Predictors for hemorrhagic transformation among patients with Ischemic stroke admitted in a Tertiary Hospital in the Philippines from July 2018-July 2019

Background@#Among the multiple scoring systems for hemorrhagic transformation, only few of these address spontaneous hemorrhagic transformation after an ischemic stroke, with most done with Western population data. @*Objectives@#This study aims to identify the predictors for hemorrhagic transformation among patients with ischemic stroke admitted in a tertiary hospital in Cebu City, Philippines.@*Methods@#This is a retrospective cohort study of patients with ischemic stroke admitted in a tertiary hospital in Cebu City. Patients’ baseline characteristics, clinical, and radiologic data were collected. Chi square test and t-test were used to determine which variables were significantly different between patients with and without hemorrhagic transformation. Odds ratio (OR) and 95% confidence interval (CI) were determined to measure the association between the different variables and hemorrhagic transformation. @*Results@#A total of 500 ischemic stroke patients were included in the study. There were 28 (6%) ischemic stroke patients with Hemorrhagic Transformation. The mean age of these patients is 66.93 ± 12.42 years, 48.8% male, 10.8% had atrial fibrillation, and 2.4% had myocardial infarction. Controlling for the effect of confounders, white blood cell count (OR 1.11; 95% CI 1.03-1.19), myocardial infarction (OR 5.25; 95% CI 1.13-24.34), and presence of brain edema (OR 2.86; 95% CI 1.05-7.80) were significant predictors of hemorrhagic transformation.@*Conclusion@#White blood cell count, presence of brain edema, and myocardial infarction were significantly associated with hemorrhagic transformation among ischemic stroke patients.

Effects of acupuncture on hemorrhagic transformation and motor function in stroke patients after intravenous thrombolysis with rt-PA: a prospective cohort study / 中国针灸

OBJECTIVE@#To observe the effects of the Xingnao Kaiqiao (regaining consciousness and opening orifices) acupuncture on hemorrhagic transformation and limb motor function after intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in stroke patients.@*METHODS@#A total of 130 stroke patients after rt-PA thrombolytic were divided into an acupuncture group (58 cases, 1 case dropped off) and a non-acupuncture group (72 cases, 7 cases dropped off) according to whether they received acupuncture treatment. Propensity score matching (PSM) was used to match each group, with 38 patients in each group. The patients in the non-acupuncture group received rt-PA thrombolytic therapy and western medical basic treatment. In addition to the basic treatment, the patients in the acupuncture group received Xingnao Kaiqiao acupuncture at Shuigou (GV 26), bilateral Neiguan (PC 6), and ipsilateral Sanyinjiao (SP 6), Chize (LU 5), once a day for 14 days. The incidence of hemorrhagic transformation within 30 days after onset was compared between the two groups. The Fugl-Meyer assessment (FMA) score and activities of daily living (ADL) score were observed at baseline and 30 days, 6 months, 1 year after onset in the two groups. The disability rate at 6 months and 1 year after onset was recorded, and safety was evaluated in both groups.@*RESULTS@#The incidence of hemorrhagic transformation in the acupuncture group was 5.3% (2/38), which was lower than 21.1% (8/38) in the non-acupuncture group (P<0.05). At 30 days, 6 month, and 1 year after onset, the FMA and ADL scores of both groups were higher than those at baseline (P<0.01), and the scores in the acupuncture group were higher than those in the non-acupuncture group (P<0.01). The disability rate in the acupuncture group at 1 year after onset was 10.5% (4/38), which was lower than 28.9% (11/38) in the non-acupuncture group (P<0.05). There was no significant difference in the incidence of adverse events between the two groups (P>0.05).@*CONCLUSION@#The Xingnao Kaiqiao acupuncture method could reduce the incidence of hemorrhagic transformation in stroke patients after intravenous thrombolysis with rt-PA, improve their motor function and daily living ability, and reduce the long-term disability rate.

A nomogram for individualized prediction of the probability of hemorrhagic transformation in patients with acute ischemic stroke after endovascular treatment based on 4-dimensional CT angiography factors / 中华放射学杂志

Objective:To assess the value of 4-dimensional CT angiography (4D CTA) to predict hemorrhagic transformation (HT) with a new nomogram model in acute ischemic stroke (AIS) patients after endovascular treatment (EVT).Methods:Imaging and clinical data of 101 AIS patients with internal carotid artery and/or middle cerebral artery occlusion who underwent "one-stop" CTA-CT perfusion and EVT in green channel of Beijing Hospital from March 2016 to November 2020 were analyzed retrospectively. The patients were divided into HT group (45 patients) and non-HT group (56 patients). Multivariate logistic regression analysis was used to select relevant clinical and imaging variables, such as age, initial National Institute of Health stroke scale (NIHSS) score, 4D CTA collateral circulation score, Alberta stroke program early CT score (ASPECTS), clot burden score, and a predictive nomogram model were developed. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the efficacy of predictive nomogram model for diagnosing HT.Results:Univariate analysis showed that there were significant difference of age[79.00(68.00, 85.00) years, 73.00(62.75, 80.00) years, Z=-2.20, P=0.028], NIHSS score [16.00(12.00, 21.00), 9.50(6.00, 14.00), Z=-4.44, P<0.001], ASPECTS score [5.00(3.00, 8.00), 8.00(7.00, 9.00), Z=-4.23, P<0.001], 4D CTA collateral circulation score [2.00(0, 3.00), 3.00(3.00, 4.00), Z=-5.39, P<0.001], clot burden score [4.00(1.00, 7.00), 7.50(6.00, 9.00), Z=-3.42, P=0.001], location of the occlusion(internal carotid artery/middle cerebral artery occlusion was 23/22, 11/45 cases, χ2=9.70, P=0.002), and atrial fibrillation (27 and 19 cases respectively, χ2=5.83, P=0.016) between HT group and non-HT group. Multivariate logistic regression analysis showed that ASPECTS score (OR=0.64, 95%CI 0.47-0.87), NIHSS score (OR=1.13, 95%CI 1.01-1.26), 4D CTA collateral circulation score (OR=0.40,95%CI 0.22-0.76) were independent predictors of HT in AIS patients ( P<0.05). The AUC of the nomogram based on the ASPECTS score, NIHSS score and 4D CTA collateral circulation score to predict HT of AIS patients was 0.876 (95%CI 0.807-0.945), with a sensitivity of 77.8% and specificity of 87.5%. Conclusions:Patients with low ASPECTS score, high NIHSS score and low 4D CTA collateral circulation score have a higher risk of HT after EVT. The nomogram model may predict the probability of HT of AIS patients and provide effective assistance for clinical decision-making.

The clinical study of the correlation between different types of hemorrhage transformation and serum uric acid in patients with acute cerebral infarction / 中国医师进修杂志

Objective:To investigate the relationship between different types of hemorrhagic transformation and serum uric acid in patients with acute cerebral infarction.Methods:The clinical data of 365 patients with acute cerebral infarction in Jinhua Central Hospital of Zhejiang Province from June 2018 to December 2020 were retrospectively analyzed. The clinical data and the serum uric acid level at the time of admission were recorded, and the occurrences of hemorrhagic infarction (HI) and cerebral parenchymal hematoma (PH) were counted. The risk factors of HI and PH in patients with acute cerebral infarction were analyzed by multivariate Logistic regression analysis.Results:Among 365 patients, 328 cases had no hemorrhagic transformation (control group); 37 cases (10.1%) had hemorrhagic transformation, with 20 cases of HI (HI group) and 17 cases of PH (PH group). The uric acid in PH group was significantly lower than that in control group and HI group: (243.59 ± 61.49) μmol/L vs. (307.84 ± 80.12) and (305.45 ± 94.99) μmol/L, and there was statistical difference ( P<0.05); there was no statistical difference in uric acid between control group and HI group ( P>0.05). The patients was divided into 3 groups according to the tertiles of serum uric acid, uric acid ≤ 264.9 μmol/L was in 121 cases (Ⅰ group), 265.0 to 338.8 μmol/L was in 122 cases (Ⅱ group) and ≥338.9 μmol/L was in 122 cases (Ⅲ group). The rate of PH in Ⅲ group was significantly lower than that in Ⅰ group: 0.8% (1/122) vs. 8.3% (10/121), and there was statistical difference ( P<0.05). Taking patients without hemorrhage transformation as a reference, multivariate Logistic regression analysis result showed that diabetes, atrial fibrillation and large-area infarction were independent risk factors of HI in patients with acute cerebral infarction ( P<0.01); the age, large-area cerebral infarction, thrombolytic therapy, platelet count and uric acid were independent risk factors of PH in patients with acute cerebral infarction ( P<0.05 or <0.01). Conclusions:In patients with acute cerebral infarction, higher serum uric acid is independently correlated with lower PH, and has no correlation with HI. Serum uric acid level has certain value in predicting PH.

Predictors of hemorrhagic transformation after acute ischemic stroke based on the experts opinion / Preditores de transformação hemorrágica após acidente vascular cerebral isquêmico agudo a partir da opinião de especialistas

ABSTRACT Background: Hemorrhagic transformation (HT) is a common complication after ischemic stroke. It may be associated to poor outcomes. Some predictors of HT have been previously identified, but there remain controversies. Objective: To describe the risk factors for HT more frequently reported by a panel of experts surveyed for this project. Methods: We sent a standard questionnaire by e-mail to specialists in Vascular Neurology from 2014 to 2018. Forty-five specialists were contacted and 20 of them responded to the invitation. Predictors cited by three or more specialists were included in a table and ranked by the frequency in which they appeared. A review of the literature looking for published predictive scores of HT was performed, comparing to the answers received. Results: The 20 responding specialists cited 23 different risk factors for HT. The most frequent factors in the order of citation were the volume of ischemia, previous use of antithrombotic medication, neurological severity, age, hyperglycemia at presentation, hypertension on admission, and cardioembolism. Most variables were also found in previously published predictive scores, but they were reported by the authors with divergences of frequency. Conclusion: Although many studies have evaluated HT in patients with acute ischemic stroke, the published risk factors were neither uniform nor in agreement with those cited by the stroke specialists. These findings may be helpful to build a score that can be tested with the goal of improving the prediction of HT.

RESUMO Introdução: A transformação hemorrágica (TH) é uma complicação comum após a isquemia cerebral e pode estar associada a desfechos desfavoráveis. Alguns fatores de risco para TH têm sido identificados, mas ainda há controvérsias. Objetivo: Descrever os fatores de risco para TH mais frequentemente reportados por um painel de especialistas consultados para esse projeto. Métodos: Enviamos um questionário padronizado por e-mail para 45 especialistas em Neurologia Vascular no período de 2014 a 2018. Vinte dos 45 especialistas responderam ao convite. Preditores citados por três ou mais especialistas foram incluídos em uma tabela e classificados pela frequência em que foram reportados. Uma revisão de literatura foi realizada em busca de escores preditivos de TH publicados anteriormente, comparando-os com as respostas recebidas. Resultados: Os 20 especialistas citaram 23 diferentes fatores de risco para TH. Os fatores mais frequentemente citados foram, pela ordem, volume da isquemia, uso prévio de medicação antitrombótica, gravidade neurológica, idade, hiperglicemia na apresentação, hipertensão na admissão e cardioembolismo. A maioria das variáveis também foi incluída em escores preditivos de TH já publicados, mas sem a mesma frequência e com divergências entre os especialistas consultados. Conclusão: Embora muitos estudos tenham avaliado a TH em pacientes com isquemia cerebral, os fatores de risco já publicados não foram uniformes na concordância com aqueles reportados pelos neurologistas vasculares consultados. Esses achados podem ser úteis para elaborar um escore que possa ser testado para aperfeiçoar a predição de transformação hemorrágica.

Relationship between glycosylated hemoglobin and hemorrhagic transformation after cerebral infarction / 中国医师进修杂志

Objective To assess the relationship between hemoglobin A1c (HbA1c) and hemorrhagic cerebral infarction (HI) in patients with acute cerebral infarction.Methods From January 2014 to June 2016,in the Lianyungang Hospital Affiliated to Xuzhou Medical University,426 patients with acute anterior circulation infarction were included.The blood sugar status before stroke was expressed by HbA1c.HbA1c and fasting blood glucose (FBG) were measured on the second day after admission.The National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of neurological function at admission.The modified Rankin scale (mRS) was used to evaluate the prognosis at discharge.CT or MRI/SWI examination was performed to determine whether there was HT.Logistic regression was used to evaluate the risk factors for HT and short-term prognosis after cerebral infarction.Results Of the 426 patients enrolled,93 (21.8％) appeared HT,60 (14.1％) had hemorrhagic cerebral infarction (HI) and 33 (7.7％) had parenchymal hemorrhage (PH).Multivariate analysis showed that HbA1c and infarct volume were independent predictor of HT.When patients were grouped according to fasting blood glucose (FBG ＜ 7.8 mmol/L or ≥ 7.8 mmol/L),the predictive effect of HbA1c on HT was found in both groups.In multiple Logistic regression analysis,HbA1c was also a predictor of poor prognosis after stroke (OR =1.482,95％ CI 1.228-1.788).Conclusions In patients with ischemic stroke,elevated HbA1c is independently associated with post-infarction HT,and this result doesn't change even in patients with well-controlled blood glucose.HbA1c is also a predictor of poor prognosis after stroke.These findings are important for blood glucose management in patients with diabetes and acute anterior circulation infarction.

Relationship between glycosylated hemoglobin and hemorrhagic transformation after cerebral infarction / 中国医师进修杂志

Objective@#To assess the relationship between hemoglobin A1c (HbA1c) and hemorrhagic cerebral infarction (HI) in patients with acute cerebral infarction.@*Methods@#From January 2014 to June 2016, in the Lianyungang Hospital Affiliated to Xuzhou Medical University, 426 patients with acute anterior circulation infarction were included. The blood sugar status before stroke was expressed by HbA1c. HbA1c and fasting blood glucose (FBG) were measured on the second day after admission. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of neurological function at admission. The modified Rankin scale (mRS) was used to evaluate the prognosis at discharge. CT or MRI/SWI examination was performed to determine whether there was HT. Logistic regression was used to evaluate the risk factors for HT and short-term prognosis after cerebral infarction.@*Results@#Of the 426 patients enrolled, 93 (21.8%) appeared HT, 60 (14.1%) had hemorrhagic cerebral infarction (HI) and 33 (7.7%) had parenchymal hemorrhage (PH). Multivariate analysis showed that HbA1c and infarct volume were independent predictor of HT. When patients were grouped according to fasting blood glucose (FBG<7.8 mmol/L or ≥ 7.8 mmol/L), the predictive effect of HbA1c on HT was found in both groups. In multiple Logistic regression analysis, HbA1c was also a predictor of poor prognosis after stroke (OR=1.482, 95% CI 1.228 -1.788).@*Conclusions@#In patients with ischemic stroke, elevated HbA1c is independently associated with post-infarction HT, and this result doesn′t change even in patients with well-controlled blood glucose. HbA1c is also a predictor of poor prognosis after stroke. These findings are important for blood glucose management in patients with diabetes and acute anterior circulation infarction.

Incidence of Stroke (Infarct and Haemorrhage) and Mortality Rate among Stroke Patients

Background: Infarct and hemorrhage are frequently encountered problem. Assessment of possible hemorrhage in acute stroke before appropriate therapy remains important. Causes, outcome and treatment strategies differ from patient to patient. Aim: To determine the incidence of stroke (infarct and haemorrhage) in patients and mortality admitted to Netaji Subhash Chandra Bose Medical College Jabalpur. Methods: 100 patients of both genders and age > 15 years presenting with stroke were included in the study. All patients had CT scan brain. The results were them compared with clinical diagnosis on case to case basis and precision of clinical diagnosis was as refrained. Results: In current study highest incidence in the age group was 61-70 yrs in 32% cases. In current study the incidence of stroke was much more common in males. Results showed that of the 100 cases studies cerebral infarct was seen in 65% cases, cerebral hemorrhage in 33% cases, and subarachnoid hemorrhage in 1% and cerebral venous thrombosis in 1% cases. The mortality form cerebral infarct was 30 % from intra cerebral hemorrhage was 36%. As a whole out of 100 patient of stroke of all types, 32 patients died within span of 30 days. Conclusion: As the age increases incidence of stroke increases, increased mortality was seen in present study.

Comparing performance of C5.0 decision tree and radial basis function neural network for predicting hemorrhagic transformation in patients with acute ischemic stroke / 中华疾病控制杂志

@# Objective To compare performance of C5.0 decision tree models and radial basis function(RBF) neural network in predicting the risk of hemorrhagic transformation in acute ischemic stroke. Methods Patients with acute ischemic stroke admitted to hospital were enrolled. Hemorrhagic transformation group and non-hemorrhagic transformation group were divided according to whether hemorrhagic transformation occurred within 2 weeks after admission. Retrospectively collected patients’ case information. C5.0 decision tree models and RBF neural network model were established with the ratio of 7 :3 for training set and test set, and the prediction performance of the model was compared. Results A total of 460 patients’ case information were collected and divided in 314 training set samples and 146 test set samples. Accuracy rates of the C5.0 decision tree model were 96.5% and 80.1%, sensitivities were 98.1% and 82.6%, specificities were 94.8% and 77.9%, Kappa index were 0.93 and 0.60, and AUC were 0.97 and 0.80. Accuracy rates of the neural network model were 72.6% and 74.7%, sensitivities were 87.6% and 88.4%, specificities were 56.9% and 62.3%, Kappa index were 0.45 and 0.50, and AUCs were 0.72 and 0.75. In the training set, the prediction performance of the C5.0 decision tree model was superior to the RBF neural network model. However, there was no statistical difference in the test set.Conclusion C5.0 decision tree model is better than RBF neural network model in risk prediction.

Effect of modified Buyang Huanwu Decoction on hemorrhagic transformation after rt-PA intravenous thrombolysis in patients with super early cerebral infarction / 中国中药杂志

To study the effect of modified Buyang Huanwu Decoction on the hemorrhagic transformation after intravenous thrombolysis of recombinant tissue type plasminogen activator(rt-PA) in patients with super early(onset time<4. 5 h) cerebral infarction. From March 2016 to July 2018,at the brain disease zone of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,212 cases of super early cerebral infarction were selected and divided into two group according to the randomized complete blocks designs: control group(106 cases) and traditional Chinese medicine group(106 cases). The control group was treated with rt-PA intravenous thrombolysis,while the traditional Chinese medicine group was treated with modified Buyang Huanwu Decoction in addition to the therapy of the control group. Both groups were treated for 14 days. Neurological deficit score,serum matrix metalloproteinase-9(MMP-9),neuron specific enolase(NSE),vascular endothelial growth factor(VEGF) and plasma cellular fibronectin(c-FN) levels,the incidence of hemorrhagic transformation,clinical efficacy and adverse drug reactions before and after treatment were compared between the two groups. According to the findings,at the 14 thday after treatment,the rank sum test of the grade data showed that the clinical efficacy of the traditional Chinese medicine group was better than that of the control group(Z =-2. 033,P = 0. 042); on the basis of χ2 test,the total efficiency of the traditional Chinese medicine group was higher than that of the control group(χ2= 4. 895,P =0. 027); the hemorrhagic transformation rate of the traditional Chinese medicine group was lower than that of the control group within14 days of treatment(χ2= 3. 962,P = 0. 047). MMP-9 levels in the traditional Chinese medicine group were lower than those in the control group at the 3 rd,5 th,7 th,10 th,14 thd after treatment(t =-2. 474,-3. 022,-5. 163,-6. 998,-9. 821; P = 0. 014,0. 003,0,0,0). The improvement of c-FN,NSE,VEGF and NIHSS scores in the traditional Chinese medicine group was superior to that of the control group after 14 days of treatment(t =-2. 343,-3. 187,-2. 129,-3. 105; P = 0. 020,0. 002,0. 034,0. 002). No obvious adverse reactions of modified Buyang Huanwu Decoction were observed during 14 days of treatment. Modified Buyang Huanwu Decoction could reduce the expressions of MMP-9,c-FN,NSE and VEGF after rt-PA intravenous thrombolysis in patients with super early cerebral infarction,and decrease the hemorrhagic transformation rate after thrombolysis,with high safety.

Hemorrhagic Transformation in Thalamic Infarction

No abstract available.

Recent advances in the relationship between cerebral small vessel disease and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke / 中华神经科杂志

Cerebral small vessel disease refers to a series of clinical, imaging and pathological syndromes caused by various diseases affecting small arteries, arterioles, capillaries, venules, and venules in the brain, thereby causing ischemia or hemorrhage in brain tissue. At present, intravenous thrombolytic therapy is the first choice for the treatment of acute ischemic stroke, however a large number of studies have shown that the presence of cerebral small vessel disease before acute ischemic stroke increases the risk of intravenous thrombolysis. In this article, the recent research progresses about the relationship between cerebral small vessel disease and hemorrhagic transformation after venous thrombolysis in acute ischemic stroke are reviewed, aiming to provide a new reference for clinical intravenous thrombolytic therapy.

The role of pinocembrin in t-PA thrombolysis-induced hemorrhagic transformation / 药学学报

Hemorrhagic transformation (HT) is a frequent complication of ischemic stroke, especially after thrombolytic therapy. This event is associated with increased morbidity and mortality. Tissue plasminogen activator (t-PA), the only FDA proved drug for breaking blood clots, is underutilized in ischemic stroke, because of its limited therapeutic window and hemorrhagic complications. Due to the lack of clear understanding of the pathological mechanism, there are no effective drugs to decrease the incidence of HT. Pinocembrin is a natural flavonoid compound and has neuroprotective effects in animal ischemic stroke models. In this study, we investigated the role of pinocembrin in t-PA thrombolysis-induced HT in rat thromboembolic stroke model. t-PA was administrated 6 h after ischemia and pinocembrin (5, 10 and 20 mg·kg-1) was given 5 min before t-PA administration. Infarct volume, neurological score and hemoglobin content were evaluated at 24 h after ischemia. Evans blue leakage was used to detect blood-brain barrier (BBB) permeability. All procedures were approved by the Institutional Animal Care and Use Committee of the Peking Union Medical College. The results showed that treatment with t-PA at 6 h after ischemia aggravated brain injury and increased the risk of HT, with infarct volume and brain water content reached 39% and 83.4%, respectively. Pretreatment with pinocembrin decreased the infarct volume and brain water content to 28.5% and 80.3%, and improved neurological function. In addition, the combined application of pinocembrin with t-PA reduced hemoglobin content and Evans blue content in brain tissue by 50% and 40%, indicating that pinocembrin could protect the BBB permeability and reduce the occurrence of HT. Among these doses, 10 mg·kg-1 is most effective. In conclusion, our results demonstrate that the combination of pinocembrin with t-PA protects against cerebral ischemia, reduces the occurrence of HT induced by t-PA thrombolysis. Thus, pinocembrin may be a potential therapeutic drug for t-PA induced HT.

Predictive effect of microvascular permeability surface on spontaneous hemorrhagic transformation in patients with acute ischemic cerebral infarction / 中国介入影像与治疗学

Objective: To explore the predictive effect of microvascular permeability surface (PS) on spontaneous hemorrhagic transformation (HT) in acute ischemic stroke patients. Methods: A retrospective analysis was performed on 43 patients with acute ischemic stroke who underwent CT perfusion imaging (CTPI). Neither arterial thrombolysis nor intravenous thrombolysis was carried out in these patients. The patients were divided into HT group (n=20) and control group (n=23) according to whether HT occurred within 2 weeks after the onset of stroke detected with CT or MRI. Mann-whitney U test was used to compare the differences of CTPI parameters, including PS, cerebral blood volume (CBV) and cerebral blood flow (CBF) between the affected and contralateral areas in HT group, and CTPI parameters of the affected area were also compared between HT and control groups. ROC curve was used to analyze the efficiency of PS value to predict HT. Results: In HT group, PS (Z=-5.410, P<0.001) and CBV (Z=-3.517, P<0.001) of the affected area were higher than those of contralateral area, while CBF (Z=-2.245, P=0.024) of the affected area was lower than that of contralateral area. PS (Z=-5.065, P<0.001) and CBV (Z=-3.458, P=0.001) of the affected area in HT group were higher than those in control group, while there was no statistical difference of CBF (Z=-1.729, P=0.084) of the affected area between HT and control group. ROC analysis showed that the AUC was 0.952 for predicting HT in acute ischemic stroke patients with the threshold of PS as 0.032 4 ml/(100 ml•min). The sensitivity, specificity and accuracy was 90.00%, 82.60% and 86.05%, respectively. Conclusion: PS value can be used to predict HT in patients with acute ischemic stroke, therefore being helpful to appropriate treatments in clinic.

Progress of adjuvant treatment with tissue plasminogen activator beyond time window in ischemic stroke / 解剖学报

Tissue plasminogen activator (tPA) thrombolysis remains the gold standard for the treatment of ischemic stroke. However, the time window of tPA treatment and the fatal side effects caused by application beyond the time window limit clinical application of tPA. In order to address the limitations, combined use of tPA with other drug or non-drug interventional approaches has been proposed and some combination therapies have been experimentally validated to decrease the complications beyond the time window, especially hemorrhagic transformation (HT). The mechanisms by which the combined drugs act include protecting the blood-brain barrier, enhancing angiogenesis, protecting cerebral blood vessels, etc. Non-drug interventions include stem cell transplantation and gas therapy with multiple biological effects. The combination of tPA and the above treatments intends to alleviate the side effects of delayed tPA treatment and the neurological deficits and behavioral impairment induced by stroke. Therefore, adjuvant therapy is an innovative form of treatment which addresses the limiting factors of tPA therapy and may prolong the time window of ischemic stroke.

Flat-panel ct high-density sign and hemorrhagic transformation and prognosis in mechanical thrombectomy:an analysis of influencing factors / 中国脑血管病杂志

Objective To analyze the characteristics of local brain tissue flat-panel CT high-density sign in mechanical thrombectomy for acute ischemic stroke with large vessel occlusion anil the effect on the hemorrhagic transformation and prognosis of patients. Methods From September 2013 to March 2018, a total of 244 consecutive patients (64 posterior circulation lesions) with acute ischemic stroke of large vessel occlusion treated with mechanical thrombectomy, checked by intraoperative flat-panel CT and admitted to the Department of Cerebrovascular Disease Center, First Hospital Affiliated to Naval Military Medical University were enrolled retrospectively. Eighty-five of them were treated with bridging treatment. According to whether the findings of flat-panel CT having local high-density sign or not,they were divided into either a high-density sign group (n =71) or a non-high-density sign group (n = 173). The inter-group differences of the baseline data of both groups (sex,age,preoperative National Institutes of Health Stroke Scale [N1HSS] score),clinical data (bridge treatment,occlusion site,revascularization reaching the modified treatment in cerebral infarction [mTICI] grade 2b-3,good prognosis at 90 d after procedure,hemorrhagic transformation, and mortality) were documented and analyzed. The distribution characteristics of high-density signs of intraoperative flat CT were analyzed. Univariate and multivariate logistic regression analyses of tlie hemontiagic transformation and good prognosis in the high-density group were evaluated. Results (1) The preoperative NIHSb score of the high density sign group was higher than that of the non-hjgh density sign group. There was significant difference between the two groups (20[15,23] vs. I7( 10,22] ,Z = 5. 454,/' =0.028). There were no significant differences in other baseline data between the two groups (all P > 0. 05). (2) The occlusion ratio of T-shaped and l.-shaped internal carotid artery and Ml segment of middle cerebral artery in the high-density sign group were higher than those in the non-high-density sign group (36. 6% [26/71 ] w. 22. 5% [39/173] ,50.7% [36/71 ] vs. 35. 3% [61/173] ) ,and the occlusion ratio of vertebrobasilar artery was lower than that in the non-high-density sign group (5.6% [4/71] vs. 31.2% [54/173] ). There was significant difference between the two groups (all P en

Research progress in hemorrhagic transformation after intravenous thrombolysis / 中华神经科杂志

Stroke has increasingly become one of the three major diseases threatening human beings,among which acute ischemic stroke is the most common.Intravenous thrombolysis has become the first choice for acute ischemic stroke,but a large number of studies have shown that intravenous thrombolysis increases the risk of hemorrhagic transformation.The latest advances in clinical types,incidence,mechanism and risk factors of hemorrhagic transformation after thrombolysis with recombinant human tissue plasminogen activator are reviewed in this article,and the possible predictors of hemorrhagic transformation are discussed,aiming to provide new reference for clinical thrombolytic therapy.

Consensus on diagnosis and treatment of hemorrhagic transformation after acute ischemic stroke in China 2019 / 中华神经科杂志

Hemorrhagic transformation (HT) is part of the natural history of ischemic stroke,and is a common complication of therapeutic interventions used in the acute phase of ischemic stroke,such as intravenous thrombolytic therapy.HT is associated with poor outcomes after stroke and the reason for underusing of reperfusion therapies.Understanding of the definitions,classifications,risk factors,diagnosis and treatment of HT is helpful for better management and future researches on HT.Therefore,a consensus statement for diagnosis and treatment of HT was drafted based on current available evidence.Several drafts were circulated until a consensus was achieved,and the final statement was approved by the Chinese Society of Neurology and the Chinese Stroke Society.

Relationship between total cerebral small vessel disease burden and hemorrhagic transformation of acute ischemic stroke patients after intravenous thrombolysis / 中华神经科杂志

Objective To investigate the relationship between total cerebral small vessel disease (CSVD) burden and intracranial hemorrhage transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods One hundred and fifty-four patients who suffered from ischemic stroke within 4.5 hours of onset and received recombinant tissue plasminogen activator thrombolytic therapy in the emergency green channel of the First Affiliated Hospital of Soochow University from August 2016 to January 2018 were enrolled.HT examined by computed tomography scan within 24 hours after thrombolysis was included.The magnetic resonance imaging examination was performed within 48 hours.The patients were divided into two groups:HT group and control group according to the presence or absence of HT.Periventricular white-matter hyperintensities (WMH) with Fazekas score of 3 or deep WMH with Fasekas score of 2 or 3 was recorded as 1 point,MRI of cerebral microbleeds (CMBs) or lacunar infarction (LI) was recorded as 1 point respectively,and peripheral vascular space (PVS) in basal ganglia graded 2-4 (≥11)was counted 1 point.Single-factor analysis was used to compare total CSVD burden score,baseline data and clinical data between the two groups.Multivariate Logistic regression analysis was performed to explore the relationship between total CSVD burden score and HT.Results The age of the 154 patients was 66.00(59.00,74.25) years,males accounted for 66.9％ (103/154),onset to treatment time (OTT) was 174.50 (131.50,200.00) minutes and the NIHSS score before thrombolytic therapy was 6.00 (3.00,10.25).There were 43 cases (27.9％) with moderate to severe WMH,35 cases (22.7％) with CMBs,52 cases (33.8％) with PVS graded 2-4,and 96 cases (62.3％) with LI.There were 21 enrolled patients (13.6％) who suffered from HT.Symptomatic intracranial hemorrhage occurred in nine cases (5.8％).In the multivariate Logistic regression model,the results demonstrated that baseline diastolic pressure (OR=1.072,95％CI 1.027-1.118,P=0.001)and atrial fibrillation (OR=28.564,95％CI 6.217-131.241,P=0.000) were independently associated with HT.After using the mild CSVD burden score as a reference,moderate CSVD burden (OR=0.810,95％ CI 0.154-4.257,P=0.804) was not associated with HT after thrombolysis,and severe CSVD burden (OR=8.429,95％ CI 1.643-43.227,P=0.011) was independently associated with HT.Conclusions The severity of total CSVD burden in patients with AIS was closely related to HT after thrombolysis.Severe CSVD was an independent risk factor for HT after thrombolysis.

Effect of thrombolytic therapy on intravenous thrombolytic therapy of DNT in acute ischemic stroke and its effect analysis / 中华急诊医学杂志

Objective Analyze the effect of emergency thrombolytic therapy on door to needle time (DNT) in patients with acute ischemic stroke (AIS) and effect.Method Selected 182 cases of AIS patients underwent intravenous thrombolysis at the First Hospital of Qinhuangdao from May 2015 to June 2017.Thrombolytic therapy group (83 cases),for the May 2015-May 2016 after neurological consultation intravenous thrombolysis patients;Emergency thrombolytic group(99 cases),for the June 2016-June 2017 emergency thrombolysis group Emergency Department of intravenous thrombolysis patients.Compare the two groups of DNT,thrombolytic therapy 24 h symptomatic hemorrhage conversion rate,Thrombolysis 24 h,7 dNIHSS score,7 dthrombolysis and 3 months thrombolysis and thrombolysis 3 months improved Rankin score (mRs).Results There was no significant difference in baseline characteristics between the two groups (P＞0.05).Compared with the consultation group,the DNT[(69.77±11.66)min vs (80.12±15.49) min,t=5.745,P ＜ 0.01] of emergency thrombolytic group was significantly shortened,and the good score[39(39.4％) vs 21(25.3％),x2=4.272,P=0.039] at 3 months after treatment was significantly higher (P＜0.05);Treatment of 24 h intracranial hemorrhage conversion rate[12(12.12％) vs 5(6.02％),x2=1.982,P=0.159]、Treatment 7d mortality rate [10(10.10％) vs 6(7.22％),x2=0.464,P=0.496],3 months mortality rate [14(14.14％) vs 11 (13.25％),x2=0.030,P=0.862]、There was no significant difference in the 24h effective rate [57(57.6％) vs 53(63.8％),x2=0.745,P=0.388] and 7d effective rate [50(50.5％) vs 46(55.4％),x2=0.438,P0.508] after treatment (P＞0.05).Conclusions The emergency thrombolytic model can shorten the DNT of rt-PA intravenous thrombolysis in patients with AIS.The safety and efficacy of DNT are not different from the neurological consultation mode,and can improve the good prognosis rate.