Juglone induces ferroptosis in glioblastoma cells by inhibiting the Nrf2-GPX4 axis through the phosphorylation of p38MAPK.

BACKGROUND: Ferroptosis, a non-apoptotic form of cell death induced by accumulation of free iron ions and lipid peroxidation, its importance for cancer treatment is gradually being recognized. Research on the anti-cancer mechanism of juglone is accumulating. However, the specific mechanism by which it directs glioblastoma (GBM) to death is unknown. METHODS: We used in vitro and in vivo experiments to explore the anti-GBM effect generated by juglone through the ferroptosis pathway. RESULTS: Juglone mainly causes cell death by inducing ferroptosis. Mechanistically, juglone can significantly activate the phosphorylation of p38MAPK. According to transcriptome sequencing and protein interaction analysis, the Nrf2-GPX4 signaling pathway is identified as the primary pathway through which juglone mediates ferroptosis. In vitro and in vivo experiments further verified that juglone induces the ferroptosis of GBM by activating the phosphorylation of p38MAPK and negatively regulating the Nrf2-GPX4 signaling pathway. CONCLUSION: Juglone induces ferroptosis and inhibits the growth of GBM by targeting the Nrf2/Gpx4 signaling pathway and thus holds promise as a novel ferroptosis inducer or anti-GBM drug.

Endovascular thrombectomy with or without intravenous alteplase in acute stroke: a systematic review and meta-analysis of randomized clinical trials.

BACKGROUND AND PURPOSE: This study investigated clinical outcomes after direct endovascular thrombectomy (EVT) compared to bridging therapy (EVT with prior intravenous alteplase) in acute stroke within 4.5 h after onset. METHODS: PubMed and Embase were searched for eligible randomized controlled trials. The primary outcome was the rates of neurological functional independence defined as modified Rankin scale score 0-2 at 90 days, whose non-inferiority margin was set at - 15%, - 10%, - 6.5%, - 5%, and - 1.3% for its risk difference (RD). RESULTS: We included six studies enrolling 2334 participants. The crude cumulative rates of functional independence were 49.0% with direct EVT vs 50.9% with bridging therapy, without significant difference (Odd ratio [OR] = 0.93, 95% confidence interval [CI] 0.79-1.09) between two groups, where the pooled RD was - 2% (95% CI - 6 to 2%) whose lower 95% CI bound fell within non-inferiority margins of - 15%, - 10%, -6.5%, but not - 5% and - 1.3%. Between the two groups, no significant difference was found in excellent function rate (30.2% vs 30.6%, OR = 0.99, 95% CI 0.82-1.18) with RD of 0% (95% CI - 3 to 4%), mortality rate (16.0% vs 15.0%, OR = 1.08, 95% CI 0.86-1.35) with RD of 1% (95% CI - 2 to 4%), and symptomatic intracranial hemorrhage rate (4.3% vs 5.0%, OR = 0.86, 95% CI 0.58-1.27) with RD of 0% (95% CI - 2 to 1%). CONCLUSIONS: No statistical difference was found in functional and safety outcomes between direct EVT and bridging therapy groups in acute stroke within 4.5 h after symptom onset. EVT alone was non-inferior to bridging therapy for several, but not the more stringent, non-inferiority margins.

Neurological Functional Independence After Endovascular Thrombectomy and Different Imaging Modalities for Large Infarct Core Assessment : A Systematic Review and Meta-analysis.

PURPOSE: To investigate the rate of neurological functional independence (NFI) at 90 days in patients with large infarct core (LIC), which was evaluated by different imaging modalities before endovascular thrombectomy (EVT). METHODS: PubMed and EMBASE were searched for original studies on clinical functional outcomes at 90 days in LIC patients who received EVT treatment from inception to 28 September 2021. The pooled NFI rates were calculated using random effects model according to different imaging modalities and criteria. RESULTS: We included 34 studies enrolling 2997 LIC patients. The NFI rates were 23% (95% confidence interval, CI 15-32%) and 24% (95% CI 10-38%) when LIC was defined as core volume ≥50 ml and ≥ 70 ml separately on computed tomography perfusion, 36% (95% CI 23-48%) and 21% (95% CI 17-25%) when LIC was defined as core volume ≥ 50 ml and ≥ 70 ml separately on magnetic resonance diffusion-weighted imaging (DWI), 28% (95% CI 24-32%) and 37% (95% CI 21-53%) when LIC was defined as DWI-ASPECTS ≤ 5 and ≤ 6 separately, 23% (95% CI 19-27%) and 32% (95% CI 18-46%) when LIC was defined as NCCT-ASPECTS ≤ 5 and ≤ 6 separately. CONCLUSION: Similar NFI rates could be obtained after EVT in LIC patients if proper LIC criteria were select according to the imaging modality.

Laterality of Posterior Cerebral Artery and White Matter Hyperintensities in Patients with Severe Internal Carotid Artery Stenosis.

Background: Collateral status of the circle of Willis was associated with white matter hyperintensities (WMHs) in patients with internal carotid artery (ICA) stenosis, but few have investigated the effect of leptomeningeal anastomoses. Objective: The aim of this study was to observe the association between WMHs and the laterality of the posterior cerebral artery (PCA) that presents leptomeningeal anastomoses in patients with severe ICA stenosis. Materials and Methods: WMHs and ipsilateral PCA laterality were evaluated in patients with unilateral ICA stenosis ≥70% (including occlusion) and contralateral ICA stenosis <50% or no stenosis. Ipsilateral PCA laterality was compared between two groups of no/mild and severe score of global, deep and periventricular WMHs, respectively. Results: We included 115 patients with unilateral ICA stenosis ≥70%. There were 60 patients with no/mild and 55 with severe global WMHs. The patients with severe global WMHs were older (OR = 1.849, 95% CI: 1.058-3.229, P = 0.031) and had higher incidence of negative PCA laterality (OR = 3.301, 95% CI: 1.140-9.558, P = 0.028). The patients with severe deep WMHs were also older (OR = 2.031, 95% CI: 1.130-3.651, P = 0.018) and had higher incidence of negative PCA laterality (OR = 4.250, 95% CI: 1.501-12.032, P = 0.006). There was no significant difference between the patients with no/mild and severe periventricular WMHs in the incidence of negative PCA laterality. Conclusions: The incidence of negative PCA laterality was higher in patients with severe global and deep WMHs, but not higher in patients with severe periventricular WMHs. The leptomeningeal anastomoses may affect the deep WMHs in patients with severe ICA stenosis.

Single-Cell Sequencing Analysis Identified ASTN2 as a Migration Biomarker in Adult Glioblastoma.

Glioblastoma is the most common and aggressive primary central nervous system malignant tumors. With the development of targeted sequencing and proteomic profiling technology, some new tumor types have been established and a series of novel molecular markers have also been identified. The 2021 updated World Health Organization classification of central nervous system tumors first mentioned the classification of adult glioma and pediatric glioma based on the molecular diagnosis. Thus, we used single-cell RNA sequencing analysis to explore the diversity and similarities in the occurrence and development of adult and pediatric types. ASTN2, which primarily encodes astrotactin, has been reported to be dysregulated in various neurodevelopmental disorders. Although some studies have demonstrated that ASTN2 plays an important role in glial-guided neuronal migration, there are no studies about its impact on glioblastoma cell migration. Subsequent single-cell RNA sequencing revealed ASTN2 to be a hub gene of a cell cluster which had a poor effect on clinical prognosis. Eventually, a western blot assay and a wound-healing assay first confirmed that ASTN2 expression in glioblastoma cell lines is higher than that in normal human astrocytes and affects the migration ability of glioblastoma cells, making it a potential therapeutic target.

Prognostic Value of Serum Cardiac Troponin in Acute Ischemic Stroke: An Updated Systematic Review and Meta-Analysis.

BACKGROUND AND PURPOSE: Cardiac troponin (cTn) is a specific biomarker of cardiac injury and elevation of cTn is related to increased mortality. However, prognostic value of cTn in patients with acute ischemic stroke (AIS) still remains to be elucidated. The aim of this review is to explore the strength of association between elevated cTn and mortality after AIS onset. METHODS: PubMed, EMBASE, and Cochrane Library were searched from inception to July 12, 2021 without language restriction. All studies reporting the association between cTn on admission and mortality in AIS patients have been included in this review. Meta-analysis was performed for overall and pre-specified subgroup risk ratios (RR) were obtained using a random effect model. Study quality was assessed for each included study. RESULTS: There were 20 studies included in this meta-analysis with 9779 AIS patients met the inclusion criteria. There was significant association between elevated cTn and mortality in patients with AIS (RR 3.87; 95% CI 3.24-4.63). The association was consistent across the pre-specified subgroup analyses by type of troponin (cTnT or cTnI), assay of troponin (conventional or high-sensitivity), region (Asian or Non-Asian), definite exclusion of ACS/AMI patients or not (yes or not mentioned), adjusted AF, HF and impaired renal function or not (yes or no). CONCLUSIONS: AIS patients with elevated cTn at baseline has an increased risk of mortality. Early and routine evaluation of cTn may contribute to timely detection of comorbid cardiac injury and prevent unfavorable outcomes in patients with AIS. PROSPERO REGISTRATION NUMBER: CRD42020160912.

Incompleteness of circle of Willis and silent brain infarction in patients with internal carotid artery stenosis.

PURPOSE: To investigate the association between the prevalence of silent brain infarction (SBI) and incompleteness of circle of Willis (CoW) in patients with internal carotid artery stenosis (ICA). METHODS: We included patients with unilateral intra- or extracranial ICA stenosis ≥ 50% or occlusion without previous history of stroke or transient ischemic attack. SBIs were evaluated on magnetic resonance image. We compared SBI prevalence between patients with complete and incomplete CoW, and between ipsilateral and contralateral hemispheres to stenosed ICA. RESULTS: We included 257 patients with ICA stenosis, among them 120 patients had complete CoW and 137 patients had incomplete CoW. SBI prevalence was significantly higher in patients with incomplete CoW than those with complete CoW (73.0% vs 43.3%, OR 3.09, 95% CI 1.70-5.63). Further, in patients with incomplete CoW, SBIs prevalence was significantly higher in ipsilateral hemisphere than that in contralateral hemisphere (63.5% vs 46.7%, OR = 2.01, 95% CI 1.21-3.34). While, in patients with complete CoW, SBI prevalence was not significantly different between two hemispheres (31.7% vs 23.3%, OR = 1.51, 95% CI 0.83-2.73). CONCLUSION: In patients with ICA stenosis, SBI prevalence was associated with incompleteness of CoW.

Outcomes of mechanical thrombectomy with pre-intravenous thrombolysis: a systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Whether pre-intravenous thrombolysis (IVT) provides any extra benefits to mechanical thrombectomy (MT) remains controversial. We conducted a systematic review and meta-analysis to compare MT with pre-IVT (IVT + MT) and MT without pre-IVT (MT) for acute ischemic stroke of large vessel occlusion. METHODS: We systematically searched PubMed, EMBASE and Cochrane Library to identify studies comparing outcomes between IVT + MT and MT from inception to Jan 24, 2019. Random effects mode was used to pool relative risk (RR) with confidence intervals (CI) to compare functional independence in terms of modified Rankin Scale (mRS) 0-2, favorable outcome (mRS 0-1) and mortality at three-months, symptomatic intracerebral hemorrhage, successful reperfusion, and complete reperfusion between the two treatments groups. RESULTS: We included 30 studies enrolling 8970 patients with acute ischemic stroke of large vessel occlusion. Compared with MT, IVT + MT significantly increased the rate of 3-month functional independence (RR 1.20, 95% CI 1.12-1.30; P < 0.0001) and favorable outcome (RR 1.28; 95% CI 1.16-1.40; P < 0.0001), increased the rate of successful reperfusion (RR 1.04,95% CI 1.01-1.08; P = 0.013) and complete reperfusion (RR 1.10; 95% CI 1.01-1.19; P = 0.024), reduced the rate of mortality (RR 0.74, 95% CI 0.67-0.82; P < 0.0001), without significantly increasing the rate of symptomatic intracerebral hemorrhage (RR 0.98,95% CI 0.82-1.17; P = 0.833). The results remained stable in sensitivity analyses and adjusting for publication bias. CONCLUSIONS: Pre-IVT provides extra benefits to MT on clinical and imaging outcomes without increasing symptomatic intracerebral hemorrhage in acute ischemic stroke of large vessel occlusion.

Clinical characteristics of non-ampullary duodenal polyps in the elderly and the outcomes of endoscopic mucosal resection.

At present, there are no reports on non-ampullary polyps of the duodenum (NAPDs) in the elderly. The aim of this study was to analyze the clinicopathological features of NAPDs in elderly and non-elderly patients to explore the efficacy and safety of endoscopic mucosal resection (EMR) of NAPDs in the elderly.A total of 110 patients underwent EMR of NAPDs between April 2016 and December 2019. The shape, location, size, postoperative complications, and histopathological types of NAPDs were compared between the elderly group (n = 44) and the non-elderly group (n = 66).Sessile type was the most common form of NAPD in both groups. In the elderly group, the average size of NAPDs was 12.6 ±â€Š3.9 mm. In the non-elderly group, NAPDs had an average size of 10.1 ±â€Š5.8 mm. Complete EMR was performed in both groups. The postoperative complications of EMR did not significantly differ between the 2 groups. Postoperative pathological examination showed that tubular villous adenomas were more common in the elderly group than in the non-elderly group (P = .005), while tubular adenomas were more common in the non-elderly group than in the elderly group (P = .007). Of the 110 patients, 99 completed postoperative follow-up (median follow-up duration, 20.93 months). There were no residual or recurrent lesions.EMR is safe and effective for the treatment of NAPDs in elderly patients.

A meta-analysis of collateral status and outcomes of mechanical thrombectomy.

OBJECTIVES: To perform a systematic review and meta-analysis to investigate pretreatment collaterals and outcomes of mechanical thrombectomy in patients with acute ischemic stroke of large-vessel occlusion in anterior circulation. METHODS: We systematically searched Embase, PubMed, and the Cochrane Library from their dates of inception to March 5, 2020, and also manually searched reference lists of relevant articles. Pooled relative risk with 95% confidence interval on the association between good collaterals and functional independence (in terms of mRS 0-2), symptomatic intracranial hemorrhage, mortality, and successful reperfusion were synthesized using a random-effects model. RESULTS: Thirty-four studies enrolling 5768 patients were included in analysis. Good collaterals were significantly associated with functional independence (RR 1.93, 95%CI 1.64-2.27, P < .0001), successful reperfusion (RR 1.23, 95%CI 1.12-1.35, P < .0001), decreased rate of symptomatic intracranial hemorrhage (RR 0.68, 95%CI 0.47-0.97, P = .032), and mortality (RR 0.37, 95%CI 0.27-0.52, P < .0001). The results were consistent in sensitivity analysis. The associations between good collaterals and reperfusion remained stable after adjusting for publication bias. CONCLUSIONS: Good pretreatment collaterals were associated with functional independence, successful reperfusion, and decreased rate of sICH and mortality after receiving mechanical thrombectomy in patients with acute ischemic stroke of large-vessel occlusion.

Pre-treatment cerebral microbleeds and intracranial hemorrhage in patients with ischemic stroke receiving endovascular therapy: a systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Predicting the risk of intracranial hemorrhage (ICH) is an important aspect for improving the efficacy and safety of endovascular therapy (EVT). We intended to perform a systematic review and meta-analysis to show whether pre-treatment cerebral microbleeds (CMBs) were associated with an increased incidence of ICH in patients with ischemic stroke receiving EVT. METHODS: We searched PubMed, EMBASE, Web of Science and Cochrane Library from their dates of inception to December 18, 2018, and also manually searched reference lists of relevant articles. Cumulative prevalence of CMBs and ICH was calculated. Relative risk and 95% confidence interval (CI) were calculated for the incidence of ICH in patients with CMBs versus those without after EVT. RESULTS: Four studies involving 598 patients were included. The pooled prevalence of CMBs was 18% (95% CI 15-21%) and the pooled prevalence of ≥ 5 CMBs was 1% (95% CI 0-2%). The pooled incidence of ICH was 29% (95% CI 8-49%) in all patients, 25% (95% CI 5-45%) in those with CMBs and 29% (95% CI 8-50%) in those without CMBs. The pooled relative risk of ICH was 0.90 (95% CI 0.65-1.25, P = 0.528; I2 = 0%, P = 0.949) in patients with CMBs versus those without CMBs. CONCLUSIONS: There is no evidence that pre-treatment CMBs were associated with an increased incidence of ICH in patients with ischemic stroke receiving EVT.

Pretreatment cerebral microbleeds and symptomatic intracerebral hemorrhage post-thrombolysis: a systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Cerebral microbleeds (CMBs) are a possible predictor of symptomatic intracranial hemorrhage (sICH) and poor function outcome (PFO). We aimed to investigate the presence of CMBs on increased incidence of sICH and PFO in acute ischemic stroke patients receiving intravenous thrombolysis (IVT) treatment. METHODS: We searched PubMed, EMBASE, and Cochrane Library from 1 January 1997 to 13 May 2018, for relevant studies and calculated the pooled relative risk (RR) for the incidence of sICH and PFO in patients with CMBs versus those without after IVT. RESULTS: We included 2407 participants from nine studies. The cumulative sICH incidence was higher in patients with CMBs (6%, 95% CI 4-8%) than that in patients without CMBs (4%, 95% CI 2-6%) with pooled RR 1.51 (95% CI, 1.04-2.21; P = 0.031). Four studies including 1550 patients reported data on 3- to 6-month PFO. The cumulative PFO incidence was higher in patients with CMBs (53%, 95% CI 47-59%) than that in patients without CMBs (41%, 95% CI 36-46%) with pooled RR 1.25 (95% CI 1.11-1.41; P = 0.000). CONCLUSIONS: The pretreatment CMBs were associated with increased incidence of sICH and PFO in acute ischemic stroke patients receiving IVT. However, it was not convincing enough to set the presence of CMBs as contraindication to IVT.

Isorhamnetin alleviates esophageal mucosal injury in a chronic model of reflux esophagitis.

Gastro-esophageal reflux disease is one of the most common disorders in gastroenterology. The aim of this work was to investigate the protection of isorhamnetin against esophageal mucosal injury in rats with chronic reflux esophagitis (RE). Chronic RE model was established through fundus ligation and partial obstruction of the pylorus in rats. Then, the rats were treated with isorhamnetin (5 mg/kg) daily for a period of 14 days. Through histological and gross assessment, it was found that administration of isorhamnetin alleviated esophageal mucosal injury in RE rats. Treatment of RE rats with isorhamnetin improved esophageal barrier function, through upregulating proteins expression of occludin and zonula occludens-1 (ZO-1) and downregulating proteins expression of matrix matalloproteinases-3 (MMP3) and -9. Administration of isorhamnetin decreased CD68-positive cells and mRNA levels of IL-6, TNF-α, and IL-1ß in the esophagus of RE rats. Administration of isorhamnetin downregulated inducible nitric oxide synthase (iNOS) protein expression and decreased production of nitric oxide (NO) and 3-nitrotyrosin in the esophagus of RE rats. Administration of isorhamnetin enhanced heme oxygenase-1 (HO-1) activities and reduced malondialdehyde (MDA) levels in esophagus of RE rats. Additionally, treatment with isorhamnetin inhibited p38 MAPK and NFκB activation in RE esophagus. In conclusion, isorhamnetin attenuated esophageal mucosal injury in rats with chronic RE, possibly by suppressing formation of cytokines and infiltration of inflammatory cells, inhibiting p38 and NFκB pathways, and enhancing HO-1 activity.

Completeness of circle of Willis and white matter hyperintensities in patients with severe internal carotid artery stenosis.

BACKGROUND: We investigated whether completeness of the circle of Willis (CoW) protected patients with severe internal carotid artery (ICA) stenosis against white matter hyperintensities (WMHs). METHODS: We included 115 patients with unilateral ICA stenosis ≥ 70%. The completeness of CoW was assessed and WMHs were rated on a visual scale. The score of deep and periventricular WMHs was compared between patients with complete and incomplete CoW and between the two hemispheres, ipsilateral and contralateral to stenosed ICA. RESULTS: We included 115 patients with severe ICA stenosis, 60 patients had a complete CoW (52.17%) and 55 had an incomplete CoW (47.83%). The patients with incomplete CoW had higher score of deep WMHs (OR = 1.82, 95% CI 1.08-3.06, P = 0.023) and periventricular WMHs (OR = 4.53, 95% CI 2.09-9.81, P = 0.000) than those with complete CoW. In the patients with incomplete CoW, the score of deep WMHs (OR = 4.14, 95% CI 1.33-12.93, P = 0.014) and periventricular WMHs (OR = 5.46, 95% CI 1.16-25.62, P = 0.032) was higher in the hemisphere ipsilateral to stenosed ICA than that in the contralateral hemisphere. In the patients with complete CoW, there was no significant difference in the score of deep WMHs (OR = 2.10, 95% CI 0.37-11.91, P = 0.401) and periventricular WMHs (OR = 2.83, 95% CI 0.99-8.05, P = 0.051) between the ipsilateral and contralateral hemispheres to stenosed ICA. CONCLUSION: The completeness of CoW protected patients with severe ICA stenosis against WMHs.

Antiplatelet Therapy, Cerebral Microbleeds, and Intracerebral Hemorrhage: A Meta-Analysis.

BACKGROUND AND PURPOSE: Antiplatelet therapy is associated with the presence of cerebral microbleeds (CMBs) with limited studies. We further investigate the topic focusing on different effects of antiplatelet therapy on strict lobar and deep/infratentorial MBs. METHODS: We searched PubMed and EMBASE from January 1, 1997 to December 1, 2017, for relevant studies, calculated the pooled odds ratios (OR) for CMB incidence and distribution (strictly lobar, deep/infratentorial) in antiplatelet users versus nonantiplatelet users and calculated the OR for the incidence of intracerebral hemorrhage in antiplatelet users with CMBs versus those without. RESULTS: We included 20 988 participants from 37 studies. CMBs were more frequent in antiplatelet users than those in nonantiplatelet users (pooled OR, 1.21; 95% confidence interval, 1.07-1.36; P=0.002). There was a significant association of antiplatelet therapy with strictly lobar MBs (OR, 1.45; 95% confidence interval, 1.15-1.84; P=0.002) rather than deep/infratentorial MBs (OR, 1.37; 95% confidence interval, 0.98-1.90; P=0.062). Intracerebral hemorrhage incidence was higher in participants with CMBs than those without CMBs (OR, 3.40; 95% confidence interval, 2.00-5.78; P=0.000) in antiplatelet users. CONCLUSIONS: Antiplatelet drug use was associated with increased risk of strictly lobar MBs and increased the intracerebral hemorrhage incidence in participants with CMBs.

White matter hyperintensities and their subtypes in patients with carotid artery stenosis: a systematic review and meta-analysis.

OBJECTIVE: We aimed to perform a systematic review and meta-analysis to clarify the association between white matter hyperintensities (WMHs) and carotid artery (CA) stenosis. STUDY DESIGN: Systematic review and meta-analysis. PARTICIPANTS: CA stenosis was set at ≥50%, and WMHs were assessed by MRI and evaluated quantitatively or semiquantitatively. DATA SOURCES: A comprehensive literature search was performed in PubMed, EMBASE and Cochrane Library for studies evaluating the association between WMHs and CA stenosis ≥50% from inception to 13 September 2017. MAIN OUTCOMES AND MEASURES: Standardised mean difference (SMD) with 95% CI was used to evaluate the association between WMHs and CA stenosis. Results were presented in a forest plot with a fixed-effects model or random-effects model. We assessed the quality of included studies using the Newcastle-Ottawa Scale. Funnel plots and Egger's and Begg's tests were conducted to assess publication bias. Sensitivity analysis was performed to evaluate the influence of each individual study. RESULTS: Eight studies enrolling 677 patients were included. There was a positive relationship between the total WMHs and CA stenosis, with a pooled fixed-effects SMD of 0.326 (95% CI 0.194 to 0.459, p=0.000). Heterogeneity and publication bias were low among these studies. Subgroup analysis of three studies enrolling 225 patients showed an association between periventricular WMHs and CA stenosis, with a pooled fixed-effects SMD of 0.412 (95% CI 0.202 to 0.622, p=0.000). CONCLUSION: This meta-analysis showed that the total WMHs and periventricular WMHs were associated with CA stenosis. WMHs may be considered as an individual risk stratification score when choosing a proper plan for therapy of CA stenosis.

Stenosis length of middle cerebral artery and branch atheromatous disease associated infarct.

BACKGROUND: We analyzed the relationship between the characteristics of branch atheromatous disease associated infarct (BAI) and stenosis length (SL) of relevant middle cerebral artery (MCA) M1 segment. METHODS: Ninety-five patients with BAI were recruited from 1024 consecutive acute ischemic stroke patients. Among them, 59 patients (62.11%) had concurrent relative stenosis of MCA M1 segment. The neurologic deficit severity at admission was assessed by National Institutes of Health Stroke Scale (NIHSS) and the infarct size by infarct lesion thickness and maximum diameter. The SL and the distance from the carotid terminal segment to stenosis (DT) were measured on coronary projection on 3D TOF MRA. The correlations between SL and NIHSS, SL and infarct lesion maximum diameter were analyzed. RESULTS: There was no difference between BAI patients with or without M1 stenosis in image markers for infarct etiological subtype. SL was significant difference in patients with NIHSS >3 vs. ≤ 3 (p = 0.032) at admission. Further analysis showed that SL correlated with NIHSS at admission (rs = 0.613, p = 0.000) and maximum diameter (rs = 0.621, p = 0.000) significantly. CONCLUSION: SL is a significant moderate predictor for infarct lesion diameter and neurologic deficit severity.