BACKGROUND: Morbidity remains high among patients who undergo successful mechanical thrombectomy (MT) for anterior circulation large vessel occlusion (LVO). Stress hyperglycemia worsens the prognosis after acute ischemic stroke (AIS), but aggressively treating hyperglycemia does not improve the outcome. There is no consensus on how to best manage glycemia after AIS. Glycemic variability (GV) reflects glycemic fluctuations over time and could be the culprit. We aimed to elucidate how GV impacts outcome of AIS patients treated with MT.
METHODS: This was a single-center retrospective study. We consecutively included AIS patients who received MT for anterior circulation LVO. We recorded discrete blood glucose measurements within the first 24 hours post thrombectomy, from which we calculated two measures of GV: standard deviation (SD) and coefficient of variation. Univariate and multivariate analyses were conducted to identify predictors of poor functional outcome (modified Ranking scale score 3-6) and mortality at 3-month follow-up.
RESULTS: We included 657 patients. Patients with poor functional outcome (42.5%) and patients that died (14.8%) had significantly higher GV as measured by SD. In a multivariable model adjusted for confounders, higher SD was associated with mortality -adjusted odds ratio: 1.020 (95% CI 1.001-1.040)- but not with functional outcome -adjusted odds ratio for modified Ranking scale score 3-6: 1.007 (95% CI 0.990-1.025)-.
CONCLUSIONS: Our results suggest that higher GV after MT for anterior circulation AIS is an independent risk factor for 3-month mortality. Future trials should evaluate the benefit of reducing GV in this setting.
BACKGROUND: Variabilidad glucémica tras trombectomía mecánica en el ictus isquémico agudo de la circulación anterior.
Introducción. La morbilidad de los pacientes con ictus isquémico agudo (IIA) sometidos a trombectomía mecánica (TM) exitosa permanece alta. La hiperglucemia empeora el pronóstico tras un IIA, pero tratarla agresivamente no mejora los resultados. No existe consenso sobre el tratamiento óptimo de la glucemia después de un IIA. La variabilidad glucémica (VG), que refleja las fluctuaciones glucémicas a lo largo del tiempo, puede ser un factor importante. Nuestro objetivo fue investigar cómo la VG afecta el resultado de pacientes con IIA tratados con TM. Pacientes y métodos. Realizamos un estudio retrospectivo unicéntrico que incluyó a pacientes con IIA que recibieron TM para la oclusión de un gran vaso de la circulación anterior. Se registraron mediciones discretas de glucemia en las primeras 24 horas postrombectomía, a partir de las cuales se calcularon dos medidas de VG: desviación estándar y coeficiente de variación. Se realizó un análisis univariado y multivariado para identificar predictores de resultado funcional desfavorable (escala de Rankin modificada: 3-6) y mortalidad a los tres meses. Resultados. Se incluyó a 657 pacientes. Los que tenían una puntuación en la escala de Rankin modificada = 3 (42,5%) y los fallecidos (14,8%) tuvieron una VG significativamente mayor medida por desviación estándar. En un modelo multivariado, una mayor desviación estándar se asoció de forma independiente con la mortalidad –odds ratio ajustada: 1,02 (intervalo de confianza al 95%: 1,001-1,04)– pero no con el resultado funcional –odds ratio ajustada de la escala de Rankin modificada = 3: 1,007 (intervalo de confianza al 95%: 0,99-1,025)–. Conclusiones. Nuestros resultados sugieren que una mayor VG tras la TM para el IIA de la circulación anterior es un factor de riesgo independiente de mortalidad a los tres meses. Los futuros ensayos deben evaluar el beneficio de reducir la VG en este contexto.

CONCLUSIONS: A scoping review was carried out to identify gaps in the performance of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) towards the preparedness of the public health system especially at primary level in dealing with hypertension (HTN). The World Health Organization Innovative Care for Chronic Conditions (WHO ICCC) framework was adapted for the current review under three levels namely micro, meso, and macro. PubMed Central was accessed to retrieve eligible articles published since 2010. Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews checklist was followed for reporting. A final selection of 27 articles that fulfilled the eligibility criteria of the current review was drawn from a long list of 542 articles. Cross-sectional studies contributed to 51.8% of the included studies. We observed that NPCDCS had gaps across all levels of health care, especially at the primary level. At the micro-level noncommunicable diseases (NCDs), awareness among patients was suboptimal and treatment adherence was poor. At the meso-level, there was a vacancy in all cadres of workers and lack of regular training of workforce, laboratory services, and inconsistent availability of essential drugs, equipment, and related supplies to be ensured. At the macro-level, public spending on NCD care needs to be increased along with strategies to reduce out-of-pocket expenditure and improve universal health coverage. In conclusion, there is a need to improve components related to all three levels of the WHO ICCC framework to amplify the impact of HTN care through NPCDCS, particularly at the primary level.

BACKGROUND: Experimental preeclampsia (ePE) has been shown to have worsened outcome from stroke. We investigated the effect of low-dose aspirin, known to prevent preeclampsia, on stroke hemodynamics and outcome, and the association between the vasoconstrictor and vasodilator cyclooxygenase products thromboxane A2 and prostacyclin.
RESULTS: Middle cerebral artery occlusion was performed for 3 hours with 1 hour of reperfusion in normal pregnant rats on day 20 of gestation and compared with ePE treated with vehicle or low-dose aspirin (1.5 mg/kg per day). Multisite laser Doppler was used to measure changes in cerebral blood flow to the core middle cerebral artery and collateral vascular territories. After 30 minutes occlusion, phenylephrine was infused to increase blood pressure and assess cerebral blood flow autoregulation. Infarct and edema were measured using 2,3,5-triphenyltetrazolium chloride staining. Plasma levels of thromboxane A2, prostacyclin, and inflammatory markers in plasma and cyclooxygenase levels in cerebral arteries were measured. ePE had increased infarction compared with normal pregnant rats (P<0.05) that was reduced by aspirin (P<0.001). ePE also had intact cerebral blood flow autoregulation and reduced collateral perfusion during induced hypertension that was also prevented by aspirin. Aspirin increased prostacyclin in ePE (P<0.05) without reducing thromboxane B2, metabolite of thromboxane A2, or 8-isoprostane-prostaglandin-2α, a marker of lipid peroxidation. There were no differences in cyclooxygenase levels in cerebral arteries between groups.
CONCLUSIONS: Low-dose aspirin in ePE reduced infarction that was associated with increased vasodilator prostacyclin and improved collateral perfusion during induced hypertension. The beneficial effect of aspirin on the brain and cerebral circulation is likely multifactorial and worth further study.

BACKGROUND: We aimed to clarify the predictive value of cerebral small-vessel disease and intracranial large artery disease (LAD) observed in magnetic resonance imaging of the brain and magnetic resonance angiography on future vascular events and cognitive impairment.
RESULTS: Data were derived from a Japanese cohort with evidence of cerebral vessel disease on magnetic resonance imaging. This study included 862 participants who underwent magnetic resonance angiography after excluding patients with a modified Rankin Scale score >1 and Mini-Mental State Examination score <24. We evaluated small-vessel disease such as white matter hyperintensities and lacunes in magnetic resonance imaging and LAD with magnetic resonance angiography. Outcomes were incident stroke, dementia, acute coronary syndrome, and all-cause death. Over a median follow-up period of 4.5 years, 54 incident stroke, 39 cases of dementia, and 27 cases of acute coronary syndrome were documented. Both small-vessel disease (white matter hyperintensities and lacunes) and LAD were associated with stroke; however, only white matter hyperintensities were related to dementia. In contrast, only LAD was associated with acute coronary syndrome. Among the 357 patients with no prior history of stroke, coronary or peripheral artery disease, or atrial fibrillation, white matter hyperintensities emerged as the sole predictor of future stroke and dementia, while LAD was the sole predictor of acute coronary syndrome.
CONCLUSIONS: Among cerebral vessels, small-vessel disease could underlie the cognitive impairment while LAD was associated with coronary artery disease as atherosclerotic vessel disease.

BACKGROUND: The authors aimed to elucidate the relationship between latest ischemic event and the incidence of subsequent ischemic stroke in patients with symptomatic artery occlusion.
RESULTS: We analyzed the association between qualifying event-the latest ischemic event (transient ischemic attack [TIA] or stroke)-and the incidence of ipsilateral ischemic stroke in patients with symptomatic artery occlusion treated with medical therapy alone in CMOSS (Carotid or Middle Cerebral Artery Occlusion Surgery Study). The incidence of CMOSS primary outcomes, including any stroke or death within 30 days after randomization or ipsilateral ischemic stroke between 30 days and 2 years, between the bypass surgical and medical groups, stratified by qualifying events, was also compared. Of the 165 patients treated with medical therapy alone, 75 had a TIA and 90 had a stroke as their qualifying event. The incidence of ipsilateral ischemic stroke did not significantly differ between patients with a TIA and those with a stroke as their qualifying event (13.3% versus 6.7%, P=0.17). In multivariate analysis, the qualifying event was not associated with the incidence of ipsilateral ischemic stroke. There were no significant differences in the CMOSS primary outcomes between the surgical and medical groups, regardless of the qualifying event being TIA (10.1% versus 12.2%, P=0.86) or stroke (6.7% versus 8.9%, P=0.55).
CONCLUSIONS: Among patients with symptomatic artery occlusion and hemodynamic insufficiency, the risk of subsequent ipsilateral ischemic stroke does not appear to be lower in patients presenting with a TIA compared with those with a stroke.
BACKGROUND: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01758614.

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a hereditary small vessel disease of the brain characterized by progressive white matter lesions, subcortical infarcts, and cognitive decline. This autosomal dominant disorder is caused by mutations in the NOTCH3 gene located on chromosome 19, resulting in the accumulation of granular osmiophilic material within the walls of small arteries and arterioles. Clinically, CADASIL typically manifests in mid-adulthood with recurrent ischemic events, migraine with aura, mood disturbances, and cognitive impairment. Neuroimaging plays a crucial role in the diagnosis of CADASIL, with characteristic findings including white matter hyperintensities particularly in the anterior temporal lobe and external capsule.

OBJECTIVE: To study the relationship between brain-derived neurotrophic factor (BDNF) and the severity of nocturnal hypoxemia in patients in the acute and early recovery period of ischemic stroke (IS).
METHODS: We enrolled 44 patients (27 men, 17 women), aged 18-85 years, in the acute phase of IS. At 3-month follow-up, 35 people were examined (21 men and 14 women). In the acute period, in addition to routine diagnostic procedures, respiratory monitoring was carried out, and the serum level of BDNF was measured by enzyme-linked immunosorbent assay. BDNF level was also evaluated at 3-month follow-up visit. Neurological status and its dynamics in the acute period of stroke were assessed as part of the clinical routine according to the National Institutes of Health Stroke Scale (NIHSS) at admission and discharge.
RESULTS: We found a direct correlation between the duration of hypoxemia with SpO2 less than 90% (r=0.327, p=0.035) and less than 85% (r=0.461, p=0.003) and BDNF level in the acute phase of IS. BDNF level in the acute period of IS was negatively correlated with the minimum saturation value (r=-0.328, p=0.034). There was a direct relationship between BDNF level in the early recovery period and the duration of hypoxemia with SpO2 less than 85% (r=-0.389, p=0.028). A regression model showed that BDNF level was associated with the minimum SpO2 level. No significant associations were found with indicators of sleep-disordered breathing severity, such as the apnea-hypopnea index and the oxygen desaturation index.
CONCLUSIONS: The severity of nocturnal hypoxemia is associated with the increase in BDNF levels both in the acute and recovery periods of IS, regardless of the presence of concomitant breathing disorders during sleep.
UNASSIGNED: Изучение связи уровня мозгового нейротрофического фактора (BDNF) и выраженности ночной гипоксемии у пациентов в остром и раннем восстановительном периодах ишемического инсульта (ИИ).
UNASSIGNED: В рамках работы были обследованы 44 пациента (27 мужчин, 17 женщин) в возрасте 18—85 лет в остром периоде ИИ. При повторном визите через 3 мес были обследованы 35 больных — 21 мужчина и 14 женщин. В остром периоде в дополнение к рутинным диагностическим процедурам проводился респираторный мониторинг, а также измерялся уровень BDNF в сыворотке крови при помощи метода иммуноферментного анализа. Уровень BDNF также оценивался повторно в рамках амбулаторного визита пациента через 3 мес после ИИ. Неврологический статус и его динамика в остром периоде инсульта оценивались в рамках клинической рутинной практики по шкале инсульта Национальных институтов здоровья (NIHSS) при поступлении и выписке.
UNASSIGNED: Выявлена слабая прямая взаимосвязь длительности гипоксемии с уровнем сатурации (SpO2) <90% (r=0,327, p=0,035) и <85% (r=0,461, p=0,003) с уровнем BDNF в остром периоде ИИ. Уровень BDNF в остром периоде ИИ отрицательно коррелировал с минимальным значением сатурации (r=–0,328, p=0,034). Также было показано наличие прямой взаимосвязи между уровнем BDNF в раннем восстановительном периоде ИИ и продолжительностью гипоксемии с SpO2 <85% (r= –0,389, p=0,028). Согласно результатам регрессионного анализа, предиктором уровня BDNF является уровень минимальной сатурации. С показателями тяжести нарушений дыхания во сне, такими как индекс апноэ-гипопноэ и индекс десатурации, значимых связей выявлено не было.
UNASSIGNED: Выраженность гипоксемии в ночное время ассоциирована с повышением уровня BDNF как в остром, так и в восстановительном периодах ИИ, независимо от наличия сопутствующих нарушений дыхания во время сна.

暂无摘要。

暂无摘要。

暂无摘要。