Abstract Background and aims The cerebroprotective effects of hypothermia via selective intra-arterial cooling infusion (SI-AC) as an adjunct to endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO) are uncertain. Methods We conducted a multicenter, randomized, controlled, and sigle blinded clinical trial conducted at 12 hospitals in China. Patients with anterior circulation LVO-AIS presenting within 24 hours of symptom onset were randomized 1:1 to receive SI-AC plus EVT (SI-AC group) or EVT (control group). The primary outcome was mRS score distribution at 90 days. Results A total of 258 patients were randomized (130 to the SI-AC group and 128 to the control group) . There was no significant difference between the groups in the distribution of mRS scores at 90 days (unadjusted common odds ratio, 1.15; 95% CI, 0.75 to 1.77). Secondary outcomes showed no significant differences in mRS (0-2), mRS (0-1), or early neurologic improvement. For safety outcomes, SI-AC was associated with a significantly lower incidence of intracranial hemorrhage at 24 hours compared to the control group (unadjusted risk ratio, 0.64; 95% CI, 0.43 to 0.95). There was no significant difference in symptomatic intracranial hemorrhage rates (unadjusted risk ratio, 0.82; 95% CI, 0.26 to 2.62) or 90-day mortality (unadjusted risk ratio, 0.93; 95% CI, 0.49 to 1.75). Conclusions SI-AC did not improve functional recovery at 90 days compared to EVT alone, but it reduced the incidence of intracranial hemorrhage. Further research is needed to better understand its role in improving clinical outcomes in AIS patients undergoing EVT. Trial registration: ClinicalTrials.gov (NCT06485427). Conflict of interest Figure 1 - belongs to Conclusions

INTRODUCTION:The cerebroprotective effects of hypothermia via selective intra-arterial cooling infusion (SI-AC) as an adjunct to endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) due to large vessel occlusion (LVO) are uncertain. This trial aimed to determine the efficacy and safety of SI-AC in patients with anterior circulation LVO-AIS undergoing EVT. METHODS:A multicenter, national, investigator-initiated and -conducted, randomized, controlled, and subject- and assessor-blinded superiority clinical trial was conducted at 12 hospitals in China. Patients with anterior circulation LVO-AIS presenting within 24 h of symptom onset are randomized 1:1 to receive SI-AC plus EVT (intervention) or EVT (control) in addition to standard care and be followed up for 90 days. Using a two-sided significance level of 0.05 and assuming a 5% loss of patients at follow-up, we estimate 258 patients provides 80% power to detect a common odds ratio of 1.9 for improved functional recovery, evaluated using the modified Rankin Scale (mRS) at 90 days. The primary outcome is mRS score distribution at 90 days. Secondary outcomes include different cut points on the mRS (0-2 and 0-1) at 90 days, Barthel index scores at 90 days, infarct volume at 7 days, and early neurologic improvement at 24 h. Safety outcomes include the incidence of symptomatic intracranial hemorrhage and any intracranial hemorrhage at 24 h, procedure-related complications, and all-cause mortality at 90 days. CONCLUSION:This trial is designed to evaluate the efficacy and safety of SI-AC as a novel cerebroprotective strategy for patients with anterior circulation LVO-AIS undergoing EVT.

Background: Accurate diagnosis of cerebral amyloid angiopathy (CAA) in surviving patients is indispensable for making treatment decisions and conducting clinical trials. We aimed to evaluate the diagnostic value and clinical utility of the simplified Edinburgh computed tomography (CT) criteria for CAA-related hemorrhage in Chinese patients. Methods: We analyzed 212 patients with lobar hemorrhage who underwent brain CT and magnetic resonance imaging (MRI) from a multicentre cohort. Using the Boston criteria version 2.0 (v2.0) as the gold standard, we assessed the application value of the simplified Edinburgh CT criteria, and investigated whether the Edinburgh CT criteria predict patient outcomes. Results: Patients with probable CAA accounted for 36.6% according to the Boston criteria v2.0. The Edinburgh CT criteria indicated an area under the receiver operating characteristic curves (AUC) of 0.735 for the diagnosis of probable CAA, and it performed better when there was a high-risk threshold of CAA in the decision curve analysis. Patients with a high risk of CAA based on the Edinburgh CT criteria had poorer outcomes at 90-day after adjusting for confounding factors ( p = 0.034). Finger-like projections in the Edinburgh CT criteria were associated with lobar microbleeds, cortical superficial siderosis, and multispot white matter hyperintensity according to the Boston criteria. Conclusions: Taking the Boston criteria v2.0 as the gold standard, the Edinburgh CT criteria demonstrated good diagnostic value and predicted outcomes well at 90-day in Chinese patients with lobar hemorrhage. Further studies with larger sample sizes are required to confirm these findings.

AIMS:With the progress of thrombectomy technology, the vascular recanalization rate of patients with stroke has been continuously improved, but the proportion of futile recanalization (FR) is still quite a few. The long-term prognosis and survival of patients with FR and its influencing factors remain unclear.METHODS:Consecutive patients who received endovascular treatment (EVT) for ischemic stroke were enrolled between 2013 and 2021 from a single-center prospectively registry study. We evaluated the long-term outcome of these patients by Kaplan-Meier survival analysis, and the multivariable logistic regression curve was performed to analyze influencing factors.RESULTS:Among 458 patients with FR, 56.4% of patients survived at 1 year, and 50.4% at 2 years. In the multivariate regression analysis, age, premorbid modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), posterior circulation infarct, general anesthesia, symptomatic intracerebral hemorrhage (sICH), and decompressive craniectomy were found to be related to unfavorable outcomes in long-term. Age, premorbid mRS, NIHSS, general anesthesia, and sICH were predictors of long-term mortality.CONCLUSIONS:Futile recanalization accounts for a large proportion of stroke patients after thrombectomy. This study on the long-term prognosis of such patients is beneficial to the formulation of treatment plans and the prediction of therapeutic effects.

AIMS:The significance of the correlation of computed tomography (CT)-based cerebral small vessel disease (SVD) markers with the clinical outcomes in patients with cerebral amyloid angiopathy (CAA)-related intracerebral hemorrhage (ICH) remains uncertain. Thus, this study aimed to explore the relationship between SVD markers and short-term outcomes of CAA-ICH.METHODS:A total of 183 patients with CAA-ICH admitted to the Xuanwu Hospital, and Beijing Fengtai You'anmen Hospital, from 2014 to 2021 were included. The multivariate logistic regression analysis was performed to identify the correlation between SVD markers based on CT and clinical outcomes at 7-day and 90-day.RESULTS:Of the 183 included patients, 66 (36%) were identified with severe SVD burden. The multivariate analysis showed that the total SVD burden, white matter lesion (WML) grade, and brain atrophy indicator were independent risk factors for unfavorable outcomes at 90-day. The brain atrophy indicator was independently associated with mortality at 90-day. Severe cortical atrophy was significantly associated with early neurological deterioration.CONCLUSIONS:The neuroimaging profiles of SVD based on CT in patients with CAA-ICH might predict the short-term outcome more effectively. Further studies are required to validate these findings and identify modifiable factors for preventing CAA-ICH development.

To investigate the relationship between the initiation time of anticoagulation after endovascular treatment (EVT) and the outcomes in atrial fibrillation (AF)-related acute ischemic stroke (AIS) patients. In this prospective registry study, from March 2013 to June 2022, patients with anterior circulation territories AF-related AIS who underwent EVT within 24 h were included. The primary outcome was favorable [modified Rankin Scale (mRS) 0–1) at ninety days and the secondary outcome was hemorrhage events after anticoagulants. Factors affecting the outcomes were pooled into multivariate regression and ROC curve analysis. Of 234 eligible patients, there were 63 (26.9%) patients achieved a favorable outcome. The symptomatic intracranial hemorrhage (sICH), ICH, and systemic hemorrhage events after anticoagulants occurred in 8 (3.4%), 28 (12.0%), and 39 (16.7%) patients, severally. A longer EVT to anticoagulation time (p = 0.033) was associated with an unfavorable outcome (mRS 3–6). An earlier EVT to anticoagulation time was the independent risk factor of sICH (p = 0.043), ICH (p = 0.005), and systemic hemorrhage (p = 0.005). There was no significant difference in recurrent AIS/ transient ischemic attack (TIA) or mortality among patients who started anticoagulation at ≤ 4 days, ≥ 15 days, or 4 to 15 days. The optimum cut-off for initiating anticoagulants to predict a favorable outcome and hemorrhage events was 4.5 days and 3.5 days after EVT, respectively. In AF-related AIS, the time of EVT to anticoagulation is an independent factor of the functional outcome and hemorrhage events after anticoagulation. The optimal initiate time of anticoagulant after EVT is 4.5 days. NCT03754738.

Background Despite the continuing effort in investigating the preventive therapies for stroke-associated pneumonia (SAP), which is closely associated with unfavorable outcomes, conclusively effective therapy for the prevention of SAP is still lacking. Remote ischemic conditioning (RIC) has been proven to improve the survival in the sepsis model and inflammatory responses have been indicated as important mechanisms involved in the multi-organ protection effect of RIC. This study aimed to assess the safety and the preliminary efficacy of RIC in the prevention of SAP in patients with acute ischemic stroke. Methods We performed a proof-of-concept, pilot open-label randomized controlled trial. Eligible patients (age > 18 years) within 48 h after stroke onset between March 2019 and October 2019 with acute ischemic stroke were randomly allocated (1:1) to the RIC group and the control group. All participants received standard medical therapy. Patients in the RIC group underwent RIC twice daily for 6 consecutive days. The safety outcome included any adverse events associated with RIC procedures. The efficacy outcome included the incidence of SAP, changes of immunological profiles including mHLA-DR, TLR-2, and TLR-4 as well as other plasma parameters from routine blood tests. Results In total, 46 patients aged 63.1 ± 12.5 years, were recruited (23 in each group). Overall, 19 patients in the RIC group and 22 patients in the control group completed this study. No severe adverse event was attributed to RIC procedures. The incidence of SAP was lower in the remote ischemic conditioning group (2 patients [10.5%]) than that in the control group (6 patients [27.3%]), but no significant difference was detected in both univariate and multivariate analysis ( p = 0.249 and adjusted p = 0.666). No significance has been found in this pilot trial in the level of immunological profiles HLA-DR, TLR4 and TLR2 expressed on monocytes as well as blood parameters tested through routine blood tests between the two groups ( p > 0.05). The IL-6 and IL-1β levels at day 5 after admission in the RIC group were lower than those in the control group ( p < 0.05). Interpretation This proof-of-concept pilot randomized controlled trial was to investigate RIC as a prevention method for SAP. Remote ischemic conditioning is safe in the prevention of SAP in patients with acute ischemic stroke. The preventive effect of RIC on SAP should be further validated in future studies.

OBJECT:The long-term functional outcome of cerebral amyloid angiopathy-related hemorrhage (CAAH) patients is unclear. We sought to assess the long-term functional outcome of CAAH and determine the prognostic factors associated with unfavorable outcomes. METHODS:We enrolled consecutive CAAH patients from 2014 to 2020 in this observational study. Baseline characteristics and clinical outcomes were presented. Multivariable logistic regression analysis was performed to identify the prognostic factors associated with long-term outcome. RESULTS:Among the 141 CAAH patients, 76 (53.9%) achieved favorable outcomes and 28 (19.9%) of them died at 1-year follow-up. For the longer-term follow-up with a median observation time of 19.0 (interquartile range, 12.0-26.5) months, 71 (50.4%) patients obtained favorable outcomes while 33 (23.4%) died. GCS on admission (OR, 0.109; 95% CI, 0.021-0.556; p = 0.008), recurrence of ICH (OR, 2923.687; 95% CI, 6.282-1360730.14; p = 0.011), WML grade 3-4 (OR, 31.007; 95% CI, 1.041-923.573; p = 0.047), severe central atrophy (OR, 4220.303; 95% CI, 9.135-1949674.84; p = 0.008) assessed by CT was identified as independent predictors for long-term outcome. INTERPRETATION:Nearly 50% of CAAH patients achieved favorable outcomes at long-term follow-up. GCS, recurrence of ICH, WML grade and cerebral atrophy were identified as independent prognostic factors of long-term outcome.

BACKGROUND:Postinterventional sedation is commonly used in clinical practice to ensure patient safety and comfort. Although sedation or anesthesia during thrombectomy has been well studied, the association between postinterventional sedation and functional outcomes in endovascularly treated patients with acute ischemic stroke (AIS) has yet to be investigated. We describe the association between postinterventional sedation and functional outcomes in patients with AIS treated with endovascular therapy (EVT). METHODS:This observational study was based on a prospective registry. Patients with AIS treated with EVT from January 2013 to August 2017 at Xuanwu Hospital, Capital Medical University were included. Patients receiving postinterventional sedation were compared with patients not receiving sedation. The primary outcome was the 3 months modified Rankin Scale score. RESULTS:A total of 268 patients were eligible for study: 112 patients (41.8%) receiving postinterventional sedation and 156 patients (58.2%) without sedation. At 3 months follow-up, the median modified Rankin Scale score was 4 (interquartile range, 3-6) in the sedation group and 2 (interquartile range, 1-4) in the nonsedation group (P < 0.001). Multivariable regression analysis suggested that the need for postinterventional sedation was associated with unfavorable outcomes, with an odds ratio of 0.20 for functional independence (95% confidence interval [CI], 0.078-0.487; P < 0.001), 0.06 for freedom from disability (95% CI, 0.017-0.228; P < 0.001), and 8.37 for death (95% CI, 2.196-31.889; P = 0.002). CONCLUSIONS:Postinterventional sedation worsens functional outcomes in patients with AIS with large-vessel occlusions treated with EVT. Whether the sedation is a causative factor or a surrogate for poor functional outcomes remains to be determined.

BACKGROUND:Asymptomatic intracerebral hemorrhage (AICH) is a common phenomenon in patients with acute ischemic stroke (AIS) who were treated with endovascular thrombectomy (ET). This study aimed to evaluate the clinical effects of AICH and its risk factors in this patient population.METHODS:This observational study was based on a prospective registry study. AIS patients with large-vessel occlusion in the anterior circulation and treated with ET were recruited. During thrombectomy procedures, intra-arterial infusion of thrombolytics or antiplatelet and permanent stenting were used as remedial therapies. The primary outcome was the overall distribution of modified Rankin scale (mRS) 90 days after ET.RESULTS:This study included 102 patients (61.1 ± 12.7 years old), in whom 39 patients (38.2%) experienced AICH. At 90-day follow-up, the median mRS was 2 (interquartile range [IQR] 0-3) for patients without AICH and 4 (IQR 2-6) for those with AICH (adjusted P = .005). Fourteen patients with AICH and 7 patients without AICH died, which was significantly different (35.9% versus 11.1%, adjusted P = .015). Thirty-nine patients (61.9%) without AICH and 14 patients (35.9%) with AICH achieved functional independence at 3-month follow-up (adjusted P = .117). The length of intensive care unit staying was 5 days (IQR 2-10) in patients without AICH and 8 days (IQR 3-19) in those with AICH (adjusted P = .840). In multivariate analysis, lower Alberta Stroke Program Early CT Score (ASPECTS) (adjusted P = .003) and adjunctively intra-arterial thrombolysis (adjusted P = .016) were independently associated with AICH.CONCLUSIONS:In AIS patients treated with ET AICH appears to be associated with worse functional outcomes and high mortality. Lower ASPECTS and adjectively intra-arterial thrombolysis were independent risk factors of AICH.

Objective:To investigate the feasibility and safety of remote ischemic postconditioning (RIPC) in acute ischemic stroke patients after intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis (IVT).Methods:We performed a pilot randomized trial involving acute ischemic stroke patients with IVT. The patients were randomized 1:1 to receive RIPC or standard medical therapy. In the RIPC group, the participants underwent instant RIPC within 2 h of IVT, followed by repeated RIPC therapy for 7 days. The feasibility end point was the completion of RIPC and time from the first RIPC to finishing IVT in the RIPC group. The safety end point included tissue and neurovascular injury resulting from RIPC, changes in vital signs, level of plasma myoglobin, any hemorrhagic transformation, and other adverse events.Results:Thirty patients (15 RIPC and 15 Control) were recruited after IVT. The mean age was 65.7 ± 10.2 years, with a National Institutes of Health Stroke Scale (NIHSS) score of 6.5 (4.0-10.0). The completion rate for RIPC was 97.0%. The mean time from first RIPC to completing IVT was 66.0 (25.0-75.0) min in the RIPC group. One case of hemorrhagic transformation was observed in the RIPC group. No significant difference was found in the level of myoglobin between the two groups (P > 0.05).Interpretation:RIPC is effective and safe for AIS patients after intravenous rt-PA thrombolysis.

Hypothermia is considered as a promising neuroprotective treatment for ischemic stroke but with many limitations. To expand its clinical relevance, this study evaluated the combination of physical (ice pad) and pharmacological [transient receptor potential vanilloid channel 1 (TRPV1) receptor agonist, dihydrocapsaicin (DHC)] approaches for faster cooling and stronger neuroprotection. A total of 144 male Sprague Dawley rats were randomized to 7 groups: sham (n=16), stroke only (n=24), stroke with physical hypothermia at 31ºC for 3 h after the onset of reperfusion (n=24), high-dose DHC (H-DHC)(1.5 mg/kg, n=24), low-dose DHC (L-DHC)(0.5 mg/kg, n=32) with (n=8) or without (n=24) external body temperature control at ~38 ºC (L-DHC, 38 ºC), and combination therapy (L-DHC+ ice pad, n=24). Rats were subjected to middle cerebral artery occlusion (MCAO) for 2 h. Infarct volume, neurological deficits and apoptotic cell death were determined at 24 h after reperfusion. Expression of pro- and anti-apoptotic proteins was evaluated by Western blot. ATP and reactive oxygen species (ROS) were detected by biochemical assays at 6 and 24 h after reperfusion. Combination therapy of L-DHC and ice pad significantly improved every measured outcome compared to monotherapies. Combination therapy achieved hypothermia faster by 28.6% than ice pad, 350% than L-DHC and 200% than H-DHC alone. Combination therapy reduced (p<0.05) neurological deficits by 63% vs. 26% with L-DHC. No effect was observed when using ice pad or H-DHC alone. L-DHC and ice pad combination improved brain oxidative metabolism by reducing (p<0.05) ROS at 6 and 24 h after reperfusion and increasing ATP levels by 42.9% compared to 25% elevation with L-DHC alone. Finally, combination therapy decreased apoptotic cell death by 48.5% vs. 24.9% with L-DHC, associated with increased anti-apoptotic protein and reduced pro-apoptotic protein levels (p<0.001). Our study has demonstrated that combining physical and pharmacological hypothermia is a promising therapeutic approach in ischemic stroke, and warrants further translational investigations.

Introduction: Asymptomatic hemorrhagic transformation (AHT) is a common complication in acute ischemic stroke (AIS) patients treated with endovascular therapy. However, whether AHT has impact on the functional outcome of this patient’s populations is unclear, especially in patients treated with endovascular thrombectomy (ET). In this study, we aim to evaluate the influence of AHT on the functional outcome of AIS patients treated with ET. Methods: This observational study based on a prospective registry study. AIS patients with anterior circulation large artery occlusion and underwent ET with second-generation stent retrievers (i.e., Solitaire FR and Trevo) were recruited. AHT was diagnosed by CT according to the Heidelberg Bleeding Clarification. Head CT was performed 12-24 hours and 5-7 days post-treatment. The primary outcome was functional outcome at 3 months post-treatment assessed by modified Rankin Scale (mRS). Results: One hundred and two consecutive AIS patients (aged 61.1 years old) were recruited. 39 patients (38.2%) had AHT on post-treatment CT. Patients with AHT were more likely to receive post-procedures sedation (69.2% vs. 23.8%, p <0.001). Less patients with AHT achieved favorable outcome (mRS<3) at 3 months follow up (35.9% vs. 61.9%, p =0.011). Compared with 7 of 63 subjects (11.1%) died in no AHT group, 14 of 39 subjects (35.9%) died in AHT group, which was significantly higher ( p =0.003). The median length of follow-up was 19 (IQR 3.5-32) months. In long-term follow up, less patients with AHT achieved favorable outcome (30.8% vs. 66.7%, p <0.001). 15 of 26 subjects (57.7%) died in AHT group, as compared with 8 of 50 subjects (16.0%) died in no AHT group, which was significant higher ( p <0.001). On multivariate analysis, AHT was an independent predictor for both short- and long-term functional outcome and mortality. Conclusions: In AIS patients undergoing ET with second-generation stent retrievers, AHT is associated with increased risk of poor outcome.

OBJECTIVE:Remote ischemic conditioning (RIC) has been demonstrated to be safe and feasible for patients with acute ischemic stroke (AIS), as well as for those receiving intravenous thrombolysis. We assessed the safety and feasibility of RIC for AIS patients undergoing endovascular treatment (ET).METHODS:We conducted a pilot study with patients with AIS who were suspected of having an emergent large-vessel occlusion in the anterior circulation and who were scheduled for ET within 6 hours of ictus. Four cycles of RIC were performed before recanalization, immediately following recanalization, and once daily for the subsequent 7 days. The primary outcome was any serious RIC-related adverse events.RESULTS:Twenty subjects, aged 66.1 ± 12.1 years, were recruited. No subject experienced serious RIC-related adverse events. The intracranial pressure, cranial perfusion pressure, mean arterial pressure, heart rate, middle cerebral artery peak systolic flow velocity, and pulsatility index did not change significantly before, during, or after the limb ischemia (P > 0.1 for all). Of 80 cycles, 71 (89%) were completed before recanalization and 80 (100%) were completed immediately after recanalization; 444 of 560 cycles (78%) were completed within 7 days posttreatment. No patients had to stop RIC because it affected routine clinical managements. Six subjects (30%) experienced intracerebral hemorrhage, which was symptomatic in one case (5%). At the 3-month follow-up, 11 subjects (55%) had achieved functional independence, and two subjects (10%) died.INTERPRETATION:RIC appears to be safe and feasible for patients with AIS undergoing ET. Investigations are urgently needed to determine the efficacy of RIC in this patient population.

Endothelial injury is inevitable after Endovascular thrombectomy (ET) in acute ischemic stroke, which may lead to early re-occlusion and attenuate the beneficial effects of ET. Tirofiban, a Glycoprotein(GP) IIb/IIIa antagonist, is often used to prevent local platelet aggregation and early re-occlusion. However, its effectiveness in preventing early re-occlusion is still unknown. Here, we investigate the efficacy of tirofiban in preventing early re-occlusion after ET. This observational study was based on a registry study. AIS patients treated with ET were recruited if they met one of the following criteria: treated with permanent intracranial stenting, balloon angioplasty, or >3 passes with retriever during thrombectomy. If used, a low dose bolus tirofiban (0.25 to 0.5 mg) was administrated intraarterially, followed by intravenous tirofiban continuously at a rate of 0.2 to 0.25 mg/h for 12 to 24 hours. Re-occlusion was defined as an in-situ re-thrombosis assessed by TCD and/or CTA within 7 days after ET. The primary outcome was the incidence of early re-occlusion within 7 days post-treatment. Eight one subjects (aged 60.6±12.2 years old) were included. There were 48 subjects treated with tirofiban and 33 subjects not treated with tirofiban. The median NIHSS at admission was 18 (12.5-25.5). Compared with 3 subjects (9.1%) treated without tirofiban, 4 subjects (8.0%) treated with tirofiban experience re-occlusion ( p =0.905). In Multivariate logistic regression analysis, tirofiban was also not associated with early re-occlusion ( p >0.05). 15 subjects (31.3%) experienced ICH in tirofiban group, compared with 13 (39.4%) in non-tirofiban group ( p =0.449). For sICH, 2 subjects (4.2%) from the tirofiban group versus 6 (18.2%) subjects from the tirofiban group ( p =0.089). At 3 months follow-up, compared with subjects treated without tirofiban, more subjects treated with tirofiban achieved independent walking ability (mRS 0-3) (18.2% vs. 2.0%, P =0.033). For a long term follow-up with a median time of 16 (2.5-28.0) months, no significant differences were found between two groups ( p >0.05). In conclusion, adjunct tirofiban in AIS patients treated with ET may not prevent early re-occlusion. But it may improve the functional outcome at 3 months after ET.

Introduction: In real world practice, patients with minor stroke symptoms are still treated with thrombolytic therapy and majority of them recover with favorable outcomes at 90 days, but there is room to identify avenues to further enhance their outcomes. We aimed to investigate the risk factors associated with the unfavorable outcome at 90 days after thrombolysis for acute minor ischemic stroke (AMIS). Methods: 152 consecutive patients presented with AMIS (NIHSS ≤3) and received intravenous alteplase between December 2012 and February 2017. Baseline clinic-demographic, characteristics and laboratory tests were recorded. Unfavorable outcome was defined as modified Rankin Scale (mRS) of 2-6 at 90 days. Univariate analysis followed by multivariate analysis was used to identify risk factors for unfavorable outcome. A receiver operating characteristic curve was used to evaluate the predictive value. Results: 113 out of 152 patients (74%) were included in the final analysis, age 59 (53-67), 72.6% men. 32 patients (28.3%) experienced unfavorable outcomes. After adjusting for covariates, only serum glucose level on admission remained an independent factor for unfavorable outcome (OR 1.43, 95% CI: 1.10-2.72, p =0.014), with a 0.617 predictive value for the unfavorable outcome. Conclusions: About 28% of patients with AMIS in this cohort had an unfavorable outcome at 3 months after thrombolysis. Addressing higher serum glucose level on admission may be a viable therapeutic strategy to improve prognoses in these patients.

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Background and Purpose— Chinese patients largely experience acute ischemic stroke (AIS) because of large artery atherosclerosis rather than cardioembolism, and whether tirofiban is safe and effective in these patients treated with endovascular thrombectomy (ET) is unknown. This study evaluated the safety and efficacy of tirofiban in Chinese patients with AIS treated with ET. Methods— This observational study is based on a single-center prospective registry study. Patients with AIS undergoing ET with second-generation stent retrievers from January 2013 to February 2017 were treated with ET alone or ET plus low dose of tirofiban. The primary outcome was symptomatic intracerebral hemorrhage (sICH). The secondary outcomes included rate of early reocclusion, any ICH, fatal ICH, and 3-month and long-term functional outcomes. Results— One hundred eighty AIS subjects were included in the analysis, including 90 subjects treated with tirofiban and 90 subjects without tirofiban. Sixty-three subjects (35%) had any ICH, 19 of them (11%) were sICH, and 9 of them (5%) were fatal ICH. Ten subjects (11%) treated with tirofiban experienced sICH and 9 subjects (10%) not given tirofiban experienced sICH, not a significant difference ( P =0.808). Early reocclusion happened in 4 of 90 subjects (4.4%) treated with tirofiban and 8 of 90 subjects (8.9%) not treated with tirofiban ( P =0.370). One hundred sixty-one subjects (89%) completed long-term follow-up, subjects treated tirofiban were associated with lower odds of death (23% versus 44%, P =0.005) when compared with those who were not treated. Additionally, tirofiban was associated with better odds of long-term functional independence (adjusted odds ratio, 4.37; 95% confidence interval, 1.13–16.97; P =0.033). Conclusions— In patients with AIS undergoing ET, tirofiban is not associated with higher sICH, it seems to lead to lower odds of deaths and better odds of long-term functional independence. Further investigations are needed to determine the efficacy of tirofiban in preventing early reocclusion, the underlying mechanisms, and its optimal treatment protocol.

Background: The management of blood pressure (BP) for acute ischemic stroke (AIS) patients undergoing thrombolysis is still under debate. The purpose of this study was (1) to explore the association between post-thrombolysis BP and functional outcome and (2) to examine whether post-thrombolysis BP can predict functional outcome in Chinese AIS patients undergoing thrombolysis therapy. Methods: From December 2012 to November 2016, AIS patients undergoing thrombolysis were reviewed retrospectively in the Department of Neurology at Xuanwu Hospital. The BP levels were measured before and immediately after thrombolysis. Clinical outcomes, which comprised favorable outcome (modified Rankin Scale score 0-2) and unfavorable outcome (modified Rankin Scale score 3-6) at 3 months, were analyzed by logistic regression model. A receiver operating characteristic curve was used to evaluate the predictive value of post-thrombolysis BP. Results: Patients with unfavorable outcome at 3 months had a higher post-thrombolysis systolic BP than those with favorable outcome (P = .015). Multivariate analysis showed that post-thrombolysis systolic BP below 159.5 mm Hg was associated with favorable outcome. According to the receiver operating characteristic curve, post-thrombolysis systolic BP was a predictor of functional outcome with an area under the curve of .573 (95% confidence interval = .504-.642). Conclusions: Our study indicated that post-thrombolysis systolic BP is a predictor of functional outcome for Chinese AIS patients undergoing thrombolysis therapy. It is reasonable for AIS patients to keep post-thrombolysis systolic BP below 159.5 mm Hg to obtain a favorable outcome.

急性缺血性卒中( acute ischemic stroke,AIS)为血管闭塞后脑组织供血障碍而发生缺血坏死所导致的一大类疾病. 1995 年至2015 年,静脉溶栓是唯一被证实有效的AIS血管再通治疗措施,但静脉溶栓存在治疗时间窗短、禁忌证多、出血风险大、对大动脉闭塞的开通效果差等缺点. 2015 年以来,随着"五大试验"(即MR CLEAN、EXTEND IA、ESCAPE、SWIFT PRIME及REVASCAT )结果的公布,血管内治疗对AIS的治疗效果首次得到肯定,能显著提高血管再通率并改善患者预后[1-6].