Background For patients with stroke with large-vessel occlusion(LVO),study of factors predicting response to intravenous thrombolysis(IVT)would allow identifying subgroups with high expected gain,and those for whom it...Background For patients with stroke with large-vessel occlusion(LVO),study of factors predicting response to intravenous thrombolysis(IVT)would allow identifying subgroups with high expected gain,and those for whom it could be considered as futile,and even detrimental.From patients included in the Mechanical Thrombectomy After Intravenous Alteplase vs Alteplase Alone After Stroke trial,we investigated clinical-imaging factors associated with optimal response to IVT.Methods We included patients receiving IVT alone.Excellent outcome was defined by a 3-month modified Rankin Scale(mRS)score≤1.Clinical-imaging predictors were assessed on multivariate analysis after multiple imputations.The predictive performance of the model was assessed with the C-statistic.Results Among 247 patients with LVO treated with IVT alone,77(31%)showed 3-month mRS≤1.Predictors of 3-month mRS≤1 were no medical history of hypertension(OR 2.43;95%CI 1.74 to 3.38;p=0.007);no current smoking(OR 2.76;95%CI 1.79 to 4.26;p=0.02);onset-to IVT time(OR 0.47 per hour increase;95%CI 0.23 to 0.78;p=0.003);diffusion-weighted imaging(DWI)volume(OR 0.78 per 10 mL increase;95%CI 0.68 to 0.89;p=0.0004);presence of susceptibility vessel sign(SVS)(OR 7.89;95%CI 1.65 to 37.78;p=0.01)and SVS length(OR 0.87 per mm increase;95%CI 0.80 to 0.94;p=0.001).The prediction models showed a C-statistic=0.79(95%CI 0.79 to 0.80).Conclusions In patients with stroke with anterior-circulation LVO treated with IVT alone,predictors of excellent outcome at 3 months were no medical history of hypertension or current smoking,reduced onset-to IVT time,small DWI volume,presence of SVS and short SVS length.These predictive factors could help practitioners in decision-making for IVT implementation in reperfusion strategies,all the more for the drip and ship paradigm.Trial registration number NCT01062698.展开更多
The central nervous system is an immunologically active environment where several components of the immune and inflammatory response interact among them and with the constituents of nervous tissue and vasculature in a...The central nervous system is an immunologically active environment where several components of the immune and inflammatory response interact among them and with the constituents of nervous tissue and vasculature in a critically orchestrated manner,influencing physiologic and pathologic processes.In particular,inflammation takes a central role in the pathogenesis of intracranial aneurysms(IAs).The common pathway for aneurysm formation involves endothelial dysfunction and injury,a mounting inflammatory response,vascular smooth muscle cells(VSMCs)phenotypic modulation,extracellular matrix remodeling,and subsequent cell death and vessel wall degeneration.We conducted a literature review(1980-2014)by Medline and EMBASE databases using the searching terms“IA”and“cerebral aneurysm”and further search was performed to link the search terms with the following key words:inflammation,hemodynamic(s),remodeling,macrophages,neutrophils,lymphocytes,complement,VSMCs,mast cells,cytokines,and inflammatory biomarkers.The aim of this review was to summarize the most recent and pertinent evidences regarding the articulated processes of aneurysms formation,growth,and rupture.Knowledge of these processes may guide the diagnosis and treatment of these vascular malformations,the most common cause of subarachnoid hemorrhage,which prognosis remains dismal.展开更多
文摘Background For patients with stroke with large-vessel occlusion(LVO),study of factors predicting response to intravenous thrombolysis(IVT)would allow identifying subgroups with high expected gain,and those for whom it could be considered as futile,and even detrimental.From patients included in the Mechanical Thrombectomy After Intravenous Alteplase vs Alteplase Alone After Stroke trial,we investigated clinical-imaging factors associated with optimal response to IVT.Methods We included patients receiving IVT alone.Excellent outcome was defined by a 3-month modified Rankin Scale(mRS)score≤1.Clinical-imaging predictors were assessed on multivariate analysis after multiple imputations.The predictive performance of the model was assessed with the C-statistic.Results Among 247 patients with LVO treated with IVT alone,77(31%)showed 3-month mRS≤1.Predictors of 3-month mRS≤1 were no medical history of hypertension(OR 2.43;95%CI 1.74 to 3.38;p=0.007);no current smoking(OR 2.76;95%CI 1.79 to 4.26;p=0.02);onset-to IVT time(OR 0.47 per hour increase;95%CI 0.23 to 0.78;p=0.003);diffusion-weighted imaging(DWI)volume(OR 0.78 per 10 mL increase;95%CI 0.68 to 0.89;p=0.0004);presence of susceptibility vessel sign(SVS)(OR 7.89;95%CI 1.65 to 37.78;p=0.01)and SVS length(OR 0.87 per mm increase;95%CI 0.80 to 0.94;p=0.001).The prediction models showed a C-statistic=0.79(95%CI 0.79 to 0.80).Conclusions In patients with stroke with anterior-circulation LVO treated with IVT alone,predictors of excellent outcome at 3 months were no medical history of hypertension or current smoking,reduced onset-to IVT time,small DWI volume,presence of SVS and short SVS length.These predictive factors could help practitioners in decision-making for IVT implementation in reperfusion strategies,all the more for the drip and ship paradigm.Trial registration number NCT01062698.
文摘The central nervous system is an immunologically active environment where several components of the immune and inflammatory response interact among them and with the constituents of nervous tissue and vasculature in a critically orchestrated manner,influencing physiologic and pathologic processes.In particular,inflammation takes a central role in the pathogenesis of intracranial aneurysms(IAs).The common pathway for aneurysm formation involves endothelial dysfunction and injury,a mounting inflammatory response,vascular smooth muscle cells(VSMCs)phenotypic modulation,extracellular matrix remodeling,and subsequent cell death and vessel wall degeneration.We conducted a literature review(1980-2014)by Medline and EMBASE databases using the searching terms“IA”and“cerebral aneurysm”and further search was performed to link the search terms with the following key words:inflammation,hemodynamic(s),remodeling,macrophages,neutrophils,lymphocytes,complement,VSMCs,mast cells,cytokines,and inflammatory biomarkers.The aim of this review was to summarize the most recent and pertinent evidences regarding the articulated processes of aneurysms formation,growth,and rupture.Knowledge of these processes may guide the diagnosis and treatment of these vascular malformations,the most common cause of subarachnoid hemorrhage,which prognosis remains dismal.
