Management Of Stroke Research Articles

Epigenetic regulation of the inflammatory response in stroke

Stroke is classified as ischemic or hemorrhagic, and there are few effective treatments for either type. Immunologic mechanisms play a critical role in secondary brain injury following a stroke, which manifests as cytokine release, blood–brain barrier disruption, neuronal cell death, and ultimately behavioral impairment. Suppressing the inflammatory response has been shown to mitigate this cascade of events in experimental stroke models. However, in clinical trials of anti-inflammatory agents, long-term immunosuppression has not demonstrated significant clinical benefits for patients. This may be attributable to the dichotomous roles of inflammation in both tissue injury and repair, as well as the complex pathophysiologic inflammatory processes in stroke. Inhibiting acute harmful inflammatory responses or inducing a phenotypic shift from a pro-inflammatory to an anti-inflammatory state at specific time points after a stroke are alternative and promising therapeutic strategies. Identifying agents that can modulate inflammation requires a detailed understanding of the inflammatory processes of stroke. Furthermore, epigenetic reprogramming plays a crucial role in modulating post-stroke inflammation and can potentially be exploited for stroke management. In this review, we summarize current findings on the epigenetic regulation of the inflammatory response in stroke, focusing on key signaling pathways including nuclear factor-kappa B, Janus kinase/ signal transducer and activator of transcription, and mitogen-activated protein kinase as well as inflammasome activation. We also discuss promising molecular targets for stroke treatment. The evidence to date indicates that therapeutic targeting of the epigenetic regulation of inflammation can shift the balance from inflammation-induced tissue injury to repair following stroke, leading to improved post-stroke outcomes.

Effects of Social Determinants of Health on Acute Stroke Care Among Patients With Acute Ischemic Stroke: A Retrospective Cohort Study.

Social determinants of health (SDOH) are important contributors to poor stroke-related outcomes. While some have suggested that this association is driven by the increased incidence of stroke observed with poor SDOH, others have raised concerns regarding disparities in acute stroke care. This study aimed to determine the association between SDOH and the administration of thrombolytic therapy and mechanical thrombectomy among patients with acute ischemic stroke. A retrospective cohort analysis was conducted using Texas Emergency Department Public Use Data (2016-2019), including adult patients diagnosed with acute ischemic stroke. The risk ratios (RRs) of administering thrombolysis and thrombectomy based on variables representing SDOH and a collective measure (Social Vulnerability Index [SVI]) were computed using mixed-effects Poisson regression models accounting for the nested nature of patients in hospitals and neighborhoods. The Charlson comorbidity score was considered as a covariate. Of the 139,852 patients with ischemic stroke (female, 51.7%; White, 67.2%; Black, 16.6%; Hispanic, 25.1%), 16,831 (12.3%) received thrombolytic therapy and 5,951 (4.3%) received mechanical thrombectomy. Age older than 65 years (RR 0.578 [0.537-0.621]) vs 18-45 years, Black (RR 0.801 [0.761-0.844]) vs White, Hispanic (RR 0.936 [0.895-0.98]) vs non-Hispanic, Medicare/Medicaid/Veterans Affairs (VA) (RR 0.917 [0.882-0.954]) or uninsured (RR 0.883 [0.833-0.935]) vs private insurance, and rural (RR 0.782 [0.723-0.845]) vs urban dwelling were less likely to be associated with thrombolysis. Patients in the highest quintile based on the SVI were less likely to receive thrombolysis than those in the lowest quintile (RR 0.926 [0.867-0.989]). Patients were less likely to receive thrombectomy if they were 65 years and older (RR 0.787 [0.691-0.895]), belonged to the Black race (RR 0.745 [0.679-0.818]) or Hispanic ethnicity (RR 0.919 [0.851-0.992]), had Medicare/Medicaid/VA insurance (RR 0.909 [0.851-0.971]), or were from a rural area (RR 0.909 [0.851-0.971]). Similarly, SVI decreased the likelihood of undergoing mechanical thrombectomy (RR 0.842 [0.747-0.95]). Despite many improvements in stroke management, SDOH continue to be a significant driver of treatment access for acute ischemic stroke. While our findings are limited to Texas, our results should raise awareness and promote more studies regarding the effects of these SDOH at the national and international levels.

Preoperative management and anticoagulant efficacy in atrial myxoma-associated acute ischemic stroke: a case report and literature review

Acute ischemic stroke (AIS) is a common complication of atrial myxoma (AM), and most emboli originate from a thrombus attached to the surface of the myxoma, with occasional shedding of tumor fragments leading to stroke. Clinical manifestations of AM include mitral valve obstruction, systemic embolism, and weakness. However, neurological deficits and other nonspecific manifestations may mask the presence of AM. The surgical resection is the most effective treatment for these conditions. However, the main problem is the lack of consensus regarding the prevention and treatment of stroke complicated by myxoma during the perioperative period. This study aims to improve the diagnosis and treatment of AM and the associated AIS. Here, we report the case of a 27-year-old patient with AM who presented with chest pain, palpitations, and sudden dizziness and had a stroke under anticoagulant treatment during the admission period. We also reviewed and summarized the clinical presentations and characteristics of similar previously reported cases. Our review emphasized the importance of early diagnosis and appropriate perioperative management of AM and its associated AIS.

Abstract 4120957: Endovascular Thrombectomy Versus Medical Management for Acute Ischemic Stroke with Large Infarct: An Updated Meta-Analysis of Randomized Controlled Trials

Background: Endovascular therapy (EVT) has revolutionized the treatment of acute ischemic stroke due to large vessel occlusions. Despite the increasing evidence for EVT, its efficacy remains understudied in patients with acute ischemic stroke with large infarcts. Patients with large-volume ischemic strokes are excluded from major randomized controlled trials (RCTs) despite contributing up to 25% of all acute ischemic strokes. Aim: This study aimed to compare clinical outcomes with endovascular thrombectomy versus medical management in patients with acute ischemic stroke with large infarct. Methods: We conducted a systematic literature review on PubMed, Embase, Scopus and Cochrane Library from inception to 15th May 2024 for RCTs. The inverse-variance random-effects model was used to pool odds ratio (OR) and risk ratio (RR) with 95% confidence intervals. The statistical significance was set at p<0.05. Results: 6 RCTs with 1887 patients (945: EVT and 942: medical management) were included. The mean age in both EVT and medical management groups was 70 ± 11.4 years. EVT was associated with a better modified Rankin Score (mRS) at 90 days [OR: 1.68; 95% CI: 1.38, 2.04; p<0.00001], mRS at 90 days (0-2) [OR: 2.47; 95% CI: 1.87, 3.27; p<0.00001], mRS at 90 days (0-3) [OR: 1.96; 95% CI: 1.56, 2.46; p<0.00001], and early neurological improvement [RR: 2.35; 95% CI: 1.79, 3.10; p<0.00001] compared to medical management. EVT was also associated with a higher risk of symptomatic intracranial hemorrhage [RR: 1.71; 95% CI: 1.09, 2.66; p=0.02]. The 90-day mortality [RR: 0.86; 95% CI: 0.72, 1.02; p=0.08] was comparable between the two groups. Conclusion: Patients with acute ischemic stroke with large infarct had superior functional outcomes with EVT as compared to medical management alone. However, EVT was associated with higher risks of symptomatic intracranial hemorrhage, with comparable 90-day mortality risk. Further large RCTs are warranted to evaluate the outcomes with EVT in acute ischemic stroke with large infarct.

E-Healthcare System for Stroke Management Using IoT and Machine Learning

Machine learning is one of the hottest topics in e-healthcare and has a big social impact. It is challenging to build and develop an efficient and successful e-healthcare system without machine learning. Machine learning's primary function is to analyse healthcare data, which is gathered from various sources and can be both homogeneous and heterogeneous. Therefore, creating an effective machine learning algorithm that functions with both homogeneous and heterogeneous data is a difficult task. On the other hand, it is noted that a sizable number of health-related products, such as fitness bands, smart watches, and sensors, are being developed, and the majority of people use these items to track their own health. Each person's health data is also gathered by these devices, and a machine learning algorithm is integrated into the data to identify any strange patterns or behaviours. These gadgets capture any aberrant behaviour or pattern, and an alarm message is sent to the individual. Thus, machine learning (ML) presents a promising technique for cutting healthcare device costs and describing doctor-patient relationships at a higher level.

Advancing ischemic stroke diagnosis and clinical outcome prediction using improved ensemble techniques in DSC-PWI radiomics.

Ischemic stroke is a leading global cause of death and disability and is expected to rise in the future. The present diagnostic techniques, like CT and MRI, have some limitations in distinguishing acute from chronic ischemia and in early ischemia detection. This study investigates the function of ensemble models based on the dynamic radiomics features (DRF) from the dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) ischemic stroke diagnosis, neurological impairment assessment, and modified Rankin Scale (mRS) outcome prediction). DRF is extracted from the 3D images, features are selected, and dimensionality is reduced. After that, ensemble models are applied. Two model structures were developed: a voting classifier with 6 bagging classifiers and a stacking classifier based on 4 bagging classifiers. The ensemble models were evaluated on three core tasks. The Stacking_ens_LR model performed best for ischemic stroke detection, the LR Bagging model for NIH Stroke Scale (NIHSS) prediction, and the NB Bagging model for outcome prediction. These outcomes illustrate the strength of ensemble models. The work showcases the role of ensemble models and DRF in the stroke management process.

Evaluating the Usability of a Remote Ischemic Conditioning Device for Pre-Hospital Stroke Management: Insights from Paramedic Simulations

Background/Objectives: In acute stroke, often-prolonged hospital transport times present an opportunity for early interventions to salvage brain tissue. Remote ischemic conditioning (RIC), where brief cycles of ischemia–reperfusion in a limb are induced to protect the brain, is a promising treatment for this setting. We assessed the usability of a novel RIC system in a simulated emergency response scenario. Methods: Paramedics were asked to use the RIC device in an emergency stroke care and ambulance transport simulation, overseen by a confederate. Feedback on device use was collected through questionnaires, including the System Usability Scale (SUS) and the NASA Task Load Index (NASA-TLX), and a semi-structured interview. Questionnaire responses were summarized using descriptive statistics; interview transcripts were analyzed thematically. Results: Nine paramedics (including the confederate) participated, with a mean of 10.0 ± 10.3 years of professional experience. Questionnaire responses indicated high device usability (mean SUS score: 85.3 ± 12.9 out of 100) and low task-related demands, effort, and frustration (mean NASA-TLX domain scores: ≤3.9 out of 20). Seven paramedics stated they would use the device in daily practice. They expressed concerns related to display screen clarity, interference with standard procedures, cable management, device fragility, and patient discomfort. Suggested improvements included adding indicators of device performance and refining the cuff design. Conclusions: While the device was considered easy to use, paramedics also identified important areas of improvement. With a small, localized study sample, our findings are primarily applicable to the refinement of the RICovery system for use in future clinical trials in the same healthcare setting. However, feedback on the importance of mitigating potential interference of newly introduced procedures with those already established, robustness of equipment, and effective paramedic–patient communication may also help inform the design of other pre-hospital interventions.

Prevention of stroke and cognitive decline in pediatric population in resource-limited settings

There is an increasing global burden of pediatric stroke especially in low- and middle-income countries (LMICs). This is worsened by the specific risk factors in these areas, including Sickle Cell Disease and endemic infections like Tuberculosis and Human Immunodeficiency disease. Stroke occurs 221–300 times more frequently in patients with SCD when compared to healthy children. Although established stroke units and acute stroke care can improve outcomes, these are often not available in resource-poor settings. Primary and secondary prevention of strokes become a very important strategy to reduce the mortality and debilitating physical and cognitive long-term effects of stroke. There are myriads of challenges with implementing already established global policies and guidelines for stroke care in LMICs. These include paucity of data on this subject, poor knowledge and awareness about the symptoms of childhood stroke, adverse cultural beliefs regarding strokes, lack of screening and diagnostic equipment, inadequately trained manpower as well as nonexistent evidence-based management guidelines in these regions. To address these challenges, simple, cost-effective, stroke care models that determine the process of care and how available services should be delivered have been proposed to suit the peculiarities of LMICs in the areas of stroke risk assessment, prevention, and management.

TARGET: A Major European Project Aiming to Advance the Personalised Management of Atrial Fibrillation-Related Stroke via the Development of Health Virtual Twins Technology and Artificial Intelligence.

TARGET: A Major European Project Aiming to Advance the Personalised Management of Atrial Fibrillation-Related Stroke via the Development of Health Virtual Twins Technology and Artificial Intelligence.

A longitudinal investigation of the determinants of stroke survivors’ utilisation of a healthy lifestyle for stroke rehabilitation in Australia

This study aimed to determine the longitudinal predictors of lifestyle behaviours among stroke survivors in New South Wales, Australia. This longitudinal study utilised data from the baseline survey (2005–2009) and a sub-study survey (2017) of the 45 and Up Study. Physical activity, alcohol consumption, smoking status, and supplement use were included as dependent variables. Generalised estimating equation models were employed to assess the longitudinal association between the dependent variable and demographic and health status measures. The average age of the participants (n = 576) was 67 (SD = 9) years at baseline and 76 (SD = 9) years at the sub-study survey time, with 54.9% being male. The longitudinal analysis revealed that the likelihood of moderate/high physical activity significantly declined over time and was lower among participants with diabetes, but was higher among those with university education. The likelihood of smoking was significantly higher in females, moderate/high-risk alcohol consumers, and those with depression, but was lower among supplement users. The likelihood of moderate/high-risk alcohol consumption significantly declined with time, and was lower among females, but higher among smokers. The likelihood of supplement use significantly declined over time, but was higher among females and/or those with asthma. Our findings help illustrate that many stroke survivors may benefit from further support in adopting and maintaining a healthy lifestyle as part of their stroke management and long-term rehabilitation, which is crucial to optimising their quality of life and successful secondary stroke prevention.

Contemporary Management of Acute Ischemic Stroke.

In the past decade, adding mechanical thrombectomy (MT) of intracranial arterial occlusions to intravenous (IV) thrombolysis has revolutionized the treatment of acute ischemic stroke (AIS) by expanding the therapeutic window to 24h. Treatment decisions require establishing a high probability of AIS; confirming time since last known well (LKW); assessing severity of the neurological deficit; determining any contraindications to IV thrombolysis; and performing neuroimaging, usually noncontrast computed tomography (NCCT), to exclude intracerebral hemorrhage. If time since LKW is less than 4.5h, patients with disabling stroke without contraindications can proceed immediately to IV thrombolysis while the decision about MT is under way. For some patients, the MT decision can be made on the basis of clinical assessment, NCCT, and CT angiography showing a large vessel occlusion. Others may require additional neuroimaging. Patients who are not candidates for IV thrombolysis within 4.5h or MT should be immediately evaluated for eligibility for extended-window IV thrombolysis or early antiplatelet treatment.

A Hybrid Simulation‐Based Workshop Improves Knowledge and Confidence in the Management of Hemorrhagic Conversion of Stroke Among Interventional Neurology Trainees

Background Mechanical thrombectomy is the standard of care in acute ischemic stroke with anterior large vessel occlusion presenting within 6 hours of symptom onset, but complications do exist. We assessed the feasibility of a hybrid simulation‐based workshop at a national meeting for interventional neurology trainees focused on the management of acute ischemic stroke and tissue‐plasminogen activator‐related hemorrhage. Methods In this prospective, observational, hybrid simulation‐based study at a fellows’ workshop at a national conference, participants were asked to manage a patient with acute ischemic stroke in the neurointerventional suite followed by thrombolytic‐related hemorrhage leading to cerebral herniation during mechanical thrombectomy. We evaluated the participants’ ability to complete critical actions that were developed based on best practices and relevant American Heart Association guidelines and the Neurocritical Care Society's Emergency Neurological Life Support protocols. The primary outcome was the improvement in knowledge from a precourse to postcourse test. Secondary outcomes included participant reactions. Results Sixty trainees completed the simulation session in 8 groups. The mean sum of critical actions completed by trainees was 9.75/14 (70%). There was a moderate effect of the intervention on trainees’ knowledge from pretest (mean 3.8, SD = 0.3) to posttest (mean 4.3, SD = 0.3). The simulation scenario was described as moderately realistic, very engaging, and extremely satisfactory. Following the workshop, all fellows endorsed an increase in proficiency and confidence in neurological emergency management. Conclusion Simulation‐based workshops at national conferences are feasible and a potentially useful tool for safely educating a large audience of trainees who may not have access to high‐fidelity simulation platforms at their institutions.

Finding MeVO: Identifying Intracranial Medium-Vessel Occlusions at CT Angiography.

The development of methods to detect and treat intracranial large-vessel occlusions (LVOs) has revolutionized the management of acute ischemic stroke. CT angiography (CTA) of the head and neck is effective in depicting LVOs and widely used in the evaluation of patients who have had a stroke. Ongoing efforts are now focused on the potential to detect and treat intracranial medium-vessel occlusions (MeVOs), which by definition are smaller than LVOs and thus more difficult to detect with CTA. The authors review common and variant anatomies of medium-sized cerebral arteries and the appearance of a variety of MeVOs on CT angiograms. Possible pitfalls in MeVO detection include rare anatomic variants, calcified thrombi, and stump occlusions. Current recommendations for performing CTA and ancillary methods that might aid in MeVO detection are discussed. Understanding the relevant anatomy and the variety of appearances of MeVOs aids radiologists in identifying these occlusions, particularly in the setting of urgent stroke. ©RSNA, 2024 See the invited commentary by Ospel and Nguyen in this issue.

Deep Learning‐Based Prediction of Final Infarct Core from CT Perfusion Data: A Comparison to the Clinical Standard

Background In the management of acute ischemic stroke, computed tomography perfusion (CTP) is used to define the ischemic core and penumbra to estimate tissue fate after reperfusion therapy. The core/penumbra dichotomy uses single‐value thresholds, which potentially discards valuable data and oversimplifies the complexity of core and penumbral estimation. Advancing the dichotomous CTP output to a probability model has several advantages such as more sophisticated modeling of pathophysiology, supporting reader interpretation, and assessing a greater range of available data to estimate tissue fate. Methods In this retrospective study, we developed a CTP probability model to move away from single perfusion thresholds to estimate tissue fate. All patients from the International Stroke Perfusion Imaging Registry database had baseline CTP and were included in the current study if they had a large vessel occlusion that recanalized fully after thrombectomy and had follow‐up diffusion‐weighted imaging. Data were split into training, validation, and testing groups. Training and validation cohorts were used to develop a deep learning model in project MONAI (Medical Open Network for Artificial Intelligence) and performance metrics were derived from the testing set. Results In total, 243 patients were included in the study. The Attention U‐Net was the best performing deep learning model, producing the best prediction of follow‐up infarct core on the test set (n = 48): mean diverse counterfactual explanations score = 0.430±0.213, mean area under the curve = 0.765±0.095; better than the single‐value thresholding with a diverse counterfactual explanations scoreof 0.247±0.167 (paired t ‐test, P <0.0001) and area under the curveof 0.604±0.074 ( P <0.0001). Conclusion The deep learning probabilistic CTP model outperformed the current clinical standard, providing a more accurate core estimate than single‐threshold‐based measures.

Clinical Features, Management, and Recurrence of Acute Ischemic Stroke Occurring in Patients on Oral Anticoagulant Treatment for Nonvalvular Atrial Fibrillation: A Real-World Retrospective Study.

The optimal management of acute ischemic stroke (AIS) in patients with oral anticoagulation (OA) is challenging. Our study aimed to analyze the clinical characteristics and outcome of AIS in patients with OA for nonvalvular atrial fibrillation (NVAF). We retrospectively analyzed data on NVAF patients with AIS on direct oral anticoagulants (DOAC) or vitamin K antagonists (VKA) admitted to our Stroke Unit from 2017 to 2022. Ninety-day modified Rankin Scale (mRS), 90-day, and 12-month stroke recurrences were recorded. A total of 169 patients (53.2% female, mean age 82.8±6.7 y), 117 (69.2%) on DOAC, and 52 on VKA (30.8%), were enrolled. Mean age, in-hospital mortality, and 90-day mRS ≥4 were significantly higher in VKA patients. 63.4% of VKA patients had subtherapeutic INR, whereas 47.1% of DOAC patients were on low-dose (14.2% off-label). Large vessel occlusion and embolic etiology were more frequent in VKA patients (34.6% vs. 26.4%, P =0.358; 92.3% vs. 74.3%, P =0.007, respectively), whereas lacunar strokes were more frequent in DOAC patients (19.8% vs. 12.2%, P =0.366). Among patients on VKA before AIS 86.4% were switched to DOAC, whereas a DOAC-to-VKA and a DOAC-to-DOAC switch were done in 25.4% and 11.7%, respectively. Stroke recurrence occurred in 6.4% of patients at 90 days and 10.7% at 12 months. Anticoagulant switching was not associated with stroke recurrences. In our study, nonembolic etiology was more frequent in DOAC patients and anticoagulant switching did not reduce the risk of stroke recurrence. Prospective multicentric studies are warranted.

Rational development of fingolimod nano-embedded microparticles as nose-to-brain neuroprotective therapy for ischemic stroke.

Ischemic stroke is one of the major diseases causing varying degrees of dysfunction and disability worldwide. The current management of ischemic stroke poses significant challenges due to short therapeutic windows and limited efficacy, highlighting the pressing need for novel neuroprotective treatment strategies. Previous studies have shown that fingolimod (FIN) is a promising neuroprotective drug. Here, we report the rational development of FIN nano-embedded nasal powders using full factorial design experiments, aiming to provide rapid neuroprotection after ischemic stroke. Flash nanoprecipitation was employed to produce FIN nanosuspensions with the aid of polyvinylpyrrolidone and cholesterol as stabilizers. The optimized nanosuspension (particle size = 134.0 ± 0.6nm, PDI = 0.179 ± 0.021, physical stability = 72 ± 0h, and encapsulation efficiency of FIN = 90.67 ± 0.08%) was subsequently spray-dried into a dry powder, which exhibited excellent redispersibility (RdI = 1.09 ± 0.04) and satisfactory drug deposition in the olfactory region using a customized 3D-printed nasal cast (45.4%) and an Alberta Idealized Nasal Inlet model (8.6%) at 15L/min. The safety of the optimized FIN nano-embedded dry powder was confirmed in cytotoxicity studies with nasal (RPMI 2650 and Calu-3 cells) and brain related cells (SH-SY5Y and PC 12 cells), while the neuroprotective effects were demonstrated by observed behavioral improvements and reduced cerebral infarct size in a middle cerebral artery occlusion mouse stroke model. The neuroprotective effect was further evidenced by increased expression of anti-apoptotic protein BCL-2 and decreased expression of pro-apoptotic proteins CC3 and BAX in brain peri-infarct tissues. Our findings highlight the potential of nasal delivery of FIN nano-embedded dry powder as a rapid neuroprotective treatment strategy for acute ischemic stroke.

Endovascular Thrombectomy for Large Core Volume Acute Ischemic Stroke. Updated Systematic Review and Meta-Analysis

Background: Several recent studies assessed the efficacy and safety of endovascular thrombectomy (EVT) for patients with acute ischemic stroke caused by an anterior circulation large vessel occlusion (LVO) with large core infarct volumes. Methods: We performed a systematic review and meta-analysis from inception until July 2024 of all randomized clinical trials (RCTs) and observational studies to date comparing the efficacy and safety of EVT plus best medical management (MM) for acute ischemic stroke due to anterior circulation LVO with large core, versus MM alone. Primary efficacy outcome was optimal functional outcome defined by a 90-day modified Rankin scale score (mRS) of 0-2. Safety outcomes were risk of symptomatic intracranial hemorrhage (sICH) and 90-day mortality. Subgroup analyses were done by study design. Relative risk (RR) and 95% CIs were calculated using random-effects models and heterogeneity was assessed by I2 statistics. Results: A total of 16 studies with 3,717 participants met inclusion criteria (6 RCTs and 10 observational studies). The quality of the evidence was moderate to high. Compared with MM alone, EVT increased the outcome of mRS 0-2 (RR=2.91, 95% CI [2.12, 4.01], I2=63%), decreased mortality (RR=0.75 [0.63, 0.88], I2=60%), but did not influence the risk of sICH (I2=14%). When the analysis was restricted to data from RCTs (n=1,887), EVT increased the outcome of mRS 0-2 (RR=2.50 [1.89, 3.29], I2=8%) and sICH (RR=1.71 [1.09, 2.66], I2=0%) but did not affect mortality (I2=45%). In observational studies (n=1,830), patients receiving EVT had a higher likelihood of achieving a mRS 0-2 (RR=3.39 [1.98-5.79], I2=74%), lower mortality (RR=0.63 [1.49-0.82], I2=50%), but equal risk of sICH (I2=29) than those receiving MM alone. Conclusion: Among patients with LVO with large core infarct, EVT was associated with improved functional outcome at 90 days. When the analysis was restricted to RCTs, EVT increased the risk of sICH, but did not affect 90-day mortality. However, in real-world (observational) studies, EVT did not modify the risk of sICH but reduced 90-day mortality.

Exploring Education Interventions for Stroke Prevention Among Adults and Older Individuals: A Scoping Review.

This investigation aims to conduct a comprehensive review of educational interventions targeting stroke prevention to provide effective preventive measures and optimize resource utilization in adults and the elderly populations. A comprehensive literature search was conducted on PubMed, SCOPUS, and Embase for articles published online or in print until February 22, 2022. Inclusion criteria for studies were limited to the studies that examined stroke education or training interventions aimed at improving knowledge among adults aged 30 years and above, with a particular focus on older adults. A review of 97,848 papers was conducted, resulting in the inclusion of 19 papers. Of these, six were randomized controlled trials (RCTs), six were non-randomized studies, five were campaign studies, one was a cross-sectional study, one was a pilot study, and one was a prospective study. The provided information describes various interventions and educational programs related to stroke awareness, prevention, and management. The intervention subjects were categorized as awareness of warning signs and symptoms of stroke (n = 14), comprehensive awareness campaigns (n = 5), multilevel strategies for stroke education (n = 4), community-based nursing education and rehabilitation program (n = 5), multimedia campaign for 9-1-1 awareness (n = 3), and self-management interventions (n = 1). The categorized interventions, addressing awareness of warning signs and symptoms, comprehensive awareness campaigns, multilevel strategies, community-based nursing education and rehabilitation programs, multimedia campaigns for 9-1-1 awareness, and self-management interventions, collectively enrich our understanding of the multifaceted approaches to stroke education.

Buyang Huanwu Decoction restores the balance of mitochondrial dynamics after cerebral ischemia-reperfusion through calcium overload reduction by the PKCε-Nampt-Sirt5 axis

Ethnopharmacological relevanceStroke is a common condition that poses a significant threat to human health. Buyang Huanwu Decoction (BYHWD) is a traditional treatment used for stroke management. However, the exact mechanism by which BYHWD mitigates cerebral ischemia-reperfusion by regulating calcium overload and restoring mitochondrial function is not yet fully understood. AimThe objective of this research was to examine the neuroprotective properties of BYHWD in reducing the damage produced by cerebral ischemia/reperfusion (I/R) injury via the modulation of calcium overload and mitochondrial dynamics (MD). MethodsMCAO/R model success was evaluated via PSI laser scatter flowmetry. The neurological function scores were assessed. The cerebral infarct (CI) volume was detected via TTC staining. NeuN expression was detected via immunohistochemistry, and degenerated neurons were observed via FJC staining. The mitochondrial permeability transition pore (mPTP), the mitochondrial membrane potential (MMP), and ATP were detected. The reactive oxygen species (ROS) content and the NAD+/NADH ratio were determined. The glutamate (Glu) and glutamine (Gln) contents as well as the Ca2+ concentration were determined. The expression of PKCε, p-PKCε, namely, Sirt5, GLS, Drp1, p-Drp1 616, Fis1, Opa1, and Mfn2 was determined via Western blotting. Immunohistochemistry was used to detect p-PKCε, which is expressed at high levels. Immunofluorescence was used to detect p-Drp1 616, Opa1 and Sirt5 fluorescence intensity. ResultsBYHWD treatment enhanced neurological function, decreased the amount of CI, mitigated neuronal damage, decreased mPTP opening, restored the MMP, increased ATP synthesis, and decreased the ROS content after brain I/R. It also increased PKCε, p-PKCε, Sirt5, GLS, Opa1 and Mfn2 expression; downregulated p-Drp1 616, Drp1 and Fis1 expression; elevated the NAD+/NADH ratio and Gln content; and decreased the Glu content and Ca2+ concentration. The effects of BYHWD were reversed by the administration of the PKCε inhibitor εV1-2. BYHWD administration led to increased PKCε mRNA expression. ConclusionsBYHWD modulates MD by diminishing calcium overload through the PKCε-Nampt-Sirt5 axis, which restores mitochondrial function and mitigates brain I/R damage.

Stroke Prevention and Treatment for Youth with Sickle Cell Anemia: Current Practice and Challenges and Promises for the Future.

Sickle cell anemia (SCA) is an autosomal recessive inherited hemoglobinopathy that results in a high risk of stroke. SCA primarily affects an underserved minority population of children who are frequently not receiving effective, multi-disciplinary, preventative care. This article reviews primary and secondary stroke prevention and treatment for children with SCA for the general adult and pediatric neurologist, who may play an important role in providing critical neurologic evaluation and care to these children. Primary stroke prevention is efficacious at reducing ischemic stroke risk, but it is not consistently implemented into clinical practice in the United States, resulting in these children remaining at high risk. Acute symptomatic stroke management requires neurology involvement and emergent transfusion to limit ischemia. Furthermore, while chronic transfusion therapy is a proven secondary preventative modality for those with prior symptomatic or silent cerebral infarcts, it carries significant burden. Newer therapies (e.g., stem cell therapies and voxelotor) deserve further study as they may hold promise in reducing stroke risk and treatment burden. Effective primary and secondary stroke prevention and treatment remain a challenge. Informing and engaging neurology providers to recognize and provide critical neurologic evaluation and treatment has potential to close care gaps.