Potential Protective Effect of Dl-3-n-Butylphthalide on Chronic Cerebral Ischemia Brain Injury

: Chronic cerebral ischemia is one of the common ischemic cerebrovascular diseases. Chronic cerebral ischemia can lead to brain dysfunction, and its pathophysiological mechanism involves inflammation, blood-brain barrier destruction, oxidative stress, and other factors. Due to it being difficult to detect, it is easily overlooked, and it is often only observed following onset of cognitive dysfunction. At present, there are few drugs for this treatment. DL-3-N-BUTYLPHTHALIDE (NBP), a compound extracted from celery seed, may play an important role in protecting against brain damage caused by chronic cerebral ischemia. Therefore, we pay more attention to the prevention and treatment of NBP on chronic cerebral ischemia.

Whole-Brain Volume CT Angiography can Effectively Detect Early Ischemic Cerebrovascular Diseases

Objective: To investigate the role of whole-brain volume computed tomography (CT) perfusion in assessing early ischemic cerebrovascular diseases. Materials and Methods: Seventy-two patients with early ischemic cerebrovascular diseases who had undergone routine CT scan and 320-row volume CT whole-brain perfusion imaging within 8 h after admission were retrospectively enrolled in this one-center case-sectional study. The perfusion parameters of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and dynamic CT angiogram (4D-CTA) were obtained and analyzed. Results: Among 72 patients, 29 cases with 37 cerebral ischemic lesions were found in plain CT scan, whereas 51 cases with 76 lesions were found in whole-brain CT perfusion, with 30.6% more patients being detected. The CBF value was significantly lower in the abnormal than normal corresponding perfusion area in the healthy hemisphere (P<0.05), while the MTT and TTP values were significantly higher in the abnormal than the normal corresponding area (P<0.05). 4D-CTA image suggested that 59 cases had different degrees of stenosis or occlusion, including 11 mild, 18 moderate, 21 severe, and 9 occlusive cases. Four-D-CTA imaging could detect significantly (P<0.05) more patients with abnormal perfusion in severe cerebral vascular stenosis or occlusion than those with no, mild or moderate stenosis (93.33% vs. 16.67%) (P<0.05). The stenosis of intracranial and carotid arteries was positively correlated with MTT and TTP values (P<0.05). Conclusion: Whole-brain volume CT angiography can comprehensively display early cerebral ischemic lesions, cerebral blood perfusion status, and cerebral vascular stenosis, providing valuable information for early detection of ischemic cerebral diseases and appropriate treatment planning.

Abstract 1122‐000146: A Survey of Current Status and Roles of Interventional Neurologists in Japan

Introduction : In Japan, there are more board‐certified neurosurgeons than board‐certified neurologists, and a significant part of stroke practice is provided by neurosurgeons. In neuroendovascular therapy practice, the trend of neurosurgeons to be in majority is more pronounced. The most of neuroendovascular therapy specialists (n = 1,586) certified by the Japanese Society for Neuroendovascular Therapy (JSNET) consists of neurosurgeons, and the proportion of neurologists/internists is only 8% (n = 128) as of April 2021. The aim of this study is to investigate the current status and roles of interventional neurologists, the minority providing neuroendovascular therapy, in Japanese clinical setting. Methods : Between 16th and 28th February 2021, the Japan Society of Vascular and Interventional Neurology (JSVIN) conducted a survey for society‐member neurologists and internists using questionnaires on Google Forms. The questionnaires consisted of 11 items regarding years after graduation, facility location, department, work style (full‐time or concurrent interventionalist), diseases for which respondents were engaged, disease/procedure preferences which respondents would treat by themselves, respondents’ roles in their own neuroendovascular therapy team, and others. Results : Replies were obtained from 112 (67.1%) out of all JSVIN‐member neurologists and internists (n = 167). The respondents included 71 JSNET‐certified specialists and they consisted of 56.3% of all the JSNET‐certified neurologists/internists. The departments to where the respondents belonged were Neurology in 66%, Cerebrovascular medicine in 25%, Neuroendovascular therapy in 4%, and Neurosurgery in 3%. The median years after graduation was 15 years (interquartile range, 10 – 21 years) and the proportion of respondents who have graduated 10 years or less was 30%. Respondents’ facilities were distributed around 27 prefectures of all 47 Japanese prefectures and a significant proportion of those was located in urban area; 20% in Osaka and 13% in Tokyo. The number of full‐time interventionalist was only 1. Sixty‐three (56%) were concurrently engaged in general neurology practice, and 33 (30%) in stroke neurology practice. The proportions of diseases for which the respondents were engaged were ischemic cerebrovascular diseases (acute large vessel occlusion strokes, carotid stenoses, and others) in 100%, hemorrhagic cerebrovascular diseases (cerebral aneurysms, arteriovenous shunts, and others) in 44%, and other diseases (tumors, spinal vascular disorders, and others) in 28%. The proportions of disease/procedure preferences which respondents would treat by themselves were acute stroke thrombectomy in 90%, carotid/intracranial stenoses in 87%, ruptured cerebral aneurysms in 38%, unruptured cerebral aneurysms in 31%, cerebral arteriovenous shunts in 33%, brain tumors in 29%, spinal vascular disorders in 13%, and pediatric diseases in 3%. Respondents’ roles in their own neuroendovascular therapy team were diagnostic performances based on neurologist’s skills in 89%, comorbidity assessment and management based on internist’s skills in 88%, precise neurological evaluation in 77%, neurosonological evaluation in 75%, and establishments of in‐hospital workflow/multi‐disciplinary collaboration in 71%. Conclusions : Most of interventional neurologists in Japan were engaged in neuroendovascular therapy mainly for ischemic cerebrovascular diseases in parallel with general neurology and/or stroke neurology practices. Interventional neurologists’ skill set developed in neurology/internist trainings and practices might contribute to the quality improvement of neuroendovascular therapy in Japan.

Study on pharmacokinetics of nimodipine nano-controlled release agent modified by host-guest reaction of β-cyclodextrin in rats

Nimodipine (NIMO) has been identified as a second-generation dihydropyridine calcium channel antagonist. NIMO’s specificity for the cerebrovascular smooth muscle contributes to its broad usage in treating ischemic cerebrovascular diseases in the elderly. Therefore, enhancing NIMO’s therapeutic effect and reducing its adverse reactions caused by short-term repeated use have become a focus of research. As a result, a new controlled-release preparation of NIMO, the carboxymethyl chitosan/nimodipine-hydroxypropyl-β-cyclodextrin nanoparticle (Nano-NIMO), was constructed based on hydroxypropyl-β-cyclodextrin. The novel composite Nano-NIMO preparation could significantly improve the stability of NIMO in rat plasma, achieving an absolute bioavailability as high as 62.3%, which is three times that of the traditional NIMO oral preparation. Therefore, Nano-NIMO is expected to provide a new direction for the preparation of modified controlled-release Nano- NIMO agents.

Research progress of imaging technologies for ischemic cerebrovascular diseases

Cerebrovascular diseases mainly affect the blood supply of the brain, which has a high demand for oxygen and glucose for the nerve tissues to perform its nerve functions. Ischemic cerebrovascular disease can not only cause stroke, but is also associated with a high incidence of asymptomatic infarction and minimal bleeding that can lead to cognitive and behavioral changes. These changes ultimately manifest as vascular dementia or cognitive impairment. In clinical settings, ischemic cerebrovascular disease can be classified as a transient ischemic attack, reversible ischemic neurological deficit, progressive stroke, complete stroke, marginal infarction, or lacunar infarction. In this review, the research progress of imaging technologies for ischemic cerebrovascular diseases was reviewed, with an aim to provide evidence for clinical practitioners.

Intraoperative BOLD-fMRI Cerebrovascular Reactivity Assessment

Blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) has gained attention in recent years as an effective way to investigate CVR, a measure of the hemodynamic state of the brain, with high spatial and temporal resolution. An association between impaired CVR and diverse pathologies has been observed, especially in ischemic cerebrovascular diseases and brain gliomas. The ability to obtain this information intraoperatively is novel and has not been widely tested. We report our first experience with this intraoperative technique in vascular and oncologic neurosurgical patients, discuss the results of its feasibility, and the possible developments of the intraoperative employment of BOLD-CVR.

Hemispheric lateralization of depression and attention deficit

Objective: There is a complex interaction among to the ischemic cerebrovascular diseases, cognition and depression. The aim of present study is to investigate the relationship between lesion side and depression and attention deficit in patients with Middle Cerebral Artery (MCA) infarction. Methods: This study was conducted on 41 patients with right and left MCA infarction. Beck Depression Inventory (BDI) was used for determination of depression severity of patients and Montreal Cognitive Assessment (MoCA) scoring was used for evaluation of cognitive status. Attention sub-test of MoCA score was also examined. Results: 20 patients had right MCS. The mean age of the patients was 72.21 years. 51.2% of the patients were male. BDI mean score was found to be 11.25 in patients with right MCA infarction and 16.9 in patients with left MCA infarction (p:0.04). The total MoCA scores between two groups were similar (right/left MCA infarction: 20.8/21.3). It was seen to be lower attention sub-score in patients with right hemisphere effects compared to patients with left hemispheric lesion (3.1/5.9; p:0.00). Conclusion: According to our findings, it is understood that attention of patients with right MCA infarction is more affected and patients with left MCA infarction is more depressed. In future studies, depression and attention affects which are at risk of developing after MCA infarctions should be evaluated in detail and should be put emphasis to rehabilitation of these areas.

Abstract TP316: Urban Crural Comparisons of Treatments and Outcomes for Ischemic Cerebrovascular Diseases

Background: Little is known about healthcare quality and patient outcomes of ischemic cerebrovascular diseases between urban and rural areas in China during the past decade. Methods: We used a two-stage random sampling method to create a nationally representative sample of patients in China hospitalized for ischemic stroke (IS)/ Transient ischemic attack (TIA) in 2005, 2010, and 2015. Firstly, we used simple random sampling to obtain a list of participating hospitals in 2 urban and 3 rural strata. Secondly, we obtained medical records at each hospital on clinical profiles, tests, treatments and outcomes using a systematic sampling approach. We weighted our findings to explore rural-urban disparities from 2005 to 2015. Results: A total of 30 827 patients were sampled from 189 hospitals with 14 418 (46.8%) from urban and 16 409 (53.2%) from rural. We observed a decreased disparity between urban and rural in eligible patients receiving antiplatelet and anticoagulant for atrial fibrillation (AF) (both P trend <0.0001), a diminished disparity of statins use by 2015 (70.9% in urban versus 69.9% in rural; P=0.1852) and an emerging disparity of antihypertensive treatment (P trend <0.0001). The disparities of composite score of tests (from 0.24 in urban vs 0.18 in rural to 0.30 in urban vs 0.33 in rural, P trend <0.0001) and in-hospital treatments (from 0.45 in urban vs 0.49 in rural to 0.70 in urban vs 0.69 in rural, P trend <0.0001) were all decreased from 2005 to 2015. In-hospital mortality have both decreased significantly in urban or rural areas, the adjusted risk of in-hospital mortality in urban was higher than rural in both 2005 (OR [95% CI]: 2.26 [1.12-4.55], p=0.0223) and 2015 (OR [95% CI]: 2.64 [1.30-5.36], p=0.0070), however, the trend of disparity was not significant (P for interaction =0.9527). Conclusion: Although urban-rural disparities in evidence-based treatments for IS/TIA patients have largely been eliminated, substantial gaps in quality of care persist in both settings.