mRS Score Research Articles

Factors associated with unfavorable outcome of anterior circulation ischemic stroke following emergency endovascular therapy after complete recanalization

Objective: Endovascular thrombectomy (EVT) improves long-term patients outcomes and decreases mortality among ischemic stroke patients. However, not all patients can benefit from EVT recanalization. The present study aims to evaluate the predictors of unfavorable outcomes associated with emergency endovascular therapy despite complete recanalization. Methods: We investigated 74 eligible patients receiving EVT from January 2019 to January 2022 at a comprehensive stroke center. Demographics, clinical, radiological and treatment characteristics, safety, and functional outcomes were collected. Modified Rankin scale (mRS) score ≤ 2 at 90 days was defined as a good functional outcome. Results: A total of 111 patients were initially eligible for the study, of which 37 were excluded, resulting in 74 patients in the final study. The mean age was 69.08±12.12 years old, 67.57% patients were male, 44.59% patients with atrial fibrillation, 64.86% with hypertension, 21.62% patients with diabetes mellitus, 16.22% patients with coronary artery diseases, 6.76% with parenchymal hematoma. Median pre-EVT NIHSS (IQR) was 15.5 (12.0, 19.25). Median door-to-recanalization time (DRT) (IQR) was 208.0 (160.0,278.5) minutes and median last known norma to puncture time (LKNPT) (IQR), was 362.0 (280, 452.5) minutes. Individuals with a poorer outcome were older [73.56±9.29 vs. 65.28±13.02 years old, P=0.002], had a higher prevalence of atrial fibrillation (AF) [58.82 vs. 13%, P=0.023] and a higher National Institute of Health Stroke Scale (NIHSS) [median 16 (IQR 12.0-22.3) vs median 15 (IQR 10.0-18.0), P=0.143]. Female sex, hypertension, diabetes mellitus, coronary artery disease, and a slightly longer door-to-recanalization time were more prevalent in the unfavorable prognosis group; however, statistical analysis did not show any significant differences. Logistics binary regression model showed that older age [OR: 0.1.160 (1.011 to 1.112, P=0.031)] and AF [OR: 3.190 (1.111 to 9.164, P=0.031)] were associated with an unfavorable outcome. Conclusion: Older age, and atrial fibrillation were factors associated with the unfavorable outcome despite complete recanalization after emergency EVT of ischemic stroke.

Temporalis muscle thickness as a predictor of functional outcome after reperfusion therapies for acute ischemic stroke: a retrospective, cohort study.

Sarcopenia, defined as the loss of skeletal muscle mass, has been associated with a worse functional outcome after stroke. Measurement of temporal muscle thickness (TMT) has been introduced as an easily obtainable surrogate marker to identify patients with sarcopenia. Our study aims to investigate the correlation between pre-stroke sarcopenia, measured by TMT assessment, and functional outcome in patients treated with revascularization procedures for acute ischemic stroke. We included consecutive adult patients who underwent thrombolysis, endovascular thrombectomy or both for acute ischemic stroke at our Centre from January 2020 to June 2022. Besides collecting baseline clinical and neuroradiological features, TMT was measured on brain computed tomography scans according to a standardized protocol. Modified Rankin Scale (mRS) scores at 3months represented the main endpoint of functional outcome. A total of 261 patients were available for the analysis. In univariate models, patients with excellent outcomes (mRS = 0-1) were younger, had higher TMT values and lower pre-event disability and stroke severity. In multivariate models higher TMT values resulted independently associated with reduced mortality (Odds Ratio 0.708, 95% Confidence Interval 0.538-0.930, p = 0.013). Age, diabetes, brain bleeding events and stroke severity were found to be predictors of mortality, too. Our retrospective analysis shows that in patients who underwent revascularization treatments for ischemic stroke TMT is as an independent predictor of survival easily obtainable from the baseline CT scan. Further investigation is required to confirm the role of sarcopenia assessment and TMT measurement in the prognostication toolkit of this disease.

Neutrophil-to-Lymphocyte Ratio, Lymphocyte-to-Monocyte Ratio and Platelet-to-Lymphocyte Ratio as Predictors of Short- and Long-Term Outcomes in Ischemic Stroke Patients with Atrial Fibrillation.

Inflammatory response plays essential roles in the pathophysiology of both ischemic stroke and atrial fibrillation (AF). We aimed to investigate whether composite inflammatory markers, including neutrophil to lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR), can serve as early predictors of short- and long-term outcomes in ischemic stroke patients with AF. Ischemic stroke patients with AF were enrolled in this cohort study. The primary outcome was 1-year functional dependence or death (modified Rankin scale (mRS) score 3-6). Secondary outcomes included hemorrhagic transformation (HT) and early neurological deterioration (END, increase in the National Institutes of Health Stroke Scale (NIHSS) ≥4 within 7 days). Partial correlations were performed to assess the correlation between systemic inflammation markers and admission NIHSS scores. Univariate and multivariate logistic analyses were performed to investigate whether systemic inflammatory markers were independent predictors of adverse outcomes. A total of 408 patients were included. Partial correlation analysis revealed statistically significant but weak correlations between the NLR (r = 0.287; P < 0.001), PLR (r = 0.158; P = 0.001) and admission NIHSS score. Compared with patients without HT or END, patients who developed HT or END had higher NLR and PLR, and lower LMR. Patients in the functional dependence or death group had significantly higher NLR and PLR, and lower LMR than those in the functional independence group (all P < 0.001). Multivariate logistic analysis indicated that NLR, LMR and PLR were independent predictors of HT (OR = 1.069, 0.814 and 1.003, respectively), END (OR = 1.100, 0.768 and 1.006, respectively) and adverse 1-year functional outcome (OR = 1.139, 0.760 and 1.005, respectively). NLR, LMR and PLR were independent predictors for in-hospital HT, END and long-term functional outcome in ischemic stroke patients with AF. Close monitoring of these inflammatory markers may help guide risk stratification and clinical treatment strategies.

Medication prescribing trends and its associated adverse drug reactions among hospitalized stroke patients from a main stroke center in Penang, Malaysia: A retrospective 5-year study

Adverse drug reactions (ADRs) are one of the major threats in our healthcare system, which profusely affects health, transience, and quality of life, especially among hospitalized patients. This 5-year study was conducted to determine the incidence and analyze the pattern of ADRs among stroke patients at Hospital Seberang Jaya (HSJ), Malaysia which is the main stroke center for all tertiary healthcare institutions in Penang, Malaysia. A total of 1,993 patients were hospitalized for stroke during the study period of 5 years out of which only 30 of them were reported to experience ADRs during hospitalization. The study patients had a mean (SD) of 61 (±11.8) years, Modified Rankin Score (mRS) score of 1.8 (±1.6), NIH Stroke Scale (NIHSS) score of 3.0 (4.0) with median (IQR) duration of adverse drug reaction of 3.0 (7.0) days. The majority of the patients were Malay (66.7%); female (50.0%); experienced ischemic stroke (90.0%); with first episode of stroke (93.3%); with comorbidity dyslipidemia (60.0%); and mostly recovered post ADRs (80.0%). The major drug classes that contributed to ADRs were vaccines, anti-infective, anti-epileptic, anti-platelets, and others. Evaluation of the causality of ADRs indicated majority were possible (50.0%) ADRs based on the Naranjo scale. The evaluated incidence of ADRs among stroke patients is low in this study. This low incidence rate could be possibly due to active clinical interventions by healthcare professionals during hospitalization. ADR monitoring is highly warranted among the sub-population of stroke patients due to the existence of multiple risk factors and their state of vulnerability.

Clinical characteristics and outcomes of patients with antibody-related autoimmune encephalitis presenting with disorders of consciousness: A prospective cohort study.

To explore the clinical characteristics, short- and long-term functional outcomes, and risk factors for antibody-related autoimmune encephalitis (AE) in patients with disorders of consciousness (DoC). Clinical data were collected from AE patients admitted to Xuanwu Hospital of Capital Medical University from January 2012 to December 2021, and patients were followed up for up to 24 months after immunotherapy. A total of 312 patients with AE were included: 197 (63.1%) with anti-NMDAR encephalitis, 71 (22.8%) with anti-LGI1 encephalitis, 20 (6.4%) with anti-GABAbR encephalitis, 10 (3.2%) with anti-CASPR2 encephalitis, 10 (3.2%) with anti-GAD65 encephalitis, and 4 (1.3%) with anti-AMPAR2 encephalitis. Among these patients, 32.4% (101/312) presented with DoC, and the median (interquartile range, IQR) time to DoC was 16 (7.5, 32) days. DoC patients had higher rates of various clinical features of AE (p < .05). DoC was associated with elevated lumbar puncture cerebrospinal fluid (CSF) pressure, CSF leukocyte count, and specific antibody titer (p < .05). A high percentage of patients in the DoC group had a poor prognosis at discharge and at 6 months after immunotherapy (p < .001), but no significant difference in prognosis was noted between the DoC group and the non-DoC group at 12 and 24 months after immunotherapy. Dyskinesia (OR = 3.266, 95% CI: 1.550-6.925, p = .002), autonomic dysfunction (OR = 5.871, 95% CI: 2.574-14.096, and p < .001), increased CSF pressure (OR = 1.007, 95% CI: 1.001-1.014, p = .046), and modified Rankin scale (mRS) score ≥3 at the initiation of immunotherapy (OR = 7.457, 95% CI: 3.225-18.839, p < .001) were independent risk factors for DoC in AE patients. DoC is a relatively common clinical symptom in patients with AE, especially critically ill patients. Despite requiring longer hospitalization, DoC mostly improves with treatment of the primary disease and has a good long-term prognosis after aggressive life support and combination immunotherapy.

Usefulness of plasma glucose to potassium ratio in predicting the short-term mortality of patients with aneurysmal subarachnoid hemorrhage

Rationale and objectivesTo investigate the relationship between the glucose/potassium ratio (GPR) at admission and 30-day mortality in patients diagnosed with aneurysmal subarachnoid hemorrhage (SAH) in the emergency department (ED). Materials and methodsPatients with a modified Rankin Scale (mRS) score of ≤2 before SAH and patients aged 18 years or older were included in the study. The patients were divided into two groups based on their functional outcomes (poor-good) and 30-day mortality rates (survivor and non-survivor) and their clinical and laboratory values were compared. ResultsThe study included 134 patients with a mean age of 65.9 ± 16.7 years, of whom 68 (50.7 %) were female. The mean glucose and GPR levels in the poor functional outcome group were significantly higher than those in the good functional outcome group (p = 0.003, p = 0.03, respectively). The mean glucose and GPR levels in the non-survivor group were significantly higher than those in the survivor group (p = 0.004, p = 0.023, respectively). Multivariate logistic regression analysis identified GPR as an independent predictor of 30-day mortality (p = 0.043, OR: 4.041, 95 % CI: 1.45–26.147), alongside the Rankin Scale score (p = 0.002, OR: 12.714, 95 % CI: 2.578–62.706). Other variables, including age, Hunt-Hess score, and Glasgow Coma Scale, were not statistically significant. ConclusionThe findings indicate that the GPR is a significant independent predictor of short-term mortality in patients with aneurysmal subarachnoid hemorrhage. The translation of these findings into clinical practice may help achieve better outcomes in the management of SAH patients.

Dynamic changes of platelets before and after surgery predict the prognosis of patients with aneurysmal subarachnoid hemorrhage

ObjectiveThis investigation explored the association between postoperative/preoperative platelet ratio (PPR) and the incidence of unfavorable outcomes within 90 days in individuals with aneurysmal subarachnoid hemorrhage (aSAH). MethodsThis investigation, utilizing data from 2015 to 2022, concentrated on patients diagnosed with aSAH, categorizing them into four groups based on PPR quartiles. The association between PPR levels and clinical outcomes—comprising in-hospital complications, mortality, and modified Rankin Scale (mRS) scores at discharge and 90 days after that—was evaluated through logistic regression analyses. To explore potential non-linear associations between PPR levels and outcomes, restricted cubic spline (RCS) regression was applied. Further, mediation analysis was performed to elucidate the role of in-hospital complications in modulating the impact of PPR levels on 90-day outcomes. ResultsThis study analyzed data from 948 patients. Upon adjustment for confounding variables, it was observed that patients in the higher quartiles showed reduced incidences of anemia, hypoproteinemia, and pneumonia, alongside a decreased frequency of unfavorable outcomes within a 90-day follow-up period. The RCS analysis indicated a linear association of PPR with pneumonia, hypoproteinemia, and adverse 90-day outcomes (p for nonlinear = 0.61, 0.52, and 0.96, respectively). Moreover, the association of PPR with anemia was found to be nonlinear (p for nonlinear = 0.01). Mediation analysis further indicated that anemia and pneumonia significantly influenced the association between PPR and unfavorable outcomes at 90 days, accounting for 15.49 % and 27.61 % of the effect, respectively. ConclusionsThis study establishes a significant correlation between decreased PPR levels and 90-day adverse outcomes following aSAH, potentially relating to pneumonia and anemia.

Association of Perfusion Variables with Functional Outcome in Acute Mild Ischemic Stroke Patients or Transient Ischemic Attack.

Some patients with acute minor stroke or transient ischemic attack (TIA) are at risk for a poor prognosis. There are a limited number of studies that have investigated the functional prognosis of acute mild ischemic stroke or TIA based on imaging indicators. This study aims to explore the relationship between Perfusion Variables and poor prognosis in patients with mild ischemic stroke or TIA. A retrospective analysis was conducted on a cohort of 344 patients with mild ischemic stroke or TIA, who were admitted and treated at the First Affiliated Hospital of Soochow University between January 2016 and March 2022. The criteria were National Institutes of Health Stroke Scale (NIHSS) scores of ≤5. Poor outcome was defined as a modified Rankin Scale (mRS) score of ≥2 points at 90 days. Multivariate logistic regression was performed to identify the risk factors associated with clinical outcomes. The receiver operating characteristic (ROC) analysis was used to explore the cutoff value of factors. Following a 3-month follow-up period, 49 (12.4%) out of the 344 patients with mild stroke or TIA demonstrated a poor prognosis. Multivariable regression analysis identified mismatch volume as independent predictors of a poor 90-day prognosis. The ROC curve analysis indicated that a mismatch volume exceeding 16.5 ml was associated with a higher risk of unfavorable functional outcomes. A mismatch volume of ≥16.5mL predicted poor functional outcome in mild stroke or TIA patients.

Effects of thrombus characteristics on clinical outcome and success of recanalization in acute ischemic stroke

Background: Despite current developments in mechanical thrombectomy (MT), successful recanalization cannot be achieved in all patients. One of the factors related to this is the characteristics of the thrombus. In this study, we aimed to evaluate the effects of thrombus length and permeability on procedural success and clinical outcome. Methods: Patients with intracranial ICA, middle cerebral artery M1, or M2 occlusions, who underwent MT between November 2019 and January 2022 were included in the study. Thrombus length, density and permeability were calculated and the relationship between recanalization success and modified Rankin Scores (mRS) at the 3rd month was evaluated. Good clinical outcome was defined as an mRS score of 2 or less. Results: Forty-six of the 79 patients included in the study had a good clinical outcome. Although thrombus length was shorter and permeability was higher in patients with good clinical outcome, statistical significance was not achieved. There was a positive correlation between thrombus density, thrombus length and the number of passes, and a negative correlation between permeability. There was no significant difference in thrombus length, density and permeability between patients with and without successful recanalisation. Thrombus length was found to be a predictor of clinical outcome at 3 months in univariate analysis, whereas only age was found to be an independent predictor in multivariate analysis. Conclusions: In conclusion, despite certain findings not achieving statistical significance, the observed trends offer valuable insights for future research. A comprehensive understanding of thrombus nature could guide personalized stroke treatment strategies in the future.

Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker of Functional Outcome in Patients With Intracerebral Hemorrhage (ICH) and Its Comparison With ICH Score: A Hospital-Based Study.

The neutrophil-to-lymphocyte ratio (NLR) signifies systemic inflammation, which may correlate with worse outcomes in intracerebral hemorrhage (ICH) patients. This study explored NLR as a prognostic marker of functional outcomes in ICH and compared it with the ICH score. This cross-sectional study was conducted at a tertiary-care hospital in India. Blood was collected from patients with ICH to calculate NLR. Functional outcomes were evaluated using the modified Rankin Scale (mRS) at discharge and 90 days follow-up. The area under receiver operating characteristic curve (AUROC) for NLR predicting poor mRS scores (3-6) at discharge was 0.695 (p = 0.109), and at follow-up, it was 0.729 (p < 0.001) with a cut-off of ≥7.2, sensitivity 68%, and specificity 72%. The AUROC for ICH score was 0.846 (p = 0.003) at discharge and 0.845 (p < 0.001) at follow-up. DeLong's test indicated the ICH score had significantly better predictive performance than NLR at follow-up (p = 0.018). NLR is a potential prognostic marker for ICH outcomes, showing significant predictive value at 90 days follow-up. However, the ICH score remains a more reliable predictor. Integrating NLR into the ICH score may enhance its prognostic accuracy, but further validation in multicentric studies is needed.

Association between the C-reactive protein to albumin ratio and poor clinical outcome in patients with spontaneous intracerebral hemorrhage

BackgroundThe C-reactive protein-to-albumin ratio (CAR) is a novel prognostic biomarker of systemic inflammation and nutritional status. The association between CAR and the long-term outcome of spontaneous intracerebral hemorrhage (ICH) remains unclear. MethodsFrom January 2014 to September 2016, 497 patients with spontaneous ICH were enrolled in our study from 13 hospitals in Beijing. According to the CAR quartiles, patients were classified into four groups (Q1-Q4). Logistic regression was applied to analyze the relationship between different CAR levels and main outcome (90-day and 1-year mRS 4-6). Restricted cubic splines and receiver operating characteristic (ROC) curves of CAR for poor clinical outcomes were assessed. ResultsIn the multivariate logistic regression model, compared with the lowest quartile of CAR, the adjusted odds ratios of the Q2, Q3, and Q4 group for 90-day mRS score of 4-6 were 3.64 (1.61–8.23), 3.83 (1.67–8.77), and 8.91 (3.85–20.64). In terms of 1-year mRS score of 4-6, compared with the lowest quartile of CAR, the adjusted odds ratios of the Q3 and Q4 group were 3.31 (1.33–8.22) and 6.87 (2.81–16.78). ConclusionsA high CAR level was associated with a high risk of long-term adverse prognosis in patients with ICH, and the risk of ICH poor outcome increased steadily with CAR rising in a certain range, and maintained in a high level thereafter.

Clinical outcome and cost effectiveness of acute ischemic stroke transfers for endovascular reperfusion therapy from geographically distant counties: Stroke transfer outcomes

ObjectivesEndovascular reperfusion therapy (EVT) for acute ischemic stroke (AIS) with large vessel occlusion (LVO) has resulted in increased patient transfers to comprehensive stroke centers (CSCs). Clinical outcomes including the financial impact of these transfers from geographically dispersed population are lacking. Hence, we studied outcomes and cost-effectiveness of stroke transfers from remote areas. Materials and methodsWe used a 3-year cohort of AIS patients transferred from geographically dispersed counties (<100 mi., 101-200 mi., and >200 mi.). A 3-month modified Rankin scale (mRS) score of 0-2 defined a favorable clinical outcome. Cost-effectiveness is studied by calculating the incremental cost effectiveness ratio, using hospital costs reimbursed data and utility-weighted (UW)-mRS. ResultsAmong 172 patients transferred for EVT, patients transferred from nearby counties were more likely to undergo intervention compared to other counties (56.9 % vs. 36.7 % vs. 49.2 % p = .11). Irrespective of proximity (in mi.) to CSC [21.5 (14-56.3)] vs. 185 (137-185) vs. 349 (325-355)], there was a similar delay (in min.) to arrival from all locations [321.5 (244-490), 366 (298-432), and 460 (385–554.5) respectively], but no statistically significant differences in favorable outcomes (18.0 %, 34.1 %, and 22.2 %, respectively, p = .41). Patients undergoing EVT had higher hospital costs reimbursed compared to non-EVT patients [$37,303 (25,745-40,658) vs. $14,008 (8,640-21,273) respectively, p < .001] and no statistically significant difference in UW-mRS [0.32 (0.06-0.56) vs. 0.06 (0-0.56), p = .30]. ConclusionsOur study identifies a need for targeted interventions to improve community awareness and optimize systems of care to improve outcomes and cost-effectiveness of EVT.

Involvement of Subinsular Territory Stroke as Predictor of Outcome after Successful Endovascular Recanalization of Left Middle Cerebral Artery Occlusion.

Subinsular stroke (subIS) can occur between the penetrating middle cerebral artery (MCA) branches, which clinical and radiological findings sometimes encounter in patients after the recanalization of left proximal MCA occlusion. However, no supportive data are available to clarify this relationship. This study investigated whether the involvement of subIS can impact outcomes after successful reperfusion therapy. Data from 152 consecutive patients who underwent endovascular thrombectomy between 2019 and 2023 were collected. A 3-month functional independence defined as a modified Rankin Scale 0-2 (primary outcome) and influencing factors were analyzed retrospectively. Recanalization was achieved in 35 patients, of whom 11 (31%) developed subIS. Patients with subIS were older in age (81 vs. 75; p < 0.05), had lower apparent diffusion coefficient (ADC) values on admission (0.52 vs. 0.62; p < 0.001), and higher modified Rankin Scale (mRS) scores (4 vs. 2; p < 0.001) than those without subIS. In a multivariate analysis, subIS was independently associated with a worse functional outcome (odds ratio: 10.5, p = 0.02). The cut-off value of the ADCs was 0.52 with a sensitivity and specificity of 70% and 64%, respectively. Subinsular ischemic lesions contribute to poor functional independence in patients after the successful recanalization of left MCA occlusion. The attenuation of the ADC value in these territories could be a valuable predictor of the outcome.

A Randomized Trial on Hemodynamic Optimization of Cerebral Perfusion after Successful Endovascular Therapy in Patients with Acute Ischemic Stroke (HOPE)

Introduction: In patients with acute ischemic stroke (AIS) secondary to intracranial large vessel occlusion, optimal blood pressure (BP) management following endovascular treatment (EVT) has not yet been established. The randomized trial on Hemodynamic Optimization of Cerebral Perfusion after Successful Endovascular Therapy in Patients with Acute Ischemic Stroke (HOPE) (clinicaltrials.gov id: NCT04892511) aims to demonstrate whether hemodynamic optimization using different systolic BP targets following EVT according to the degree of final recanalization, is more effective than currently recommended BP management in improving functional outcomes of patients with AIS. Methods: HOPE is an investigator-initiated multicenter clinical trial with randomized allocation, open-label treatment, and blinded endpoint evaluation (PROBE). Patients with an anterior circulation AIS within 24 h of symptom onset, treated with EVT, and showing successful recanalization (mTICI ≥2b) at the end of the procedure, are equally allocated (1:1) to hemodynamic optimization according to the study protocol versus BP management according to current guidelines (≤180/105 mm Hg). The protocol includes two different targets of systolic BP depending on the recanalization status (mTICI = 2b: 140–160 mm Hg; mTICI = 2c/3: 100–140 mm Hg). The protocol is applied within the first 72 h and includes BP lowering as well as vasopressor therapies when needed. The primary outcome is the proportion of favorable outcome (modified Rankin Scale [mRS] 0–2) at 90 days. Secondary outcomes include the shift on the mRS score, neurological deterioration, symptomatic intracerebral hemorrhage, and mortality. Conclusion: The HOPE trial will provide new information on the safety and efficacy of different BP targets following EVT according to the degree of final recanalization in patients with AIS.

Traditional craniotomy versus current minimally invasive surgery for spontaneous supratentorial intracerebral haemorrhage: A propensity-matched analysis.

Minimally invasive surgery (MIS) and craniotomy (CI) are the current treatments for spontaneous supratentorial cerebral haemorrhage (SSTICH). To compare the efficacy and safety of MIS and CI for the treatment of SSTICH. Clinical and imaging data of 557 consecutive patients with SSTICH who underwent MIS or CI between January 2017 and December 2022 were retrospectively analysed. The patients were divided into two subgroups: The MIS group and CI group. Propensity score matching was performed to minimise case selection bias. The primary outcome was a dichotomous prognostic (favourable or unfavourable) outcome based on the modified Rankin Scale (mRS) score at 3 months; an mRS score of 0-2 was considered favourable. In both conventional statistical and binary logistic regression analyses, the MIS group had a better outcome. The outcome of propensity score matching was unexpected (odds ratio: 0.582; 95%CI: 0.281-1.204; P = 0.144), which indicated that, after excluding the interference of each confounder, different surgical modalities were more effective, and there was no significant difference in their prognosis. Deciding between MIS and CI should be made based on the individual patient, considering the hematoma size, degree of midline shift, cerebral swelling, and preoperative Glasgow Coma Scale score.

Combining the deployment of only the distal basket segment of the EMBOTRAP III and an aspiration catheter for M2 occlusions: the ONE-SEG technique.

Endovascular therapy (EVT) for distal medium vessel occlusions requires prioritizing effectiveness and safety. We developed a technique combining the deployment of only the distal basket segment of the EMBOTRAP III and an aspiration catheter (AC) for M2 occlusions, called the "ONE-SEG technique," and evaluated its clinical and technical impacts. This was a retrospective review of 30 consecutive patients with M2 segment middle cerebral artery occlusion treated using the ONE-SEG technique. This method involves deploying the EMBOTRAP III through a microcatheter in only one segment and guiding the AC to the M2 origin or distal M1. The rates of final-pass expanded thrombolysis in cerebral infarction (eTICI) scores of 2c/3 or 2b/2c/3, safety (symptomatic intracranial hemorrhage [sICH]), and clinical outcomes (modified Rankin Scale [mRS] score 0-2, 0-3 at 90 days, and mortality at 90 days) were evaluated. Of the 30 cases, 36.7% were female, and the mean age was 75.6 ± 11.0 years. The ONE-SEG technique was used for 17 cases (56.7%, median NIHSS 10 [5-15.5]) with primary M2 occlusion and 13 cases (43.3%, median NIHSS 20 [14-22.5]) with secondary M2 occlusion after proximal thrombus removal. The successful final reperfusion rate (eTICI 2b/2c/3) was 90% overall (27/30 cases). One case (3.3%) developed sICH with secondary M2 occlusion. At 3 months, mRS scores 0-2 were seen in 64.7% of patients with primary M2 occlusion (11/17 cases) and in 23.1% (3/13 cases) with secondary M2 occlusion. EVT using the ONE-SEG technique appears to be safe and effective for M2 occlusion.

Clinical characteristics of overlapping syndrome in patients with GFAP-IgG and MOG-IgG: a case series of 8 patients and literature review.

The overlapping syndrome of anti-GFAP and anti-MOG antibodies is extremely rare. This retrospective study reports 8 adult cases of the GFAP-MOG overlapping syndrome. We reviewed the clinical characteristics of 8 adult patients with the GFAP-MOG overlapping syndrome from Jan 2019 and Sep 2023 at the Third Affiliated Hospital, Sun Yat-sen University. Moreover, we searched the literature and included all case reports with this overlapping syndrome since 2018 on PubMed. The predominant clinical syndrome was meningoencephalomyelitis (5/8), followed by meningoencephalitis (2/8), and myelitis (1/8). Five patients had a flu-like prodromal symptom or diarrhea. No neoplasms were found in these patients. Regarding brain MRI, T2-weighted/fluid-attenuated inversion recovery hyperintensities were in 7 patients and leptomeningeal enhancement was in 4 patients. However, only one patient had periventricular radial linear enhancement. Besides, two patients had large space-occupying lesions. For spinal MRI, T2-hyperintensities were observed in 4 patients, in which 3 patients had longitudinally extensive lesions. All patients were treated with immunotherapy, the median follow-up period was 18months (range, 3-36months). Three patients presented relapses during the follow-up, but all cases recovered to mRS scores ≤ 2 at last follow-up. In addition, we also reviewed 14 cases (including 7 adults and 7 children) with this overlapping syndrome by literature review. Our findings provide data to understandthe clinical features and prognosis of the GFAP-MOG overlapping syndrome. Recognizing this overlapping syndrome will expand our knowledge, allowing for better management of these patients.

Exploring the Impact of Age and Pre-Stroke Modified Rankin Scale in Elderly Thrombectomy: A 15-Year Single-Center Experience

Introduction: The selection of endovascular thrombectomy (EVT) for acute ischemic stroke in the elderly remains challenging due to the underrepresentation of these patients in landmark randomized trials. The aim of this study was to assess the association between age and the pre-stroke modified Rankin scale score with functional outcomes after EVT in elderly patients aged ≥80 years. Methods: We prospectively collected data from consecutive elderly patients who underwent EVT of the anterior or posterior circulation at our institution between 2007 and 2022. Clinical and radiological parameters were analyzed using a fair outcome (mRS ≤3 or retained pre-stroke mRS score of 4) as the primary outcome. Results: In total, 307 elderly patients were included in the analysis. Fair functional outcomes were achieved in 162 (53%) patients. Eighty-four (27.4%) patients were deceased at 3-month follow-up and the mortality rate increased to 37.1% (114 deceased) at 1-year follow-up. The likelihood of achieving a fair functional outcome decreased by 8% for every 1-year age increase (OR 0.81, 95% CI 0.73–0.90). Lower National Institutes of Health Stroke Scale (OR 0.89, 95% CI 0.85–0.93, p < 0.001) and pre-stroke mRS (OR 0.67, 95% CI 0.53–0.84, p < 0.001) were associated with fair outcomes. Conclusions: EVT in elderly patients with stroke is beneficial in selected cases. Increasing age was associated with an increased risk of an mRS change to 4 or worse and death within 1 year. The pre-stroke mRS may aid clinicians in the selection of elderly patients for EVT.

Endovascular vs Medical Management of Acute Basilar Artery Occlusion

In several randomized clinical trials, endovascular thrombectomy led to better functional outcomes than conventional treatment at 90 days poststroke in patients with acute basilar artery occlusion. However, the long-term clinical outcomes of these patients have not been well delineated. To evaluate 1-year clinical outcomes in patients with acute basilar artery occlusion following endovascular thrombectomy vs control. This study is an extension of the ATTENTION trial, a multicenter, randomized clinical trial. Patients were included between February 2021 and January 2022, with 1-year follow-up through April 2023. This multicenter, population-based study was conducted at 36 comprehensive stroke sites. Patients with acute basilar artery occlusion within 12 hours of estimated symptom onset were included. Of the 342 patients randomized in the ATTENTION trial, 330 (96.5%) had 1-year follow-up information available. Endovascular thrombectomy (thrombectomy group) vs best medical treatment (control group). The primary outcome was defined as a score of 0 to 3 on the modified Rankin Scale (mRS) at 1 year. Secondary outcomes were functional independence (mRS score 0-2), excellent outcome (mRS score 0-1), level of disability (distribution of all 7 mRS scores), mortality, and health-related quality of life at 1 year. Among 330 patients who had 1-year follow-up data, 227 (68.8%) were male, and the mean (SD) age was 67.0 (10.7) years. An mRS score 0 to 3 at 1 year was achieved by 99 of 222 patients (44.6%) in the thrombectomy group and 21 of 108 (19.4%) in the control group (adjusted rate ratio, 2.23; 95% CI, 1.51-3.29). Mortality at 1 year compared with 90 days was more frequent in both the thrombectomy group (101 of 222 [45.5%] vs 83 of 226 [36.7%]) and the control group (69 of 108 [63.9%] vs 63 of 114 [55.3%]). Excellent outcome (mRS score 0-1) at 1 year compared with 90 days increased in the thrombectomy group (62 of 222 [27.9%] vs 45 of 226 [19.9%]) but not in the control group (9 of 108 [8.3%] vs 9 of 114 [7.9%]) resulting in a magnified treatment benefit. Among patients with basilar artery occlusion within 12 hours of onset, the benefits of endovascular thrombectomy at 1 year compared with 90 days were sustained for favorable (mRS score 0-3) outcome and enhanced for excellent (mRS score 0-1) outcome.

Treatment outcome of bridge mechanical thrombectomy with different IV-tPA dosages in the standard and extended time window in real-world practice.

Differences of treatment outcome between full or reduced dose of tissue plasminogen activator (tPA) for bridge mechanical thrombectomy (MT) in the extended time window have not been clearly established. We aimed to present real-world results of bridge MT with different tPA dosages in the standard and extended windows. Patients with anterior circulation stroke treated with MT between 2017 and 2021 at two stroke referral centers were retrospectively reviewed. Bridge MT with tPA were categorized as full (0.9mg/kg) or reduced (<0.9mg/kg) dose. Standard window (SW) cohort was defined as MT performed within 6h of acute ischemic stroke onset, while those beyond 6h as the extended window (EW) cohort. 90days Modified Rankin Scale (mRS) score, technical treatment success, in-hospital mortality, and post-treatment hemorrhage were analyzed. A total of 423 patients met the inclusion criteria, 218 of which treated in the SW, while 205 treated in the EW. Within the SW cohort, the full-dose tPA group demonstrated a higher proportion of good functional outcome (GFO) at 90days (mRS0-3) versus reduced (49% vs 21%, p = 0.0358). The overall GFO of SW was higher than that of the EW cohort (33% vs 20%, p = 0.0480). Within the EW cohort, GFO was similar between full and reduced dose groups. Successful reperfusion rate was lower in SW versus EW cohorts (39% vs 58%, p = 0.0199). In real-world practice, the GFO of bridge MT is better than MT alone. The tPA dosage is not a determining factor of GFO in EW MT.