Impaired Cerebrovascular Autoregulation in Large Vessel Occlusive Stroke after Successful Mechanical Thrombectomy: A Prospective Cohort Study

Introduction: Successful thrombectomy improves morbidity and mortality after stroke. The present prospective, observational cohort study investigated a potential correlation between the successful restoration of tissue perfusion by mechanical thrombectomy and intact cerebrovascular autoregulation (CA). Objective: Status of CA in patients with large vessel occlusive stroke after thrombectomy. Methods: After thrombectomy CA was measured using transcranial Doppler ultrasound. For this purpose a moving correlation index (Mxa) based on spontaneous arterial blood pressure fluctuations and corresponding cerebral blood flow velocity changes was calculated. CA impairment was defined by Mxa values more than .3. Results: Twenty patients with an acute occlusion of the middle cerebral artery or distal internal carotid artery were included. A successful recanalization of the occluded vessel via interventional thrombectomy was achieved in 10 of these patients (successful recanalization group), while in 10 patients mechanical recanalization failed or could not be applied (no recanalization group). Mean Mxa at stroke side was .58 ± .21 Table 2a in patients with successful intervention. At the unaffected hemisphere Mxa was .50 ± .20 Table 2a in successful recanalization group and .45 ± .24 Table 2b in no recanalization group without statistically significant differences. Based on the previously defined Mxa cut off more than .3, CA impairment was observable in all successful recanalized patients and in 8 of 10 patients with unsuccessful interventional treatment. Conclusions: These results suggest that brain perfusion may be affected due to impaired CA even after successful mechanical thrombectomy. Therefore, a tight blood pressure management is of great importance in post-thrombectomy stroke treatment to avoid cerebral hypo- and hyperperfusion.     

Unstable Cerebral Hemodynamics in Carotid Artery Occlusion and Large Hemispheric Stroke: A Cerebral Blood Flow Volume Study

PURPOSE: In chronic internal carotid artery (ICA) occlusion, cerebral hemodynamics are likely to be stable due to collateral flow. The authors evaluated cerebral hemodynamics in ICA occlusion using the sonographic method of cerebral blood flow volume (CBVF) measurement to find differences that might identify patients with large hemispheric stroke in ICA occlusion. METHOD AND RESULTS: The ultrasound method of CBVF measurement was used, which represents the sum of flow volumes of both internal carotid and both vertebal arteries. CBVF was measured in 29 patients with ICA occlusion including patients with (1) chronic ICA occlusion without acute minor stroke, (2) chronic ICA occlusion with acute minor stroke, (3) acute minor stroke due to acute ICA occlusion, and (4) ICA occlusion and large hemispheric stroke. In ICA occlusion, overall CBVF is lower compared to healthy volunteers, due to a significant reduction of CBVF in groups 3 and 4. Comparing groups, there were no differences in CBVF between groups 1, 2, and 3. CBVF in group 4 is reduced compared to all other groups. By receiver-operating characteristic analysis, a CBVF cutoff value for large hemispheric stroke was computed with a sensitivity of 100% and a specificity of 95.8%. CONCLUSION: Stroke due to acute ICA occlusion is associated with decreased CBVF compared to chronic ICA occlusion. Moreover, ICA occlusion and large hemispheric stroke are associated with decreased CBVF compared to all other groups, indicating instability of cerebral hemodynamics. CBVF measurement thus may be a useful tool in predicting large middle cerebral artery stroke early in ICA occlusion.     

Cerebral Air Embolism Resulting in Fatal Stroke in an Airplane Passenger with a Pulmonary Bronchogenic Cyst

Introduction  Cerebral air embolism is a rare cause of stroke, but may occur in patients undergoing invasive cardiac and pulmonary procedures, as well as in divers suffering pulmonary barotrauma from rapid ascent. Cerebral air embolism during air travel, however, is particularly rare. Case  We present a case of a previously healthy gentleman who presented with an acute stroke after a commercial flight; the stroke was initially felt to be of cardioembolic origin. A large intrapulmonary cyst was noted on his imaging studies, but thought to be an incidental finding. During a return flight, he suffered another stroke and was found to have cerebral air emboli. Conclusion  This case suggests the importance of considering cerebral air embolism in patients with stroke associated with air travel; restricting air travel in patients with intrapulmonary cysts may be prudent.     

2006年天坛国际脑血管病会议:中国卒中事业飞速发展的里程碑

2006年天坛国际脑血管病会议于2006年6月16～18日在北京国际会议中心隆重举行。本次会议由卫生部国际交流与合作中心、国际华人脑血管病联盟、中国医学科学院神经科学研究所、全国脑血管病防治研究办公室、北京市脑血管病抢救治疗中心及首都医科大学附属北京天坛医院等联合主办。     

Large Vessel Occlusion Score: A Screening Tool to Detect Large Vessel Occlusion in the Acute Stroke Setting

Background: The results of recent trials of mechanical thrombectomy for acute ischemic stroke have increased the demand for identification of patients with large vessel occlusion (LVO) at the primary stroke center, where a prompt detection may expedite transfer to a comprehensive stroke center for endovascular treatment. However, in developing countries, a noncontrast computed tomography (NCCT) may be the only neuroimaging modality available at the primary stroke center scenario, what calls for a screening strategy accurate enough to avoid unnecessary transfers of noneligible patients for endovascular therapy. Algorithms based on National Institute of Health Stroke Scale (NIHSS) and NCCT findings can be used to screen for LVO in patients with anterior circulation stroke (ACS). Objective: To test the accuracy of a score based on NIHSS and NCCT to detect LVO in patients with ACS. Methods: We evaluated 178 patients from a prospective stroke registry of patients admitted to an academic tertiary emergency unit. NIHSS and vessel attenuation values of the middle cerebral artery on NCCT absolute vessel attenuation (VA) were collected by 2 investigators that were blind to CT angiography (CTA) findings. We used receiver operating characteristics curve analysis and C-statistics to predict LVO on CTA. Results: NIHSS and vessel attenuation were highly associated with LVO with an area under the curve (AUC) of .86 and .77. The LVO score, built by logistic regression coefficients of the NIHSS and VA, showed the highest accuracy for the presence of LVO on CTA (AUC of .91). Conclusion: The LVO score may be a useful screening approach to identify LVO in patients with ACS.     

2020国际卒中大会亮点解读（二）——缺血性卒中神经保护的大门再次开启了吗？

缺血性卒中发生后,会迅速出现神经细胞能量缺乏、兴奋性氨基酸毒性作用、细胞去极化和坏死等病理现象。如果此时对损伤的病理生理过程进行针对性的阻断,从理论上会延缓神经细胞的死亡,减轻损伤。但是多年来缺血性卒中后神经保护治疗却一直无法成功从基础研究转化到临床实践。     

2020年国际卒中大会亮点解读（一）

2020年第一场卒中领域的学术盛宴——国际卒中大会2020(Inter national Stroke Conference 2020,ISC 2020)于2月19~21日在美国的洛杉矶召开。因为新型冠状病毒感染的肺炎疫情的影响,绝大多数国内的研究者未能出席。《中国卒中杂志》特邀请本刊主编首都医科大学附属北京天坛医院王拥军教授(图1)和本刊编辑部主任王春雪教授(图2)对大会的部分亮点进行解读。     

国际卒中协会主席为我刊题词

获悉《中国卒中杂志》的出版我非常高兴。在中国,作为第二大致死因素,卒中是一个非常严重的问题。所以我们必须一起努力来降低卒中所带来的危害。通过这样的专业杂志,我们可以拓展知识面,形成新的科学态度,从而使全人类受益。