•The rate of intravenous thrombolysis and endovascular for IS were 9.5 % and 4.4 %.•In-hospital death rate was 1.9 % for strokes, ranging from 0.9 % for IS to 5.1 % for ICH.•The 1-year fatality rate ...was 8.6 % for discharged strokes: 6.0 % for IS to 17.7 % for ICH.•The disability and rate recurrence were 16.6 % and 5.7 % for stroke survivors.•The prognosis of Chinese strokes appears to have improved and is not very bad.
There is currently a lack of data on stroke hospitalizations and long-term outcomes in China. Therefore, we investigated 12-month stroke fatality, disability, and recurrence rates after the first-ever stroke.
This was a prospective nationwide hospital-based cohort study. From August to September 2019, all patients with first-ever stroke (ischemic stroke IS, intracerebral hemorrhage ICH, and subarachnoid hemorrhage SAH) and with symptom onset within 14 days from 232 hospitals were included. Case fatality, disability, and recurrence rates for one year were estimated.
In total, 36250 first-ever stroke patients from 194 hospitals were recruited (median age was 65(IQR, 56-73) years and 61.4 % were male). The rate of intravenous thrombolysis and endovascular treatment for IS were 9.5 % and 4.4 %, respectively. In-hospital death rate was 1.9 % (95 %CI: 1.7 %–2.0 %) for stroke inpatients, ranging from 0.9 % (0.8 %–1.1 %) for IS to 5.1 % (4.6 %–5.6 %) for ICH. The 12-month fatality rate was 8.6 % (95 %CI: 8.3 %–8.9 %) for discharged stroke patients, ranging from 6.0 % (5.7 %–6.3 %) for IS to 17.7 % (16.7 %–18.7 %) for ICH. The 12-month disability rate was 16.6 % (95 %CI: 16.2 %–17.0 %) for stroke survivors, ranging from 11.1 % (9.3 %–12.8 %) for SAH to 29.2 % (27.9 %–30.4 %) for ICH. The stroke recurrence rate was 5.7 % (5.5 %–6.0 %) for stroke survivors, ranging from 2.5 % (1.7 %–3.3 %) for SAH to 6.4 % (6.0 %–6.7 %) for IS.
Our results support the hypothesis that the prognosis of Chinese stroke patients appears to have improved and is not very bad.
Background
To assess whether stroke patients admitted to stroke units (SU) have a better short-term outcome than those treated in conventional wards (CW).
Methods
A total of 20 hospitals from 16 ...provinces in China were initially selected in this study. Finally, 24,090 consecutive admissions in 2013–2015 treated in CW and 21,332 consecutive entries in 2017–2019 treated in SU were included. The primary endpoint of this study was the all-cause death or dependency condition three months after admission.
Results
Patients in the SU group were more likely receiving thrombolytic therapy (3.9 vs 2.1%) and intravascular treatment (1.2 and 0.7%). In-hospital death were lower in the SU group than the CW group (SU vs CW: 2.93 vs 4.58% absolute difference, − 2.28% {95% CI, − 3.32% to − 0.93%}, odd ratio {OR}, 0.72{95% CI, 0.61 to 0.82}. Death after discharge was also lower in the SU group than the CW (SU vs CW: 5.07 vs 6.72% absolute difference, − 2.33% {95% CI, − 3.39% to − 0.90%}, odd ratio {OR}, 0.75{95% CI, 0.68 to 0.84}. In addition, patients who received SU care were less likely to be dead or disabled than those patients who received CW care after adjusting for other variability (SU vs CW: 36.20 vs 44.33% absolute difference, − 11.33% {95% CI, − 15.32% to − 7.14%}, odd ratio {OR}, 0.78{95% CI, 0.80 to 0.85}.
Conclusions
Among patients with stroke, admission to a designated SU was associated with modestly lower mortality at discharge, reduced probability of death, or being disabled at the end of follow-up.
In China, stroke is a major cause of mortality, and long-term physical and cognitive impairment. To meet this challenge, the Ministry of Health China Stroke Prevention Project Committee (CSPPC) was ...established in April 2011. This committee actively promotes stroke prevention and control in China. With government financial support of 838.4 million CNY, 8.352 million people from 536 screening points in 31 provinces have received stroke screening and follow-up over the last seven years (2012–2018). In 2016, the CSPPC issued a plan to establish stroke centers. To shorten the pre-hospital period, the CSPPC established a stroke center network, stroke map, and stroke “Green Channel” to create three 1-h gold rescue circles, abbreviated as “1-1-1” (onset to call time <1 h; pre-hospital transfer time < 1 h, and door-to-needle time < 1 h). From 2017 to 2018, the median door-to-needle time dropped by 4.0% (95% confidence interval (CI), 1.4–9.4) from 50 min to 48 min, and the median onset-to-needle time dropped by 2.8% (95% CI, 0.4–5.2) from 180 min to 175 min. As of 31 December 2018, the CSPPC has established 380 stroke centers in mainland China. From 1 November 2018, the CSPPC has monitored the quality of stroke care in stroke center hospitals through the China Stroke Data Center Data Reporting Platform. The CSPPC Stroke program has led to a significant improvement in stroke care. This program needs to be further promoted nationwide.
Background
Timely recognition of futile recanalization might enable a prompter response and thus improve outcomes in patients receiving successful thrombectomy. This study aims to evaluate whether ...postoperative fibrinogen‐to‐albumin ratio (FAR) could act as an indicator of futile recanalization.
Methods
This is a single‐center, retrospective analysis of patients with acute anterior circulation large‐vessel occlusion and successful thrombectomy between May 2019 and June 2022. FAR was defined as postoperative blood levels of fibrinogen divided by those of albumin, and dichotomized into high and low levels based on the Youden index. Futile recanalization was defined as patients achieving a successful recanalization with a modified Rankin Scale score of 3–6 at 90 days. Multivariable logistic regression was used to assess the association of FAR with futile recanalization.
Results
A total of 255 patients were enrolled, amongst which 87 patients (34.1%) had high postoperative FAR. Futile recanalization was more prevalent among patients with high FAR compared to those with low FAR (74.7% vs. 53.0%, p = .001). After adjusting for potential confounders, high postoperative FAR was found to independently correspond with the occurrence of futile recanalization (adjusted OR 2.40, 95%CI 1.18–4.87, p = .015). This association was consistently observed regardless of prior antithrombotic therapy, treatment of intravenous thrombolysis, occlusion site, time from symptom onset to groin puncture, and reperfusion status.
Conclusion
Our findings support high postoperative FAR serving as an indicator of futile recanalization in patients with anterior circulation large‐vessel occlusion and successful thrombectomy.
Timely recognition of futile recanalization might enable a prompter response and thus improve outcome in patients receiving successful thrombectomy. The fibrinogen‐to‐albumin ratio is a valuable serological marker that may reflect information on both blood hemorheology and inflammation. Futile recanalization was more prevalent among patients with high postoperative fibrinogen‐to‐albumin ratio. High postoperative fibrinogen‐to‐albumin ratio could serve as an indicator of futile recanalization.
Summary
Introduction
The neuroprotective effects of hypothermia in acute ischemic stroke are well documented. However, the mechanisms involved in the effects remain to be clearly elucidated and the ...role of hypothermia on long‐term white matter integrity after acute ischemic stroke has yet to be investigated.
Aims
To investigate the role of mild focal hypothermia on long‐term white matter (WM) integrity after transient cerebral ischemia.
Results
Mild focal hypothermia treatment immediately after ischemic stroke significantly promotes WM integrity 28 days after the occlusion of the middle cerebral artery (MCAO) in mice. Higher integrity of white matter, lower activation of total microglia, less infarct volume, and better neurobehavioral function were detected in hypothermia‐treated mice compared to normothermia‐treated mice. Furthermore, we found that hypothermia could decrease detrimental M1 phenotype microglia and promote healthy M2 phenotype microglia. In vitro, results also indicated that hypothermia promoted oligodendrocytes differentiation and maturation after oxygen glucose deprivation.
Conclusion
Hypothermia promotes long‐term WM integrity and inhibits neuroinflammation in a mouse model of ischemic brain injury.
Aims
This study aimed to identify the clinical profiles of cervical spondylosis‐related internal jugular vein stenosis (IJVS) comprehensively.
Methods
A total of 46 patients, who were diagnosed as ...IJVS induced by cervical spondylotic compression were recruited. The clinical manifestations and imaging features of IJVS were presented particularly in this study.
Results
Vascular stenosis was present in 69 out of the 92 internal jugular veins, in which, 50.7% (35/69) of the stenotic vessels were compressed by the transverse process of C1, and 44.9% (31/69) by the transverse process of C1 combined with the styloid process. The transverse process of C1 compression was more common in unilateral IJVS (69.6% vs 41.3%, P = 0.027) while the transverse process of C1 combined with the styloid process compression had a higher propensity to occur in bilateral IJVS (52.2% vs 30.4%, P = 0.087). A representative case underwent the resection of the elongated left lateral mass of C1 and styloid process. His symptoms were ameliorated obviously at 6‐month follow‐up.
Conclusions
This study proposes cervical spondylotic internal jugular venous compression syndrome as a brand‐new cervical spondylotic subtype. A better understanding of this disease entity can be of great relevance to clinicians in making a proper diagnosis.
Summary
Extracranial venous abnormalities, especially jugular venous outflow disturbance, were originally viewed as nonpathological phenomena due to a lack of realization and exploration of their ...feature and clinical significance. The etiology and pathogenesis are still unclear, whereas a couple of causal factors have been conjectured. The clinical presentation of this condition is highly variable, ranging from insidious to symptomatic, such as headaches, dizziness, pulsatile tinnitus, visual impairment, sleep disturbance, and neck discomfort or pain. Standard diagnostic criteria are not available, and current diagnosis largely depends on a combinatory use of imaging modalities. Although few researches have been conducted to gain evidence‐based therapeutic approach, several recent advances indicate that intravenous angioplasty in combination with stenting implantation may be a safe and efficient way to restore normal blood circulation, alleviate the discomfort symptoms, and enhance patients’ quality of life. In addition, surgical removal of structures that constrain the internal jugular vein may serve as an alternative or adjunctive management when endovascular intervention is not feasible. Notably, discussion on every aspect of this newly recognized disease entity is in the infant stage and efforts with more rigorous designed, randomized controlled studies in attempt to identify the pathophysiology, diagnostic criteria, and effective approaches to its treatment will provide a profound insight into this issue.
Summary
Aims
Remote ischemic preconditioning (RIPC) of a limb is a clinically feasible strategy to protect against ischemia–reperfusion injury after stroke. However, the mechanism underlying RIPC ...remains elusive.
Methods
We generated a rat model of noninvasive RIPC by four repeated cycles of brief blood flow constriction (5 min) in the hindlimbs using a tourniquet. Blood was collected 1 h after preconditioning and 3 days after brain reperfusion. The impact of RIPC on immune cell and cytokine profiles prior to and after transient middle cerebral artery occlusion (MCAO) was assessed.
Results
Remote ischemic preconditioning protects against focal ischemia and preserves neurological functions 3 days after stroke. Flow cytometry analysis demonstrated that RIPC ameliorates the post‐MCAO reduction of CD3+CD8+ T cells and abolishes the reduction of CD3+/CD161a+ NKT cells in the blood. In addition, RIPC robustly elevates the percentage of B cells in peripheral blood, thereby reversing the reduction in the B‐cell population after stroke. RIPC also markedly elevates the percentage of CD43+/CD172a+ noninflammatory resident monocytes, without any impact on the percentage of CD43−/CD172a+ inflammatory monocytes. Finally, RIPC induces IL‐6 expression and enhances the elevation of TNF‐α after stroke.
Conclusion
Our results reveal dramatic immune changes during RIPC‐afforded neuroprotection against cerebral ischemia.
Aims
This study investigated the safety and efficacy of remote ischemic conditioning (RIC) on ameliorating the sequelae of ischemic moyamoya disease (iMMD).
Methods
A total of 30 iMMD patients ...underwent long‐term RIC and were followed up at 0.5, 1, and 2 years for clinical outcomes, including frequency of stroke recurrence, Patient Global Impression of Change (PGIC) scale, peak systolic velocities (PSV), and cerebral perfusion.
Results
During the whole RIC treatment process, no RIC‐related adverse event occurred. Only one of 30 patients suffered a onetime infarction (3.3%), and the ratios of acceptable PGIC were 88.2%, 64.3%, and 92.3% at 0.5, 1, and 2 years follow‐up. Kaplan‐Meier analysis showed the frequency of stroke recurrence was significantly reduced after RIC (P = .013). The frequency of TIA per week was 1.1 (0.6, 2.8) prior to RIC and 0.1 (0.0, 0.5) post‐RIC (P < .01). Compared to baseline, PSV values were significantly reduced after RIC treatment (P = .002 at 0.5, P = .331 at 1, and P = .006 at 2 years). In patients undergoing perfusion studies, 75% obtained improvement on followed‐up SPECT and 95% on followed‐up PET maps.
Conclusions
Remote ischemic conditioning may be beneficial on controlling iMMD‐induced ischemic events, relieving symptoms, and improving cerebral perfusion, without incidence of complications in this case series.
Aims
To explore the safety and efficacy of normobaric oxygen (NBO) on correcting chronic cerebral ischemia (CCI) and related EEG anomalies.
Methods
This prospective randomized trial (NCT03745092) ...enrolled 50 cases of CCI patients, which were divided into NBO (8 L/min of oxygen supplement) group and control group (room air) randomly, and also enrolled 21 healthy volunteers. Two times of 30‐min EEG recordings with the interval of 45min of NBO or room air were analyzed quantitatively.
Results
The CCI‐mediated EEG presented with two patterns of electrical activities: high‐power oscillations (high‐power EEG, n = 26) and paroxysmal slow activities under the normal‐power background (normal‐power EEG, n = 24). The fronto‐central absolute power (AP) of the beta, alpha, theta, and delta in the high‐power EEG was higher than that in healthy EEG (p < 0.05). The fronto‐central theta/alpha, delta/alpha and (delta + theta)/(alpha + beta) ratios in the normal‐power EEG were higher than those in healthy EEG (p < 0.05). The high‐power EEG in NBO group had higher fronto‐central AP reduction rates than those in control group (p < 0.05). NBO remarkably reduced the fronto‐central theta/alpha, delta/alpha, and (delta + theta)/(alpha + beta) ratios in the normal‐power EEG (p < 0.05).
Conclusions
NBO rapidly ameliorates CCI‐mediated EEG anomalies, including attenuation of the abnormal high‐power oscillations and the paroxysmal slow activities associated with CCI.
We provided clinical evidences for use of normobaric oxygen (NBO) in patients with chronic cerebral ischemia (CCI). NBO can rapidly ameliorate CCI‐related EEG anomalies, including attenuating the abnormal high‐power oscillations and suppressing the paroxysmal slow activities in the CCI condition. Long‐term NBO performance may still benefit in the CCI patients.
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