Effects of different doses of statins on clinical outcomes in patients with acute ischemic stroke who received intravenous urokinase thrombolysis / 解放军医学杂志

Objective To investigate the effect of different doses of statins on the clinical efficacy and safety outcome of intravenous thrombolytic therapy of urokinase in patients with acute ischemic stroke(AIS).Methods Based on a large prospective,multicenter study,the Chinese Intravenous Thrombolysis Registry for AIS within 4.5 h of onset(INTRECIS)database,clinical data of 898 patients with urokinase intravenous thrombolysis for AIS were retrospectively analyzed.According to the amount of statin used during hospitalization,the patients were divided into 132 patients in no-statin group,591 patients in conventional statin group and 175 patients in intensive statin group.Clinical outcome measures included 14-day improvement in the National Institutes of Health Stroke Scale(NIHSS)and 90-day excellent prognosis(improved Rankin score≤1 point).Safety measures included recurrent stroke,bleeding events,and 90-day all-cause mortality.Results After adjusting for differences in baseline characteristics(age,coronary heart disease,diabetes,atrial fibrillation,systolic blood pressure,OTT,DNT,previous anti-plate use,blood glucose,and treatment in Class A hospitals),NIHSS scores improved at 14 days after admission and excellent prognosis at 90 days after admission in convention-dose and intensive statin groups were superior to those in no-statin group(P<0.05);Univariate and multivariate analysis of safety outcome indicators showed no statistically significant differences in stroke recurrence and bleeding events among the three groups(P>0.05);The 90-day all-cause mortality was significantly higher in no-statin group(10.6%)than in convention-dose statin group(2.0%)and intensive dose statin group(2.9%)(P<0.01).Conclusions In patients with AIS who were treated with intravenous urokinase thrombolytic therapy,intensive statin use was associated with improved 14-day NIHSS score and near-term prognosis without increasing the risk of stroke recurrence and bleeding events.Statin use is beneficial to reduce mortality.

Predictive value of triglyceride-glucose index on the outcome in patients with acute ischemic stroke undergoing intravenous alteplase thrombolysis / 中国医科大学学报

Objective To explore the predictive role of the triglyceride-glucose(TyG)index in patients with acute ischemic stroke(AIS)treated with alteplase thrombolysis and create a comprehensive predictive model integrating multiple factors for assessing patient out-comes.Methods The clinical data of 302 patients with AIS undergoing alteplase intravenous thrombolysis at the Neurology Department of Fushun Central Hospital from January 2019 to October 2022 were retrospectively analyzed.The patients were categorized into a good prognosis group(n= 193)and a poor prognosis group(n= 109)based on their mRS scores at 90 days post-thrombolysis.Univariate and multivariate logistic regression analyses were employed to identify risk factors influencing adverse outcomes and to establish a predictive model.The predictive performance of the model was assessed using receiver operating characteristic(ROC)curve analysis.Results The results of the multivariate logistic regression analysis revealed that pre-thrombolysis high NIHSS score and TyG index≥9.37 were inde-pendent risk factors for unfavorable prognosis in AIS patients.A predictive model for AIS patient prognosis was successfully established:Logit(Y)=-17.167 + 1.681×TyG index+0.147×pre-thrombolysis NIHSS score.The optimal cutoff value for the TyG index was 9.37.The ROC areas under the curve for predicting unfavorable prognosis in AIS patients at 90 days post-thrombolysis were 0.713 for TyG index,0.705 for pre-thrombolysis NIHSS score,and 0.787 for the combined variable(Y),with the combined variable(Y)exhibiting the largest ROC curve area.Conclusion TyG index≥9.37 and pre-thrombolysis high NIHSS score are independent risk factors for poor prognosis.The combined variable the combined variable(Y)has higher predictive efficiency than the separate variables.

Real-world setting comparison of bridging therapy versus direct mechanical thrombectomy for acute ischemic stroke: A meta-analysis

Abstract Background and purpose Intravenous Thrombolysis (IVT) prior to Mechanical Thrombectomy (MT) for Acute Ischaemic Stroke (AIS) due to Large-Vessel Occlusion (LVO) remains controversial. Therefore, the authors performed a meta-analysis of the available real-world evidence focusing on the efficacy and safety of Bridging Therapy (BT) compared with direct MT in patients with AIS due to LVO. Methods Four databases were searched until 01 February 2023. Retrospective and prospective studies from nationwide or health organization registry databases that compared the clinical outcomes of BT and direct MT were included. Odds Ratios (ORs) and 95 % Confidence Intervals (CIs) for efficacy and safety outcomes were pooled using a random-effects model. Results Of the 12 studies, 86,695 patients were included. In patients with AIS due to LVO, BT group was associated with higher odds of achieving excellent functional outcome (modified Rankin Scale score 0-1) at 90 days (OR = 1.48, 95 % CI 1.25-1.75), favorable discharge disposition (to the home with or without services) (OR = 1.33, 95 % CI 1.29-1.38), and decreased mortality at 90 days (OR = 0.62, 95 % CI 0.56-0.70), as compared with the direct MT group. In addition, the risk of symptomatic intracranial hemorrhage did not increase significantly in the BT group. Conclusion The present meta-analysis indicates that BT was associated with favorable outcomes in patients with AIS due to LVO. These findings support the current practice in a real-world setting and strengthen their validity. For patients eligible for both IVT and MT, BT remains the standard treatment until more data are available.

Impact of ambulance transport on the prognosis of thrombolytic therapy in patients with acute ischemic stroke / 中华急诊医学杂志

Objective:Intravenous thrombolysis (IVT) in patients with acute ischemic stroke is strongly time-dependent.The purpose of this study was to investigate whether the transfer of ischemic stroke patients to hospital through emergency medical service (EMS) could shorten onset to needle time (ONT),onset to door time (ODT), door to imaging time(DIT), door to needle time(DNT) and improve the clinical outcomes of intravenous thrombolysis patients.Methods:We retrospectively collected the clinical and time data of acute ischemic stroke(AIS) patients who received IVT in the Affiliated Hospital of Qingdao University on Laoshan campus from September 2021 to August 2022 were retrospectively collected. Patients were divided into EMS group and Non-EMS group according to patients whether transferred by ambulance. The baseline characteristics, length of each period and differences in clinical outcome were compared. Good prognosis was defined as modified Rankin Scale score of 0-2 at 3-months.Results:A total of 175 patients aged (66.1 ±12.3) years were selected, including 63 females (36.0%) and 53 patients (30.3%) were transferred by EMS. Compared with the Non-EMS group, the patients in the EMS group were older, the baseline NIHSS score was higher, ODT and ONT were shorter (all P< 0.05), but there were no significant difference in DIT and DNT between the two groups. Binary Logistic regression model showed that after adjusting for age, sex, baseline NIHSS score, bridging therapy, history of atrial fibrillation, history of hypertension, the number of previous diseases and intracranial hemorrhage, EMS was independently associated with good prognosis of patients with acute ischemic stroke [odds ratio ( OR) 0.376, 95% confidence interval ( CI) 0.144~0.890, P=0.027). Conclusion:EMS could improve the clinical outcomes of acute stroke patients by shortening the ODT and ONT in patients with acute ischemic stroke.

Value of red blood cell distribution width in predicting early poor neurologic improvement after intravenous thrombolysis in patients with ischemic stroke / 中国临床药理学与治疗学

AIM: To explore the predictive value of red blood cell distribution width (RDW) in early poor neurologic improvement after intravenous thrombolysis in acute ischemic stroke (AIS). METHODS: A total of 102 patients with acute ischemic stroke who received intravenous thromblysis with alteplase within 4.5 hours of onset were analyzed retrospectively. RDW level was measured before thrombolysis. According to the percentage change in NIHSS at 24 hours, the patients were divided into two groups: good neurological improvement (≥ 30%) group (n=53) and poor neurological improvement (<30%) group (n=49). The univariate and multivariate Logistic regression analysis were used to investigate whether RDW level is an independent factor affecting patients' neurological improvement. The receiver operating characteristic (ROC) curve was used to analyze the cut-off value of RDW to predict poor early neurological improvement after thrombolysis. RESULTS: Compared with the good neurological improvement group, higher proportion of atrial fibrillation (24.5% vs. 9.4%, P= 0.042), diabetes mellitus (57.1% vs. 30.2%, P= 0.006), hemorrhagic transformation (10.2% vs. 0%, P=0.023) in the poor neurological improvement group. The level of RDW in poor neurological improvement group was significantly higher than that in good neurological improved group(14.09±0.77) vs. (13.31±0.63), P=0.000. Logistic regression analysis showed that elevated RDW (OR=4.614, 95%CI: 2.263-9.408, P=0.000) and history of diabetes mellitus (OR=2.606, 95%CI: 1.034-6.573, P=0.042) were independently associated with early poor neurological improvement. The ROC curve analysis showed that the optimal cut-off value of RDW to predict poor early neurological improvement after thrombolysis was 13.56% (AUC=0.782, 95%CI: 0.690-0.874; sensitivity 76%; specificity 74%). CONCLUSION: Elevated RDW is of a certain value in predicting the poor early neurological improvement of AIS patients after thrombolysis.

Efficacy of mechanical thrombectomy in acute ischemic stroke with large vessel occlusion and analysis of related factors affecting its prognosis / 中华老年医学杂志

Objective:To compare the effectiveness of intravenous thrombolysis(IVT)alone versus mechanical thrombectomy(MT)in treating acute large vessel occlusive stroke(AIS-LVO).Amd to analyze the factors that are associated with the prognosis of MT.Methods:A total of 197 patients with acute ischemic stroke with large vessel occlusion(AIS-LVO)who received intravenous thrombolysis(IVT)and/or mechanical thrombectomy(MT)at the Stroke Center of the Second Hospital of Dalian Medical University from April 2016 to July 2021 were included in this retrospective analysis.Baseline data, clinical data, and 90-day Modified Rankin Scale(mRS)scores were collected for each group.The efficacy and risk of IVT alone and MT were compared using univariate and multivariate logistic regression analysis.Additionally, factors influencing the prognosis of MT were identified.Results:A total of 197 patients who met the inclusion criteria were included in this study.Out of these, 62 patients were in the IVT alone group and 135 patients were in the MT group.The results of the univariate analysis showed that the MT group had lower admission systolic blood pressure(147±23 vs.158±27 mmHg, P=0.003), higher baseline NIHSS score[15(12, 19) vs.12(8, 16), P=0.003], and there were also differences in vascular occlusion between the two groups( χ2=15.504, P=0.004).Specifically, the middle cerebral artery and basilar artery occlusion were higher in the MT group.In terms of outcome, the MT group had a higher percentage of good outcomes at 90 days[53(39%) vs.13(21%), χ2=6.381, P=0.012], and there was no significant difference in symptomatic intracranial hemorrhage(sICH)and mortality within 90 days.Among the 135 patients who underwent MT, 53 patients were classified as having a good prognosis, while 82 patients were classified as having a poor prognosis.Multivariate analysis revealed that age( OR=1.078, 95% CI: 1.025-1.133, P=0.003), neutrophil to lymphocyte ratio(NLR)( OR=1.164, 95% CI: 1.013-1.338, P=0.032), time from onset to recanalization( OR=1.004, 95% CI: 1.000-1.007, P=0.049), sICH( OR=15.585, 95% CI: 1.397-173.865, P=0.026), ASPECTS/pc-ASPECTS score( OR=0.524, 95% CI: 0.017-0.582, P=0.024), and good recanalization( OR=0.099, 95% CI: 1.718-59.046, P=0.010)were identified as independent prognostic factors.The results indicate that percutaneous transluminal angioplasty, stent implantation, and the use of tirofiban and butylphthalide did not significantly affect the prognosis of the MT group. Conclusions:The use of mechanical thrombectomy(MT)in patients with acute ischemic stroke due to large vessel occlusion(AIS-LVO)is more effective than intravenous thrombolysis(IVT)alone and has a similar safety profile.However, there are certain factors that can influence the prognosis of MT treatment.Older age, higher neutrophil-to-lymphocyte ratio(NLR), longer time from symptom onset to recanalization, and the occurrence of postoperative symptomatic intracranial hemorrhage(sICH)were identified as independent predictors of poor prognosis in MT treatment.On the other hand, a higher ASPECTS/pc-ASPECTS score and successful recanalization were found to be protective factors associated with a favorable prognosis in MT treatment.

Relationship between the levels of thrombo-inflammatory factors and the prognosis of intravenous thrombolysis in elderly patients with acute cerebral infarction / 中风与神经疾病杂志

@#Objective To analyze the relationship between the levels of thrombo-inflammatory factors and the prognosis of intravenous thrombolysis in elderly patients with acute cerebral infarction （ACI）. Methods The 197 elderly patients with ACI admitted to our hospital from December 2020 to January 2023 were selected as study subjects. According to the prognosis of patients after intravenous thrombolysis， patients were divided into a good prognosis group （n=143） and a poor prognosis group （n=54）. The clinical data of patients in the two groups were compared. Multivariate analysis was used to identify independent risk predictors of poor prognosis in patients undergoing intravenous thrombolysis. The predictive value of thrombo-inflammatory factor levels for poor prognosis of intravenous thrombolysis in elderly patients with ACI was evaluated. A restricted cubic spline model was used to analyze the dose-response relationship between the levels of thrombo-inflammatory factors and the poor prognosis of intravenous thrombolysis in elderly patients with ACI. A nomograph model was constructed， and the effectiveness of the model was verified. Bootstrap resampling was used for external verification. Results Multivariate analysis results showed that the time from onset to receiving thrombolysis， pre-treatment National Institutes of Health Stroke Scale score，Trial of ORG 10 172 in Acute Stroke Treatment typing， monocyte chemoattractant protein-1，t-PA， sCD40L， and P-selectin levels were independent influencing factors for poor prognosis of patients undergoing intravenous thrombolysis （P<0.05）. The levels of thrombo-inflammatory factors had a certain predictive value for poor prognosis of patients undergoing intravenous thrombolysis， and the value of combined detection was higher than that of individual detection（area under the curve=820）. The dose-response relationship analysis results showed that when t-PA≤60 μg/L，the risk of poor prognosis increased with increasing t-PA level （HR 1.005，95%CI 1.003-1.007， P<0.001）；when t-PA>60 μg/L，the risk of poor prognosis almost no longer increased with increasing t-PA level （HR 1.003， 95%CI 1.001-1.006，P=0.614）. The C-index of the nomograph model was 0.814 and 0.823， and the area under the receiver operating characteristic curve was 0.861 and 0.843， indicating that the prediction model had good discrimination. The calibration curve fitted well， indicating high accuracy. The threshold probability of the clinical decision curve ranged from 0.03 to 0.95 and from 0.03 to 0.97， with a high net benefit value， indicating that the method was effective， safe， reliable， and practical. Conclusion The levels of thrombo-inflammatory factors have a certain impact on the prognosis of intravenous thrombolysis in elderly patients with ACI， and have a certain predictive value. The combined detection of various factors shows a higher predictive value.

Association between the overall burden of cerebral small vascular disease and the hemorrhagic transformation of acute ischemic stroke after intravenous thrombolysis / 中风与神经疾病杂志

@#Objective To investigate the association between the overall burden of cerebral small vascular disease （CSVD） and the hemorrhagic transformation of acute ischemic stroke after intravenous thrombolysis. Methods A retrospective analysis was performed for 268 patients with acute ischemic stroke who received rt-PA intravenous thrombolysis in our hospital from January 2019 to October 2022, and according to the presence or absence of hemorrhagic transformation after thrombolysis, they were divided into hemorrhagic transformation group and non-hemorrhagic transformation group. Related data were collected for both groups, including demographic information （sex, age）, smoking history, medical history （hypertension, diabetes, hyperlipidemia, coronary heart disease, atrial fibrillation, and ischemic stroke）, and clinical data after onset, such as onset-to-treatment time （OTT）, systolic pressure/diastolic pressure/blood glucose at baseline, laboratory findings within 24 hours after onset [fasting blood glucose, glycated hemoglobin, homocysteine, creatinine, triglyceride, total cholesterol, high-density lipoprotein cholesterol （HDL-C）, low-density lipoprotein cholesterol （LDL-C）, uric acid, platelet, prothrombin time （PT）, international normalized ratio （INR）, fibrinogen, fibrinogen, C-reactive protein （CRP）], location of infarction （anterior circulation or posterior circulation）, TOAST typing, and the overall burden of CSVD （mild, moderate or severe）. The two groups were compared in terms of baseline data, clinical data, and CSVD score, and the logistic regression analysis was used to investigate the association between the overall burden of CSVD and hemorrhagic transformation after intravenous thrombolysis. Results A total of 268 patients with acute ischemic stroke who received intravenous thrombolysis were enrolled, with an age of 23-97 years （mean 65.5 years）, and male patients accounted for 70.5% （189/268）. The baseline NIHSS score was 7.5 （0, 27） points, and OTT was 151.2 （20, 270） minutes. Among these patients, 138 （51.4%） had moderate to severe WMH, 193 （72.0%） had lacunar infarction, 56（20.8%） had cerebral microbleeds,and 106（39.5%） had perivascular spaces. There were 115 patients（42.9%） in the mild CSVD group,65（24.2%） in the moderate CSVD group,and 88 （32.8%） in the severe CSVD group. There were 29 patients with hemorrhagic transformation （10.3%）. Atrial fibrillation （odds ratio OR=5.628,95%CI 1.862-17.009,P=0.002）,cerebral microbleeds （OR=4.062,95%CI 1.437-11.485,P=0.008）, and baseline NIHSS score （OR=1.182,95%CI 1.082-1.292,P<0.001） were independent risk factors for hemorrhagic transformation after thrombolysis, and with mild CSVD as the reference, severe CSVD（OR=0.694,95%CI 1.458-9.360,P=0.006） was independently associated with hemorrhagic transformation. Conclusion The overall burden of CSVD in patients with acute ischemic stroke is closely associated with hemorrhagic transformation after intravenous thrombolysis, and severe CSVD is an independent risk factor for hemorrhagic transformation after intravenous thrombolysis.

Safety of tirofiban in patients with acute anterior circulation large vessel occlusive cerebral infarction during bridging endovascular treatment after intravenous thrombolysis / 中华神经医学杂志

Objective:To investigate the safety of tirofiban in patients with anterior circulation acute large vessel occlusion cerebral infarction during bridging endovascular treatment (EVT) after intravenous thrombolysis (IVT).Methods:Two hundred and three patients received bridging EVT after IVT in Department of Intervention, First Affiliated Hospital of Soochow University from January 2017 to January 2022 were chosen. Patients were divided into tirofiban group ( n=80) and non-tirofiban group ( n=123) according to whether or not tirofiban was used during EVT, and then patients from tirofiban group were subdivided into stent implantation group ( n=52) and non-stent implantation group ( n=28) according to whether or not emergency stent implantation was performed. The clinical data, safety indexes (intracranial hemorrhage [ICH] rate 24 h, 2-3 d, and 90 d after EVT, new ICH incidence 3-90 d after EVT, fatal ICH rate, and mortality 90 d after EVT), and prognoses 90 d after EVT were compared. Results:(1) Compared with the non-tirofiban group, the tirofiban group had significantly higher proportions of males, and patients with tandem occlusion, balloon dilation or stent implantation, and statistically lower proportion of patients with atrial fibrillation, significantly longer surgical time, and significantly different distribution of stroke types ( P<0.05). No significant differences were noted in ICH incidences 24 h after EVT, 2-3 d after EVT and 90 d after EVT, fatal ICH incidence, mortality incidence 90 d after EVT, or good prognosis rate 90 d after surgery between tirofiban group and non-tirofiban group ( P>0.05). (2) Patients in the stent implantation group had significantly higher percentages of tandem occlusion and balloon dilation compared with those in the non-stent implantation group ( P<0.05). No significant difference was noted in good prognosis rate 90 d after EVT or new ICH incidence 3-90 d after EVT between the stent implantation group and the non-stent implantation group ( P>0.05). Compared with the non-stent implantation group, the stent implantation group had statistically higher ICH incidences 24 h after EVT, 2-3 d after EVT, and 90 d after EVT, significantly higher fatal ICH incidence and mortality 90 d after EVT ( P<0.05). Conclusion:Tirofiban is safe in patients with anterior circulation acute large vessel occlusion cerebral infarction during EVT after IVT; however, if emergency stent implantation is performed, it will lead to increased intracranial hemorrhage and mortality.

Effect of rt-PA intravenous thrombolysis on thrombi after mechanical thrombectomy in patients with acute ischemic stroke / 中华神经医学杂志

Objective:To investigate the effect of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) on sizes and components of thrombi in patients with acute ischemic stroke (AIS) after mechanical thrombectomy (MT).Methods:Ninety-eight AIS patients accepted MT in Department of Neurology, Huaian First Hospital Affiliated to Nanjing Medical University from June 2018 to June 2022 were enrolled; they were divided into bridging therapy group and direct thrombectomy group according to the treatments. Baseline data, prognoses and thrombus features between the 2 groups were compared.Results:No significant differences were observed between the 2 groups in terms of age, gender, previous medical history, baseline scores, sites and types of vascular occlusion, TOAST causative classifications, time frame, MT frequencies and techniques, successful recanalization, or prognoses 90 d after MT ( P>0.05). Compared with the direct thrombectomy group, the bridging therapy group had significantly reduced thrombus area (37[22, 78] mm 2vs. 27[14, 62] mm 2) and areas of major pathological components [red blood cells: 16.1([9.0, 37.4] mm 2vs. 11.8[6.1, 22.1] mm 2, fibrin/platelets: 19.5[9.5, 26.4] mm 2vs. 10.7[5.0, 22.8] mm 2, white blood cells: 4.0[2.2, 8.0] mm 2vs. 2.4[1.4, 5.7] mm 2, P<0.05); however, no significant differences in proportions of areas of major pathological components were noted between the 2 groups of patients ( P>0.05). Conclusion:The rt-PA intravenous thrombolysis can significantly reduce the thrombi volume and decrease the contents of major thrombus components in AIS patients after MT, but not change the proportions of major pathological components in thrombi.

Mediating effects of disease perception on disease uncertainty and health behaviors among thrombolysis therapy in patients with acute ischemic stroke / 中国实用护理杂志

Objective:To explore the mediating effects of disease perception on disease uncertainty and health behaviors among thrombolysis therapy in patients with acute ischemic stroke, to provide a theoretical basis for improving patient health behavior.Methods:By cross-sectional survey methods, from June 2021 to June 2022, a total of 123 thrombolysis therapy in patients with acute ischemic stroke were investigated by general information, Mishel Uncertainty in Illness Scale, Health Behavior Scale for Stroke Patients and Revised Illness Perception Questionnaire by convenience sampling method. The mediating effect of disease perception between disease uncertainty and health behavior was verified by structural equation model.Results:The scores of disease uncertainty, health behaviors and disease perception were (52.21 ± 7.67), (63.77 ± 9.40), (127.70 ± 26.19) points in patients with acute ischemic stroke. Health behaviors and each dimension including exercise, medication, instruction, nutrition, responsibility, tobacco and alcohol were negatively correlation between disease uncertainty ( r values were -0.762 to -0.411, all P<0.01), and positively correlation between disease perception ( r values were 0.689 to 0.912, all P<0.01). Disease uncertainty was a significantly negative predictor for health behaviors ( β= -0.71, P<0.01); disease perception was also a significantly negative predictor for disease perception ( β = -0.85, P<0.01). Disease uncertainty had a significantly indirect effect on the health behaviors for thrombolysis therapy in patients with acute ischemic stroke through disease perception, which showed the mediating effect of health behaviors accounts for 15.2% of total effect. Conclusions:Disease perception play a mediating role in the relationship between disease uncertainty and health behaviors among thrombolysis therapy in patients with acute ischemic stroke.

Eficacia de tenecteplase comparada con alteplase para tratamiento de ictus isquémico agudo. Una revisión narrativa

Introducción: La trombólisis intravenosa con Alteplase (ALT) se recomienda como tratamiento estándar siendo el único agente trombolítico aprobado por la FDA, en infarto cerebral. La Tenecteplase (TNK), un activador tisular del plasminógeno modificado, surge como agente antitrombótico alternativo. Esta revisión narrativa evalúa la evidencia actual y aborda los problemas prácticos sobre la eficacia y seguridad de tenecteplase en comparación con alteplase. Metodología: Se realizó una búsqueda sistemática y analítica de la literatura, y se proporcionó una síntesis cualitativa de metaanálisis y ensayos clínicos concluidos, que compararon la efectividad y seguridad de la tenecteplase con alteplase en el AIS, utilizando artículos indexados en MEDLINE, Cochrane Library y Scopus. Resultados: Los ensayos clínicos aleatorizados en su mayoría coinciden al encontrar que TNK es al menos tan o más efectiva que la ALT para mejoría neurológica después del AIS; mientras los metaanálisis coinciden en que los pacientes que recibieron TNK presentaron una mayor recanalización exitosa, pero difieren en cuanto a los hallazgos de mejoría neurológica temprana, resultado funcional a los 90 días y mortalidad a los 90 días. Conclusión: La tenecteplase es al menos tan eficaz como la Alteplase con respecto a la mejoría neurológica después del tratamiento del accidente cerebrovascular isquémico agudo.

Introduction: Intravenous thrombolysis with alteplase (ALT) is recommended as standard treatment, being the only thrombolytic agent approved by the FDA. Tenecteplase (TNK), a modified tissue plasminogen activator, is emerging as an alternative antithrombotic agent. This narrative review assesses the current evidence and addresses practical issues regarding the efficacy and safety of tenecteplase compared to alteplase. Methodology: A systematic and analytical search of the literature was performed, providing a qualitative synthesis of meta-analyses and completed clinical trials comparing the effectiveness and safety of tenecteplase with alteplase in AIS, using articles indexed in MEDLINE, the Cochrane Library, and Scopus. Results: Randomized clinical trials mostly agree in finding TNK to be at least as or more effective than ALT for neurological improvement after AIS; while the meta-analyses agree that patients who received TNK had more successful recanalization, they differ in terms of the findings of early neurological improvement, functional outcome at 90 days, and mortality at 90 days. Conclusion: Tenecteplase is at least as effective as alteplase with regard to neurological improvement after treatment of acute ischemic stroke.

Nuevos paradigmas: 12 años de trombólisis sistémica. Unidad ACV, Hospital de Clínicas / New paradigms: 12 years of systemic thrombolysis. Stroke Unit, Clinicas Hospital / Novos paradigmas: 12 anos de trombólise sistêmica. Unidade AVC, Hospital de Clínicas

Introducción: el ACV constituye un problema de salud y la trombólisis sistémica una estrategia de reperfusión con alto nivel de evidencia para su tratamiento. Los reportes nacionales sobre su utilización son escasos. Objetivos: comunicar y analizar los resultados de esta terapia en el Hospital de Clínicas. Establecer predictores de buena evolución, hemorragia intracraneana y mortalidad. Métodos: estudio observacional analítico de los pacientes trombolizados en el Hospital de Clínicas (2010-2021). Resultados: se realizó trombólisis sistémica a 268 pacientes. La mediana del NIHSS al ingreso fue 12 puntos. Un 42% fueron infartos totales de la circulación anterior. La cardioembolia constituyó la etiopatogenia más frecuente. El 59,3% de los pacientes fueron externalizados con independencia funcional y 55,2% con déficit neurológico mínimo. Las tasas de hemorragia intracraneana sintomática y mortalidad fueron 7,1% y 18,7% respectivamente. El 57% de los pacientes se trataron con tiempo puerta aguja ≤60 minutos. El porcentaje de trombólisis en el total de ACV fue 18,9%. La edad, NIHSS al ingreso e internación en unidad de ACV se comportaron como variables importantes para predecir buena evolución, hemorragia intracraneana y muerte. Discusión y conclusiones: se comunicó la mayor casuística nacional sobre el tema. Los parámetros de efectividad y seguridad del tratamiento fueron comparables a los reportados internacionalmente. Se destacaron los buenos tiempos puerta aguja y tasa trombólisis sobre ACV totales como indicadores satisfactorios de calidad asistencial. La internación en unidad de ACV se comportó como un factor predictor de independencia funcional y protector frente a mortalidad hospitalaria.

Introduction: Strokes are a health problem and systemic thrombolysis constitutes a reperfusion strategy backed up by significant evidence on its positive therapeutic impact. National reports on its use are scarce. Objectives: To report and analyze results obtained with this therapeutic approach at the Clinicas Hospital. To establish predictive factors for a good evolution, intracranial hemorrhage and mortality. Method: Observational, analytical study of thrombolysed patients at Clinicas Hospital (2010-2021). Results: Systemic thrombolysis was performed in 268 patients. Average NIHSS score was 12 points when admitted to hospital.42 % of cases were total anterior circulation infarct (TACI). Cardioembolic ischaemmic stroke was the most frequent etiopahogenesis. 59.3% of patients were discharged with functional independence and 55.2% had minimal neurologic deficit. Symptomatic intracranial hemorrhage and mortality rates were 7.1% and 18.7% respectively. 57% of patients were assisted within ≤60 minutes they showed up at the ER. Thrombolysis percentage in total number of strokes was 18.9%. Age, NIHSS score upon arrival to hospital and admission to the stroke unit were significant variables to predict a good evolution, intracranial hemorrhage and death. Discussion and conclusions: The large number of cases in the country was reported. Effectiveness and safety parameters for this treatment were comparable to those reported internationally. The good door-to-needle time and thrombolysis rate versus total number of strokes stood out as satisfactory indicators of healthcare quality. Admission to the stroke unit behaved as a predictive factor of functional independence and it protected patients from hospital mortality.

Introdução: o AVC é um problema de saúde sendo a trombólise sistêmica uma estratégia de reperfusão com alto nível de evidência para seu tratamento. Os dados nacionais sobre seu uso são escassos. Objetivos: comunicar e analisar os resultados desta terapia no Hospital de Clínicas. Estabelecer preditores de boa evolução, hemorragia intracraniana e mortalidade. Métodos: estudo observacional analítico de pacientes trombolisados no Hospital de Clínicas (2010-2021). Resultados: a trombólise sistêmica foi realizada em 268 pacientes. A mediana do índice NIHSS na admissão foi de 12 pontos. 42% eram infartos totais da circulação anterior. A cardioembolia foi a etiopatogenia mais frequente. 59,3% dos pacientes tiveram alta da unidade com independência funcional e 55,2% com déficit neurológico mínimo. As taxas de hemorragia intracraniana sintomática e mortalidade foram de 7,1% e 18,7%, respectivamente. 57% dos pacientes foram tratados com tempo porta-agulha ≤60 minutos. A porcentagem de trombólise no AVC total foi de 18,9%. Idade, NIHSS na admissão e internação na unidade de AVC se comportaram como variáveis importantes para prever boa evolução, hemorragia intracraniana e óbito. Discussão e conclusões: este trabajo inclui a maior casuística nacional sobre o tema. Os parâmetros de eficácia e segurança do tratamento foram comparáveis aos descritos na bibliografia internacional. Foram destacados como indicadores satisfatórios da qualidade do atendimento os bons tempos porta-agulha e taxa de trombólise em relação ao AVC total. A internação em unidade de AVC comportou-se como preditor de independência funcional e protetor contra a mortalidade hospitalar.

Effect of emergency "zero channel" process on improving efficiency of intravenous thrombolysis in stroke / 中华神经医学杂志

Objective:To explore the effect of emergency "zero channel" process on improving the efficiency of intravenous thrombolysis in stroke.Methods:Fifty-eight acute ischemic stroke patients admitted to our hospital from January 2020 to December 2020 were enrolled into experimental group; another 58 acute ischemic stroke patients admitted to our hospital from January 2019 to December 2019 and matched with age and gender were selected as control group. "Green channel" process was adopted for patients in the control group, and optimized "zero channel" process (moving the working passageway forward to the ambulance) was implemented for patients in the experimental group. Door to rescue room time (DRRT), door to consultation time (DCT), door to laboratory examination completion time (DLECT), door to CT report time (DCRT), and door to needle time (DNT) were used to evaluate the times of emergency treatment. The thrombolytic effect of the two groups was compared by evaluating the recanalization rate of occluded vessels and thrombolytic efficiency. Modified Rankin scale (mRS) was used to evaluate the prognoses 6 months after treatment in both groups, and mRS scores≤2 was defined as good prognosis.Results:The DCRT, DCT and DNT in the experimental group were significantly shorter than those in the control group ( P<0.05); the compliance rate of DNT≤60 min in the experimental group was significantly higher as compared with that in the control group ( P<0.05). The immediate recanalization rate of occluded vessels in the experimental group and control group was 60.3% and 27.6%, and the thrombolytic efficiency was94.83% and 82.76%; significant differences were noted between the two groups ( χ2=12.633, P<0.001; χ2=4.245, P=0.039). The good prognosis rate of the experimental group and control group was 36.2% and 15.5%, respectively, after 6 months of follow-up ( χ2=4.016, P=0.041). Conclusion:Emergency "zero channel" can further shorten DCT, DCRT, and DNT, and improve the efficiency of thrombolysis and prognoses of acute ischemic stroke patients.

Correlation between white matter hyperintensity and early neurological deterioration after intravenous recombinant tissue plasminogen activator thrombolysis in acute ischemic stroke patients / 中华神经医学杂志

Objective:To investigate the effects of white matter hyperintensity (WMH) of different lesion areas and severities on early neurological deterioration (END) in acute ischemic stroke (AIS) patients after intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis.Methods:Three hundred and seventy-three AIS patients, admitted to our hospital from April 2019 to July 2021, were chosen in our study. These patients were treated with intravenous rt-PA thrombolysis within 4.5 h of onset. According to the presence or absence of END, these patients were divided into END group ( n=89) and non-END group ( n=284). Fazekas scale was used to assess the periventricular WMH (PVWMH) and subcortical WMH (SCWMH): none-mild PVWMH/SCWMH was defined at 0-1 score and moderate to severe PVWMH/SCWMH was defined at 2-3 scores; the sum scores of the two sites were calculated, and none-mild WMH was defined at 0-2 scores and moderate-severe WMH was defined at 3-6 scores. Univariate analysis was used to compare the baseline data of the two groups, and multivariate Logistic regression was used to determine the correlations of END with WMH lesion areas and severities. Results:Univariate analysis showed that there was significant difference between the END group and non-END group in age, baseline blood glucose, baseline National Institutes of Health Stroke Scale (NIHSS) scores, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, hemorrhagic transformation after thrombolysis, and PVWMH, SCWMH, and WMH scores ( P<0.05). Multivariate Logistic analysis showed that only baseline NIHSS scores ( OR=1.064, 95%CI: 1.019-1.111, P=0.005), hemorrhagic transformation after thrombolysis ( OR=3.931, 95%CI: 2.007-7.701, P=0.000), moderate-severe WMH ( OR=4.736, 95%CI: 2.737-8.195, P=0.000), and moderate-severe SCWMH ( OR=5.557, 95%CI: 3.156-9.783, P=0.000) were independently related to the occurrence of END. Conclusion:Patients with moderate-severe SCWMH, moderate-severe WMH, or high NIHSS scores after thrombolysis trend to have END.

Intravenous thrombolysis with recombinant tissue plasminogen activator in patients with acute ischemic stroke and maintenance hemodialysis / 中华神经医学杂志

Objective:To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with maintenance hemodialysis (MHD) and acute ischemic stroke.Methods:The clinical data of 235 patients with acute ischemic stroke receiving MHD were collected in our hospital from March 2018 to October 2021. According to the treatment methods chosen by themselves, these patients were divided into control group ( n=70, only receiving standardized secondary stroke prevention), rt-PA low-dose group ( n=85, receiving rt-PA intravenous thrombolysis, 0.6 mg/kg) and rt-PA standard-dose group ( n=80, receiving rt-PA intravenous thrombolysis, 0.9 mg/kg). The effective rate 24 h after treatment, good efficacy rate 7 d after treatment, and good prognosis rate and mortality 90 d after treatment were used to evaluate the effectiveness. The incidences of intracranial hemorrhage, symptomatic intracranial hemorrhage, and severe extracranial hemorrhage 90 d after treatment were used to evaluate the safety. Results:There was no statistical difference in the good prognosis rate 90 d after treatment among the rt-PA low-dose group, the rt-PA standard-dose group and the control group (71.8%, 68.8%, and 64.3%; P>0.05), but the effective rate 24 h after treatment and good efficacy rate 7 d after treatment in the rt-PA low-dose group and rt-PA standard-dose group (44.7%, 57.7%; 46.3%, 62.5%) were both significantly higher than those in the control group (27.1%, 38.6%; P<0.05). The mortality 90 d after treatment in the rt-PA low-dose group (7.1%) was significantly lower than that in the rt-PA standard-dose group (22.5%) and control group (21.4%, P<0.05). The incidences of intracranial hemorrhage and symptomatic intracranial hemorrhage in the rt-PA low-dose group (8.2%, 3.5%) were significantly lower than those in the rt-PA standard-dose group (22.5%, 16.3%; P<0.05), and the incidences of extracranial complications and gastrointestinal bleeding (5.9%, 1.2%) were significantly lower than those in the rt-PA standard-dose group (18.8%, 10.0%; P<0.05). Conclusion:Intravenous thrombolytic therapy with 0.6 mg/kg rt-PA is recommended for acute ischemic stroke patients receiving MHD.

Association between hyperfibrinogenemia and prognosis in patients with acute ischemic stroke receiving intravenous thrombolysis / 中风与神经疾病杂志

@#To explore the association between hyperfibrinogenemia and prognosis in patients with acute ischemic stroke （AIS） receiving intravenous thrombolysis.Methods Patients with acute ischemic stroke who received recombinant tissue plasminogen activator （rt PA） intravenous thrombolysis within 4.5 h of onset from August 2018 to December 2021 in the Department of Neurology of Zhejiang Provincial People's Hospital were retrospectively collected.Hyperfibrinogenemia were diagnosed according to the fibrinogen （FIB） level before thrombolysis.The prognosis of these patients were evaluated according to the modified Rankin Scale （mRS） scores 90 d after discharge.Multivariate logistic regression analysis was performed to determine the independent risk factors for prognoses of acute ischemic stroke patients after rt PA intravenous thrombolysis.Results Among the 327 patients，52 patients（15.90%） in the hyperfibrinogenemia group and 275（84.10%） in the non hyperfibrinogenemia group；63 patients （19.27%） had a poor prognosis and 264 （80.73%） had a good prognosis.As compared with the patients in nonhyperfibrinogenemia group，the patients in hyperfibrinogenemia group had significantly higher levels of the baseline FIB，proportion of drinking history and a poor prognosis （P<0.05）.Compared with the good prognosis group，the poor prognosis group had significantly advanced age，significantly longer door to needle time （DNT），significantly higher level of the baseline FIB，significantly lower proportion of small artery occlusion type and lower proportion of early neurological improvement，significantly higher the proportion of use anticoagulants，significantly higher of large atherosclerotic type，significantly higher of cardioembolic type，significantly higher of PH hemorrhagic transformation，significantly higher of symptomatic intracranial hemorrhage and significantly higher of severe cerebral edema （P<0.05）.Multivariate Logistic regression showed that the levels of the baseline FIB（OR=0.566，95%CI 0.368-0.872，P<0.05），and the 7 d NIHSS scores （OR=0.638，95%CI 0.490-0.831，P<0.05） were independent risk factors for poor prognosis.Conclusion Hyperfibrinogenemia is associated with poor prognosis after intravenous thrombolysis in patients with acute ischemic stroke.Acute ischemic stroke patients with higher baseline FIB levels and higher 7 d NIHSS scores are prone to have poor prognosis.

The clinical research of multi-modality assessment-based strategies for intravenous thrombolysis in acute mild ischemic stroke patients / 中风与神经疾病杂志

@#Objective　To evaluate the efficacy and safety of intravenous thrombolysis in acute mild ischemic stroke patients (National Institution of Health Stroke Scale≤5),moreover,to verify the effectiveness of multi-modality assessment in screening high-risk patients.Methods　We retrospectively included 227 patients identified with acute mild neurological deficits treated with or without intravenous thrombolysis.Odds ratios (OR) with their confidence intervals (CI) for different outcomes between groups were assessed by using multivariable binary logistic regression analyses.And the heterogeneity of treatment effect magnitude for excellent outcome［modified Rankin scale (mRS) 0~1 was estimated in different subgroups stratified by optimal cut-off value from receiver operating characteristic curve.Results　In multivariate analysis,intravenous thrombolysis could both achieve higher rate of excellent outcome(OR=3.302，95%CI1.488~7.326，P=0.003) and 7 day significant improvement (OR=2.566，95%CI1.287~5.118，P=0.007).However,there was no significant difference in the risk of early neurological deterioration,intracranial hemorrhage transformation or the 90 day stroke recurrence(P>0.05).It is indicated from the subgroup analysis that,compared with non-thrombolytic group,the classification of large artery atherosclerosis(OR=9.448，95%CI1.129~79.035，P=0.038) and baseline ABCD-2 score of 5 or more(OR=2.664，95%CI1.150~6.168，P=0.022) might benefit more from intravenous thrombolysis.Conclusion　For acute mild ischemic stroke patients,we reassured the safety and especially the efficacy of intravenous thrombolysis at 7 days and 90 days.Patients with ABCD-2 score of 5 or more and classification of large artery atherosclerosis might benefit more from intravenous thrombolytic therapy.

Correlation between serum galectin-3,MMP-9 expression and neurological deficit after intravenous thrombolysis in patients with acute ischemic stroke / 中风与神经疾病杂志

@#Objective　To investigate the relationship between the expression of serum galectin-3 and matrix metalloproteinase-9 (MMP-9) and neurological deficit after intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods　The clinical data of 100 patients with AIS who received intravenous thrombolytic therapy in the hospital were retrospectively analyzed.The neurological deficit （NIHSS） of all patients after thrombolytic therapy was evaluated.They were divided into severe group (NIHSS score≥15，71 patients) and mild to moderate group (NIHSS score 0~14，29 patients),and the relationship between the levels of serum galectin-3 and MMP-9 and the neurological deficit after intravenous thrombolytic therapy of AIS patients was analyzed.Results　The serum galectin-3 and MMP-9 levels of severe group high than mild to moderate group (P<0.05).The high expression of serum galectin-3 and MMP-9 before thrombolysis may be the risk factors of severe neurological deficit after thrombolysis in AIS patients （OR=1.385、1.166，P<0.001、=0.002，95%CI1.160~1.653、1.060~1.282）.Besides,they can predict the risk of severe neurological deficit in patients with AIS after thrombolytic therapy (AUC=0.781、0.718).Conclusion　The levels of serum galectin-3 and MMP-9 in patients with AIS before thrombolysis are related to the neurological deficit after thrombolysis.Their overexpression may increase the risk of severe neurological deficit.

The feasibleness study of forecasting the prognostic of sick person acute ischemic stroke by intravenous thrombolysis based on multi-phase CTA / 中风与神经疾病杂志

@#Evaluate the feasibleness of forecast the prognostic of sick person acute ischemic stroke Intravenous thrombolysis based on multi-phase CT angiography（mCTA）united with medical message. MethodsThe sufferer acute ischemic stroke accomplished mCTA scan were choose. The multi-phase ASPECTS collateral circulation，blood glucose results red blood cell distribution width（RDW）and neutrophil to lymphocyte ratio（NLR）were record. Pursuant to the modified Rankin Scale（mRS）as the criterion，90 daytime after therapy，sufferer mRS score≤2 were specified as set A（n=18），and sufferer mRS score≥3 were specified as set B（n=33）. The information with statistics discrepancies in univariate analysis were contained in binary Logistics regression analysis. The standalone risk elements for forecast the prognostic of sick person acute ischemic stroke were sifted out and the prognostic modeling was effected. The ROC curvature of all the variable with statistics meaning and the binary Logistics regression analysis was used to assess the diagnosis effectivity，Delong test was used to evaluate the discrepancies in between the ROC curvature. ResultsThe blood glucose results，RDW and NLR of set A were higher than those of set B，and the multi-phase score of set A was lower Compare of set B（P<0.05）. Binary Logistics regression analysis showed multi-phase score and NLR were standalone risk factor for 90 daytime prognostic of sick person acute ischemic stroke. The prediction model was logit（P）=-4.877+aspects score×-0.624+NLR×When the threshhold was 0.5288，the sensitivities and specificity were 77.8% and 93.9%，respectively. ConclusionAspects score and NLR are independent risk factors for predicting 90 daytime prognosis of patients with AIS. multi-phase CTA combined with laboratory examination can forecast the prognostic of sick person acute ischemic stroke and bestow precise forecast information for clinical sick person acute ischemic stroke.