Association Between Post-procedure Cerebral Blood Flow Velocity and Severity of Brain Edema in Acute Ischemic Stroke With Early Endovascular Therapy

Neuroimaging predictors of malignant brain oedema after thrombectomy in ischemic stroke: a systematic review and meta-analysis

BACKGROUND

We systematically reviewed neuroimaging predictors for malignant brain oedema (MBE) after thrombectomy in patients with ischemic stroke.

METHODS

We searched MEDLINE and EMBASE in November 2023 for studies of patients with ischemic stroke. We included studies investigating neuroimaging predictors or prediction models for MBE after thrombectomy. We estimated effect size for the association between predictors and MBE by odds ratios (ORs) or standardized mean differences (SMDs), and pooled results using random-effects modelling.

RESULTS

We included 19 studies (n = 6007) with 17 neuroimaging factors and 5 models. Lower Alberta Stroke Program Early CT scores (ASPECTS, n = 3052, SMD -1.84, 95% CI -2.52 - -1.16; df = 9) and longer extent of arterial occlusion at baseline were associated with higher risk of MBE. Post-thrombectomy ASPECTS was associated with MBE in general stroke patients (n = 453, SMD -2.91, -4.02 - -1.79; df = 1), but not in successfully reperfused patients (n = 110, SMD 0.24, -0.16 - 0.65). Successful reperfusion reduced risk of MBE (n = 4851, OR 0.39, 0.30-0.51; df = 13). Contrast enhancement on CT after thrombectomy was associated with higher risk of MBE (n = 998, OR 4.82, 2.53-9.20; df = 4). More reserved brain volume capacity (baseline: n = 683, OR 0.83, 0.77-0.91, p < .001; post-thrombectomy: n = 329, OR 0.53, 0.37-0.77, p < .001) and good collaterals (baseline: n = 2301, OR 0.14, 0.10-0.20, df = 3; post-thrombectomy: n = 1006, OR 0.28, 0.15-0.51; df = 2) were associated with lower risk of MBE.

CONCLUSION

Lower ASPECTS and longer arterial occlusion at baseline, and post-thrombectomy CT contrast enhancement increased risk of MBE. Reperfusion after thrombectomy, more reserved brain volume and good collaterals at baseline and post-thrombectomy reduced its risk.

Analyzing post-endovascular treatment stroke prognosis with transcranial Doppler and quantitative electroencephalography

OBJECTIVE

Despite successful recanalization following acute ischemic stroke, patients may have a poor prognosis. We investigated whether transcranial Doppler combined with quantitative electroencephalography can identify patients with a poor prognosis at an early stage.

METHODS

Prospectively recruited patients with successful recanalization after endovascular treatment for acute ischemic stroke were assessed for prognosis at 90 days using the modified Rankin Scale. Clinical information and National Institute of Health Stroke Scale scores were recorded. Transcranial Doppler combined with quantitative electroencephalography was used to evaluate brain function.

RESULTS

Of the 37 patients (63.5 ± 11.7 years) studied, 18 had a poor prognosis at 90 days (modified Rankin Scale >3). Multivariable analysis revealed that transcranial Doppler indicators of the pulsatility index of the unaffected side, quantitative electroencephalography indicators of the pairwise-derived Brain Symmetry Index, and National Institute of Health Stroke Scale score were independent prognostic indicators. Modeling indicated that combining these independent predictors yielded superior accuracy and net clinical benefit to any single variable. With the final predictive model presented as a nomogram, internal validation by bootstrap resampling showed good discrimination with a concordance index of 0.961. The calibration curve displayed good agreement of predicted and actual probabilities.

INTERPRETATION

The nomogram prediction model combining transcranial Doppler with quantitative electroencephalography and National Institute of Health Stroke Scale scores can provide guidance for individualized risk prediction in patients with acute ischemic stroke after revascularization.

Risk factors of acute ischemic stroke and the role of angiotensin I in predicting prognosis of patients undergoing endovascular thrombectomy

Purpose

The interaction between the renin-angiotensin system (RAS) and the acute ischemic stroke (AIS) is definite but not fully understood. This study aimed to analyze the risk factors of AIS and explore the role of serum indicators such as angiotensin I (Ang I) in the prognosis of patients undergoing endovascular thrombectomy (EVT).

Patients and methods

Patients with AIS who underwent EVT and healthy controls were retrospectively enrolled in this study, and the patients were divided into a good or a poor prognosis group. We compared Ang I, blood routine indexes, biochemical indexes, electrolyte indexes, and coagulation indexes between patients and controls. We used univariate and multivariate logistic regression analyses to evaluate possible risk factors for AIS and the prognosis of patients undergoing EVT. Independent risk factors for the prognosis of patients undergoing EVT were identified through multifactorial logistic regression analyses to construct diagnostic nomograms, further assessed by receiver operating characteristic curves (ROC).

Results

Consistent with previous studies, advanced age, high blood glucose, high D-dimer, and high prothrombin activity are risk factors for AIS. In addition, Ang I levels are lower in AIS compared to the controls. The level of Ang I was higher in the good prognosis group. Furthermore, we developed a nomogram to evaluate its ability to predict the prognosis of AIS after EVT. The AUC value of the combined ROC model (Ang I and albumin-globulin ratio (AGR)) was 0.859.

Conclusions

In conclusion, advanced age, high blood glucose, high D-dimer, and high prothrombin activity are risk factors for AIS. The combined Ang I and AGR model has a good predictive ability for the prognosis of AIS patients undergoing arterial thrombectomy.

Neutrophil extracellular traps in central nervous system (CNS) diseases

Excessive induction of inflammatory and immune responses is widely considered as one of vital factors contributing to the pathogenesis and progression of central nervous system (CNS) diseases. Neutrophils are well-studied members of inflammatory and immune cell family, contributing to the innate and adaptive immunity. Neutrophil-released neutrophil extracellular traps (NETs) play an important role in the regulation of various kinds of diseases, including CNS diseases. In this review, current knowledge on the biological features of NETs will be introduced. In addition, the role of NETs in several popular and well-studied CNS diseases including cerebral stroke, Alzheimer's disease, multiple sclerosis, amyotrophic lateral sclerosis (ALS), and neurological cancers will be described and discussed through the reviewing of previous related studies.