Association between neutrophil/lymphocyte ratio and symptomatic intracranial haemorrhage in ischaemic stroke patients treated with endovascular treatment / 中风与神经疾病杂志

@#Objective To investigate the relationship between NLR and symptomatic intracranial hemorrhage (sICH) in patients with acute anterior circulation stroke undergoing endovascular treatment. Methods A total of 437 consecutive patients with acute stroke treated with endovascular treatment (EVT) were included. The patients were divided into two groups according to whether symptomatic intracranial hemorrhage was present. Univariate and multivariate analyses were performed. Results Compared with the non-symptomatic intracranial hemorrhage group. Multivariate Logistic regression analysis showed that the history of stroke and neutrophil/lymphocyte ratio were independent risk factors for postoperative symptomatic intracranial hemorrhage. The Area Under The Curve(AUC) value of NLR showed moderate accuracy,with an AUC value of 0.589 (95%CI 0.509-0.688,P=0.029). The NSE cut-off value was set at 5.89.When the NLR≥ 5.89,the sensitivity was 65.00%,and the specificity was 51.65% (P=0.029). Conclusion Elevated NLR is an independent predictor for patients with acute anterior circulation stroke who are undergoing endovascular treatment.

Intracranial stenting as a rescue therapy for acute anterior large vessel occlusive stroke after retrievable stent thrombectomy failure / 中华神经医学杂志

Objective To evaluate the efficacy and safety of intracranial stenting as a rescue therapy for acute anterior large vessel occlusive stroke after stentriever thrombectomy failure.Methods A total of 60 patients with acute anterior large vessel occlusive stroke failed to stent retriever thrombectomy in our hospital from January 2014 to December 2017 were chosen in our study.Among the 60 patients with stent retrieval failure,43 patients received stent placement as rescue therapy (stenting rescue group),and 17 patients received other methods as rescue therapy (non-stenting rescue group).Modified thrombolysis in cerebral infarction grading was applied to evaluate vascular re-canalization immediately after operation;modified Rankin scale (mRS) was applied to determine the prognoses of the patients 90 d after operation;the occurrences of symptomatic intracranial hemorrhage and stent re-stenosis within 6 months after operation were recorded in the two groups.Results As compared with those in the non-stenting rescue group,the rate of immediate postoperative vascular re-canalization and favorable prognosis rate in the stenting rescue group (35.29％ vs.81.40％ and 23.53％ vs.53.49％)were statistically higher (P＜0.05).There were no statistically significant differences in proportions of symptomatic intracranial hemorrhage and death between the stenting rescue group and non-stenting rescue group (11.76％ vs.13.95％;29.41％ vs.23.26％,P＞0.05).DSA follow-up showed that 4 patients in the stenting rescue group had stent re-stenosis,but all of them were asymptomatic.Conclusions Intracranial stenting as a rescue therapy for acute anterior large vessel occlusive stroke after failure of retrieval stent is feasible and safe.

Prognostic factors of acute cardiogenic ischemic stroke patients treated with alteplase intravenous thrombolysis / 第二军医大学学报

Objective To explore the prognostic influencing factors of acute cardiogenic ischemic stroke patients treated with alteplase intravenous thrombolysis. Methods Ninety-one patients with acute cardiogenic ischemic stroke, who received intravenous thrombolysis with alteplase in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) between Sep. 2013 and Sep. 2017, were included in this study. The modified Rankin scale (mRS) score at 3 months after thrombolysis was used as an prognostic indicator, and the patients with mRS score≤2 were good prognosis group (n＝54) and those with mRS score 3-6 were poor prognosis group (n＝37). The age, gender, medical history, baseline National Institutes of Health stroke scale (NIHSS) score, baseline Glasgow coma scale (GCS) score and Alberta stroke program early computed tomograghy score (ASPECTS) before thrombolysis were analyzed in each group. Multivariate logistic regression analysis was used to analyze the prognostic influencing factors. Results The good prognosis rate was 59.3% (54/91) at 3 months after thrombolysis. There were significant differences in age ([66.57±13.46] years vs [75.95±6.06] years), incidence of patent foramen ovale (11.1% [6/54] vs 0.0% [0/37]), baseline NIHSS score (7.5 [3.5, 13.0] vs 18.0 [13.0, 22.0]), baseline GCS score (14.5 [12.0, 15.0] vs 10.0 [8.0, 14.0]), ASPECTS before thrombolysis (10.0 [9.0, 10.0] vs 9.0 [8.0, 10.0]) and incidence of symptomatic intracranial hemorrhage (SICH, 1.9% [1/54] vs 32.4% [12/37]) between the good and poor prognosis groups (t＝3.964, χ2＝4.401, Z＝5.235, Z＝4.079, Z＝2.519, χ2＝16.768; all P0.05). Multivariate logistic regression analysis showed that age (odds ratio [OR]＝3.236, 95% confidence interval [CI] 1.077-9.709, P＝0.036), baseline NIHSS score (OR＝2.874, 95% CI 1.074-6.329, P＝0.034) and SICH (OR＝9.346, 95% CI 1.017-83.333, P＝0.048) were influencing factors for poor prognosis of acute cardiogenic ischemic stroke patients treated with intravenous thrombolysis. Conclusion The age, baseline NIHSS score and SICH are independent factors for poor prognosis of patients with acute cardiogenic ischemic stroke. The patients with elder age, more serious stroke or SICH may have a worse prognosis.

Tratamiento trombolítico del ictus isquémico agudo / Thrombolytic therapy of the ischemic stroke

El tratamiento trombolítico ha producido un cambio positivo en la actitud de los clínicos ante los pacientes con ictus isquémico agudo. Un modesto beneficio de un 13% contrasta con un aumento del 10% en la ocurrencia de hemorragia intracerebral sintomática. Sin embargo, la mortalidad no es diferente entre los pacientes que reciben el agente trombolítico rt-PA y los que reciben placebo. Se continua estudiando la ventana terapéutica extendida actualmente hasta 4,5 horas de iniciado el evento y la organización de la atención que permita beneficiar a un mayor número de pacientes, pues por varias razones solo son elegibles en promedio 3%. Se revisan los estudios más relevantes sobre la trombólisis especialmente intravenosa: el NINDS, el ECAS III, el IST-3 y el DIDAS y DEDAS. Se describen las principales complicaciones de este tipo de terapia: la hemorragia intracerebral sintomática, otros tipos de hemorragias, angioedema y ruptura miocárdica

Thrombolytic therapy has positively changed the attitude of clinicians to treat patients with acute ischemic stroke. Treated patients were 13% more likely to achieve a recover with no significant disability after 3 month. This benefit was achieved at the cost of a 10% increase in the rate of symptomatic intracranial hemorrhage. However, this increase did not result in a higher rate of death or severe disability in the treated group. Intravenous rt-PA can be given with significant but decreasing benefit and an acceptable risk to benefit ratio up to 4,5 hours as therapeutic window. Thrombolytic therapy remains substantially underused. Most relevant trials which deal with thrombolytic therapy: NINDS, ECAS III, IST-3, DIDAS andDEDAS, are analyzed. The most frequent complications of this therapy are described

Intravenous - Thrombolysis in a 90 year Old.

Intravenous thrombolysis in acute ischemic stroke has been conventionally avoided in the elderly (>80years of age) with fear of higher incidence of complications like symptomatic intracranial hemorrhage (SICH) and possible loss of efficacy of thrombolysis in view of lack of evidence with most previous trials excluding this group of patients. There has been recent evidence suggesting benefit of IV thrombolysis in the elderly (>80 years) especially when treated within 3 hours of stroke onset. We report a successful thrombolysis in a 90 years old lady which to our knowledge is the first successful thrombolysis reported from India.

Analysis of multi-factors affecting symptomatic intracranial hemorrhage in intraarterial thrombolysis with urokinase for acute ischemic stroke / 介入放射学杂志

Objective To explore the causes and preventive measures of symptomatic intracranial hemorrhage in 217 patients with acute cerebral ischemic stroke treated with local intra-arterial urokinase. Methods From February1999 to June 2004, 217 patients were treated for acute ischemic stroke with local intra-arterial urokinase in our hospital. Factors associated with symptomatic intracranial hemorrhage of intra-arterial thrombolysis were analyzed by Stepwise logistic regression to identify some factors relating the prediction symptomatic intracranial hemorrhage. Results Symptomatic intracranial hemorrhage occurred in 8 cases (3.7%). Predictors of the symptomatic intracranial hemorrhage were the elevated systolic blood pressure before therapy (odds ratio, 1.096; 95% CI, 1.006 to 1.194) and urokinase (UK) treatment (odds ratio , 1.068; 95% CL, 1.053 to 1.247). Risk of secondary symptomatic intracranial hemorrhage was increased with elevated systolic blood pressure. Other factors like age, initial treating time, NIHSS, diabetes and collateral circulation did not predict the symptomatic intracranial hemorrhage respectively. Conclusions Predictors of symptomatic intracranial hemorrhage after local intra-arterial infusion of urokinase for acute ischemic stroke were the elevated systolic blood pressure before therapy and urokinase (UK) treatment.