Stroke Research and Treatment最新文献

Background: Calcified cerebral emboli (CCEs) represent a rare cause of acute ischemic stroke and can pose technical challenges for neurointerventionalists. The few studies on endovascular thrombectomy (EVT) of CCE to date show poor recanalization rates and unfavorable outcomes. Objective: This study is aimed at investigating the technical and clinical results concerning EVT of CCE compared with noncalcified cerebral emboli (NCCEs). Methods: All cases of EVT for acute stroke from January 2014 to December 2021 from a single center were analyzed retrospectively. Emboli with a maximum density of ≥ 130 Hounsfield units on preinterventional CT scans were considered calcified. Propensity score matching was performed to compare technical and clinical results between patients with CCE and NCCE. Results: CCEs were present in 26 of 1004 cases (2.6%). Successful recanalization (mTICI ≥ 2b) was achieved less frequently in CCE (CCE: 62%, NCCE: 92%, p = 0.009). Also, first-pass reperfusion was less common in CCE (CCE: 12%, NCCE: 46%, p = 0.006). In CCE, infarct growth was more frequent (CCE: 81%, NCCE: 42%, p = 0.004) and more severe (p = 0.005). National Institutes of Health Stroke Scale improvement after EVT was lower in CCE patients (CCE: median 2, range -23 to 20, interquartile range (IQR) 2.75; NCCE: median 5, range -8 to 17, IQR 11, p = 0.008). Conclusion: First-pass reperfusion is less common in EVT of CCE. Also, there is a more frequent and severe infarct growth in CCE patients after EVT, which helps to understand the poorer clinical results. Thrombectomy devices optimized for CCE are desirable to improve outcomes in this subgroup of stroke patients.

Poststroke cognitive impairment (PSCI) refers to any level of cognitive decline occurring after a stroke, ranging from mild to severe impairments, while PSCI with dementia describes a more severe form where the cognitive decline significantly affects daily functioning and meets the clinical criteria for dementia. PSCI occurs in more than half of individuals who have had a stroke. Despite its high prevalence, the pharmacotherapeutic options for PSCI are limited. Several pharmacotherapeutic options like cholinesterase inhibitors (e.g., donepezil, galantamine, and rivastigmine) and N-methyl-d-aspartate receptor antagonists (e.g., memantine) have shown potential in improving cognitive functions. However, their overall effectiveness remains inconsistent across different studies and patient populations. Newer drugs such as citicoline, cilostazol, and antidepressants have shown promise, but further research is needed to validate their efficacy and safety specifically for PSCI management.

Background: Cerebral venous thrombosis (CVT) is a rare but potentially debilitating form of stroke. Current management guidelines recommend a course of low molecular weight heparin (LMWH) followed by an oral vitamin K antagonist. However, there is an emerging body of evidence to support the use of direct oral anticoagulant (DOAC) medications. Here, we assess the efficacy of rivaroxaban compared to the standard of care in a resource-limited setting. Methods: The study was designed as a Phase III, prospective, parallel, open-label, randomized controlled trial conducted in three sites in Syria. Seventy-one participants met inclusion criteria and were randomized 1:1 to receive either rivaroxaban or warfarin following initial bridging with LMWH for 3.5-12 days. The primary outcome was functional improvement determined by the Barthel Index. Secondary outcomes were adverse events during follow-up, including CVT recurrence, thrombotic events, intracranial pressure (ICP) requiring shunt placement, extra and intracranial bleeding, neurological deficit, and all-cause mortality. Results: Barthel Index scores did not differ between the study cohorts at 1-, 2-, 3-, 4-, 5-, or 6-month follow-up. Secondary analysis yielded no difference in rates of adverse effects or return of CVT. Two patients in the warfarin group developed major extracranial bleeds (uterine bleeding); however, there were no other extracranial or intracranial bleeds or thrombotic events reported. Rates of all-cause mortality and all assessed adverse effects were similar between the groups. Conclusion: We offer a prospective, parallel randomized controlled trial that suggests rivaroxaban may have comparable safety and efficacy when compared to warfarin for the treatment of CVT. Importantly, we offer the first randomized control trial of oral anticoagulants for the treatment of CVT in a resource-limited setting, providing support for the evolving literature and suggesting the safety and efficacy of oral anticoagulants in the management of CVT. Trial Registration: ClinicalTrials.gov identifier: NCT04569279.

Over 80% of stroke survivors experience walking dysfunction, impacting quality of life. Rehabilitation is crucial for gait recovery, and accurate assessments facilitate tailored programs. While computerized gait analysis is the gold standard, it is costly and requires specialized training, making observational gait analysis (OGA) more common. However, OGA can also be time-consuming. This study validates the Malta Gait Scale (MGS), a concise, illustrated 7-item observational tool using video recordings for gait measurements. The aim is to provide an effective, time-efficient method for gait evaluations by comparing the MGS with the established Wisconsin Gait Scale (WGS) and Gait Assessment Intervention Tool (GAIT), which have 14 and 31 items, respectively. Forty-nine participants were included in a retrospective study to validate the MGS. We evaluated its reliability using weighted Cohen's kappa (κ) for intrarater and interrater reliability. Concurrent validity was assessed by comparing the MGS with the WGS and GAIT scales using Spearman's rho (ρ). The Wilcoxon test assessed the efficacy of the MGS in detecting rehabilitation-induced changes, differentiating healthy from stroke participants, and evaluating time efficiency. The MGS demonstrated almost perfect agreement, with interrater and intrarater κ values of 0.952 and 0.977, respectively. It showed high positive correlations with the WGS and GAIT, with ρ values of 0.898 and 0.877. MGS required an average administration time of 7 min and 29 s, significantly less than the WGS (27 min and 46 s) and GAIT (50 min and 6 s) (p < 0.001). Following rehabilitation, significant improvements were observed in patients using both the MGS and WGS scales (p = 0.018), and the MGS effectively distinguished between healthy individuals and stroke patients (p < 0.001). The MGS is a valid, reliable, and efficient tool for gait assessment in stroke survivors, supporting smartphone use and facilitating rapid measurements in clinical settings where time is critical.

Introduction: While the machine learning (ML) model's black-box nature presents a significant barrier to effective clinical application, the dynamic nature of stroke patients' recovery further undermines the reliability of established predictive scores and models, making them less suitable for accurate prediction and appropriate patient care. This research is aimed at building and evaluating an interpretable ML-based model, which would perform outcome prediction at different time points of patients' recovery, giving more secure and understandable output through interpretable packages. Materials and Methods: A retrospective analysis was conducted on acute ischemic stroke (AIS) patients treated with alteplase at the Neurology Clinic of the University Clinical Center of Vojvodina (Novi Sad, Serbia), for 14 years. Clinical data were grouped into four categories based on collection time-baseline, 2-h, 24-h, and discharge features-serving as inputs for three different classifiers-support vector machine (SVM), logistic regression (LR), and random forest (RF). The 90-day modified Rankin scale (mRS) was used as the outcome measure, distinguishing between favorable (mRS ≤ 2) and unfavorable outcomes (mRS ≥ 3). Results: The sample was described with 49 features and included 355 patients, with a median age of 67 years (interquartile range (IQR) 60-74 years), 66% being male. The models achieved strong discrimination in the testing set, with area under the curve (AUC) values ranging from 0.80 to 0.96. Additionally, they were compared with a model based on the DRAGON score, which showed an AUC of 0.760 (95% confidence interval (CI), 0.640-0.862). The decision-making process was more thoroughly understood using interpretable packages: Shapley additive explanation (SHAP) and local interpretable model-agnostic explanation (LIME). They revealed the most significant features at both the group and individual patient levels. Conclusions and Clinical Implications: This study demonstrated the moderate to strong efficacy of interpretable ML-based models in predicting the functional outcomes of alteplase-treated AIS patients. In all constructed models, age, onset-to-treatment time, and platelet count were recognized as the important predictors, followed by clinical parameters measured at different time points, such as the National Institutes of Health Stroke Scale (NIHSS) and systolic and diastolic blood pressure values. The dynamic approach, coupled with interpretable models, can aid in providing insights into the potential factors that could be modified and thus contribute to a better outcome.

Introduction: Stroke is a leading global contributor to mortality and disability. Low- and middle-income countries are disproportionately affected and account for 87% of stroke-related disabilities and 70% of stroke-related fatalities. The challenges of stroke care accessibility in Africa are compounded by financial constraints, geographical barriers, and inadequate healthcare infrastructure, necessitating the adoption of innovative models such as telestroke. Telestroke is a critical component of modern stroke care systems. Telestroke enables real-time remote assessments, optimizes patient triage and hospital transfers, improves the efficiency of thrombolysis administration, and enhances poststroke management by mitigating logistical and mobility-related challenges. This demonstrates telestroke's potential to expand access to specialized stroke care, improve functional outcomes, and address critical gaps in stroke management within underserved regions such as Africa. This paper assesses the advantageous impact of telestroke on stroke management, with the aim of drawing global insights for Africa. Methodology: This scoping review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted across ProQuest, PubMed, Google Scholar, and Scopus to identify peer-reviewed studies published in English from 2017 to 2023. This ensured the inclusion of the most recent advancements in telestroke research. Results: The initial literature search retrieved 881 articles, of which 143 duplicates (16.2%) and 58 non-English studies (6.6%) were removed, followed by the exclusion of 451 nonpeer-reviewed publications (51.2%) and 128 articles (14.5%) unrelated to the study area, leaving 101 studies (11.5%) for full-text review. After further screening, 70 studies were excluded for not aligning with the study's title, objectives, or key search terms. This resulted in 31 studies (3.5%) being included in the final analysis, with 21 studies originating from outside Africa. The limited availability of high-indexed, peer-reviewed African telestroke studies highlighted a research gap, impacting the generalizability of findings. Conclusion: Telestroke has demonstrated significant benefits in stroke management, including improved functional outcomes, reduced onset-to-treatment time, enhanced diagnostic accuracy, and increased healthcare accessibility, particularly in medically underserved regions. However, its implementation in Africa faces challenges related to ethical concerns, technological infrastructure, regulatory inconsistencies, financial sustainability, and limited clinician buy-in. This necessitates strategic interventions such as standardized regulatory frameworks, network expansion, sustainable financing, capacity-building, and the integration of cost-effective imaging technologies to enhance stroke care delivery across the continent.

Background: Polypharmacy is a predictor of adverse outcomes, making its management crucial for improving patient health and recovery. Managing polypharmacy is particularly challenging in patients with stroke with many comorbidities and sequelae. Although reducing inappropriate prescribing is necessary, the number of medications may increase to effectively implement secondary prevention, potentially offsetting any changes in medication count. For patients with stroke undergoing recovery-phase rehabilitation, balancing secondary prevention and optimizing drug use early without hindering recovery of activities of daily living are crucial. This study is aimed at examining the effect of increasing or decreasing the use of polypharmacy on recovery of motor and cognitive function during recovery-phase rehabilitation in patients with stroke. Methods: The study was conducted from July 2010 to June 2019 among patients with stroke discharged from the convalescent rehabilitation ward during the study period. Patients who were using more than five drugs on admission and had either an increase or decrease in the number of drugs used on discharge were compared. Propensity score matching (PSM) was used to control for background variables such as patient demographics, laboratory values, and functional independence measure (FIM) scores at baseline. The primary outcomes were motor, cognition, and total FIM gain. Results: Of the 226 patients initially enrolled, 156 were matched on propensity score. The total motor FIM gain, total cognitive FIM gain, and total FIM gain were significantly higher in the decreased group than in the increased group (p = 0.0139, p = 0.0377, and p = 0.0077, respectively). Conclusion: In patients with stroke, reducing rather than increasing the number of drugs administered during recovery-phase rehabilitation could improve rehabilitation outcomes. Therefore, it is important to consider whether the drugs are essential for the patient and proactively revise the drug regimen to ensure rapid rehabilitation of patients with stroke.

Background: Task-based action observation and imitation (AOI) is a promising intervention to enhance upper limb (UL) motor function poststroke. However, whether whole/part task must be trained in the AOI therapy needs further substantiation. Objective: The objective of this study is to assess and compare the mirror neuron activity and UL muscle activity during AOI of reaching task in terms of whole task (complete movement) and part task (proximal arm movements and distal arm movements). Methods: In this cross-sectional study, 26 participants with first-time unilateral stroke were asked to observe the prerecorded videos of a reaching task in terms of a whole task and proximal and distal components, followed by imitation of the task, respectively. Electroencephalographic (EEG) mu rhythm suppression and electromyographic amplitude of six UL muscles were measured during the task. Results: The analysis of EEG revealed a statistically significant mu suppression score, indicating mirror neuron system activity, during AOI of the whole task in C3 (p = <0.001) and C4 (p = <0.001) electrodes compared to the part task. Percentage maximum voluntary contraction amplitudes of the deltoid (p = 0.002), supraspinatus (p = <0.001), triceps brachii (p = 0.002), brachioradialis (p = 0.006), and extensor carpi radialis (p = <0.001) muscles showed a significant increase in muscle activity during AOI of the whole task. Also, there seems to be a task observation-specific activation of muscles following AOI of proximal or distal tasks. Conclusion: The practice of the whole task should be given emphasis while framing the AOI treatment module to enhance reaching in people with stroke. Trial registration: Clinical Trials Registry-India (CTRI) identifier: CTRI/2018/04/013466.