Acute Ischemic Stroke Research Articles

Extracorporeal Counterpulsation Therapy Enhances Neurological Outcomes in Patients Experiencing Acute Ischemic Stroke.

The aim of this study was to assess the effects of extracorporeal counterpulsation therapy (ECP) on the short-term outcomes of patients with acute ischemic stroke in the mid-stroke phase. A total of 171 patients with acute ischemic stroke from the Department of Neurology at our hospital were selected and randomly assigned to 2 groups: 84 patients in the ECP group and 87 patients in the control group. Both groups received standard medication and rehabilitation. In addition, extracorporeal counterpulsation was incorporated into the treatment for the ECP group. At the conclusion of the treatment and after 90 days, both groups were evaluated based on the NIHSS and MRS scores. No statistically significant differences were detected between the NIHSS and MRS scores of the 2 groups before and following treatment (P>0.05). However, on the 90th day, the NIHSS and MRS scores of the ECP group were significantly lower than those of the comparison group (P<0.05). The difference in the proportion of patients with NIHSS scores ≤1 between the 2 groups was 20.8%, whereas the absolute difference in MRS scores was 14.1%. Extracorporeal counter therapy effectively enhances neurological function in patients with ischemic stroke, thereby improving their ability to perform activities of daily living and overall prognosis.

Shengui Sansheng San alleviates the worsening of blood–brain barrier integrity resulted from delayed tPA administration through VIP/VIPR1 pathway

BackgroundIntravenous tissue plasminogen activator (tPA) is currently the only FDA-approved thrombolytic therapy for acute ischemic stroke (AIS), however, relative narrow therapeutic time window (within 4.5 h of AIS onset) and high risk of hemorrhagic transformation due to blood–brain barrier (BBB) disruption limit tPA therapeutic benefits for patients. In this study, we extended the time window of tPA administration (5 h after the occurrence of AIS) and investigated whether Chinese medicine classical formula Shengui Sansheng San (SSS) administration was able to alleviate BBB integrity worsening, and the mechanism was related to vasoactive intestinal peptide (VIP)/ VIP receptor 1 (VIPR1) pathway.MethodsSSS was extracted using aqueous heating method and SFE-CO2 technology, and quality control was performed using UHPLC/MS analysis. Male C57BL/6 mice were suffered from middle cerebral artery occlusion (MCAo), followed by the removal of a silicone filament after 5 h, then, t-PA was administered via tail vein injection at once, along with SSS administration by gavage. Hemoglobin levels and Evans blue leakage were measured to assess brain hemorrhagic transformation and BBB permeability, respectively. Transmission electron microscope (TEM) was utilized to present brain microvascular endothelial cells (BMECs) tight junction morphology. TTC staining and laser speckle contrast imaging were employed for infarct volume and cerebral blood flow measurements. The modified neurological severity score (mNSS) test was conducted to evaluate neurological function. The expressions of VIP, VIPR1, ZO-1, Occludin, Lectin, GFAP, NeuN were detected by immunofluorescence staining or western blotting. In vitro, bEnd.3 and N2a cells were insulted by oxygen–glucose deprivation (OGD), and VIPR1 siRNA, and VIP shRNA transfection were respectively performed, and the molecular docking was applied to verify the SSS in-serum active compounds interacted with VIPR1. The transwell system was utilized to detect OGD-insulted BMECs permeability.ResultsSSS treatment significantly reduced the infarct area, cerebral hemorrhage, and neurological deficits, and enhanced cerebral blood flow in AIS mice received intravenous tPA beyond 4.5 h time window. Simultaneously, the permeability of BBB declined, with increased expressions of tight junction proteins ZO-1, and Occludin and proper BMECs tight junction morphology, and it suggested that VIP was released by neurons rather than astrocytes or BMECs. It also showed high expressions of VIP and VIPR1 in the penumbra area. The inhibition of VIP in N2a cells or VIPR1 in bEnd.3 cells abolished the viability and integrity of OGD-insulted bEnd.3 cells treated by tPA after SSS-containing serum administration, and the SSS in-serum active compounds were proved have high affinity to VIPR1 by molecular docking.ConclusionSSS alleviates the worsening of BBB integrity resulted from delayed tPA administration, reduces hemorrhagic transformation and infarction volume, and ameliorates brain blood flow and neurological function in AIS mice. The mechanisms are associated with the activation of VIP/VIPR1 pathway to enhance BMECs viability and maintain tight junction phenotype.Graphical

Racial and Ethnic Disparities in Ischemic Stroke Severity in the National Inpatient Sample Between 2018 and 2021.

The purpose of this study is to examine the association between race and ethnicity and ischemic stroke severity in the United States. We performed an analysis of adult hospital discharges in the National Inpatient Sample from 2018 to 2021 with a primary discharge diagnosis of ischemic stroke. We stratified our cohort based on self-reported race and ethnicity and evaluated stroke severity using the National Institutes of Health Stroke Scale. Age- and sex-adjusted estimates of the National Institutes of Health Stroke Scale were derived from linear regression models. We included 231 396 stroke discharges with a mean National Institutes of Health Stroke Scale of 6.5±7.2. The cohort was 68.1% White, 17.4% Black, 8.2% Hispanic, and 6.3% other. The age- and sex-adjusted National Institutes of Health Stroke Scale for White patients was 6.25 (95% CI, 6.22-6.29), for Black patients was 7.12 (95% CI, 7.05-7.19), for Hispanic patients was 6.86 (95% CI, 6.76-6.97), and for patients of other races and ethnicities was 7.29 (95% CI, 7.18-7.41). Further adjustment for the Charlson Comorbidity Index, socioeconomic factors, and poorly controlled hypertension or diabetes did not significantly alter these findings. In a large, contemporary, and nationally representative sample of patients with acute ischemic stroke, we show an association between non-White race and ethnicity and higher stroke severity. These results are concerning for an underappreciated health disparity in acute ischemic stroke.

Influence of impaired renal function on the outcomes of patients with acute ischaemic stroke treated with intravenous tenecteplase and alteplase: a post hoc analysis of the TRACE-2 trial

ObjectiveLimited evidence is available regarding the risk-benefit ratio of thrombolytic therapy in patients with stroke and renal impairment complications, particularly for the drug tenecteplase. Therefore, we examined the association of...

Comparative Time Efficiency of CT and MRI Multimodal Imaging Protocols in Acute Ischemic Stroke Evaluation.

To assess the time efficiency of computed tomography (CT) and magnetic resonance imaging (MRI) multimodal scanning protocols in the assessment of acute ischemic stroke (AIS), with potential implications for craniocerebral emergency management. A retrospective analysis was conducted to assess the imaging workflows of CT and MRI for the assessment of AIS. The total examination time, derived from DICOM source data, encompassed pre-scan waiting periods, sequence acquisition times, and image reconstruction durations. In addition, the influence of the experience of radiologic technologists on scanning efficiency was analyzed. The CT imaging protocols included noncontrast CT, CT angiography (CTA), and CT perfusion (CTP), whereas the MRI protocols comprised noncontrast MRI, diffusion-weighted imaging (DWI), magnetic resonance angiography (MRA), susceptibility-weighted imaging (SWI), and arterial spin labeling (ASL). Craniocerebral imaging characteristics were documented without additional measurements. CT multimodal scanning demonstrated a shorter acquisition time, while MRI was associated with a reduced reconstruction duration. The total waiting period for CT (11.76min) and scanning time (11.65min) were slightly lower compared with MRI. However, MRI had a significantly shorter reconstruction time (7.09min) compared with CT (13.42min), resulting in a longer overall radiology department time for CT (36.83min) than for MRI (31.00min). Notably, during the night shift, the waiting period for MRI (12.1min) was shorter than during the day shift (15.4min). In addition, the experience of radiologic technologists had a significant impact on procedural efficiency. MRI demonstrates greater efficiency in AIS evaluation during night shifts in municipal hospitals, leveraging its superior diagnostic capabilities and optimized time efficiency. Conversely, CT is better suited for rapid initial assessments during day shifts, particularly in high-risk scenarios. Aligning imaging protocols with the expertise of radiologic technologists and shift schedules can further enhance the efficiency and effectiveness of stroke management. These findings may inform protocol optimization in craniocerebral emergency settings.

Quantitative histopathological analysis of thrombi retrieved by mechanical thrombectomy and their association with stroke aetiology

Background and purposeApproximately 25% of acute large vessel occlusive (LVO) ischaemic strokes are of unknown thrombotic origin, and there is a need to establish the aetiology to guide subsequent preventative...

OSGEP, A Negative Ferroptotic Regulator, Alleviates Cerebral Ischemia-Reperfusion Injury Through Modulating m6A Methylation of GPX4 mRNA.

Cerebral ischemia-reperfusion injury (CIRI) is a devastating condition that triggers neuronal death and cerebral infarction. O-sialoglycoprotein endopeptidase (OSGEP), identified as a crucial element of the highly conserved KEOPS complex, regulated cellular proliferation and mitochondrial metabolism. Despite its known role in cellular homeostasis, the potential contribution of OSGEP to the development of CIRI remains elusive. This study was designed to investigate the potential role of ferroptosis in the pathogenesis of CIRI and indicate whether OSGEP could suppress ferroptosis to alleviate CIRI by modulating GPX4 m6A methylation. To this end, MCAO and OGD/R models were employed to closely simulate the CIRI. The potent ferroptosis inhibitors conferred prominent neuroprotection in both in vivo and in vitro models. Moreover, OSGEP expression level was not only downregulated in MCAO-treated mice and in cultured cerebrocortical neurons subjected to OGD/R, but also it was related to the prognosis of acute ischemic stroke (AIS) cases. Additionally, OSGEP overexpression exerted potent anti-ferroptotic effects in both MCAO and OGD/R models, while OSGEP depletion exhibited the opposite effect. Moreover, OSGEP regulated GPX4 expression by modulating m6A methylation of its mRNA. Furthermore, the inhibitory effect of OSGEP on ferroptosis was dependent on the presence of GPX4. Specifically, OSGEP knockout exacerbated ferroptosis-like cell death under MCAO condition. Besides, OSGEP regulated GPX4 mRNA stability through competition with YTHDC1 for binding to GPX4 mRNA and forming a complex with HNRNPUL1 in the neuronal primary cultures subjected to OGD/R. These findings highlighted the critical role of OSGEP, as a new contributing anti-ferroptotic factor, in the pathogenesis of CIRI.

Can Serum GFAP and UCH-L1 Replace CT in Assessing Acute Ischemic Stroke Severity?

Can Serum GFAP and UCH-L1 Replace CT in Assessing Acute Ischemic Stroke Severity?

EIF4A3-Induced circ_0029941 Promotes Astrocyte Activation Through Enhancing Autophagy via miR-224-5p/NFAT5 Axis.

The abnormal expression of circular RNA (circRNA) has been implicated in the development of many human diseases, including acute ischemic stroke (AIS). However, the role and mechanism of circ_0029941 in AIS progression remain unclear. Transient middle cerebral artery occlusion (tMCAO) was constructed to mimic AIS mice model, and oxygen-glucose deprivation/reoxygenation (OGD/R)-induced astrocytes were used to mimic AIS cell model. The expression of circ_0029941, eukaryotic translation initiation factor 4A-III (EIF4A3), microRNA (miR)-224-5p and nuclear factor activated T cell 5 (NFAT5) were determined by quantitative real-time PCR. Triphenyl tetrazolium chloride staining was used to evaluate infarct size in mice, and immunostaining was performed to confirm GFAP, MAP1LC3B, and NFAT5 levels. Protein expression was tested by western blot analysis, and FISH was used for co-location. The interaction between circ_0029941 and miR-224-5p was verified by RIP and RNA pull-down assays. And the interaction between miR-224-5p and NFAT5 was confirmed by RIP and dual-luciferase reporter assays. Circ_0029941 had elevated expression in AIS patients, tMCAO models and OGD/R-induced astrocytes. Knockdown of circ_0029941 alleviated brain infarction in tMCAO mice. Also, circ_0029941 knockdown inhibited astrocyte activation and ATG5-mediated autophagy. In addition, EIF4A3 promoted circ_0029941 level, and circ_0029941 sponged miR-224-5p to regulate NFAT5. Besides, miR-224-5p inhibitor or NFAT5 overexpression reversed the inhibition effect of circ_0029941 knockdown on astrocyte activation and autophagy. In addition, antagomiR-224-5p also abolished the relieving effect of circ_0029941 knockdown on brain infarction of tMCAO mice. EIF4A3-induced circ_0029941 promoted astrocyte activation and autophagy through regulating the miR-224-5p/NFAT5 axis.

Prevalence and characteristics of acute ischemic stroke and intracranial hemorrhage in patients with immune thrombocytopenic purpura and immune thrombotic thrombocytopenic purpura: a systematic review and meta-analysis

BackgroundThere is an emerging understanding of the increased risk of stroke in patients with immune thrombocytopenic purpura (ITP) and immune thrombotic thrombocytopenic purpura (iTTP). We aimed to determine the prevalence and characteristics of acute ischemic stroke (AIS) and intracranial hemorrhage (ICH) in patients with ITP and iTTP in a systematic review and meta-analysis.MethodsWe used PubMed, Embase, Cochrane, Web of Science, and Scopus using text related to ITP, iTTP, stroke, AIS, and ICH from inception to 11/3/2023. Our primary outcome was to determine prevalence of AIS and/or ICH in a cohort of ITP or iTTP patients (age > 18). Our secondary outcomes were to determine stroke type associated with thrombopoietin receptor agonists (TPO-RAs) in ITP patients, as well as risk factors associated with stroke in ITP and iTTP patients.ResultsWe included 42 studies with 118,019 patients (mean age = 50 years, 45% female). Of those, 27 studies (n = 116,334) investigated stroke in ITP patients, and 15 studies (n = 1,685) investigated stroke in iTTP patients. In all ITP patients, the prevalence of AIS and ICH was 2.1% [95% Confidence Interval (CI) 0.8-4.0%] and 1.5% (95% CI 0.9%-2.1%), respectively. ITP patients who experienced stroke as an adverse event (AE) from TPO-RAs had an AIS prevalence of 1.8% (95% CI 0.6%-3.4%) and an ICH prevalence of 2.0% (95% CI 0.2%-5.3%). Prevalence of stroke did not significantly differ between all ITP patients and those treated with TPO-RAs. iTTP patients had a prevalence of AIS and ICH of 13.9% (95% CI 10.2%-18.1%) and 3.9% (95% CI 0.2%-10.4%), respectively. Subgroup analysis revealed the prevalence of AIS and ICH was greater in iTTP patients vs. all ITP patients (p < 0.01 and p = 0.02, respectively). Meta-regression analysis revealed none of the collected variables (age, sex, history of diabetes or hypertension) were risk factors for stroke in all ITP patients, although there were high levels of data missingness.ConclusionsPrevalence of different stroke types was lower in all ITP patients vs. iTTP patients. Additionally, ITP patients experienced a similar prevalence of stroke regardless of if they were specifically denoted to have been treated with TPO-RAs or not, supporting the continued use of TPO-RAs in management. Risk factors for stroke remain unclear, and future studies should continue to investigate this relationship.

Dual-Energy CT-Based Thrombus Radiomics Can Predict Functional Outcome of Intravenous Thrombolysis in Acute Ischemic Stroke.

To explore the predictive value of dual-energy CT-based thrombus radiomics for the functional outcome of intravenous thrombolysis in patients with acute ischemic stroke (AIS). One hundred four AIS patients who received intravenous thrombolysis were enrolled and classified into favorable and unfavorable outcome based on their modified Rankin Scale (mRS) scores at 90days. All patients underwent a one-stop-shop CT scan upon admission, including NCCT, dual-energy CTA, and CTP. The thrombus radiological and radiomics models were developed using NCCT, CTA, and iodine overlay map (IOM) images. The clinical model was developed using clinical information and other radiological data. The best-performing radiomics model was selected for the further development of a clinical-radiomics nomogram. The performance of these models was evaluated using receiver operating characteristic (ROC) curves, clinical decision curves, calibration curves, and DeLong's test. The AUCs of the modelThrombus built using the thrombus characteristics were lower than those of most radiomics models (training, 0.77; test, 0.75). The AUCs of the modelIOM were higher than those of modelCTA (training, 0.84 vs. 0.71; test, 0.78 vs. 0.66) and were comparable to modelNCCT (training, 0.84 vs. 0.82; test, 0.78 vs. 0.78). The modelNCCT+IOM demonstrated improved predictive performance compared to either single-sequence model alone (training, 0.92; test, 0.83). Systolic blood pressure and baseline NIHSS score were independent predictors of favorable outcome. Among all models, the nomogram has the highest predictive value (training, 0.96; test, 0.91). The thrombus radiomics model based on dual-energy CT can effectively predict functional outcome of intravenous thrombolysis in patients with AIS. The addition of clinical data to the model can improve predictive performance.

Systolic Blood Pressure Modifies the Effect of Endovascular Thrombectomy in Acute Ischemic Stroke: A Mediation Analysis.

Systolic blood pressure (BP) is a key factor in the outcomes of patients with acute ischemic stroke (AIS) receiving endovascular thrombectomy (EVT). However, the factors that mediate the association between BP and clinical outcome are unclear. Consecutive patients with AIS in the anterior circulation underwent continuous BP monitoring for 24 hours. The 3-month modified Rankin scale (mRS) score was defined as the clinical functional outcome. The systolic BPI indices (BPIs) were successive variation, standard deviation, variability independent of mean BP (VIM), and 24-hour mean BP. Regression analysis was used to assess the correlation between different BPIs and functional outcomes, whereas mediation analysis was employed to assess the potential mediating effects of baseline risk factors through BP on functional outcomes. A total of 140 of 292 patients (47.9%) achieved functional independence, and 87 (29.8%) experienced hemorrhagic transformation (HT). A history of stroke or hypertension and NIHSS score at onset were associated with SD and VIM (P < 0.05). BP variation (BPV) was still strongly associated with functional outcomes after adjustment for different risk factors. Mediation analysis revealed that stroke affected functional outcomes by affecting BPV, while the hypertension history affected functional prognosis by impacting the 24-hour mean BP and BPV. In addition, higher National Institute of Health stroke scale (NIHSS) scores were associated with increased BPV, whereas increased BPV was correlated with a greater proportion of unfavorable outcomes. To our knowledge, this study is the first to explore the mediating effects of different BPIs on the relationships between risk factors and functional outcomes and may provide new insights and potential mechanisms for improving AIS prognosis.

Automated Identification of Stroke Thrombolysis Contraindications from Synthetic Clinical Notes - a Proof-of-Concept Study.

Timely thrombolytic therapy improves outcomes in acute ischemic stroke. Manual chart review to screen for thrombolysis contraindications may be time-consuming and prone to errors. We developed and tested a large language model (LLM)-based tool to identify thrombolysis contraindications from clinical notes using synthetic data in a proof-of-concept study. We generated 150 synthetic clinical notes containing randomly assigned thrombolysis contraindications using LLMs. We then used Llama 3.1 405B with a custom prompt to generate a list of thrombolysis contraindications from each note. Performance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and F1 score. A total of 150 synthetic notes were generated using five different models: ChatGPT-4o, Llama 3.1 405B, Llama 3.1 70B, ChatGPT-4o mini, and Gemini 1.5 Flash. On average, each note contained 241.6 words (SD 110.7; range 80-549) and included 1.5 contraindications (SD 1.1; range 0-5). Our tool achieved a sensitivity of 90.9% (95% CI: 86.3%-94.3%), specificity of 99.2% (95% CI: 98.8%-99.5%), PPV of 87.7% (95% CI: 82.7%-91.7%), NPV of 99.4% (95% CI: 99.1%-99.6%), accuracy of 98.7% (95% CI: 98.2%-99.0%), and an F1 score of 0.892. Among the false positives, 24 (86%) were due to the inclusion of irrelevant contraindications, and 4 (14%) resulted from repetitive information. No hallucinations were observed. Our LLM-based tool may identify stroke thrombolysis contraindications from synthetic clinical notes with high sensitivity and PPV. Future studies will validate its performance using real EMR data and integrate it into acute stroke workflows to facilitate faster and safer thrombolysis decision-making.

3-Monothiopomalidomide, a new immunomodulatory imide drug (IMiD), blunts inflammation and mitigates ischemic stroke in the rat.

An overactive neuroinflammatory response is often evident in the elderly and is a significant contributor to brain tissue damage following acute ischemic stroke. Such an inflammatory response is largely mediated by microglial cells and peripheral blood mononuclear cells (PBMCs). Classical anti-inflammatory agents have not proved clinically effective in mitigating the impact of ischemic stroke but have highlighted targets for new drug development, in particular excessive proinflammatory cytokine release. The immunomodulatory imide drug (IMiD) class has shown potential in reducing neuroinflammation and switching microglial phenotypic expression away from a proinflammatory to a regenerative anti-inflammatory one. 3-Monothiopomalidomide (3-MP), a new IMiD, has a brain/plasma concentration ratio of 0.5 to 0.6, an oral bioavailability of 38.5%, and a monophasic disappearance of half-life 3.2h following oral administration. 3-MP pretreatment mitigates lipopolysaccharide (LPS)-induced inflammation in cellular human PBMCs and, in rat studies, 3-MP pretreatment lowers proinflammatory cytokine levels in the conditioned media and in plasma and the brain, respectively. Administered systemically to rats challenged with middle cerebral artery occlusion (MCAo) and reperfusion, 3-MP post-MCAo treatment reduced infarction volume; improved body asymmetry, a behavioral measure of stroke impact; and lowered inflammation. In summary, 3-MP exerted neuroprotective effects via anti-inflammatory actions against MCAo-induced ischemic injury and represents a therapeutic that warrants further investigation as a treatment for brain damage and related disorders associated with excessive inflammation.

Bioinformatics Approach to Investigating the Immuno-Inflammatory Mechanisms of Periodontitis in the Progression of Atherosclerosis

Unstable atherosclerotic plaques are a major cause of acute cardiovascular events and ischemic stroke. Clinical studies have suggested a link between periodontitis and atherosclerotic plaque progression, but the underlying mechanisms remain unclear. To investigate this, transcriptomic datasets related to periodontitis and atherosclerosis were downloaded from Gene Expression Omnibus. A weighted gene co-expression network analysis was used to identify gene modules associated with periodontitis, and the Limma R package identified differentially expressed genes (DEGs) between unstable and stable plaques. Overlapping genes were defined as periodontitis-related DEGs, followed by functional enrichment analysis and protein–protein interaction network construction. Machine learning methods were used to identify biomarkers for unstable plaques related to periodontitis, which were validated using external datasets. Immune infiltration and single-cell analyses were performed to explore the relationship between biomarkers and immune cells. A total of 161 periodontitis-related DEGs were identified, with the pathway analysis showing associations with immune regulation and collagen matrix degradation. HCK, NCKAP1L, and WAS were identified as biomarkers for unstable plaques, demonstrating a high diagnostic value (AUC: 0.9884, 95% CI: 0.9641–1). Immune infiltration analysis revealed an increase in macrophages within unstable plaques. Single-cell analysis showed HCK expression in macrophages and dendritic cells, while NCKAP1L and WAS were expressed in macrophages, dendritic cells, NK cells, and T cells. Consensus clustering identified three expression patterns within unstable plaques. Our findings were validated in atherosclerotic mouse models with periodontitis. This study provides insights into how periodontitis contributes to plaque instability, supporting diagnosis and intervention in patients with periodontitis.

Effects of glycemic indicators on early neurological outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis.

Stress hyperglycemia (SH) is a common phenomenon that is present in about 50% of patients with acute ischemic stroke (AIS). It is thought to be a main risk factor for poor functional outcome among patients with AIS undergoing intravenous thrombolysis (IVT). To investigate the predictive value of glycemic indicators for early neurological outcomes (ENOs) in patients with AIS treated with IVT. We retrospectively reviewed a prospectively collected database of patients with AIS who underwent IVT at the Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, between January 2017 and June 2022. ENO included early neurological improvement (ENI) and early neurological deterioration (END), defined as a decrease or increase in the National Institutes of Health Stroke Scale (NIHSS) score between baseline and 24 hours after IVT. We analyzed the associations between glycemic indicators [including admission hyperglycemia (AH), fasting blood glucose (FBG), and SH ratio (SHR)] and ENO in all patients and in subgroups stratified by diabetes mellitus (DM). A total of 819 patients with AIS treated with IVT were included. Among these, AH was observed in 329 patients (40.2%). Compared with patients without AH, those with AH were more likely to have a higher prevalence of DM (P < 0.001) and hypertension (P = 0.031) and presented with higher admission NIHSS scores (P < 0.001). During the first 24 hours after IVT, END occurred in 208 patients (25.4%) and ENI occurred in 156 patients (19.0%). Multivariate mixed logistic regression analyses indicated that END was independently associated with AH [odds ratio (OR): 1.744, 95% confidence interval (CI): 1.236-2.463; P = 0.002]. Subjects were classified into four groups representing quartiles. Compared with Q1, patients in the higher quartiles of SHR (Q2: OR: 2.306, 95%CI: 1.342-3.960; P = 0.002) (Q3: OR: 2.284, 95%CI: 1.346-3.876; P = 0.002) (Q4: OR: 3.486, 95%CI: 2.088-5.820; P = 0.001) and FBG (Q3: OR: 1.746, 95%CI: 1.045-2.917; P = 0.033) (Q4: OR: 2.436, 95%CI: 1.476-4.022; P = 0.001) had a significantly higher risk of END in the overall population. However, none of the glycemic indicators were found to be associated with ENI in patients with or without DM. Our study demonstrated that glycemic indicators in patients with stroke treated with IVT were associated with the presence of END rather than ENI during the first 24 hours after admission.

Association Between Sociodemographic Disparities and Door to Computerized Tomography Time in Patients with Acute Ischemic Stroke Across COVID-19 Periods in the Emergency Department: A Multi-Center Cohort Study

Introduction: Stroke is the fifth leading cause of death and long-term disability in the United States. The current guideline for stroke management includes a 25 min timeframe from door-to-computed tomography time (DTCT). However, sociodemographic backgrounds may impact the DTCT in acute stroke patients. Methods: This was a retrospective, multicenter, cohort study between January 2018 and August 2022 throughout North Texas. The primary endpoint was DTCT ≤ 25 min upon arrival to hospital for all patients suspected of acute ischemic stroke. Results: During the study period, a total of 23,364 patients were included. Only 4468 patients (19.1%) had DTCT times less than or equal to 25 min, and 16,464 patients (70.5%) had DTCT times more than 25 min. In our cohort, Black (OR 1.35; 95% CI 1.23–1.49) and Asian patients (OR 1.33; 95% CI 1.01–1.74) were more likely to have DTCT &gt; 25 min compared to White patients. Hispanic patients (OR 1.20; 95% CI 1.07–1.34) were more likely to have DTCT &gt; 25 min compared to non-Hispanics. Patients presenting during the COVID (OR 1.45; 95% CI 1.34–1.57) and post-COVID period (OR 1.46; 95% CI 1.30–1.65) were more likely to have DTCT &gt; 25 min compared to the pre-COVID period. Conclusions: We demonstrated a discrepancy in DTCT time for acute ischemic stroke patients based on their race and ethnic population and an increase in DTCT time after the start of COVID-19, which has persisted after the pandemic. These diverse factors highlight the complex interplay of logistical, organizational, and healthcare challenges that have influenced DTCT time.

Complications of reperfusion therapy of acute ischemic stroke (scientific review)

Reperfusion therapy using intravenous thrombolysis and mechanical thrombectomy is the main type of specific treatment for ischemic stroke. However, restoration of cerebral blood flow may paradoxically lead to reperfusion injury of brain tissue. The main causes of complications of reperfusion therapy are considered in this scientific review. The scientific search was carried out using the PubMed (https://pubmed.ncbi.nlm.nih.gov), ClinicalKey Elsevier (https://www.clinicalkey.com), Cochrane Library (https://www.cochranelibrary.com) and Google Scholar (https://scholar.google.com) databases for publications of 2008–2024. Intracranial hemorrhage is one of the most dangerous complications of thrombolytic therapy for ischemic stroke, which is associated with poor prognosis. Risk factors for the development of reperfusion complications, including hemorrhagic transformation of a brain infarction, can be age, pre-stroke treatment and conditions, infarct volume. The risk and frequency may depend on the reperfusion technique in the acute phase of stroke and various reperfusion strategies like intravenous thrombolysis with alteplase, tenecteplase, mechanical thrombectomy, etc. Reperfusion injuries of the brain have complex pathophysiological cellular and biochemical mechanisms of development, and one of the main factors is damage to the blood-brain barrier. Its increased permeability is mediated by the activation of matrix metalloproteinases. A number of laboratory biomarkers are being investigated to assess the permeability of the blood-brain barrier and the risk of hemorrhagic transformation. Several studies prove that an increase in the level of matrix metalloproteinase 9 is associated with increased brain infarct size and the development of hemorrhagic transformation. Another encouraging laboratory marker is caveolin-1, whose reduced levels are associated with intracranial hemorrhage and poor functional outcome after endovascular therapy. Various neuroprotective strategies are being investigated to reduce the risk of complications of reperfusion therapy. Modern approaches to revascularization have become very successful and continue to improve, and perhaps the concept of reperfusion injury will develop further.

Features of anesthesiological support during mechanical thrombectomy: preoperative assessment and pain management strategies

Mechanical thrombectomy is acknowledged as one of the most effective treatments for acute ischemic stroke, as it facilitates the rapid restoration of blood flow to the affected brain regions. Timely execution of this procedure is critical for reducing neurological deficits and improving patient prognosis. In situations where the speed and precision of intervention can determine treatment success, the role of the anesthesiologist becomes indispensable. Anesthesiological support during mechanical thrombectomy not only ensures patient monitoring but also involves active participation in risk management throughout and after the procedure. Adherence to modern anesthesiological protocols not only increases the likelihood of successful outcomes but also allows for the adaptation of treatment to the specific needs of patients, particularly those with less favorable clinical indicators. In this context, it is essential not only to explore optimal anesthesia approaches but also to investigate the physiological factors influencing anesthesiological support. Furthermore, developing effective strategies for postoperative pain management is necessary. Raising awareness about these aspects will contribute to improving clinical outcomes, reducing the risk of complications, and enhancing the overall quality of life for patients following thrombectomy.

Initiation of direct oral anticoagulation after reperfusion therapy in ischemic stroke in clinical practice: Results from Sits-International Stroke Registry.

Data is limited on the safety of early initiation of direct oral anticoagulation (DOAC) treatment after acute ischemic stroke (AIS) receiving reperfusion therapy in patients with atrial fibrillation (AF). We investigated the timing of DOAC initiation and its association with safety and outcomes. We included AIS patients receiving reperfusion therapy with AF diagnosis (prevalent or new) registered in the Safe Implementation of Treatments in Stroke international registry during 2013-2024. Safety outcomes were hemorrhage and death. Secondary outcomes were recurrent AIS, any embolism and functional independence (modified Rankin Scale [mRS] 0-2) at 3 months. We performed descriptive statistics and multivariable analysis for DOAC initiation time as an ordinal variable (0-3, 4-7, and 8-100 days after stroke onset) and its association with outcomes. Explorative analyses were performed to investigate factors associated with DOAC initiation time, as a continuous or ordinal variable. In total, 13,389 patients had data on DOAC initiation time, and 7861 patients had new event data by 3-month follow-up. We observed 0.1% intracranial hemorrhage, 0.4% major extracranial hemorrhage, 1.1% recurrent ischemic stroke, and 0.2% systemic embolism. At 3 months, 4.8% patients had died, and functional independence was seen in 60.9%. In multivariable analyses, DOAC initiation after stroke onset was not associated with any outcomes. Higher 24 h NIHSS and lower pre-stroke mRS score were associated with delayed DOAC initiation. DOAC initiation time was not associated with any outcomes in AIS patients who received reperfusion therapy. Severe stroke symptoms at 24 h were associated with delayed DOAC initiation. The low incidence of safety outcomes and missing data in this study should lead to cautious interpretations of these results.