Cerebral Infarction Research Articles

Mimicking aneurysm in a patient with chronic occlusion of the left middle cerebral artery

The chronic occlusion of intracranial arteries generally has no or mild clinical symptoms, and the clinical symptoms of acute cerebral artery occlusion are mostly manifested as severe cerebral infarction symptoms, which often make early diagnosis difficult, thus losing the best treatment opportunity. Once cerebral infarction occurs, the consequences are difficult to recover. This is also an important reason for the high misdiagnosis rate and mortality of this disease. In this paper, the characteristics of the disease were analyzed to provide clinical reference.

Successful use of avacopan in a case of ANCA-associated vasculitis with treatment-resistant medium-sized vessel involvement.

We report the case of a 75-year-old woman who presented with fever, right back pain, paresthesia in the right extremities, erythema, purpura, and nodules. She had previously initiated dialysis due to rapidly progressive glomerulonephritis and was transferred to our hospital. Imaging studies revealed multiple cerebral and splenic infarcts and hemorrhage encapsulating the right kidney, likely due to microaneurysms in multiple renal arteries. High MPO-ANCA titers were observed, and a skin biopsy revealed granulomatous inflammation affecting medium-sized vessels, leading to a diagnosis of granulomatosis with polyangiitis (GPA) and ANCA-associated vasculitis (AAV) involving medium-sized vessels. Treatment began with intravenous pulse steroid therapy (methylprednisolone 1000mg/day) and subsequent oral prednisolone (PSL) 40mg (about 0.8mg/kg) and intravenous cyclophosphamide (IVCY) at 250mg. While her symptoms improved, she developed severe infections, including candidemia and febrile neutropenia. Consequently, we combined PSL with the C5a receptor antagonist avacopan, which allowed for PSL tapering and stabilized her disease. This case is significant as no previous reports of avacopan's efficacy in AAV with medium-sized vessel involvement suggest its potential effectiveness in such cases.

Risk factors for perioperative cerebral infarction in moyamoya disease: a meta-analysis

Risk factors for perioperative cerebral infarction in moyamoya disease: a meta-analysis

A nomogram to predict postoperative new-onset cerebral infarction after revascularization of moyamoya disease in adults and its validation: a retrospective study

A nomogram to predict postoperative new-onset cerebral infarction after revascularization of moyamoya disease in adults and its validation: a retrospective study

Tenzing Assisted Delivery of Aspiration (TADA) technique for thrombectomy of medium vessel occlusions using the Freeclimb 54 catheter: multicenter experience.

Medium vessel occlusions (MeVOs) account for 25-40% of acute ischemic stroke. The Tenzing 5 (Route 92 Medical, San Mateo, California, USA) and FreeClimb 54 (Route 92 Medical, San Mateo, California, USA) catheter is a novel delivery-aspiration catheter combination designed to facilitate aspiration thrombectomy (AT) of MeVOs. We report our clinical experience using the Tenzing assisted delivery of aspiration (TADA) technique with FreeClimb 54 for first-line AT of MeVO. We retrospectively reviewed consecutive patients who underwent MeVO first-line AT using TADA with FreeClimb 54 at nine institutions in the USA and one in New Zealand. 94 MeVOs (65 primary, 29 secondary) were treated in 92 patients: median age 71 (IQR 58-81) years; 49/92 (53%) women. FreeClimb 54 was successfully delivered by Tenzing 5 to all 94/94 MeVOs: 26 proximal M2; 44 distal M2; 5 M3; 6 A2; 4 A3; and 8 P2. Median target vessel diameter on DSA was 1.7 (IQR 1.4-1.8) mm. A leading microwire was used to advance Tenzing in 84% of cases. A stent retriever was used for additional thrombectomy passes in 6/94 (6%) patients. For a primary MeVO, final modified expanded Thrombolysis in Cerebral Infarction (meTICI) 2B-3 reperfusion was achieved in 63/65 (97%) patients, after a median of 1 (IQR 1-2) pass, with a first pass effect (FPE, meTICI 2C-3) in 43/65 (66%). Secondary MeVO FPE (eTICI 2C-3) was achieved in 20/29 (69%) patients. Tenzing 5-FreeClimb 54 related complications occurred in 2/94 (2%) patients: one perforation with asymptomatic subarachnoid hemorrhage and one embolus to new territory. MeVO first-line AT using the TADA technique with Tenzing 5 and FreeClimb 54 had a high FPE with a low complication rate.

Delirium after deep brain stimulation for Parkinson's disease: a meta-analysis of incidence and risk factors.

Deep brain stimulation (DBS) is a valuable treatment for Parkinson's disease (PD), but postoperative delirium (POD) is a common complication. Understanding the risk factors for POD is crucial for optimizing patient selection and developing preventative measures. This systematic review and meta-analysis aims to identify predictors of POD in PD patients undergoing DBS surgery. We conducted a comprehensive search of four major databases for cohort studies on POD in patients undergoing DBS for PD, up to June 2024. Two reviewers independently screened studies, assessed the risk of bias using the Newcastle-Ottawa Scale, and extracted data. Meta-analysis was conducted using Review Manager, with heterogeneity assessed the I2 statistic and chi-square p value. Subgroup and sensitivity analyses were also performed to explore the consistency of findings. Eleven studies, including 1,368 patients, were analyzed to determine the incidence of POD in PD patients undergoing DBS. The incidence of POD in PD patients undergoing DBS, which was found to be 21% (95% CI: [14.6%, 27.4%]). Age, Mini-Mental State Examination (MMSE), and Non-Motor Symptom Scale (NMSS) were significant predictors, with effect sizes of (OR = 1.10, 95% CI: [1.06, 1.15], P < 0.00001), (OR = 0.85, 95% CI: [0.72, 1.00], P = 0.05), and (OR = 1.01, 95% CI: [1.00, 1.02], P = 0.04), respectively. However, gender, UPDRS-III ON score, brain atrophy, diabetes, Hamilton Anxiety Score (HAMA), operation time, disease duration, BMI, and cerebral infarction were not significant predictors. This meta-analysis suggests that age, cognitive function, and non-motor symptoms are important factors associated with POD patients undergoing DBS surgery. Further research with larger sample sizes and diverse populations is needed to confirm these findings and identify more specific predictors.

Clinical outcomes of patients with unsuccessful mechanical thrombectomy versus best medical management of medium vessel occlusion stroke in the middle cerebral artery territory.

Current randomized controlled trials are investigating the efficacy and safety of mechanical thrombectomy (MT) in patients with medium vessel occlusion (MeVO) stroke. Whether best medical management (MM) is more efficient than unsuccessful vessel recanalization during MT remains unknown. This was a retrospective cohort study using data from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. Only patients with occlusion of the distal branches (M2 and M3) of the middle cerebral artery territory were included. Unsuccessful MT was defined as a modified Thrombolysis in Cerebral Infarction score of 0-2a. Propensity score matching was used to control for confounders. The primary outcome was functional independence, defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days after treatment. Multivariable regression analysis was used to assess factors associated with the primary outcome. Of 2903 patients screened for eligibility, 532 patients were analyzed (266 per group) after propensity score matching. The MM group had superior functional outcomes, with 32% achieving mRS 0-1 at 90 days compared with 21% in the MT group (P=0.011). Patients in the MM group also had significantly lower rates of symptomatic intracranial hemorrhage (sICH) (3.4% vs 16%, P<0.001) and any hemorrhage (18% vs 48%, P<0.001). On multivariable regression, unsuccessful MT was associated with reduced odds of functional independence (OR 0.50, 95% CI 0.29 to 0.85, P=0.011) and increased odds of sICH (OR 4.32, 95% CI 1.84 to 10.10, P<0.001). Mortality rates were similar between groups (27% in MM vs 29% in MT, P=0.73). Unsuccessful MT for MeVO was linked to worse outcomes than best MM. These findings highlight the risks of prolonged attempts and emphasize the importance of efficient procedural decision-making to reduce complications and improve patient outcomes.

Prevalence and risk factors of covert brain infarction: A community-based cross-sectional study.

Covert brain infarction (CBI) is common and poses a potential and non-negligible burden of disease worldwide. The prevalence and risk factors for CBI have been reported inconsistently in previous studies. This study aims to ascertain the prevalence and risk factors of CBI and its imaging phenotypes in community-dwelling adults. The study population was derived from the baseline survey of a population-based cohort from the Polyvascular Evaluation for Cognitive Impairment and Vascular Events study, involving adults aged 50-75 years from Lishui City, Southeast China. The 3.0T magnetic resonance imaging (MRI) was performed to access CBI and detect intracranial and extracranial vascular lesions. The prevalence rates of CBI and three imaging phenotypes were stratified separately by age, sex, atherosclerotic burden, and artery stenosis. The intracranial and extracranial atherosclerotic burden was graded by summing atherosclerosis scores. Multivariable logistic regression with a stepwise selection method was used to identify independent CBI risk factors. A total of 2947 participants (mean age of 61.1 ± 6.6 years, 53.8% women) were included. CBI prevalence among study subjects was 9.6%, and the most common subtype was other chronic infarction (5.6%), followed by cavitatory lesions (4.6%) and acute cerebral infarction (0.5%). In multivariable analysis, older age (odds ratio (OR): 1.59, 95% confidence interval (CI): 1.40-1.83), hypertension (OR: 1.45, 95% CI: 1.08-1.94), higher levels of low-density lipoprotein cholesterol (LDL-C) (OR: 1.17, 95% CI: 1.04-1.32), homocysteine (OR: 1.12, 95% CI: 1.01-1.23) and diastolic blood pressure (DBP) (OR: 1.22, 95% CI: 1.06-1.41), intracranial artery plaque (OR: 1.56, 95% CI: 1.16-2.10), and severe extracranial atherosclerotic burden (OR: 6.57, 95% CI: 1.67-25.79) were associated with a higher CBI odds. There is a linear relationship between age, DBP, LDL-C, and CBI odds, while homocysteine shows a nonlinear relevancy. Age, DBP, homocysteine, and LDL-C elevation increase CBI risk. CBI prevalence in this Chinese community-based population was not low. Age, hypertension, intracranial artery plaque, extracranial atherosclerotic burden, homocysteine, LDL-C, and DBP were found to be the risk factors of CBI.

Retinal vascular geometry and its association to silent brain infarction

ObjectiveTo examine the relationship between retinal vascular geometry and silent brain infarction (SBI) in the Chinese population.MethodsWe conducted a cross-sectional study that retrospectively analyzed the fundus photographs, MRI and other clinical data of 227 SBIs and 227 controls who visited Shanghai Health And Medical Center for physical examination. The retinal vessel fractal dimension (FD), retinal artery fractal dimension (FDa), retinal vein fractal dimension (FDv), central retinal artery diameter in the region from 0.5 ~ 1.0 disc diameter (DD) from the disc margin (CRAEB), central retinal artery diameter in the region from 1.0 ~ 2.0 DD from the disc margin (CRAEC), central retinal vein diameter in the region from 0.5 ~ 1.0 DD from the disc margin (CRVEB), central retinal vein diameter in the region from 1.0 ~ 2.0 DD from the disc margin (CRVEC), retinal arteriovenous diameter ratio in the region from 0.5 ~ 1.0 DD from the disc margin (AVRB), and retinal arteriovenous diameter ratio in the region from 1.0 ~ 2.0 DD from the disc margin (AVRC) were accessed by the Singapore “I” Vessel Assessment (SIVA) software.ResultsFD, FDa, FDv, CRAEB, CRAEC, CRVEB, CRVEC and AVRB in SBI subjects were 1.25 (1.21–1.28), 1.11 (1.08–1.14), 1.09 (1.06–1.13), 168.78 ± 19.39, 163.55 ± 18.97, 235.77 (222.64-254.08), 224.39 ± 23.29, 0.72 ± 0.06, respectively, significantly lower than those of control subjects [1.30 (1.28–1.32), 1.15 (1.13–1.18), 1.14 (1.12–1.16), 196.81 ± 27.94, 183.81 ± 25.46, 273.03 (247.59–296.30), 249.59 ± 32.03, and 0.73 ± 0.08]. Logistic regression results showed that higher FD (OR, 0.04), FDa (OR, 0.07), FDv (OR, 0.06), CRAEB (OR, 0.02), CRAEC (OR, 0.04), CRVEB (OR, 0.03), CRVEC (OR, 0.06), and AVRB (OR, 0.55) were associated with a lower of SBI. There was no significant difference in AVRC between the two groups.ConclusionOur study shows the association between retinal vascular geometry and SBI, and the results may provide new biomarkers for the early detection of SBI.

Basic Fibroblast Growth Factor-Releasing Polyglycolic Acid Duras Improve Neurological Function after Cerebral Infarction.

Regenerative therapy using stem cells to treat cerebral infarction is currently in the research phase. However, this method is costly. It also faces other significant challenges, including optimization of timing, delivery methods, and dosage. Therefore, more practical and effective therapies are required. Bioabsorbable artificial dura mater made from nonwoven Polyglycolic Acid (PGA) fabric is used clinically to treat cerebral infarction. Basic Fibroblast Growth Factor (bFGF) has attracted considerable attention as a potential therapeutic candidate for the treatment of cerebral infarctions. In this study, we aimed to prepare a bFGF-releasing PGA dura mater and investigate its therapeutic efficacy for the recovery of neurological function in a mouse model of focal cerebral infarction. An artificial dura mater (Durawave) made from nonwoven PGA fabric was subjected to oxygen plasma treatment, followed by bFGF adsorption. The release of bFGF from the resulting PGA dura mater was evaluated in vitro using enzyme-linked immunosorbent assays. bFGF-releasing PGA dura mater was placed at the site of induced cerebral infarctions in mice. Neurological function was assessed 14 days after insertion, followed by a histological assessment. The prepared PGA dura mater released bFGF in a dose-dependent manner. Neurological function in the bFGF-treated groups was significantly better than that in the control group. bFGFreleasing PGA dura mater also significantly increased the number of neural progenitor cells in the peri-infarct cortex and striatum and showed a trend toward promoting angiogenesis. bFGF-releasing PGA dura mater improved neurological function in a mouse model of focal cerebral infarction.

Association of external ventricular drain duration and output with cerebral infarct risk in aneurysmal subarachnoid hemorrhage.

The optimal duration of external ventricular drain (EVD) in patients with aneurysmal subarachnoid hemorrhage (aSAH) is debatable. We sought to determine the association of EVD duration and output with outcomes, including cerebral infarct. We performed a retrospective study of a prospectively collected cohort of consecutive patients with aSAH who were admitted to an academic center from 2016 to 2023. Multivariable logistic regression was used to determine the association of EVD duration and output with outcomes, including cerebral infarct prior to discharge, poor outcome defined as 3-month modified Rankin Scale (mRS) 3-6 and ventriculoperitoneal (VP) shunt placement. We reviewed 429 cases of aSAH and included 306 patients who received EVD with mean age 57.9years (SD 13.9), 67% female and 69% white. Longer EVD duration was associated with higher odds of cerebral infarct (OR 1.04 for each day increase, 95% CI 1.01-1.07; p=0.003) independent of age, sex, Hunt and Hess grade and modified Fisher scale. Longer EVD duration was also associated with poor functional outcomes (OR 1.03 per each day increase, 95% CI 1.01-1.06; p=0.019) and VP shunt placement (OR 1.15 per each day increase, 95% CI 1.09-1.21; p<0.001) independent of other predictors. There was no independent association between daily EVD output and outcomes. Although longer EVD duration was associated with more cerebral infarcts and poor outcomes in patients with aSAH, no causal interferences can be drawn. Larger multicenter prospective studies are needed to better strategize the mode, duration, and amount of CSF drainage in aSAH patients.

Clinical study of colorViz fusion image vascular grading based on multi-phase CTA reconstruction in acute ischemic stroke

ObjectiveThis study aimed to evaluate the diagnostic value of ColorViz fused images from multi-phase computed tomography angiography (mCTA) using GE Healthcare’s FastStroke software for newly diagnosed cerebral infarctions in patients with acute ischemic stroke (AIS).MethodsA total of 106 AIS patients with unilateral anterior circulation occlusion were prospectively enrolled. All patients underwent mCTA scans during the arterial peak phase, venous peak phase, and venous late phase. The vascular information from these mCTA phases was combined into a time-varying color-coded image using GE Healthcare’s FastStroke software. All participants also underwent magnetic resonance diffusion-weighted imaging (MR-DWI) within three days. The diagnostic capability of the mCTA ColorViz fusion images for identifying newly diagnosed intracranial infarction was assessed using MR-DWI as the gold standard, focusing on the degree of delayed vascular perfusion and the number of visible blood vessels.ResultsThe mCTA ColorViz fusion images revealed ischemic changes in brain tissue, demonstrating a sensitivity of 88.7% for superficial infarctions and 48.5% for deep infarctions. Additionally, the subjective vascular grading score of the mCTA ColorViz fusion images showed a strong negative correlation with the infarct area identified by MR-DWI (r = − 0.6, P < 0.001).ConclusionThe mCTA ColorViz fusion images produced by FastStroke software provide valuable diagnostic insights for newly diagnosed cerebral infarction in AIS patients. The sensitivity of these images is notably higher for superficial infarctions compared to deep ones. This technique allows for relatively accurate detection of the ischemic extent and the likelihood of infarction in the superficial regions where lesions are located.

Safety and Efficacy of Thrombectomy for Distal Medium Vessel Occlusions of the Middle Cerebral Artery.

Mechanical thrombectomy (MT) for distal medium vessel occlusions (DMVOs) in the middle cerebral artery (MCA) is less established than for large vessel occlusions. This study evaluates the safety and efficacy of MT in DMVOs, comparing it with M1-segment occlusions. This retrospective study analyzed 218 patients who underwent MT for isolated M1 (n=123) or distal M2+M3 (n=35) occlusions between January 2020 and August 2023. Outcomes included procedural complications, hemorrhagic events, reperfusion rates, and clinical severity and disability at admission and discharge. Multivariate logistic regression identified predictors of favorable outcomes (modified Rankin Scale≤2) at discharge. Median admission National Institutes of Health Stroke Scale (NIHSS) scores were higher in the M1 group (13, interquartile range [IQR]: 8) compared to the distal M2+M3 group (8, IQR: 7; P<0.001), with significant improvements at discharge in both groups (6 [IQR: 8] for M1 and 2.5 [IQR: 5] for M2+M3; P=0.025). Favorable outcomes were more frequent in the M2+M3 group (50.0%) compared to M1 (28.1%; P=0.023). Recanalization rates (modified Thrombolysis in Cerebral Infarction≥2b) were excellent (>90% in both groups; P=0.300). Procedural complications were rare, with vessel perforations occurring infrequently (M1: 1.6%; M2+M3: 2.9%; P=0.531). Symptomatic intracranial hemorrhage rates were similarly low (2.4% vs. 2.9%; P=0.889). Multivariate analysis identified younger age (P=0.045) and lower NIHSS (P=0.061) as predictors of favorable outcomes in distal occlusions. MT is safe and effective for DMVOs of the MCA, demonstrating significant improvements in clinical outcomes and comparable complication rates to MT for M1-segment occlusions. Given the typically less severe presentations in DMVO and similar risk profiles, careful patient selection and individualized treatment remain critical.

Retraction: Overexpression of lncRNA ANRIL up-regulates VEGF expression and promotes angiogenesis of diabetes mellitus combined with cerebral infarction by activating NF-κB signaling pathway in a rat model.

Retraction: Overexpression of lncRNA ANRIL up-regulates VEGF expression and promotes angiogenesis of diabetes mellitus combined with cerebral infarction by activating NF-κB signaling pathway in a rat model.

The effect of SARS-CoV-2 Omicron BA. 5.2 infection on perioperative physiological indicators in orthopedic patients

ObjectiveThe aim of this study was to investigate the effect of SARS-CoV-2 Omicron BA. 5.2 (hereafter referred to as Omicron BA. 5.2) infection on perioperative physiological indices and to provide clinical considerations for the precautions needed for patients who tested negative for SARS-CoV-2 infection perioperatively.MethodsPatients who underwent time-limited surgery (surgery that must be performed within a certain time) at the Department of Orthopedics of our hospital from September 1, 2022, to March 31, 2023, were divided into an observation group (those with Omicron BA 5.2 and a negative nucleic acid test after December 7, 2022, n = 100) and a control group (those negative for SARS-CoV-2 infection before December 7, 2022, n = 100). Changes in the following factors were compared within and between the two groups: heart rate, mean arterial pressure, oxygenation index at the time of entry into the operating room, incision of the skin and exit from the operating room and the neutrophil‒lymphocyte ratio (NLR), platelet‒lymphocyte ratio (PLR), systemic immune inflammation index (SII), D-dimer level, and fibrinogen degradation product (FDP) level. Changes in interleukin-6 and calcitonin levels were assessed the day after surgery, and multivariate regression analysis of the meaningful results was conducted.ResultsHeart rate, mean arterial pressure, oxygenation index, NLR, PLR, SII, interleukin-6 and calcitonin were similar between the two groups (P > 0.05). The observation group had higher postoperative D-dimer and FDP levels (P < 0.05). Multivariate regression analysis revealed that Omicron BA 5.2 infection, older age and a history of cerebral infarction were associated with increased D-dimer and FDP levels, and their odds ratios (ORs) and confidence intervals are 3.339 [95% CI, 1.372–8.419], P = 0.008; OR, 1.080 [95% CI, 1.023–1.139]; P = 0.005; OR, 10.644 [95% CI, 1.352–83.320], P = 0.025, respectively.ConclusionOmicron BA. 5.2 Infection affects the perioperative coagulation function of orthopedic patients, thereby inducing a hypercoagulable state characterized by significant elevations in D-dimer and FDP levels and increasing the risk of venous thrombosis. This infection had no obvious effect on other physiological indices. Early surgery is feasible, but thrombotic events need to be considered.

Thrombolysis for aneurysmal subarachnoid haemorrhage.

Aneurysmal subarachnoid haemorrhage continues to cause a significant burden of morbidity and mortality despite advances in care. Trials investigating local administration of thrombolytics have reported promising results. - To assess the effect of thrombolysis on improving functional outcome and case fatality following aneurysmal subarachnoid haemorrhage - To determine the effect of thrombolysis on the risk of cerebral artery vasospasm, delayed cerebral ischaemia, and hydrocephalus following subarachnoid haemorrhage - To determine the risk of complications of local thrombolysis in aneurysmal subarachnoid haemorrhage SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (last searched 9 March 2023), MEDLINE Ovid (1946 to 9 March 2023), and Embase Ovid (1974 to 9 March 2023). We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP). We performed forward and reverse citation tracking of included studies using Google Scholar. We included randomised controlled trials comparing subarachnoid thrombolysis via any route of administration into any anatomical site continuous with the subarachnoid space versus placebo, sham thrombolysis, or standard treatment. Two review authors independently selected studies for inclusion in the review. We extracted study data and used version 2 of the Cochrane risk-of-bias tool for randomised trials to assess the risk of bias in the studies. We resolved any disagreement through discussion with a third author. Our primary outcome was poor functional outcome. Secondary outcomes were case fatality, haemorrhagic complications, cerebral artery vasospasm, delayed cerebral ischaemia, cerebral infarction, and hydrocephalus. We performed meta-analyses for each outcome and performed sensitivity analysis excluding studies at high risk of bias. We presented results as risk ratios (RRs) with 95% confidence intervals (CIs). We performed further sensitivity analysis by including all intervention groups from studies reporting more than one intervention group. For each outcome, we used the GRADE criteria to determine the certainty of the evidence. We included eight studies from six countries in this review. The studies had a total of 410 participants, of whom 205 received thrombolysis. We identified three ongoing trials. We assessed one trial as having a high risk of bias for all outcomes; we assessed the remainder as having a low risk of bias or some concerns. Thrombolysis likely results in a reduction in poor functional outcome when compared to placebo or standard care (29.4% versus 39.7%, RR 0.73, 95% CI 0.56 to 0.94; 8 studies, 408 participants; moderate-certainty evidence). Thrombolysis likely results in little to no difference in case fatality (12.8% versus 17.7%, RR 0.71, 95% CI 0.46 to 1.10; 8 studies, 408 participants; moderate-certainty evidence). Thrombolysis may result in little to no difference in haemorrhagic complications (10.3% versus 7.2%, RR 1.40, 95% CI 0.73 to 2.68; 6 studies, 341 participants; low-certainty evidence). Thrombolysis likely results in a reduction in cerebral artery vasospasm (32.9% versus 47.6%, RR 0.70, 95% CI 0.54 to 0.91; studies, participants; moderate-certainty evidence), and may result in a reduction in delayed cerebral ischaemia (23.8% versus 38.2%, RR 0.62, 95% CI 0.45 to 0.88; studies, participants; low-certainty evidence). Thrombolysis may result in little to no difference in cerebral infarction (28.6% versus 37.5%, RR 0.76, 95% CI 0.44 to 1.31; studies, participants; low-certainty evidence), and likely results in little to no difference in the risk of hydrocephalus (18.3% versus 24.1%, RR 0.77, 95% CI 0.54 to 1.10; studies, participants; moderate-certainty evidence). There is some evidence that thrombolysis can probably improve outcomes after aneurysmal subarachnoid haemorrhage, without increasing the risk of haemorrhagic complications. Thrombolysis likely reduces the risk of poor functional outcome and cerebral artery vasospasm, and may reduce the risk of delayed cerebral ischaemia, but it likely makes little to no difference to case fatality or hydrocephalus, and may make little to no difference to the risk of cerebral infarction. However, the current evidence is still uncertain. The uncertainty is primarily due to the small total number of participants and outcome events. Data from further studies are required to confirm the efficacy of thrombolysis for improving outcomes after aneurysmal subarachnoid haemorrhage.

The effects of admission hyperglycemia and diabetes mellitus on mechanical thrombectomy outcomes: A systematic review and meta-analysis.

The impact of certain comorbidities on mechanical thrombectomy (MT) outcomes remains largely unexplored. Diabetes mellitus (DM) and admission hyperglycemia have been associated with poor clinical outcomes for patients treated with MT. In this study, we sought to investigate the effects of DM and admission hyperglycemia on MT outcomes. Following PRISMA guidelines, a systematic literature search was conducted in Medline, Embase, Scopus, and Web of Science databases. Data regarding successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] ≥2b), functional independence (modified Rankin Scale [mRS] 0-2), excellent outcomes (mRS 0-1), symptomatic intracranial hemorrhage (sICH), and mortality were extracted from the included studies. The pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated using random effects model. Twenty-one studies comprising 9708 patients were included. A total of 2311 patients (24%) had a history of DM, and 2026 patients (21%) had admission hyperglycemia. Admission hyperglycemia was associated with significantly lower odds of mTICI ≥2b (OR = 0.7, 95% CI = 0.55-0.89), mRS 0-2 (OR = 0.47, 95% CI = 0.41-0.53), and mRS 0-1 (OR = 0.43, 95% CI = 0.34-0.55) as compared to normoglycemic state. Patients with hyperglycemia had significantly higher rates of sICH (OR = 2.05, 95% CI = 1.66-2.54) and mortality (OR = 1.99, 95% CI = 1.58-2.52) than normoglycemic patients. Diabetes mellitus was associated with significantly high rates of mortality (OR = 1.74, 95% CI = 1.31-2.3) and lower rates of mRS 0-2 (OR = 0.60, 95% CI = 0.48-0.76) in sensitivity analyses. Our results indicate that admission blood glucose levels and DM can negatively affect MT outcomes. Further research should focus on optimizing MT outcomes for these patients.

Comparison of Clazosentan and Nimodipine on Vasospasm and Vasospasm-Related Outcomes after Aneurysmal Subarachnoid Hemorrhage : A Post-hoc Propensity Score-Matched Analysis of Six Randomized Clinical Trials.

Clazosentan is a recently approved endothelin receptor antagonist indicated for the prevention of vasospasm and related complications following aneurysmal subarachnoid hemorrhage (aSAH). To date, no direct, head-to-head comparison between clazosentan and nimodipine has been conducted. In this study, we indirectly assessed the efficacy and safety of these two drugs in preventing vasospasm and its associated outcomes after aSAH. Participants from six randomized clinical trials of clazosentan were reclassified into three subgroups based on their concomitant use of oral nimodipine: (1) a clazosentan subgroup (without nimodipine), (2) a nimodipine subgroup (without clazosentan), and (3) a placebo subgroup (receiving neither clazosentan nor nimodipine). Data from participants who received the approved dose of clazosentan 10 mg/h was analyzed. To account for heterogeneities among the analyzed studies, we performed within-study comparisons of subgroups and pooled data from the same subgroup. To further balance the three groups, we conducted a propensity score-matching and compared the outcomes among subgroups. The outcomes measured were angiographic vasospasm within 14 days after aSAH and vasospasm-related morbidity and all-cause mortality (MM) within 6 weeks, defined as death, vasospasm-related new cerebral infarcts, delayed ischemic neurological deficits, or initiation of rescue therapy. Incidence and relative risk reduction (RRR) were analyzed across subgroups, and overall safety was reviewed. The pooled data from within-study comparisons demonstrated that clazosentan significantly reduced the risk of vasospasm (RRR 0.48 [95 % CI: 0.35, 0.58]) and MM (RRR 0.47 [95 % CI: 0.30, 0.60]) compared to placebo, whereas nimodipine did not. In the propensity score-matched analysis, clazosentan demonstrated a significant risk reduction in outcomes when compared to nimodipine (RRR 0.63 [95% CI: 0.46, 0.75] for vasospasm; RRR 0.29 [95% CI: 0.04, 0.48] for MM) and placebo (RRR 0.59 [95% CI: 0.40, 0.72] for vasospasm; RRR 0.41 [95% CI: 0.21, 0.56] for MM).The overall safety results were comparable across the three subgroups and consistent with the expected range for endothelin receptor antagonists. Clazosentan at 10 mg/h significantly reduced the incidence of cerebral vasospasm and MM following aSAH, compared to both placebo and nimodipine. Further clinical studies are warranted to compare the efficacy of clazosentan and nimodipine to optimize treatment strategies for aSAH.

The Impacts of the Covid-19 Pandemic on Cerebral Infarction Treatment: Challenges and Opportunities

The Impacts of the Covid-19 Pandemic on Cerebral Infarction Treatment: Challenges and Opportunities

Toona sinensis fruit polyphenols alleviate cerebral ischemia-reperfusion injury in rats by inhibiting MAPK signaling pathways and NLRP3 inflammasome/pyroptosis.

Toona sinensis fruit polyphenols (TSFP) are polyphenols that have been separated and extracted from mature Toona sinensis fruits. TSFP anti-inflammatory and neuroprotective properties have demonstrated promise. However, the underlying mechanisms require more elucidation. The aim of this study is to investigate the mechanisms by which TSFP alleviates cerebral ischemia-reperfusion injury (CIRI) through the mitogen-activated protein kinase (MAPK) and NOD-,LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome pathways on middle cerebral artery occlusion/reperfusion (MCAO/R) rats. The TSFP neuroprotective effect was evaluated using transmission electron microscope (TEM), 2,3,5-triphenyltetrazolium chloride (TTC), neurological function, and hematoxylin-eosin (H&E) staining. An enzyme-linked immunosorbent assay (ELISA) and immunofluorescence were used to measure the TSFP influence on inflammation. In addition, a western blot assay was performed to assess the NLRP3 inflammasome and MAPK pathway proteins expressions in the prefrontal cortex (PFC) and hippocampus, and double immunofluorescence methods were used to identify gasdermin D (GSDMD) secretion in neurons. The TSFP group in the MCAO/R model had improved levels of cerebral infarction and brain pathological damage. The TEM demonstrated that TSFP ameliorated ischemia-induced neuronal pyroptosis, and there was a significant decrease in the expressions of NLRP3, the apoptosis-associated speck-like protein containing Caspase recruitment domain (ASC), cysteine aspartate-specific protease-1 (caspase-1), and GSDMD in the TSFP groups. TSFP reduced the phosphorylation of p38 mitogen-activated protein kinase (p38) and extracellular signal-regulated kinase 1/2 (ERK1/2), promoted the phosphorylation of extracellular signal-regulated kinase 5 (ERK5), and reduced the phosphorylation of c-Jun amino terminal kinase (JNK) in the hippocampus. The results also revealed that TSFP significantly lowered the interleukin-1β (IL-1β) and interleukin-1β (IL-18) expressions and attenuated glial cell activation caused by ischemia in the PFC and hippocampus DG areas. This study provided evidence for the efficacy of TSFP in the treatment of CIRI, with potential mechanisms that involved the control of the MAPK signaling pathways and NLRP3 inflammasome/pyroptosis, which highlights the potential benefits of TSFP in the treatment of CIRI.