Cases Of Acute Ischemic Stroke Research Articles

A Case of Acute Ischemic Stroke due to Tandem Lesion Treated with Endovascular Thrombectomy by Internal Carotid Artery Direct Puncture

A Case of Acute Ischemic Stroke due to Tandem Lesion Treated with Endovascular Thrombectomy by Internal Carotid Artery Direct Puncture

Concurrent acute myocardial infarction and acute ischemic stroke in a diabetic patient undergoing chemotherapy for non-Hodgkin lymphoma: Should I administer thrombolytic therapy? A case report.

Concurrent ST-elevation myocardial infarction (STEMI) and acute ischemic stroke (AIS) are extremely rare, and their management remains perplexing due to the absence of high-quality evidence and limited resources. For the first time, we report a rare, preventable, and suboptimally managed case of concurrent AIS and STEMI in a patient with non-Hodgkin lymphoma (NHL) who received cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy. A 59-year-old postmenopausal woman of African origin with a background history of type 2 diabetes mellitus presented to the Jakaya Kikwete Cardiac Institute with sudden onset of left-sided weakness and typical ischemic chest pain for 3days. The patient was recently diagnosed with NHL and started CHOP chemotherapy 3weeks prior. Physical examination revealed left-sided hemiplegia. Emergency brain computed tomography and 12-lead echocardiography (ECG) revealed AIS and STEMI, respectively. A diagnosis of concurrent AIS and STEMI was reached, and the patient was loaded with dual antiplatelets and heparin and rushed for emergency coronary angiography (GAG) and percutaneous coronary intervention (PCI). CAG revealed massive thrombotic occlusion of the mid-segment of the left anterior descending coronary artery (mLAD) and proximal segment of the right coronary artery. Revascularization was achieved in both vessels with a resultant TIMI flow grade of 3. The post-PCI period was marked by significant improvement in chest pain and resolution of ST-elevation, as revealed by 12-lead ECG. However, the patient remained hemiplegic. We have described a rare case of concurrent AIS and STEMI in a postmenopausal woman who had a significant risk of thromboembolism. The patient had uncontrolled type 2 diabetes and received CHOP chemotherapy for NHL, which was diagnosed 3weeks prior. This case underscores the need for thromboembolic prophylaxis for selected cancer patients receiving chemotherapy. The need to individualize management is also emphasized, as both PCI and thrombolysis carry the risk of serious repercussions. In our patient, if thrombolysis was attempted it would have caused myocardial rupture and immediate death. The patient would have benefited from endovascular mechanical embolectomy for AIS; however, this practice is lacking at our institution. This calls for the establishment and strengthening of neurointerventional practices in our tertiary healthcare facilities.

Diffusion-derived vessel density (DDVD) for penumbra delineation in brain acute ischemic stroke: initial proof-of-concept results using single NEX DWI.

Neuroimaging is a cornerstone in the diagnosis and treatment decision-making for brain acute ischemic stroke. A rapid and accurate diagnosis is the key, specifically for time-critical reperfusion therapies. Successful reperfusion of salvageable penumbra can reduce the extent of ischemic stroke and thus improve clinical outcomes, whereas reperfusion of irreversibly affected brain tissue is thought to be futile and may result in harm due to the risk of hemorrhagic transformation. For neuroimaging work-up of acute stroke, computed tomography (CT) is more commonly applied than magnetic resonance imaging (MRI), due to the wider availability of CT scanners in emergency settings. However, the CT perfusion readout thresholds to define infarct area remain controversial. Diffusion-weighted (DW) MRI remains the best imaging modality to define the infarct area. Low-cost portable MRI scanners are available in recent years. MRI diffusion-derived vessel density (DDVD) reflects in vivo microvascular status. The analysis of DDVD requires DW images of only two b-values (with one being b=0 s/mm2 and the other being non-zero low b-value), with a significantly shorter scanning time than contrast enhanced CT/MRI. In this article, we describe our preliminary results of three brain acute ischemic stroke cases scanned with a DDVD protocol. These cases prove the concept that DDVD pixelwise map assessments of brain ischemic area/volume are consistent with perfusion CT results, and a combination of DDVD pixelwise map and high b-value DW image identify the exitance and the size of a penumbra.

Comparison of prehospital stroke assessment scales for acute ischemic stroke with large vessel occlusion within six hours of onset: A single-center study in Eastern Taiwan

ABSTRACT Objectives: In Taiwan, acute ischemic stroke (AIS) with large vessel occlusion (LVO) remains a significant health concern. Reperfusion therapy is more effective if the patient arrives at the medical center within the early time window, emphasizing the importance of prehospital stroke assessment to identify LVO and rapid transfer. This study focused on Eastern Taiwan, where the Hualien Tzu Chi Hospital is the sole comprehensive stroke center. We compared different prehospital stroke assessment scales in identifying LVO. Materials and Methods: We reviewed 598 patients with acute stroke admitted to our hospital’s emergency department between April 1, 2021, and March 31, 2022. Of these, 110 AIS cases presenting within 6 h of symptom onset were retrospectively analyzed using the medical records and National Institute of Health Stroke Scale (NIHSS) scores to evaluate the efficacies of prehospital stroke scales, including our institution’s Tzu Chi Stroke Severity Scale and its modified version. LVO was defined as occlusion of the anterior cerebral artery, middle cerebral artery, and its main branches, intracranial carotid arteries, and vertebrobasilar arteries. Results: Among 110 patients, 39.1% had LVO, which showed a higher mortality rate and prevalence of atrial fibrillation. LVO had higher NIHSS scores and longer hospital stays. The Vision Aphasia Neglect (VAN) Scale and Modified Tzu Chi Stroke Severity Scale showed the highest sensitivity, with the latter also exhibiting the highest sensitivity for posterior circulation LVO. Conclusion: The VAN and the modified Tzu Chi Stroke Severity Scale offer comparable sensitivity for detecting LVO in the prehospital setting. Our study supports the adoption of the modified Tzu Chi scale in the regional emergency medical service transfer algorithm for LVO detection for timely intervention.

First-in-human trial of a self-expandable, temporary dilation system for intracranial atherosclerotic disease in patients presenting with acute ischemic stroke

BackgroundIntracranial atherosclerotic disease (ICAD) significantly contributes to ischemic stroke, especially among Asian populations. Large vessel occlusion (LVO) due to underlying ICAD accounts for 15–35% of acute ischemic stroke cases requiring...

Case Report: Delayed Cerebral Ischemia with Infarction following an Undiagnosed Aneurysmal Rupture - The Diagnostic and Management Challenge

Delayed Cerebral Ischemia (DCI) typically occurs a few days after a patient suffers subarachnoid hemorrhage and can lead to a range of poor outcomes. It is primarily driven by vasospasm and its delayed and variable presentation complicates diagnosis and treatment. Here we report a case of DCI in a 31-yearold man who presented with acute onset aphasia, right-sided weakness, and difficulty swallowing. He had experienced a severe headache accompanied by nausea and vomiting 5 days prior, with an initial NIH stroke scale score of 10. Imaging revealed a left internal carotid artery aneurysm and a watershed infarct between the anterior cerebral artery and middle cerebral artery. The patient was treated with aneurysmal coiling, intraarterial verapamil, and oral nimodipine for suspected DCI secondary to subarachnoid hemorrhage. Close monitoring of the patient and treatment led to the resolution of neurological deficits over the subsequent days., with imaging confirming reperfusion. This case presents a unique challenge due to the delayed presentation and vague history. Diagnosis and treatment of DCI following aneurysmal rupture are complicated due to its delayed and variable onset. It is crucial to consider acute aneurysmal subarachnoid hemorrhage and DCI when evaluating patients who present with multiple stroke-like symptoms over several days as the management and prognosis differ from other cases of acute ischemic stroke.

The Interrelation of Blood Urea Nitrogen-to-Albumin Ratio with Three-Month Clinical Outcomes in Acute Ischemic Stroke Cases: A Secondary Analytical Exploration Derived from a Prospective Cohort Study.

This study targeted elucidating the intricate correlation of the blood urea nitrogen (BUN)-to-albumin (BUN/Alb) ratio with adverse outcomes (AOs) at 3-month in acute ischemic stroke (AIS) cases within a Korean cohort. The cohort involved a comprehensive dataset of 1850 AIS cases from a South Korean hospital, spanning from January 2010 to December 2016. To discern the linear relationship of the BUN/Alb ratio with AOs in AIS cases, utilization of a binary logistic regression model (BLRM) was implemented. Additionally, it was attempted to utilize sophisticated statistical techniques, such as generalized additive models (GAMs) and smooth curve fitting methods, to unravel the nonlinear association of the BUN/Alb ratio with AOs in such patients. The incidence of AOs was determined to be 28.49%, with the median BUN/Alb ratio being 3.85. After adjusting for a number of covariates, the BLRM disclosed that the linear association of BUN/Alb ratio with the risk of AOs particularly in AIS cases did not achieve statistical significance. However, a noticeable nonlinear relationship emerged, with an inflection point identified at 2.86. To the left of this inflection point, the relationship is not statistically significant. On the right side of the inflection point, there was a remarkable 9.47% rise in the risk of AOs (odds ratio (OR) = 1.09, 95% confidence interval (CI): 1.00, 1.19, P = 0.04). The outcomes illuminate the complex and nonlinear relationship of the BUN/Alb ratio with 3-month AOs in AIS cases. This study established a robust groundwork for the future research, underscoring the potential clinical utility of monitoring the BUN/Alb ratio to enhance the prognostic assessment and management of AIS cases.

Abstract 092: Efficacy and Safety of Transcarotid Approach for Mechanical Thrombectomy in Acute Ischemic Stroke: A Multicenter Study with Systematic Review and Meta‐Analysis

Background Anatomical or technical challenges in certain patients during mechanical thrombectomy (MT) can render recanalization through distal access sites impossible. The transcarotid approach is a valuable rescue technique. Despite its potential, this approach is infrequently employed in clinical practice due to concerns about serious complications or operator unfamiliarity. As a result, the safety and efficacy of the transcarotid approach in MT remain insufficiently characterized. Methods We conducted a multicenter two‐arm case series comparing cases of acute ischemic stroke (AIS) with large vessel occlusion (LVO) that were managed with MT via the transcarotid approach to medical management alone after failed MT. We included our results in a systematic review and single‐arm meta‐analysis of the literature investigating the transcarotid approach for MT by pooling our cases with data from existing literature. The pooled data were reported as proportions or means with 95% confidence intervals (CI). Subsequently, we performed logistic and linear regressions using individual patient data from all studies to identify predictors of outcomes such as mortality and complications. Results Nine studies were included in this systematic review and meta‐analysis. MT with the transcarotid approach had a 31% complication rate (95% CI 0.23; 0.40), 37% mortality rate at 90 days (95% CI 0.27; 0.49), and 86% reperfusion rate (95% CI 0.79; 0.91). 38% of cases had mRS 0‐3 at 90 days (95% CI 0.23; 0.56). Factors predicting complications were tPA use (OR 3.35, 95% CI 1.37; 8.24). Factors predicting mortality at 90 days were higher age (OR 1.04, 95% CI 1.01; 1.09), higher NIHSS at presentation (OR 1.10, 95% CI 1.01; 1.19) lower ASPECTS score (OR 0.70, 95% CI 0.47; 0.98), and higher mRS at discharge (OR 28, 95% CI 3.72; 211.3). Recanalization was associated with lower odds of mortality at 90 days (OR 0.30, 95% CI 0.08; 0.95). Conclusion MT using the transcarotid approach is an effective rescue strategy for recanalization in the setting of failed femoral and radial access, with promising complication and mortality rates and excellent reperfusion rate. The proportion of transcarotid cases achieving mRS 0‐3 at 90 days is comparable to the outcomes reported for traditional femoral access.

Air pollution and cerebrovascular diseases - retrospective analysis of 10,486 cases of acute ischemic stroke requiring intravenous thrombolysis. A report from the EP-PARTICLES study

Abstract Introduction Air pollution (AP) is becoming an increasingly important non-classical CVD risk factor. Recent years have brought us the introduction of new types of AP, such as ‘Polish smog’, rich in particulate matter (PM) and benzo(alpha)pyrene (B(a)P) - thus far overlooked in scientific research. Acute ischemic stroke (AIS) is an increasing healthcare challenge, with the ageing population and associated presence of atrial fibrillation worldwide. Intravenous thrombolysis (IVT), alongside thrombectomy, is the most effective AIS treatment method. Purpose To analyze the impact of AP on AIS requiring IVT incidence. To our knowledge this is the first study of its kind worldwide. Methods The study covered 500 municipalities inhabited by 5.7 million people in Poland in 2011-2020. AIS requiring IVT incidence data [hospitalizations with ICD-10 diagnosis (I63.X) and concomitant ICD-9 procedure (99.101/99.102/99.103)] and AP concentrations (PM2.5 and B(a)P) were obtained from the National Health Fund and Inspectorate for Environmental Protection, respectively. IVT was administered within 4.5 hours from the onset of AIS symptoms, ensuring accuracy in the timing of exposure. Using the GEM-AQ model we calculated AP levels for all 500 municipalities. To analyze the effects of AP we used quasi-Poisson generalized additive models with covariates such as weather conditions, day of the week, bank holidays, and seasonal trends. Results are presented as relative risks (RRs) and 95% confidence intervals (95% CI) per interquartile range increase in AP on the day of exposure (LAG 0) and the following days (LAG 1, etc). Results In the study period, we recorded 96,122 AIS with a slight predominance of females (52.6%) and median age 76 years old (y.o) [IQR 66-83]; 10,486 (10.9%) were treated with IVT (median age 74 y.o. IQR 65-82), females 51.3%. Mortality rates were lower in patients treated with IVT than overall AIS patients (13.3% vs 15.4%, p<0.001). Exposure to B(a)P was associated with the highest increase in AIS requiring IVT incidence on LAG 0 and this effect persisted for up to 3 days after exposure [Figure 1]. In the overall population, an increase in PM2.5 concentration was associated with an increased risk of AIS requiring IVT on LAG 0, LAG 1, and LAG 3 [Figure 1]. AP increased the risk of AIS requiring IVT in both young and older individuals, as well as in women and men. We recorded no differences between the effects of analyzed air pollutants and AIS requiring IVT depending on age and sex [Figure 2]. Conclusions AP acts as a trigger for AIS requiring IVT with a similar impact regardless of sex and age. Patients undergoing IVT are characterized by better survival. Public health changes should consider efforts to decrease levels of air pollutants. Highly polluted areas should have centers with rapid access to AIS treatments and our study could help to identify high risk areas that require adaptations in local infrastructure.Figure 1.Figure 2.

Thrombectomy Alone or Alongside Intravenous Thrombolysis in Managing Acute Ischemic Stroke Caused by Basilar Artery Occlusion: A Multicenter Observational Study.

It remains unclear whether the combination of endovascular treatment (EVT) with intravenous thrombolysis (IVT) results in a more favorable functional outcome than EVT alone in managing cases of acute ischemic stroke (AIS) caused by basilar artery occlusion (BAO). Thus, this study aimed to compare the outcomes of two approaches-direct EVT (DEVT) and bridging therapy (IVT plus EVT)-in acute BAO patients presenting within 4.5 hours of stroke onset. This multicenter retrospective cohort study included 153 acute BAO patients presenting within 4.5 hours of stroke onset. Of these patients, 65 (42.5%) and 88 (57.5%) underwent DEVT and bridging therapy, respectively. The primary outcome was defined as good functional outcome (modified Rankin Scale, 0-3) at 90 days. Additionally, pre-operative clinical features, thrombectomy attempts, successful reperfusion rates, incidences of symptomatic intracranial hemorrhage (sICH), and mortality were compared between the two groups. At 90 days, the rate of good functional outcome was comparable between the DEVT (44.6%) and bridging-therapy (39.8%) groups (adjusted odds ratio [aOR], 1.12; 95% confidence interval [CI], 0.55-2.31; p = 0.753). The bridging-therapy group exhibited a lower percentage of patients requiring ≥ 3 attempts of stent retrieval (aOR, 0.39; 95% CI, 0.16-0.93; p = 0.034). Pre-operative clinical features, rate of successful reperfusion, sICH, and mortality were similar between the two groups. In patients with BAO-induced AIS, DEVT demonstrates a comparable functional outcome to bridging therapy within 4.5 hours of symptom onset, but IVT reduces the number of thrombectomy attempts. AIS, acute ischemic stroke; LVO, large-vessel occlusion; EVT, endovascular treatment; IVT, intravenous thrombolysis; BAO, basilar artery occlusion; DEVT, direct endovascular treatment; sICH, symptomatic intracranial hemorrhage; RCT, randomized controlled trial; IRIS, Improving Reperfusion Strategies in Ischemic Stroke; TOAST, Trial of ORG 10172 in Acute Stroke Treatment; mTICI, modified thrombolysis in cerebral infarction; SD, standard deviation; IQR, interquartile range; ICAS, intracranial atherosclerotic stenosis.

Trans-Clot MAP gradient: A novel innovative technique during thrombectomy for acute ischemic stroke with potential applications for assessing collateral circulation, determining clot etiology, informing device selection, and predicting first-pass success.

Endovascular mechanical thrombectomy has significantly improved recovery in acute ischemic stroke (AIS). While traditional patient selection has relied on factors such as last known well and penumbra volume, emerging research highlights the importance of collateral circulation in influencing thrombectomy success. However, current methods to assess collateral circulation are often unreliable and lack standardization, limiting their integration into clinical decision-making and prompting the need for innovative approaches. This study introduces trans-clot manometry as a promising approach for quantitatively assessing collateral blood flow before thrombectomy. Two patients were included in this study: a 64-year-old female with a left M1 near-complete occlusion and an 81-year-old male with a left P1 occlusion. After receiving intravenous tenecteplase, each patient underwent emergent thrombectomy where intraoperative trans-clot manometry revealed significant trans-clot mean arterial pressure (MAP) gradients (66.7% for Patient 1 and 96.9% for Patient 2). Both patients had successful first-pass thrombectomy (Patient 1: TICI 3; Patient 2: TICI 3), with substantial clinical improvement (Patient 1: NIHSS 11 to 1; Patient 2: NIHSS 19 to 8). Intraoperative trans-clot manometry offers a simple yet powerful, objective, and generalizable measure of collateral circulation, applicable to a wide range of AIS cases regardless of clot location or vessel size. In addition, real-time correlations with heart-rate variability and radial artery pressures provide an intrinsic quality control, ensuring proper execution of the technique and accuracy of the resulting MAP gradient. Future research will focus on validating this approach, determining its generalizability, and establishing MAP gradient thresholds to enhance device selection and predict first-pass success.

“The association between HALP score and infection in acute ischemic stroke patients”

Background and purposeStroke-associated infection (SAI) is related to increased mortality in acute ischemic stroke (AIS) cases. The HALP index is used to evaluate nutrition and inflammation. Our research aimed to assess the relation between HALP scores and infection risk in AIS cases. Materials and methods132 cases of acute ischemic stroke were registered. 77 cases were male and 55 cases were female. The median age of the attending cases was 66 (35–104) years. Laboratory variables were assessed within 24 h after hospitalization in the neurology care unit. The HALP score is evaluated utilizing the formula “Hemoglobin (g/dL) × Albumin (g/dL) × Lymphocyte (/10^3/uL) / Platelet (/10^3/uL)”. ResultsCases were separated into two groups according to their corresponding HALP score. Group-1 cases have a low HALP score (HALP score ≤ 18227,93). Group-2 cases have a high HALP score (HALP score > 18227,93). 26 (19.6 %) cases were diagnosed with various infections after hospitalization in the neurology care unit. Urinary tract infections were frequent infection causes in AIS cases (13 cases, 50 %). Pneumonia was observed in 8 cases, making up 30 % of the total cases. Another infection was seen in 5 (20 %) of the cases. The frequently encountered bacteria were Escherichia coli ESBL + (n = 7, 27 %) and Staphylococcus aureus (n = 6, 23 %). The mortality ratio was higher in Group-1 cases than in Group-2 cases (34 % vs 7 %). ConclusionsThis investigation has suggested a relationship between infection and HALP score in AIS patients.

Temporal Trends and Racial Disparities in Long-Term Survival After Stroke.

Few studies have examined trends and disparities in long-term outcome after stroke in a representative US population. We used a population-based stroke study in the Greater Cincinnati Northern Kentucky region to examine trends and racial disparities in poststroke 5-year mortality. All patients with acute ischemic strokes (AISs) and intracerebral hemorrhages (ICHs) among residents ≥20 years old were ascertained using ICD codes and physician-adjudicated using a consistent case definition during 5 periods: July 1993-June 1994 and calendar years 1999, 2005, 2010, and 2015. Race was obtained from the medical record; only those identified as White or Black were included. Premorbid functional status was assessed using the modified Rankin Scale, with a score of 0-1 being considered "good." Mortality was assessed with the National Death Index. Trends and racial disparities for each subtype were analyzed with logistic regression. We identified 8,428 AIS cases (19.3% Black, 56.3% female, median age 72) and 1,501 ICH cases (23.5% Black, 54.8% female, median age 72). Among patients with AIS, 5-year mortality improved after adjustment for age, race, and sex (53% in 1993/94 to 48.3% in 2015, overall effect of study year p = 0.009). The absolute decline in 5-year mortality in patients with AIS was larger than what would be expected in the general population (5.1% vs 2.8%). Black individuals were at a higher risk of death after AIS (odds ratio [OR] 1.23, 95% CI 1.08-1.39) even after adjustment for age and sex, and this effect was consistent across study years. When premorbid functional status and comorbidities were included in the model, the primary effect of Black race was attenuated but race interacted with sex and premorbid functional status. Among male patients with a good baseline functional status, Black race remained associated with 5-year mortality (OR 1.4, 95% CI 1.1-1.7, p = 0.002). There were no changes in 5-year mortality after ICH over time (64.4% in 1993/94 to 69.2% in 2015, overall effect of study year p = 0.32). Long-term survival improved after AIS but not after ICH. Black individuals, particularly Black male patients with good premorbid function, have a higher mortality after AIS, and this disparity did not change over time.

Incidence and Outcomes of Cardiocerebral Infarction: A Cohort Study of 2 National Population-Based Registries.

Cardiocerebral infarction (CCI), which is concomitant with acute myocardial infarction (AMI) and acute ischemic stroke (AIS), is a rare but severe presentation. However, there are few data on CCI, and the treatment options are uncertain. We investigated the characteristics and outcomes of CCI compared with AMI or AIS alone. We performed a retrospective cohort study of 120 531 patients with AMI and AIS from the national stroke and AMI registries in Singapore. Patients were categorized into AMI only, AIS only, synchronous CCI (same-day), and metachronous CCI (within 1 week). The primary outcome was all-cause mortality, and the secondary outcome was cardiovascular mortality. The mortality risks were compared using Cox regression. Multivariable models were adjusted for baseline demographics, clinical variables, and treatment for AMI or AIS. Of 127 919 patients identified, 120 531 (94.2%) were included; 74 219 (61.6%) patients had AMI only, 44 721 (37.1%) had AIS only, 625 (0.5%) had synchronous CCI, and 966 (0.8%) had metachronous CCI. The mean age was 67.7 (SD, 14.0) years. Synchronous and metachronous CCI had a higher risk of 30-day mortality (synchronous: adjusted HR [aHR], 2.41 [95% CI, 1.77-3.28]; metachronous: aHR, 2.80 [95% CI, 2.11-3.73]) than AMI only and AIS only (synchronous: aHR, 2.90 [95% CI, 1.87-4.51]; metachronous: aHR, 4.36 [95% CI, 3.03-6.27]). The risk of cardiovascular mortality was higher in synchronous and metachronous CCI than AMI (synchronous: aHR, 3.03 [95% CI, 2.15-4.28]; metachronous: aHR, 3.41 [95% CI, 2.50-4.65]) or AIS only (synchronous: aHR, 2.58 [95% CI, 1.52-4.36]; metachronous: aHR, 4.52 [95% CI, 2.95-6.92]). In synchronous CCI, AMI was less likely to be managed with PCI and secondary prevention medications (P<0.001) compared with AMI only. Synchronous CCI occurred in 1 in 200 cases of AIS and AMI. Synchronous and metachronous CCI had higher mortality than AMI or AIS alone.

Hourly effect of atmospheric reactive nitrogen species on the onset of acute ischemic stroke: Insight from the Shanghai Stroke Service System Database

Acute ischemic stroke (AIS) is one of the most predominant causes of mortality and disability in China. Significant uncertainties in stroke diagnosis and time of onset have resulted in inconsistent evidence on the association between ambient air pollution and the risk of AIS. The present study aimed to evaluate the impact of air pollution on AIS onset based on high time-resolution air pollution data and a stroke-specific registry across the past five years. Hourly concentrations of PM2.5, PM10, O3, SO2, CO, NO2 and nitrous acid (HONO) were monitored from 2017 to 2021, with which a distributed lag non-linear model and conditional logistic regression models coupled with a time-stratified case-crossover design were applied to 106,623 AIS cases recorded in the Shanghai Stroke Service (4S) database during the study period. Results from the conditional logistic regression models indicate that acute exposure to PM2.5, PM10, SO2, NO2 and HONO was found to be associated with AIS onset, respectively. The corresponding cumulative excessive risks of AIS onset were 0.8 %, 1 %, 2.4 %, 2.1 % and 1.8 % for each interquartile range increase in the respective concentration. The longest lag-effect (up to 13 h) was observed for reactive nitrogen species (RNS), such as NO2 and HONO, which remained robust in two-pollutant models. Similar important role of RNS in AIS onset were confirmed by the distributed lag non-linear model. By demonstrating the transient effect of ambient air pollution on AIS, especially the relationships between RNS and AIS for the first time, our study provides stringent evidence for future mitigation strategies for pollution emission and public health.

Multicenter Validation of lncRNA and Target mRNA Diagnostic and Prognostic Biomarkers of Acute Ischemic Stroke From Peripheral Blood Leukocytes.

Long noncoding RNA (lncRNA) and mRNA profiles in leukocytes have shown potential as biomarkers for acute ischemic stroke (AIS). This study aimed to identify altered lncRNA and target mRNA profiles in peripheral blood leukocytes as biomarkers and to assess the diagnostic value and association with AIS prognosis. Differentially expressed lncRNAs (DElncRNAs) and differentially expressed target mRNAs (DEmRNAs) were screened by RNA sequencing in the discovery set, which consisted of 10 patients with AIS and 20 controls. Validation sets consisted of a multicenter (311 AIS versus 303 controls) and a nested case-control study (351 AIS versus 352 controls). The discriminative value of DElncRNAs and DEmRNAs added to the traditional risk factors was estimated with the area under the curve. NAMPT-AS, FARP1-AS1, FTH1, and NAMPT were identified in the multicenter case-control study (P<0.05). LncRNA NAMPT-AS was associated with cis-target mRNA NAMPT and trans-target mRNA FTH1 in all validation sets (P<0.001). Similarly, AIS cases exhibited upregulated lncRNA FARP-AS1 and FTH1 expression (P<0.001) in the nested case-control study (P<0.001). Furthermore, lncRNA FARP1-AS1 expression was upregulated in AIS patients at discharge with an unfavorable outcome (P<0.001). Positive correlations were found between NAMPT expression level and NIHSS scores of AIS patients (P<0.05). Adding 2 lncRNAs and 2 target mRNAs to the traditional risk factor model improved area under the curve by 22.8% and 5.2% in the multicenter and the nested case-control studies, respectively. lncRNA NAMPT-AS and FARP1-AS1 have potential as diagnostic biomarkers for AIS and exhibit good performance when combined with target mRNA NAMPT and FTH1.

Two cases of acute ischemic stroke associated with strut exposure in the cerebral artery lumen after stent-assisted coil embolization

Stent-assisted coil embolization (SAC) is used for complex wide-necked aneurysms but can expose stent struts to the arterial lumen, leading to thrombosis. Herein, we report two cases of delayed thromboembolic stroke post-SAC. Case 1: A 71-year-old woman had an acute ischemic stroke 2 months after Y-stent SAC for a basilar artery aneurysm, and aspirin was prescribed post-procedure. Diffusion-weighted imaging revealed multiple scattered infarcts of various sizes in the posterior circulation. Case 2: A 72-year-old woman experienced an acute ischemic stroke 3 years post-SAC for a right posterior communicating artery aneurysm. The stroke occurred after discontinuation of antiplatelet therapy. Diffusion-weighted imaging revealed scattered acute infarctions in the right middle and anterior cerebral artery territories. These two cases of delayed thromboembolic stroke after SAC might have been due to stent strut exposure in the arterial lumen and concurrent thrombosis.

ISCHEMIC STROKE SECONDARY DUE TO BLUNT CAROTID ARTERY INJURY A CASE REPORT AND LITERATURE REVIEW

Ischemic stroke secondary due to blunt cerebrovascular injury is a rare complication, with high morbidities, severity neurological outcome. However, we do not pay enough attention to the diagnosis and treatment of acute ischemic stroke due to blunt cerebrovascular injury. We report a typical case of acute ischemic stroke due to blunt cerebrovascular injury. Unfortunately, this patient did not receive timelineless emergency and treatment, suffered from severe neurological deficit. These patients suffered from blunt cerebrovascular injury required to be careful screening, prompt diagnosis, and aggressive treatment with therapies such as anticoagulants, endovascular intervention, and surgery to reduce mortality and severe neurological deficit.

P.026 Success with incrementally faster times to endovascular therapy (SWIFT-EVT): a systematic review and meta-analysis

Background: Previous research demonstrates that for acute ischemic stroke (AIS) cases, rapid endovascular therapy (EVT) performance improves outcomes. This study provides updated metrics summarizing estimates for modified Rankin Scale (mRS) gains accrued by streamlining time to EVT. Methods: A systematic review and meta-analysis (MA) was conducted using electronic databases. Eligible studies reported time-benefit slope with times from AIS onset (or time last-seen-normal) to EVT commencement; the predictor was onset-to-groin (OTG) time. Primary and secondary outcomes were 90-day functional independence (mRS 0-2) and 90-day excellent function (mRS 0-1), respectively. Results: The five included studies showed increased chance of good outcome with each hour of pre-EVT time savings for mRS 0-2 for 0-270’ (OR 1.25, 95% CI 1.16-1.35, I2 40%) and 271-360’ time frame (1.22, 95% CI 1.12-1.33, I2 58%). For studies assessing mRS 0-1, pooled effect estimates were appropriate for the 0-270’ time frame (OR 1.34, 95% CI 1.19-1.51, I2 27%) and the 271-360’ time frame (OR 1.20, 95% CI 1.03-1.38, I2 60%). Conclusions: Each hour saved from AIS onset to EVT start is associated with a 22-25% increased odds of functional independence, a useful metric to inform patient-specific and systems planning decisions.

Factors Affecting Management of Acute Ischaemic Stroke with Reference to Intravenous Thrombolysis and Its Impact on Short-term Outcome

Background: Stroke is a major global health concern, ranking second in terms of fatality worldwide, following ischaemic heart disease. However, few stroke patients arrive at the hospital within the optimal time for thrombolysis, and even among those who do, not all receive this therapy. Therefore, the objective of the study was to examine the factors that influence the treatment of acute ischaemic stroke (AIS), particularly with intravenous thrombolysis and to evaluate the short-term outcomes. Methods: This prospective observational study was carried out between August 2019 and August 2021 in the emergency department of a tertiary care hospital. Patients with AIS who were eligible for intravenous thrombolysis within 4.5 hours of the beginning of symptoms were included in the study. Comprehensive assessments, including history, examinations and blood investigations, were conducted. Thrombolytic treatment was administered within the specified time frame, while antiplatelets were given in other cases. Follow-up evaluations were conducted at discharge and 90 days. Results: The age distribution, comorbidities and CT-MRI findings were similar between individuals who received thrombolysis and those who did not. Among the thrombolysis group, 84% had no complications, while 8% experienced intracerebral haemorrhage and 8% had an extension of the infarction. The overall mortality rate was 13.33% for non-thrombolysis patients and 12% for thrombolysis recipients, with no statistically significant difference between the two groups. Conclusion: The results highlight the need for careful consideration when deciding to use thrombolysis for AIS cases. Additionally, they emphasise the importance of actively monitoring and effectively managing any potential treatment complications.