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Lei Z, Li S, Feng H, Wu X, Hu S, Li J, Xu G, Ren L, Pan S. Effects of intravenous rtPA in patients with minor stroke. Ann Med 2024; 56:2304653. [PMID: 38289926 PMCID: PMC10829835 DOI: 10.1080/07853890.2024.2304653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Whether minor ischemic stroke (MIS) patients can benefit from intravenous thrombolysis (IVT) remains controversial. The association between the efficacy of IVT and baseline National Institute of Health Stroke Scale (NIHSS) score is unclear in MIS, while the association in moderate and severe stroke is known. This study aimed to explore the effect of IVT in patients with MIS and analyze its efficacy in patients with different baseline NIHSS scores. METHODS Patients with a NIHSS score ≤5 within 4.5 h of stroke onset were screened in 32 centers. Patients with and without IVT were matched to a ratio of 1:1 with propensity scores. An excellent outcome was defined as a modified Rankin Scale (mRS) score ≤1 at three months after stroke onset. Safety outcomes included mortality and symptomatic intracranial hemorrhage (sICH). Multivariate analysis was used to compute the adjusted odds ratio (OR) for excellent outcomes. The effect of IVT was further analyzed in subgroups according to the baseline NIHSS score. RESULTS Of the 23,853 screened, 3336 patients with MIS who arrived at the hospital within 4.5 h of onset were included. The 1163 patients treated with IVT were matched with 1163 patients without IVT. IVT in minor strokes generated an adjusted OR of 1.38 (95% CI: 1.09-1.75, p = 0.009) for excellent outcomes. There were no significant differences in mortality (0.17% vs. 0.09%, p = 1.000) and sICH (0.69% vs. 0.86%, p = 0.813) between patients with and without IVT. Subgroup analysis showed that there was no significant effect of IVT in the baseline NIHSS 0-1 or 2-3 subgroups, with adjusted OR of 0.816 (95% CI 0.437-1.53, p = 0.525) and1.22 (95% CI 0.845-1.77, p = 0.287), respectively. In patients with NIHSS score of 4-5, IVT was significantly effective, with an adjusted OR of 1.53 (95% CI 1.02-2.30, p = 0.038). CONCLUSION IVT can improve MIS outcomes. The risks of sICH and mortality did not increase, especially in patients with NIHSS scores 4 to 5, who could benefit from IVT significantly.
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Affiliation(s)
- Zhihao Lei
- Department of Neurology, Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Shuanglin Li
- Department of Anatomy and Histology, School of Basic Medical Sciences, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, China
| | - Hongye Feng
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Xiaohong Wu
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Shiyu Hu
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Jun Li
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Gelin Xu
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Lijie Ren
- Department of Neurology, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China
| | - Suyue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Chen C, Ai Q, Tian H, Wei Y. CKLF1 in cardiovascular and cerebrovascular diseases. Int Immunopharmacol 2024; 139:112718. [PMID: 39032474 DOI: 10.1016/j.intimp.2024.112718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/14/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
Chemokine like factor 1 (CKLF1) is a novel atypical chemokine, playing a crucial role in cardiovascular and cerebrovascular diseases (CCVDs) demonstrated by a growing body of works. In cardiovascular diseases including atherosclerosis and myocardial infarction, meanwhile in cerebrovascular diseases such as ischemic stroke and hemorrhagic stroke, the expression levels of CKLF1 change markedly, which triggers downstream signaling pathways by binding with its functional receptors, and then exerts multiple effects to participate in the occurrence and development of these CCVDs. The functional roles of CKLF1 are dynamic and CKLF1 may act as a double-edged sword. The CCVDs-promoting role is related to recruiting inflammatory cells, enhancing the proliferation of vascular smooth muscle cells and endothelial cells, while the CCVDs-suppressing role may correlate with migration of nerve cells and promotion of hematopoietic stem cell proliferation which contributes to disease recovery. Based on this, the paper intends to review expression shifts, potential roles, and molecular mechanisms of CKLF1 in CCVDs, and the current status of CKLF1 targeted therapeutic strategies is also included. We hope this review may provide a valuable reference for using CKLF1 as a diagnostic and prognostic biomarker for CCVDs or developing novel treatments.
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Affiliation(s)
- Chen Chen
- Department of Pharmacy, The First Hospital of Lanzhou University, Lanzhou 730000, China.
| | - Qidi Ai
- Hunan University of Traditional Chinese Medicine, Changsha 410208, China
| | - Haiyan Tian
- Department of Pharmacy, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Yuhui Wei
- Department of Pharmacy, The First Hospital of Lanzhou University, Lanzhou 730000, China
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Zhang Y, Lv T, Nguyen TN, Wu S, Li Z, Bai X, Chen D, Zhao C, Lin W, Chen S, Sui Y. Intravenous Alteplase Versus Best Medical Therapy for Patients With Minor Stroke: A Systematic Review and Meta-Analysis. Stroke 2024; 55:883-892. [PMID: 38465591 DOI: 10.1161/strokeaha.123.045495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/29/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND The efficacy of thrombolysis (IVT) in minor stroke (National Institutes of Health Stroke Scale score, 0-5) remains inconclusive. The aim of this study is to compare the effectiveness and safety of IVT with best medical therapy (BMT) by means of a systematic review and meta-analysis of randomized controlled trials and observational studies. METHODS We searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to IVT in minor stroke from inception until August 10, 2023. The primary outcome was an excellent functional outcome, defined as a modified Rankin Scale score of 0 or 1 at 90 days. The associations were calculated for the overall and preformulated subgroups by using the odds ratios (ORs). This study was registered with PROSPERO (CRD42023445856). RESULTS A total of 20 high-quality studies, comprised of 13 397 patients with acute minor ischemic stroke, were included. There were no significant differences observed in the modified Rankin Scale scores of 0 to 1 (OR, 1.10 [95% CI, 0.89-1.37]) and 0 to 2 (OR, 1.16 [95% CI, 0.95-1.43]), mortality rates (OR, 0.67 [95% CI, 0.39-1.15]), recurrent stroke (OR, 0.89 [95% CI, 0.57-1.38]), and recurrent ischemic stroke (OR, 1.09 [95% CI, 0.68-1.73]) between the IVT and BMT group. There were differences between the IVT group and the BMT group in terms of early neurological deterioration (OR, 1.81 [95% CI, 1.17-2.80]), symptomatic intracranial hemorrhage (OR, 7.48 [95% CI, 3.55-15.76]), and hemorrhagic transformation (OR, 4.73 [95% CI, 2.40-9.34]). Comparison of modified Rankin Scale score of 0 to 1 remained unchanged in subgroup patients with nondisabling deficits or compared with those using antiplatelets. CONCLUSIONS These findings indicate that IVT does not yield significant improvement in the functional prognosis of patients with acute minor ischemic stroke. Additionally, it is associated with an increased risk of symptomatic intracranial hemorrhage when compared with the BMT. Moreover, IVT may not have superiority over BMT in patients with nondisabling deficits or those using antiplatelets.
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Affiliation(s)
- Yang Zhang
- School of Public Health, China Medical University, Shenyang, China (Y.Z., X.B., D.C., Y.S.)
| | - Tian Lv
- Department of Neurology, Zhuji Affliated Hospital of WenZhou University, China (T.L.)
| | - Thanh N Nguyen
- Department of Neurology and Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine (T.N.N.)
| | - Simiao Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.W.)
| | - Zhi Li
- Department of Medical Oncology (Z.L.), The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xue Bai
- School of Public Health, China Medical University, Shenyang, China (Y.Z., X.B., D.C., Y.S.)
| | - Dan Chen
- School of Public Health, China Medical University, Shenyang, China (Y.Z., X.B., D.C., Y.S.)
| | - Chuansheng Zhao
- and Department of Neurology (C.Z., Y.S.), The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wanyi Lin
- Department of Neurology, Qingtian County Hospital, Lishui, China (W.L.)
| | - Shiqin Chen
- Department of Neurology, Second People's Hospital of Yuhuan, China (S.C.)
| | - Yi Sui
- School of Public Health, China Medical University, Shenyang, China (Y.Z., X.B., D.C., Y.S.)
- Department of Neurology and Neurointervention, Shenyang First People's Hospital, Shenyang Medical College Affiliated Brain Hospital, China (Y.S.)
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Hagberg G, Ihle-Hansen H, Abzhandadze T, Reinholdsson M, Hansen HI, Sunnerhagen KS. Prognostic value of acute National Institutes of Health Stroke Scale Items on disability: a registry study of first-ever stroke in the western part of Sweden. BMJ Open 2023; 13:e080007. [PMID: 38110379 DOI: 10.1136/bmjopen-2023-080007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVES We aimed to study how the individual items of the National Institutes of Health Stroke Scale (NIHSS) at admission predict functional independence 3 months post-stroke in patients with first-ever stroke. SETTING This registry-based study used data from two Swedish stroke registers (Riksstroke, the mandatory national quality register for stroke care in Sweden, and Väststroke, a local quality stroke register in Gothenburg). PARTICIPANTS This study included patients with first-ever acute stroke admitted from November 2014 to August 2018, with available NIHSS at admission and modified Rankin Scale (mRS) at 3-month follow-up. PRIMARY OUTCOME The primary outcome variable was mRS≤1 (defined as an excellent outcome) at 3-month follow-up. RESULTS We included 1471 patients, mean age was 72 (± 14.5) years, 48% were female, and 66% had mild strokes (NIHSS≤3). In adjusted binary logistic regression analysis, the NIHSS items impaired right motor arm and leg, and impairment in visual field, reduced the odds of an excellent outcome at 3 months ((OR 0.60 (95% CI 0.37 to 0.98), OR 0.60 (95% CI 0.37 to 0.97), and OR 0.65 (95% CI 0.45 to 0.94)). When exploring the effect size of associations between NIHSS items and mRS≤1 p, orientation, language and right leg motor had the largest yet small association. CONCLUSIONS Stroke patients with scores on the NIHSS items right motor symptoms or visual field at admission are less likely to have an excellent outcome at 3 months. Clinicians should consider the NIHSS items affected, not only the total NIHSS score, both in treatment guidance and prognostics.
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Affiliation(s)
- Guri Hagberg
- Oslo Stroke Unit, Neurological Department, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Gothenburg University, Goteborg, Sweden
| | - Haakon Ihle-Hansen
- Bærum Hospital- Vestre Viken Hospital Trust, Department of Medicine, Drammen, Norway
| | - Tamar Abzhandadze
- Institute of Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Gothenburg University, Goteborg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Malin Reinholdsson
- Institute of Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Gothenburg University, Goteborg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Hege Ihle Hansen
- Oslo Stroke Unit, Neurological Department, Oslo University Hospital, Ullevål, Oslo, Norway
- Bærum Hospital- Vestre Viken Hospital Trust, Department of Medicine, Drammen, Norway
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Gothenburg University, Goteborg, Sweden
- Neurocare, Sahlgrenska University Hospital, Goteborg, Sweden
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Monday O, Rawat A, Isaak AK, Manzoor A, Jaiswal G, Saeed L, Kumari A, Amin A. Comparing the Effectiveness of Intravenous Tissue Plasminogen Activator and Dual Antiplatelet Therapy in Patients With Minor Stroke: A Meta-Analysis. Cureus 2023; 15:e46436. [PMID: 37927654 PMCID: PMC10624328 DOI: 10.7759/cureus.46436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
The aim of this study was to compare the outcomes between dual antiplatelet therapy (DAPT) versus intravenous tissue plasminogen activator (IV t-PA) in patients with minor stroke. This meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Two authors independently conducted online database searches using PubMed, Web of Science, and EMBASE to identify articles published in English language from inception to September 5, 2023. Outcomes assessed in this meta-analysis included all-cause mortality, stroke incidence, and functional outcomes (measured by modified ranking scale (mRS) scores of 0 to 1). A total of three studies fulfilled the eligibility criteria and included in the final analysis. Pooled analysis showed that the risk of all-cause mortality was not significantly different between the t-PA group and DAPT group (relative risk (RR): 1.14, 95% confidence interval (CI): 0.32-4.06). Compared with those treated with DAPT, there was no significant difference in t-PA in terms of the number of patients with a favorable functional outcome (defined as an mRS score of 0-1). The risk of stroke was not significantly different between the t-PA group and DAPT group (RR: 1.11, 95% CI: 0.68 to 1.82). The analysis, based on three studies, revealed no significant differences between t-PA and DAPT regarding all-cause mortality, stroke incidence, and functional outcomes.
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Affiliation(s)
- Obinna Monday
- Medicine, Norfolk and Norwich University Hospital, Norwich, GBR
| | - Anurag Rawat
- Interventional Cardiology, Himalayan Institute of Medical Sciences, Dehradun, IND
| | - Abraham K Isaak
- Telemetry, Sharp Memorial Hospital, San Diego, USA
- Internal Medicine, Orotta School of Medicine and Dentistry, Asmara, ERI
| | - Amima Manzoor
- Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Goldi Jaiswal
- Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | - Leena Saeed
- Internal Medicine, National Ribat University, Khartoum, SDN
| | - Ajanta Kumari
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Adil Amin
- Cardiology, Pakistan Navy Ship Shifa (PNS Shifa), Karachi, PAK
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Ekkert A, Milmantienė D, Jokimaitytė U, Jatužis D. Posterior Circulation Stroke Patients Receive Less Reperfusion Therapy Because of Late Arrival and Relative Contraindications: A Retrospective Study. J Clin Med 2023; 12:5181. [PMID: 37629223 PMCID: PMC10455447 DOI: 10.3390/jcm12165181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Reperfusion treatment (RT) is administered to individuals with posterior circulation strokes (PCS) later and less frequently. We aimed to study the impact of demographic and clinical factors on the decision for RT in PCS. METHODS We conducted a retrospective analysis of the data from 500 subjects admitted to the tertiary stroke centre's emergency department between 2018 and 2020 due to PCS. Demographic and clinical factors were analysed among three groups: the RT group, the group with no RT because of absolute contraindications (ACI), and the group with no RT because of relative contraindications (RCI). RESULTS Of the patients, 202 (40.3%) were female. The median NIHSS was four (4), and the subjects' median age was 69 (18). RT was performed on 120 (24%) subjects. FAST symptoms (OR-5.62, 95% CI [2.90-12.28]) and higher NIHSS (OR-1.13, 95% CI [1.09-1.18]) at presentation, atrial fibrillation (OR-1.56, 95% CI [1.02-2.38]), hypertension (OR-2.19, 95% CI [1.17-4.53]) and diabetes (OR-1.70, 95% CI [1.06-2.71]) increased the chance of RT. Late arrival was the most prevalent ACI for 291 (58.2%) patients. FAST-negative subjects (OR-2.92, 95% CI [1.84-4.77]) and males (OR-1.58, 95% CI [1.11-2.28]) had a higher risk of arriving late. Because of RCI, 50 (10%) subjects did not receive RT; the majority were above 80 and had NIHSS ≤ 5. Subjects with RCI who received the RT had a higher NIHSS (4 vs. 3, p < 0.001), higher hypertension (59 (92.2%) vs. 35 (77.8%), p = 0.032) and heart failure (23 (35.9%) vs. 7 (15.6%), p = 0.018) prevalence. There was a trend for less RT in females with RCI. CONCLUSIONS Late arrival was the most common barrier to RT, and the male gender increased this risk. because of relative contraindications, 10% of subjects were not considered for RT. The presence of FAST symptoms, vascular risk factors, and a higher NIHSS increased the chance of RT.
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Affiliation(s)
- Aleksandra Ekkert
- Faculty of Medicine, Vilnius University, LT-03225 Vilnius, Lithuania; (D.M.); (U.J.); (D.J.)
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