{"title":"Late Endovascular Treatment for Ischemic Stroke with Moderate to Large Infarct Volume is Associated with a better Clinical Prognosis.","authors":"Peng Jiang, Sheng Zhang, Weitao Yu, Zongjie Shi, Xinzhao Jiang, Xu Wang, Longting Lin, Mark Parsons, Wenting Guo","doi":"10.2174/0115672026370829250108051837","DOIUrl":"10.2174/0115672026370829250108051837","url":null,"abstract":"<p><strong>Objective: </strong>The concept of \"time is brain\" is crucial for the reperfusion therapy of ischemic stroke. However, the Infarct Growth Rate (IGR) varies among individuals, which is regarded as a more powerful factor than the time when determining infarct volume and its association with clinical outcomes. For stroke patients with a similar infarct volume, a longer time from stroke Onset to Imaging (OTI) correlates with a lower IGR, which may indicate a better prognosis. This study aimed to compare the prognoses of patients with anterior circulation stroke who received Endovascular Treatment (EVT), specifically comparing early EVT vs. late EVT.</p><p><strong>Methods: </strong>We analyzed 255 patients with acute anterior circulation stroke due to large vessel occlusion and who have successfully undergone recanalization after EVT. All patients were divided into the late (OTI≥6 hours) and early (<6 hours) time window groups and compared. The primary outcome was moderate functional prognosis, defined as a modified Rankin Scale (mRS) ≤3 at 90 days. The secondary outcome was No Significant Infarct Expansion (NSIE), defined as a reduction of less than 2 points on the Alberta Stroke Program Early CT Score (ASPECTS).</p><p><strong>Results: </strong>In the moderate to large infarct subgroup, the late time window EVT was independently associated with a higher rate of moderate functional outcome (P =0.007) and NSIE (P =0.001); mediation analysis showed that NSIE partially mediated the effects of the late time window EVT on moderate functional outcome (coefficient: 0.112, 95% CI: 0.051 to 0.239, P =0.011); however, these associations were not consistent in the small infarct group.</p><p><strong>Conclusion: </strong>For anterior circulation stroke patients who received EVT according to current guidelines, those with moderate to large infarct volume and having a longer OTI had better clinical outcomes than those who had a shorter OTI and were more suitable for EVT.</p>","PeriodicalId":93965,"journal":{"name":"Current neurovascular research","volume":" ","pages":"564-573"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070115","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}
Yuan Kan, Lu Yang, Changhong Ren, Chuanhui Li, Jiali Xu, Wenting Guo, Wenbo Zhao, Xunming Ji
{"title":"The Effect of Systemic Inflammatory Response on Mechanical Thrombectomy is Partly Mediated by Pre-thrombectomy Cerebral Edema in Acute Stroke Patients.","authors":"Yuan Kan, Lu Yang, Changhong Ren, Chuanhui Li, Jiali Xu, Wenting Guo, Wenbo Zhao, Xunming Ji","doi":"10.2174/0115672026348875241011100717","DOIUrl":"10.2174/0115672026348875241011100717","url":null,"abstract":"<p><strong>Objective: </strong>To explore the effect of baseline Systemic Inflammatory Response reflected by platelet-to-lymphocyte ratio (PLR) and pre-thrombectomy cerebral edema reflected by Net Water Uptake (NWU) on futile recanalization in patients with Acute Ischemic Stroke (AIS) after successful thrombectomy, and to investigate the potential mediating role of baseline cerebral edema.</p><p><strong>Methods: </strong>134 Patients with anterior circulation ischemic stroke receiving successful thrombectomy were retrospectively studied. Their demographic and clinical characteristics were collected at admission, and the NWU was quantitatively calculated based on baseline computed tomography (CT). The predictive value of PLR for futile recanalization and the relationship between PLR, NWU, and futile recanalization using mediation analysis were explored. Patients were followed up for 90 days and were divided into a futile recanalization group and a favorable prognosis group [90-day modified Rankin Scale score of 0-2].</p><p><strong>Results: </strong>High baseline PLR, NWU, no first-pass reperfusion, and large baseline ischemic core volume were independent predictors of futile recanalization after successful thrombectomy in patients with AIS. Mediation analysis results indicate that PLR may partially mediate the occurrence of futile recanalization through NWU.</p><p><strong>Conclusion: </strong>Baseline PLR and NWU were independent predictors of futile recanalization, and higher PLR and NWU values were associated with a higher likelihood of futile recanalization. The findings suggest that early cerebral edema reflected by a high NWU value may be a mediator of PLR-affecting prognosis.</p>","PeriodicalId":93965,"journal":{"name":"Current neurovascular research","volume":" ","pages":"447-457"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515173","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":"Risk Factors for Silent Brain Infarction in Nonvalvular Atrial Fibrillation Patients with Low CHA<sub>2</sub>DS<sub>2</sub>-VASc Score.","authors":"Lijun Hao, Xing Chen, Wei Sun, Chunjian Li, Yimin Li, Xiangqing Kong","doi":"10.2174/0115672026354260241218115435","DOIUrl":"10.2174/0115672026354260241218115435","url":null,"abstract":"<p><strong>Background: </strong>Silent Brain Infarction (SBI) has been found to be linked to an increased risk of cognitive impairment and future symptomatic stroke. Atrial fibrillation is a significant risk factor for SBI. Even in low-risk atrial fibrillation patients, the incidence of SBI remains high. This study aims to investigate the risk factors for SBI in nonvalvular atrial fibrillation (NVAF) patients with a CHA<sub>2</sub>DS<sub>2</sub>-VASc score of 0 to 1.</p><p><strong>Methods: </strong>A total of 301 consecutive low-risk NVAF patients (male: CHA<sub>2</sub>DS<sub>2</sub>-VASc=0, female: CHA<sub>2</sub>DS<sub>2</sub>-VASc=1) were enrolled. According to brain Magnetic Resonance Imaging (MRI), patients were divided into SBI (n=90) and non-SBI (n=211) groups. Baseline characteristics, blood parameters, and echocardiography results were analyzed. Multivariate logistic regression was performed to identify independent predictors. Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the diagnostic power of the relevant risk factors.</p><p><strong>Results: </strong>The study revealed that neutrophil count, monocyte count, Platelet-To-Lymphocyte Ratio (PLR), neutrophil-to-high density lipoprotein cholesterol ratio (NHR), and left atrial diameter (LAD) were significantly higher in the SBI group than non-SBI group (p <0.05). Multivariate logistic regression analysis identified PLR (OR, 1.004; 95%CI 1.001-1.007; p =0.026) and LAD (OR 1.092; 95%CI 1.054-1.130; p <0.001) as the independent risk factors associated with SBI. The ROC showed that the Area Under the Curve (AUC) of PLR is 0.589 (95%CI 0.515- 0.662; p =0.015) with an optimal cut-off point of 151 (sensitivity 43.3%, specificity 74.6%). The AUC of LAD is 0.676 (95%CI 0.606-0.746; p <0.001) with an optimal cut-off point of 39 mm (sensitivity 61.1%, specificity 72.0%). The AUC of PLR combined with LAD is 0.711 (95%CI 0.646-0.777; p <0.001) with a sensitivity of 63.3% and specificity of 73.5% for SBI.</p><p><strong>Conclusion: </strong>PLR and LAD can be independent risk factors for SBI in NVAF patients with low CHA<sub>2</sub>DS<sub>2</sub>-VASc scores. The combination of the two factors can enhance the predictive ability of SBI in these patients.</p>","PeriodicalId":93965,"journal":{"name":"Current neurovascular research","volume":" ","pages":"503-510"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934108","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}
Tarun Sharma, Sidharth Mehan, Aarti Tiwari, Zuber Khan, Ghanshyam Das Gupta, Acharan S Narula
{"title":"Targeting Oligodendrocyte Dynamics and Remyelination: Emerging Therapies and Personalized Approaches in Multiple Sclerosis Management.","authors":"Tarun Sharma, Sidharth Mehan, Aarti Tiwari, Zuber Khan, Ghanshyam Das Gupta, Acharan S Narula","doi":"10.2174/0115672026336440240822063430","DOIUrl":"10.2174/0115672026336440240822063430","url":null,"abstract":"<p><p>Multiple sclerosis (MS) is a progressive autoimmune condition that primarily affects young people and is characterized by demyelination and neurodegeneration of the central nervous system (CNS). This in-depth review explores the complex involvement of oligodendrocytes, the primary myelin- producing cells in the CNS, in the pathophysiology of MS. It discusses the biochemical processes and signalling pathways required for oligodendrocytes to function and remain alive, as well as how they might fail and cause demyelination to occur. We investigate developing therapeutic options that target remyelination, a fundamental component of MS treatment. Remyelination approaches promote the survival and differentiation of oligodendrocyte precursor cells (OPCs), restoring myelin sheaths. This improves nerve fibre function and may prevent MS from worsening. We examine crucial parameters influencing remyelination success, such as OPC density, ageing, and signalling pathway regulation (e.g., Retinoid X receptor, LINGO-1, Notch). The review also examines existing neuroprotective and antiinflammatory medications being studied to see if they can assist oligodendrocytes in surviving and reducing the severity of MS symptoms. The review focuses on medicines that target the myelin metabolism in oligodendrocytes. Altering oligodendrocyte metabolism has been linked to reversing demyelination and improving MS patient outcomes through various mechanisms. We also explore potential breakthroughs, including innovative antisense technologies, deep brain stimulation, and the impact of gut health and exercise on MS development. The article discusses the possibility of personalized medicine in MS therapy, emphasizing the importance of specific medicines based on individual molecular profiles. The study emphasizes the need for reliable biomarkers and improved imaging tools for monitoring disease progression and therapy response. Finally, this review focuses on the importance of oligodendrocytes in MS and the potential for remyelination therapy. It also underlines the importance of continued research to develop more effective treatment regimens, taking into account the complexities of MS pathology and the different factors that influence disease progression and treatment.</p>","PeriodicalId":93965,"journal":{"name":"Current neurovascular research","volume":" ","pages":"359-417"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116419","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}
Beny Rilianto, Ricky Gusanto Kurniawan, Bambang Tri Prasetyo, Nurfadilah M Rajab, Abrar Arham
{"title":"Thrombectomy Failure and Associated Factors for Large-Vessel Occlusion Stroke.","authors":"Beny Rilianto, Ricky Gusanto Kurniawan, Bambang Tri Prasetyo, Nurfadilah M Rajab, Abrar Arham","doi":"10.2174/0115672026356656241118065115","DOIUrl":"10.2174/0115672026356656241118065115","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke due to Large Vessel Occlusion (LVO) represents a critical and time-sensitive neurological emergency. Advancements in imaging technology and endovascular therapies have transformed the management of LVO. Nonetheless, thrombectomy failure diminishes the chances of patients achieving a favorable clinical outcome.</p><p><strong>Objective: </strong>We aimed to determine the factors influencing recanalization failure in order to optimize thrombectomy therapy along with enhancing patient outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was performed employing consecutive LVO patients who underwent Endovascular Thrombectomy (EVT) in a tertiary comprehensive stroke center between January 2020 and June 2024. Recanalization failure (mTICI 0-2a) following thrombectomy was assessed using the Kolmogorov-Smirnov test, χ<sup>2</sup> test, Fisher's exact test, and multivariable logistic regression to identify the related factors.</p><p><strong>Results: </strong>A total of 82 EVT patients were analyzed. The mean age was 58.20 years and 70.73% of the patients were male. The rate of recanalization failure was 61%. Multivariable logistic regression analysis with age-sex adjusted factors has revealed hypertension [aOR: 5.31 (95% CI: 1.23-22.77); p =0.025] and no IVT [aOR: 2.75 (95% CI: 1.06-7.14); p =0.037] to be independent predictors of recanalization failure in this study.</p><p><strong>Conclusion: </strong>Hypertension and the absence of prior intravenous thrombolysis have been found to be significant contributing factors to the high rate of thrombectomy failure in large-vessel occlusion.</p>","PeriodicalId":93965,"journal":{"name":"Current neurovascular research","volume":" ","pages":"483-490"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142735412","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}
Yunpeng Liu, Jumei Huang, Jianwen Jia, Yingting Zuo, Yang Wang, He Liu
{"title":"CT Perfusion Metrics as Indicators of Intracranial Atherosclerotic Stenosis in Acute Ischemic Stroke: A Clinical Analysis.","authors":"Yunpeng Liu, Jumei Huang, Jianwen Jia, Yingting Zuo, Yang Wang, He Liu","doi":"10.2174/0115672026370562241223100210","DOIUrl":"10.2174/0115672026370562241223100210","url":null,"abstract":"<p><strong>Background: </strong>Intracranial Atherosclerotic Stenosis (ICAS) is a prevalent etiology of acute ischemic stroke (AIS), leading to significant morbidity and mortality. The accurate diagnosis and treatment of ICAS-induced AIS are critical to improving outcomes. This study assesses the application of Computed Tomography Perfusion (CTP) in predicting ICAS in AIS patients and its potential impact on patient management.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 224 AIS patients who underwent endovascular therapy (EVT) at one single Chinese Stroke Center between April 2022 and December 2023. Clinical and radiological data were collected, including patients' demographics, CTP parameters, and 90-day modified Rankin Scale (mRS) scores. Logistic regression and receiver operating characteristic (ROC) curves evaluated the predictive power of CTP parameters for ICAS.</p><p><strong>Results: </strong>CTP analysis revealed significant differences in perfusion parameters between ICASinduced AIS and other etiologies. ICAS patients had a smaller ischemic volume on admission and higher mismatch ratios [Time to Maximum, T<sub>max</sub>>6s: Other Causes: 132.4 [70.5, 183.3] mL, ICAS: 96.3 [79.8, 107.3] mL, p =0.0064; relative cerebral blood flow, rCBF<30%: Other Causes: 2.4 [0.0, 10.8] mL, ICAS: 0.6 [0.0, 7.0] mL, p =0.0145; mismatch ratio: 7.4 [2.5, 15.0], ICAS: 11.0 [4.6, 17.8], p =0.0285], indicating more salvageable brain tissue. The 90-day mRS showed better functional outcomes in the ICAS group, with a higher likelihood of minimal to no disability [mRS 90 equals 0-1: ICAS: 53.0% vs. Other Causes: 36.3%, p =0.0122]. The predictive model for ICAS, combining clinical manifestations and CTP parameters, yielded an area under the curve (AUC) of 0.7779, demonstrating good diagnostic performance.</p><p><strong>Conclusion: </strong>CTP is a valuable diagnostic tool for ICAS-induced AIS, offering the potential for early identification and informing the decision for endovascular treatment. The positive correlation between CTP findings and patient outcomes supports its utility in clinical practice.</p>","PeriodicalId":93965,"journal":{"name":"Current neurovascular research","volume":" ","pages":"554-563"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Association of Alkaline Phosphatase Level with Futile Recanalization in Acute Ischemic Stroke Patients Treated with Endovascular Thrombectomy.","authors":"Milan Jia, Wantong Yu, Feiyang Jin, Jiali Xu, Wenting Guo, Mengke Zhang, Sijie Li, Changhong Ren, Yuchuan Ding, Wenbo Zhao, Jing Lan, Xunming Ji","doi":"10.2174/0115672026344020240911114809","DOIUrl":"10.2174/0115672026344020240911114809","url":null,"abstract":"<p><strong>Objective: </strong>Nearly half of Acute Ischemic Stroke (AIS) patients failed to achieve favorable outcomes despite successful reperfusion treatment. This phenomenon is referred to as Futile Recanalization (FR). Screening patients at risk of FR is vital for stroke management. Previous studies reported the diagnostic value of alkaline phosphatase (ALP) levels in certain aspects of stroke prognosis. However, the association between serum ALP level and FR among AIS patients treated with thrombectomy remained unclear.</p><p><strong>Methods: </strong>We screened stroke patients who underwent thrombectomy at our center from January 2017 to June 2021, and those who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction score=3) were ultimately analyzed. Demographic information, vascular risk factors, and laboratory test results were collected at admission. The 3-month unfavorable outcome was defined as a modified Rankin Scale score of 3 to 6. The effect of ALP levels on FR was investigated with a logistic regression model.</p><p><strong>Results: </strong>Of 788 patients who underwent thrombectomy, 277 achieved successful reperfusion. Among them, 142 patients (51.3%) failed to realize favorable outcomes at 3 months. After adjusting for confounding variables, higher ALP levels (p =0.002) at admission were independently associated with unfavorable outcomes at three months. Adding ALP values to conventional risk factors improved the performance of prediction models for FR.</p><p><strong>Conclusion: </strong>The current study found that the serum ALP levels at admission emerged as a potential biomarker for futile reperfusion in stroke patients undergoing thrombectomy. Further studies are warranted to confirm the clinical applicability of ALP level for futile recanalization prediction.</p>","PeriodicalId":93965,"journal":{"name":"Current neurovascular research","volume":" ","pages":"418-426"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373874","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":"Plumbagin's Healing Effect on Motor Impairment in Rotenone-toxified Rodents.","authors":"Aanchal Verma, Ahsas Goyal","doi":"10.2174/0115672026349500240826100531","DOIUrl":"10.2174/0115672026349500240826100531","url":null,"abstract":"<p><strong>Background: </strong>Parkinson's disease is an illness marked by a gradual mitigation of dopamine neurons within the substantia nigra, which eventually leads to a deficiency of dopamine that further gives rise to mobility as well as cognitive impairments. Through long-established traditions, a wide array of Traditional Chinese Medicines (TCM) have undergone testing and are employed to avoid neurodegenerative disorders. Plumbagin is the primary active component of a medication called Baihua Dan or <i>Plumbago zeylanica</i> L., which is clinically used in China.</p><p><strong>Objectives: </strong>This study investigated plumbagin-induced alterations in a Parkinson's disease rat model instigated by subcutaneous rotenone injection.</p><p><strong>Methods: </strong>Male rats were administered subcutaneous injections of rotenone at a dosage of 1.5 mg/kg, followed by the treatment with varying doses of plumbagin (10, 20, and 40 mg/kg) through the oral route. The rats underwent various motor ability tests, including the actophotometer, rotarod, open field, beam walk, gait evaluation, ability to grip, and catalepsy bar tests. Furthermore, the brain dopamine level was then estimated for the extracted tissues. Also, through molecular docking, the binding effectiveness of plumbagin was assessed for human MAO-B. After that, plumbagin was put through 100 ns of molecular dynamic simulations to examine the stability of its conformational binding to the target protein. Furthermore, ADMET tests were used to verify Plumbagin's druggability.</p><p><strong>Results: </strong>Plumbagin was found to alleviate rotenone-induced motor abnormalities and restore brain dopamine levels. Furthermore, plumbagin showed excellent interactions with MAO-B (monoamine oxidase-B) when compared with selegiline (a standard drug for Parkinson's disease).</p><p><strong>Conclusion: </strong>These findings underscore the potential therapeutic efficacy of plumbagin in mitigating behavioural deficits in rotenone-induced rodents. Considering this, plumbagin might be a feasible pharmacological strategy for the control of rotenone-triggered behavioural impairment in rats (<i>in vivo</i>), and it might display interesting interactions with MAO-B (<i>in silico</i>).</p>","PeriodicalId":93965,"journal":{"name":"Current neurovascular research","volume":" ","pages":"434-446"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127729","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":"Prognostic Value of Serum Bilirubin in Aneurysmal Subarachnoid Hemorrhage Patients.","authors":"Ruoran Wang, Hongying Luo, Jianguo Xu, Min He","doi":"10.2174/0115672026365408241230061133","DOIUrl":"10.2174/0115672026365408241230061133","url":null,"abstract":"<p><strong>Background: </strong>Bilirubin plays a crucial role in the pathophysiological processes of strokes. However, the relationship between serum bilirubin levels and the prognosis of aneurysmal subarachnoid hemorrhage (aSAH) remains unexplored. This study aims to investigate the association between serum bilirubin levels and the mortality rate of aSAH patients.</p><p><strong>Methods: </strong>695 aSAH patients were included to analyze the relationship between direct bilirubin (DBil), indirect bilirubin (IDBil), total bilirubin (TBil), and mortality. The univariate and multivariate logistic regression were conducted to discover risk factors for the mortality of aSAH. The restricted cubic spline (RCS) was used to show the correlation between DBil, IDBil, TBil, and mortality. A logistic regression predictive model was developed by incorporating significant factors in the multivariate logistic regression. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of serum bilirubin and the developed predictive model.</p><p><strong>Results: </strong>139 aSAH patients suffered death, with a mortality of 20.0%. Non-survivors had older age (p =0.007), lower GCS (p <0.001), higher Hunt Hess (p <0.001), and mFisher (p <0.001). Both DBil (p <0.001) and TBil (p =0.011) were significantly higher among non-survivors. While the IDBil did not show a difference between survivors and non-survivors. The multivariate analysis found age (p =0.111), Glasgow Coma Scale (p =0.005), white blood cell (p <0.001), glucose (p =0.004), DBil (p =0.001), delayed cerebral ischemia (p <0.001) were significantly related with the mortality of aSAH. A logistic regression predictive model for mortality was developed incorporating these five factors, which had an area under the ROC curve (AUC) of 0.876. The AUC of DBil, IDBil, and TBil for predicting mortality was 0.607, 0.570, and 0.529, respectively.</p><p><strong>Conclusion: </strong>Serum DBil level is positively associated with the mortality risk of aSAH. The predictive model incorporating DBil is beneficial for clinicians to evaluate the mortality risk of aSAH and adopt personalized therapeutics.</p>","PeriodicalId":93965,"journal":{"name":"Current neurovascular research","volume":" ","pages":"537-544"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960689","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}
Yu Huang, Chuyue Wu, Cuiping Du, Da Lei, Li Li, Shengli Chen
{"title":"A Clinical Model predicting the 90-Day Prognosis after Mechanical Thrombectomy in Patients with Acute Ischemic Stroke: A Retrospective Study.","authors":"Yu Huang, Chuyue Wu, Cuiping Du, Da Lei, Li Li, Shengli Chen","doi":"10.2174/0115672026309198240605102300","DOIUrl":"https://doi.org/10.2174/0115672026309198240605102300","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy (MT) is usually recommended for acute ischemic stroke (AIS) due to large vessel occlusion (LVO) within the time window (6 hours after the disease onset). However, poor prognosis in acute great vascular occlusive stroke after MT, which is not an uncommon occurrence, can be attributed to an absence of appropriate postoperative monitoring. Transcranial Doppler (TCD) ultrasound and quantitative electroencephalography (QEEG) offer the advantages of fast, convenient, and bedside examinations compared with conventional imaging techniques.</p><p><strong>Objective: </strong>We aimed to analyze the predictive performance of clinical factors, Transcranial Doppler (TCD) ultrasound and quantitative electroencephalography (QEEG) for the prognosis of patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) at 90 days after discharge.</p><p><strong>Method: </strong>Patients achieved revascularization through MT performed within 6 hours after the onset of AIS due to LVO were included. We use the data to build four predictive models of prognosis and compared the predictive performance measured by the area under the curve, sensitivity, and specificity.</p><p><strong>Result: </strong>A total of 74 patients were included in the study. Among them, 47 patients had a poor prognosis (63.5%) on discharge, and 45 patients had a poor prognosis (60.8%) at 90 days after discharge. Independent predictors of poor prognosis at 90 days after discharge were identified as follows: age, NIHSS score on admission, PI on the affected/healthy side, and RAP. Among the four models built, AUC was the highest (reaching 0.831) when age was combined with NIHSS score on admission, TCD parameters (VD on the affected side, PI on the affected/healthy side), and QEEG parameter (RAP) for prognostic prediction. However, AUC of the four predictive models did not differ significantly (P>0.05).</p><p><strong>Conclusion: </strong>Age, NIHSS score on admission, TCD parameters, and QEEG parameter were independent predictors of the prognosis at 90 days after discharge in patients receiving MT for AIS due to LVO in the anterior circulation. The model combining the above four parameters may be helpful for prognostic prediction in such patients.</p>","PeriodicalId":93965,"journal":{"name":"Current neurovascular research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443966","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}