• Lifestyle
• Minor stroke
• Recurrent stroke
• Stroke

• Humans
• Female
• Middle Aged
• Male
• Aged
• Ischemic Stroke/diagnosis
• Ischemic Stroke/epidemiology
• Retrospective Studies
• Recurrence
• Risk Factors
• Risk Assessment
• Stroke

• 2024B03J0436 Guangzhou Municipal Science and Technology Bureau Key Research and Development Program

• acute ischemic stroke
• acute respiratory failure
• lateral medullary infarction
• stroke classification

• Humans
• Male
• Respiratory Insufficiency/etiology
• Respiratory Insufficiency/diagnosis
• Respiratory Insufficiency/therapy
• Middle Aged
• Aged
• Female
• Lateral Medullary Syndrome/complications
• Lateral Medullary Syndrome/diagnosis
• Medulla Oblongata/pathology
• Acute Disease
• Magnetic Resonance Imaging

• clopidogrel
• ischemic stroke
• pharmacogenomics
• randomized controlled trial
• transient ischemic attack

Treatment decision making is strictly associated with the outcomes in patients with ischemic stroke who show a large core infarct. Medical care alone may result in suboptimal treatment efficacy, and endovascular treatment may be accompanied by safety issues. Whether endovascular treatment is superior to medical care is not well investigated in the clinical studies.

To investigate the efficacy of endovascular treatment and drug therapy alone in mild ischemic stroke patients with large infarct cores.

Fifty patients with mild ischemic stroke and 50 patients with acute ischemic stroke caused by anterior large vessel occlusion were selected at the First Affiliated Hospital of Hebei North University between January 2021 and December 2021. Patients were divided into an endovascular therapy group and a drug therapy group according to different treatment methods. In the endovascular therapy group, there were 28 patients with minor stroke and 22 patients with large infarct cores. The drug therapy group had 22 patients with minor stroke and 28 patients with large infarct cores. The National Institutes of Health Stroke Scale (NIHSS) scores were collected and compared between the two groups immediately after the operation and 24 h and 7 d after the operation. The modified Rankin scale (mRS) and/or activity of daily living were assessed at hospital discharge.

There was no significant difference in NIHSS scores between the two groups before the operation (P > 0.05). NIHSS scores were lower in the endovascular therapy group than in the drug therapy group at 24 h and 7 d after the operation and at hospital discharge (all P < 0.05). The incidence of early neurologic deterioration was significantly lower in the endovascular therapy group than in the drug therapy group (P < 0.05). At hospital discharge, the mRS score was lower in the endovascular treatment group than in the drug therapy group, and the activity of daily living score was better in the endovascular treatment group than in the drug therapy group (all P < 0.05). During a follow-up of 3 mo, 17 patients (34.0%) had good prognosis (mRS ≤ 2), 33 patients (66.0%) had poor prognosis (mRS > 2), and 11 patients (22.0%) died. In the medical treatment group, 16 patients (mRS ≤ 2) had good prognosis (32.0%), 34 patients (mRS > 2) had poor prognosis (68.0%), and 14 patients (28.0%) died. There was no significant difference in prognosis and mortality between the two groups (P > 0.05).

Endovascular therapy can improve NIHSS score and mRS score in patients with mild ischemic stroke and large infarct cores. It is suitable for clinical application.

• Ischemic stroke
• Large infarct cores
• Endovascular therapy
• Drug therapy
• Efficacy

The effect of head position on stroke is not clear. The current study aimed to observe the effect of head-down tilt on acute ischemic stroke (AIS) patients with large vessel occlusion.

We observed the influence of head-down tilt position on clinical outcomes, myocardial enzymogram and N-terminal pro b-type Natriuretic Peptide in 4 AIS patients who suffered early neurological deterioration (END). Cerebral perfusion imaging was performed in 3 patients using arterial spin labeling.

In series of AIS patients with END, head down tilt (-20°) prevented further neurological deterioration and improved clinical outcomes. An increase in cerebral blood flow was observed by arterial spin labeling after head down tilt treatment. No obvious adverse events occurred.

The case series suggest that head-down tilt may improve clinical outcome in AIS patients through increasing the cerebral perfusion with no obvious adverse events. The finding needs to be confirmed in future clinical trials.

• Natural Science Foundation of Liaoning Province

• anticoagulant
• dual antiplatelet
• early neurological deterioration
• ischemic stroke
• large artery atherosclerosis

• Arginine/analogs & derivatives
• Arteries
• Atherosclerosis/complications
• Hemorrhage/complications
• Humans
• Intracranial Hemorrhages/epidemiology
• Ischemic Stroke/drug therapy
• Pipecolic Acids
• Platelet Aggregation Inhibitors/adverse effects
• Prospective Studies
• Retrospective Studies
• Sulfonamides
• Treatment Outcome

• Functional prognosis
• Large-vessel occlusion
• Mechanical thrombectomy
• Meta-analysis
• Mild acute ischemic stroke

In modern society, subarachnoid hemorrhage, mostly caused by intracranial aneurysm rupture, is accompanied by high disability and mortality rate, which has become a major threat to human health. Till now, the etiology of intracranial aneurysm has not been entirely clarified. In recent years, more and more studies focus on the relationship between hemodynamics and intracranial aneurysm. Under the physiological condition, the mechanical force produced by the stable blood flow in the blood vessels keeps balance with the structure of the blood vessels. When the blood vessels are stimulated by the continuous abnormal blood flow, the functional structure of the blood vessels changes, which becomes the pathophysiological basis of the inflammation and atherosclerosis of the blood vessels and further promotes the occurrence and development of the intracranial aneurysm. This review will focus on the relationship between hemodynamics and intracranial aneurysms, will discuss the mechanism of occurrence and development of intracranial aneurysms, and will provide a new perspective for the research and treatment of intracranial aneurysms.

• Atherosclerosis
• Hemodynamics
• Inflammation
• Intracranial aneurysm

tPA (tissue‐type plasminogen activator) remains the only approved drug for acute ischemic stroke, with a potentially serious adverse effect: hemorrhagic transformation. The effects of antithrombotic agents on tPA‐induced hemorrhagic transformation after ischemic stroke are not clearly defined. We performed a systematic review and meta‐analysis in preclinical studies aiming to evaluate the efficacy of antithrombotic agents on tPA‐induced hemorrhagic transformation after ischemic stroke.

We conducted a systematic review and meta‐analysis of studies testing antithrombotic agents in animal models of tPA‐induced hemorrhagic transformation. The pooled effects were calculated using random‐effects models, and heterogeneity was explored through meta‐regression and subgroup analyses. Publication bias was assessed using trim and fill method and the Egger test. The efficacy of 18 distinct interventions was described in 22 publications. The pooled data showed a significant improvement in cerebral hemorrhage, infarct size, and neurobehavioral outcome in treated compared with control animals (standardized mean difference, 0.45 [95% CI, 0.11–0.78]; standardized mean difference, 1.18 [95% CI, 0.73–1.64]; and standardized mean difference, 0.91 [95% CI, 0.49–1.32], respectively). Subgroup analysis indicated that quality score, random allocation, control of temperature, anesthetic used, stroke model used, route of drug delivery, time of drug administration, and time of assessment were significant factors that influenced the effects of interventions.

Administration with antiplatelet agents revealed statistically significant improvement in all the outcomes. Anticoagulant agents showed significant effects in infarct size and neurobehavioral score, but fibrinolytic agents did not show any significant improvement in all the outcomes. The conclusions should be interpreted cautiously given the heterogeneity and publication bias identified in this analysis.

• animal model
• antithrombotic
• hemorrhagic transformation
• ischemic stroke
• tPA (tissue‐type plasminogen activator)

• 3' Untranslated Regions
• Animals
• Apoptosis/genetics
• Atherosclerosis/etiology
• Atherosclerosis/genetics
• Atherosclerosis/pathology
• Cell Proliferation/genetics
• Cells, Cultured
• Computational Biology
• Disease Models, Animal
• Gene Expression Regulation
• Humans
• Male
• Mathematical Concepts
• Mice
• Mice, Inbred C57BL
• Mice, Knockout, ApoE
• MicroRNAs/genetics
• Myocytes, Smooth Muscle/metabolism
• Myocytes, Smooth Muscle/pathology
• Nuclear Receptor Subfamily 1, Group F, Member 1/genetics
• Plaque, Atherosclerotic/genetics
• Plaque, Atherosclerotic/metabolism
• Plaque, Atherosclerotic/pathology
• RNA, Long Noncoding/genetics
• RNA, Messenger/genetics
• RNA, Messenger/metabolism