Frontiers in stroke最新文献

{"title":"Methodological considerations in PISCES 3: a randomized, placebo-controlled study of intracerebral stem cells in subjects with disability following an ischemic stroke","authors":"D. Laskowitz, K. Muir, S. Savitz, L. Wechsler, J. Pilitsis, S. Rahimi, R. Beckman, Vincent Holmes, P. Chen, Laura Juel, Deborah C. Koltai, B. Kolls","doi":"10.3389/fstro.2023.1182537","DOIUrl":"https://doi.org/10.3389/fstro.2023.1182537","url":null,"abstract":"At present, there are no medical interventions proven to improve functional recovery in patients with subacute stroke. We hypothesize that the intraparenchymal administration of CTX0E03, a conditionally immortalized neural stem cell line, linked with a standardized rehabilitation therapy regimen for the upper limb, would improve functional outcomes in patients 6–12 months after an index ischemic stroke.PISCES III was designed as a multicenter prospective, sham-controlled, outcome-blinded randomized clinical trial. Eligibility required a qualifying ischemic stroke 6–12 months prior to surgical intervention. Patients must be between 35 and 75 years of age and have residual moderate or moderately severe disability (mRS 3 or 4), with the preservation of some residual upper limb movement. All patients received a standardized regimen of home physical therapy following the intervention.The primary outcome measure is improvement in the modified Rankin Scale (mRS) of disability at 6 months post treatment. Secondary outcomes include assessment of activities of daily living (Barthel Index), functional mobility (Timed Up and Go; Fugl Meyer Assessment), neurological impairment (NIHSS), upper limb function (Chedoke Arm and Hand Inventory), as well as patient related quality of life and global rating scales.PISCES III was designed as a randomized trial directly comparing the effects of intraparenchymal injection of a conditional stem cell line vs. sham procedure in patients with subacute stroke. This is one of the first studies of this type to include a standardized minimum rehabilitation protocol. As there are a limited number of studies evaluating invasive stem cell administration in the chronic setting of CNS injury, study design considerations are discussed.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75495331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanisms of pediatric ischemic strokes in COVID-19: a systematic review","authors":"E. J. Layug, A. D. A. O. Apor, Rudolf V. Kuhn, M. Tan","doi":"10.3389/fstro.2023.1197714","DOIUrl":"https://doi.org/10.3389/fstro.2023.1197714","url":null,"abstract":"Coronavirus disease 2019 (COVID-19) has been shown to cause vasculopathic and hemostatic derangements predisposing to cerebrovascular and thrombotic disorders in adults. Data in children, however, are limited to case reports and series. Given the unique risk factors and potential pathomechanisms in children, it is imperative to characterize stroke in children with COVID-19. Understanding these mechanisms is essential in drafting an appropriate management protocol to improve outcomes in a population where stroke carries higher disability-adjusted life years.A systematic literature search was done in MEDLINE, EMBASE, Web of Science and Google Scholar using the terms “pediatric ischemic stroke,” “cerebral sinovenous thrombosis,” “SARS-CoV-2,” and “COVID-19.” Patient demographics, clinical profile, stroke risk factors, neuroimaging findings, interventions and outcomes were recorded.The search produced 776 records. After preliminary review of titles, abstracts and selected full texts, 52 articles comprising of 74 patients were studied. The cohort has slight female predominance (51.5%), with mean age of 9.2 years (±2SD 5.6). Pediatric ischemic strokes were categorized as arterial ischemic strokes (82.40%), cerebral sinovenous thrombosis (12.20%) and combined arterial and venous strokes (5.41%). Mechanisms of ischemic stroke included thrombophilia (47.3%), vasculopathies (27%) and cardioembolism (6.8%). Twenty cases (27%) had comorbidities predisposing to stroke and only 18.9% met the criteria for multisystem inflammatory syndrome in children (MIS-C). Outcomes ranged from complete recoveries (13/58), residual deficits (35/58), and mortalities (10/58).This study presents a comprehensive summary of the currently available published literature on pediatric ischemic strokes in the background of COVID-19. The clinical profiles and outcomes of patients reviewed support prior hypotheses that the virus can cause both a vasculopathy and induce a derangement in the coagulation system, predisposing to ischemic strokes.This paper's protocol has been registered in PROSPERO with ID number CRD42022315219.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88284012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Animal models of focal ischemic stroke: brain size matters","authors":"Błażej Nowak, P. Rogujski, Raphael G Guzman, P. Walczak, A. Andrzejewska, M. Janowski","doi":"10.3389/fstro.2023.1165231","DOIUrl":"https://doi.org/10.3389/fstro.2023.1165231","url":null,"abstract":"Stroke remains the second leading cause of death worldwide and the third cause of disability-adjusted life-years. Most strokes are ischemic in nature, meaning they are caused by the disruption of cerebral blood flow resulting from obstructed blood vessels. Reperfusion therapies such as thrombolysis with tissue plasminogen activator and endovascular mechanical thrombectomy are very effective and are becoming game changers for eligible patients. Despite these advances, the achieved effects are insufficient from the perspective of the entire population of stroke patients. Therefore, there is an urgent need to expand eligibility for reperfusion therapies and implement adjuvant therapeutic measures. Animal stroke models are at the forefront of these efforts, helping to untangle complex pathophysiology and providing valuable preclinical data to guide further clinical trials. Various stroke models are available, including direct blocking of cerebral arteries or using other means to recapitulate stroke pathophysiology. International advisory boards recommend initial in vivo experiments be performed in smaller animals, such as rodents. However, second testing would be more desirable in larger animals such as cats, pigs, dogs, and non-human primates. Due to larger cerebral volume, gyrencephalization, and higher white/gray matter ratio, large animals are crucial in translational stroke research. Animal stroke models differ in the time and complexity of the stroke induction procedure, the reproducibility rate, the level of similarity to the human condition, and the possibilities for analysis, imaging, and follow-up studies. The choice of the most appropriate stroke model may translate to better bench-to-bedside translation of preclinical stroke research; ideally, this choice should be based solely on scientific merit.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"152 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78691146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct dotterising or angioplasty of acute stroke due to tandem atherosclerotic occlusions","authors":"L. Yeo, D. Simonato, P. Bhogal, A. Gopinathan, Y. Cunli, Samuel W. Q. Ong, M. Jing, B. Tan, C. Sia, Tom Jia, G. Cester, J. Gabrieli, T. Andersson","doi":"10.3389/fstro.2023.1163106","DOIUrl":"https://doi.org/10.3389/fstro.2023.1163106","url":null,"abstract":"Background Tandem occlusions cause 10–15% of LVO acute ischemic strokes but are difficult to treat endovascularly and frequently excluded from clinical trials. The optimum endovascular method is still debated, however going directly through the carotid occlusion can speed up the procedure and reduce procedural risk by eliminating an exchange maneuver. Method Using retrospective data from three centers, we compared treating atherosclerotic tandem occlusions using a 0.035'-guidewire and direct dotterisation or angioplasty with a peripheral vascular balloon suitable for the wire, vs. the usual technique of an 0.014'wire. We compared the successful recanalization (mTICI 2b-3) rates, 90 days' functional outcomes (mRS 0–2), and puncture-to-recanalization times between both procedures. Results Forty-two consecutive patients with atherosclerotic tandem occlusions were included; 25 were treated with the 0.014'wire technique and 17 with the 0.035'-guidewire and direct dotterisation or angioplasty with a peripheral vascular balloon technique. The direct technique achieved a higher rate of successful recanalization (100 vs. 72%, P = 0.018), better functional outcome (88.4 vs. 48.0%, P = 0.044), and faster procedure times (mean 65.1 mins vs. 114.8 mins, P < 0.001). The number of attempts was similar between both groups (median 2 vs 3 attempts, P = 0.101). There was no significant difference in the complication rate between both groups (5.9 vs. 12.0%, P = 0.462). Conclusion Compared to previous endovascular techniques for treating atherosclerotic tandem occlusions, the direct technique using standard 0.035' guidewires and dotterisation or a peripheral vascular balloon is significantly faster with better outcomes. However, this will require further external validation in larger cohorts.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90780593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Grand challenges in pediatric stroke","authors":"N. Ullman, D. Licht","doi":"10.3389/fstro.2023.1204718","DOIUrl":"https://doi.org/10.3389/fstro.2023.1204718","url":null,"abstract":"COPYRIGHT © 2023 Ullman and Licht. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Grand challenges in pediatric stroke","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"33 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90452126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between edema and intracranial pressure following intracerebral hemorrhage in rat","authors":"Anna C J Kalisvaart, Natasha A. Bahr, F. Colbourne","doi":"10.3389/fstro.2023.1155937","DOIUrl":"https://doi.org/10.3389/fstro.2023.1155937","url":null,"abstract":"Elevated intracranial pressure (ICP) is a potentially fatal consequence of intracerebral hemorrhage (ICH). As the mass of the hematoma and regional edema builds, ICP rises and becomes increasingly variable acutely after stroke. High ICP may worsen cellular injury and edema by impairing local tissue perfusion, fueling a cycle that may ultimately cause fatality through ischemia and brain herniation. Time spent above an ICP of 20 mmHg often predicts a greater risk of death and disability following ICH. Compensatory mechanisms combat rising ICP. Classically, these include cerebrospinal fluid volume loss and cerebrovascular autoregulation, such as a reduction in the volume of venous blood. Additional mechanisms such as brain tissue compliance and skull volume compensation may also contribute. Compensatory compliance mechanisms are limited, and they vary by age and many other factors. Animal models of ICH are widely used to assess these variables and to gauge putative therapeutics. Most often those studies rely upon simple measures of edema, which may not accurately predict ICP data. Thus, we analyzed our past studies characterizing ICP, edema, and tissue compliance responses to striatal ICH in rat, including the collagenase (C-ICH) and whole blood models (WB-ICH). We found that both ICH models raised ICP, with greater effects in the C-ICH model, which may thus better reflect clinical findings of concern. Importantly, measures of edema, such as in the damaged hemisphere, on their own are not predictive of average or peak ICP response within either model, unless assessing across a very wide range of injury severities, or when including non-stroke animals. We caution against using edema data as a surrogate measure of mass effect and ICP following ICH.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78325876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of post stroke depression and anxiety on health-related quality of life in young Filipino adults","authors":"K. H. Ignacio, J. Medrano, Sitti Khadija U. Salabi, Alvin J. Logronio, Sedric John V. Factor, S. Ignacio, J. L. R. Pascual, Maria Carissa C. Pineda-Franks, J. Diestro","doi":"10.3389/fstro.2023.1149406","DOIUrl":"https://doi.org/10.3389/fstro.2023.1149406","url":null,"abstract":"Background Health-related quality of life (HRQoL) is important to assess in young adults who suffer from various physical and mental consequences after stroke. We aimed to evaluate the HRQoL of young adults after ischemic or hemorrhagic stroke and to determine the association of anxiety and depression with poor HRQoL in this special population. Methods We administered the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) to assess the HRQoL in our study population. This tool describes health outcomes in five dimensions. Socio-demographic and clinical data including modified Rankin scale (mRS), Barthel Index and Hospital Anxiety and Depression Scale scores were available from our previous cross-sectional study on young adults with stroke. We performed bivariate analyses to assess the association of psychiatric comorbidities with categorical characteristics and determined risk factors for poor HRQoL using multivariable logistic regression analysis. Results We evaluated HRQoL, psychiatric and functional outcomes in 114 young adult stroke patients. CVD infarct was more common than hemorrhage (58.8 vs. 41.2%). Patients with both anxiety and depression were found to have the lowest ratings on the HRQoL scales, with an EQ VAS of 60 vs. 90 (p = 0.01) and an EQ Index of 0.64 vs. 0.89 (p < 0.01) when compared to those without both conditions. Anxiety and depression were significantly correlated with poor quality of life on all dimensions of the EQ-5D-5L. Similarly, Barthel Index was a significant predictor for problems in HRQoL (OR 0.17, 95% CI 0.03–1.02 on the mobility dimension and OR 0.08, 95% CI 0.01–0.55 on the self-care dimension). Cerebral hemorrhage was an independent predictor for poorer self-care dimension scores (OR 4.99, 95% CI 1.42–17.56). Conclusions Our study showed that anxiety, depression and poor functional status are associated with poorer HRQoL in young adult Filipinos after stroke. Screening for psychiatric conditions and evaluating mobility are crucial in the management of this special population after stroke.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83012935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial pressure elevation post-stroke: Mechanisms and consequences","authors":"R. Hood, Daniel J. Beard, D. McLeod, L. Murtha, N. Spratt","doi":"10.3389/fstro.2023.1119120","DOIUrl":"https://doi.org/10.3389/fstro.2023.1119120","url":null,"abstract":"Intracranial pressure (ICP) elevation post-stroke has long been thought of as a cause of secondary deterioration after large, malignant infarction, and dramatic ICP elevation is frequently a pre-terminal event. However, there is an increasing body of evidence to suggest that ICP also rises after small stroke, typically within 24 h of the infarct. The timing of this rise suggests that it may play an important role in the collateral failure associated with early infarct expansion. Despite its increasingly recognized importance to patient outcome, very little is currently known about the underlying mechanisms of ICP elevation post-stroke. The traditional understanding suggests ICP elevation occurs solely due to cerebral edema, however this does not seem to be the case in mild-moderate infarction. Instead, recent studies suggest a role for changes in cerebrospinal fluid (CSF) volume. In this article, we will discuss recent mechanistic observations, as well as the consequences of ICP elevation post-stroke.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79976813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parallel stent retriever mechanical thrombectomy of an acute internal carotid artery occlusion refractory to standard techniques: A case report","authors":"T. Yoshimoto, Satoshi Hosoki, Kanta Tanaka, J. Koge, T. Satow, H. Yamagami, K. Toyoda, M. Ihara","doi":"10.3389/fstro.2023.1066491","DOIUrl":"https://doi.org/10.3389/fstro.2023.1066491","url":null,"abstract":"Although mechanical thrombectomy for acute large vessel occlusion is generally effective, some occlusions are refractory. We report a patient in whom the parallel stent retriever technique using two Trevo stent retrievers (Stryker Neurovascular, Fremont, California, USA) was required to treat an intracranial and epidural internal carotid artery occlusion after other techniques had failed. A 68-year-old woman presented with an acute left internal carotid artery occlusion 4 days after mechanical thrombectomy of a left middle cerebral artery occlusion. She was not a candidate for intravenous thrombolysis because of a recent cerebral infarction. Attempts at mechanical thrombectomy using a stent retriever, contact aspiration, or combined contact aspiration and stent retriever were unsuccessful. The parallel stent retriever technique using two 6 × 25-mm Trevo stent retrievers enabled coverage of the entire thrombus, and successful reperfusion was achieved (extended Thrombolysis in Cerebral Infarction grade 2b). After the procedure, the patient was able to walk without assistance. Her modified Rankin Scale score was 2 at 90 days follow-up. Microscopic examination of the retrieved thrombi demonstrated red blood cells, fibrin, and partial endothelialization. The parallel Trevo stent retriever technique has the potential as rescue therapy for refractory large-vessel occlusion. However, complications arising from this technique remain uncertain. Further studies are needed to determine the effect of this technique in terms of recanalization and clinical safety.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"166 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73813493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subarachnoid hemorrhage: New insights on pathogenesis","authors":"D. Nwafor, Allison L. Brichacek, Michael S. Rallo, Nina Bidwai, R. Marsh","doi":"10.3389/fstro.2023.1110506","DOIUrl":"https://doi.org/10.3389/fstro.2023.1110506","url":null,"abstract":"Subarachnoid hemorrhage (SAH) is a type of hemorrhagic stroke characterized by high morbidity and mortality. Saccular intracranial aneurysms account for most cases of SAH. While the role of hemodynamic stress and inflammation have been extensively studied in SAH, little is known about the role of the microbiome in SAH despite recent studies uncovering new insights on the effects of microbiome alteration in ischemic stroke. This review presents the current knowledge around the role of the microbiome in intracranial aneurysm formation and rupture. We also highlight the influence of diet on intracranial aneurysm formation and provide evidence that corroborates the targeting of inflammatory pathways as a potential strategy to curb SAH-associated neurological dysfunction.","PeriodicalId":73108,"journal":{"name":"Frontiers in stroke","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73247639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}