An Appraisal of the 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke

Jadhav, Ashutosh P.; Mokin, Maxim; Ortega‐Gutiérrez, Santiago; Haussen, Diogo C; Liebeskind, David S; Nogueira, Raul G; Jovin, Tudor G; Linfante, Italo

doi:10.1159/000495041

Cited by 6 publications

(4 citation statements)

References 19 publications

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“…However, increasing data indicate that MT can be safely and effectively applied in the real-world setting outside the constraints of randomized controlled trial and guideline requirements, including clinical and imaging inclusion and exclusion criteria 24 25. Furthermore, several studies have shown that a large proportion of patients with AIS and LVO do not fit the strict set of criteria set in the guidelines, indicating that the validation of MT safety and efficacy in a real-world setting is necessary to better understand the generalizability of this treatment 26–28…”

Section: Discussionmentioning

confidence: 99%

Non-contrast head CT alone for thrombectomy in acute ischemic stroke: analysis of the ANGEL-ACT registry

Ren

Mokin

et al. 2021

J NeuroIntervent Surg

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BackgroudThe goal of this study was to determine if the choice of imaging paradigm performed in the emergency department influences the procedural or clinical outcomes after mechanical thrombectomy (MT).MethodsThis is a retrospective comparative outcome study which was conducted from the ANGEL-ACT registry. Comparisons were made between baseline characteristics and clinical outcomes of patients with acute ischemic stroke undergoing MT with non-contrast head computed tomography (NCHCT) alone versus patients undergoing NCHCT plus non-invasive vessel imaging (NVI) (including CT angiography (with or without CT perfusion) and magnetic resonance angiography). The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included change in mRS score from baseline to 90 days, the proportions of mRS 0–1, 0–2, and 0–3, and dramatic clinical improvement at 24 hours. The safety outcomes were any intracranial hemorrhage (ICH), symptomatic ICH, and mortality within 90 days.ResultsA total of 894 patients met the inclusion criteria; 476 (53%) underwent NCHCT alone and 418 (47%) underwent NCHCT + NVI. In the NCHCT alone group, the door-to-reperfusion time was shorter by 47 min compared with the NCHCT + NVI group (219 vs 266 min, P<0.001). Patients in the NCHCT alone group showed a smaller increase in baseline mRS score at 90 days (median 3 vs 2 points; P=0.004) after adjustment. There were no significant differences between groups in the remaining clinical outcomes.ConclusionsIn patients selected for MT using NCHCT alone versus NCHCT + NVI, there were improved procedural outcomes and smaller increases in baseline mRS scores at 90 days.

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Section: Discussionmentioning

confidence: 99%

Non-contrast head CT alone for thrombectomy in acute ischemic stroke: analysis of the ANGEL-ACT registry

Ren

Mokin

et al. 2021

J NeuroIntervent Surg

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“…IVT was administered applying established laboratory and clinical inclusion and exclusion criteria, as considered appropriate by the treating physician, and only alteplase has been used. [12][13][14] Endovascular procedures were performed using approved devices (i.e., stent retriever and/or aspiration catheters). The choice of thrombectomy device was left to the discretion of the attending neurointerventionalist.…”

Section: Study Cohortmentioning

confidence: 99%

Investigating Neurologic Improvement After IV Thrombolysis

Broocks,

Meyer,

Bechstein

et al. 2023

Neurology

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Background and Objectives:Time from stroke onset is associated with clinical response to intravenous thrombolysis with alteplase (IVT) and is therefore used to select patients for treatment. Alternatively, neuroimaging may be used for treatment in the uncertain or extended time window. We hypothesized that the patient-specific imaging indicator of ischemic lesion progression (“tissue clock”) using CT-perfusion (CTP) or quantitative net water uptake (NWU) is a predictor of early neurological improvement (ENI) independent of time.Methods:Observational study of anterior circulation ischemic stroke patients with proximal vessel occlusion and known time from symptom onset triaged by multimodal-CT undergoing endovascular treatment. Quantitative NWU using an established threshold (11.5%) or CTP lesion-core mismatch (EXTEND criteria) were used to estimate ischemic lesion progression. The treatment effect of IVT depending on lesion progression defined by tissue clock versus time clock was assessed by inverse-probability weighting (IPW). Endpoints were binarized ENI and functional independence at day-90.Results:409 patients were included, of which 223 (54.5%) received IVT. The proportion of patients within an early time window (<4.5h), low NWU, and CTP-mismatch were 45.0%/86.5%/80.3%. In IPW, IVT was associated with higher rates of ENI (%-difference: 7.3%,p=0.02). For patients with CTP-mismatch or low NWU, IVT was associated with a 9.6%/7.2% higher rate of ENI, which was different than the effect of IVT in patients without CTP-mismatch or high NWU (-9.3%/-7.3%; p=0.004/p=0.03), while early treatment window did not modifiy the effect of IVT.Discussion:CT-based measures of the “tissue clock” might identify patients who benefit from IVT more accurately than conventional time windows. Considering the high number of patients with early “tissue clock” (low NWU/CTP-mismatch) within an extended time window, considerable benefit from IVT using imaging indicators of the “tissue clock” may be achieved.

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“…The prevalence of stroke is highest in developing countries, and ischemic stroke is the most common type. Ischemic stroke is brain tissue infarction due to cerebral artery occlusion, accompanied by damage to neurons, astrocytes, and oligodendrocytes [ 2 ]. The conventional treatment for ischemic stroke is either thrombolytic therapy or surgical or mechanical removal of blood clots [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Ischemic stroke is brain tissue infarction due to cerebral artery occlusion, accompanied by damage to neurons, astrocytes, and oligodendrocytes [ 2 ]. The conventional treatment for ischemic stroke is either thrombolytic therapy or surgical or mechanical removal of blood clots [ 2 , 3 ]. However, these treatments have a limited time window, high recurrence rates, and limited neurological recovery.…”

Section: Introductionmentioning

confidence: 99%

Allicin promotes functional recovery in ischemic stroke via glutathione peroxidase-1 activation of Src-Akt-Erk

Zhuang,

Shi,

Qiao

et al. 2023

Cell Death Discov.

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Allicin exhibits various pharmacological activities and has been suggested to be beneficial in the treatment of stroke. However, the underlying mechanisms are largely unknown. Here, we confirmed that allicin protected the brain from cerebral injury, which could be ascribed to its anti‑apoptotic and anti‑inflammatory effects, as well as the regulation of lipid metabolism, using proteomics and metabolomics analysis. Our results suggested that allicin could significantly ameliorate behavioral characteristics, cerebral infarct area, cell apoptosis, inflammatory factors, and lipid metabolic-related factors (arachidonic acid, 15-hydroperoxy-eicosatetraenoic acid (15S-HPETE), palmitoylcarnitine, and acylcarnitine) by recalibrating astrocyte homeostasis in mice with photothrombotic stroke (PT). In astrocytes, allicin significantly increased glutathione peroxidase 1 (GPX1) levels and inhibited the arachidonic acid-related pathway, which was also observed in the brains of mice with PT. Allicin was proven to inhibit hypoxia-induced astrocyte apoptosis by increasing GPX1 expression, activating proto-oncogene tyrosine-protein kinase Src (Src)- protein kinase B (AKT)-extracellular signal-regulated kinase (ERK) phosphorylation, and decreasing lipid peroxidation. Thus, we concluded that allicin significantly prevented and ameliorated ischemic stroke by increasing GPX1 levels to complete the complex physiological process.

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An Appraisal of the 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke

Cited by 6 publications

References 19 publications

Non-contrast head CT alone for thrombectomy in acute ischemic stroke: analysis of the ANGEL-ACT registry

Non-contrast head CT alone for thrombectomy in acute ischemic stroke: analysis of the ANGEL-ACT registry

Investigating Neurologic Improvement After IV Thrombolysis

Allicin promotes functional recovery in ischemic stroke via glutathione peroxidase-1 activation of Src-Akt-Erk

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