The safety and efficacy of albumin combined with endovascular therapy for participants with acute ischemic stroke is unknown. This randomized, double blinded, multicenter study was conducted in China and completed in 2025. Eligible participants were randomly assigned in a 1:1 ratio to albumin group (0.5 g/kg; maximum dose 150 mL; intravenously infusion once daily for 4 days) or placebo group (equivalent volume of placebo). The primary endpoint was the change in infarct volume from baseline to day 5. A total of 134 patients were randomized (66 in albumin group and 68 in placebo group) and 134 patients were included in the final analysis. Albumin reduced infarct volume growth from baseline to day 5 compared with placebo (median growth 7.5 mL vs 16.5 mL, adjusted median difference -8.63, 95%CI (-13.85 to -5.07); P = 0.003). The safety outcomes did not differ between the two groups. This work suggests that albumin plus endovascular therapy could significantly reduce infarct volume growth compared with the placebo group, without raising safety concerns. (Funded by the National Natural Science Foundation of China and others; ClinicalTrials.gov registration: NCT06538844.).

BACKGROUND:The optimal threshold or range for systolic blood pressure (SBP) control in patients with successful reperfusion after endovascular thrombectomy for acute ischemic stroke (AIS) remains undefined. This study investigated whether SBP within the first 24 hours after successful reperfusion correlates with functional outcomes in AIS. METHODS:In this secondary analysis of the ENCHANTED2/MT trial, patients were categorized into two groups (120-140 mm Hg and 140-180 mm Hg, respectively) based on achieved SBP within 24 hours after randomization. The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included neurological deterioration at 7 days, major disability (mRS score of 3-5 at 90 days), hospitalization duration, and health-related quality of life assessed by the three-level EuroQoL 5-Dimension Self-Report Questionnaire (EQ-5D-3L) at 90 days. Safety outcomes included early neurological decline (END), 90-day mortality, symptomatic intracranial hemorrhage (sICH), and any intracranial hemorrhage (ICH). Treatment effects were expressed as ORs with 95% confidence intervals (CIs). RESULTS:A total of 611 patients (363 in the 120-140 mm Hg group and 248 in the 140-180 mm Hg group) were included. The mean (SD) age was 67 (12) years and 37.8% were female. After adjusting for confounders, the 120-140 mm Hg group was significantly associated with better functional outcomes (mRS: 2 (IQR 1-4) vs 2 (IQR 1-5); adjusted OR 1.54 (95% CI 1.10 to 2.17), P=0.013). Compared with the 140-180 mm Hg group, the 120-140 mm Hg group had lower rates of neurological deterioration at 7 days (adjusted OR 0.68 (95% CI 0.47 to 0.98), P=0.037) and 90-day mortality (47 (13.0%) vs 53 (21.4%); adjusted OR 0.48 (95% CI 0.27 to 0.86), P=0.013). There were no significant differences between groups in END, major disability at 90 days, hospitalization duration, EQ-5D-3L score, sICH, or ICH (all P>0.05). CONCLUSIONS:In patients with successful reperfusion after endovascular thrombectomy, an average SBP within 24 hours of 120-140 mm Hg was associated with a greater likelihood of functional independence compared with 140-180 mm Hg.

BACKGROUND AND AIMS:Even after endovascular thrombectomy, more than half of patients with acute large vessel occlusion stroke do not achieve favourable outcomes. This study aimed to assess the efficacy and safety of remote ischaemic conditioning (RIC), a promising neuroprotective treatment, in patients with acute ischaemic stroke who received endovascular thrombectomy. METHODS:This participant-blinded, randomized controlled clinical trial was conducted at 25 hospitals. Patients were randomized 1:1 to either the RIC (cuff pressure, 200 mmHg; twice daily for 7 days) or sham RIC (60 mmHg; same procedure) groups. The primary outcome was the proportion of patients with a modified Rankin Scale score of 0-2 on Day 90. The primary safety outcome was the proportion of patients with haemorrhagic transformation within 7 days. RESULTS:In total, 498 participants were recruited. Ten patients (2.0%) were excluded because they did not receive any intervention. Thus, 488 participants (244 in the RIC group and 244 in the sham RIC group) were included in the modified intention-to-treat analysis. At 90 days, 61.1% of the patients in the RIC group and 48.9% in the sham RIC group achieved a modified Rankin Scale score of 0-2 (unadjusted risk ratio 1.25, 95% confidence interval 1.06-1.47; P = .009). The proportion of patients with haemorrhagic transformation was 37.7% and 35.2% in the RIC and sham RIC groups, respectively. CONCLUSIONS:Among patients with acute ischaemic stroke who underwent endovascular thrombectomy, intervention with RIC for 7 days, compared with sham RIC, resulted in an improved functional outcome at 90 days.

This randomized clinical trial investigates if intra-arterial alteplase improves clinical outcomes in patients with acute ischemic stroke (AIS) of the posterior circulation within 24 hours of symptom onset and after successful mechanical recanalization. QuestionAmong patients with acute basilar artery occlusion treated within 24 hours of symptom onset and achieving successful mechanical recanalization, does intra-arterial alteplase improve clinical outcomes?FindingsIn this randomized clinical trial including 246 patients, functional independence at 90 days was achieved in approximately half of patients in both the intra-arterial alteplase and control groups. Rates of symptomatic intracranial hemorrhage were similar across groups.MeaningStudy results show that adjunctive intra-arterial alteplase after successful endovascular recanalization for acute stroke due to basilar artery occlusion seems safe but did not improve functional outcomes at 90 days. ImportanceThe impact of adjunctive intra-arterial alteplase after successful endovascular thrombectomy (EVT) in patients with acute ischemic stroke due to large-vessel occlusion (AIS-LVO) in the posterior circulation requires further investigation.ObjectiveTo assess the efficacy and safety of intra-arterial alteplase after successful EVT for AIS-LVO in the posterior circulation.Design, Setting, and ParticipantsThis was a multicenter, prospective, randomized, open-label, blinded-end point (PROBE design) clinical trial. The study was conducted between September 5, 2023, and November 29, 2024, with the 3-month follow-up completed on February 18, 2025. The trial was conducted in 37 comprehensive stroke centers in China. Patients in China with acute basilar artery occlusion presenting within 24 hours of the time last known well were randomly assigned to the treatment group or control group. Eligible participants were adults who achieved successful recanalization after EVT.InterventionsEligible patients were randomly assigned to the intra-arterial alteplase group (0.225 mg/kg, maximum dose limit 22.5 mg infused at a concentration of 1.0 mg/mL within 15 minutes distal to the origin of posterior inferior cerebellar artery) or control group (no intra-arterial thrombolysis).Main Outcomes and MeasuresThe primary efficacy outcome was the proportion of patients achieving functional independence (modified Rankin Scale score of 0-2) at 90 days. The primary safety outcomes were mortality at 90 days and incidence of symptomatic intracranial hemorrhage within 48 hours.ResultsA total of 247 patients were enrolled, and 1 patient was excluded from the full analysis set due to basilar artery reocclusion before intra-arterial alteplase. The remaining 246 patients (median [IQR] age, 65.0 [56.0-72.0] years; 176 male [71.5%]) were included in this analysis, 124 (50.4%) in the treatment group and 122 (49.6%) in the control group. Among the patients recruited and followed up, functional independence at 90 days was achieved in 52 (41.9%) in the intra-arterial alteplase group and 57 (46.7%) in the control group (adjusted risk ratio, 0.93; 95% CI, 0.73-1.18; P = .55). Mortality at 90 days (29.6% vs 27.0%, respectively; adjusted hazard ratio, 1.07; 95% CI, 0.71-1.61; P = .75) and incidence of symptomatic intracranial hemorrhage (2.4% vs 2.5%, respectively; unadjusted risk ratio, 0.98; 95% CI, 0.20-4.74; P = .97) were similar across groups.Conclusions and RelevanceResults of this randomized clinical trial reveal that in patients with posterior circulation stroke due to acute basilar artery occlusion, intra-arterial alteplase after successful endovascular recanalization appeared to be safe but was not associated with improvement of functional outcomes at 90 days.Trial RegistrationClinicalTrials.gov Identifier: NCT05897554

BACKGROUND:Tocilizumab, an interleukin-6 receptor inhibitor, is a promising cytoprotective agent selected by the Stroke Preclinical Assessment Network. It showed a protective effect on infarct volume and functional outcomes in animal stroke models. METHODS:In this investigator-initiated, multicentre, randomised, double-blind, placebo-controlled trial, patients with acute ischaemic stroke undergoing EVT were recruited. Eligible patients were randomly assigned (1:1) to receive tocilizumab or placebo treatment. Both patients and investigators were blinded to the treatment assignments. A single dose of tocilizumab (240 mg) or placebo was administered intravenously as soon as possible within 24 h after stroke onset and within 1 h after randomisation. The primary efficacy outcome was the change in infarct volume from baseline (before EVT and start of study drug) to 72 h. Primary and safety analyses were done in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT06238024. FINDINGS:A total of 108 patients were enrolled (n placebo = 57; n tocilizumab = 51). The median change in infarct core volume between baseline and 72 h was 27.0 mL (7.6-62.4) in the placebo group and 8.8 mL (IQR 3.4-20.6) in the tocilizumab group (adjusted mean difference in cubic root volume [ml1/3] -0.41, 95% CI -0.79 to -0.03, P = 0.04, wald-type test). Symptomatic intracranial haemorrhage occurred in 7 (12%) patients in the placebo group and 3 (6%) patients in the tocilizumab group. The incidence of all-cause death and serious adverse events were similar between the two groups. INTERPRETATION:Among patients with acute ischaemic stroke undergoing endovascular treatment, tocilizumab tended to reduce infarct volume growth at 72 h post-treatment and is well tolerated. Future trials are necessary to confirm the beneficial effect of tocilizumab on long-term functional outcome following stroke. FUNDING:Noncommunicable Chronic Diseases-National Science and Technology Major Project, Beijing Nova Program, National Natural Science Foundation of China, Beijing Natural Science Foundation.

Importance:The impact of adjunctive intra-arterial alteplase after successful endovascular thrombectomy (EVT) in patients with acute ischemic stroke due to large-vessel occlusion (AIS-LVO) in the posterior circulation requires further investigation. Objective:To assess the efficacy and safety of intra-arterial alteplase after successful EVT for AIS-LVO in the posterior circulation. Design, Setting, and Participants:This was a multicenter, prospective, randomized, open-label, blinded-end point (PROBE design) clinical trial. The study was conducted between September 5, 2023, and November 29, 2024, with the 3-month follow-up completed on February 18, 2025. The trial was conducted in 37 comprehensive stroke centers in China. Patients in China with acute basilar artery occlusion presenting within 24 hours of the time last known well were randomly assigned to the treatment group or control group. Eligible participants were adults who achieved successful recanalization after EVT. Interventions:Eligible patients were randomly assigned to the intra-arterial alteplase group (0.225 mg/kg, maximum dose limit 22.5 mg infused at a concentration of 1.0 mg/mL within 15 minutes distal to the origin of posterior inferior cerebellar artery) or control group (no intra-arterial thrombolysis). Main Outcomes and Measures:The primary efficacy outcome was the proportion of patients achieving functional independence (modified Rankin Scale score of 0-2) at 90 days. The primary safety outcomes were mortality at 90 days and incidence of symptomatic intracranial hemorrhage within 48 hours. Results:A total of 247 patients were enrolled, and 1 patient was excluded from the full analysis set due to basilar artery reocclusion before intra-arterial alteplase. The remaining 246 patients (median [IQR] age, 65.0 [56.0-72.0] years; 176 male [71.5%]) were included in this analysis, 124 (50.4%) in the treatment group and 122 (49.6%) in the control group. Among the patients recruited and followed up, functional independence at 90 days was achieved in 52 (41.9%) in the intra-arterial alteplase group and 57 (46.7%) in the control group (adjusted risk ratio, 0.93; 95% CI, 0.73-1.18; P = .55). Mortality at 90 days (29.6% vs 27.0%, respectively; adjusted hazard ratio, 1.07; 95% CI, 0.71-1.61; P = .75) and incidence of symptomatic intracranial hemorrhage (2.4% vs 2.5%, respectively; unadjusted risk ratio, 0.98; 95% CI, 0.20-4.74; P = .97) were similar across groups. Conclusions and Relevance:Results of this randomized clinical trial reveal that in patients with posterior circulation stroke due to acute basilar artery occlusion, intra-arterial alteplase after successful endovascular recanalization appeared to be safe but was not associated with improvement of functional outcomes at 90 days. Trial Registration:ClinicalTrials.gov Identifier: NCT05897554.

RATIONALE:The Chemical Optimization of Cerebral Embolectomy (CHOICE) trial suggested that the administration of intra-arterial alteplase after successful endovascular thrombectomy (EVT) may improve neurological outcomes in patients with acute ischemic stroke due to large-vessel occlusion (AIS-LVO) in the anterior circulation. However, the use of adjunctive intra-arterial alteplase following successful EVT in acute posterior circulation stroke remains unexplored. AIMS:This study aims to investigate the efficacy and safety of intra-arterial alteplase after successful EVT for AIS-LVO in the posterior circulation. SAMPLE SIZE:To detect an estimated 15% difference in the primary outcome between the two groups, a total of 376 patients will be enrolled. This sample size allows for 80% power and a 5% significance level, with an interim analysis planned after half of the sample (188 patients) has completed a 90-day follow-up. METHODS AND DESIGN:The Intra-arterial Alteplase Thrombolysis After Successful Thrombectomy for Acute Ischemic Stroke in the Posterior Circulation (IAT-TOP) trial is a multicenter, prospective, randomized clinical trial using an open-label treatment design with blinded endpoint assessment (PROBE) conducted in China. Patients with acute basilar artery occlusion will be randomly assigned in a 1:1 ratio to receive either intra-arterial alteplase (0.225 mg/kg; maximum dose, 22.5 mg) or standard care following successful thrombectomy (defined as expanded thrombolysis in cerebral infarction [eTICI] ⩾ 2b50). STUDY OUTCOMES:The primary outcome is the modified Rankin Scale (mRS) score of 0-2 at 90 days. Key secondary outcomes include changes in eTICI scores after intra-arterial thrombolysis (in the experimental group), mRS 0-3 at 90 days, ordinal shift analysis of mRS at 90 days, early neurological improvement at 48 h, and improvement in National Institutes of Health Stroke Scale (NIHSS) scores at 48 h and 7 days or discharge. Safety outcomes include symptomatic intracranial hemorrhage (sICH) rates at 48 h, 90-day mortality, non-intracranial hemorrhagic complications, and non-hemorrhagic serious adverse events. DISCUSSION:The IAT-TOP trial will provide crucial evidence regarding the potential benefits of adjunctive intra-arterial alteplase in patients with AIS-LVO in the posterior circulation following successful thrombectomy. TRIAL REGISTRATION:ClinicalTrials.gov NCT05897554.

Background:Albumin is a multifunctional plasma protein that is mainly synthesized in the liver and may play a neuroprotective role in treating acute ischemic stroke (AIS). The efficacy of albumin in patients with AIS receiving reperfusion therapy remains unknown. Methods:ARISE is a multicenter, randomized, double-blind, placebo-controlled, phase 2 study. We will recruit 134 patients aged 18-80 years with AIS due to large-vessel occlusion in the anterior circulation, within 24 h of symptom onset, with an Alberta Stroke Program Early CT Score of 3-10 points and an infarct core volume of ≤100 mL at baseline. Eligible patients will be randomly assigned, on a 1:1 ratio, to undergo endovascular therapy (EVT) and receive albumin therapy (0.5 g/kg; intravenous injection) once daily for 4 days or to undergo EVT and receive placebo therapy once daily for 4 days. The primary efficacy outcome is the change in infarct volume from baseline to day 5. Conclusion:The ARISE trial will provide valuable evidence on the efficacy and safety of albumin in patients with AIS receiving EVT. Clinical trial registration:www.clinicaltrials.gov, NCT06538844.

Rationale Neuroprotective strategies based on reperfusion therapy hold substantial promise for acute ischaemic stroke (AIS). Preclinical research indicates that tocilizumab, an interleukin-6 receptor antagonist, can attenuate ischaemia-reperfusion damage by exerting anti-inflammatory and neuroprotective effects.Aim To determine tocilizumab's efficacy and safety when combined with endovascular thrombectomy (EVT) in patients with acute anterior circulation large vessel occlusion (LVO).Sample size estimates To determine a 30% decrease in average infarct core volume comparing the intervention and historical control groups (mean increase of 18.7 mL (SD=9.7 mL) post-thrombectomy) via a two-sided test (alpha=0.05, power=80%), accounting for a 10% drop-out rate, we plan to recruit 108 participants.Methods and design This trial is designed as a randomised, multicentre, double-blind, placebo-controlled trial. Patients will be randomly and evenly allocated to the tocilizumab or placebo groups.Study outcomes The primary endpoint is the change in infarct core volume between baseline and 72 hours post-treatment. Secondary outcomes include the 90-day modified Rankin scale score (0-2, indicating functional independence). The key safety endpoints include 90-day mortality and symptomatic intracerebral haemorrhage within 72 hours after EVT.Discussion Administering tocilizumab within 24 hours of stroke as an adjunct to EVT may effectively reduce the infarct core volume for patients experiencing AIS with anterior circulation LVO, potentially improving functional outcomes in these patients.

Objective: This study aims to investigate the impact of first pass effect (FPE) on outcomes in the posterior circulation acute ischemic stroke (PC-AIS) and the independent predictors of FPE. Methods: This was a multicenter, retrospective study. PC-AIS patients who underwent endovascular treatment were reviewed. The cohort achieving complete or nearly complete reperfusion (defined as expanded treatment in cerebralischemia [eTICI] >= 2c) was categorized into the FPE and multiple pass effect (MPE) groups. FPE was defined as achieving eTICI >= 2c with a single pass and without the use of rescue therapy. Modified FPE (mFPE) was defined as meeting the criteria for FPE but with eTICI >= 2b. The association of FPE with 90-day clinical outcomes and predictors for FPE were both investigated. Results: The study included a total of 328 patients, with 69 patients (21 %) in the FPE group. For primary outcome, FPE had a significant higher favorable outcome (mRS <= 3) rate than MPE (65.2 % vs. 44.8 %, p = 0.003). Similar outcomes were observed in the mFPE. Furthermore, FPE was significantly associated with favorable outcome (adjusted OR 2.23, 95 % CI 1.06-4.73, p = 0.036). Positive predictors for FPE included occlusion in the distal basilar artery, the first-line aspiration or combination, and cardioembolic etiology. Negative predictors for FPE included hypertension and general anesthesia. Conclusion: For PC-AIS patients due to large or medium vessel occlusion, FPE is associated with favorable clinical outcomes. The first-line techniques of aspiration or combination, as well as avoiding general anesthesia, contribute to a better realization of FPE.

目的 探讨低灌注强度比值(HIR)对急性前循环大血管闭塞性卒中(LVOS)患者血管内取栓治疗(EVT)预后的预测价值.方法 回顾性选取2021年1月至2022年6月南阳市中心医院收治的接受EVT且影像学检查显示血管再通的急性前循环LVOS患者106例为研究对象.收集患者的临床资料,对其进行非增强CT、CT血管造影术、CT灌注成像检查,计算核心梗死区体积(VIC)、低灌注区体积(VTmax>6 s)、严重低灌注区体积(VTmax>10 s)、缺血半暗带区体积(VMismatch)、HIR.术后随访90 d时采用改良Rankin量表(mRS)评价患者预后情况.采用多因素Logistic回归分析探讨急性前循环LVOS患者EVT预后的影响因素;采用ROC曲线分析年龄、入院时美国国立卫生研究院卒中量表(NIHSS)评分、发病至穿刺时间、HIR及其联合对急性前循环LVOS患者EVT预后不良的预测价值.结果 随访结果显示,患者预后良好63例(预后良好组),预后不良43例(预后不良组).两组年龄、有冠心病病史者占比、入院时NIHSS评分、CT平扫Alberta卒中项目早期CT评分(ASPECTS)、VIC、VTmax>10 s、HIR比较,差异有统计学意义(P<0.05).多因素Logistic回归分析结果显示,年龄〔OR=1.056,95％CI(1.006,1.108)〕、入院时NIHSS评分〔OR=1.101,95％CI(1.013,1.197)〕、发病至穿刺时间〔OR=1.003,95％CI(1.001,1.006)〕、HIR〔OR=492.435,95％CI(29.371,8256.315)〕是急性前循环LVOS患者EVT预后的独立影响因素(P<0.05).ROC曲线分析结果显示,年龄、入院时NIHSS评分、HIR及三者联合预测急性前循环LVOS患者EVT预后不良的AUC分别为0.612〔95％CI(0.504,0.721)〕、0.703〔95％CI(0.601,0.805)〕、0.754〔95％CI(0.655,0.853)〕、0.803〔95％CI(0.719,0.886)〕.三者联合与HIR预测急性前循环LVOS患者EVT预后不良的AUC比较,差异无统计学意义(P>0.05).结论 年龄增长、入院时NIHSS评分升高、发病至穿刺时间延长、HIR升高是急性前循环LVOS患者EVT预后不良的危险因素,且HIR对急性前循环LVOS患者EVT预后不良具有中等预测价值.

目的 探究急性后循环供血区缺血性脑梗死患者血管再通术后24 h内Alberta卒中操作早期CT评分(Alberta stroke program early CT score,ASPECTS)联合血清血红素氧合酶-1(Heme oxygenase-1,HO-1)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)水平对患者短期不良预后的预测价值.方法 选取医院2019年1月-2020年1月收治的62例急性后循环供血区缺血性脑梗死患者,均行血管再通术;术后随访3个月,根据改良Rankin量表评分(Modified Rankin scale,mRS)进行神经功能评定,分为预后良好组、预后不良组,采用单因素分析比较2组术后24h内ASPECTS评分、血清HO-1,VEGF水平等可能影响患者短期不良预后的因素;采用Logistic回归分析急性后循环供血区缺血性脑梗死患者血管再通术后影响患者短期不良预后的危险因素,并绘制受试者工作特征(Receiver operating characteristic,ROC)曲线评估术后ASPECTS评分联合血清HO-1,VEGF水平对患者短期不良预后的预测价值.结果 根据随访3个月后mRS评分判定,62例患者中40例归为预后良好组,22例归为预后不良组.单因素分析中2组患者性别、年龄、体质量指数、是否吸烟、酗酒,高脂血症、糖尿病、冠心病、既往脑卒中、高血压病等既往病史、治疗前血压、术后24 h内血压、发病至入院时间、术后24 h内实验室检查指标(白细胞计数、血小板、血糖、血尿素、血肌酐、胱抑素C)水平均无明显差异(P＞0.05);预后良好组既往病史中心房颤动占比(12.50％)低于预后不良组(45.45％)(P＜0.05),术后24 h内NIHSS评分低于预后不良组(P＜0.05),术后24 h内ASPECTS评分高于预后不良组(P＜0.05).术后24 h内实验室检查指标中预后良好组血清HO-1水平高于预后不良组,VEGF水平低于预后不良组(P＜0.05).经Logistic回归分析显示,心房颤动史、术后24 h内NIHSS评分、术后24 h内ASPECTS评分、血清HO-1,VEGF水平是影响急性后循环供血区缺血性脑梗死患者血管再通术后短期不良预后的危险因素.ROC曲线分析显示,术后24 h内ASPECTS评分联合血清HO-1,VEGF水平预测急性后循环供血区缺血性脑梗死患者血管再通术后短期不良预后的敏感度、准确度、AUC分别为93.67％、84.36％、0.873,均高于血清HO-1水平、VEGF水平、ASPECTS评分单独预测.结论 术后24 h内ASPECTS评分、血清HO-1,VEGF水平与急性后循环供血区缺血性脑梗死患者血管再通术后短期不良预后密切相关,三者联合预测的准确性更好.

目的 探讨急性前循环串联闭塞卒中患者行机械取栓治疗中颅外颈动脉病变的治疗方案,评估其有效性和安全性.方法 回顾性分析2018年1月—2019年12月南阳市中心医院收治的18例行血管内治疗的颈内动脉颅外段伴同侧颅内动脉急性串联闭塞患者的临床资料.其中男性9例,女性9例,年龄为60～70岁.根据治疗方式的不同,将18例患者分为急诊支架组(11例)和急诊非支架组(7例).术中即刻血管再通情况根据脑梗死溶栓(TICI)分级判断,将卒中发生90d改良Rankin量表(mRS)评分0～2分定义为临床预后良好.结果 2组患者年龄、性别、术前美国国立卫生研究院卒中量表(NIHSS)评分、术前Alberta卒中项目早期CT(ASPECT)评分、病因分型、治疗方式、病变类型、血管闭塞部位等临床基线资料比较,差异均无统计学意义(均P＞0.05);急诊支架组和急诊非支架组的术后血管成功再通率(TICI分级为2b～3级)分别为72.7％和71.4％,组间差异无统计学意义(P＞0.05);2组术后症状性颅内出血率分别为9.1％和0,组间差异无统计学意义(P＞0.05);2组患者术后90 d改良mRS评分及90 d病死率比较差异无统计学意义(均P＞0.05);2组患者术后残余狭窄率差异有统计学意义(P＜0.05).结论 在急性前循环串联闭塞的血管内治疗中,急诊颈动脉颅外段支架置入术可能是有效和安全的.

目的 探讨基于Neuman理论的心理危机干预对新型冠状病毒肺炎患者心理压力、情绪及睡眠质量的影响.方法 将79例新型冠状病毒肺炎患者按照住院时间分为研究组41例,对照组38例,两组均给予常规心理疏导和睡眠护理,研究组在此基础上给予基于Neuman理论的心理危机干预,观察住院全程.干预前后比较两组汉密顿焦虑量表、汉密顿抑郁量表、心理弹性量表、知觉压力量表、艾森克情绪稳定性量表、匹兹堡睡眠质量指数量表评分.结果 干预后两组汉密顿焦虑量表、汉密顿抑郁量表、知觉压力量表评分均较干预前显著降低(P<0.01),心理弹性量表评分较干预前显著升高(P<0.01),研究组较对照组变化更显著(P<0.01).干预后研究组艾森克情绪稳定性量表自卑感、抑郁性维度评分均较干预前显著升高(P<0.01),且显著高于对照组(P<0.01),焦虑、负罪感维度评分均较干预前显著降低(P<0.01),且显著低于对照组(P<0.01).干预后两组匹兹堡睡眠质量指数量表总分及各维度评分均显著低于干预前(P<0.01),研究组显著低于对照组(P<0.01).结论 基于Neuman理论的心理危机干预可有效缓解患者的焦虑、抑郁情绪,提升心理弹性,改善睡眠质量,具有较高的应用价值.

Objective:To investigate the efficacy of different preferred thrombectomy strategies for embolic acute vertebrobasilar artery occlusion (AVBAO).Methods:Forty-four patients with embolic AVBAO who underwent endovascular treatment in Department of Neurology, Nanyang Central Hospital from January 2019 to June 2021 were included in the study. Patients were divided into stent-retriever thrombectomy group ( n=27) and aspiration thrombectomy group ( n=17) according to different preferred thrombectomy strategies. Modified Rankin scale (mRS) was used to evaluate the prognoses of these patients 90 d after surgery; the differences of clinical data, surgery-related characteristics, prognoses and complications between the two groups were compared. Results:There was no significant difference between the 2 groups in terms of time from onset to puncture, sites of target vessel occlusion, proportion of patients accepted intraoperative remedial measures, and successful recirculation rate of target vessels ( P>0.05). Compared with the aspiration thrombectomy group, the stent-retriever thrombectomy group had significantly decreased utilization rate of middle catheters, significantly increased retrieval attempts in thrombectomy, statistically lower re-recanalization rate of first-time thrombectomy on the target vessels, significantly longer time from puncture to re-recanalization, and significantly higher incidence of new embolism ( P<0.05). There was no significant difference between the 2 groups in incidences of vascular rupture and postoperative spontaneous intracerebral hemorrhage (sICH), and good prognosis rate 90 d after surgery ( P>0.05). Conclusion:For embolic AVBAO patients, similar recanalization and short-term good prognosis can be obtained by aspiration thrombectomy to those by stent-retriever thrombectomy; besides that, aspiration thrombectomy has advantages as shorter recanalization time, less new embolic complications and higher re-recanalization rate of first-time thrombectomy.

目的 探讨后循环脑梗死患者血管内介入治疗效果及胶质纤维酸性蛋白(GFAP)、中性粒细胞计数和信号素7A(Sema7A)水平变化.方法 选择2019年1月至2021年1月在南阳市中心医院诊治的80例后循环脑梗死患者,均接受血管内介入治疗.在治疗前1 h及治疗结束后第3天参考美国国立卫生研究院卒中量表(NIHSS)积分变化情况进行评价疗效.治疗前1 h及治疗结束后第3天检测GFAP、中性粒细胞计数和Sema7A水平.根据临床疗效结果将临床总有效患者纳入预后良好组,将无效患者纳入预后不良组.结果 80例患者中基本痊愈41例、显著进步20例、进步9例,无效10例.总有效70例,总有效率为87.50％,无效率为12.5％.在治疗前、治疗后,预后良好组患者血清GFAP、中性粒细胞计数均低于预后不良组(P<0.05),Sema7A水平高于预后不良组患者(P<0.05).组内比较发现,预后良好组患者血清GFAP、中性粒细胞计数和Sema7A水平治疗前后差异有统计学意义(P<0.05);预后不良组患者清GFAP、中性粒细胞计数和Sema7A水平治疗前后差异无统计学意义(P>0.05).预后良好组患者治疗前后NIHSS积分均低于预后不良组患者(P<0.05).血清GFAP、中性粒细胞计数与NIHSS积分呈正相关(P<0.05),与临床疗效呈负相关(P<0.05);Sema7A水平与NIHSS积分呈负相关(P<0.05),与临床疗效呈正相关(P<0.05).结论 血清GFAP、中性粒细胞计数和Sema7A水平影响后循环脑梗死患者血管内介入治疗效果,血清GFAP、中性粒细胞计数水平升高不利于预后,而Sema7A水平升高有利于临床疗效及预后.

目的 分析血清相关因子水平与急性缺血性脑卒中(AIS)患者阿替普酶(rt-PA)静脉溶栓后预后的相关性.方法 选取淅川县人民医院2019年10月至2021年12月收治的238例AIS患者作为疾病组,并选取同期健康体检者159例作为健康对照组,于rt-PA静脉溶栓治疗7 d后根据美国国立卫生研究院卒中量表(NIHSS)评分将疾病组分为预后良好组(142例)、预后不良组(96例).采集所有入选者血液,测定血清尿酸(UA)、成纤维细胞生长因子4(FGF4)、脑钠肽(BNP)、过氧化还原蛋白1(PRDX1)水平,分别比较疾病组与健康对照组、预后良好组与预后不良组上述血清因子水平,分析其与预后的关联性.结果 疾病组血清UA、BNP、FGF4、PRDX1水平均较健康对照组高(P＜0.05),预后不良组血清UA、BNP、FGF4、PRDX1水平较预后良好组高(P＜0.05).相关性分析显示,AIS患者血清UA、BNP、FGF4、PRDX1水平与rt-PA静脉溶栓后预后不良呈正相关(P＜0.05).结论 血清UA、BNP、FGF4、PRDX1水平在AIS患者中呈异常表达,且与临床预后紧密相关.

Objective:To explore whether circular RNA HECTD1 (circ-HECTD1) is involved in oxygen-glucose deprivation (OGD)-induced neuronal cell damage by regulating the expressions of miR-98-5p/ephrin A4 (EPHA4).Methods:Mouse primary cortical neuronal cells were isolated and cultured in vitro. The targeting relations of circ-HECTD1 and miR-98-5p with EPHA4 were detected by dual luciferase reporter assay and RNA binding protein immunoprecipitation assay. These neurons were randomly divided into control group (cultured for 24 h under normal condition) and 6, 12 and 24 h OGD treatment groups (treated with OGD for 6, 12 and 24 h, respectively), OGD+Vector group and OGD+circ-HECTD1 group, OGD+small interfering RNA (siRNA) negative control (si-NC) group and OGD+siRNA circ-HECTD1 (si-circ-HECTD1) group, OGD+micro RNA (miR) negative control (miRNC) group and OGD+miR-98-5p mimic group, OGD+miRNA inhibitor negative control (anti-miRNC) group and OGD+miR-98-5p inhibitor (anti-miR-98-5p) group, OGD+miR-98-5p mimic+pcDNA group and OGD+miR-98-5p mimic+EPHA4 group, OGD+si-circ-HECTD1+anti-miR-NC group and OGD+si-circ-HECTD1+miR-98-5p inhibitor group; pCD5-ciR empty vector, pCD5-ciR-circ-HECTD1, si-NC, si-circ-HECTD1, miR-NC, miR-98-5p mimic, anti-miR-NC or anti-miR-98-5p were transfected into the neurons, and miR-98-5p mimi and pcDNA3.1 empty vector, miR-98-5p mimic and pcDNA3.1-EPHA4 overexpression vector, si-circ-HECTD1 and anti-miR-NC, or si-circ-HECTD1 and anti-miR-98-5p were co-transfected into the neurons. After 24 h of OGD treatment, the circ-HECTD1, miR-98-5p and EPHA4 mRNA expressions were detected by real-time fluorescent quantitative PCR (qRT-PCR), the EPHA4 protein expression was detected by Western blotting, the proliferation activity was detected by MTT assay, the apoptosis rate was detected by flow cytometry, the levels of interleukin (IL)-1β and tumor necrosis factor (TNF)-α in cell culture medium were detected by ELISA, and the activities of superoxide dismutase (SOD) and malondialdehyde (MDA) were detected by kit assay. Results:(1) Targeting relations between circ-HECTD1 and miR-98-5p, and EPHA4 and miR-98-5p were verified. (2) As compared with the control group, the neurons in 6, 12 and 24 h OGD treatment groups had significantly increased circ-HECTD1 and EPHA4 protein expressions and significantly decreased miR-98-5p expression ( P<0.05). (3) As compared with OGD+Vector group, OGD+circ-HECTD1 group had significantly increased circ-HECTD1 expression, and significantly decreased miR-98-5p expression ( P<0.05); as compared with OGD+si-NC group, OGD+si-circ-HECTD1 group had significantly increased miR-98-5p expression, and significantly decreased EPHA4 mRNA and protein expressions ( P<0.05); as compared with OGD+miR-NC group, OGD+miR-98-5p mimic group had significantly increased miR-98-5p expression, and significantly decreased EPHA4 protein expression ( P<0.05); as compared with OGD+anti-miR-NC group, OGD+anti-miR-98-5p group had significantly decreased miR-98-5p expression, and significantly increased EPHA4 protein expression ( P<0.05); as compared with the OGD+si-circ-HECTD1+anti-miR-NC group, OGD+si-circ-HECTD1+anti-miR-98-5p group had significantly increased EPHA4 mRNA and protein expressions ( P<0.05). (4) As compared with the control group, the OGD groups had significantly decreased cell viability and SOD activity, and significantly increased IL-1β and TNF-α levels, apoptosis rate and MDA activity ( P<0.05); as compared with the OGD+si-NC group, the OGD+si-circ-HECTD1 group had significantly decreased cell apoptosis rate, IL-1β and TNF-α levels, and MDA activity, and significantly increased cell viability and SOD activity ( P<0.05); as compared with the OGD+si-circ-HECTD1+anti-miR-NC group, the OGD+si-circ-HECTD1+anti-miR-98-5p group had significantly decreased cell viability and SOD activity, and significantly increased IL-1β and TNF-α levels, apoptosis rate and MDA activity ( P<0.05); as compared with the OGD+miR-NC group, OGD+miR-98-5p mimic group had significantly decreased cell apoptosis rate, IL-1β and TNF-α levels, and MDA activity, and significantly increased cell viability and SOD activity ( P<0.05); as compared with OGD+miR-98-5p mimic+pcDNA group, OGD+miR-98-5p mimic+EPHA4 group has significantly increased cell apoptosis rate, IL-1β and TNF-α levels, and MDA activity, and significantly increased cell viability and SOD activity ( P<0.05). Conclusion:Knockdown of circ-HECTD1 could ameliorate the OGD-induced neuronal cell damage in mice by targeting the expressions of miR-98-5p/EPHA4.

目的 观察曲克芦丁脑蛋白水解物联合阿替普酶治疗急性脑梗死的临床效果.方法 选择2019月12—2021年12月南阳市中心医院接收的106例急性脑梗死患者,随机分为对照组和治疗组,每组各53例.对照组予以注射用阿替普酶0.9 mg/kg,在超声引导下给药,先静推10％,60 s内结束,剩余静脉滴注,60 min内结束,依照超声监测结果可适当调整剂量,治疗1次,溶栓后继续予以常规治疗至2周.治疗组在对照组基础上静脉滴注曲克芦丁脑蛋白水解物注射液,10 mL融于250 mL生理盐水混匀,1次/d,持续应用2周.观察两组患者临床疗效,比较治疗前后两组患者美国国立卫生研究院脑卒中量表(NIHSS)和改良Rankin量表(MRS)评分,脑血流动力学指标平均血流速度(Vm)、舒张末期血流速度(Vd)和收缩期峰值血流速度(Vp)水平,以及膜联蛋白A2(Annexin A2)、同型半胱氨酸(Hcy)和血管内皮生长因子(VEGF)水平.结果 治疗后,治疗组临床总有效率(90.57％)较对照组(75.47％)明显升高(P<0.05);治疗后,两组NIHSS评分、MRS评分均较治疗前显著降低(P<0.05),且治疗组较对照组降低更明显(P<0.05).治疗后,两组大脑中动脉(MCA)的Vm、Vd、Vp均较治疗前显著升高(P<0.05),且治疗组较对照组升高更显著(P<0.05).治疗后,两组患者Annexin A2、VEGF水平均较治疗前明显升高,而Hcy水平均较治疗前明显降低(P<0.05),且治疗组患者Hcy、Annexin A2、VEGF水平明显好于对照组(P<0.05).结论 曲克芦丁脑蛋白水解物联合阿替普酶治疗急性脑梗死可调节Annexin A2、Hcy、VEGF水平,改善脑血流动力学,发挥良好神经保护作用,改善疗效及预后.

目的 探讨颈内动脉颅外段伴同侧颅内动脉急性串联闭塞患者血管内治疗方法,评估其疗效和安全性.方法 回顾性分析2015年1月至2019年12月在南阳市中心医院接受血管内治疗的63例颈内动脉颅外段伴同侧颅内动脉急性串联闭塞患者临床资料.根据治疗方式不同,分为顺行再通组(n=41)和逆行再通组(n=22).采用改良溶栓治疗脑梗死(mTICI)血流分级判断术后血管再通程度,改良Rankin量表(mRS)评分评估术后90 d临床预后.结果 两组患者年龄、性别、伴高血压病、伴糖尿病、伴心房颤动、吸烟史、术前美国国立卫生研究院卒中量表(NIHSS)评分、术前Alberta卒中项目早期CT评分(ASPECTS)、脑卒中病因等差异均无统计学意义(均P>0.05).顺行再通组、逆行再通组分别有16例(39.0％)、15例(68.2％)接受急诊颈内动脉起始段支架植入(P=0.027),穿刺至再通时间分别为(138+55)min、(120+47)min(P<0.01),90 d恢复良好(mRS评分≤2分)分别有17例(41.5％)、15例(68.2％)(P=0.043),差异均有统计学意义.结论 血管内逆行再通治疗颈内动脉颅外段伴同侧颅内大血管急性串联闭塞,是一种安全有效的治疗选择.