Measurement of cerebrovascular reserve by multimodal image for cerebral arterial occlusion or stenosis patients: study protocol of a randomized paralleled controlled trial

Abstract Background Cerebrovascular reactivity (CVR), index of cerebral hemodynamics, might guide the treatment of ischemic stroke. However, the previous studies that the therapeutic strategy of stroke mainly depends on the degree of vascular stenosis with steady-state vascular parameters, such as cerebral blood flow, and CVR factors are not under consideration. Measurement of CVR by multimodal image might improve the prognosis for ischemic stroke. Methods/design The study is a prospective, randomized, paralleled controlled clinical trial to examine the multimodal image evaluation for CVR. A total of 66 eligible patients will be recruited from Renji hospital, Shanghai Jiaotong University School of Medicine. The patients will be categorized based on CVR into two subgroups as follows: CVR>10% group and CVR<10% group. And the patients will be randomly assigned to medical management, percutaneous transluminal angioplasty and stenting, and intracranial and extra-cranial bypass groups in a 1:1:1 ratio. The primary end point is all adverse events and ipsilateral stroke recurrence at 6, 12, 24 months after the management. The secondary outcomes include the CVR, the National Institute of Health stroke scale and the Modified Rankin Scale at 6, 12, 24 months. Discussion Measurement of cerebrovascular reserve by multimodal image is recommended by most recent studies to guide the treatment of ischemic stroke, and thus its efficacy and evaluation accuracy need to be established in randomized controlled settings. This prospective, randomized, paralleled controlled registry study, together with other ongoing studies, will present more evidence for optimal individualized accurate treatment of ischemic stroke.

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Measurement of cerebrovascular reserve by multimodal imaging for cerebral arterial occlusion or stenosis patients: protocol of a prospective, randomized, controlled clinical trial

10.21203/rs.2.12484/v2 ◽

2019 ◽

Author(s):

xiao zhipeng ◽

ji ke ◽

lin yong ◽

wan jieqing ◽

pan yaohua ◽

...

Keyword(s):

Clinical Trial ◽

Ischemic Stroke ◽

Arterial Occlusion ◽

Transluminal Angioplasty ◽

Cerebrovascular Reactivity ◽

Stroke Recurrence ◽

Controlled Clinical Trial ◽

Cerebrovascular Reserve ◽

Randomized Controlled ◽

Cerebral Arterial Occlusion

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Impacts of treatments on recurrence and 28-year survival of ischemic stroke patients

Scientific Reports ◽

10.1038/s41598-021-94757-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ting-Ann Wang ◽

Tzy-Haw Wu ◽

Shin-Liang Pan ◽

Hsiu-Hsi Chen ◽

Sherry Yueh-Hsia Chiu

Keyword(s):

Ischemic Stroke ◽

Cerebrovascular Disease ◽

Cox Regression ◽

Controlled Trial ◽

Stroke Recurrence ◽

Long Term Effects ◽

Stroke Patients ◽

Double Blind ◽

Term Survival

AbstractAspirin and nicametate are well-established therapies for preventing recurrence and mortality from stroke in patients diagnosed as ischemic stroke. However, their respective effects on the recurrence, making allowance for the duration of recurrence and death without the occurrence of recurrence, and long-term survival have not been well elucidated. We aimed to evaluate long-term effect of two kinds of treatment on cerebrovascular death among ischemic stroke patients with or without the recurrence of stroke. Data used in this study were derived from the cohort based on a multicenter randomized double-blind controlled trial during 1992 to 1995 with the enrollment of a total of 466 patients with first-time non-cardioembolic ischemic stroke who were randomly allocated to receive aspirin (n = 222) or nicametate (n = 244). The trial cohort was followed up over time to ascertain the date of recurrence within trial period and death until Sep of 2019. The time-dependent Cox regression model was used to estimate the long-term effects of two treatments on death from cerebrovascular disease with and without recurrence. A total of 49 patients experienced stroke recurrence and 89 cerebrovascular deaths was confirmed. Patients treated with nicametate were more likely, but non statistically significantly, to have recurrence (aHR: 1.73, 95% CI 0.96–3.13) as compared with those treated by aspirin. Nicametate reduced the risk of cerebrovascular death about 37% (aHR: 0.63, 95% CI 0.41–0.97) compared with aspirin. The aspirin group had a lower recurrence rate than the nicametate group even with recurrence after 1–2 years of follow-up of first stroke but the latter had significantly reduced death from cerebrovascular disease for nicametate group, which requires more research to verify.

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Abstract WP419: Secondary Prevention Of Cardiovascular Events With Lifestyle Intervention In Patients With Mild Ischemic Stroke - A Randomized Controlled Trial -

Stroke ◽

10.1161/str.44.suppl_1.awp419 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Sumio Yamada ◽

Yuji Kono ◽

Kotaro Iwatsu ◽

Hisako Okumura ◽

Junko Yamaguchi ◽

...

Keyword(s):

Ischemic Stroke ◽

Lifestyle Intervention ◽

Lifestyle Modification ◽

Controlled Trial ◽

Intervention Group ◽

Stroke Recurrence ◽

Control Group ◽

Vascular Events ◽

Randomized Controlled ◽

New Onset

Introduction: Lifestyle modification is associated with a substantially decreased risk of cardiovascular events. However, the role of lifestyle intervention for the secondary prevention in patients with ischemic stroke (IS) is inadequately defined. We assessed the hypothesis that lifestyle intervention which comprised exercise, salt reduction and nutrition advice could reduce new onset of vascular events in patients with mild IS. Methods: We conducted a single-blind randomized controlled trial that enrolled 66 patients (45 men, 21 women; mean age, 63.5 yo) with acute mild ischemic stroke. The patients were randomly allocated to a lifestyle intervention group (n = 33) or control group (n = 33). We performed lifestyle interventions, which comprised exercise training, salt restriction and nutrition advice for 24 weeks. The primary endpoint was ospitalization due to stroke recurrence and new onset of coronary heart disease. We also evaluated blood pressure, serum lipid profile and hemoglobin A1c to compare the efficacy of the lifestyle modification intervention. Results: This trial was terminated earlier than expected because the prespecified early stopping rule for efficacy had been met. After 24 weeks intervention period, the intervention group showed a significant decrease in the clinic and home blood pressure and significant increase in the high density lipoprotein cholesterol (HDL-C) levels from the baseline to the 6-month assessment (clinic and home SBP, P <0.001; HDL-C, P =0.018), with significant differences between the randomized groups (clinic and home SBP, P <0.001; HDL-C, P =0.022). Median duration of follow-up was 2.9 years, 12 patients allocated the control group and 1 patient allocated the lifestyle intervention group had at least one major vascular event. A sequential plans analysis indicated that lifestyle intervention superior to control in interim analysis. Kaplan-Meier survival curves after log-rank test showed significant prognostic difference between randomized groups ( P =0.005). Conclusions: In conclusion, the results of this study indicate that lifestyle intervention is beneficial for preventing stroke recurrence and other vascular events.

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Abstract 1911: Recanalization of Proximal Arterial Occlusion in the SENTIS Trial

Stroke ◽

10.1161/str.43.suppl_1.a1911 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

David S Liebeskind ◽

Ashfaq Shuaib ◽

Martin Köhrmann ◽

William P Dillon ◽

Songling Liu ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Medical History ◽

Controlled Trial ◽

Arterial Occlusion ◽

Stroke Severity ◽

Nihss Score ◽

Logistic Regression Models ◽

Multivariable Logistic Regression

Background: Collateral circulation may enhance recanalization in acute ischemic stroke. Augmentation of collaterals with partial aortic occlusion may promote recanalization and thereby influence outcomes in the SENTIS randomized controlled trial of the NeuroFlo device. We conducted a post hoc analysis of angiography acquired in SENTIS to evaluate potential differences in recanalization rates between NeuroFlo-treated and non-treated arms, accounting for site of arterial occlusion. Methods: Blinded imaging expert review of baseline and 6-hour follow-up angiography (CTA, MRA, or DSA) from the core lab was conducted for evaluation of recanalization. Recanalization was defined as TIMI 2-3 in the arterial segment distal to baseline occlusion. Baseline demographics, stroke presentation characteristics, and medical history variables were analyzed with respect to recanalization in univariate and subsequent multivariable logistic regression models after adjusting by treatment arm. Results: Serial angiography was available in 109/515 SENTIS subjects, including 56 in the treatment arm and 53 in the non-treated arm. Baseline demographics, stroke presentation characteristics, and medical history variables did not differ statistically between arms. Across all sites of arterial occlusion, recanalization occurred in 25.7% of cases, with similar rates between device (25.0%) and medical therapy (26.4%) arms. Age and baseline stroke severity (NIHSS score) were significant predictors of recanalization in univariate analyses. Multivariable logistic regression analyses confirmed that baseline NIHSS score was the sole predictor of recanalization (OR 0.90, p=0.0458) per one unit increase, with decreased recanalization in more severe strokes. Device treatment was not associated with significant increases in recanalization rates (p=NS). Recanalization of terminal internal carotid artery (12.5%), proximal MCA or M1 (17.9%) and M2 (46.7%) occlusions was not different between arms (all p=NS). Recanalization of proximal arterial occlusion in acute ischemic stroke cases enrolled in SENTIS was more frequent in M2 occlusions. Conclusions: More severe strokes at baseline were less likely to recanalize and device therapy did not increase recanalization rates. Treatment with the NeuroFlo device may invoke mechanisms of collateral perfusion distinct from direct arterial recanalization.

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Antithrombotic treatment in patients with stroke and supracardiac atherosclerosis

Neurology ◽

10.1212/wnl.0000000000009823 ◽

2020 ◽

Vol 95 (5) ◽

pp. e499-e507

Author(s):

Dimitrios Sagris ◽

Georgios Georgiopoulos ◽

Ioannis Leventis ◽

Konstantinos Pateras ◽

Lesly A. Pearce ◽

...

Keyword(s):

Ischemic Stroke ◽

Major Bleeding ◽

Controlled Trial ◽

Meta Analysis ◽

Oral Anticoagulants ◽

Stroke Recurrence ◽

Ischemic Event ◽

Random Effects Models ◽

Randomized Controlled ◽

Increased Risk

ObjectiveTo compare the efficacy and safety of oral anticoagulants vs antiplatelets in patients with stroke and atherosclerotic plaques in the aortic arch or cervical or intracranial arteries, collectively described as supracardiac atherosclerosis.MethodsWe searched PubMed and Scopus until August 28, 2019, for randomized trials comparing oral anticoagulants vs antiplatelets in patients with stroke and supracardiac atherosclerosis using the terms “anticoagulant or anticoagulation” and “antiplatelet or aspirin” and “randomized controlled trial or RCT” and “stroke or cerebral ischemia” and “aortic or carotid or vertebrobasilar or intracranial or atherosclerosis or stenosis or arterial.” Four outcomes were assessed: recurrent ischemic stroke, major ischemic event or death, major bleeding, and intracranial bleeding. Treatment effects (relative risk [RR] and 95% confidence interval [CI]) were estimated by meta-analysis using random-effects models.ResultsAmong 1,117 articles identified in the literature search, results from 10 randomized controlled trials involving 6,068 patients with stroke/TIA with supracardiac atherosclerosis were included in the meta-analysis. Recurrent ischemic stroke rates were 2.94 per 100 patient-years in the anticoagulant-assigned patients vs 3.30 per 100 patient-years in the antiplatelet-assigned patients (RR, 0.91; 95% CI, 0.70–1.18 for the SJ estimator, I2 = 26%). Major ischemic event or death rates were 4.39 per 100 patient-years in anticoagulant-assigned patients vs 4.32 in antiplatelet-assigned patients (RR, 1.03; 95% CI, 0.79–1.35; I2 = 54.5%). Major bleeding rates were 2.88 per 100 patient-years in anticoagulant-assigned patients vs 0.82 in antiplatelet-assigned patients (RR, 3.21; 95% CI, 1.96–5.24; I2 = 46%).ConclusionThis systematic review and meta-analysis showed that anticoagulant-assigned patients with stroke and supracardiac atherosclerosis were not at different risk of ischemic stroke recurrence and increased risk of major bleeding compared to antiplatelet-assigned patients.

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Measurement of the Intracranial Arterial Wedge Pressure in Cases of Acute Cerebral Arterial Occlusion to Determine the Indication of Intraarterial Thrombolytic Therapy

Interventional Neuroradiology ◽

10.1177/15910199000060s135 ◽

2000 ◽

Vol 6 (1_suppl) ◽

pp. 213-215

Author(s):

T. Terada ◽

M. Tsuura ◽

H. Matsumoto ◽

O. Masuo ◽

G. Hyotani ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Arterial Occlusion ◽

Time Loss ◽

Cerebral Arterial Occlusion ◽

The Relationship ◽

The Brain ◽

Wedge Pressure

Wedge pressure of the occluded major cerebral artery (distal pressure beyond the occlusion) was measured to estimate the residual cerebral blood flow in thirteen patients with acute ischemic stroke. There existed the relationship that patients with higher wedge pressure tolerated longer ischemic insults than those with lower wedge pressure. Wedge pressure is measured with minimum time loss before starting thrombolytic therapy and may be a good indicator to estimate the brain tissue reversibility.

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Aloe-emodin prevents nerve injury and neuroinflammation caused by ischemic stroke via PI3K/AKT/mTOR and NF-κB pathway

Food & Function ◽

10.1039/d1fo01144h ◽

2021 ◽

Author(s):

Minghua Xian ◽

Jiale Cai ◽

Kening Zheng ◽

Qu Liu ◽

Yali Liu ◽

...

Keyword(s):

Oxidative Stress ◽

Ischemic Stroke ◽

Nerve Injury ◽

Arterial Occlusion ◽

Vital Role ◽

Pathological Process ◽

Morbidity And Mortality ◽

Aloe Emodin ◽

Cerebral Arterial Occlusion

Ischemic stroke (IS) caused by cerebral arterial occlusion is the leading cause of global morbidity and mortality. Cellular oxidative stress and inflammation play a vital role in the pathological process...

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Abstract WP24: Improvement In Collateral Score And Level Of Occlusion Are Early Angiographic Indicators Of The Degree of Infarction In Acute Ischemic Stroke

Stroke ◽

10.1161/str.44.suppl_1.awp24 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Matthew R Amans ◽

Maya Vella ◽

Daniel L Cooke ◽

Steven W Hetts

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Brain Infarction ◽

Arterial Occlusion ◽

Brain Parenchyma ◽

Post Intervention ◽

Vessel Occlusion ◽

Post Procedure ◽

Before And After ◽

Cerebral Arterial Occlusion

INTRODUCTION: Brain parenchyma contrast staining on CT after recanalization therapy and digital subtraction angiography (DSA) in large vessel occlusion acute ischemic stroke (LVO-AIS) patients has been demonstrated to be a marker for significant brain injury, possibly indicating blood brain barrier breakdown or no-reflow phenomena at the capillary level. Most often stained parenchyma undergoes infarction. We evaluated several DSA parameters in order to determine if findings on DSA at the time of LVO-AIS intervention can predict postintervention parenchymal contrast staining on CT and, thus, serve as early prognostic factors for brain infarction. HYPOTHESIS: Point of cerebral arterial occlusion, TICI score, and degree of pial collateraliation correlate with presence of parenchymal contrast staining on post-intervention CT in LVO-AIS patients. METHODS: Our institution’s CHR approved this analysis of imaging and patient charts. We reviewed 17 years of LVO-AIS intervention at our institution, and 67 patients met inclusion criteria. Angiograms were evaluated for level of occlusion, TICI scores before and after intervention, and level of collateralization before and after intervention. Statistical analysis was performed using Fisher’s exact test and ANOVA. RESULTS: More proximal sites of cerebral arterial occlusion were more likely patients to have post-intervention staining (p=0.08). Preprocedure TICI, postprocedure TICI and improvement in TICI score did not predict contrast staining on post procedure CT (p=0.34, 0.54, and 0.52). Preprocedure collateral score, post procedure collateral score were similarly not predictive (p=0.28 and 0.93). Decreasing collateral score (i.e., increased antegrade flow with decreased need for collateral supply) was predictive of contrast staining (p=0.09). CONCLUSION: Improvement in pial collateral score was more predictive of postprocedure contrast staining than was change in TICI grade, and thus may serve as a complement to TICI in the assessment of revascularization efficacy at the time of stroke intervention.

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Neuroprotection by glutamate oxaloacetate transaminase in ischemic stroke: An experimental study

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.2011.3 ◽

2011 ◽

Vol 31 (6) ◽

pp. 1378-1386 ◽

Cited By ~ 86

Author(s):

Francisco Campos ◽

Tomás Sobrino ◽

Pedro Ramos-Cabrer ◽

Bárbara Argibay ◽

Jesús Agulla ◽

...

Keyword(s):

Animal Model ◽

Ischemic Stroke ◽

Arterial Occlusion ◽

Brain Parenchyma ◽

Resonance Spectroscopy ◽

Glutamate Oxaloacetate Transaminase ◽

Neuroprotective Effects ◽

Sensorimotor Deficits ◽

Cerebral Arterial Occlusion ◽

The Brain

As ischemic stroke is associated with an excessive release of glutamate into the neuronal extracellular space, a decrease in blood glutamate levels could provide a mechanism to remove it from the brain tissue, by increasing the brain-blood gradient. In this regard, the ability of glutamate oxaloacetate transaminase (GOT) to metabolize glutamate in blood could represent a potential neuroprotective tool for ischemic stroke. This study aimed to determine the neuroprotective effects of GOT in an animal model of cerebral ischemia by means of a middle cerebral arterial occlusion (MCAO) following the Stroke Therapy Academic Industry Roundtable (STAIR) group guidelines. In this animal model, oxaloacetate-mediated GOT activation inhibited the increase of blood and cerebral glutamate after MCAO. This effect is reflected in a reduction of infarct size, smaller edema volume, and lower sensorimotor deficits with respect to controls. Magnetic resonance spectroscopy confirmed that the increase of glutamate levels in the brain parenchyma after MCAO is inhibited after oxaloacetate-mediated GOT activation. These findings show the capacity of the GOT to remove glutamate from the brain by means of blood glutamate degradation, and suggest the applicability of this enzyme as an efficient and novel neuroprotective tool against ischemic stroke.

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