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Zhang L, Wang S, Ren N. Efficacy of urokinase and alteplase intravenous thrombolysis in the treatment of acute phase cerebral infarction and impact on serum S-100β and nerve growth factor levels. Int J Neurosci 2024:1-8. [PMID: 38376498 DOI: 10.1080/00207454.2024.2322137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/17/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To compare the efficacy of urokinase and alteplase intravenous thrombolysis in the treatment of acute phase cerebral infarction and investigate their impact on serum S-100β and nerve growth factor (NGF) levels. METHODS Parameters assessed included NIHSS score reduction, vascular recanalization rates, mRS, Barthel Index, and adverse reactions. Post-treatment blood samples were also collected for further analysis. RESULTS The clinical treatment effectiveness and Vascular recanalization rate in Group A was higher than in Group B, with p < 0.05. After treatment, the NIHSS score in Group A was lower than in Group B (p < 0.05), and the mRS score was slightly lower, but the difference was not significant (p > 0.05). After treatment, the levels of IL-6, TNF-α, and CRP in Group A were lower than in the control group (p < 0.05). The S-100β level in Group A was lower than in Group B, and NGF level was higher than in Group B (p < 0.05). Group A had better prognosis. CONCLUSION The efficacy and safety of both urokinase and alteplase intravenous thrombolysis for acute phase cerebral infarction have been demonstrated, yet disparities exist in neurological function recovery and regulation of biochemical indicators. Alteplase intravenous thrombolysis emerges as the superior option, displaying greater effectiveness and safety, alongside improved regulation of serum S-100β and NGF levels. Tailoring treatment plans to individual patient characteristics and drug mechanisms is essential. Given these findings, the promotion of alteplase intravenous thrombolysis in the management of acute phase cerebral infarction is justified.
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Affiliation(s)
- Lei Zhang
- Cerebrovascular Disease, Jinan Central Hospital, Jinan, China
| | - Si Wang
- Cerebrovascular Disease, Jinan Central Hospital, Jinan, China
| | - Nannan Ren
- Cerebrovascular Disease, Jinan Central Hospital, Jinan, China
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Li Y, Wang H, Zhao J, Xia L, Xiong K, Zhong H. Effects of butylphthalide on cerebral vascular circulation, coagulation function, and neurological function in patients with acute severe ischemic stroke following intravenous thrombolysis: a preliminary study. Int J Neurosci 2024:1-8. [PMID: 38197188 DOI: 10.1080/00207454.2023.2301424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To analyze the effects of Butylphthalide on cerebral vascular circulation, coagulation function, and neurological function in patients with acute severe ischemic stroke following intravenous thrombolysis. METHODS Clinical efficacy, cerebral vascular circulation indicators [anterior cerebral artery (ACA), middle cerebral artery (MCA), vertebral artery (VA) blood flow velocity], coagulation function indicators [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB)], neurological function indicators [Activities of Daily Living (ADL) score. RESULTS The total effective rate of treatment in the control group was 76.47%, while in the observation group, it was 96.08%, with the observation group showing a significantly higher total effective rate than the control group (p < 0.05). Before treatment, there was no significant difference in ACA, MCA, and VA blood flow velocity between the two groups (p > 0.05). However, after treatment, the ACA, MCA, and VA blood flow velocity in the observation group were significantly higher than those in the control group (p < 0.05). Before treatment, there was no significant difference in PT, APTT, TT, and FIB levels between the two groups (p > 0.05). CONCLUSION In patients with acute severe ischemic stroke undergoing intravenous thrombolysis, the addition of Butylphthalide to the treatment regimen yields favorable clinical outcomes. Compared to Alteplase alone, the addition of Butylphthalide further improves cerebral vascular circulation and coagulation function, promoting the recovery and reconstruction of neurological function in patients. Importantly, the addition of Butylphthalide does not increase the risk of adverse reactions, making it a safe and ideal option for clinical application.
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Affiliation(s)
- Yu Li
- Department of Critical Care Medicine, The People's Hospital of Rongchang District, Chongqing, China
| | - Hui Wang
- Department of Neurology, The People's Hospital of Rongchang District, Chongqing, China
| | - Jiansen Zhao
- Department of Critical Care Medicine, The People's Hospital of Rongchang District, Chongqing, China
| | - Lei Xia
- Department of Neurology, The People's Hospital of Rongchang District, Chongqing, China
| | - Kaiju Xiong
- Department of Neurology, The People's Hospital of Rongchang District, Chongqing, China
| | - Huaping Zhong
- Department of Neurology, The People's Hospital of Rongchang District, Chongqing, China
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Zhang L, Li J, Yang B, Li W, Wang X, Zou M, Song H, Shi L, Duan Y. The risk and outcome of malignant brain edema in post-mechanical thrombectomy: acute ischemic stroke by anterior circulation occlusion. Eur J Med Res 2023; 28:435. [PMID: 37833809 PMCID: PMC10571427 DOI: 10.1186/s40001-023-01414-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND AND PURPOSE Malignant brain edema (MBE) occurring after mechanical thrombectomy (MT) in acute ischemic stroke (AIS) could lead to severe disability and mortality. We aimed to investigate the incidence, predictors, and clinical outcomes of MBE in patients with AIS after MT. METHODS The clinical and imaging data of 155 patients with AIS of anterior circulation after MT were studied. Standard non-contrast CT was used to evaluate baseline imaging characteristics at admission. Clinical outcomes were measured using the 90-day modified Rankin Scale (mRS) score. Based on the follow-up CT scans performed within 72 h after MT, the patients were classified into MBE and non-MBE group. MBE was defined as a midline shift of ≥ 5 mm with signs of local brain swelling. Univariate and multivariate regression analyses were used to analyze the relationship between MBE and clinical outcomes and identify the predictors that correlate with MBE. RESULTS MBE was observed in 19.4% of the patients who underwent MT and was associated with a lower rate of favorable 90-day clinical outcomes. Significant differences were observed in both MBE and non-MBE groups: baseline Alberta Stroke Program Early CT (ASPECT) score, hyperdense middle cerebral artery sign (HMCAS), baseline signs of early infarct, angiographic favorable collaterals, number of retrieval attempts, and revascularization rate. Multivariate analysis indicated that low baseline ASPECT score, absent HMCAS, angiographic poor collaterals, more retrieval attempt count, and poor revascularization independently influenced the occurrence of MBE in AIS patients with anterior circulation after MT. CONCLUSION MBE was associated with a lower rate of favorable 90-day clinical outcomes. Low baseline ASPECT score, absent HMCAS, angiographic poor collaterals, more retrieval attempt count and poor revascularization were independently associated with MBE after MT.
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Affiliation(s)
- Luojin Zhang
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China
- Department of Radiology, Shanxi Fenyang Hospital, Shanxi, China
| | - Jinze Li
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China
- Northern Theater Command Postgraduate Training Base of Jinzhou Medical University General Hospital, Shenyang, China
| | - Benqiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Wei Li
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xinrui Wang
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China
| | - Mingyu Zou
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China
| | - Hongyan Song
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China
| | - Lin Shi
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China
| | - Yang Duan
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, China.
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Chen Y, Diana F, Mofatteh M, Zhou S, Chen J, Huang Z, Wu W, Yang Y, Zeng Z, Zhang W, Ouyang Z, Nguyen TN, Yang S, Baizabal-Carvallo JF, Liao X. Functional and technical outcomes in acute ischemic stroke patients with hyperdense middle cerebral artery sign treated with endovascular thrombectomy. Front Neurol 2023; 14:1150058. [PMID: 37305752 PMCID: PMC10247996 DOI: 10.3389/fneur.2023.1150058] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/04/2023] [Indexed: 06/13/2023] Open
Abstract
Background and objective The hyperdense middle cerebral artery sign (HMCAS) is observed in a proportion of patients with acute ischemic stroke (AIS). This sign reflects the presence of an intravascular thrombus rich in red blood cells. Several studies have demonstrated that HMCAS increases the risk of poor outcomes in AIS patients treated with IV thrombolysis or no reperfusion therapy; however, whether HMCAS predicts a poor outcome in patients treated with endovascular thrombectomy (EVT) is less clear. We aimed to evaluate the functional outcome by the modified Rankin scale (mRS) at 90 days and technical challenges in patients with HMCAS undergoing EVT. Methods We studied 143 consecutive AIS patients with middle cerebral artery M1 segment or internal carotid artery + M1 occlusions who underwent EVT. Results There were 73 patients (51%) with HMCAS. Patients with HMCAS had a higher frequency of cardioembolic stroke (p = 0.038); otherwise, no other baseline difference was observed. No differences in functional outcomes (mRS) at 90 days (p = 0.698), unfavorable outcomes (mRS > 2) (p = 0.929), frequency of symptomatic intracranial hemorrhage (p = 0.924), and mortality (mRS-6) (p = 0.736) were observed between patients with and without HMCAS. In patients with HMCAS, EVT procedures were 9 min longer, requiring a higher number of passes (p = 0.073); however, optimal recanalization scores (modified thrombolysis in cerebral infarction: 2b-3) were equally achieved by both groups. Conclusion Patients with HMCAS treated with EVT do not have a worse outcome at 3 months compared with no-HMCAS patients. Patients with HMCAS required a greater number of thrombus passes and longer procedure times.
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Affiliation(s)
- Yimin Chen
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China
| | - Francesco Diana
- Department of Neuroradiology, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Sijie Zhou
- Department of Surgery of Cerebrovascular Diseases, First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Juanmei Chen
- The Second Clinical College, Guangzhou Medical University, Guangzhou, China
| | - Zhou Huang
- Department of Radiology, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China
| | - Weijuan Wu
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China
| | - Yajie Yang
- The First School of Clinical Medicine, Southern Medical University, Foshan, China
| | - Zhiyi Zeng
- Department of Scientific Research and Education, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China
| | - Weijian Zhang
- Department of Surgery of Cerebrovascular Diseases, First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Ziqi Ouyang
- Department of Neurosurgery, Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China
| | - Thanh N. Nguyen
- Department of Neurology and Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Shuiquan Yang
- Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China
| | - José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States
- Department of Sciences and Engineering, University of Guanajuato, León, Mexico
| | - Xuxing Liao
- Department of Surgery of Cerebrovascular Diseases, First People's Hospital of Foshan, Foshan, Guangdong, China
- Department of Neurosurgery, Advanced National Stroke Center, Foshan Sanshui District People's Hospital, Foshan, Guangdong, China
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Dai Y, Xu H, Fang X, Xiong X, Song Z, Hu S, Yu Y, Hu C, Zhang Y. Dual-energy CT in assessment of thrombus perviousness and its application in predicting outcomes after intravenous thrombolysis in acute ischemic stroke. Eur J Radiol 2023; 164:110861. [PMID: 37167682 DOI: 10.1016/j.ejrad.2023.110861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/02/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE To evaluate the feasibility of using iodine overlay maps reconstructed from dual-energy CT (DECT) to assess thrombus perviousness and investigate its value in predicting outcomes after intravenous thrombolysis in patients with acute ischemic stroke. METHOD 86 patients with proximal intracranial occlusions of the anterior circulation who underwent intravenous thrombolysis were included in this study. Thrombus iodine concentrations (ICthrombus) and normalized iodine concentrations (NICthrombus) were compared to conventional perviousness parameters (thrombus attenuation increase, TAI; void fraction, ε and CTA-index). The associations between perviousness parameters and outcomes were analyzed by Spearman's correlation and regression analysis. RESULTS ICthrombus and NICthrombus were significantly correlated with conventional perviousness parameters (P < 0.001). The median ICthrombus was 6.81 (interquartile range [IQR], 4.76-8.73) mg/ml in the favorable functional outcome group, which was higher than 3.52 (IQR, 2.08-6.86) mg/ml in the unfavorable outcome group (P = 0.001). The median NICthrombus was 0.095 (IQR, 0.068-0.116) and 0.054 (IQR, 0.031-0.083) in the favorable and unfavorable outcome groups, respectively (P < 0.001). NICthrombus predicted favorable outcome with a higher area under the curve (AUC) of 0.755 than any conventional perviousness parameter (P < 0.05). In the multivariable regression model, ICthrombus was independently associated with favorable outcome (odds ratio [OR] = 1.472, 95 % CI: 1.154-1.877, P = 0.002) and successful recanalization (OR = 1.356, 95 % CI: 1.093-1.681, P = 0.006). ICthrombus was negatively correlated with the final infarct volume (FIV) (r = -0.262, P = 0.020). Results for NICthrombus were similar. CONCLUSIONS DECT is of great value in assessing thrombus perviousness. NICthrombus is a meaningful predictor of stroke prognosis and recanalization after intravenous thrombolysis in acute ischemic stroke.
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Affiliation(s)
- Yao Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; Department of Radiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215124, China
| | - Haimin Xu
- Department of Radiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215124, China
| | - Xiang Fang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xing Xiong
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Ziyang Song
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Su Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Yixing Yu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
| | - Yu Zhang
- Department of Radiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215124, China.
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Liu Z, Zhang R, Ouyang K, Hou B, Cai Q, Xie Y, Liu Y. Predicting functional outcome in acute ischemic stroke patients after endovascular treatment by machine learning. Transl Neurosci 2023; 14:20220324. [PMID: 38035150 PMCID: PMC10685342 DOI: 10.1515/tnsci-2022-0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023] Open
Abstract
Background Endovascular therapy (EVT) was the standard treatment for acute ischemic stroke with large vessel occlusion. Prognosis after EVT is always a major concern. Here, we aimed to explore a predictive model for patients after EVT. Method A total of 156 patients were retrospectively enrolled. The primary outcome was functional dependence (defined as a 90-day modified Rankin Scale score ≤ 2). Least absolute shrinkage and selection operator and univariate logistic regression were used to select predictive factors. Various machine learning algorithms, including multivariate logistic regression, linear discriminant analysis, support vector machine, k-nearest neighbors, and decision tree algorithms, were applied to construct prognostic models. Result Six predictive factors were selected, namely, age, baseline National Institute of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early CT (ASPECT) score, modified thrombolysis in cerebral infarction score, symptomatic intracerebral hemorrhage (sICH), and complications (pulmonary infection, gastrointestinal bleeding, and cardiovascular events). Based on these variables, various models were constructed and showed good discrimination. Finally, a nomogram was constructed by multivariate logistic regression and showed a good performance. Conclusion Our nomogram, which was composed of age, baseline NIHSS score, ASPECT score, recanalization status, sICH, and complications, showed a very good performance in predicting outcome after EVT.
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Affiliation(s)
- Zhenxing Liu
- Department of Neurology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, 430071, Wuhan, Hubei, China
- Department of Neurology, Yiling Hospital of Yichang City, 443100, Yichang, Hubei, China
| | - Renwei Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, 430071, Wuhan, Hubei, China
| | - Keni Ouyang
- Department of Neurology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, 430071, Wuhan, Hubei, China
- Department of Neurology, Wuhan Fourth Hospital, 430033, Wuhan, Hubei, China
| | - Botong Hou
- Department of Neurology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, 430071, Wuhan, Hubei, China
- Department of Neurology, Wuhan Fourth Hospital, 430033, Wuhan, Hubei, China
| | - Qi Cai
- Department of Neurology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, 430071, Wuhan, Hubei, China
| | - Yu Xie
- Department of Neurology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, 430071, Wuhan, Hubei, China
| | - Yumin Liu
- Department of Neurology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, 430071, Wuhan, Hubei, China
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Fully automatic identification of post-treatment infarct lesions after endovascular therapy based on non-contrast computed tomography. Neural Comput Appl 2022. [DOI: 10.1007/s00521-022-08094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Effectiveness of Combined Thrombolysis and Mild Hypothermia Therapy in Acute Cerebral Infarction: A Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4044826. [PMID: 35469165 PMCID: PMC9034919 DOI: 10.1155/2022/4044826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 03/05/2022] [Accepted: 03/18/2022] [Indexed: 11/18/2022]
Abstract
Objective To evaluate the effectiveness and safety of thrombolytic therapy combined with mild hypothermia in patients with acute cerebral infarction (ACI), based on a meta-analysis of randomized controlled trials (RCTs). Methods PubMed, EMBASE, Cochrane Library, and Chinese National Knowledge Infrastructure Database of Controlled Trials were systematically screened for randomized controlled trials (RCTs) of thrombolytic therapy combined with mild hypothermia in treating ACI from inception to January 2021. Participation and outcomes among intervention enrollees are as follows: P, participants (patients in ACI); I, interventions (thrombolysis in combination with mild hypothermia therapy); C, controls (thrombolysis merely); O, outcomes (main outcomes are the change of NIHSS, glutathione peroxidase, superoxide dismutase, malondialdehyde, inflammatory factor interleukin-1β, tumor necrosis factor-α, and adverse reaction). Following data extraction and quality assessment, a meta-analysis was performed using RevMan 5.3 software. Results A total of 26 RCTs involving 2071 patients were included. Compared to thrombolysis alone, thrombolytic therapy combined with mild hypothermia leads to better therapeutic efficacy [RR = 1.23, 95% CI (1.16, 1.31)], NIHSS [MD = -2.02, 95% CI (-2.55, -1.49)], glutathione peroxidase [MD = 8.71, 95% CI (5.55, 11.87)], superoxide dismutase [MD = 16.52, 95% CI (12.31, 19.74)], malondialdehyde [MD = -1.86, 95% CI (-1.98, -1.75)], interleukin-1β [MD = -3.48, 95% CI (-4.88, -2.08)], tumor necrosis factor-α [MD = -0.46, 95% CI (-3.39, 2.48)], and adverse reaction [RR = 0.87, 95% CI (0.63, 1.20)]. Conclusions Thrombolytic therapy combined with mild hypothermia demonstrates a beneficial role in reducing brain nerve function impairment and inflammatory reactions in ACI subjects analysed in this meta-analysis.
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Shi C, Killingsworth MC, Bhaskar SMM. Prognostic capacity of hyperdense middle cerebral artery sign in anterior circulation acute ischaemic stroke patients receiving reperfusion therapy: a systematic review and meta-analysis. Acta Neurol Belg 2022; 122:423-435. [PMID: 34095978 PMCID: PMC8180356 DOI: 10.1007/s13760-021-01720-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/31/2021] [Indexed: 12/29/2022]
Abstract
Pre-intervention CT imaging-based biomarkers, such as hyperdense middle cerebral artery sign (HMCAS) may have a role in acute ischaemic stroke prognostication. However, the clinical utility of HMCAS in settings of reperfusion therapy and the level of prognostic association is still unclear. This systematic review and meta-analysis investigated the association of HMCAS sign with clinical outcomes and its prognostic capacity in acute ischaemic stroke patients treated with reperfusion therapy. Prospective and retrospective studies from the following databases were retrieved from EMBASE, MEDLINE and Cochrane. Association of HMCAS with functional outcome, symptomatic intracerebral haemorrhage (sICH) and mortality were investigated. The random effect model was used to calculate the risk ratio (RR). Subgroup analyses were performed for subgroups of patients receiving thrombolysis (tPA), mechanical thrombectomy (EVT) and/or combined therapy (tPA + EVT). HMCAS significantly increased the rate of poor functional outcome by 1.43-fold in patients (RR 1.43; 95% CI 1.30-1.57; p < 0.0001) without any significant differences in sICH rates (RR 0.91; 95% CI 0.68-1.23; p = 0.546) and mortality (RR 1.34; 95% CI 0.72-2.51; p = 354) in patients with positive HMCAS as compared to negative HMCAS. In subgroup analyses, significant association between HMCAS and 90 days functional outcome was observed in patients receiving tPA (RR 1.53; 95% CI 1.40-1.67; p < 0.0001) or both therapies (RR 1.40; 95% CI 1.08-1.80; p = 0.010). This meta-analysis demonstrated that pre-treatment HMCAS increases risk of poor functional outcomes. However, its prognostic sensitivity and specificity in predicting long-term functional outcome, mortality and sICH after reperfusion therapy is poor.
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Affiliation(s)
- Chenyu Shi
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW Australia
| | - Murray C. Killingsworth
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- NSW Brain Clot Bank, NSW Health Statewide Biobank and NSW Health Pathology, Sydney, NSW Australia
- Correlative Microscopy Facility, Ingham Institute for Applied Medical Research, Sydney, Australia
- Department of Anatomical Pathology, NSW Health Pathology and Liverpool Hospital, Liverpool, NSW Australia
| | - Sonu Menachem Maimonides Bhaskar
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, Australia
- South West Sydney Local Health District (SWSLHD), Sydney, Australia
- Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
- NSW Brain Clot Bank, NSW Health Statewide Biobank and NSW Health Pathology, Sydney, NSW Australia
- Thrombolysis and Endovascular WorkFLOw Network (TEFLON), Sydney, Australia
- Present Address: Department of Neurology and Neurophysiology, Liverpool Hospital, Clinical Sciences Building, Elizabeth St, Liverpool, NSW 2170 Australia
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10
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Prognosis with non-contrast CT and CT Perfusion imaging in thrombolysis-treated acute ischemic stroke. Eur J Radiol 2022; 149:110217. [DOI: 10.1016/j.ejrad.2022.110217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/13/2022] [Accepted: 02/10/2022] [Indexed: 11/21/2022]
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Appelros P, Svensson E, Heidenreich K, Svantesson M. Ethical issues in stroke thrombolysis revisited. Acta Neurol Scand 2021; 144:611-615. [PMID: 34725820 DOI: 10.1111/ane.13530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Peter Appelros
- Faculty of Medicine and Health University Health Care Research CenterÖrebro University Örebro Sweden
| | - Elisabeth Svensson
- Faculty of Medicine and Health University Health Care Research CenterÖrebro University Örebro Sweden
| | - Kaja Heidenreich
- Faculty of Medicine and Health University Health Care Research CenterÖrebro University Örebro Sweden
| | - Mia Svantesson
- Faculty of Medicine and Health University Health Care Research CenterÖrebro University Örebro Sweden
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Abstract
The article reflects the current achievements in the field of reperfusion therapy for ischemic stroke. The data are presented that allow a practicing neurologist to make informed decisions about intravenous thrombolysis in difficult clinical situations: minor stroke, suspected stroke "mask", atypical clinical picture, patient's age over 80 years, posterior circulation stroke, isolated dizziness, severe neurological deficit, large artery occlusion, chronic neuroimaging changes, polymorbidity and low functional level before stroke. It has been shown that an increase in the number of candidates for intravenous thrombolysis can be achieved by intensifying the selection of patients within the 4.5-hour therapeutic window, which primarily implies the optimization of local stroke treatment protocols with a reduction in the door-to-needle time, as well as, in the short term, expanding the therapeutic window. Approaches to reduce the risk of symptomatic hemorrhagic transformation are discussed. We are also talking about a rare but life-threatening complication angioedema. Thus, the intensification of intravenous thrombolysis, as well as an increase in its effectiveness and safety are the primary tasks of each stroke department.
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Herath HMMTB, Rodrigo C, Alahakoon AMBD, Ambawatte SB, Senanayake S, Senanayake B, Fernando A. Outcomes of stroke patients undergoing thrombolysis in Sri Lanka; an observational prospective study from a low-middle income country. BMC Neurol 2021; 21:434. [PMID: 34753432 PMCID: PMC8576930 DOI: 10.1186/s12883-021-02475-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/29/2021] [Indexed: 11/12/2022] Open
Abstract
Background Stroke related deaths are relatively higher in low- and middle-income countries where only a fraction of eligible patients undergo thrombolysis. There is also limited evidence on post-thrombolysis outcomes of patients from Asian countries in these income bands. Methods This is a single center prospective observational study of a patient cohort with acute ischaemic stroke, undergoing thrombolysis with alteplase (low and standard dose), over a 24-month period in 2019/2020. Modified Rankin scale (mRS) for dependency at 3 months (primary outcome), duration of hospital stay, incidence of symptomatic intracranial haemorrhages and all-cause mortality at 3 months (secondary outcomes) were recorded. Demographic, clinical and treatment related factors associated with these outcomes were explored. Results Eighty-nine patients (males – 61, 69%, mean age: 60 years ±12.18) were recruited. Time from symptom onset to reperfusion was 174 min ± 56.50. Fifty-one patients were independent according to mRS, 11 (12.4%) patients died, and 11 (12.5%) developed symptomatic intracranial haemorrhages by 3 months. Functional independence at 3 months was independently associated with National Institutes of Health Stroke Scale (NIHSS) on admission (p < 0.05). Thrombolysis with low dose alteplase did not lead to better or worse outcomes compared to standard dose. Conclusions On admission NIHSS is predictive of functional independence at 3 months post-thrombolysis. Low dose alteplase may be as efficacious as standard dose alteplase with associated cost savings, but this needs to be confirmed by a prospective clinical trial for the Sri Lankan population. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02475-3.
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Affiliation(s)
- H M M T B Herath
- Neurology Department, National Hospital of Sri Lanka, Colombo, Sri Lanka.
| | - Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, UNSW Sydney, Sydney, NSW, Australia
| | - A M B D Alahakoon
- Neurology Department, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | | | - Bimsara Senanayake
- Neurology Department, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Arjuna Fernando
- Neurology Department, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Mowla A, Razavi SM, Lail NS, Mohammadi P, Shirani P, Kavak KS, Sawyer RN, Kamal H. Hyperdense middle cerebral artery sign and response to combination of mechanical Thrombectomy plus intravenous thrombolysis in acute stroke patients. J Neurol Sci 2021; 429:117618. [PMID: 34418800 DOI: 10.1016/j.jns.2021.117618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/20/2021] [Accepted: 08/15/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Combining intra-arterial mechanical thrombectomy (IAMT) and intravenous thrombolysis (IVT) has shown to have an excellent recanalization rate and better clinical outcome in acute ischemic stroke (AIS) patients. Hyperdense middle cerebral artery sign (HMCAS) on pretreatment non-contrast head CT scan of AIS patients is one of the early ischemic radiological findings in middle cerebral artery territory AIS. We aimed to evaluate whether the presence of HMCAS predicts the outcome of AIS patients receiving combination therapy with IAMT and IVT. METHODS We retrospectively reviewed medical records and cerebrovascular images of the patients treated with IAMT and IVT for AIS in our center. Patients with occlusion in the terminal internal carotid artery or middle cerebral artery on pretreatment CT angiogram of the head were included. Clinical outcome was compared between subjects with HMCAS and those without. Modified Rankin Score (mRS) and symptomatic intracranial hemorrhage (sICH) were used as measures of efficacy and safety, respectively. RESULTS Of 93 patients, 46 (49%) had HMCAS on their initial head CT scan. Both groups had comparable baseline characteristics and stroke severity. After adjusting for age, NIHSS score, time from symptom onset to starting IVT, and history of diabetes mellitus in multivariate logistic regression analysis, there was no difference in terms of a poor outcome (mRS >2) (OR = 0.5 [CI 0.2-1.4], p = 0.188) or rate of sICH (OR = 3.3 [CI 0.6-19.0], p = 0.190) between the two groups. CONCLUSIONS HMCAS is not a predictor of poor outcome in AIS patients receiving combination therapy with IAMT and IVT and does not affect treatment safety.
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Affiliation(s)
- Ashkan Mowla
- Division of Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, United States of America.
| | - Seyed-Mostafa Razavi
- Division of Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, United States of America; Heart and Rhythm Clinic, San Jose, CA, United States of America
| | - Navdeep S Lail
- Department of Neurology, University at Buffalo, State University of New York, Buffalo, NY, United States of America
| | - Pegah Mohammadi
- Department of Medicine, Eisenhower Medical Center, Rancho Mirage, CA, USA
| | - Peyman Shirani
- Departments of Neurology and Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, United States of America
| | - Katelyn S Kavak
- Department of Neurology, University at Buffalo, State University of New York, Buffalo, NY, United States of America
| | - Robert N Sawyer
- Department of Neurology, University at Buffalo, State University of New York, Buffalo, NY, United States of America
| | - Haris Kamal
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, United States of America
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Liu Y, Yang Y, Li Y, Peng X. Comparison of Efficacy and Safety of Recombinant Human Prourokinase and Alteplase in the Treatment of STEMI and Analysis of Influencing Factors of Efficacy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:6702965. [PMID: 34531919 PMCID: PMC8440075 DOI: 10.1155/2021/6702965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of recombinant human prourokinase (rhPro-UK) and alteplase for thrombolytic therapy in acute ST-segment elevation myocardial infarction (STEMI) and to analyze the related factors affecting efficacy. METHODS From January 2017 to December 2019, 100 patients diagnosed with STEMI were selected and randomly divided into the control group (n = 50) and the observation group (n = 50). Based on conventional treatments, the control group was treated with alteplase, and the observation group was treated with rhPro-UK, and both were treated for 7 days. After treatment, the vascular recanalization, left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF) were compared. The bleeding and major adverse cardiovascular events (MACE) were recorded in both groups. According to the patient's vascular recanalization, it was divided into two subgroups: recanalization group and occlusion group. Multiple logistic regression models were used to analyze the related factors that affect the efficacy. RESULTS The recanalization rate of the observation group (96.00%) was higher than that of the control group (84.00%) (P < 0.05). After treatment, LVDs and LVEDD in both groups were lower than those before treatment, and LVEF was higher than that before treatment. The LVDs and LVEDD in the observation group were lower than those in the control group, and the LVEF was higher than that in the control group (P < 0.05). The incidence of bleeding in the observation group (2.00%) was lower than that in the control group (12.00%), and the incidence of MACE (4.00%) was lower than that in the control group (16.00%) (P < 0.05). Univariate analysis showed that age, smoking history, diabetes history, myocardial infarction history, infarct location, and intravenous thrombolysis time were related to the efficacy after treatment (P < 0.05). Multivariate logistic analysis showed that age, history of diabetes, vascular infarction site, and venous thrombolysis time were independent influencing factors after treatment (P < 0.05). CONCLUSION Both rhPro-UK and alteplase thrombolytic therapy can effectively recanalize blood vessels and improve the cardiac function of patients with STEMI. However, rhPro-UK has better effect than alteplase and is safer and worth promoting. The curative effect is related to age, diabetes history, vascular infarction site, and venous thrombolysis time.
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Affiliation(s)
- Yizhou Liu
- The Affiliated Nanhua Hospital, Department of Cardiology, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Yulin Yang
- The Affiliated Nanhua Hospital, Department of Recovery from Anesthesia, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Ying Li
- The Affiliated Nanhua Hospital, Department of Nursing Teaching and Research, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Xiaoqing Peng
- The Affiliated Nanhua Hospital, Department of Cardiology, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
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Zhu Z, Zhang R, Ren K, Cong R, Zhu X, Zhu L, Wang T. The prognosis prediction significance of Hounsfield unit value for stroke patients treated by intravenous thrombolysis. BMC Med Imaging 2021; 21:62. [PMID: 33827465 PMCID: PMC8028233 DOI: 10.1186/s12880-021-00592-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intravenous thrombolysis (IVT) is a rapid and effective treatment in the early stage of ischemic stroke patients and the purpose of this work is to explore the significance of Hounsfield unit (HU) value in Alberta Stroke Program Early CT Score (ASPECTS) for predicting the clinical prognosis of stroke patients with middle cerebral artery occlusion (MCAO) treated by IVT. METHODS The 84 stroke patients with MCAO treated by IVT were divided into good prognosis group (48 cases) and poor prognosis group (36 cases). HU ratio and HU difference calculated from non-contrast computed tomography between groups were analyzed. RESULTS The HU ratio of good prognosis group was higher than that in poor prognosis group and the HU difference of good prognosis group was lower than that in poor prognosis group (P < 0.05). The HU ratio and ASPECTS were negatively correlated with the infarct volume, and the HU difference was positively correlated with the infarct volume (P < 0.05). HU difference was an independent risk factor for prognosis of patients with MCAO treated by IVT. The area under the receiver operating characteristic curve of HU ratio and HU difference for prognosis was 0.743 and 0.833 respectively. CONCLUSION The HU value changes are related to the clinical prognosis of stroke patients with MCAO treated by IVT, HU value may be a prognostic indicator for stroke patients with MCAO treated by IVT.
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Affiliation(s)
- Zhengqi Zhu
- Department of Radiology, The Second Affiliated Hospital of Nantong University, 6 Haierxiang North Road, Nantong, 226001, Jiangsu, China
| | - Ru Zhang
- Department of Radiology, The Second Affiliated Hospital of Nantong University, 6 Haierxiang North Road, Nantong, 226001, Jiangsu, China
| | - Kaixuan Ren
- Department of Radiology, The Second Affiliated Hospital of Nantong University, 6 Haierxiang North Road, Nantong, 226001, Jiangsu, China
| | - Ruochen Cong
- Department of Radiology, The Second Affiliated Hospital of Nantong University, 6 Haierxiang North Road, Nantong, 226001, Jiangsu, China
| | - Xiangyang Zhu
- Department of Neurology, The Second Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Li Zhu
- Department of Radiology, The Second Affiliated Hospital of Nantong University, 6 Haierxiang North Road, Nantong, 226001, Jiangsu, China
| | - Tianle Wang
- Department of Radiology, The Second Affiliated Hospital of Nantong University, 6 Haierxiang North Road, Nantong, 226001, Jiangsu, China.
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Kristoffersen ES, Jahr SH, Thommessen B, Rønning OM. Effect of COVID-19 pandemic on stroke admission rates in a Norwegian population. Acta Neurol Scand 2020; 142:632-636. [PMID: 32620027 PMCID: PMC7361547 DOI: 10.1111/ane.13307] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/17/2020] [Accepted: 06/26/2020] [Indexed: 11/25/2022]
Abstract
Objectives There are concerns that public anxiety around COVID‐19 discourages patients from seeking medical help. The aim of this study was to see how lockdown due to the pandemic affected the number of admissions of acute stroke. Methods All patients discharged from Akershus University Hospital with a diagnosis of transient ischemic attack (TIA) or acute stroke were identified by hospital chart review. January 3 to March 12 was defined as before, and March 13 to April 30 as during lockdown. Results There were 21.8 admissions/week before and 15.0 admissions/week during the lockdown (P < .01). Patients had on average higher NIHSS during the lockdown than before (5.9 vs. 4.2, P = .041). In the multivariable logistic regression model for ischemic stroke (adjusted for sex, age, living alone and NIHSS ≤ 5), there was an increased OR of 2.05 (95% CI 1.10‐3.83, P = .024) for not reaching hospital within 4.5 hours during the lockdown as compared to the period before the lockdown. Conclusion There was a significant reduction in number of admissions for stroke and TIAs during the lockdown due to the COVID‐19 pandemic in Norway.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Department of Neurology Akershus University Hospital Lørenskog Norway
- Department of General Practice University of Oslo Oslo Norway
| | - Silje Holt Jahr
- Department of Neurology Akershus University Hospital Lørenskog Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Bente Thommessen
- Department of Neurology Akershus University Hospital Lørenskog Norway
| | - Ole Morten Rønning
- Department of Neurology Akershus University Hospital Lørenskog Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
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