Brain Circulation最新文献

{"title":"Arachidonic acid and adenosine diphosphate-induced platelet aggregation rate for predicting mild bleeding in patients with aspirin and clopidogrel.","authors":"Mengqi Wang, Xiaoming Zhang, Xunming Ji, Ran Meng, Da Zhou","doi":"10.4103/bc.bc_140_24","DOIUrl":"https://doi.org/10.4103/bc.bc_140_24","url":null,"abstract":"<p><strong>Background and purpose: </strong>Mild bleeding, often overlooked but significantly impacting life quality, results from reduced platelet aggregation in antiplatelet-treated patients. Both adenosine diphosphate-induced platelet aggregation rate (PL_ADP) and arachidonic acid-induced platelet aggregation rate (PL_AA) have been shown to predict mild bleeding risk. This study evaluates their predictive value in antiplatelet-treated patients with mild bleeding events.</p><p><strong>Methods: </strong>This real-world study analyzed the data from antiplatelet-treated patients with mild bleeding events, comparing their PL_AA and PL_ADP levels to those without bleeding. A multivariate analysis assessed significant variables associated with mild bleeding, including PL_AA, PL_ADP, and other potential predictors. In the aspirin-bleeding group, patients were stratified based on whether PL_AA monitoring was used to adjust therapy during a 6-month follow-up.</p><p><strong>Results: </strong>Among 66 aspirin-treated patients, those with mild bleeding (51.5%) had significantly lower PL_AA levels (8.23% vs. 12.05%, <i>P</i> < 0.001). Receiver operating characteristic (ROC) curve analysis identified a PL_AA threshold of 8.55% as the best predictor of bleeding risk (area under the curve [AUC] = 0.864, 95% confidence interval [CI]: 0.790-0.939). In dual antiplatelet therapy, patients with mild bleeding (51.79%) had significantly lower PL_ADP (29.16% vs. 35.74%, <i>P</i> = 0.009) and PL_AA (8.04% vs. 10.85%, <i>P</i> = 0.025) levels. ROC analysis identified PL_ADP < 28.96% (AUC = 0.760, 95% CI: 0.635-0.886) and PL_AA < 8.01% (AUC = 0.832, 95% CI: 0.713-0.950) as predictive thresholds for bleeding risk. Regular monitoring of PL_AA levels (8.55%-20%) was associated with a reduction in bleeding risk for aspirin. In addition, no recurrent strokes were observed, and patients who underwent regular PL_AA monitoring experienced lower bleeding rates.</p><p><strong>Conclusion: </strong>PL_AA and PL_ADP are predictive of mild bleeding events induced by antiplatelets. Regular monitoring of platelet aggregation may improve their outcomes.</p><p><strong>Trial registration: </strong>The clinical trial was registered at Chinese Clinical Trial Registry (ChiCTR2200057621).</p>","PeriodicalId":9288,"journal":{"name":"Brain Circulation","volume":"12 1","pages":"22-30"},"PeriodicalIF":4.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431134","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":"Chronic mental stress and ischemic injury: Mechanisms and implications - A mini review.","authors":"Yuequan Zhu, Leticia Simo, Xiaokun Geng, Fengwu Li, Yuchuan Ding","doi":"10.4103/bc.bc_88_24","DOIUrl":"10.4103/bc.bc_88_24","url":null,"abstract":"<p><p>Ischemic stroke is a leading cause of mortality and disability worldwide. Emerging evidence has highlighted a strong link between genetically predisposed risk factors, such as depression and chronic mental stress, and worsens stroke outcomes. This mini review explores the multifaceted role of mental stress in exacerbating ischemic injury. We discuss mechanisms at the cellular, subcellular, and epigenetic levels, including differential brain cell sensitivity, mitochondrial dysfunction, and novel epigenetic modifications like lactylation. This review provides a theoretical framework and scientific basis for understanding the clinical implications of mental stress in ischemic stroke management. The findings underscore the importance of further research to clarify these mechanisms and develop targeted interventions to mitigate the adverse effects of mental stress on stroke outcomes.</p>","PeriodicalId":9288,"journal":{"name":"Brain Circulation","volume":"11 3","pages":"171-177"},"PeriodicalIF":4.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944078","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":"Global shifts in ischemic stroke research: Evolving focus on management, risk factors, and national contributions (2012-2022).","authors":"Siddhant Kumarapuram, Allen Ye Fu, Arevik Abramyan, Sanjeev Ariyandath Sreenivasan, Ashwin Bhaskar, Shirleen Xu, Sarah Quraishi, Medha Satti, Igor Rybinnik, Sudipta Roychowdhury, Gaurav Gupta","doi":"10.4103/bc.bc_119_24","DOIUrl":"10.4103/bc.bc_119_24","url":null,"abstract":"<p><strong>Introduction: </strong>Ischemic stroke leads to significant morbidity and mortality. Although research into the field has remained pervasive over time, few studies have investigated how ischemic stroke research has changed. In the present study, we strive to characterize the changes in ischemic stroke research between 2012 and 2022 in order to gain insight into the major topics of interest and contributors to the field.</p><p><strong>Methods: </strong>The Web of Science database isolated 92,535 articles. Subsequently, networks were constructed for the top keywords, terms, countries, and journals. The clusters in these networks were compared between 2012 and 2022 to isolate the items with the greatest changes. The degree of connectivity for items within the network was measured as link strengths for keywords, countries, and journals. Meanwhile, relevancy scores were determined for the top terms.</p><p><strong>Results: </strong>Keywords were categorized into five major clusters: cellular changes, risk factors, biological recovery, medical therapies, and cardiac associations. Among these, \"stroke\" remained the most popular keyword, showing the greatest increase in link strength over time. In addition, the terms \"thrombectomy\" and \"atrial fibrillation\" increased by 4,797 and 2,057, respectively. When examining individual countries, the United States had the greatest average link strength (1,664) between 2012 and 2022, with the largest number of documents in 2012 (1,720). However, by 2022, China produced the greatest number of documents (3,678).</p><p><strong>Conclusions: </strong>Ischemic stroke literature has increased in prevalence. The growth of research in this stems from the development of endovascular techniques and the increasing incidence of atrial fibrillation with modern monitoring devices leading to greater awareness and identification, although the prevalence of atrial fibrillation itself is likely unchanged. Furthermore, both China and the United States continue to maintain the largest influence on ischemic stroke research. As both countries progress in ischemic stroke research, it will be important to continue to understand how areas of exploration change within the field.</p>","PeriodicalId":9288,"journal":{"name":"Brain Circulation","volume":"11 4","pages":"315-321"},"PeriodicalIF":4.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965144","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":"Dealing with oral anticoagulants in stroke patients: A narrative review based on current practice guidelines.","authors":"Deepak Goel, Priya Singh","doi":"10.4103/bc.bc_151_24","DOIUrl":"10.4103/bc.bc_151_24","url":null,"abstract":"<p><p>A significant subgroup of stroke patients require oral anticoagulants (OACs) for the prevention of recurrence of thromboembolic events. For a long time, clinicians have been using conventional warfarin as OAC in stroke prevention. However, the discovery of newer OACs that do not require strict monitoring with an international normalized ratio (INR) has resulted in changes in guidelines for stroke prevention. For the last 10 years, there has been a flood of literature on the use of Vitamin K antagonist (VKA) versus non-vitamin K antagonist oral anticoagulants (NOACs) in stroke prevention. More than 100 meta-analyses, randomized trials, and more than six new guidelines or comparisons of guidelines are available in the medical literature. Hence, we have planned to write a review on this topic to compile all new findings and recommendations. Therefore, now, clinicians have to use currently available knowledge and guidelines for choosing appropriate OAC in stroke settings. The current review is divided into 6 segments: 1) general information and protocol for VKA use; 2) current definition to describe \"valvular\" versus \"non-valvular\" AF; 3) to describe current recommendations for uses of VKA and NOACs for recurrent stroke prevention; 4) how to use VKA/NOACs in special populations; 5) perioperative management of patients on OAC; and 6) OAC recommendations for Asian population. This narrative review can help for the better understanding and clear clinical decision making for selection of OAC in stroke patients. Further, it will highlight the gray areas with no clearcut guidance for the selection of OAC.</p>","PeriodicalId":9288,"journal":{"name":"Brain Circulation","volume":"11 4","pages":"288-300"},"PeriodicalIF":4.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145964940","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":"Improved preoperative planning for endovascular therapy: High-resolution vessel wall magnetic resonance imaging shows promise in identifying proximal occlusion site and distal boundary of the occlusion of acute ischemic stroke.","authors":"Yuchao Dou, Qinghai Yao, Yongbo Xu, Leilei Luo, Sifei Wang, Bohao Zhang, Da Lu, Sihu Pan, Shuling Liu, Shuai Liu, Yuanyuan Xue, Kangjie Du, Chaowei Hao, Chen Cao, Ming Wei","doi":"10.4103/bc.bc_103_24","DOIUrl":"10.4103/bc.bc_103_24","url":null,"abstract":"<p><strong>Background and purpose: </strong>Detecting the proximal occlusion site (POS) and distal boundary of the occlusion (DBO) of arterial occlusion is very important for the prognosis of endovascular treatment. Recent studies have shown that magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) are also beneficial for preoperative patient selection for endovascular therapy. High-resolution vessel wall MRI (HRVW-MRI) for intraluminal detection of arterial largevessel occlusions (LVOs) is receiving increasing attention. The purpose of this study was to evaluate the diagnostic efficacy of HRVW-MRI for POS and DBO.</p><p><strong>Materials and methods: </strong>The data of 42 patients with acute anterior circulation cerebral infarction were retrospectively analyzed. By comparing with digital subtraction angiography (DSA), the POS and DBO were analyzed to determine the efficacy of HRVW-MRI for LVO location.</p><p><strong>Results: </strong>Good to excellent interobserver consistency was achieved in the analysis and evaluation of all image data (<i>k</i> > 0.70). There was better concordance for the POS between HRMRI and DSA than that between MRA and DSA (<i>k</i> = 0.834 vs. <i>k</i> = 0.309). Compared with DSA, HRVW-MRI showed an advantage over DSA in terms of clearly determining DBO (<i>χ</i>² = 9.389, <i>P</i> < 0.01).</p><p><strong>Conclusion: </strong>HRVW-MRI demonstrated a comparative advantage over Time-of-flight-MRA for differentiating the POS, with accuracy near-equivalent to that of DSA and a clear advantage over DSA for DBO detection. HRVW-MRI has the potential to improve preoperative planning for endovascular therapy.</p>","PeriodicalId":9288,"journal":{"name":"Brain Circulation","volume":"11 3","pages":"219-227"},"PeriodicalIF":4.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944034","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":"Nexfin versus conventional oscillometric cuff for blood pressure monitoring during neuro-endovascular procedures.","authors":"Huanwen Chen, Rosy Linda Njonkou-Tchoquessi, Marco Colasurdo, Christopher J Cobb, Seyedmehdi Payabvash, Ajay Malhotra, Dheeraj Gandhi","doi":"10.4103/bc.bc_146_24","DOIUrl":"10.4103/bc.bc_146_24","url":null,"abstract":"<p><strong>Background: </strong>Nexfin, a noninvasive blood pressure (BP) monitoring system, can provide continuous real-time measurements of BP, which can be useful for patients with acute neurological injury who require urgent neuroendovascular interventions. While Nexfin has shown promising reliability for other clinical scenarios, its performance has not been demonstrated during neuroendovascular procedures for patients with neurological injury.</p><p><strong>Methods: </strong>This was a single-center retrospective study. Consecutive patients who underwent neuro-endovascular procedures with Nexfin BP monitoring were identified at a single institution. Mean arterial pressure (MAP) and systolic BP (SBP) from Nexfin, conventional oscillometric cuff, and arterial line were recorded every 5 to 15 min Concordance between measurement modalities was assessed. Nexfin's ability to detect the significant drops in BP (MAP decrease of 10 or more or SBP decrease of 20 or more) on the arterial line was also assessed and compared with cuff.</p><p><strong>Results: </strong>A total of 620 blood measurements (264 Nexfin, 197 cuff, and 159 arterial line) from 33 patients who underwent neuro-endovascular procedures were collected. Overall, Nexfin measurements correlated well with the arterial line measurements for MAP (Pearson's R = 0.74, <i>P</i> < 0.001) and SBP (Pearson's R = 0.67, <i>P</i> < 0.001). Overall, Nexfin performed similarly to cuff in estimating arterial line measurements; however, Nexfin was more sensitive for detecting MAP drops than conventional cuff (70.6% vs. 50.0%), while maintaining similar specificity (92.8% vs. 91.1%). This culminated in higher positive predictive value (60.0% vs. 50.0%), negative predictive value (95.4% vs. 91.1%), and F1-score (0.65 vs. 0.50). Similar results were seen for detecting SBP drops, where Nexfin also outperformed cuff.</p><p><strong>Conclusions: </strong>For patients undergoing neuro-endovascular treatments, Nexfin performed as well as conventional cuffs in estimating intraoperative BP measurements from arterial lines, and it was more sensitive than cuffs in detecting intraprocedural relative hypotension without compromising specificity.</p>","PeriodicalId":9288,"journal":{"name":"Brain Circulation","volume":"11 4","pages":"309-314"},"PeriodicalIF":4.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965212","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":"A literature review on neuron scaffolding for repairing peripheral nerves: Advances, challenges, and future directions.","authors":"Alexander Weiss, Yuchuan Ding, Matthew Rodriguez","doi":"10.4103/bc.bc_138_24","DOIUrl":"10.4103/bc.bc_138_24","url":null,"abstract":"<p><p>Peripheral nerve injuries (PNIs) present significant clinical challenges and affect a substantial portion of the population. Current treatments often fall short of desirable outcomes, leading to a diminished quality of life for patients. Advancements in neuron scaffolding materials offer promising solutions to enhance the clinical management of PNIs and address the limitations of traditional treatments. This paper assesses the current state of treatments, examines the anatomy and physiology of peripheral nerves, and discusses the mechanisms of PNIs and their impact on recovery. It also explores the principles of neuron scaffolding and recent advancements in various natural and synthetic biomaterials. This review focuses on collagen, fibrin, chitosan, poly (lactic acid), poly (glycolic acid), and polycaprolactone (PCL), detailing each material's advantages and challenges in neuron scaffolding applications. This review paper focuses on the innovative use of neuron scaffolding in the treatment of PNIs, emphasizing the potential of both natural and synthetic biomaterials to enhance nerve regeneration. The study underlines the promising future of neuron scaffolding while acknowledging the current limitations that need to be addressed for more effective treatment outcomes.</p>","PeriodicalId":9288,"journal":{"name":"Brain Circulation","volume":"11 4","pages":"266-275"},"PeriodicalIF":4.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145964702","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":"Advances in intracerebral hemorrhage management: A comprehensive review.","authors":"Shengjun Wang, Jing Wang, Omar Elmadhoun, Yong Liang, Wenbo Zhao","doi":"10.4103/bc.bc_177_24","DOIUrl":"https://doi.org/10.4103/bc.bc_177_24","url":null,"abstract":"<p><p>Intracerebral hemorrhage (ICH), caused by the rupture of small blood vessels, remains the least treatable subtype of stroke. The pathophysiology of ICH involves immediate mechanical compression from the hematoma, followed by secondary injuries such as cerebral edema, inflammation, and neuronal damage. Management aims to prevent hematoma expansion, enable safe and effective hematoma evacuation, and mitigate secondary injuries. Recent advancements in clinical management, including blood pressure control, hemostatic therapy, surgical and minimally invasive hematoma removal, and complication management, offer new hope. This review synthesizes these advancements, integrating insights from recent research and clinical trials, and highlights significant progress in evidence-based approaches that pave the way for precise and personalized treatment strategies. Nonetheless, further research is necessary to enhance our understanding of ICH mechanisms and develop more effective clinical interventions.</p>","PeriodicalId":9288,"journal":{"name":"Brain Circulation","volume":"12 1","pages":"13-21"},"PeriodicalIF":4.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431069","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":"Pupillometry: A loupe to mirror intracranial status during recovery after neurosurgery.","authors":"Sangeetha R Palaniswamy, Rajeeb Mishra, Abhay Sikaria, Shivakeshava Murthy","doi":"10.4103/bc.bc_19_25","DOIUrl":"10.4103/bc.bc_19_25","url":null,"abstract":"","PeriodicalId":9288,"journal":{"name":"Brain Circulation","volume":"11 3","pages":"247-249"},"PeriodicalIF":4.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944068","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":"A narrative review of reperfusion therapy in acute ischemic stroke: Emerging advances, current challenges, and future directions.","authors":"Qiuting Wang, Na Liu, Leticia Simo, Qingfeng Ma, Chuanhui Li","doi":"10.4103/bc.bc_161_24","DOIUrl":"10.4103/bc.bc_161_24","url":null,"abstract":"<p><p>Significant advancements over the past decade have transformed reperfusion therapy for acute ischemic stroke. Standard treatments, including intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT), offer distinct benefits, with recent innovations expanding their efficacy and applicability. IVT, previously limited by a narrow therapeutic window, has seen enhancement with alternative agents such as tenecteplase, which may deliver comparable or superior outcomes to alteplase in selected cases. Expanding indications for EVT, particularly for large vessel occlusions and in extended time windows, have demonstrated promising results, underscoring its effectiveness beyond conventional time constraints. Recent trials further support the use of EVT for patients with large infarct cores in the anterior circulations, although mortality outcomes remain sensitive to treatment timing. In addition, mobile stroke units (MSUs) and prehospital management strategies have emerged as critical components for minimizing delays and improving clinical outcomes. Future research should focus on optimizing reperfusion therapies to individual patient profiles, investigating neuroprotective adjuncts, and expanding the global availability of MSUs to facilitate timely, accessible stroke care.</p>","PeriodicalId":9288,"journal":{"name":"Brain Circulation","volume":"11 3","pages":"187-199"},"PeriodicalIF":4.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944012","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}