Royal Stoke University Hospital,University Hospitals of North Midlands NHS Trust

EVT is standard care for acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but benefit with mild stroke (NIHSS ≤ 5) remains unclear. Patients from the INSPIRE‑S global registry with AIS treated with Medtronic Neurovascular devices on the first pass were grouped by mild stroke (NIHSS ≤ 5) and moderate-to-severe stroke (NIHSS > 5) at baseline. Clinical and safety outcomes were compared, with analysis for the subset treated with Solitaire™ on first pass with or without aspiration. From May 2020–December 2022, 801 patients (29 sites, 13 countries) met eligibility criteria and were enrolled into stent retriever, aspiration alone, or combination therapy cohorts. For this analysis, outcomes were compared by baseline NIHSS: mild stroke (n = 75) versus moderate-to-severe stroke (n = 713). Mild stroke patients had higher rates of 90-day mRS 0–2 (75.3

INTRODUCTION:The role of CT angiography (CTA) and CT perfusion (CTP) in patient selection for thrombolysis <4.5 h after onset is unclear. Additional imaging may improve specificity of diagnosis by excluding stroke mimics or those without salvageable tissue, but may delay treatment. PATIENTS AND METHODS:In a multicentre prospective randomised trial, thrombolysis-eligible patients <4.5 h from symptom onset were randomised 1:1 to non-contrast CT (NCCT) or multimodal CT (NCCT + CTA + CTP). The primary endpoint was the proportion receiving thrombolysis. Secondary end-points were times to decision-making and treatment delivery, early neurological recovery, functional recovery at 3 months and incidence of symptomatic intracerebral haemorrhage (SICH). RESULTS:Between March 2015 and May 2018, 271 patients were randomised, 134 to multimodal CT and 137 to NCCT. After initial NCCT, 114 had no contraindication to thrombolysis in the multimodal CT group and 108 in the NCCT group. Mean age was 67.5 years and median NIHSS score was 6 (interquartile range 3-12). Fewer patients assigned multimodal CT received thrombolysis (56/114, 49.1%) compared to NCCT (73/108, 67.6%, adjusted odds ratio (aOR) 0.46 (95% CI: 0.25-0.83), p = 0.0102). Times to treatment decision or thrombolytic administration, early neurological recovery and day 90 functional outcome did not differ significantly. SICH occurred in two patients, both assigned NCCT. Mortality was 6/114 (5.3%) in the multimodal CT group compared to 11/108 (10.2%; aOR 0.46 (95% CI: 0.16, 1.31), p = 0.147) in the NCCT group. DISCUSSION:Despite fewer patients receiving thrombolysis after multimodal imaging, treatment decision times and clinical outcomes did not differ significantly. Multimodal CT may identify patients who do not require thrombolysis such as stroke mimics and non-disabling strokes. CONCLUSION:Among acute stroke patients imaged <4.5 h from symptom onset, multimodal CT reduced use of thrombolysis. Treatment decision times and clinical outcomes did not differ between groups.

Introduction 10%–15% of strokes occur between 18 and 50 years old. Young stroke incidence in the UK is increasing with high risk factor burden and varied aetiology. Long-term functional and psychological sequelae are highly prevalent. This study will provide representative information on UK young strokes and develop a prognostic tool guiding primary and secondary prevention.Methods and analysis The United Kingdom Young Stroke Study (UKYSS) is an ambispective observational study of young adults aged 18–49 years with a first ever ischaemic or haemorrhagic stroke. Young strokes between 1 January 2013 and 31 December 2020 will be identified from UK stroke centres and screened for eligibility. Data will be collected on demographics, risk factors, clinical presentation, investigation, imaging, diagnosis and discharge status at baseline and survival, vascular events, epilepsy and malignancy. Patients will complete a life after stroke questionnaire to obtain current information on a variety of functional domains.Descriptive analysis will use χ2 and Fisher’s Exact tests (if value <5) to compare categorical variables across groups and Student’s t-test or Mann-Whitney U test to compare means. Kaplan-Meier curves will measure cumulative incidences and a Cox proportional hazards model fitted to estimate the prognostic value of individual risk factors. A multivariable prognostic model for stroke recurrence and mortality will be developed and validated.Ethics and dissemination UKYSS has regulatory and ethical approval. Data will be anonymised and housed securely. Data management and confidentiality will be compliant with national regulations. Results will be submitted to peer-reviewed conferences and journals and disseminated to participants, patient organisations and local media and government organisations.Trial registration number ISRCTN11029266.

Chronic gastritis is a common manifestation of Helicobacter pylori infection. Clinical presentations can range from epigastric discomfort to gastrointestinal bleeding. The clinical course and gross endoscopic findings can mimic alternative diagnoses such as gastric adenocarcinoma and gastrointestinal stromal tumors (GISTs). We report a case of H. pylori-associated chronic gastritis that initially presented with frank melena. Subsequent blood tests demonstrated a drop in hemoglobin and a rise in serum urea. The case was managed according to the hospital's upper gastrointestinal bleed protocols. The next day, endoscopy demonstrated a large polypoidal mass in the gastric antrum suspicious for GIST. However, subsequent biopsy and histological examination showed lymphoid aggregates and active inflammation with comma-shaped bacilli consistent with H. pylori infection. The case was subsequently managed with triple eradication therapy. This case underscores the value of prompt management of upper gastrointestinal bleeding and the need to validate diagnoses with definitive modalities to optimize long-term management.