Brain Circulation最新文献

Background: Remote ischemic conditioning (RIC) has gained significant attention across various professional fields as a safe and effective neuroregulatory technique. To gain a comprehensive understanding of the current status, emerging trends, and potential future directions in this field, a swift and intuitive statistical analysis method is essential for summarizing the available information.

Methods: This review conducted a literature search using the Web of Science Core Collection database and utilized VOSviewer software for visualization and analysis of publication trends, countries of origin, and keywords spanning the years 1985 to 2023.

Results: From 1998 to 2023, a total of 1,524 reviews on RIC were published, demonstrating a consistent increase in publications over the years. China emerged as the leading contributor in terms of publication, but the average number of citations was not dominant. Current RIC research hotspots encompass mechanism studies, stroke, neuroprotection, and cardiac protection. Among these, stroke, neuroprotection, and mechanisms play a major role in future.

Conclusions: There is a consistent upward trajectory in RIC research publications. While China led in terms of publication quantity, the recognition of articles still needs to be improved. Stroke, neuroprotection, and mechanism research are poised to be the primary research focal points in the present and future of RIC studies.

Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder with no specific clinical symptoms in the early stage; thus, early imaging identification is of great importance. A 29-year-old pregnant woman at 37 weeks experienced sudden generalized seizures accompanied by impaired consciousness. Brain computed tomography, conducted around 3 h after the onset, revealed symmetric areas of decreased density in the basal ganglia, brainstem, and suboccipital cortex, along with cerebral swelling. Following treatment with positive inotrope, diuretics, antihypertensives, and dehydration therapy, the patient regained clear consciousness on the 2^nd day. On the 9^th day postonset, a follow-up contrast-enhanced magnetic resonance imaging (MRI) showed slightly elevated signals in the bilateral occipital lobes on the T2 fluid-attenuated inversion recovery sequence. A subsequent brain MRI on day 47 postonset indicated no significant abnormal changes. Neuroimaging is pivotal for PRES diagnosis, revealing typical signs of widespread vasogenic edema in the posterior brain white matter, affecting the occipital lobes, cerebellum, brainstem, thalamus, and basal ganglia. With timely treatment, these lesions can partially or completely resolve within days or weeks.

Background: The N2H3 model was evaluated for forecasting the 3-month outcomes for patients experiencing acute ischemic stroke who received intravenous thrombolysis (IVT), in our previous study. The present study aimed to validate the predictive ability of the N2H3 model and to compare its accuracy to the THRIVE-c and START models (both of which are widely employed for prognostic predictions following IVT).

Methods: Our study prospectively enrolled consecutive stroke patients who received IVT from 16 hospitals. Cases from one hospital were included in External Validation Dataset 1, whereas External Validation Dataset 2 included patients from the other 15 hospitals. The effectiveness of each model in distinguishing outcomes was assessed by calculating the area under the receiver operating characteristic curve (AUC-ROC). In addition, the overall performance of the N2H3 model was assessed through the scaled Brier score.

Results: Finally, 794 patients were included, of which 582 were included in External Validation Dataset 1 and 212 in External Validation Dataset 2. The N2H3 model's AUC-ROC for forecasting unfavorable outcomes at 3-months was 0.810 (95% confidence interval [CI]: 0.771-0.848) in the first dataset and 0.782 (95% CI: 0.699-0.863) in the second dataset. For the START model, the AUC-ROCs in the two validation datasets were 0.729 (95% CI: 0.685-0.772) and 0.731 (95% CI: 0.649-0.772), respectively. The THRIVE-c model showed AUC-ROCs of 0.726 (95% CI: 0.682-0.770) and 0.666 (95% CI: 0.573-0.759), respectively. The Brier scores of the N2H3 model were 0.153 and 0.147 in cohorts 1 and 2, respectively.

Conclusions: The N2H3 model exhibited good predictive ability in both external validation cohorts. Moreover, it demonstrated advantages over the THRIVE-c and is not inferior to the START nomogram in this regard.

Trial registration: Clinical Research of Intravenous Thrombolysis for Ischemic Stroke in Northeast of China (CRISTINA) (identifier: NCT05028868).

Patients with neurofibromatosis undergo multiple surgeries during their lifetime, presenting as challenging scenarios to the perioperative team. We present the case report of a young male patient with type 1 neurofibromatosis scheduled for endovascular embolization of thoracic spinal arteriovenous malformation under general anesthesia. Associated vasculopathy included stented descending thoracic aortic coarctation, an unrepaired saccular aortic aneurysm (AA) distal to the stent suggestive of a type 1 endoleak, bilateral segmental pulmonary arterial thrombosis, bilateral subclavian artery stenosis, and a retroperitoneal neurofibroma compressing the coeliac artery. Our primary concerns were a possible periprocedural AA rupture becoming a surgical emergency, difficult vascular access, and perioperative thromboembolism. Periprocedural hemodynamic surges were avoided using continuous hemodynamic monitoring, adequate anesthetic depth, and analgesia. After an uneventful procedure, the patient was extubated with a smooth postoperative course. An in-depth knowledge about underlying pathophysiology, anticipation and preparedness for potential complications, and interdisciplinary coordinated teamwork serve to preserve patient outcomes.

Reperfusion therapy, which substantially promotes the vessel recanalization rate and improves clinical outcomes, remains the most effective treatment of acute ischemic stroke (AIS). However, a substantial number of patients are either unsuitable for recanalization therapy or experience limited recovery postreperfusion. There is growing recognition that adjunctive neuroprotective therapies may further improve the outcomes in AIS patients by protecting brain tissue during ischemia. Recent advancements in neuroprotective approaches, including pharmacologic agents such as nerinetide edaravone, and uric acid, as well as nonpharmacological interventions, such as remote ischemic conditioning and normobaric hyperoxia, offer promising potentials in stroke care. This review provides an overview of the current neuroprotective therapies, examines recent clinical evidence, and discusses the strengths and weaknesses of certain clinical trials aimed at cerebral protection.

Introduction: Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke for select patients with large vessel occlusion (LVO). Although racial disparities in the utilization of thrombectomy have been previously identified, disparities in the utilization of thrombectomy in a single center with a standardized patient selection protocol have not been described in the literature.

Methods: Using the American Heart Association Quality Improvement Programs Registry, we retrospectively reviewed the records of 1,143 patients with LVO between December 1, 2014, and May 31, 2021. Patient records were assessed for demographic data, stroke risk factors, process metrics, and success of thrombectomy. A Pearson's Chi-Squared and an independent two-sample t-test were used to determine the significance. Following this, a multivariate logistic regression was run to determine predictably of thrombectomy outcomes.

Results: Of the 1,143 LVO patients, 567 were male (49.6%), 576 were female, (50.4%), 963 were white (84.3%), and 180 were nonwhite (15.7%). Based on our Pearson's Chi-squared analysis, female patients were more like to undergo thrombectomy compared to male patients (62.4% vs. 48.9%; P < 0.001). White patients were also more likely to undergo thrombectomy compared to nonwhite patients (58.7% vs. 39.7%; P < 0.001). After the multivariate logistic regression analysis and after controlling for comorbidities, insurance status, age, time to presentation (last known well to arrival), transfer from outside hospital, and zip codes, white patients were 2.29 times more likely to receive a thrombectomy compared to nonwhite patients (odds ratio [OR], 2.29, 95% confidence interval [CI], 1.33, 3.944). Patients with Medicare insurance were 33.57 times more likely to receive a thrombectomy compared to those without medicare (OR, 33.57, 95% CI, 20.37, 55.327). In the regression model, sex did not contribute significantly to the likelihood of receiving a thrombectomy.

Conclusions: White patients were more likely to undergo MT. Female patients tended to have higher rates of MT, accounting for the fact that other variables could have influenced this. These disparities may result from a multitude of other factors such as eligibility for MT, delayed presentation, and adequate diagnosis of LVO in the emergency department. This study highlights the importance of and potential causes of these disparities. Further investigation with data from multiple centers is necessary to validate these findings and identify strategies for improving utilization of thrombectomy.

Background: The role of arterial collateral and venous outflow status on the response to intravenous tissue plasminogen activator (IV-tPA) has not been sufficiently clarified in acute major cerebral occlusions.

Patients and methods: A total of 130 patients (mean age: 71 years; 73 females) with acute middle cerebral artery M1/M2 segment or terminal internal carotid artery occlusion treated solely with IV-tPA were analyzed. Regional leptomeningeal score (rLMC) was used for cerebral arterial collateral scoring, and the cortical vein opacification score (COVES) and modified Prognostic Evaluation based on Cortical vein score difference In Stroke (PRECISE) superficial and deep scores were used for venous outflow profile. Exploratory logistic models for response to IV-tPA [positive response: National Institutes of Health Stroke Scale (NIHSS) decrease 4 (or decrease to 0) at 24 h; dramatic response: NIHSS decrease ≥8 (or decrease to 0 or 1)], functional outcome (modified Rankin's score 0-1 as "excellent" and 0-2 "good") and tPA-associated hemorrhagic transformation were constructed.

Results: IV-tPA efficacy was positive in 47% and dramatic in 32%. Dramatic response was linked to better arterial collateral status (exp[B] =1.115 [95% confidence interval (CI), 1.016-1.223]). Excellent outcome was noted in 26% and good in 45%. One-point increase in rLMC score independently increased good prognosis (exp[B] =1.209 [1.034-1.412]). Patients with good prognosis had higher (by 0.5 points) modified PRECISE deep score (P = 0.047) and less frequent nonsufficient modified PRECISE deep score (0-2) (P = 0.017) in univariate analyses. However, these associations failed to survive in multiple regression. Any type tPA-associated cerebral hemorrhagic transformation was observed in 23% and parenchymal hemorrhage type 2 in 5.4%. While rLMC score showed a borderline strength correlation to hemorrhage (exp[B] =0.899 [95% CI, 0.808-1.001]), outflow scores not.

Conclusion: While arterial collateral status modifies the effect of tPA in acute anterior circulation major artery occlusions, venous outflow capacity is not so critical.

Moyamoya disease (MMD) is a cerebrovascular disorder characterized by progressive occlusion of intracranial arteries, often leading to stroke and intracerebral hemorrhage. While MMD classically affects the intracranial vasculature, we present an unusual case of bilateral vertebral steno-occlusion, resulting in vertebrobasilar insufficiency in a 37-year-old man with MMD and treated with angioplasty and stenting of the dominant vertebral artery. Review of the literature demonstrates proximal vertebral artery involvement to be a rare manifestation of moyamoya disease. This report contributes to the understanding of the clinical spectrum of MMD and emphasizes the need for vigilance and awareness of the possibility of extracranial vascular complications in affected individuals.

Stroke remains a significant contributor to global morbidity and mortality, with acute ischemic stroke comprising the majority of cases. Secondary stroke, the recurrent stroke, is often more severe and linked to worse functional outcomes and increased mortality. The secondary prevention of ischemic stroke is crucial for reducing the risk of recurrent events. Significant advancements have been made in secondary prevention strategies in recent years. These include the refinement of antithrombotic regimens, the use of direct oral anticoagulants in managing atrial fibrillation, and the implementation of more aggressive targets for blood pressure, lipid management, and glucose management. Furthermore, emerging therapeutic approaches, such as remote ischemic conditioning and anti-inflammatory agents such as colchicine, have shown promise in reducing stroke recurrence through nontraditional mechanisms. This review summarizes the latest advancements in the secondary prevention of ischemic stroke over the past 5 years, highlighting the key clinical trials and novel interventions. The optimization of traditional risk factor management and the emergence of novel therapeutic methods have provided more options for clinical practice. Future research should focus on identifying the optimal treatment strategies for specific patient subgroups and the clinical translation and application of new therapeutic methods.