Journal of Stroke & Cerebrovascular Diseases最新文献

{"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}

{"title":"Investigating the role of gut microbiota in hemorrhagic stroke: Evidence from causal analysis","authors":"Jiaxin Li MD ,&nbsp;Chenyang Zang MD ,&nbsp;Peihong Li MD ,&nbsp;Dandan Sheng MD ,&nbsp;Zheng Xiao MD ,&nbsp;Bo Xiao MD, PhD ,&nbsp;Jian Xia MD ,&nbsp;Luo Zhou MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108131","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108131","url":null,"abstract":"<div><h3>Background</h3><div>Hemorrhagic stroke is potentially fatal and debilitating. Previous studies have indicated a potential correlation between gut microbiota and hemorrhagic stroke.</div></div><div><h3>Methods</h3><div>We conducted a two-sample Mendelian randomization (MR) study to assess the potential causal effects of gut microbiota on hemorrhagic stroke, including nontraumatic intracranial hemorrhage (ntICH), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). The inverse variance weighted (IVW) method was employed as the primary MR evaluation approach. Complementary methods of MR‒Egger, simple mode, weighted mode, and weighted median were utilized for validation. Heterogeneity and pleiotropy were assessed using Cochran's Q and MR‒Egger intercept tests. MR-PRESSO and leave-one-out analyses were employed to identify instrumental outliers.</div></div><div><h3>Results</h3><div>The IVW estimates demonstrated significant causal associations between ntICH and taxa from two classes (Clostridia, Methanobacteria), one order (Methanobacteriales), two families (Clostridiales vadin BB60 group, Methanobacteriaceae), and two genera (Catenibacterium, unknown genus id. 1000000073) (P&lt;0.05). Subgroup analyses revealed causal links between ICH and taxa from two classes (Clostridia, Methanobacteria), two orders (Methanobacteriales, Rhodospirillales), two families (Acidaminococcaceae, Methanobacteriaceae), and four genera (Butyricimonas, Catenibacterium, Lachnospiraceae UCG010, unknown genus id.2755) (P&lt;0.05). Furthermore, for the SAH subgroup, we identified causal associations with taxa from one family (Rikenellaceae) and six genera (Alloprevotella, Enterorhabdus, Hungatella, Lachnoclostridium, Parabacteroides, Ruminococcus gauvreauii group) (P&lt;0.05). These findings remained robust across all sensitivity tests.</div></div><div><h3>Conclusions</h3><div>Our findings provide support for the causal effects of specific gut microbial taxa on hemorrhagic stroke and identify promising targets for its prevention and therapy. Further research is warranted to validate these associations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108131"},"PeriodicalIF":2.0,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632632","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":"To bridge or not to bridge: The role of intravenous thrombolysis in mechanical thrombectomy for large cerebral infarctions through a two-center cohort study and meta-analysis","authors":"Wang Chen MD ,&nbsp;Lei Yang MD ,&nbsp;Simeng Wang MD ,&nbsp;Ji Liu MD ,&nbsp;Mengen Wang MD ,&nbsp;Jincheng Wu MD ,&nbsp;Wei Qin MD ,&nbsp;Xianjun Wang MD ,&nbsp;Wenli Hu MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108115","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108115","url":null,"abstract":"<div><h3>Background</h3><div>The effectiveness and safety of intravenous thrombolysis before mechanical thrombectomy (MT) in large cerebral infarctions remains uncertain. This study compares bridging MT, which includes intravenous thrombolysis, to direct MT without it.</div></div><div><h3>Methods</h3><div>Data from 298 patients with anterior circulation large cerebral infarctions, assessed via non-enhanced CT (ASPECTS 0-5), who underwent MT in two-center cohort studies, were analyzed. Primary outcomes focused on independent ambulation (modified Rankin Scale scores 0-3) at 90 days post-stroke. Safety outcomes included parenchymal hemorrhage (PH) rates and mortality. We conducted a sensitivity analysis considering the timing from symptom onset to imaging within 4.5 hours. Additionally, a meta-analysis of 17 studies involving 3527 patients assessed the interventions' effectiveness and safety, with further scrutiny of high-quality studies (Newcastle-Ottawa Scale ratings 7-9) to increase robustness of results.</div></div><div><h3>Results</h3><div>No significant differences were found in 90-day independent ambulation between the bridging MT and the direct MT group (adjusted odds ratio [aOR] 1.15, 95% CI 0.68-1.94). Rates of PH and mortality were also similar across groups. These outcomes were consistent in the subgroup imaged within 4.5 hours of symptom onset. The meta-analysis supported these outcomes, showing no improvement in ambulation (aOR 1.16, 95% CI 0.82-1.64) or reduction in PH with bridging MT. Further analysis of high-quality studies supported these results.</div></div><div><h3>Conclusions</h3><div>The cohort study and meta-analysis provide Class II evidence indicating no significant differences in functional outcomes or hemorrhagic risks between bridging and direct MT for large cerebral infarctions. This suggests that direct MT might be a viable alternative to bridging MT.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108115"},"PeriodicalIF":2.0,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632645","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":"Associations between chinese visceral adiposity index and incident stroke among community populations in Pudong New Area, Shanghai","authors":"Qingping Liu,&nbsp;Yi Zhou,&nbsp;Kang Wu,&nbsp;Jiahui Song,&nbsp;Juzhong Ke,&nbsp;Hua Qiu,&nbsp;Zhitao Li,&nbsp;Xiaonan Ruan","doi":"10.1016/j.jstrokecerebrovasdis.2024.108100","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108100","url":null,"abstract":"<div><h3>Background</h3><div>To analyze the relationship between Chinese Visceral Adiposity Index (CVAI) and stroke in Pudong New Area, and to provide a scientific basis for the prevention and treatment of this condition.</div></div><div><h3>Materials and Methods</h3><div>Based on the Follow-up Cohort Program of Chronic Disease Risk Factors in Pudong New Area, a total of 7,194 residents from 12 townships and 35 village committees or neighborhood committees were selected. The cohort data in 2016 served as the baseline, and a follow-up was conducted on 5462 individuals from 2019 to 2020.</div></div><div><h3>Results</h3><div>In the analysis of stroke incidence, 5,462 subjects were included, with 616 stroke events recorded. The incidence density of stroke was 33.41 per 1000 person-years, while the China standard rate and the world standard rate were 13.78 and 12.52 per 1000 person-years, respectively. The incidence density of stroke rose with increasing quartiles of CVAI. After adjusting for potential confounders, the risk of stroke for males and females with CVAI ≥ 132.11 was 2.492 times (95% CI: 1.457 ∼ 4.260) and 1.759 times (95% CI: 1.070-2.891), respectively, compared to the groups with CVAI &lt; 81.91. Among the eight obesity indicators, including CVAI, Visceral Adiposity Index (VAI), Body Mass Index (BMI), Waist Circumference (WC), Waist Hip Ratio (WHR), Waist Height Ratio (WHtR), Body Adiposity Index (BAI), A Body Shape Index (ABSI),and Body Roundness Index (BRI), CVAI has the highest diagnostic accuracy for female stroke using Receiver Operator Characteristic (ROC) curves (the Area under the ROC curve/AUC = 0.619). Subgroup analysis showed that smoking and dyslipidemia significantly modified the association between CVAI and stroke risk in females (interaction P &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>CVAI is identified as a significant risk factor for stroke and serves as a valuable predictor of stroke, particularly in females.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108100"},"PeriodicalIF":2.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632618","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":"Causal association between COVID-19 vaccination and thrombosis-related biomarkers/thrombosis/ischemic stroke: Mendelian randomization study","authors":"Xiaoqi Peng ,&nbsp;Lianjia Zhuo ,&nbsp;Yong Ma ,&nbsp;Yingxia Liu ,&nbsp;Zeming Wu","doi":"10.1016/j.jstrokecerebrovasdis.2024.108113","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108113","url":null,"abstract":"<div><h3>Background</h3><div>Observational studies about the association between coronavirus disease 2019 (COVID-19) vaccination and thrombosis/ischemic stroke are inconsistent. The aim of this study is to assess the causality between COVID-19 vaccination and thrombosis-related biomarkers/thrombosis/ischemic stroke using mendelian randomization (MR) analysis.</div></div><div><h3>Methods</h3><div>A two-sample MR analysis using publicly available genome-wide association study (GWAS) data was conducted. Causal effects were appraised using inverse variance weighted (IVW, as a primary method), with supplementary methods including constrained maximum likelihood and model averaging, MR-Robust Adjusted Profile Score, MR-Egger regression, simple mode, weighted median, and weighted mode. Sensitivity analyses were conducted using Cochran's Q test, MR-Egger intercept test, and leave-one-out analysis.</div></div><div><h3>Results</h3><div>Genetically predicted COVID-19 vaccination was negatively associated with C-C motif chemokine 3 [CCL3, odds ratio (OR): 0.694, 95% confidence intervals (CI): 0.484-0.995] and multiple coagulation factor deficiency protein 2 (MCFD2, OR: 0.806, 95% CI: 0.675-0.963). Meanwhile, the IVW analysis revealed significant causal effects between genetically predicted COVID-19 vaccination and ischemic stroke (OR: 1.088, 95% CI: 1.006-1.177), large artery stroke (LAS, OR: 1.251, 95% CI: 1.028-1.521). The leave-one-out analysis revealed that no individual SNP exerted a significant effect on the overall causal estimate.</div></div><div><h3>Conclusion</h3><div>Our study provided evidence supporting a potential causal association of genetically predicted COVID-19 vaccination with CCL3 levels, MCFD2 levels, ischemic stroke risk and LAS risk. These results provide preliminary evidence of potential adverse associations, but further studies are required to fully understand the mechanisms and to validate these findings across broader populations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108113"},"PeriodicalIF":2.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632621","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":"Hydroxysafflor Yellow A promotes angiogenesis of brain microvascular endothelial cells from ischemia/reperfusion injury via glycolysis pathway in vitro.","authors":"Juxuan Ruan, Lei Wang, Ning Wang, Ping Huang, Dennis Chang, Xian Zhou, Saiwang Seto, Dan Li, Jincai Hou","doi":"10.1016/j.jstrokecerebrovasdis.2024.108107","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.108107","url":null,"abstract":"<p><strong>Background: </strong>Angiogenesis of brain microvascular endothelial cells (BMECs) after cerebral ischemia was conducive to improving the blood supply of ischemia tissues, which was upregulated by glycolysis. Hydroxysafflor Yellow A (HSYA) mends damaged tissues through increasing angiogenesis.</p><p><strong>Methods: </strong>HSYA treated proliferation, migration and angiogenesis of BMECs in vitro in vitro during OGD/R. HSYA regulated the key enzymes of glycolysis, such as hexokinase 2 (HK2) and 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3 (PFKFB3), glucose uptake and products (pyruvate, ATP and lactate) were detected by western blot and kits, respectively. Scratch wound assay, transwell, tube formation and spheroid sprouting were used to explore the pathway that HSYA recovered migration and angiogenesis of BMECs. We evaluated the potential target of HSYA promoting glycolysis via molecular docking, drug affinity responsive target stability (DARTS) and cellular thermal shift assay (CETSA).</p><p><strong>Results: </strong>HSYA promoted the proliferation, migration, tube formation and spheroid sprouting of BMECs during OGD/R, and stimulated the expression of tip phenotype marker protein (CD34), and the receptor (Notch-1) that regulated the differentiation of endothelial cells into tip/stalk phenotype. In glycolysis, PFKFB3 expression was upregulated by HSYA; HSYA also improved ATP and pyruvate levels, as well as lactate release after OGD/R. Finally, upregulating VEGFA and p-VEGFR2 of HSYA was weakened because of suppressing glycolysis; the HSYA's improvement of BMECs migration and angiogenesis was attenuated under the inhibition of glycolysis, which confirmed that HSYA were upregulating angiogenesis and expression of VEGFA/VEGFR2 by glycolysis pathway. The result about molecular docking, DARTS and CETSA suggested that PFKFB3 was the possible target of HSYA.</p><p><strong>Conclusion: </strong>HSYA promotes angiogenesis of BMECs in vitro through the glycolysis mediated VEGFA/VEGFR2 pathway, and PFKFB3 is the potential target of HSYA to heighten glycolysis.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108107"},"PeriodicalIF":2.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632629","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":"Efficacy of anodal transcranial direct current stimulation for upper extremity function after ischemic stroke: A systematic review of parallel randomized clinical trials","authors":"Liqiang Yu RN, MS (Nurse) ,&nbsp;Han Chen MD, PhD (Associate Chief Physician) ,&nbsp;Chaiying Chen RN, BS (Charge Nurse) ,&nbsp;Yang Lin RN, BS (Associate Chief Nurse) ,&nbsp;Zhuofan Huang RN, BS (Charge Nurse) ,&nbsp;Jianhong Wang RN, MS (Associate Chief Nurse) ,&nbsp;Qiaoling Chen RN, MS (Chief Nurse)","doi":"10.1016/j.jstrokecerebrovasdis.2024.108112","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108112","url":null,"abstract":"<div><h3>Background</h3><div>Although existing studies had shown therapeutic effects of transcranial direct current stimulation (tDCS) on upper limb dysfunction after stroke, previous systematic reviews had mostly provided general analyses on the polarity of tDCS and the type of stroke, with inconsistent results. We aimed to determine the efficacy of anodal transcranial direct current stimulation in enhancing upper extremity function following ischemic stroke.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted across a variety of databases, spanning from their inception to March 15th, 2024.The focus was on parallel randomized clinical trials published that explored the impact of anodal transcranial direct current stimulation on upper extremity function in ischemic stroke patients. Data extraction and quality assessment were conducted independently by two reviewers. The Cochrane Risk of Bias Tool was utilized to assess the risk of bias in the included studies.</div></div><div><h3>Results</h3><div>A total of 19 studies involving 1032 participants were included in the analysis. The pooled results of these studies indicated that anodal transcranial direct current stimulation had a positive impact on the Fugl-Meyer Assessment Upper Extremity, Wolf Motor Function Test, Resting Motion Threshold, and Barthel Index Score in ischemic stroke patients with upper extremity dysfunction. Follow-up data suggested the potential long-term efficacy of anodal transcranial direct current stimulation in ischemic stroke. Reported adverse reactions indicated that anodal transcranial direct current stimulation was relatively safe for stroke patients.</div></div><div><h3>Conclusions</h3><div>Anodal transcranial direct current stimulation is an effective intervention and relatively safe and effective intervention for improving upper extremity function in ischemic stroke patients.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108112"},"PeriodicalIF":2.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592067","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":"Temporal trends in endovascular therapy for acute stroke in the era of modern mechanical thrombectomy: The JR-NET4 study","authors":"Mikito Hayakawa MD, PhD ,&nbsp;Hiroshi Yamagami MD, PhD ,&nbsp;Yuji Matsumarum MD, PhD ,&nbsp;Koji Hirata MD, PhD ,&nbsp;Hisayuki Hosoo MD, PhD ,&nbsp;Yoshiro Ito MD, PhD ,&nbsp;Aiki Marushima MD, PhD ,&nbsp;Wataro Tsuruta MD, PhD ,&nbsp;Koji Iihara MD, PhD ,&nbsp;Akira Ishii MD, PhD ,&nbsp;Hirotoshi Imamura MD, PhD ,&nbsp;Chiaki Sakai MD, PhD ,&nbsp;Tetsu Satow MD, PhD ,&nbsp;Shinichi Yoshimura MD, PhD ,&nbsp;Nobuyuki Sakai MD, DMSc ,&nbsp;the JR-NET4 Study Group","doi":"10.1016/j.jstrokecerebrovasdis.2024.108110","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108110","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to examine nationwide trends in acute stroke endovascular thrombectomy (EVT) following five pivotal trials in 2015 that established it as the ‘standard of care’.</div></div><div><h3>Methods</h3><div>The Japanese Registry of NeuroEndovascular Therapy 4 was a nationwide retrospective study registering consecutive patients who underwent neurointervention by specialists certified by the Japanese Society for Neuroendovascular Therapy at 166 centers from January 2015 to December 2019. We extracted patients who underwent EVT, and analyzed the annual trends in baseline characteristics, revascularization procedures and outcomes.</div></div><div><h3>Results</h3><div>A total of 13,090 patients (75.3 ± 12.2 years, 5637 women) were included. Analyses revealed an annual increase in patient age and treatments beyond 6 h after onset. However, there was an annual decline in premorbidly independent patients and those with large vessel occlusion. The frequency of stent-aspiration techniques and rate of successful reperfusions significantly increased from 19.9 % to 51.0 % and from 81.4 % to 83.9 %, respectively through the study period. Trends in patients achieving a favorable (modified Rankin Scale score of 0-2 at 30 days) or fatal outcome, or experiencing intracranial hemorrhagic complications remained unchanged. However, calendar time was associated with favorable outcomes after adjusting for clinical and treatment characteristics (odds ratio, 1.040; <em>P</em> = 0.015).</div></div><div><h3>Conclusions</h3><div>During the study period, EVT indications expanded for patients with characteristics linked to worse outcomes. However, factors such as advancements in techniques, have led to modest but significant improvements in reperfusion status, leading to maintenance of the post-EVT clinical outcomes.</div></div><div><h3>Registration</h3><div>URL: <span><span>https://www.umin.ac.jp/ctr/</span><svg><path></path></svg></span>; Unique identifier: UMIN000038869</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108110"},"PeriodicalIF":2.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583285","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":"Efficacy and safety of tirofiban plus recombinant tissue plasminogen activator versus recombinant tissue plasminogen activator alone in acute ischemic stroke patients: a meta-analysis","authors":"Yonghong Yang MB ,&nbsp;Qingwu Yang MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108111","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108111","url":null,"abstract":"<div><h3>Objective</h3><div>Tirofiban plus recombinant tissue plasminogen activator (rtPA) shows good efficacy and safety in treating acute ischemic stroke (AIS) patients, but there is a lack of comprehensive assessment. This meta-analysis aimed to compare the efficacy and safety of rtPA plus tirofiban with rtPA alone in AIS patients.</div></div><div><h3>Methods</h3><div>This meta-analysis retrieved studies comparing rtPA intravenous thrombolysis followed by tirofiban (rtPA+T group) versus rtPA intravenous thrombolysis alone (rtPA group) for AIS patients in Excerpt Medica Database, Web of Science, Cochrane, PubMed, China National Knowledge Infrastructure, Wanfang, and SinoMed until March 2024.</div></div><div><h3>Results</h3><div>Twenty studies with 2048 AIS patients were enrolled in this meta-analysis. National Institute of Health stroke scale (NIHSS) score after treatment was lower in the rtPA+T group than the rtPA group [standardized mean differences (SMD)=-1.41; 95 % confidence interval (CI)=-1.83, -0.98; <em>P</em>&lt;0.001]. The proportion of AIS patients achieving a favorable functional outcome (modified Rankin Scale score ≤2) was increased in the rtPA+T group versus the rtPA group [relative risk (RR)=1.13; 95 % CI=1.05, 1.21; <em>P</em>=0.001]. The incidence of re-occlusion was lower in the rtPA+T group than in the rtPA group (RR=0.24; 95 % CI=0.10, 0.59; <em>P</em>=0.002), but the incidence of intracranial hemorrhage (ICH) (RR=0.85; 95 % CI=0.51, 1.43), symptomatic ICH (RR=1.10; 95 % CI=0.43, 2.84), and mortality (RR=1.39; 95 % CI=0.53, 3.65) was not different between the two groups (all <em>P</em>&gt;0.05). The stability assessed by sensitivity analysis was good, and no publication bias was found.</div></div><div><h3>Conclusion</h3><div>rtPA plus tirofiban achieves superior efficacy with comparable safety profiles compared to rtPA alone in AIS patients.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108111"},"PeriodicalIF":2.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582759","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}