OBJECTIVE: To investigate the association between intracranial hemorrhage (ICH) and preoperative levels of neutrophils and low-density lipoprotein-cholesterol (LDL-C) in acute ischemic stroke (AIS) patients following endovascular thrombectomy (EVT), and to assess the predictive value of preoperative levels of neutrophils and LDL-C.
METHODS: A retrospective analysis was performed on the clinical records of patients diagnosed with AIS who underwent EVT at Nanchong Central Hospital between 2019 and 2023. Multivariate regression analysis was employed to examine the association of preoperative levels of neutrophils and LDL-C with the occurrence of ICH. Furthermore, a receiver operating characteristic curve was constructed to assess the predictive efficacy of these parameters.
RESULTS: A total of 300 patients with a mean age of 68.0 years (standard deviation, 11.1 years) and a median baseline National Institutes of Health Stroke scale (NIHSS) score of 15.5 (interquartile range, 12.0-19.75) were identified in this cohort. Of these, 28 (9.3%) patients experienced ICH. Multivariate regression analysis revealed that elevated preoperative neutrophil (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.10-1.38, P < 0.001) and LDL-C (OR 2.64, 95% CI 1.52-4.58, P < 0.001) levels were independently associated with ICH. The combined indicator demonstrated a higher area under the curve (AUC 0.759, 95% CI 0.654-0.865) compared with preoperative neutrophil (AUC 0.647, 95% CI 0.532-0.763) and LDL-C (AUC 0.711, 95% CI 0.607-0.814) levels individually.The specificity and sensitivity of the combined indicator were 67.9% and 83.1%, respectively.
CONCLUSIONS: Preoperative levels of neutrophils and LDL-C may serve as predictive indicators for ICH in patients with AIS who have undergone EVT; moreover, the combination of preoperative neutrophil and LDL-C levels demonstrates enhanced predictive efficacy.

UNASSIGNED: The clinical impact of patient selection using FLAIR vascular hyperintensity (FVH)-diffusion-weighted imaging (DWI) mismatch for endovascular thrombectomy (EVT) in patients who have been symptomatic for over 6 h remains unclear. Herein, a retrospective study was conducted to compare the inter-rater reliability and clinical outcomes of patients selected for thrombectomy based on FVH-DWI mismatch with perfusion.
UNASSIGNED: Patients with anterior-circulation large-vessel occlusion selected simultaneously with MRI and perfusion imaging in the late time window from a single-center retrospective study were categorized into EVT-applicable (FVH-DWI mismatch on MRI or perfusion imaging meeting the DEFUSE3 standards) and EVT-inapplicable groups based on MRI and perfusion imaging. The primary outcome was the 90-day functional independence rate. Safety outcomes encompassed symptomatic intracranial hemorrhage and mortality in 90 days. We assessed the consistency of the two profiles and compared the differences in functional independence rates of EVT patients among the EVT-applicable groups determined by MRI and perfusion.
UNASSIGNED: A total of 130 patients were enrolled, of which 114 were classified into the EVT-applicable group after triaging using MRI images. In this group, 96 patients underwent EVT, with 53 of them (55.2%) achieving functional independence. A total of 110 patients were divided into EVT-applicable group based on perfusion, among which 92 underwent EVT, with 49 of them (53.2%) achieving functional independence. The consistency of identifying EVT indication was moderate between two groups (κ = 0.42, 95% CI, 0.17-0.67). The functional independence rate was comparable between patients in the two EVT-applicable groups based on the two methods (55.2% vs. 53.2%, p = 0.789).
UNASSIGNED: MRI triaging based on FVH-DWI mismatch showed moderate inter-rater reliability compared with perfusion-based triage and comparable efficacy in predicting clinical outcomes after EVT.

BACKGROUND: The ideal blood pressure (BP) target in patients who undergo endovascular thrombectomy (EVT) with successful reperfusion is uncertain. Observational studies show that elevated BP during this period is associated with a higher risk of intracranial hemorrhage (ICH) and worse clinical outcomes. Several randomized controlled trials (RCTs) have explored whether intensive BP lowering improves clinical outcomes in these patients.
OBJECTIVE: This review aims to summarize the recent RCTs that compare intensive and conventional BP management strategies following EVT and discuss the innovative directions to improve.
RESULTS: The recently published RCTs failed to demonstrate the benefit of intensive BP control on the functional outcome and decreasing the risk of ICH. The complex mechanism in cerebral blood flow regulation and the inappropriate BP range chosen in RCTs may be the reasons behind the inconsistent results between observational studies and RCTs. Individualized BP management, reducing BP variability, and multi-stage BP management should be paid more attention in future exploration.
CONCLUSIONS: Intensive BP target did not improve clinical outcomes after successful EVT as compared with a conventional BP target. Further research is required to identify the optimal BP management strategy after reperfusion.

BACKGROUND: Symtomatic hemorrhagic transformation(sHT) was defined as any intracerebral hemorrhage that combined with clinical deterioration. While recent studies showed low rates of sHT in large core ischemic strokes treated with endovascular thrombectomy (EVT), the specific impact of core size on overall hemorrhagic transformation (HT) remains unclear. We aim to investigate the relationship between ischemic core size and development of HT post thrombectomy.
METHODS: This prospective study enrolled acute ischemic stroke (AIS) patients with anterior large vessel occlusion undergoing EVT who had baseline MRI from 2017-2019. Pre-EVT Arterial Spin Labeling (ASL) and Diffusion-Weighted Imaging (DWI) scans were performed for volume calculations. Primary outcome was HT assessed within 72 hours post EVT. Multivariable logistic regression was used to analyze the associations between baseline DWI and ASL volumes and HT occurrence. Discriminative ability for HT was compared using receiver operating curve analysis (c-statistic).
RESULTS: We included 101 patients (median age: 64 [IQR 56-74] years, baseline NIHSS 13 [IQR 9-16]). Median DWI and ASL volume were 21.0 ml [IQR 8.3-47.2] and 105ml [59.5-172.9], respectively. 36.8% recieved intravenous thrombolysis before EVT. HT occurred in 36.6% of patients, including 16.8% with sHT. Baseline DWI volume was independently associated with HT (OR=1.030, 95% CI 1.008 to 1.053, P=0.009), while ASL volume wasn\'t statistically significant(P=0.330). The DWI model was superior to ASL model in predicting HT within 72 hours (c-statistic, 0.787).Neither DWI (P=0.149) nor ASL volume (P=0.834) effectively indicated sHT.
CONCLUSIONS: DWI-based ischemic core volume correlates significantly with HT within 72 hours post successful thrombectomy. This highlights the potential clinical utility of DWI in guiding treatment decisions for this population.

OBJECTIVE: The aim of this study is to investigate the efficacy and safety of preoperative versus intraoperative tirofiban in patients with large vessel occlusion (LVO) due to large artery atherosclerosis (LAA).
METHODS: This is a retrospective multicenter cohort study based on the RESCUE-RE (Registration Study for Critical Care of Acute Ischemic Stroke After Recanalization) trial enrolling patients with anterior circulation LVO classified as LAA within 24 h of onset. Patients were divided into three groups: preoperative tirofiban (PT), intraoperative tirofiban (IT), and no tirofiban (NT). Propensity score matching (PSM) was used to balance baseline characteristics. The efficacy outcomes included 90-day functional independence (modified Rankin Scale score = 0-2) and early partial recanalization (EPR; defined as a modified Thrombolysis in Cerebral Infarction score = 1-2a). The safety outcomes included symptomatic intracranial hemorrhage (sICH).
RESULTS: A total of 104 matched triplets were obtained through PSM. Compared with NT, PT increased 90-day functional independence (60.8% vs. 42.3%, p = 0.008) and EPR (42.7% vs. 18.3%, p < 0.001) rate, with a tendency to increase the asymptomatic intracranial hemorrhage (aICH) proportion (28.8% vs. 18.3%, p = 0.072). Compared with IT, PT had a higher 90-day functional independence (60.8% vs. 45.2%, p = 0.025) and EPR (42.7% vs. 20.2%, p = 0.001) rate, with no significant difference in sICH (14.4% vs. 7.7%, p = 0.122) and aICH (28.8% vs. 21.2%, p = 0.200). Compared with NT, IT had a lower 90-day mortality rate (9.6% vs. 24.0%, p = 0.005).
CONCLUSIONS: Tirofiban shows good adjuvant therapy potential in acute ischemic stroke-LVO due to LAA patients. PT is associated with higher rates of EPR and better therapeutic efficacy. In addition, EPR may be a potential way to improve prognosis.

UNASSIGNED: The endovascular thrombectomy procedure has become an established standard of care in clinical practice for the management of acute ischemic stroke. However, the anesthesia modality on endovascular thrombectomy remains controversial. The aim of this meta-analysis was to investigate the impact of general anesthesia compared to sedation on immediate and 3-month neurological outcomes in patients undergoing endovascular thrombectomy.
UNASSIGNED: PubMed, Scopus, and Embase databases were systematically searched to identify randomized controlled trials (RCTs) comparing general anesthesia with sedation in patients undergoing endovascular thrombectomy. The primary outcomes assessed were immediate and 3-month neurological function as well as the rate of successful recanalization. Additionally, secondary outcomes included pulmonary infection and symptomatic intracerebral hemorrhage.
UNASSIGNED: The analysis included eight randomized controlled trials with a total of 1352 patients (General Anesthesia group,N = 609; Sedation group,N = 743) for endovascular thrombectomy. Pooled data revealed that general anesthesia achieved successful reperfusion in 84.3 %, whereas the sedation group had a rate of 70.7 % (RR = 1.77, 95 % CI 1.33 to 2.35, P < 0.0001). Furthermore, Trial Sequential Analysis (TSA) confirmed the significant impact of general anesthesia on achieving successful reperfusion. The meta-analyses found no differences in the rates of favorable cerebral outcome, as evaluated by the National Institutes of Health Stroke Scale (NIHSS) at 24-48 h and the modified Rankin Scale (mRS) at 3 months, between the general anesthesia (GA) and sedation groups. However, The incidence of pulmonary infection was significantly higher in the GA group compared to the sedation group (RR = 1.86, 95 % CI 1.07 to 3.23; P = 0.03). The incidence of symptomatic intracranial hemorrhage did not differ between the groups receiving general anesthesia and sedation.
UNASSIGNED: General anesthesia enhances the efficacy of recanalization without no improvement in cerebral function, while concurrently increasing the susceptibility to pulmonary infection among patients undergoing endovascular thrombectomy for acute ischemic stroke.

A recent study by Brian Mac Grory and colleagues investigated the safety of endovascular thrombectomy (EVT) among patients under vitamin K antagonists (VKAs) use within 7 days prior to hospital admission. Through this retrospective, observational cohort study, they found prior VKA use did not increase the risk of symptomatic intracranial hemorrhage (sICH) overall. However, recent VKA use with a presenting international normalized ratio (INR) > 1.7 was associated with a significantly increased risk of sICH. Future large-scale randomized controlled trials should be conducted to further clarify the effects and feasibility of EVT therapy in ischemic stroke patients under anticoagulation.

OBJECTIVE: The aim of this study was to investigate the factors influencing good outcomes in patients receiving only intravenous tirofiban with endovascular thrombectomy for large vessel occlusion stroke.
METHODS: Post hoc exploratory analysis using the RESCUE BT trial identified consecutive patients who received intravenous tirofiban with endovascular thrombectomy for large vessel occlusion stroke in 55 comprehensive stroke centers from October 2018 to January 2022 in China.
RESULTS: A total of 521 patients received intravenous tirofiban, 253 of whom achieved a good 90-day outcome (modified Rankin Scale [mRS] 0-2). Younger age (adjusted odds ratio [aOR]: 0.965, 95% confidence interval [CI]: 0.947-0.982; p < 0.001), lower serum glucose (aOR: 0.865, 95%CI: 0.807-0.928; p < 0.001), lower baseline National Institutes of Health Stroke Scale (NIHSS) score (aOR: 0.907, 95%CI: 0.869-0.947; p < 0.001), fewer total passes (aOR: 0.791, 95%CI: 0.665-0.939; p = 0.008), shorter punctures to recanalization time (aOR: 0.995, 95%CI:0.991-0.999; p = 0.017), and modified Thrombolysis in Cerebral Infarction (mTICI) score 2b to 3 (aOR: 8.330, 95%CI: 2.705-25.653; p < 0.001) were independent predictors of good outcomes after intravenous tirofiban with endovascular thrombectomy for large vessel occlusion stroke.
CONCLUSIONS: Younger age, lower serum glucose level, lower baseline NIHSS score, fewer total passes, shorter punctures to recanalization time, and mTICI scores of 2b to 3 were independent predictors of good outcomes after intravenous tirofiban with endovascular thrombectomy for large vessel occlusion stroke.
UNASSIGNED: ChiCTR-IOR-17014167.

UNASSIGNED: The interaction between the renin-angiotensin system (RAS) and the acute ischemic stroke (AIS) is definite but not fully understood. This study aimed to analyze the risk factors of AIS and explore the role of serum indicators such as angiotensin I (Ang I) in the prognosis of patients undergoing endovascular thrombectomy (EVT).
UNASSIGNED: Patients with AIS who underwent EVT and healthy controls were retrospectively enrolled in this study, and the patients were divided into a good or a poor prognosis group. We compared Ang I, blood routine indexes, biochemical indexes, electrolyte indexes, and coagulation indexes between patients and controls. We used univariate and multivariate logistic regression analyses to evaluate possible risk factors for AIS and the prognosis of patients undergoing EVT. Independent risk factors for the prognosis of patients undergoing EVT were identified through multifactorial logistic regression analyses to construct diagnostic nomograms, further assessed by receiver operating characteristic curves (ROC).
UNASSIGNED: Consistent with previous studies, advanced age, high blood glucose, high D-dimer, and high prothrombin activity are risk factors for AIS. In addition, Ang I levels are lower in AIS compared to the controls. The level of Ang I was higher in the good prognosis group. Furthermore, we developed a nomogram to evaluate its ability to predict the prognosis of AIS after EVT. The AUC value of the combined ROC model (Ang I and albumin-globulin ratio (AGR)) was 0.859.
UNASSIGNED: In conclusion, advanced age, high blood glucose, high D-dimer, and high prothrombin activity are risk factors for AIS. The combined Ang I and AGR model has a good predictive ability for the prognosis of AIS patients undergoing arterial thrombectomy.

OBJECTIVE: The efficacy of endovascular thrombectomy in patients with posterior circulation ischemic stroke remains controversial. Early neurological deterioration (END) as an important predictor of poor outcome is poorly understood, except in cases of symptomatic intracranial hemorrhage, recanalization failure, and malignant cerebral edema. The objective of this study was to assess predictors of unexplained END (UnEND) after endovascular thrombectomy.
METHODS: The BASILAR study is a multicenter prospective observational study in which 647 patients with vertebrobasilar occlusion on imaging within 24 hours of stroke onset and who underwent endovascular treatment were enrolled, of whom 477 who had undergone successful recanalization were included in this study. Multivariate analysis was used to identify the predictors of UnEND, defined as a ≥ 4-point increase in National Institutes of Health Stroke Scale (NIHSS) score at 24 hours after endovascular thrombectomy.
RESULTS: Among the 477 eligible patients included, UnEND occurred in 86 (18%) patients. The predictors of UnEND were stress hyperglycemic ratio (SHR) (OR 2.2, 95% CI 1.1-4.6; p = 0.031), baseline NIHSS score (OR 0.9, 95% CI 0.83-0.95; p = 0.001), and asymptomatic intracerebral hemorrhage (aICH) (OR 5.9, 95% CI 1.7-20.0; p = 0.004). The occurrence rate of a favorable outcome, defined as a modified Rankin Scale score of 0-3 at 90 days, was lower in the UnEND group (5.8% vs 47.6%, p < 0.001) compared with the group without END, and the UnEND group had higher mortality at 90 days (66.3% vs 27.4%, p < 0.001).
CONCLUSIONS: UnEND may be associated with poor outcome after endovascular thrombectomy in patients with acute vertebrobasilar occlusion. Some modifiable factors such as SHR and aICH could be targeted to improve the efficacy of endovascular thrombectomy.