (LAA) patients compared to that in small-vessel occlusion (SAA), cardioembolism (CE) and stroke of undetermined etiology (SUE) group. In addition, exosome miR-152-3p level was significantly lower in acute phase than in chronic phase. ROC curve showed that the AUC of exosome miR-152-3p level was 0.935, which indicated that exosome miR-152-3p level could distinguish AIS patients from non-healthy controls. In summary, exosome miR-152-3p is a risk factor of cerebral infarction. Enhancing the expression of exosome miR-152-3p in the circulating system may be a promising strategy for the prevention and treatment of AIS.

Association between Serum Gamma-glutamyl transferase and Intracranial Arterial Calcification in Acute Ischemic Stroke Subjects

Intracranial artery calcification (IAC) is an important risk factor for cerebral infarction and a key biomarker for intracranial artery stenosis. Gamma-glutamyl transferase (GGT) has been independently associated with increased cardiovascular events and coronary calcification. Our study assessed whether GGT is an independent factor for IAC in acute ischemic stroke (AIS) patients. This cross-sectional study involved a total of 754 patients with AIS (mean age: 65 ± 13.2 years). All the patients had received brain computed tomography angiography (CTA) examination to evaluate IAC. Further, serum GGT levels and other biochemical parameters were analyzed. The average GGT level in patients who died was also significantly increased (37.0 ± 26.8 vs 29.0 ± 21.5 U/L, p = 0.012). Partial correlation analysis showed that serum GGT levels were associated with NIHSS score at admission after adjustment for age and gender was considered (r = 0.150, p = 0.001). Logistic regression analysis showed that serum GGT levels independently predicted all-cause mortality (OR = 1.036, 95% CI: 1.014–1.060, p = 0.002), NIHSS scores (β = 0.051, 95% CI: 0.020–0.082, p = 0.001) and IAC scores (β = 0.006, 95% CI: 0.003–0.014, p = 0.005) in male patients. Each SD (standard deviation) increase of serum GGT levels was also associated with risk of all-cause mortality (OR = 2.272, 95% CI: 1.364–3.787, P = 0.002). GGT levels in patients with severe IAC were significantly elevated (37.6 ± 33.6 vs 28.6 ± 19.2, p < 0.001). However, serum GGT levels could not independently predict the severity of IAC in AIS patients. Our study identified that serum GGT levels were significantly elevated in patients who died, and the GGT levels had a certain association with the risk of death and IAC in male patients.

Interaction between Urinary 11 Dehydrothromboxane B2 and Some Other Risk Factors in the Occurrence of Cerebral Infarction

Objective:The objective of this study is to analyze the interaction between the urinary 11-dehydrothromboxane B2 (11-DH-TXB2) content and the smoking, drinking, hypertension or diabetes history of patients with cerebral infarction, and to determine the value of 11-DH-TXB2 in the occurrence and prevention of cerebral infarction.Methods:117 patients with cerebral infarction and 50 healthy controls were selected. Their general information, including smoking, drinking, hypertension and diabetes history, was analyzed, and their urinary11-DH-TXB2 contents were measured. The difference in the urinary 11-DH-TXB2 content between the two groups, and the additive model of the interaction between the urinary 11-DH-TXB2 content and other risk factors of cerebrovascular diseases were statistically analyzed.Results:There was no significant difference in the general information between the two groups (P&gt; 0.05). Significant differences were observed in the urinary 11-DH-TXB2 content, and the smoking, diabetes and hypertension history between the two groups, while there was no significant difference in the drinking history between the two groups. The analysis of the interaction additive model showed that the OR value was 1, the synergy index (S) of increased 11-DH-TXB2 and smoking history was 1.219, the S of increased 11-DHTXB2 and hypertension history was 5.578 and that of increased 11-DH-TXB2 and the diabetes history was 4.604.Conclusion:There is a correlation between the urinary 11-DH-TXB2 content and the occurrence of cerebral infarction, and there is a synergistic interaction between the urinary DH-TXB2 content and the smoking, hypertension or diabetes history of patients with cerebral infarction. The increased 11-DH-TXB2 may be a risk factor for cerebral infarction and the urinary 11-DHTXB2 content can be used as an index to predict the occurrence and progression of cerebral infarction.

Study on the relationship between post-circulatory lesions and cerebral infarction in children with ischemic moyamoya disease

Objective To explore the relationship between post-circulatory lesions and cerebral infarction in children with ischemic moyamoya disease (MMD). Methods A total of 44 children with ischemic MMD who were admitted to Department of Neurosurgery, Tianjin Medical University General Hospital from January 2010 to December 2018 were retrospectively enrolled into this study. All of them were divided into cerebral infarction group (15 cases) and non-cerebral infarction group (29 cases) according to whether they had cerebral infarction or not. Three cases were treated with encephalo-myosynangiosis (EMS), 5 cases with superficial temporal artery-middle cerebral artery anastomosis bypass (STA-MCA bypass) and 36 cases with EMS+ STA-MCA. All children were followed up by outpatient visits or telephone and were asked about the improvement of clinical symptoms and whether there were any cerebral infarction events. The outcome was assessed by the modified Rankin scale score (mRS). The clinical efficacy was compared between the 2 groups of children. The clinical factors affecting the children with cerebral infarction were further analyzed by single factor and multiple factor logistic regression. Results All 44 patients underwent successful operation. Postoperative complications occurred in 12 cases (27.3%, 12/44). There was no statistically significant difference in the incidence of complications between 2 groups [40.0% (6/15) vs. 28.7% (6/29), P=0.615]. The follow-up duration of 44 cases was 7.2±1.5 months (6-12 months). During the follow-up period, none of the children had cerebral infarction. Among the 44 cases, 35 (79.5%) had good outcomes and 9 (20.5%) had poor outcomes. There was no statistically significant difference in the favorable prognosis rate between the 2 groups [66.7% (10/15) vs. 86.3% (25/29), P=0.130]. Single factor analysis showed that MCA stenosis, PCA (posterior cerebral artery) stenosis and transient ischemic attack before operation were the influencing factors of cerebral infarction in children (all P < 0.05). Further multiple factor analysis showed that PCA stenosis was an independent risk factor for cerebral infarction in children (OR=5.465, 95% CI: 1.224-24.400, P=0.026). Conclusion In children with ischemic MMD, PCA stenosis is an independent risk factors for cerebral infarction, and whether there is cerebral infarction has no significant effect on the prognosis of those children. Key words: Moyamoya disease; Child; Factor analysis, statistical; Post-circulatory lesions; Cerebral infarction

Risk Factors for Cerebral Infarction in Duchenne Muscular Dystrophy: Review With our 2 Cases

Background: Although the incidence of cerebral infarction is higher in Duchenne muscular dystrophy (.75 per 100) than in the general population (7.5-11.4 per 100 000), only 18 cases have been reported, and prevention and management guidelines for infarction in this disorder remain lacking. Patients and Methods: We encountered 2 cases of Duchenne muscular dystrophy with cerebral infarction. To clarify risk factors for such infarction in Duchenne muscular dystrophy, we reviewed 20 cases, including our 2 patients. Results: Age at onset of infarction ranged from 4 to 31 years (n = 19). Most patients were 16-21 years old (14 of 19; 73.7%). Eighteen patients (90%) had dilated cardiomyopathy (DCM), showing a higher frequency than in the age-matched general Duchenne muscular dystrophy population. Left ventricular ejection fraction (LVEF) ranged from 10.2% to 42% (median, 20%; n = 9). Detectable cardiac thrombus and atrial fibrillation were rare (2 of 17; 11.8%, and 1 of 17; 5.9%, respectively). Conclusions: Presence of DCM with low LVEF seems to be the strongest risk factor for cerebral infarction in Duchenne muscular dystrophy.

Relevant factors of type 2 diabetic patients with cerebral infarction

Objective To investigate the relevant factors of type 2 diabetes mellitus(T2DM) with cerebral infarction(CI). Methods A total of 323 patients with T2DM from February 2012 to March 2017 in Inner Mongolia medical university affiliated hospital were included in this study. 150 patients with T2DM and CI were considered as experiment group, 173 cases of T2DM without CI were considered as control group. The clinical data of two groups were analyzed. Results The history of diabetes, smoking and hypertension were longer in experiment group than in control group (P<0.05). The patients in experiment group had higher fasting blood glucose(FBG), glycosylated hemoglobin(HbA1c), total triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, homocysteine(Hcy), fibrinogen(FIB), retinol binding protein 4(RBP4) and lower HDL-C, apolipoprotein A1(ApoA1) than the patients in control group(P<0.05). Multiple-factor logistic regression analysis showed that long-term smoking, long history of hypertension, high TG, high LDL-C, high non-HDL-C, high Hcy, high RBP4, low HDL-C and low ApoA1 were risk factors for CI in patients with T2DM (P<0.05). After adjusting common variables (diabetes history, hypertension history, smoking history, HbA1c, TG, TC), multiple-factor logistic regression analysis showed that LDL-C, non-HDL-C, Hcy, RBP4 were risk factors for CI in T2DM (P<0.05). HDL-C and ApoA1 were protective factors for CI in T2DM (P<0.05). Conclusion The risk factors for CI in patients with T2DM include long-term smoking, long hypertension history, high HbA1c, high TG, high LDL-C, high non-HDL-C, high Hcy, high RBP4, low HDL-C and low ApoA1. Patients should be advised to quit smoking, control blood glucose and blood pressure, and regulate blood lipid levels. Key words: Type 2 diabetes mellitus; Cerebral infarction; Relevant factors

Trousseau syndrome with multiple acute cerebral infarction as initial presentation: a clinical analysis of 12 cases

Clinical data of 12 cases of Trousseau syndrome with cerebral infarction as initial presentation admitted in the neurology department of the Fourth Affiliated Hospital of Hebei Medical University from December 2011 to December 2017 were retrospectively analyzed. Of the 12 patients, 4 cases had risk factors for cerebral infarction and 8 ones had no risk factors. There were 2 patients with 1 lesion and 10 patients with two or more lesions in brain imaging. The infarction lesions of 9 patients were located in 2 or more arterial blood supply areas. Ten patients showed an elevated plasma D-dimer level, 5 had elevated fibrinogen level, 7 showed increased blood platelet count and 8 had increased homocysteine level. Ten cases were confirmed by pathology, 2 cases by clinic and imaging diagnosis. The study suggests that multiple lesions with several cerebral arteries involved, high plasma D-dimer and fibrinogen levels may be the clinical characteristics of Trousseau syndrome with initial presentation as acute ischemic stroke and lacking of risk factors. The hypercoagulation state may be the important pathogenesis of this disorder. Key words: Neoplasms; Cerebral infarction; Signs and symptoms

Homocysteine might increase the risk of recurrence in patients presenting with primary cerebral infarction

Purpose: Although hyperhomocysteinemia (Hhcy) is a risk factor for cerebral infarction, its effect on recurrent cerebral infarction is less-defined. We aimed to investigate the association of Hhcy and increased risk of recurrent cerebral infarct.Materials and methods: From 2011 to 2013, we recruited 231 primary cerebral infarct patients that were divided to a Hhcy group (n = 105) and a control group (n = 126) according to plasma homocysteinemia (Hcy) levels exceeding 15 μmol/L. In this prospective study, risk factors such as gender, age, blood lipid and glucose levels, history of diabetes, high blood pressure, smoking habits and plasma Hhcy levels were determined. A three-year follow-up compared differences in cerebral infarction recurrence rates. Statistical analyses identified whether plasma Hhcy levels were an independent risk factor for recurrent cerebral infarction.Results: Triglyceride and low-density lipoprotein (LDL) levels in the Hhcy group were significantly higher than controls, and cerebral infarct recurrence rates in the Hhcy group exceeded control subject rates through the three-year follow-up (p = .021, p = .036 and p = .025). Cox proportional hazards modeling showed that elevated Hhcy levels (hazard ratio [HR] = 3.062, p < .001), increased age (HR = 1.069, p < .01), circulating triglyceride levels (HR = 1.686, p = .048), and relative National Institutes of Health Stroke (NIHSS) score (HR = 1.068, p = .016) were risk factors for recurrent cerebral infarction.Conclusions: Level of Hhcy was a risk factor for recurrent cerebral infarction. Further, particular demographic and clinical outcomes including age, relative NIHSS scores, and circulating triglyceride levels were markedly associated with the occurrence of cerebral infarction.

Influencing factors of cerebral infarction in elderly patients with hypertensive intracerebral hemorrhage after hematoma clearance

Objective To investigate the influencing factors of cerebral infarction in elderly patients with hypertensive intracerebral hemorrhage after hematoma clearance. Methods A total of 197 elderly patients with hypertensive intracerebral hemorrhage were selected and treated with craniotomy hematoma removal and decompression of bone flap. Cerebral infarction was checked by craniocerebral CT after operation.Univariate and multivariate Logistic regression analysis was used to identify the independent risk factors for cerebral infarction. Results The incidence of cerebral infarction after hematoma clearance in hypertensive intracerebral hemorrhage was 26.90%(53/197). There was no significant difference in the incidence of cerebral infarction after hematoma clearance in hypertensive intracerebral hemorrhage on gender and age (P>0.05), while the differences were statistically significant in diabetes(χ2=7.986), hypertension history(χ2=10.399), hematoma volume(χ2=10.396), edema(χ2=12.436), systolic blood pressure(χ2=12.128), diastolic blood pressure(χ2=13.040) and GCS score(χ2=3.940) (all P 35 ml(β=2.361, OR=3.890, 95%CI=1.792-5.132), area of brain edema (> 65 cm3) (β=2.471, OR=4.321, 95%CI=1.879-5.487), systolic pressure (> 150 mm Hg, 1 mmHg=0.133 kPa) (β=2.073, OR=3.172, 95%CI=1.428-4.768), diastolic pressure (> 90 mm Hg) (β=1.715, OR=2.498, 95%CI=1.276-3.451)and GCS score < 8(β=2.592, OR=4.871, 95%CI=1.974-5.798)were independent risk factors for cerebral infarction after hematoma clearance in hypertensive intracerebral hemorrhage. Conclusion Elderly patients with cerebral infarction after hematoma clearance in hypertensive intracerebral hemorrhage is affected by diabetes mellitus, hypertension, hematoma volume, edema, systolic blood pressure, diastolic blood pressure and other factors. Early intervention on these factors may effectively reduce the incidence of cerebral infarction. Key words: Hypertensive cerebral hemorrhage; Hematoma; Cerebral infarction; The elderly; Influencing factors

New Silent Cerebral Infarction in Patients with Acute Non-Cerebral Amyloid Angiopathy Intracerebral Hemorrhage as a Predictor of Recurrent Cerebrovascular Events.

BackgroundThe aim of this study was to investigate the incidence and related risk factors of new silent cerebral infarction in patients with acute non-cerebral amyloid angiopathy (non-CAA) intracerebral hemorrhage (ICH) and to explore clinical cerebrovascular event recurrence within 1 year.Material/MethodsThis prospective study observed 152 patients with non-CAA ICH diagnosed by computed tomography within 3 days after onset. All patients underwent magnetic resonance imaging on day 14 to identify silent cerebral infarction, and their subsequent clinical cerebrovascular events were followed up regularly within 1 year.ResultsOf the 152 patients, 46 (30.26%) had silent cerebral infarctions. Multiple logistic regression analysis revealed that the white blood cell (WBC) count, cerebral microbleeds (CMBs), and leukoaraiosis were silent cerebral infarction risk factors. At 1-year follow-up, 34 (22.37%) had clinical cerebrovascular events, with 8 (23.53%) having vascular-related deaths. Multiple logistic regression analysis showed that silent cerebral infarction was the only independent predictor of future clinical cerebrovascular events.ConclusionsSilent cerebral infarction is common during acute non-CAA ICH and is independently related to WBC counts, CMBs, and leukoaraiosis. The risk of clinical cerebrovascular events in non-CAA ICH patients with silent cerebral infarction increases in the following year; thus, silent cerebral infarction may be a useful predictor of recurrent cerebrovascular events.

Cerebral Infarction After Lobectomy for Lung Cancer

Background and objective: The left upper lobectomy as treatment for lung cancer has been identified as a risk factor for cerebral infarction. We analyzed cases of surgery for lung cancer to clarify factors that increase the risk for postoperative cerebral infarction. Methods: This study included patients with primary lung cancer who underwent lobectomy or segmentectomy with >ND1 lymph node dissection from 2008 to 2014 at Hachioji Medical Center of Tokyo Medical University. In total, 479 patients (294 males and 157 females) were examined. Cases of cerebral infarction occurring within 30 days of surgery were retrospectively studied. All surgeries were performed under mini-thoracotomy with thoracoscopy support. Vessels >7 mm in diameter were amputated using a linear stapler. Results: Cerebral infarction occurred in four male patients, representing 0.8% (4/479) of all lung cancers and 1.4% (4/294) of all male patients. Of these four patients, three were in their 60s (1.4% of 157 patients in their 60s) and one was in his 70s (0.5% of 215 patients in their 70s). Two cases involved adenocarcinomas, and two involved squamous cell carcinomas. One patient underwent right upper lobectomy, two underwent right lower lobectomy, and one underwent left upper lobectomy. The cerebral infarctions occurred in a branch of the vertebral artery. The pons was impaired in three cases, and the cerebellum was impaired in one. Three patients had pl2 disease, and one patient had pl3 disease. Operative time was 4–5 h in two cases, 5–6 h in one, and >6 h in one. Only pl factor significantly differed between patients with and without postoperative cerebral infarction. Conclusions: To prevent cerebral infarction, the following factors should be considered: preoperative smoking cessation, operative positioning to protect the vertebral artery, shortening of operative time, and stronger anticoagulant therapy for high-risk patients, such as those with past history of transient ischemic attack.

Predictors of cerebral infarction in patients with ruptured anterior communicating artery aneurysms

Objective To investigate the incidence and predictors of cerebral infarction in patients with ruptured ACoA aneurysms, and to provide diagnostic and therapeutic information. Methods A total of 319 patients with ruptured ACoA aneurysms in our hospital from January 2009 to February 2015 were reviewed in this study. The author collected data regarding clinical characteristics, and measured the aneurysm morphologies on CTA images. Age, flow angle, vessel angle were analyzed by independent-samples t tests in patients with or without cerebral infarction. Mann-Whitney U tests were used for aneurysm size, aneurysm height, perpendicular height, neck size, size ratio, aspect ratio, aneurysm angle, World Federation of Neurosurgical Societies (WFNS) grade at admission and Fisher grade. Chi-square tests and Fisher's exact tests were used for sex, histories of hypertension, smoking and stroke, treatment modalities, anterior cerebral A1 segment configuration and angiographic vasospasm on CTA images. The multivariate logistic regression analyses were used to determine the independent risk factors of cerebral infarction using the stepwise regression method. Results Of the 319 patients, there were 253 without and 66 patients with cerebral infarction. Differences of age (53±11 vs 57±12,respectively;t=-2.415, P=0.016) , Fisher grade [Ⅰ 23(9.1%), Ⅱ 27(10.7%), Ⅲ 74(29.2%), Ⅳ 129(51.0%) vs Ⅰ 1(1.5%), Ⅱ 7(10.6%), Ⅲ 13(19.7%), Ⅳ 45(68.2%), respectively;Z=-2.541, P=0.035] and treatment modalities[endovascular coil embolization 155(61.3%), neurosurgical clipping 98(38.7%) vs endovascular coil embolization 23(34.8%), neurosurgical clipping 43(65.2%), respectively; χ2=14.810, P<0.001] reached statistical significance. Multivariate analysis showed that Fisher grade Ⅳ (OR=10.36, 95% CI 1.34-80.29, P=0.025) and neurosurgical clipping (OR=3.28, 95% CI 1.84-5.86, P<0.001)still had statistical significance. Conclusions Cerebral infarction in patients with ruptured ACoA aneurysms may be associated with Fisher grade and treatment modalities. Although there is difference between the two groups in age, it is not a predictor of the occurrence of cerebral infarction. Key words: Aneurysm; Subarachnoid hemorrhage; Cerebral infarction; Tomography, X-ray computed

Biomarkers of gastric cancer-related ischemic stroke and its underlying pathogenesis.

This study aimed to investigate the biomarkers and underlying pathogenesis of ischemic stroke in patients with gastric cancer (GC).Patients with active gastric cancer who had experienced acute ischemic stroke without conventional vascular risk factors (gastric cancer-related stroke [GCS] group) and visited The First Affiliated Hospital of Guangxi Medical University and First Affiliated Hospital of Sun Yat-sen University from January 2003 to December 2016 were retrospectively enrolled. The patients’ clinical features and laboratory findings were compared with those of age-, sex-, and disease progression-matched patients with GC without ischemic stroke (GC group) who had been admitted to the same hospital during the same period (GCS:GC ratio = 1:2).Among the 9166 patients diagnosed with GC, 70 had experienced a cerebral infarction and were enrolled in this study. Among them, 53 (75.71%) harbored multiple lesions in multiple vascular territories. Notably, patients in the GCS group exhibited significant increases in the D-dimer and cancer antigen 125 (CA125) levels and platelet-to-neutrophil ratio (PNR), compared to their counterparts in the GC group. A multiple logistic regression analysis identified all 3 factors as independent risk factors for cerebral infarction in patients with GC (D-dimer, odds ratio [OR] = 1.006 per 1 ng/mL increase, 95% confidence interval [CI], 1.004–1.009, P = .000; CA125, OR = 1.016 per 1 U/mL increase, 95% CI, 1.005–1.027, P = .005; PNR, OR = 1.025 per 1 point increase, 95% CI: 1.003–1.048, P = .023).Elevated plasma D-dimer and CA125 levels and an increased PNR might affect the occurrence of GC-related ischemic stroke and could therefore serve as potential biomarkers.

Prospective Study on the Incidence of Cerebrovascular Disease After Coronary Angiography.

Aim: Previous studies have reported a 10.2%–22% rate of silent cerebral infarction and a 0.1% –1% rate of symptomatic cerebral infarction after coronary angiography (CAG). However, the risk factors of cerebral infarction after CAG have not been fully elucidated. For this reason, we investigated the incidence and risk factors of CVD complications within 48 h after CAG using magnetic resonance imaging (MRI) (Diffusion-weighted MRI) at Kagoshima University Hospital.Methods: From September 2013 to April 2015, we examined the incidence and risk factors, including procedural data and patients characteristics, of cerebrovascular disease after CAG in consecutive 61 patients who underwent CAG and MRI in our hospital.Results: Silent cerebral infarction after CAG was observed in 6 cases (9.8%), and they should not show any neurological symptoms of cerebral infarction. Only prior coronary artery bypass grafting (CABG) was more frequently found in the stroke group (n = 6) than that in the non-stroke group (n = 55); however, no significant difference was observed (P = 0.07). After adjusting for confounders, prior CABG was a significant independent risk factor for the incidence of stroke after CAG (odds ratio: 11.7, 95% confidence interval: 1.14–129.8, P = 0.04).Conclusions: We suggested that the incidence of cerebral infarction after CAG was not related to the catheterization procedure per se but may be caused by atherosclerosis with CABG.

Elevated hemoglobin is associated with cerebral infarction in Tibetan patients with primary hemorrhagic neurovascular diseases

ObjectivesAlthough many studies have focused on primary hemorrhagic neurovascular diseases (PHNVDs) in different races, studies of PHNVDs in the plateau area of China are still insufficient. Chinese Tibetan people are the largest population living in the plateau area. Previous studies have shown that Tibetan PHNVD patients have a significantly higher incidence of cerebral infarction, but the mechanism remains uncertain. This study aimed to develop a better understanding on the mechanism of their high risk of cerebral infarction. Patients and methodsIn this retrospective case control study, we used a hospital information system to search for consecutive Tibetan patients with PHNVDs from January 2012 to June 2016. Intra-hospital data including baseline information and complications were recorded, and the risk factors for cerebral infarction were analyzed. ResultsUnivariate analysis and cox proportional hazard multivariate regression analysis revealed that elevated hemoglobin (HGB) concentration was positively associated with an increased incidence of cerebral infarction (P<0.001). The cutoff value that maximized the ability to predict in-hospital infarction in Tibetans with PHNVDs was 15.2g/dL. Tibetan PHNVD patients with an increased HGB concentration were more likely to present with cerebral infarction within the first 5days after onset of PHNVDs, and the probability was highest on the 3rd day. ConclusionsHGB levels could be used to predict in-hospital cerebral infarction in Tibetan patients with PHNVDs. These patients are more likely to develop in-hospital infarction when the HGB concentration is higher than 15.2g/dL. For Tibetan PHNVD patients with an elevated HGB concentration, most cerebral infarctions occurred within the first five days after onset, with more incidents occurring on the third day.