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Peycheva M, Padlina G, Genceviciute K, Krasteva MP, Boronylo A, Goeldlin MB, Müller M, Wenz ES, Müller MD, Hammer H, Bücke P, Bigi S, Simonetti BG, Hoffmann A, Umarova RM, Pilgram-Pastor S, Gralla J, Mordasini P, Antonenko K, Heldner MR. Baseline characteristics and outcome of stroke patients after endovascular therapy according to previous symptomatic vascular disease and sex. Front Neurol 2024; 15:1293905. [PMID: 38694775 PMCID: PMC11061446 DOI: 10.3389/fneur.2024.1293905] [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] [Received: 09/22/2023] [Accepted: 04/02/2024] [Indexed: 05/04/2024] Open
Abstract
Aim The aim of this study was to investigate baseline characteristics and outcome of patients after endovascular therapy (EVT) for acute large vessel occlusion (LVO) in relation to their history of symptomatic vascular disease and sex. Methods Consecutive EVT-eligible patients with LVO in the anterior circulation admitted to our stroke center between 04/2015 and 04/2020 were included in this observational cohort study. All patients were treated according to a standardized acute ischaemic stroke (AIS) protocol. Baseline characteristics and successful reperfusion, recurrent/progressive in-hospital ischaemic stroke, symptomatic in-hospital intracranial hemorrhage, death at discharge and at 3 months, and functional outcome at 3 months were analyzed according to previous symptomatic vascular disease and sex. Results 995 patients with LVO in the anterior circulation (49.4% women, median age 76 years, median admission NIHSS score 14) were included. Patients with multiple vs. no previous vascular events showed higher mortality at discharge (20% vs. 9.3%, age/sex - adjustedOR = 1.43, p = 0.030) and less independency at 3 months (28.8% vs. 48.8%, age/sex - adjustedOR = 0.72, p = 0.020). All patients and men alone with one or multiple vs. patients and men with no previous vascular events showed more recurrent/progressive in-hospital ischaemic strokes (19.9% vs. 6.4% in all patients, age/sex - adjustedOR = 1.76, p = 0.028) (16.7% vs. 5.8% in men, age-adjustedOR = 2.20, p = 0.035). Men vs. women showed more in-hospital symptomatic intracranial hemorrhage among patients with one or multiple vs. no previous vascular events (23.7% vs. 6.6% in men and 15.4% vs. 5.5% in women, OR = 2.32, p = 0.035/age - adjustedOR = 2.36, p = 0.035). Conclusions Previous vascular events increased the risk of in-hospital complications and poorer outcome in the analyzed patients with EVT-eligible LVO-AIS. Our findings may support risk assessment in these stroke patients and could contribute to the design of future studies.
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Affiliation(s)
- Marieta Peycheva
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Department of Neurology and Research Institute, Medical University Plovdiv, Plovdiv, Bulgaria
| | - Giovanna Padlina
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Clinica Luganese, Mancucco, Lugano, Switzerland
| | - Kotryna Genceviciute
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marina P. Krasteva
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital Queen Giovanna, Sofia, Bulgaria
| | - Anna Boronylo
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Martina B. Goeldlin
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Madlaine Müller
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Elena S. Wenz
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Mandy D. Müller
- Department of Neurosurgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Helly Hammer
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Philipp Bücke
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Sandra Bigi
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Division of Paediatric Neurology, Department of Paediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Barbara Goeggel Simonetti
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Division of Neuropaediatrics, Istituto Pediatrico della Svizzera Italiana IPSI EOC, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Angelika Hoffmann
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Roza M. Umarova
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Sara Pilgram-Pastor
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Netzwerk Radiologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Kateryna Antonenko
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Mirjam R. Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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Shao G, Li X, Da M, Huo X, Zhang S. Outcome Comparison of Endovascular Treatment for Acute Large Vessel Occlusion Due to Large Artery Atherosclerosis and Cardioembolism in the Chinese Population: Data from the ANGEL Registry. Clin Interv Aging 2024; 19:339-346. [PMID: 38434575 PMCID: PMC10906272 DOI: 10.2147/cia.s442339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Background and Purpose Studies on outcome comparison after endovascular treatment (EVT) for large vessel occlusion (LVO) between large artery atherosclerosis (LAA) and cardioembolism (CE) in the Asian population are scarce. We aimed to compare the baseline characteristics and clinical outcomes after EVT for anterior circulation LVO with LAA and CE in the Chinese population. Methods Patients were selected from the ANGEL registry and divided into LAA and CE groups. The primary outcome was the 90-day modified Rankin Scale (mRS) 0-2. The secondary outcomes were 90-day mRS distribution, 90-day mRS 0-1, 90-day mRS 0-3, and early neurological improvement. The safety outcomes included death, symptomatic intracranial hemorrhage, and any intracranial hemorrhage. We conducted logistic regression models with adjustments to compare the outcomes. Results A total of 632 patients were included, of whom, 488 were in the LAA group and 144 were in the CE group. No significant difference in 90-day mRS 0-2 was observed between LAA and CE groups (55.7%vs.43.1%, odds ratio[OR] 1.19, 95% confidence interval(CI), 0.92-1.53, P=0.190). The LAA group exhibited a higher frequency of mRS 0-3 compared to the CE group (69.1% vs 32.6%, OR1.32, 95% CI 1.02-1.72, P=0.038). However, the incidence of death within 90 days did not significantly differ between the LAA and CE groups (10.9%vs.24.3%, OR0.91, 95% CI0.66-1.25, P=0.545), nor did the occurrences of symptomatic intracranial hemorrhage(SICH) (4.5%vs.9.7%,OR1.08, 95% CI 0.65-1.78, P=0.779) or intracranial hemorrhage(ICH) (21.9%vs.30.6%, OR 0.94, 95% CI0.71-1.25, P=0.680). Moreover, no significant disparities were detected in other outcomes between the two groups (All P>0.05). Conclusion In the ANGEL registry, a higher prevalence of patients undergoing EVT for acute anterior circulation LVO with LAA was found than those with CE. However, our study revealed that the efficacy and safety of EVT remained consistent regardless of the stroke's etiology such as LAA or CE.
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Affiliation(s)
- Guangcai Shao
- Department of Neurosurgery, Anshan Central Hospital, Anshan, People’s Republic of China
| | - Xiang Li
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Meiyue Da
- Department of Neurosurgery, Anshan Central Hospital, Anshan, People’s Republic of China
| | - Xiaochuan Huo
- Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Shuheng Zhang
- Department of Neurosurgery, Anshan Central Hospital, Anshan, People’s Republic of China
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Xu X, Ni C, Wu K, Zha M, Sun Y, Wang H, Xu J, Yang K, Guo Y, Huang X, Zhou Z. The relationship between occlusion patterns and outcomes after thrombectomy in patients with acute internal carotid artery occlusion. J Neuroradiol 2023; 50:455-461. [PMID: 37061029 DOI: 10.1016/j.neurad.2023.04.002] [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: 04/06/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND AND PURPOSES Ischemic stroke caused by acute internal carotid artery occlusions (AICO) is usually associated with high disability and mortality. We aimed to investigate whether occlusion patterns significantly influence clinical outcome in patients receiving endovascular thrombectomy (EVT). PATIENTS AND METHODS We performed a retrospective analysis of databases from two comprehensive stroke centers and consecutively investigated patients who had underwent EVT. AICO was defined as acute internal carotid artery occlusions (cervical segment to terminal segment). The clinical characteristics, intervention parameters, and prognosis data were collected. Leptomeningeal collaterals (LMC) were assessed with the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scale (ASITN/SIRs), graded on a 5-point scale. The occlusion patterns based on Willisian collaterals were categorized into I-type, L-type, and T-type by contralateral carotid artery injections at digital subtraction angiography. Multivariate regression models were applied to evaluate the relationship between occlusion patterns and the prognosis of patients at 90 days after stroke. RESULTS A total of 213 patients were included in the study. Of those,142 (66.7%) achieved successful reperfusion and 64 (30.0%) achieved favorable outcomes at 90 days. Overall, 26 (12.2%), 117 (54.9%), and 70 (32.9%) cases respectively suffered from I-type, L-type, and T-type occlusion. In addition, patients with I-type occlusions had a higher percentage of complete LMC compared with L-type or T-type occlusions (88.5% versus 30.8% versus 27.1%, P< 0.0167). In multivariable logistic regression, we found T-type occlusion was no longer an independent predictor of poor functional outcomes in AICO after adjusting LMC (T versus I, OR, 2.555, 95%CI: 0.717-9.103, P = 0.148; L versus I, OR, 0.815, 95%CI: 0.258-2.574, P = 0.727). CONCLUSIONS For ACIO, occlusion patterns are still a topic that needs attention. Furthermore, compensatory LMC may affect the association between occlusion patterns and functional prognosis in AICO. Occlusion patterns and LMC status distinguish the nature and impact of AICO on expected EVT and subsequent clinical outcomes.
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Affiliation(s)
- Xin Xu
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China
| | - Chuyuan Ni
- Department of Neurology, Huangshan City People's Hospital, Huangshan, Anhui province, China
| | - Kangfei Wu
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China
| | - Mingming Zha
- Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University
| | - Yi Sun
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China
| | - Hao Wang
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China
| | - Junfeng Xu
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China
| | - Ke Yang
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China
| | - Yapeng Guo
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China
| | - Xianjun Huang
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China.
| | - Zhiming Zhou
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui province, China
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Song P, Xie J, Li W, Zhang X, Sun Z, You C. Effect of plasma thrombin-antithrombin complex on ischemic stroke: a systematic review and meta-analysis. Syst Rev 2023; 12:17. [PMID: 36788633 PMCID: PMC9930276 DOI: 10.1186/s13643-023-02174-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/11/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Thrombin-antithrombin complex (TAT) is a prethrombotic marker, and its application in ischemic stroke is still uncertain. The purpose of this systematic review and meta-analysis is to evaluate the relationship between plasma TAT and ischemic stroke base on the current evidence. METHODS A systematic literature search was conducted for searching the relative studies that investigated the association of TAT and ischemic stroke in PubMed, EMBASE, and Cochrane library databases. Mean difference and 95% confidence interval as the effect sizes were synthesized by random effects model in Review Manager (RevMan) Version 5.4. The heterogeneity was investigated using the chi-square test and the possible sources of heterogeneity were explored by sensitivity analysis and meta-regression. The publication bias was estimated by Egger's tests. RESULTS A total of 12 eligible studies were included involving 1431 stroke cases and 532 healthy controls, of which six studies were eventually included in the meta-analysis. Plasma TAT in patients with ischemic stroke was significantly higher than that in healthy controls (MD 5.31, 95% CI = 4.12-6.51, P < 0.0001, I2 = 97.8%). There is a difference of TAT level in the same period among cardioembolic, lacunar, and atherothrombotic stroke (all P < 0.0001), in which the cardioembolic stroke with the highest level. Meanwhile, it is significant of TAT levels among various phases of cardioembolic stroke and the acute phase are markedly elevated (MD 7.75, 95CI%, 6.07-9.43, P < 0.001). However, no difference was found in the atherothrombotic (P = 0.13) and lacunar stroke (P = 0.34). Besides, the higher TAT level is closely related to the poor prognosis of patients with ischemic stroke, including higher recurrence, mortality, unfavorable recovery (modified Rankin scale > 2), and poor revascularization. CONCLUSIONS This study suggested that plasma TAT levels are different in ischemic stroke subtypes, which are closely associated with the progression and might have an effect on the prognosis. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD: 42021248787.
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Affiliation(s)
- Peipei Song
- Laboratory Medicine Center, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Jianqin Xie
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Wei Li
- Laboratory Medicine Center, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Xinying Zhang
- Laboratory Medicine Center, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Zhipeng Sun
- Academic Department, Sysmex Shanghai Ltd., Shanghai, 200120, China
| | - Chongge You
- Laboratory Medicine Center, Lanzhou University Second Hospital, Lanzhou, 730000, China.
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5
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Delayed neurological improvement after endovascular treatment for acute large vessel occlusion: data from ANGEL-ACT registry. J Thromb Thrombolysis 2023; 55:1-8. [PMID: 36301460 DOI: 10.1007/s11239-022-02712-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND A subgroup of patients with acute large vessel occlusion (ALVO) may experience delayed neurological improvement (DNI) after endovascular treatment (EVT). Our study aimed to investigate the incidence and independent predictors of DNI in patients with ALVO after EVT. METHODS We selected subjects from ANGEL-ACT Registry. The definition of DNI is patients with ALVO who did not experience early neurological improvement (ENI) despite complete recanalization after EVT. These patients achieved a 90-day favorable outcome assessed by a modified Rankin Scale (mRS) score. We defined ENI as a ≥ 4-point decrease in the National Institutes of Health Stroke Scale (NIHSS) between baseline and 24 h or NIHSS of 0 or 1 at 24 h, with complete recanalization after EVT. We performed logistic regression analyses to determine the independent predictors of DNI. RESULTS Among the 1056 enrolled patients, 406 (38.4%) did not experience ENI. 106 (26.1%) patients without ENI achieved DNI. On Multivariate analysis, lower admission NIHSS score (odds ratio [OR] = 1.17,95% confidence interval [CI]: 1.11-1.23, P < 0.001), underlying ICAD (OR = 2.03, 95% CI: 1.07-3.85, P = 0.029) and absence of general anesthesia (OR = 2.13, 95% CI: 1.24-3.64, P = 0.006) were independent predictors of DNI. CONCLUSION DNI occurred in 26.1% of patients with ALVO who did not experience ENI after EVT. Our study identified several independent predictors of DNI that should be highly considered in daily clinical practice to improve ALVO management.
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Li H, Liu P, Ma HY, Hua WL, Zhang YX, Zhang L, Zhang YW, Hong B, Yang PF, Liu JM. Novel predictors and a predictive model of cerebrovascular atherosclerotic ischemic stroke based on clinical databases. Neurol Res 2022; 45:391-399. [PMID: 36413433 DOI: 10.1080/01616412.2022.2149185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Early identification of cerebrovascular atherosclerotic ischemic stroke is necessary for accurate treatment and clinical research. AIMS To identify novel predictors and build a predictive model of ischemic strokes due to cerebrovascular atherosclerosis. METHOD MIMIC-IV database was used to search for clinical data of patients with ischemic stroke. Included patients were divided into two groups according to their etiologies. Univariate and multivariate logistic regressions were used to build the predictive model, and the model reliability parameters were calculated. The cut-off value for the model was selected according to the Youden index. Clinical data from the Neurovascular Center of Changhai Hospital were used to verify the predictive model. RESULTS Logistical regressions showed a positive correlation between advanced age, peripheral atherosclerosis, history of transient ischemia, and the diagnosis of ischemic strokes due to cerebrovascular atherosclerosis. The history of atrial fibrillation, levels of the National Institutes of Health Stroke Scale, serum potassium, and activated partial thromboplastin time were negatively correlated to the diagnosis of cerebrovascular atherosclerotic ischemic stroke. The predictive model was constructed from logistic regression results, and the area under the curve was 0.764. The cut-off value for the model was set at 0.089 to achieve the highest Youden index, with sensitivity and specificity of 75.9% and 64.1%. Clinical verification of the model revealed that the sensitivity and specificity of the model were 52.5% and 93.0% respectively. CONCLUSION The efficacy of the predictive model was acceptable as an aid in predicting cerebrovascular atherosclerotic ischemic stroke.
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Affiliation(s)
- He Li
- Emergency Department, Naval Hospital of Eastern Theater, Zhoushan, China
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Pei Liu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hong-Yu Ma
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wei-Long Hua
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yong-Xin Zhang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lei Zhang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yong-Wei Zhang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Bo Hong
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Peng-Fei Yang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jian-Min Liu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
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Peng L, Hu G, Yao Q, Wu J, He Z, Law BYK, Hu G, Zhou X, Du J, Wu A, Yu L. Microglia autophagy in ischemic stroke: A double-edged sword. Front Immunol 2022; 13:1013311. [PMID: 36466850 PMCID: PMC9708732 DOI: 10.3389/fimmu.2022.1013311] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/25/2022] [Indexed: 08/14/2023] Open
Abstract
Ischemic stroke (IS) is one of the major types of cerebrovascular diseases causing neurological morbidity and mortality worldwide. In the pathophysiological process of IS, microglia play a beneficial role in tissue repair. However, it could also cause cellular damage, consequently leading to cell death. Inflammation is characterized by the activation of microglia, and increasing evidence showed that autophagy interacts with inflammation through regulating correlative mediators and signaling pathways. In this paper, we summarized the beneficial and harmful effects of microglia in IS. In addition, we discussed the interplay between microglia autophagy and ischemic inflammation, as along with its application in the treatment of IS. We believe this could help to provide the theoretical references for further study into IS and treatments in the future.
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Affiliation(s)
- Li Peng
- Sichuan Key Medical Laboratory of New Drug Discovery and Druggability Evaluation, School of Pharmacy, Southwest Medical University, Luzhou, China
- Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, School of Pharmacy, Southwest Medical University, Luzhou, China
- Department of Medicine Imaging, School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Guangqiang Hu
- Department of Anatomy, School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Qianfang Yao
- Sichuan Key Medical Laboratory of New Drug Discovery and Druggability Evaluation, School of Pharmacy, Southwest Medical University, Luzhou, China
- Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Jianming Wu
- Sichuan Key Medical Laboratory of New Drug Discovery and Druggability Evaluation, School of Pharmacy, Southwest Medical University, Luzhou, China
- Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Ziyang He
- Sichuan Key Medical Laboratory of New Drug Discovery and Druggability Evaluation, School of Pharmacy, Southwest Medical University, Luzhou, China
- Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Betty Yuen-Kwan Law
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macao, Macao SAR, China
| | - Guishan Hu
- Sichuan Key Medical Laboratory of New Drug Discovery and Druggability Evaluation, School of Pharmacy, Southwest Medical University, Luzhou, China
- Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Xiaogang Zhou
- Sichuan Key Medical Laboratory of New Drug Discovery and Druggability Evaluation, School of Pharmacy, Southwest Medical University, Luzhou, China
- Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Junrong Du
- Key Laboratory of Drug Targeting and Drug Delivery Systems of Ministry of Education, Department of Pharmacology, West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Anguo Wu
- Sichuan Key Medical Laboratory of New Drug Discovery and Druggability Evaluation, School of Pharmacy, Southwest Medical University, Luzhou, China
- Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Lu Yu
- Sichuan Key Medical Laboratory of New Drug Discovery and Druggability Evaluation, School of Pharmacy, Southwest Medical University, Luzhou, China
- Luzhou Key Laboratory of Activity Screening and Druggability Evaluation for Chinese Materia Medica, School of Pharmacy, Southwest Medical University, Luzhou, China
- Department of Medicine Imaging, School of Clinical Medicine, Southwest Medical University, Luzhou, China
- Department of Chemistry, School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
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Zhang Y, Hong L, Ling Y, Yang L, Li S, Cheng X, Dong Q. Association of time to groin puncture with patient outcome after endovascular therapy stratified by etiology. Front Aging Neurosci 2022; 14:884087. [PMID: 36299609 PMCID: PMC9590449 DOI: 10.3389/fnagi.2022.884087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background Randomized clinical trials and large stroke registries have demonstrated a time-dependent benefit of endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). The aim of this study was to investigate whether this could be applied to different stroke subtypes in a real-world single-center cohort. Materials and methods Consecutive ischemic stroke patients with LVOs presenting within 24 h after symptom onset were prospectively registered and retrospectively assessed. Baseline multimodal imaging was conducted before EVT. Independent predictors of functional independence [90-day modified Rankin scale (mRS), 0–2] and any incidence of intracranial hemorrhage (ICH) were explored using a stepwise logistic regression model in the entire cohort and in stroke subtypes. Results From 2015 to 2020, 140 eligible patients received EVT, of whom 59 (42%) were classified as large artery atherosclerosis (LAA)-related. Time from last known normal to groin puncture was identified as an independent predictor for functional independence in patients of cardioembolic (CE) subtype [odds ratio (OR) 0.90 per 10 min; 95% CI 0.82–0.98; P = 0.013] but not in the LAA subtype and the whole cohort. Groin puncture within 6 h after the time of last known normal was associated with a lower risk of any ICH in the whole cohort (OR 0.36, 95% CI 0.17–0.75, P = 0.007). Sensitivity analysis of patients with complete imaging profiles also confirmed the above findings. Besides, compared with patients of the CE subtype, the LAA subtype had a smaller baseline ischemic core volume, a better collateral status, a slower core growth rate, and a numerically smaller final infarct volume. Conclusion Faster groin puncture has a more pronounced effect on the functional outcome in patients of CE subtype than those of LAA subtype. Reducing time to groin puncture is of great importance in improving the prognosis of patients after EVT, especially those of CE subtype, and reducing the incidence of any ICH in all patients.
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Affiliation(s)
- Yiran Zhang
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Lan Hong
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yifeng Ling
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Lumeng Yang
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Siyuan Li
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Cheng
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Xin Cheng,
| | - Qiang Dong
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
- Qiang Dong,
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Sinha A, Stanwell P, Beran RG, Calic Z, Killingsworth MC, Bhaskar SMM. Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy-A Meta-Analysis. Neurol Int 2021; 13:608-621. [PMID: 34842774 PMCID: PMC8628951 DOI: 10.3390/neurolint13040060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The interplay between collateral status and stroke aetiology may be crucial in the evaluation and management of acute ischemic stroke (AIS). Our understanding of this relationship and its level of association remains sub-optimal. This study sought to examine the association of pre-intervention collateral status with stroke aetiology, specifically large artery atherosclerosis (LAA) and cardio-embolism (CE), in AIS patients receiving reperfusion therapy, by performing a meta-analysis. METHODS Relevant search terms were explored on Medline/PubMed, Embase and Cochrane databases. Studies were included using the following inclusion criteria: (a) patients aged 18 or above; (b) AIS patients; (c) patients receiving reperfusion therapy; (d) total cohort size of >20, and (e) qualitative or quantitative assessment of pre-intervention collateral status on imaging using a grading scale. Random-effects meta-analysis was performed to investigate the association of aetiology with pre-intervention collateral status, and forest plots of risk ratio (RR) were generated. RESULTS A meta-analysis was conducted on seven studies, with a cumulative cohort of 1235 patients, to assess the association of pre-intervention collateral status with stroke aetiology. Patients with LAA were associated significantly with an increased rate of good collaterals (RR 1.24; 95% CI 1.04-1.50; p = 0.020, z = 2.33). Contrarily, CE aetiology was associated significantly with a decreased rate of good collaterals (RR 0.83; 95% CI 0.71-0.98; p = 0.027, z = -2.213). CONCLUSIONS This study demonstrates that, in AIS patients receiving reperfusion therapy, LAA and CE aetiologies are associated significantly with collateral status.
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Affiliation(s)
- Akansha Sinha
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia; (A.S.); (R.G.B.); (Z.C.); (M.C.K.)
- South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW 2170, Australia
| | - Peter Stanwell
- School of Health Sciences, University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia;
| | - Roy G. Beran
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia; (A.S.); (R.G.B.); (Z.C.); (M.C.K.)
- South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW 2170, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South-Western Sydney Local Health District, Sydney, NSW 2170, Australia
- Medical School, Griffith University, Gold Coast, QLD 4222, Australia
- Faculty of Sociology, Sechenov Moscow First State University, 119991 Moscow, Russia
| | - Zeljka Calic
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia; (A.S.); (R.G.B.); (Z.C.); (M.C.K.)
- South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW 2170, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South-Western Sydney Local Health District, Sydney, NSW 2170, Australia
| | - Murray C. Killingsworth
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia; (A.S.); (R.G.B.); (Z.C.); (M.C.K.)
- South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW 2170, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia
- Correlative Microscopy Facility, Department of Anatomical Pathology, NSW Health Pathology, Liverpool, NSW 2170, Australia
| | - Sonu M. M. Bhaskar
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW 2170, Australia; (A.S.); (R.G.B.); (Z.C.); (M.C.K.)
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South-Western Sydney Local Health District, Sydney, NSW 2170, Australia
- Correspondence: ; Tel.: +61-(02)-873-89179
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