Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Temporal trends in endovascular therapy for acute stroke in the era of modern mechanical thrombectomy: The JR-NET4 study","authors":"Mikito Hayakawa MD, PhD ,&nbsp;Hiroshi Yamagami MD, PhD ,&nbsp;Yuji Matsumarum MD, PhD ,&nbsp;Koji Hirata MD, PhD ,&nbsp;Hisayuki Hosoo MD, PhD ,&nbsp;Yoshiro Ito MD, PhD ,&nbsp;Aiki Marushima MD, PhD ,&nbsp;Wataro Tsuruta MD, PhD ,&nbsp;Koji Iihara MD, PhD ,&nbsp;Akira Ishii MD, PhD ,&nbsp;Hirotoshi Imamura MD, PhD ,&nbsp;Chiaki Sakai MD, PhD ,&nbsp;Tetsu Satow MD, PhD ,&nbsp;Shinichi Yoshimura MD, PhD ,&nbsp;Nobuyuki Sakai MD, DMSc ,&nbsp;the JR-NET4 Study Group","doi":"10.1016/j.jstrokecerebrovasdis.2024.108110","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108110","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to examine nationwide trends in acute stroke endovascular thrombectomy (EVT) following five pivotal trials in 2015 that established it as the ‘standard of care’.</div></div><div><h3>Methods</h3><div>The Japanese Registry of NeuroEndovascular Therapy 4 was a nationwide retrospective study registering consecutive patients who underwent neurointervention by specialists certified by the Japanese Society for Neuroendovascular Therapy at 166 centers from January 2015 to December 2019. We extracted patients who underwent EVT, and analyzed the annual trends in baseline characteristics, revascularization procedures and outcomes.</div></div><div><h3>Results</h3><div>A total of 13,090 patients (75.3 ± 12.2 years, 5637 women) were included. Analyses revealed an annual increase in patient age and treatments beyond 6 h after onset. However, there was an annual decline in premorbidly independent patients and those with large vessel occlusion. The frequency of stent-aspiration techniques and rate of successful reperfusions significantly increased from 19.9 % to 51.0 % and from 81.4 % to 83.9 %, respectively through the study period. Trends in patients achieving a favorable (modified Rankin Scale score of 0-2 at 30 days) or fatal outcome, or experiencing intracranial hemorrhagic complications remained unchanged. However, calendar time was associated with favorable outcomes after adjusting for clinical and treatment characteristics (odds ratio, 1.040; <em>P</em> = 0.015).</div></div><div><h3>Conclusions</h3><div>During the study period, EVT indications expanded for patients with characteristics linked to worse outcomes. However, factors such as advancements in techniques, have led to modest but significant improvements in reperfusion status, leading to maintenance of the post-EVT clinical outcomes.</div></div><div><h3>Registration</h3><div>URL: <span><span>https://www.umin.ac.jp/ctr/</span><svg><path></path></svg></span>; Unique identifier: UMIN000038869</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108110"},"PeriodicalIF":2.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of tirofiban plus recombinant tissue plasminogen activator versus recombinant tissue plasminogen activator alone in acute ischemic stroke patients: a meta-analysis","authors":"Yonghong Yang MB ,&nbsp;Qingwu Yang MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108111","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108111","url":null,"abstract":"<div><h3>Objective</h3><div>Tirofiban plus recombinant tissue plasminogen activator (rtPA) shows good efficacy and safety in treating acute ischemic stroke (AIS) patients, but there is a lack of comprehensive assessment. This meta-analysis aimed to compare the efficacy and safety of rtPA plus tirofiban with rtPA alone in AIS patients.</div></div><div><h3>Methods</h3><div>This meta-analysis retrieved studies comparing rtPA intravenous thrombolysis followed by tirofiban (rtPA+T group) versus rtPA intravenous thrombolysis alone (rtPA group) for AIS patients in Excerpt Medica Database, Web of Science, Cochrane, PubMed, China National Knowledge Infrastructure, Wanfang, and SinoMed until March 2024.</div></div><div><h3>Results</h3><div>Twenty studies with 2048 AIS patients were enrolled in this meta-analysis. National Institute of Health stroke scale (NIHSS) score after treatment was lower in the rtPA+T group than the rtPA group [standardized mean differences (SMD)=-1.41; 95 % confidence interval (CI)=-1.83, -0.98; <em>P</em>&lt;0.001]. The proportion of AIS patients achieving a favorable functional outcome (modified Rankin Scale score ≤2) was increased in the rtPA+T group versus the rtPA group [relative risk (RR)=1.13; 95 % CI=1.05, 1.21; <em>P</em>=0.001]. The incidence of re-occlusion was lower in the rtPA+T group than in the rtPA group (RR=0.24; 95 % CI=0.10, 0.59; <em>P</em>=0.002), but the incidence of intracranial hemorrhage (ICH) (RR=0.85; 95 % CI=0.51, 1.43), symptomatic ICH (RR=1.10; 95 % CI=0.43, 2.84), and mortality (RR=1.39; 95 % CI=0.53, 3.65) was not different between the two groups (all <em>P</em>&gt;0.05). The stability assessed by sensitivity analysis was good, and no publication bias was found.</div></div><div><h3>Conclusion</h3><div>rtPA plus tirofiban achieves superior efficacy with comparable safety profiles compared to rtPA alone in AIS patients.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108111"},"PeriodicalIF":2.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of SUR1 polymorphisms with acute infarct size: The MRI-GENIE study","authors":"Arlinda Deng MD ,&nbsp;Huichun Xu MD, PhD ,&nbsp;Brady J. Gaynor MS ,&nbsp;John W. Cole MD, MS ,&nbsp;Anne-Katrin Giese MD, PhD ,&nbsp;Markus D. Schirmer PhD ,&nbsp;Patrick F. McArdle PhD ,&nbsp;Braxton D. Mitchell PhD ,&nbsp;Ona Wu PhD ,&nbsp;Natalia S. Rost MD, MPH ,&nbsp;Steven J. Kittner MD, MPH ,&nbsp;MRI-GENIE Investigators","doi":"10.1016/j.jstrokecerebrovasdis.2024.108109","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108109","url":null,"abstract":"<div><h3>Background</h3><div>The sulfonylurea receptor 1 (SUR1) is a known mediator of cerebral edema in large ischemic strokes, however, genetically induced response variability has yet to be evaluated. SUR1, encoded by the ABCC8 gene, is an ion channel regulator in ischemia-induced cerebral edema. Previous studies in severe traumatic brain injury demonstrated four tag single nucleotide polymorphisms (SNPs) of the ABCC8 gene to be associated with cerebral edema and functional outcome. We hypothesized that these four SNPs would also be associated with acute infarct size and functional outcome in non-lacunar ischemic stroke.</div></div><div><h3>Methods</h3><div>Using 2,205 MRI–GENetics Interface Exploration (MRI-GENIE) study subjects with acute non-lacunar ischemic strokes, we evaluated the association between the 4 ABCC8 tag-SNPs and stroke infarct size (as measured in a standardized fashion from MRIs using diffusion-weighted imaging), adjusting for age, sex and population stratification. Modified Rankin scale (mRS) outcome was available at 3-months for a subset of 798 strokes in MRI-GENIE and was evaluated as a dichotomous variable (0-2 vs. 3-6), adjusting for age, sex, stroke severity (baseline NIH Stroke Scale (NIHSS) score), and population stratification.</div></div><div><h3>Results</h3><div>The candidate SNPs, rs7105832, rs2237982, rs11024286, rs4148622, were not statistically associated with DWI (beta = −0.065, −0.057, 0.037, 0.018; <em>p</em> = 0.053, 0.078, 0.28, 0.61) or dichotomous mRS outcome (OR = 0.80, 0.86, 1.14, 0.90; <em>p</em> = 0.117, 0.289, 0.353, 0.502).</div></div><div><h3>Conclusion</h3><div>rs7105832, rs2237982, rs11024286, rs4148622 polymorphisms of the ABCC8 gene did not demonstrate a significant effect on acute ischemic infarct size or 3-month functional outcome. Nonetheless, further studies with delayed imaging and more sensitive outcome measures remain warranted.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108109"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of walking pace and risk of stroke: A two- sample mendelian randomization study in a European ancestry cohort","authors":"Cong Liang ,&nbsp;Xinlin Huang ,&nbsp;Yucui Pu ,&nbsp;Pei Zhang ,&nbsp;Rong Wang PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108104","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108104","url":null,"abstract":"<div><h3>Background</h3><div>Walking pace (WP), a simple physiological indicator, has been found to be strongly associated with a variety of health outcomes in recent years. Among them, the relationship between walking pace and stroke is of particular interest. Given the high morbidity, disability and mortality associated with stroke, identifying modifiable indicators of health, such as walking pace, could help in stroke prevention strategies. However, the causal relationship between WP and stroke risk remains unclear. This study aims to determine the causal relationship between walking pace and risk of stroke using a two-sample Mendelian randomization approach in a European-ancestry population.</div></div><div><h3>Methods</h3><div>In order to evaluate the potential for a causal relationship between WP and stroke in people of European heritage, a two-sample Mendelian randomization (MR) study was carried out. Statistics about the association of single nucleotide polymorphisms (SNPs) with stroke were taken from FinnGen (R8) (n = 284,040), while the UK Biobank genome-wide association studies (GWAS) provided the summary data on the association of SNPs with WP (n = 459,915). The inverse-variance weighted (IVW) method was utilised as the primary strategy to examine the causal connection between WP and stroke. Additionally, complementary analyses were conducted using the MR-Egger and weighted median. In order to identify the potential directional pleiotropy and heterogeneity, the MR-Egger intercept test, the MR-PRESSO test, and Cochran's Q statistic were all carried out. This connection was evaluated using OR with 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>A total of 48 SNPs were identified as valid instrumental variables in our two-sample MR analysis. The result showed that a slower walking pace is associated with a higher risk of stroke (OR = 0.573; 95% CI, 0.383-0.858, <em>P</em> = 0.007). The “leave-one-out” analysis demonstrated that the absence of a single SNP did not affect the robustness of our results. The MR-Egger intercept test indicated that genetic pleiotropy did not introduce bias into the results [intercept = −2.9E−03, SE = 0.008, <em>P</em> = 0.719] and Cochran's Q test revealed no heterogeneity. Therefore, the sensitivity analyses yielded comparable results. Consequently, the results of the sensitivity analyses were consistent.</div></div><div><h3>Conclusion</h3><div>Our MR study revealed that WP is inversely associated with risk of stroke. These results provided evidence that slower WP causally increased the risk of stroke, recommending that patients with lower WP should have a prompt physical examination and targeted interventions to reduce their risk of stroke and enhance their quality of life.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108104"},"PeriodicalIF":2.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"White matter lesions as a prognostic marker of recurrence in cryptogenic stroke with high-risk patent foramen ovale","authors":"Shunichi Niiyama MD ,&nbsp;Yuji Ueno MD, PhD ,&nbsp;Naohide Kurita MD, PhD ,&nbsp;Sho Nakajima MD, PhD ,&nbsp;Chikage Kijima MD, PhD ,&nbsp;Kenichiro Hira MD, PhD ,&nbsp;Nobukazu Miyamoto MD, PhD ,&nbsp;Masao Watanabe MD, PhD ,&nbsp;Kazuo Yamashiro MD, PhD ,&nbsp;Takao Urabe MD, PhD ,&nbsp;Nobutaka Hattori MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108048","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108048","url":null,"abstract":"<div><h3>Purpose</h3><div>A high-risk patent foramen ovale (PFO) could be the cause of cryptogenic stroke, and an atrial septal aneurysm (ASA) increases the risk of stroke recurrence in cryptogenic stroke patients with a patent foramen ovale (PFO). Factors related to stroke recurrence according to PFO characteristics have not been fully evaluated.</div></div><div><h3>Methods</h3><div>Data from a multicenter, observational registry of ischemic stroke patients undergoing transesophageal echocardiography were used for this study. Patients were classified into three groups: high-risk PFO, PFO with large shunt (≥20 microbubbles) or ASA; right-to-left shunt (RLS), RLS including PFO with &lt;20 microbubbles or without ASA, or pulmonary arteriovenous fistula; and negative RLS. Cox proportional hazards regression analysis was used to explore the factors related to stroke recurrence in these three groups.</div></div><div><h3>Results</h3><div>In total, 586 patients (185 females; 65.5±13.2 years) were analyzed. In cryptogenic stroke (329 patients) with median follow-up of 4.2 (interquartile range, 1.0–6.1) years, 55 patients had stroke recurrence. The negative RLS, RLS, and high-risk PFO groups included 179, 90, and 60 patients, in which stroke recurrence occurred in 5.3%, 2.5%, and 4.6% per person-year, respectively. In patients with high-risk PFO, the National Institutes of Health stroke scale score (hazard ratio [HR] 1.257 [1.034-1.530]) and periventricular hyperintensity (HR 3.369 [1.103-10.294]) were predictors of stroke recurrence on multivariable Cox hazards analysis, but no factors were related to stroke recurrence in the RLS and negative RLS groups.</div></div><div><h3>Conclusion</h3><div>Periventricular hyperintensity was shown to predict recurrent stroke in patients with a high-risk PFO.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108048"},"PeriodicalIF":2.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of glucose levels in patients with anterior circulation acute ischemic stroke treated with endovascular therapy using continuous glucose monitoring","authors":"C.J.B.A. Kersten ,&nbsp;A.A.M. Zandbergen ,&nbsp;M.J. Fokkert ,&nbsp;R.J. Slingerland ,&nbsp;I.L.H. Knottnerus ,&nbsp;M. van der Molen ,&nbsp;M.L.B. Wijlens ,&nbsp;J. Hofmeijer ,&nbsp;H.M. den Hertog","doi":"10.1016/j.jstrokecerebrovasdis.2024.108103","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108103","url":null,"abstract":"<div><h3>Introduction</h3><div>Hyperglycemia is common in acute ischemic stroke, and associated with larger infarct volume and unfavorable functional outcome. To identify a subgroup that may benefit from glucose lowering in future studies, we assessed the evolution of glucose levels in the first 24 hrs after admission using continuous glucose monitoring in patients with anterior circulation large vessel occlusion ischemic stroke who underwent endovascular therapy (EVT).</div></div><div><h3>Methods</h3><div>In a prospective two center cohort study, consecutive patients with anterior circulation ischemic stroke, who were eligible for EVT within 24 hrs of symptom onset, were enrolled. Glucose monitoring was performed using a Freestyle Libre Flash 2 device during 24 hrs. We analysed median glucose on admission, time ratio of glucose &gt; 7.8 mmol/L (7.8 time-ratio) and coefficient of variation (% CV), including relations with predefined patient characteristics and outcomes.</div></div><div><h3>Results</h3><div>One hundred and two patients were included in the analyses, with a median stroke-onset-to-measurement-time of 4 hrs. Median glucose on admission was 7.0 mmol/L (IQR 6.0-8.4 mmol/L). Overall, 7.8 time-ratio and % CV were 13% and 4% respectively. In patients who were normoglycemic or hyperglycemic on admission, the glucose variability was small with % CV of 6% and 4% respectively. Hyperglycemia on admission, high HbA1C, successful recanalization, older age, and high NIHSS scores were associated with higher 7.8 time-ratio.</div></div><div><h3>Conclusion</h3><div>Glucose monitoring and studies on effectiveness of glucose lowering may be especially useful in EVT patients with hyperglycemia on admission, high HbA1C, successful recanalization, older age and high initial NIHSS scores.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108103"},"PeriodicalIF":2.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iatrogenic cerebral amyloid angiopathy: Two case reports to explore clinical heterogeneity and pathological patterns","authors":"Carla Vera-Cáceres MD ,&nbsp;Nerses Nersesyan MD ,&nbsp;Maria Obon MD, Ph.D ,&nbsp;Mikel Terceño MD, Ph.D ,&nbsp;Joaquin Serena MD, Ph.D ,&nbsp;Juan Álvarez-Cienfuegos MD ,&nbsp;Tomàs Xuclà MD ,&nbsp;Saima Bashir MD ,&nbsp;Yolanda Silva MD, Ph.D","doi":"10.1016/j.jstrokecerebrovasdis.2024.107969","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.107969","url":null,"abstract":"<div><h3>Introduction</h3><div>These case reports illustrate Iatrogenic Cerebral Amyloid Angiopathy (iCAA) due to neurosurgical procedures. Recent studies propose prion transmission during neurosurgery as a potential mechanism for β-amyloid seed implantation, linking neurosurgical history to the development of iCAA. The majority of reported cases in the literature have an unfavorable prognosis, with recurrence of intracerebral hemorrahge (ICH) and subsequent death during the first months of follow-up. There is no effective treatment for preventing the progression of the disease.</div></div><div><h3>Results</h3><div>a 41-year-old man with a previous history of left frontotemporal traumatic brain injury and subsequent neurosurgical intervention in childhood was admitted with an ICH leading to the diagnosis of iCAA. The patient's history of exposure, combined with imaging studies and neuropsychological assessments, supported the suspicion of iCAA. Confirmatory PET-CT scans revealed β-amyloid deposits in the cortical regions, aligning with the proposed criteria for iCAA. At the 2-year follow-up, the patient presents an NIHSS of 0 and a Modified Rankin Scale (mRS) of 1. The second case involved a 50-year-old man with a history of surgical treatment for Arnold-Chiari malformation, who developed transient neurological deficits and presented multiple ICH. The patient's history of neurosurgical intervention and the radiological and clinical features supported the diagnosis of probable iAAC. Despite a negative PET-CT result, CSF analysis provided evidence of ß-amyloid accumulation in the CNS. At the 6-year follow-up, the patient presented an NIHSS of 1(hemihypoesthesia) and mRS of 3.</div></div><div><h3>Conclusion</h3><div>iCAA is an emerging pathology probably driven by prion transmission of β-amyloid seed after neurosurgical interventions. It is important to suspect this condition in young patients with ICH and a history of neurosurgical procedure. Recognizing iCAA's clinical and radiological features is crucial for early identification. The diagnosis process is based on demonstrating the accumulation of β-amyloid protein in the central nervous system using PET-CT or cerebrospinal fluid (CSF) studies and also conducting genetics studies. As an evolving pathology without a clear pathophysiology and a potential divergent evolution between phenotypes, establishing standardized diagnostic criteria and a multicenter registry is imperative for a comprehensive understanding of iCAA.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 107969"},"PeriodicalIF":2.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-hospital outcomes of intravenous recombinant tissue plasminogen activator treatment for acute ischemic stroke in patients aged >80 years: Findings from the Chinese Stroke Center Alliance","authors":"Yingyu Jiang ,&nbsp;Chunjuan Wang ,&nbsp;Hongqiu Gu ,&nbsp;Qi Zhou ,&nbsp;Yong Jiang ,&nbsp;Zixiao Li ,&nbsp;Yongjun Wang","doi":"10.1016/j.jstrokecerebrovasdis.2024.108102","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108102","url":null,"abstract":"<div><h3>Background</h3><div>Intravenous (IV) recombinant plasminogen activator (rt-PA) within 4.5 hours of symptom onset has established benefit for patients with acute ischemic stroke (AIS); however, evidence on the use of IV rt-PA in elderly Chinese patients is limited. This study evaluated the patient characteristics and in-hospital clinical outcomes of Chinese patients aged &gt;80 years who received IV rt-PA within 4.5 h of symptom onset, using patients aged 18–80 years as a reference group. (NCT05395351).</div></div><div><h3>Methods</h3><div>This study analyzed adult Chinese patients with AIS who arrived at the hospital within 4.5 hours of symptom onset between August 2015 and July 2019 and were registered in the nationwide, hospital-based Chinese Stroke Center Alliance platform. Patients were categorized by treatment (IV rt-PA versus no IV rt-PA) and age (&gt;80 years versus 18–80 years). In-hospital outcomes were evaluated in IV rt-PA-treated patients. Primary outcome was all-cause mortality during hospitalization; secondary outcomes included proportion of patients with intracranial hemorrhage (ICH) during hospitalization, change in National Institutes of Health Stroke Scale (NIHSS) before and 24 h after IV rt-PA, modified Rankin Scale (mRS) at discharge, proportion of patients with stroke recurrence during hospitalization, and duration of hospital stay.</div></div><div><h3>Results</h3><div>Of 113,035 patients with AIS included in the study, 31,418 patients received IV rt-PA within 4.5 hours after symptom onset (aged &gt;80 years: n=3,332; 18–80 years: n=28,086). Among IV rt-PA-treated patients, all-cause mortality was 2.6 % (95 % CI 2.1–3.2 %) and 0.8 % (95 % CI 0.7–0.9 %) in patients aged &gt;80 years and 18–80 years, respectively. Intracranial hemorrhage occurred in 6.7 % (95 % CI 5.8–7.5 %) and 3.1 % (95 % CI 2.9–3.3 %) of patients; mean±SD change in NIHSS score was 2.8±5.0 and 2.5±4.3; mRS 0–1 at discharge in 42.8 % (95 % CI 40.8 %–44.8 %) and 63.6 % (95 % CI 62.9 %–64.3 %); stroke recurrence in 11.1 % (95 % CI 10.0–12.1 %) and 7.3 % (95 % CI 7.0–7.6 %). Median duration of hospital stay was 11 days in both age groups.</div></div><div><h3>Conclusions</h3><div>Chinese patients aged &gt;80 years with AIS who received IV rt-PA within 4.5 hours after symptom onset had higher all-cause mortality during hospitalization than those aged 18–80 years.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108102"},"PeriodicalIF":2.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dopamine receptor agonist pramipexole exerts neuroprotection on global cerebral ischemia/reperfusion injury by inhibiting ferroptosis","authors":"Xiaoyu Kang ,&nbsp;Wenzhu Wang ,&nbsp;Yao Zuo ,&nbsp;Yunlei Wang ,&nbsp;Linyao Zhang ,&nbsp;Lixu Liu","doi":"10.1016/j.jstrokecerebrovasdis.2024.108101","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108101","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the mechanism of dopamine receptor agonist pramipexole in exerting neuroprotection on global cerebral ischemia/reperfusion injury (GCI/R).</div></div><div><h3>Material and method</h3><div>Male Sprague-Dawley rats were randomly divided into four groups (n = 36 in each group), and the Pulsinelli's four-vessel occlusion method was used to establish the rat model of GCI/R injury. Pramipexole administration group was intraperitoneally injected with pramipexole 0.5 mg kg^-1 once a day for 14 days. Pramipexole combined with levodopa administration group was intraperitoneally injected with pramipexole 0.5 mg kg^-1 and levodopa 50 mg kg^-1 once a day for 14 days. The mNSS scores and Y maze test were used to evaluate neurological behaviors. Nissl staining and transmission electron microscopy were used to respectively observe hippocampal neurons and mitochondrial ultrastructure. Molecular biological tests including tissue iron concentration, GSH, MDA were used to detect the degree of ferroptosis. Western blotting was used to detect the expression levels of Nrf2, GPX4, X-CT and p53 proteins at 3 days, 7 days and 14 days after GCI/R injury.</div></div><div><h3>Results</h3><div>Pramipexole alone or combined with levodopa for 14 days improved neurological behaviors, improved the morphology of neurons, increased the number of surviving neurons in the hippocampal CA1 region of GCI/R rats, which showed similar neuroprotective effects. Pramipexole alone or combined with levodopa for 14 days restored mitochondrial ultrastructure, decreased tissue iron concentration and MDA concentration, increased GSH concentration in the brain of GCI/R rats, which also induced the relative expressions of Nrf2, GPX4 and X-CT proteins and reduced p53 protein.</div></div><div><h3>Conclusion</h3><div>Pramipexole alone or combined with levodopa exert neuroprotection by inhibiting ferroptosis after GCI/R injury via Nrf2/GPX4/SLC7A11 pathway, and long-term intervention could be applied as an effective therapeutic strategy for neuroprotection against GCI/R injury.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108101"},"PeriodicalIF":2.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to editor regarding “Prevalence of stroke in Bangladesh a systematic review and meta-analysis”","authors":"Aashima Walia ,&nbsp;Muhammed Shabil ,&nbsp;Sanjit Sah","doi":"10.1016/j.jstrokecerebrovasdis.2024.108098","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108098","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108098"},"PeriodicalIF":2.0,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}