Mechanical thrombectomy and postoperative complications after acute ischemic stroke with large vessel occlusion

Acute ischemic stroke is one of the common discases in Chinese,among which acute ischemic stroke with large vessel occlusion(AIS-LVO)has thc most serious complications and has the risk of death.Studies have shown that reperfusion is a first-line treatment for the effective rescue of ischemic brain tissue,usually mainly by mechanical|hrombectomy(MT),supplemented by intravenous thrombolysis.However,there are still complications after large blood vessel occlusion and MT.such as blecding and infection at the puncture point,vasospasm,vascular dissection,subarachnoid hemorrhage,hcmonhagic transfomation,reembolization,and massive cerebral infarction,ctc.The high risk factors and corresponding measures of complications after MT by revicwing the rescarch analysis.

Clinical characteristics and treatment strategies of acute ischemic stroke with internal carotid artery occlusion: a case report

Acute ischemic stroke has the characteristics of high disability,lethality and recurrence rate,which seriously threatens the health of middle-aged and elderly people.This article describes the acute ischemic stroke with internal carotid artery occlusion as the main clinical feature and discusses its treatment strategy.Treatment remedies:clinical diagnosis was carried out based on the present medical history,physical examination and craniocerebral CT(computed tomography).Neurological function was improved by intravenous thrombolysis,cerebrovascular angiography was used to clarify cerebrovascular occlusion,cerebral blood supply was identified by CT perfusion,and neurological function recovery was followed up.After intravenous thrombolysis,the patient’s consciousness turned clear and the right limb muscle strength recovery was not obvious,but the patient did not receive bridging therapy.Cerebral angiography showed about 90%stenosis at the beginning of the left internal carotid artery,and the blood flow terminated at the C7 segment.Cerebral CT perfusion imaging showed decreased perfusion in the left cerebral hemisphere,but the patient did not receive carotid endarterectomy and vascular bypass treatment.Post treatment evaluating:follow-up showed that NIHSS(National Institute of Health stroke scale)score was significantly decreased and limb function was significantly restored.Conclusion:early intravenous thrombolytic therapy can help reduce the area of ischemic penumbra and improve long-term prognosis.Severe vascular stenosis can stimulate vascular compensation,significantly reduce the range of ischemia when thrombus occurs,and effectively reduce the disability rate without bridging therapy.Whether vascular stenosis and occlusion are treated by vascular bypass,etc.,individualized plans should be made according to vascular compensation.

Effect of coronary artery revascularization on in-hospital outcomes and long-term prognoses in acute myocardial infarction patients with prior ischemic stroke

Objective To investigate whether coronary artery revascularization therapies （CART）, including percutaneous coronary intervention （PCI） and coronary artery bypass grafting （CABG）, can improve the in-hospital and long-term outcomes for acute myocardial infarction （AMI） patients with prior ischemic stroke （IS）. Methods A total of 387 AMI patients with prior IS were enrolled consecutively from January 15, 2005 to December 24, 2011 in this cohort study. All patients were categorized into the CART group （n = 204） or the conservative medications （CM） group （n = 183）. In-hospital cardiocerebral events and long-term mortality of the two groups after an average follow-up of 36 months were recorded by Kaplan-Meier survival curves and compared by Logistic regression and the Cox regression model. Results The CART patients were younger （66.5 ± 9.7 years vs. 71.7 ± 9.7 years, P 〈 0.01）, had less non-ST segment elevation myocardial infarction （11.8% vs. 20.8%, P = 0.016） and more multiple-vascular coronary lesions （50% vs. 69.4%, P = 0.031）. The hospitalization incidence of cardiocerebral events in the CART group was 9.3% while 26.2% in the CM group （P 〈 0.01）. CART significantly reduced the risk of in-hospital cardiocerebral events by 65% [adjusted odds ratio （OR） = 0.35, 95% CI： 0.13-0.92]. By the end of follow-up, 57 cases （41.6%） died in CM group （n = 137） and 24 cases （12.2%） died in CART group （n = 197）. Cox regression indicated that CART decreased the long-term mortality by 72% [adjusted hazard ratio （HR） = 0.28, 95% CI： 0.064）.46], while categorical analysis indicated no s{gnificant dif- ference between PCI and CABG. Conclusions CART has a significant effect on improving the in-hospital and long-term prognoses for AMI patients with prior IS.

High-frequency repetitive transcranial magnetic stimulation promotes neural stem cell proliferation after ischemic stroke

Prolife ration of neural stem cells is crucial for promoting neuronal regeneration and repairing cerebral infarction damage.Transcranial magnetic stimulation(TMS)has recently emerged as a tool for inducing endogenous neural stem cell regeneration,but its underlying mechanisms remain unclea r In this study,we found that repetitive TMS effectively promotes the proliferation of oxygen-glucose deprived neural stem cells.Additionally,repetitive TMS reduced the volume of cerebral infa rction in a rat model of ischemic stro ke caused by middle cerebral artery occlusion,im p roved rat cognitive function,and promoted the proliferation of neural stem cells in the ischemic penumbra.RNA-sequencing found that repetitive TMS activated the Wnt signaling pathway in the ischemic penumbra of rats with cerebral ischemia.Furthermore,PCR analysis revealed that repetitive TMS promoted AKT phosphorylation,leading to an increase in mRNA levels of cell cycle-related proteins such as Cdk2 and Cdk4.This effect was also associated with activation of the glycogen synthase kinase 3β/β-catenin signaling pathway,which ultimately promotes the prolife ration of neural stem cells.Subsequently,we validated the effect of repetitive TMS on AKT phosphorylation.We found that repetitive TMS promoted Ca2+influx into neural stem cells by activating the P2 calcium channel/calmodulin pathway,thereby promoting AKT phosphorylation and activating the glycogen synthase kinase 3β/β-catenin pathway.These findings indicate that repetitive TMS can promote the proliferation of endogenous neural stem cells through a Ca2+influx-dependent phosphorylated AKT/glycogen synthase kinase 3β/β-catenin signaling pathway.This study has produced pioneering res ults on the intrinsic mechanism of repetitive TMS to promote neural function recove ry after ischemic stro ke.These results provide a stro ng scientific foundation for the clinical application of repetitive TMS.Moreover,repetitive TMS treatment may not only be an efficient and potential approach to support neurogenesis for further therapeutic applications,but also provide an effective platform for the expansion of neural stem cells.

Analysis on Endovascular Therapy for Acute Ischemic Stroke with Large Vessel Occlusion and Large-Scaled Core Infarct Volume in the Time Window

Patients who received endovascular therapy (EVT) for acute ischemic stroke with large vessel occlusion (AIS-LVO) and large-scaled core infarct volume in the time window were analyzed. Literature data were reviewed. Results showed that although EVT is the first choice to AIS-LVO, patients often have poor prognosis. Alberta stroke program early CT score (ASPECTS) based on computerized tomography angiography source image (CTA-SI) can reflect the real cerebral perfusion more truly, and it can assess the size of core infarct more quickly and accurately, thus enabling to judge prognosis.

Vertebral Artery Stenting for Acute Multiple Cerebral Infarctions Caused by Vertebral Artery Dissection After Massage:A Case Report

Vertebral artery dissection is a rare pathology that can cause ischemic stroke in young people.Cervical massage,especially improper pulling manipulation,is a cause of vertebral artery dissection.We present a case of 32-year old woman who developed acute multiple posterior circulation ischemic cerebral infarctions as a result of left vertebral artery V4 segment dissection after receiving neck massage.She underwent emergency vertebral artery stent implantation at the site of the dissection.Symptoms were relieved the day after treatment.The patient recovered without adverse complications or endovascular restenosis in the following year.

Subintimal recanalization for non-acute occlusion of intracranial vertebral artery in an emergency endovascular procedure:A case report

BACKGROUND Endovascular recanalization of non-acute intracranial artery occlusion is technically difficult,particularly when the microwire enters the subintima.Although the subintimal tracking and re-entry technique has been well established in the endovascular treatment of coronary artery occlusion,there is limited experience with its use in intracranial occlusion due to anatomical variations and a lack of dedicated devices.CASE SUMMARY A 74-year-old man was admitted to the hospital two days after experiencing acute weakness in both lower extremities,poor speech,and dizziness.After admission,imaging revealed acute ischemic stroke and non-acute occlusion of bilateral intracranial vertebral arteries(ICVAs).On the fourth day of admission,the patient's condition deteriorated and an emergency endovascular recanalization of the left ICVA was performed.During this procedure,a microwire was advanced in the subintima of the vessel wall and successfully reentered the distal true lumen.Two stents were implanted in the subintima.The patient's Modified Rankin Scale was 1 at three months postoperatively.CONCLUSION We present a technical case of subintimal recanalization for non-acute ICVA occlusion in an emergency endovascular procedure.However,we emphasize the necessity for caution when applying the subintimal tracking approach in intracranial occlusion due to the significant dangers involved.

Different strategies for ultra-early reperfusion therapy in anterior circulation acute ischemic stroke safety and effectiveness of the comparative observation

Background:To compare the safety and effectiveness of direct mechanical thrombectomy and bridging therapy for stroke with acute anterior circulation large vessel occlusion within 4.5 hours of onset.Methods:Retrospectively collected from 66 patients with acute ischemic stroke admitted to the Department of Neurology of Tongliao Hospital and Xuanwu Hospital from August 2019 to November 2021 within 4.5 hours.According to the different recanalization methods,30 patients were assigned to the direct thrombectomy treatment group,and 36 patients in the bridging treatment group(i.e.,the intravenous thrombolysis bridging mechanical thrombectomy treatment group).The primary outcome measure was the neurological outcome at the onset of 90d.Secondary outcome measures were intraoperative vascular recanalization and reperfusion,and the US National Institute of Health Stroke Scale score at 24 hours after surgery.The primary safety indicators are intracranial hemorrhage,including symptomatic intracranial hemorrhage and non-symptomatic intracranial hemorrhage,and 90d mortality.Results:The direct thrombectomy group had lower body mass index,hypertension and baseline Alberta early computed tomography score than the bridging treatment group,and longer time from onset to visit than the bridging group(206.5(119.5,256.25)min vs.150.5(25.205,212.75)min),the above difference were statistically significant(P<0.05).There were no significant differences in successful vascular reperfusion(93%vs.89%),24 hours postoperative National Institute of Health Stroke Scale score(11(5,18)vs.11(5,20)),intracranial hemorrhage(11%vs.14%),symptomatic intracranial hemorrhage(7%vs.17%),90d mRS0 to 2 points(43%vs.36%)and 90d mortality(23%vs.22%)(P>0.05).Conclusion:Similar clinical efficacy and safety of direct mechanical thrombectomy and bridging therapy for acute anterior circulation large vessel occlusive stroke within 4.5 hours of onset,direct thrombectomy can be used as an alternative scheme for acute anterior circulation intracranial large artery occlusive stroke.

Predictors of short-term outcome in patients with acute middle cerebral artery occlusion: unsuitability of fluid-attenuated inversion recovery vascular hyperintensity scores

Fluid-attenuated inversion recovery （FLAIR） vascular hyperintensity （FVH） is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the present study was to assess a FVH score and explore its relationship with clinical outcomes. Patients with acute ischemic stroke due to middle cerebral artery M1 occlusion underwent magnetic resonance imaging and were followed up at 10 days （National Institutes of Health Stroke Scale） and 90 days （modified Rankin Scale） to determine short-term clinical outcomes. Effective collateral circulation indirectly improved recovery of neurological function and short-term clinical outcome by extending the size of the pial penumbra and reducing infarct lesions. FVH score showed no correlation with 90-day functional clinical outcome and was not sufficient as an independent predictor of short-term clinical outcome.

Middle cerebral artery occlusion methods in rat versus mouse model of transient focal cerebral ischemic stroke

Experimental stroke research commonly employs focal cerebral ischemic rat models （Bederson et al., 1986a; Longa et al., 1989）. In human patients, ischemic stroke typically results from thrombotic or embolic occlusion of a major cerebral artery, usually the mid- dle cerebral artery （MCA）. Experimental focal cerebral ischemia models have been employed to mimic human stroke （Durukan and Tatlisumak, 2007）. Rodent models of focal cerebral ischemia that do not require craniotomy have been developed using intraluminal suture occlusion of the MCA （MCA occlusion, MCAO） （Rosamond et al., 2008）. Furthermore, mouse MCAO models have been wide- ly used and extended to genetic studies of cell death or recovery mechanisms （Liu and McCullough, 2011）. Genetically engineered mouse stroke models are particularly useful for evaluation of isch- emic pathophysiology and the design of new prophylactic, neuro- protective, and therapeutic agents and interventions （Armstead et al., 2010）. During the past two decades, MCAO surgical techniques have been developed that do not reveal surgical techniques for mouse MCAO model engineering. Therefore, we compared MCAO surgical methods in rats and mice.

Successful recanalization with multimodality endovascular interventional therapy in acute ischemic stroke

Stroke is an important cause of death and disability in adults. However, effective treatments for patients with acute ischemic stroke are limited. Intravenous recombinant tissue plasminogen activator(iv rtPA) within 4.5 h after onset has been approved as a standard treatment for patients with acute ischemic stroke. However, due to time constraints, less than one percent of acute ischemic stroke patients in Thailand are able to obtain iv rtPA. Although endovascular interventional therapy has not yet been approved as standard treatment in acute ischemic stroke, it is the one of the potentially effective treatment options. There are several reliable methods of endovascular therapy for acute ischemic stroke patients. Endovascular interventional therapy has rarely been done in Thailand. We report seven patients with successful recanalization after endovascular treatment in acute large vessel stroke from a single stroke center in Thailand. Patient screening and selection with multimodal imaging protocol and multimodality methods of endovascular interventional therapy are described.

miR-181b promotes angiogenesis and neurological function recovery after ischemic stroke

Promotion of new blood vessel formation is a new strategy for treating ischemic stroke.Non-coding miRNAs have been recently considered potential therapeutic targets for ischemic stroke.miR-181b has been shown to promote angiogenesis in hypoxia and traumatic brain injury model,while its effect on ischemic stroke remains elusive.In this study,we found that overexpression of miR-181b in brain microvascular endothelial cells subjected to oxygen-glucose deprivation in vitro restored cell prolife ration and enhanced angiogenesis.In rat models of focal cerebral ischemia,ove rexpression of miR-181b reduced infarction volume,promoted angiogenesis in ischemic penumbra,and improved neurological function.We further investigated the molecular mechanism by which miR-181b participates in angiogenesis after ischemic stroke and found that miR-181b directly bound to the 3’-UTR of phosphatase and tensin homolog(PTEN) mRNA to induce PTEN downregulation,leading to activation of the protein kinase B(Akt) pathway,upregulated expression of vascular endothelial growth facto rs,down-regulated expression of endostatin,and promoted angiogenesis.Taken togethe r,these results indicate that exogenous miR-181b exhibits neuroprotective effects on ischemic stro ke through activating the PTEN/Akt signal pathway and promoting angiogenesis.

Pharmacodynamic evaluation of Cordyceps sinensis (Berk.) Sacc. for ischemic stroke in rats and potential mechanism through network pharmacology and molecular docking

Objective:To explore the therapeutic potential of Cordyceps sinensis(Berk.)Sacc.(C.sinensis,Dong Chong Xia Cao)in an ischemic stroke(IS)model and predict its possible mechanism through network pharmacology.Methods:Thirty-three SpragueeDawley rats were randomly divided into the Sham,model,and C.sinensis groups.After 5 days of pre-treatment,the model group and the C.sinensis group were sub-jected to middle cerebral artery occlusion(MCAO)modeling.Effect of C.sinensis on MCAO rats was evaluated by comparing cerebral infarct size,neurological function,cerebral water content,pathological changes,and certain biochemical indicators.Intersection targets between C.sinensis and IS was screened using network pharmacology analysis.Relationship among core components,targets and pathways of C.sinensis in treating IS was constructed through network pharmacology analysis and further verified by molecular docking.Finally,the DAVID v8.8 database was used for performing GO analysis and KEGG pathway enrichment analysis by importing the intersection targets.Results:Compared with the model group,C.sinensis significantly reduced the volume of cerebral infarction(P=0.026),the cerebral water content(P¼.0013),the mNSS score(P<0.001),and the levels of IL-17(P=0.031),TNF-α(P=0.016),MDA(P=0.014),and glutamate(P=0.014)in serum,while upregulating the level of SOD in serum and improving the pathological morphology in MCAO rat ischemic brains.The results of network pharmacology analysis showed that core targets(such as CASP3,PTGS2,and PPARG)and the main enrichment pathways(IL-17,AGE-RAGE,and TNF signaling pathways)were regulated by 30 chemical components of C.sinensis,which effectively treated IS in MCAO rats.Conclusion:The results of this study showed that C.sinensis effectively interfered with MCAO rats,and the mechanism may be related to the regulation of blood lipids and to anti-apoptosis and anti-inflammatory effects.

Application of retrievable Solitaire AB stents in the endovascular treatment of acute ischemic stroke

Purpose: Retrievable stents are widely used in acute ischemic stroke(AIS); however, the results remain unclear in Chinese patients. This study aimed to explore the usefulness of Solitaire AB stents in AIS. Materials and Methods: Seventy-three AIS patients treated with Solitaire AB stents for thrombectomy of large artery occlusion of anterior circulation in January 2014-June 2015 were retrospectively evaluated. Recanalization was assessed with the Thrombolysis In Cerebral Ischemia(TICI) scale. Clinical outcomes were assessed according to the National Institute of Health Stroke Scale(NIHSS) and the modified Rankin Scale(mRS). Operation-related complications were recorded. The main factors affecting successful recanalization with Solitaire AB were analyzed. Results: The 73 patients enrolled included 39 males and 34 females(median age of 59 [31-78] years); 77 Solitaire AB stents were used. The initial recanalization rate with Solitaire AB as the first thrombectomy method was 53.42%(39/73; recanalization group). Among the 34 patients with failed stent retrieval, 32 underwent other treatments; the final arterial recanalization rate was 89.04%(65/73). Perioperative embolization events and symptomatic intracranial hemorrhage(sICH) occurred in 5 and 8 patients, respectively. The mean NIHSS score was 9.12±3.86 one week after thrombectomy, significantly lower compared with admission values. In 31 patients(42.47%), NIHSS score decreased by >8. Good functional independence(mRS score≤2) was achieved in 39 patients(53.42%) at 90 days; 12 patients(16.44%) died. Compared with the recanalization group, the remaining patients showed lower AF and higher LAA percentages. Conclusion: Solitaire AB stents are useful in the endovascular treatment of AIS.

Association of G-protein coupled purinergic receptor P2Y2 with ischemic stroke in a Han Chinese population of North China

The G-protein-coupled purinergic receptor P2Y2(P2RY2) plays an important role in the mechanism of atherosclerosis, which is relevant to ischemic stroke. This retrospective case-control study aimed to assess the relationship between P2RY2 gene polymorphisms and ischemic stroke risk in the northern Han Chinese population. In this study, clinical data and peripheral blood specimens were collected from 378 ischemic stroke patients and 344 controls. The ischemic stroke participants were recruited from the First Affiliated Hospital of China Medical University and the First Affiliated Hospital of Liaoning Medical University. The controls were recruited from the Health Check Center at the First Affiliated Hospital of China Medical University. Ischemic stroke patients were divided into two subgroups according to the Trial of ORG 10172 in Acute Stroke Treatment(TOAST) classification: large-artery atherosclerosis(n = 178) and small-artery occlusion(n = 200) strokes. All subjects were genotyped for three single nucleotide polymorphisms(rs4944831, rs1783596, and rs4944832) in the P2RY2 gene using peripheral venous blood samples. The distribution of the dominant rs4944832 phenotype(GG vs. GA+AA) differed significantly between small-artery occlusion patients and control subjects(odds ratio(OR) = 1.720, 95% confidence interval(CI): 1.203–2.458, P < 0.01). Multivariable logistic regression analysis revealed that the GG genotype of rs4944832 was significantly more prevalent in small-artery occlusion patients than in control subjects(OR = 1.807, 95% CI: 1.215–2.687, P < 0.01). The overall distribution of the haplotype established by rs4944831-rs1783596-rs4944832 was significantly different between ischemic stroke patients and controls(P < 0.01). In ischemic stroke patients, the frequency of the G-C-G haplotype was significantly higher than in control subjects(P = 0.028), whereas the frequency of the T-C-A haplotype was lower than in control subjects(P = 0.047). These results indicate that the G-C-G haplotype of P2RY2 is a susceptibility haplotype for ischemic stroke. In addition, the GG genotype of rs4944832 may be associated with the development of small-artery occlusion in the northern Han Chinese population. The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of China Medical University on February 20, 2012(No. 2012-38-1) and the First Affiliated Hospital of Liaoning Medical University, China, on March 1, 2013(No. 2013-03-1). All participants gave their informed consent. This trial was registered with the ISRCTN Registry(ISRCTN11439124) on October 24, 2018. Protocol version(1.0).

Low Ankle Brachial Index in Acute Ischemic Stroke: Does ApoE Gene Polymorphism Have a Role?

Background: The existence of asymptomatic peripheral arterial disease among patients with acute ischemic stroke has been studied and proved. Low ankle brachial index (ABI) is considered as a marker of atherosclerosis, and its relation to stroke severity was documented in some studies. The effect of different alleles of ApoE gene on acute ischemic stroke presentation in patients with low ABI is not known. Objective: To study the effect of ApoE gene polymorphism on stroke severity, outcome and recurrence in patients with asymptomatic peripheral arterial disease identified by low ABI. Methods: Patients with acute ischemic stroke were screened for the presence of asymp-tomatic peripheral arterial disease by estimating the ABI using a pocket Doppler ultrasound device. Assay of ApoE gene was done using the real-time PCR technique. Results: Low ABI was present in 31% of patients with acute ischemic stroke. There was no significant difference among patients with different ApoE alleles regarding the severity of their symptoms. Also, there was no significant difference among patients with normal ABI and those with abnormal ABI regarding the ApoE gene polymorphism. Conclusion: The current study showed that there was no significant relation between ApoE gene polymorphism and low ABI in ischemic stroke patients who had asymptomatic peripheral arterial disease.

Limb remote ischemic postconditioning protects integrity of the blood-brain barrier after stroke

Integrity of the blood-brain barrier structure is essential for maintaining the internal environment of the brain.Development of cerebral infarction and brain edema is strongly associated with blood-brain barrier leakage.Therefore,studies have suggested that protecting the blood-brain barrier may be an effective method for treating acute stroke.To examine this possibility,stroke model rats were established by middle cerebral artery occlusion and reperfusion.Remote ischemic postconditioning was immediately induced by three cycles of 10-minute ischemia/10-minute reperfusion of bilateral hind limbs at the beginning of middle cerebral artery occlusion reperfusion.Neurological function of rat models was evaluated using Zea Longa’s method.Permeability of the blood-brain barrier was assessed by Evans blue leakage.Infarct volume and brain edema were evaluated using 2,3,5-triphenyltetrazolium chloride staining.Expression of matrix metalloproteinase-9 and claudin-5 m RNA was determined by real-time quantitative reverse transcription-polymerase chain reaction.Expression of matrix metalloproteinase-9 and claudin-5 protein was measured by western blot assay.The number of matrix metalloproteinase-9-and claudin-5-positive cells was analyzed using immunohistochemistry.Our results showed that remote ischemic postconditioning alleviated disruption of the blood-brain barrier,reduced infarct volume and edema,decreased expression of matrix metalloproteinase-9 m RNA and protein and the number of positive cells,increased expression of claudin-5 m RNA and protein and the number of positive cells,and remarkably improved neurological function.These findings confirm that by suppressing expression of matrix metalloproteinase-9 and claudin-5 induced by acute ischemia/reperfusion,remote ischemic postconditioning reduces blood-brain barrier injury,mitigates ischemic injury,and exerts protective effects on the brain.

Inhibition of microRNA-29b suppresses oxidative stress and reduces apoptosis in ischemic stroke

MicroRNAs(miRNAs) regulate protein expression by antagonizing the translation of mRNAs and are effective regulators of normal nervous system development, function, and disease. Micro RNA-29 b(mi R-29 b) plays a broad and critical role in brain homeostasis. In this study, we tested the function of mi R-29 b in animal and cell models by inhibiting mi R-29 b expression. Mouse models of middle cerebral artery occlusion were established using the modified Zea-Longa suture method. Prior to modeling, 50 nmol/kg mi R-29 b antagomir was injected via the tail vein. Mi R-29 b expression was found to be abnormally increased in ischemic brain tissue. The inhibition of mi R-29 b expression decreased the neurological function score and reduced the cerebral infarction volume and cell apoptosis. In addition, the inhibition of mi R-29 b significantly decreased the malondialdehyde level, increased superoxide dismutase activity, and Bcl-2 expression, and inhibited Bax and Caspase3 expression. PC12 cells were treated with glutamate for 12 hours to establish in vitro cell models of ischemic stroke and then treated with the mi R-29 antagomir for 48 hours. The results revealed that mi R-29 b inhibition in PC12 cells increased Bcl-2 expression and inhibited cell apoptosis and oxidative damage. These findings suggest that the inhibition of mi R-29 b inhibits oxidative stress and cell apoptosis in ischemic stroke, producing therapeutic effects in ischemic stroke. This study was approved by the Laboratory Animal Care and Use Committee of the First Affiliated Hospital of Zhengzhou University(approval No. 201709276 S) on September 27, 2017.

Gelfoam embolization for distal, medium vessel injury during mechanical thrombectomy in acute stroke: A case report

BACKGROUND Arterial perforation has inevitably increased as endovascular treatments have become more common for intracranial large vessel occlusions,and even distal,medium vessel occlusions.A distal,medium vessel has a tortuous course and thinner wall compared to large arteries,making it more susceptible to damage.Here,we review the treatment strategies for arterial perforation during mechanical thrombectomy,and we report the case of a patient treated with gelfoam embolization.CASE SUMMARY A 63-year-old woman presented to the emergency department with sudden neurologic symptoms of right hemiparesis and global aphasia.The initial National Institutes of Health Stroke Scale score was 15.Computed tomography(CT)and CT angiography revealed hyperacute infarction and emergent arterial occlusion of the left middle cerebral artery M2-3 portion.During endovascular mechanical thrombectomy,arterial rupture occurred.The patient’s vital signs were stable,but delayed angiography showed persistent active bleeding.Therefore,selective embolization of the injured artery was performed using gelfoam.Subsequent left vertebral and internal carotid angiography was performed to confirm hemostasis.A localized subarachnoid hemorrhage(SAH)was confirmed on a follow-up CT scan.A repeated CT scan after 12 d showed resolution of the SAH,and rebleeding did not occur.CONCLUSION Rescue embolization with gelfoam could be considered an additional option in distal,medium vessel perforation.

Associations between thromboxane A synthase 1 gene polymorphisms and the risk of ischemic stroke in a Chinese Han population

Thromboxane A synthase 1 （TBXAS1） catalyses the synthesis of thromboxane A2 （TXA2）, which plays an important role in the pathogenesis of ischemic stroke. Thus, the TBXAS1 gene was investigated as a candidate gene involved in the formation of atherosclerosis. This case-control study collected peripheral blood specimens and clinical data of 370 ischemic stroke patients and 340 healthy controls in the Northern Chinese Han population from October 2010 to May 2011. Two TBXAS1 single-nucleotide polymorphisms, rs2267682 and rs10487667, were analyzed using a SNaPshot Multiplex sequencing assay to explore the relationships between the single-nucleotide polymorphisms in TBXAS1 and ischemic stroke. The TT genotype frequency and T allele frequency of rs2267682 in the patients with ischemic stroke were significantly higher than those in the controls （P 〈 0.01 and P = 0.02）. Furthermore, compared with the GG ＋ GT genotype, the TT rs2267682 genotype was associated with increased risk of ischemic stroke （odds ratio （OR） = 1.80, 95% confidence interval （CI）： 1.16–2.79, P 〈 0.01）. Multivariate logistic analysis with adjustments for confounding factors revealed that rs2267682 was still associated with ischemic stroke （OR = 1.94,95% CI ： 1.13–3.33, P = 0.02）. The frequency of the T-G haplotype in the patients was significantly higher than that in the controls according haplotype analysis （OR = 1.49, 95% CI： 1.10–2.00, P 〈 0.01）. These data reveal that the rs2267682 TBXAS1 polymorphism is associated with ischemic stroke. The TT genotype of TBXAS1 and T allele of rs2267682 increase susceptibility to ischemic stroke in this Northern Chinese Han population. The protocol has been registered with the Chinese Clinical Trial Registry （registration number： ChiCTR-COC-17013559）.