RESUMO
BACKGROUND: The effective treatment for patients with acute ischemic stroke (AIS) with cervical internal carotid pseudo-occlusion (cICA-PO) requires comprehensive research on the safety and outcomes of endovascular thrombectomy (EVT). However, there are limited data available, highlighting the need for further research to ensure better treatment strategies and improve the quality of care for these patients. PURPOSE: This study aims to assess the management and outcomes in this population group compared with patients with true carotid occlusion. DATA SOURCES: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive systematic review was conducted by using PubMed, Embase, Web of Science, and Scopus from database inception to November 2023. STUDY SELECTION: The size of the included studies ranged from 16 patients to 146 patients. Through the 4 full-text articles, a total of 259 patients were collected. We compared outcomes between patients with cICA-PO compared with patients with true carotid occlusions undergoing EVT due to AIS. We excluded studies with patients with carotid pseudo-occlusion without stroke, review articles, duplicate studies, overlapped data that included the same patients presented in another included study, case reports, case series with fewer than 5 patients, and meeting abstracts that did not contain the outcomes of interest. We did not pose any limitations regarding sample size or patient characteristics. DATA ANALYSIS: We utilized the R statistical software (V.4.3.1; R package meta) to conduct the analysis of all the data obtained. We calculated the OR for binary variables, and the corresponding 95% CI. To synthesize the data, random-effect models, as well as forest plots were generated to visually represent the synthesis of the data. Additionally, we assessed heterogeneity by using Cochran Q and I 2 tests. A P value < .05 for the Q statistic or I 2 more than 50% suggests notable heterogeneity. Based on a small number of studies (<10), the assessment of publication bias could not be reliably performed. DATA SYNTHESIS: This meta-analysis encompassed data from 4 studies. Patients with cICA-PO and AIS who underwent EVT (n = 135) exhibited lower rates of functional independence (OR = 0.35; 95% CI, 0.20-0.61; P < .001) compared with patients with true occlusions (n = 103), as well as successful recanalization rates (OR = 0.39; 95% CI, 0.20-0.74; P = .004). In addition, the cICA-PO group experienced higher mortality and symptomatic intracranial hemorrhage (sICH) compared with the group with true carotid occlusions (OR = 2.62; 95% CI, 0.21-7.24; and OR = 2.23; 95% CI, 1.00-4.95; P = .049, respectively). LIMITATIONS: Individual patient data were not available. Studies were a retrospective design and some of the studies had small sample sizes. The included studies in our meta-analysis did not exclude patients with tandem occlusions that might influence the results of the comparison. CONCLUSIONS: Compared with patients with true carotid occlusion, the cICA-PO group with AIS undergoing EVT presented poor outcomes with lower functional independence and successful recanalization, as well as higher sICH and mortality rates.
RESUMO
Here we reported a study of metal ions-assisted assembly of DNA-minocycline (MC) complexes and their potential application for controlling MC release. In the presence of divalent cations of magnesium or calcium ions (M2+), MC, a zwitterionic tetracycline analogue, was found to bind to phosphate groups of nucleic acids via an electrostatic bridge of phosphate (DNA)-M2+-MC. We investigated multiple parameters for affecting the formation of DNA-Mg2+-MC complex, including metal ion concentrations, base composition, DNA length, and single- versus double-stranded DNA. For different nitrogen bases, single-stranded poly(A)20 and poly(T)20 showed a higher MC entrapment efficiency of DNA-Mg2+-MC complex than poly(C)20 and poly(G)20. Single-stranded DNA was also found to form a more stable DNA-Mg2+-MC complex than double-stranded DNA. Between different divalent metal ions, we observed that the formation of DNA-Ca2+-MC complex was more stable and efficient than the formation of DNA-Mg2+-MC complex. Toward drug release, we used agarose gel to encapsulate DNA-Mg2+-MC complexes and monitored MC release. Some DNA-Mg2+-MC complexes could prolong MC release from agarose gel to more than 10 days as compared with the quick release of free MC from agarose gel in less than 1 day. The released MC from DNA-Mg2+-MC complexes retained the anti-inflammatory bioactivity to inhibit nitric oxide production from pro-inflammatory macrophages. The reported study of metal ion-assisted DNA-MC assembly not only increased our understanding of biochemical interactions between tetracycline molecules and nucleic acids but also contributed to the development of a highly tunable drug delivery system to mediate MC release for clinical applications.
