Neuroprotective effects of Tongxinluo capsule in acute ischemic stroke: A systematic review and meta-analysis.

Thrombotic thrombocytopenic purpura (TTP) is rare, life-threatening autoimmune disorder characterized by microvascular thrombosis, severe thrombocytopenia, and hemolytic anemia. It can lead to organ ischemia and increase the risk of thromboembolic events, including acute ischemic stroke (AIS). Caplacizumab, an essential adjunct in TTP management, rapidly inhibits platelet aggregation and prevents disease progression. We present 3 cases of TTP diagnosed in patients with AIS. Treatment included plasma exchange (PLEX), corticosteroids, and caplacizumab. All 3 patients exhibited acute neurologic deficits, with brain MRI confirming AIS. Laboratory tests revealed thrombocytopenia, hemolytic anemia, and ADAMTS-13 activity <1%, confirming TTP. Two patients initially treated only with PLEX and corticosteroids experienced thrombocytopenia exacerbation, requiring caplacizumab for stabilization. The third patient, treated with caplacizumab from stroke onset, maintained stable platelet counts without exacerbation. No adverse events or deaths occurred, emphasizing caplacizumab's role in sustained hematologic recovery. This case series underscores caplacizumab's potential role in stabilizing platelet counts, reducing exacerbation rates, and improving clinical outcomes in TTP-associated AIS. Although all patients experienced favorable neurologic outcomes, a faster recovery cannot be directly attributed to caplacizumab given the multimodal treatment approach. These findings are suggestive of its early use as first-line adjunct, potentially optimizing treatment strategies and improving prognosis.

Sleep deprivation attenuates acute ischemic stroke-induced hippocampal neuronal injury via the IL-38/NF-κB axis.

Predictors of symptomatic intracranial hemorrhage after endovascular thrombectomy in acute ischemic stroke: A retrospective study.

Acute ischemic stroke (AIS) is a leading global cause of disability and mortality, with limited therapeutic options beyond reperfusion strategies. Evidence suggests that mitophagy and astrocyte polarization play critical roles in neuronal survival and inflammatory regulation after stroke. Xuming tongmai (XMTM) decoction has shown clinical potential in improving AIS outcomes, but the underlying mechanisms remain unclear. This study aimed to investigate the molecular mechanisms of XMTM in the middle cerebral artery occlusion (MCAO) model rats, with a specific focus on its role in regulating astrocyte polarization and mitophagy. In vivo, the MCAO model rats were established and administered 12.90g/kg and 25.80g/kg XMTM decoction, with 20mg/kg aspirin serving as the positive control. In vitro, an oxygen-glucose deprivation/reperfusion (OGD/R) model was induced in astrocytes. Serum containing XMTM (XMTM serum) was prepared from rats administered XMTM decoction. The optimal working concentration of XMTM serum was determined using the CCK-8 assay before cell treatment. OGD/R-induced astrocytes were treated with negative serum, XMTM serum, Mdivi-1 (a mitophagy inhibitor), si-NC, si-PINK1, or their combination. The therapeutic effects of XMTM on MCAO rats were evaluated through pathological analysis, cerebral infarct volume measurement, and neurological deficit scoring. Astrocyte polarization was assessed using A1-type markers (C3, iNOS) and A2-type markers (Arg1, S100A10), while XMTM serum components were characterized by LC-MS/MS. Mitophagy activity was determined by measuring the mitochondrial membrane potential (MMP) and quantifying the expression levels of PINK1, Parkin, LC3II/I, p62, and reactive oxygen species (ROS). 25.80g/kg XMTM decoction significantly reduced cerebral infarct volume, ameliorated neurological deficits, and improved pathological outcomes in AIS rats. LC-MS/MS results revealed that the main components of XMTM in the blood were alkaloids, anthraquinones, flavonoids, and phenolic acids. Both in vivo and vitro experiments demonstrated that XMTM upregulated Arg1 and S100A10 expression but downregulated C3 and iNOS, activated the PINK1/Parkin signaling pathway, and induced mitophagy in astrocytes. However, these beneficial effects of XMTM serum were abolished by si-PINK1 and mdivi-1. XMTM decoction exerts its neuroprotective effects in AIS rats by targeting the PINK1/Parkin-mediated mitophagy pathway, which subsequently promotes the polarization of astrocytes toward the neuroprotective A2 phenotype.

Combined treatment with tPA and Chinese herbal medicine for ischemic stroke: is it valuable?

Elevated baseline glucose and hemorrhagic complications in bridging vs direct EVT.

Association between the cumulative defined daily dose of statins and ischemic stroke recurrence: a cohort study.

Experience-driven differences in acute ischemic stroke management: A nationwide study.

Right-hemisphere glymphatic dysfunction is associated depressive symptoms in subacute stroke: A diffusion tensor imaging-along the perivascular space index study.

Contrast-associated acute kidney injury (CA-AKI) is a potentially preventable complication after exposure to iodinated contrast media. In patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), the incidence and clinical impact are poorly characterized, and no validated prediction tool is currently available. The aim of this study was to assess the incidence and prognostic significance of CA-AKI in EVT-treated patients with AIS and to develop and validate a predictive score. A retrospective, multicenter cohort study was conducted involving EVT-treated patients across 73 centers in 16 countries (January-December 2023). Inclusion criteria were age ≥18 years, absence of dialysis, availability of preprocedural and 48-hour postprocedural creatinine levels, and available 90-day follow-up (modified Rankin Scale [mRS] score). The primary outcome was CA-AKI, defined by KDIGO (Kidney Disease: Improving Global Outcomes criteria;creatinine increase ≥0.3 mg/dL or ≥1.5 times baseline, within 48 hours). Secondary outcomes were (1) in-hospital mortality, (2) 90-day mRS score, and (3) 90-day severe disability or death (mRS score >3). Logistic models assessing associations with outcomes accounted for within-center clustering by applying robust standard errors. CA-AKI prediction models were developed across imputed data sets using univariable selection (p < 0.20), backward elimination (p < 0.05), and coefficient-based scoring after categorization of continuous predictors, with internal validation by bootstrap to obtain optimism-adjusted estimates. Among 6,638 patients (median age 74 years; 48.7% male), CA-AKI occurred in 326 (4.9%) and was independently associated with in-hospital mortality (adjusted odds ratio [aOR] 2.269; 95% CI 1.615-3.190), higher 90-day mRS scores (adjusted common odds ratio 1.584; 95% CI 1.110-2.258), and 90-day severe disability or death (aOR 1.530; 95% CI 1.057-2.216). A preprocedural risk model including 12 routine clinical variables-sex, ethnicity, arterial hypertension, dyslipidemia, chronic kidney disease, antiplatelet therapy, NIH Stroke Scale score at admission, serum glucose, estimated glomerular filtration rate, hemoglobin, mean arterial pressure, and IV thrombolysis-demonstrated acceptable discrimination (area under the receiver operating characteristic curve 0.710 [95% CI 0.682-0.738]; precision-recall area under the curve 0.13 [95% CI 0.10-0.16]), good calibration (slope 0.870 [95% CI 0.759-0.928]), good overall performance (Brier score 0.045 [95% CI 0.042-0.049]). A second model that included EVT-related variables (e.g., contrast volume) showed similar performances. In this large, international cohort, CA-AKI occurred in approximately 1 in 20 EVT-treated patients with AIS and was independently associated with poor outcomes. A simple preprocedural risk score enables early identification of high-risk individuals and may support preventive strategies.

Previous antiplatelet therapy (APT) may influence outcomes in patients undergoing direct endovascular therapy (EVT) for anterior circulation large vessel occlusion (LVO) stroke, but evidence on clinical benefits and safety is limited and inconsistent. We aimed to evaluate the effects of previous APT on the outcomes of direct EVT. We conducted a retrospective analysis of consecutive patients treated at 20 high-volume stroke centers across 9 European countries and Israel (EVA-TRISP registry, 2015-2023). We included adults with anterior circulation LVO strokes, without previous use of IV thrombolysis (IVT) or anticoagulants. We compared outcomes of direct EVT patients stratified by previous APT regimen, using propensity score matching based on medical history and multilevel models to address confounders. The primary outcome was the 90-day modified Rankin Scale (mRS) score. The secondary efficacy outcomes were 90-day independence and the rate of successful reperfusion. The secondary safety outcomes were the rate of symptomatic intracranial hemorrhage (sICH) and mortality. Among 12,950 patients, 2,611 met the criteria and 1,308 were matched: 480 without previous APT and 828 with any previous APT, among whom 764 were on single APT and 64 on dual APT. The overall mean age was 75.8 ± 11.4 years, and 49.4% were female; the mean NIH Stroke Scale score was 13.1 ± 7.2 points, the successful reperfusion rate was 74.7%, and the median mRS score was 3 (interquartile range 2-4), with 38.8% of patients independent at 90 days. When compared with no previous APT, any previous APT was associated with a shift toward lower mRS scores at 90 days (odds ratio [OR] 1.30, CI 1.04-1.61, p = 0.018). Independence at 90 days was associated with any previous APT (OR 1.62, CI 1.22-2.16, p = 0.001). Any previous APT was not associated with successful reperfusion (OR 0.96, CI 0.69-1.35, p = 0.821), sICH (OR 1.06, CI 0.47-2.39, p = 0.880), or mortality (OR 0.89, CI 0.66-1.21, p = 0.821). There was no significant interaction between any previous APT and proximal/distal occlusion location (p = 0.213) or time-to-groin earlier/later than 6 hours (p = 0.743). In patients with anterior circulation LVO stroke treated with direct EVT and no previous anticoagulation, pretreatment with any APT was independently linked to better 90-day functional outcomes and higher independence, without increasing sICH risk. This study provides Class III evidence that, in patients with anterior circulation LVO stroke treated with direct EVT, previous APT is associated with better 90-day functional outcomes compared with no previous APT.

Emergency consent pathways in acute ischemic stroke trials: determinants, consequences, and stakeholder attitudes-an evidence-mapping study.

Low atherogenic index of plasma is associated with spontaneous hemorrhagic transformation in acute ischemic stroke patients: a retrospective cohort study and predictive modeling based on machine learning.

Acute ischemic stroke (AIS) is a leading cause of mortality and morbidity, yet largely preventable. An urgent clinical need exists for new biomarkers that enable early, noninvasive, and accurate diagnosis, even before the incident occurs. This study aims to determine the valency of serum sclerostin (SOST), receptor activator of nuclear factor-kappa B ligand (RANKL), oxidized low-density lipoproteins (OxLDL), and phoenixin-14 in AIS. A case-control study was conducted in the emergency department (ED) of a tertiary care hospital between June 2024 and September 2024, including 48 patients with AIS and 40healthy individuals. The enzyme-linked immunosorbent assay was used to determine the levels of SOST, OxLDL, RANKL, and phoenixin-14. Diagnostic accuracy and independent associations with AIS were examined. Biomarker levels were significantly higher in AIS group. SOST was the best, with an area under the curve of 0.809. A one-unit increase in SOST and OxLDL levels increased the probability of stroke by 1.418 and 1.006 times, respectively. SOST, OxLDL, RANKL, and phoenixin-14 May be complementary markers that warrant further validation, even though the results show an association rather than a causal relationship, suggesting they might be useful for differentiating AIS from healthy controls.

Acute ischemic stroke affecting the middle cerebral artery (MCA) remains a major global cause of death and disability. However, it remains unclear whether the laterality of MCA strokes independently influences inpatient outcomes. Despite the fact that the National Institutes of Health Stroke Scale score is heavily weighted toward left-sided acute ischemic stroke, we hypothesize that right MCA strokes (R-MCASs) are associated with worse inpatient outcomes because they would require more severe deficits to amount to a comparable National Institutes of Health Stroke Scale score for a left MCA stroke. A retrospective cross-sectional analysis was conducted using data from the National Inpatient Sample between 2015 and 2022. This nationally representative sample included adult patients (aged ≥18 years) in the United States hospitalized primarily for MCA strokes and with reported National Institutes of Health Stroke Scale scores. Patients were stratified into R-MCAS and left MCA stroke. Outcomes included odds of inpatient mortality, routine discharge, complications, and receipt of reperfusion therapy. Propensity score-based inverse probability of treatment weighting is adjusted for confounding factors. Multivariable logistic regression evaluated adjusted odds ratios (aORs) and 95% CIs for all outcomes. Among 489 360 acute ischemic stroke hospitalizations, 263 495 (53.8%) were left MCA stroke, and 225 865 (46.2%) were R-MCAS. Following inverse probability of treatment weighting, R-MCASs were significantly more likely to receive endovascular thrombectomy (aOR, 1.26 [95% CI, 1.22-1.30]; P<0.001) and less likely to receive intravascular thrombolysis (aOR, 0.965 [95% CI, 0.937-0.994]; P=0.018). R-MCAS was associated with significantly increased odds of cerebral edema/herniation (aOR, 1.53 [95% CI, 1.47-1.59]; P<0.001), hemorrhagic transformation (aOR, 1.25 [95% CI, 1.20-1.30]; P<0.001), and sepsis (aOR, 1.35 [95% CI, 1.25-1.46]; P<0.001). Left MCA stroke was associated with a higher likelihood of coma (aOR, 0.920 [95% CI, 0.889-0.952]; P<0.001). R-MCAS had significantly higher odds of inpatient mortality (aOR, 1.19 [95% CI, 1.12-1.26]; P<0.001) and lower odds of routine discharge (aOR, 0.786 [95% CI, 0.760-0.812]; P<0.001). Patients with R-MCAS were more likely to receive endovascular thrombectomy and less likely to receive intravascular thrombolysis. R-MCASs were also associated with worse discharge disposition and increased likelihood of inpatient mortality. The National Institutes of Health Stroke Scale bias toward assessment and valuation of patients' language abilities may place patients with R-MCAS at increased risk of adverse poststroke outcomes and complications. Recognition of the subtle signs of nondominant hemisphere strokes may lead to more rapid detection, effective treatment, and improved outcomes.

Thromboembolic cardiovascular diseases (CVD), including acute coronary syndromes, ischemic stroke, and venous thromboembolism, remain a leading cause of morbidity and mortality worldwide. Despite significant improvements in prevention and diagnosis, thromboembolic CVD remains a major global health challenge, reflecting the incomplete control of multifactorial vascular risk. Growing evidence indicates that air, noise, and light pollution are important yet underrecognized contributors to cardiovascular morbidity. Exposure to particulate matter (PM2.5, PM10), gaseous pollutants (NO2, SO2, CO, O3), chronic noise, and artificial light at night promotes endothelial dysfunction, oxidative stress, inflammation, and platelet activation-key mechanisms fostering a prothrombotic setting. Although regulatory progress has been achieved, air pollution remains the most significant environmental determinant of cardiovascular health globally, and the combined effects of coexisting pollutants are not fully understood. The convergence of urbanization, industrialization, and increasing light exposure further amplifies environmental impacts on vascular health. This scientific statement aims to synthesize current epidemiological and mechanistic evidence, highlight the complex interactions among air, noise, and light pollution, identify critical research gaps, and provide a comprehensive conceptual framework for understanding how environmental stress contributes to thromboembolic cardiovascular complications. Strengthening multidisciplinary research, integrating exposome-based data, and implementing effective prevention policies are essential steps toward mitigating the cardiovascular burden of environmental pollution.

The association between occluded vessel diameter measured using pre-recanalization digital subtraction angiograms and clinical outcomes in patients with acute ischemic stroke undergoing mechanical thrombectomy for M2 occlusion remains unclear. Consecutive patients with acute ischemic stroke undergoing mechanical thrombectomy for M2 occlusion at our institution between January 2020 and December 2024 were retrospectively analyzed. Based on pre-recanalization digital subtraction angiograms, patients were classified as having large M2 occlusion (LM2O, ≥ 1.7 mm) or small M2 occlusion (SM2O, < 1.7 mm). Favorable 90-day outcome, defined as modified Rankin Scale0-2 or recovery to pre-stroke level, were compared between the two groups. There were 56 (58.3%) LM2O patients and 40 (41.7%) SM2O patients. Median occluded vessel diameter was 1.85 mm (IQR 1.78-2.11) for LM2O and 1.52 mm (IQR 1.43-1.62) for SM2O. LM2O patients were more likely to have dominant M2 occlusion (67.9% vs. 40.0%, P = 0.012), favorable outcome (62.5% vs. 25.0%; OR 6.67, 95% CI 2.59-17.15; P < 0.001), and first-pass effect (48.2% vs. 17.5%; OR 4.39, 95% CI 1.66-11.57; P = 0.002). In multivariable analysis, occluded vessel diameter ≥ 1.7 mm was independently associated with favorable outcome (OR 10.50, 95% CI 3.17-35.0; P < 0.001). Patients with acatheter-to-vessel ratio < 1.0 experienced higher first-pass effect more frequently than those with acatheter-to-vessel ratio ≥ 1.0 (46.8% vs. 24.5%; P = 0.032). Occluded M2 vessel diameter ≥ 1.7 mm may be associated with favorable 90-day outcome in patients with acute ischemic stroke undergoing mechanical thrombectomy for M2 occlusion.

Existing evidence suggests that a high glucose-to-potassium ratio (GPR) is associated with poor outcomes in various conditions: acute, critical, and urgent. This study investigated the association of the GPR with 3-month functional outcomes in Caucasian patients with acute ischemic stroke (AIS), who underwent mechanical thrombectomy (MT), as well as its potential as a biomarker. In a prospective study, 20 commonly available parameters in 464 patients with AIS were analyzed. Of these patients, 309 achieved a good outcome, defined as a modified Rankin Scale (mRS) score of 0-2, while 155 experienced an unfavorable outcome (mRS 3-6) at day 90. Both, univariate model and multivariate logistic regression model adjusted for age and sex, indicated that GPR was associated with an unfavorable outcome [odds ratio (OR) = 1.78; 95% confidence intervals (CI): 1.34-2.40, p < 0.001, OR = 1.68, 95% CI: 1.26-2.26, p < 0.001; respectively]. A further multivariate logistic regression model, adjusted for parameters with a significance threshold of 0.05 in univariate analysis, showed that an increased GPR (OR = 2.38, 95% CI: 1.48-3.90, p < 0.001) was linked to an unfavorable outcome. Additionally, factors such as older age (OR = 1.06, 95% CI: 1.03-1.10, p < 0.001), longer intervention duration (OR = 1.46, 95% CI: 0.99-2.13, p = 0.037), higher initial National Institutes of Health Stroke Scale (NIHSS) score (OR = 1.15, 95% CI: 1.09-1.23, p < 0.001), hemorrhagic transformation (HT) on computed tomography 24 h post-stroke onset (OR = 2.04, 95% CI: 1.08-3.86; p = 0.029), larger initial ischemic core volume on perfusion computed tomography (CT) (OR = 1.01, 95% CI: 1.00-1.02, p = 0.05), successful reperfusion (OR = 0.20, 95% CI: 0.08-0.49, p < 0.001), and higher C-reactive protein (CRP) levels (OR = 1.01, 95% CI: 1.00-1.03, p = 0.029) were also associated with an unfavorable outcome. Similar results were obtained when GPR was analyzed as a categorical variable. The relationship between GPR and the 90-day outcome was demonstrated to be linear. Receiver operating characteristics (ROC) analysis indicated an area under the curve (AUC) of 0.634 (95% CI: 0.580-0.688, p < 0.001) with sensitivity and specificity being 52.3% and 70.6%, respectively for GPR in predicting an unfavorable outcome at day 90. It was confirmed that GPR was associated with unfavorable outcome at day 90 in AIS patients who received MT. Further studies on the significance of predictive value of GPR are required across various clinical scenarios, including different populations and outcome measures. Additionally, enhancing the predictive power of GPR by incorporating definitive disease biomarkers should be considered.

In patients with acute ischemic stroke (AIS), robust collaterals are associated with lower rates of infarct growth. Perfusion-based collateral matrices including hypoperfusion intensity ratio (HIR), relative cerebral blood volume index (rCBV-Index), and perfusion collateral index (PCI) have been used successfully to assess collaterals in AIS patients. We aimed to assess and compare the diagnostic ability of these perfusion-based collateral indices in prediction of infarct growth in AIS patients following successful reperfusion. In this retrospective multicenter study, anterior circulation large vessel occlusion patients were included if they had pretreatment perfusion (CT or MR), successful reperfusion (mTICI ≥2b), and follow up MRI within 24-48 hours from the date of treatment. The primary outcome assessed was substantial infarct growth which was defined as final infarct volume of ≥10 mL compared to baseline ischemic core volume. Perfusion-based collateral indices including HIR (volume of Tmax >10 sec/volume of Tmax >6 sec) and rCBV-Index (mean of rCBV values within the volume of Tmax > 6sec) were calculated using RAPID software (iSchemaView, version 5.0.4), and PCI (volume of delay 2-6sec multiplied by its corresponding mean rCBV) was calculated using Olea software (Olea Medical, SP.23). The association between perfusion-based collateral indices, along with demographic and clinical variables for determination of infarct growth was tested using appropriate univariate analysis. Multivariable logistic regression using a stepwise backward selection approach was performed to identify independent predictors of infarct growth. Among 116 included patients, 58 (50%) had infarct growth ≥10 mL. Infarct growth volume (median, IQR) was: 11, 2.6-34.7 mL. Poor collaterals determined by PCI and rCBV index was significantly (p<0.01) associated with infarct growth while HIR was not (p=0.83). Following multivariate logistic regression, three variables remained as independent predictors of infarct growth: baseline NIHSS (OR=1.10, 95%CI: 1.02-1.15, p=0.005); rCBV-Index (OR=0.005, 95%CI: 0.00-0.14, p=0.002); and PCI (OR=0.99, 95%CI: 0.98-0.99, p=0.01). Perfusion-based collateral indices that integrate CBV (rCBV-Index and PCI) outperformed delay-based HIR in prediction of substantial infarct growth in AIS patients and hence may play an important role in treatment decision-making, patient transfer decisions, and prognostication.