Clinical Neurology and Neurosurgery最新文献_第2页

Independent elevation of plasma fibulin-5 proceeding chronic hydrocephalus development after aneurysmal subarachnoid hemorrhage 动脉瘤性蛛网膜下腔出血后，血浆纤维蛋白-5的独立升高会导致慢性脑积水。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-11-08 DOI: 10.1016/j.clineuro.2024.108634

Yume Suzuki, Takeshi Okada, Hiroki Oinaka, Hideki Nakajima, Mai Nampei, Fumihiro Kawakita, Hidenori Suzuki, pSEED group

Background

Aneurysmal subarachnoid hemorrhage (aSAH) causes chronic hydrocephalus (CH) due to disturbance in the reabsorption of cerebrospinal fluid following subarachnoidal fibrosis via inflammatory reactions or blood clotting products. Fibulin-5 (FBLN5) is one of matricellular proteins associated with fibrosis processes.

Objective

The aim of this study was to assess whether FBLN5 elevation is related to CH after aSAH.

Methods

This study prospectively enrolled consecutive aSAH patients at 9 institutions in Japan from 2013 to 2016. Plasma FBLN5 levels at days 1–3, 4–6, 7–9, and 10–12 were measured. Relationships between plasma FBLN5 levels and incidence of CH were analyzed. Multivariate logistic regression analyses were performed on clinical variables with a p value of < 0.05 on univariate analyses and plasma FBLN5 levels with the highest area under the receiver-operating characteristic (ROC) curve.

Results

A total of 229 aSAH patients were analyzed, and CH occurred in 67 patients. FBLN5 levels at days 4–6 from aSAH onset elevated in patients resulting in subsequent CH occurrence. The ROC curve analyses revealed that the area under the curve (AUC) at days 4–6 post-aSAH was the highest (AUC, 0.592; 95 % confidence interval, 0.514–0.671) among the four time points. Multivariate logistic regression analyses using clinical variables related to CH on univariate analyses and plasma FBLN5 levels at days 4–6 post-aSAH revealed that FBLN5 levels at days 4–6 post-aSAH ≥ 366.4 ng/mL (adjusted odds ratio, 3.14) were an independent determinant of subsequent CH development.

Conclusion

The elevation of plasma FBLN5 levels in a subacute phase of aSAH may contribute to the development of CH. FBLN5 may be a molecular target to develop a new therapy against post-aSAH CH.

背景：动脉瘤性蛛网膜下腔出血（aSAH）会导致慢性脑积水（CH），原因是蛛网膜下腔纤维化后，脑脊液通过炎症反应或凝血产物重吸收发生障碍。纤维蛋白-5（FBLN5）是与纤维化过程相关的母细胞蛋白之一：本研究旨在评估 FBLN5 升高是否与急性脑梗死后的 CH 有关：本研究前瞻性地纳入了2013年至2016年期间日本9家医疗机构连续收治的aSAH患者。测量了第1-3、4-6、7-9和10-12天的血浆FBLN5水平。分析了血浆FBLN5水平与CH发病率之间的关系。对单变量分析中P值小于0.05的临床变量和接收者操作特征曲线（ROC）下面积最大的血浆FBLN5水平进行多变量逻辑回归分析：共分析了229例aSAH患者，其中67例发生了CH。导致随后发生CH的患者在aSAH发病后第4-6天的FBLN5水平升高。ROC 曲线分析显示，在四个时间点中，急性SAH 后第 4-6 天的曲线下面积（AUC）最高（AUC，0.592；95 % 置信区间，0.514-0.671）。使用单变量分析中与CH相关的临床变量和脑梗死后第4-6天的血浆FBLN5水平进行多变量逻辑回归分析发现，脑梗死后第4-6天的FBLN5水平≥366.4纳克/毫升（调整后的几率为3.14）是随后发生CH的独立决定因素：结论：ASAH亚急性期血浆FBLN5水平的升高可能会导致CH的发生。FBLN5可能是一种分子靶点，可用于开发针对aSAH后CH的新疗法。

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引用次数: 0

Genetic associations between physical activity levels and functional outcome after ischemic stroke: Insights from Mendelian randomization 缺血性脑卒中后体力活动水平与功能预后之间的遗传关联：孟德尔随机化的启示。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-11-07 DOI: 10.1016/j.clineuro.2024.108631

Zeyan Zhang , Xingzhu Li , Tianyu Jin , Zhixuan Duan , Tong Zhang , Xiaoxia Du

Objective

The genetic relationship between daily physical activity (PA) levels and functional outcome after ischemic stroke remains unclear. This study aimed to investigate the genetic associations of PA on functional outcome after ischemic stroke using Mendelian randomization (MR).

Methods

We conducted two-sample MR analyses using genome-wide association studies (GWASs). This included data on light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) from the UK Biobank, and functional outcome after ischemic stroke from the Genetics of ischemic stroke Functional Outcome (GISCOME). The inverse-variance weighted (IVW) method served as our primary MR analysis approach, supplemented by several sensitivity analyses.

Results

In univariable Mendelian randomization (UVMR) analysis, MVPA was significantly associated with a reduced risk of poor functional outcome (OR = 0.15, 95 % CI = 0.04–0.56, P < 0.01), whereas LPA had no genetic relationship (OR = 0.37, 95 % CI = 0.002–51.40, P = 0.69). In multivariate Mendelian randomization (MVMR) analysis adjusting for potentially confounding traits including hypertension, type 2 diabetes, and smoking, the overall patterns between MVPA and poststroke outcome remained (OR = 0.23, 95 % CI = 0.07–0.78, P = 0.02).

Conclusion

MVPA is a protective factor for functional outcome after ischemic stroke. This finding is important for the rehabilitation and functional outcome of stroke patients.

目的：日常体力活动（PA）水平与缺血性脑卒中后功能预后之间的遗传关系仍不清楚。本研究旨在利用孟德尔随机法（Mendelian randomization，MR）研究 PA 与缺血性脑卒中后功能预后的遗传关系：我们利用全基因组关联研究（GWASs）进行了双样本 MR 分析。方法：我们利用全基因组关联研究（GWAS）进行了两个样本的 MR 分析，其中包括英国生物库（UK Biobank）中关于轻度体力活动（LPA）和中度至剧烈体力活动（MVPA）的数据，以及缺血性中风功能结果遗传学（GISCOME）中关于缺血性中风后功能结果的数据。反方差加权（IVW）法是我们的主要 MR 分析方法，并辅以几种敏感性分析：在单变量孟德尔随机化（UVMR）分析中，MVPA 与功能预后不良风险的降低显著相关（OR = 0.15，95 % CI = 0.04-0.56，P < 0.01），而 LPA 与遗传无关（OR = 0.37，95 % CI = 0.002-51.40，P = 0.69）。在多变量孟德尔随机化（MVMR）分析中，对包括高血压、2型糖尿病和吸烟在内的潜在混杂特质进行调整后，MVPA与卒中后结局之间的总体模式依然存在（OR = 0.23，95 % CI = 0.07-0.78，P = 0.02）：结论：MVPA 是缺血性脑卒中后功能预后的保护因素。结论：MVPA 是缺血性脑卒中后功能预后的保护因素，这一发现对脑卒中患者的康复和功能预后非常重要。

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引用次数: 0

Distance from the midline to the aneurysm as simple predictor of ischemic complication with small unruptured middle cerebral artery aneurysm surgery 从中线到动脉瘤的距离作为小型未破裂大脑中动脉动脉瘤手术缺血性并发症的简单预测指标。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-11-06 DOI: 10.1016/j.clineuro.2024.108630

Shun Suzuki , Hidetoshi Ooigawa , Kaima Suzuki , Hiroki Sato , Junichi Takeda , Milan Lepic , Hiroki Kurita

Background

This study aimed to clarify the risk factors for postoperative cerebral infarction in surgical clipping for prevalent small middle cerebral artery aneurysms (MCA Ans).

Methods

This retrospective study included 246 patients (mean age, 64.8 ± 10.0 years; 25.6 % males, 74.4 % females) with 258 aneurysms (mean aneurysm size, 5.4 ± 2.4 mm) who underwent direct surgery for unruptured MCA Ans at our institution from January 2015 to December 2020. All surgeries were performed under general anesthesia, incorporating indocyanine green videoangiography and transcranial motor-evoked potentials to enhance surgical precision and safety. The occurrence of surgery-related cerebral infarction was evaluated using postoperative CT scans within one week, comparing them with preoperative images. Patients were categorized based on the presence or absence of postoperative stroke and were analyzed for age, sex, past medical history, aneurysm size, number of clips used, and distance from the midline to the aneurysm.

Results

Seventeen patients had postoperative cerebral infarction (6.6 %, symptomatic 6, asymptomatic 11). There were no significant differences in terms of age, number of clips, or aneurysm size between the two groups; however, the distance from the midline to the aneurysm was significantly shorter in the stroke group (27.1 ± 4.7 mm; p < 0.001), with a cutoff value of 29 mm using the receiver operating characteristic curve.

Conclusion

Surgical clipping for MCA Ans presents a high risk of cerebral infarction for aneurysms located closer to the midline, emphasizing the importance of considering aneurysm location as a risk indication in surgical clipping.

背景：本研究旨在明确手术切除流行性小脑中动脉瘤（MCA Ans）时术后脑梗死的风险因素：本研究旨在明确手术切除流行性小型大脑中动脉动脉瘤（MCA Ans）时术后脑梗死的风险因素：这项回顾性研究纳入了2015年1月至2020年12月期间在我院接受直接手术治疗未破裂MCA动脉瘤的246例患者（平均年龄为64.8±10.0岁；男性占25.6%，女性占74.4%），共258个动脉瘤（平均动脉瘤大小为5.4±2.4毫米）。所有手术均在全身麻醉下进行，并结合吲哚青绿视频血管造影和经颅运动诱发电位以提高手术的精确性和安全性。通过术后一周内的 CT 扫描评估手术相关脑梗塞的发生情况，并与术前图像进行比较。根据术后中风与否对患者进行分类，并对患者的年龄、性别、既往病史、动脉瘤大小、使用的夹子数量以及中线到动脉瘤的距离进行分析：17名患者术后发生了脑梗塞（6.6%，有症状的6人，无症状的11人）。两组患者在年龄、夹子数量或动脉瘤大小方面无明显差异；但卒中组患者中线到动脉瘤的距离明显较短（27.1 ± 4.7 mm；P < 0.001），根据接收者操作特征曲线，临界值为 29 mm：结论：对 MCA Ans 进行手术切除时，动脉瘤位置越靠近中线，发生脑梗死的风险越高，这强调了将动脉瘤位置作为手术切除的风险指征的重要性。

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引用次数: 0

Stabbing injury of the spinal cord: A case report and systematic literature review 脊髓刺伤：病例报告和系统文献综述。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-11-05 DOI: 10.1016/j.clineuro.2024.108629

Michał Szymoniuk , Marek Kochański , Aleksandra Dryla , Piotr Kamieniak

Background

Spinal cord injury caused by stab wounds (SCISW) represents one of the rarest causes of traumatic spinal cord injury. Because of their rarity, management of such cases may be challenging due to the lack of specific guidelines.

Methods

The systematic review was performed on 30th June 2024 according to the PRISMA 2020 guidelines. A literature search was conducted across four databases: PubMed, Scopus, Web of Science, and The Polish Medical Bibliography. Additionally, a unique case was presented as an illustrative clinical presentation.

Results

A total of 89 eligible articles, including 78 case reports (89 patients) and 11 case series (882 patients), were found. The current report describes a case of a 41-year-old man with one neck stab wound and a stab wound of the chest. Clinical examination demonstrated complete paraplegia and a lack of sensation below the level of T1. Magnetic resonance imaging (MRI) showed a complete transection of the spinal cord at the T1-T2 level. Due to the lack of foreign bodies at the injury site, the patient was managed conservatively.

Conclusion

Direct stabbing injuries rarely lead to complete transection of the spinal cord as in our case. Computed tomography (CT) scans or plain radiographs are necessary to exclude retained foreign bodies. MRI as a further imaging tool can confirm the SCI and may be useful as a predictor of outcomes. Regarding optimal management, conservative treatment should be preferred over surgical intervention in the absence of a foreign body at the injury site.

背景：刺伤导致的脊髓损伤（SCISW）是外伤性脊髓损伤中最罕见的原因之一。由于其罕见性，此类病例的处理可能因缺乏特定指南而具有挑战性：该系统性综述于 2024 年 6 月 30 日根据 PRISMA 2020 指南进行。在四个数据库中进行了文献检索：PubMed、Scopus、Web of Science 和《波兰医学书目》。此外，还提供了一个独特的病例作为临床表现的例证：结果：共找到 89 篇符合条件的文章，包括 78 篇病例报告（89 名患者）和 11 篇系列病例（882 名患者）。本报告描述了一例 41 岁男性的病例，患者颈部有一处刀伤，胸部也有一处刀伤。临床检查显示他完全截瘫，T1 水平以下无知觉。磁共振成像（MRI）显示 T1-T2 水平脊髓完全横断。由于受伤部位没有异物，患者接受了保守治疗：结论：直接刺伤很少会导致脊髓完全横断。计算机断层扫描（CT）或普通X光片是排除异物残留的必要手段。核磁共振成像作为一种进一步的成像工具，可以确认脊髓损伤，并可用于预测预后。关于最佳治疗方法，如果损伤部位没有异物，应首选保守治疗，而不是手术干预。

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引用次数: 0

Pre-operative collapsed disc is a negative prognostic factor of back-pain outcome in trans-foraminal endoscopic discectomy. A single cohort clinical study 术前椎间盘塌陷是经腔镜椎间盘切除术后腰痛预后的一个负面因素。一项单一队列临床研究

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-11-04 DOI: 10.1016/j.clineuro.2024.108628

Francesco Paglia , Daniele Armocida , Lorenzo Sgarbanti , Carlo Conti

Purpose

Trans-foraminal endoscopic discectomy (TELD) is an alternative surgical technique for lumbar disc herniation (LDH). Compared with microscope-assisted open discectomy, TELD is expected to result in less postoperative low back pain (LBP) and has a lower likelihood of complications. However, some clinical analysis report patients still had persistent LBP at follow-up. Several studies have identified different known risk factors for LBP after TELD, including the preoperative presence of disc height loss and “microinstability” of the lumbar spine, which can be detrimental to a patient's successful outcome.

Methods

We conducted a retrospective review of a cohort of 86 patients with symptomatic LDH who underwent TELD surgery in a single Neurosurgery Unit from 2021 to 2023 and subjected themselves to a clinical and radiological follow-up program up to one year, focusing on the presence of collapsed disc (Group A) and the presence of normal intersomatic height (Group B) at the site of lumbar herniation.

Results

The two groups demonstrated no significant differences in the pain and disability scales at the preoperative and postoperative phases, both after surgery and during follow-up. However, at the 1-year clinical evaluation, patients who had signs of a collapsed disc before surgery experienced less recovery on the ODI scale compared to the other group

Conclusion

Our study showed that the presence of severe intervertebral disc height loss, accompanied by pre-operative signs of a collapsed disc at the site of the LDH, may serve as a predictor of poor postoperative pain recovery.

目的经肛门内窥镜椎间盘切除术（TELD）是治疗腰椎间盘突出症（LDH）的另一种手术技术。与显微镜辅助下的开放式椎间盘切除术相比，经肛门内窥镜椎间盘切除术可减少术后腰痛，并降低并发症的发生率。然而，一些临床分析报告称，患者在随访时仍有持续的腰背痛。有几项研究发现了导致 TELD 术后 LBP 的不同已知风险因素，包括术前存在椎间盘高度缺失和腰椎 "微不稳定"，这些因素都可能对患者的成功治疗不利。方法我们对 2021 年至 2023 年期间在一家神经外科单位接受 TELD 手术的 86 例无症状 LDH 患者进行了回顾性研究，并对他们进行了长达一年的临床和放射学随访，重点关注腰椎间盘是否塌陷（A 组）以及腰椎间盘突出部位是否有正常的椎间高度（B 组）。结论我们的研究表明，椎间盘高度严重减低并伴有腰椎间盘突出部位椎间盘塌陷的术前体征，可作为术后疼痛恢复不良的预测因素。

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引用次数: 0

Validation of a diagnostic support tool for early recognition of cervical arterial dissection in primary care 验证诊断支持工具，以便在初级保健中及早识别宫颈动脉夹层

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-11-02 DOI: 10.1016/j.clineuro.2024.108627

L. Thomas , M. Fowler , L. Marsh , K. Chu , Claire Muller , A. Wong

Background

Cervical arterial dissection (CeAD) is a leading cause of stroke in young adults with an early presentation often mimicking musculoskeletal pain. Currently, no validated tests exist and CAD may be missed. A diagnostic support tool could help guide urgent referral for imaging, when to monitor, or when safe to proceed with treatment, and ultimately help stroke prevention.

Objectives

To validate a 4-criteria diagnostic support tool for early recognition of CeAD in primary care, to refine tool descriptors as needed, and propose optimal cut-offs for clinical application.

Design

Prospective observational study

Method

Participants with radiologically confirmed CeAD and controls without CeAD were identified from adults >18 years presenting to a tertiary metropolitan hospital with initial diagnosis of headache or neck pain. All were scored with criteria out of7 (acute onset pain [2], recent trauma/infection [1], neurological features [2], age <55 years [2]). Diagnostic values were calculated to determine cut offs and the tool was refined based on the analysis.

Results

Thirty participants with CeAD and 261 controls with non-CeAD causes of headache and neck pain were included. The diagnostic support tool was an ‘excellent’ predictor of CeAD (AUC 0.83) but demonstrated poor specificity. Refining the tool to ‘acute/sudden onset’ [1], ‘unusual/unfamiliar headache/neck pain’ [1], recent trauma/infection [1] and neurological features ≥2 [1], scored out of 4, showed 100 % sensitivity and 74 % specificity to detect CeAD at a cut-off of 3/4 (AUC 0.87).

Conclusions

The refined tool shows acceptable clinical utility at a cut-off ≥3, where referral for vascular imaging is recommended. Further validation in Emergency and primary care is needed.

背景颈部动脉夹层（CeAD）是导致青壮年中风的主要原因之一，其早期症状通常表现为肌肉骨骼疼痛。目前还没有有效的检测方法，因此可能会漏诊颈部动脉夹层。目的验证用于初级保健中早期识别 CeAD 的 4 项标准诊断支持工具，根据需要完善工具描述，并提出临床应用的最佳临界值。设计前瞻性观察研究方法从因头痛或颈部疼痛到一家三级甲等医院就诊的 18 岁成年人中识别出经放射学确诊的 CeAD 患者和无 CeAD 的对照组。所有患者均按照7项标准（急性发作性疼痛[2]、近期外伤/感染[1]、神经系统特征[2]、55岁[2]）进行评分。结果纳入了 30 名患有 CeAD 的患者和 261 名患有非 CeAD 引起的头痛和颈部疼痛的对照组患者。诊断支持工具是预测 CeAD 的 "优秀 "工具（AUC 0.83），但特异性较差。将该工具细化为 "急性/突然发作"[1]、"不寻常/不熟悉的头痛/颈痛"[1]、近期创伤/感染[1]和神经特征≥2[1]，满分为 4 分，结果显示，在 3/4 分界时，检测 CeAD 的灵敏度为 100%，特异度为 74%（AUC 0.87）。需要在急诊和初级保健中进一步验证。

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引用次数: 0

Tirofiban vs. aspirin in patients with acute ischemic stroke: A meta-analysis of randomized clinical trials 治疗急性缺血性脑卒中患者的替罗非班与阿司匹林：随机临床试验的荟萃分析。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-31 DOI: 10.1016/j.clineuro.2024.108626

Marcos Paulo Rodrigues de Oliveira , Pedro Henrique Ferreira Sandes , Davi Chaves Rocha de Souza , Gabriel Teles de Oliveira Piñeiro , Gabriel Souza Medrado-Nunes , Nara Samara Silva Felipe dos Santos , Jamary Oliveira‑Filho

Background and objectives

Antiplatelet therapy is recommended as the standard treatment for patients with acute ischemic stroke (AIS) who, for several reasons, did not receive thrombolysis or thrombectomy. However, whether tirofiban or aspirin provides greater benefits for these patients remains unclear. Therefore, we aimed to perform a meta-analysis comparing the functional outcomes and hemorrhagic risks associated with tirofiban and aspirin in the management of AIS.

Methods

We searched PubMed, EMBASE, Web of Science, and Cochrane Library for studies comparing tirofiban to aspirin in patients with AIS who did not receive thrombolysis or thrombectomy until September 2024. Outcomes were modified Rankin Scale (mRS) and mortality at 90 days, symptomatic intracranial hemorrhage, and any bleeding events. Statistical analysis was performed using the R Studio (version 2024.04.1+748).

Results

We included 3 randomized controlled trials with a total of 1959 patients, of whom 996 (50.8 %) were in the tirofiban group. Excellent (mRS 0–1) functional outcome (RR 1.25, 95 % CI: 1.05–1.49; I² = 70 %) and favorable (mRS 0–2) functional outcome at 90 days (RR 1.09, 95 % CI: 1.01–1.16; I² = 35 %) were significantly higher in tirofiban compared to aspirin. Furthermore, tirofiban showed no difference in mortality (RR 0.77, 95 % CI: 0.24–2.53; I² = 56 %), or symptomatic intracranial hemorrhage (RR 3.42, 95 % CI: 0.27–43.30; I² = 38 %). However, any bleeding event (RR 1.75, 95 % CI: 1.25–2.45; I² = 0 %) was more common in the tirofiban group. Lastly, the meta-regression analysis showed that the outcomes were not influenced by the initial NIHSS of the included studies (p > 0.05).

Conclusion

Tirofiban is associated with better functional outcomes at 90 days, with no difference in mortality. Additionally, despite being associated with higher bleeding events, there is no difference in symptomatic intracranial hemorrhage. Therefore, our results suggest that tirofiban is a promising alternative to aspirin.

背景和目的：对于因多种原因未接受溶栓或血栓切除术的急性缺血性卒中（AIS）患者，建议将抗血小板治疗作为标准治疗方法。然而，替罗非班或阿司匹林是否能为这些患者带来更大的益处仍不清楚。因此，我们旨在进行一项荟萃分析，比较替罗非班和阿司匹林在AIS治疗中的功能性结果和出血风险：我们检索了 PubMed、EMBASE、Web of Science 和 Cochrane Library，以寻找在 2024 年 9 月之前未接受溶栓或血栓切除术的 AIS 患者中比较替罗非班和阿司匹林的研究。研究结果包括改良Rankin量表（mRS）和90天死亡率、症状性颅内出血以及任何出血事件。统计分析使用 R Studio（版本 2024.04.1+748）进行：我们纳入了3项随机对照试验，共有1959名患者，其中996人（50.8%）属于替罗非班组。与阿司匹林相比，替罗非班的功能预后极佳（mRS 0-1）（RR 1.25，95% CI：1.05-1.49；I2 = 70%），90 天后功能预后良好（mRS 0-2）（RR 1.09，95% CI：1.01-1.16；I2 = 35%）。此外，替罗非班在死亡率（RR 0.77，95 % CI：0.24-2.53；I2 = 56 %）或症状性颅内出血（RR 3.42，95 % CI：0.27-43.30；I2 = 38 %）方面没有差异。然而，任何出血事件（RR 1.75，95 % CI：1.25-2.45；I2 = 0 %）在替罗非班组更常见。最后，元回归分析表明，纳入研究的结果不受初始 NIHSS 的影响（P > 0.05）：结论：替罗非班与更好的90天功能预后相关，但死亡率没有差异。此外，尽管替罗非班与较高的出血事件相关，但无症状性颅内出血并无差异。因此，我们的研究结果表明，替罗非班有望成为阿司匹林的替代药物。

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引用次数: 0

Zoom71 navigation: Does tip orientation matter? Zoom71 导航：提示方向重要吗？

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-30 DOI: 10.1016/j.clineuro.2024.108625

Miguel S. Litao , Brent Flusty , Mohamad Ezzeldin , Adam Delora , Omar Tanweer , Eytan Raz , Ryan T. Kellogg , Jan-Karl Burkhardt , Mohamed Salem , Brian Jankowitz

Background

Aspiration thrombectomy is one of the mainstays for stroke interventions. The Zoom 71 (Z71) aspiration catheter is unique with its angled tip. This study describes the orientation of the angled tip as it is navigated around the carotid siphon in relation to trackability.

Method

Prospectively collected cases involving large vessel occlusions of the anterior circulation intervened upon using the Z71 were retrospectively analyzed. 71 passes in 50 patients were analyzed with respect to Z71 tip orientation. 3 anatomical “turns” were defined as follows: “1”: proximal cavernous, “2”- ophthalmic turn, and “3”-ICA terminus to M1. The tip was described as “Toward” Vs “Away” with respect to the inner curve of each turn. The tip getting “caught” was also analyzed.

Results

There was no preferential angled tip orientation of the Z71 as it was navigated around “Turn 1”, 51 % “Away” vs 44 % “Toward”, p= 0.54; “2”, 46.5 % “Away” vs 53.5 % “Toward”, p= 0.55; and “3”, 43.7 % “Away” vs 46.5 % “Toward”, p=0.63. The tip was not caught in Turn 1. It was caught up in “2” in 15.5 % of passes. “Away” at “2” got caught up in 21 % of passes vs 10.5 % for “Toward”, p= 0.22. Z71 got caught up in “3” in 4.7 % of passes. “Away” was associated with getting caught in 6.5 % of passes vs 3 % for “Toward”, p=0.52. Zoom 88 (Z88) usage as guide catheter may be associated with Z71 getting caught less in “2” compared to “Others”, 9.3 % for Z88 vs 25 %, p= 0.07. This also applied to Turn 3, 0 % for Z88 vs 11.1 %, p=0.038.

Conclusion

There is no preferential angled tip orientation of the Z71 as it navigates around the carotid siphon. The tip orientation does not appear to significantly affect navigation. Usage of Z88 as guide catheter helps with Z71 trackability around the siphon.

背景：抽吸血栓切除术是中风介入治疗的主要方法之一。Zoom 71 (Z71) 抽吸导管的独特之处在于其倾斜的尖端。本研究描述了倾斜顶端在颈动脉虹吸管内航行时的方向与可追踪性的关系：方法：对前瞻性收集的使用 Z71 进行干预的前循环大血管闭塞病例进行回顾性分析。对 50 名患者的 71 次手术进行了 Z71 尖端方向分析。3 个解剖学 "转向 "定义如下：1"：近端海绵体，"2"-眼部转向，"3"-ICA 终点至 M1。相对于每个弯道的内侧曲线，尖端被描述为 "朝向 "或 "远离"。同时还分析了尖端被 "夹住 "的情况：结果：在绕过 "1 号弯 "时，Z71 的尖端方向没有偏好的角度，"远离 "的比例为 51%，"朝向 "的比例为 44%，P=0.54；"2 号弯"，"远离 "的比例为 46.5%，"朝向 "的比例为 53.5%，P=0.55；"3 号弯"，"远离 "的比例为 43.7%，"朝向 "的比例为 46.5%，P=0.63。在 "第 1 个转弯 "中，没有发现提示。在 "2 "弯，有 15.5 % 的车辆被卷入。在 "2 "弯 "远离 "时，有 21% 的通行被卡住，而 "靠近 "时为 10.5%，P=0.22。Z71 在 "3 "处被追上的比例为 4.7%。6.5%的传球与 "Away "有关，而 "Toward "为 3%，P=0.52。与 "其他 "相比，使用 Zoom 88（Z88）作为引导导管可能与 Z71 在 "2 "中被夹住的比例较低有关，Z88 为 9.3%，而 Z71 为 25%，P=0.07。这也适用于第 3 个弯，Z88 为 0% vs 11.1%，p=0.038：Z71在绕颈动脉虹吸管航行时，其尖端方向没有偏好的角度。尖端方向似乎不会对导航产生重大影响。使用 Z88 作为导引导管有助于 Z71 在虹吸管周围的追踪。

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引用次数: 0

Efficacy and safety of intravenous tirofiban versus standard medical treatment in acute ischemic stroke: A meta-analysis of randomized controlled trials 急性缺血性脑卒中静脉注射替罗非班与标准药物治疗的疗效和安全性对比：随机对照试验荟萃分析

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-25 DOI: 10.1016/j.clineuro.2024.108602

Gabriel de Almeida Monteiro , Antonio Mutarelli , Marianna Leite , Gabriel Marinheiro , Beatriz Araujo , Ocílio Ribeiro Gonçalves , Joaquim Francisco Cavalcante-Neto , Paulo Roberto Lacerda Leal , Keven Ferreira da Ponte , Eberval Gadelha Figueiredo , João Paulo Mota Telles

Introduction

Tirofiban is a fast-acting glycoprotein IIb-IIIa inhibitor that inhibits the final common pathway to platelet aggregation and has been studied as adjuvant therapy for acute ischemic stroke (AIS). Since the prior meta-analysis new randomized controlled trials (RCTs) have been published. This meta-analysis aimed to update the current knowledge on the efficacy of tirofiban for patients with AIS not submitted to reperfusion therapies.

Methods

We systematically searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for RCTs reporting the use of tirofiban in AIS. The efficacy outcomes were favorable functional outcome, functional disability, modified Rankin Scale change at 90 days, and changes in the National Institutes of Health Stroke Scale score after 24 hours and 7 days of the symptom onset. The safety outcomes include symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage (ICH), and all-cause mortality.

Results

A higher rate of favorable functional outcome was associated with tirofiban administration (RR= 1.09; 95 % CI 1.04–1.14; p<0.001). The mRS after 90 days was significantly lower in the tirofiban group (MD= −0.55; 95 % CI −0.90 – [-0.20]; p<0.01). Tirofiban administration was not significantly associated with higher rates of sICH in AIS patients (RR= 0.85; 95 % CI 0.26–2.81; p = 0.79) or any ICH compared to the control group (RR= 1.01; 95 % CI 0.42–2.39; p = 0.98). All-cause mortality was similar between groups (RR= 0.64; 95 % CI 0.34–1.23; p = 0.18).

Conclusion

Tirofiban increases the number of patients achieving a favorable functional outcome in patients. There was no improvement in NIHSS after 24 hours and 7 days. Tirofiban did not increase the risk of sICH or any ICH, and mortality was similar between groups.

简介：替罗非班是一种快速起效的糖蛋白 IIb-IIIa 抑制剂，可抑制血小板聚集的最终共同途径，已被研究作为急性缺血性中风（AIS）的辅助疗法。自上次荟萃分析以来，又有新的随机对照试验（RCT）发表。本荟萃分析旨在更新关于替罗非班对未接受再灌注治疗的 AIS 患者疗效的现有知识。方法我们系统检索了 PubMed、Embase 和 Cochrane Central Register of Controlled Trials 中报告替罗非班用于 AIS 的 RCT。疗效结果包括良好的功能预后、功能障碍、90天时改良Rankin量表的变化以及症状发作24小时后和7天后美国国立卫生研究院卒中量表评分的变化。安全性结果包括症状性颅内出血（sICH）、任何颅内出血（ICH）和全因死亡率。结果使用替罗非班可提高功能良好率（RR= 1.09；95 % CI 1.04-1.14；p<0.001）。替罗非班组 90 天后的 mRS 显著降低（MD= -0.55；95 % CI -0.90 - [-0.20]；p<0.01）。与对照组（RR= 1.01；95 % CI 0.42-2.39；p = 0.98）相比，服用替罗非班与 AIS 患者 sICH 发生率升高（RR= 0.85；95 % CI 0.26-2.81；p = 0.79）或任何 ICH 发生率升高无明显相关性。各组的全因死亡率相似（RR= 0.64; 95 % CI 0.34-1.23; p = 0.18）。24小时和7天后NIHSS没有改善。替罗非班不会增加 sICH 或任何 ICH 的风险，各组死亡率相似。

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引用次数: 0

Patient-completed online “follow-up form” to assess continuation of anti-CGRP(r) antibody therapy in patients with chronic migraine: A pilot study 由患者填写的在线 "随访表"，用于评估慢性偏头痛患者继续接受抗CGRP(r)抗体治疗的情况：试点研究

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-24 DOI: 10.1016/j.clineuro.2024.108594

Sarah Stuart , Stephanie Gregg , Sally Ware , Prut Koonalintip , Benjamin R. Wakerley

Background

The introduction of new drugs that target the Calcitonin Gene-Related Peptide (CGRP) system has provided significant hope for patients with otherwise treatment-resistant migraine, but also resulted in significant capacity issues at the point of delivery, as patients require follow-up at certain timepoints.

Aim

Pilot a patient-completed “follow-up form” (FuF) to replace direct patient contact at the time of 1-year treatment review in patients receiving anti-CGRP (receptor (r)) antibody therapy for chronic migraine.

Methods

Patients with chronic migraine already receiving anti-CGRP(r) antibody therapy and due for 1-year review were contacted by telephone and recruited into the study. Patients completed a simple online form, which mirrored questions asked at 1-year follow-up, and a patient satisfaction survey.

Results

Thirty-nine (78 %) of 50 patients completed the FuF, which resulted in further telephone contact in 3 (8 %) patients. Over 90 % strongly agreed that the FuF was easy to understand and complete. 80 % strongly agreed that they felt confident in decision making regarding continuation or cessation of anti-CGRP(r) antibody therapy. Overall, 88 % rated their experience of the online form as “Excellent” and 12 % as “Good”.

Conclusions

Within our headache service, we have demonstrated that an appropriately designed online patient-completed form has the potential to replace direct patient contact at 1-year review in patients already receiving anti-CGRP(r) antibody therapy for chronic migraine.

背景以降钙素基因相关肽（CGRP）系统为靶点的新药的问世为原本耐药的偏头痛患者带来了重大希望，但也导致了治疗点的重大能力问题，因为患者需要在某些时间点进行随访。方法通过电话联系已在接受抗CGRP（受体（r））抗体治疗的慢性偏头痛患者，并招募他们参加为期1年的复查。结果50名患者中有39名（78%）完成了FuF，其中3名（8%）患者通过电话与FuF取得了联系。超过 90% 的患者强烈认为，FuF 表格易于理解和填写。80% 的患者强烈认为，他们对继续或停止抗 CGRP(r) 抗体治疗的决策充满信心。结论在我们的头痛服务中，我们已经证明，对于已经接受抗CGRP(r)抗体治疗的慢性偏头痛患者，设计合理的在线患者填写表格有可能取代1年复查时与患者的直接接触。

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引用次数: 0