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In patients who had a stroke or TIA, enlarged perivascular spaces in basal ganglia may cause future haemorrhagic strokes. 在中风或 TIA 患者中,基底节血管周围间隙增大可能会导致未来的出血性中风。
IF 5.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-02-27 DOI: 10.1136/svn-2022-002157
Yu Tian, Mengxing Wang, Yuesong Pan, Xia Meng, Xingquan Zhao, Liping Liu, Yongjun Wang, Yilong Wang

Introduction: It remains unclear whether enlarged perivascular spaces (EPVS) predict poor clinical outcomes in patients with acute ischaemic stroke (AIS) or transient ischaemic attack (TIA).

Method: Data were obtained from the Third China National Stroke Registry study. We estimated EPVS in basal ganglia (BG) and centrum semiovale (CSO) using a semiquantified scale (Grade from 0 to 4). Using Cox and logistic regression analyses, the associations of EPVS with 3-month and 1-year adverse outcomes (including recurrent stroke, ischaemic stroke, haemorrhagic stroke, combined vascular event, disability and mortality) were explored. Sensitivity analyses of any association of cerebral small vessel disease at baseline and development of a small arterial occlusion (SAO) were conducted.

Result: Among 12 603 patients with AIS/TIA, median age was 61.7±11.6 years, and 68.2% were men. After adjusting for all potential confounders, frequent-to-severe BG-EPVS was associated with a decreased risk of recurrent ischaemic stroke (HR 0.71, 95% CI 0.55 to 0.92, p=0.01) but an increased risk of haemorrhagic stroke (HR 1.99, 95% CI 1.11 to 3.58, p=0.02) at 1 year after AIS/TIA, compared with none-to-mild BG-EPVS. Patients with frequent-to-severe CSO-EPVS had a decreased risk of disability (OR 0.76, 95% CI 0.62 to 0.92, p=0.004) and all-cause death (HR 0.55, 95% CI 0.31 to 0.98, p=0.04) within 3-month but not 1-year follow-ups, compared with those with none-to-mild BG-EPVS. Sensitivity analyses showed that both BG-EPVS (HR 0.43, 95% CI 0.21 to 0.87, p=0.02) and CSO-EPVS (HR 0.58, 95% CI 0.35 to 0.95, p=0.03) were associated with a decreased risk of subsequent ischaemic stroke in patients with SAO during 1-year follow-up.

Conclusion: BG-EPVS increased the risk of haemorrhagic stroke in patients already with AIS/TIA within 1 year. Therefore, caution is recommended when selecting antithrombotic agents for secondary stroke prevention in patients with AIS/TIA and more severe BG-EPVS.

导言:血管周围间隙增大(EPVS)是否预示着急性缺血性卒中(AIS)或短暂性脑缺血发作(TIA)患者的临床预后不佳,目前仍不清楚:方法:数据来自第三届中国全国卒中登记研究。我们使用半量化量表(0 至 4 级)估算了基底节(BG)和半卵圆中心(CSO)的 EPVS。通过 Cox 和逻辑回归分析,探讨了 EPVS 与 3 个月和 1 年不良预后(包括复发性中风、缺血性中风、出血性中风、合并血管事件、残疾和死亡率)的关系。还对基线时脑小血管疾病与小动脉闭塞(SAO)发生的任何关联进行了敏感性分析:在12 603名AIS/TIA患者中,中位年龄为(61.7±11.6)岁,68.2%为男性。调整所有潜在混杂因素后,与非轻度 BG-EPVS 相比,AIS/TIA 一年后,频繁至重度 BG-EPVS 与缺血性卒中复发风险降低相关(HR 0.71,95% CI 0.55 至 0.92,p=0.01),但出血性卒中风险增加(HR 1.99,95% CI 1.11 至 3.58,p=0.02)。与非轻度BG-EPVS患者相比,频繁至重度CSO-EPVS患者在3个月随访期间的残疾风险(OR为0.76,95% CI为0.62至0.92,p=0.004)和全因死亡风险(HR为0.55,95% CI为0.31至0.98,p=0.04)均有所降低,但随访1年的风险并没有降低。敏感性分析显示,BG-EPVS(HR 0.43,95% CI 0.21 至 0.87,p=0.02)和 CSO-EPVS(HR 0.58,95% CI 0.35 至 0.95,p=0.03)均与 SAO 患者随访 1 年期间发生缺血性卒中的风险降低有关:结论:BG-EPVS 增加了 AIS/TIA 患者 1 年内发生出血性卒中的风险。结论:BG-EPVS 会增加 AIS/TIA 患者 1 年内发生出血性脑卒中的风险。因此,建议在为 AIS/TIA 和较严重的 BG-EPVS 患者选择抗血栓药物进行脑卒中二级预防时要谨慎。
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引用次数: 0
Rationale and design of Tenecteplase Reperfusion Therapy in Acute Ischaemic Cerebrovascular Events III (TRACE III): a randomised, phase III, open-label, controlled trial. 急性缺血性脑血管事件中的替奈普酶再灌注疗法 III (TRACE III) 的原理和设计:一项随机、III 期、开放标签对照试验。
IF 5.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-02-27 DOI: 10.1136/svn-2023-002310
Yunyun Xiong, Bruce C V Campbell, Marc Fisher, Lee H Schwamm, Mark Parsons, Hao Li, Yuesong Pan, Xia Meng, Xingquan Zhao, Yongjun Wang

Background and purpose: Recombinant human TNK tissue-type plasminogen activator (rhTNK-tPA) was not inferior to alteplase for ischaemic stroke within 4.5 hours. Our study aimed to investigate the efficacy and safety of rhTNK-tPA in patients who had an ischaemic stroke due to large vessel occlusion (LVO) of anterior circulation beyond 4.5 hours.

Methods and design: Tenecteplase Reperfusion Therapy in Acute Ischaemic Cerebrovascular Events-III (TRACE III) is a multicentre, prospective, randomised, open-label, blind endpoint, controlled clinical trial. Patients who had an ischaemic stroke due to anterior circulation LVO (internal carotid artery, middle cerebral artery M1 and M2 segments) within 4.5-24 hours from last known well (including wake-up stroke and no witness stroke) and with salvageable tissue (ischaemic core volume <70 mL, mismatch ratio ≥1.8 and mismatch volume ≥15 mL) based on CT perfusion or MRI perfusion-weighted imaging (PWI) were included and randomised to rhTNK-tPA 0.25 mg/kg (single bolus) to a maximum of 25 mg or standard medical therapy. Specially, we will exclude patients who are intended for direct thrombectomy. All will be followed up for 90 days.

Study outcomes: Primary efficacy outcome is modified Rankin Scale (mRS) score ≤1 at 90 days. Secondary efficacy outcomes include ordinal distribution of mRS at 90 days, major neurological improvement defined by a decrease ≥8 points compared with the initial deficit or a score ≤1 on the National Institutes of Health Stroke Scale (NIHSS) at 72 hours, mRS score ≤2 at 90 days, the rate of improvement on Tmax >6 s at 24 hours and NIHSS score change from baseline at 7 days. Safety outcomes are symptomatic intracerebral haemorrhage within 36 hours and mortality at 90 days.

Discussion: TRACE III will provide evidence for the efficacy and safety of rhTNK-tPA in patients who had an ischaemic strokes due to anterior circulation LVO beyond 4.5 hours.

Trial registration number: NCT05141305.

背景和目的:重组人TNK组织型纤溶酶原激活剂(rhTNK-tPA)治疗4.5小时内缺血性脑卒中的疗效并不比阿替普酶差。我们的研究旨在探讨 rhTNK-tPA 对前循环大血管闭塞(LVO)导致的缺血性中风患者超过 4.5 小时的疗效和安全性:急性缺血性脑血管事件中的替尼肽酶再灌注疗法-III(TRACE III)是一项多中心、前瞻性、随机、开放标签、盲终点、对照临床试验。研究对象为自最后一次已知脑卒中(包括唤醒脑卒中和无目击脑卒中)起 4.5-24 小时内因前循环 LVO(颈内动脉、大脑中动脉 M1 和 M2 段)导致缺血性脑卒中且组织(缺血核心容积)可挽救的患者:主要疗效指标为 90 天时改良 Rankin 量表(mRS)评分≤1。次要疗效指标包括:90 天时的 mRS 排序分布、72 小时时与初始缺损相比下降≥8 分或美国国立卫生研究院卒中量表(NIHSS)评分≤1 分所定义的主要神经功能改善、90 天时的 mRS 评分≤2 分、24 小时时 Tmax >6 秒的改善率以及 7 天时 NIHSS 评分与基线相比的变化。安全性结果为36小时内无症状性脑内出血和90天时的死亡率:讨论:TRACE III将为rhTNK-tPA治疗因前循环LVO导致缺血性脑卒中超过4.5小时的患者的有效性和安全性提供证据:试验注册号:NCT05141305。
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引用次数: 0
Ten-year follow-up investigation of stroke risk in systemic lupus erythematosus. 系统性红斑狼疮患者中风风险的十年跟踪调查。
IF 5.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-02-27 DOI: 10.1136/svn-2022-001499
Jin-An Huang, Ching-Heng Lin, Ming-Ju Wu, Yi-Hsing Chen, Kuo-Cheng Chang, Chung-Wei Hou

Background and purpose: To analyse the long-term risk of ischaemic stroke and the clinical effects of antithrombotics on the risk of haemorrhagic stroke in patients with systemic lupus erythematosus (SLE).

Methods: A retrospective cohort study was conducted using a population-based database taken from Taiwan National Health Insurance Research Database. Patients with SLE between 2000 and 2008 were registered and matched with two controls by the index date, age, gender and Charlson Comorbidity Index (CCI). These subjects were followed until either stroke event or 31 December 2013. Adjusted HRs (aHRs) for strokes were estimated with Cox regression models, and the cumulative incidence of ischaemic stroke was analysed by log-rank test and Kaplan-Meier survival analysis.

Results: In total, 8310 patients with SLE and 16 620 patients without SLE were included. In general, patients with SLE had higher rates of ischaemic stroke (5.4% vs 3.3%) and haemorrhagic stroke (1.5% vs 0.6%) than in controls. In multivariate analysis adjusted to age, gender, CCI, urbanisation level and antithrombotics uses, aHRs of all strokes, ischaemic stroke and haemorrhagic stroke were 1.73 (95% CI: 1.54 to 1.94), 1.65 (95% CI: 1.45 to 1.87) and 2.24 (95% CI: 1.71 to 2.95), respectively, in patients with SLE. Patients with SLE were significantly more likely to suffer ischaemic stroke than patients without SLE, even 10 years after SLE diagnosis (6.12% vs 3.50%, p<0.001). Antiplatelet use increased the risk of haemorrhagic stroke in SLE group (aHR=1.74, 95% CI: 1.18 to 2.57).

Conclusions: Patients with SLE are at greater risk of developing ischaemic stroke that lasts for 10 years. Antiplatelets should be carefully administered to prevent cardiovascular events in patients with SLE due to the risk of haemorrhagic stroke.

背景和目的:分析系统性红斑狼疮(SLE)患者缺血性中风的长期风险以及抗血栓药物对出血性中风风险的临床影响:方法:我们利用台湾国民健康保险研究数据库中的人口数据库进行了一项回顾性队列研究。2000年至2008年间的系统性红斑狼疮患者被登记在册,并与两名对照者进行了指数日期、年龄、性别和夏尔森综合征指数(CCI)的配对。对这些受试者进行随访,直至发生中风事件或 2013 年 12 月 31 日。采用 Cox 回归模型估算脑卒中的调整 HRs(aHRs),并通过对数秩检验和 Kaplan-Meier 生存分析对缺血性脑卒中的累积发病率进行分析:结果:共纳入 8310 名系统性红斑狼疮患者和 16 620 名非系统性红斑狼疮患者。一般来说,系统性红斑狼疮患者缺血性中风(5.4% 对 3.3%)和出血性中风(1.5% 对 0.6%)的发病率高于对照组。在根据年龄、性别、CCI、城市化水平和抗血栓药物使用情况进行调整的多变量分析中,系统性红斑狼疮患者所有中风、缺血性中风和出血性中风的aHRs分别为1.73(95% CI:1.54至1.94)、1.65(95% CI:1.45至1.87)和2.24(95% CI:1.71至2.95)。即使在确诊系统性红斑狼疮 10 年后,系统性红斑狼疮患者发生缺血性中风的几率也明显高于非系统性红斑狼疮患者(6.12% 对 3.50%,p 结论:系统性红斑狼疮患者发生缺血性中风的风险比非系统性红斑狼疮患者更高:系统性红斑狼疮患者发生持续10年的缺血性中风的风险更大。由于出血性中风的风险,系统性红斑狼疮患者应谨慎使用抗血小板药物,以预防心血管事件的发生。
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引用次数: 0
Balloon Angioplasty for Symptomatic Intracranial Artery Stenosis (BASIS): protocol of a prospective, multicentre, randomised, controlled trial. 无症状颅内动脉狭窄的球囊血管成形术(BASIS):前瞻性、多中心、随机对照试验方案。
IF 4.4 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-02-27 DOI: 10.1136/svn-2022-002288
Xuan Sun, Ming Yang, Dapeng Sun, Guangge Peng, Yiming Deng, Xingquan Zhao, Liping Liu, Ning Ma, Feng Gao, Dapeng Mo, Wengui Yu, Yongjun Wang, Yilong Wang, Zhongrong Miao

Background: The superiority of balloon angioplasty plus aggressive medical management (AMM) to AMM alone for symptomatic intracranial artery stenosis (sICAS) on efficacy and safety profiles still lacks evidence from randomised controlled trials (RCTs).

Aim: To demonstrate the design of an RCT on balloon angioplasty plus AMM for sICAS.

Design: Balloon Angioplasty for Symptomatic Intracranial Artery Stenosis (BASIS) trial is a multicentre, prospective, randomised, open-label, blinded end-point trial to investigate whether balloon angioplasty plus AMM could improve clinical outcome compared with AMM alone in patients with sICAS. Patients eligible in BASIS were 35-80 years old, with a recent transient ischaemic attack within the past 90 days or ischaemic stroke between 14 days and 90 days prior to enrolment due to severe atherosclerotic stenosis (70%-99%) of a major intracranial artery. The eligible patients were randomly assigned to receive balloon angioplasty plus AMM or AMM alone at a 1:1 ratio. Both groups will receive identical AMM, including standard dual antiplatelet therapy for 90 days followed by long-term single antiplatelet therapy, intensive risk factor management and life-style modification. All participants will be followed up for 3 years.

Study outcomes: Stroke or death in the next 30 days after enrolment or after balloon angioplasty procedure of the qualifying lesion during follow-up, or any ischaemic stroke or revascularisation from the qualifying artery after 30 days but before 12 months of enrolment, is the primary outcome.

Discussion: BASIS trail is the first RCT to compare the efficacy and safety of balloon angioplasty plus AMM to AMM alone in sICAS patients, which may provide an alternative perspective for treating sICAS.

Trial registration number: NCT03703635; https://www.

Clinicaltrials: gov.

背景:球囊血管成形术加积极药物治疗(AMM)治疗症状性颅内动脉狭窄(sICAS)在疗效和安全性方面优于单纯AMM,但目前仍缺乏随机对照试验(RCT)的证据:无症状颅内动脉狭窄的球囊血管成形术(BASIS)试验是一项多中心、前瞻性、随机、开放标签、盲法终点试验,旨在研究球囊血管成形术加AMM与单纯AMM相比是否能改善sICAS患者的临床预后。有资格参加BASIS的患者年龄在35-80岁之间,在过去90天内曾发生短暂性脑缺血发作,或在入组前14天至90天内因颅内主要动脉严重粥样硬化性狭窄(70%-99%)而发生缺血性中风。符合条件的患者按 1:1 的比例随机分配接受球囊血管成形术加 AMM 或单纯 AMM。两组患者都将接受相同的AMM治疗,包括为期90天的标准双联抗血小板疗法,然后是长期单联抗血小板疗法、强化风险因素管理和生活方式调整。所有参与者都将接受为期 3 年的随访:研究结果:中风或在入组后30天内死亡,或在随访期间合格病变的球囊血管成形术后死亡,或在入组后30天后但在入组后12个月前发生缺血性中风或合格动脉血管再通,是主要结果:BASIS试验是第一项比较球囊血管成形术加AMM与单纯AMM对sICAS患者的疗效和安全性的RCT试验,为治疗sICAS提供了另一种视角:NCT03703635; https://www.Clinicaltrials: gov.
{"title":"Balloon Angioplasty for Symptomatic Intracranial Artery Stenosis (BASIS): protocol of a prospective, multicentre, randomised, controlled trial.","authors":"Xuan Sun, Ming Yang, Dapeng Sun, Guangge Peng, Yiming Deng, Xingquan Zhao, Liping Liu, Ning Ma, Feng Gao, Dapeng Mo, Wengui Yu, Yongjun Wang, Yilong Wang, Zhongrong Miao","doi":"10.1136/svn-2022-002288","DOIUrl":"10.1136/svn-2022-002288","url":null,"abstract":"<p><strong>Background: </strong>The superiority of balloon angioplasty plus aggressive medical management (AMM) to AMM alone for symptomatic intracranial artery stenosis (sICAS) on efficacy and safety profiles still lacks evidence from randomised controlled trials (RCTs).</p><p><strong>Aim: </strong>To demonstrate the design of an RCT on balloon angioplasty plus AMM for sICAS.</p><p><strong>Design: </strong>Balloon Angioplasty for Symptomatic Intracranial Artery Stenosis (BASIS) trial is a multicentre, prospective, randomised, open-label, blinded end-point trial to investigate whether balloon angioplasty plus AMM could improve clinical outcome compared with AMM alone in patients with sICAS. Patients eligible in BASIS were 35-80 years old, with a recent transient ischaemic attack within the past 90 days or ischaemic stroke between 14 days and 90 days prior to enrolment due to severe atherosclerotic stenosis (70%-99%) of a major intracranial artery. The eligible patients were randomly assigned to receive balloon angioplasty plus AMM or AMM alone at a 1:1 ratio. Both groups will receive identical AMM, including standard dual antiplatelet therapy for 90 days followed by long-term single antiplatelet therapy, intensive risk factor management and life-style modification. All participants will be followed up for 3 years.</p><p><strong>Study outcomes: </strong>Stroke or death in the next 30 days after enrolment or after balloon angioplasty procedure of the qualifying lesion during follow-up, or any ischaemic stroke or revascularisation from the qualifying artery after 30 days but before 12 months of enrolment, is the primary outcome.</p><p><strong>Discussion: </strong>BASIS trail is the first RCT to compare the efficacy and safety of balloon angioplasty plus AMM to AMM alone in sICAS patients, which may provide an alternative perspective for treating sICAS.</p><p><strong>Trial registration number: </strong>NCT03703635; https://www.</p><p><strong>Clinicaltrials: </strong>gov.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":" ","pages":"66-74"},"PeriodicalIF":4.4,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9487491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pipeline Embolization Device for intracranial aneurysms presenting with mass effect: a large Chinese cohort. 管道栓塞装置治疗出现群体效应的颅内动脉瘤:一项大型中国队列研究。
IF 5.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-02-27 DOI: 10.1136/svn-2022-002213
Yang Zhao, Junlin Lu, Hongqi Zhang, Tianxiao Li, Donglei Song, Sheng Guan, Aisha Maimaitili, Yunyan Wang, Wenfeng Feng, Yang Wang, Jieqing Wan, Guohua Mao, Huaizhang Shi, Xinjian Yang, Jianmin Liu, Yuanli Zhao

Background: Unruptured intracranial aneurysm treatment aims to reduce the risk of aneurysm rupture and bleeding, relieves symptoms and improve the quality of life for patients. This study aimed to assess the safety and efficacy of Pipeline Embolization Device (PED, Covidien/Medtronic, Irvine, CA) treatment for intracranial aneurysms presenting with mass effect in real-world settings.

Methods: We selected patients from the PED in China Post-Market Multi-Center Registry Study with mass effect presentation. The study endpoints included postoperative mass effect deterioration and mass effect relief at follow-up (3-36 months). We conducted multivariate analysis to identify factors associated with mass effect relief. Subgroup analyses by aneurysm location, size and form were also performed.

Results: This study included 218 patients with a mean age of 54.3±11.8 years and a female predominance of 74.0% (162/218). The postoperative mass effect deterioration rate was 9.6% (21/218). During a median follow-up period of 8.4 months, the mass effect relief rate was 71.6% (156/218). Notably, immediate aneurysm occlusion following treatment was significantly associated with mass effect relief (OR 0.392, 95% CI, 0.170 to 0.907, p=0.029). Subgroup analysis demonstrated that adjunctive coiling contributed to mass effect relief in cavernous aneurysms, while dense embolism impeded symptom relief in aneurysms<10 mm and saccular aneurysms.

Conclusions: Our data confirmed the efficacy of PED in relieving mass effect. The findings of this study provide support for endovascular treatment to alleviate mass effect in unruptured intracranial aneurysms.

Trial registration number: NCT03831672.

背景:未破裂颅内动脉瘤治疗的目的是降低动脉瘤破裂和出血的风险,缓解症状并改善患者的生活质量。本研究旨在评估管道栓塞装置(PED,Covidien/Medtronic,Irvine,CA)治疗颅内动脉瘤的安全性和有效性:我们从《PED 在中国上市后多中心注册研究》中选取了出现肿块效应的患者。研究终点包括术后肿块效应恶化和随访(3-36 个月)后肿块效应缓解。我们进行了多变量分析,以确定与肿块效应缓解相关的因素。我们还根据动脉瘤的位置、大小和形态进行了分组分析:本研究共纳入 218 例患者,平均年龄为(54.3±11.8)岁,女性占 74.0%(162/218)。术后肿块效应恶化率为 9.6%(21/218)。在中位 8.4 个月的随访期间,肿块效应缓解率为 71.6%(156/218)。值得注意的是,治疗后动脉瘤立即闭塞与质量效应缓解显著相关(OR 0.392,95% CI,0.170 至 0.907,P=0.029)。亚组分析表明,在海绵状动脉瘤中,辅助卷绕有助于缓解肿块效应,而在动脉瘤中,致密栓塞阻碍了症状缓解:我们的数据证实了 PED 在缓解肿块效应方面的疗效。这项研究结果为血管内治疗减轻未破裂颅内动脉瘤的肿块效应提供了支持:NCT03831672.
{"title":"Pipeline Embolization Device for intracranial aneurysms presenting with mass effect: a large Chinese cohort.","authors":"Yang Zhao, Junlin Lu, Hongqi Zhang, Tianxiao Li, Donglei Song, Sheng Guan, Aisha Maimaitili, Yunyan Wang, Wenfeng Feng, Yang Wang, Jieqing Wan, Guohua Mao, Huaizhang Shi, Xinjian Yang, Jianmin Liu, Yuanli Zhao","doi":"10.1136/svn-2022-002213","DOIUrl":"10.1136/svn-2022-002213","url":null,"abstract":"<p><strong>Background: </strong>Unruptured intracranial aneurysm treatment aims to reduce the risk of aneurysm rupture and bleeding, relieves symptoms and improve the quality of life for patients. This study aimed to assess the safety and efficacy of Pipeline Embolization Device (PED, Covidien/Medtronic, Irvine, CA) treatment for intracranial aneurysms presenting with mass effect in real-world settings.</p><p><strong>Methods: </strong>We selected patients from the PED in China Post-Market Multi-Center Registry Study with mass effect presentation. The study endpoints included postoperative mass effect deterioration and mass effect relief at follow-up (3-36 months). We conducted multivariate analysis to identify factors associated with mass effect relief. Subgroup analyses by aneurysm location, size and form were also performed.</p><p><strong>Results: </strong>This study included 218 patients with a mean age of 54.3±11.8 years and a female predominance of 74.0% (162/218). The postoperative mass effect deterioration rate was 9.6% (21/218). During a median follow-up period of 8.4 months, the mass effect relief rate was 71.6% (156/218). Notably, immediate aneurysm occlusion following treatment was significantly associated with mass effect relief (OR 0.392, 95% CI, 0.170 to 0.907, p=0.029). Subgroup analysis demonstrated that adjunctive coiling contributed to mass effect relief in cavernous aneurysms, while dense embolism impeded symptom relief in aneurysms<10 mm and saccular aneurysms.</p><p><strong>Conclusions: </strong>Our data confirmed the efficacy of PED in relieving mass effect. The findings of this study provide support for endovascular treatment to alleviate mass effect in unruptured intracranial aneurysms.</p><p><strong>Trial registration number: </strong>NCT03831672.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":" ","pages":"50-58"},"PeriodicalIF":5.9,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9602159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Early anticoagulation in patients with stroke and atrial fibrillation is associated with fewer ischaemic lesions at 1 month: the ATTUNE study. 中风合并心房颤动患者早期抗凝与 1 个月后缺血性病变减少有关:ATTUNE 研究。
IF 5.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-02-27 DOI: 10.1136/svn-2023-002357
Angelos Sharobeam, Longting Lin, Christina Lam, Carlos Garcia-Esperon, Yash Gawarikar, Ronak Patel, Matthew Lee-Archer, Andrew Wong, Michael Roizman, Amanda Gilligan, Andrew Lee, Kee Meng Tan, Susan Day, Christopher Levi, Stephen M Davis, Mark Parsons, Bernard Yan

Background: The optimal time to commence anticoagulation in patients with atrial fibrillation (AF) after ischaemic stroke or transient ischaemic attack (TIA) is unclear, with guidelines differing in recommendations. A limitation of previous studies is the focus on clinically overt stroke, rather than radiologically obvious diffusion-weighted imaging ischaemic lesions. We aimed to quantify silent ischaemic lesions and haemorrhages on MRI at 1 month in patients commenced on early (<4 days) vs late (≥4 days) anticoagulation. We hypothesised that there would be fewer ischaemic lesions and more haemorrhages in the early anticoagulant group at 1-month MRI.

Methods: A prospective multicentre, observational cohort study was performed at 11 Australian stroke centres. Clinical and MRI data were collected at baseline and follow-up, with blinded imaging assessment performed by two authors. Timing of commencement of anticoagulation was at the discretion of the treating stroke physician.

Results: We recruited 276 patients of whom 208 met the eligibility criteria. The average age was 74.2 years (SD±10.63), and 79 (38%) patients were female. Median National Institute of Health Stroke Scale score was 5 (IQR 1-12). Median baseline ischaemic lesion volume was 5 mL (IQR 2-17). There were a greater number of new ischaemic lesions on follow-up MRI in patients commenced on anticoagulation ≥4 days after index event (17% vs 8%, p=0.04), but no difference in haemorrhage rates (22% vs 32%, p=0.10). Baseline ischaemic lesion volume of ≤5 mL was less likely to have a new haemorrhage at 1 month (p=0.02). There was no difference in haemorrhage rates in patients with an initial ischaemic lesion volume of >5 mL, regardless of anticoagulation timing.

Conclusion: Commencing anticoagulation <4 days after stroke or TIA is associated with fewer ischaemic lesions at 1 month in AF patients. There is no increased rate of haemorrhage with early anticoagulation. These results suggest that early anticoagulation after mild-to-moderate acute ischaemic stroke associated with AF might be safe, but randomised controlled studies are needed to inform clinical practice.

背景:缺血性卒中或短暂性脑缺血发作(TIA)后的心房颤动(AF)患者开始抗凝治疗的最佳时间尚不明确,相关指南的建议也不尽相同。以往研究的局限性在于只关注临床上明显的中风,而非放射学上明显的弥散加权成像缺血性病变。我们的目的是量化早期中风患者 1 个月后 MRI 上的沉默缺血性病变和出血:澳大利亚 11 家卒中中心开展了一项前瞻性多中心观察性队列研究。在基线和随访期间收集临床和 MRI 数据,由两名作者进行盲法成像评估。抗凝治疗的开始时间由中风主治医生决定:我们招募了 276 名患者,其中 208 人符合资格标准。平均年龄为 74.2 岁(SD±10.63),女性患者为 79 人(38%)。美国国立卫生研究院卒中量表评分中位数为 5(IQR 1-12)。基线缺血性病变体积中位数为 5 mL(IQR 2-17)。在指数事件发生后≥4天开始接受抗凝治疗的患者中,随访磁共振成像中出现新缺血性病灶的人数较多(17% vs 8%,P=0.04),但出血率没有差异(22% vs 32%,P=0.10)。基线缺血性病变体积≤5 mL的患者在1个月后发生新出血的可能性较小(P=0.02)。无论抗凝时间如何,初始缺血性病变体积大于 5 毫升的患者的出血率没有差异:结论:开始抗凝
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引用次数: 0
Rationale and design of the GOLDEN BRIDGE II: a cluster-randomised multifaceted intervention trial of an artificial intelligence-based cerebrovascular disease clinical decision support system to improve stroke outcomes and care quality in China. 金桥 II 的原理与设计:基于人工智能的脑血管疾病临床决策支持系统的分组随机多方面干预试验,旨在改善中国的卒中预后和医疗质量。
IF 5.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-02-02 DOI: 10.1136/svn-2023-002411
Zixiao Li, Xinmiao Zhang, Lingling Ding, Jing Jing, Hong-Qiu Gu, Yong Jiang, Xia Meng, Chunying Du, Chunjuan Wang, Meng Wang, Man Xu, Yanxu Zhang, Meera Hu, Hao Li, Xiping Gong, Kehui Dong, Xingquan Zhao, Yilong Wang, Liping Liu, Ying Xian, Eric Peterson, Gregg C Fonarow, Lee H Schwamm, Yongjun Wang

Background: Given the swift advancements in artificial intelligence (AI), the utilisation of AI-based clinical decision support systems (AI-CDSSs) has become increasingly prevalent in the medical domain, particularly in the management of cerebrovascular disease.

Aims: To describe the design, rationale and methods of a cluster-randomised multifaceted intervention trial aimed at investigating the effect of cerebrovascular disease AI-CDSS on the clinical outcomes of patients who had a stroke and on stroke care quality.

Design: The GOLDEN BRIDGE II trial is a multicentre, open-label, cluster-randomised multifaceted intervention study. A total of 80 hospitals in China were randomly assigned to the AI-CDSS intervention group or the control group. For eligible participants with acute ischaemic stroke in the AI-CDSS intervention group, cerebrovascular disease AI-CDSS will provide AI-assisted imaging analysis, auxiliary stroke aetiology and pathogenesis analysis, and guideline-based treatment recommendations. In the control group, patients will receive the usual care. The primary outcome is the occurrence of new vascular events (composite of ischaemic stroke, haemorrhagic stroke, myocardial infarction or vascular death) at 3 months after stroke onset. The sample size was estimated to be 21 689 with a 26% relative reduction in the incidence of new composite vascular events at 3 months by using multiple quality-improving interventions provided by AI-CDSS. All analyses will be performed according to the intention-to-treat principle and accounted for clustering using generalised estimating equations.

Conclusions: Once the effectiveness is verified, the cerebrovascular disease AI-CDSS could improve stroke care and outcomes in China.

Trial registration number: NCT04524624.

背景:目的:描述一项分组随机多方面干预试验的设计、原理和方法,该试验旨在研究脑血管疾病人工智能临床决策支持系统(AI-CDSS)对中风患者临床预后和中风护理质量的影响:金桥II试验是一项多中心、开放标签、分组随机的多方面干预研究。中国共有 80 家医院被随机分配到 AI-CDSS 干预组或对照组。对于AI-CDSS干预组中符合条件的急性缺血性脑卒中患者,脑血管病AI-CDSS将提供AI辅助影像分析、辅助脑卒中病因和发病机制分析以及基于指南的治疗建议。对照组患者将接受常规治疗。主要结果是中风发生 3 个月后新血管事件的发生率(缺血性中风、出血性中风、心肌梗死或血管性死亡的复合结果)。样本量估计为 21 689 个,通过使用 AI-CDSS 提供的多种质量改进干预措施,3 个月后新发复合血管事件的发生率相对降低 26%。所有分析都将按照意向治疗原则进行,并使用广义估计方程考虑聚类因素:结论:脑血管病 AI-CDSS 的有效性一旦得到验证,就能改善中国的卒中治疗和预后:NCT04524624.
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引用次数: 0
Comparing a novel Catfish flow restoration device and the Solitaire stent retriever for thrombectomy revascularisation in emergent largevessel occlusion stroke: a prospective randomised controlled study. 前瞻性随机对照研究:比较新型 Catfish 血流恢复装置和 Solitaire 支架回取器在急诊大血管闭塞性脑卒中血栓切除血管重建术中的应用。
IF 5.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2023-12-29 DOI: 10.1136/svn-2022-002036
Gang Luo, Xiaoyan Yan, Guodong Xiao, Liping Wei, Ya Li Kun Nai Bi Jiang, Rongyao Ma, Wenhuo Chen, Chun Fang, Zhiming Zhou, Jieqing Wan, Ya Peng, Guilian Zhang, Junfeng Zhao, Li Li, Haicheng Yuan, Jin Wu, Bing Li, Fan Zhang, Yuhong Cheng, Feng Gao, Zhongrong Miao

Background: The Catfish stent retriever is a newly developed mechanical thrombectomy device for rapid recanalisation in emergent large vessel occlusion (ELVO) stroke. The current trial aimed to assess whether the Catfish stent retriever is non-inferior to the Solitaire stent retriever in terms of outcomes in ELVO stroke.

Methods: This was a randomised, prospective, parallel-group, multicentre, open-label, non-inferiority study conducted at 18 sites in China. The primary outcome was the proportion of cases with successful recanalisation (modified thrombolysis in cerebral infarction score of 2b or 3) following the procedure. Secondary efficacy outcomes included the National Institutes of Health Stroke Scale scores at 24 hours and 7 days or discharge if earlier, time from artery puncture to successful recanalisation and good clinical outcome (modified Rankin scale score ≤2) at 90 days. Safety outcomes included symptomatic intracranial haemorrhage, all cause-death and severe adverse events at 90 days.

Results: Between 3 March 2019 and 5 June 2021, 118 and 120 patients were randomly allocated to the Catfish and Solitaire groups, respectively. The primary endpoint after all endovascular procedures was non-inferior in the Catfish group (88.5%, 100/113) than in the Solitaire group (87.7%, 100/114), with a rate difference (RD) of 0.78% (95% CI -7.64 to -9.20; p=0.001). Sensitivity analysis only considering the per-protocol set also yielded similar results, with an RD of 0.83% (95% CI -7.03 to -8.70; p<0.001). Additionally, the proportions of cases with good clinical outcomes (47.8% vs 50.0%, p=0.739) and all-cause death rates (17.7% vs 18.8%, p=0.700) were similar in both groups at 90 days.

Conclusions: The Catfish stent retriever is an effective and safe device for endovascular recanalisation in ELVO stroke.

Trial registration number: NCT03820882.

背景:Catfish支架回取器是一种新开发的机械血栓切除装置,用于快速再通畅急诊大血管闭塞(ELVO)卒中。目前的试验旨在评估 Catfish 支架取栓器与 Solitaire 支架取栓器相比,在 ELVO 中风的治疗效果方面是否无差别:这是一项随机、前瞻、平行组、多中心、开放标签、非劣效性研究,在中国的18个地点进行。主要研究结果是手术后成功再通的病例比例(改良脑梗塞溶栓评分 2b 或 3 分)。次要疗效指标包括24小时和7天后的美国国立卫生研究院脑卒中量表评分(如果出院时间更早)、从动脉穿刺到成功再通的时间以及90天后的良好临床疗效(改良Rankin量表评分≤2)。安全性结果包括90天内无症状性颅内出血、全因死亡和严重不良事件:2019年3月3日至2021年6月5日期间,118名和120名患者分别被随机分配到Catfish组和Solitaire组。所有血管内手术后的主要终点,鲶鱼组(88.5%,100/113)不劣于纸牌组(87.7%,100/114),比率差异(RD)为0.78%(95% CI -7.64 至 -9.20;P=0.001)。仅考虑按协议组的敏感性分析也得出了类似的结果,RD 为 0.83%(95% CI -7.03 至 -8.70;p 结论:Catfish支架回取器是一种用于ELVO卒中血管内再通术的有效而安全的设备:试验注册号:NCT03820882。
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引用次数: 0
Prestroke physical activity is associated with admission haematoma volume and the clinical outcome of intracerebral haemorrhage. 脑卒中前的体力活动与入院血肿量和脑内出血的临床结果有关。
IF 5.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2023-12-29 DOI: 10.1136/svn-2023-002316
Adam Viktorisson, Dongni Buvarp, Anna Danielsson, Thomas Skoglund, Katharina S Sunnerhagen

Background: Prestroke physical activity (PA) has been linked to improved outcomes after intracerebral haemorrhage (ICH), but its association with ICH volume is unknown. We aimed to investigate associations of prestroke PA with location-specific haematoma volume and the clinical outcome of ICH.

Methods: All patients with primary ICH, admitted to three hospitals between 2014 and 2019, were included. Patients performing light PA ≥4 hour/week the year before stroke were considered physically active. Haematoma volumes were assessed from admission brain imaging. Adjusted associations were estimated using multivariate linear and logistic regression models. Haematoma volume was explored as mediator to the relationship between prestroke PA and mild stroke severity (0-4 points on the National Institutes of Health Stroke Scale), a good 1-week functional status (0-3 points on the modified Rankin Scale) and 90-day survival. Average direct effects (ADE) and average causal mediation effects (ACME) were computed.

Results: Of 686 primary ICH cases, 349 were deep, 240 lobar and 97 infratentorial. Prestroke PA predicted smaller haematoma volumes in deep ICH (β=-0.36, SE=0.09, p<0.001) and lobar ICH (β=-0.23, SE=0.09, p=0.016). Prestroke PA was also associated with mild stroke severity (OR 2.53, 95% CI 1.59 to 4.01), a good 1-week functional status (OR 2.12, 95% CI 1.37 to 3.30) and 90-day survival (OR 3.48, 95% CI 2.06 to 5.91). Haematoma volume partly mediated the relationships between PA and stroke severity (ADE 0.08, p=0.004; ACME 0.10, p<0.001), 1-week functional status (ADE 0.07, p=0.03; ACME 0.10, p<0.001) and 90-day survival (ADE 0.14, p<0.001; ACME 0.05, p<0.001).

Conclusions: Light PA ≥4 hour/week prior to ICH was associated with smaller haematoma volumes in deep and lobar locations. Physically active patients with ICH had a higher likelihood of mild stroke, a good 1-week functional status and 90-day survival, in part mediated by smaller haematoma volumes on admission.

背景:卒中前体力活动(PA)与改善脑内出血(ICH)后的预后有关,但其与ICH体积的关系尚不清楚。我们旨在研究卒中前体力活动与特定位置血肿体积和 ICH 临床预后的关系:方法:纳入2014年至2019年期间三家医院收治的所有原发性ICH患者。中风前一年进行轻度PA≥4小时/周的患者被视为体力活动量大的患者。根据入院脑成像评估血肿体积。使用多变量线性和逻辑回归模型估算调整后的相关性。血肿体积被视为卒中前体力活动与轻度卒中严重程度(美国国立卫生研究院卒中量表 0-4 分)、良好的 1 周功能状态(修正的 Rankin 量表 0-3 分)和 90 天存活率之间关系的中介因素。计算了平均直接效应(ADE)和平均因果中介效应(ACME):结果:在 686 例原发性 ICH 中,349 例为深部 ICH,240 例为脑叶 ICH,97 例为脑膜下 ICH。卒中前 PA 预测深部 ICH 的血肿体积较小(β=-0.36,SE=0.09,p结论:ICH 前轻度 PA≥4 小时/周与深部和脑叶位置较小的血肿体积有关。体力活动较多的 ICH 患者发生轻度中风、1 周功能状态良好和 90 天存活的可能性较高,部分原因是入院时血肿体积较小。
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引用次数: 0
Detailed phenotype of RNF213 p.R4810K variant identified by the Chinese patients with acute ischaemic stroke or transient ischaemic attack. 中国急性缺血性脑卒中或短暂性脑缺血发作患者发现的 RNF213 p.R4810K 变异的详细表型。
IF 5.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2023-12-29 DOI: 10.1136/svn-2022-002276
Hongyu Zhou, Jing Jing, Yuehua Pu, Wei Li, Xia Meng, Anxin Wang, Yingting Zuo, Zhe Xu, Qin Xu, Yue Suo, Hao Li, Yongjun Wang

Background and purpose: The ring finger protein 213 gene (RNF213) p.R4810K variant increased the risk of acute ischaemic stroke (AIS) attributable to intracranial arterial stenosis (ICAS) in the Japanese and Korean populations. In this study, we aimed to examine the prevalence of the RNF213 p.R4810K variant in Chinese patients with AIS or transient ischaemic attack and identify the phenotype of the carriers.

Methods: We analysed data from the Third China National Stroke Registry. All included participants were divided into two groups by carrier status of the p.R4810K variant. The aetiological classification was conducted according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. The presence of ICAS and extracranial arterial stenosis (ECAS) was defined as 50%-99% stenosis or occlusion of any intracranial and extracranial artery. Logistic regression models and Cox regression models were used to evaluate the association of the p.R4810K variant with TOAST classification, stenosis phenotypes and clinical outcomes.

Results: A total of 10 381 patients were enrolled, among which 56 (0.5%) had the heterozygote GA genotype for p.R4810K. The variant carriers were younger (p=0.01), and more likely to suffer from peripheral vascular disease (p=0.04). The p.R4810K variant was associated with large-artery atherosclerosis (LAA) (adjusted OR=1.94, 95% CI 1.13 to 3.33), anterior circulation stenosis (adjusted OR=2.12, 95% CI 1.23 to 3.65) and ECAS (adjusted OR=2.29, 95% CI 1.16 to 4.51). Nevertheless, the p.R4810K variant was not associated with recurrence, poor functional outcome and mortality at 3 months and 1 year.

Conclusions: The RNF213 p.R4810K variant was associated with LAA, anterior circulation stenosis and ECAS in Chinese patients. Given the low carrying rate and only 1-year follow-up information, caution should be taken to interpret our findings in no statistically significant association between the p.R4810K variant and stroke prognosis in Chinese patients.

背景和目的:在日本和韩国人群中,环指蛋白 213 基因(RNF213)p.R4810K 变异增加了因颅内动脉狭窄(ICAS)导致急性缺血性卒中(AIS)的风险。在这项研究中,我们旨在检测 RNF213 p.R4810K 变体在中国 AIS 或短暂性脑缺血发作患者中的流行率,并确定携带者的表型:我们分析了第三届中国卒中登记中心的数据。方法:我们分析了第三届中国全国脑卒中登记中心的数据,按照p.R4810K变异体的携带状态将所有纳入者分为两组。根据急性卒中治疗中的 Org 10172 试验(TOAST)标准进行病因分类。ICAS和颅外动脉狭窄(ECAS)定义为任何颅内和颅外动脉50%-99%的狭窄或闭塞。采用逻辑回归模型和Cox回归模型评估p.R4810K变异与TOAST分类、狭窄表型和临床结果的关系:共有 10 381 名患者入选,其中 56 人(0.5%)具有 p.R4810K 杂合子 GA 基因型。变异携带者更年轻(p=0.01),更有可能罹患外周血管疾病(p=0.04)。p.R4810K变异与大动脉粥样硬化(LAA)(调整后OR=1.94,95% CI 1.13至3.33)、前循环狭窄(调整后OR=2.12,95% CI 1.23至3.65)和ECAS(调整后OR=2.29,95% CI 1.16至4.51)有关。然而,p.R4810K变异与3个月和1年后的复发、不良功能预后和死亡率无关:结论:RNF213 p.R4810K变异与中国患者的LAA、前循环狭窄和ECAS有关。由于携带率较低且仅有 1 年的随访资料,因此在解释我们的研究结果时应谨慎,即 p.R4810K 变异与中国患者的卒中预后无统计学意义。
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引用次数: 0
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Stroke and Vascular Neurology
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