Prevention and follow-up in thromboembolic ischemic stroke: Do we need to think out of the box?

Analysis of the Incidence and Influencing Factors of Depression in the Acute Stage of Ischemic Stroke: A Retrospective Clinical Study

BACKGROUND

Poststroke depression (PSD) is a common complication following a stroke, but the risk factors for its onset remain controversial. The purpose of this study was to investigate the incidence of PSD and its relationship with stroke sites to provide more evidence for the early identification of high-risk patients with PSD.

METHODS

This retrospective clinical study recruited acute ischemic stroke patients and assessed them for 2 weeks after the onset. Blood samples were collected from the patients upon admission for routine blood tests and blood biochemical analysis. Stroke patients with the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-V) depressive diagnosis were rated for severity using the Hamilton Depression Rating Scale (HAMD), as measured by the National Institutes of Health Stroke Scale (NIHSS). Stroke prognosis was measured by the Modified Rankin Scale (mRS).

RESULTS

A total of 192 stroke patients were evaluated. Two weeks after the stroke, 73 patients developed depression, and the incidence of PSD was 38.02%. The proportion of depression composition after 2 weeks was as follows: 63 cases were mild depression, accounting for 91.8%; 6 cases were moderate depression, accounting for 8.2%. In univariate analysis, red blood cell (RBC) count, thalamic infarction, mRS score, and mini-mental state examination (MMSE) score were identified as risk factors associated with the occurrence of PSD. Multivariate logistic regression analysis further confirmed that RBC count, mRS score, and MMSE score were significantly correlated with PSD development.

CONCLUSION

This study suggests that patients with thalamic infarction and TOAST type I stroke should receive increased clinical attention. RBC count, high mRS scores, and high MMSE scores are three independent risk factors for PSD occurrence.

The Therapeutic Effects of Endovascular Therapy with mTICI2b and 3 Recanalization for Acute Anterior Circulation Stroke Patients

BACKGROUND AND PURPOSE

Modified Thrombolysis in Cerebral Infarction (mTICI)2b/3 has been considered the criterion for successful reperfusion in endovascular treatment. This study aimed to compare the therapeutic safety and efficacy of mTICI2b and mTICI3 recanalization, and to analyze the factors related to outcomes in everyday clinical practice.

MATERIALS AND METHODS

This is a single-center retrospective analysis of 224 patients who underwent successful thrombectomy (achieving a mTICI score ≥2b). The primary outcomes included a modified Rankin score (mRS) of 0-2 at 90-day, mortality, and symptomatic intracranial hemorrhage.

RESULTS

A total of 111 patients achieved mTICI2b status (49.6%), and 113 achieved mTICI3 status (50.4%). The comparison between mTICI2b and 3 reperfusions showed no differences in short-term outcomes, 90-day mRS, complications, and mortality. There was a trend toward more passes in mTICI2b patients, although the difference was not significant. The univariate analysis showed that poor outcomes after endovascular treatment were associated with older age, previous history of coronary heart disease, atrial fibrillation, diabetes, tandem occlusions, high National Institutes of Health Stroke Scale (NIHSS) score on admission, and general anesthesia. A previous history of coronary heart disease, a high NIHSS score on admission, and the use of general anesthesia were independent factors that affected the therapeutic effects.

CONCLUSION

The superiority (efficacy and safety) of mTICI3 reperfusion was not significant compared with that of mTICI2b reperfusion. Prolonged efforts to achieve mTICI3 after achieving mTICI2b should be considered prudently for those with difficulty achieving 100% reperfusion.

Thromboelastography Detects Possible Coagulation Disturbance in Pediatric Patients with Portal Cavernoma

Background

Thromboelastography (TEG) allows a dynamic assessment of clot formation and dissolution that might be useful for assessing the relative contribution of the coagulation components to overall clot formation and dissolution, but it has not been fully defined in patients with portal cavernoma (PC).

Methods

We retrospectively recruited consecutive patients with PC between July 2006 and June 2016 who had no abdominal malignancy or liver cirrhosis. Blood samples were drawn on admission and were subjected to coagulation parameter assessment, including conventional coagulation tests, measurement of the circulating levels of procoagulant and anticoagulant factors, and TEG assessment.

Results

Compared with controls, patients with PC showed significant reductions in the serum levels of procoagulant factors and anticoagulants factors, whereas factor VIII was slightly elevated. TEG showed clot formation (α-angle), and the maximal clot strength (MA) was higher in patients with PC than in controls, indicating a hypercoagulable state. Thrombocytopenia decreased both clot formation (α-angle) and the maximal clot strength (MA) but was still significantly higher than the control. Furthermore, patients with PC had a higher level of D-dimer and LY30 than did controls, indicating the in vivo activation of coagulation and fibrinolysis.

Conclusion

TEG analysis showed that patients with PC were in a hypercoagulable state that could be partially masked by thrombocytopenia secondary to splenomegaly and hypersplenism in these patients, which indicates that our current prophylaxis and therapy regimen could be improved.