Background Current guidelines recommend avoiding intravenous thrombolysis (IVT) in patients receiving direct oral anticoagulants (DOACs) because of concerns regarding intracranial hemorrhage (ICH). However, emerging evidence has reported inconsistent findings regarding the safety and efficacy of IVT in this population. We aimed to reassess the safety and clinical outcomes of IVT in patients with acute ischemic stroke (AIS) receiving DOAC therapy. Methods Four databases (PubMed, Scopus, Web of Science, and the Cochrane Library) were systematically searched to identify comparative studies evaluating intravenous thrombolysis in patients with acute ischemic stroke receiving DOACs. The primary outcomes included symptomatic intracranial hemorrhage (sICH), mortality, and favorable functional outcome defined as a modified Rankin Scale (mRS) score of 0–2. Secondary outcomes included any ICH and major extracranial bleeding. Random-effects meta-analyses were performed using RevMan Web. Results Eleven studies involving 262,325 patients were included, of whom 9,497 received DOAC therapy prior to IVT. The pooled analysis demonstrated no significant difference between DOAC-treated and non-anticoagulated patients regarding symptomatic intracranial hemorrhage (sICH) (RR = 1.01, 95% CI: 0.79–1.29), any intracranial hemorrhage (ICH) (RR = 1.47, 95% CI: 0.77–2.83), or mortality (RR = 0.63, 95% CI: 0.32–1.23). Patients receiving DOACs demonstrated a significantly higher likelihood of achieving favorable functional outcomes (mRS 0–2) at 3 months (RR = 2.43, 95% CI: 1.51–3.89). However, major extracranial bleeding was significantly more frequent in the DOAC group (RR = 1.62, 95% CI: 1.18–2.21). Conclusion This meta-analysis suggests that IVT in carefully selected patients with recent DOAC exposure may not be associated with a substantial increase in intracranial hemorrhage or mortality. Nevertheless, given the observational nature of the available evidence and the possibility of residual confounding, these findings should be interpreted cautiously. Further prospective studies are needed to better define the safety and efficacy of IVT in DOAC-treated patients.
Acute middle cerebral artery occlusion is a common and critical cerebrovascular disease in clinical practice, characterized by its sudden onset and severe clinical symptoms, posing a substantial threat to neurological function and survival. Therefore, clinicians need to quickly and accurately identify the occlusion type and develop appropriate treatment plans accordingly. In recent years, with the development of neuroimaging technology and a deeper understanding of the pathophysiological mechanisms of acute middle cerebral artery occlusion, various diagnostic methods have been applied to determine the occlusion type. The core treatment goal of acute ischemic stroke is to minimize irreversible neuronal injury and restore effective brain tissue perfusion as soon as possible. Systematic reviews and meta-analyses of multiple randomized controlled trials have consistently confirmed that mechanical thrombectomy (MT) has significant clinical efficacy in acute anterior circulation stroke patients with large vessel occlusion (LVO). Therefore, domestic and international evidence-based guidelines list it as a first-line endovascular intervention for LVO stroke in the early stage of onset (within 6 h; expandable to 24 h with imaging screening). This narrative review summarizes current evidence on diagnostic approaches for different types of acute middle cerebral artery occlusion and mechanical thrombectomy strategies tailored to the presumed occlusion mechanism, with the aim of informing mechanism-based diagnostic assessment and endovascular treatment decisions.
Objective To investigate the association between the neutrophil-to-lymphocyte ratio (NLR) divided by low-density lipoprotein cholesterol (LDL-C), termed the NLR/LDL-C ratio, and 90-day functional outcomes in patients with large vessel occlusion-related acute ischemic stroke undergoing endovascular thrombectomy. Methods This single-center retrospective cohort study included patients treated at Beijing Chaoyang Hospital of Capital Medical University, Beijing, China, between January 2022 and December 2024. Patients were classified as having favorable (modified Rankin Scale [mRS] 0-2) or unfavorable (mRS 3-6) functional outcome at 90 days. Baseline demographic, clinical, procedural, and laboratory variables were analyzed. Multivariable logistic regression used a prespecified covariate set and avoided simultaneous entry of the NLR/LDL-C ratio with its component variables to reduce collinearity. Discrimination was assessed using receiver operating characteristic curves. Results A total of 336 patients were analyzed, including 164 with favorable outcomes and 172 with unfavorable outcomes. Compared with the favorable group, the unfavorable group was older (69.3±11.9 vs. 62.8±11.6 years, P<0.001) and had higher admission National Institutes of Health Stroke Scale scores [14 (9, 20) vs. 8 (5, 12), P<0.001]. The unfavorable group also had higher neutrophil counts, higher NLR, lower lymphocyte counts, lower LDL-C, and a higher NLR/LDL-C ratio (all P≤0.012). In the adjusted model (n=315), the NLR/LDL-C ratio remained independently associated with unfavorable outcome (adjusted OR=1.968, 95% CI: 1.601-2.419, P<0.001). The area under the curve improved from 0.827 for Model A to 0.852 for Model B after adding the NLR/LDL-C ratio (DeLong P=0.014). Conclusion The NLR/LDL-C ratio was associated with 90-day unfavorable outcome after endovascular thrombectomy in this retrospective cohort. This composite marker may augment risk stratification, but external validation and analyses accounting for lipid-lowering therapy are required before routine clinical implementation.
Objective To explore the feasibility and safety of 3D-Slicer deep 3D reconstruction technology combined with neuroendoscopic minimally invasive technique in the surgery of distal intracranial aneurysms (DCAs). Method Retrospective analysis of clinical data of patients with distal intracranial aneurysms treated with 3D-Slicer reconstruction combined with neuroendoscopic minimally invasive surgery in our neurosurgery department from January 2021 to December 2024. Result 8 cases with complete data were collected. Among them, there were 5 cases of distal cerebral artery aneurysm in the anterior cerebral artery, 2 cases of distal cerebral artery aneurysm in the middle cerebral artery, and 1 case of distal cerebral artery aneurysm in the posterior cerebral artery. Preoperative use of 3D-Slicer to reconstruct structures such as aneurysms, parent arteries, hematomas, skulls, and scalp, creating virtual 3D models for preoperative evaluation and designing minimally invasive surgical channels. After surgery, except for one patient who did not undergo follow-up cranial CTA due to family reasons, the remaining seven patients were confirmed by cranial CTA to have complete occlusion of the aneurysm and unobstructed distal arterial blood vessels. Conclusion Using 3D Slicer reconstruction technology, the morphology and location of aneurysms, the course of parent arteries, and their 3D virtual reality images relative to structures such as the skull can be deeply restored. This technology facilitates preoperative evaluation and surgical path planning, and can even be applied for in vitro surgical simulation training via 3D printing, providing a new and optional surgical strategy for the surgical treatment of DCAs.
Objective Long non-coding RNAs (lncRNAs) and messenger RNAs (mRNAs) are implicated in the development and progression of Parkinson’s disease (PD). This study aims to examine the potential of any lncRNA as biomarkers underlying PD rehabilitation. Methods Pre-post rehabilitation study of lncRNA and mRNA expression profiles may identify the potential biomarkers associated with rehabilitation. We enrolled 6 patients with PD (PWP) and 6 age- and sex-matched healthy controls (HCs) in this study. Peripheral blood samples were collected before and after 14-day rehabilitation treatment to extract total RNA from exosomes. Differentially expressed mRNAs (DEmRNAs) and differentially expressed lncRNAs (DElncRNAs) were identified by next-generation sequencing (NGS). A co-expression network was built. Results Overall, pre-post rehabilitation study of exosomal mRNA revealed 1,662 DEmRNAs (606 upregulated and 1,056 downregulated) in PWPs. Compared with the HCs, 1,723 DElncRNAs (1,278 upregulated and 445 downregulated lncRNAs) and 1,931 DElncRNAs (1,561 upregulated and 370 downregulated) were identified in the blood exosomes of pre-rehab and post-rehab PWPs, respectively. GO and KEEG enrichment analyses revealed significant enrichment of proteasome-mediated ubiquitin-dependent protein catabolic process, and ubiquitin mediated proteolysis pathways, suggesting their potential role in the progression of PD. Co-expression network analysis identified one DElncRNA (ENST00000421331) and one positively related DEmRNA (ENSG00000132388, UBE2G1). RT-qPCR validated that ENST00000421331 and ENSG00000132388 were significantly downregulated in the pre-rehab PWPs compared with the HCs ( P < 0.05), but significantly upregulated in the post-rehab PWPs compared with the pre-rehab PWPs ( P < 0.01). Conclusion This is the first report about the role of UBE2G1 in rehabilitation of PD patients. The preliminary findings suggest that UBE2G1 is implicated in PD rehabilitation. Correlation analyses between changes in UBE2G1/lncRNA expression and clinical outcomes, mechanistic study, and longitudinal validation are required to further confirm the role of UBE2G1 as a biomarker in PD rehabilitation.
