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Objective:To explore the prognostic prediction value of quantitative digital subtraction angiography (DSA) parameters in patients with acute anterior circulation ischemic stroke undergoing mechanical thrombectomy, and whether the clinical values vary by stroke etiology.Methods:This study was a post hoc analysis of the Multicenter Prospective Captor Trial. Patients with acute anterior circulation large-vessel occlusion and successful recanalization from April 2018 to July 2019 were screened. Post-processing analysis was performed on the DSA imaging sequence after recanalization, and 4 regions of interest (ROI) were selected in the target vessel: ROI1 (the proximal of the internal carotid artery-C2 segment), ROI2 (the starting point of the internal carotid artery-C7 segment), ROI3 (the end of the middle cerebral artery-M1 segment), and ROI4 (the end of the middle cerebral artery-M2 segment). Time to peak (TTP) was defined as the time at contrast concentration of selected ROI reached its maximum. Relative TTP (rTTP) was calculated by subtracting the TTP of ROI1 from the TTP of distalis ROIs. Successful recanalization was defined as modified Thrombolysis In Cerebral Infarction (mTICI) grade≥2b. Favorable outcomes at 3 months were defined as the modified Rankin Scale score≤2. According to the modified Rankin Scale score, the patients were divided into good prognosis group and poor prognosis group. The differences in clinical characteristics, postoperative hemodynamic parameters, and other data were compared between patients with good and poor prognoses. Univariate and multivariate Logistic regression was used to analyze factors related to a good prognosis. Finally, the prognostic prediction value of hemodynamic parameters was analyzed in patients with different Trial of Org10172 in Acute Stroke Treatment etiological classifications.Results:A total of 245 patients were collected, of which 161 patients [age 69 (60, 76) years, 92 (57.1%) male] were finally included in the analysis, including 36 cases of large artery atherosclerosis (LAA) stroke, 76 cases of cardiogenic embolism (CE), and 49 cases of other causes of stroke. Seventy-one (44.1%) patients had favorable outcomes at 3 months. The post-operative hemodynamic analysis indicated that patients with favorable outcomes ( n=71) had a higher proportion of mTICI grade 3 [54/71 (76.1%) vs 41/90 (45.6%),χ 2=15.26, P<0.001] and lower rTTP 31 [means TTP ROI3-TTP ROI1;0.33 (0.23, 0.54) s vs 0.47 (0.31, 0.65) s, Z=-2.71, P=0.007] than patients with unfavorable outcomes ( n=90). The mTICI score and rTTP 31 were respectively included in multivariate Logistic regression models. It was shown that mTICI grade 3 (adjusted OR=5.97, 95% CI 2.49-14.27, P<0.001) and rTTP 31 (adjusted OR=0.24, 95% CI 0.06-0.99, P=0.048) were significantly associated with favorable outcomes, and the area under the receiver operating characteristic curve of the models had no statistically significant difference ( P=0.170). Subgroup analysis showed that rTTP 31 was significantly associated with the prognosis of patients with LAA stroke ( OR=0, 95% CI 0-0.25, P=0.014), while mTICI grade was associated with the prognosis of patients with CE ( OR=3.91, 95% CI 1.40-10.91, P=0.009) and other etiologies ( OR=7.35, 95% CI 1.92-28.14, P=0.004). Conclusions:In patients with acute anterior circulation ischemic stroke and successful recanalization, both mTICI score and rTTP 31 had significant predictive value for favorable outcomes at 3 months. Moreover, rTTP 31 was significantly associated with the prognosis of patients with LAA stroke, while mTICI score was significantly related to the prognosis of patients with CE and other causes of stroke.
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Objective:To compare the effectiveness of first-line mechanical thrombectomy (MT) with other types of endovascular treatment (EVT) in patients with acute vertebrobasilar artery occlusion (VBAO).Methods:From May 2012 to December 2019, acute VBAO patients diagnosed by angiographic examinations were consecutively enrolled from Nanjing Stroke Registry. Patients were divided into first-line MT group who were treated with stent retriever and direct aspiration, and other types of EVT group who underwent intraarterial thrombolysis, tirofiban infusion, balloon dilation, and stent placement etc. Clinical characteristics at baseline with statistical trends ( P<0.1) between different groups were analyzed to calculate propensity scores, which were adjusted in binary Logistic regression for the relationship between first-line treatment and clinical outcome. Results:A total of 107 patients were enrolled in this study including 82 males and 25 females with average age 62 years old (35-82). The overall recanalization rate was 82.2% (88/107). During follow-up, 33.6% (36/107) and 37.1% (39/105) patients achieved good outcome (defined as modified Rankin Scale score 0-3) at 90 days and 1 year, respectively. The MT group received EVT earlier than the other types of EVT group (median year: 2017 vs. 2015, P=0.017), as well as higher proportion of atrial fibrillation history (21.6% vs. 0, P=0.002), higher baseline National Institution of Health Stroke Scale scores (median: 26 vs. 23, P=0.049), lower Glasgow Coma Scale scores (median: 6 vs. 7, P=0.027), and longer estimated occlusion to groin-puncture time (median: 367 min vs. 283 min, P=0.023). There were significant differences in the stroke etiologies between two groups ( P=0.002). The MT group had a lower ratio of rescue device treatment (28.4% vs. 54.5%, P=0.009). After propensity scores were adjusted, the recanalization rate of MT group was significantly higher than that in the other group [odds ratio (95% confidence interval [ CI]):5.201, 95 %CI 1.562-17.317, P=0.007]. No difference was noted regarding other clinical outcomes. Subgroup analysis indicated that recanalization rates in patients without atherosclerosis were different between intervention types [odds ratio (95 %CI): 7.859, 95 %CI 1.469-42.042, P=0.016], while the recanalization rates was comparable in population with atherosclerosis [odds ratio (95 %CI): 3.739, 95 %CI 0.613-22.812, P=0.153]. Conclusion:In acute VBAO patients, first-line MT is associated with higher recanalization rate compared with other types of EVT, especially in non-atherosclerosis patients.
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Objective:To validate the predictive function of Field Assessment Stroke Triage for Emergency Destination (FAST-ED) score on large vessel occlusion (LVO) in Chinese population.Methods:The information about the patients who had the disease onset within 24 hours, were treated in the Emergency Department of Jinling Hospital, and diagnosed as ‘acute ischemic stroke’ was collected. Via the emergent brain computed tomography angiography or digital subtraction angiography, the patients were divided into LVO group and non-LVO group. The scores of FAST-ED were calculated according to the National Institutes of Health Stroke Scale (NIHSS) scores and compared with Rapid Arterial oCclusion Evaluation (RACE), 3-item Stroke Scale (3I-SS), Cincinnati Stroke Triage Assessment Tool (C-STAT), and Prehospital Acute Stroke Scale (PASS) scores. Moreover, the patients were further divided into anterior and posterior circulation lesion groups to explore whether the FAST-ED scale can differ the anterior or posterior circulation effectively.Results:Three hundred and eighty-one patients were eventually included, among whom 284 were diagnosed as LVO, and 97 were diagnosed as non-LVO. Receiver operating characteristic curves showed that cut-off value of 4 optimized the scale (sensitivity: 0.76, specificity: 0.69, area under the curve: 0.78). The area under the curve of FAST-ED score(0.78) showed no statistically significant difference with NIHSS (0.79), RACE (0.77), 3I-SS (0.78) and C-STAT scores (0.75), and exhibited statistically significant difference with PASS score (0.74; 95% CI 0.69-0.78, P=0.01). FAST-ED score showed no statistically significant difference in predicting anterior and posterior circulation lesions. Conclusions:FAST-ED score can predict LVO in a rather accurate manner. It can predict anterior and posterior circulation lesions with similar effectiveness. So FAST-ED is able to be a prehospital screening tool and make assistance to the prehospital treatment.
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The morbidity and mortality of stroke caused by large vessel occlusion are high,and its outcome is closely associated with emergency treatment.In order to receive treatment within the time window,the effective prehospital assessment is very important.The prehospital stroke scale simplifies emergency screening and assessment of such patients.Although the predictive value is good,its role remains controversial.This article reviews some of the prehospital stroke scales used to identify large vessel occlusions and analyzed the characteristics of different scales.
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Objective To preliminarily discuss the effect and safety of stent thrombectomy for acute middle cerebral artery M2 segment occlusion in patients with ischemic stroke. Methods From January 2014 to February 2019,19 consecutive acute ischemic stroke patients with acute middle cerebral artery M2 segment occlusion registered in Stroke Database of General Hospital of Eastern War Zone were enrolled retrospectively. They all receive stent thrombectomy. Of Lhe 19 patients, 12 were male and 7 were female;the age ranged from 48 to 83 years,with a median age of 69 ( 51,75) years;9 patients also had atrial fibrillation, 15 had hypertension,6 had diabetes,and 4had a history of coronary heart disease,and 2 had a history of stroke (the pre-onset modified Rankin scale [MRS] score 1) ;8 had a history of smoking;the National Institutes of Health Stroke Scale (NIHSS) scores on admission were 5 to 28,and the median score was 15 ( 11,22) ;the early CT scores (ASPECTS) of the Alberta Stroke Project were 3-10,and the median score was 8 (6,9);according to the etiological typing of Trial of Org 10172 in Acute Stroke Treatment (TOAST) ,9 were large atherosclerosis and 10 were cardiac embolism The NIHSS scores before and after thrombectomy, surgical methods, recanalization, and intracranial hemorrhage were analyzed, and the prognosis at 90 d after surgery was analyzed. The modified Thrombolysis in Cerebrovascular Infarction (mTICI) grade (mTICI) 2b-3 were successful recanalization; the MRS scores 0 -2 were clinical good prognosis, and the MRS scores 3 -6 were poor prognosis. Results The time from onset to puncture in 19 patients was 137-545min,a median time was 265 (184,347) min,and the time from puncture to recanalization was 75 (58,98) min;17 patients only used stent thrombectomy and 2 were also treated with a balloon recanalization. The median number of thrombectomy was 1 ( 1 ,2) times;the proportion of successful recanalization was 16/19, and 3 patients were mTICI grade 2a. The NIHSS scores were 1 to 30 at 24 h after surgery,and the median score was 17 (4,21). The NIHSS scores were 1 - 30 at discharge and the median score was 11 (2,15). Seven patients occurred intracranial hemorrhage, 1 of them was symptomatic intracranial hemorrhage; the other 12 did not have intracranial hemorrhage. Three of 19 patients died during the follow-up at 90d,including 1 herniation of brain, 1 diabetic nephropathy caused renal insufficiency,and 1 cerebral hemorrhage. The median MRS score was 2 (1,4) ,and the proportion of the good prognosis was 11/19 (including 10 successful recanalists) ,and the proportion of the poor prognosis was 8/19 (including 6 successful recanalists). Conclusion Preliminary analysis of the effect of stent thrombectomy in ischemic stroke patients with acute middle cerebral artery M2 segment occlusion is considered safe and effective, but the conclusion needs further verification.
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BACKGROUND@#Epidemiological studies have suggested that noise exposure may increase the risk of type 2 diabetes mellitus (T2DM), and experimental studies have demonstrated that noise exposure can induce insulin resistance in rodents. The aim of the present study was to explore noise-induced processes underlying impaired insulin sensitivity in mice.@*METHODS@#Male ICR mice were randomly divided into four groups: a control group without noise exposure and three noise groups exposed to white noise at a 95-dB sound pressure level for 4 h/day for 1, 10, or 20 days (N1D, N10D, and N20D, respectively). Systemic insulin sensitivity was evaluated at 1 day, 1 week, and 1 month post-noise exposure (1DPN, 1WPN, and 1MPN) via insulin tolerance tests (ITTs). Several insulin-related processes, including the phosphorylation of Akt, IRS1, and JNK in the animals' skeletal muscles, were examined using standard immunoblots. Biomarkers of inflammation (circulating levels of TNF-α and IL-6) and oxidative stress (SOD and CAT activities and MDA levels in skeletal muscles) were measured via chemical analyses.@*RESULTS@#The data obtained in this study showed the following: (1) The impairment of systemic insulin sensitivity was transient in the N1D group but prolonged in the N10D and N20D groups. (2) Noise exposure led to enhanced JNK phosphorylation and IRS1 serine phosphorylation as well as reduced Akt phosphorylation in skeletal muscles in response to exogenous insulin stimulation. (3) Plasma levels of TNF-α and IL-6, CAT activity, and MDA concentrations in skeletal muscles were elevated after 20 days of noise exposure.@*CONCLUSIONS@#Impaired insulin sensitivity in noise-exposed mice might be mediated by an enhancement of the JNK/IRS1 pathway. Inflammation and oxidative stress might contribute to insulin resistance after chronic noise exposure.