scholarly journals To the issue of degree of removal of gliomas of supratentorial localization

2021 ◽  
Vol 35 (1) ◽  
pp. 50-55
Author(s):  
S.A. Usatov ◽  
B.R. Rashidi ◽  
Yu.V. Boguslavskiy
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Surgical Care ◽  
Hemorrhagic Transformation ◽  
Neurological Deficits ◽  
Therapeutic Window ◽  
Surgical Interventions ◽  
Retrograde Blood Flow ◽  
Continue Research ◽  
Occlusive Lesion

Objective ‒ to assess the possibility of increasing the time of surgical restoration of blood flow in the acute period of ischemic stroke due to occlusive lesion of the internal carotid artery (ICA).Materials and methods. Among the patients who were admitted for treatmentat in the Regional Odessa Hospital with acute ischemic stroke in the carotid region a group of 6 patients was identified in whom the cause of stroke was occlusion of the ICA by an atherosclerotic plaque. Age of patients ‒ from 54 to 71 years. Patients were hospitalized later 6 hours from the onset of stroke. The survey was carried out according to the established protocol. Neurological deficits are mild to moderate. In order to eliminate the occlusion of the ICA, all patients underwent endarterectomy.Results. Carotidendarterectomy was performed from 2 to 11 days after onset of stroke. Retrograde blood flow through the ICA was obtained in three (50 %) patients in whom surgical interventions were performed up to 4 days after the disease. In the postoperativeperiod a typical therapy was carried out. In cases with the obtained retrograde blood flowon control carotid angiograms demonstrated revascularization of the ICA basin according to mTICI-3. On the control CT of the brain in postoperative period in one case the point subarachnoid hemorrhages was determined. In the other two cases there was no evidence hemorrhagic transformation. Operated patients showed positive dynamics: a decrease hemiparesis by 1 poin and regression of mental disorders. The patients were discharged withm RS 1‒2. During the follow-up examination 90 days the neurological condition of the patients improved to mRS 1‒0.Conclusions. Results obtained in increasing the “therapeutic window” for revascularization of the occluded ICA allow to continue research in the indicated direction and improve the quality of surgical care for patients with acute stroke.

scholarly journals Possibility of increasing the «therapeutic window» for revascularization of the carotid arteries in the acute period of ischemic stroke

2021 ◽  
Vol 35 (1) ◽  
pp. 43-49
Author(s):  
O.A. Spinul ◽  
O.A. Kartashov ◽  
O.O. Shpak
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Surgical Care ◽  
Hemorrhagic Transformation ◽  
Neurological Deficits ◽  
Therapeutic Window ◽  
Surgical Interventions ◽  
Acute Period ◽  
Retrograde Blood Flow ◽  
Continue Research

Objective ‒ to assess the possibility of increasing the time of surgical restoration of blood flow in the acute period of ischemic stroke due to occlusive lesion of the internal carotid artery (ICA).Materials and methods. Among the patients who were admitted for treatmentat in the Regional Odessa Hospital with acute ischemic stroke in the carotid region a group of 6 patients was identified in whom the cause of stroke was occlusion of the ICA by an atherosclerotic plaque. Age of patients ‒ from 54 to 71 years. Patients were hospitalized later 6 hours from the onset of stroke. The survey was carried out according to the established protocol. Neurological deficits are mild to moderate. In order to eliminate the occlusion of the ICA, all patients underwent endarterectomy.Results. Carotidendarterectomy was performed from 2 to 11 days after onset of stroke. Retrograde blood flow through the ICA was obtained in three (50 %) patients in whom surgical interventions were performed up to 4 days after the disease. In the postoperativeperiod a typical therapy was carried out. In cases with the obtained retrograde blood flowon control carotid angiograms demonstrated revascularization of the ICA basin according to mTICI-3. On the control CT of the brain in postoperative period in one case the point subarachnoid hemorrhages was determined. In the other two cases there was no evidence hemorrhagic transformation. Operated patients showed positive dynamics: a decrease hemiparesis by 1 poin and regression of mental disorders. The patients were discharged withm RS 1‒2. During the follow-up examination 90 days the neurological condition of the patients improved to mRS 1‒0.Conclusions. Results obtained in increasing the “therapeutic window” for revascularization of the occluded ICA allow to continue research in the indicated direction and improve the quality of surgical care for patients with acute stroke.

Abstract WP291: Diabetes Impairs Long-term Functional Recovery in an Embolic Stroke Model in Sex Independent Manner

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Weiguo Li ◽  
Sherif Hafez ◽  
John Paul Valenzuela ◽  
Rebecca Ward ◽  
Guangkuo Dong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Recovery ◽  
Hemorrhagic Transformation ◽  
Cognitive Outcome ◽  
Embolic Stroke ◽  
Neurological Deficits ◽  
Independent Manner ◽  
Male And Female ◽  
The Impact

Ischemic stroke is a leading cause of death and disability. Diabetes not only increases the risk of stroke, it also worsens the outcomes, increases the risk of hemorrhagic transformation (HT) and impairs recovery after stroke. It is well established that young females are more protected and show better outcomes than males after stroke. However, the impact of diabetes on long term recovery after stroke in both sexes was not clear. Accordingly, this study tested the hypothesis that diabetes impairs long term functional recovery after ischemic stroke in a sex independent manner. Methods: Diabetes was induced in male and female Wistar rats using high fat diet and low dose streptozotocin (30 mg/Kg). After 8 weeks of diabetes, animals were subjected to embolic stroke. Male and female Wistar normoglycemic age matched rats were used as controls. Motor (composite score: 14 best outcome and adhesive removal-ART) and cognitive (novel object recognition, NOR) deficits were assessed at day1, 3, 7 and 14. Results: Female control animals had better outcomes compared to the males. Mortality was higher in diabetic animals, especially in males. The neurological deficits were greater in diabetic animals with no difference between males and females. Conclusion: Diabetes impaired functional and cognitive outcome and recovery after ischemic stroke in a sex independent manner.

IM-12 activates the Wnt–β-catenin signaling pathway and attenuates rtPA-induced hemorrhagic transformation in rats after acute ischemic stroke

2019 ◽  
Vol 97 (6) ◽  
pp. 702-708 ◽  
Author(s):  
Ting Wang ◽  
Yu-Mei Duan ◽  
Qiao Fu ◽  
Tao Liu ◽  
Jin-Cheng Yu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Signaling Pathway ◽  
Glycogen Synthase ◽  
Hemorrhagic Transformation ◽  
Neurological Deficits ◽  
Control Group ◽  
High Morbidity ◽  
Sprague Dawley ◽  
Gsk 3Β

Hemorrhagic transformation (HT) is a devastating complication for patients with acute ischemic stroke (AIS) who are treated with tissue plasminogen activator (tPA). HT is associated with high morbidity and mortality, but no effective treatments are currently available to reduce the risk of HT. Therefore, methods to prevent HT are urgently needed. In this study, we used IM-12, an inhibitor of glycogen synthase kinase 3β (GSK-3β), to evaluate the role of the Wnt–β-catenin signaling pathway in recombinant tPA (rtPA)-induced HT. Sprague–Dawley rats were subjected to a middle cerebral artery occlusion (MCAO) model of ischemic stroke, and then were either administered rtPA, rtPA combined with IM-12, or the vehicle at 4 h after stroke was induced. Our results indicate that rats subjected to HT had more severe neurological deficits, brain edema, and blood–brain barrier (BBB) breakdown, and had a greater infarction volume than the control group. Rats treated with IM-12 had improved outcomes compared with those of rats treated with rtPA alone. Moreover, IM-12 increased the protein expression of β-catenin and downstream proteins while suppressing the expression of GSK-3β. These results suggest that IM-12 reduces rtPA-induced HT and attenuates BBB disruption, possibly through activation of the Wnt–β-catenin signaling pathway, and provides a potential therapeutic strategy for preventing tPA-induced HT after AIS.

Abstract TP231: Predictors of Early Neurological Deterioration in Acute Minor Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sang Min Sung ◽  
Yoon Jung Kang ◽  
Sung Hwan Jang ◽  
Nae Ri Kim ◽  
Suk Min Lee
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcomes ◽  
Vascular Diseases ◽  
Hemorrhagic Transformation ◽  
Neurological Deterioration ◽  
Arterial Stenosis ◽  
Neurological Deficits ◽  
Stroke Severity ◽  
Minor Ischemic Stroke ◽  
Early Neurological Deterioration

Introduction: Early neurological deterioration is one of the critical determinants of functional outcomes in patients with minor ischemic stroke. The purpose of this study was to identify predictors of early neurological deterioration in patients with acute minor ischemic stroke. Methods: A total of 739 patients with acute minor ischemic stroke who are admitted within 24 hours after onset of stroke symptom between January 2014 and December 2018 were enrolled in this study. We analyzed demographic characteristics, risk factors for vascular diseases, stroke severity, stroke subtypes, neuroimaging parameters, and relevant arterial steno-occlusive lesions. Early neurological deterioration was defined as any worsening of neurological deficits within 3 days after admission. Logistic regression was used to determine independent predictors of early neurological deterioration. Results: Seventy-eight of 739 (10.5%) patients had early neurological deterioration. Among 78 patients with early neurological deterioration, 61 (78.2%) had poor functional outcomes at 90 days after stroke onset. By contrast, 131 of 661 (19.8%) patients without early neurological deterioration had poor functional outcomes. Multivariate analysis identified hemorrhagic transformation (OR, 3.8; 95% CI, 1.4-10.5; P=0.010), higher score of NIHSS on admission (OR, 1.4; 95% CI, 1.1-1.7; P=0.003), relevant arterial stenosis (OR, 2.0; 95% CI, 1.2-3.5; p=0.014) and occlusion (OR, 2.6; 95% CI, 1.4-4.8; p=0.004) were the factors associated with early neurological deterioration. Conclusions: The results of this study suggest that hemorrhagic transformation, higher NIHSS score on admission, relevant arterial steno-occlusive lesions are independent predictors of early neurological deterioration in patients with acute minor ischemic stroke.

Abstract TP33: Ischemic Stroke Outcomes in Medical vs Endovascular Treatment of Proximal Carotid Artery Occlusion

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Yamin Shwe ◽  
Chunyan Cai ◽  
Anjail Z Sharrief ◽  
Amrou Sarrraj
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Endovascular Treatment ◽  
Small Sample Size ◽  
Retrospective Chart Review ◽  
Hemorrhagic Transformation ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Small Sample ◽  
Neurological Deficits

Background: Acute ischemic stroke (AIS) due to proximal carotid artery occlusion (pCAO) can be associated with significant neurological deficits and poor outcome without timely intervention and successful reperfusion. Intravenous thrombolytics (IT) have low recanalization rates in pCAO and these patients were excluded from recent randomized controlled trials which showed superiority of endovascular therapy (EVT) over IT. Purpose: The purpose of this study is to investigate clinical outcomes in AIS due to pCAO treated with medical vs. endovascular treatment. Methods: We conducted a retrospective chart review of patients who underwent IT or EVT±IT for all types of pCAO from January 2008 to June 2015. Our primary outcome was the functional outcome at discharge measured by modified Rankin score (mRS) 0-3. The secondary outcomes were hemorrhagic transformation (HT), neurological worsening (NW), symptomatic hemorrhage (sICH) and death. Logistic regression analysis was used to compare outcomes between the two groups. Results: A total of 133 patients were included in the study. Baseline characteristics are depicted in table 1. There were no significant differences between the two groups. IV tPA was given in 56% IT vs. 72% EVT (p=0.14). While there was a shift towards better outcomes in the mRS distribution in EVT group (22% vs. 16%) as shown in Figure 1, the treatment effect did not reach significance (OR 1.71, 95% CI (0.55, 5.34), p=0.35). There was also no difference in HT (26% vs. 14%, p=0.14), or NW (26% vs. 21%, p=0.6). However, sICH was higher in EVT (3.7% vs. 0%, p=0.2). Conclusion: Our study did not show difference in discharge functional outcomes between EVT and IT in AIS with pCAO. Our results are limited by small sample size and retrospective nature. Future prospective studies randomizing patients to medical vs. endovascular treatments are warranted to guide management.

scholarly journals Neurological Instability in Ischemic Stroke: Relation with Outcome, Latency Time, and Molecular Markers

2021 ◽  
Author(s):  
Ramón Iglesias-Rey ◽  
Andres da Silva-Candal ◽  
Manuel Rodríguez-Yáñez ◽  
Ana Estany-Gestal ◽  
Uxía Regueiro ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Neurological Deficits ◽  
Therapeutic Window ◽  
Inverse Association ◽  
Clinical Markers ◽  
Poor Outcome ◽  
Clinical Biomarkers ◽  
Good Functional Outcome ◽  
Patient’S Outcome

AbstractThe National Institutes of Health Stroke Scale (NIHSS) is commonly used to evaluate stroke neurological deficits and to predict the patient’s outcome. Neurological instability (NI), defined as the variation of the NIHSS in the first 48 h, is a simple clinical metric that reflects dynamic changes in the area of the brain affected by the ischemia. We hypothesize that NI may represent areas of cerebral instability known as penumbra, which could expand or reduce brain injury and its associated neurological sequels. In this work, our aim was to analyze the association of NI with the functional outcome at 3 months and to study clinical biomarkers associated to NI as surrogate biomarkers of ischemic and inflammatory penumbrae in ischemic stroke (IS) patients. We included 663 IS patients in a retrospective observational study. Neutral NI was defined as a variation in the NI scale between − 5 and 5% (37.1%). Positive NI is attributed to patients with an improvement of > 5% NI after 48 h (48.9%), while negative NI is assigned to patients values lower than − 5% (14.0%). Poor outcome was assigned to patients with mRS ≥ 3 at 3 months. We observed an inverse association of poor outcome with positive NI (OR, 0.35; 95%CI, 0.18–0.67; p = 0.002) and a direct association with negative NI (OR, 6.30; 95%CI, 2.12–18.65; p = 0.001). Negative NI showed a higher association with poor outcome than most clinical markers. Regarding good functional outcome, positive NI was the marker with the higher association (19.31; CI 95%, 9.03–41.28; p < 0.0001) and with the highest percentage of identified patients with good functional outcome (17.6%). Patients with negative NI have higher glutamate levels compared with patients with neutral and positive NI (p < 0.0001). IL6 levels are significantly lower in patients with positive NI compared with neutral NI (p < 0.0001), while patients with negative NI showed the highest IL6 values (p < 0.0001). High glutamate levels were associated with negative NI at short latency times, decreasing at higher latency times. An opposite trend was observed for inflammation, and IL6 levels were similar in patients with positive and negative NI in the first 6 h and then higher in patients with negative NI. These results support NI as a prognosis factor in IS and the hypothesis of the existence of a delayed inflammatory penumbra, opening up the possibility of extending the therapeutic window for IS.

scholarly journals Radiological predictors of hemorrhagic transformation after acute ischemic stroke: An evidence-based analysis

2020 ◽  
Vol 33 (2) ◽  
pp. 118-133 ◽  
Author(s):  
Nada Elsaid ◽  
Wessam Mustafa ◽  
Ahmed Saied
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Ct Perfusion ◽  
Treatment Plan ◽  
Hemorrhagic Transformation ◽  
Lesion Volume ◽  
Ischemic Lesion ◽  
Blood Brain Barrier Disruption

Hemorrhagic transformation (HT) is one of the most common adverse events related to acute ischemic stroke (AIS) that affects the treatment plan and clinical outcome. Identification of a sensitive radiological marker may influence the controversial thrombolytic decision in the setting of AIS and may at a minimum indicate more intensive monitoring or further prophylactic interventions. In this article we summarize possible radiological biomarkers and the role of different radiological modalities including computed tomography (CT), magnetic resonance imaging, angiography, and ultrasound in predicting HT. Different radiological indices of early ischemic changes, large ischemic lesion volume, severe blood flow restriction, blood-brain barrier disruption, poor collaterals and high blood flow velocities have been reported to be associated with higher risk of HT. The current levels of evidence of the available studies highlight the role of the different CT perfusion parameters in predicting HT. Further large standardized studies are recommended to compare the sensitivity and specificity of the different radiological markers combined and delineate the most reliable predictor.

scholarly journals Association of pre-stroke hyperglycemia with hemorrhagic transformation in patients undergoing thrombolysis.

2021 ◽  
Author(s):  
Gabriel Praxedes Freire ◽  
Juliana de Alencar Fontes ◽  
Gabriel Nascimento Silva ◽  
Pedro Antonio Pereira de Jesus
Keyword(s):  
Ischemic Stroke ◽  
Cross Sectional Study ◽  
Hemorrhagic Transformation ◽  
Therapeutic Window ◽  
Admission Criteria ◽  
Thrombolytic Treatment ◽  
Sectional Study ◽  
Vascular Events ◽  
Cross Sectional ◽  
Frequent Finding

Background: Hyperglycemia is a frequent finding in patients suffering from ischemic stroke. Hemorrhagic transformation is a complication associated with thrombolytic treatment, with poor prognosis. In addition, hyperglycemia and diabetes are related to worse outcomes in vascular events. Objective: This study aims to analyze the association between hyperglycemia at admission and hemorrhagic transformation in patients undergoing thrombolysis after ischemic stroke. Methods: A cross-sectional study was carried out with patients from the DISPASS cohort (DOI: 10.1161 / STROKEAHA.120.026425), admitted in a reference stroke unit in Salvador-BA. Those over 18 years of age who underwent thrombolysis with alteplase were included and patients without data on glycemic control or who did not meet the admission criteria in the cohort were excluded. Results: Of the 173 patients within the therapeutic window for thrombolysis, 14 underwent hemorrhagic transformation evidenced in computed tomography of the skull and, among these, only 04 presented with hyperglycemia at admission and beginning of thrombolytic treatment, which represented a non-important association (p <0.485) between hyperglycemia and hemorrhagic transformation after thrombolysis. Discussion and Conclusion: The findings are in line with what was reported by Olsen in 2009 and with what was expected, due to the known relationship between hyperglycemia and diabetes with hemorrhagic complications in patients who suffered a stroke. The present study found no association between the incidence of hemorrhagic transformations in patients with pre- thrombolysis hyperglycemia in a stroke context.

scholarly journals Targets of vascular protection in acute ischemic stroke differ in type 2 diabetes

2013 ◽  
Vol 304 (6) ◽  
pp. H806-H815 ◽  
Author(s):  
Aisha I. Kelly-Cobbs ◽  
Roshini Prakash ◽  
Weiguo Li ◽  
Bindu Pillai ◽  
Sherif Hafez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Hemorrhagic Transformation ◽  
Artery Occlusion ◽  
Neurological Deficits ◽  
Diabetic Patients ◽  
Vascular Protection ◽  
Acute Therapy

Hemorrhagic transformation is an important complication of acute ischemic stroke, particularly in diabetic patients receiving thrombolytic treatment with tissue plasminogen activator, the only approved drug for the treatment of acute ischemic stroke. The objective of the present study was to determine the effects of acute manipulation of potential targets for vascular protection [i.e., NF-κB, peroxynitrite, and matrix metalloproteinases (MMPs)] on vascular injury and functional outcome in a diabetic model of cerebral ischemia. Ischemia was induced by middle cerebral artery occlusion in control and type 2 diabetic Goto-Kakizaki rats. Treatment groups received a single dose of the peroxynitrite decomposition catalyst 5,10,15,20-tetrakis(4-sulfonatophenyl)prophyrinato iron (III), the nonspecific NF-κB inhibitor curcumin, or the broad-spectrum MMP inhibitor minocycline at reperfusion. Poststroke infarct volume, edema, hemorrhage, neurological deficits, and MMP-9 activity were evaluated. All acute treatments reduced MMP-9 and hemorrhagic transformation in diabetic groups. In addition, acute curcumin and minocycline therapy reduced edema in these animals. Improved neurological function was observed in varying degrees with treatment, as indicated by beam-walk performance, modified Bederson scores, and grip strength; however, infarct size was similar to untreated diabetic animals. In control animals, all treatments reduced MMP-9 activity, yet bleeding was not improved. Neuroprotection was only conferred by curcumin and minocycline. Uncovering the underlying mechanisms contributing to the success of acute therapy in diabetes will advance tailored stroke therapies.

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