Cerebral Vascular Occlusion Research Articles

Sodium-glucose cotransporter-2 inhibitors (SGLT2) in frail or older people with type 2 diabetes and heart failure: a systematic review and meta-analysis.

Sodium-glucose cotransporter-2 inhibitors (SGLT2Is) reduce cardio-metabolic and renal outcomes in patients with type 2 diabetes (T2D) but their efficacy and safety in older or frail individuals remains unclear. We searched PubMed, Scopus, Web of Science, Cochrane CENTRA and Google Scholar and selected randomised controlled trials and observational studies comparing SGLT2Is versus placebo/other glucose-lowering agent for people with frailty or older individuals (>65years) with T2D and heart failure (HF). Extracted data on the change in HbA1c % and safety outcomes were pooled in a random-effects meta-analysis model. We included data from 20 studies (22 reports; N = 77,083 patients). SGLT2Is did not significantly reduce HbA1c level (mean difference -0.13, 95%CI: -0.41 to 0.14). SGLT2Is were associated with a significant reduction in the risk of all-cause mortality (risk ratio (RR) 0.81, 95%CI: -0.69 to 0.95), cardiac death (RR 0.80, 95%CI: -0.94 to 0.69) and hospitalisation for heart failure (HHF) (RR 0.69, 95%CI: 0.59-0.81). However, SGLT2Is did not demonstrate significant effect in reducing in the risk of macrovascular events (acute coronary syndrome or cerebral vascular occlusion), renal progression/composite renal endpoint, acute kidney injury, worsening HF, atrial fibrillation or diabetic ketoacidosis. In older or frail patients with T2D and HF, SGLT2Is are consistently linked with a decrease in total mortality and the overall burden of cardiovascular (CV) events, including HHF events and cardiac death, but not protective for macrovascular death or renal events. Adverse events were more difficult to quantify but the risk of diabetic ketoacidosis or acute kidney injury was not significantly increase.

Expert consensus on technical strategies for interventional treatment of acute large vessel occlusive stroke in China

Ischemic stroke caused by acute large vessel occlusion is associated with high rates of disability and mortality. Endovascular interventional therapy is evidently an effective treatment for occlusion of large cerebral vessels within the relevant time window, but there is no established methodological standard for recanalization interventional therapy. The Professional Committee of Interventional Neurology in Chinese Research Hospital Association organized cerebrovascular disease experts in China and developed the expert consensus described herein, to provide a reference for clinicians to formulate technical strategies for recanalization of acute cerebral vascular occlusion.

Protective effects of salvianolic acid B on intestinal ischemia/reperfusion injury in rats by regulating the AhR/IL-22/STAT6 axis

Purpose Intestinal ischemia/reperfusion (I/R) injury (IIRI) is associated with high morbidity and mortality. Salvianolic acid B (Sal-B) could exert neuroprotective effects on reperfusion injury after cerebral vascular occlusion, but its effect on IIRI remains unclear. This study set out to investigate the protective effects of Sal-B on IIRI in rats. Methods The rat IIRI model was established by occluding the superior mesenteric artery and reperfusion, and they were pretreated with Sal-B and aryl hydrocarbon receptor (AhR) antagonist CH-223191 before surgery. Pathological changes in rat ileum, IIRI degree, and intestinal cell apoptosis were evaluated through hematoxylin-eosin staining, Chiu’s score scale, and TUNEL staining, together with the determination of caspase-3, AhR protein level in the nucleus, and STAT6 phosphorylation by Western blotting. The levels of inflammatory cytokines (IL-1β/IL-6/TNF-α) and IL-22 were determined by ELISA and RT-qPCR. The contents of superoxide dismutase (SOD), glutathione (GSH), and malondialdehyde (MDA) in intestinal tissues were determined by spectrophotometry. Results Sal-B alleviated IIRI in rats, evidenced by slight villi shedding and villi edema, reduced Chiu’s score, and diminished the number of TUNEL-positive cells and caspase-3 expression. SAL-B alleviated inflammation and oxidative stress (OS) responses induced by IIRI. Sal-B promoted IL-22 secretion by activating AhR in intestinal tissue after IIRI. Inhibition of AhR activation partially reversed the protective effect of Sal-B on IIRI. Sal-B promoted STAT6 phosphorylation by activating the AhR/IL-22 axis. Conclusion Sal-B plays a protective role against IIRI in rats by activating the AhR/IL-22/STAT6 axis, which may be achieved by reducing the intestinal inflammatory response and OS responses.

Application of transcranial Doppler in cerebrovascular diseases.

Transcranial Doppler (TCD) is a rapid and non-invasive diagnostic technique that can provide real-time measurements of the relative changes in cerebral blood velocity (CBV). Therefore, TCD is a useful tool in the diagnosis and treatment of clinical cerebrovascular diseases (CVDs). In this review, the basic principles of TCD and its application in CVD were outlined. Specifically, TCD could be applied to evaluate occlusive CVD, assess collateral circulation in patients with ischemic stroke, and monitor cerebral vascular occlusion before and after thrombolysis as well as cerebral vasospasm (VSP) and microembolization signals after aneurysmal subarachnoid hemorrhage (SAH). Moreover, TCD could predict short-term stroke and transient cerebral ischemia in patients with anterior circulation occlusion treated with endovascular therapy and in patients with anterior circulation vascular occlusion. Additionally, TCD not only could monitor blood velocity signals during carotid endarterectomy (CEA) or carotid artery stenting (CAS) but also allowed earlier intervention through early recognition of sickle cell disease (SCD). Presently, TCD is a useful prognostic tool to guide the treatment of CVD. On the one hand, TCD is more commonly applied in clinical research, and on the other hand, TCD has an increasing role in the management of patients. Collectively, we review the principles and clinical application of TCD and propose some new research applications for TCD.

S1039 Tofacitinib-Associated Adverse Vascular Events Reported to the Federal Adverse Event Reporting System (FAERS) Database

Introduction: Tofacitinib, an intracellular tyrosine kinase (Jak-Kinase) inhibitor, is approved by the U.S. Food and Drug Administration (FDA) for active rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ulcerative colitis (UC). In 2019, the FDA released a safety alert for the risk of blood clots and death in patients receiving tofacitinib. In 2021, Black Box Warnings were issued for low dose (5mg BID) and high dose (10mg BID) tofacitinib, for increased risk of serious heart-related adverse events (AEs) and cancer. Methods: FAERS is a database of voluntarily reported AEs used for post-marketing surveillance of medications. 8,863,077 FAERS reports from January 2018 to September 2021 were examined. Of these, there were 84,225 reports of tofacitinib-related AEs. Using MeDRA terminology, reports of cardiovascular (CV) AEs emphasized in recent black box warnings (Pulmonary Embolism, Deep Vein Thrombosis, Cerebral Thrombosis, Cerebral Venous Thrombosis, and Cerebral Vascular Occlusion) were reviewed. There were 650 CV AEs reported in the study period. Demographics, cumulative dosage, indications for drug use, outcomes, reactions, and reporter trends were analyzed. Reporter odds ratio (ROR) for all reporting groups (physicians, lawyers, community, pharmacists, etc.) were calculated. ROR >1 indicates interference in reporting. Results: The most common indication for tofacitinib was RA 43,386 (52%) of reports. Hospitalization occurred in 10,182/84,225 (12.0%) of reports. There were 3,856 (5%) reports when tofacitinib was indicated for UC. 42,671 (51%) of AEs occurred in subjects 36-64 years old. Females represented 65,806 (78%) of reports. Physicians were 13% of reporters while consumers accounted for 59% of reporters, (ROR = 1.52; 95%; CI = 1.49-1.54). CV specific AEs concerning Tofacitinib accounted for 650/84,225 (0.77%) of reports. Lawyer reporting demonstrated a sharp rise in 2021. Lawyer reports accounted for 70/170 (41%) CV AEs in 2021(ROR = 942; 95%; CI = 505-1757). Conclusion: Interference of the reporting of tofacitinib-related CV AEs to FAERS appears to be occurring, initially by excess consumer reporting and more recently by lawyers. The effect of reporting bias on the use of tofacitinib in the clinical setting requires further investigation.Figure 1.: Tofacitinib Cardiovascular AEs by Reporter Type

Transcranial ultrasound stimulation applied in ischemic stroke rehabilitation: A review.

Ischemic stroke is a serious medical condition that is caused by cerebral vascular occlusion and leads to neurological dysfunction. After stroke, patients suffer from long-term sensory, motor and cognitive impairment. Non-invasive neuromodulation technology has been widely studied in the field of stroke rehabilitation. Transcranial ultrasound stimulation (TUS), as a safe and non-invasive technique with deep penetration ability and a tiny focus, is an emerging technology. It can produce mechanical and thermal effects by delivering sound waves to brain tissue that can induce the production of neurotrophic factors (NFs) in the brain, and reduce cell apoptosis and the inflammatory response. TUS, which involves application of an acoustic wave, can also dissolve blood clots and be used to deliver therapeutic drugs to the ischemic region. TUS has great potential in the treatment of ischemic stroke. Future advancements in imaging and parameter optimization will improve the safety and efficacy of this technology in the treatment of ischemic stroke.

Whole-Brain Volume CT Angiography can Effectively Detect Early Ischemic Cerebrovascular Diseases.

To investigate the role of whole-brain volume computed tomography (CT) perfusion in assessing early ischemic cerebrovascular diseases. Seventy-two patients with early ischemic cerebrovascular diseases who had undergone routine CT scan and 320-row volume CT whole-brain perfusion imaging within 8 h after admission were retrospectively enrolled in this one-center case-sectional study. The perfusion parameters of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and dynamic CT angiogram (4D-CTA) were obtained and analyzed. Among 72 patients, 29 cases with 37 cerebral ischemic lesions were found in plain CT scan, whereas 51 cases with 76 lesions were found in whole-brain CT perfusion, with 30.6% more patients being detected. The CBF value was significantly lower in the abnormal than normal corresponding perfusion area in the healthy hemisphere (P<0.05), while the MTT and TTP values were significantly higher in the abnormal than the normal corresponding area (P<0.05). 4D-CTA image suggested that 59 cases had different degrees of stenosis or occlusion, including 11 mild, 18 moderate, 21 severe, and 9 occlusive cases. Four-D-CTA imaging could detect significantly (P<0.05) more patients with abnormal perfusion in severe cerebral vascular stenosis or occlusion than those with no, mild or moderate stenosis (93.33% vs. 16.67%) (P<0.05). The stenosis of intracranial and carotid arteries was positively correlated with MTT and TTP values (P<0.05). Whole-brain volume CT angiography can comprehensively display early cerebral ischemic lesions, cerebral blood perfusion status, and cerebral vascular stenosis, providing valuable information for early detection of ischemic cerebral diseases and appropriate treatment planning.

MiR-539 Targeting SNAI2 Regulates MMP9 Signaling Pathway and Affects Blood-Brain Barrier Permeability in Cerebrovascular Occlusive Diseases: A Study Based on Head and Neck Ultrasound and CTA.

This study aimed to explore the expression level of miR-539 in the blood-brain barrier permeability induced by cerebrovascular occlusion and its mediated mechanism. Altogether, 48 patients with cerebral vascular occlusion lesions from March 2018 to June 2020 were collected. The expression level of miR-539 in the peripheral blood serum of the subjects was analyzed by qRT-PCR, and the participants were divided into two groups according to the results of head and neck ultrasound and CTA hemodynamics. The MCAO model of cerebral ischemia was established in rats, and the expression level of miR-539 was detected by qRT-PCR in brain tissues of different groups of rats. The effects of miR-539 on the permeability of blood-brain barrier were investigated by intraventricular injection of agomiR-539 and antagomir-539. The model of blood-brain barrier was established by culturing brain microvascular endothelial cells and pericytes in vitro, and the changes of miR-539 expression level and permeability after glucose and oxygen deprivation were detected. The expression level of SNAI2/MMP9 signaling pathway protein in cells was detected by Western blot. Compared with the healthy control group, the expression level of miR-539 in peripheral blood of patients with cerebrovascular occlusive disease decreased significantly, and the expression level of miR-539 in the MCAO rat model decreased and affected the permeability of blood-brain barrier. Glucose and oxygen deprivation treatment in brain microvascular endothelial cells can lead to downregulation of miR-539 expression and affect cell permeability. miR-539 in brain microvascular endothelial cells can target and bind to SNAI2 and participate in the regulation of endothelial cell permeability by affecting the SNAI2/MMP9 signaling pathway. The results of this study suggested that circulating miR-539 in peripheral blood may be a potential marker for predicting blood-brain barrier permeability after ischemic stroke. More detailed studies are needed to determine its diagnostic value.

Low-level blast exposure induces chronic vascular remodeling, perivascular astrocytic degeneration and vascular-associated neuroinflammation

Cerebral vascular injury as a consequence of blast-induced traumatic brain injury is primarily the result of blast wave-induced mechanical disruptions within the neurovascular unit. In rodent models of blast-induced traumatic brain injury, chronic vascular degenerative processes are associated with the development of an age-dependent post-traumatic stress disorder-like phenotype. To investigate the evolution of blast-induced chronic vascular degenerative changes, Long-Evans rats were blast-exposed (3 × 74.5 kPa) and their brains analyzed at different times post-exposure by X-ray microcomputed tomography, immunohistochemistry and electron microscopy. On microcomputed tomography scans, regional cerebral vascular attenuation or occlusion was observed as early as 48 h post-blast, and cerebral vascular disorganization was visible at 6 weeks and more accentuated at 13 months post-blast. Progression of the late-onset pathology was characterized by detachment of the endothelial and smooth muscle cellular elements from the neuropil due to degeneration and loss of arteriolar perivascular astrocytes. Development of this pathology was associated with vascular remodeling and neuroinflammation as increased levels of matrix metalloproteinases (MMP-2 and MMP-9), collagen type IV loss, and microglial activation were observed in the affected vasculature. Blast-induced chronic alterations within the neurovascular unit should affect cerebral blood circulation, glymphatic flow and intramural periarterial drainage, all of which may contribute to development of the blast-induced behavioral phenotype. Our results also identify astrocytic degeneration as a potential target for the development of therapies to treat blast-induced brain injury.

The role of vascular endothelial growth factor in ischemic stroke.

Ischemic stroke is an injury caused by temporary or permanent cerebral vascular occlusion. It has a high incidence, mortality, and disability rate in clinical practice, and thus poses a considerable threat to public health as one of the top three major conditions endangering human health. Vascular endothelial growth factor is a specific mitogen of endothelial cells and a protein factor that is closely related to ischemic stroke. Vascular endothelial growth factor plays an important role in a multitude of physiological and pathological conditions. As a potential angiogenic protein for the treatment of ischemic stroke, vascular endothelial growth factor plays a role in promoting angiogenesis and neuroprotection and regeneration. At the same time, it plays a role in brain edema, collateral artery formation, and atherosclerosis. An increase in vascular endothelial growth factor levels contributes to the early pathological changes in patients with stroke and is closely related to the formation of cerebral edema in ischemic stroke complications. In theory, the neuroprotective and angiogenic effects of vascular endothelial growth factor make it an ideal candidate for the treatment of stroke. Here, we review the mechanism by which vascular endothelial growth factor participates in various stages of ischemic stroke and its prospects for use in the treatment of ischemic stroke.

Stroke Pentagon: Stroke Management Approach in Resource Poor Settings

Stroke is a neurological condition that is characterized by sudden onset focal neurological deficit due to spontaneous cerebral vascular occlusion or rupture. It is a neurological emergency and its prevalence is very high, especially in developing countries where it assumes an epidemic proportion. It is globally the second most common cause of death after ischaemic heart disease. The poor indices in developing countries are multifactorial and related to late case presentation, ignorance, poverty, and unavailability of comprehensive and well-coordinated stroke care. There is a need to identify the available and cheap stroke management steps in the developing countries and strengthen the system to maximize the benefits in reduction of the morbidity and mortality of stroke. It is against this background that we identified Stroke prevention, acute stroke management, Stroke rehabilitation, Stroke research, and Stroke support as five pillars (stroke pentagon) in stroke management in developing countries. There is a need to sensitize the stakeholders in stroke management as highlighted in the stroke pentagon to assume more responsibility. Moreover, there is the need to have a more coordinated and concerted stroke management approach which will involve all the identified five pillars to ensure improved stroke indices in the developing countries.

Relationship Between Exercise and 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging of Brain in the Elderly

CT were analyzed. The subjects were elderly people aged 55–75 who volunteered for brain 18F of the FDG CT and PET scanning. The elderly who maintained exercise were divided into exercise group and non-exercise group into control group. The images obtained by CT examination showed that the brain of the elderly who insisted on exercise showed a significant increase in glucose metabolism, which indicated that exercise had a preventive effect on brain diseases of the elderly, and reduced the risk of cerebral vascular occlusion and brain atrophy.

Correlation of Smoking and National Institutes of Health Stroke Scale (NIHSS) in Acute Ischemic Stroke Patients

Background: Ischemic stroke is the most common type of stroke with 87.00% prevalence of atherosclerosis as one of the causes of cerebral vascular lumen occlusion. Smoking is known as a modifiable risk factor for stroke. The process of atherosclerosis leads to a neurological deficit resulting in impairment of the patient. One of the scales used to assess impairment is the National Institutes of Health Stroke Scale (NIHSS).Objectives: To know the correlation between smoking status and functional degree of acute ischemic stroke patients as measured by NIHSS.Method: The subjects were 48 patients. The study design was cross-sectional and clinical sampling consecutive admissions and an acute ischemic stroke image imaging. Smoking status data was obtained through anamnesis at the time the patient was hospitalized supported by the testimony of the immediate family. NIHSS values were obtained on the first day of hospitalization. Data analysis used chi-square test and logistic regression.Result: Sex (p = 0.001) and smoking (p = 0.013) were variables that had significant correlations with NIHSS. There was no association between smoking and the functional degree of acute ischemic stroke patients measured by NIHSS, (p = 0.57) with Adjusted Odds Ratio 1.5 (CI 95% 0.35 - 6.9).Conclusion: There was no significant association between smoking with functional degree of acute ischemic stroke patients as measured by NIHSS.

In a diabetic patient, each vision loss is not dependent on diabetes: case report, giant suprasellar mass, menengiomjiom

Diabetes is considered an epidemic of our age and the prevalence of the whole world is rapidly increasing. Diabetes is predisposing to the development of many diseases and adverse events. Diabetic retinopathy is the most important cause of blindness in middle and advanced age; is the third cause of blindness in developed countries. However, there are many reasons for slow vision loss other than diabetic retinopathy. Slow-developing visual loss is most often due to cataracts, eye defects, diabetes, age-related yellow spot disease. Sudden elevation of eye pressure, such as eye infection, can also cause permanent visual loss with pain. In many neurological diseases, complaints about vision can occur. These include optic neuritis, blockage of the optic nerve, ocular neural tumors, pituitary gland tumors, cerebral vascular occlusions and genetic diseases. We present to our endocrinology outpatient clinic a case of complete loss of vision for 5 years, but a giant suprasellar mass is detected in the examination and a diagnosis of menengioma after that.

Long-term prognosis of patients with stroke associated with middle cerebral artery occlusion. Single-centre registration study

IntroductionLarge artery intracranial occlusive disease including middle cerebral artery (MCA) is a major contributor to the incidence of stroke in China. The data on the prognosis of symptomatic atherosclerotic MCA occlusions (MCAO) are limited. We aimed to investigate the related factors of unfavorable outcomes in patients with stroke associated with MCAO.Material and methodsA total of 119 patients with MCAO symptom were enrolled in this retrospective longitudinal cohort study. All patients met inclusion criteria of cerebral angiography by CT angiography or magnetic resonance angiography. Stroke severity was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS).ResultsWe showed an average follow-up time of 46.8 months, within which 20 (19.6%) cases died and 14 (13.7%) cases had stroke recurrence. Using mRS as an evaluation index, the patients were divided into an unfavourable outcome group (mRS > 2, 48 cases) and a favourable outcome group (mRS ≤ 2, 54 cases). Logistic regression analysis suggests that age and NIHSS score were independent risk factors for a poor outcome value. Coexisting other cerebral vascular occlusion was an independent risk factor for stroke recurrence. Age was an independent risk factor for death.ConclusionsThe prognosis of patients with MCAO was generally optimistic, with higher survival rate and longer survival time. As compared, elder age and higher NIHSS score both tend to be associated with worse prognosis of survival. MCAO patients with other extracranial or intracranial vascular occlusion have higher risk of recurrent stroke. Death rate increases with age among the MCAO patients.

Multiple Cerebrovascular Occlusion With Hypothyroidism: A Powerful Compensation

Cerebral vascular occlusion can often cause severe neurological deficits. This study aims to describe a case characterized by multiple large vessel occlusions with hypothyroidism and without clinical symptoms. The patient’s blood vessel condition, compensatory pathway and perfusion situation were understood through medical history inquiry, neurological physical examination, combined with blood lipid, blood glucose, electrocardiogram, transcranial Doppler (TCD), brain computed tomography (CT), cerebral angiography, cerebral perfusion imaging and other examinations. The main symptoms of the patient were dizziness and headache, with no symptoms of neurological function loss. Digital subtraction angiography (DSA) showed multiple large vessel occlusions in the head and neck: the initial part of the left internal carotid artery, the M1 segment of the left middle cerebral artery, the V2 segment of the right vertebral artery, and the V3 terminal segment of the left vertebral artery. According to CT perfusion (CTP) examination, the blood flow (BF) value of the left temporoparietal occipital lobe was lower than that of the contralateral side, the mean blood flow passage time value was increased, and the cerebral blood volume (BV) was slightly higher than that of the contralateral side. Cerebral vascular occlusion is affected by many factors, hypothyroidism can accelerate the process of atherosclerosis, and in severe cases multiple large vessel occlusions may occur. Powerful compensatory mechanisms can reduce the incidence of stroke. J Med Cases. 2019;10(6):158-163 doi: https://doi.org/10.14740/jmc3303

Multiple Cerebrovascular Occlusion With Hypothyroidism: A Powerful Compensation

Cerebral vascular occlusion can often cause severe neurological deficits. This study aims to describe a case characterized by multiple large vessel occlusions with hypothyroidism and without clinical symptoms. The patient’s blood vessel condition, compensatory pathway and perfusion situation were understood through medical history inquiry, neurological physical examination, combined with blood lipid, blood glucose, electrocardiogram, transcranial Doppler (TCD), brain computed tomography (CT), cerebral angiography, cerebral perfusion imaging and other examinations. The main symptoms of the patient were dizziness and headache, with no symptoms of neurological function loss. Digital subtraction angiography (DSA) showed multiple large vessel occlusions in the head and neck: the initial part of the left internal carotid artery, the M1 segment of the left middle cerebral artery, the V2 segment of the right vertebral artery, and the V3 terminal segment of the left vertebral artery. According to CT perfusion (CTP) examination, the blood flow (BF) value of the left temporoparietal occipital lobe was lower than that of the contralateral side, the mean blood flow passage time value was increased, and the cerebral blood volume (BV) was slightly higher than that of the contralateral side. Cerebral vascular occlusion is affected by many factors, hypothyroidism can accelerate the process of atherosclerosis, and in severe cases multiple large vessel occlusions may occur. Powerful compensatory mechanisms can reduce the incidence of stroke. J Med Cases. 2019;10(6):158-163 doi: https://doi.org/10.14740/jmc3303

Effect of periodic psychological intervention on blood pressure control after cerebral vascular occlusion

Objective To expolre the effect of phased psychological intervention on stress response and blood pressure control in patients with cerebral vascular occlusion and opening. Methods A total of 72 cases of patients with underwent cerebral vascular occlusion in this hospital were randomly divided into observation group and control group according to the random number table method, 36 cases of each group.The control group was given with routine nursing in the department of cerebrovascular medicine during the perioperative period.The observation group was treated with phased psychological intervention on the basis of the control group.The effects of stress response, negative emotions and blood pressure control and prognosis before and after intervention were compared between the two groups. Results The heart rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels of the patients in the observation group after intervention, as well as the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) were all lower than those of the control group(P<0.05). The success rate of successful opening of vascular blockage in the observation group was higher than that of the control group, while the incidence of hypertension was lower than that of the control group(P<0.05). Conclusions The phased psychological intervention can effectively reduce the stress response and negative emotion during the operation of patients with cerebrovascular occlusion.It can improve the success rate of operation.At the same time, it can effectively control postoperative blood pressure, which is beneficial to the prognosis of patients. Key words: Phased psychological intervention; Cerebral vascular occlusion; Stress response; Blood pressure control

Highlights From the Circulation Family of Journals.

Highlights From the Circulation Family of Journals.

Revisiting the NIH Stroke Scale as a screening tool for proximal vessel occlusion: can advanced imaging be targeted in acute stroke?

Background and purposeMost patients with stroke-like symptoms screened by advanced imaging for proximal occlusion will not have a thrombus accessible by neurointerventional techniques. Development of a sensitive clinical scoring system...