Efficacy of Solitaire Stent Arterial Embolectomy in Treating Acute Cardiogenic Cerebral Embolism in 17 Patients

Aldehyde Dehydrogenase 2 (ALDH2) Glu504Lys Polymorphism Affects Collateral Circulation and Short-Term Prognosis of Acute Cerebral Infarction Patients

Background

Acute cerebral infarction is a major clinical subtype of ischemic stroke that has become a leading cause of death and disability worldwide. Aldehyde dehydrogenase 2 (ALDH2) is an important oxidative enzyme in alcohol metabolism. The polymorphism of ALDH2 Glu504Lys polymorphism modifies the activity of this enzyme. However, the potential association between the allelic variation of ALDH2 Glu504Lys with collateral circulation and short-term prognosis of acute cerebral infarction remains unclear.

Material/Methods

A total of 394 patients with acute cerebral infarction were recruited for ALDH2 genotyping using direct sequencing. Cerebrovascular stenosis and collateral circulation were evaluated by digital subtraction angiography (DSA). Short-term prognosis was assessed in accordance with the modified Ranking Scale (mRS).

Results

We identified 297 as EAS and 394 as IAS. There were more patients with occluded blood vessel in the opened group and far fewer in the unopened group. ALDH2 polymorphism was significantly different among the primary, secondary, and tertiary opened groups. ALDH2 gene Glu504Lys was significantly associated with short-term prognosis. The genotype GA+AA of ALDH2 gene Glu504Lys locus was an independent risk factor of poor 90-day prognosis.

Conclusions

ALDH2 Glu504Lys could be a risk factor for collateral circulation and a negative predictor for short-term prognosis in acute cerebral infarction in Han Chinese. ALDH2 Glu504Lys could be a new therapeutic target for patients with acute cerebral infarction.

Impact of hyperlipidemia and atrial fibrillation on the efficacy of endovascular treatment for acute ischemic stroke: a meta-analysis

Introduction

Stroke is the crucial cause of death annually. Inconsistent results from the randomized controlled trials (RCTs) aroused controversy on efficacy of endovascular treatment (EVT).

Materials and Methods

To evaluate the efficacy of EVT in stroke patients. We searched three databases including PubMed, Web of science and the Cochrane Library from Jan 2011 to Apr 2017. Eligible studies were RCTs comparing EVT versus standard medical therapy alone. The primary outcomes were favorable functional outcomes (modified Rankin Scale score, 0–2) at 3 months. Meta regression analysis and subgroup analysis were used to explore potential influence factors responsible for the effectiveness of EVT.

Results

Eleven RCTs involving 3018 patients were included in our study. EVT showed better functional outcomes at 90 days (OR, 1.71; 95% CI, 1.28–2.28; P < 0.001) and a higher recanalization rate at 24h (OR, 6.49; 95% CI, 4.79–8.79; P < 0.001). In meta-regression and subgroup analysis, primary outcomes were significantly better among patients with atrial fibrillation (Adj R-squared 46.30%, P = 0.054; OR, 2.40; 95% CI, 1.81–3.19; P < 0.001), patients without hyperlipidemia (Adj R-squared 35.21%, P = 0.159; OR, 2.34; 95% CI, 1.80–3.04; P < 0.001) and when new generation thrombectomy device was used (Adj R-squared 72.21%, P = 0.011; OR, 2.14; 95% CI, 1.75–2.61; P < 0.001).

Conclusions

EVT showed superior clinical outcomes compared with standard medical therapy. The rate of using new generation thrombectomy device was the critical factor influencing therapeutic outcome. Hyperlipidemia and atrial fibrillation may also cause the potential effect.