Atherosclerotic Cerebral Infarction Research Articles

To Investigate the Influence of Smoking Cessation Intention and Common Downstream Variants of HDAC9 Gene on Large Artery Atherosclerotic Cerebral Infarction.

To investigate the association of smoking cessation intention and single nucleotide polymorphism of HDAC9 gene with LAA-S in Han people in Hainan province. A case-control study was conducted. Six single nucleotide polymorphisms (SNPS) of HDAC9 gene were genotyped by SNPscan genotyping technique in 248 patients with LAA-S and 237 controls in Hainan Han population. SNP loci (rs10227612, rs12669496, rs1548577, rs2074633, rs2526626, and rs2717344) were genotyped, and the genotype and allele frequencies were compared between the case and control group. At the same time, the distribution of smoking between the case and control group was compared, and the 3-year and 7-year follow-up smoking cessation between the case and control group was compared, so as to find out the effects of smoking cessation intention and HDAC9 SNP on LAA-S. (1) The GT genotype at rs10227612, GG genotype at rs2717344, and GA genotype at rs1548577 in the case group were significantly higher than those in the control group, and the differences were statistically significant. (2) There were significant differences in the distribution of smoking between the case and control group (P < 0.05), and there were significant differences in the smoking cessation after 3 years and 7 years of follow-up between the case and control group (P < 0.05). The intention to quit smoking was positively correlated with the incidence of LAA-S. (1) The rs10227612, rs1548577, rs2074633, rs2717344 of HDAC9 gene may be significantly related to atherosclerotic cerebral infarction of great arteries in Hainan Han population, while rs12669496 and rs2526626 may not be related. (2) According to the statistics of smoking in the case and control group, smoking was related to large artery atherosclerotic cerebral infarction, and the intention to quit smoking was a very important factor affecting the success of smoking cessation.

Predictive value of fibrinogen for early neurological deterioration in large-artery atherosclerotic cerebral infarction

Background &amp; Objective: To evaluate the predictive value of fibrinogen at admission for early neurological deterioration (END) in patients with large artery atherosclerotic (LAA) stroke without reperfusion therapy. Fibrinogen, a glycoprotein crucial for clotting, is associated with worse outcomes in ischemic stroke patients. While its connection with thrombolytic therapy’s prognosis is recognized, its predictive role for non-thrombolytic-treated patients is less clear. The objective of this study is to evaluate the predictive value of fibrinogen at admission for early neurological deterioration (END) in patients with large artery atherosclerotic (LAA) stroke without reperfusion therapy. Methods: This retrospective case-control study included consecutive inpatients with LAA stroke admitted within 72 h of onset at the Fifth Affiliated Hospital of Sun Yat-Sen University between January 2021 and December 2021. An increase of &gt;2 in the National Institutes of Health Stroke Scale (NIHSS) within 7 days after admission was defined as END. Results: This study included 179 patients (121 males); the mean age was 62.67±13.51 years. There were 42 and 137 patients in the END and non-END groups. The NIHSS score at admission was higher in the END group than in the non-END group, the fibrinogen levels were higher, and the uric acid levels were lower (all P&lt;0.05). NIHSS at admission (OR=1.086, 95%CI: 1.001-1.179), fibrinogen levels (OR=2.182, 95%CI: 1.286- 3.702), and uric acid levels (OR=0.995, 95%CI=0.990-0.999) were independently associated with END. Receiver-operating characteristic curve analysis suggested that the sensitivity, specificity, and area under the curve for fibrinogen for END were 62.9%, 78.1%, and 0.730 (95% CI: 0.532-0.828, P&lt;0.009), respectively. Conclusions: Elevated fibrinogen is independently associated with END in patients with LAA stroke without reperfusion therapy.

Construction and validation of a nomogram model to predict symptomatic intracranial hemorrhage after intravenous thrombolysis in elderly population with severe white matter lesions

Background and Objective: Elderly people are at high prevalence of atherosclerotic cerebral infarction. Cerebral white matter lesions (WMLs) increase the risk of bleeding after intravenous thrombolysis (IVT) although they may also require the IVT. The aim of this study is to develop a clinical nomogram model for post-IVT symptomatic intracranial hemorrhage (sICH), with the aim to prevent sICH in elderly patients with severe WMLs when IVT is being considered. Methods: This is a large single-center retrospective analysis study of elderly patients with severe WMLs receiving IVT from January 2018 to December 2022. Univariate and multi-factor logistic regression analysis were used to construct nomogram model, and a series of validations were performed on the model. Results: More than 2,000 patients with IVT were screened for inclusion in this study after cranial magnetic resonance imaging evaluation. Out of these, 163 elderly patients had cerebral WMLs, and 25 had sICH. In univariate analysis, history of hypertension (p=0.037), hyperlipidemia (p&lt;0.001), NIHSS score before IVT (p&lt;0.001), low-density lipoprotein levels (p=0.016), cholesterol levels (p=0.020), platelet count (p=0.006), systolic blood pressure (p&lt;0.001), diastolic blood pressure (p&lt;0.001) were significantly associated with sICH. In a multifactorial analysis, the NIHSS score before IVT (OR 42.056 CI 7.308-242.012, p&lt;0.001), and diastolic blood pressure (OR 1.050 CI 1.002-1.100, p=0.040) were found to be significantly associated with sICH after IVT. The four most significant risk factors from logistic regression are subsequently fitted to create a predictive model. The accuracy was verified using calibration curves, decision curves, and clinical impact curves, and the model was considered to have strong stability. Conclusions: The NHISS score before IVT and diastolic blood pressure are independent risk factors for sICH after IVT in elderly patients with severe WMLs. The models are highly accurate and can be applied clinically to provide a reliable predictive basis for IVT in elderly patients with severe WMLs.

Retracted: Diagnostic Predictive Value of Tryptase, Serum Amyloid A and Lipoprotein-Associated Phospholipase A2 Biomarker Groups for Large Atherosclerotic Cerebral Infarction

Retracted: Diagnostic Predictive Value of Tryptase, Serum Amyloid A and Lipoprotein-Associated Phospholipase A2 Biomarker Groups for Large Atherosclerotic Cerebral Infarction

Neural oscillations after acute large artery atherosclerotic cerebral infarction during resting state and sleep spindles.

Electroencephalogram-microstate analysis was conducted using low-resolution electromagnetic tomography (LORETA)-KEY to evaluate dynamic brain network changes in patients with acute large artery atherosclerotic cerebral infarction (LAACI) during the rest and sleep stages. This study included 35 age- and sex-matched healthy controls and 34 patients with acute LAACI. Each participant performed a 3-h, 19-channel video electroencephalogram test. Subsequently, 20 epochs of 2-s sleep spindles during stage N2 sleep and five epochs of 10-s electroencephalogram data in the resting state for each participant were obtained. In both the resting state and sleep spindles, patients with LAACI displayed altered neural oscillations. The parameters of microstate A (coverage, occurrence, and duration) increased during the resting state in the patients with LAACI compared with healthy controls. The coverage and occurrence of microstate B and D were reduced in the LAACI group compared with the healthy controls (p < 0.05). Moreover, during sleep spindles, the duration of microstate A and the transition probability from microstate A and B to C decreased, but the coverage of microstate B and the transition rate from microstate B to D increased (p < 0.05) in the LAACI group compared with the healthy controls. These results enable better understanding of how neural oscillations are modified in patients with LAACI during the resting state and sleep spindles. Following LAACI, the dynamic brain network undergoes changes during sleep spindles and the resting state. Continued long-term investigations are required to determine how well these changes in brain dynamics reflect the clinical characteristics of patients with LAACI.

The relationship between severe extracranial artery stenosis or occlusion and cerebral small vessel disease in patients with large artery atherosclerotic cerebral infarction.

Extracranial artery stenosis (ECAS) is associated with the presence of individual markers of cerebral small vessel disease (CSVD). Here, we investigated the relationship between severe extracranial artery stenosis or occlusion and CSVD in patients with large artery atherosclerotic (LAA) cerebral infarction. A total of 128 patients with LAA cerebral infarction who met our specific inclusion criteria were selected, including 92 males and 36 females. These patients were divided into three groups based on whether they had severe symptomatic extracranial arterial stenosis or occlusion, severe asymptomatic extracranial artery stenosis or occlusion, or severe extracranial artery stenosis or occlusion (both symptomatic and asymptomatic). Intra-group comparisons were then performed to examine whether there were any differences in the total CSVD scores and Fazekas scores. Patients with severe extracranial arterial stenosis or occlusion and those with severe asymptomatic extracranial arterial stenosis or occlusion had a significantly higher total CSVD score (P < 0.05), but there were no significant differences between the groups in terms of Fazekas scores. Furthermore, there were no significant difference in the total CSVD scores and Fazekas scores when compared between patients with or without severe symptomatic extracranial arterial stenosis or occlusion. Severe stenosis or occlusion of the contralateral extracranial artery may increase the incidence of CSVD in patients with LAA cerebral infarction. Active and effective clinical intervention following comprehensive evaluation should be undertaken for unilateral cerebral infarction patients with severe stenosis or occlusion of the contralateral extracranial arterial.

Diagnostic Predictive Value of Tryptase, Serum Amyloid A and Lipoprotein-Associated Phospholipase A2 Biomarker Groups for Large Atherosclerotic Cerebral Infarction.

Background There has been a gradual trend towards younger ageing of acute cerebral infarction in recent years. Atherosclerotic plaque rupture followed by dislodgement of emboli and resulting arterial embolism is an important mechanism for the development of acute cerebral infarction. Traditional independent risk factors for cerebral infarction have received attention from clinicians, but the risk factors for large artery atherosclerotic cerebral infarction are still unclear. Various blood biomarkers have an important role in the early diagnosis of large artery atherosclerotic cerebral infarction. Objective To assess the diagnostic predictive value of a group of biomarkers for large artery atherosclerotic cerebral infarction. Methods Lipoprotein-associated phospholipase A2 (LP-PLA2), trypsin-like protein (TPS), serum amyloid A (SAA), and supersensitive C-reactive protein (hs-CRP) levels were measured in the case group (30 cases) and control group (54 cases), respectively. Results The differences in the general data between the two groups were not statistically significant (P > 0.05). Logistic regression and ROC curve analysis showed that Lp-PLA2, TPS, and SAA were positively associated with the diagnosis of large atherosclerotic cerebral infarction (P < 0.05). The area under the ROC curve of the multivariate model for the biomarker group reached 0.995. Conclusion Biomarkers are closely associated with the occurrence of large atherosclerotic cerebral infarction and can be used as clinical adjuncts for diagnosis and assessment of prognosis.

Association between C-reactive protein and all-cause mortality among critically ill patients with acute kidney injury.

To explore the relationship between C-reactive protein (CRP) and mortality in critically ill patients with acute kidney injury (AKI). A total of 580 patients diagnosed with AKI within 48 hours of ICU admission between September 2017 and August 2019 were enrolled. Patients were followed for all-cause mortality in-hospital and then up to 2 years after discharge. We performed two multivariate regression analysis to assess the association between CRP and mortality, and conducted stratified analysis to assess whether the effect of the CRP differed across subgroups. According to initial CRP quartiles, patients were divided into 4 groups (quartile 1, CRP ≤2.87mg/L; quartile 2, CRP: 2.87-25.95mg/L; quartile 3, CRP: 25.95-111.51mg/L; quartile 4, CRP > 111.51 mg/L). Patients with high CRP levels have higher APACHE-II score, longer length of stay in the ICU, and higher mortality. In multivariate regression analysis, high CRP was associated with the increased risk of in-hospital mortality after adjusting for age, gender, surgical grade, heart rate, serum potassium, serum chloride, coronary heart disease, and atherosclerotic cerebral infarction (quartile 4 vs. quartile 1, OR: 3.810, 95%CI: 2.081-6.973). For 2-year mortality, the increased trend was still significant with the OR (95% CI) of the quartile 4 group of 5.117 (2.678-9.780) after adjusting for confounders. Subgroup analyses detected in each group showed that the in-hospital and 2-year risk of mortality increased with higher CRP levels. Higher CRP level was associated with the increased risk of mortality in critically ill patients with AKI.

Risk factors and their correlation with severity of cerebral microbleed in acute large artery atherosclerotic cerebral infarction patients

ObjectiveRisk factors and prognosis of cerebral microbleeding (CMB) complicated acute large artery atherosclerotic cerebral infarction (ALAACI) patients was controversial. Present study aimed to investigate the risk factors and severity of CMB among ALAACI. MethodsTotally 256 ALAACI patients receiving treatment in Central Hospital of Wuhan between May 2020 and September 2021 were included into this analysis. There were 152 simple ALAACI without CMB patients (simple group) and 104 ones with CMB (combined group). Based on the number of CMB, there were 19 (CMB≥10) patients in severe group, 34 (CMB=5–9) in moderate group, and 51 (CMB=1–4) in mild group. Logistic regression was used to explore the risk factors of CMB. Spearman rank analysis was conducted to investigate association of risk factors and severity of CMB. ResultsThere was no difference of sex, drinking, and smoking among the severe, the moderate, the mild, and the simple groups (P > 0.05). Age, rate of hypertension, lacunar cerebral infarction and prior cerebral infarction were all increased with the severity of CMB among these groups (P < 0.05). Logistic regression showed that the risk factors of CMB were hypertension, history of cerebral infarction, total cholesterol, and homocysteine. Spearman rank analysis revealed that hypertension, history of cerebral infarction, and homocysteine were positively correlated with the severity of CMB in ALAACI patients (r = 0.389, 0.154, 0.563, P = 0.003, 0.006, 0.012, respectively), while total cholesterol was negatively correlated with CMB (r = −0.321, P = 0.008). ConclusionsHypertension, history of cerebral infarction. homocysteine were positively associated with severity of CMB, and total cholesterol was negatively correlated with it in ALAACI patients.

Correlation Between Angiotensin Receptor Type 1 Polymorphisms and Atherosclerotic Cerebral Infarction Risk.

BackgroundEmerging evidences suggest that the angiotensin receptor type 1 (AT1R) contributes heavily to the pathogenesis of atherosclerotic cerebral infarction (ACI). Herein, we examined a potential link between AT1R gene polymorphisms and ACI risk among a Southern Han Chinese population.MethodsThe rs3772616, rs275645, and rs377262 AT1R polymorphisms were genotyped in 689 ACI patients and 712 healthy controls, using the iMLDR-TM assay.ResultsThe genotypic and allelic frequencies of AT1R rs3772616 differed tremendously between ACI patients and healthy controls, and the rs3772616 T allele is a risk allele for ACI. However, the rs275645 and rs377262 allelic and genotypic frequency distributions were comparable between ACI patients and controls. In addition, the G-T-T haplotype was linked to an enhanced risk of ACI. We, next, classified our study subjects based on environmental factors and revealed that the rs3772616 T allele was strongly associated with an elevated ACI risk in males, hypertensive individuals, and those over 65 years old. In addition, we observed a marked link between the rs3772616 T allele and enhanced AT1R levels.ConclusionBased on our research, there is a strong correlation between the AT1R rs3772616 polymorphism and enhanced ACI risk. Hence, the AT1R rs3772616 polymorphism can serve as a potential therapeutic target and bioindicator for ACI development.

Correlation Between Plasma Levels of RIP3 and Acute Ischemic Stroke with Large-Artery Atherosclerosis.

Receptor-interacting serine-threonine protein kinase 3 (RIP3) was previously discovered to be an important medium in the occurrence and development of major atherosclerotic cerebral infarction. However, the role of RIP3 in acute ischemic stroke remains unclear. This study aimed to explore the correlation between plasma levels of RIP3 and acute ischemic stroke with large-artery atherosclerosis (LAA). This prospective study enrolled 116 patients with LAA, 40 healthy controls, and 30 acute ischemic stroke patients with small-artery occlusion. The patients with LAA were divided according to the quartile of plasma levels of RIP3. A logistic regression model was used for comparison. The ROC curve was performed to evaluate the predictive value. In patients with LAA, the RIP3 levels in patients with poor outcomes as well as neurological deterioration were significantly higher than those with good outcomes (P < 0.001) and without neurological deterioration (P = 0.014). Patients in the highest levels of plasma RIP3 quartile were more likely to have neurological deterioration (OR, 11.07; 95% CI, 1.990-61.582) and poor outcomes (OR, 35.970; 95% CI, 5.392-239.980) compared with the lowest. The optimal cut-off value for neurological deterioration was 1127.75 pg/mL (specificity, 66.7%; sensitivity, 69.2%) and that for poor prognosis was 1181.82 pg/mL (specificity, 89.7%; sensitivity, 62.1%). Elevated levels of plasma RIP3 were significantly associated with neurological deterioration and poor prognosis in patients with LAA. A significant increase in plasma RIP3 levels can predict neurological deterioration and the poor prognosis of these patients.

Gene Differential Expression and Interaction Networks Illustrate the Biomarkers and Molecular Mechanisms of Atherosclerotic Cerebral Infarction.

Atherosclerotic cerebral infarction (ACI) seriously threatens the health of the senile patients, and the strategies are urgent for the diagnosis and treatment of ACI. This study investigated the mRNA profiling of the patients with ischemic stroke and atherosclerosis via excavating the datasets in the GEO database and attempted to reveal the biomarkers and molecular mechanism of ACI. In this study, GES16561 and GES100927 were obtained from Gene Expression Omnibus (GEO) database, and the related differentially expressed genes (DEGs) were analyzed with R language. Furthermore, the DEGs were analyzed with Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. Besides, the protein-protein interaction (PPI) network of DEGs was analyzed by STRING database and Cytoscape. The results showed that 133 downregulated DEGs and 234 upregulated DEGs were found in GES16561, 25 downregulated DEGs and 104 upregulated DEGs were found in GSE100927, and 6 common genes were found in GES16561 and GES100927. GO enrichment analysis showed that the functional models of the common genes were involved in neutrophil activation, neutrophil degranulation, neutrophil activation, and immune response. KEGG enrichment analysis showed that the DEGs in both GSE100927 and GSE16561 were connected with the pathways including Cell adhesion molecules (CAMs), Cytokine-cytokine receptor interaction, Phagosome, Antigen processing and presentation, and Staphylococcus aureus infection. The PPI network analysis showed that 9 common DEGs were found in GSE100927 and GSE16561, and a cluster with 6 nodes and 12 edges was also identified by PPI network analysis. In conclusion, this study suggested that FCGR3A and MAPK pathways were connected with ACI.

Application value and feasibility analysis of cervical cerebrovascular ultrasonography in the diagnosis of coronary atherosclerotic cerebral infarction.

article: Application value and feasibility analysis of cervical cerebrovascular ultrasonography in the diagnosis of coronary atherosclerotic cerebral infarction - Minerva Surgery 2022 December;77(6):629-31 - Minerva Medica - Journals

Identification of lncRNA-mRNA regulatory network associated with isolated systolic hypertension and atherosclerotic cerebral infarction.

BackgroundIncreasingly, evidence has shown that long non-coding RNAs (lncRNAs) play an important role in isolated systolic hypertension (ISH). However, a systematic lncRNA-messenger RNA (mRNA) regulatory network is still absent in isolated systolic hypertension and atherosclerotic cerebral infarction patients (ISH & ACI). This research aimed to establish a lncRNA-mRNA co-expression network in patients with ISH & ACI, to probe into the potential functions of lncRNA in such patients.MethodsExpression profiles of lncRNA and mRNAs were collected and compared, from 8 patients with ISH and 8 patients with ISH & ACI by RNA-seq data. Differentially expressed lncRNAs and mRNAs were screened out via high-throughput sequencing in the plasma of ISH/ACI patients and control ISH patients. Then, a lncRNA-mRNA interaction network was built using the Pearson correlation coefficient by Cytoscape software. The expression levels of the hub genes and lncRNAs were verified by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) in another 10 ISH/ACI patients and 10 control patients. This study was approved by the responsible institutional review board (IRB) and informed consent was provided by participants.ResultsA total of 2,768 differentially expressed lncRNAs and 747 differentially expressed mRNAs were identified. We identified two hub genes (CD226 and PARVB) and 11 lncRNAs in the lncRNA-mRNA interaction network. The results of qRT-PCR and cell assay verified that lncRNAs ENST00000590604 and CD226 are highly expressed in patients of ISH & ACI. Further, CD226 was associated with vascular endothelial cells growth and stability through the platelet activation and focal adhesion pathway.ConclusionsWe established a novel mRNA-lncRNA interaction network. The lncRNAs ENST00000590604 and CD226 might be the potential biomarkers of ISH & ACI.

Application of Ultrasonography in Diagnosis of Carotid Atherosclerotic Plaque and Cerebral Infarction

Application of Ultrasonography in Diagnosis of Carotid Atherosclerotic Plaque and Cerebral Infarction

早期强化药物治疗对合并吞咽障碍大动脉粥样硬化性脑梗死的影响

早期强化药物治疗对合并吞咽障碍大动脉粥样硬化性脑梗死的影响

Vascular events from carotid artery atherosclerosis after radiation therapy for laryngeal and hypopharyngeal cancer: the incidence and risk factors.

ABSTRACTIn this retrospective cohort study, we evaluated the incidence of vascular events from carotid artery atherosclerosis after radiotherapy indication for laryngeal and hypopharyngeal cancer. From January 2007 to December 2016, we investigated 111 laryngeal/hypopharyngeal cancer patients who underwent curative radiotherapy and were followed up for ≥1 year (median follow-up duration, 60 months). We evaluated the incidence of vascular events from carotid artery atherosclerosis, defined as a transient ischemic attack or an atherothrombotic cerebral infarction, or from undergoing treatment such as carotid artery stenting for carotid artery stenosis. The median radiation dose was 66 Gy (range, 60–74); 48 patients (43.2%) received concurrent chemotherapy. The 5-year overall survival was 86.2%. Six patients required treatment for carotid artery disease. Carotid stenting was performed in three patients with carotid artery stenosis; three patients developed atherosclerotic cerebral infarction and received medical treatment, with a median of 51.7 months (range, 0.3–78.3) after radiotherapy initiation. The vascular event occurrence rate was 5.4% within 5 years and 10.7% within 8 years. In the univariate analysis, dyslipidemia, diabetes mellitus, and carotid calcification were significant factors for event occurrence. Because three out of six cases occurred out of the irradiated field, no carotid artery or carotid bulb dosimetric parameters showed significant correlation. As laryngeal/hypopharyngeal cancer patients, particularly with complications including dyslipidemia and diabetes mellitus, are at a high risk of carotid artery stenosis after radiotherapy, long-term carotid artery evaluation is necessary. Early intervention by stroke specialists can reduce the risk of fatal cerebral infarction.

Prognosis of Subtypes of Acute Large Artery Atherosclerotic Cerebral Infarction by Evaluation of Established Collateral Circulation

Background: The prognosis of acute ischemic stroke is related to collateral circulation, which is different with different pathogenesis. Objective: To explore the prognosis of acute large atherosclerotic (LAA) cerebral infarction with different pathogenesis by assessing the establishment of collateral circulation. Methods: 108 patients with acute LAA cerebral infarction in our hospital, who failed to thrombolytic or thrombectomy in the acute phase were selected and classified by Chinese ischemic stroke subclassification (CISS). They were evaluated by National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). CT angiography (CTA) of head and neck were used to evaluate the collateral circulation for patients with large vessel stenosis or occlusion within one week of admission. The CTA collateral scores (CS) were recorded in a dichotomized fashion (ie, poor vs good). Results: Patients with good CS had significantly lower NIHSS score and good prognosis at 2 weeks and 3 months than patients with poor CS (P < 0.001). The arterial-to-arterial embolization mechanism was the highest in the ratio of good CS and good prognosis at 3 months (P < 0.001). Multivariate Logistic regression analysis showed that baseline NIHSS score (OR=1.407, 95%CI:1.153–1.717, P=0.001) was an independent factor affecting poor CS. The NIHSS score at baseline (OR=0.604, 95%CI:0.436–0.837, P=0.002) and good CS (OR=39.552, 95%CI:8.908–175.618, P=0.000) were important predictors of good prognosis at 3 months. Conclusion: The prognosis and collateral circulation of acute LAA cerebral infarction with different pathogenesis was different. Baseline NIHSS score and collateral circulation had great impact on prognosis at 3 months.

A case report of thrombolysis resistance: thrombus ultrastructure in an ischemic stroke patient

BackgroundFollowing acute ischemic stroke (AIS), approximately half of patients do not achieve recanalization after intravenous administration of tissue plasminogen activator (rt-PA). Thrombolysis resistance is a possible reason for recanalization failure. Thrombolysis resistance is likely related to the ultrastructure and composition of the thrombus. However, there is a paucity of published information on the relationship between thrombus ultrastructure and thrombolysis resistance.Case presentationTwo patients who underwent mechanical thrombectomy were observed within 4.5 h after stroke onset. One patient failed to respond to rt-PA (defined as thrombolysis resistant), and the other patient did not receive rt-PA treatment (non-rtPA). In each patient, the occluded artery was the internal carotid artery or middle cerebral artery. According to the Trial of ORG 10172 in Acute Stroke Treatment classification, both patients had large atherosclerotic cerebral infarction. By scanning electron microscopy (SEM) and transmission electron microscopy (TEM), we found that the thrombus structure was significantly different between the two patients.ConclusionGrid-like dense fibrin, compressed polyhedral erythrocytes, and large accumulation of neutrophils may be characteristics of thrombolysis resistant thrombi.

Clinical Features of Embolic Stroke of Undetermined Source.

Background and Objective: One-third of ischemic strokes have no identifiable cause following standard evaluation. In 2014, researchers have proposed the concept of Embolic Stroke of Undetermined Source (ESUS). The purpose of this study was to report the clinical characteristics of ESUS and its difference from cardiogenic embolism (CE), large-artery atherosclerosis (LA), and small-artery occlusion lacunar (SA).Methods: Acute ischemic stroke (AIS) patients admitted to the department of Beijing Haidian Hospital from January 2017 to December 2017 were prospectively and consecutively enrolled. Base-line characteristics were collected. Stroke etiologies were presented and compared. We compared the clinical features and infarct sites of patients with acute cerebral infarction of different etiologies.Results: A total of 119 AIS patients were analyzed in the study. There were 33 (27.73%) cases in ESUS group, 11 (9.24%) cases in CE group, 45 (37.82%) cases in LAA group and 30 (25.21%) cases in SA group. There were significant differences between the ESUS group and the CE group in the NIHSS score [3 (1.5–5) vs. 6 (2–20), p = 0.007], Modified Rankin Score [19, (57.58) vs. 9, (81.82), p = 0.008], hemorrhagic transformation [0, (0) vs. 5, (45.45), p < 0.001], and left atrial diameter [37.09 ± 3.16 vs. 41.73 ± 5.00, p = 0.001]. ESUS group and LA group have different mRS scores [19, (57.58) vs. 42, (93.33), p < 0.001]. ESUS group and SA group have different mRS scores [19, (57.58) vs. 28, (93.33), p = 0.001]. During 1 year follow-up, there were 5 cases (15.15%) in ESUS group, 3 cases (27.27%) in CE group, 3 cases (6.67%) in LA group, and 1 case (3.33%) in SA group with ischemic stroke (cerebral infarction or transient ischemic attack).Conclusion: ESUS is more similar to atherosclerotic cerebral infarction in clinical features, but the distribution of lesions is more similar to cardiogenic embolism, suggesting that the pathogenesis of ESUS needs to be further explored.