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.

Intensive blood pressure (BP) targets of less than 120 mm Hg have been shown to worsen functional outcomes after endovascular thrombectomy (EVT) for acute ischemic stroke. However, their effects on self-reported health-related quality of life (HRQoL) remain uncertain. This post-hoc exploratory analysis used data from ENCHANTED2/MT, an open-label, blinded-endpoint randomized trial conducted in 44 Chinese hospitals. Adults with elevated BP within 3 h after successful reperfusion were randomized to intensive (< 120 mmHg) or less intensive (140–180 mmHg) systolic BP targets. HRQoL at 90 days was assessed using the EQ-5D-3 L and EQ visual analogue scale (EQ VAS). Functional outcome was measured by the modified Rankin Scale (mRS). Treatment effects were estimated using adjusted regression models, and causal mediation analysis was performed to explore indirect and direct pathways. Of 816 randomized patients, EQ-5D data were available in 685. At 90 days, both EQ-5D index (0.66 vs. 0.72) and EQ VAS (73.01 vs. 76.84) were lower in the more intensive BP group. Adjusted mean differences favored the less intensive treatment group: 0.06 (95

BACKGROUND AND PURPOSE:Cerebral hemodynamics hold profound clinical significance in the comprehensive management of intracranial atherosclerotic stenosis (ICAS). We have developed Angio-FF, a novel noninvasive fractional flow (FF) calculation technique derived from cerebral angiography, for evaluating hemodynamics in patients with ICAS. This study aims to evaluate the clinical applicability of Angio-FF in reflecting cerebral hemodynamics by assessing its correlation with in-stent restenosis (ISR) in patients with ICAS. MATERIALS AND METHODS:A total of 54 patients with severe ICAS who had undergone cerebral angiography were recruited in the study between January 2019 and September 2022. For each patient, both preoperative and immediate postoperative Angio-FF values were collected and compared. During the 6-month follow-up, 9 patients were confirmed to have developed ISR. Receiver-operating characteristic curve (ROC) analysis was performed to evaluate the predictive efficacy of immediate postoperative Angio-FF value in differentiating between ISR and non-ISR. RESULTS:No statistically significant disparities were detected in preoperative morphologic and hemodynamic between ISR and non-ISR groups. However, the immediately postoperative degree of stenosis% was significantly different between the ISR and non-ISR groups (26 [22-33] versus 10 [0-20]; P < .001). The postoperative Angio-FF value in the ISR group was markedly lower than that in the non-ISR group (0.84 [0.81-0.90] versus 0.94 [0.87-0.97]; P = .007). ROC analysis was performed to assess the predictive value of postoperative Angio-FF for ISR (area under the curve = 0.785; 95% CI, 0.647-0.923), with a cutoff value of 0.845. CONCLUSIONS:This study reveals that immediately postoperative Angio-FF is an effective predictor of ISR, providing valuable intraoperative information for assessing the effectiveness of stent placement in patients with ICAS.

Historical trials (ACAS/ACST) supported revascularization for asymptomatic carotid stenosis, but contemporary medical management with statins, antithrombotics, and blood pressure control may reduce stroke risk. This meta-analysis compares medical management versus revascularization (carotid endarterectomy [CEA] or stenting [CAS]) in current practice. We searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to "Asymptomatic Carotid Stenosis", "Medical Management" and "Revascularization" until December 5, 2025. The primary outcome was a composite of any stroke (ischemic or hemorrhagic) or death, assessed from randomization to the peri-procedural period, or ipsilateral ischemic stroke, assessed during the remaining follow-up. This study was registered in PROSPERO, CRD420251247217. Three RCTs (SPACE-2, ECST-2, CREST-2; 3,426 patients) were included. For the primary outcome, no significant difference existed between revascularization (CEA/CAS) and medical management: 4.76

BACKGROUND AND PURPOSE:Early neurologic improvement (ENI) following mechanical thrombectomy (MT) has been a topic of substantial interest. The literature has more than 40 ENI definitions, yet no consensus has been reached. In this Delphi study, we sought to investigate experts' perspectives on the available ENI definitions and determine whether a consensus can be achieved. MATERIALS AND METHODS:The Delphi approach assessed experts' perspectives on available ENI definitions. Following a systematic literature review, the first survey round was prepared and sent to 20 experts using a Web-based anonymous survey platform (qualtrics.com). The first round of questions was publicly shared on the letsgetproof.com platform to gather perspectives of neurointerventionalists worldwide on ENI definitions. Expert and volunteer answers formed the basis of subsequent rounds, in which closed-ended questions were sent only to experts. Consensus was defined as an agreement of ≥70% for binary closed-ended questions and ≥50% for closed-ended questions with >2 response options. RESULTS:Experts completed 3 survey rounds. They recognized that the heterogeneity in ENI definitions is the most critical factor limiting the use of ENI in clinical practice and stroke research. All experts acknowledged that stroke physicians need a standardized universal ENI definition. Consensus was reached on the notion that a unified ENI definition should focus on predicting functional independence at 3 months. They agreed that NIHSS improvement of ≥8 points at 24 hours could serve as the unified ENI definition. They acknowledged that incorporating prestroke comorbidities, occlusion location, baseline NIHSS scores, and procedure-related parameters would complicate the ideal ENI definition and limit its use in clinical settings. The experts could not reach a consensus on the potential utility of ENI as a primary end point in MT trials. CONCLUSIONS:In our Delphi analysis, experts agreed on an ENI definition. They did not endorse using different ENI criteria for patients with comorbidities, posterior circulation occlusions, or high baseline NIHSS scores. Further prospective studies are needed to validate or refine ENI definitions and to address the paucity of data on the prognostic utility of ENI in specific clinical scenarios.

Ischemic stroke disrupts cerebral metabolism and initiates a cascade of pathological events, including excitotoxicity, mitochondrial dysfunction, and neuroinflammation. These interconnected processes drive neuronal apoptosis, necrosis, and synaptic loss, ultimately leading to irreversible brain injury, persistent neurological deficits, and high rates of long-term disability and mortality. Ketone bodies, including β-hydroxybutyrate, acetoacetate, and acetone, have demonstrated neuroprotective properties through multiple mechanisms. These include sustaining cerebral energy supply and mitochondrial stability, attenuating excitotoxicity and calcium overload, suppressing inflammatory responses, and promoting neural remodeling and functional recovery. Accordingly, ketone bodies are increasingly recognized as a promising therapeutic strategy for ischemic stroke. However, evidence supporting their clinical application and systematic implementation in humans remains limited. In this review we summarize ketone body metabolism and the mechanisms underlying its neuroprotective effects, evaluate the evidence supporting translation from preclinical studies to clinical application, and highlight key challenges that must be addressed in future investigations. Based on the current evidence, we also propose priorities for short-term clinical research and outline future perspectives.

BackgroundThe choice of anesthesia modality during mechanical thrombectomy (MT) for acute ischemic stroke remains debated. This study aimed to analyze the impact of anesthesia type on clinical outcomes following endovascular therapy (EVT).MethodsThis subgroup analysis of the ENCHANTED2/MT trial included patients with large vessel occlusion (LVO) acute ischemic stroke who achieved successful reperfusion (eTICI ≥2b). Patients were stratified by anesthesia type: general anesthesia (GA) or non-general anesthesia (Non-GA). The primary outcome was functional recovery, assessed by the distribution of scores on the modified Rankin Scale (mRS; range 0 [no symptoms] to 6 [death]) at 90 days. Efficacy was analyzed using ordinal logistic regression.ResultsA total of 809 patients were included (GA: 344; Non-GA: 465). There was no significant between-group difference in the primary outcome of mRS score distribution. The incidence of postoperative pneumonia was significantly lower in the Non-GA group (adjusted odds ratio [aOR] 0.33, 95% CI 0.14–0.74; p = 0.008). Among patients with milder initial neurological deficits (admission NIHSS score <15), the Non-GA group had higher odds of achieving functional independence (mRS 0–2) at 90 days (aOR 1.71, 95% CI 1.00–2.91; p = 0.049); this association was not observed in patients with more severe deficits (NIHSS ≥15) (P for interaction = 0.05). No significant differences were found between groups in the rates of symptomatic intracranial haemorrhage, recurrent stroke, mortality, or in the level of reperfusion.ConclusionIn patients undergoing mechanical thrombectomy for acute ischemic stroke, Non-GA may be associated with better functional outcomes in patients presenting with milder neurological deficits. GA was associated with an increased risk of postoperative pneumonia.

INTRODUCTION:Recent advancements in endovascular thrombectomy (EVT) devices and pivotal trial evidence have revolutionised acute ischemic stroke management. However, translational gaps persist between guideline recommendations and real-world practice, particularly regarding operator experience-dependent technical preferences in resource allocation. METHODS:A national survey with 53 questions was designed to extract information regarding strategy decisions and clinical scenarios, including technical variations of thrombectomy and thrombolysis, blood pressure preference. The survey link was sent individually via email with a website link. RESULTS:1,289 responses from 883 hospitals were obtained and were included in the final analysis. Junior physicians exhibited reluctance to deviate from thrombolysis-centric paradigms, while senior physicians preferred thrombectomy. Conversely, junior physicians were more likely to use Balloon-guide catheters (BGC), thrombolysis after thrombectomy, local anesthesia, and radial access. CONCLUSION:This nationwide study highlights significant heterogeneity in acute ischemic stroke management among Chinese physicians, driven by experience-based differences. Findings underscore the need for stratified training, standardized protocols, and collaborative platforms to harmonize practice and accelerate evidence translation.

BACKGROUND:The value of intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) in acute ischemic stroke due to large-vessel occlusion (AIS-LVO) is debated. This study evaluated the association of IVT with arterial collateral, tissue-level collateral (TLC), and venous outflow (VO) profiles on CT angiography and perfusion imaging in EVT-treated AIS-LVO patients. MATERIALS AND METHODS:This case-matched retrospective study included consecutive adult patients diagnosed with AIS-LVO and treated with EVT between January 2018 and December 2022. The primary efficacy outcomes were arterial and venous profiles including arterial collateral defined by the Tan score, TLC defined by hypoperfusion intensity ratio, and VO defined by cortical vein opacification score, assessed on CTA after IVT administration. Multivariable logistic regression analyses were performed on propensity score-matched cohorts, and the analyses were repeated in subsequent 1:1 matched cohorts using two different sensitivity analysis protocols. The primary analysis was performed using ordinal logistic regression with treatment allocation as fixed effect. RESULTS:Among 87 IVT-treated and 584 non-IVT patients, IVT was independently associated with better arterial collateral scores (OR 0.57; 95% CI: 0.32-0.96; p = 0.019) and more favorable venous outflow profiles (OR 0.50; 95% CI: 0.28-0.88; p = 0.016). Associations strengthened after incorporating ASPECTS scores (arterial collateral: OR 0.40, p = 0.002; VO: OR 0.31, p < 0.001). Rates of 72-hour intracranial hemorrhage and 90-day functional outcomes were comparable. CONCLUSION:In patients with AIS due to LVO, IVT before EVT was associated with favorable arterial collateral and venous outflow profiles on radiological assessment.

BACKGROUND:High-quality randomized controlled trials (RCTs) have extended the endovascular therapy (EVT) time window to 24 h post-stroke onset in selected patients with acute ischemic stroke (AIS). Recent retrospective studies indicate that EVT performed beyond 24 h may still improve clinical outcomes. However, the specific benefit-risk profile in this ultra-late window remains unclear. AIM:The trial is designed to address this evidence gap and determine the benefit-risk balance of EVT in the ultra-late window. METHODS AND DESIGN:The Large Artery occlusion Treated in Extended Time with Mechanical Thrombectomy (LATE-MT) is an investigator-initiated, multicenter, prospective, randomized, open, blinded-endpoint assessment (PROBE) clinical trial. The trial adopted an adaptive group-sequential design, recruiting 336 AIS patients with large-vessel occlusion within 24-72 h of the last known well across 35 stroke centers in China. Eligible subjects who meet both clinical and imaging selection criteria are randomized 1:1 to EVT or medical management. OUTCOMES:The primary outcome is an ordinal shift analysis of scores on the modified Rankin scale (mRS) at 90 days. Key secondary outcomes include neurological function at 24 h and 7 days, death/major disability, and utility-weighted mRS (UW-mRS) at 90 days. Safety outcomes include any intracranial hemorrhage (ICH), symptomatic ICH, serious adverse event, and all procedural complications.

BACKGROUND:Endovascular thrombectomy (EVT) is the standard treatment for acute ischemic stroke due to anterior circulation large vessel occlusion (LVO) within 6-24 h. However, the safety and feasibility of EVT for anterior circulation strokes beyond 24 h remain uncertain. METHODS:We conducted a retrospective cohort study of consecutive patients with anterior circulation LVO who underwent EVT at Changhai Hospital from 2018 to 2023. Patients were stratified into late (6-24 h) and very late (>24 h) windows. Propensity score matching (PSM) was performed to adjust for baseline imbalances, including age, sex, NIHSS, ASPECTS, occlusion location, perfusion parameters, and vascular risk factors. The primary outcome was functional independence (modified Rankin Scale [mRS] ≤ 2) at 3 months. Secondary outcomes included successful reperfusion (TICI 2b-3) and symptomatic intracranial hemorrhage (sICH). RESULTS:Among 1043 screened patients, 429 patients with anterior circulation LVO were included after exclusions, comprising 373 in the late window and 56 in the very late window. PSM yielded 42 matched pairs. Compared with the late window group, the very late window group showed no statistically significant differences in functional independence (54.8% vs. 57.1%; OR = 0.908, 95% CI 0.382-2.153, p = 0.830), successful reperfusion (88.1% vs. 92.9%; OR = 1.800, 95% CI 0.481-7.096, p = 0.460), sICH (2.4% vs. 9.5%; OR = 0.232, 95% CI 0.012-1.652, p = 0.200), intraprocedural complications (26.2% vs. 19.0%; OR = 1.508, 95% CI 0.540-4.362, p = 0.440), or postoperative complications (33.3% vs. 35.7%; OR = 0.900, 95% CI 0.363-2.219, p = 0.820). CONCLUSIONS:In this selected, single-center cohort of anterior circulation LVO patients undergoing EVT, treatment initiated beyond 24 h appeared to have comparable effectiveness and safety to treatment initiated within 6-24 h. Definitive evidence requires confirmation from adequately powered randomized controlled trials.

Importance Asymptomatic hemorrhagic infarction (HI) and subarachnoid hemorrhage (SAH) after endovascular treatment (EVT) for acute ischemic stroke are commonly considered low risk, but their long-term impact on functional outcomes is unclear. Objective To determine whether asymptomatic HI and SAH are associated with worse 90-day functional recovery in patients with acute ischemic stroke treated with EVT. Design, Setting, and Participants This is a secondary analysis of the DIRECT-MT randomized clinical trial, which compared intravenous thrombolysis prior to EVT with EVT alone. The multicenter study was conducted at tertiary hospitals in China between 2016 and 2019 with 90-day follow-up. Trial patients with asymptomatic HI, SAH, or no hemorrhage were included in the present analysis, which was performed in December 2024. Exposure Asymptomatic HI and SAH detected on follow-up imaging. Main Outcomes and Measures The primary outcome was the score on the modified Rankin scale (mRS) assessed at 90 days. Secondary analyses categorized mRS scores into thresholds of 0 to 1, 0 to 2, and 0 to 3, representing excellent, good, and favorable recovery, respectively. Results A total of 490 patients were included (median [IQR] age, 70 [60-76] years; 210 [42.9%] female), with 133 (27.1%) in the asymptomatic HI and SAH group and 357 (72.9%) in the no hemorrhage group. After propensity score matching, the odds ratio of having a worse mRS scores at 90 days in the asymptomatic HI and SAH group compared with the no hemorrhage group was 2.59 (95% CI, 1.45-4.63; P = .001). For binary outcomes, asymptomatic HI and SAH were consistently associated with worse recovery across mRS score thresholds of 0 to 1 and 0 to 2 in all models. Conclusions and Relevance In this secondary analysis of a randomized clinical trial, asymptomatic HI and SAH were associated with worse 90-day functional outcomes in patients with acute ischemic stroke treated with EVT. These findings emphasize the need for close monitoring and tailored management strategies in patients with asymptomatic hemorrhagic events following thrombectomy. Trial Registration ClinicalTrials.gov Identifier: NCT03469206

INTRODUCTION:The impact of antihypertensive drugs on functional outcome in patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT) remains controversial and may vary with collateral status (CS). We aimed to investigate the joint effect of CS and antihypertensive drugs on functional outcome in patients with AIS. METHODS:We retrospectively analyzed anterior circulation large-vessel occlusion AIS patients who underwent EVT in our hospital between January 2018 and December 2022. The patients were dichotomized to good CS, reflected by hypoperfusion index ratio (HIR) ≤0.4, and poor CS, reflected by HIR >0.4. Functional outcome was assessed using modified Rankin Scale (90d mRS). The primary outcome was defined as the 90d mRS > 2. The association between antihypertensive drugs within 48 h after EVT and functional outcome was evaluated. Furthermore, the interaction between HIR and antihypertensive drugs was measured. RESULTS:A total of 372 patients were included. The proportion of patients receiving antihypertensive drugs was comparable between the good CS and poor CS group (51% vs. 56%, p = 0.285). Antihypertensive drugs were significantly associated with higher odds ratio (OR) of unfavorable outcome {OR 3.83 (95% confidence interval [CI], 2.12-6.90); p < 0.001} in poor CS group. No correlation was found in good CS group (p = 0.159). The interaction between antihypertensive drugs and baseline CS was statistically significant (Pinteraction = 0.040, adjusted Pinteraction = 0.029). CONCLUSION:The association between antihypertensive drugs and functional outcome varied based on the CS. These findings suggest that antihypertensive drugs should be used with caution in AIS patients with poor CS after EVT.

Heat shock protein beta-1 may be involved in regulating ferroptosis in cells. The expression of heat shock protein beta-1 is upregulated after stroke; however, the underlying mechanism of action of heat shock protein beta-1 in cerebral ischemia/reperfusion injury remains unclear. Here, using both in vivo and in vitro models of ischemic injury-middle cerebral artery occlusion/reperfusion in C57BL/6J mice and oxygen-glucose deprivation/reoxygenation in BV-2 microglial cells-we observed that heat shock protein beta-1 overexpression significantly reduced infarct volume, mitigated neuronal loss, and improved neurological outcomes. Mechanistically, heat shock protein beta-1 attenuated lipid peroxidation, intracellular iron accumulation, and reactive oxygen species generation in microglia; this was accompanied by enhanced glutathione peroxidase 4 expression and suppressed nuclear factor-κB pathway activation. Notably, the pharmacological activation of nuclear factor-κB with phorbol 12-myristate 13-acetate reversed the protective effects of heat shock protein beta-1, confirming the functional relevance of this pathway. Together, our findings indicate that heat shock protein beta-1 exerts neuroprotective effects against cerebral ischemia/ reperfusion injury by suppressing microglial ferroptosis and pro-inflammatory activation via modulation of the nuclear factor-κB/glutathione peroxidase 4 signaling axis. These findings establish heat shock protein beta-1 as a critical regulator of the nuclear factor-κB/glutathione peroxidase 4 axis in microglia, thereby offering a dual-targeted strategy to inhibit ferroptosis and inflammation in ischemic stroke. Importantly, our study highlights heat shock protein beta-1 as a promising therapeutic candidate for preserving neurological function following cerebral ischemic injury.

Stroke is one of the leading causes of death and disability worldwide, making the search for effective neuroprotective and neurorepair strategies crucial. Remote ischemic conditioning, as an endogenous neuroprotective method, involves transient limb ischemia followed by reperfusion, potentially reducing the infarct area and improving neurological function. Although animal studies have indicated the neuroprotective effects of remote ischemic conditioning, its clinical efficacy in patients with acute ischemic stroke remains controversial. This meta-analysis aims to evaluate the efficacy and safety of remote ischemic conditioning in patients with acute ischemic stroke, focusing on its effects on neurological recovery and neuroprotection. We performed a comprehensive search of the PubMed, Web of Science, Scopus, and Cochrane databases for randomized controlled trials published from their inception to 2023. Studies were included if they met the following criteria: 1) they were randomized controlled trials; 2) they involved patients with acute ischemic stroke or transient ischemic attack; and 3) they included adult patients with a baseline National Institutes of Health Stroke Scale score of less than 24 and a modified Rankin Scale score of 2 or lower. We excluded animal studies, review articles, and studies for which full texts were not accessible. The quality of the included studies was evaluated via the Cochrane Collaboration tool, and the data were analyzed with Cochrane Review Manager 5.3, utilizing either fixed-effect or random-effects models to evaluate heterogeneity. Ultimately, 11 randomized controlled trials involving 5407 patients (2682 in the remote ischemic conditioning group and 2725 in the control group) were included. The results revealed that remote ischemic conditioning significantly reduced the National Institutes of Health Stroke Scale score at 90 days (MD = –0.75, 95% CI: –1.48, –0.01, P = 0.05) and increased the rate of good functional outcomes (modified Rankin Scale score 0–1) (RR = 1.08, 95% CI: 1.12, 1.15, P = 0.01). Additionally, remote ischemic conditioning significantly decreased the recurrence rate of acute ischemic stroke (RR = 0.79, 95% CI: 0.78, 0.93; P = 0.0003). However, remote ischemic conditioning did not significantly affect the volume of brain infarction. These results suggest that remote ischemic conditioning has significant neuroprotective effects in patients with acute ischemic stroke, improving neurological recovery and reducing stroke recurrence rates. Although the effects on the volume of brain infarction are not significant, remote ischemic conditioning is a safe and straightforward treatment method that provides an effective neuroprotective strategy for patients with acute ischemic stroke, particularly for improving long-term neurological outcomes and preventing stroke recurrence. Future research should further explore the neuroprotective mechanisms of remote ischemic conditioning and optimize treatment protocols to promote nerve repair.

Cerebral ischemia-reperfusion (I/R) injury is a critical condition leading to severe neurological deficits. Inflammation, driven by microglial polarization, plays a significant role in the progression of I/R injury. Gallic acid (GA), a natural polyphenol, has been recognized for its anti-inflammatory and neuroprotective properties. Male mice subjected to middle cerebral artery occlusion (MCAO) were treated with GA. Neurological deficits, infarct size, and brain edema were assessed to evaluate the neuroprotective effects of GA. In vitro, oxygen-glucose deprivation/reoxygenation (OGD/R) models were used to simulate I/R injury in microglial cells. The polarization of microglia was analyzed by flow cytometry, qPCR, and Western blot, focusing on M1 and M2 markers. Autophagy and inflammasome activation were investigated using Western blot, immunofluorescence, and flow cytometry, with the effects of GA modulated by autophagy and inflammasome inhibitors. GA treatment significantly improved neurological outcomes in MCAO mice by reducing infarct size, brain edema, and promoting the M2 polarization of microglia while inhibiting M1 polarization. GA enhanced autophagy and suppressed NLRP3 inflammasome activation via the mTOR pathway, reducing pro-inflammatory cytokine expression. Inhibition of autophagy reversed the protective effects of GA, leading to increased M1 polarization and exacerbated neuroinflammation. Additionally, activation of the NLRP3 inflammasome counteracted GA's effects, emphasizing the role of this pathway in microglial modulation. GA exerts neuroprotective effects in cerebral I/R injury by modulating microglial polarization through the NLRP3/mTOR axis. Its ability to promote autophagy and suppress inflammasome activation positions GA as a potential therapeutic agent for reducing neuroinflammation and improving outcomes in I/R injury.

The association between serum bilirubin levels and clinical outcomes in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) remains elusive, warranting further investigation. This retrospective cohort study encompassed 787 AIS patients who underwent MT between January 2018 and December 2022. Baseline serum levels of direct bilirubin (DBIL), indirect bilirubin (IBIL), and total bilirubin (TBIL) were documented. Adverse clinical outcomes comprised any intracranial hemorrhage (ICH) within 72 h, symptomatic intracranial hemorrhage, stroke-associated pneumonia (SAP), early neurological deterioration, 3-month poor functional outcome, and 3-month mortality. The findings revealed that DBIL and TBIL levels exhibited positive correlations with the incidence of SAP, ICH, and 3-month poor functional outcome. IBIL levels demonstrated a positive association with ICH occurrence. Notably, DBIL tends to exhibite superior predictive value for adverse outcomes compared to IBIL and TBIL. In conclusion, baseline serum bilirubin could as a potential biomarker for adverse clinical outcomes in AIS patients undergoing MT, pending further validation.

Patients with systemic lupus erythematosus (SLE) typically have an increased risk of thrombosis, especially at a younger age. The prognosis of those acute ischemic stroke (AIS) patients due to acute intracranial artery occlusion seems to be favorable; however, with few published reports. We report two cases of AIS that were treated with intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) with a prior diagnosis of SLE and were treated with regular oral corticosteroids before the onset. During the 1-year follow-up, these two patients were able to live normally without experiencing another ischemic stroke or changing medication. SLE-associated strokes necessitate urgent attention, with prompt diagnosis and immediate therapeutic measures, including thrombolytic therapy or MT, being crucial for achieving favorable patient outcomes.

Background Previous studies suggest that it may be inappropriate to determine treatment strategies solely based on the degree of stenosis for patients with intracranial atherosclerotic stenosis (ICAS). In order to better risk stratify patients with ICAS, we developed a novel non-invasive fractional flow (FF) calculation technique based on intracranial angiography (Angio-FF) to assess the hemodynamics for patients with ICAS. This study aims to investigate the difference in FF between symptomatic and asymptomatic patients with ICAS and its potential optimal threshold. Methods A total of 124 patients with ICAS with severe intracranial stenosis who had undergone cerebral angiography were recruited. According to the time of onset, the patients were divided into a symptomatic ICAS group (n=78) and an asymptomatic ICAS group (n=46). The Angio-FF of each group was collected and compared. Receiver-operating characteristic curve (ROC) analysis was performed to assess the discriminative ability of Angio-FF to predict hemodynamics for ICAS. Results Compared with the asymptomatic ICAS group, the symptomatic ICAS group had a significantly lower Angio-FF (0.75 (0.66-0.85) vs 0.85 (0.77-0.89), P<0.001). The optimal cut-off value of Angio-FF for distinguishing symptomatic ICAS from asymptomatic ICAS was 0.785 (sensitivity 71.74%, specificity 57.69%). Conclusions Patients with Angio-FF <0.7853 may be more prone to intracranial ischemic events. Angio-FF of 0.7853 can serve as a boundary for whether patients with ICAS exhibit clinical symptoms.