Ischaemic stroke is a debilitating disease with immense personal,societal and economic impact.Thrombolysis with recombinant tissue plasminogen activator remains the only approved pharmacotherapy for this disease.As ea...Ischaemic stroke is a debilitating disease with immense personal,societal and economic impact.Thrombolysis with recombinant tissue plasminogen activator remains the only approved pharmacotherapy for this disease.As each year less than 1%of eligible patients receive this therapy worldwide,efficacious new therapeutics are desperately needed.Emerging evidence suggest endothelial progenitor cells(EPCs),capable of repairing damaged vasculature,as one such therapeutics.However,questions regarding their optimal dose,delivery route and in vivo survivability remain largely unanswered.Outgrowth endothelial cells,generated in large numbers by ex vivo expansion of EPCs,enable effective assessment of these issues and may eventually serve as off-the-shelf therapeutics.Correlations between circulating EPC levels and stroke outcome imply that EPCs may also serve as clinical biomarkers for stroke.This viewpoint briefly evaluates the current evidence,pinpoints the gaps in the literature and proposes new directions for research.展开更多
Ischaemic stroke is one of the commonest causes of morbidity and mortality worldwide and around a fifth of events can be attributed to a cardioembolic source. This is typically due to atrial fibrillation(AF), the most...Ischaemic stroke is one of the commonest causes of morbidity and mortality worldwide and around a fifth of events can be attributed to a cardioembolic source. This is typically due to atrial fibrillation(AF), the most common sustained cardiac arrhythmia. However, AF can, at times, be difficult to detect due to a relative lack of symptoms and the fact that it can be paroxysmal in nature. Studies have shown that diagnosis of AF improves as the length of cardiac monitoring increases. However, prolonged cardiac monitoring is not a costeffective way of diagnosing AF. Therefore, an alternative approach may be to empirically anticoagulate individuals who are at high risk of stroke. This article summarises current evidence surrounding stroke risk prediction, the use of anticoagulation in the secondary prevention of stroke and its use in the primary prevention of stroke in high risk groups with the aim of determining whether empirical anticoagulation is a safe and effective strategy.展开更多
Objective:To screen risk factors for epilepsy after acute ischaemic stroke based on meta-analysis and cohort study and to establish a predictive model.Methods:Computer searches of MEDLINE,Embase,Cochrane library,Web o...Objective:To screen risk factors for epilepsy after acute ischaemic stroke based on meta-analysis and cohort study and to establish a predictive model.Methods:Computer searches of MEDLINE,Embase,Cochrane library,Web of Scinence,PubMed,CNKI,and WanFang Data data were conducted to collect literature on epilepsy after in acute ischemic stroke,from database creation to September 1,2022.The RRs and their 95%confidence intervals(CI)for risk factors for post stroke epilepsy were extracted for each study,and pooled estimates of the RRs and 95%CIs for each study were generated using either a random-effects model or a fixed-effects model.Beta coefficients for each risk factor were calculated based on the combined RR and their corresponding 95%CIs.The beta coefficients were multiplied by 10 and rounded.Results:Ten articles were identified for final inclusion in this meta-analysis,with a total of 141948 cases and 3702 cases of post stroke epilepsy.The risk factors included in the final risk prediction model were infarct size(RR 4.67,95%CI 1.41~15.47;P=0.01),stroke recuRRence(RR 2.48,95%CI 2.01~3.05;P<0.00001),stroke etiology(RR 1.70,95%CI 1.34~2.15;P<0.00001),stroke severity(RR 1.70,95%CI 1.34~2.15;P<0.00001),and stroke risk.stroke severity(RR 1.53,95%CI 1.39~1.70;P<0.00001),NIHSS score(RR 2.91,95%CI 1.64~5.61;P=0.0003),early-onset epilepsy(RR 5.62,95%CI 5.08~6.22;P<0.00001),cortical lesions(RR 3.83.95%CI 2.23~6.58;P<0.00001),total anterior circulation infarction(RR 18.94,95%CI 10.38~34.57;P<0.00001),partial anterior circulation infarction(RR 4.39,95%CI 2.29~8.40;P<0.00001),cardiovascular events(RR 1.78,95%CI 1.59~1.99;P<0.00001).Conclusion:Based on a systematic review and meta-analysis,we developed a simple risk prediction model for late epilepsy in baseline ischemic stroke that integrates clinical risk factors,including infarct size,stroke recurrence,stroke etiology,stroke severity,NIHSS score,early onset epilepsy,cortical lesions,stroke subtype,and cardiovascular events.展开更多
<strong>Introduction:</strong> Ischemic strokes represent a classic complication of infective endocarditis (IE) and are most often related to the fragmentation of valvular vegetation. In most cases, they o...<strong>Introduction:</strong> Ischemic strokes represent a classic complication of infective endocarditis (IE) and are most often related to the fragmentation of valvular vegetation. In most cases, they occur in the Sylvian territory and are related to<em> Staphylococcus aureus</em>. MRI can demonstrate, in addition to the AVCI image, cerebral microbleeds (CMBs) that are very suggestive of the diagnosis. We present the case of a patient who presented an ischemic stroke occurring in the context of infective endocarditis.<strong> Observation:</strong> A 32-year-old woman with no previous medical history initially presented with acute febrile headache, two weeks later she developed right hemiplegia with aphasia in the context of fever. Her general examination revealed lesions on the soles of her feet, in the form of nodules, infected in places, suggestive of Janeway nodules (characteristic of IE). The brain MRI showed an ischemic stroke in the Sylvian territory, with the presence of multiple microbleeds on the magnetic susceptibility sequences. The biological examination showed a severe inflammatory syndrome;the transthoracic echocardiography (TTE) confirmed the presence of vegetation on the aortic valve;and the blood cultures showed a <em>Staphylococcus aureus</em>. Antibiotic therapy was started, and the patient was transferred to the cardiology department. <strong>Discussion: </strong>Our observation has a double interest. The first is clinical due to the presence of plantar nodules (Janeway’s nodules) that are characteristic of IE which should orientate the diagnosis before the installation of the stroke, and the second is radiological and linked to the discovery of microbleeds. Their presence is increasingly reported in the literature, but their pathophysiology is not yet very clear. <strong>Conclusion:</strong> Stroke is the most frequent extracardiac complication during IE. The presence of microbleeds contributes to early diagnosis, especially in asymptomatic forms.展开更多
Background The benefit-risk profile of tenecteplase in the elderly patients with acute ischaemic stroke(AIS)is uncertain.We sought to investigate the efficacy and safety of 0.25 mg/kg tenecteplase compared with altepl...Background The benefit-risk profile of tenecteplase in the elderly patients with acute ischaemic stroke(AIS)is uncertain.We sought to investigate the efficacy and safety of 0.25 mg/kg tenecteplase compared with alteplase for AIS patients aged≥80 years.Methods We performed a post hoc analysis of the Tenecteplase Reperfusion Therapy in Acute Ischaemic Cerebrovascular Events-2 Trial,a randomised,phase 3,non-inferiority clinical trial.Disabling AIS patients aged≥80 years who initiated intravenous thrombolytics within 4.5 hours of symptom onset were enrolled from June 2021 to May 2022 across 53 centres in China and were randomly allocated to receive 0.25 mg/kg tenecteplase or 0.9 mg/kg alteplase.The primary efficacy outcome was the proportion of participants with a modified Rankin Scale(mRS)score of 0-1 at 90 days.Symptomatic intracranial haemorrhage(sICH)within 36 hours was the safety outcome.Results Of 137 participants,mRS 0-1 at 90 days occurred in 37(49.3%)of 75 in the tenecteplase group vs 20(33.9%)of 59 in the alteplase group(risk ratio(RR)1.47,95%CI 0.96 to 2.23).sICH within 36 hours was observed in 3(4.0%)of 76 in the tenecteplase group and two(3.3%)of 61 in the alteplase group(RR 1.30,95%CI 0.20 to 8.41).Conclusions The risk-benefit profile of tenecteplase thrombolysis was preserved in the elderly patients,which lends further support to intravenous 0.25 mg/kg tenecteplase as an alternative to alteplase in these patients.展开更多
Background Statins are essential for secondary prevention after ischaemic stroke(IS).However,statin intensity recommendations differ,and there is a concern about intracerebral haemorrhage(ICH).We studied the long-term...Background Statins are essential for secondary prevention after ischaemic stroke(IS).However,statin intensity recommendations differ,and there is a concern about intracerebral haemorrhage(ICH).We studied the long-term impacts of initial statin intensity following IS.Methods Consecutive patients using high-intensity,moderate-intensity or low-intensity statin early after IS(n=45512)were retrospectively studied using national registries in Finland.Differences were adjusted using multivariable regression.The primary outcome was all-cause death within 12-year follow-up(median 5.9 years).Secondary outcomes were recurrent IS,cardiovascular death and ICH studied using competing risk analyses.Results High-intensity therapy was initially used by 16.0%,moderate-intensity by 73.8%and low-intensity by 10.2%.Risk of death was lower with high-intensity versus moderate-intensity(adjusted HR(adj.HR)0.92;95%CI 0.87 to 0.97;number needed to treat(NNT)32.0),with moderate-intensity versus low-intensity(adj.HR 0.91;95%CI 0.87 to 0.95;NNT 27.5)and with high-intensity versus low-intensity(adj.HR 0.83;95%CI 0.78 to 0.89;NNT 14.6)statin.There was a dose-dependent association of initial statin intensity with a lower probability of recurrent IS(p<0.0001)and cardiovascular death(p<0.0001).The occurrence of ICH was not associated with initial statin intensity(p=0.646).Conclusions Following IS,more intense initial statin treatment is associated with improved long-term outcomes but not with the risk of ICH.These findings emphasise the importance of high statin intensity shortly after IS.展开更多
Background Previous studies have shown contradictory results between early application of antiplatelet therapy and intravenous thrombolysis(IVT)for mild acute ischaemic stroke(AIS),with National Institutes of Health S...Background Previous studies have shown contradictory results between early application of antiplatelet therapy and intravenous thrombolysis(IVT)for mild acute ischaemic stroke(AIS),with National Institutes of Health Stroke Scale score 0-5.Objective To compare the benefits and risks of antiplatelet therapy and IVT in patients with mild AIS.Methods A systematic search of MEDLINE,Embase and Cochrane Library was conducted from database inception until July 2023,without language restriction.Randomised clinical trials(RCTs)or observational studies were selected.The primary outcomes were 90-day functional outcomes,measured by the modified Rankin Scale(mRS)score.The protocol has been registered before data collection.Results Two RCTs and four observational studies with relatively low risk of bias that enrolled 3975 patients were analysed(2454 in antiplatelet therapy and 1521 in IVT therapy).There were no significant differences between antiplatelet therapy and IVT in 90-day functional outcomes(mRS 0-1,OR 1.08(95%CI 0.73 to 1.58);mRS 0-2,OR,1.04(95%CI 0.63 to 1.73)),death(OR,0.64(95%CI 0.19 to 2.13))and stroke recurrence(OR,0.71(95%CI 0.28 to 1.79)).Antiplatelet therapy was associated with a reduced risk of symptomatic intracranial haemorrhage(sICH)compared with IVT(OR,0.20(95%CI 0.06 to 0.69)).Conclusions Among patients with mild AIS,compared with IVT,early application of antiplatelet therapy was not significantly associated with improved functional outcomes,reduced death or stroke recurrence,but was significantly associated with a reduced risk of sICH.展开更多
Background Stroke is a major cause of global mortality and disability.Currently,the treatment of acute ischaemic stroke through reperfusion has posed several challenges,raising the need for complementary options to pr...Background Stroke is a major cause of global mortality and disability.Currently,the treatment of acute ischaemic stroke through reperfusion has posed several challenges,raising the need for complementary options to protect the ischaemic penumbra.Recent investigations have indicated that certain epigenetic factors,specifically,histone deacetylases(HDACs)and sirtuins,can be promising for ischaemic stroke therapy,with recent studies suggesting that inhibitors of HDACs or sirtuins may provide neuronal protection after ischaemic stroke.However,the impact of specific HDAC/sirtuin isoforms on the survival of neuronal cells following stroke is still uncertain.This study aims to provide a comprehensive overview of the function of HDACs and their modulators in the treatment of acute ischaemic stroke.Methods This systematic review and meta-analysis will encompass animal intervention studies that explore the efficacy of modulation of HDACs and sirtuins in the acute phase of ischaemic stroke.The review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Electronic searches will be conducted in PubMed,Web of Science and Scopus,with subsequent screening by independent reviewers based on the established eligibility criteria.Methodological quality will be evaluated using the SYRCLE risk of bias tool.The primary outcomes will be infarct volume and functional response,with the secondary outcomes established a priori.Data pertaining to infarct volume will be used for random-effects meta-analysis.Additionally,a descriptive summary will be conducted for the functional response and secondary outcomes.Discussion No systematic review and meta-analysis on the treatment of ischaemic stroke through HDAC modulation has been conducted to date.A comprehensive analysis of the available literature on the relevant preclinical investigations can yield invaluable insights in discerning the most effective trials and in further standardisation of preclinical studies.展开更多
Background GD-11,a novel brain cytoprotective drug,was designed to be actively taken up and transported across the blood-brain barrier via the glucose transporter.This study aimed to evaluate the safety and efficacy o...Background GD-11,a novel brain cytoprotective drug,was designed to be actively taken up and transported across the blood-brain barrier via the glucose transporter.This study aimed to evaluate the safety and efficacy of GD-11 for improving the recovery of patients with acute ischaemic stroke(AIS).Methods A double-blind,randomised,placebo-controlled,phase 2 trial was conducted at 15 clinical sites in China.Patients aged 18-80 years with AIS within 48 hours were randomly assigned(1:1:1)to receive 160 mg GD-11,80 mg GD-11 and placebo,two times a day for 10 days.The primary endpoint was a modified Rankin Scale(mRS)score of 0-1 at 90 days after treatment.The safety outcome was any adverse events within 90 days.Results From 17 November 2022 to 22 March 2023,a total of 80 patients in the 160 mg GD-11 group,79 patients in the 80 mg GD-11 group and 80 patients in the placebo group were included.The proportion of an mRS score of 0-1 at day 90 was 77.5%in the 160 mg GD-11 group,72.2%in the 80 mg GD-11 group and 67.5%in the placebo group.Though no significant difference was found(p=0.3671),a numerically higher proportion was observed in the GD-11 group,especially in the 160 mg GD-11 group.The incidence of adverse events was similar across the three groups(p=0.1992).Conclusion GD-11 was safe and well-tolerated.A dosage of GD-11160 mg two times a day was recommended for a large trial to investigate the efficacy.展开更多
Background Both genetic and lifestyle factors contribute to myocardial infarction(MI)and stroke,including ischaemic stroke(IS)and intracerebral haemorrhage(ICH).We explored how and the extent to which a healthy lifest...Background Both genetic and lifestyle factors contribute to myocardial infarction(MI)and stroke,including ischaemic stroke(IS)and intracerebral haemorrhage(ICH).We explored how and the extent to which a healthy lifestyle,by considering a comprehensive list,could counteract the genetic risk of those diseases,respectively.Methods 315044 participants free of stroke and MI at baseline were identified from the UK Biobank.Genetic risk scores(GRS)for those diseases were constructed separately and categorised as low,intermediate and high by tertile.Lifestyle risk scores(LRS)were constructed separately using smoking,alcohol intake,physical activity,dietary patterns and sleep patterns.Similarly,participants were categorised into low,intermediate and high LRS.The data were analysed using Cox proportional hazard models.Results Over a median follow-up of 12.8 years,4642,1046 and 9485 participants developed IS,ICH and MI,respectively.Compared with participants with low levels of GRS and LRS,the HRs of those with high levels of GRS and LRS were 3.45(95%CI 2.71 to 4.41),2.32(95%CI 1.40 to 3.85)and 4.89(95%CI 4.16 to 5.75)for IS,ICH and MI,respectively.Moreover,among participants with high GRS,the standardised 14-year rates of IS events were 4.40%(95%CI 3.45%to 5.36%)among those with high LRS.In contrast,it is only 1.78%(95%CI 1.63%to 1.94%)among those with low LRS.Similarly for MI,the high LRS group had standardised rates of 8.60%(95%CI 7.38%to 9.81%),compared with 3.34%(95%CI 3.12%to 3.56%)in low LRS.Among the high genetic risk group of ICH,the rate is reduced by about half compared low LRS to high LRS,although the rate was low for both(0.36%(95%CI 0.31%to 0.42%)and 0.71%(95%CI 0.36%to 1.05%),respectively).Conclusion Healthy lifestyles were substantially associated with a reduction in the risk of IS,ICH and MI and attenuated the genetic risk of IS,ICH and MI by at least half,respectively.展开更多
background The occurrence of acute ischaemic stroke(AIS)while using oral anticoagulants(OAC)is an increasingly recognised problem among nonvalvular atrial fibrillation(NVAF)patients.We aimed to elucidate the potential...background The occurrence of acute ischaemic stroke(AIS)while using oral anticoagulants(OAC)is an increasingly recognised problem among nonvalvular atrial fibrillation(NVAF)patients.We aimed to elucidate the potential role of left atrial appendage closure(LAAC)for stroke prevention in patients with AIS despite OAC use(AIS-despite OAC).Methods We retrospectively collected baseline and follow-up data from consecutive NVAF patients who had AIS-despite OAC and subsequently underwent endovascular LAAC,between January 2015 and October 2021.The primary outcome measure was the occurrence of AIS after LAAC,and the safety outcome was symptomatic intracerebral haemorrhage(ICH).results 29 patients had LAAC specifically because of AIS-despite OAC.The mean age at the time of the procedure was 73.4±8.7,13 were female(44.82%).The mean CHA2DS2-VASc score was 5.96±1.32,with an expected AIS risk of 8.44 per 100 patient-years.14 patients(48%)had two or more past AIS-despite OAC.After LAAC,27 patients(93.10%)were discharged on OAC which was discontinued in 17(58.62%)after transoesophageal echocardiogram at 6 weeks.Over a mean of 1.75±1.0 years follow-up after LAAC,one patient had an AIS(incidence rate(IR)1.97 per 100 patient-years).One patient with severe cerebral microangiopathy had a small ICH while on direct OAC and antiplatelet 647 days after LAAC.Conclusions LAAC in AIS-despite OAC patients demonstrated a low annual AIS recurrence rate in our cohort(1.97%)compared with the expected IR based on their CHA2DS2-VASc scores(8.44%)and to recent large series of AIS-despite OAC patients treated with OAC/aspirin only(5.3%-8.9%).These hypothesis-generating findings support randomised trials of LAAC in AIS-despite OAC patients.展开更多
Background: Stroke patients form an integral part of patients admitted into the intensive care unit (ICU);and may need airway maintenance, supplemental oxygen and even endotracheal intubation for mechanical ventilatio...Background: Stroke patients form an integral part of patients admitted into the intensive care unit (ICU);and may need airway maintenance, supplemental oxygen and even endotracheal intubation for mechanical ventilation. Method: In this retrospective study, the medical records and radiological investigations of the patients were assessed. Also, their socio-demographics, and clinical diagnosis and background co-morbidities were noted. The radiological diagnosis post CT was used to determine the type of stroke for those compliant;while clinical assessment alone was used to determine the diagnosis in those who did not do CT. They were also classified into 2 groups: those requiring mechanical ventilation (for ICU care) and those without the need for mechanical ventilation (for high dependency Unit (HDU) care). The eventual clinical outcome was noted. Result: A total of eighty-eight cases, 67% (n = 59) were males and 33% (n = 29) females. 89.8% (n = 79) had hypertension, 3.4% (n = 3) had diabetes while 6.8% (n = 6) had both hypertension and diabetes. Of the hypertensives, 36.7% (n = 29) had hemorrhagic stroke and 66.3% (n = 50) had ischaemic stroke. 53.3% (n = 46) patients had High dependency Unit (HDU care while 47.7% (n = 42) were mechanically ventilated. Of the number in HDU, 51.5% (n = 17) were haemorrhagic, while 52.7% (n = 29) were ischaemic. Clinical diagnosis of ischemic stroke was done in 55 (62.5%) and hemorrhagic stroke in 37.5% (n = 33). Of the lot, only 19.3% (n = 17) of them did CT and 80.7% (n = 71) did not have CT done. None did MRI. Late presentation (beyond 24 hrs) was a common feature for most of the patients, for whom immediate cardio-respiratory support became necessary. Overall mortality rate was 62.5% (n = 55). 39.1% (n = 18) of the HDU (46) patients died, while 88.1% (n = 37) of the ventilated (42) patients died. 56.6% (n = 26) were discharged from the HDU and 4.3% (n = 2) referred to another facility. Of the 42 patients on mechanical ventilation 88.1% (37) died, 9.5% (n = 4) discharged, and 2.4% (n = 1) referred to another health facility. Summary: Low neuroimaging compliance by Stroke patients in our environment and late presentation to hospital, impacts negatively on good outcome of the disease. This, coupled with the high cost of these facilities, makes their use unaffordable, suggesting a strong indication for comprehensive quality and affordable health care and health insurance in the country.展开更多
The bifurcation regions of intracranial and extracranial arteries are common sites for atherosclerosis,predisposing to ischaemic stroke.1 Previous studies have shown that the unique haemodynamics at the bifurca-tion m...The bifurcation regions of intracranial and extracranial arteries are common sites for atherosclerosis,predisposing to ischaemic stroke.1 Previous studies have shown that the unique haemodynamics at the bifurca-tion may lead to alterations in genes and proteins in this region.2 Elastin is closely associated with the progression of athero-sclerosis.3 However,under physiological conditions,the expression and distribu-tion of elastin in bifurcation regions have not yet been elucidated.Mice are the most frequently used animal model for studying atherosclerosis.This study focuses on carotid bifurcation,optimising the iDISCO(immunolabeling-enabled three-dimensional imaging of solvent-cleared organs)technique for whole tissue clearing and staining of the carotid artery in mice.4 These techniques,along with fluorescence micro-optical sectioning tomography(FMOST)technology,have also been used in studies on ischaemic stroke and kidney diseases,4 highlighting their potential for broader applications due to their high precision and three-dimensional imaging capabilities.5 Using FMOST technology in vitro,we have made a detailed visualisation of a U-shaped expression pattern of elastin at bifurcation regions for the first time.Specifically,elastin expression is found to be lowest at the bifurcation itself compared with the regions adjacent to or proximal to the bifurcation(figures 1A,B).Further-more,we observed disorganised arrange-ment of elastic fibres within the bifurcation zone(figures 1C,D).These findings provide important evidence linking elastic fibres to the pathogenesis of atherosclerosis at bifurcations and suggest the potential for more precise local therapies for athero-sclerosis,which could significantly advance precision medicine and reduce the poten-tial side effects on normal tissues.展开更多
<p align="left"> <span style="font-family:Verdana;">Background: Capsular warning syndrome (CWS) is defined as a recurrent stereotype transient lacunar syndrome without cortical symptoms...<p align="left"> <span style="font-family:Verdana;">Background: Capsular warning syndrome (CWS) is defined as a recurrent stereotype transient lacunar syndrome without cortical symptoms. However, to date, there is limited literature proposed on the definitive treatment options for the prevention of persistent stroke in cases of capsular warning syndrome. Aim: The aim of this case report is to address dual antiplatelet therapy as a treatment choice in CWS to prevent progressive stroke. Case presentation: A 56-year-old man with several comorbidities experienced recurrent periods of limb weakness and dysarthria lasting 5 - 20 minutes with a complete resolution of symptoms in between. The fluctuating episodes lasted for 72 hours followed by a persistent minor stroke. A gadolinium-enhanced MRI scan of the brain revealed a right basal ganglia infarct. He was treated with dual antiplatelet, and his functional outcome was favourable at 90 days post stroke. Conclusion: Dual antiplatelet may be a beneficial therapeutic option in CWS in improving functional outcomes in the early neurological deficit and decreasing the clinical fluctuation.</span> </p>展开更多
Objectives Endovascular therapy(EVT)now penetrates the once obscure realm of large infarct core volume acute ischaemic stroke(LICV-AIS).This research aimed to investigate the potential correlation between different an...Objectives Endovascular therapy(EVT)now penetrates the once obscure realm of large infarct core volume acute ischaemic stroke(LICV-AIS).This research aimed to investigate the potential correlation between different anaesthetic approaches and post-EVT outcomes in LICV-AIS patients.Methods Between October 2020 and May 2022,the China ANGEL-Alberta Stroke Programme Early CT Score(ASPECT)trial studied patients with LICV-AIS,randomly assigning them to the best medical management(BMM)or BMM with EVT.This post hoc subgroup analysis categorised subjects receiving BMM with EVT into general anaesthesia(GA)and non-GA groups based on anaesthesia type.We applied multivariable logistic regression to evaluate the relationship between anaesthesia during EVT and patient functional outcomes,as measured by the modified Rankin scale(mRS),in addition to the occurrence of complications.Further adjustment for selection bias was achieved through propensity score matching(PSM).Results In total,230 patients with LICV-AIS were enrolled(GA 84 vs Non-GA 146).No significant difference was observed between the two groups in terms of the proportion of patients who achieved an mRS score of 0-2 at 90 days(27.4%for the GA group vs 31.5%for the non-GA group,p=0.51).However,the GA group had significantly longer median surgical times(142 min vs 122 min,p=0.03).Furthermore,GA was associated with an increased risk of postoperative pneumonia(adjusted OR 2.03,95%CI 1.04 to 3.98).The results of PSM analysis agreed with the results of the multivariate regression analysis.No significant difference in intracranial haemorrhage incidence or mortality rate was observed between the groups.Conclusion This post hoc analysis of subgroups of the ANGEL-ASPECT trial suggested that there may be no significant association between the choice of anaesthesia and neurological outcomes in LICV-AIS patients.However,compared with non-GA,GA prolongs the duration of EVT and is associated with a greater postoperative pneumonia risk.展开更多
Background Approximately 20%of all transient ischaemic attacks(TIAs)and ischaemic strokes occur within the posterior circulation,with vertebrobasilar stenosis identified as the cause in roughly 25%of the cases.Studies...Background Approximately 20%of all transient ischaemic attacks(TIAs)and ischaemic strokes occur within the posterior circulation,with vertebrobasilar stenosis identified as the cause in roughly 25%of the cases.Studies have shown that about a quarter of these patients have atherosclerotic stenosis of at least 50%of the vertebrobasilar artery.Stenosis has been shown to be associated with an increased risk of 90-day recurrent vertebrobasilar stroke,particularly in the first few weeks,which is significantly higher when compared with patients with stenosis of the anterior circulation.Therefore,aggressive treatment is important for the patient’s prognosis.Stenting is emerging as a promising therapeutic strategy for persistent ischaemia events that do not respond to the best medical treatment,but it is not without complications.We systematically reviewed the literature on percutaneous transluminal angioplasty and stenting(PTAS)for intracranial vertebrobasilar artery stenosis(IVBS).Methods PubMed,Web-of Science and Scopus were searched upon the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to include prospective/retrospective cohort,randomised/non-randomised clinical trials and case series studies describing PTAS for IVBS.Pooled rates of intervention-related complications and outcomes were analysed with random-effect model meta-analysis using StataMP V.18.0 software.Results 31 studies were found eligible which included 1928 cases.1103 basilar artery stenosis cases were reported in 27 studies 0.65(95%CI 0.53,0.76),I2:99.72%.648 vertebral cases were reported in 18 studies 0.60(95%CI 0.49,0.70),I2:97.49%.In four studies,the rate of vertebrobasilar stenosis cases calculated as a proportion of the total sample size was 0.10(95%CI 0.05,0.15).Mean stenosis in 21 included studies was found to be 0.83(95%CI 0.79,0.88),I2:0.00%,which shows variation of baseline stenosis between studies was minimal.51 deaths were recorded in 24 studies.Meta-analysis of mortality showed the overall rate of mortality was 0.03(95%CI 0.02,0.05),I2:44.90%.In 14 studies,symptomatic intracranial haemorrhage events were recorded at an overall rate of 0.01(95%CI 0.00,0.02),I2:0.00%.Generally,a follow-up period of at least 3 months was reported in the included studies.Furthermore,procedural stroke/TIA was evaluated in seven studies,four of which reported no events(0.03(95%CI 0.00,0.08),I2:20.38%).Mean time from initial symptoms to recanalisation was 23.98(95%CI 18.56,29.40),I2=98.8%,p=0.00 days.Conclusion In certain individuals with medically unresolved,severe,symptomatic and non-acute IVBS,elective vertebrobasilar PTAS appears to be both safe and effective.Various stent designs and angioplasty-assisted techniques should be taken into consideration based on the specific clinical and radiological traits of the lesions.Future randomised controlled trials are required to verify these results.展开更多
Background The incidence of vascular cognitive impairment(VCI)is high in patients suffering from ischaemic stroke or transient ischaemic attack(TIA)or with vascular risk factors.Effective prevention strategies for VCI...Background The incidence of vascular cognitive impairment(VCI)is high in patients suffering from ischaemic stroke or transient ischaemic attack(TIA)or with vascular risk factors.Effective prevention strategies for VCI remain limited.Anaemia or low haemoglobin was found as an independent risk factor for adverse outcomes after acute stroke.Anaemia or low haemoglobin was possibly associated with an increased risk of poststroke cognitive impairment.Whether supplement of ferrous iron to correct anaemia reduces the risk of VCI and improves adverse outcomes in patients with ischaemic cerebrovascular disease remains uncertain.Aim We aim to introduce the design and rationale of the safety and efficacy of Ferrous iron on the prevention of Vascular cOgnitive impaiRment in patients with cerebral Infarction or TIA(FAVORITE)trial.Design FAVORITE is a randomised,placebo-controlled,double-blind,multicentre trial that compares supplement of ferrous iron with placebo for recent minor stroke/TIA patients complicated with mild anaemia or iron deficiency:Ferrous succinate sustained-release tablet 0.2 g(corresponding to 70 mg of elemental iron)once daily after or during breakfast for 12 weeks or placebo with much the same colour,smell and size as ferrous iron once daily during or after breakfast for 12 weeks.All paticipants will be followed within the next year.Study outcomes The primary effective outcome is the incidence of VCI at 3 months after randomisation and the primary safety outcome includes any gastrointestinal adverse event during 3 months.Discussion The FAVORITE trial will clarify whether supplement of ferrous iron to correct low haemoglobin reduces the risk of VCI in patients with recent ischaemic stroke or TIA complicated with mild anaemia or iron deficiency compared with placebo.展开更多
Background Despite considerable improvements in the care of patients with cardiovascular disease in various populations over the last few decades, there are still limited data about long-term treatment patterns among ...Background Despite considerable improvements in the care of patients with cardiovascular disease in various populations over the last few decades, there are still limited data about long-term treatment patterns among patients with various atherosclerotic vascular conditions in China, especially the use of statin therapy. Methods Between June 2007 and October 2009, 16 860 patients aged 50-80 years with established history of atherosclerotic vascular disease （coronary heart disease （CHD）, atherosclerotic cerebrovascular disease （CVD）, or peripheral arterial disease （PAD）） from 51 hospitals in 14 cities of China were screened for a large randomized trial. Detailed information about current use of statins and various other treatments was recorded and analyzed by prior disease history, adjusting for various baseline characteristics. Results Among the 16 860 patients, the mean age was 63 years and 74% were male. Overall, 78% of the patients had documented CHD, 40% had CVD, 5% had PAD and 21% reported more than one condition. The median time from initial diagnosis of vascular disease to screening was 18 months. At screening, the proportions who took various treatments were 83% for antiplatelet agents, 49% for beta-blockers, 47% for statins and 28% for angiotensin-converting enzyme inhibitors. The proportion treated with statin was much higher in CHD than in CVD or PAD patients （61% vs. 10% vs. 22% respectively） and decreased significantly with time from initial diagnosis. Simvastatin （mainly 20 mg） and atorvastatin （mainly 10 mg） each accounted for about 40% of total statin use. Conclusions In urban China, there is still significant underuse of various proven secondary preventive therapies, with particularly low use of statins in patients with ischaemic stroke.展开更多
基金This work was supported by a grant to Dr.Ulvi Bayraktutan from the Dunhill Medical Trust(R459/0216)The funder had no role in study design,data collection and analysis,decision to publish or preparation of the manuscript.The contents are solely the responsibility of the author and do not necessarily represent the official views of the DMT.
文摘Ischaemic stroke is a debilitating disease with immense personal,societal and economic impact.Thrombolysis with recombinant tissue plasminogen activator remains the only approved pharmacotherapy for this disease.As each year less than 1%of eligible patients receive this therapy worldwide,efficacious new therapeutics are desperately needed.Emerging evidence suggest endothelial progenitor cells(EPCs),capable of repairing damaged vasculature,as one such therapeutics.However,questions regarding their optimal dose,delivery route and in vivo survivability remain largely unanswered.Outgrowth endothelial cells,generated in large numbers by ex vivo expansion of EPCs,enable effective assessment of these issues and may eventually serve as off-the-shelf therapeutics.Correlations between circulating EPC levels and stroke outcome imply that EPCs may also serve as clinical biomarkers for stroke.This viewpoint briefly evaluates the current evidence,pinpoints the gaps in the literature and proposes new directions for research.
文摘Ischaemic stroke is one of the commonest causes of morbidity and mortality worldwide and around a fifth of events can be attributed to a cardioembolic source. This is typically due to atrial fibrillation(AF), the most common sustained cardiac arrhythmia. However, AF can, at times, be difficult to detect due to a relative lack of symptoms and the fact that it can be paroxysmal in nature. Studies have shown that diagnosis of AF improves as the length of cardiac monitoring increases. However, prolonged cardiac monitoring is not a costeffective way of diagnosing AF. Therefore, an alternative approach may be to empirically anticoagulate individuals who are at high risk of stroke. This article summarises current evidence surrounding stroke risk prediction, the use of anticoagulation in the secondary prevention of stroke and its use in the primary prevention of stroke in high risk groups with the aim of determining whether empirical anticoagulation is a safe and effective strategy.
基金This study was supported by Hainan Provincial Key Research and Development Plan(ZDYF2021SHFZ092,ZDYF2022SHFZ109),Hainan Provincial Natural Science Foundation(822RC832)Hainan Provincial Clinical Medical Center(2021)Epilepsy Research Innovation Team of Hainan Medical College(2022)。
文摘Objective:To screen risk factors for epilepsy after acute ischaemic stroke based on meta-analysis and cohort study and to establish a predictive model.Methods:Computer searches of MEDLINE,Embase,Cochrane library,Web of Scinence,PubMed,CNKI,and WanFang Data data were conducted to collect literature on epilepsy after in acute ischemic stroke,from database creation to September 1,2022.The RRs and their 95%confidence intervals(CI)for risk factors for post stroke epilepsy were extracted for each study,and pooled estimates of the RRs and 95%CIs for each study were generated using either a random-effects model or a fixed-effects model.Beta coefficients for each risk factor were calculated based on the combined RR and their corresponding 95%CIs.The beta coefficients were multiplied by 10 and rounded.Results:Ten articles were identified for final inclusion in this meta-analysis,with a total of 141948 cases and 3702 cases of post stroke epilepsy.The risk factors included in the final risk prediction model were infarct size(RR 4.67,95%CI 1.41~15.47;P=0.01),stroke recuRRence(RR 2.48,95%CI 2.01~3.05;P<0.00001),stroke etiology(RR 1.70,95%CI 1.34~2.15;P<0.00001),stroke severity(RR 1.70,95%CI 1.34~2.15;P<0.00001),and stroke risk.stroke severity(RR 1.53,95%CI 1.39~1.70;P<0.00001),NIHSS score(RR 2.91,95%CI 1.64~5.61;P=0.0003),early-onset epilepsy(RR 5.62,95%CI 5.08~6.22;P<0.00001),cortical lesions(RR 3.83.95%CI 2.23~6.58;P<0.00001),total anterior circulation infarction(RR 18.94,95%CI 10.38~34.57;P<0.00001),partial anterior circulation infarction(RR 4.39,95%CI 2.29~8.40;P<0.00001),cardiovascular events(RR 1.78,95%CI 1.59~1.99;P<0.00001).Conclusion:Based on a systematic review and meta-analysis,we developed a simple risk prediction model for late epilepsy in baseline ischemic stroke that integrates clinical risk factors,including infarct size,stroke recurrence,stroke etiology,stroke severity,NIHSS score,early onset epilepsy,cortical lesions,stroke subtype,and cardiovascular events.
文摘<strong>Introduction:</strong> Ischemic strokes represent a classic complication of infective endocarditis (IE) and are most often related to the fragmentation of valvular vegetation. In most cases, they occur in the Sylvian territory and are related to<em> Staphylococcus aureus</em>. MRI can demonstrate, in addition to the AVCI image, cerebral microbleeds (CMBs) that are very suggestive of the diagnosis. We present the case of a patient who presented an ischemic stroke occurring in the context of infective endocarditis.<strong> Observation:</strong> A 32-year-old woman with no previous medical history initially presented with acute febrile headache, two weeks later she developed right hemiplegia with aphasia in the context of fever. Her general examination revealed lesions on the soles of her feet, in the form of nodules, infected in places, suggestive of Janeway nodules (characteristic of IE). The brain MRI showed an ischemic stroke in the Sylvian territory, with the presence of multiple microbleeds on the magnetic susceptibility sequences. The biological examination showed a severe inflammatory syndrome;the transthoracic echocardiography (TTE) confirmed the presence of vegetation on the aortic valve;and the blood cultures showed a <em>Staphylococcus aureus</em>. Antibiotic therapy was started, and the patient was transferred to the cardiology department. <strong>Discussion: </strong>Our observation has a double interest. The first is clinical due to the presence of plantar nodules (Janeway’s nodules) that are characteristic of IE which should orientate the diagnosis before the installation of the stroke, and the second is radiological and linked to the discovery of microbleeds. Their presence is increasingly reported in the literature, but their pathophysiology is not yet very clear. <strong>Conclusion:</strong> Stroke is the most frequent extracardiac complication during IE. The presence of microbleeds contributes to early diagnosis, especially in asymptomatic forms.
基金funded by Beijing Municipal Science&Technology Committee(Z211100003521019)China Shijiazhuang Pharmaceutical Company Recomgen Pharmaceutical(Guangzhou)Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2019-I2M 5-029)National Natural Science Foundation(82111530203,82171272).
文摘Background The benefit-risk profile of tenecteplase in the elderly patients with acute ischaemic stroke(AIS)is uncertain.We sought to investigate the efficacy and safety of 0.25 mg/kg tenecteplase compared with alteplase for AIS patients aged≥80 years.Methods We performed a post hoc analysis of the Tenecteplase Reperfusion Therapy in Acute Ischaemic Cerebrovascular Events-2 Trial,a randomised,phase 3,non-inferiority clinical trial.Disabling AIS patients aged≥80 years who initiated intravenous thrombolytics within 4.5 hours of symptom onset were enrolled from June 2021 to May 2022 across 53 centres in China and were randomly allocated to receive 0.25 mg/kg tenecteplase or 0.9 mg/kg alteplase.The primary efficacy outcome was the proportion of participants with a modified Rankin Scale(mRS)score of 0-1 at 90 days.Symptomatic intracranial haemorrhage(sICH)within 36 hours was the safety outcome.Results Of 137 participants,mRS 0-1 at 90 days occurred in 37(49.3%)of 75 in the tenecteplase group vs 20(33.9%)of 59 in the alteplase group(risk ratio(RR)1.47,95%CI 0.96 to 2.23).sICH within 36 hours was observed in 3(4.0%)of 76 in the tenecteplase group and two(3.3%)of 61 in the alteplase group(RR 1.30,95%CI 0.20 to 8.41).Conclusions The risk-benefit profile of tenecteplase thrombolysis was preserved in the elderly patients,which lends further support to intravenous 0.25 mg/kg tenecteplase as an alternative to alteplase in these patients.
基金supported by grant funding from the Finnish Foundation for Cardiovascular Research sr,and the Finnish State research funding.
文摘Background Statins are essential for secondary prevention after ischaemic stroke(IS).However,statin intensity recommendations differ,and there is a concern about intracerebral haemorrhage(ICH).We studied the long-term impacts of initial statin intensity following IS.Methods Consecutive patients using high-intensity,moderate-intensity or low-intensity statin early after IS(n=45512)were retrospectively studied using national registries in Finland.Differences were adjusted using multivariable regression.The primary outcome was all-cause death within 12-year follow-up(median 5.9 years).Secondary outcomes were recurrent IS,cardiovascular death and ICH studied using competing risk analyses.Results High-intensity therapy was initially used by 16.0%,moderate-intensity by 73.8%and low-intensity by 10.2%.Risk of death was lower with high-intensity versus moderate-intensity(adjusted HR(adj.HR)0.92;95%CI 0.87 to 0.97;number needed to treat(NNT)32.0),with moderate-intensity versus low-intensity(adj.HR 0.91;95%CI 0.87 to 0.95;NNT 27.5)and with high-intensity versus low-intensity(adj.HR 0.83;95%CI 0.78 to 0.89;NNT 14.6)statin.There was a dose-dependent association of initial statin intensity with a lower probability of recurrent IS(p<0.0001)and cardiovascular death(p<0.0001).The occurrence of ICH was not associated with initial statin intensity(p=0.646).Conclusions Following IS,more intense initial statin treatment is associated with improved long-term outcomes but not with the risk of ICH.These findings emphasise the importance of high statin intensity shortly after IS.
基金funded by the National Key R&D Program of China(2022YFC3501100).
文摘Background Previous studies have shown contradictory results between early application of antiplatelet therapy and intravenous thrombolysis(IVT)for mild acute ischaemic stroke(AIS),with National Institutes of Health Stroke Scale score 0-5.Objective To compare the benefits and risks of antiplatelet therapy and IVT in patients with mild AIS.Methods A systematic search of MEDLINE,Embase and Cochrane Library was conducted from database inception until July 2023,without language restriction.Randomised clinical trials(RCTs)or observational studies were selected.The primary outcomes were 90-day functional outcomes,measured by the modified Rankin Scale(mRS)score.The protocol has been registered before data collection.Results Two RCTs and four observational studies with relatively low risk of bias that enrolled 3975 patients were analysed(2454 in antiplatelet therapy and 1521 in IVT therapy).There were no significant differences between antiplatelet therapy and IVT in 90-day functional outcomes(mRS 0-1,OR 1.08(95%CI 0.73 to 1.58);mRS 0-2,OR,1.04(95%CI 0.63 to 1.73)),death(OR,0.64(95%CI 0.19 to 2.13))and stroke recurrence(OR,0.71(95%CI 0.28 to 1.79)).Antiplatelet therapy was associated with a reduced risk of symptomatic intracranial haemorrhage(sICH)compared with IVT(OR,0.20(95%CI 0.06 to 0.69)).Conclusions Among patients with mild AIS,compared with IVT,early application of antiplatelet therapy was not significantly associated with improved functional outcomes,reduced death or stroke recurrence,but was significantly associated with a reduced risk of sICH.
文摘Background Stroke is a major cause of global mortality and disability.Currently,the treatment of acute ischaemic stroke through reperfusion has posed several challenges,raising the need for complementary options to protect the ischaemic penumbra.Recent investigations have indicated that certain epigenetic factors,specifically,histone deacetylases(HDACs)and sirtuins,can be promising for ischaemic stroke therapy,with recent studies suggesting that inhibitors of HDACs or sirtuins may provide neuronal protection after ischaemic stroke.However,the impact of specific HDAC/sirtuin isoforms on the survival of neuronal cells following stroke is still uncertain.This study aims to provide a comprehensive overview of the function of HDACs and their modulators in the treatment of acute ischaemic stroke.Methods This systematic review and meta-analysis will encompass animal intervention studies that explore the efficacy of modulation of HDACs and sirtuins in the acute phase of ischaemic stroke.The review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Electronic searches will be conducted in PubMed,Web of Science and Scopus,with subsequent screening by independent reviewers based on the established eligibility criteria.Methodological quality will be evaluated using the SYRCLE risk of bias tool.The primary outcomes will be infarct volume and functional response,with the secondary outcomes established a priori.Data pertaining to infarct volume will be used for random-effects meta-analysis.Additionally,a descriptive summary will be conducted for the functional response and secondary outcomes.Discussion No systematic review and meta-analysis on the treatment of ischaemic stroke through HDAC modulation has been conducted to date.A comprehensive analysis of the available literature on the relevant preclinical investigations can yield invaluable insights in discerning the most effective trials and in further standardisation of preclinical studies.
基金supported by Beijing Municipal Science&Technology Commission(Z221100007422050)Capital's Funds for Health Improvement and Research(2020-1-2041,2022-2G 2049).
文摘Background GD-11,a novel brain cytoprotective drug,was designed to be actively taken up and transported across the blood-brain barrier via the glucose transporter.This study aimed to evaluate the safety and efficacy of GD-11 for improving the recovery of patients with acute ischaemic stroke(AIS).Methods A double-blind,randomised,placebo-controlled,phase 2 trial was conducted at 15 clinical sites in China.Patients aged 18-80 years with AIS within 48 hours were randomly assigned(1:1:1)to receive 160 mg GD-11,80 mg GD-11 and placebo,two times a day for 10 days.The primary endpoint was a modified Rankin Scale(mRS)score of 0-1 at 90 days after treatment.The safety outcome was any adverse events within 90 days.Results From 17 November 2022 to 22 March 2023,a total of 80 patients in the 160 mg GD-11 group,79 patients in the 80 mg GD-11 group and 80 patients in the placebo group were included.The proportion of an mRS score of 0-1 at day 90 was 77.5%in the 160 mg GD-11 group,72.2%in the 80 mg GD-11 group and 67.5%in the placebo group.Though no significant difference was found(p=0.3671),a numerically higher proportion was observed in the GD-11 group,especially in the 160 mg GD-11 group.The incidence of adverse events was similar across the three groups(p=0.1992).Conclusion GD-11 was safe and well-tolerated.A dosage of GD-11160 mg two times a day was recommended for a large trial to investigate the efficacy.
基金supported by the National Key Research and Development programme of China(grant number:2021YFC2500100)Science and Technology Innovation 2030 Major Projects(grant number:2022ZD0211600)+4 种基金Shanghai Rising-Star Programme(grant number:22QA1404000)Shanghai Municipal Science and Technology Major Project(grant number:2017SHZDZX01)Natural Science Foundation of Shanghai,China(grant number:22ZR1405300)Key Research and Development Plans of Jiangsu Province,China(grant number:BE2021696)Shanghai New Three-year Action Plan for Public Health(Grant No.GWVI-11.1-23)。
文摘Background Both genetic and lifestyle factors contribute to myocardial infarction(MI)and stroke,including ischaemic stroke(IS)and intracerebral haemorrhage(ICH).We explored how and the extent to which a healthy lifestyle,by considering a comprehensive list,could counteract the genetic risk of those diseases,respectively.Methods 315044 participants free of stroke and MI at baseline were identified from the UK Biobank.Genetic risk scores(GRS)for those diseases were constructed separately and categorised as low,intermediate and high by tertile.Lifestyle risk scores(LRS)were constructed separately using smoking,alcohol intake,physical activity,dietary patterns and sleep patterns.Similarly,participants were categorised into low,intermediate and high LRS.The data were analysed using Cox proportional hazard models.Results Over a median follow-up of 12.8 years,4642,1046 and 9485 participants developed IS,ICH and MI,respectively.Compared with participants with low levels of GRS and LRS,the HRs of those with high levels of GRS and LRS were 3.45(95%CI 2.71 to 4.41),2.32(95%CI 1.40 to 3.85)and 4.89(95%CI 4.16 to 5.75)for IS,ICH and MI,respectively.Moreover,among participants with high GRS,the standardised 14-year rates of IS events were 4.40%(95%CI 3.45%to 5.36%)among those with high LRS.In contrast,it is only 1.78%(95%CI 1.63%to 1.94%)among those with low LRS.Similarly for MI,the high LRS group had standardised rates of 8.60%(95%CI 7.38%to 9.81%),compared with 3.34%(95%CI 3.12%to 3.56%)in low LRS.Among the high genetic risk group of ICH,the rate is reduced by about half compared low LRS to high LRS,although the rate was low for both(0.36%(95%CI 0.31%to 0.42%)and 0.71%(95%CI 0.36%to 1.05%),respectively).Conclusion Healthy lifestyles were substantially associated with a reduction in the risk of IS,ICH and MI and attenuated the genetic risk of IS,ICH and MI by at least half,respectively.
文摘background The occurrence of acute ischaemic stroke(AIS)while using oral anticoagulants(OAC)is an increasingly recognised problem among nonvalvular atrial fibrillation(NVAF)patients.We aimed to elucidate the potential role of left atrial appendage closure(LAAC)for stroke prevention in patients with AIS despite OAC use(AIS-despite OAC).Methods We retrospectively collected baseline and follow-up data from consecutive NVAF patients who had AIS-despite OAC and subsequently underwent endovascular LAAC,between January 2015 and October 2021.The primary outcome measure was the occurrence of AIS after LAAC,and the safety outcome was symptomatic intracerebral haemorrhage(ICH).results 29 patients had LAAC specifically because of AIS-despite OAC.The mean age at the time of the procedure was 73.4±8.7,13 were female(44.82%).The mean CHA2DS2-VASc score was 5.96±1.32,with an expected AIS risk of 8.44 per 100 patient-years.14 patients(48%)had two or more past AIS-despite OAC.After LAAC,27 patients(93.10%)were discharged on OAC which was discontinued in 17(58.62%)after transoesophageal echocardiogram at 6 weeks.Over a mean of 1.75±1.0 years follow-up after LAAC,one patient had an AIS(incidence rate(IR)1.97 per 100 patient-years).One patient with severe cerebral microangiopathy had a small ICH while on direct OAC and antiplatelet 647 days after LAAC.Conclusions LAAC in AIS-despite OAC patients demonstrated a low annual AIS recurrence rate in our cohort(1.97%)compared with the expected IR based on their CHA2DS2-VASc scores(8.44%)and to recent large series of AIS-despite OAC patients treated with OAC/aspirin only(5.3%-8.9%).These hypothesis-generating findings support randomised trials of LAAC in AIS-despite OAC patients.
文摘Background: Stroke patients form an integral part of patients admitted into the intensive care unit (ICU);and may need airway maintenance, supplemental oxygen and even endotracheal intubation for mechanical ventilation. Method: In this retrospective study, the medical records and radiological investigations of the patients were assessed. Also, their socio-demographics, and clinical diagnosis and background co-morbidities were noted. The radiological diagnosis post CT was used to determine the type of stroke for those compliant;while clinical assessment alone was used to determine the diagnosis in those who did not do CT. They were also classified into 2 groups: those requiring mechanical ventilation (for ICU care) and those without the need for mechanical ventilation (for high dependency Unit (HDU) care). The eventual clinical outcome was noted. Result: A total of eighty-eight cases, 67% (n = 59) were males and 33% (n = 29) females. 89.8% (n = 79) had hypertension, 3.4% (n = 3) had diabetes while 6.8% (n = 6) had both hypertension and diabetes. Of the hypertensives, 36.7% (n = 29) had hemorrhagic stroke and 66.3% (n = 50) had ischaemic stroke. 53.3% (n = 46) patients had High dependency Unit (HDU care while 47.7% (n = 42) were mechanically ventilated. Of the number in HDU, 51.5% (n = 17) were haemorrhagic, while 52.7% (n = 29) were ischaemic. Clinical diagnosis of ischemic stroke was done in 55 (62.5%) and hemorrhagic stroke in 37.5% (n = 33). Of the lot, only 19.3% (n = 17) of them did CT and 80.7% (n = 71) did not have CT done. None did MRI. Late presentation (beyond 24 hrs) was a common feature for most of the patients, for whom immediate cardio-respiratory support became necessary. Overall mortality rate was 62.5% (n = 55). 39.1% (n = 18) of the HDU (46) patients died, while 88.1% (n = 37) of the ventilated (42) patients died. 56.6% (n = 26) were discharged from the HDU and 4.3% (n = 2) referred to another facility. Of the 42 patients on mechanical ventilation 88.1% (37) died, 9.5% (n = 4) discharged, and 2.4% (n = 1) referred to another health facility. Summary: Low neuroimaging compliance by Stroke patients in our environment and late presentation to hospital, impacts negatively on good outcome of the disease. This, coupled with the high cost of these facilities, makes their use unaffordable, suggesting a strong indication for comprehensive quality and affordable health care and health insurance in the country.
基金supported by the National Natural Science Foundation of China grant number 81530037 to Yuming Xu,82401556 to Shen Li and 82301320 to Peipei Li.
文摘The bifurcation regions of intracranial and extracranial arteries are common sites for atherosclerosis,predisposing to ischaemic stroke.1 Previous studies have shown that the unique haemodynamics at the bifurca-tion may lead to alterations in genes and proteins in this region.2 Elastin is closely associated with the progression of athero-sclerosis.3 However,under physiological conditions,the expression and distribu-tion of elastin in bifurcation regions have not yet been elucidated.Mice are the most frequently used animal model for studying atherosclerosis.This study focuses on carotid bifurcation,optimising the iDISCO(immunolabeling-enabled three-dimensional imaging of solvent-cleared organs)technique for whole tissue clearing and staining of the carotid artery in mice.4 These techniques,along with fluorescence micro-optical sectioning tomography(FMOST)technology,have also been used in studies on ischaemic stroke and kidney diseases,4 highlighting their potential for broader applications due to their high precision and three-dimensional imaging capabilities.5 Using FMOST technology in vitro,we have made a detailed visualisation of a U-shaped expression pattern of elastin at bifurcation regions for the first time.Specifically,elastin expression is found to be lowest at the bifurcation itself compared with the regions adjacent to or proximal to the bifurcation(figures 1A,B).Further-more,we observed disorganised arrange-ment of elastic fibres within the bifurcation zone(figures 1C,D).These findings provide important evidence linking elastic fibres to the pathogenesis of atherosclerosis at bifurcations and suggest the potential for more precise local therapies for athero-sclerosis,which could significantly advance precision medicine and reduce the poten-tial side effects on normal tissues.
文摘<p align="left"> <span style="font-family:Verdana;">Background: Capsular warning syndrome (CWS) is defined as a recurrent stereotype transient lacunar syndrome without cortical symptoms. However, to date, there is limited literature proposed on the definitive treatment options for the prevention of persistent stroke in cases of capsular warning syndrome. Aim: The aim of this case report is to address dual antiplatelet therapy as a treatment choice in CWS to prevent progressive stroke. Case presentation: A 56-year-old man with several comorbidities experienced recurrent periods of limb weakness and dysarthria lasting 5 - 20 minutes with a complete resolution of symptoms in between. The fluctuating episodes lasted for 72 hours followed by a persistent minor stroke. A gadolinium-enhanced MRI scan of the brain revealed a right basal ganglia infarct. He was treated with dual antiplatelet, and his functional outcome was favourable at 90 days post stroke. Conclusion: Dual antiplatelet may be a beneficial therapeutic option in CWS in improving functional outcomes in the early neurological deficit and decreasing the clinical fluctuation.</span> </p>
基金funded by Covidien Healthcare International Trading(Shanghai),Johnson&Johnson MedTech,Genesis MedTech(Shanghai)and Shanghai HeartCare Medical Technologysupported by the Clinical Medicine Development of Special Funding Support(ZYLX201708+2 种基金DFL20180502)the Beijing Municipal Science&Technology Commission(Z19110700660000)the Capital’s Funds for Health Improvement and Research(CFH 2024-2-2046).
文摘Objectives Endovascular therapy(EVT)now penetrates the once obscure realm of large infarct core volume acute ischaemic stroke(LICV-AIS).This research aimed to investigate the potential correlation between different anaesthetic approaches and post-EVT outcomes in LICV-AIS patients.Methods Between October 2020 and May 2022,the China ANGEL-Alberta Stroke Programme Early CT Score(ASPECT)trial studied patients with LICV-AIS,randomly assigning them to the best medical management(BMM)or BMM with EVT.This post hoc subgroup analysis categorised subjects receiving BMM with EVT into general anaesthesia(GA)and non-GA groups based on anaesthesia type.We applied multivariable logistic regression to evaluate the relationship between anaesthesia during EVT and patient functional outcomes,as measured by the modified Rankin scale(mRS),in addition to the occurrence of complications.Further adjustment for selection bias was achieved through propensity score matching(PSM).Results In total,230 patients with LICV-AIS were enrolled(GA 84 vs Non-GA 146).No significant difference was observed between the two groups in terms of the proportion of patients who achieved an mRS score of 0-2 at 90 days(27.4%for the GA group vs 31.5%for the non-GA group,p=0.51).However,the GA group had significantly longer median surgical times(142 min vs 122 min,p=0.03).Furthermore,GA was associated with an increased risk of postoperative pneumonia(adjusted OR 2.03,95%CI 1.04 to 3.98).The results of PSM analysis agreed with the results of the multivariate regression analysis.No significant difference in intracranial haemorrhage incidence or mortality rate was observed between the groups.Conclusion This post hoc analysis of subgroups of the ANGEL-ASPECT trial suggested that there may be no significant association between the choice of anaesthesia and neurological outcomes in LICV-AIS patients.However,compared with non-GA,GA prolongs the duration of EVT and is associated with a greater postoperative pneumonia risk.
文摘Background Approximately 20%of all transient ischaemic attacks(TIAs)and ischaemic strokes occur within the posterior circulation,with vertebrobasilar stenosis identified as the cause in roughly 25%of the cases.Studies have shown that about a quarter of these patients have atherosclerotic stenosis of at least 50%of the vertebrobasilar artery.Stenosis has been shown to be associated with an increased risk of 90-day recurrent vertebrobasilar stroke,particularly in the first few weeks,which is significantly higher when compared with patients with stenosis of the anterior circulation.Therefore,aggressive treatment is important for the patient’s prognosis.Stenting is emerging as a promising therapeutic strategy for persistent ischaemia events that do not respond to the best medical treatment,but it is not without complications.We systematically reviewed the literature on percutaneous transluminal angioplasty and stenting(PTAS)for intracranial vertebrobasilar artery stenosis(IVBS).Methods PubMed,Web-of Science and Scopus were searched upon the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to include prospective/retrospective cohort,randomised/non-randomised clinical trials and case series studies describing PTAS for IVBS.Pooled rates of intervention-related complications and outcomes were analysed with random-effect model meta-analysis using StataMP V.18.0 software.Results 31 studies were found eligible which included 1928 cases.1103 basilar artery stenosis cases were reported in 27 studies 0.65(95%CI 0.53,0.76),I2:99.72%.648 vertebral cases were reported in 18 studies 0.60(95%CI 0.49,0.70),I2:97.49%.In four studies,the rate of vertebrobasilar stenosis cases calculated as a proportion of the total sample size was 0.10(95%CI 0.05,0.15).Mean stenosis in 21 included studies was found to be 0.83(95%CI 0.79,0.88),I2:0.00%,which shows variation of baseline stenosis between studies was minimal.51 deaths were recorded in 24 studies.Meta-analysis of mortality showed the overall rate of mortality was 0.03(95%CI 0.02,0.05),I2:44.90%.In 14 studies,symptomatic intracranial haemorrhage events were recorded at an overall rate of 0.01(95%CI 0.00,0.02),I2:0.00%.Generally,a follow-up period of at least 3 months was reported in the included studies.Furthermore,procedural stroke/TIA was evaluated in seven studies,four of which reported no events(0.03(95%CI 0.00,0.08),I2:20.38%).Mean time from initial symptoms to recanalisation was 23.98(95%CI 18.56,29.40),I2=98.8%,p=0.00 days.Conclusion In certain individuals with medically unresolved,severe,symptomatic and non-acute IVBS,elective vertebrobasilar PTAS appears to be both safe and effective.Various stent designs and angioplasty-assisted techniques should be taken into consideration based on the specific clinical and radiological traits of the lesions.Future randomised controlled trials are required to verify these results.
基金funded by the National Key R&D Program of China(2018YFC1312300)the National Science and Technology Major Project(2017ZX09304018).
文摘Background The incidence of vascular cognitive impairment(VCI)is high in patients suffering from ischaemic stroke or transient ischaemic attack(TIA)or with vascular risk factors.Effective prevention strategies for VCI remain limited.Anaemia or low haemoglobin was found as an independent risk factor for adverse outcomes after acute stroke.Anaemia or low haemoglobin was possibly associated with an increased risk of poststroke cognitive impairment.Whether supplement of ferrous iron to correct anaemia reduces the risk of VCI and improves adverse outcomes in patients with ischaemic cerebrovascular disease remains uncertain.Aim We aim to introduce the design and rationale of the safety and efficacy of Ferrous iron on the prevention of Vascular cOgnitive impaiRment in patients with cerebral Infarction or TIA(FAVORITE)trial.Design FAVORITE is a randomised,placebo-controlled,double-blind,multicentre trial that compares supplement of ferrous iron with placebo for recent minor stroke/TIA patients complicated with mild anaemia or iron deficiency:Ferrous succinate sustained-release tablet 0.2 g(corresponding to 70 mg of elemental iron)once daily after or during breakfast for 12 weeks or placebo with much the same colour,smell and size as ferrous iron once daily during or after breakfast for 12 weeks.All paticipants will be followed within the next year.Study outcomes The primary effective outcome is the incidence of VCI at 3 months after randomisation and the primary safety outcome includes any gastrointestinal adverse event during 3 months.Discussion The FAVORITE trial will clarify whether supplement of ferrous iron to correct low haemoglobin reduces the risk of VCI in patients with recent ischaemic stroke or TIA complicated with mild anaemia or iron deficiency compared with placebo.
文摘Background Despite considerable improvements in the care of patients with cardiovascular disease in various populations over the last few decades, there are still limited data about long-term treatment patterns among patients with various atherosclerotic vascular conditions in China, especially the use of statin therapy. Methods Between June 2007 and October 2009, 16 860 patients aged 50-80 years with established history of atherosclerotic vascular disease （coronary heart disease （CHD）, atherosclerotic cerebrovascular disease （CVD）, or peripheral arterial disease （PAD）） from 51 hospitals in 14 cities of China were screened for a large randomized trial. Detailed information about current use of statins and various other treatments was recorded and analyzed by prior disease history, adjusting for various baseline characteristics. Results Among the 16 860 patients, the mean age was 63 years and 74% were male. Overall, 78% of the patients had documented CHD, 40% had CVD, 5% had PAD and 21% reported more than one condition. The median time from initial diagnosis of vascular disease to screening was 18 months. At screening, the proportions who took various treatments were 83% for antiplatelet agents, 49% for beta-blockers, 47% for statins and 28% for angiotensin-converting enzyme inhibitors. The proportion treated with statin was much higher in CHD than in CVD or PAD patients （61% vs. 10% vs. 22% respectively） and decreased significantly with time from initial diagnosis. Simvastatin （mainly 20 mg） and atorvastatin （mainly 10 mg） each accounted for about 40% of total statin use. Conclusions In urban China, there is still significant underuse of various proven secondary preventive therapies, with particularly low use of statins in patients with ischaemic stroke.
