Search Results (217)

Introduction: A validated clinical decision tool predictive of favorable functional outcomes following endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) remains elusive. We performed a retrospective case series of patients at our regional Comprehensive Stroke Center, over a four-year period, who have undergone EVT to elucidate patient characteristics and factors associated with a favorable functional outcome after EVT. Methods: We reviewed all cases of EVT at our institution between February 2018 and February 2022 in the extended time window from 6–24 h. Demographic, clinical, imaging, and procedure co-variates were included. A favorable clinical outcome was defined as a modified Rankin scale of 0–2. We included patients with M1 or internal carotid artery occlusion treated with EVT within 6–24 h after symptom onset. We used a univariate and multivariate logistic regression analysis to identify patient factors associated with a favorable clinical outcome at 90 days. Results: Our study included evaluation of 121 patients who underwent EVT at our comprehensive stroke center. Our analysis demonstrates that a higher recanalization score based on the modified Thrombolysis In Cerebral Infarction (mTICI) scale (2B-3) was a strong indicator of a favorable outcome (OR 7.33; CI 2.06–26.07; p = 0.0021). Our data also showed that a higher baseline National Institutes of Health Stroke Scale (NIHSS) score (p = 0.0095) and the presence of pre-existing hypertension (p = 0.0035) may also be predictors of an unfavorable outcome (mRS > 2) per our multivariate analysis. Conclusion: Patients without pre-existing hypertension had more favorable outcomes following EVT in the expanded time window. This is consistent with other multicenter data in the expanded time window that demonstrates greater odds of a poor outcome with elevated pre-, peri-, and post-endovascular-treatment blood pressure. Our data also demonstrate that the mTICI score is a strong predictor of favorable outcome, even after controlling for other variables. A lower baseline NIHSS at the time of thrombectomy may also indicate a favorable outcome. Furthermore, the presence of clinical or radiographic mismatch based on the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and NIHSS per DAWN and DEFUSE-3 criteria did not emerge as a predictor of favorable outcome, which is congruent with recent randomized controlled trials and meta-analyses. Full article

Background/Objectives: An aberrant internal carotid artery (aICA) in the middle ear is a rare vascular anomaly with potentially catastrophic consequences if injured during otologic procedures. Given its rarity, standardized treatment recommendations are lacking. This study aims to present four cases of aICA bleeding, systematically review the literature, and evaluate the outcomes of conservative and interventional management. Methods: A retrospective review of four patients treated for intraoperative aICA hemorrhage at two tertiary referral centers was performed. A systematic review was conducted following PRISMA guidelines. Neurologic and otologic outcomes, hemostasis, and complications were analyzed. Results: Two patients were treated conservatively with external auditory canal packing, while two required endovascular coil embolization due to pseudoaneurysm formation or persistent bleeding. One patient suffered a stroke due to traumatic ICA occlusion. The systematic review identified 20 additional cases. Conservative treatment alone sufficed in 37.5% of cases, whereas 62.5% required vessel occlusion via coiling, balloon occlusion, or stenting. Neurologic complications occurred in 25% of patients, while otologic outcomes varied widely and were inconsistently reported. Conclusions: Initial external auditory canal packing and a CT angiogram should be recommended for all patients. Initial conservative management may be appropriate for cases with early hemostasis if close monitoring is ensured. Endovascular treatment is often necessary, particularly in cases of pseudoaneurysm or rebleeding. Full article

Background: While carotid pathologies are well-established risk factors for stroke, their specific effects on outcomes following stroke that cannot be classified as atherosclerotic remain unclear. In this study, we aimed to determine whether carotid pathologies are associated with functional dependence (FD) 3 months after small vessel occlusion (SVO) stroke. Methods: This retrospective study included patients with a first-ever SVO stroke admitted to a single cerebrovascular-specialty hospital between October 2021 and March 2024. Standardized ultrasound criteria were used to grade the carotid plaques. The modified Rankin scale (mRS) was used to assess functional outcomes at 3 months. Logistic regression analysis was performed to identify FD predictors (mRS of ≥2). Results: Of the 372 included patients, 276 achieved functional independence and 96 experienced FD at 3 months. Univariable analysis revealed an association between carotid plaque grade III and FD (odds ratio [OR], 2.46; 95% confidence interval [CI], 1.05–6.51; p = 0.049). However, this association was not significant in the multivariable model. Overall, age (adjusted OR, 1.07; 95% CI 1.03–1.10, p < 0.001), NIHSS at initial presentation (adjusted OR, 1.84; 95% CI, 1.55–2.18; p < 0.001), and diabetes (adjusted OR, 2.84; 95% CI, 1.37–5.92; p = 0.005) were independently associated with FD 3 months after SVO stroke. Conclusions: Carotid plaque severity was not independently associated with functional outcomes 3 months after SVO stroke. Age, NIHSS at initial presentation, and diabetes were identified as independent FD predictors. Future in-depth studies are warranted to confirm the complex interplay of factors influencing functional outcomes in patients with SVO stroke and carotid pathologies simultaneously. Full article

Background and Purpose: Mechanical thrombectomy in the context of internal carotid artery dissection (ICA-D) lesions is an undesirable procedure that may necessitate carotid stenting. Flow-diverting stents (FDSs) are promising devices with numerous advantages, particularly in cases involving tortuous anatomy. Here, we investigate the use of FDSs in the acute management of carotid dissection during mechanical thrombectomy procedures in patients with dissection-related strokes. Materials and Methods: This was a multicentric retrospective observational study of consecutive patients admitted for mechanical thrombectomy due to acute ischaemic stroke with ICA-D and treated with an FDS in the acute setting between July 2018 and February 2023. Patient records, procedural details, and post-procedural outcomes, including follow-up data, were reviewed. Results: A total of 11 patients (10 patients with unilateral ICA-D and one patient with bilateral ICA-D) were included, 10 of whom were male, with a median age of 54 years (range: 35–85 years) and NIHSS scores at admission ranging from 3 to 32 (median 13). Eight cases (73%) involved intracranial occlusion (tandem stroke), with the intracranial occlusion managed first each time. An FDS was selected when the dissection was long and/or the ICA was tortuous, and successful deployment was achieved in all patients with a favourable angiographic outcome (TICI 2B-3). A favourable outcome (modified Rankin scale 0–2 at 90 days) was observed in five patients (45%), with four patients (36%) experiencing symptomatic ICH and three patients having stent occlusion out of the 12 treated ICA-D cases. Conclusions: The use of FDSs for acute stenting in ICA-D-related stroke can be performed efficiently, resulting in excellent angiographic outcomes and an acceptable rate of favourable outcomes specific to the pathology. Larger prospective studies are still needed to confirm the potential benefits of FDSs in acute situations. Full article

Moyamoya angiopathy (MMA) is a cerebrovascular disease determining chronic progressive steno-occlusion of the supraclinoid internal carotid arteries and their main branches. The pathogenesis of MMA remains largely unknown. Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease of the central nervous system characterized by the progressive accumulation of focal demyelinating lesions, whose pathophysiology has been theorized but still incompletely understood. Beyond misdiagnoses due to mimicking features among the two disorders, MS coexisting with MMA have been previously, rarely, reported. Herein, we present two other cases of patients with MMA with a concomitant, previously missed, diagnosis of MS and discuss their overlapping features as a hint for a potentially shared pathophysiology. The finding of typical angiographic features enables MMA diagnosis, yet it does not allow us to rule out other potentially concomitant disorders affecting the CNS. The association may be easily missed if the clinical/neuroradiological picture is not carefully assessed. Cerebral spinal fluid analysis and spine neuroimaging should be suggested in all MMA patients with atypical MRI lesions. Full article

(1) Background: Ischemic stroke is a major global public-health concern with complex pathogenesis. Current treatment strategies face challenges. Low-intensity pulsed ultrasound stimulation (LIPUS), a non-invasive neuromodulation technology, shows promise in treating ischemic stroke, yet its underlying mechanisms lack in-depth investigation, especially in quantitative efficacy evaluation. (2) Methods: This study aimed to develop a neuromuscular functional coupling-based dynamic time warping (DTW) model to evaluate LIPUS’s neuroprotective effects in a mouse model of ischemic stroke. A bilateral carotid artery occlusion (BCAO) model in mice was established, and LIPUS treatment was given. Time- and frequency-domain analyses of local field potentials (LFPs) and electromyography (EMG) were conducted, and outcomes were quantified using a percentage-based scoring system. (3) Results: The BCAO+LIPUS group scored significantly higher than the BCAO group. (4) Conclusions: This study demonstrated that LIPUS is neuroprotective in BCAO mice and that the DTW-100 assessment evaluation model can quantify the neuroprotective effects of LIPUS. Full article

Background and Clinical Significance: Carotid stump syndrome (CSS) is a rare and unexpected cause of recurrent ischemic ipsilateral events in the carotid vascular territory despite the demonstrated occlusion of the internal carotid artery (ICA). It is believed to be caused by microemboli due to turbulent blood flow in the patent stump of the occluded ICA that passes through anastomotic channels and retrograde flow into the middle cerebral artery circulation. Case Presentation: We describe the case of a 65-year-old male patient who suffered multiple concurrent transient ischemic attacks (TIAs) with a totally occluded ipsilateral ICA revealed by computed tomography angiography (CTA). He was diagnosed with CSS, which required the safest therapeutic approach. A further investigation with digital subtraction angiography (DSA) was performed, and a trickle of blood flow was observed in the reportedly occluded ICA. The diagnosis of a true ICA occlusion was withdrawn, and a diagnosis of pseudo-occlusion was established, affecting the final treatment strategy. Therefore, the patient underwent an ipsilateral carotid endarterectomy (CEA), and he has remained asymptomatic since then. Conclusions: The differentiation between a pseudo-occlusion and a true ICA occlusion is essential in promptly managing acute recurrent ipsilateral ischemic strokes in the carotid vascular territory. A further investigation with DSA in cases with a totally occluded ICA using CTA is essential for excluding pseudo-occlusions in ipsilaterally symptomatic patients. Full article

Background/Objectives: Carotid endarterectomy (CEA) is the treatment of choice for severe symptomatic and asymptomatic carotid artery stenosis. Nonetheless, it carries risks and several complications, including stroke and death. Previous studies have indicated that elevated matrix metalloproteinase-9 (MMP-9) levels may serve as biomarkers for adverse outcomes after CEA. This systematic review investigates the association between plasma MMP-9 levels and adverse cardiovascular outcomes following CEA. Methods: PubMed/MedLine, Scopus and Web of Science were searched for studies assessing the relationship between plasma MMP-9 levels and postoperative outcomes after CEA. Assessment of studies’ quality was performed using the National Heart, Lung, and Blood Institute (NHLBI) Study Quality Assessment Tool for observational cohorts and cross-sectional studies. Results: Five studies were included (n = 891 participants). All five were retrospective cohort studies. MMP-9 was significantly higher in patients who presented with a combination of amaurosis fugax, central retinal artery occlusion, TIA and minor/major stroke at follow-up. However, individual outcomes like TIA or stroke did not consistently correlate with MMP-9 levels. Additionally, increased MMP-9 levels were also associated with cognitive dysfunction post CEA. Conclusions: Despite the potential of MMP-9 levels to serve as a biomarker for predicting postoperative cerebrovascular complications, this review presents limitations, including a high risk of bias in included studies and variability in methodologies. There is a need for further research with larger cohorts to validate these findings and improve risk stratification and management strategies for patients undergoing CEA. Full article

Background and Objectives: Thermography is a non-invasive diagnostic technique that measures skin surface temperatures to reflect normal or abnormal physiology. This review explores the clinical utility of thermography in diagnosing and monitoring stroke, with an emphasis on its clinical applications. Materials and Methods: This systematic review followed PRISMA guidelines, with a protocol published prior to analysis. Three databases were screened up to end of 2024. Article selection was conducted in two stages: title and abstract screening using Rayyan^®, followed by full-text eligibility assessment. Discrepancies were resolved through consensus. Risk of bias assessment was performed with ROBINS-I. Narrative synthesis was planned in addition to descriptive statistics. Results: A total of 20 studies were included after screening 277 records. Thermography emerged as a promising tool for stroke patients in both the acute and chronic phases. In the acute phase, it demonstrated potential in detecting early signs of carotid occlusive disease by identifying temperature differences in the forehead or neck regions. Additionally, thermography contributed to the differential diagnosis of Wallenberg syndrome. In the chronic phase, it exhibited clinical utility in monitoring rehabilitation progress. Conclusions: Thermography shows promise as a non-invasive tool for stroke assessment and monitoring. While preliminary studies suggest physiological relevance, its clinical utility remains investigational and requires further validation. Full article

Diabetic retinopathy (DR) is a leading cause of visual impairment. To better understand the pathology, clinically relevant experimental models are needed. Widely used DR models (especially streptozotocin (STZ)-induced) require extended timeframes to reach DR phenotype endpoints and lack ischemic phenotypes, which are in contrast to the human condition. Unilateral common carotid artery occlusion (UCCAO) could provide a retinal ischemic insult. We explored the pathologic synergistic effects of UCCAO in STZ mice. STZ (90 mg/kg) was injected intraperitoneally into adult C57BL/6 mice for three days. Four weeks later, right UCCAO was performed. One week after UCCAO, retinal samples were stained with isolectin B4 to analyze cellular and vascular changes. Retinal samples were obtained one day and one week after UCCAO and quantitative PCR (qPCR) were performed to observe inflammatory and ischemic responses. Only the STZ UCCAO group showed increased inflammatory cells. STZ UCCAO retina demonstrated a significant difference in capillary and large vessel size compared to other groups. At one day and one week, there was a change in mRNA expressions in inflammatory genes Ccl2, Ccl12, Bnip3, Pdk1, Hsp25, and Vegfa in the STZ UCCAO group compared to other groups. Our model can serve as an accelerated DR model for studying inflammatory vascular changes. Full article

Background and Objectives: The benefit of carotid artery stenting (CAS) for stroke prevention has been established, but less is known about CAS’s effect on cognition. Here, we investigate (1) changes in the blood flow in both treated and non-treated carotid arteries, (2) associations between the severity of artery occlusion and CAS-induced flow change, and (3) whether the flow changes relate to cognitive improvement. Materials and Methods: We used quantitative flow magnetic resonance imaging to assess blood flow and computerized neurocognitive assessment to evaluate cognitive performance. Fourteen patients identified for CAS as part of their standard care participated in this study; ten completed the CAS procedure and the pre- and post-CAS assessments (age = 77.0 ± 5.6; 70% males). Results: An increased ipsilateral flow following CAS was seen in 70% of the participants, while 50% also showed an increase in the total flow. The participants with ≥90% stenosis showed the greatest flow changes, such that the post-CAS flow was 60% higher relative to pre-CAS (p < 0.050). Cognitive responses to the flow increase were variable: attention showed a positive association; in comparison, higher cognitive flexibility and memory were only seen when treated stenosis was below 80%. Conclusions: Our preliminary findings highlight the impact of CAS and the complex relationship between blood flow and cognitive changes post-CAS, warranting larger-scale studies with extended follow-up periods. Full article

Background: Endovascular mechanical thrombectomy (EVT) is regarded as the standard treatment for acute ischemic stroke with large vessel occlusion. Few studies have examined the evolution of cerebral flow after the acute stage of ischemic stroke. In this study, we examined the association of functional outcomes with cerebral blood flow by extracranial carotid sonography during the subacute phase after EVT and multiple prognostic variables. Methods: We conducted a single-center, retrospective, observational study between January 2018 and June 2023. Patients with acute stroke resulting from anterior circulation large vessel occlusion who underwent EVT were included. All patients underwent carotid sonography in the second week after EVT. Patients with fair (modified Rankin Scale [mRS]: 0–3) and poor outcomes (mRS: 4–6) were compared to determine the association between and identify the predictors of these factors and functional outcomes. Results: A total of 89 patients were included (female: 38 (42.7%); mean age: 69.45 ± 13.59 years). Multivariable logistic regression analysis revealed that three factors were independent predictors of fair outcomes: (1) the Alberta Stroke Program Early CT Score (odds ratio [OR]: 1.79; 95% confidence interval [CI]: 1.16–2.78; p = 0.009); (2) Thrombolysis in Cerebral Infarction 2b to 3 (OR: 4.91; 95%CI: 1.10–21.89; p = 0.037); (3) the ratio of treatment-side blood flow between the internal carotid artery and common carotid artery (QTI/QTC, OR: 45.35; 95% CI: 1.11–1847.51; p = 0.04). Conclusions: The ratio of QTI/QTC is a clinically relevant parameter as a potential predictor of favorable outcomes. This parameter can be used to formulate patient prognostic scores and help clinicians determine whether adequate cerebral perfusion is maintained during the subacute phase. Full article

Background: Tandem Lesions (TLs) or Tandem Occlusions (TOs) are characterized by simultaneous high-grade stenosis or occlusion of the proximal extracranial internal carotid artery and the intracranial terminal internal carotid artery or its branches. These lesions can result in stroke and pose significant challenges to endovascular treatment. This study introduces and evaluates the “T-Top technique” as an innovative approach to address TLs, assessing its safety and technical efficacy. Methods: Data from acute ischemic stroke (AIS) patients treated with the T-Top technique between September 2022 and September 2023 were retrospectively analyzed. The technique involves using the pusher wire of a stent retriever as a microwire to guide a monorail angioplastic balloon to the extracranial carotid stenosis, performing angioplasty simultaneously with stent retriever anchorage. Clinical outcomes, procedural data, and safety were assessed. Results: Successful reperfusion (mTICI > 2b) was achieved in 91% of cases, with a median groin puncture to final recanalization time of 50 min. Favorable clinical outcomes (mRS < 3) were observed in 69% of patients, with a low mortality rate of 6% after 90 days. Conclusions: The T-Top technique offers a rapid and reliable strategy for TL treatment, improving reperfusion rates and clinical outcomes. Further studies are warranted to validate its efficacy in larger cohorts. This technique holds promise for enhancing endovascular treatment outcomes in patients with Tandem Lesions. Full article

Objectives: Ischemic stroke is a severe neurological disorder with high morbidity, mortality, and disability rates, posing a substantial burden on patients, families, and healthcare systems. Soy isoflavone (SI), a naturally occurring phytoestrogen, has demonstrated promising neuroprotective effects. This study aimed to evaluate the anti-stroke efficacy of SI and elucidate its underlying mechanisms through integrated phytochemical profiling, network pharmacology, and both in vitro and in vivo experimental validation. Methods: Active constituents of SI were extracted via reflux and identified using liquid chromatography–mass spectrometry (LC-MS). Network pharmacology was employed to predict therapeutic targets and signaling pathways. The neuroprotective effects of SI were first assessed in PC12 cells subjected to oxygen–glucose deprivation/reoxygenation (OGD/R) injury in vitro. For in vivo evaluation, transient cerebral ischemia–reperfusion injury was induced using the bilateral common carotid artery occlusion (BCCAO) model in adult male ICR rats (27.3 ± 1.8 g; 6–8 weeks old), obtained from the Shanghai Experimental Animal Center, Chinese Academy of Sciences. Forty-eight rats were randomly assigned into four groups (n = 12): sham, model (BCCAO), SI-treated (100 mg/kg, oral gavage for 5 days), and edaravone (EDA)-treated (10 mg/kg, i.p., positive control). All procedures were approved by the Institutional Animal Care and Use Committee of Changchun Normal University (Approval No. 2024003, 13 March 2024) and conducted in accordance with the NIH guidelines and ARRIVE 2.0 reporting standards. Results: In vitro, SI significantly enhanced PC12 cell viability from 57.23 ± 2.88% to 80.76 ± 4.43% following OGD/R. It also reduced intracellular Ca²⁺ by 58.42%, lactate dehydrogenase (LDH) release by 37.67%, caspase-3 activity by 55.05%, and reactive oxygen species (ROS) levels by 74.13% (p < 0.05). A flow cytometry analysis revealed that OGD/R increased the apoptosis rate from 5.34% (control) to 30.85% (model group), which was significantly attenuated by SI treatment, especially in the 560 µg/mL group (20.00%), followed by the 140 and 280 µg/mL groups. In vivo, SI improved neurological scores from 8.3 ± 1.09 to 6.8 ± 1.68, reduced cerebral infarction volume by 18.49%, and alleviated brain edema by 10.42% (p < 0.05). SI also decreased malondialdehyde (MDA) and LDH levels by 31.15% and 39.46%, respectively, while increasing the activity of antioxidant enzymes: superoxide dismutase (SOD) by 11.70%, catalase (CAT) by 26.09%, and glutathione peroxidase (GSH-px) by 27.55% (p < 0.01). Scratch assay results showed that SI restored the impaired migratory ability of the OGD/R-treated PC12 cells, further supporting its role in cellular repair. A Western blot analysis demonstrated the upregulation of nuclear factor erythroid 2–related factor 2 (Nrf2), heme oxygenase-1 (HO-1), and NAD(P)H:quinone oxidoreductase 1 (NQO1) and the downregulation of Kelch-like, ECH-associated protein 1 (Keap1) in the cerebral ischemia–reperfusion model. Conclusions: These findings indicate that soy isoflavone confers significant neuroprotective effects against cerebral ischemia–reperfusion injury by enhancing endogenous antioxidant defense mechanisms, reducing oxidative stress, inhibiting apoptosis, and promoting cell migration. The protective effects are likely mediated through the activation of the Nrf2/Keap1 signaling pathway, supporting the therapeutic potential of SI in ischemic stroke treatment. Full article

Dysphagia is a serious complication of stroke, yet effective pharmacological treatments remain limited. This study investigated the effects of FAD012 (3,5-dimethyl-4-hydroxy cinnamic acid), a synthetic derivative of ferulic acid (FA), on cerebral damage and swallowing dysfunction in a rat model of bilateral common carotid artery occlusion (2VO). Sprague–Dawley rats were orally administered FAD012 (3 or 10 mg/kg), FA (10 mg/kg), or 0.5% carboxymethyl cellulose (CMC, suspension vehicle) starting one week before 2VO. Two weeks after 2VO surgery, which was performed under isoflurane anesthesia, reflex swallowing was assessed by electromyographic recordings of the mylohyoid muscle under urethane anesthesia. Two weeks after 2VO, cerebral blood flow (CBF) declined to approximately 40% of baseline, and the number of reflex swallowing responses was significantly reduced in the CMC group. Additionally, 2VO induced O₂⁻ production, apoptotic cell death in the striatum, and a reduction in tyrosine hydroxylase expression. Substance P (SP) levels in the laryngopharyngeal mucosa, positively regulated by dopaminergic signaling in the basal ganglia, also decreased. FAD012 (10 mg/kg) effectively prevented the 2VO-induced reduction in CBF, enhanced the reflex swallowing, and preserved the dopamine-SP system. Notably, FAD012 exerted significantly stronger effects than FA at the same dose. These findings suggest that FAD012 maintains CBF under cerebral hypoperfusion and enhances the swallowing reflex by maintaining neuronal function in the striatal and laryngopharyngeal regions of 2VO rats. Full article