Acute ischemic stroke is the most common type of stroke. Hemorrhagic transformation is one of its serious complications, which may lead to severe neurological deterioration and poor prognosis. The occurrence of hemorrhagic transformation is mainly related to the inflammatory mechanism after infarction, blood-brain barrier injury, ischemia-reperfusion injury and abnormal coagulation function. Identification of early predictors of hemorrhagic transformation can help reduce its incidence and severity. However, the mechanism of hemorrhagic transformation is complex, and there is currently no unified standard for its prediction. This article aims to review the related mechanisms and early predictors of hemorrhagic transformation after stroke, in order to provide a reference for early identification and prevention.
ObjectiveTo systematically review the efficacy and safety of lumbrokinase capsule for patients with acute ischemic stroke (AIS).MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on lumbrokinase capsule for patients with AIS from inception to 1st December, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 33 RCTs involving 4 751 patients were included. The results of meta-analysis indicated that compared with control group, lumbrokinase capsule could improve the treatment efficiency (RR=3.51, 95%CI 2.29 to 5.39, P<0.001), enhance neurological function (SMD=−0.55, 95%CI −0.72 to −0.38, P<0.001) and reduce fibrinogen after treatment (SMD=−0.93, 95%CI −1.41 to −0.44, P<0.001). Reported adverse reactions included dizziness, nausea and gastric discomfort, and no mortality was reported.ConclusionsCurrent evidence shows that lumbrokinase capsule can improve the neurological deficit in patients with AIS. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectivesTo systematically review the efficacy and safety of nalmefene hydrochloride for acute cerebral infarction.MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on nalmefene hydrochloride for acute cerebral infarction from inception to February 21st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 8 RCTs involving 1 038 patients were included. The results of meta-analyses showed that, compared to the routine treatment group, the nalmefene hydrochloride group was significantly associated with an increased reduction in total effective rate (RR=1.14, 95%CI 1.04 to 1.23, P=0.003), GCS (MD=1.30, 95%CI 0.66 to 1.94, P<0.0001), patient satisfaction (RR=1.26, 95%CI 1.03 to 1.55, P=0.03), cerebral blood flow (MD=5.00, 95%CI 3.81 to 6.19, P<0.05), and cerebral blood volume (MD=0.28, 95%CI 0.23 to 0.32, P<0.05). It was also significantly associated with an reduction of NIHSS, CSS, level of inflammatory factors after treatment in 14 days, level of MMP-9 and mean transit time of contrast medium (P<0.05). However, no significant association was observed between two groups in level of inflammatory factors after treatment in 20 days. For safety outcomes, no significant association was found between two groups in mortality, dizziness, and nausea and vomiting.ConclusionsThe current evidence indicates that the nalmefene hydrochloride can be used to treat acute cerebral infarction based on routine treatment of acute cerebral infarction, and the safety is relatively good. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.
ObjectiveTo explore the association between glycosylated hemoglobin level and poor prognosis in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis.MethodsThe AIS patients treated with recombinant tissue-type plasminogen activator who were hospitalized in the Department of Neurology of the First Affiliated Hospital of Henan University of Science and Technology from September to December 2020 were retrospectively included. According to different levels of glycosylated hemoglobin, they were divided into pre-diabetic group (5.7%≤glycated hemoglobin≤6.4%), diabetic group (previously diabetic or glycosylated hemoglobin≥6.5%), and non-diabetic group (glycated hemoglobin <5.7%). The relevant information of the patients was collected, and a telephone follow-up was conducted 90 days after discharge. According to the modified Rankin Scale (mRS) score, the patients were divided into the good prognosis group (mRS score≤2) and the poor prognosis group (mRS score>2). Logistic regression analysis was used to determine the risk factors for the poor prognosis of intravenous thrombolysis in patients with AIS.ResultEventually 101 patients were included, including 44 in the non-diabetic group, 24 in the pre-diabetic group, and 33 in the diabetic group. And 64 patients were in the good prognosis group and 37 patients were in the poor prognosis group. Regression analysis results showed that diabetes was associated with poor prognosis 3 months after intravenous thrombolysis in patients with AIS [odds ratio=6.518, 95% confidence interval (1.568, 27.096), P=0.010]; and the higher the National Institutesof Health Stroke Scale score at admission was, the higher the risk of poor prognosis would be [odds ratio=1.421, 95% confidence interval (1.231, 1.640), P<0.001].ConclusionIn AIS patients who received intravenous thrombolysis, diabetes is associated with poor prognosis after 3 months.
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.
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.
Objective To investigate the association of serum albumin and relevant composite indicators with malignant brain edema after acute ischemic stroke. Methods We screened patients with acute ischemic stroke admitted to the Department of Neurology, West China Hospital of Sichuan University between January and December 2022. The case group consisted of patients who developed malignant brain edema within 7 days of admission, while the control group consisted of patients who did not develop malignant brain edema within 7 days of admission. Multivariate logistic regression analysis was used to explore the association of serum albumin and relevant composite indicators with malignant brain edema after acute ischemic stroke. Results Finally, 428 patients were included, aged 70.00 (58.00, 82.00) years, with females accounting for 40.9% (n=175). The time from onset to admission was 10.00 (4.00, 24.00) hours. Forty-three patients (10.0%) developed malignant brain edema and were classified as the case group, and their onset time of malignant brain edema was 34.00 (22.50, 56.50) hours after the onset of the disease. Multivariate logistic regression analysis showed that the increase in the score of the baseline National Institutes of Health Stroke Scale scores [odds ratio (OR)=1.167], the combination of diabetes (OR=5.525), the treatment of thrombectomy (OR=23.875), and the neutrophil percentage-to-albumin ratio higher than the median (OR=3.806) were associated with the increased risk of malignant brain edema (P<0.05), and the successful reperfusion after thrombectomy (OR=0.120) was associated with the reduced risk of malignant brain edema (P<0.05). Conclusion A higher percentage of serum neutrophil percentage-to-albumin ratio within 24 hours of onset in patients with acute ischemic stroke is associated with an increased risk of malignant brain edema within 7 days of admission.
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.
This article explores the application and research progress of shared decision-making (SDM) tools in ultra-early vascular recanalization therapy for ischemic stroke, focusing on analyzing the functional characteristics and advantages and disadvantages of various tools. Based on functional goals, SDM tools can be divided into four categories: brief decision aids, risk communication tools, patient information tools, and prognosis assessment tools. These tools can assist patients and doctors in making informed treatment decisions quickly in time-sensitive situations, providing a reference for optimizing stroke revascularization treatment. Additionally, SDM tools can facilitate communication between doctors and patients, enabling patients to better understand the risks and benefits of treatment options, leading to choices more aligned with personal preferences and values. Through an in-depth study of these SDM tools, it is expected to improve the diagnostic and treatment efficiency for stroke patients, reduce decision conflicts, promote collaboration between doctors and patients, and provide new ideas and methods for stroke treatment and management.