Acute Stroke Patients Research Articles

Dyselectrolytaemia in Acute Stroke Patients, A Study of Hundred Cases in Holy Family Red Crescent Medical College Hospital

Introduction: Stroke is a growing public health concern in low- and middle-income countries. There are many studies on stroke, its associated conditions, and its effect on stroke patients’ outcomes, but few studies on dyselectrolytaemia in stroke patients have been done in our country. This study aimed to highlight the pattern and correlation of dyselectrolytaemia in acute stroke patients of a tertiary care hospital. Methods: This cross-sectional study was conducted in the Department of Medicine, Holy Family Red Crescent Medical College Hospital, from January, 2016 to June, 2016. A total of 100 patients with stroke were selected as study subjects as per inclusion and exclusion criteria. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 20.0 for Windows. The mean values were calculated for continuous variables. The quantitative observations were indicated by frequencies and percentages. The chi-square test with Yates correction was used to analyze the categorical variables. Student t-test was used for continuous variables. P values <0.05 were considered statistically significant. Result: In this study, 31 (31.0%) patients had dyselectrolytaemia. This study shows serum electrolytes of the study patients, it was observed that 17(17.0%) patients had hyponatremia: serum sodium level (<135 mmol/I), 13(13.0%) patients had hypokalaemia serum potassium (<3.5 mmol/l), 16(16.0%) patients had hypochloraemia serum Chloride level (<96 mmol/l) and 11(11.0%) patients had low bicarbonate level (< 24 mmol/I). Conclusion: This study highlights the prevalence of dyselectrolytaemia in acute stroke patients. Among the 100 patients studied, 17% experienced hyponatremia, 13% had hypokalaemia, 16% exhibited hypochloraemia, and 11% had low bicarbonate levels. These findings highlight the importance of routine electrolyte monitoring and prompt management in acute stroke care to prevent complications and improve patient outcomes.

Predicting 6-month modified Rankin Scale score in stroke patients

The study aimed to identify predictors of 6-month outcomes in acute ischemic stroke (AIS) patients using the modified Rankin Scale (mRS). A prospective observational cohort study was conducted on 277 AIS patients admitted to the Neurology Departments of Cluj-Napoca Emergency County Clinical Hospital between December 2020 and July 2021. After excluding those lost to follow-up or who withdrew due to COVID-19 concerns, 121 patients were followed for six months. Data collected included demographic details, clinical assessments (including NIHSS and mRS scores), laboratory tests, and imaging results. The study found significant differences between patients with mild/moderate disability (mRS 0-3) and those with severe disability (mRS 4-5) at six months. Age, heart failure, NIHSS score, resistin levels, C-reactive protein, and lesion volume were significantly associated with worse outcomes. Multivariate logistic regression revealed that heart failure was an independent predictor of severe disability, increasing the risk by over seven times. Specific clinical and biochemical markers at admission may be able to predict long-term functional outcomes in AIS patients, which may inform individualized patient management and rehabilitation strategies.

Epidemiology and Functional Outcome of Acute Stroke Patients in Korea using Nationwide data.

Korea's healthcare system and policy promotes early, actively stroke treatment to improve prognosis. This study represents stroke epidemiology and outcomes in Korea. This study investigated data from the Acute Stroke Assessment Registry. The registry collects data from over 220 hospitals nationwide, focusing on quality stroke service management. Data analysis included patient demographics, stroke severity assessment, and discharge prognosis measurement using standardized scales. 86,568 acute stroke patients were collected with demographic and clinical characteristics during 18 months from 2016 to 2021, focusing on acute subarachnoid hemorrhage, acute intracerebral hemorrhage, and acute ischemic stroke. Of these 86,568 patients, 8.3% was subarachnoid hemorrhage, 16.3% intracerebral hemorrhage, and 74.9% ischemic stroke. Trends showed decreasing subarachnoid hemorrhage and increasing intracerebral hemorrhage cases over the years. 68.3% stroke patients had the clear onset time. 49.6 % stroke patients arrived within 4.5 hours of symptom onset, with more treated at general hospitals. Good functional outcomes at discharge was obtained with 58.3% of acute stroke patients, 55.9% of subarachnoid hemorrhage patients, 34.6% of intracerebral hemorrhage patients, and 63.8% of ischemic stroke patients. The results showed that ischemic stroke was the most common subtype, followed by intracerebral hemorrhage and subarachnoid hemorrhage. Prognosis differed among subtypes, with favorable outcomes more common in ischemic stroke and subarachnoid hemorrhage compared to intracerebral hemorrhage.

Clinical and Imaging Features Associated With Fast Infarct Growth During Interhospital Transfers of Patients With Large Vessel Occlusions.

Acute ischemic stroke patients with a large vessel occlusion (LVO) who present to a primary stroke center (PSC) often require transfer to a comprehensive stroke center (CSC) for thrombectomy. Not much is known about specific characteristics at the PSC that are associated with infarct growth during transfer. Gaining more insight into these features could aid future trials with cytoprotective agents targeted at slowing infarct growth. We aimed to identify baseline clinical and imaging characteristics that are associated with fast infarct growth rate (IGR) during interhospital transfer. We included patients from the CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project, a prospective multicenter study. Patients with an anterior circulation LVO who were transferred from a PSC to a CSC for consideration of thrombectomy were eligible if imaging criteria were fulfilled. A CT perfusion (CTP) needed to be obtained at the PSC followed by an MRI at the CSC, before consideration of thrombectomy. The interhospital IGR was defined as the difference between the infarct volumes on MRI and CTP, divided by the time between the scans. Multivariable logistic regression was used to determine characteristics associated with fast IGR (≥5 mL/h). A total of 183 patients with a median age of 74 years (interquartile range 61-82), of whom 99 (54%) were male and 82 (45%) were fast progressors, were included. At baseline, fast progressors had a higher NIH Stroke Scale score (median 16 vs 13), lower cerebral blood volume index (median 0.80 vs 0.89), more commonly poor collaterals on CT angiography (35% vs 13%), higher hypoperfusion intensity ratios (HIRs) (median 0.51 vs 0.34), and larger core volumes (median 11.80 mL vs 0.00 mL). In multivariable analysis, higher HIR (adjusted odds ratio [aOR] for every 0.10 increase 1.32 [95% CI 1.10-1.59]) and larger core volume (aOR for every 10 mL increase 1.54 [95% CI 1.20-2.11]) remained independently associated with fast IGR. Fast infarct growth during interhospital transfer of acute stroke patients is associated with imaging markers of poor collaterals on baseline imaging. These markers are promising targets for patient selection in cytoprotective trials aimed at reducing interhospital infarct growth.

Intracerebral hemorrhage risk after adjunct intraarterial thrombolysis in thrombectomy‐treated acute ischemic stroke

AbstractBackground and PurposeIntraarterial thrombolysis as an adjunct to mechanical thrombectomy is increasingly being considered to enhance reperfusion in acute ischemic stroke patients. Intraarterial thrombolysis may increase the risk of post‐thrombectomy intracerebral hemorrhage (ICH) in certain patient subgroups.MethodsWe analyzed acute ischemic stroke patients treated with mechanical thrombectomy in a multicenter registry. The occurrence of any (asymptomatic and symptomatic) post‐thrombectomy ICH was ascertained using standard definition requiring serial neurological examinations and computed tomographic scans acquired within 48 hours of the thrombectomy. We determined the risk of ICH in subgroups defined by clinical characteristics and the use of intravenous (IV) thrombolysis.ResultsA total of 146 (7.5%) patients received intraarterial thrombolysis among 1953 acute ischemic stroke patients who underwent mechanical thrombectomy. The proportion of patients who developed any ICH was 26 (17.8%) and 510 (28.2%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .006). The proportion of patients who developed symptomatic ICH was 4 (2.7%) and 30 (1.7%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .34). Among patients who received IV thrombolysis (n = 1042), the proportion of patients who developed any ICH was 9 (16.7%) and 294 (30.7%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .028). The risk was not different in strata defined by age, gender, location of occlusion, preprocedure National Institutes of Health Stroke Scale score, time interval between symptom onset and thrombectomy, Alberta Stroke Program Early CT Score, systolic blood pressure, and serum glucose concentrations.ConclusionsIn patients undergoing mechanical thrombectomy, the risk of any ICH and symptomatic ICH was not increased with intraarterial thrombolysis, including in those who had already received IV thrombolytics.

Effectiveness of Proprioceptive Neuromuscular Facilitation on Walking Speed, Discomfort, and Knee Extension in an Acute Stroke Patient: A Case Study

This study investigates the impact of proprioceptive neuromuscular facilitation (PNF) on improving functional mobility in a stroke patient, with a focus on walking speed, discomfort levels, and knee extension range of motion (ROM). PNF techniques were applied over four weeks to assess their effectiveness. The patient's walking performance was evaluated using the 6-minute walk test (6MWT), and discomfort was measured using the visual analogue scale (VAS) during walking and knee extension movements in both seated and standing positions. The results revealed a significant reduction in 6MWT time from 16.47 seconds to 14.2 seconds post-intervention. VAS scores showed a marked decrease in discomfort during the 6MWT from 8 to 1 and during knee extension from 7 to 4 in both positions. Additionally, the knee extension ROM increased significantly, with the most pronounced improvement observed in the seated position (from 141.3° to 158.5°). These findings suggest that PNF is an effective therapeutic approach for enhancing walking performance and reducing discomfort related to hamstring stiffness in acute stroke patients. The study's limitations include its single-case design, limiting the generalizability of the results. Future research with a larger sample size and more objective assessment tools is recommended to validate these findings.

Endovascular treatment for proximal middle cerebral artery occlusion due to underlying intracranial atherosclerotic disease: A retrospective single-center case series

ObjectiveTo compare treatment outcomes between patients who received a front-line stent-retriever thrombectomy (SRT) or first stenting without retrieval (FRESH) for treating proximal M1 occlusion due to underlying intracranial atherosclerotic disease (ICAD). MethodsWe retrospectively reviewed consecutive acute ischemic stroke (AIS) patients with intracranial large vessel occlusion (LVO) in the anterior circulation who underwent endovascular treatment (EVT) between January 2017 and August 2021 at Yeungnam University Medical Center. LVO in the anterior circulation was classified according to etiology as follows: Embolic group and ICAD group. Occlusion of the proximal M1 due to ICAD were enrolled in this study. The ICAD group was divided into SRT and FRESH groups according to the treatment method. ResultsAmong the 72 patients in the ICAD group, 55 patients had occlusion of the M1, and 27 had occlusion of the proximal M1 (27/55, 49.1 %). Among the 27 patients, 11 (40.7 %) underwent SRT and 16 (59.3 %) underwent FRESH. The puncture-to-recanalization time was significantly shorter in the FRESH group (28 min vs. 52 min, p = 0.023). Symptomatic ICH tended to occur more frequently in the SRT group than in the FRESH group (27.3 % vs. 0.0 %, p=0.056). There was a nonsignificant trend towards a good functional outcome in the FRESH group compared to the SRT group (81.3 % vs. 45.5 %, p=0.097). ConclusionIn the FRESH group, the puncture-to-recanalization time was significantly shorter, symptomatic ICH tended to occur less frequently, and good functional outcomes were more common.

Development of a Natural Language Processing (NLP) model to automatically extract clinical data from electronic health records: results from an Italian comprehensive stroke center

IntroductionData collection often relies on time-consuming manual inputs, with a vast amount of information embedded in unstructured texts such as patients’ medical records and clinical notes. Our study aims to develop a pipeline that combines active learning (AL) and NLP techniques to enhance data extraction in an acute ischemic stroke cohort. Materials and methodsConsecutive acute ischemic stroke patients who received reperfusion therapies at IRCCS Humanitas Research Hospital were included. The Italian NLP Bidirectional Encoder Representations from Transformers (BERT) model was trained with AL to automatically extract clinical variables from electronic health text. Simulated active learning performances were evaluated on a set of labels representing patients’ comorbidities, comparing Bayesian Uncertainty Sampling by Disagreement (BALD) and random text selection. Prognostic models predicting patients’ functional outcomes using Gradient Boosting were trained on manually labelled and semi-automatically extracted data and their performance was compared. ResultsThe active learning process initially showed null performance until around 20% of texts were labelled, possibly due to root layers freezing in the BERT model, yet overall, active learning improves model learning efficiency across most comorbidities. Prognostic modelling showed no significant difference in performance between models trained on manually labelled versus semi-automatically extracted data, indicating effective prediction capabilities in both settings. ConclusionsWe developed an efficient language model to automate the extraction of clinical data from Italian unstructured health texts in a cohort of ischemic stroke patients. In a preliminary analysis, we demonstrated its potential applicability for enhancing prediction model accuracy.

Emergency Department and Critical Care Use of Clevidipine for Treatment of Hypertension in Patients with Acute Stroke.

Clevidipine is a parenteral dihydropyridine calcium channel blocker that received Food and Drug Administration (FDA) approval in 2008 for the reduction of blood pressure (BP) when oral therapy is not feasible or not desirable. Soon after approval, our institution incorporated clevidipine into protocols for management of hypertension among acute stroke patients, based on the drug's rapid onset of action and straightforward titration to goal. A subsequent retrospective review of its use in otherwise alteplase-eligible ischemic stroke patients with BP greater than 185/110 mmHg (n=32, in 2014) revealed that clevidipine in that setting demonstrated the shortest median time to BP control, the shortest median door to alteplase administration time, and the lowest administered volume of any parenteral antihypertensive used. As a result, clinical protocols in our institution were modified to make clevidipine first-line antihypertensive in both ischemic and hemorrhagic acute stroke. In this study we report our institution's experience with clevidipine in acute stroke, comprising the largest such report to date. . We conducted a retrospective chart review of all acute stroke patients who received clevidipine in the Emergency Department (ED) or intensive care unit (ICU) (n=295) for the management of clinically significant hypertension between January 1, 2015 and December 31, 2017. Metrics analyzed included target (goal) BP for thrombolysis eligibility among patients intended for lytic therapy according to stroke management guidelines in effect at the time of care. The median time for initial parenteral antihypertensive Dose-to-Goal (DTG) BP for all ischemic stroke patients (both those intended for and those not intended for lytic therapy) with complete data (n= 71 of 204) was 15 minutes; median time for Door-to-IV-alteplase administration for ischemic stroke patients with complete data (n=14 of 34 treated patients) was 59 minutes. The median time for initial parenteral antihypertensive DTG BP for all hemorrhagic stroke patients with complete data (n=33 of 91 treated patients) was 39 minutes. We conclude that the salutary findings of the initial small study are valid across a larger patient sample of all acute stroke types. Based on these data, clevidipine is shown to be safe, consistent, and effective in the treatment of acute hypertension in ischemic and hemorrhagic stroke events, and is a reasonable first-line treatment option for acute hypertension in this setting.

Acquisition of Prehospital Stroke Severity Scale is associated with shorter door-to-puncture times in patients with prehospital notifications transported directly to a thrombectomy center

BackgroundWe sought to identify systemic factors influencing door-to-puncture times (DTP) among patients with pre-arrival notifications presenting directly to a comprehensive stroke center (CSC) and undergoing emergent mechanical thrombectomy (MT).MethodsIn this...

Reperfusion therapy and risk of post-stroke delirium

ABSTRACT Objectives Delirium is a common and serious post-stroke complication. Early reperfusion by ameliorating brain damage could potentially prevent delirium after ischemic stroke, but the impact of this therapy on delirium remains unclear. We aimed to explore the association between reperfusion therapy (RT) and post-stroke delirium. Methods We retrospectively analyzed data from the PRospective Observational POLIsh Study on post-stroke delirium. Symptoms of delirium were examined during the first 7 days after admission and a diagnosis of delirium was made using Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. We used logistic regression to examine the association between RT and delirium. Results We included 301 acute stroke patients (median age: 77; median NIHSS: 14; 55.1% female). In the whole group of patients, RT was associated with a lower odds of delirium (34.2% vs 44.8%; adjusted OR: 0.56, 95% CI: 0.32–0.96, p = 0.035). There was a significant interaction between RT and pre-stroke cognitive status. As a result, RT was associated with a lower odds of delirium in patients without premorbid cognitive decline (28.8% vs 48.2%; adjusted OR: 0.34, 95% CI: 0.17–0.66, p = 0.002) and a higher odds of delirium in patients with pre-stroke cognitive decline (72.7% vs 41.0%; adjusted OR: 3.55, 95% CI: 1.03–12.20, p = 0.040). Discussion The association between RT and delirium is modified by pre-stroke cognitive status. In patients without cognitive decline, RT is associated with a lower likelihood of delirium. Delirium should be considered as a relevant outcome in future controlled trials.

Automated ASPECTS Segmentation and Scoring Tool: a Method Tailored for a Colombian TelestrokeNetwork.

To evaluate our two non-machine learning (non-ML)-based algorithmic approaches for detecting early ischemic infarcts on brain CT images of patients with acute ischemic stroke symptoms, tailored to our local population, to be incorporated in our telestroke software. One-hundred and thirteen acute stroke patients, excluding hemorrhagic, subacute, and chronic patients, with accessible brain CT images were divided into calibration and test sets. The gold standard was determined through consensus among three neuroradiologist. Four neuroradiologist independently reported Alberta Stroke Program Early CT Scores (ASPECTSs). ASPECTSs were also obtained using a commercial ML solution (CMLS), and our two methods, namely the Mean Hounsfield Unit (HU) relative difference (RELDIF) and the density distribution equivalence test (DDET), which used statistical analyze the of the HUs of each region and its contralateral side. Automated segmentation was perfect for cortical regions, while minimal adjustment was required for basal ganglia regions. For dichotomized-ASPECTSs (ASPECTS < 6) in the test set, the area under the receiver operating characteristic curve (AUC) was 0.85 for the DDET method, 0.84 for the RELDIF approach, 0.64 for the CMLS, and ranged from 0.71-0.89 for the neuroradiologist. The accuracy was 0.85 for the DDET method, 0.88 for the RELDIF approach, and was ranged from 0.83 - 0.96 for the neuroradiologist. Equivalence at a margin of 5% was documented among the DDET, RELDIF, and gold standard on mean ASPECTSs. Noninferiority tests of the AUC and accuracy of infarct detection revealed similarities between both DDET and RELDIF, and the CMLS, and with at least one neuroradiologist. The alignment of our methods with the evaluations of neuroradiologist and the CMLS indicates the potential of our methods to serve as supportive tools in clinical settings, facilitating prompt and accurate stroke diagnosis, especially in health care settings, such as Colombia, where neuroradiologist are limited.

Transforming healthcare performance monitoring - A cutting-edge approach with generalized additive profiles: GAMs for healthcare quality monitoring.

Recent findings indicate a growing trend in data analysis within healthcare using statistical process control. However, the diversity of variables involved necessitates the expansion of new process control methodologies. This study examined control chart applications in cardiology by using generalized additive models (GAMs) to construct profiles while involving multiple healthcare variables (08). Two distinct statistics: deviation (D), and Hotelling (T2) were employed for constructing control charts: a commonly used single-variable statistic for nonparametric profiles and an innovative multivariate statistic that assesses the contribution of each element to process changes. These statistics were tested for monitoring ischemic and hemorrhagic strokes in 1-year acute stroke (369) patients at the Faisalabad Institute of Cardiology. Demographic parameters (age, gender), vascular risk factors (diabetes, family history, sleep), socioeconomic variables (smoking, location), and blood pressure are included in the model. The research includes the computation of zero-state average run length (ARL) for assessing the performance of control charts. The characteristics of the proposed profile were analyzed, such as the T2 control chart, performing better than the D chart for medium-to-large shifts (δ ≥ 0.50). On the other hand, for small δ = 0.25, the D control chart produces smaller ARL values but more significant standard deviations. While both statistics contribute to profile monitoring, T2 is more effective at identifying and tracing medium and large shifts. In conclusion, such handy tools may aid healthcare performance monitoring, especially for complicated predictor-response relationships. Monitored profiles demonstrated that GAMs are useful for healthcare analysis and process monitoring.

Optimizing Acute Ischemic Stroke Care: Evaluating Emergency Stroke Code Activation and Thrombolytic Therapy in East Azerbaijan Province

Background: Stroke remains a significant global health challenge, contributing to mortality and disability burdens. Optimizing stroke care involves understanding the complexities of in-hospital management, especially in regions like East Azerbaijan Province, where stroke incidence is high. Objectives: This study evaluates the effectiveness of Emergency Stroke Code (ESC) activation and thrombolytic therapy in acute ischemic stroke care at Imam Reza Hospital, Tabriz, a referral center. Methods: A cross-sectional study was carried out between April 2021 and March 2022, including patients with activated ESC or receiving thrombolysis at Imam Reza Hospital, Tabriz. Data on patient demographics, risk factors, time intervals, thrombolysis administration, adverse events, and outcomes were collected and analyzed using SPSS software. Results: Among 748 acute stroke patients, 165 received thrombolysis, with 117 having ESC activation. The main reasons for not administering tissue plasminogen activator (tPA) in patients with ESC code activation included mild symptoms (23.6%), exceeding thrombolysis time (14.8%), and hemorrhagic stroke (10.4%). Pre-hospital ESC activation significantly reduced time intervals from hospital arrival to CT-scan and tPA injection (P &lt; 0.001). The incidence of intracranial hemorrhage was 6.7% overall, with rare systemic bleeding (0.6%). Pre-hospital notification did not show significant changes in the National Institutes of Health Stroke Scale (NIHSS) or Modified Rankin Scale (MRS) scores. Conclusions: While ESC activation streamlines in-hospital processes, it alone may not improve clinical outcomes without efficient out-of-hospital systems. Pre-hospital communication systems like ESC can aid in reducing in-hospital processing time for thrombolysis but must be coupled with efforts to enhance early diagnosis and efficient dispatch systems to optimize stroke care.

The effect of intravenous thrombolysis in stroke patients with unsuccessful thrombectomy.

The benefit of intravenous thrombolysis (IVT) is well established. We aim to study the benefits of IVT in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) who underwent unsuccessful mechanical thrombectomy (MT). We included AIS patients who underwent MT for anterior circulation LVO with failed recanalization (modified treatment in cerebral ischemia [mTICI] score ≤ 2A). Patients who received IVT prior to MT were compared to those who received MT alone. Propensity score matching using demographic, clinical, radiographic and procedural variables was used to match patients with and without IVT. The primary outcome was favorable 90-day good functional outcome (defined as modified Rankin scale of 0-2), and secondary outcomes included intracranial hemorrhage (ICH), symptomatic ICH (sICH), and 90-day mortality. Totally, 610 AIS patients with unsuccessful MT were included. After propensity matching, 219 patients were identified in each group. Median age was 70 years and 73 years in the IVT + MT and MT alone groups, respectively. In the IVT + MT group, final mTICI scores of 0, 1, and 2A were achieved in 92 (42.0%), 33 (15.1%), and 94 (42.9%) patients, respectively, versus 76 (34.7%), 29 (13.2%), and 114 (52.1%) in the MT alone group. The IVT + MT group had greater odds of 90-day good functional outcome (adjusted odds ratio 2.54, 95% confidence interval 1.53-4.32). There were no significant differences in secondary outcomes. IVT is associated with improved functional outcomes in AIS patients with LVO despite unsuccessful MT.

Magnetic resonance imaging features and stroke etiology of ischemic stroke in essential thrombocythemia

BackgroundVarious essential thrombocythemia (ET)-related stroke mechanisms have been proposed, including microcirculatory disturbance due to coagulopathy, vasculitis, and embolism due to thrombus formation in large vessels. However, the stroke mechanism in ET remains largely unexplored. The purpose of this study was to evaluate magnetic resonance image (MRI) features of ischemic stroke in ET and determine the potential stroke mechanism. MethodsWe retrospectively collected data from 21 acute ischemic stroke patients with ET who were admitted to two stroke centers between 2010 and 2023. ET was diagnosed according to the World Health Organization criteria. We evaluated MRI features including the diffusion-weighted image (DWI) lesion pattern, and the presence of hemorrhagic transformation and intracranial artery steno-occlusive lesion, as well as other etiological workup results. ResultsOf 21 patients, 20 exhibited multiple ischemic lesions on DWI, mainly within a single vascular territory. Cortical infarcts were observed in 19 patients. Hemorrhagic transformation occurred in 15 patients. Additionally, 15 patients had intracranial steno-occlusive arteries, which regressed to normal in 11 patients during follow-up. Out of all patients, only 2 had potential causes of stroke other than ET (1 with atrial fibrillation and 1 with intracranial atherosclerotic stenosis). The remaining 19 patients had ET as the only identified potential cause. ConclusionsMRI features, including DWI lesion pattern in ischemic stroke patients with ET, suggested embolic etiology despite the absence of major embolic sources. Intra-arterial thrombus appears to be part of the stroke mechanism related to ET and may contribute to ischemic stroke in ET.

Role of Circadian Rhythm Changes on Functional Dependence Despite Successful Repercussion in Patients with Endovascular Treatment.

Increasing evidence of circadian biology may influence the physiopathologic mechanism, progression, and recovery of stroke. However, few data have shown about circadian rhythm on futile recanalization (FR) in patients treated with endovascular treatment (EVT). From 2017 to 2021, an observational cohort of acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) underwent EVT was conducted. FR was defined as the failure to achieve functional independence in patients at 90 days after EVT, although the occluded vessels reached a recanalization. The effect of circadian rhythm on FR was investigated using the logistic regression model. Of 783 patients, there were 149 patients who had stroke onset between 23:00-6:59, 318 patients between 7:00-14:59, and 316 patients between 15:00-22:59. Patients suffered a stroke during 15:00-22:59 had shorter OTP (p =0.001) time, shorter OTR (p<0.001) time, higher rate of intravenous thrombolysis (p =0.001) than groups of other time intervals. The rate of FR post-EVT in patients who had a stroke between 15:00-22:59 was significantly higher than in those with stroke onset between 23:00-6:59 (p =0.017). After adjusting for confounding factors, the time of stroke occurring during 15:00-22:59 (adjusted OR [aOR], 1.652; 95%CI, 1.024-2.666, p =0.04) was an independent predictor of FR. Circadian rhythm can directly or indirectly affect the occurrence, development, and prognosis of AIS. More studies may be needed in the future to validate the results of our study and to explore the potential mechanisms behind the effects of circadian rhythms on FR.

Analysis of predictors of hemorrhagic transformation after reperfusion therapy with recombinant tissue plasminogen activator in patients with acute ischemic stroke: a single-center experience

BackgroundHemorrhagic transformation (HT) is a serious complication of thrombolytic therapy for acute ischemic stroke, limiting its indications and affecting treatment plans and clinical prognosis. Identifying risk factors for HT could help improve the risk–benefit ratio of thrombolytic therapy. We aimed to analyze the predictors of HT after reperfusion therapy with recombinant tissue plasminogen activator (rTPA) in patients with acute ischemic stroke. This study included 115 patients who received rTPA. All patients underwent history taking, clinical examination, neurological examination including Glasgow Coma Scale and National Institutes of Health Stroke Scale scores (NIHSS), radiological investigation, and cardiac investigation. Patients were followed up strictly every 2 h for 1st 24 h then for two weeks clinically using the NIHSS and radiologically using CT or MRI to detect HT.ResultsPatients with HT represented 21.7% of all patients receiving rTPA, while symptomatic intracranial hemorrhage (sICH) represented 6.9%. Patients with HT had significantly higher blood pressure, respiratory rate, atrial fibrillation rate, NIHSS score, INR, prothrombin time, neutrophil-to-lymphocyte ratio (NLR), and lower platelet count, LDL level, higher Fazekas score, lower ASPECT score, and prolonged onset-to-needle time.ConclusionPredicting HT in acute ischemic stroke patients is crucial for optimizing management and potentially improving outcomes. In our study, six predictors were associated with HT: higher respiratory rate, higher atrial fibrillation rate, higher NLR, lower LDL level, higher Fazekas score, lower ASPECT score, and onset-to-needle time greater than 180 min.

Association of plasma VEGF with futile recanalization and intracranial angiogenesis in ischemic stroke post-endovascular treatment

ObjectiveThis study aimed to compare baseline and subsequent vascular endothelial growth factor (VEGF) levels in predicting futile recanalization (FR) in acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT), and to explore the association between angiogenesis and VEGF. Methods84 participants were recruited, including 46 AIS in the EVT group, 20 AIS in the conventional treatment group, and 18 healthy controls. Plasma VEGF levels were measured at different time points. FR was defined as a modified Rankin scale score of 3–6 at 3 months. Multivariable analysis evaluated whether VEGF levels at different time points independently predicted FR, and receiver operating characteristic (ROC) curves assessed their predictive value. Using intracranial lesion side vascular imaging, the Maas scoring system assessed angiogenesis post-onset, with scores of 4 to 5 indicating angiogenesis. ResultsIn the conventional treatment group, VEGF levels significantly decreased by day 7, while in the EVT group, reduction was observed as early as day 3. After adjusting for potential confounders, only VEGF levels on day 3 emerged as an independent predictor of FR. The combined model incorporating VEGF levels on day 3 with other factors effectively predicted FR (area under the curve = 0.916; sensitivity = 84.21 %; specificity = 100 %, P<0.0001). Plasma VEGF levels were notably higher in patients with angiogenesis in specific brain regions compared to those without angiogenesis at days 1, 3, 7, and 14 (P<0.05). ConclusionVEGF levels on the 3rd day post-EVT demonstrate superior predictive value for FR. Elevated VEGF levels correlate with angiogenesis, suggesting its potential as a therapeutic target.

Characteristics of Vascular Cognitive Impairment in Acute Stroke Patients at Prof. Dr. I.G.N.G. Ngoerah General Hospital, September-October 2023

Characteristics of Vascular Cognitive Impairment in Acute Stroke Patients at Prof. Dr. I.G.N.G. Ngoerah General Hospital, September-October 2023