Association between Serum Insulin-Like Growth Factor-1 and Neurological Severity in Acute Ischemic Stroke

Background and PurposeSerum insulin-like growth factor-1 (IGF-1) is known to have a neuroprotective effect. This study aimed to determine the effects of serum IGF-1 on the severity and clinical outcome of acute ischemic stroke (AIS).MethodsThis study included 446 patients with AIS who were admitted to Hallym University Sacred Heart Hospital within 7 days of stroke onset from February 2014 to June 2017. Serum IGF-1 levels were measured within 24 hours of admission. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS) score at admission, and the functional outcome at 3 months after symptom onset was assessed using the modified Rankin Scale score. The effects of serum IGF-1 levels on stroke severity and 3-month functional outcomes were analyzed using multivariate logistic regression analysis.ResultsThis study evaluated 379 patients with AIS (age 67.2±12.6 years, mean±standard deviation; 59.9% males) after excluding 67 patients who had a history of previous stroke (n=25) or were lost to follow-up at 3 months (n=42). After adjusting for clinically relevant covariates, a higher serum IGF-1 level was associated with a lower NIHSS score at admission (adjusted odds ratio=0.44, 95% confidence interval=0.24–0.80, p=0.01), while there was no significant association at 3 months.ConclusionsThis study showed that a higher serum IGF-1 level is associated with a lower NIHSS score at admission but not at 3 months. Further studies are required to clarify the usefulness of the serum IGF-1 level as a prognostic marker for ischemic stroke.     

Biomarkers predict hemorrhagic transformation and stroke severity after acute ischemic stroke

ObjectivesHemorrhagic transformation (HT) is a complication occurring in patients with acute ischemic stroke (AIS) either spontaneously or post-thrombolysis leading to significant morbidity and mortality. We assessed circulating matrix metalloproteinase-9 (MMP-9), Claudin-5, and soluble serum stimulation-2 (sST2) in HT and stroke severity in AIS based on their temporal distribution.Materials and methodsWe prospectively enrolled 111 AIS patients within 12 h from onset. Patient demographic, clinical, and imaging details were documented. Follow-up imaging was conducted 24–48 h after admission. Blood samples were taken at three time-points from stroke onset. HT was classified according to the European Co-operative Acute Stroke Study-III(ECASS-III). Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Multiple logistic regression and receiver operating characteristic curve were conducted to determine the discriminative capacity.ResultsMean age was 62.3 ± 11.7 years and median baseline NIHSS was 12[IQR 8.0–18.0]. HT was detected in 30(27%) patients. Biomarker levels at 12 h were elevated with median MMP-9 concentration of 153.9 ng/mL[IQR 110.6–309 ng/mL] indicating a trend toward significant positive correlation with HT(P = 0.05). Claudin-5 levels at 12 h was elevated but was not statistically significant (43.1 pg/mL[IQR:26.7–72.6 pg/mL] vs 59.4 pg/mL[IQR:24.5–100.8 pg/mL];P = 0.4). Multiple logistic regression indicated Claudin-5 levels at 12 h (OR 9.46;95% CI:1.97–64.6;P = 0.010) and baseline low ASPECTS score(OR 20.3;95% CI:3.46–193; P = 0.003) independently predicted HT. MMP-9 at 12 h was significantly elevated in patients with moderate to severe strokes (P = 0.04).ConclusionsClaudin-5 and low ASPECTS independently predicted HT. MMP-9 was positively correlated with baseline stroke severity.     

ASPECTS-Region-Dependent Functional Outcomes after Endovascular Therapy in Patients with Cardioembolic Stroke

ObjectivesCardioembolic stroke has a poor prognosis. We evaluated the region-dependent efficacy of endovascular therapy (EVT) based on diffusion-weighted imaging-Alberta Stroke Program Early CT Score (DWI-ASPECTS).MethodsThis post-hoc analysis of the RELAXED study, which investigated the optimal timing of rivaroxaban to prevent nonvalvular atrial fibrillation (NVAF) recurrence in patients with acute ischemic stroke (AIS), included NVAF patients admitted with AIS or transient ischemic attack in the middle cerebral artery (MCA), with internal carotid artery (ICA), M1, or M2-MCA occlusion. Relationships between DWI-ASPECTS region and functional outcome (modified Rankin Scale [mRS]), mortality, recurrence, and hemorrhagic stroke were compared between patients with and without EVT, and adjusted odds ratios for age, pre-stroke mRS, National Institutes of Health Stroke Scale (NIHSS), ICA occlusion, infarct size, recombinant tissue plasminogen activator (rt-PA) use, and onset-to-hospitalization time were estimated.ResultsEVT patients had significantly lower hemoglobin levels, higher median NIHSS scores, more lentiform nucleus infarcts, ICA or M1-MCA occlusions, treatment with rt-PA, and fewer M3, M5, or M6 infarcts and M2-MCA occlusions than no-EVT patients. EVT patients had shorter onset-to-hospitalization times and more frequent favorable functional outcomes (p=0.007). Mortality, recurrent ischemic stroke, and hemorrhagic infarction were similar in both groups. EVT was associated with significantly better functional outcomes among patients with insular ribbon (p=0.043) and M3 (p=0.0008) infarcts. M3 patients had significantly fewer rt-PA and EVT, and longer onset-to-hospitalization times.ConclusionsAn occlusion in the insular ribbon or M3 region was associated with favorable functional outcomes in patients treated with EVT after cardioembolic stroke.     

Obstructive Sleep Apnea before Ischemic Stroke: Clinical Relevance to Infarction Volume and Neurological Recovery

Background: Obstructive sleep apnea (OSA) is a probable risk factor with speculative roles in the induction or aggravation of acute ischemic stroke (AIS). Methods: The association between OSA and AIS severity was retrospectively analyzed using clinical data of first-onset AIS patients, admitted to our hospital between January 2013 and September 2016. Eligible patients were categorized based on the presence of OSA prior to stroke. Stroke severity and functional outcomes were evaluated using the National Institute of Health Stroke Severity Scale (NIHSS) and the modified Rankin scale (mRS), respectively. Results: No significant differences were observed among OSA and non-OSA groups for infarction volume, NIHSS at admission and discharge, or mRS at discharge and at the 3-month follow-up (all P > .05). OSA prior to stroke negatively correlated with infarction volume (P = .008), NIHSS at discharge (P = .006), and the 3-month mRS (P = .015). In addition to OSA, it was also found that infarction volume significantly correlated with large artery occlusion (LAO), anterior circulation involvement, neutrophil count, and fibrinogen level; NIHSS at discharge significantly correlated with LAO, transient ischemia attack (TIA), neutrophil count, and thrombolysis; and the 3-month mRS significantly correlated with LAO, TIA, age, neutrophil count, and thrombolysis. Conclusions: OSA before AIS does not increase the severity of stroke. The negative association between OSA and infarction volume, stroke severity, and clinical outcomes suggests an endogenous neuroprotective effect.     

Combination of high-sensitivity C-reactive protein and homocysteine predicts the short-term outcomes of Chinese patients with acute ischemic stroke

Abstract

Background: Ischemic stroke is one of the most common causes of death worldwide. Early and accurate prediction of outcome in acute ischemic stroke (AIS) is important and influences risk-optimized therapeutic strategies. We investigated the changes in high-sensitivity C-reactive protein (Hs-CRP) and homocysteine (HCY) levels, two of the risk factors, during the acute period of AIS and evaluated the relationship between these levels and short-term prognosis.

Methods: We prospectively studied 189 patients with AIS who were admitted within 24 hours after the onset of symptoms. Serum Hs-CRP, HCY levels, and National Institutes of Health Stroke Scale (NIHSS) were measured at the time of admission. Short-term functional outcome was measured by the modified Rankin scale (mRS), 90 days after admission.

Results: The median serum Hs-CRP and HCY levels were significantly higher in AIS patients as compared to normal controls (P < 0·0001, respectively). High-sensitivity C-reactive protein and HCY were independent prognostic markers of functional outcome and death (adjusted for age and the NIHSS) in patients with AIS. In receiver operating characteristic curve analysis, the prognostic accuracy of the combined model (HCY and Hs-CRP) was higher compared to all measured biomarkers individually and the NIHSS score.

Conclusion: High-sensitivity C-reactive protein and HCY are independent predictors of short-term outcome and mortality after AIS. The combined model may provide additional general prognostic information.     

Serum Neurofilament Light Chain Concentration Correlates with Infarct Volume but Not Prognosis in Acute Ischemic Stroke

Background and Purpose: We studied serum neurofilaments diagnostic value in patients with acute ischemic stroke (AIS) or TIA and evaluated any correlation with symptom severity, cerebral infarction volume, aetiology, and clinical outcome. Methods: One hundred and thirty-six patients (101 with AIS, and 35 with TIA) were included. Acute-phase serum neurofilament light chain (sNfL) was analyzed with a novel ultrasensitive single molecule array (Simoa). Cerebral infarction volume was measured from brain computed tomography in the subacute phase (>2 days). Stroke aetiology was defined by trial of ORG 10172 in acute stroke treatment classification, severity by National Institute of Health stroke scale (NIHSS) and the degree of disability by the Modified Rankin Scale (mRS) after 90 days. Results: sNfL was markedly higher in patients with AIS (89.5 pg/mL [IQR: 44.7-195.3]) than with TIA (25.2 pg/mL [IQR: 14.6-48.0]), P= <.001), also after adjusting for age, NIHSS, and stroke volume (P= .003). In receiver operating characteristic analysis, sNfL concentration greater than or equal to 49 pg/mL proved to be the best cut-off value to differentiate between patients with stroke and those with TIA (sensitivity of 73% and specificity of 80%). sNfL concentration significantly correlated with cerebral infarction volume (r = .413, P= <.001), this association remained significant after adjusting for established predictors (P= .019). Patients with AIS due to cardioembolism or large artery atherosclerosis had the highest sNfL concentrations. NIHSS on admission (r = .343, P = <.001) and mRS scores after 3 months (r = .306, P = .004) correlated with sNfL concentration, however functional outcome 3 months after stroke was not associated with sNfL after adjusting for potential confounders. Conclusions: Cases with stroke were distinguishable from those with TIA following the determination of sNfL in the blood samples. The presence and amount of axonal damage estimated by sNfL correlated with the final cerebral infarction volume but was not predictive of degree of disability.     

Calcium Channel Subunit α2δ-1 as a Potential Biomarker Reflecting Illness Severity and Neuroinflammation in Patients with Acute Ischemic Stroke

BackgroundVoltage-gated calcium channels (VGCCs) dysfunction is involved in the development of acute ischemic stroke (AIS). As a subunit of VGCC complexes, we detected the levels of α2δ-1 subunit in serum and cerebrospinal fluid (CSF) specimens from AIS patients.MethodsThe study included 105 patients with first-ever AIS, who were admitted within 48 hours after stroke onset. The serum and CSF levels of α2δ-1 were measured with ELISA and the severity of AIS patients was evaluated according to the National Institutes of Health Stroke Scale (NIHSS) score. The cerebral infarct volume was calculated through the Pullicino formula based on the cranial CT or MRI scan. C-reactive protein (CRP) and serum amyloid A (SAA) were measured using the latex-enhanced immunoturbidimetric assay.ResultsCompared to the control subjects, the serum α2δ-1 level was significantly increased in AIS patients with large infarct volume and in severe AIS cases with high NIHSS score, which correlated positively with the inflammatory markers CRP and SAA. Furthermore, the concentration of α2δ-1 in CSF was elevated with the infarct volume, which was higher in severe AIS patients.ConclusionOur study suggests that the increased α2δ-1 levels in serum and CSF specimens may be used as a potential marker for reflecting VGCCs dysfunction, illness severity and neuroinflammation in AIS patients.     

Prognostic value of serum thioredoxin levels in ischemic stroke

Objectives: Thioredoxin (Trx) is one of significant antioxidative molecules to diminish oxidative stress. Current evidence suggests that Trx is a potent antioxidant with cytoprotective functions. The aim of our study was to investigate specifically the association between serum Trx levels and acute ischemic stroke (AIS) patients.

Methods: 198 AIS patients and 75 controls were enrolled to the study. Serum Trx levels were measured using an enzyme-linked immunosorbent assay (ELISA). Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS) score on admission. Clinical endpoint was functional outcome measured by Barthel Index (BI) 3 months after admission. Multivariate binary logistic regression analyses were performed to identify predictors.

Results: We found that serum Trx levels were significantly increased in patients as compared to controls. Serum Trx was an independent biomarker to predict ischemic stroke (OR, 1.264; 95% CI, 1.04–1.537; P = 0.019). In addition, there was a negative correlation between NIHSS score at admission and serum Trx levels in cardioembolic stroke patients (r = ?0.422; P = 0.013). Furthermore, higher serum Trx levels in AIS patients were associated with favorable functional outcome. Serum Trx was an independent predictor for the functional outcome (OR, 0.862; 95% CI, 0.75–0.991; P = 0.037).

Conclusions: Serum Trx might be as a biomarker of cardioembolic stroke severity. Increased serum Trx levels could be a useful tool to predict good prognosis in patients with AIS.     

Elevated bilirubin after acute ischemic stroke linked to the stroke severity

Background

Our previous study demonstrated that the level of serum bilirubin after acute ischemic stroke (AIS) was correlated to the severity of stroke, also there has the evidence of hyperbilirubinemia prevalent in AIS. We aimed to identify the exact change of bilirubin in the early phase of AIS, and study if this kind of change linked to the severity of stroke.

Methods

Bilirubin and other biochemical indexes were measured in 608 AIS patients and 188 transient ischemic attack (TIA) patients which set as the control group. National Institutes of Health Stroke Scale (NIHSS) scores were assessed simultaneously with blood collection. First, the level of bilirubin and its distribution were compared between the AIS and control group. According to a cut-off point, we next analyzed the impacted factors of elevated bilirubin including the direct bilirubin (Dbil) and total bilirubin (Tbil), especially the correlation between elevated bilirubin and the severity of stroke. Finally, we compared the difference of concentration and percent of elevated bilirubin among the Oxford Community Stroke Project (OCSP) subtypes.

Results

The level of serum Dbil and Tbil was significantly higher in the AIS group than that in the TIA group. Different distribution was observed between the two groups, which manifested as the percent of low bilirubin level group was lower while high level group was higher in AIS than that in TIA, the p value were 0.043 and 0.078 in Dbil and Tbil, respectively. When the cut-off point of elevated bilirubin was selected as Dbil ≥ 6.84 μmol/L and Tbil ≥ 22.2 μmol/L, we found that both NIHSS score and relative severity of AIS were significantly associated with elevated bilirubin whenever in Dbil or Tbil, so did the OCSP subtypes. This trend was still maintained by multivariable logistic regression analysis adjust for relative influence factors. In regard of OCSP subtypes, the highest level of bilirubin was found in TACI, so did the highest rate of elevated bilirubin.

Conclusion

The serum levels of Dbil and Tbil were increased after AIS, which linked to the severity of stroke.     

Assessment of ABCD2 scale in patients with transient ischaemic attack or stroke

Background and purposeStroke risk prediction scores have been designed to stratify risk of recurrent cerebrovascular events in patients with transient ischaemic attack (TIA) or minor ischaemic stroke (MIS).Material and methodsConsecutive patients with TIA or MIS referring to Ghaem Hospital, Mashhad presenting within 24 hours from the onset of symptoms were recruited to the prospective cohort study between 2010 and 2011. MIS was defined as an ischaemic stroke with National Institutes of Health Stroke Scale (NIHSS) score < 4. The end-point of the study was a new ischaemic cerebrovascular event or vascular death at 90 days and, additionally, at 3 days after the index TIA or MIS. The decision to admit and of method of treatment in each case was left to the discretion of the stroke neurologist. The predictive accuracy of the ABCD² scoring system for recurrent stroke or TIA was quantified by the area under the curve (AUC), using the c-statistics.ResultsThe study included 393 patients with TIA (238 males, 155 females) and 118 patients with MIS (77 males, 41 females). Among 511 patients with minor ischaemic events, 117 strokes (23.2%), 99 TIAs (19.6%), and 11 vascular deaths (2.2%) occurred within 3 months after the index event. The ABCD² score had a weak predictive value for 3-month and 3-day recurrent stroke in patients with TIA (AUC = 0.599 and 0.591, respectively), but a high predictive value for 3-month and 3-day recurrent stroke in patients with MIS (AUC = 0.727 and 0.728, respectively).ConclusionsThe ABCD² score is highly predictive for short-term recurrent stroke in patients with MIS but not in patients with TIA, although it was originally designed for patients with TIA.     

The diagnostic and prognostic value of serum neurogranin in acute ischemic stroke

ObjectivesStroke is a frequently encountered life-threatening medical condition in emergency departments (EDs). Despite all worldwide efforts, a reliable circulating biomarker has not been identified yet. This study investigates the diagnostic and prognostic value of neurogranin (Ng) in acute ischemic stroke (AIS).MethodsThis prospective case-control study was conducted on ED patients with AIS and healthy volunteers. We collected the basic demographics, measured serum Ng levels of the patients vs. controls, and followed up the patient group for 6-month by phone or clinical notes to assess the functional outcomes.ResultsData analysis was completed with 142 subjects (86 patients vs. 55 controls). The groups did not differ in terms of age and gender. The median serum Ng level of the patient group was significantly higher compared to the control group [160.00 (75.93) vs. 121.26 (90.35) ng/mL and p ? 0.001, respectively]. Serum Ng level of 25 patients admitted to the ED within the first 6 hours from the onset of AIS was 177.93 (24.03) ng/mL, while serum Ng level of 61 patients admitted to the ED within 6-24 hours was 131.84 (76.44) ng/mL. AUROC results were 0.717 vs. 0.868 vs. 0.874 for stroke patients admitted during the first 24 hours, 6 hours, and 4.5 hours after the onset, respectively. Lesion volume, NIHSS, and modified Rankin Scale scores (mRS) at admission showed no significant correlation with Ng levels as well as 6-month mortality and 6-month mRS.ConclusionsTimely AIS diagnosis is still a challenge for emergency departments due to the dependency on imaging. Serum Ng can be a promising diagnostic biomarker for AIS patients admitted in the first 24 hours. Even it outperformed in the first 4.5 and 6-hour time windows. However, it did not show a significant prognostic value.     

Pre-Hospital Diagnosis in Mobile Stroke Unit

ObjectivesMobile stroke unit (MSU) has been shown to rapidly provide pre-hospital thrombolysis in acute ischemic stroke (AIS). MSU encounters neurological disorders other than AIS that require emergent treatment.Methods/MaterialsWe obtained pre-hospital diagnosis and treatment data from the prospectively collected dataset on 221 consecutive MSU encounters. Based on initial clinical evaluation and neuroimaging obtained on MSU, the diagnosis of AIS (definite, probable, and possible AIS, transient ischemic attack), intracranial hemorrhage, and likely stroke mimics was made.ResultsFrom July 2014 to April 2015, 221 patients were treated on MSU. 78 (35%) patients had initial clinical diagnosis of definite/probable AIS or TIA, 69 (31%) were diagnosed as possible AIS or TIA, 15 (7%) had intracranial hemorrhage while 59 patients (27%) were diagnosed as likely stroke mimics. Stroke mimics encountered included 13 (6%) metabolic encephalopathy, 11 (5%) seizures, 9 (4%) migraines, 3 (1%) substance abuse, 2 (1%) CNS tumor, 3 (1%) infectious etiology and 3 (1%) hypoglycemia. Fifty-four (24%) patients received non-thrombolytic treatments on MSUConclusionAbout one third of MSU encounters were not AIS initially, including intracranial hemorrhage and stroke mimics. MSU can be utilized to provide pre-hospital treatments in emergent neurological conditions other than AIS.     

Comparing the benefit of ASPECTS on maximum intensity projection images of computed tomography angiography to source images and noncontract computed tomography in predicting infarct volume and collaterals extent

IntroductionIn acute ischemic strokes (AIS), the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and CT perfusion (CTP) are commonly used to determine mechanical thrombectomy eligibility. Prior work suggests that CTA source image (CTA-SI) ASPECTS (CTA_asp) and a newly described CTA maximum intensity projection (CTA-MIP) ASPECTS (MIP_asp) better predict the final infarct core. Our goal was to compare MIP_asp to CTA_asp and non-contrast CT ASPECTS (NCCT_asp) for predicting ischemic core and collaterals established by CTP.Methods and materialsA single institution, retrospective database for AIS due to internal carotid artery (ICA) or proximal middle cerebral artery (MCA) occlusions between January 2016 and February 2021 was reviewed. We rated ASPECTS on NCCT, CTA-SI, and CTA-MIP at baseline, then used the automated RAPID software to measure CTP ischemic core volume. The accuracy of each ASPECTS in predicting ischemic core volume (ICV) >70 cc and Hypoperfusion intensity ratio (HIR) >0.4 was compared using the receiver operating characteristic (ROC) curve.Results122/319 patients fulfilled the inclusion criteria. Area under the curve (AUC) for MIP_asp was significantly higher than NCCT_asp and CTA_asp for predicting ICV >70 cc (0.95 vs. 0.89 and 0.95 vs. 0.92, P =0.03 and P = 0.04). For predicting HIR >0.4, AUC for MIP_asp was significantly higher than NCCT_asp and CTA_asp (0.85 vs. 0.72 and 0.85 vs. 0.81, P < 0.001 and P < 0.01).ConclusionThe predictive accuracy of detecting ischemic stroke with ICV >70cc and HIR >0.4 can be significantly improved using the MIP_asp instead of CTA_asp or NCCT_asp.     

Association of serum growth differentiation factor 15 level with acute ischemic stroke in a Chinese population

Abstract

Background: Growth differentiation factor 15 (GDF-15) is a member of the transforming growth factor-ß family. Elevated GDF-15 concentrations are associated with increased risks of cardiovascular diseases, diabetes mellitus and cerebrovascular disease.

Objective: This study aimed to determine the clinical significance of serum GDF-15 level after acute ischemic stroke (AIS) in a Chinese population.

Methods: We compared serum GDF-15 levels between 83 AIS patients and 124 controls. At admission and on day 7, we recorded the National Institutes of Health Stroke Scale score and measured serum GDF-15 levels for AIS patients and for control patients at admission. Stroke volumes were calculated using diffusion-weighted magnetic resonance imaging performed at admission. Clinical outcomes were evaluated 90?days later using the modified Rankin Scale.

Results: Serum GDF-15 level at admission was significantly higher in AIS patients than in controls (p?<?.01). GDF-15 level on day 7 was significantly higher in the poor outcomes group than in the good outcomes group (p?<?.05). Higher GDF-15 levels at admission and on day 7 were related to larger stroke volumes (p?<?.01). Binary logistic regression indicated that serum GDF-15 level at admission may be independently related with AIS (p?<?.01). Serum GDF-15 level on day 7 may independently associated with poor outcomes after AIS (p?<?.05).

Conclusions: GDF-15 level at admission may independently related to AIS, and GDF-15 level on day 7 could independently predict outcomes at 90?days after AIS. GDF-15 may provide prognostic information after AIS in a Chinese population.     

Evidence of redox unbalance in post-acute ischemic stroke patients

Measurements of the redox balance after the ischemic stroke occurrence might be useful to monitor the outcome of patients who suffered an ischemic stroke in terms of stroke recurrence and other vascular events. For this purpose, fifteen patients (mean age 71.40±2.50 years) with a first-ever ischemic stroke were included in the study within 30 days of stroke onset. Stroke severity was evaluated according to the National Institutes of Health Stroke Scale (NIHSS). Redox balance was assessed by measuring plasma amount of total peroxidative by-products, nitrite/nitrate metabolites (NOx), as expression of nitric oxide (NO) plasma bioavailability, total plasma antioxidant capacity (TEAC), Cu/Zn Superoxide Dismutase (Cu/Zn SOD) activity, serum urate concentration and autoantibodies against ox-LDL (OLAB) serum level. Total cholesterol, triglycerides, high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C) were also measured. Fifteen apparently healthy controls (mean age 70.28±2.03 years) were investigated to compare redox markers. Stroke patients had higher plasma values of total peroxidative by-products, NOx stable metabolites and of total cholesterol, triglycerides, and LDL-C than controls (P < 0.05). No differences in OLAB levels, Cu/Zn-SOD activity, serum urate concentration, and plasma HDL-C amount were found in stroke patients when compared to controls. Total plasma antioxidant capacity was lower in stroke patients than in controls. NOx values correlated positively with the NIHSS score in stroke patients (r=0.668; P=0.0065). The observed presence of redox unbalance in stroke patients could represent an early indicator of diffuse endothelial activation during which patients may be at increased risk of stroke recurrence and other vascular events.     

Plasma Levels of miR-125b-5p and miR-206 in Acute Ischemic Stroke Patients After Recanalization Treatment: A Prospective Observational Study

Introduction: Multiple microRNAs (miRNAs) participate in the response to hypoxic/ischemic and ischemia-reperfusion events. However, the expression of these miRNAs in circulation from patients with acute ischemic stroke (AIS) receiving recanalization treatment has not been examined, and whether they are associated with the severity and outcome of stroke is still unknown. Materials and methods: In this prospective cohort study, plasma levels of miR-125b-5p, miR-15a-3p, miR-15a-5p, and miR-206 were measured at 24 hours after thrombolysis with or without endovascular treatment in 94 patients with AIS, as determined by qRT-PCR. Stroke severity was assessed based on National Institutes of Health Stroke Scale (NIHSS) score and infarct lesion. Intracranial haemorrhage (ICH) was recorded. An unfavorable outcome was defined as a modified Rankin Scale score greater than 2 at day 90 after stroke. Results: miR-125b-5p and miR-206 levels were correlated with NIHSS scores (P = .014 and P = .002) and cerebral infarction volumes (P = .025 and P = .030). miR-125b-5p levels were significantly higher in patients with an unfavorable outcome than in patients with a favorable outcome (P = .002) and showed good diagnostic accuracy in discriminating the presence of an unfavorable outcome (area under the curve .735, 95% confidence interval .623-.829, P < .001). No association was found between different miRNAs and ICH. Conclusions: In AIS patients after thrombolysis with or without endovascular treatment, miR-125b-5p is a novel prognostic biomarker highly associated with an unfavorable outcome. miR-125b-5p and miR-206 levels are associated with stroke severity.     

Increased Serum Alkaline Phosphatase in Patients with Acute Ischemic Stroke

Background

Stroke is one of the most common causes of disability and death. Higher alkaline phosphatase (ALP) levels have been associated with poor functional outcomes and mortality in previous studies. We investigated alterations in serum ALP concentrations and functional outcomes in patients with acute ischemic stroke (AIS).

Recombinant tissue plasminogen activator (rTPA) management for first onset acute ischemic stroke with covid -19 and non-covid -19 patients

ObjectivesCerebrovascular stroke (CVS) is one of the well-known complications of coronavirus-2019 (Covid-19), but less is known about the outcome and safety of thrombolytic therapy in these patients. In this study we compare the efficacy and safety of Tissue plasminogen activator (rTPA) in acute ischemic stroke (AIS) patients with or without Covid-19 infection.Materials and methodsA comparative prospective study in which all patients who presented with AIS and eligible for rTPA were recruited from the emergency department and classified into 2 groups (AIS with Covid-19 infection and AIS without Covid-19 as controls). Demographic data, symptoms of Covid-19, clinical examination, neuroimaging, and laboratory investigations were obtained in each patient. National Institute of Health Stroke Scale (NIHSS) and the Modified Rankin Scale (mRS) were assessed before, immediately after rTPA, and 3 months later.ResultsThere were 22 patients in the COVID-19 group and 25 control patients. Those with COVID-19 were more likely to have a history of smoking and Diabetes Mellitus than controls. On admission, motor symptoms were more severe in patients with COVID-19. COVID-19 patients were more likely to have symptomatic intra-cerebral hemorrhage and radiological hemorrhagic transformation than controls. Onset to door time (ODT) and onset to successful reperfusion time were significantly longer in Covid-19 patients than controls. Clinical improvement and frequency of re-occlusion and recurrent ischemic stroke at 3 months follow-up did not differ between groups, although there was higher number of deaths (27.3%) in the Covid-19 group than controls (16%).ConclusionsUsing rTPA is safe and effective in patients with AIS with or without COVID-19 infection despite the high frequency of hemorrhagic transformation and high number of deaths.     

Effect of inpatient rehabilitation facility care on ninety day modified Rankin score in ischemic stroke patients

ObjectiveTo determine Inpatient Rehabilitation Facility (IRF) treatment effect on modified Rankin Scale (mRS) scores at 90 days in acute ischemic stroke (AIS) patients.Materials and methodsThis prospective cross-sectional study included 738 AIS patients admitted 1/1/2018-12/31/2020 to a Comprehensive Stroke Center with a Stroke Rehabilitation program. We compared outcomes for patients who went directly home versus went to IRF at hospital discharge: (1) acute care length of stay (LOS), (2) National Institutes of Health Stroke Scale (NIHSS) score, (3) mRS score at hospital discharge and 90 days, (4) the proportion of mRS scores ≤ 2 from hospital discharge to 90 days.ResultsAmong 738 patients, 499 went home, and 239 went to IRF. IRF patients were more likely to have increased acute LOS (10.7 vs 3.9 days; t-test, P<0.0001), increased mean NIHSS score (7.8 vs 4.8; t-test, P<0.0001) and higher median mRS score (3 vs 1, t-test, P<0.0001) compared to patients who went home. At 90 days, ischemic stroke patients who received IRF care were more likely to progress to a mRS ≤ 2 (18.7% increase) compared to patients discharged home from acute care (16.3% decrease). Home patients experienced a one-point decrease in mRS at 90 days compared to those who received IRF treatment (median mRS of 3 vs. 2, t-test, P<0.05).ConclusionsIn ischemic stroke patients, IRF treatment increased the likelihood of achieving mRS ≤ 2 at 90 days indicating the ability to live independently, and decreased the likelihood of mRS decrease, compared with patients discharged directly home after acute stroke care.     

Laterality is an Independent Predictor of Endovascular Thrombectomy in Patients With Low National Institute of Health Stroke Scale

Objective

Endovascular thrombectomy (ET) for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO) is offered to select patients meeting strict criteria. One of the criteria is stroke severity as indicated by the National Institute of Health Stroke Scale (NIHSS). Inherently, NIHSS is biased towards left hemisphere strokes (LHS) with median NIHSS score 4 points higher than right hemisphere strokes (RHS). This may potentially affect clinical decision making and thrombectomy eligibility. We sought to test this hypothesis.