A prediction model for large vessel occlusion in suspected stroke patients based on available prehospital information

Objective:Early and accurate identification of large vessel occlusion(LVO)acute ischemic stroke(AIS)patients is critically important for stroke management.Practicable scales with simple items can facilitate prehospital paramedics distinguishing LVO-AIS patients with high efficiency and help to avoid unnecessary and costly delays.The current study aims to develop a screening tool to predict AIS-LVO patients based on prehospital available data.Method:A total of 251 suspected stroke patients who were transported to the emergency department of our hospital via emergency medical services were consecutively enrolled from August,2020 to January,2022.Data including demographic information,medical history,clinical manifestations,and vital signs were collected.A multivariate logistic regression model was developed based on statistically significant variables selected from univariate analysis.Result:Forty-two patients(16.7%)were diagnosed as LVO-AIS based on imaging validation at admission.A comprehensive model was developed with past medical history factors such as atrial fibrillation and coronary heart disease,vital signs such as systolic blood pressure,and prominent symptoms and signs such as gaze palsy,facial paralysis,and dysarthria.The model showed better diagnostic performance in terms of area under the receiver operating characteristic curves(0.884,95%CI,0.830-0.939),which was higher than other common prehospital prediction scales such as the Face,Arm,Speech,Time test(FAST),the Field Assessment Stroke Triage for Emergency Destination(FAST-ED)scale,and the Gaze-Face-Arm-Speech-Time test(G-FAST).Calibration curve analysis,decision curve analysis,and clinical impact curve analysis further validated the reliability,net benefit,and potential clinical impact of the prediction model,respectively.Conclusion:We conducted a prediction model based on prehospital accessible factors including past history of atrial fibrillation and coronary heart disease,systolic blood pressure,and signs such as gaze palsy,facial palsy,and dysarthria.The prediction model showed good diagnostic power and accuracy for identification of the high-risk patients with LVO and may become an effective tool for the LVO recognition in prehospital settings.Future studies are warranted to refine and validate the model further in order to enhance the accuracy and objectivity of clinical judgments.

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.

Gastric pentadecapeptide BPC 157 in cytoprotection to resolve major vessel occlusion disturbances,ischemia-reperfusion injury following Pringle maneuver,and Budd-Chiari syndrome

The stable gastric pentadecapeptide BPC 157 counteracts various venous occlusion-induced syndromes.Summarized are all these arguments,in the Robert’s cytoprotection concept terms,to substantiate the resolution of different major vessel occlusion disturbances,in particular ischemia-reperfusion injury following the Pringle maneuver and Budd-Chiari syndrome,which was obtained by BPC 157 therapy.Conceptually,there is new point(bypassed occluded or ruptured vessel,the equation endothelium maintenance→epithelium maintenance=blood vessel recruitment and activation towards defect or bypassing vessel occlusion),the recruitment of collateral blood vessels to compensate for vessel occlusion and reestablish blood flow.In this paper,we summarize the evidence of the native cytoprotective gastric pentadecapeptide BPC 157,which is stable in the human gastric juice,is a membrane stabilizer and counteracts gut-leaky syndrome.As a particular target,it is distinctive from the standard peptide growth factors,with particular molecular pathways involved,controlling VEGF and NO pathways.In the early 1990s,BPC 157 appeared as a late outbreak of the Robert’s and Szabo’s cytoprotection-organoprotection concept,epithelium,endothelium protection as previous theoretical/practical breakthrough in the 1980s,and brain-gut axis and gut-brain axis.As the time went on,with its reported effects,it is likely most useful theory practical implementation and justification.Meantime,several reviews suggest that BPC 157,which does not have a lethal dose(LD1),has profound cytoprotective activity,used to be demonstrated in ulcerative colitis and invented to multiple sclerosis trials.Likely,it may bring the theory to practical application,starting with the initial argument,no degradation in human gastric juice for more than 24 h,and thereby,the therapeutic effectiveness(including therapeutic per-oral regimen)and pleiotropic beneficial effects.

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.

Endovascular Application of Magnetic Resonance Double Mismatch Technique for Acute Anterior Circulation Large Vessel Occlusion with Cerebral Infarction in an Unknown Time Window

Objective:To investigate the clinical effects of applying the magnetic resonance double mismatch technique to endovascular treatment of acute anterior circulation,large vessel occlusion with cerebral infarction in an unknown time window.Methods:The research work was carried out in our hospital,the work was carried out from November 2018 to November 2019,the patients with acute anterior circulation large vessel occlusion with cerebral infarction who were treated in our hospital during this period,100 patients,50 patients with an unknown time window and 50 patients with definite time window were selected,and they were named as the experimental and control groups,given different examination methods,were given to investigate the clinical treatment effect.Results:Patients’data on HIHSS score before treatment,the incidence of intracranial hemorrhage and rate of Mrs≤2 rating after 90 days of treatment were not significantly different(P>0.05),which was not meaningful.The differences in data between the two groups concerning HIHSS scores were relatively significant before,and after treatment(P<0.05).Conclusion:The magnetic resonance double mismatch technique will be applied in the endovascular treatment of acute anterior circulation large vessel occlusion with cerebral infarction of unknown time window.

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.

A New Point of Consideration for the Definition of Minor Ischemic Stroke: Review

Stroke is the second highest cause of death globally and a leading cause of not only physical disability but also cognitive. Approximately two-thirds of Ischemic Stroke patients, who represent the most common type of stroke are found to have mild deficits. Minor stroke, sometimes also referred to as “mild stroke”, is often defined in research studies as a National Institute of Health Stroke Scale (NIHSS) score of 5 or less, although, the cut point for NIHSS score or standardized criterion to define minor stroke has not been established. In the past, many studies have been focusing on the definition of the minor stroke to better stabilize the acute treatment guidelines, to predict the functional outcome, and also for early risk factors stratification. Different studies use different criteria or different cut-points of NIHSS scores to define minor stroke. Aside from indecision of acute management of minor stroke, many other questions have been raised regarding minor strokes, for example, the interaction of large vessel occlusion with minor stroke, the prevalence rate of depression, anxiety, cognitive dysfunction, chronic head after minor stroke, and so on. Finding a universal definition for minor stroke is the key to establish the guideline for management for this group of patients. However, the guidance of treatment of minor stroke is not the focus of this review. The review will focus on the deep comprehension of minor stroke characteristics, summarizing the new findings related to minor stroke, and highlight the essential points to consider for characterizing mild stroke symptoms for a new direction guide for future studies.

Enhancement of oligodendrocyte autophagy alleviates white matter injury and cognitive impairment induced by chronic cerebral hypoperfusion in rats

Cognitive impairment caused by chronic cerebral hypoperfusion(CCH)is associated with white matter injury(WMI),possibly through the alteration of autophagy.Here,the autophagy—lysosomal pathway(ALP)dysfunction in white matter(WM)and its relationship with cognitive impairment were investigated in rats subjected to two vessel occlusion(2VO).The results showed that cognitive impairment occurred by the 28th day after 2VO.Injury and autophagy activation of mature oligodendrocytes and neuronal axons sequentially occurred in WM by the 3rd day.By the 14th day,abnormal accumulation of autophagy substrate,lysosomal dysfunction,and the activation of mechanistic target of rapamycin(MTOR)pathway were observed in WM,paralleled with mature oligodendrocyte death.This indicates autophagy activation was followed by ALP dysfunction caused by autophagy inhibition or lysosomal dysfunction.To target the ALP dysfunction,enhanced autophagy by systemic rapamycin treatment or overexpression of Beclin1(BECN1)in oligodendrocytes reduced mature oligodendrocyte death,and subsequently alleviated the WMI and cognitive impairment after CCH.These results reveal that early autophagy activation was followed by ALP dysfunction in WM after 2VO,which was associated with the aggravation of WMI and cognitive impairment.This study highlights that alleviating ALP dysfunction by enhancing oligodendrocyte autophagy has benefits for cognitive recovery after CCH.