Cerebral Infarction Clinical Trial
Official title:
Study on the Relationship Between Asymmetric Vascular Sign of Cortex and Cerebral Edema and Prognosis of Massive Cerebral Infarction
Susceptibility weighted imaging (SWI) technology has developed in the decade which is being a
kind of cerebrovascular disease diagnostic tools in the clinical application, especially for
paramagnetic material (such as DNA hemoglobin and hemosiderin) has a high sensitivity.
The change of the signal on SWI bases on the change of local oxygenated hemoglobin content in
the blood and deaeration hemoglobin content ratio, which can be used to indirectly reflect
the hypoxia group oxygen intake fraction (OEF) and cerebral metabolic rate. When the
intracranial vascular occlusion, corresponding responsibility vascular blood flow area of
brain tissue will occur hypoperfusion, brain tissue will improve the compensation in
accordance with its own OEF, causing ischemia area inside the venous drainage of deaeration
hemoglobin content ratio increases and the hypointensity on SWI ,which display the asymmetric
cortical vessel sign (ACVS). Studies have suggested that ACVS is more prone to early
neurological deterioration and has a poor long-term outcome. After recanalization of ischemic
stroke, the presence of equal CVS(return to normal) on SWI is associated with a good clinical
outcome. In addition, the relationship between ACVS grade and collateral circulation in
patients with acute ischemic stroke has been studied. For patients with massive cerebral
infarction, the relationship between ACVS on SWI and the clinical prognosis of cerebral edema
and cerebral hemodynamics is not completely clear. In this study, the clinical data of
patients with massive cerebral infarction will be analyzed to explore the relationship
between ACVS, cerebral edema , cerebral hemodynamic and clinical prognosis.
Sodium aescinate is widely used in cerebral edema caused by cerebral hemorrhage or cerebral
infarction.The main mechanism of sodium aescinate is anti - inflammatory, anti - exudate,
anti - oxygen free radical, anti - edema, increase vein tension, improve blood circulation
and nerve protection. In this study, investigators will investigate whether the application
of sodium aescinate had an effect on ACVS on SWI in patients with massive cerebral
infarction. Plasma s100-β, procalcitonin, neutrophil count, serum fibronectin, and
endothelin-1 could predict cerebral edema in patients with cerebral infarction, this study
will analyze the relationship between these markers and ACVS on SWI in patients with massive
cerebral infarction.
Clinical data and plasma samples of patients diagnosed with massive cerebral infarction in
the department of neurology of the second hospital of hebei medical university during
2020.1-2021.6 are collected.Clinical data include gender, age, TOAST classification, history
of hypertension, diabetes and heart disease, head Computerized Tomography (CT), Magnetic
Resonance Imaging(MRI), Diffusion-Weighted Imaging (DWI),Susceptibility weighted imaging SWI
within 72 hours after onset, admission National Institute of Health stroke scale ( NIHSS)
score, admission DWI-aspect score, Modified Rankin Scale (MRS) score on day 90 of
onset.Venous blood will be taken within 72 hours of onset (and before the use of sodium
aescinate) to detect serum s100-β, serum procalcitonin, plasma fibronectin, serum
endothelin-1 by ELISA.The cortical vessel signs(CVSs)on SWI in the ischemic territory are
classified as 'prominent' if there are more veins and/or larger veins with a greater signal
loss than those in the opposite normal hemisphere, 'equal' if there are no significant
differences in appearance of veins in the both cerebral hemispheres, and 'less' if the veins
in the affected area are decreased compared to those in the normal cortex.
Patients with massive cerebral infarction to be included are randomly divided into
experimental group and control group by random number table method.The experimental group is
treated with sodium aescinate for injection on the basis of conventional treatment. The
control group is not treated with sodium aescinate for injection.
This study will explore the relationship between asymmetric cortical vessel sign(ACVS) grade
and baseline clinical data, serum factors associated with brain edema in patients with
massive cerebral infarction.In addition,after 10 days of sodium aescinate injection, the CVS
level of the experimental group will be compared with that of the control group.The
difference of CVS grading before and after injection of sodium aescinate in the experimental
group will be compared.Finally,the indexes with significance in single factor analysis will
be screened out, and the factors related to prognosis of massive cerebral infarction will be
further analyzed by multi-factor logistics regression.
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