Journal of Investigative Medicine最新文献

{"title":"Role of histone deacetylases and sirtuins in the ischaemic stroke: a systematic review and meta-analysis of animal studies.","authors":"Ali Majdi, Shahin Yaraghi, Ali Moharrami, Amirreza Ghaffari Tabrizi, Morteza Dojahani, Erfan Alirezapour, Kamyar Mansori, Mehdi Eskandari, Hossein Mostafavi","doi":"10.1136/svn-2025-004159","DOIUrl":"https://doi.org/10.1136/svn-2025-004159","url":null,"abstract":"<p><strong>Background: </strong>Treatment of ischaemic stroke requires exploration of novel neuroprotective strategies owing to the constraints of thrombolytic therapy. Recent research implies that modulation of histone deacetylases (HDAC) or sirtuins (SIRT) could be beneficial in achieving this goal.</p><p><strong>Methods: </strong>This systematic review and meta-analysis evaluates the effectiveness of HDAC/SIRT enzyme modulation in treating acute ischaemic stroke. It includes relevant studies but excludes human and in vitro research and non-primary studies. An electronic search was conducted across databases PubMed, Web of Science and Scopus until 20 March 2025. The methodological quality was assessed using a modified SYRCLE risk of bias tool. Infarct volume and neurological responses were extracted as key outcomes, and a random-effects meta-analysis of infarct volume was conducted for studies directly targeting HDAC/SIRT enzymes.</p><p><strong>Results: </strong>A review of 71 studies involving over 1600 animals focused on ischaemic stroke treatments, predominantly using male rodents in a transient middle cerebral artery occlusion model. Most treatments were administered intraperitoneally, starting from the inception of ischaemia until 5 days afterwards. Non-selective HDAC inhibitors and SIRT1 modulators were targeted most frequently. The meta-analysis on infarct volume with 95% CI showed an overall effect estimate of -1.529 and suggested that non-selective HDAC inhibitors exhibit the most promise in reducing infarct size. Additionally, agonists of SIRT3/7, SIRT6, SIRT1 and HDAC1, along with inhibitors of SIRT5, HDAC6 and HDAC3, may play a significant role in the treatment of ischaemic stroke. Importantly, neuroprotective treatments have been found to be most effective in reducing infarct volume when administered within 24 hours following ischaemia.</p><p><strong>Discussion: </strong>This study highlights the most promising neuroprotective trials for ischaemic stroke by focusing on infarct volume as a key outcome. However, relying exclusively on infarct volume may not fully capture the effectiveness of these treatments.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombolytic agents, more options, more challenges.","authors":"Yi Dong, Lu Xu, Lan Hong, Ye Liu, Wenjun Tu, Huaguang Zheng, Xinyi Leng, Yunyun Xiong, Xin Cheng, David Z Wang","doi":"10.1136/svn-2025-004072","DOIUrl":"https://doi.org/10.1136/svn-2025-004072","url":null,"abstract":"","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the effectiveness and safety of rescue balloon angioplasty versus stenting in acute large vessel occlusion after thrombectomy.","authors":"Yu Jiang, Chao Li, Mingchao Shi, Kangjia Song, Menglu Cong, Wenbin Zhang, Lanqi Li, Shouchun Wang","doi":"10.1136/svn-2024-003851","DOIUrl":"https://doi.org/10.1136/svn-2024-003851","url":null,"abstract":"<p><strong>Background: </strong>Intracranial atherosclerotic stenosis (ICAS) is a leading cause of failed mechanical thrombectomy (MT). To achieve successful recanalisation, rescue strategies such as balloon angioplasty and stenting are frequently employed. In this study, we aimed to investigate the comparative efficacy and safety of these strategies.</p><p><strong>Methods: </strong>We retrospectively analysed the data of 321 patients with ICAS-related large vessel occlusion (LVO) treated with rescue balloon angioplasty (n=212) or stenting (n=109) after MT. The primary outcome was favourable outcomes (modified Rankin Scale score of 0-2) at 3 months. Multivariate logistic regression identified predictors of outcomes, including subgroup analyses for anterior and posterior circulation.</p><p><strong>Results: </strong>Overall, data of 321 patients (median age, 60 (IQR, 53-67) years; 80.4% male) were analysed from an initial cohort of 1601 patients. At 3 months, the balloon group demonstrated a trend towards a higher rate of favourable outcomes (34.9% vs 45.8%; OR 0.62, 95% CI 0.36 to 1.09, p=0.098). The stent group showed a trend towards a higher incidence of symptomatic intracranial haemorrhage (11.0% vs 4.2%; OR 2.22, 95% CI 0.80 to 6.14, p=0.124). In the posterior circulation subgroup, favourable outcomes were significantly lower in the stent group (20.5% vs 41.5%; OR 0.32, 95% CI 0.10 to 0.98, p=0.047).</p><p><strong>Conclusion: </strong>Balloon angioplasty after MT may improve clinical outcomes to some extent in ICAS-related LVO with a lower incidence of intracranial haemorrhage compared with stenting, while stenting is an effective measure to prevent long-term restenosis.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting clinical outcome in posterior circulation large-vessel occlusion patients with endovascular recanalisation: the GNC score.","authors":"Jia-Qi Wang, Si-Qi Qiu, Wei Li, Jing Qiu, Thanh Nguyen, Hui-Sheng Chen","doi":"10.1136/svn-2025-004131","DOIUrl":"https://doi.org/10.1136/svn-2025-004131","url":null,"abstract":"<p><strong>Background and purpose: </strong>Acute ischaemic strokes caused by posterior circulation large-vessel occlusions (pc-LVOs) are associated with particularly poor prognoses, including significant disability and mortality rates. This study sought to develop and validate a novel scoring system for predicting functional outcomes in pc-LVO cases following successful endovascular recanalisation.</p><p><strong>Methods: </strong>We derived a predictive model from the DETECT-China cohort and externally validated it using the DETECT2-China dataset. Poor outcome was defined as a modified Rankin Scale score of 4-6 at 90 days. Cerebral circulation time (CCT), measured via digital subtraction angiography (DSA), served as a key predictor. Multivariable logistic regression was employed to construct the scoring system.</p><p><strong>Results: </strong>The training cohort comprised 92 patients, of whom 52 (56.5%) experienced poor outcomes. Multivariate analysis identified prolonged CCT (adjusted OR (aOR) 1.365; 95% CI 1.105 to 1.686; p=0.004), elevated admission National Institutes of Health Stroke Scale (NIHSS) (aOR 1.235; 95% CI 1.120 to 1.363; p<0.001) and higher blood glucose levels (aOR 1.345; 95% CI 1.023 to 1.769; p=0.034) as independent predictors. These variables were integrated into the GNC score (Glucose-NIHSS-CCT). The GNC score demonstrated excellent predictive performance for clinical outcome, good discrimination and calibration in this cohort, as well as the bootstrap validation. Importantly, the excellent performance of this score was further validated in DETECT2-China.</p><p><strong>Conclusions: </strong>This is the first report that CCT based on DSA is an independent prognostic marker in pc-LVO patients with successful recanalisation post-endovascular treatment. The GNC score, incorporating readily available clinical and angiographic parameters, offers a reliable tool for outcome prediction in this high-risk population.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic significance of contrast staining following mechanical thrombectomy in acute ischaemic stroke.","authors":"Jing Yan, Xiang Xu, Haiyan Li, Zhonghua Yang, Ximing Nie, Na Wei, Dandan Yu, Hongyi Yan, Miao Wen, Ling Wang, Liping Liu","doi":"10.1136/svn-2025-004113","DOIUrl":"https://doi.org/10.1136/svn-2025-004113","url":null,"abstract":"<p><strong>Background: </strong>Advances in endovascular thrombectomy (EVT) and extended treatment criteria have improved outcomes in acute ischaemic stroke (AIS). However, contrast staining (CS) on postoperative CT complicates clinical decision-making and outcome evaluation. We investigated the association between postoperative CS and 90-day clinical outcomes in AIS patients.</p><p><strong>Methods: </strong>In this multicentre observational study, we enrolled AIS patients treated with EVT who underwent non-contrast CT (NCCT) within 2 hours postprocedure. Patients were stratified into two groups based on the presence or absence of CS to further explore the relationship between CS characteristics and clinical outcomes. The primary outcome was poor functional outcome, defined as a modified Rankin Scale score ≥3 at 90 days, evaluated with the logistic regression analysis adjusted for age, sex and other clinical features.</p><p><strong>Results: </strong>Among the 420 patients (mean age 63 years; 74.3% male), CS was observed in 250 (59.5%) following EVT. Logistic regression analysis showed that CS was strongly associated with poor functional outcomes. At 3 months, the proportion of patients with functional dependence was significantly higher in the CS group (76.8%) compared with the non-CS group (62.4%). In addition, the CS group exhibited a higher death rate compared with the non-CS group (p=0.028). Our study found that CS in the pons, as well as larger and denser staining volumes, was often indicative of poor prognosis.</p><p><strong>Conclusion: </strong>In around half of AIS patients with EVT, CS can be observed and independently associate with poor clinical outcomes, primarily related to the location and density of CS.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of intravenous recombinant plasminogen activator treatment in Chinese patients with acute ischaemic stroke aged over 80 years: a retrospective cohort study.","authors":"Jiansheng Yang, Yu-Hui Huang, Wansi Zhong, Xiaoxian Gong, Yi Chen, Zhicai Chen, Haidi Jin, Shenqiang Yan, Liyan Huang, Chang-Zheng Yuan, Min Lou","doi":"10.1136/svn-2024-004004","DOIUrl":"https://doi.org/10.1136/svn-2024-004004","url":null,"abstract":"<p><strong>Background: </strong>Risks and benefits of intravenous recombinant tissue plasminogen activator (rt-PA) remain unclear among elderly patients with acute ischaemic stroke (AIS). This study investigated 1-year clinical outcomes of intravenous rt-PA treatment in Chinese patients aged >80 years with AIS.</p><p><strong>Methods: </strong>This retrospective multicentre study included patients with AIS aged >80 years from the Computer-based Online Database of Acute Stroke Patients for Stroke Management Quality Evaluation stroke registry platform between January 2017 and March 2020 who arrived at the hospital within 4.5 hours of symptom onset. Patients who received intravenous rt-PA were propensity score-matched (1:1) by baseline characteristics with those who did not receive reperfusion therapy. The primary outcome was modified Rankin scale (mRS) score 0-1 at 1 year; secondary outcomes were any intracranial haemorrhage (ICH) and all-cause mortality during hospitalisation, mRS 0-2, mRS score distribution and all-cause mortality at 1 year.</p><p><strong>Results: </strong>The analysis included 1560 propensity score-matched elderly patients (intravenous rt-PA, n=780; non-reperfusion, n=780). At 1 year, the intravenous rt-PA group had a higher proportion of patients with mRS 0-1 (27.7% vs 23.8%; OR 1.87, 95% CI 1.35 to 2.59, p<0.001), mRS 0-2 (37.3% vs 33.7%; OR 2.02, 95% CI 1.48 to 2.75, p<i><</i>0.001) and an overall shift towards better outcomes than placebo (mRS mean±SD score: 3.5±2.4 vs 3.7±2.3; OR 0.77, 95% CI 0.64 to 0.93, p=0.007). No significant differences were observed in any ICH and all-cause mortality during hospitalisation and at 1 year.</p><p><strong>Conclusions: </strong>This study provided real-world evidence for a positive benefit-risk profile of intravenous rt-PA in Chinese patients with AIS aged >80 years.</p><p><strong>Trial registration number: </strong>NCT05401149.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of GD-11 in patients with ischaemic stroke: a multicentre, double-blind, randomised, placebo-controlled, phase 2 trial.","authors":"Runhua Zhang, Gaifen Liu, Xingquan Zhao, Yilong Wang, Zixiao Li, Guofang Chen, Bo Liu, Yun Ling, Yongjun Wang, Shuya Li","doi":"10.1136/svn-2024-003338","DOIUrl":"10.1136/svn-2024-003338","url":null,"abstract":"<p><strong>Background: </strong>GD-11, a novel brain cytoprotective drug, was designed to be actively taken up and transported across the blood-brain barrier via the glucose transporter. This study aimed to evaluate the safety and efficacy of GD-11 for improving the recovery of patients with acute ischaemic stroke (AIS).</p><p><strong>Methods: </strong>A double-blind, randomised, placebo-controlled, phase 2 trial was conducted at 15 clinical sites in China. Patients aged 18-80 years with AIS within 48 hours were randomly assigned (1:1:1) to receive 160 mg GD-11, 80 mg GD-11 and placebo, two times a day for 10 days. The primary endpoint was a modified Rankin Scale (mRS) score of 0-1 at 90 days after treatment. The safety outcome was any adverse events within 90 days.</p><p><strong>Results: </strong>From 17 November 2022 to 22 March 2023, a total of 80 patients in the 160 mg GD-11 group, 79 patients in the 80 mg GD-11 group and 80 patients in the placebo group were included. The proportion of an mRS score of 0-1 at day 90 was 77.5% in the 160 mg GD-11 group, 72.2% in the 80 mg GD-11 group and 67.5% in the placebo group. Though no significant difference was found (p=0.3671), a numerically higher proportion was observed in the GD-11 group, especially in the 160 mg GD-11 group. The incidence of adverse events was similar across the three groups (p=0.1992).</p><p><strong>Conclusion: </strong>GD-11 was safe and well-tolerated. A dosage of GD-11 160 mg two times a day was recommended for a large trial to investigate the efficacy.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous transluminal angioplasty and stenting (PTAS) in patients with symptomatic intracranial vertebrobasilar artery stenosis (IVBS).","authors":"Ramtin Pourahmad, Kiarash Saleki, Sina Zoghi, Ramtin Hajibeygi, Hamed Ghorani, Amin Javanbakht, Sina Goodarzi, Parsa Alijanizadeh, Kelly Trinh, Ravi Shastri, Mohammad Ghasemi-Rad","doi":"10.1136/svn-2024-003224","DOIUrl":"10.1136/svn-2024-003224","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Approximately 20% of all transient ischaemic attacks (TIAs) and ischaemic strokes occur within the posterior circulation, with vertebrobasilar stenosis identified as the cause in roughly 25% of the cases. Studies have shown that about a quarter of these patients have atherosclerotic stenosis of at least 50% of the vertebrobasilar artery. Stenosis has been shown to be associated with an increased risk of 90-day recurrent vertebrobasilar stroke, particularly in the first few weeks, which is significantly higher when compared with patients with stenosis of the anterior circulation. Therefore, aggressive treatment is important for the patient's prognosis. Stenting is emerging as a promising therapeutic strategy for persistent ischaemia events that do not respond to the best medical treatment, but it is not without complications. We systematically reviewed the literature on percutaneous transluminal angioplasty and stenting (PTAS) for intracranial vertebrobasilar artery stenosis (IVBS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;PubMed, Web-of-Science and Scopus were searched upon the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to include prospective/retrospective cohort, randomised/non-randomised clinical trials and case series studies describing PTAS for IVBS. Pooled rates of intervention-related complications and outcomes were analysed with random-effect model meta-analysis using StataMP V.18.0 software.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;31 studies were found eligible which included 1928 cases. 1103 basilar artery stenosis cases were reported in 27 studies 0.65 (95% CI 0.53, 0.76), I&lt;sup&gt;2&lt;/sup&gt;: 99.72%. 648 vertebral cases were reported in 18 studies 0.60 (95% CI 0.49, 0.70), I&lt;sup&gt;2&lt;/sup&gt;: 97.49%. In four studies, the rate of vertebrobasilar stenosis cases calculated as a proportion of the total sample size was 0.10 (95% CI 0.05, 0. 15). Mean stenosis in 21 included studies was found to be 0.83 (95% CI 0.79, 0.88), I&lt;sup&gt;2&lt;/sup&gt;: 0.00%, which shows variation of baseline stenosis between studies was minimal. 51 deaths were recorded in 24 studies. Meta-analysis of mortality showed the overall rate of mortality was 0.03 (95% CI 0.02, 0.05), I&lt;sup&gt;2&lt;/sup&gt;: 44.90%. In 14 studies, symptomatic intracranial haemorrhage events were recorded at an overall rate of 0.01 (95% CI 0.00, 0.02), I&lt;sup&gt;2&lt;/sup&gt;: 0.00%. Generally, a follow-up period of at least 3 months was reported in the included studies. Furthermore, procedural stroke/TIA was evaluated in seven studies, four of which reported no events (0.03 (95% CI 0.00, 0.08), I&lt;sup&gt;2&lt;/sup&gt;: 20.38%). Mean time from initial symptoms to recanalisation was 23.98 (95% CI 18.56, 29.40), I&lt;sup&gt;2&lt;/sup&gt;=98.8%, p=0.00 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In certain individuals with medically unresolved, severe, symptomatic and non-acute IVBS, elective vertebrobasilar PTAS appears to be both safe and effective. Various stent designs and angioplasty-assisted techniq","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaesthesia modality on endovascular therapy outcomes in patients with large infarcts: a post hoc analysis of the ANGEL-ASPECT trial.","authors":"Fa Liang, Kangda Zhang, Youxuan Wu, Xinyan Wang, Xuan Hou, Yun Yu, Yunzhen Wang, Mengxing Wang, Yuesong Pan, Xiaochuan Huo, Ruquan Han, Zhongrong Miao","doi":"10.1136/svn-2024-003320","DOIUrl":"10.1136/svn-2024-003320","url":null,"abstract":"<p><strong>Objectives: </strong>Endovascular therapy (EVT) now penetrates the once obscure realm of large infarct core volume acute ischaemic stroke (LICV-AIS). This research aimed to investigate the potential correlation between different anaesthetic approaches and post-EVT outcomes in LICV-AIS patients.</p><p><strong>Methods: </strong>Between October 2020 and May 2022, the China ANGEL-Alberta Stroke Programme Early CT Score (ASPECT) trial studied patients with LICV-AIS, randomly assigning them to the best medical management (BMM) or BMM with EVT. This post hoc subgroup analysis categorised subjects receiving BMM with EVT into general anaesthesia (GA) and non-GA groups based on anaesthesia type. We applied multivariable logistic regression to evaluate the relationship between anaesthesia during EVT and patient functional outcomes, as measured by the modified Rankin scale (mRS), in addition to the occurrence of complications. Further adjustment for selection bias was achieved through propensity score matching (PSM).</p><p><strong>Results: </strong>In total, 230 patients with LICV-AIS were enrolled (GA 84 vs Non-GA 146). No significant difference was observed between the two groups in terms of the proportion of patients who achieved an mRS score of 0-2 at 90 days (27.4% for the GA group vs 31.5% for the non-GA group, p=0.51). However, the GA group had significantly longer median surgical times (142 min vs 122 min, p=0.03). Furthermore, GA was associated with an increased risk of postoperative pneumonia (adjusted OR 2.03, 95% CI 1.04 to 3.98). The results of PSM analysis agreed with the results of the multivariate regression analysis. No significant difference in intracranial haemorrhage incidence or mortality rate was observed between the groups.</p><p><strong>Conclusion: </strong>This post hoc analysis of subgroups of the ANGEL-ASPECT trial suggested that there may be no significant association between the choice of anaesthesia and neurological outcomes in LICV-AIS patients. However, compared with non-GA, GA prolongs the duration of EVT and is associated with a greater postoperative pneumonia risk.</p><p><strong>Trial registration number: </strong>NCT04551664.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnitude of systolic blood pressure reduction following endovascular treatment and clinical outcomes in acute large artery occlusion stroke.","authors":"Xianjun Huang, Xianhui Ding, Hao Wang, Qiankun Cai, Junfeng Xu, Zibao Li, Qian Yang, Zhiming Zhou, Jie Xu","doi":"10.1136/svn-2024-003221","DOIUrl":"10.1136/svn-2024-003221","url":null,"abstract":"<p><strong>Background: </strong>The impact of lowering systolic blood pressure (SBP) following endovascular treatment (EVT) in acute large vessel occlusion stroke (LVOS) patients remains unclear. We aimed to explore the effect of the magnitude of SBP reduction (SBPr) after EVT on outcomes in LVOS patients.</p><p><strong>Methods: </strong>We consecutively registered patients at three comprehensive stroke centres who had experienced EVT as a result of acute anterior circulation LVOS. SBPr was calculated as follows: (baseline SBP-mean SBP/baseline SBP)×100%. The 90-day modified Rankin Scale score ranging from 0 to 2 was defined as a favourable functional outcome. Based on CT scans obtained within 24 hours after procedure, symptomatic intracranial haemorrhage (sICH) was assessed according to the criteria of the European Cooperative Acute Stroke Study III.</p><p><strong>Results: </strong>We enrolled 1080 patients, of which 908 (84.1%) had successful recanalisation. In the overall cohort, SBPr was correlated with lower odds of sICH (SBPr±10% as a reference, 20%-30%: OR 0.460; 95% CI: 0.245 to 0.864; p=0.016; >30%: OR 0.304; 95% CI 0.123 to 0.749; p=0.010). In patients who achieved successful reperfusion, SBPr>30% was correlated with higher odds of a poor outcome (SBPr±10% as a reference, OR 2.150; 95% CI 1.268 to 3.645; p=0.004) and SBPr has a similar tendency towards reducing the incidence of sICH. In the subgroup analyses, baseline Alberta Stroke Programme Early CT (ASPECT) score (p_interact=0.024) modified the effect of SBPr on the 90-day outcome.</p><p><strong>Conclusion: </strong>Among patients with EVT, a significant drop in SBP may be related to a poor functional outcome and a reduced incidence of sICH. Baseline ASPECT score may be an important interacting factor in the association of SBPr with the 90-day outcome. This study provides new insights for individualised BP management in patients with EVT.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}