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Cerebral infarction, with high incidence, high mortality, high disability and high recurrence rates, can impose a serious burden on families and society. After cerebral infarction occurrence, neurons, as the fundamental structures of the central nervous system, are unable to renew or multiply after death; hence, full recovery from neurological impairments following cerebral infarction is challenging. With stem cell and genetic recombination advancements, cellular replacement therapy after cerebral infarction progresses, which helps clinical transformation and application. In this paper, the basic researches of cellular replacement therapy after cerebral infarction are reviewed from 3 aspects: endogenous nerve regeneration, exogenous stem cell transplantation, and in situ somatic cell trans-differentiation into neurons, in order to provide references for cerebral infarction treatment
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The reperfusion therapies for acute ischemic stroke (AIS) patients in the past have set strict limits on time window. However, with the imaging assessment algorithms for "tissue window" becoming more mature, the time window for reperfusion therapies has been continuously extended. Nowadays the time window of intravenous thrombolysis has been extended to 9 hours after onset of stroke and is expected to be further broadened to 24 hours. At the same time, clinical studies of mechanical thrombectomy for posterior circulation large vessel occlusion (LVO), LVO with large ischemic cores and distal and medium vessel occlusion are all in hot progress. This article summarized diverse imaging assessment algorithms for "tissue window" and the latest advances of clinical research related to different fibrinolytic drugs for intravenous thrombolysis, mechanical thrombectomy for various vascular occlusion and bridging therapy of AIS in the extended time window. The objective of this review was to provide some references for the clinical diagnosis and therapy of stroke beyond time window.
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Objective@#Symptomatic intracranial hemorrhage (sICH) is one of the severe complications of ischemic stroke thrombolysis. Several prognostic scales have been developed to predict the risk of sICH. The performance of seven scales was compared in a single center cohort.@*Methods@#Data of patients with consecutive ischemic stroke who received 0.9 mg/kg intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis within 4.5 h time window from stroke onset were collected. Seven scales that can provide an estimate of risk of sICH were identified and evaluated: Hemorrhage After Thrombolysis (HAT), blood Sugar, Early infarct signs, (hyper) Dense cerebral artery sign, Age, National Institutes of Health (NIH) Stroke Scale (SEDAN), Stroke Prognostication using Age and NIH Stroke Scale (SPAN)-100, Safe Implementation of Thrombolysis in Stroke (SITS), Total Health Risks In Vascular Events (THRIVE), Glucose at presentation, Race (Asia), Age, Sex (male), systolic blood Pressure at presentation, and Severity of stroke at presentation (NIH Stroke Scale; GRASPS) and Multicenter Stroke Survey (MSS). The area under the receiver operating characteristic curve (AUROC) was calculated and Logistic regression and the Hosmer-Lemeshow test were also performed.@*Results@#The current study included 293 patients, of whom 7.85% (23/293) had sICH by National Institute of Neurological Disorders and Stroke (SICHNINDS), 5.46% (16/293) by Europe Cooperative Acute Stroke Study Ⅱ (SICHECASSⅡ) and 4.44% (13/293) by Safe Implementation of Thrombolysis in Stroke (SICHSITS) criteria. SEDAN had the highest AUROC for predicting sICH: sICHNINDS: AUROC=0.843, OR=3.167, 95%CI 2.106-4.762, P<0.01; sICHECASSⅡ: AUROC=0.797, OR=2.509, 95%CI 1.652-3.812, P<0.01; sICHSITS: AUROC=0.784, OR=2.172, 95%CI 1.405-3.357, P<0.01. And SPAN-100 had the lowest AUROC among all the seven scales and was only associated with risk of SICHNINDS in regression analysis. Furthermore, when sub-grouped the cohort into anterior circulation infarction and posterior circulation infarction, regression analysis suggested that all the seven scales were however not associated with sICH risk in patients with posterior circulation infarction.@*Conclusions@#SEDAN constantly had the highest predictive power, SPAN-100 had the worst. The seven scales studied could not predict sICH in posterior circulation infarction.
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Ischemic stroke has the characteristics of high disability,high mortality,and high recurrence rate,and the abundant collateral circulation is an independent predictor of good outcomes in stroke.This article mainly elaborates the cytological and molecular mechanisms of vascular remodeling process after ischemic stroke in order to provide new ideas and targets for the treatment of ischemic stroke.