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Correlation between early intracranial pressure and cerebral perfusion pressure with 28-day intensive care unit mortality in patients with hemorrhagic stroke. 出血性脑卒中患者早期颅内压和脑灌注压与 28 天重症监护室死亡率的相关性。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-02-14 DOI: 10.1177/23969873241232311
Yang Zhang, Shuaijie Zhu, Yan Hu, Heng Guo, Jin Zhang, Tianfeng Hua, Zhongheng Zhang, Min Yang

Introduction: Hemorrhagic stroke may cause changes in intracranial pressure (ICP) and cerebral perfusion pressure (CPP), which may influence the prognosis of patients. The aim of this study was to investigate the relationship between early ICP, CPP, and 28-day mortality in the intensive care unit (ICU) of patients with hemorrhagic stroke.

Patients and methods: A retrospective study was performed using the Medical Information Mart for Intensive Care (MIMIC-IV) and the eICU Collaborative Research Database (eICU-CRD), including hemorrhagic stroke patients in the ICU with recorded ICP monitoring. The median values of ICP and CPP were collected for the first 24 h of the patient's monitoring. The primary outcome was 28-day ICU mortality. Multivariable Cox proportional hazards models were used to analyze the relationship between ICP, CPP, and 28-day ICU mortality. Restricted cubic regression splines were used to analyze nonlinear relationships.

Results: The study included 837 patients with a 28-day ICU mortality rate of 19.4%. Multivariable analysis revealed a significant correlation between early ICP and 28-day ICU mortality (HR 1.08, 95% CI 1.04-1.12, p < 0.01), whereas early CPP showed no correlation with 28-day ICU mortality (HR 1.00, 95% CI 0.98-1.01, p = 0.57), with a correlation only evident when CPP < 60 mmHg (HR 1.99, 95% CI 1.14-3.48, p = 0.01). The study also identified an early ICP threshold of 16.5 mmHg.

Discussion and conclusion: Early ICP shows a correlation with 28-day mortality in hemorrhagic stroke patients, with a potential intervention threshold of 16.5 mmHg. In contrast, early CPP showed no correlation with patient prognosis.

简介出血性脑卒中可引起颅内压(ICP)和脑灌注压(CPP)的变化,从而影响患者的预后。本研究旨在探讨出血性脑卒中患者在重症监护病房(ICU)的早期ICP、CPP和28天死亡率之间的关系:使用重症监护医学信息市场(MIMIC-IV)和 eICU 合作研究数据库(eICU-CRD)进行了一项回顾性研究,研究对象包括重症监护室中有 ICP 监测记录的出血性卒中患者。收集了患者头 24 小时的 ICP 和 CPP 中位值。主要结果是重症监护室 28 天死亡率。采用多变量 Cox 比例危险模型分析 ICP、CPP 和 28 天 ICU 死亡率之间的关系。限制性三次回归样条用于分析非线性关系:研究共纳入 837 名患者,ICU 28 天死亡率为 19.4%。多变量分析显示,早期 ICP 与 28 天 ICU 死亡率之间存在显著相关性(HR 1.08,95% CI 1.04-1.12,p p = 0.57),只有当 CPP p = 0.01 时相关性才明显。)该研究还确定了 16.5 mmHg 的早期 ICP 阈值:早期 ICP 与出血性脑卒中患者 28 天死亡率相关,潜在干预阈值为 16.5 mmHg。相比之下,早期 CPP 与患者预后没有相关性。
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引用次数: 0
Artificial intelligence, machine learning, and reproducibility in stroke research. 中风研究中的人工智能、机器学习和可重复性。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-01 DOI: 10.1177/23969873241275863
Michele Romoli, Pietro Caliandro
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引用次数: 0
Swiss trial of decompressive craniectomy versus best medical treatment of spontaneous supratentorial intracerebral haemorrhage (SWITCH): an international, multicentre, randomised-controlled, two-arm, assessor-blinded trial. 瑞士自发性幕上脑室内出血减压开颅术与最佳药物治疗对比试验(SWITCH):一项国际性、多中心、随机对照、双臂、评估者盲法试验。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-02-12 DOI: 10.1177/23969873241231047
Urs Fischer, Christian Fung, Seraina Beyeler, Lukas Bütikofer, Werner Z'Graggen, Florian Ringel, Jan Gralla, Karl Schaller, Nikolaus Plesnila, Daniel Strbian, Marcel Arnold, Werner Hacke, Peter Jüni, Alexander David Mendelow, Christian Stapf, Rustam Al-Shahi Salman, Jenny Bressan, Stefanie Lerch, Claudio L A Bassetti, Heinrich P Mattle, Andreas Raabe, Jürgen Beck

Rationale: Decompressive craniectomy (DC) is beneficial in people with malignant middle cerebral artery infarction. Whether DC improves outcome in spontaneous intracerebral haemorrhage (ICH) is unknown.

Aim: To determine whether DC without haematoma evacuation plus best medical treatment (BMT) in people with ICH decreases the risk of death or dependence at 6 months compared to BMT alone.

Methods and design: SWITCH is an international, multicentre, randomised (1:1), two-arm, open-label, assessor-blinded trial. Key inclusion criteria are age ⩽75 years, stroke due to basal ganglia or thalamic ICH that may extend into cerebral lobes, ventricles or subarachnoid space, Glasgow coma scale of 8-13, NIHSS score of 10-30 and ICH volume of 30-100 mL. Randomisation must be performed <66 h after onset and DC <6 h after randomisation. Both groups will receive BMT. Participants randomised to the treatment group will receive DC of at least 12 cm in diameter according to institutional standards.

Sample size: A sample of 300 participants randomised 1:1 to DC plus BMT versus BMT alone provides over 85% power at a two-sided alpha-level of 0.05 to detect a relative risk reduction of 33% using a chi-squared test.

Outcomes: The primary outcome is the composite of death or dependence, defined as modified Rankin scale score 5-6 at 6 months. Secondary outcomes include death, functional status, quality of life and complications at 180 days and 12 months.

Discussion: SWITCH will inform physicians about the outcomes of DC plus BMT in people with spontaneous deep ICH, compared to BMT alone.

Trial registration: ClinicalTrials.gov Identifier: NCT02258919.

理由:减压开颅术(DC)对恶性大脑中动脉梗死患者有益。目的:确定对 ICH 患者进行不清除血肿的减压开颅术加最佳治疗(BMT)与单纯 BMT 相比,是否会降低患者 6 个月后死亡或依赖的风险:SWITCH是一项国际多中心、随机(1:1)、双臂、开放标签、评估者盲法试验。主要纳入标准为:年龄⩽75 岁,因基底节或丘脑 ICH 引起的中风,且 ICH 可能扩展到脑叶、脑室或蛛网膜下腔,格拉斯哥昏迷量表评分 8-13 分,NIHSS 评分 10-30 分,ICH 容量 30-100 毫升。必须进行随机抽样:300名参与者按1:1的比例随机接受DC加BMT治疗与单纯BMT治疗,在双侧α水平为0.05的情况下,使用卡方检验可检测到超过85%的力量,以检测到33%的相对风险降低:主要结果是死亡或依赖的复合结果,定义为 6 个月时修改后的 Rankin 量表评分 5-6 分。次要结果包括 180 天和 12 个月时的死亡、功能状态、生活质量和并发症:SWITCH将使医生了解自发性深部ICH患者接受DC加BMT治疗与单纯BMT治疗的结果:试验注册:ClinicalTrials.gov Identifier:试验注册:ClinicalTrials.gov Identifier:NCT02258919。
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引用次数: 0
Risk of major adverse cardiovascular events and stroke associated with treatment with GLP-1 or the dual GIP/GLP-1 receptor agonist tirzepatide for type 2 diabetes: A systematic review and meta-analysis. 使用 GLP-1 或 GIP/GLP-1 受体双重激动剂替西帕肽治疗 2 型糖尿病时发生主要不良心血管事件和中风的风险:系统回顾和荟萃分析。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-02-23 DOI: 10.1177/23969873241234238
Maria-Ioanna Stefanou, Aikaterini Theodorou, Konark Malhotra, Diana Aguiar de Sousa, Mira Katan, Lina Palaiodimou, Aristeidis H Katsanos, Ioanna Koutroulou, Vaia Lambadiari, Robin Lemmens, Sotirios Giannopoulos, Andrei V Alexandrov, Gerasimos Siasos, Georgios Tsivgoulis

Introduction: Mounting evidence suggests that glucagon-like-peptide-1 receptor-agonists (GLP-1 RAs) attenuate cardiovascular-risk in type-2 diabetes (T2DM). Tirzepatide is the first-in-class, dual glucose-dependent-insulinotropic-polypeptide GIP/GLP-1 RA approved for T2DM.

Patients and methods: A systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) was performed to estimate: (i) the incidence of major adverse cardiovascular events (MACE); and (ii) incidence of stroke, fatal, and nonfatal stroke in T2DM-patients treated with GLP-1 or GIP/GLP-1 RAs (vs placebo).

Results: Thirteen RCTs (9 and 4 on GLP-1 RAs and tirzepatide, respectively) comprising 65,878 T2DM patients were included. Compared to placebo, GLP-1RAs or GIP/GLP-1 RAs reduced MACE (OR: 0.87; 95% CI: 0.81-0.94; p < 0.01; I2 = 37%), all-cause mortality (OR: 0.88; 95% CI: 0.82-0.96; p < 0.01; I2 = 21%) and cardiovascular-mortality (OR: 0.88; 95% CI: 0.80-0.96; p < 0.01; I2 = 14%), without differences between GLP-1 versus GIP/GLP-1 RAs. Additionally, GLP-1 RAs reduced the odds of stroke (OR: 0.84; 95% CI: 0.76-0.93; p < 0.01; I2 = 0%) and nonfatal stroke (OR: 0.85; 95% CI: 0.76-0.94; p < 0.01; I2 = 0%), whereas no association between fatal stroke and GLP-1RAs was uncovered (OR: 0.80; 95% CI: 0.61-1.05; p = 0.105; I2 = 0%). In secondary analyses, GLP-1 RAs prevented ischemic stroke (OR: 0.74; 95% CI: 0.61-0.91; p < 0.01; I2 = 0%) and MACE-recurrence, but not hemorrhagic stroke (OR: 0.92; 95% CI: 0.51-1.66; p = 0.792; I2 = 0%). There was no association between GLP-1RAs or GIP/GLP-1 RAs and fatal or nonfatal myocardial infarction.

Discussion and conclusion: GLP-1 and GIP/GLP-1 RAs reduce cardiovascular-risk and mortality in T2DM. While there is solid evidence that GLP-1 RAs significantly attenuate the risk of ischemic stroke in T2DM, dedicated RCTs are needed to evaluate the efficacy of novel GIP/GLP-1 RAs for primary and secondary stroke prevention.

导言:越来越多的证据表明,胰高血糖素样肽-1受体激动剂(GLP-1 RA)可降低2型糖尿病(T2DM)患者的心血管风险。替扎帕肽是首款获准用于 T2DM 的葡萄糖依赖性促胰岛素多肽 GIP/GLP-1 RA:对随机对照临床试验(RCTs)进行了系统回顾和荟萃分析,以估计:(i) 主要不良心血管事件(MACE)的发生率;(ii) 使用 GLP-1 或 GIP/GLP-1 RAs(与安慰剂相比)治疗的 T2DM 患者的中风、致命性和非致命性中风的发生率:共纳入 13 项 RCT(其中 9 项和 4 项分别涉及 GLP-1 RA 和替哌肽治疗),包括 65,878 名 T2DM 患者。与安慰剂相比,GLP-1 RAs 或 GIP/GLP-1 RAs 可降低 MACE(OR:0.87;95% CI:0.81-0.94;p I2 = 37%)、全因死亡率(OR:0.88;95% CI:0.82-0.96;p I2 = 21%)和心血管死亡率(OR:0.88;95% CI:0.80-0.96;p I2 = 14%),GLP-1 与 GIP/GLP-1 RAs 之间无差异。此外,GLP-1 RA 可降低中风(OR:0.84;95% CI:0.76-0.93;p I2 = 0%)和非致命性中风(OR:0.85;95% CI:0.76-0.94;p I2 = 0%)的几率,而致命性中风与 GLP-1RA 之间没有关联(OR:0.80;95% CI:0.61-1.05;p = 0.105;I2 = 0%)。在二次分析中,GLP-1 RAs 可预防缺血性中风(OR:0.74;95% CI:0.61-0.91;p I2 = 0%)和 MACE 复发,但不能预防出血性中风(OR:0.92;95% CI:0.51-1.66;p = 0.792;I2 = 0%)。GLP-1RA或GIP/GLP-1 RA与致命性或非致命性心肌梗死之间没有关联:讨论和结论:GLP-1 和 GIP/GLP-1 RAs 可降低 T2DM 患者的心血管风险和死亡率。虽然有确凿证据表明 GLP-1 RAs 能显著降低 T2DM 患者缺血性中风的风险,但仍需进行专门的 RCT 研究,以评估新型 GIP/GLP-1 RAs 在一级和二级中风预防方面的疗效。
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引用次数: 0
Incremental value of serum neurofilament light chain and glial fibrillary acidic protein as blood-based biomarkers for predicting functional outcome in severe acute ischemic stroke. 血清神经丝轻链和胶质纤维酸性蛋白作为血液生物标记物在预测严重急性缺血性脑卒中功能预后方面的增量价值。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-02-24 DOI: 10.1177/23969873241234436
Christoph Vollmuth, Cornelia Fiessler, Felipe A Montellano, Alexander M Kollikowski, Fabian Essig, Patrick Oeckl, Lorenzo Barba, Petra Steinacker, Cara Schulz, Kathrin Ungethüm, Judith Wolf, Mirko Pham, Michael K Schuhmann, Peter U Heuschmann, Karl Georg Haeusler, Guido Stoll, Markus Otto, Hermann Neugebauer

Introduction: Blood-based biomarkers may improve prediction of functional outcome in patients with acute ischemic stroke. The role of neurofilament light chain (NfL) and glial fibrillary acidic (GFAP) as potential biomarkers especially in severe stroke patients is unknown.

Patients and methods: Prospective, monocenter, cohort study including consecutive patients with severe ischemic stroke in the anterior circulation on admission (NIHSS score ⩾ 6 points or indication for mechanical thrombectomy). Outcome was assessed 3 months after the index stroke by the modified Rankin Scale (mRS). Serum biomarkers levels of NfL and GFAP were determined by ultrasensitive ELISA. Univariate and multivariate logistic regression models were performed to determine the association of biomarker levels and functional disability. Discrimination, calibration, and overall performance were analyzed in different models via AUROC, calibration plots (with Emax and Eavg), Brier-score and R2 using variables, identified as important covariates for functional outcome in previous studies.

Results: Between 06/2020 and 08/2021, 213 patients were included [47% female, mean age 76 (SD ± 12) years, median NIHSS score 13 (interquartile range, IQR 9; 17)]. Biomarker serum levels were measured at a median of 1 [IQR, 1; 2] day after admission. Compared to patients with mRS 0-2 at 3 months, patients with mRS 3-6 had higher serum levels of NfL (median: 136 pg/ml vs 41 pg/ml; p < 0.0001) and GFAP (700 ng/ml vs 9.6 ng/ml; p < 0.0001). Both biomarkers were significantly associated with functional outcome [adjusted logistic regression, odds ratio (95% CI) for NfL: 2.63 (1.62; 4.56), GFAP: 2.16 (1.58; 3.09)]. In all models the addition of serum NfL led to a significant improvement in the AUROC, as did the addition of serum GFAP. Calibration plots showed high agreement between the predicted and observed outcomes and after addition of the two blood-based biomarkers there was an improvement of the overall performance.

Conclusion: Prediction of functional outcome after severe acute ischemic stroke was improved by the blood-based biomarkers serum NfL and GFAP, measured in the acute phase of stroke. These findings have to be replicated in independent external cohorts.Study registration: DRKS00022064.

导言:基于血液的生物标志物可改善急性缺血性卒中患者功能预后的预测。神经丝蛋白轻链(NfL)和胶质纤维酸性蛋白(GFAP)作为潜在的生物标志物,尤其是在重症中风患者中的作用尚不清楚:前瞻性、单中心、队列研究,包括入院时患有前循环严重缺血性卒中的连续患者(NIHSS评分⩾ 6分或有机械血栓切除指征)。卒中发生 3 个月后,采用改良兰金量表(mRS)对患者的预后进行评估。血清生物标志物 NfL 和 GFAP 水平采用超灵敏 ELISA 法测定。采用单变量和多变量逻辑回归模型来确定生物标志物水平与功能障碍之间的关系。通过AUROC、校准图(含Emax和Eavg)、Brier-score和R2分析了不同模型的辨别、校准和总体性能,这些变量在之前的研究中被确定为功能结果的重要协变量:2020 年 6 月至 2021 年 8 月间,共纳入 213 名患者[47% 为女性,平均年龄 76(SD ± 12)岁,NIHSS 评分中位数为 13(四分位数间距,IQR 9; 17)]。生物标志物血清水平在入院后 1 [IQR, 1; 2] 天进行中位测量。与 3 个月时 mRS 为 0-2 的患者相比,mRS 为 3-6 的患者血清中的 NfL 水平更高(中位数为 136 pg/ml vs 41 pg/ml):136 pg/ml vs 41 pg/ml; p p 结论:在中风急性期测量的血液生物标志物血清 NfL 和 GFAP 能更好地预测严重急性缺血性中风后的功能预后。这些研究结果需要在独立的外部队列中进行验证:研究注册号:DRKS00022064。
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引用次数: 0
Case fatality and functional outcome after spontaneous subarachnoid haemorrhage: A systematic review and meta-analysis of time trends and regional variations in population-based studies. 自发性蛛网膜下腔出血后的病死率和功能预后:以人群为基础的研究中的时间趋势和地区差异的系统回顾和荟萃分析。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-02-14 DOI: 10.1177/23969873241232823
Andreas Ziebart, Judith Dremel, Svetlana Hetjens, Dennis J Nieuwkamp, Francisca Hh Linn, Nima Etminan, Gabriel Je Rinkel

Introduction: A previous systematic review of population-based studies from 1973 to 2002 found a decrease in case fatality for spontaneous subarachnoid haemorrhage, but could not find a sufficient number of studies to assess changes in functional outcome. Since then, treatment has advanced distinctly. We assessed whether case fatality has decreased further and whether functional outcome has improved.

Patients and methods: We searched PubMed and Web of Science for new population-based studies using the same criteria as in our previous systematic review. We assessed changes in case fatality and functional outcome over time using linear regression.

Results: We included 24 new studies with 827 patients and analysed 9542 patients described in 62 study periods between 1973 and 2017. Case fatality decreased by 0.3% (95% CI: -0.7 to 0.1) per year. In a sensitivity analysis excluding studies that did not provide 1-month outcome and outliers, the age and sex-adjusted decrease was 0.1% per year (95% CI: -0.9 to 0.6). The mean case fatality rate decreased from 47% (95% CI: 31-63) in the 1970s to 35% (95% CI: 30-39) in the 1990s, and remained stable in the 2000s (34%; 95% CI: 27-41) and 2010s (38%; 95% CI: 15-60). In 15 studies, the mean proportion of patients living independently increased by 0.2% per year (95%CI: -0.7 to 1.1) and the mean was 45% (95% CI: 39-50) in six studies that reported outcome after 12 months.

Discussion and conclusion: From 1973 to 2017, the case-fatality rate of spontaneous subarachnoid haemorrhage declined overall by 13.5%, but remained stable over the last two decades. The data on time trends in functional outcome were inconclusive.

导言:之前对 1973 年至 2002 年期间的人口研究进行的系统性回顾发现,自发性蛛网膜下腔出血的病死率有所下降,但未能找到足够数量的研究来评估功能结果的变化。从那时起,治疗方法有了明显的进步。我们评估了病死率是否进一步下降以及功能预后是否有所改善:我们在 PubMed 和 Web of Science 上搜索了基于人群的新研究,采用的标准与之前的系统综述相同。我们使用线性回归法评估了病死率和功能预后随时间的变化:我们纳入了 24 项新研究,共收录了 827 名患者,并分析了 1973 年至 2017 年间 62 项研究中描述的 9542 名患者。病死率每年下降 0.3%(95% CI:-0.7 至 0.1)。在一项敏感性分析中,排除了未提供1个月结果的研究和异常值,经年龄和性别调整后,病死率每年下降0.1%(95% CI:-0.9至0.6)。平均病死率从20世纪70年代的47%(95% CI:31-63)下降到20世纪90年代的35%(95% CI:30-39),并在2000年代(34%;95% CI:27-41)和2010年代(38%;95% CI:15-60)保持稳定。在15项研究中,独立生活的患者平均比例每年增加0.2%(95%CI:-0.7至1.1),在6项报告12个月后结果的研究中,独立生活的患者平均比例为45%(95%CI:39至50):从1973年到2017年,自发性蛛网膜下腔出血的病死率总体下降了13.5%,但在过去二十年中保持稳定。功能性结果的时间趋势数据尚无定论。
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引用次数: 0
Impact of prodromal symptoms on the prognosis of patients with basilar artery occlusion treated with mechanical thrombectomy. 前驱症状对接受机械血栓切除术治疗的基底动脉闭塞患者预后的影响。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-02-25 DOI: 10.1177/23969873241234844
Thomas Accettone, Thomas Personnic, Martin Bretzner, Helene Behal, Charlotte Cordonnier, Hilde Henon, Laurent Puy

Introduction: Even with reperfusion therapies, the prognosis of patients with basilar artery occlusion (BAO) related stroke remains poor. We aimed to test the hypothesis that the presence of prodromal symptoms, an easily available anamnestic data, is a key determinant of poor functional outcome.

Patients and methods: Data from patients with BAO treated in Lille, France, with mechanical thrombectomy (MT) between 2015 and 2021 were prospectively collected. The presence of prodromal symptoms was defined by previous transient neurological deficit or gradual progressive clinical worsening preceding a secondary sudden clinical worsening. We compared the characteristics of patients with and without prodromal symptoms. We built multivariate logistic regression models to study the association between the presence of prodromal symptoms and functional (mRS 0-3 and mortality), and procedural (successful recanalization and early reocclusion) outcomes.

Results: Among the 180 patients, 63 (35%) had prodromal symptoms, most frequently a vertigo. Large artery atherosclerosis was the predominant cause of stroke (41.3%). The presence of prodromal symptoms was an independent predictor of worse 90-day functional outcome (mRS 0-3: 25.4% vs 47.0%, odds ratio (OR) 0.39; 95% confidence interval (CI) 0.16-0.86) and 90-day mortality (OR 2.17; 95% CI 1.02-4.65). Despite similar successful recanalization rate, the proportion of early basilar artery reocclusion was higher in patients with prodromal symptoms (23.8% vs 5.6%, p = 0.002).

Discussion and conclusion: More than one third of BAO patients treated with MT had prodromal symptoms, especially patients with large-artery atherosclerosis. Clinicians should systematically screen for prodromal symptoms given the poor related functional outcome and increased risk of early basilar artery reocclusion.

导言:即使采用再灌注疗法,基底动脉闭塞(BAO)相关中风患者的预后仍然很差。我们的目的是验证一个假设,即前驱症状的存在是功能预后不良的一个关键决定因素:我们前瞻性地收集了2015年至2021年间在法国里尔接受机械血栓切除术(MT)治疗的BAO患者的数据。前驱症状的定义是在继发性临床症状突然恶化之前出现的一过性神经功能缺损或渐进性临床症状恶化。我们比较了有前驱症状和无前驱症状患者的特征。我们建立了多变量逻辑回归模型,研究前驱症状的存在与功能性(mRS 0-3 和死亡率)和程序性(成功再通畅和早期再闭塞)结果之间的关系:在180名患者中,63人(35%)有前驱症状,最常见的是眩晕。大动脉粥样硬化是导致中风的主要原因(41.3%)。前驱症状是90天功能预后较差(mRS 0-3:25.4% vs 47.0%,几率比(OR)0.39;95% 置信区间(CI)0.16-0.86)和90天死亡率(OR 2.17;95% CI 1.02-4.65)的独立预测因素。尽管再通成功率相似,但有前驱症状的患者早期基底动脉再闭塞的比例更高(23.8% vs 5.6%,P = 0.002):超过三分之一接受 MT 治疗的 BAO 患者有前驱症状,尤其是大动脉粥样硬化患者。考虑到相关功能预后较差以及基底动脉早期再闭塞的风险增加,临床医生应系统筛查前驱症状。
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引用次数: 0
Intravenous alteplase in minor nondisabling ischemic stroke: A systematic review and meta-analysis. 静脉注射阿替普酶治疗轻度非致残性缺血性脑卒中:系统回顾和荟萃分析。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-03-11 DOI: 10.1177/23969873241237312
Adel Alhazzani, Fahad S Al-Ajlan, Ahmed Alkhiri, Ahmed A Almaghrabi, Aser F Alamri, Basil A Alghamdi, Hassan K Salamatullah, Abdullah R Alharbi, Maher B Almutairi, Hui-Sheng Chen, Yongjun Wang, Mohamad Abdalkader, Guillaume Turc, Pooja Khatri, Thanh N Nguyen

Background: Minor ischemic stroke, defined as National Institute of Health Stroke Scale score of 0-5 on admission, represents half of all acute ischemic strokes. The role of intravenous alteplase (IVA) among patients with minor stroke is inconclusive; therefore, we evaluated clinical outcomes of these patients treated with or without IVA.

Materials and methods: We searched Medline, Embase, Scopus, and the Cochrane library until August 1, 2023. Inclusion was restricted to the English literature of studies that reported on minor nondisabling stroke patients treated with or without IVA. Odds ratios (ORs) with their corresponding 95% CIs were utilized using a random-effects model. Efficacy outcomes included rates of excellent (modified Rankin scale [mRS] of 0-1) and good (mRS of 0-2) functional outcome at 90 days. The main safety outcome was symptomatic intracerebral hemorrhage (sICH).

Results: Five eligible studies, two RCTs and three observational studies, comprising 2764 patients (31.8% female) met inclusion criteria. IVA was administered to 1559 (56.4%) patients. Pooled analysis of the two RCTs revealed no difference between the two groups in terms of 90-days excellent functional outcomes (OR 0.76 [95% CI, 0.51-1.13]; I2 = 0%) and sICH rates (OR 3.76 [95% CI, 0.61-23.20]). No significant differences were observed between the groups in terms of good functional outcomes, 90-day mortality, and 90-day stroke recurrence.

Conclusion: This meta-analysis of minor nondisabling stroke suggests that IVA did not prove more beneficial compared to no-IVA.

背景:入院时美国国立卫生研究院卒中量表评分为 0-5 分的轻微缺血性卒中占所有急性缺血性卒中的一半。静脉注射阿替普酶(IVA)在轻微脑卒中患者中的作用尚无定论;因此,我们对这些患者接受或不接受 IVA 治疗的临床结果进行了评估:我们检索了 Medline、Embase、Scopus 和 Cochrane 图书馆,直至 2023 年 8 月 1 日。纳入的研究仅限于报道轻度非致残性中风患者接受或不接受 IVA 治疗的英文文献。采用随机效应模型计算出了比值比 (OR) 及其相应的 95% CI。疗效结果包括 90 天后的功能预后优良率(修正的 Rankin 评分表 [mRS] 为 0-1)和良好率(mRS 为 0-2)。主要的安全性结果是症状性脑出血(sICH):符合纳入标准的研究有五项,其中两项为研究性临床试验,三项为观察性研究,共有 2764 名患者(31.8% 为女性)。1559名患者(56.4%)接受了IVA治疗。对两项研究的汇总分析显示,两组患者的 90 天优良功能预后(OR 0.76 [95% CI, 0.51-1.13];I2 = 0%)和 sICH 发生率(OR 3.76 [95% CI, 0.61-23.20])无差异。在良好功能预后、90 天死亡率和 90 天中风复发率方面,各组间未观察到明显差异:这项针对轻微非致残性卒中的荟萃分析表明,与无 IVA 相比,IVA 并未证明更有益。
{"title":"Intravenous alteplase in minor nondisabling ischemic stroke: A systematic review and meta-analysis.","authors":"Adel Alhazzani, Fahad S Al-Ajlan, Ahmed Alkhiri, Ahmed A Almaghrabi, Aser F Alamri, Basil A Alghamdi, Hassan K Salamatullah, Abdullah R Alharbi, Maher B Almutairi, Hui-Sheng Chen, Yongjun Wang, Mohamad Abdalkader, Guillaume Turc, Pooja Khatri, Thanh N Nguyen","doi":"10.1177/23969873241237312","DOIUrl":"10.1177/23969873241237312","url":null,"abstract":"<p><strong>Background: </strong>Minor ischemic stroke, defined as National Institute of Health Stroke Scale score of 0-5 on admission, represents half of all acute ischemic strokes. The role of intravenous alteplase (IVA) among patients with minor stroke is inconclusive; therefore, we evaluated clinical outcomes of these patients treated with or without IVA.</p><p><strong>Materials and methods: </strong>We searched Medline, Embase, Scopus, and the Cochrane library until August 1, 2023. Inclusion was restricted to the English literature of studies that reported on minor nondisabling stroke patients treated with or without IVA. Odds ratios (ORs) with their corresponding 95% CIs were utilized using a random-effects model. Efficacy outcomes included rates of excellent (modified Rankin scale [mRS] of 0-1) and good (mRS of 0-2) functional outcome at 90 days. The main safety outcome was symptomatic intracerebral hemorrhage (sICH).</p><p><strong>Results: </strong>Five eligible studies, two RCTs and three observational studies, comprising 2764 patients (31.8% female) met inclusion criteria. IVA was administered to 1559 (56.4%) patients. Pooled analysis of the two RCTs revealed no difference between the two groups in terms of 90-days excellent functional outcomes (OR 0.76 [95% CI, 0.51-1.13]; <i>I</i><sup>2</sup> = 0%) and sICH rates (OR 3.76 [95% CI, 0.61-23.20]). No significant differences were observed between the groups in terms of good functional outcomes, 90-day mortality, and 90-day stroke recurrence.</p><p><strong>Conclusion: </strong>This meta-analysis of minor nondisabling stroke suggests that IVA did not prove more beneficial compared to no-IVA.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"521-529"},"PeriodicalIF":5.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140094803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Perispinal Etanercept to improve STroke Outcomes (PESTO): Protocol for a multicenter, international, randomized placebo-controlled trial. 改善脑卒中预后的外周依那西普(PESTO):多中心、国际、随机安慰剂对照试验方案。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-04-27 DOI: 10.1177/23969873241249248
Vincent Thijs, Geoffrey C Cloud, Nigel Gilchrist, Brooke Parsons, Forum Tilvawala, Jan Ho, Lara Ruthnam, Vimal Stanislaus, Nikola Sprigg, Marion Walker, Philip M Bath, Leonid Churilov, Julie Bernhardt

Rationale: A large proportion of stroke survivors will have long-lasting, debilitating neurological impairments, yet few efficacious medical treatment options are available. Etanercept inhibits binding of tumor necrosis factor to its receptor and is used in the treatment of inflammatory conditions. Perispinal subcutaneous injection followed by a supine, head down position may bypass the blood brain barrier. In observational studies and one small randomized controlled trial the majority of patients showed improvement in multiple post stroke impairments.

Aim: Perispinal Etanercept to improve STroke Outcomes (PESTO) investigates whether perispinal subcutaneous injection of etanercept improves quality of life and is safe in patients with chronic, disabling, effects of stroke.

Methods and design: PESTO is a multicenter, international, randomized placebo-controlled trial. Adult participants with a history of stroke between 1 and 15 years before enrollment and a current modified Rankin scale between 2 and 5 who are otherwise eligible for etanercept are randomized 1:1 to single dose injection of etanercept or placebo.

Study outcomes: The primary efficacy outcome is quality of life as measured using the Short Form 36 Health Inventory at day 28 after first injection. Safety outcomes include serious adverse events.

Sample size target: A total of 168 participants assuming an improvement of the SF-36 in 11% of participants in the control arm and in 30% of participants in the intervention arm, 80% power and 5% alpha.

Discussion: PESTO aims to provide level 1 evidence on the safety and efficacy of perispinal etanercept in patients with long-term disabling effects of stroke.

理由很大一部分中风幸存者会有长期的、使人衰弱的神经功能损伤,但目前几乎没有有效的药物治疗方案。Etanercept 可抑制肿瘤坏死因子与其受体的结合,用于治疗炎症。椎周皮下注射,然后采取仰卧、低头姿势,可绕过血脑屏障。在观察性研究和一项小型随机对照试验中,大多数患者中风后的多种功能障碍都有所改善。目的:"围皮下注射依那西普改善中风预后"(PESTO)研究了围皮下注射依那西普是否能改善中风慢性致残患者的生活质量,并且是否安全:PESTO 是一项多中心、国际性、随机安慰剂对照试验。研究结果:主要疗效指标是患者的生活质量和安全性:主要疗效结果为首次注射后第28天的生活质量,采用简表36健康量表进行测量。安全性结果包括严重不良事件:样本量目标:共 168 名参与者,假设对照组中 11% 的参与者和干预组中 30% 的参与者 SF-36 有所改善,功率为 80%,α为 5%:PESTO旨在为脑卒中长期致残患者使用围手术期依那西普的安全性和有效性提供1级证据。
{"title":"Perispinal Etanercept to improve STroke Outcomes (PESTO): Protocol for a multicenter, international, randomized placebo-controlled trial.","authors":"Vincent Thijs, Geoffrey C Cloud, Nigel Gilchrist, Brooke Parsons, Forum Tilvawala, Jan Ho, Lara Ruthnam, Vimal Stanislaus, Nikola Sprigg, Marion Walker, Philip M Bath, Leonid Churilov, Julie Bernhardt","doi":"10.1177/23969873241249248","DOIUrl":"10.1177/23969873241249248","url":null,"abstract":"<p><strong>Rationale: </strong>A large proportion of stroke survivors will have long-lasting, debilitating neurological impairments, yet few efficacious medical treatment options are available. Etanercept inhibits binding of tumor necrosis factor to its receptor and is used in the treatment of inflammatory conditions. Perispinal subcutaneous injection followed by a supine, head down position may bypass the blood brain barrier. In observational studies and one small randomized controlled trial the majority of patients showed improvement in multiple post stroke impairments.</p><p><strong>Aim: </strong>Perispinal Etanercept to improve STroke Outcomes (PESTO) investigates whether perispinal subcutaneous injection of etanercept improves quality of life and is safe in patients with chronic, disabling, effects of stroke.</p><p><strong>Methods and design: </strong>PESTO is a multicenter, international, randomized placebo-controlled trial. Adult participants with a history of stroke between 1 and 15 years before enrollment and a current modified Rankin scale between 2 and 5 who are otherwise eligible for etanercept are randomized 1:1 to single dose injection of etanercept or placebo.</p><p><strong>Study outcomes: </strong>The primary efficacy outcome is quality of life as measured using the Short Form 36 Health Inventory at day 28 after first injection. Safety outcomes include serious adverse events.</p><p><strong>Sample size target: </strong>A total of 168 participants assuming an improvement of the SF-36 in 11% of participants in the control arm and in 30% of participants in the intervention arm, 80% power and 5% alpha.</p><p><strong>Discussion: </strong>PESTO aims to provide level 1 evidence on the safety and efficacy of perispinal etanercept in patients with long-term disabling effects of stroke.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"789-795"},"PeriodicalIF":5.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Burden of intracranial artery calcification in white patients with ischemic stroke. 缺血性脑卒中白人患者颅内动脉钙化的负担。
IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-01 Epub Date: 2024-03-20 DOI: 10.1177/23969873241239787
Bernhard P Berghout, Robin Yr Camarasa, Dianne Hk Van Dam-Nolen, Aad van der Lugt, Marleen de Bruijne, Peter J Koudstaal, M Kamran Ikram, Daniel Bos

Introduction: The diagnostic workup of stroke doesn't identify an underlying cause in two-fifths of ischemic strokes. Intracranial arteriosclerosis is acknowledged as a cause of stroke in Asian and Black populations, but is underappreciated as such in whites. We explored the burden of Intracranial Artery Calcification (IAC), a marker of intracranial arteriosclerosis, as a potential cause of stroke among white patients with recent ischemic stroke or TIA.

Patients and methods: Between December 2005 and October 2010, 943 patients (mean age 63.8 (SD ± 14.0) years, 47.9% female) were recruited, of whom 561 had ischemic stroke and 382 a TIA. CT-angiography was conducted according to stroke analysis protocols. The burden of IAC was quantified on these images, whereafter we assessed the presence of IAC per TOAST etiology underlying the stroke and assessed associations between IAC burden, symptom severity, and short-term functional outcome.

Results: IAC was present in 62.4% of patients. Furthermore, IAC was seen in 84.8% of atherosclerotic strokes, and also in the majority of strokes with an undetermined etiology (58.5%). Additionally, patients with larger IAC burden presented with heavier symptoms (adjusted OR 1.56 (95% CI [1.06-2.29]), but there was no difference in short-term functional outcome (1.14 [0.80-1.61]).

Conclusion: IAC is seen in the majority of white ischemic stroke patients, aligning with findings from patient studies in other ethnicities. Furthermore, over half of patients with a stroke of undetermined etiology presented with IAC. Assessing IAC burden may help identify the cause in ischemic stroke of undetermined etiology, and could offer important prognostic information.

导言:五分之二的缺血性中风患者在中风的诊断检查中无法确定潜在病因。颅内动脉硬化被认为是亚裔和黑人中风的原因之一,但在白人中却未得到足够重视。颅内动脉钙化(IAC)是颅内动脉硬化的标志物,我们探讨了颅内动脉钙化作为近期缺血性中风或 TIA 的白人患者中风潜在病因的负担:2005 年 12 月至 2010 年 10 月间,共招募了 943 名患者(平均年龄 63.8(SD ± 14.0)岁,47.9% 为女性),其中 561 人患有缺血性中风,382 人患有 TIA。根据中风分析方案进行了 CT 血管造影。在这些图像上量化了 IAC 的负荷,然后我们根据 TOAST 病因评估了中风是否存在 IAC,并评估了 IAC 负荷、症状严重程度和短期功能预后之间的关联:结果:62.4%的患者存在 IAC。此外,84.8%的动脉粥样硬化性脑卒中和大多数病因不明的脑卒中(58.5%)都存在 IAC。此外,IAC负担较大的患者症状较重(调整后OR值为1.56(95% CI [1.06-2.29]),但短期功能预后无差异(1.14 [0.80-1.61]):结论:大多数白人缺血性卒中患者存在 IAC,这与其他种族患者的研究结果一致。此外,半数以上病因不明的卒中患者伴有 IAC。评估 IAC 负担有助于确定病因不明的缺血性卒中的病因,并可提供重要的预后信息。
{"title":"Burden of intracranial artery calcification in white patients with ischemic stroke.","authors":"Bernhard P Berghout, Robin Yr Camarasa, Dianne Hk Van Dam-Nolen, Aad van der Lugt, Marleen de Bruijne, Peter J Koudstaal, M Kamran Ikram, Daniel Bos","doi":"10.1177/23969873241239787","DOIUrl":"10.1177/23969873241239787","url":null,"abstract":"<p><strong>Introduction: </strong>The diagnostic workup of stroke doesn't identify an underlying cause in two-fifths of ischemic strokes. Intracranial arteriosclerosis is acknowledged as a cause of stroke in Asian and Black populations, but is underappreciated as such in whites. We explored the burden of Intracranial Artery Calcification (IAC), a marker of intracranial arteriosclerosis, as a potential cause of stroke among white patients with recent ischemic stroke or TIA.</p><p><strong>Patients and methods: </strong>Between December 2005 and October 2010, 943 patients (mean age 63.8 (SD ± 14.0) years, 47.9% female) were recruited, of whom 561 had ischemic stroke and 382 a TIA. CT-angiography was conducted according to stroke analysis protocols. The burden of IAC was quantified on these images, whereafter we assessed the presence of IAC per TOAST etiology underlying the stroke and assessed associations between IAC burden, symptom severity, and short-term functional outcome.</p><p><strong>Results: </strong>IAC was present in 62.4% of patients. Furthermore, IAC was seen in 84.8% of atherosclerotic strokes, and also in the majority of strokes with an undetermined etiology (58.5%). Additionally, patients with larger IAC burden presented with heavier symptoms (adjusted OR 1.56 (95% CI [1.06-2.29]), but there was no difference in short-term functional outcome (1.14 [0.80-1.61]).</p><p><strong>Conclusion: </strong>IAC is seen in the majority of white ischemic stroke patients, aligning with findings from patient studies in other ethnicities. Furthermore, over half of patients with a stroke of undetermined etiology presented with IAC. Assessing IAC burden may help identify the cause in ischemic stroke of undetermined etiology, and could offer important prognostic information.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"743-750"},"PeriodicalIF":5.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
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European Stroke Journal
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