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Accurate definition and better understanding of the mechanisms of stroke are crucial as this will guide the effective care and therapy. In this paper, we review the previous basic and clinical researches on the causes or mechanisms of ischemic cerebrovascular diseases (ICVD) and interpret the correlation between embolism and hypoperfusion based on...
Citations
... Previous reports have explored the mechanisms of ischemic stroke. 1 Additionally, endovascular thrombectomy 2 and olfactory ensheathing cell transplantation have been used as treatment. 3 Additionally, the clinical, diagnostic, and therapeutic guidelines of stroke neurorestoration 4 have been reported. ...
Objective
To investigate the effectiveness and safety of tirofiban in patients with acute ischemic stroke (AIS) without large-vessel occlusions and not receiving intravenous thrombolysis.
Methods
Overall, 267 cases were included in the study (134 cases in tirofiban group; 133 cases in control group). After admission, patients in the tirofiban group were administered tirofiban for at least 72 h, and aspirin 100 mg and hydroclopidogrel 75 mg were administered 4 h before discontinuation of tirofiban administration. All patients were followed for 3 months, and the National Institutes of Health Stroke Scale (NIHSS) scores on admission, 24 h, and 7 d after treatment, intracerebral hemorrhage transformation within 48 h from stroke onset, and bleeding were assessed.
Results
There was no significant difference between both groups in the incidence of non-symptomatic and symptomatic intracranial hemorrhage (sICH), extracranial hemorrhage events, and thrombocytopenia (p > 0.05). There was a significant different between the NIHSS scores at baseline and 7 d after treatment in the tirofiban group (p = 0.043). At 90 d after treatment, the proportion of patients with a good prognosis in the tirofiban group (modified Rankin Scale [mRS] = 0, 1) was higher than that in the control group (p = 0.021). There was no difference in the proportion of patients with a mRS of 0–2 between the two groups (p > 0.05).
Conclusion
Administration of tirofiban for >72 h (72 h to 108 h) is safe and can improve the long-term (90 d) prognosis of patients with AIS without large-vessel occlusions and not receiving intravenous thrombolysis.
... Cerebrovascular disease refers to acute and chronic cerebrovascular diseases caused by various reasons. As a common and frequently occurring disease in the nervous system, cerebrovascular disease is currently one of the three major diseases leading to human death, second only to cardiovascular disease and cancer (1,2). Ischemic cerebrovascular diseases mainly include transient ischemic attack and cerebral infarction, accounting for about 80% of all strokes, and the proportion is higher in elderly patients. ...
Objective
To explore the effects of two different hemostasis methods, namely, arterial compression devices and vascular closure devices, in the ischemic cerebrovascular intervention to provide a theoretical basis for clinical selection of hemostasis methods.MethodsA total of 302 patients who underwent ischemic cerebrovascular intervention in our hospital from January 2016 to December 2020 were selected as the research subjects and randomly divided into the control group (n = 151) and the observation group (n = 151). The patients in both groups underwent cerebrovascular intervention. The patients in the control group were treated with an artery compressor for hemostasis after the operation, while those in the observation group were treated with vascular closure devices for hemostasis. The hemostatic indexes and vascular parameters at the puncture site before and after the operation were compared between the two groups. The comfort level of the patients was assessed at 6, 12, and 24 h after the operation with the Kolcaba Comfort Scale score, and the postoperative complications were recorded.ResultsThere was no significant difference in the success rate of hemostasis between the two groups (p > 0.05). The hemostatic time and immobilization time of (2.69 ± 0.62) min and (4.82 ± 0.93) h in the observation group were lower than those in the control group with (16.24 ± 3.58) min and (7.94 ± 1.86) h (p < 0.05). The differences in the minimum inner diameter of the puncture site and its nearby vessels and the peak velocity of blood flow between the two groups before and after the operation were not statistically significant within or between groups (p > 0.05). The scores of the Kolcaba comfort scale in the observation group (80.16 ± 8.49) and (93.65 ± 9.26) at 6 and 12 h, respectively, after the operation, were higher than those in the control groups (72.08 ± 7.54) and (85.49 ± 8.63) (p < 0.05). The 24 h postoperative Kolcaba comfort scale score was (97.54 ± 9.86) in the observation group and (96.82 ± 9.64) in the control group, and the difference was not statistically significant (p > 0.05). In the control group, there were 7 cases of dysuria, 12 cases of low back pain, 14 cases of sleep disorder, 20 cases of mental stress, and 5 cases of wound bleeding, and the total incidence of complications was 38.41% (58/151). In the observation group, there were 4 cases of dysuria, 8 cases of low back pain, 10 cases of sleep disorder, 14 cases of mental stress, and 3 cases of wound bleeding, and the total incidence of complications was 25.83% (39/151). The total incidence of complications in the observation group was lower than that in the control group (p < 0.05).Conclusion
For patients with ischemic cerebrovascular disease undergoing femoral artery puncture intervention, the use of vascular closure devices can stop the bleeding quickly, which can significantly shorten the bleeding time, and the postoperative braking time of patients is short, with high comfort and fewer complications.
... Atherosclerosis is a major cause of hypertension, hyperglycemia, and hyperlipemia, and results in different levels of stenosis in the cerebral arteries. [1][2][3][4][5] Therefore, arterial sclerosis and stenosis may play a significant role in clinical investigation and treatment of individuals with ICVD. ...
... An increasing number of individuals ignore good dietary habits (i.e., balanced diet) and healthy lifestyle as current living Table 3 Perioperative characteristics, complications, and prognosis. characterized as a series of pathological changes due to the longterm effects of abnormal hemodynamics, which further result in the accumulation of atherosclerotic plaque, [2,10] vascular stenosis, [5] and cerebral infarction. [11] Therefore, early diagnosis and intervention of cerebrovascular lesions can effectively improve the ischemic condition of cerebral tissue, preventing the occurrence and progression of cerebral infarction. ...
This study aimed to investigate the therapeutic effect of cerebrovascular stent implantation in southwest Chinese patients with ischemic cerebrovascular disease and underlying risk factors for stent restenosis.
We made a retrospectively analysis of occurring risk, cerebrovascular lesion, stent implantation, complication treatment, and prognosis of 54 patients with ischemic cerebrovascular disease in our department.
A total of 85 stents were implanted into 54 patients, involving 44 of the internal carotid artery system, 34 of the vertebral-basal artery system and 7 of the subclavian artery system. All patients with stenosis were reduced by >70%, with all stenosis complete reduction in 5 (9%) patients and reduction of over 90% in 25 (46%) patients. A total of 50 patients were followed up for 28.5 (21–35) months. The stents in 42 patients exhibited satisfactory shape and location while restenosis occurred in 8 patients. Univariate analysis revealed that hyperlipidemia, hyperuricemia, surgery duration, and total length of hospital stay are significantly correlated with stent restenosis, and hyperlipidemia and hyperuricemia were proven to be independent risk factors for restenosis using logistic regression analysis.
Cerebrovascular stent implantation and balloon inflation surgery can assist in abating angiostenosis and improving blood supplement effectively in patients with ischemic cerebrovascular disease. Besides, an overall evaluation, strict care, and regular check-up in perioperative period may reduce the occurrence of complications. Finally, several clinical parameters may need to be highly focused on in surgery for better prognosis.
... Patients with cerebral vascular stenosis with poor collateral circulation when exposed to aggressive BP management, the presence of ICAS predisposes them to BZI and RS. Further, increasing BP improves the prognosis of BZI patients [26,27]. Therefore, knowledge of ICAS seems essential to prevent and manage BZI [2]. ...
Background: Border zone infarcts (BZI) are ischemic lesions occurring between two non- anastomosing arterial territories. BZI patients have higher incidence of recurrent strokes (RS). The predictors of peripheral arterial disease (PAD), low ankle-brachial index (ABI) and high inter-arm blood pressure difference (IABD) are associated with intracranial atherosclerosis and thus, could also have an association with BZI. Our single blind prospective study explores the predictive value of these clinical variables, ABI and IABD for BZI in patients with acute ischemic stroke.
Methods: The subjects fulfilling the inclusion criterion (183 of 335, 78.14% men) were divided into BZI (n=89) and pure core arterial territory infarct (CATI, n=94) groups, based upon MRI characteristics of infarcts. The value of ABI (
... However, another possibility is that, in the presence of arterial stenosis greater than 50%, there is likely interplay between hypoperfusion and emboli formation from a ruptured plaque in the stroke mechanism in which poor collateralization and marginal blood flow reduces the washout and clearance of emboli. 16 Therefore, prevention of emboli without treating the hypoperfusion may be unlikely to be sufficient to reduce the occurrence of stroke; hence, the previously shown superiority of surgical interventions vs medical management with antithrombotic therapy. ...
Importance
The COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) randomized clinical trial was stopped early owing to the efficacy of low-dose rivaroxaban plus aspirin in preventing major cardiovascular events. The main reason for early trial termination was the effect of combination therapy on reducing ischemic strokes.
Objective
To analyze the association between low-dose rivaroxaban with or without aspirin and different ischemic stroke subtypes.
Design, Setting, and Participants
This is a secondary analysis of a multicenter, double-blind, randomized, placebo-controlled study that was performed in 33 countries from March 12, 2013, to May 10, 2016. Patients with stable atherosclerotic vascular disease were eligible, and a total of 27 395 participants were randomized and followed up to February 6, 2017. All first ischemic strokes and uncertain strokes that occurred by this date were adjudicated using TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. The analysis of ischemic stroke subtypes was evaluated using an intention-to-treat principle. Statistical analysis was performed from March 12, 2013, to February 6, 2017.
Interventions
Participants received rivaroxaban (2.5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban (5 mg twice a day), or aspirin (100 mg once a day).
Main Outcomes and Measures
Risk of ischemic stroke subtypes during follow-up.
Results
A total of 291 patients (66 women; mean [SD] age, 69.4 [8.5] years; 43 [14.8%] had a previous nonlacunar stroke) experienced an ischemic stroke. During the study, 49 patients (16.8%) received a diagnosis of atrial fibrillation. Applying TOAST criteria, 59 strokes (20.3%) were cardioembolic, 54 strokes (18.6%) were secondary to greater than 50% stenosis of the ipsilateral internal carotid artery, 42 strokes (14.4%) had a negative evaluation that met criteria for embolic stroke of undetermined source, and 21 strokes (7.2%) were secondary to small vessel disease. There were significantly fewer cardioembolic strokes (hazard ratio [HR], 0.40 [95% CI, 0.20-0.78]; P = .005) and embolic strokes of undetermined source (HR, 0.30 [95% CI, 0.12-0.74]; P = .006) in the combination therapy group compared with the aspirin-only group. A trend for reduction in strokes secondary to small vessel disease (HR, 0.36 [95% CI, 0.12-1.14]; P = .07) was not statistically significant. No significant difference was observed between the 2 groups in strokes secondary to greater than 50% carotid artery stenosis (HR, 0.85 [95% CI, 0.45-1.60]; P = .61). Rivaroxaban, 5 mg, twice daily showed a trend for reducing cardioembolic strokes compared with aspirin (HR, 0.57 [95% CI, 0.31-1.03]; P = .06) but was not associated with reducing other stroke subtypes.
Conclusions and Relevance
For patients with systemic atherosclerosis, low-dose rivaroxaban plus aspirin was associated with large, significant reductions in cardioembolic strokes and embolic strokes of undetermined source. However, these results of exploratory analysis need to be independently confirmed before influencing clinical practice.
Trial Registration
ClinicalTrials.gov identifier: NCT01776424
... Dysregulation of TJ proteins results in increased BBB permeability and entry of blood-borne substances and cells, such as macrophages and neutrophils, into the infarct zone and brain parenchyma. higher risk for stroke by compressing the carotid artery or causing cardio-embolism, hypoxia, or hypoperfusion (Lee et al., 2013;Hamzei Moqaddam et al., 2009;Hamzei-Moghaddam et al., 2013;Yu YP, 2016;Baldini et al., 2012). Pathologically, chronic opioid use is also shown to alter the BBB integrity (Baba et al., 1988;Mahajan et al., 2008). ...
Chronic use of prescription opioids exacerbates risk and severity of ischemic stroke. Annually, 6 million people die from stroke worldwide and there are no neuroprotective or neurorestorative agents to improve stroke outcomes and promote recovery. Prescribed opioids such as morphine have been shown to alter tight junction protein expression, resulting in the disruption of the blood brain barrier (BBB), ultimately leading to stroke pathogenesis. Consequently, protection of the BBB has been proposed as a therapeutic strategy for ischemic stroke. This perspective addresses the deficiency in stroke pharmacological options and examines a novel application and repurposing of FDA-approved opioid antagonists as a prospective neuroprotective therapeutic strategy to minimize BBB damage, reduce stroke severity, and promote neural recovery. Future directions discuss potential drug design and delivery methods to enhance these novel therapeutic targets.
... Sutures are the most widely used medical devices in surgical procedures. 1,2 One of the most common applications of sutures is vascular anastomosis, the connection of two tubular structures within the vascular system. Vascular graft implantation and bypass surgery both rely upon suture-based anastomosis. ...
... 14,16−20 Since the first report of the fabrication of electrospun nanofibers as a delivery carrier for the model drug tetracycline, many studies have investigated drug delivery from nanofibers. Drug loading can be achieved by (1) dissolving or dispersing the drugs in polymer solutions, resulting in one-phase nanofibers or (2) conjugating the drugs directly onto the polymers for a sustained or stimuli-responsive drug release or (3) using multiaxial needles to develop multiphase nanofibers. 16,21−24 For example, Lu et al. developed cationized gelatin-coated polycaprolactone fibers by coaxial electrospinning for constructing a core−shell fibrous membrane and immobilized the heparin/vascular endothelial growth factor (VEGF) complex through ionic interactions. ...
... Anastomotic thrombosis, the most frequent complication in vascular surgery, often results in stenosis of the vessel, leading to the graft failure and revision surgery or can cause an embolism, leading to life-threatening ischemia. 2,49 Numerous pharmaceutical agents have been tested to reduce thrombus formation, and ultimately prevent these high-risk complications, but the results have been disappointing. The agents either have undesirable systemic effects, or they cannot achieve a controlled, timed release in the circulation. ...
... The pathophysiological mechanisms of LAA have been proposed as (1) hypoperfusion of the involved vascular territory, (2) unstable plaque with artery-to-artery embolism, and (3) hypoperfusion-mediated microembolus formation. It is difficult to infer which mechanism may be responsible for an individual patient's condition in clinical practice (30). We hypothesized that the presence of HARM in acute stroke patients diagnosed with LAA etiology may be attributable to the artery-to-artery embolism, whereas the absence of HARM may be attributable to hypoperfusion. ...
Purpose
The hyperintense acute reperfusion marker (HARM) is a delayed enhancement of the subarachnoid or subpial space observed on post-contrast fluid-attenuated inversion recovery (FLAIR) images and is associated with permeability changes to the blood–brain barrier in acute stroke. We investigated the relationship between HARM and stroke etiology based on the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. In addition, we evaluated the relationship between HARM and stroke locations with respect to vascular territories and anatomic compartments.
Materials and methods
We recruited 264 consecutive patients (109 women; mean age 68.63 years) who were diagnosed with acute ischemic stroke and underwent brain magnetic resonance imaging (MRI) including post-contrast FLAIR and DWI within 7 days of symptom onset from May 2015 to March 2016 for this retrospective study. Post-contrast FLAIR images were obtained 5 min after gadolinium administration. The mean time interval between the onset of stroke symptoms and MRI acquisition in total included patients was 18 h and 7 min (median 12 h and 57 min, range 2–127 h). We analyzed the overall incidence and distribution patterns of HARM in acute ischemic stroke cases and compared the relative incidence and distribution patterns of HARM between the subgroups of stroke etiology based on conventional TOAST classification. We obtained odds ratio (OR) of HARM in different stroke locations based on vascular territories and anatomical compartments. This study was approved by our institutional review board.
Results
Among the 264 patients, 67 (25.38%) patients were HARM positive and 197 (74.62%) patients were HARM negative. There was significant difference in HARM incidence among the stroke subgroups (p < 0.001). Small vessel occlusion (SVO) was associated with the HARM-negative group (p < 0.001), while large artery atherosclerosis (LAA) and cardioembolism (CE) were associated with the HARM-positive group (p = 0.001). Also, regional pattern of HARM on the same vascular territory as the acute infarction was dominantly demonstrated regardless of stroke etiology. The OR for HARM from middle cerebral artery (MCA) infarction was 1.868 [95% confidence interval (CI): 1.025–3.401]. The OR for HARM from cortical infarction was 9.475 (95% CI: 4.754–18.883) compared to other anatomic compartments.
Conclusion
The presence of the HARM was significantly associated with embolic infarctions including LAA and CE. Conversely, SVO was exclusively associated with the absence of the HARM. Second, MCA and cortical infarction showed a more pronounced HARM compared to infarctions at other vascular territories and anatomic compartments. According to the results in the current study, we speculate that the presence of HARM on post-contrast FLAIR images was associated with specific stroke causes especially in embolic causes.
A 4‐year‐old, spayed, female, mix‐breed dog presented for acutely rolling to the left. She had developed an apathetic behaviour over the last 5 months and also recurrent urinary tract infections. On presentation, cardiac auscultation revealed a fast heart rate and premature beats. The dog was stuporous, with a head tilt to the left, abnormal eye position and movements and absent facial sensation on the left side of the head. Clinicopathologic analysis was consistent with hypothyroidism. Electrocardiography evaluation revealed an accelerated idioventricular rhythm interrupted by ventricular premature complexes. Postmortem examination revealed infarction of the right thalamus due to an occlusive thrombus associated with atherosclerosis, together with acute myocardial infarction of the left ventricular wall with an associated thrombus and atherosclerosis in a supplying coronary artery. This report illustrates a concurrent cardio‐cerebral infraction in a dog. Neurological and electrocardiographic abnormalities are explained, and the pathophysiology of the clinical signs is discussed.
