Background Hemorrhagic transformation (HT) following reperfusion therapies for acute ischaemic stroke often predicts a poor prognosis. This systematic review and meta-analysis aims to identify risk factors for HT, and how these vary with hyperacute treatment [intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT)]. Methods Electronic databases PubMed and EMBASE were used to search relevant studies. Pooled odds ratio (OR) with 95% confidence interval (CI) were estimated. Results A total of 120 studies were included. Atrial fibrillation and NIHSS score were common predictors for any intracerebral hemorrhage (ICH) after reperfusion therapies (both IVT and EVT), while a hyperdense artery sign (OR = 2.605, 95% CI 1.212–5.599, I2 = 0.0%) and number of thrombectomy passes (OR = 1.151, 95% CI 1.041–1.272, I2 = 54.3%) were predictors of any ICH after IVT and EVT, respectively. Common predictors for symptomatic ICH (sICH) after reperfusion therapies were age and serum glucose level. Atrial fibrillation (OR = 3.867, 95% CI 1.970–7.591, I2 = 29.1%), NIHSS score (OR = 1.082, 95% CI 1.060–1.105, I2 = 54.5%) and onset-to-treatment time (OR = 1.003, 95% CI 1.001–1.005, I2 = 0.0%) were predictors of sICH after IVT. Alberta Stroke Program Early CT score (ASPECTS) (OR = 0.686, 95% CI 0.565–0.833, I2 =77.6%) and number of thrombectomy passes (OR = 1.374, 95% CI 1.012–1.866, I2 = 86.4%) were predictors of sICH after EVT. Conclusion Several predictors of ICH were identified, which varied by treatment type. Studies based on larger and multi-center data sets should be prioritized to confirm the results. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=268927, identifier: CRD42021268927.

/pdf/risk-factors-of-hemorrhagic-transformation-in-acute-14pj9asj.pdf

Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis

Abstract In the field of stroke thrombectomy, ineffective clinical and angiographic reperfusion after successful recanalization has drawn attention. Partial or complete microcirculatory reperfusion failure after the achievement of full patency of a former obstructed large vessel, known as the “no‐reflow phenomenon” or “microvascular obstruction,” was first reported in the 1960s and was later detected in both experimental models and patients with stroke. The no‐reflow phenomenon (NRP) was reported to result from intraluminal occlusions formed by blood components and extraluminal constriction exerted by the surrounding structures of the vessel wall. More recently, an emerging number of clinical studies have estimated the prevalence of the NRP in stroke patients following reperfusion therapy, ranging from 3.3% to 63% depending on its evaluation methods or study population. Studies also demonstrated its detrimental effects on infarction progress and neurological outcomes. In this review, we discuss the research advances, underlying pathogenesis, diagnostic techniques, and management approaches concerning the no‐reflow phenomenon in the stroke population to provide a comprehensive understanding of this phenomenon and offer references for future investigations.

No‐reflow after stroke reperfusion therapy: An emerging phenomenon to be explored

Background Acute ischemic stroke (AIS) caused by distal medium vessel occlusions (DMVOs) represents a significant proportion of overall stroke cases. While intravenous thrombolysis (IVT) has been a primary treatment, advancements in endovascular procedures have led to increased use of mechanical thrombectomy (MT) in DMVO stroke patients. However, symptomatic intracerebral hemorrhage (sICH) remains a critical complication of AIS, particularly after undergoing intervention. This study aims to identify factors associated with sICH in DMVO stroke patients undergoing MT. Methods This retrospective analysis utilized data from the Multicenter Analysis of Distal Medium Vessel Occlusions: Effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe. Middle cerebral artery (MCA) DMVO stroke patients were included. The primary outcome measured was sICH, as defined per the Heidelberg Bleeding Classification. Univariable and multivariable logistic regression were used to identify factors independently associated with sICH. Results Among 1708 DMVO stroke patients, 148 (8.7%) developed sICH. Factors associated with sICH in DMVO patients treated with MT included older age (adjusted odds ratio (aOR) 1.01, 95% confidence interval (95% CI) 1.00 to 1.03, P=0.048), distal occlusion site (M3, M4) compared with medium occlusions (M2) (aOR 1.71, 95% CI 1.07 to 2.74, P=0.026), prior use of antiplatelet drugs (aOR 2.06, 95% CI 1.41 to 2.99, P&lt;0.001), lower Alberta Stroke Program Early CT Scores (ASPECTS) (aOR 0.75, 95% CI 0.66 to 0.84, P&lt;0.001), higher preoperative blood glucose level (aOR 1.00, 95% CI 1.00 to 1.01, P=0.012), number of passes (aOR 1.27, 95% CI 1.15 to 1.39, P&lt;0.001), and successful recanalization (Thrombolysis In Cerebral Infarction (TICI) 2b-3) (aOR 0.43, 95% CI 0.28 to 0.66, P&lt;0.001). Conclusion This study provides novel insight into factors associated with sICH in patients undergoing MT for DMVO, emphasizing the importance of age, distal occlusion site, prior use of antiplatelet drugs, lower ASPECTS, higher preoperative blood glucose level, and procedural factors such as the number of passes and successful recanalization. Pending confirmation, consideration of these factors may improve personalized treatment strategies. 

Symptomatic intracerebral hemorrhage in proximal and distal medium middle cerebral artery occlusion patients treated with mechanical thrombectomy

The invention discloses a tubular cavity stent which comprises a bare stent section and a covered stent section connected with the bare stent section The bare stent section comprises at least two coaxial wave-shaped annuluses and rigid connecting parts and further comprises non-elastic flexible connecting parts capable of being optionally bent, wherein every two wave-shaped annuluses of at least two coaxial wave-shaped annuluses are connected through the corresponding rigid connecting part and the corresponding flexible connecting part, the rigid connecting parts and the flexible connecting parts are arranged in the circumferential direction in a mixed mode, and the length of each flexible connecting part is slightly greater than the shortest separation distance between every two wave-shaped annuluses The flexibility of the tubular cavity stent can be improved, and the axial connecting strength of the tubular cavity stent can be kept

Tubular cavity stent

Prevalence and Clinical Predictors of Intracranial Hemorrhage Following Carotid Artery Stenting for Symptomatic Severe Carotid Stenosis.

Background and purpose Hyperperfusion (HP) is a devastating complication associated with carotid artery stenting (CAS) or endarterectomy. The efficacy and safety of staged angioplasty (SAP) in patients with CAS at high risk of HP remains unclear. We sought to determine whether SAP is superior to regular CAS in patients with high risk of HP. Methods A randomised, multicentre open-label clinical trial with blinded outcome assessment (STEP) was conducted. Patients with severe carotid stenosis at high risk of HP were randomly assigned (1:1) to the SAP or regular CAS group. The primary endpoint was hyperperfusion syndrome (HPS) and intracerebral haemorrhage (ICH) within 30 days after the procedure. Results From November 2014 to January 2017, a total of 64 patients were enrolled in 11 centres. 33 patients were allocated to the SAP group and 31 to the regular CAS group. At 30 days, the rate of primary endpoint was 0.0% (0/33) in the SAP group and 9.7% (3/31) in the regular CAS group (absolute risk reduction (ARR), 9.7%; 95% CI −20.1% to 0.7%; p=0.11). As one of the secondary endpoints, the incidence of HP phenomenon (HPP) was lower in the SAP group than the regular CAS group (0.0% vs 22.6%, ARR,−22.6%; 95% CI −36.8% to −10.2%; p=0.04). Conclusion The rate of HPS and ICH was not significantly lower in SAP group; the extended secondary endpoint of HPP, however, significantly reduced, which suggested that SAP may be a safe and effective carotid revascularisation procedure to prevent HP. Trial registration number NCT02224209.

https://svn.bmj.com/content/svnbmj/6/1/95.full.pdf

Staged angioplasty versus regular carotid artery stenting in patients with carotid artery stenosis at high risk of hyperperfusion: a randomised clinical trial.

Background and purpose To investigate the safety and efficacy of oral antiplatelet therapy (APT) for patients who had acute ischaemic stroke (AIS), receiving endovascular therapy (EVT). Methods Patients were divided into non-APT group and APT (single APT or dual APT (DAPT)) group. The safety and efficacy endpoints at 3-month follow-up were symptomatic intracranial haemorrhage (sICH), recanalisation rate, clinical outcome and mortality. Results Among 915 patients who had AIS, those in APT group (n=199) showed shorter puncture-to-recanalisation time, lower frequency of intravenous thrombolysis and more use of tirofiban compared with those in non-antiplatelet group (n=716) (p Conclusions Oral APT prior to undergoing EVT is safe and may accompany with superior clinical outcomes. DAPT may associate with superior clinical outcomes and lower risk of mortality.

https://svn.bmj.com/content/svnbmj/6/2/230.full.pdf

Safety and efficacy of oral antiplatelet for patients who had acute ischaemic stroke undergoing endovascular therapy

The utility model discloses a vertebral artery support. The vertebral artery support comprises multiple groups of annular supporting units (10) arranged along the same central axis and connecting units (20) connected between every two adjacent groups of supporting units (10), wherein circumferential unfolding structures of the supporting units (10) are corrugated structures, every two adjacent groups of supporting units (10) are arranged in a mirror symmetry mode, a plurality of adjacent wave shape peak pairs are arranged between every two adjacent groups of supporting units (10), and each of connecting units (20) is connected between every two centered wave shape peaks of wave shape peaks. By means of the vertebral artery support, the re-stenosis rate of vertebral artery blood vessels can be reduced, and the stenosis treatment effect of the starting portion of the vertebral artery can be improved.

Vertebral artery support

The utility model discloses an intracranial arterial stent which comprises a bare stent The bare stent comprises a plurality of sets of circular supporting units (10) arranged along an identical central axis and connecting units (20) connected between two adjacent sets of supporting units (10), and the circumferential unfolding structures of the supporting units (10) are ripple structures The intracranial arterial stent can prevent vascular restenosis from occurring, and improves the therapeutic effect of intracranial arterial stenosis

Intracranial arterial stent

The utility model discloses an arteia subclavia support which comprises a bare support. The bare support comprises a plurality of groups of annular supporting units (10) arranged along the same central axis, and connecting units (20) connected between every two adjacent groups of supporting units (10). A circumferential spread structure of each supporting unit (10) is of a wave-shaped structure. Concave parts (12) of wave-shaped structures of every two adjacent groups of supporting units (10) correspond to each other. Various connecting units (20) are respectively connected between every two adjacent supporting units (10). The arteia subclavia support can reduce binary restenosis of subclavian vein blood vessels and improve treating effects on pathologically-changed arteria subclavia.

Arteria subclavia support

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