Chinese Stroke Association guidelines for clinical management of ischaemic cerebrovascular diseases: executive summary and 2023 update

A prospective cohort study on prognostic implications of serum platelet derived microparticles levels in acute cerebral infarction

Platelet-derived microparticles (PDMPs) participate in ischemic brain injury. We further determined the relationships between serum PDMPs levels and early neurological deterioration (END) as well as functional outcome after acute cerebral infarction (ACI). In this prospective cohort study, serum PDMPs levels were measured in 125 controls and 621 patients with ACI. Univariate analysis and multivariate analysis were sequentially applied to investigate the relations of serum PDMPs levels to END and poor prognosis (modified Rankin scale score > 2) at six months after ACI. Serum PDMPs levels were significantly higher in patients than in controls (median, 14.00 ng/L vs. 27.00 ng/L; P < 0.001). Serum PDMPs levels were strongly correlated with infarction volume (ρ = 0.532, P < 0.001), National Institutes of Health Stroke Scale score (ρ = 0.627, P < 0.001) and modified Rankin scale score (ρ = 0.528, P < 0.001). It was independently associated with END [odds ratio (OR) 1.117, 95% confidence interval (CI) 1.008-1.238; P = 0.001] and poor prognosis (OR 1.092, 95% CI 1.066-1.119; P = 0.001). There were linear relationships between serum PDMPs levels and risks of poor prognosis (P for non-linear = 0.055) plus END (P for non-linear = 0.061) under restricted cubic spline. Using subgroup analysis, significant interaction existed between serum PDMPs levels and age in association of poor prognosis (P for interaction = 0.006), as well as between serum PDMPs levels and coronary heart disease in association of END (P for interaction = 0.017). Serum PDMPs levels significantly discriminated the development of poor prognosis (Area under curve 0.705, 95% CI 0.632-0.778; P < 0.001) and END (The area 0.733, 95% CI 0.664-0.803; P < 0.001). Serum PDMPs levels may predict the risk of END and 6-month poor prognosis in patients with ACI.

Clinical value of Lp-PLA2, LDL-C, HDL-C, hs-CRP, leukocyte, FPG and HbA1c in type 2 diabetes mellitus patients with acute ischemic stroke

Background

To evaluate the clinical significance of human plasma lipoprotein-associated phospholipase A2 (Lp-PLA2), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), high-sensitivity C-reactive protein (hs-CRP), leukocyte count, fasting plasma glucose (FPG), and glycated hemoglobin (HbA1c) in patients with Type 2 diabetes mellitus (T2DM) and acute ischemic stroke (AIS).

Methods

A total of 155 T2DM patients with AIS, admitted to the Second Affiliated Hospital of Shantou University Medical College between October 2023 and October 2024, were included in the stroke group. Additionally, 86 T2DM subjects from the same period were included in the T2DM control group. Serum levels of Lp-PLA2, LDL-C, HDL-C, hs-CRP, leukocyte count, FPG, and HbA1c were compared between the T2DM-AIS group and the T2DM control group, as well as among T2DM-AIS patients with different infarct sizes and degrees of neurological impairment. The clinical value of the above indexes in the diagnosis of T2DM with AIS was analyzed by receiver operating characteristic curve (ROC curve).

Results

Serum levels of Lp-PLA2 (142.9 [115.8, 178.3] ng/L), LDL-C (3.4 [2.6, 4.2] mmol/L), hs-CRP (3.6 [1.5, 11.2] mg/L), leukocytes (8.0 [6.8, 10.3] × 10^9/L), FPG (10.2 [7.5, 14.4] mmol/L), and HbA1c (10.2 [7.5, 14.4] %) were significantly higher in the T2DM-AIS group compared to the T2DM control group (Lp-PLA2: 102.1 [76.6, 121.9] ng/L, LDL-C: 3.2 [2.4, 3.7] mmol/L, hs-CRP: 2.4 [0.9, 5.2] mg/L, leukocytes: 7.0 [6.1, 8.1] × 10^9/L, FPG: 7.4 [6.1, 10.3] mmol/L, HbA1c: 7.0 [6.4, 8.2] %). In contrast, serum HDL-C levels (1.1 [0.9, 1.3] mmol/L) were significantly lower than those in the control group (1.3 [1.1, 1.5] mmol/L), which correlated with larger infarct size and greater neurological injury. ROC curve analysis indicated that the combined use of seven tests had an AUC of 0.906, with a sensitivity of 77.40% and a specificity of 95.30%.

Conclusion

Monitoring serum levels of Lp-PLA2, LDL-C, HDL-C, hs-CRP, leukocyte count, FPG, and HbA1c provides a comprehensive assessment of cerebral infarction in T2DM patients with AIS and serves as auxiliary indicators for evaluating disease severity.

Effect of DU meridian acupuncture and temporal three-needle on vascular protection mechanisms in patients with acute cerebral infarction: a randomized controlled evaluator-blinded clinical trial

Background

The incidence of acute ischemic stroke has been rising steadily in China and globally, with its high mortality and disability rates significantly affecting quality of life. As an important adjunct therapy, acupuncture has been widely implemented in stroke management. Emerging studies have investigated the effects of DU meridian and Chong Mai acupuncture on ischemic hemiparesis; however, the vascular protective mechanisms of electroacupuncture therapy targeting these meridians require further elucidation in stroke rehabilitation research.

Objective

This prospective cohort study aims to investigate the clinical efficacy and limitations of DU meridian acupuncture combined with Temporal Triple Needling (Sanjian) therapy in stroke rehabilitation. The intervention's therapeutic potential is evaluated through its modulatory effects on CD14+/CD14- monocyte subpopulations within peripheral blood mononuclear cells (PBMCs), with particular focus on angiogenesis-mediated vascular protection mechanisms.

Methods

Sixty-six patients with acute ischemic stroke will be randomly assigned 1:1 to control (conventional basal therapy, n = 33) and acupuncture (conventional standard stroke care + acupuncture, n = 33) groups for 10 days of intervention. The primary outcome is NIHSS score. The secondary outcomes: BMI and mRS scores, the level of TNF-A and IL-1B in serum, vascular endothelial growth factor (VEGF), Endocan ES, CD14+ and CD14- levels of peripheral blood mononuclear cells.

Discussion

The aim of this study is to investigate whether electroacupuncture targeting the DU meridian combined with Temporal Triple Needling (Sanjian) improves cerebrovascular endothelial function in acute ischemic stroke patients, thereby reducing the NIHSS score and preventing further disease progression. This study also aims to contribute positively to the development of relevant clinical treatment protocols and to facilitate further research into the underlying mechanisms of these effects.

Clinical trial registration

International Traditional Medicine Clinical Trial Registry ITMCTR2024000508.

Association of deep tiny flow voids with prognosis of acute middle cerebral artery atherosclerotic occlusion

Background

Deep tiny flow voids (DTFVs) have recently been identified as a novel form of collateral circulation linked to chronic steno-occlusive atherosclerotic middle cerebral artery (MCA) lesions, detectable via high-resolution magnetic resonance imaging (HR-MRI). To date, no study has focused on the presence and clinical significance of DTFVs in acute MCA atherosclerotic occlusion.

Materials and methods

This retrospective study included patients with acute MCA atherosclerotic occlusion from two multicenter HR-MRI cohorts. The incidence of DTFVs and its association with baseline National Institute of Health Stroke Scale (NIHSS) scores, infarct volume, and the proportion of patients with a favorable 90-day clinical outcome defined as a modified Rankin Scale (mRS) ≤ 2 were analyzed.

Results

Sixty-six patients (mean age 58.2 ± 9.2 years; 71.2% men) were included. The median time from stroke onset to image was 44.5 (27.3-67.0) hours. DTFVs were identified in 57.6% of patients with MCA atherosclerotic occlusion. After adjusting the potential confounders, DTFVs were significantly associated with lower baseline NIHSS scores (β, -3.68; 95% CI, -6.30, -1.07; p = 0.007), smaller infarct volume (β, -40.88; 95% CI, -70.15, -11.60; p = 0.007), and a higher proportion of patients with favorable 90-day clinical outcome (OR, 6.03; 95% CI, 1.39-26.19; p = 0.017).

Conclusion

The presence of DTFVs was correlated with a favorable outcome in patients with acute MCA atherosclerotic occlusion. Improved recognition and awareness of this imaging marker of collaterals could help understand the varying infarct evolution seen in MCA occlusion and contribute to more individualized management and treatment.

Polygenic Risk Score for the Efficacy of Clopidogrel in Patients With Minor Stroke or Transient Ischemic Attack: A Post Hoc Analysis of the CHANCE Trial

BACKGROUND

Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is recommended for secondary prevention in patients with a minor stroke or transient ischemic attack. However, the effectiveness of DAPT can be significantly influenced by genetic variations. This study aimed to estimate the impact of multiple single-nucleotide polymorphisms across various genes on DAPT efficacy using polygenic risk score (PRS).

METHODS

In this post hoc analysis, we included 2905 patients from the CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events), which enrolled a total of 5170 patients in China between October 2009 and July 2012. The primary outcome was new stroke within 90 days. Sixteen single-nucleotide polymorphisms across 7 genes involved in clopidogrel metabolism were selected for PRS development. PRS were calculated by summing single-nucleotide polymorphisms from each individual. The Cox proportional-hazards regression model was utilized to estimate the hazard ratio (HR) and 95% CIs of PRS. The predictive value of PRS was estimated by C statistic and compared with a previously validated model.

RESULTS

The elevated PRSs were associated with an increased risk of new stroke within 90 days (Ptrend=0.01). The efficacy of DAPT versus aspirin alone in preventing 1-year composite vascular events was significantly different between patients with low (adjusted HR, 0.47 [95% CI, 0.31-0.71]) and high PRSs (adjusted HR, 0.84 [95% CI, 0.60-1.18]; Pinteraction=0.03). In patients receiving DAPT, higher PRSs were associated with increased risk of new stroke and composite vascular events at 90 days (adjusted HR per SD increase was 1.51 [95% CI, 1.15-1.99]) and at 1 year (adjusted HR per SD increase was 1.34 [95% CI, 1.08-1.67]). The C statistic for predicting 90-day new stroke using the PRS developed in this study was 0.57 (95% CI, 0.52-0.62), compared with 0.52 (95% CI, 0.48-0.55) for the ABCD-GENE score.

CONCLUSIONS

Using PRS integrating multiple genes may enhance the precision of secondary prevention strategies for patients with minor stroke or transient ischemic attack in the short and long term.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT00979589.

Butylphthalide reduces plaque burden and improves neurological function in carotid atherosclerotic disease: a pooled analysis

Background

The influence of butylphthalide on atherosclerotic plaque burden remains underexplored. This pooled analysis was aimed to evaluate its efficacy and safety in carotid atherosclerosis.

Methods

The literature were retrieved in online databases. Carotid intima-media thickness (IMT), plaque size, Crouse score, National Institute of Health Stroke Scale (NIHSS), circulating biomarkers, and drug-related adverse events were extracted and compared between the butylphthalide group and the control group without butylphthalide.

Results

Nine randomized controlled trials with 892 subjects were included. Compared with the control group, butylphthalide significantly reduced carotid IMT (MD -0.24 mm, 95% CI [-0.31, -0.16], P < 0.00001), plaque size (MD -3.83 mm2, 95% CI [-5.64, -2.01], P < 0.0001), Crouse score (MD -0.48, 95% CI [-0.89, -0.08], P = 0.02), hs-CRP (MD -1.65 mg/L, 95% CI [-2.99, -0.30], P = 0.02) and MMP-9 (MD -12.29 μg/L, 95% CI [-16.24, -8.33], P < 0.00001). Neurological improvement (NIHSS reduction: MD -2.94, 95% CI [-4.15, -1.73], P < 0.00001) and comparable safety profiles (OR 0.93, 95% CI [0.37, 2.37], P = 0.89) were observed.

Conclusion

Butylphthalide treatment reduces carotid plaque burden, improves neurological recovery and has a high safety profile, supporting its role in stroke prevention.

Tenecteplase for ischemic stroke at 4.5 to 24 hours without thrombectomy: a cost-utility analysis from the perspective of Chinese healthcare system

Background

Tenecteplase improves functional outcomes in acute ischemic stroke (AIS) patients treated 4.5 to 24 h after symptom onset who do not undergo thrombectomy. However, its cost-utility remains unexamined.

Methods

A hybrid model combining a short-term decision tree and a long-term Markov model was developed to simulate the costs and quality-adjusted life years (QALYs) for Chinese patients with AIS at 4.5 to 24 h, who did not undergo thrombectomy. Clinical data were sourced from the TRACE-III trial, while cost data were obtained from the China National Stroke Registry and the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China database. The primary outcome was the incremental cost-effectiveness ratio (ICER). Secondary outcomes included total costs, total QALYs and remaining life expectancy, as well as the incremental cost, incremental QALYs, and incremental remaining life expectancy. One-way sensitivity analysis, probabilistic sensitivity analysis (PSA), and scenario analysis were conducted to test the robustness of the results.

Results

For a Chinese patient with AIS treated within 4.5 to 24 h after symptom onset without thrombectomy, adding tenecteplase to standard care resulted in an incremental cost of 2,536 Chinese Yuan (CNY) and an increase of 0.40 QALYs, yielding an ICER of 6,386 CNY per QALY. One-way sensitivity analysis revealed that the most significant factors influencing the ICER were the efficacy and cost of tenecteplase. PSA and scenario analyses confirmed the robustness of these results.

Conclusion

Compared to standard medical treatment alone, administering intravenous tenecteplase between 4.5 and 24 h after onset for Chinese patients with AIS who did not undergo thrombectomy, is highly cost-effective.

Early Versus Delayed Antihypertensive Treatment After Acute Ischemic Stroke by Hypertension History

BACKGROUND

We performed a prespecified subgroup analysis of the CATIS-2 trial (China Antihypertensive Trial in Acute Ischemic Stroke II) to compare the effect of early versus delayed antihypertensive treatment on death and disability in patients with and without medical history of hypertension.

METHODS

CATIS-2 is a multicenter randomized clinical trial conducted in 106 hospitals in China. The trial randomized 4810 patients with acute ischemic stroke within 24 to 48 hours of symptom onset and elevated systolic blood pressure between 140 and <220 mm Hg to receive antihypertensive treatment immediately after randomization or to discontinue antihypertensive medications for 7 days and then receive treatment on day 8. The primary outcome was a combination of death or functional dependency (modified Rankin Scale score ≥3) at 90 days.

RESULTS

At the 90-day follow-up, the primary outcome of death or functional dependency was not different between early- and delayed-treatment groups according to the history of hypertension; the odds ratios (95% CIs) associated with the early-treatment group were 1.11 (0.91-1.36) and 1.38 (0.92-2.08) for participants with and without a history of hypertension. However, the ordinal logistic regression showed that early antihypertensive treatment was associated with the odds of a higher modified Rankin Scale score in patients without hypertension (odds ratio, 1.35 [95% CI, 1.01-1.82]), but not in those with hypertension (odds ratio, 0.95 [95% CI, 0.82-1.10]; P=0.04 for interaction).

CONCLUSIONS

Early antihypertensive treatment did not reduce the odds of dependency or death at 90 days by hypertension history among patients with ischemic stroke but worsened functional outcomes for patients without hypertension in the ordinal analysis.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03479554.

Factors influencing the occurrence of ischemic stroke in elderly patients with hypertension and type 2 diabetes mellitus: a case-control study

OBJECTIVE

To investigate the risk factors for ischemic stroke in elderly patients with hypertension and type 2 diabetes mellitus.

METHODS

A total of 112 elderly patients with hypertension and type 2 diabetes, treated at Jiangmen Central Hospital from January 2023 to December 2023, were selected and categorized into a stroke group and a non-stroke group, each comprising 56 patients. The two groups were examined for demographic data, risk variables were evaluated by multifactorial logistic regression analysis, and the predictive value was determined using ROC curves.

RESULTS

The comparison of hyperhomocysteinemia (HHcy), fibrinogen (FIB), and high-density lipoprotein cholesterol (HDL-C) between the non-stroke and stroke groups revealed statistically significant differences (P < 0.05). Logistic regression analysis indicated that HHcy (OR 16.936; 95% CI 1.946-146.071; P = 0.010), FIB (OR 1.773; 95% CI 1.238-2.540; P = 0.002), and HDL-C (OR 0.182; 95% CI 0.043-0.775; P = 0.021) were significant factors in the onset of ischemic stroke among elderly patients with hypertension and type 2 diabetes. ROC curve analysis revealed that the area under the curve (AUC) for FIB, HDL-C, and HHcy in diagnosing stroke associated with hypertension and type 2 diabetes mellitus in the elderly were 0.704, 0.640, and 0.598, respectively, while the AUC for the combined diagnosis of all three was 0.784.

CONCLUSIONS

HHcy, FIB, and HDL-C independently influence the occurrence of ischemic stroke in elderly patients with hypertension combined with type 2 diabetes mellitus, and their combined enhanced predictive capability for ischemic stroke occurrence.

Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial

OBJECTIVE

To assess whether intra-arterial tenecteplase administered after successful endovascular recanalisation improves outcomes in patients with acute arterial occlusion of the posterior circulation.

DESIGN

Multicentre randomised controlled trial.

SETTING

31 hospitals in China, 24 January 2023 to 24 August 2023.

PARTICIPANTS

208 patients with successful recanalisation (grade 2b50-3 on the extended thrombolysis in cerebral infarction scale) of an occlusion in the V4 segment of the vertebral artery; proximal, middle, or distal segment of the basilar artery; or P1 segment of the posterior cerebral artery: 104 were randomly allocated to receive tenecteplase and 104 to receive standard care.

INTERVENTIONS

Intra-arterial tenecteplase (0.0625 mg/kg, maximum dose 6.25 mg) administered proximal to the residual thrombus (if still present) or distal to the origin of the main pontine perforator branches over 15 seconds, or endovascular treatment only (control group).

MAIN OUTCOME MEASURES

The primary outcome was freedom from disability (modified Rankin scale score 0 or 1) at 90 days after randomisation. Primary safety outcomes included symptomatic intracranial haemorrhage within 36 hours and all cause mortality at 90 days. All efficacy and safety analyses were conducted by intention to treat and adjusted for age, pre-stroke modified Rankin scale score, time from onset of moderate to severe stroke (National Institutes of Health stroke scale score ≥6) to randomisation, hypertension, and baseline stroke severity.

RESULTS

At 90 days, 36 patients (34.6%) in the tenecteplase group and 27 (26.0%) in the control group had a modified Rankin scale score of 0 or 1 (adjusted risk ratio 1.36, 95% confidence interval 0.92 to 2.02; P=0.12). Mortality at 90 days was similar between the tenecteplase and control groups: 29 (27.9%) v 28 (26.9%), adjusted risk ratio 1.13, 0.73 to 1.74. Symptomatic intracranial haemorrhage within 36 hours occurred in eight patients (8.3%) in the tenecteplase group and three (3.1%) in the control group (adjusted risk ratio 3.09, 0.78 to 12.20).

CONCLUSIONS

In patients with acute ischaemic stroke due to acute posterior large or proximal vessel occlusion, intra-arterial tenecteplase administered after successful recanalisation was not associated with a statistically significant reduction in combined disability and mortality at 90 days.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05684172.

The pleiotropic effects of statins: a comprehensive exploration of neurovascular unit modulation and blood-brain barrier protection

The blood-brain barrier (BBB) is the most central component of the neurovascular unit (NVU) and is crucial for the maintenance of the internal environment of the central nervous system and the regulation of homeostasis. A multitude of neuroprotective agents have been developed to exert neuroprotective effects and improve the prognosis of patients with ischemic stroke. These agents have been designed to maintain integrity and promote BBB repair. Statins are widely used as pharmacological agents for the treatment and prevention of ischemic stroke, making them a cornerstone in the pharmacological armamentarium for this condition. The primary mechanism of action is the reduction of serum cholesterol through the inhibition of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, which results in a decrease in low-density lipoprotein cholesterol (LDL-C) and an increase in cholesterol clearance. Nevertheless, basic and clinical research has indicated that statins may exert additional pleiotropic effects beyond LDL-C reduction. Previous studies on ischemic stroke have demonstrated that statins can enhance neurological function, reduce inflammation, and promote angiogenic and synaptic processes following ischemic stroke. The BBB has been increasingly recognized for its role in the development and progression of ischemic stroke. Statins have also been found to play a potential BBB protective role by affecting members of the NVU. This review aimed to provide a comprehensive theoretical basis for the clinical application of statins by systematically detailing how statins influence the BBB, particularly focusing on the regulation of the function of each member of the NVU.

Nanomaterials for stroke diagnosis and treatment

Nanomaterials and nanotechnology innovations possess unique physicochemical properties that present new opportunities in the realm of stroke detection, diagnosis, and treatment. This comprehensive review explores the utilization of nanomaterials in the diagnosis and treatment of strokes, encompassing recent advancements in computed tomography (CT), magnetic resonance imaging (MRI) and magnetic particle imaging (MPI), as well as groundbreaking applications of nanomaterials and bionanomaterials in drug delivery systems and brain tissue repair. Additionally, this review meticulously examines significant challenges such as biocompatibility toxicity and long-term safety, proposing potential strategies to surmount these obstacles. Moreover, this review delves into the application of nanomaterials to improve the clinical diagnosis of stroke patients, elucidates the potential of nanotechnology in post-stroke therapy, and identifies future research directions and potential clinical applications.

Stroke nurse-led intravenous thrombolytic therapy strategy for ischemic stroke based on timeline process: A quality improvement program from China

Objective

Early thrombolytic therapy for ischemic stroke within the therapeutic window is associated with improved clinical outcomes. This study investigated whether optimizing intravenous thrombolytic (IVT) therapy strategies for stroke could reduce treatment delays.

Methods

To reduce delays in IVT therapy for ischemic stroke, a series of quality improvement measures were implemented at a tertiary hospital in Hangzhou, Zhejiang Province, from June 2021 to August 2023, which included developing a timeline process management system, forming a nurse-led stroke process management team, providing homogeneous training, standardizing the IVT therapy process for ischemic stroke, and introducing an incentive policy. During the pre- (from June 2021 to February 2022, group A) and post- (from March to November 2022, group B1; from December 2022 to August 2023, group B2 [implementation of an additional incentive policy]) of the implementation the strategy, the door-to-computed tomographic angiography (CTA) time (DCT), CTA time, neurology consultation to consent for IVT, CTA-to-needle time (CNT), and door-to-needle time (DNT), the percentage of people who underwent CTA within 20 min, 15 min, and 10 min and DNT within 60 min, 45 min, and 30 min were collected and compared.

Results

Following the implementation of the standardized IVT process management strategy for stroke, the DNT for group B1 and group B2 were 30 (24, 44) min and 31 (24, 41) min, respectively, both significantly lower than the 46 (38, 58) min in group A (P < 0.001); the median DCT were both 13 min in group B1 and B2 lower than 17min in group A (P < 0.001); the median CTA were 12 min in Group B1 and 9 min in Group B2 lower than 14 min in group A (P < 0.001); similar results were observed during the neurology consultation to obtain consent for IVT and CNT. Compared with group A, the proportion of DCT ≤ 20 min, 15 min, and 10 min was higher in groups B1 and B2 (P < 0.05), and the same result was observed at DNT ≤60 min, 45 min, and 30 min (P < 0.05). However, the additional incentive policy did not significantly differ between Group B2 and Group B1.

Conclusions

Optimizing IVT therapy for ischemic stroke is a feasible approach to limit the DNT to 30 min in ischemic stroke, significantly reducing delays within the therapeutic window and increasing the number of patients meeting target time segments. Additionally, generating a timeline for the IVT therapy process by scanning positioning quick response codes was a significant breakthrough in achieving the informatization of IVT quality management for stroke.

Combined Selective Endovascular Brain Hypothermia with Edaravone Dexborneol versus Edaravone Dexborneol Alone for Endovascular Treatment in Acute Ischemic Stroke (SHE): Protocol for a Multicenter, Single-Blind, Randomized Controlled Study

INTRODUCTION

Selective endovascular brain hypothermia has been proposed as a potential neuroprotective strategy; however, its effectiveness is still not well established. The primary objective of this trial is to investigate the efficacy and safety of selective endovascular brain hypothermia with edaravone dexborneol for endovascular treatment in acute ischemic stroke (AIS).

METHODS

The SHE study is a multicenter, single-blind, randomized controlled clinical trial. Patients with acute anterior circulation ischemic stroke who received endovascular treatment within 24 h after stroke onset and achieved successful recanalization will be enrolled and centrally randomized into combined selective endovascular brain hypothermia with edaravone dexborneol or edaravone dexborneol alone groups in a 1:1 ratio (n = 564). Patients allocated to the hypothermia group will receive 300 mL cool saline at 4°C through guiding catheter (30 mL/min) into target vessel within 3 min after recanalization and then receive edaravone dexborneol (edaravone dexborneol 15 mL + NS 100 mL ivgtt bid for 10-14 days) within 24 h after admission. The control group will receive 300 mL 37°C saline (30 mL/min) infused into target vessel through guiding catheter and then receive edaravone dexborneol. All patients enrolled will receive standard care according to current guidelines for stroke management. The primary outcome is the proportion of functional independence, defined as a mRS score of 0-2 at 90 days after randomization.

CONCLUSION

This is a randomized clinical trial with a large sample size to compare combined selective endovascular brain hypothermia and edaravone dexborneol with edaravone dexborneol alone in patients with acute anterior ischemic stroke. The SHE trial aims to provide further evidence of the benefit of selective endovascular brain hypothermia in AIS patients who received endovascular treatment.

Big data analysis of endovascular treatment for acute ischemic stroke: a study based on bibliometric analysis

BACKGROUND

 While bibliometric analyses are prevalent in the medical field, few have focused on ther endovascular treatment for acute ischemic stroke (AIS).

OBJECTIVE

 To employ big data analysis to examine the research status, trends, and hotspots in endovascular treatment for AIS.

METHODS

 We conducted a comprehensive search using the Web of Science (WOS) database to identify relevant articles on the endovascular treatment for AIS from 1980 to the present. We used various tools for data analysis, including an online platform (https://bibliometric.com/app), the Citespace software, the Vosviewer software, and the ArcMap software, version 10.8. A number of bibliometric indicators were collected and analyzed, such as publication date, country where the studies were conducted, institutions to which the authors were affiliated, authors, high-frequency keywords, cooperative relationship etc. RESULTS:  A total of 5,576 articles were retrieved. A substantial increase in the number of articles occurred after 2010. High-frequency keywords included terms such as large vessel occlusion, reperfusion, outcome, and basilar artery occlusion. Among the top 10 most productive authors, Raul G. Nogueira ranked first, with 136 published articles. Among the journals, The New England Journal of Medicine ranked first, with 5,631 citations. The United States has the closest collaborative ties with other nations.

CONCLUSION

 In the present study, we found that the reports of endovascular treatment for AIS gradually increased after 2010. Among them, Raul G. Nogueira was the most productive author in this field. The New England Journal of Medicine was the most cited, and it had the greatest impact. The Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) trial study was the most cited, and it was a landmark study. There are many interesting studies on endovascular treatment for AIS, such as ischemic penumbra, collateral circulation, bridging therapy etc.

Effect of occupational therapy on the occurrence of delirium in critically ill patients: a systematic review and meta-analysis

Aim

Delirium poses a major challenge to global health care, yet there is currently a dearth of single effective interventions or medications. Particularly, addressing delirium induced by critical illness is a complex process. Occupational therapy is considered to have a high potential for use in the prevention of delirium, as it involves both cognitive training and training in ADL. To comprehensively analyze the effect of occupational therapy on delirium prevention, we evaluated the effects of occupational therapy vs. standard non-pharmacological prevention on incidence and duration of delirium, clinical outcomes and rehabilitation outcomes in critically ill patients.

Methods

The data sources, including PubMed/Medline, Web of Science, EMBASE, and Cochrane Library, were comprehensively searched from their inception until 15 October 2023. Following the PICOS principle, a systematic screening of literature was conducted to identify relevant studies. Subsequently, the quality assessment was performed to evaluate the risk of bias in the included literature. Finally, outcome measures from each study were extracted and comprehensive analysis was conducted using Review Manager 5.4.

Results

A total of four clinical trials met the selection criteria. The pooled analysis indicated no significant difference in the incidence and duration of delirium between the OT group and standard non-pharmacological interventions. A comprehensive analysis of clinical outcomes revealed that OT did not significantly reduce the length of hospital stay or ICU stay. Meanwhile, there was no significant difference in mortality rates between the two groups. It is noteworthy that although grip strength levels did not exhibit significant improvement following OT intervention, there were obvious enhancements observed in ADL and MMSE scores.

Conclusion

Although occupational therapy may not be the most effective in preventing delirium, it has been shown to significantly improve ADL and cognitive function among critically ill patients. Therefore, we contend that occupational therapy is a valuable component of a comprehensive multidisciplinary approach to managing delirium. In the future, high-quality researches are warranted to optimize the implementation of occupational therapy interventions for delirium prevention and further enhance their benefits for patients.

LXR agonism for CNS diseases: promises and challenges

The unfavorable prognosis of many neurological conditions could be attributed to limited tissue regeneration in central nervous system (CNS) and overwhelming inflammation, while liver X receptor (LXR) may regulate both processes due to its pivotal role in cholesterol metabolism and inflammatory response, and thus receives increasing attentions from neuroscientists and clinicians. Here, we summarize the signal transduction of LXR pathway, discuss the therapeutic potentials of LXR agonists based on preclinical data using different disease models, and analyze the dilemma and possible resolutions for clinical translation to encourage further investigations of LXR related therapies in CNS disorders.