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Oliveira R, Correia MA, Marto JP, Carvalho Dias M, Mohamed GA, Nguyen TN, Nogueira RG, Aboul-Nour H, Marin H, Bou Chebl A, Mohammaden MH, Al-Bayati AR, Haussen DC, Abdalkader M, Fifi JT, Ortega-Gutierrez S, Yavagal DR, Mayer SA, Tsivgoulis G, Neto LL, Aguiar de Sousa D. Reocclusion after successful endovascular treatment in acute ischemic stroke: systematic review and meta-analysis. J Neurointerv Surg 2023; 15:964-970. [PMID: 36328479 DOI: 10.1136/jnis-2022-019382] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Endovascular treatment (EVT) is the standard of care for selected patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). OBJECTIVE To systematically review the available data on: (1) incidence, predictors, and outcomes of patients with reocclusion after successful EVT for AIS and, (2) the characteristics, complications, and outcomes of patients with reocclusion treated with repeated EVT (rEVT) within 30 days of the first procedure. METHODS PubMed was searched (between January 2012 and April 2021) to identify studies reporting reocclusion following successful EVT (Thrombolysis in Cerebral Infarction ≥2b) in patients with AIS due to LVO. Pooled incidence of reocclusion per 100 patients with successful recanalization following EVT was calculated using a random-effects model with Freeman-Tukey double arcsine transformation. Extracted incidences of reocclusion according to etiology and use of intravenous thrombolysis were pooled using random-effects meta-analytic models. RESULTS A total of 840 studies was identified and seven studies qualified for the quantitative analysis, which described 91 same-vessel reocclusions occurring within the first 7 days after treatment among 2067 patients (4.9%; 95% CI 3% to 7%, I2=70.2%). Large vessel atherosclerosis was associated with an increased risk of reocclusion (OR=3.44, 95% CI 1.12 to 10.61, I2=50%). We identified 90 patients treated with rEVT for recurrent LVO, described in five studies. The rates of procedural complications, mortality, and unfavorable functional outcome at 3 months were 18.0%, 18.9%, and 60.3%, respectively. CONCLUSION In cohorts of patients with AIS due to LVO, 5% of patients experienced reocclusion within 7 days after successful EVT. Repeated EVT can be a safe and effective treatment for selected patients with reocclusion.
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Affiliation(s)
- Renato Oliveira
- Department of Neurology, Hospital da Luz Lisboa, Lisboa, Portugal
- Department of Geriatrics, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Manuel A Correia
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - João Pedro Marto
- Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Lisboa, Portugal
| | - Mariana Carvalho Dias
- Department of Neurology, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Ghada A Mohamed
- Department of Neurology, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Raul G Nogueira
- Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hassan Aboul-Nour
- Department of Neurology, Emory University Hospitals, Atlanta, Georgia, USA
| | - Horia Marin
- Department of Radiology, Henry Ford Health, Detroit, Michigan, USA
| | - Alex Bou Chebl
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Alhamza R Al-Bayati
- Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Diogo C Haussen
- Department of Neurology and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Johanna T Fifi
- Departments of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Dileep R Yavagal
- Department of Neurology and Neurosurgery, University of Miami, Miami, Florida, USA
| | - Stephan A Mayer
- Department of Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | - Lia Lucas Neto
- Department of Neuroradiology, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
- Institute of Anatomy, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Diana Aguiar de Sousa
- Institute of Anatomy, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
- Stroke Center, Lisbon Central University Hospital, Lisbon, Portugal
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Fu LJ, Zhao BB, Yang TH, Yu CS. Application Value of CT Perfusion Imaging in Patients with Posterior Circulation Hyperacute Cerebral Infarction. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2022. [DOI: 10.1166/jmihi.2022.3707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objectives: This study aims to evaluate the application value of computed tomography perfusion (CTP) imaging in patients with posterior circulation cerebral infarction in the hyperacute phase. Methods: The changes in CTP parameters, such as time to peak (TTP), mean transfer
time (MTT), cerebral blood flow (CBF) and the cerebral blood volume (CBV) of ischemic region, as well as the ischemic penumbra, infarction core at the affected side and normal brain tissue at the uninjured side, of 168 patients with suspected posterior circulation acute ischemic stroke were
analyzed. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of each parameter map of CTP in displaying the cerebral infarction size in each part of the posterior circulation were evaluated. Results: The CTP results revealed that CBF and
CBV in the infarction area significantly decreased, and MTT and TTP in the blood supply area of cerebellum, thalamus and posterior cerebral artery (PCA) were significantly delayed. These were statistically different from those in the surrounding penumbra and normal brain tissue (P <
0.05). Furthermore, the CBF of the penumbra in each part slightly decreased, and the delay of MTT and TTP was statistically different from that in normal brains (P < 0.05). The CBV of the penumbra in the pons, midbrain and thalamus decreased, which was statistically different from
that in normal brain tissue and simple cerebral ischemia tissue (P < 0.05). The changes in CBF and MTT of the simple cerebral ischemia in each part, and TTP, except for the cerebellum, were statistically different from those of cerebral infarction and normal brain tissue (P
< 0.05). The total sensitivity, specificity and accuracy for the posterior circulation cerebral infarction was 77.2%, 98.6% and 94.9%, respectively, according to the CTP evaluation. Conclusion: The CTP parameter map can reflect the difference between an ischemic penumbra and an infraction
core in the posterior circulation. It has high sensitivity, specificity and accuracy in the CTP evaluation of posterior circulation cerebral infarctions.
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Affiliation(s)
- Le-Jun Fu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Bi-Bo Zhao
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin 300350, China
| | - Tian-Hao Yang
- Department of Radiology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin 300350, China
| | - Chun-Shui Yu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
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Ye Z, Hu J, Xu H, Sun B, Jin Y, Zhang Y, Zhang J. Serum Exosomal microRNA-27-3p Aggravates Cerebral Injury and Inflammation in Patients with Acute Cerebral Infarction by Targeting PPARγ. Inflammation 2021; 44:1035-1048. [PMID: 33394189 DOI: 10.1007/s10753-020-01399-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 12/21/2022]
Abstract
Acute cerebral infarction (ACI) possesses high mortality. Exosomes present in serum have potential application value in ACI diagnosis. This study investigated the mechanism of serum exosomes in ACI. Serum exosomes isolated from ACI patients and normal people were identified and then injected into the established middle cerebral artery occlusion (MCAO) rat model to evaluate cerebral injury and inflammation. Exosomal microRNA (miR)-27-3p expression was detected and interfered to analyze rat cerebral inflammation. The binding relationship between miR-27-3p and PPARγ was predicted and verified. The lipopolysaccharide (LPS)-treated microglia model was established and intervened with miR-27-3p to detect PPARγ, Iba-1, and inflammation-related factor expressions. After overexpressing PPARγ, rat cerebral inflammation was evaluated. The clinical significance of serum exosomal miR-27-3p in ACI was evaluated. Serum exosomes from ACI patients caused exacerbated MCAO rat cerebral injury and poor behavior recovery, as well as promoted cerebral inflammation. Serum exosomal miR-27-3p deepened rat brain inflammation. miR-27-3p targeted PPARγ to promote microglia activation and inflammation-related factor expressions in MCAO rats, and overexpressing PPARγ attenuated MCAO rat cerebral inflammation. Serum exosomal miR-27-3p promised to be a biomarker for ACI. We proved that serum exosomes from ACI patients aggravated ACI patient cerebral inflammation via the miR-27-3p/PPARγ axis.
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Affiliation(s)
- Zhinan Ye
- Department of Neurology, Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, 318000, Zhejiang Province, China
| | - Jingchun Hu
- Department of Anesthesiology, Lishui Municipal Central Hospital, Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Wenzhou, 323000, Zhejiang Province, China
| | - Hao Xu
- Department of Neurology, Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, 318000, Zhejiang Province, China
| | - Bin Sun
- Department of Neurology, Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, 318000, Zhejiang Province, China
| | - Yong Jin
- Department of Neurosurgery, Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, 318000, Zhejiang Province, China
| | - Yaping Zhang
- Department of Neurology, Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, 318000, Zhejiang Province, China
| | - Jianli Zhang
- Department of Neurology, Lishui Municipal Central Hospital, Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, No.289 Kuocang Road, Liandu District of Lishui City, Wenzhou, 323000, Zhejiang Province, China.
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