1
|
Yang X, Jia X, Ren H, Zhang H. The short- and long-term efficacies of endovascular interventions for the treatment of acute ischemic stroke patients. Am J Transl Res 2021; 13:5436-5443. [PMID: 34150141 PMCID: PMC8205676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE We aimed to investigate the short- and long-term efficacies of endovascular interventional therapy in acute ischemic stroke (AIS) patients. METHODS In this retrospective study, 94 patients with AIS were recruited and divided into a control group (n=51) that was administered intra-arterial thrombolysis and an observation group (n=43) that was administered Solitaire stent thrombectomies. The postoperative recanalization and overall response rates were recorded in both groups. The hemodynamic parameters (high shear viscosity, low shear viscosity, plasma viscosity, and hematocrit), and the C-reactive protein, interleukin 6, and fibrinogen levels were compared between the two groups before and after the treatment. In addition, the National Institutes of Health Stroke Scale and the modified Rankin Scale scores were analyzed before the treatment and at 1 and 3 months after the treatment in both groups. After a 3-year follow-up, a survival analysis was also performed using the Kaplan-Meier survival method. RESULTS The overall response and recanalization rates were higher in the observation group than they were in the control group (P<0.05). Before the treatment, there were no significant differences in the hemodynamic parameter, C-reactive protein, interleukin, 6 and fibrinogen levels in the two groups (P>0.05). After the treatment, the above levels in both groups decreased compared to their levels before the treatment, and the observation group had significantly lower levels than the control group (P<0.05). Moreover, no significant differences were seen in National Institutes of Health Stroke Scale and modified Rankin Scale scores between the two groups before the treatment (P>0.05). After the treatment, the above scores were decreased in both groups at 1 and 3 months compared to their pre-treatment levels, and the scores were significantly lower in the observation group than they were in the control group at 1 month after the treatment (P<0.05). After a 3-year follow-up, the Kaplan-Meier survival curves demonstrated that the survival times were significantly longer in the observation group than they were in the control group (P<0.05). CONCLUSION Solitaire stent thrombectomy markedly ameliorates neurological deficits in AIS patients, improves their recanalization rated, regulates the inflammatory response and hemodynamics in the lesion areas, thus exerting favorable short- and long-term clinical effects.
Collapse
Affiliation(s)
- Xingxiu Yang
- Department of Neurology, Nanchong Central HospitalNanchong, Sichuan Province, China
| | - Xiaohui Jia
- Department of Neurology, Nanchong Central HospitalNanchong, Sichuan Province, China
| | - Hua Ren
- Department of Neurology, Nanchong Central HospitalNanchong, Sichuan Province, China
| | - Hongxing Zhang
- Department of Neurology, Xi’an Gaoxin Hospital, Affiliated to Northwest UniversityXi’an, Shaanxi Province, China
| |
Collapse
|
2
|
Liang W, Wang Y, Du Z, Mang J, Wang J. Intraprocedural Angiographic Signs Observed During Endovascular Thrombectomy in Patients With Acute Ischemic Stroke: A Systematic Review. Neurology 2021; 96:1080-1090. [PMID: 33893205 DOI: 10.1212/wnl.0000000000012069] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/25/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In the real-world practice of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), the analysis of intraprocedural angiographic signs (IPASs) still challenges neurointerventionists. This review provides insights into the significance of these subtle changes for predicting underlying etiology, technical feasibility, and patient prognosis, thus promoting the potential real-time application of these signs. METHODS A systematic literature search was conducted using PubMed, Ovid Medline/Embase, and Cochrane. The search focused on studies published between January 1995 and August 2020 that reported findings related to intraprocedural angiographic manifestations in endovascular recanalization therapy for AIS. RESULTS We identified 12 IPASs in 22 studies involving 1,683 patients. The IPASs were assigned into 3 subsets according to their clinical meanings. CONCLUSION The systematic analysis of IPAS in clinical trials and practice will lead to a better understanding of treatment effects, responses, and mechanisms during EVT. Studies of larger cohorts using more robust statistical methods are needed.
Collapse
Affiliation(s)
- Wenzhao Liang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
| | - Yimeng Wang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
| | - Zhihua Du
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
| | - Jing Mang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China.
| | - Jun Wang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
| |
Collapse
|
3
|
Romanenko AV, Solovyeva EY. [Pathogenetic and therapeutic aspects of cardioembolic stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:165-172. [PMID: 33834736 DOI: 10.17116/jnevro2021121031165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardioembolic stroke (CS) is the one of the most severe and requiring dynamic monitoring among the all subtypes of ischemic stroke. Patients with CS require joint treatment with cardiologists. CS is characterized by a greater severity of neurological deficits, a high risk of repeated acute cerebral circulatory disorders and fatal outcomes. This review considers the main causes of CS, the etiopathogenesis of thrombus formation in the heart chambers, current verification criteria and therapeutic aspects of CS, recommendations for the prescription of anticoagulant therapy for primary and secondary preventive treatment.
Collapse
Affiliation(s)
- A V Romanenko
- Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - E Yu Solovyeva
- Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| |
Collapse
|
4
|
Zhao Z, Zhang J, Jiang X, Wang L, Yin Z, Hall M, Wang Y, Lai L. Is Endovascular Treatment Still Good for Ischemic Stroke in Real World?: A Meta-Analysis of Randomized Control Trial and Observational Study in the Last Decade. Stroke 2020; 51:3250-3263. [PMID: 32921259 DOI: 10.1161/strokeaha.120.029742] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Although endovascular treatment (EVT) for acute ischemic stroke is classified as I evidence, outcomes after EVT in real-world practice appear to be less superior than those in randomized clinical trials (RCTs). Additionally, the effect of EVT is unclear compared with medical treatment (MT) for patients with mild symptoms defined by National Institutes of Health Stroke Scale score <6 or with severe symptoms defined by Alberta Stroke Program Early CT Score <6. METHODS Literatures were searched in big databases and major meetings from December 6, 2009, to December 6, 2019, including RCTs and observational studies comparing EVT against MT for patients with acute ischemic stroke. Observational studies were precategorized into 3 groups based on imaging data on admission: mild stroke group with National Institutes of Health Stroke Scale score <6, severe stroke group with Alberta Stroke Program Early CT Score <6 or ischemic core ≥50 mL, and normal stroke group for all others. Outcome was measured as modified Rankin Scale score of 0 to 2, mortality at 90 days, and symptomatic intracranial hemorrhage (sICH) at 24 hours. RESULTS Fifteen RCTs (n=3694) and 37 observational studies (n=9090) were included. EVT was associated with higher modified Rankin Scale 0 to 2 rate and lower mortality in RCTs and normal stroke group, whereas EVT was associated with higher sICH rate in normal stroke group, and no difference of sICH rate appeared between EVT and MT in RCTs. In severe stroke group, EVT was associated with higher modified Rankin Scale 0 to 2 rate and lower mortality, whereas no difference of sICH rate was found. In mild stroke group, there was no difference in modified Rankin Scale 0 to 2 rate between EVT and MT, whereas EVT was associated with higher mortality and sICH rate. CONCLUSIONS Evidence from RCTs and observational studies supports the use of EVT as the first-line choice for eligible patients corresponding to the latest guideline. For patients with Alberta Stroke Program Early CT Score <6, EVT showed superiority over MT, also in line with the guidelines. On the contrary to the guideline, our data do not support EVT for patients with National Institutes of Health Stroke Scale score <6.
Collapse
Affiliation(s)
- Zixu Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Jiangxi, PR China (Z.Z., J.Z., X.J., Y.W., L.L.).,Queen Mary School, Jiangxi Medical College (Z.Z., J.Z.), Nanchang University, Jiangxi, PR China
| | - Jiarui Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Jiangxi, PR China (Z.Z., J.Z., X.J., Y.W., L.L.).,Queen Mary School, Jiangxi Medical College (Z.Z., J.Z.), Nanchang University, Jiangxi, PR China
| | - Xin Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Jiangxi, PR China (Z.Z., J.Z., X.J., Y.W., L.L.).,The First Clinical Medical School, Jiangxi Medical College (X.J.), Nanchang University, Jiangxi, PR China
| | - Li Wang
- Centre for Evidence-Based Medicine, School of Public Health (L.W.), Nanchang University, Jiangxi, PR China
| | - Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, PR China (Z.Y.)
| | - Michael Hall
- Institute of Ophthalmology, University College London, United Kingdom (M.H.)
| | - Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Jiangxi, PR China (Z.Z., J.Z., X.J., Y.W., L.L.)
| | - Lingfeng Lai
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Jiangxi, PR China (Z.Z., J.Z., X.J., Y.W., L.L.)
| |
Collapse
|