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Feng J, Yang Q, Chen M, Wang Y, Luo D, Hu D, Cheng J, Song X, Zhou X, Meng Q, Lin Q, He F. Protective effects of 4-HBd on blood-brain barrier integrity in MCAO/R model rats based on brain pharmacokinetic characteristics. Front Pharmacol 2025; 16:1528839. [PMID: 40264675 PMCID: PMC12012380 DOI: 10.3389/fphar.2025.1528839] [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: 11/15/2024] [Accepted: 03/03/2025] [Indexed: 04/24/2025] Open
Abstract
Objectives This study explored the brain-targeting properties and mechanisms of 4-hydroxybenzaldehyde (4-HBd), the primary active component of Gastrodia elata, in mitigating ischemic stroke (IS)-induced injury by preserving blood-brain barrier (BBB) integrity, based on brain pharmacokinetic characteristics. Methods The anti-IS effects of the G. elata extract were assessed using a rat middle cerebral artery occlusion/reperfusion (MCAO/R) model, leading to the identification of 4-HBd as the principal active ingredient. BBB protection was evaluated through neurological scoring, Evans Blue (EB) extravasation, cerebral infarct volume, and ultrastructural integrity. Oxidative stress markers, including superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide (NO), and inducible nitric oxide synthase (iNOS), were quantified in ischemic brain tissue via biochemical assays. The expression levels of tight junction (TJ) proteins claudin-5 and occludin, as well as matrix metalloproteinase MMP-2/9 and aquaporin-4 (AQP-4), were analyzed by Western blotting. Microdialysis, combined with liquid chromatography-tandem mass spectrometry (LC-MS/MS), was employed to determine the temporal distribution of 4-HBd in the brains of both normal and MCAO/R model rats. The ability of 4-HBd to scavenge intracellular reactive oxygen species (ROS) in brain endothelial cells (bEnd.3) was evaluated using a single-cell biochemical analyzer. Results G. elata ethanol extract exhibited significant anti-IS effects. When compared with the model group, 4-HBd treatment markedly alleviated BBB disruption and neurological deficits, suppressed oxidative stress in ischemic brain tissue, reduced MDA and NO levels, and enhanced SOD activity. The expressions of claudin-5, occludin, MMP-2/9, and AQP-4 were significantly upregulated in the 4-HBd group relative to the model group. Additionally, 4-HBd selectively eliminated nuclear-derived ROS. Pharmacokinetic analysis demonstrated that 4-HBd preferentially accumulated in the striatum and cortex of both normal and MCAO/R model rats. Under ischemic conditions, 4-HBd exhibited accelerated cortical penetration, increased exposure, and prolonged retention. Conclusion These findings indicate that 4-HBd exerts a pronounced brain-targeting effect and preserves BBB integrity via the RNS/ROS-MMP-TJ signaling pathway, highlighting its potential as a therapeutic agent for IS.
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Affiliation(s)
- Jin Feng
- Department of Pharmacology, School of Chinese Materia Medica, Yunnan University of Chinese Medicine, Kunming, China
| | - Qian Yang
- Department of Pharmacology, School of Chinese Materia Medica, Yunnan University of Chinese Medicine, Kunming, China
| | - Ming Chen
- Department of Pharmacology, School of Chinese Materia Medica, Yunnan University of Chinese Medicine, Kunming, China
| | - Yan Wang
- Department of Pharmacology, School of Chinese Materia Medica, Yunnan University of Chinese Medicine, Kunming, China
| | - Dan Luo
- Department of Pharmacology, School of Chinese Materia Medica, Yunnan University of Chinese Medicine, Kunming, China
| | - Dongxiong Hu
- Department of Pharmacology, School of Chinese Materia Medica, Yunnan University of Chinese Medicine, Kunming, China
- School of Basic Medicine, Yunnan University of Chinese Medicine, Kunming, China
| | - Jianjun Cheng
- Department of Pharmacology, School of Chinese Materia Medica, Yunnan University of Chinese Medicine, Kunming, China
| | - Xuelan Song
- Department of Pharmacology, School of Chinese Materia Medica, Yunnan University of Chinese Medicine, Kunming, China
| | - Xiaonan Zhou
- Department of Pharmacology, School of Chinese Materia Medica, Yunnan University of Chinese Medicine, Kunming, China
| | - Qingting Meng
- Department of Pharmacology, School of Chinese Materia Medica, Yunnan University of Chinese Medicine, Kunming, China
| | - Qing Lin
- Department of Pharmacology, School of Chinese Materia Medica, Yunnan University of Chinese Medicine, Kunming, China
| | - Fangyan He
- Department of Pharmacology, School of Chinese Materia Medica, Yunnan University of Chinese Medicine, Kunming, China
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He R, Xu X, Chen X, Cai H, Huang X, Shu H. Nomogram Model for Predicting the Functional Outcomes in Patients With Minor Ischemic Stroke Based on Clinical Characteristics and Small Vessel Disease Burden. Neurologist 2025:00127893-990000000-00183. [PMID: 40104991 DOI: 10.1097/nrl.0000000000000614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2025]
Abstract
OBJECTIVES Our purpose is to assess the role of total small vessel disease (SVD) burden affecting the clinical outcome and develop and validate a prognostic nomogram for minor ischemic stroke (MIS) patients. METHODS Between January 2018 and April 2023, 454 MIS patients were enrolled. The functional outcome was the modified Rankin scale (mRS) score at 90 days. The least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression model were used to identify prognostic predictors, and then a nomogram was drawn. RESULTS Our nomogram comprising of systolic blood pressure (SBP), baseline National Institutes of Health Stroke Scale score (NIHSS), total SVD burden scores, coronary heart disease, disabling stroke, progressive stroke, alteplase treatment, and infarction location demonstrated a good discriminative power in both the training set (AUC=0.870; 95% CI: 0.827-0.912) and the internal validation set (AUC=0.876; 95% CI: 0.817-0.935). The calibration curve and DCA in our result showed the model's high degree of calibration and clinical value. The DeLong test was used to compare the AUCs between the nomogram and non-SVD burden score model in the training (P=0.028) and internal validation sets (P=0.013), indicating that our nomogram performs significantly better than the non-SVD burden score model. CONCLUSIONS The SVD burden is an important prognosis factor. Furthermore, the proposed nomogram has good discrimination, calibration, and clinical benefits and is better than the non-SVD burden score model in predicting the outcomes for MIS patients.
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Affiliation(s)
| | | | | | - Haoye Cai
- Rehabilitation, The Third Affiliated Hospital of Wenzhou Medical University (Ruian People's Hospital), Wenzhou, Zhejiang, People's Republic of China
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Xia Y, Liu H, Zhu R, Zhou X, Huang C, Sun Z. Analysis of Non-Cardiogenic Young Minor Ischemic Stroke Patients' Risk Factors in Chinese Han Population. Med Sci Monit 2025; 31:e946146. [PMID: 39891380 PMCID: PMC11796284 DOI: 10.12659/msm.946146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Accepted: 11/15/2024] [Indexed: 02/03/2025] Open
Abstract
BACKGROUND Young adults with minor ischemic stroke (MIS) often experience early onset and mild symptoms but face a high recurrence rate. Research into risk factors and etiology of young adult MIS in developing countries is limited. We investigated these aspects in young non-cardiogenic MIS patients from the Chinese Han population and identified risk factors for initial stroke and long-term poor prognosis. MATERIAL AND METHODS Data from MIS patients aged 18 to 50 years and a healthy control group at The First Affiliated Hospital of Anhui Medical University and The Third People's Hospital of Hefei City from January 2019 to July 2023 were analyzed. Risk factors and stroke etiology were compared. ROC curves assessed the predictive ability of original and modified Essen Stroke Risk Scores (ESRS). RESULTS Among 155 patients, 25 (16.1%) experienced recurrence within a year. Patients with MIS differed significantly from the control group in sex, hypertension history, diabetes, dyslipidemia, smoking, higher biomarkers (SBP, TG, VLDL-C, hs-CRP, WBC, RBC, NEUT, HB), and lower HDL-C. Univariate analysis found dyslipidemia, moderate to severe vascular stenosis, resting heart rate, and modified ESRS scores linked to recurrence. Multivariate analysis identified dyslipidemia, vascular stenosis, and resting heart rate as key risk factors. Large artery atherosclerosis was the most common stroke etiology (59.2%). ROC curves revealed areas under the curve for ESRS, modified ESRS-1, and modified ESRS-2 as 0.550, 0.660, and 0.937, respectively. CONCLUSIONS MIS was associated with a high recurrence rate and specific risk factors. Improved ESRS effectively predicted stroke recurrence within 1 year, with large artery atherosclerosis being the predominant etiology.
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Affiliation(s)
- Yu Xia
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
- Department of Neurology, The Third People’s Hospital of Hefei (The Third Clinical College of Anhui Medical University), Hefei, Anhui, PR China
| | - Han Liu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Rui Zhu
- Department of Neurology, The Third People’s Hospital of Hefei (The Third Clinical College of Anhui Medical University), Hefei, Anhui, PR China
| | - Xia Zhou
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Chaojuan Huang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Zhongwu Sun
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
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Moawad MHED, Salem T, Alaaeldin A, Elaraby Y, Awad PD, Khalifa AA, Naggar AE, Mohamed KA, Elhalal M, Badr M, Abdelnaby R. Safety and efficacy of intravenous thrombolysis: a systematic review and meta-analysis of 93,057 minor stroke patients. BMC Neurol 2025; 25:33. [PMID: 39844066 PMCID: PMC11752810 DOI: 10.1186/s12883-024-04000-8] [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: 10/05/2024] [Accepted: 12/13/2024] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND The definition of minor ischemic stroke (MIS) is a topic of debate, however, the most accepted definition is a stroke with National Institutes of Health Stroke Scale (NIHSS) ≤ 5. Intravenous thrombolysis (IVT) is a crucial treatment option for acute ischemic stroke (AIS) including: alteplase, recombinant human tissue-type plasminogen activator (r-tPA), and the recently approved tenecteplase. However, there is a debate regarding its safety and efficacy. Therefore, our objective was to determine the safety and efficacy of IVT in treating minor stroke patients (NIHSS ≤ 5). METHODS Using the search strategy assigned which was based on three keywords: "mild" or "minor", "stroke", and "intravenous thrombolysis", we searched for eligible articles on PubMed, Web of Science, Embase, and Scopus from inception till 10th January 2024. We conducted this meta-analysis using the random effect model to account for the heterogeneity among the studies. For the dichotomous variables, we calculated the odds ratio (OR) from the event and total of these variables. While for the continuous variables, we calculated the mean difference (MD) of these variables. Pooling of OR for the occurrence of events was also conducted. RESULTS A total of 21 articles with 93,057 patients with MIS were included. The mean age of the participants ranged from 62.3 to 79.6. Most of the included patients had comorbidities such as hypertension, diabetes, previous stroke, smoking, atrial fibrillation, and hyperlipidemia. Of these, 10,850 received IVT while 82,207 did not. The use of IVT was statistically significant associated with 90-day modified Rankin score (mRs) 0-1 when compared with control with OR of 1.67 (95%CI: 1.46, 1.91, p < 0.00001) and was statistically significantly associated with improvement of NIHSS on discharge with OR of 2.19 (95%CI: 1.56, 3.08, p < 0.00001). In terms of safety outcomes, IVT has proven a safe profile, as there was no significant difference in intracranial hemorrhage (ICH) and mortality rates between the IVT and control groups with OR of 1.75 (95CI: 0.95, 3.23, p = 0.07) and 0.93 (95%CI: 0.77, 1.11, p = 0.41), respectively. CONCLUSION Although some studies have not found any benefits of IVT in MIS patients, a substantial body of literature strongly endorses IVT as an effective and safe treatment for MIS. IVT has been shown to improve the mRs and NIHSS scores at the 90-day mark without an increased risk of ICH or mortality.
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Affiliation(s)
- Mostafa Hossam El Din Moawad
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Alexandria Main University Hospital, Alexandria, Egypt
| | - Talal Salem
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | | | - Peter D Awad
- Department of Public Health, Theodor Bilharz Research Institute, Cairo, Egypt
| | | | | | | | - Mohamed Elhalal
- Neuroradiology Department, RWTH University Hospital of Aachen, Aachen, Germany
| | - Mostafa Badr
- Department for Epileptology, Bonn University, Bonn, Germany
| | - Ramy Abdelnaby
- Department of Neurology, RWTH Aachen University, Pauwels Street 30, Aachen, 52074, Germany.
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Lei Z, Li S, Feng H, Wu X, Hu S, Li J, Xu G, Ren L, Pan S. Effects of intravenous rtPA in patients with minor stroke. Ann Med 2024; 56:2304653. [PMID: 38289926 PMCID: PMC10829835 DOI: 10.1080/07853890.2024.2304653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Whether minor ischemic stroke (MIS) patients can benefit from intravenous thrombolysis (IVT) remains controversial. The association between the efficacy of IVT and baseline National Institute of Health Stroke Scale (NIHSS) score is unclear in MIS, while the association in moderate and severe stroke is known. This study aimed to explore the effect of IVT in patients with MIS and analyze its efficacy in patients with different baseline NIHSS scores. METHODS Patients with a NIHSS score ≤5 within 4.5 h of stroke onset were screened in 32 centers. Patients with and without IVT were matched to a ratio of 1:1 with propensity scores. An excellent outcome was defined as a modified Rankin Scale (mRS) score ≤1 at three months after stroke onset. Safety outcomes included mortality and symptomatic intracranial hemorrhage (sICH). Multivariate analysis was used to compute the adjusted odds ratio (OR) for excellent outcomes. The effect of IVT was further analyzed in subgroups according to the baseline NIHSS score. RESULTS Of the 23,853 screened, 3336 patients with MIS who arrived at the hospital within 4.5 h of onset were included. The 1163 patients treated with IVT were matched with 1163 patients without IVT. IVT in minor strokes generated an adjusted OR of 1.38 (95% CI: 1.09-1.75, p = 0.009) for excellent outcomes. There were no significant differences in mortality (0.17% vs. 0.09%, p = 1.000) and sICH (0.69% vs. 0.86%, p = 0.813) between patients with and without IVT. Subgroup analysis showed that there was no significant effect of IVT in the baseline NIHSS 0-1 or 2-3 subgroups, with adjusted OR of 0.816 (95% CI 0.437-1.53, p = 0.525) and1.22 (95% CI 0.845-1.77, p = 0.287), respectively. In patients with NIHSS score of 4-5, IVT was significantly effective, with an adjusted OR of 1.53 (95% CI 1.02-2.30, p = 0.038). CONCLUSION IVT can improve MIS outcomes. The risks of sICH and mortality did not increase, especially in patients with NIHSS scores 4 to 5, who could benefit from IVT significantly.
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Affiliation(s)
- Zhihao Lei
- Department of Neurology, Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Shuanglin Li
- Department of Anatomy and Histology, School of Basic Medical Sciences, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, China
| | - Hongye Feng
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Xiaohong Wu
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Shiyu Hu
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Jun Li
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Gelin Xu
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Lijie Ren
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Suyue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Chen C, Ai Q, Tian H, Wei Y. CKLF1 in cardiovascular and cerebrovascular diseases. Int Immunopharmacol 2024; 139:112718. [PMID: 39032474 DOI: 10.1016/j.intimp.2024.112718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/14/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
Chemokine like factor 1 (CKLF1) is a novel atypical chemokine, playing a crucial role in cardiovascular and cerebrovascular diseases (CCVDs) demonstrated by a growing body of works. In cardiovascular diseases including atherosclerosis and myocardial infarction, meanwhile in cerebrovascular diseases such as ischemic stroke and hemorrhagic stroke, the expression levels of CKLF1 change markedly, which triggers downstream signaling pathways by binding with its functional receptors, and then exerts multiple effects to participate in the occurrence and development of these CCVDs. The functional roles of CKLF1 are dynamic and CKLF1 may act as a double-edged sword. The CCVDs-promoting role is related to recruiting inflammatory cells, enhancing the proliferation of vascular smooth muscle cells and endothelial cells, while the CCVDs-suppressing role may correlate with migration of nerve cells and promotion of hematopoietic stem cell proliferation which contributes to disease recovery. Based on this, the paper intends to review expression shifts, potential roles, and molecular mechanisms of CKLF1 in CCVDs, and the current status of CKLF1 targeted therapeutic strategies is also included. We hope this review may provide a valuable reference for using CKLF1 as a diagnostic and prognostic biomarker for CCVDs or developing novel treatments.
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Affiliation(s)
- Chen Chen
- Department of Pharmacy, The First Hospital of Lanzhou University, Lanzhou 730000, China.
| | - Qidi Ai
- Hunan University of Traditional Chinese Medicine, Changsha 410208, China
| | - Haiyan Tian
- Department of Pharmacy, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Yuhui Wei
- Department of Pharmacy, The First Hospital of Lanzhou University, Lanzhou 730000, China
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Zhang Y, Lv T, Nguyen TN, Wu S, Li Z, Bai X, Chen D, Zhao C, Lin W, Chen S, Sui Y. Intravenous Alteplase Versus Best Medical Therapy for Patients With Minor Stroke: A Systematic Review and Meta-Analysis. Stroke 2024; 55:883-892. [PMID: 38465591 DOI: 10.1161/strokeaha.123.045495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/29/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND The efficacy of thrombolysis (IVT) in minor stroke (National Institutes of Health Stroke Scale score, 0-5) remains inconclusive. The aim of this study is to compare the effectiveness and safety of IVT with best medical therapy (BMT) by means of a systematic review and meta-analysis of randomized controlled trials and observational studies. METHODS We searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to IVT in minor stroke from inception until August 10, 2023. The primary outcome was an excellent functional outcome, defined as a modified Rankin Scale score of 0 or 1 at 90 days. The associations were calculated for the overall and preformulated subgroups by using the odds ratios (ORs). This study was registered with PROSPERO (CRD42023445856). RESULTS A total of 20 high-quality studies, comprised of 13 397 patients with acute minor ischemic stroke, were included. There were no significant differences observed in the modified Rankin Scale scores of 0 to 1 (OR, 1.10 [95% CI, 0.89-1.37]) and 0 to 2 (OR, 1.16 [95% CI, 0.95-1.43]), mortality rates (OR, 0.67 [95% CI, 0.39-1.15]), recurrent stroke (OR, 0.89 [95% CI, 0.57-1.38]), and recurrent ischemic stroke (OR, 1.09 [95% CI, 0.68-1.73]) between the IVT and BMT group. There were differences between the IVT group and the BMT group in terms of early neurological deterioration (OR, 1.81 [95% CI, 1.17-2.80]), symptomatic intracranial hemorrhage (OR, 7.48 [95% CI, 3.55-15.76]), and hemorrhagic transformation (OR, 4.73 [95% CI, 2.40-9.34]). Comparison of modified Rankin Scale score of 0 to 1 remained unchanged in subgroup patients with nondisabling deficits or compared with those using antiplatelets. CONCLUSIONS These findings indicate that IVT does not yield significant improvement in the functional prognosis of patients with acute minor ischemic stroke. Additionally, it is associated with an increased risk of symptomatic intracranial hemorrhage when compared with the BMT. Moreover, IVT may not have superiority over BMT in patients with nondisabling deficits or those using antiplatelets.
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Affiliation(s)
- Yang Zhang
- School of Public Health, China Medical University, Shenyang, China (Y.Z., X.B., D.C., Y.S.)
| | - Tian Lv
- Department of Neurology, Zhuji Affliated Hospital of WenZhou University, China (T.L.)
| | - Thanh N Nguyen
- Department of Neurology and Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine (T.N.N.)
| | - Simiao Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.W.)
| | - Zhi Li
- Department of Medical Oncology (Z.L.), The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xue Bai
- School of Public Health, China Medical University, Shenyang, China (Y.Z., X.B., D.C., Y.S.)
| | - Dan Chen
- School of Public Health, China Medical University, Shenyang, China (Y.Z., X.B., D.C., Y.S.)
| | - Chuansheng Zhao
- and Department of Neurology (C.Z., Y.S.), The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wanyi Lin
- Department of Neurology, Qingtian County Hospital, Lishui, China (W.L.)
| | - Shiqin Chen
- Department of Neurology, Second People's Hospital of Yuhuan, China (S.C.)
| | - Yi Sui
- School of Public Health, China Medical University, Shenyang, China (Y.Z., X.B., D.C., Y.S.)
- Department of Neurology and Neurointervention, Shenyang First People's Hospital, Shenyang Medical College Affiliated Brain Hospital, China (Y.S.)
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Hagberg G, Ihle-Hansen H, Abzhandadze T, Reinholdsson M, Hansen HI, Sunnerhagen KS. Prognostic value of acute National Institutes of Health Stroke Scale Items on disability: a registry study of first-ever stroke in the western part of Sweden. BMJ Open 2023; 13:e080007. [PMID: 38110379 DOI: 10.1136/bmjopen-2023-080007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVES We aimed to study how the individual items of the National Institutes of Health Stroke Scale (NIHSS) at admission predict functional independence 3 months post-stroke in patients with first-ever stroke. SETTING This registry-based study used data from two Swedish stroke registers (Riksstroke, the mandatory national quality register for stroke care in Sweden, and Väststroke, a local quality stroke register in Gothenburg). PARTICIPANTS This study included patients with first-ever acute stroke admitted from November 2014 to August 2018, with available NIHSS at admission and modified Rankin Scale (mRS) at 3-month follow-up. PRIMARY OUTCOME The primary outcome variable was mRS≤1 (defined as an excellent outcome) at 3-month follow-up. RESULTS We included 1471 patients, mean age was 72 (± 14.5) years, 48% were female, and 66% had mild strokes (NIHSS≤3). In adjusted binary logistic regression analysis, the NIHSS items impaired right motor arm and leg, and impairment in visual field, reduced the odds of an excellent outcome at 3 months ((OR 0.60 (95% CI 0.37 to 0.98), OR 0.60 (95% CI 0.37 to 0.97), and OR 0.65 (95% CI 0.45 to 0.94)). When exploring the effect size of associations between NIHSS items and mRS≤1 p, orientation, language and right leg motor had the largest yet small association. CONCLUSIONS Stroke patients with scores on the NIHSS items right motor symptoms or visual field at admission are less likely to have an excellent outcome at 3 months. Clinicians should consider the NIHSS items affected, not only the total NIHSS score, both in treatment guidance and prognostics.
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Affiliation(s)
- Guri Hagberg
- Oslo Stroke Unit, Neurological Department, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Gothenburg University, Goteborg, Sweden
| | - Haakon Ihle-Hansen
- Bærum Hospital- Vestre Viken Hospital Trust, Department of Medicine, Drammen, Norway
| | - Tamar Abzhandadze
- Institute of Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Gothenburg University, Goteborg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Malin Reinholdsson
- Institute of Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Gothenburg University, Goteborg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Hege Ihle Hansen
- Oslo Stroke Unit, Neurological Department, Oslo University Hospital, Ullevål, Oslo, Norway
- Bærum Hospital- Vestre Viken Hospital Trust, Department of Medicine, Drammen, Norway
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Gothenburg University, Goteborg, Sweden
- Neurocare, Sahlgrenska University Hospital, Goteborg, Sweden
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Monday O, Rawat A, Isaak AK, Manzoor A, Jaiswal G, Saeed L, Kumari A, Amin A. Comparing the Effectiveness of Intravenous Tissue Plasminogen Activator and Dual Antiplatelet Therapy in Patients With Minor Stroke: A Meta-Analysis. Cureus 2023; 15:e46436. [PMID: 37927654 PMCID: PMC10624328 DOI: 10.7759/cureus.46436] [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] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
The aim of this study was to compare the outcomes between dual antiplatelet therapy (DAPT) versus intravenous tissue plasminogen activator (IV t-PA) in patients with minor stroke. This meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Two authors independently conducted online database searches using PubMed, Web of Science, and EMBASE to identify articles published in English language from inception to September 5, 2023. Outcomes assessed in this meta-analysis included all-cause mortality, stroke incidence, and functional outcomes (measured by modified ranking scale (mRS) scores of 0 to 1). A total of three studies fulfilled the eligibility criteria and included in the final analysis. Pooled analysis showed that the risk of all-cause mortality was not significantly different between the t-PA group and DAPT group (relative risk (RR): 1.14, 95% confidence interval (CI): 0.32-4.06). Compared with those treated with DAPT, there was no significant difference in t-PA in terms of the number of patients with a favorable functional outcome (defined as an mRS score of 0-1). The risk of stroke was not significantly different between the t-PA group and DAPT group (RR: 1.11, 95% CI: 0.68 to 1.82). The analysis, based on three studies, revealed no significant differences between t-PA and DAPT regarding all-cause mortality, stroke incidence, and functional outcomes.
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Affiliation(s)
- Obinna Monday
- Medicine, Norfolk and Norwich University Hospital, Norwich, GBR
| | - Anurag Rawat
- Interventional Cardiology, Himalayan Institute of Medical Sciences, Dehradun, IND
| | - Abraham K Isaak
- Telemetry, Sharp Memorial Hospital, San Diego, USA
- Internal Medicine, Orotta School of Medicine and Dentistry, Asmara, ERI
| | - Amima Manzoor
- Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Goldi Jaiswal
- Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | - Leena Saeed
- Internal Medicine, National Ribat University, Khartoum, SDN
| | - Ajanta Kumari
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Adil Amin
- Cardiology, Pakistan Navy Ship Shifa (PNS Shifa), Karachi, PAK
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Ekkert A, Milmantienė D, Jokimaitytė U, Jatužis D. Posterior Circulation Stroke Patients Receive Less Reperfusion Therapy Because of Late Arrival and Relative Contraindications: A Retrospective Study. J Clin Med 2023; 12:5181. [PMID: 37629223 PMCID: PMC10455447 DOI: 10.3390/jcm12165181] [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: 06/25/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Reperfusion treatment (RT) is administered to individuals with posterior circulation strokes (PCS) later and less frequently. We aimed to study the impact of demographic and clinical factors on the decision for RT in PCS. METHODS We conducted a retrospective analysis of the data from 500 subjects admitted to the tertiary stroke centre's emergency department between 2018 and 2020 due to PCS. Demographic and clinical factors were analysed among three groups: the RT group, the group with no RT because of absolute contraindications (ACI), and the group with no RT because of relative contraindications (RCI). RESULTS Of the patients, 202 (40.3%) were female. The median NIHSS was four (4), and the subjects' median age was 69 (18). RT was performed on 120 (24%) subjects. FAST symptoms (OR-5.62, 95% CI [2.90-12.28]) and higher NIHSS (OR-1.13, 95% CI [1.09-1.18]) at presentation, atrial fibrillation (OR-1.56, 95% CI [1.02-2.38]), hypertension (OR-2.19, 95% CI [1.17-4.53]) and diabetes (OR-1.70, 95% CI [1.06-2.71]) increased the chance of RT. Late arrival was the most prevalent ACI for 291 (58.2%) patients. FAST-negative subjects (OR-2.92, 95% CI [1.84-4.77]) and males (OR-1.58, 95% CI [1.11-2.28]) had a higher risk of arriving late. Because of RCI, 50 (10%) subjects did not receive RT; the majority were above 80 and had NIHSS ≤ 5. Subjects with RCI who received the RT had a higher NIHSS (4 vs. 3, p < 0.001), higher hypertension (59 (92.2%) vs. 35 (77.8%), p = 0.032) and heart failure (23 (35.9%) vs. 7 (15.6%), p = 0.018) prevalence. There was a trend for less RT in females with RCI. CONCLUSIONS Late arrival was the most common barrier to RT, and the male gender increased this risk. because of relative contraindications, 10% of subjects were not considered for RT. The presence of FAST symptoms, vascular risk factors, and a higher NIHSS increased the chance of RT.
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Affiliation(s)
- Aleksandra Ekkert
- Faculty of Medicine, Vilnius University, LT-03225 Vilnius, Lithuania; (D.M.); (U.J.); (D.J.)
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