Objective To investigate the current situation of clinical studies on puerarin for ischemic stroke and the reliability of these evidence. Methods By electronic searching and handsearching, we collected all the published clinical study reports on puerarin for ischemic stroke and assessed all the included reports according to clinical epidemiologic standard. Results 35 RCTs, 22 non-randomized controlled trials and 17 case serials studies were included and analysed. Conclusions Current quality of clinical studies of puerarin for ischemic stroke is not good enough to provide reliable evidence.
ObjectiveTo systematically review the efficacy and safety of lumbrokinase capsule for patients with acute ischemic stroke (AIS).MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on lumbrokinase capsule for patients with AIS from inception to 1st December, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 33 RCTs involving 4 751 patients were included. The results of meta-analysis indicated that compared with control group, lumbrokinase capsule could improve the treatment efficiency (RR=3.51, 95%CI 2.29 to 5.39, P<0.001), enhance neurological function (SMD=−0.55, 95%CI −0.72 to −0.38, P<0.001) and reduce fibrinogen after treatment (SMD=−0.93, 95%CI −1.41 to −0.44, P<0.001). Reported adverse reactions included dizziness, nausea and gastric discomfort, and no mortality was reported.ConclusionsCurrent evidence shows that lumbrokinase capsule can improve the neurological deficit in patients with AIS. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Good collateral circulation can effectively improve the prognosis of patients with severe stenosis or occlusion of cerebral blood supply artery. Studies have shown that CT angiography (CTA) can non-invasively and intuitively evaluate the degree of stenosis and collateral blood flow in diseased vessels. Rapid and accurate CTA collateral circulation score is of great significance for clinical decision-making and judging the prognosis of ischemic stroke. At present, there are many scoring scales based on CTA collateral circulation. This article will review the existing 7 CTA collateral circulation scoring scales, the advantages and disadvantages of clinical application and related research progress in predicting prognosis, aiming to provide a reference for clinicians to choose the collateral circulation score scale and the best treatment plan according to different situations.
Endovascular treatment for acute ischemic stroke has become the main therapy for large vessel occlusion. In addition to stent thrombectomy, in recent years, the application of aspiration thrombectomy is becoming more and more common. The physical principles of aspiration and stent thrombectomy extraction are different. The thrombus is captured by the negative pressure generated by suction through the contact between the reperfusion catheter and the thrombus, thus achieving cerebrovascular recanalization. Currently, more and more researches support the application of aspiration thrombectomy. What are the advantages and disadvantages of the aspiration thrombectomy compared with the stent thrombectomy and how to apply the aspiration technology reasonably are the hot issues concerned by everyone. This paper reviews the application and research progress of aspirating thrombectomy in order to provide reference for clinical treatment decisions.
ObjectiveThis study aimed to explore the timing of the long-term antiepileptic drugs (AEDs) therapy in patients with stroke related seizures. MethodsWe enrolled 90 Patients with post-stroke seizures who diagnosed in neurology and epilepsy specialist clinic of Tianjin Medical University General Hospital and followed up for at least 12 months from September 2014 to August 2016. The patients were divided into early-onset seizure group (occurring within 2 weeks of stroke) and late-onset seizure group (occurring after 2 weeks of stroke).The two groups were subdivided into treated and untreated group after the first seizure. ResultsThe patients were followed up for 12~96m (median 20m). 31 patients in ES group, 19 of which in treated group and 12 of which in untreated group. 59 patients in LS group, 36 of which in treated group and 23 of cases in untreated group. The recurrence rate of second seizures occurred in each group and the comparison between the subgroups in the 3rd, 6th, 9th and 12th mouth of follow-up as follows. 1 LS group compared with the group of ES, the recurrence rate of second seizures was high (25.81%~38.71% vs. 49.15%~69.49%), and there was statistical difference (P < 0.05). 2 The recurrence rate of ES in untreated group was lower than that in untreated LS group (16.77% 33.33% vs. 56.52% 73.91%), but only in 3m and 12m the difference was statistically significant (P < 0.05). 3 There was on statistically significant different in ES treated group compared to untreated group, LS treated group compared to untreated group, ES treated group compared to LS treated group (P > 0.05). Both in group of ES and LS, The ratio of seizure recurred patients at different time points during follow-up period was highest at the time of 3m, 3 6m followed, within six months respectively as high as 91.67% and 76.59%. ConclusionOnly one early-onset seizure after stroke can be suspended long-term AEDs treatment, once it recurred that indicates the need for treatment. However, the recurrence rate of late-onset seizure was higher than that of early-onset seizure and it should be given long term AEDs treatment after the first seizure.
ObjectiveTo explore the association between glycosylated hemoglobin level and poor prognosis in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis.MethodsThe AIS patients treated with recombinant tissue-type plasminogen activator who were hospitalized in the Department of Neurology of the First Affiliated Hospital of Henan University of Science and Technology from September to December 2020 were retrospectively included. According to different levels of glycosylated hemoglobin, they were divided into pre-diabetic group (5.7%≤glycated hemoglobin≤6.4%), diabetic group (previously diabetic or glycosylated hemoglobin≥6.5%), and non-diabetic group (glycated hemoglobin <5.7%). The relevant information of the patients was collected, and a telephone follow-up was conducted 90 days after discharge. According to the modified Rankin Scale (mRS) score, the patients were divided into the good prognosis group (mRS score≤2) and the poor prognosis group (mRS score>2). Logistic regression analysis was used to determine the risk factors for the poor prognosis of intravenous thrombolysis in patients with AIS.ResultEventually 101 patients were included, including 44 in the non-diabetic group, 24 in the pre-diabetic group, and 33 in the diabetic group. And 64 patients were in the good prognosis group and 37 patients were in the poor prognosis group. Regression analysis results showed that diabetes was associated with poor prognosis 3 months after intravenous thrombolysis in patients with AIS [odds ratio=6.518, 95% confidence interval (1.568, 27.096), P=0.010]; and the higher the National Institutesof Health Stroke Scale score at admission was, the higher the risk of poor prognosis would be [odds ratio=1.421, 95% confidence interval (1.231, 1.640), P<0.001].ConclusionIn AIS patients who received intravenous thrombolysis, diabetes is associated with poor prognosis after 3 months.
ObjectivesTo systematically review the efficacy and safety of mechanical thrombectomy for patients with acute ischemic stroke in different ages.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) on the efficacy and safety of mechanical thrombectomy for patients with acute ischemic stroke in different ages from inception to August, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 13 studies involving 2 995 patients were included. The results of meta-analysis showed that compared with the control group, patients aged 80 and above had no statistically significant difference in reperfusion success rates (OR=0.90, 95%CI 0.71 to 1.14, P=0.378), and incidence of symptomatic intracranial hemorrhage (OR=1.30, 95%CI 0.86 to 1.94, P=0.212), however, with higher incidence of arbitrary intracranial bleeding events (OR=1.61, 95%CI 1.28 to 2.04, P<0.001), 3-month mortality (OR=2.14, 95%CI 1.73 to 2.64, P<0.001) and lower good functional prognosis rate at 3 months (OR=0.46, 95%CI 0.30 to 0.71, P<0.001).ConclusionsCurrent evidence suggests that people aged 80 and above can obtain effective perfusion through mechanical thrombectomy, however, the incidence of postoperative adverse outcome events is higher and the prognosis is relatively poor. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Objectives This study aims to examine the possible association between C-reactive protein (CRP) concentration and cognitive impairment in patients with post-stroke epilepsy. Methods Patients with post-stroke epilepsy admitted to Western China Hospital from January 2010 to June 2016 were consecutively enrolled in our study. CRP levels were assessed within one week of stroke onset, and then correlated with cognitive status assessed two years after stroke using the Six-Item Screener. Results Among the 96 patients with post-stroke epilepsy who included in our study, 24 patients were found to have cognitive impairment during the two years follow-up period. Our data showed a significant association between CRP levels and cognitive performance in these patients (31.5±36.2 vs. 11.9±19.4, P=0.029). In addition, this association persisted even after adjusting for potential confounders［OR=1.021, 95%CI (0.997, 1.206), P=0.037］. Conclusions Following ischemic stroke, higher CRP levels is associated with subsequent cognitive decline in patients with epilepsy. Association and prospective studies in larger sample size are needed in order to validate our findings, especially studies in which baseline CRP level and CRP level during follow-up are closely monitored.
Stroke is a disease that seriously affects the quality of life of patients. Its main characteristics are that the incidence rate is increasing year by year, the risk of death is high, and the prognosis of the disease is poor. For patients with acute cerebral artery occlusive ischemic stroke, intravenous thrombolysis alone has a low recanalization rate and poor long-term prognosis. With the development of interventional treatment technology for cerebrovascular disease, intravascular interventional treatment methods such as arterial thrombolysis, stent placement, and mechanical thrombectomy are more and more applied in the ultra-early stage of acute ischemic stroke. This article reviews the progress of mechanical thrombectomy in the treatment of cerebral artery occlusion in patients with acute ischemic stroke.
Ischemic stroke (IS) is one of the important diseases threatening human health. The occurrence and development of IS can trigger a series of complex pathophysiological changes, including damage to the blood-brain barrier, ion imbalance, oxidative stress, mitochondrial damage, which ultimately lead to the apoptosis and necrosis of nerve cells in the ischemic area. Impaired blood-brain barrier is a key factor for cerebral edema, hemorrhagic transformation and poor prognosis in patients with IS, and neuroinflammatory response plays an important role in the damage and repair of the blood-brain barrier. This article mainly focuses on the neuroinflammatory response mediated by glial cells, pro-inflammatory cytokines and matrix metalloproteinases and the related mechanisms of IS blood-brain barrier damage and repair, in order to provide new directions for the treatment of IS.