Optical brain pulse monitoring of microvascular blood flow during endovascular treatment for acute ischemic stroke

medRxiv (Cold Spring Harbor Laboratory), Год журнала: 2025, Номер unknown

Опубликована: Фев. 6, 2025

Abstract Background Endovascular treatment (EVT) of large vessel occlusion (LVO) strokes improves patient outcomes. However, significant challenges remain including detection microvascular no reflow phenomena, emboli to new territories and improving neuro-prognostication. Real time monitoring the brain microcirculation could assist in addressing these challenges. This first-in-human cohort study evaluated Optical Brain Pulse Monitoring (OBPM) blood flow during EVT. Methods OBPM is a non-invasive device using red infrared light capture pulse waveforms, reflecting relative arteriole venous pressure levels driving flow. classes – Arterial, Hybrid, Venous I, II Monotonous represent continuum states from normal (Arterial) critically low (Monotonous). sensors were positioned bilaterally over middle cerebral artery LVO stroke patients undergoing Data on demographics, imaging clinical outcomes collected. Results Eleven (mean age 71, NIHSS 13) enrolled. The most common class at presentation was I (64%). associated with hypoperfused tissue volume (p = 0.005). following EVT long-term outcomes, length hospital stay 0.04), modified Rankin Score 0.06) death 0.02). In one patient, detected an embolization territory that occurred internal carotid stenting. Conclusion waveforms demonstrated circulation features presenting stroke. These also such as size presentation, LOS mortality. improve intra-procedural evaluation reflow, complications has potential simple method for earlier detection. Clinical trial registration URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384769&isReview=true ; Unique identifier: ACTRN12622001320741

Язык: Английский

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No‐reflow after stroke reperfusion therapy: An emerging phenomenon to be explored

CNS Neuroscience & Therapeutics, Год журнала: 2024, Номер 30(2)

Опубликована: Фев. 1, 2024

In the field of stroke thrombectomy, ineffective clinical and angiographic reperfusion after successful recanalization has drawn attention. Partial or complete microcirculatory failure achievement full patency a former obstructed large vessel, known as "no-reflow phenomenon" "microvascular obstruction," was first reported in 1960s later detected both experimental models patients with stroke. The no-reflow phenomenon (NRP) to result from intraluminal occlusions formed by blood components extraluminal constriction exerted surrounding structures vessel wall. More recently, an emerging number studies have estimated prevalence NRP following therapy, ranging 3.3% 63% depending on its evaluation methods study population. Studies also demonstrated detrimental effects infarction progress neurological outcomes. this review, we discuss research advances, underlying pathogenesis, diagnostic techniques, management approaches concerning population provide comprehensive understanding offer references for future investigations.

Язык: Английский

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Impacts of futile reperfusion and reperfusion injury in acute ischemic stroke

Brain Circulation, Год журнала: 2024, Номер 10(1), С. 1 - 4

Опубликована: Янв. 1, 2024

Acute ischemic stroke (AIS) remains to be a challenging cerebrovascular disease. The mainstay of AIS management is endovascular reperfusion therapy, including thrombectomy and thrombolysis. However, ineffective (futile) (FR) or injury (RI) can seen in significant number patients undergoing strategy. In this article, we discuss two clinically relevant concepts known as "time window" "tissue that impact the clinical outcome therapy. We also explore patient risk factors, leading FR RI well an emerging concept "no-reflow phenomenon" reperfusion. These fundamental provide insight into references for future research.

Язык: Английский

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Perfusion patterns as a tool for emergency stroke diagnosis: differentiating proximal and distal MCA occlusions

BMJ Neurology Open, Год журнала: 2025, Номер 7(1), С. e001001 - e001001

Опубликована: Фев. 1, 2025

Background To evaluate the effectiveness of a novel Perfusion Pattern (PP) scale in differentiating between proximal and distal middle cerebral artery (MCA) occlusions patients with acute ischaemic stroke. Methods This retrospective study included 201 stroke, categorised into two groups: those M1 segment (n=114) medium vessel (n=87). We analysed multimodal stroke CT imaging clinical data, focusing on occlusion site, hypoperfusion extent basal ganglia involvement. Patients tandem stenosis or multiple were excluded. patterns three types (PP-1, PP-2 PP-3) based hypoperfusion. Statistical analysis explored associations perfusion pattern collateral status. Results Among (mean age 75±14 years, 86 men), PP-1 was observed 36.8% (74/201), 27.4% (55/201) PP-3 35.8% (72/201). The distribution PP varied significantly by site (p<0.0001). Distal associated 78.4% cases (58/74), while most prevalent (90.3%, 65/72). contingency coefficient revealed that location had stronger association (c=0.556) than type (c=0.245). However, 21.6% (16/74) showed 9.7% (7/72) exhibited PP-3. Basal infarction presence reliable indicator 94% likelihood. Conclusions can effectively differentiate MCA occlusions, aiding targeted assessment angiography.

Язык: Английский

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Persistent Tissue-Level Hypoperfusion (No-Reflow) Negates the Clinical Benefit of Successful Thrombectomy

Stroke, Год журнала: 2025, Номер unknown

Опубликована: Март 31, 2025

BACKGROUND: Tissue-level hypoperfusion (no-reflow) persists in 30% of patients with seemingly successful upstream angiographic recanalization at thrombectomy. We investigated the clinical impact no-reflow phenomenon by comparing versus varying degrees recanalization. METHODS: In a post hoc pooled analysis EXTEND-IA (Endovascular Therapy for Ischemic Stroke With Perfusion-Imaging Selection) and TNK (Tenecteplase Versus Alteplase Before Thrombectomy Stroke) part 1 2 trials, radiological outcomes were compared between (1) full (expanded Treatment Cerebral Ischemia [eTICI] 2c3–NoReflow), defined as >15% reduction relative cerebral blood flow or Volume within infarct to contralateral homolog on 24-hour-follow-up perfusion computed tomography magnetic resonance imaging despite eTICI grade 2c-3 recanalization, (2) tissue reperfusion (eTICI 2c3–CompleteFlow), (3) partial 2b), (4) unsuccessful thrombectomy 0-2a). The primary outcome, functional independence 90 days, was using mixed effect logistic regression model, both unadjusted adjusted priori-selected covariates, namely age, premorbid modified Rankin Scale, baseline National Institutes Health core volume. RESULTS: Among 537 from overall cohort, 456 included analysis. mean age 71 years old, 54% male. A favorable outcome (90-day Scale score 0–2 return Scale) observed 43.33% (n=13/30) 2c3–NoReflow, 67.50% (n=81/120) 2c3–CompleteFlow, 63.03% (n=150/238) 2b, 50.00% (n=34/68) multivariable analysis, 2c3–NoReflow had lower odds those 2c3–CompleteFlow (adjusted ratio, 0.31 [95% CI, 0.12–0.77]; P =0.01) 2b 0.40 0.17–0.96]; =0.04) but not 1.02 0.38–2.73]; =0.97). Patients similar follow-up volume ( β =−8.26 −27.38 10.86]; =0.40) =9.38 −7.33 26.09]; =0.27) larger infarcts =18.85 1.16–36.54]; =0.04). CONCLUSIONS: When occurred, Preventing reversing has potential augment benefit treatment ischemic stroke.

Язык: Английский

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Role of Endothelin-1 and Nitric Oxide in Acute Ischemic Stroke Leptomeningeal Collateral Activation

International Journal of Molecular Sciences, Год журнала: 2025, Номер 26(7), С. 3205 - 3205

Опубликована: Март 30, 2025

Good leptomeningeal collaterals (LMCs) after large vessel occlusion (LVO) extend the time window for endovascular therapy. The mechanisms regulating LMC activation are not fully understood. aim of this study was to investigate potential role two vasoactive molecules endothelin-1 (ET-1)—a vasoconstrictor agent—and nitric oxide (NO)—a vasodilator agent—in regulation post-stroke LMCs. Ischemic stroke patients within 6 h LVO were included. Collateral status assessed using Menon scoring system based on computed tomography angiography scans. Patients accordingly divided into three groups: poor, intermediate, and good Recanalization evaluated modified thrombolysis in cerebral infarction (mTICI) score. Serum levels ET-1 NO measured at points: T0 (<6 h), T1 (24 T2 (48 h). A total 105 enrolled (mean age 76 ± 12.8 years): 44 with (46.2%), 36 intermediate (37.8%), 22 poor LMCs (23.1%). values decreased, whereas increased from all groups patients. No significant association found between serum collateral status. Higher correlated outcome regardless or degree recanalization (p = 0.030). linear positive correlation revealed high neutrophil count (Spearman’s rho 0.236, p 0.035). Subgroup analysis showed a inverse score −0.251, 0.021). Although we observed no concentrations, 24 higher predictive These findings may indicate an inadequate microvascular reperfusion, possibly due ET-1-mediated vasoconstriction, activation, NO-mediated oxidative stress, suggesting their no-reflow phenomenon.

Язык: Английский

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Acupuncture as adjunctive therapy for acute cerebral infarction: a randomized clinical trial

Frontiers in Neurology, Год журнала: 2025, Номер 16

Опубликована: Апрель 11, 2025

Background Acute cerebral infarction (ACI) is the second leading cause of death and major disability worldwide, there an increasing interest in non-pharmacological treatments. Acupuncture has promising effects on ACI, but its efficacy safety need to be verified through well-designed randomized clinical trials. We aimed investigate acupuncture as adjunctive therapy improve neurological function patients with ACI. Methods The multicenter, sham-controlled, patient- assessor-blinded controlled trial was conducted 4 tertiary hospitals China from January September 2024. All participants received standard care recommended by guidelines were randomly assigned (1:1:1) manual (MA), sham (SA), or (SC) only. Participants MA SA groups treatment 6 times weekly for 2 weeks a total 12 sessions. primary outcome change National Institutes Health Stroke Scale score baseline 14 days. Safety outcomes included adverse events serious events. Results A 132 (median [IQR] age, 65 [58–69] years; 96 men [72.73%]), median (IQR) 11 (9–12) points, intention-to-treat analysis. Ten withdrew during 14-day intervention, another 7 90-day follow-up. During impairment significantly improved group compared (4 [3, 5] vs. 3 [1.25, 4] points; Cohen’s d , 0.76; 95% CI, 0.33 1.19; p = 0.001). Adverse occurred relatively equally between (19 [43.2%] 13 [29.5%]; relative risk, 1.46; 0.83 2.58; 0.184). Conclusion Twelve sessions safe effective improving results this indicate that can routine, supplemental Clinical registration ChiCTR2300079204 (Chinese Trial Registry, http://www.chictr.org.cn registered 27/12/2023).

Язык: Английский

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Biomimetic Nanomotors for Deep Ischemia Penetration and Ferroptosis Inhibition in Neuroprotective Therapy of Ischemic Stroke

Advanced Materials, Год журнала: 2024, Номер unknown

Опубликована: Ноя. 26, 2024

Nerve injury represents the primary reason of mortality and disability in ischemic stroke, but effective drug delivery to region cerebral ischemia hypoxia poses a significant challenge neuroprotective treatment. To address these clinical challenges, biomimetic nanomotor, Pt@LF is designed, facilitate deep agents inhibit ferroptosis stroke. traverses blood-brain barrier (BBB) penetrates into ischemic-hypoxic areas due active targeting capacity apo-lactoferrin (Apo-LF) self-propelling motion properties nanomotors. Subsequently, loosens thrombus alleviates "no reflow" phenomenon via mechanical thrombolysis. Thanks various enzyme-like abilities multi-target inhibition capability, ameliorates inflammatory microenvironment rescues dying neurons. In conclusion, demonstrates efficiently penetration effects vitro vivo. And this study provides promising therapeutic platform for treatment

Язык: Английский

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Safety and Efficacy of Adjunctive Intra-arterial Tenecteplase following Successful Thrombectomy in Patients with Large Vessel Occlusion: A Phase 1/2 Randomized Clinical Trial

medRxiv (Cold Spring Harbor Laboratory), Год журнала: 2024, Номер unknown

Опубликована: Ноя. 18, 2024

Abstract Background Adjunct intra-arterial thrombolysis has been shown to potentially improve clinical outcomes in patients with large vessel occlusion (LVO) stroke who have undergone successful endovascular thrombectomy (EVT). Tenecteplase, known for its enhanced fibrin specificity and extended activity duration, may be a better choice than alteplase thrombolysis. However, the optimal dose, safety efficacy of tenecteplase remain unclear. Objective To evaluate adjunctive following EVT LVO patients. Methods design This study is two-part, phase Ib/IIa, multicenter, open-label, 14+8 dose-escalation (Part I) dose-expansion II) trial conducted China involving achieved (defined as expanded Thrombolysis Cerebral Infarction [eTICI] grade 2b50 or higher) within 24 hours last well. In Part Ib, dose escalation will up four tiers patients, starting at 0.03125 mg/kg, planned maximum 0.1875mg/kg, primary outcome symptomatic intracranial hemorrhage hours. IIa, 157 randomized among two selected safe doses placebo, proportion nondisabled (modified Rankin Scale score 0 1) 90 days. Discussions pivotal provide important data on acute ischemic due support advance treatment standards. Trial registry number ChiCTR2300073787 ChiCTR2400080624 ( www.chictr.org.cn ).

Язык: Английский

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Safety and Efficacy of Adjunctive Intra-arterial Tenecteplase following Successful Thrombectomy in Patients with Large Vessel Occlusion: Study Rationale and Design of A Phase 1/2 Randomized Clinical Trial

medRxiv (Cold Spring Harbor Laboratory), Год журнала: 2024, Номер unknown

Опубликована: Ноя. 19, 2024

Abstract Background Adjunct intra-arterial thrombolysis has been shown to potentially improve clinical outcomes in patients with large vessel occlusion (LVO) stroke who have undergone successful endovascular thrombectomy (EVT). Tenecteplase, known for its enhanced fibrin specificity and extended activity duration, may be a better choice than alteplase thrombolysis. However, the optimal dose, safety efficacy of tenecteplase remain unclear. Objective To evaluate adjunctive following EVT LVO patients. Methods design This study is two-part, phase Ib/IIa, multicenter, open-label, 14+8 dose-escalation (Part I) dose-expansion II) trial conducted China involving achieved (defined as expanded Thrombolysis Cerebral Infarction [eTICI] grade 2b50 or higher) within 24 hours last well. In Part Ib, dose escalation will up four tiers patients, starting at 0.03125 mg/kg, planned maximum 0.1875mg/kg, primary outcome symptomatic intracranial hemorrhage hours. IIa, 157 randomized among two selected safe doses placebo, proportion nondisabled (modified Rankin Scale score 0 1) 90 days. Discussions pivotal provide important data on acute ischemic due support advance treatment standards. Trial registry number ChiCTR2300073787 ChiCTR2400080624 ( www.chictr.org.cn ).

Язык: Английский

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