Objective To investigate the risk factors, clinical features and outcomes of patients with large hemispheric infarction (LHI), and explore the association between TOAST classification and LHI. Methods We prospectively registered consecutive cases of acute ischemic stroke at the neurological wards of West China Hospital, Sichuan University from January 1st 2010 to February 29th 2012. We collected the demographic data, risk factors, and other related data, assessed the National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) scores at admission, and followed-up the Modified Rankin Scale (mRS) scores at the third month from the onset. In different TOAST classifications, univariate analysis and multivariate analysis were used to find predictors for the occurrence and prognosis of LHI. Results Of the enrolled 1 729 patients with acute ischemic stroke, 317 (18.3%) had LHI. The multivariate analysis showed that male, hypertension and onset to admission time were the independent predictive factors for the large-artery atherosclerosis type LHI (P<0.05); atrial fibrillation and valvulopathy were the independent predictive factors for cardioembolism type LHI (P<0.05). Meanwhile, age, hypertension, onset to admission time, and NIHSS and GCS scores at admission were the independent predictive factors for death/disability (mRS>3) within three months (P<0.05). Conclusions Hypertension, gender, onset to admission time, atrial fibrillation, and valvulopathy are independently associated with the occurrence of LHI. Young patients with lower GCS, higher NIHSS scores and no hypertension are more likely to have a better prognosis after LHI.
Objective To investigate the correlation between stress hyperglycemia ratio (SHR) and acute ischemic stroke (AIS) 1-year prognosis, to provide more clinical basis to improve the prognosis of AIS patients and to target and control the influencing factors. MethodsThe patients with AIS diagnosed for the first time and received treatment at the Shijiazhuang Fifth Hospital between May 2019 and January 2022 were retrospectively and continuously included. According to the Modified Rankin Scale score 1-year after the onset of the disease, the patients were divided into a good prognosis group and a poor prognosis group. Also the patients were divided into 2 groups based on the median of SHR. The correlation between SHR and stress blood glucose was analyzed, and the factors affecting the prognosis of AIS patients were identified. The predictive value of SHR and stress blood glucose on the prognosis of AIS patients was compared using receiver operating characteristic. Results A total of 206 patients were included. Among them, there were 125 cases (60.7%) in the good prognosis group and 81 cases (39.3%) in the poor prognosis group. The median SHR (lower quartile, upper quartile) is 1.20 (1.08, 1.33). There were statistically significant differences between the two groups in the scores of the National Institutes of Health Stroke Scale, diabetes history, hypertension history, low-density lipoprotein cholesterol, stress blood glucose, age, SHR and SHR classification (P<0.05). There was no statistically significant difference in the other indicators compared between the two groups (P＞0.05). Stress blood glucose was positively correlated with SHR (7.95±1.78 vs. 1.21±0.19; r=0.294, P<0.001). Multivariate logistic analysis showed that stress blood glucose and SHR were independent factors influencing the 1-year prognosis of AIS patients (P<0.05), and the interaction between SHR and diabetes was not significant (P>0.05) After adjusting for confounding factors, the area under the receiver operating characteristic curve of SHR for the prognosis of AIS patients was higher than that of stress blood glucose [0.682 (0.614, 0.745) vs .0.585 (0.515, 0.653); Z=2.042, P=0.041]. Conclusions SHR and stress blood glucose are independent risk factors for 1-year prognosis in AIS patients. However, SHR has a better predictive value for 1-year prognosis in AIS patients than stress blood glucose. Whether the patient has diabetes or not, the impact of SHR on the prognosis of AIS patients is consistent.
Early endovascular interventional therapy can effectively improve the prognosis of patients with acute ischemic stroke. Dual-source CT dual-energy scanning, as a new CT imaging technology developed rapidly in recent years, with its unique technical characteristics and advantages, shows potential and application prospects in early endovascular interventional therapy of acute ischemic stroke. This article discusses the value of dual-source CT dual-energy scanning in the early screening and evaluation, the identification of postoperative iodine contrast agent extravasation and secondary cerebral hemorrhage, and the prediction of prognosis of patients with early endovascular interventional treatment of acute ischemic stroke. The purpose is to provide a theoretical basis for better application of dual-source CT dual-energy scanning in early endovascular interventional treatment of acute ischemic stroke.
Clinically, non-contrastive computed tomography (NCCT) is used to quickly diagnose the type and area of stroke, and the Alberta stroke program early computer tomography score (ASPECTS) is used to guide the next treatment. However, in the early stage of acute ischemic stroke (AIS), it’s difficult to distinguish the mild cerebral infarction on NCCT with the naked eye, and there is no obvious boundary between brain regions, which makes clinical ASPECTS difficult to conduct. The method based on machine learning and deep learning can help physicians quickly and accurately identify cerebral infarction areas, segment brain areas, and operate ASPECTS quantitative scoring, which is of great significance for improving the inconsistency in clinical ASPECTS. This article describes current challenges in the field of AIS ASPECTS, and then summarizes the application of computer-aided technology in ASPECTS from two aspects including machine learning and deep learning. Finally, this article summarizes and prospects the research direction of AIS-assisted assessment, and proposes that the computer-aided system based on multi-modal images is of great value to improve the comprehensiveness and accuracy of AIS assessment, which has the potential to open up a new research field for AIS-assisted assessment.
ObjectiveTo systematically evaluate the association between red cell distribution width (RDW) and prognosis of patients with acute ischemic stroke (AIS) undergoing intravenous thrombolytic therapy.MethodsWe searched the PubMed, Embase, Cochrane Library, Web of Science, Chinese Biomedical Literature Service System, China National Knowledge Infrastructure, Wanfang database, and CQVIP database to identify eligible studies evaluating the relation between RDW and prognosis in AIS patients receiving intravenous thrombolysis from the establishment of databases to May 2021. The Newcastle-Ottawa Scale was used to evaluate the literature quality, and RevMan 5.3 software was used to process the data. The relationship between RDW and prognosis in AIS patients treated with intravenous thrombolytic therapy was analyzed using odds ratio (OR) and 95% confidence interval (CI).ResultsFive studies with a total of 1 269 participants were included into this meta-analysis. All the studies were retrospective case-control studies. Because of statistical heterogeneity (I2=59%, P=0.04), random-effects model was chosen. Meta-analysis result showed that among AIS patients who received intravenous thrombolysis, those with elevated RDW before thrombolysis were more likely to have poor prognosis than those without elevated RDW [OR=1.50, 95%CI (1.14, 1.98), P=0.004].ConclusionElevated RDW is associated with adverse outcome of AIS patients treated with thrombolysis, and may be a risk factor for poor prognosis in patients treated with thrombolytic therapy.
Objective To investigate the efficacy of systemic immune inflammation index (SII) at admission and National Institutes of Health Stroke Scale (NIHSS) score immediately after thrombolysis on evaluating the short-term prognosis of neurological function in patients with acute ischemic stroke (AIS) receiving intravenous thrombolysis. Methods Patients with AIS treated with intravenous thrombolysis in the Second People’s Hospital of Chengdu between March 2022 and March 2023 were retrospectively analyzed. The basic data of the patients, NIHSS score at emergency admission, NIHSS score immediately after thrombolysis, modified Rankin Scale (mRS) score 3 months after discharge, and laboratory data at admission were collected, and SII at admission was calculated. According to the mRS score 3 months after discharge, the patients were divided into the good prognosis group (mRS≤2) and the poor prognosis group (mRS>2). Multivariate logistic regression analysis was used to screen out the factors affecting the prognosis of patients, and the receiver operating characteristic curve was drawn to analyze the evaluation effect of SII at admission and NIHSS score immediately after thrombolysis on the poor prognosis of neurological function of patients in the short term. Results A total of 213 patients were enrolled, and the prognosis was poor in 88 patients. Multivariate logistic regression analysis showed that age, onset-to-needle time, uric acid at admission, SII at admission, fasting blood glucose after admission, and NIHSS score immediately after thrombolysis were independent risk factors for poor prognosis in AIS patients (P<0.05). The area under the receiver operating characteristic curve (AUC) of SII at admission for predicting poor prognosis was 0.715, the sensitivity was 55.7%, and the specificity was 84.0%. The AUC of NIHSS score immediately after thrombolysis for predicting poor prognosis of patients was 0.866, the sensitivity was 87.5%, and the specificity was 72.8%. The AUC of SII at admission combined with NIHSS score immediately after thrombolysis for predicting poor prognosis of patients was 0.875, the sensitivity was 84.1%, the specificity was 77.6%, the positive predictive value was 72.5%, and the negative predictive value was 87.4%. SII at admission was positively correlated with NIHSS score at emergency admission, NIHSS score immediately after thrombolysis, and mRS score 3 months after discharge (P<0.05). Conclusion SII at admission can predict the short-term prognosis of neurological function of patients with AIS after thrombolysis therapy, and the combination of SII at admission and NIHSS score immediately after thrombolysis can improve the prediction efficiency.
ObjectiveTo systematically review the efficacy and safety of Salvia miltiorrhiza injection in the treatment of acute ischemic stroke (AIS). MethodsPubMed, EMbase, The Cochrane Library, Web of Science, VIP, WanFang Data, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of Salvia miltiorrhiza injection in treatment of AIS from inception to February 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Network meta-analysis was then performed using Stata 16.0 software and RevMan 5.3 software. ResultsA total of 160 RCTs were included. The measures included 7 Chinese medicine injections and 8 treatment measures, covering Danhong injection combined with conventional treatment (DH+CT), Danshen injection combined with conventional treatment (DS+CT), Danshen ligustrazine injection combined with conventional treatment (DSCXQ+CT), Danshen polyphenolic acid for injection combined with conventional treatment (DSDFS+CT), compound Danshen injection combined with conventional treatment (FFDS+CT), Danshen polyphenolate for injection combined with conventional treatment (SI+CT), and Sodium Tanshinone ⅡA Sulfonate injection combined with conventional treatment (STS+CT) and conventional treatment (CT). Results of network meta-analysis showed that for the total effective rate, the rank of cumulative probability was: DSDFS+CT (93.0%) > DH+CT (80.5%) > STS+CT (66.7%) > DSCXQ+CT (66.4%) > SI+CT (50.0%)> DS+CT (26.7%)> FFDS+CT (16.7%)> CT (0.1%). In terms of NIHSS, the rank of cumulative probability was: STS+CT (95.5%) >DH+CT (80.9%)> DSCXQ+CT (70.1%) > SI+CT (64.7%) > DSDFS+CT (42.0%) > FFDS+CT (24.4%) > DS+CT (20.1%) > CT (2.4%). In the aspect of Barthel index, the rank of cumulative probability was: DH+CT (76.2%) > DSCXQ+CT (74.3%) > STS+CT (64.1%) > DSDFS+CT (62.2%) > FFDS+CT (51.8%) > SI+CT (46.0 %) > DS+CT (21.7%)> CT (3.8%). ConclusionCurrent evidence shows that, for patients with AIS, DSDFS has an improved effect on the total effective rate, while STS and DH show advantages in NIHSS score and Barthel index. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
Objective To explore the impact of early blood pressure reduction on the prognosis of acute ischemic stroke. Methods We searched PubMed, Embase, Cochrane Library, Wanfang, China National Knowledge Infrastructure, and Chongqing VIP, with the search period from databases establishment to December 31, 2024. Randomized controlled studies on early blood pressure reduction within 7 days after the onset of acute ischemic stroke were included, and meta-analysis was conducted using RevMan 5.4 software. Results Finally, 15 randomized controlled studies were included. The meta-analysis results showed that there was no statistically significant difference in the primary outcome (90 days disability or death) and the secondary outcomes (90 days all-cause death) between the early blood pressure reduction group and the control group (P>0.05). Compared with the control group, the early blood pressure reduction group had a higher National Institute of Health Stroke Scale score at 2 weeks [standardized mean difference=0.25, 95% confidence interval (0.07, 0.44), P=0.008]. Conclusion Early blood pressure reduction cannot reduce the risk of 90 days disability or death and 90 days all-cause death in patients with acute ischemic stroke, and may be detrimental to 2 weeks neurological function recovery.
ObjectiveTo explore the relevance of an increase in neutrophil count and early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke.MethodsA retrospective study was conducted on the patients who received thrombolysis treatment of alteplase within 4.5 hours after onset between January 2017 and November 2018. Based on the existence of END, the patients were divided into the END group and the non-END group. Univariate and multivariate logistic regression, and receiver operating characteristic curves were used to analyze the relevances between END and the indexes such as neutrophil count, lymphocyte count, and neutrophil to lymphocyte ratio (NLR) after thrombolysis. Paired sample t test and Wilcoxon signed-rank test were used to compare the changes of neutrophil and lymphocyte before and after thrombolysis.ResultsA total of 187 patients were included, including 48 in the END group and 139 in the non-END group. Before thrombolysis, the differences of total protein (t=2.130, P=0.035) and albumin (t=2.777, P=0.007) between the two groups were statistically significant, but the differences in other clinical indexes between the two groups were not statistically significant (P>0.05). After thrombolysis, white blood cell count, neutrophil count, NLR, fibrinase degradation product, baseline and change of National Institute of Health Stroke Scale score, proportion of cardiogenic embolism, degree of responsible vascular stenosis and anterior circulation cortical infarction site were all higher in the END group than those in the non-END group (P<0.05). The total protein, albumin, lymphocyte count and prealbumin in the END group were lower than those in the non-END group (P<0.05). Neutrophil in the END group increased significantly (Z=−2.314, P=0.021) after thrombolysis. Neutrophil count [odds ratio=1.288, 95% confidence interval (1.069, 1.552)] was one of the independent influencing factors of venous thrombolysis END, and the specificity was the highest (the sensitivity was 62.5%, and the specificity was 71.9%).ConclusionsAfter thrombolysis, elevated neutrophil count has some relevance to END. Dynamic monitoring on neutrophil count after intravenous thrombolysis treatment can predict the occurrence of END.
ObjectiveTo explore the risk factors of stroke-associated pneumonia (SAP) in the patients with acute ischemic stroke, in order to provide effective guidance for clinical prevention and treatment.MethodsFrom November 2016 to November 2019, 330 patients with acute ischemic stroke admitted to the Department of Neurology of West China Hospital of Sichuan University and the Department of Neurology of the Sixth People’s Hospital of Chengdu were selected as the research object. The clinical data of the patients were analyzed retrospectively. According to whether SAP occurred, they were divided into infected group and non-infected group. Multivariate logistic regression model was used to analyze the risk factors of SAP.ResultsA total of 71 cases of SAP occurred in patients with acute ischemic stroke, accounting for 21.52%. Logistic regression analysis showed that age≥70 years old [odds ratio (OR)=3.677, 95% confidence interval (CI) (1.452, 9.311), P=0.006], chronic lung disease [OR=4.985, 95%CI (1.558, 15.952), P=0.007], disturbance of consciousness [OR=7.147, 95%CI (1.617, 31.587), P=0.009], bulbar palsy [OR=5.909, 95%CI (2.668, 13.089), P<0.001], the use of nasal feeding tube [OR=7.427, 95%CI (1.681, 32.812), P=0.008] were independent risk factors for SAP in patients with acute ischemic stroke.ConclusionsAge≥70 years old, chronic lung disease, disturbance of consciousness, bulbar paralysis and use of nasal feeding tube are independent risk factors for SAP. It is necessary to strengthen the management of these risk factors in order to identify high-risk patients with SAP early, and develop intervention strategies for risk factors, so as to improve the prognosis.