The thrombus proteome in stroke reveals a key role of the innate immune system and new insights associated with its etiology, severity, and prognosis.

BACKGROUND: Nowadays little is known about the molecular profile of the occluding thrombus of patients with ischemic stroke. OBJECTIVES: To analyze the proteomic profile of thrombi in patients who experienced an ischemic stroke in order to gain insights into disease pathogenesis. METHODS: Thrombi from an exploratory cohort of patients who experienced a stroke were obtained by thrombectomy and analyzed by sequential window acquisition of all theoretical spectra-mass spectrometry. Unsupervised k-means clustering analysis was performed to stratify patients who experienced a stroke. The proteomic profile was associated with both the neurological function (National Institute of Health Stroke Scale [NIHSS]) and the cerebral involvement (Alberta Stroke Program Early CT Score [ASPECTS]) prior to thrombectomy and the clinical status of patients at 3 months using the modified Rankin Scale. In an independent cohort of 210 patients who experienced a stroke, the potential role of neutrophils in stroke severity was interrogated. RESULTS: Proteomic analysis identified 580 proteins in thrombi, which were stratified into 4 groups: hemostasis, proteasome and neurological diseases, structural proteins, and innate immune system and neutrophils. The thrombus proteome identified 3 clusters of patients with distinctive severity, prognosis, and etiology of the stroke. A protein signature clearly distinguished atherothrombotic and cardioembolic strokes. Several proteins were significantly correlated with the severity of the stroke (NIHSS and ASPECTS). Functional proteomic analysis highlighted the prominent role of neutrophils in stroke severity. This was in line with the association of neutrophil activation markers and count with NIHSS, ASPECTS, and the modified Rankin Scale score 90 days after the event. CONCLUSION: The use of sequential window acquisition of all theoretical spectra-mass spectrometry in thrombi from patients who experienced an ischemic stroke has provided new insights into pathways and players involved in its etiology, severity, and prognosis. The prominent role of the innate immune system identified might pave the way for the development of new biomarkers and therapeutic approaches in this disease.

Balloon guide catheter improvements in thrombectomy outcomes persist despite advances in intracranial aspiration technology.

BACKGROUND: First-pass effect (FPE) has been established as a key metric for technical success and strongly correlates with better clinical outcomes. Most data supporting improved outcomes with the use of a balloon guide catheter (BGC) predate the advent of last-generation large-bore intracranial aspiration catheters. We aim to evaluate the impact of BGC in FPE and clinical outcomes in a large cohort of patients treated with contemporary technology. METHODS: Patients were recruited from the prospectively ongoing ROSSETTI registry. This registry includes all consecutive patients with anterior circulation large-vessel occlusion (LVO) from 10 comprehensive stroke centers in Spain. Demographic, clinical, angiographic, and clinical outcome data were compared between BGC and non-BGC groups. FPE was defined as the achievement of mTICI2c-3 after a single device pass. RESULTS: 426 patients were included out of which 271 (63.62%) used BCG. BGC-treated patients had higher FPE rate (45.8% vs 27.7%; P<0.001), higher final mTICI ≥2 c recanalization rate (76.8% vs 50.3%, respectively; P<0.001), shorter procedural time [median (IQR), 30 (19-58) vs 43 (33-71) min; P<0.001], higher NIHSS difference from admission to 24 hours [median (IQR), 8 (2-12) vs 3 (0-10); P=0.001], and lower mortality rate (17.6% vs 29.8%, P=0.026) compared with non-BGC patients. BGC use was an independent predictor of FPE (OR 2.197, 95% CI 1.436 to 3.361; P<0.001), and excellent clinical outcome at 3 months (OR 0.34, 95% CI 0.17 to 0.68; P=0.002). CONCLUSIONS: Our results support the benefit of BGC use on angiographic and clinical outcomes in anterior circulation LVO ischemic stroke remain significant even when considering recent improvements in intracranial aspiration technology.

Half bolus dose of intravenous abciximab is safe and effective in the setting of acute stroke endovascular treatment.

BACKGROUND: A stent is often necessary for the treatment of stroke. In such cases,it is essential for the patient to have antiplatelet therapy. There are several methods of antiaggregation, such as oral loading doses of aspirin and clopidogrel, intravenous aspirin, or intravenous glycoprotein IIb/IIIa receptor antagonists, such as abciximab. The aim of this study was to evaluate the incidence of symptomatic intracerebral hematoma (sICH) associated with our antiplatelet protocol: intravenous abciximab bolus at half the dose (0125 mg/kg) at the time of the stenting procedure; oral aspirin (150 mg) and clopidogrel (75 mg) daily added the next day after CT shows no significant hematoma. MATERIALS AND METHODS: Retrospective review of our database of endovascular management of large acute vessel occlusion treated with intravenous abciximab between January 2015 and March 2018. Demographics data, material, drugs, and complications were registered. Fisher tests were used to compare the incidence of sICH in the literature where abciximab 0.25 mg/kg plus maintenance doses are often administrated. RESULTS: Intravenous abciximab was administered to 99 patients. No sICH was observed. According to the European Cooperative Acute Stroke Study Scale, there were 8 cases of hemorrhagic infarction 1, 5 cases of hemorrhagic infarction 2, 4 cases of parenchymal hemorrhage 1, and no cases of parenchymal hemorrhage 2. A comparison between sICH with conventional antiplatelet doses based on the literature showed a statistically significant difference favoring our protocol. CONCLUSION: In the endovascular treatment of acute ischemic stroke, a bolus dose of 0125 mg/kg of abciximab with no maintenance doses, followed by 150 mg of aspirin and 75 mg of clopidogrel orally the next day, is safe and effective.

Treatment of dural arteriovenous fistulas presenting as pulsatile tinnitus.

OBJECTIVE: To describe the clinical picture and treatment of dural arteriovenous fistulas (DAVFs) presenting as pulsatile subjective tinnitus. STUDY DESIGN: Review of prospectively collected data. SETTING: Academic referral center. PATIENTS: Fourteen patients with clinically and radiographically diagnosed DAVFs. INTERVENTIONS: Treated by endovascular route. MAIN OUTCOME MEASURES: Treatments, clinical course, complications, and evolution were evaluated. RESULTS: All patients presented with sleep-disruptive pulsatile tinnitus. Other symptoms included severe headaches, papilledema, proptosis, blepharoptosis, visual disturbances, and hemiparesis. Cortical venous drainage was present in 4 cases. Endovascular treatment was performed at least once by the arterial route in 14 patients and the venous route in 4 patients. The origin of tinnitus was always a vessel in or above the petrous bone. When these arteries or veins could not be visualized in the final control, the tinnitus disappeared. In the patients whose tinnitus returned, a vessel in the petrous bone could always be seen. There was no mortality. CONCLUSION: Endovascular treatment is an effective and safe treatment of DAVFs presenting as tinnitus.

Estado antioxidante y peroxidación lipídica en la disfunción eréctil: estudio preliminar / Antioxidant status and lipid peroxidation in erectile dysfuncion: preliminary

OBJETIVOS: Los objetivos de este trabajo fueron estudiar la situación metabólica del tejido cavernoso en pacientes con impotencia vascular y psicógena, e intentar establecer diferencias metabólicas entre los distintos tipos de disfunción eréctil. MÉTODO: Se estudiaron 103 pacientes divididos en dos grupos dependiendo del tipo de disfunción eréctil que presentaban: grupo A (vascular) y grupo B (psicógena). Para su diagnóstico se empleó: historia clínica, exploración física, test de inyección intracavernosa, eco-doppler peneano, cavernosografía-cavernosometría y test peneano nocturno. Se tomaron muestras de sangre cavernosa, y sangre venosa periférica de cada enfermo; en estas se cuantificó la concentración de lipoperoxidos (LPO) y el estado total antioxidante (ETA). Se empleó el SPSS V9.0 para el análisis estadístico. RESULTADOS: La edad media fue de 62 (32-73) años. La concentración de lipoperoxidos en sangre cavernosa fue estadísticamente (p< 0,05) mayor en pacientes con impotencia vascular (2,45 µmol/L) que en la impotencia psicógena (1,47 µmol/L). El estado antioxidante total en sangre cavernosa fue estadísticamente superior (p<0,05) en pacientes con impotencia psicogena (1,40 mmol/L) que en los vasculares (1,10 mmol/L). Los niveles de lipoperoxidos y estado antioxidante total en en sangre periférica, en ambos grupos fue: (1,68 µmol/L vs 1,60 µmol/L) y (1,29 mmol/L vs 1,35 mmol/L) respectivamente; sin existir diferencias significativas entre los dos grupos. CONCLUSIÓN: En conclusión, la producción de lipoperoxidos, y el estado antioxidante total de la sangre cavernosa puede ser un indicador de la situación metabolica e indirectamente de la funcionalidad del tejido cavernoso (AU)