ObjectiveTo identify risk factors for hemorrhagic transformation (HT) after mechanical thrombectomy (MT) in patients with acute anterior circulation large vessel occlusion (LVO) and to develop a predictive nomogram.MethodsThis retrospective study enrolled 193 patients with acute anterior circulation LVO who underwent MT at a single center between January 2023 and December 2025. Patients were categorized into HT (n = 45, 23.32%) and non-HT (n = 148, 76.68%) groups based on postoperative imaging at 24–72 h. Univariate analysis was performed to compare baseline characteristics, biochemical indicators, and clinical variables between the two groups. Variables with p < 0.05 were subjected to Elastic Net regression with 10-fold cross-validation (StratifiedKFold) for variable selection and dimensionality reduction, with the optimal hyperparameters determined as C = 1 and l1_ratio = 0.9 (cross-validation AUC = 0.8615). Eight variables were retained and subsequently entered into binary logistic regression with forward stepwise selection to identify independent risk factors and construct a prediction model. A nomogram was developed and evaluated using receiver operating characteristic (ROC) curve, calibration curve with bootstrap validation (1,000 resamples), and decision curve analysis (DCA).ResultsSix independent risk factors for HT were identified: history of alcohol consumption (OR = 6.423, 95% CI 2.224–18.552, p = 0.001), history of leukoencephalopathy (OR = 4.555, 95% CI 1.664–12.469, p = 0.003), elevated blood glucose-to-lymphocyte ratio (GLR) (OR = 1.105, 95% CI 1.034–1.181, p = 0.003), elevated D-dimer (OR = 1.102, 95% CI 1.029–1.180, p = 0.005), elevated venous blood glucose (OR = 1.201, 95% CI 1.037–1.390, p = 0.014), and reduced mean platelet volume (MPV) (OR = 0.704, 95% CI 0.537–0.925, p = 0.012). The nomogram demonstrated favorable discriminative ability with an AUC of 0.880 (95% CI 0.820–0.939), sensitivity of 0.933, and specificity of 0.696. Calibration curve analysis indicated good model fit (χ2 = 9.059, p = 0.337). Decision curve analysis revealed a net benefit rate > 0 when the threshold probability ranged from 0.01 to 0.97.ConclusionHistory of alcohol consumption, leukoencephalopathy, elevated GLR, D-dimer, and venous blood glucose, and reduced MPV are independent risk factors for HT after MT in acute anterior circulation LVO stroke. The constructed nomogram exhibits good discrimination, calibration, and clinical utility, providing a reliable tool for individualized risk prediction.

Ischemia-reperfusion (IR) injury is characterized by significant neuronal apoptosis and mitochondrial damage.Despite significant advancements in understanding the pathophysiological mechanisms of IR, effective therapeutic strategies remain limited. Previous studies have shown that mild hypothermia (MH) can significantly alleviate brain IR injury by reducing neuronal apoptosis and mitochondrial damage, while mitophagy plays a crucial role in maintaining cellular self-protection and mitochondrial homeostasis. However, the involvement of the PINK1/Parkin signaling pathway, a classical regulatory route for mitophagy, in the protective effects of MH against IR remains unclear. To investigate this phenomenon, we used neuron-like SH-SY5Y cells and employed an oxygen-glucose deprivation/reoxygenation (OGD/R) model to simulate the in vitro IR process, and conducted a series of cell experiments. Our results demonstrated that under MH conditions, the expression levels of PINK1 and Parkin were upregulated after 5 h of ischemia-hypoxia followed by 24 h of reoxygenation, and the protective effect on cells was also significant. Furthermore, the inhibition of the mitophagy pathway may partially eliminate the protective effect provided by MH against OGD/R-induced damage.These findings indicate that the protective effects of MH against IR is mediated, at least in part, through the PINK1/Parkin-dependent mitophagy pathway.This study provides new insights into the mechanisms by which MH mitigates IR injury and may offer potential therapeutic targets for treating IR-related diseases.

BACKGROUND:The long-term benefits of bailout intracranial angioplasty or stenting (BAOS) after thrombectomy in patients with acute large vessel occlusion remain unclear. This study compared BAOS with standard therapy in patients with large vessel occlusion with unsuccessful recanalization (expanded Thrombolysis In Cerebral Infarction score 0-2a) or >70% residual stenosis after thrombectomy. METHODS:ANGEL-REBOOT (Randomized Study of Bailout Intracranial Angioplasty Following Thrombectomy for Acute Large Vessel Occlusion) was a multicenter, open-label, blinded-end point, randomized trial conducted across 36 Chinese hospitals. Patients ≥18 years of age with anterior or posterior circulation large vessel occlusion within 24 hours of stroke onset were enrolled. After identification of thrombectomy failure or high-grade residual stenosis, patients were randomly assigned to the BAOS group (intervention) or the standard therapy group (control), in which thrombectomy was continued or terminated. The use of tirofiban was permitted in both groups during and after the procedure. In the intention-to-treat population, the primary outcome was analyzed using an assumption-free ordinal analysis (Wilcoxon-Mann-Whitney test) to compare the modified Rankin Scale scores (ordinal variable ranging from 0 to 6) between groups at 1-year follow-up, from which the generalized odds ratio was derived. Secondary outcomes included stroke recurrence in the treated artery and all-cause mortality within 1 year, analyzed using Cox proportional hazards models. RESULTS:A total of 348 patients were randomly assigned (176 to the BAOS group and 172 to the standard therapy group) and followed for 90 days, from December 19, 2021, to June 2, 2023. Of these, 326 patients (166 in the BAOS group and 160 in the standard therapy group) completed the 1-year follow-up. Compared with standard therapy, BAOS significantly improved the 1-year modified Rankin Scale score distribution (generalized odds ratio, 1.34 [95% CI, 1.05-1.73]; P=0.02). Fewer stroke recurrences in the treated artery occurred in the BAOS group than in the standard therapy group (7 of 166 [4%] versus 21 of 160 [13%]; hazard ratio, 0.30 [95% CI, 0.13-0.71]; P=0.006). One-year mortality rates were similar between groups (25 of 166 [15%] versus 27 of 160 [17%]; hazard ratio, 0.87 [95% CI, 0.50-1.50]). CONCLUSIONS:Among Chinese patients with large vessel occlusion with unsuccessful recanalization or high-grade residual stenosis after thrombectomy, BAOS was associated with reduced disability and stroke recurrence after 1 year compared with standard therapy. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: NCT05122286.

Hemorrhagic transformation (HT) is a serious and common complication following intravenous thrombolysis in acute ischemic stroke (AIS), often leading to worsened outcomes. Identifying risk factors for HT and developing accurate predictive models are essential for improving patient management and prognosis. A retrospective analysis was performed on 159 patients with acute ischemic stroke who received intravenous thrombolytic therapy at Hubei Third People’s Hospital Affiliated to Jianghan University School of Medicine from March 2019 to July 2022. Boruta algorithm and multivariable logistic regression analysis were used to identify independent factors associated with bleeding transformation. A nomogram was built based on these factors and internally verified using the bootstrap resampling method. Our analysis showed that the independent factors affecting HT were Hyperdense middle cerebral artery sign (HMCAS), pre-thrombolytic glucose, pre-thrombolytic neutrophil count and construct a nomogram based on these predictors. The area under the ROC curve (AUC) of the line graph was 0.885 (95

This study aimed to assess the risk of death from non-traumatic intracerebral hemorrhage (ICH) using a machine learning model. 1274 ICH patients who met the specified inclusion and exclusion criteria were analyzed retrospectively in the MIMIC IV 3.0 database. Patients were randomly divided into training, validation, and testing datasets in a ratio of 6:2:2 based on the outcome distribution. Data from the Second Hospital of Lanzhou University were used as an external validation set. This study used LASSO regression and multivariable logistic regression analysis to screen for features. We then employed XGBoost to construct a machine-learning model. The model’s performance was evaluated using ROC curve analysis, calibration curve analysis, clinical decision curve analysis, sensitivity, specificity, accuracy, and F1 score. Conclusively, the SHapley Additive exPlanations (SHAP) method was employed to interpret the model’s predictions. Deaths occurred in 572 out of the 1274 ICH cases included in the study, resulting in an incidence rate of 44.9

BackgroundTherapeutic hypothermia improves outcomes in experimental stroke models, especially after ischemia-reperfusion injury. In recent years, the safety and efficacy of hypothermia combining thrombolysis or mechanical thrombectomy have attracted widespread attention. The primary objective of the study was to evaluate the effectiveness and safety of hypothermia by combining reperfusion therapy in acute ischemic stroke patients.MethodsA systematic search was performed in PubMed, EMBASE, Cochrane Library, and the Clinical Trial Registries on articles published until May 2024. The full-text articles were thoroughly reviewed, and relevant information regarding study characteristics and outcomes was extracted. Mantel–Haenszel (M–H) random-effects model was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). In addition, subgroup analyses were performed focusing on the different hypothermia modalities and duration.ResultsAfter screening 2,265 articles, 10 studies were included in the present analysis with a total sample size of 785. Forest plots of clinical outcomes were as follows: modified Rankin Scale (mRS) ≤2 at 3 months (RR = 1.28, 95% CI 1.01–1.61, p = 0.04), mortality within 3 months (RR = 0.95, 95% CI 0.69–1.29, p = 0.73), total complications (RR = 1.02, 95% CI 0.89–1.16, p = 0.77) and pneumonia (RR = 1.35, 95% CI 0.76–2.40, p = 0.31). Subgroup analyses indicated a mild protective effect of selective cerebral hypothermia; however, the difference in mortality between the hypothermia and control groups was not statistically significant (RR = 0.88, 95% CI 0.57–1.35, p = 0.55). Patients undergoing hypothermia for 24–48 h experienced a higher rate of overall complications (RR = 1.37, 95% CI 1.01–1.86, p = 0.04) and pneumonia (RR = 2.84, 95% CI 1.05–7.66, p = 0.04).ConclusionThe preliminary evidence supports the safety and feasibility of hypothermia combined with reperfusion therapy, which should be further investigated in randomized controlled studies.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024556625.

Importance Evidence supports using antiplatelet therapy in patients with acute ischemic stroke. However, neurological deterioration remains common under the currently recommended antiplatelet regimen, leading to poor clinical outcomes. Objective To determine whether intravenous tirofiban administered within 24 hours of stroke onset prevents early neurological deterioration in patients with acute noncardioembolic stroke compared with oral aspirin. Design, Setting, and Participants This investigator-initiated, multicenter, open-label, randomized clinical trial with blinded end-point assessment was conducted at 10 comprehensive stroke centers in China between September 2020 and March 2023. Eligible patients were aged 18 to 80 years with acute noncardioembolic stroke within 24 hours of onset and had a National Institutes of Health Stroke Scale (NIHSS) score of 4 to 20. Intervention Patients were assigned randomly (1:1) to receive intravenous tirofiban or oral aspirin for 72 hours using a central, web-based, computer-generated randomization schedule; all patients then received oral aspirin. Main Outcome The primary efficacy outcome was early neurological deterioration (increase in NIHSS score ≥4 points) within 72 hours after randomization. The primary safety outcome was symptomatic intracerebral hemorrhage within 72 hours after randomization. Results A total of 425 patients were included in the intravenous tirofiban (n = 213) or oral aspirin (n = 212) groups. Median (IQR) age was 64.0 years (56.0-71.0); 124 patients (29.2%) were female, and 301 (70.8%) were male. Early neurological deterioration occurred in 9 patients (4.2%) in the tirofiban group and 28 patients (13.2%) in the aspirin group (adjusted relative risk, 0.32; 95% CI, 0.16-0.65; P = .002). No patients in the tirofiban group experienced intracerebral hemorrhage. At 90-day follow-up, 3 patients (1.3%) in the tirofiban group and 3 (1.5%) in the aspirin group died (adjusted RR, 1.15; 95% CI, 0.27-8.54; P = .63), and the median (IQR) modified Rankin scale scores were 1.0 (0-1.25) and 1.0 (0-2), respectively (adjusted odds ratio, 1.28; 95% CI, 0.90-1.83; P = .17). Conclusions and Relevance In patients with noncardioembolic stroke who were seen within 24 hours of symptom onset, tirofiban decreased the risk of early neurological deterioration but did not increase the risk of symptomatic intracerebral hemorrhage or systematic bleeding. Trial Registration ClinicalTrials.gov Identifier: NCT04491695

Rationale Unsuccessful thrombectomy of acute large vessel occlusions (LVOs) has been associated with unfavourable outcomes. Multiple randomised controlled trials (RCTs) have reported a failure rate of 12%–41% for thrombectomy procedures. Various factors contribute to failed thrombectomy, including technical difficulties in accessing the occlusion, unsuccessful thrombus retrieval, thrombotic reocclusion and pre-existing intracranial atherosclerotic stenosis. Although some studies have explored balloon dilation or permanent stenting as rescue intracranial angioplasty for failed thrombectomy in individual cases, there is currently no evidence from RCTs on this specific topic. Aim To evaluate the potential superiority of bailout angioplasty over standard treatment in cases of unsuccessful recanalisation (eTICI 0 to 2a) or residual severe stenosis (>70%) after thrombectomy in acute LVO patients within 24 hours of stroke onset. Design This study is a multicentre, prospective, randomised, controlled clinical trial designed by investigators. It compares bailout angioplasty with standard therapy and follows an open-label treatment approach while maintaining a blinded outcome assessment (PROBE design). Our objective is to allocate 348 patients in a 1:1 ratio to either receive bailout angioplasty as an intervention or standard therapy as a control, following unsuccessful thrombectomy. Outcome The main measure of interest is the modified Rankin Scale (mRS) Score, which will be assessed in a blinded manner at 90 (±14) days following randomisation. The primary effect size will be determined using ordered logistic regression to calculate the common OR, representing the shift on the six-category mRS Scale at the 90-day mark. Additionally, the safety outcomes will be evaluated, including symptomatic intracranial haemorrhage within 18–36 hours, severe procedure-related complications and mortality within 90 (±14) days, among others. Discussion The ANGEL-REBOOT study aims to generate substantial evidence regarding the efficacy and safety of bailout intracranial angioplasty as a treatment option for patients with LVO who have experienced unsuccessful thrombectomy. Trial registration number NCT05122286 .

Background The presence of sudden onset to maximal deficit (SOTMD) in patients with acute basilar artery occlusion often results in more severe outcomes. However, the effect of endovascular therapy on SOTMD and whether the outcome is affected by onset‐to‐puncture time remain unclear. Methods and Results This retrospective analysis was conducted using data from the prospective BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion Study Registry). Consecutive patients with basilar artery occlusion receiving endovascular therapy were dichotomized into SOTMD and non‐SOTMD cohorts. The primary outcomes included a favorable outcome (modified Rankin scale 0–3), recanalization, and mortality at 90 days. The outcomes of patients with SOTMD were analyzed using multivariable logistic regression. In the multivariate analysis, a favorable outcome was similar between the two cohorts (odds ratio [OR], 0.88 [95% CI, 0.58–1.34]; P=0.5), although the mortality of patients with SOTMD was higher than that of patients with non‐SOTMD (OR, 1.67 [95% CI, 1.14–2.44]; P=0.008). The probability of mortality increased from 40.0% at 1 hour to 70.0% at 6 hours in the SOTMD cohort, and favorable outcomes of patients with non‐SOTMD declined from 38.0% at 1 hour to 18.0% at 8 hours. Conclusions No significant difference was observed in favorable outcomes between the SOTMD and non‐SOTMD groups, although mortality was higher in the SOTMD cohort. The patients with SOTMD had a stronger time dependence for endovascular therapy in terms of mortality, while the time dependency regarding favorable outcome in the NSOTMD group was even higher. Registration URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1800014759.

OBJECTIVE The aim of this study was to investigate the efficacy and safety of endovascular treatment (EVT) plus standard medical treatment (SMT) in patients with acute basilar artery occlusion (BAO) within 6 hours of the estimated occlusion time, based on a Chinese population.METHODS The authors selected patients from the Endovascular Treatment of Acute Basilar Artery Occlusion Study (BASILAR) registry, which was a nationwide prospective registry, within 6 hours after the estimated time of onset of a stroke in acute BAO. Patients were divided into the SMT-alone group or the EVT+SMT group according to treatment modalities. The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale score between 0 and 3 at 90 days. Safety outcomes included death at 90 days and symptomatic intracerebral hemorrhage.RESULTS The authors assessed 590 patients for eligibility. Of these patients, 127 received SMT alone and 463 were treated with EVT plus SMT. EVT was associated with a higher rate of a favorable functional outcome (adjusted OR 3.804, 95% CI 1.890-7.658; p < 0.001) and a lower proportion of deaths at 90 days (adjusted OR 0.364, 95% CI 0.223-0.594; p < 0.001). Lower age (adjusted OR 0.978, 95% CI 0.960-0.997; p = 0.022); lower baseline National Institutes of Health Stroke Scale score (adjusted OR 0.926, 95% CI 0.902-0.950; p < 0.001); higher baseline posterior circulation Alberta Stroke Program Early CT Score (adjusted OR 1.681, 95% CI 1.424-1.984; p < 0.001); absence of diabetes mellitus (adjusted OR 0.482, 95% CI 0.267-0.871; p = 0.016); and modified Thrombolysis in Cerebral Infarction scores 2b-3 (adjusted OR 5.117, 95% CI 2.304-11.367; p < 0.001) were independent factors for a favorable outcome in the EVT+SMT group. CONCLUSIONS Based on the study design, patients with acute BAO who received EVT within 6 hours were associated with improved favorable outcome and decreased deaths compared with patients who received SMT. Predictors of desirable outcome in patients undergoing EVT included lower age, lower baseline National Institutes of Health Stroke Scale score, higher baseline posterior circulation Alberta Stroke Program Early CT Score, absence of diabetes mellitus, and modified Thrombolysis in Cerebral Infarction scores 2b-3.

BackgroundThe effects of secondary collateral compensation on outcomes remain unclear in patients with acute basilar artery occlusion (BAO) after endovascular treatment (EVT). This study aimed to evaluate the benefits of the anastomosis between the posterior inferior cerebellar artery (PICA) and the superior cerebellar artery (SCA) in BAO after EVT.MethodsThis cohort study was conducted using data from the Endovascular Treatment for Acute Basilar Artery Occlusion Study Registry. Patients with acute BAO and treated with EVT were included. The primary outcome was a modified Rankin Scale score of 0–2 at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage (SICH) and 90-day mortality.ResultsOf the 646 patients included in the study, 196 (30.3%) patients had a PICA–SCA anastomosis. The PICA–SCA anastomosis was significantly associated with independent functional outcome at 90 days (67/196 (34.2%) vs 109/450 (24.2%), adjusted OR (aOR) 1.80 (95% CI 1.13 to 2.86), p=0.01) and was significantly associated with a decreased rate of SICH (40/442 (9.0%) vs 5/193 (2.6%), aOR 0.29 (95% CI 0.11 to 0.76), p=0.01). No significant difference was found between PICA–SCA anastomosis and 90-day mortality (219/450 (48.7%) vs 80/196 (40.8%), aOR 0.72 (95% CI 0.48 to 1.08), p=0.11). Subgroup analysis showed that the association between independent functional outcome and PICA–SCA anastomosis was strongest in patients with middle BAO (27/77 (35.1%) vs 22/118 (18.6%), aOR 2.64 (95% CI 1.13 to 6.15), p=0.03).ConclusionsThe PICA–SCA anastomosis is significantly associated with better functional outcomes in patients with acute BAO after EVT, especially in those with middle BAO.

BACKGROUND:The effects of the glycoprotein IIb/IIIa receptor inhibitor tirofiban in patients with acute ischemic stroke but who have no evidence of complete occlusion of large or medium-sized vessels have not been extensively studied. METHODS:In a multicenter trial in China, we enrolled patients with ischemic stroke without occlusion of large or medium-sized vessels and with a National Institutes of Health Stroke Scale score of 5 or more and at least one moderately to severely weak limb. Eligible patients had any of four clinical presentations: ineligible for thrombolysis or thrombectomy and within 24 hours after the patient was last known to be well; progression of stroke symptoms 24 to 96 hours after onset; early neurologic deterioration after thrombolysis; or thrombolysis with no improvement at 4 to 24 hours. Patients were assigned to receive intravenous tirofiban (plus oral placebo) or oral aspirin (100 mg per day, plus intravenous placebo) for 2 days; all patients then received oral aspirin until day 90. The primary efficacy end point was an excellent outcome, defined as a score of 0 or 1 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days. Secondary end points included functional independence at 90 days and a quality-of-life score. The primary safety end points were death and symptomatic intracranial hemorrhage. RESULTS:A total of 606 patients were assigned to the tirofiban group and 571 to the aspirin group. Most patients had small infarctions that were presumed to be atherosclerotic. The percentage of patients with a score of 0 or 1 on the modified Rankin scale at 90 days was 29.1% with tirofiban and 22.2% with aspirin (adjusted risk ratio, 1.26; 95% confidence interval, 1.04 to 1.53, P = 0.02). Results for secondary end points were generally not consistent with the results of the primary analysis. Mortality was similar in the two groups. The incidence of symptomatic intracranial hemorrhage was 1.0% in the tirofiban group and 0% in the aspirin group. CONCLUSIONS:In this trial involving heterogeneous groups of patients with stroke of recent onset or progression of stroke symptoms and nonoccluded large and medium-sized cerebral vessels, intravenous tirofiban was associated with a greater likelihood of an excellent outcome than low-dose aspirin. Incidences of intracranial hemorrhages were low but slightly higher with tirofiban. (Funded by the National Natural Science Foundation of China; RESCUE BT2 Chinese Clinical Trial Registry number, ChiCTR2000029502.).

Background and purpose: This study aimed to develop a score to predict the risk for symptomatic intracranial haemorrhage (sICH) associated with endovascular treatment (EVT) in patients with acute ischaemic stroke caused by large vessel occlusions (LVOs) in the anterior circulation. Methods: Between January 2017 and December 2019, acute stroke patients with anterior circulation occlusion and EVT were retrospectively enroled from 11 comprehensive stroke centres in China. Univariate analyses were performed to compare the factors in patients with or without sICH. The predictive value of parameters associated with sICH was evaluated with multivariate logistic regression, and the score was developed according to the magnitude of regression coefficients. We performed external validation in a retrospective stroke registry of EVT for acute anterior circulation ischaemic stroke in 21 comprehensive stroke centres across 10 provinces in China (ACTUAL). Results: Of the 433 patients, 70 (16.2%) patients had sICH. The preoperative predictive factors of sICH were poor collateral circulation, low baseline ASPECTS, cardioembolic stroke and high serum glucose. Using the OR of preoperative predictive factors (collateral circulation status, baseline ASPECTS, TOAST type and serum glucose) in the multivariable model, we derived the ACTS score. In the derivation cohort, the area under the ROC curve (AUC) was 0.797; in the validation cohort, it was 0.727. Conclusion: The ACTS score provides a quick and easy-to-perform scale to predict the risk of sICH in acute anterior circulation stroke patients treated with EVT. This score should be further examined and improved in future prospective studies to increase its precision and applicability before it can be recommended to make clinical decisions regarding the performance of EVT.

Importance Tirofiban is a highly selective nonpeptide antagonist of glycoprotein IIb/IIIa receptor, which reversibly inhibits platelet aggregation. It remains uncertain whether intravenous tirofiban is effective to improve functional outcomes for patients with large vessel occlusion ischemic stroke undergoing endovascular thrombectomy. Objective To assess the efficacy and adverse events of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke secondary to large vessel occlusion. Design, Setting, and Participants This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 55 hospitals in China, enrolling 948 patients with stroke and proximal intracranial large vessel occlusion presenting within 24 hours of time last known well. Recruitment took place between October 10, 2018, and October 31, 2021, with final follow-up on January 15, 2022. Interventions Participants received intravenous tirofiban (n = 463) or placebo (n = 485) prior to endovascular thrombectomy. Main Outcomes and Measures The primary outcome was disability level at 90 days as measured by overall distribution of the modified Rankin Scale scores from 0 (no symptoms) to 6 (death). The primary safety outcome was the incidence of symptomatic intracranial hemorrhage within 48 hours. Results Among 948 patients randomized (mean age, 67 years; 391 [41.2%] women), 948 (100%) completed the trial. The median (IQR) 90-day modified Rankin Scale score in the tirofiban group vs placebo group was 3 (1-4) vs 3 (1-4). The adjusted common odds ratio for a lower level of disability with tirofiban vs placebo was 1.08 (95% CI, 0.86-1.36). Incidence of symptomatic intracranial hemorrhage was 9.7% in the tirofiban group vs 6.4% in the placebo group (difference, 3.3% [95% CI, -0.2% to 6.8%]). Conclusions and Relevance Among patients with large vessel occlusion acute ischemic stroke undergoing endovascular thrombectomy, treatment with intravenous tirofiban, compared with placebo, before endovascular therapy resulted in no significant difference in disability severity at 90 days. The findings do not support use of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR-IOR-17014167.

Max Cooper has made research contributions that cover phylogenetic and ontogenic aspects of lymphopoiesis and immunodeficiency diseases, and has used molecular approaches to understand lymphocyte development and function. A large gathering of international colleagues met at a recent symposium to celebrate the occasion of his 60th birthday.

目的 探讨穿支动脉粥样硬化病(branch atheromatous disease,BAD)溶栓后24 h内早期使用低剂量替罗非班的疗效及安全性.方法 收集2017年3月-2021年7月在湖北省第三人民医院神经内科住院治疗的穿支动脉粥样硬化病脑梗死的患者,筛选符合静脉溶栓资格且发病时间≤4.5 h的患者,根据溶栓后早期是否使用替罗非班分为实验组和对照组.运用倾向性评分匹配分析(propensity score matching,PSM)方法消除实验组和对照组患者的一般情况差异,对比分析两组的早期神经功能恶化(early neurological deterioration,END)发生率、治疗效果和出血风险.结果 入院后第一天的早期神经功能恶化发生率实验组明显低于对照组(P<0.05).NHISS评分两组在治疗后1 d及第7天,实验组高于对照组(P<0.05).两组90 d后mRS评分实验组低于对照组(P<0.05).其中预后较好的患者(mRS 0～1)的比例,实验组高于对照组.留有严重残疾患者(mRS≥4分)的比例,实验组明显低于对照组.两组均无脑出血及死亡病例.结论 穿支动脉粥样硬化病溶栓后早期使用小剂量替罗非班不仅安全,而且能减少早期神经功能恶化的发生,最终提高患者的远期预后.

急性缺血性脑卒中(Acute ischemic stroke ,AIS )指的是由缺血缺氧引起的脑组织坏死软化引起的神经功能缺损综合征,其发病率占所有脑卒中的60％ ～70％[1 ] ,是导致全球残疾和死亡的主要原因之一[2 ] ,其具有较高病死率及致残率,给患者家庭及社会带来了沉重的负担.超早期应用重组织型纤溶酶原激活剂(Recombinant tissue plasminogen acti-vator ,rt-PA )进行早期溶栓以恢复缺血区的血液供应在急性缺血性脑卒中的临床治疗中至关重要.然而许多患者在使用rt-PA溶栓后会出现严重的并发症,尤其是出血性转化(Hemorrhagic transformation ,HT ) ,这限制了 rt-PA 的使用[3].这种HT可导致接受 rt-PA 治疗的缺血性脑卒中患者的早期神经功能恶化和临床预后更差,甚至死亡.因此,降低rt-PA治疗后发生 HT的风险,提高溶栓治疗效果是十分必要的.本研究主要就急性缺血性脑卒中静脉溶栓后出血转化的分类、发生机制、危险因素、预测指标等方面研究进展进行综述.

目的 探讨3D-Slicer软件辅助颅内巨大血栓性动脉瘤及右侧大脑中动脉分叉部破裂动脉瘤的诊断和手术治疗的应用价值.方法 回顾性分析1例颅内巨大血栓性动脉瘤及右侧大脑中动脉分叉部动脉瘤患者的临床资料和手术方案.术前采用3D-Slicer软件对动脉瘤、血肿及额叶占位性病变三维建模,辅助动脉瘤的诊断及术前定位和手术入路的设计.并结合文献复习颅内巨大血栓性动脉瘤及右侧大脑中动脉分叉部动脉瘤的临床特征和手术治疗方法.结果 患者为54岁女性,术前CT及DSA诊断为右侧大脑中动脉分叉部动脉瘤破裂并蛛网膜下腔出血,前交通动脉瘤,右侧额叶占位性病变,术中证实右侧额叶占位性病变为前交通巨大血栓性动脉瘤,给予夹闭后切除;顺利找到并夹闭右侧大脑中动脉分叉部动脉瘤及清除颅内血肿.术后患者恢复良好,无神经功能障碍.结论 颅内多发性动脉瘤开颅夹闭难度较大,风险较高,尤其合并颅内巨大血栓性动脉瘤时.3D-Slicer软件可用于术前进行多模态三维影像重建,并利用在动脉瘤开颅夹闭手术中,是一种更精准、安全、无创的有效辅助手段,可为动脉瘤手术提供定向指导,有很好的应用前景.

Background Higher extended Thrombolysis In Cerebral Infarction (eTICI) grades are associated with better clinical outcomes after endovascular treatment (EVT) for proximal intracranial occlusion of the anterior circulation. However, the relationship between eTICI grade and outcomes after EVT in patients with acute basilar artery occlusion (BAO) remains unclear. We aimed to explore which eTICI category was the cut-off correlating with better clinical outcomes in patients with BAO undergoing EVT. Methods We included patients treated via EVT from the BASILAR study. Multivariable logistic regression analyses were performed to assess the impact of eTICI grades on 90-day favorable functional outcomes, defined as a modified Rankin Scale (mRS) score of 0-3. Other outcomes were functional independence (mRS 0-2), all-cause mortality, and symptomatic intracranial hemorrhage. Results Among 647 patients treated with EVT, 127 (19.6%), 128 (24.5%), 110 (21.1%), and 282 (54%) patients achieved eTICI grades of 0-2a, 2b, 2c, and 3, respectively. Compared with eTICI grades 0-2a, higher rates of favorable functional outcomes (adjusted OR (aOR) 2.96, 95%CI 1.33 to 6.57, and aOR 7.40, 95% CI 3.63 to 15.09, respectively) were observed for grades 2c and 3, not 2b (aOR 1.93, 95% CI 0.86 to 4.36). The risks of mortality and symptomatic intracranial hemorrhage were also lower for eTICI grades 2c and 3 than for grades 0-2a. Conclusions An eTICI grade of 2c/3 may be a target for successful reperfusion after EVT in patients with acute BAO; however, further studies with larger sample sizes and clinical trials are needed.