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Background MicroRNAs (miRNAs) are implicated in the progression of ischemic stroke (IS) and bone marrow-derived mesenchymal stem cells (BMSCs)-derived exosomes play a role in IS therapy. Herein we hypothesized that the BMSCs-derived exosomes containing overexpressed miR-138-5p could protect the astrocytes following IS involved with lipocalin 2 (LCN2). Methods The differentially expressed gene related to IS was initially identified by bioinformatics analysis. miR-138-5p was predicted to regulate LCN2. The expression of miR-138-5p and LCN2 was altered in the oxygen-glucose deprivation (OGD)-induced astrocytes. Furthermore, the cell behaviors and inflammatory responses were evaluated both in astrocytes alone and astrocytes co-cultured with exosomes derived from BMSCs overexpressing miR-138-5p to explore the involvement of miR-138-5p and LCN2 in IS. Besides, middle cerebral artery occlusion (MCAO) mouse model was established to explore the effect of BMSCs-derived exosomal miR-138-5p in IS in vivo. Results LCN2 was highly expressed in IS. Besides, LCN2 was a target gene of miR-138-5p. BMSCs-derived exosomes could be endocytosed by astrocytes via co-culture. Overexpression of miR-138-5p promoted the proliferation and inhibited apoptosis of astrocytes injured by OGD, accompanied by the reduced expression of inflammatory factors, which was achieved by down-regulating LCN2. More importantly, BMSCs delivered miR-138-5p to the astrocytes via exosomes and BMSCs-derived exosomal miR-138-5p alleviated neuron injury in IS mice. Conclusion BMSCs-derived exosomal miR-138-5p reduces neurological impairment by promoting proliferation and inhibiting inflammatory responses of astrocytes following IS by targeting LCN2, which may provide a novel target for IS treatment.

The value of intravascular ultrasound (IVUS) in the diagnosis and treatment of the venous system is not well established. Introducing a novel approach to utilizing IVUS to evaluate cerebral venous sinus (CVS) stenosis and select stent. Idiopathic intracranial hypertension (IIH) patients with CVS stenosis who underwent IVUS-guided stenting were included in the data analysis from January 2014 to February 2022. The degree of maximum stenosis was determined based on the cross-sectional area (CSA) measured by IVUS, and a stent selection method was applied in the study. Follow-up evaluations were conducted at 6 months to 1 year after endovascular treatment to assess symptom improvement. Additionally, repeated digital subtraction angiography (DSA) or Magnetic resonance venography (MRV) / CT venography（CTV） was performed to evaluate the stent patency at 6 months to 1 year post-procedure. The study included 61 patients. IVUS indicated a lower degree of stenosis compared to conventional DSA measurements when evaluating the degree of stenotic segments preprocedure (74.84 ± 10.12% vs. 78.48 ± 8.72%, p  = 0.035). Post-procedural CSA of the most severe stenotic segments showed significant improvement (36.44 ± 8.07 mm 2 vs. 7.42 ± 3.28 mm 2 , p  < 0.001). The stent achieved complete expansion (mean stent expansion index, 0.93 ± 0.20) with no significant change in the structure of the reference segment. The trans-stenotic mean pressure gradients (MPGs) across 61 patients significantly decreased from 11.00 ± 6.23 mmHg to 2.09 ± 2.34 mmHg. 47 out of 61 patients received imaging follow-up; among them, 44 (93.6%) demonstrated stent patency in the follow-up imaging. IVUS has great potential to evaluate the degree and extent of CVS stenosis, assist stent selection, and optimize stent position during the interventional procedure in conjunction with DSA.

There were limited studies comparing the anterior (AC) and posterior (PC) circulation acute ischemic strokes (AIS). Our study aimed to evaluate distinct features of AC and PC strokes regarding clinical, vascular risk, pathogenesis and outcome factors after endovascular procedures. This multicenter prospective study registered 873 patients with acute large occlusion of anterior circulation stroke (ACS) and posterior circulation stroke (PCS). Patients who underwent endovascular procedures were included in this study. The differences in ACS and PCS regarding baseline characteristics, post-operative intracranial hemorrhage and outcomes were evaluated. A total of 741 patients were included in the data analysis. Intravenous thrombolysis (31.5%), atrial fibrillation (22.7%) and stent thrombectomy (82.4%) were more frequently observed in ACS patients. While higher NIHSS score, hypertension (67.6%) and balloon angioplasty (20.7%) were more prevalent in PCS patients. Symptomatic intracranial hemorrhage was more common in ACS (7.4% vs 2.8%). However, a 3-month follow-up outcomes were better in ACS with higher functional independence and low mortality rate than PCS (46.8% vs 30.3% and 16.4% vs 33.8%, respectively, P < 0.01). In this large prospective study, there were significant differences in the pathogenesis of stroke and treatment procedure between ACS and PCS which influence the clinical outcome. These findings could lead to a tailored clinical procedures and treatment strategies to improve the prognosis in both groups.

Background: In patients with posterior circulation stroke, the association between National Institutes of Health Stroke Scale (NIHSS) scores after thrombectomy and 90-day functional outcomes remains unclear. Objectives: We aimed to explore which factors among the 24-h NIHSS score, ΔNIHSS (baseline NIHSS minus 24-h NIHSS), and NIHSS score change rate (ΔNIHSS/baseline NIHSS × 100%) are associated with favorable functional outcomes at 90 days postoperatively in patients with posterior circulation stroke. Design: We performed a post hoc analysis of a prospective observational study utilizing key techniques of endovascular treatment and emergency workflow improvements from the acute ischemic stroke registry. The study included a cohort of 353 patients who underwent thrombectomy due to posterior circulation stroke. For all patients, we collected baseline characteristics, lesion locations, NIHSS scores, ΔNIHSS (baseline NIHSS minus 24-h NIHSS), NIHSS score change rate (ΔNIHSS/baseline NIHSS × 100), and 90-day postoperative modified Rankin Scale (mRS) score. Methods: A 90-day postoperative mRS score of 0–2 was defined as a favorable functional outcome, while a score of 3–6 was defined as an unfavorable functional outcome. The 24-h NIHSS score and ΔNIHSS score were converted into binary variables based on the Youden index to determine the optimal thresholds that best predict favorable functional outcomes at 90 days postoperatively. Adjusted logistic regression analysis was used to assess the predictive efficacy of the 24-h NIHSS score, ΔNIHSS (baseline NIHSS minus 24-h NIHSS), and NIHSS score change rate (ΔNIHSS/baseline NIHSS × 100) for the 90-day mRS. Subsequently, patients were categorized into cardioembolic embolism (CE) and large artery atherosclerosis (LAA) subgroups according to the Trial of Org 10172 in Acute Stroke Treatment classification, and the predictive efficacy of the optimal thresholds was examined within these subgroups. Results: Multivariate logistic regression analysis revealed that the 24-h NIHSS score was an independent predictor of 90-day functional outcomes (odds ratio (OR): 10.61, 95% confidence interval: 6.44–17.46, p < 0.001). The Youden index identified a 24-h NIHSS score of ⩽9 as the threshold for predicting an mRS score of 0–2, demonstrating good sensitivity (78.5%) and specificity (76.3%). The receiver operating characteristic curve indicated that the predictive model had good discriminative ability (area under the ROC curve = 0.8223). In subgroup analysis, a 24-h NIHSS score of ⩽9 also showed superior predictive efficacy in both the CE (sensitivity 67.8%, specificity 73.5%) and LAA (sensitivity 81.1%, specificity 74.4%) groups. Conclusion: The 24-h postoperative NIHSS score is a reliable predictor of 90-day functional outcomes in patients with posterior circulation stroke undergoing endovascular treatment. The predictive efficacy is optimal when the NIHSS score is ⩽9.

BackgroundContact aspiration (CA) and stent retriever (SR) thrombectomy are two equally recommended first-line endovascular techniques for treating acute ischaemic stroke due to large vessel occlusion. Whether CA is more effective in achieving complete reperfusion compared with SR in patients with acute basilar artery occlusion (ABAO) remains unclear.AimThis study aims to compare the efficacy and safety of CA versus SR as the first-line strategy during endovascular treatment in improving the rates of first-pass effect (FPE) for patients with ABAO.Methods and designThe ANGEL-COAST study is a prospective, multicentre, randomised controlled, open-label, blinded-endpoint (PROBE) clinical trial. Patients with acute ischaemic stroke due to ABAO within 24 hours from symptom onset will be recruited. Participants will be randomly assigned in a 1:1 ratio to either the CA or SR group. If the assigned treatment fails after three attempts, investigators may opt for alternative treatment strategies based on their clinical judgement.Study outcomesThe primary endpoint is the FPE rate, defined as eTICI (Extended Thrombolysis in Cerebral Infarction) 2C/3 recanalisation after the first thrombectomy attempt without any rescue strategy. Key secondary endpoints include rates of modified FPE (eTICI ≥2b50), successful recanalisation (eTICI ≥2b50, eTICI ≥2b67, eTICI3) within ≤3 passes with the assigned device on conclusion of the procedure, procedural duration, use of rescue techniques and functional outcomes at 90 days, including modified Rankin Scale (mRS) 0–2 and mRS ordinal shift analysis. Safety outcomes include the rates of symptomatic intracerebral haemorrhage (sICH) at 36±12 hours, all-cause 90-day mortality and procedure-related serious adverse events.DiscussionThis is a head-to-head randomised trial to directly compare CA and SR in ABAO. The findings will help establish the optimal first-line endovascular treatment strategy for ABAO, potentially improving clinical outcomes in this high-risk group.Trial registration numberhttps://www.clinicaltrials.gov; Unique identifier: NCT05615038.

BackgroundEndovascular stenting is a promising treatment for patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis (VSS). However, data on the impact of stenosis type on clinical outcomes of patients undergoing stenting treatment remain limited. This prospective cohort study aimed to compare post-stenting outcomes in patients with IIH and intrinsic versus extrinsic VSS.MethodsPatients with IIH and VSS undergoing stenting at a tertiary hospital in China were enrolled consecutively from 2017 to 2023. Based on digital subtraction angiography, high-resolution MRI, and intravascular ultrasound findings, patients were categorized into two groups: intrinsic or extrinsic stenosis. At 6 months post-stenting, clinical outcomes including cerebrospinal fluid (CSF) pressure, headache, visual impairment, and papilledema were recorded. Multivariable regression models were used to explore the relationship between stenosis type and clinical outcomes.ResultsIn total, 92 patients were included, 60 with intrinsic stenosis and 32 with extrinsic stenosis. At 6 months, the intrinsic group had lower CSF pressure (median 180 vs 210 mmH2O, β coefficient −31.8, 95% CI −54.0 to −9.6) and a higher rate of complete symptom resolution (81.7% vs 40.6%, OR 8.88, 95% CI 2.60 to 30.30) than the extrinsic group. Additionally, 36.8% (95% CI 10.5% to 77.2%) of the effect of stenosis type on complete symptom resolution at 6 months was mediated through reduction in CSF pressure.ConclusionThis single-center study suggested that patients with IIH and intrinsic VSS had lower CSF pressure and better symptom recovery compared with those with extrinsic VSS at 6 months post-stenting. Further validation in other centers and populations is needed.Trial registration numberChiCTR.org.cn, ChiCTR-ONN-17010421.

ObjectivesThis study aimed to identify factors at baseline associated with visual outcomes of patients with idiopathic intracranial hypertension (IIH) with venous sinus stenosis who underwent venous sinus stenting.MethodsThe study eyes were divided into two groups according to mean deviation (MD) at 6-month post-stenting follow-up: MD better than −2.0 dB (the favorable visual outcome group) and equal to −2.0 or worse (the poorer visual outcome group). Variables at baseline between the two groups were compared. A multivariable logistic regression model was performed to identify the factors at baseline associated with poorer MD outcomes at 6 months.ResultsThe poorer recovery group had a lower incidence of tinnitus (5.9% vs 27.5%, P=0.015), worse initial best corrected visual acuity (0.22 vs 0, in logMAR, P=0.000), worse preoperative MD (−8.64 vs −3.05, P=0.000) and higher trans-stenotic gradient pressure (19.5 vs 16, P=0.002) and total cranial gradient pressure (TCGP) (25.75 vs 18, P=0.000), lower ganglion cell complex (GCC) thickness (90.5 vs 99, P=0.005), higher focal loss volume percentage (2.35 vs 0.84, P=0.002) and global loss volume percentage (4.87 vs 1.8, P=0.012) of GCC. Multivariate analysis showed that worse preoperative MD and higher TCGP (OR 45.61, 95% CI 5.21 to 399.48; P=0.001 and OR 8.45, 95% CI 1.60 to 44.67; P=0.012, respectively) were associated with an increased risk of poorer MD outcomes at the 6-month follow-up.ConclusionThis study found that worse preoperative MD and higher TCGP at baseline may be associated with poorer visual outcomes after stenting treatment.

Evidence is lacking about the role of serum uric acid (SUA) in the progression from prehypertension to hypertension. Herein, we aimed to investigate the association of both baseline and dynamic change in SUA with the risk of hypertension developing from prehypertension. The study enrolled 11,488 participants with prehypertension during 2006–2010 from the Kailuan study. Change in SUA was assessed as % change of SUA from 2006 (baseline) to 2010. Participants were categorized into four groups by quartiles of baseline and change in SUA, separately. Multivariable logistic regressions were used to calculation the odds ratio (OR) and 95% confidence interval (CI). During a median follow-up of 7.06 years, 2716 (23.64%) participants developed hypertension from prehypertension. In the multivariable-adjusted model, the OR for hypertension comparing participants in the highest versus the lowest quartile of baseline SUA were 1.18 (95% CI, 1.02–1.36). Increased SUA over time was also associated with elevated risk of hypertension (OR in the highest quartile was 1.41 [95% CI, 1.23–1.62] versus the lowest quartile), especially in those with baseline SUA ≥ median (OR, 1.48; 95% CI, 1.21–1.81). Moreover, the addition of SUA to a conventional risk model had an incremental effect on the predictive value for hypertension (integrated discrimination improvement 0.30%, P < 0.0001; category-free net reclassification improvement 12.36%, P < 0.0001). Both high initial SUA and increased SUA over time can independently predict the progression from prehypertension to hypertension. Strategies aiming at controlling SUA level in prehypertensive subjects may impede the onset of hypertension.

Background: We constructed a high-volume registry to identify whether risk factors of intracranial atherosclerotic plaque (ICAP) features differ in the posterior and anterior circulation in patients with symptomatic intracranial atherosclerotic stenosis (ICAS) investigated by high-resolution magnetic resonance imaging (HRMRI). Methods: The registry was constructed for patients with symptomatic ICAS who underwent HRMRI for culprit plaques. ICAP-vulnerable features included positive remodelling, diffuse distribution, intraplaque haemorrhage and strong enhancement. Results: We analysed risk factors for the same ICAP features between the posterior and anterior circulation in data of 97 patients in the posterior circulation and 105 patients in the anterior circulation ICAPs. In patients with diffuse distribution, the probability of being female were lower [odds ratio (OR):0.08; 95% confidence interval (CI):0.02–0.34; p = 0.001] and having diabetes mellitus was higher (OR: 7.75; 95% CI:1.75–34.39; p = 0.007) in posterior circulation patients. In patients with strong enhancement, the probability of having diabetes was higher in posterior circulation patients (OR:6.71; 95% CI:1.37–32.81; p = 0.019). Conclusions: Our results demonstrate more risk factors in the posterior than in the anterior circulation in patients with the same ICAP-vulnerable features, highlighting the need for stratification of risk factors in symptomatic ICAPs. Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02705599.

BackgroundThe superiority of balloon angioplasty plus aggressive medical management (AMM) to AMM alone for symptomatic intracranial artery stenosis (sICAS) on efficacy and safety profiles still lacks evidence from randomised controlled trials (RCTs).AimTo demonstrate the design of an RCT on balloon angioplasty plus AMM for sICAS.DesignBalloon Angioplasty for Symptomatic Intracranial Artery Stenosis (BASIS) trial is a multicentre, prospective, randomised, open-label, blinded end-point trial to investigate whether balloon angioplasty plus AMM could improve clinical outcome compared with AMM alone in patients with sICAS. Patients eligible in BASIS were 35–80 years old, with a recent transient ischaemic attack within the past 90 days or ischaemic stroke between 14 days and 90 days prior to enrolment due to severe atherosclerotic stenosis (70%–99%) of a major intracranial artery. The eligible patients were randomly assigned to receive balloon angioplasty plus AMM or AMM alone at a 1:1 ratio. Both groups will receive identical AMM, including standard dual antiplatelet therapy for 90 days followed by long-term single antiplatelet therapy, intensive risk factor management and life-style modification. All participants will be followed up for 3 years.Study outcomesStroke or death in the next 30 days after enrolment or after balloon angioplasty procedure of the qualifying lesion during follow-up, or any ischaemic stroke or revascularisation from the qualifying artery after 30 days but before 12 months of enrolment, is the primary outcome.DiscussionBASIS trail is the first RCT to compare the efficacy and safety of balloon angioplasty plus AMM to AMM alone in sICAS patients, which may provide an alternative perspective for treating sICAS.Trial registration number NCT03703635; https://www.clinicaltrials.gov.