Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"A unique case of cerebellar infarcts: Investigating the intersection of Type II proatlantal artery arising from the common carotid artery and cardiac malformations.","authors":"Allen Ye Fu, Arevik Abramyan, Emad Nourollah-Zadeh, Gaurav Gupta, Sudipta Roychowdhury, Srihari Sundararajan","doi":"10.1016/j.jstrokecerebrovasdis.2024.108140","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108140","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108140"},"PeriodicalIF":2.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640437","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":"Response to Dr. Lu X regarding \"Hybrid clinical-radiomics model based on fully automatic segmentation for predicting the early expansion of spontaneous intracerebral hemorrhage: A multi-center study\".","authors":"Menghui Wang, Xiang Wang, Yuanliang Xie","doi":"10.1016/j.jstrokecerebrovasdis.2024.108127","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108127","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108127"},"PeriodicalIF":2.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632560","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":"Sodium-glucose cotransporter protein 2 inhibition, plasma proteins, and ischemic stroke: A mediation Mendelian randomization and colocalization study","authors":"Zhiqing Chen ,&nbsp;Hongmei Meng ,&nbsp;Yujin Guo ,&nbsp;Huaiyu Sun ,&nbsp;Wuqiong Zhang ,&nbsp;Yu Guo ,&nbsp;Shuai Hou","doi":"10.1016/j.jstrokecerebrovasdis.2024.108136","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108136","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the effect of the sodium-glucose cotransporter protein 2 (SGLT2) inhibition on ischemic stroke (IS) and investigate the circulating proteins that mediate the effects of SGLT2 inhibition on IS.</div></div><div><h3>Methods</h3><div>The effects of SGLT2 inhibition on IS were evaluated using two-sample Mendelian randomization (MR) analyses. The 4,907 circulating proteins from the plasma proteome were assessed to identify potential mediators. Sensitivity, colocalization, and external validation analyses were conducted to validate critical findings. MR analyses were also used to evaluate the associations of SGLT2 inhibition with magnetic resonance imaging (MRI)-based biomarkers and functional prognoses post-IS.</div></div><div><h3>Results</h3><div>SGLT2 inhibition was significantly associated with decreased risks of IS (odds ratio (OR): 0.39, 95 % confidence interval (CI): 0.25–0.61, <em>p</em> = 3.53 × 10^-5) and cardioembolic stroke (OR: 0.16, 95 % CI: 0.07–0.37, <em>p</em> = 1.82 × 10^-5); the effect of SGLT2 inhibition on IS was indirectly mediated through pathways involving tryptophanyl-transfer RNA synthetase (WARS) (β:0.08, 95 % CI:0.15 – -0.01, <em>p</em> = 0.034) and matrix metalloproteinase 12 (MMP12) (β:0.06, 95 % CI:0.12 – -0.01, <em>p</em> = 0.016), with mediation proportions of 8.2 % and 6.8 %, respectively. The external validation confirmed the WARS mediating effect. In addition, the sensitivity and colocalization analyses and MR analyses of MRI biomarker-based and functional prognostic outcomes supported these results.</div></div><div><h3>Conclusion</h3><div>In this study, we demonstrated from a genetic perspective that SGLT2 inhibitors prevent the development of IS and improve functional prognostic outcomes and brain microstructural integrity. WARS and MMP12 may act as potential mediators, presenting a novel approach for IS intervention.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108136"},"PeriodicalIF":2.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632564","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":"Endovascular thrombectomy for distal medium vessel occlusions: A literature review.","authors":"Batool Aldaher, Anit Behera, Rami Z Morsi, Saryia Adra, Harsh Desai, Sachin A Kothari, Sonam Thind, Ahmad Chahine, Julián Carrión-Penagos, Archit Baskaran, Rohini Rana, Eric S Armbrecht, James E Siegler, Elisheva R Coleman, James R Brorson, Scott J Mendelson, Ali Mansour, Shyam Prabhakaran, Tareq Kass-Hout","doi":"10.1016/j.jstrokecerebrovasdis.2024.108134","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108134","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of substantial evidence supporting the safety and effectiveness of endovascular thrombectomy in treating distal medium vessel occlusions (DMVOs).</p><p><strong>Objective: </strong>To summarize the current evidence regarding endovascular thrombectomy for DMVOs.</p><p><strong>Methods: </strong>We conducted a narrative review of key articles related to the diagnosis and management of DMVOs. We manually searched PubMed and Google Scholar from January 2010 to July 2023, and only included articles published in the English language.</p><p><strong>Results: </strong>While diagnosing and treating DMVOs is tricky due to access limitations and potential limited benefit from mechanical clot removal, recent improvements in catheter and retrieval technology suggest that endovascular thrombectomy might be a potential treatment option. However, more high-quality research is needed to confirm its effectiveness for DMVOs.</p><p><strong>Conclusion: </strong>Experts disagree on how to classify DMVOs and what the best mode of endovascular treatment is.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108134"},"PeriodicalIF":2.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632623","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":"Endovascular Thrombectomy for Large Core Volume Acute Ischemic Stroke. Updated Systematic Review and Meta-Analysis","authors":"Mishaal Hukamdad ,&nbsp;José Biller MD ,&nbsp;Fernando D. Testai MD, PhD ,&nbsp;Gabriela Trifan MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108135","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108135","url":null,"abstract":"<div><h3>Background</h3><div>Several recent studies assessed the efficacy and safety of endovascular thrombectomy (EVT) for patients with acute ischemic stroke caused by an anterior circulation large vessel occlusion (LVO) with large core infarct volumes.</div></div><div><h3>Methods</h3><div>We performed a systematic review and meta-analysis from inception until July 2024 of all randomized clinical trials (RCTs) and observational studies to date comparing the efficacy and safety of EVT plus best medical management (MM) for acute ischemic stroke due to anterior circulation LVO with large core, versus MM alone. Primary efficacy outcome was optimal functional outcome defined by a 90-day modified Rankin scale score (mRS) of 0-2. Safety outcomes were risk of symptomatic intracranial hemorrhage (sICH) and 90-day mortality. Subgroup analyses were done by study design. Relative risk (RR) and 95 % CIs were calculated using random-effects models and heterogeneity was assessed by I² statistics.</div></div><div><h3>Results</h3><div>A total of 16 studies with 3,717 participants met inclusion criteria (6 RCTs and 10 observational studies). The quality of the evidence was moderate to high. Compared with MM alone, EVT increased the outcome of mRS 0-2 (RR = 2.91, 95 % CI [2.12, 4.01], I² = 63 %), decreased mortality (RR = 0.75 [0.63, 0.88], I² = 60 %), but did not influence the risk of sICH (I² = 14 %). When the analysis was restricted to data from RCTs (n = 1,887), EVT increased the outcome of mRS 0-2 (RR = 2.50 [1.89, 3.29], I² = 8 %) and sICH (RR = 1.71 [1.09, 2.66], I² = 0 %) but did not affect mortality (I² = 45 %). In observational studies (n = 1,830), patients receiving EVT had a higher likelihood of achieving an mRS 0-2 (RR = 3.39 [1.98-5.79], I² = 74 %), lower mortality (RR = 0.63 [1.49-0.82], I² = 50 %), but equal risk of sICH (I² = 29) than those receiving MM alone.</div></div><div><h3>Conclusion</h3><div>Among patients with LVO with large core infarct, EVT was associated with improved functional outcome at 90 days. When the analysis was restricted to RCTs, EVT increased the risk of sICH, but did not affect 90-day mortality. However, in real-world (observational) studies, EVT did not modify the risk of sICH but reduced 90-day mortality.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108135"},"PeriodicalIF":2.0,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632626","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":"Loganin attenuates the inflammation, oxidative stress, and apoptosis through the JAK2/STAT3 pathway in cerebral ischemia-reperfusion injury.","authors":"Yunfeng Xi, Xiaoli Hou, Yuan Huang, Yan Zhou, Yu Chen, Yixia Wang, Hong Cheng","doi":"10.1016/j.jstrokecerebrovasdis.2024.108114","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.108114","url":null,"abstract":"<p><strong>Background: </strong>Loganin, a monoterpene iridoid glycoside derived from Cornus officinalis Sieb. Et Zucc, has been reported to have anti-inflammatory and antioxidant activity. Nevertheless, the potential role and molecular mechanism of loganin in cerebral ischemia-reperfusion (I/R) injury are not well-understood. The purpose of the study was to explore the functional role of loganin in the inflammation, oxidative stress, and apoptosis in cerebral I/R injury in rats MATERIALS AND METHODS: Following middle cerebral artery occlusion (MCAO), 80 mg/kg of loganin was intragastrically administered for 7 consecutive days. Neuromotor function scores were performed 24 h after the last administration, and the cerebral infarction volume was determined by TTC straining. The expressions of IL-6, IL-1β, and TNF-α in the brain tissues of MCAO rats were detected by ELISA assay. The activities of ROS, SOD, and MDA were measured by ELISA assay as well. Cell apoptosis were was tested by TUNEL straining. Western blot assay was applied for measuring the protein levels RESULTS: We observed that the expressions of IL-6, IL-1β, and TNF-α were amplitude markedly elevated in the rats following MCAO. Treatment with loganin obviously reduced these expressions in the brain tissues of MCAO rats. ELISA assay showed that ROS generation and MDA activity were increased in MCAO group and it was decreased after treatment with loganin. However, loganin increased the SOD activity, which was reduced by MCAO operation. Moreover, loganin promoted neurological function improvement and inhibited cell apoptosis in the rats after MCAO. Mechanically, loganin triggered JAK2/STAT3 phosphorylation in the rats following MCAO, and activation of JAK2/STAT3 pathway rescued the inhibition effects of loganin on the inflammation, oxidative stress, and apoptosis CONCLUSIONS: These results provide evidence that loganin may alleviate the inflammation, oxidative stress, and apoptosis through the JAK2/STAT3 pathway in MCAO rats.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108114"},"PeriodicalIF":2.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632636","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":"Relationship between high levels of D-dimer and prognosis in patients with spontaneous supratentorial cerebral haemorrhage: A retrospective study and double validation","authors":"ZhenKun Xiao PhD ,&nbsp;Xingyu Mao MS ,&nbsp;Bing Wang PhD ,&nbsp;YiBo Yang MS ,&nbsp;Jie Niu MD ,&nbsp;Yong-Mei Yang PhD ,&nbsp;Ai-Hua Liu PhD ,&nbsp;Yong-Hong Duan MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108129","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108129","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to investigate the correlation between D-Dimer and unfavorable outcome after surgery for spontaneous supratentorial intracerebral hemorrhage(SSICH)</div></div><div><h3>Methods</h3><div>A total of 557 patients with spontaneous supratentorial intracerebral hemorrhage underwent surgical treatment, which included craniotomy evacuation of hematoma and puncture and drainage. Based on the modified Rankin Scale (mRS) bifurcation, the patients were divided into two subgroups: favorable outcome (mRS score 0–2) and unfavorable outcome (mRS score 3-5). D-dimer levels were measured within 24 h of admission, monitored until discharge, and grouped by quartiles (Q1-Q4). We collected and calculated D-dimer levels at different periods of time: (1) at admission (pre-surgery); (2) average post-surgery level; (3) average level during hospitalization; and (4) peak level during hospitalization. Two methods were used for validation, the first using a traditional multifactorial Logsitic regression equation, and the second where we chose baseline clinical, laboratory, and other variables and constructed a prognostic model through multivariate logistic regression.</div></div><div><h3>Results</h3><div>Statistical results showed statistically significant differences in age, Glasgow Coma Score (GCS) on admission, high levels of D-dimer, and bleeding. Predictive models developed on the basis of initial age, GCS, and D-Dimer showed good discriminatory power</div></div><div><h3>Conclusions</h3><div>D-dimer is an independent risk factor for the development of poor postoperative prognosis in patients with SSTICH, and a prognostic model developed on the basis of D-Dimer predicts the development of poor postoperative prognosis in patients with SSTICH. The model needs to be validated in larger studies conducted at other institutions.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108129"},"PeriodicalIF":2.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632648","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":"Perception and acquaintance of stroke specialists on non-inferiority trials: An international survey","authors":"Aristeidis H. Katsanos MD ,&nbsp;Vasileios-Arsenios Lioutas MD ,&nbsp;Laetitia Yperzeele MD ,&nbsp;Teresa Ullberg MD ,&nbsp;Linxin Li MD ,&nbsp;Emily R. Ramage PhD ,&nbsp;Ivan A. Koltsov MD, PhD ,&nbsp;Julia Shapranova MSc ,&nbsp;George Howard DrPH ,&nbsp;Philip M. Bath FMedSci ,&nbsp;Maria Khan MD ,&nbsp;World Stroke Organization Future Leaders","doi":"10.1016/j.jstrokecerebrovasdis.2024.108132","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108132","url":null,"abstract":"<div><h3>Introduction</h3><div>The adoption of non-inferiority trial designs for assessing new interventions in stroke treatment is on the rise. We designed a survey to assess stroke specialists' understanding and familiarity with non-inferiority trials and margins.</div></div><div><h3>Methods</h3><div>A brief web-based questionnaire was sent to the members of the World Stroke Organization (WSO). The median acceptable non-inferiority margins in different research settings provided by responders were summarized and reported according to the acquaintance of responders with non-inferiority trials.</div></div><div><h3>Results</h3><div>A total of 120 WSO members from 42 countries responded to the survey. Thirty-two percent (32 %) of respondents self-identified as being very familiar with non-inferiority trials, while 6 % identified as extremely familiar. When asked about the impact of non-inferiority trials on improving stroke patient care, 42 % rated it as high and 45 % as moderate. 83 % of responders reported that the findings of non-inferiority trials affect their clinical practice. Ease of administration, relative effect of the standard treatment, clinical implications of inappropriately introducing the new treatment, availability, price, ease of storage and shipping were all considered as factors that should influence the size of the non-inferiority margin. The magnitude and variability of acceptable non-inferiority margins were seen to decrease as the acquaintance of responders with non-inferiority trials increased.</div></div><div><h3>Conclusion</h3><div>Although responders acknowledge the importance of non-inferiority trials, most have limited acquaintance with this research design. Educational activities are needed to enhance literacy in non-inferiority trials and the interpretation of non-inferiority margins.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108132"},"PeriodicalIF":2.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632555","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":"Association between apolipoprotein E gene polymorphism and early MR findings in individuals with acute intracerebral hemorrhage: A retrospective cohort analysis","authors":"Zhenjie Yang M.B. ,&nbsp;Qiuxia Xiong M.B. ,&nbsp;Rui He M.B. ,&nbsp;Chuyue Wu M.D., Ph.D. ,&nbsp;Yu Huang M.M. ,&nbsp;Qian Li B.N. ,&nbsp;Xinghua Liu M.M.","doi":"10.1016/j.jstrokecerebrovasdis.2024.108128","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108128","url":null,"abstract":"<div><h3>Objective</h3><div>The Apolipoprotein E (APOE) gene plays a significant role in the development and prognosis of intracerebral hemorrhage (ICH). Imaging features identified within 48 h of ICH onset, particularly on magnetic resonance imaging (MRI), are indicative of cerebral small vessel diseases (CSVD). Our study aimed to assess these imaging characteristics and investigate their association with the APOE gene among ICH patients.</div></div><div><h3>Methods</h3><div>Clinical and imaging data from patients meeting specific inclusion and exclusion criteria from October 2021 to March 2022 were collected. MR signs or scores were evaluated following international accreditation standards and then analyzed in connection with the APOE allele genes.</div></div><div><h3>Results</h3><div>In a cohort of 220 patients, ε2 was identified as an independent risk factor for the “multiple subcortical spots” sign (OR = 13.29, 95% CI 1.88-22.59). Furthermore, ε4 emerged as an independent risk factor for the presence of perivascular space (PVS) in the centrum semiovale (OR = 2.46, 95% CI 1.03-5.89) and basal ganglia (OR = 2.64, 95% CI 1.10-6.35), as well as for cerebral microbleeds (CMB) across all locations (OR = 2.38, 95% CI 1.15-6.97), lobar CMB (OR = 2.92, 95% CI 1.11-7.65), and deep CMB (OR = 2.29, 95% CI 1.12-8.67).</div></div><div><h3>Conclusion</h3><div>The association between APOE ɛ2 and ɛ4 alleles and the presence of “subcortical multiple spots,” “PVS,” and “CMB” indirectly implies the potential role of APOE gene-related pathological changes in the progression of ICH and small vessel pathology.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108128"},"PeriodicalIF":2.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632616","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":"Rationale and design of the efficacy and safety of combination of cilostazol and gingko biloba extract EGb 761 in patients with acute non-cardioembolic ischemic stroke (RENEW): A pilot and feasibility randomized controlled trial","authors":"Sang Hee Ha MD, PhD ,&nbsp;Young Bae Lee MD, PhD ,&nbsp;Hyun goo Kang MD, PhD ,&nbsp;Kwang-Ho Choi MD, PhD ,&nbsp;Beom Joon Kim MD, PhD ,&nbsp;Ho Geol Woo MD, PhD ,&nbsp;Hyuk Sung Kwon MD, PhD ,&nbsp;Tae-Jin Song MD, PhD ,&nbsp;Bum Joon Kim MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108105","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108105","url":null,"abstract":"<div><h3>Background</h3><div>Dual antiplatelet therapy with aspirin and clopidogrel is the standard treatment for acute ischemic stroke (AIS). Cilostazol has emerged as a safe alternative with pleiotropic effects that prevent stroke without increasing the risk of bleeding and has been shown to reduce neurological deterioration (ND) in the acute phase. Ginkgo biloba extract (EGb 761) has also been reported to improve neurological impairment following AIS. This trial aimed to evaluate the efficacy and safety of the combination of cilostazol and EGb 761 in reducing early stroke recurrence and ND in patients with non-cardioembolic AIS.</div></div><div><h3>Methods</h3><div>The RENEW trial is a prospective, randomized, active-controlled, double-blind, parallel, multicenter phase IV study. Five hundred patients with non-cardioembolic AIS presenting within 72 h of symptom onset will be randomized to receive either aspirin 100 mg and cilostazol 200 mg plus EGb 761 160 mg daily or aspirin 100 mg and clopidogrel 75 mg daily for 90 days. The primary outcomes included the combined ND rate during hospitalization and stroke recurrence within 90 days. Secondary outcomes included the rates of ND, recurrent AIS, hemorrhagic stroke, hemorrhagic transformation, functional outcomes (modified Rankin Scale 0–2), bleeding events, and changes in the dizziness handicap inventory scores.</div></div><div><h3>Discussion</h3><div>The RENEW trial is expected to provide evidence for the safety and efficacy of combining aspirin, cilostazol, and EGb 761 as an alternative to standard therapy for the acute management of non-cardioembolic AIS.</div></div><div><h3>Trial Registration</h3><div>This trial was registered at ClinicalTrials.gov (NCT05445895).</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108105"},"PeriodicalIF":2.0,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632558","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}