Predictors of 30-day mortality after endovascular thrombectomy for large vessel occlusion in the elderly.

OBJECTIVES: Elderly acute ischemic stroke (AIS) patients (≥80 years) would have dismal clinical outcomes even after successful endovascular revascularization for large vessel occlusion (LVO) in the anterior circulation. We aimed to identify predictors of 30-day mortality after endovascular thrombectomy (EVT) in the elderly. MATERIALS AND METHODS: We included older patients who underwent EVT for AIS due to LVO within 6 h after stroke onset in the anterior circulation between 2017 and 2019. Patients due to posterior circulation stroke, with intracerebral hemorrhage (ICH) or pre-stroke modified Rankin Scale (mRS) score of 4 and 5 were excluded. The primary outcome was mortality within 30 days of EVT. The association between clinical, imaging, procedural, follow-up imaging and mortality were analyzed. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction (mTICI) score of 2b or 3. Possible predictors of 30-day mortality were assessed by univariate and multivariable logistic regression. RESULTS: Total 238 AIS patients eligible for EVT were identified with 58 patients aged 80 years or more. 48 patients met inclusion criteria. Median age was 86 years (age range, 82-102 years). Successful reperfusion was achieved in 38 (79.2%) patients. The 30-day and 90-day mortality rate were 25% and 33.3%, respectively. The independent predictors of 30-day mortality were collateral scores <3 on mCTA (adjusted OR, 16.571; 95% CI, 1.041-263.868; p = 0.047) and number of passes (adjusted OR, 2.475; 95% CI, 1.047-5.847; p = 0.039). CONCLUSIONS: Lower collateral scores on mCTA and higher number of passes in thrombectomy were independently predictive of 30-day mortality in the elderly.

Impact of smoking on one year functional outcomes after thrombectomy for young stroke patients.

BACKGROUND: The incidence of stroke in young patients (20-50 years old) has increased in recent decades. Unlike the use of good functional outcomes to evaluate prognosis, excellent functional outcomes are a better indicator of return to work among younger patients. The rate of return to work increases with time after stroke. This study investigated the short term (3 months) and long term (1 year) predictors of excellent functional outcomes in young patients after endovascular thrombectomy (EVT). METHODS: We included young patients who underwent EVT for acute ischemic stroke (AIS) due to large vessel occlusion within 6 hours after stroke onset between 2015 and 2021. Patients with intracerebral hemorrhage on pretreatment CT were excluded. The associations between clinical, imaging, and procedure variables, and excellent functional outcomes were analyzed using univariate and multivariable logistic regression analyses. An excellent functional outcome was defined as a modified Rankin Scale score of ≤1. RESULTS: Of the 361 patients with AIS eligible for EVT, 55 young patients (aged 24-50 years) were included. Of these, 36.4% and 41.8% achieved excellent functional outcomes at 3 and 12 months, respectively. Multivariate analysis revealed that smoking was the independent negative predictor of both 3 month (adjusted OR (aOR) 0.232, 95% CI 0.058 to 0.928; p=0.039) and 12 month (aOR 0.180, 95% CI 0.044 to 0.741; p=0.018) excellent functional outcomes. CONCLUSIONS: Current or former smoking habit was an independent negative predictor of both short term and long term excellent functional outcomes in young adults with AIS.

Configuration of the circle of Willis is associated with less symptomatic intracerebral hemorrhage in ischemic stroke patients treated with intravenous thrombolysis.

BACKGROUNDS: The circle of Willis (CoW) is a primary collateral pathway that compensates quickly for a drop in cerebral blood flow. Using the complete CoW as a surrogate marker for good collateral circulation, its prognostic value after intravenous thrombolysis was examined. METHODS: We prospectively studied 64 consecutive patients with acute ischemic stroke treated with tissue plasminogen activator within 3 hours of stroke onset between October 2005 and June 2012 in our hospital. The study protocol was based on standard guidelines for intravenous thrombolysis. On computed tomographic angiography 24 hours after thrombolysis, the CoW was complete in 21 (32.8%) cases and incomplete in 43 (67.2%). RESULTS: Patients with complete CoW were more likely to have early improvement in National Institute of Health Stroke Scale (NIHSS) score (median improvement 2 vs 0 at 2 hours; 4 vs 1 at 24 hours), be independent at 3 months (42% vs 19%). In the incomplete CoW group, the rate of symptomatic intracerebral haemorrhage (SICH) according to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) definition was almost 3 times higher. Complete CoW was one of the strongest predictors of good functional outcome at 3 months (odds ratio 2.32; P = .01). CONCLUSIONS: Complete CoW independently predicted functional independence and survival.

Electrophysiological characterization of Charcot-Marie-Tooth disease type 1A in Taiwan.

BACKGROUND: Charcot-Marie-Tooth disease type 1A (CMT1A) is the most common type of hereditary neuropathy. The demyelinating pathology of CMT1A results in significant nerve conduction slowing such that a nerve conduction study (NCS) is important in the clinical assessment of CMT1A. In this study, we analyzed and reported the electrophysiological features of a large Taiwanese cohort with CMT1A. METHODS: We retrospectively analyzed the NCS data of 106 Taiwanese patients with CMT1A. We also compared the electrophysiological parameters of the CMT1A patients with those of 20 patients with early-onset Charcot-Marie-Tooth disease type 1B (CMT1B). RESULTS: The patients with CMT1A had a significant but variable degree of slowed nerve conduction. The median motor nerve conduction velocities (MNCVs) varied from 10.0 to 37.3 m/s in the entire CMT1A cohort but were more concordant in patients within a family (p<0.001). In each patient, the MNCVs among different nerves were concordant (p<0.001), and the MNCVs tended to remain steady longitudinally. Moreover, younger patients had a slower MNCV than older patients within the CMT1A population (p<0.001). The average median MNCV was significantly faster in the CMT1A patients than in the CMT1B patients (21.8±6.2 m/s and 16.3±3.6 m/s; p<0.001). CONCLUSION: This study provides basic electrophysiological knowledge about CMT1A in Taiwan. The findings also suggest that the electrophysiological variability in the CMT1A cohort may be at least partially attributable to unknown genetic factors. These data emphasize the role of MNCV in the clinical assessment of CMT1A. A median or ulnar MNCV below 38 m/s can be a sensitive criterion for supporting the diagnosis of CMT1A. A median MNCV can sometimes help to distinguish CMT1A from CMT1B, and CMT1A should be considered in patients with median MNCVs near or above 24 m/s. Moreover, the MNCV may to some degree reflect the severity of CMT1A.

Toward the design and synthesis of lithium-ion intercalation into a coordination pi-pi framework host.

A pi-stacked coordination solid, [[[(VO)2(OH)2(C4O4)(phen)2] x H2O]n] (1: phen = phenanthroline), was synthesized by hydrothermal methods and structurally characterized by X-ray single-crystal diffraction. The structure of 1 adopts a neutral open framework in which channeling apertures and windows are surrounded by four oxovanadyl dimers, two squarates, and two pairs of pi-pi interactions of phenanthroline groups; the dimensions of the windows are about 5.38 x 7.55 A along the c axis. Surprisingly, the porous framework with hydrophilic and hydrophobic characteristics was thermally stable up to 250 degrees C, as indicated from powder X-ray diffraction patterns and thermogravimetric analysis. Further investigation of lithium-ion intercalation into the channel matrix of 1 was conformed by 7Li NMR spectroscopy and cyclic votammetry measurements. The present case represents the first example of a porous coordination solid that possesses polar channels capable of mediating lithium-ion insertion.