Predicting Outcomes After Acute Reperfusion Therapy for Basilar Artery Occlusion.
- 作者列表："Jadhav AP","Desai SM","Panczykowski DM","Rangaraju S","Campbell D","Ritvonen JK","Schreiner M","Silvennoinen H","Gerber J","Puetz V","Raza SA","Haussen DC","Nogueira RG","Strbian D","Jovin TG","Lindsberg PJ
BACKGROUND:Basilar artery occlusion (BAO) leads to high rates of morbidity and mortality, despite successful recanalization. The discordance between flow restoration and long-term functional status clouds clinical decision making regarding further aggressive care. We sought to develop and validate a practical, prognostic tool for the prediction of 3-month favorable outcome after acute reperfusion therapy for BAO. METHODS:This retrospective, multicenter, observational study was conducted at four high-volume stroke centers in the U.S. and Europe. Multivariate regression analysis was performed to identify predictors of favorable outcome (90-day mRS scores 0-2) and derive a clinically applicable prognostic model (the Pittsburgh Outcomes after Stroke Thrombectomy-VertebroBasilar (POST-VB) score). The POST-VB score was evaluated and internally validated apropos of calibration and discriminatory ability. External validity was assessed in patient cohorts at 3 separate centers. RESULTS:In the derivation cohort of 59 patients, independent predictors of favorable outcome included smaller brainstem infarct volume on post-procedure MRI (p<0.01) and younger age (p=0.01). The POST-VB score was calculated as: age + (10 × brainstem infarct volume). The POST-VB score demonstrated excellent discriminatory ability (AUC=0.91) and adequate calibration (p=0.88) in the derivation cohort (center A). POST-VB performed equally well across the 3 external validation cohorts (center B, AUC=0.89; center C, AUC=0.78; center D, AUC=0.80). Overall, a POST-VB score <49 was associated with an 88% likelihood of favorable outcome, as compared to 4% with a score ≥125. CONCLUSIONS:The POST-VB score effectively predicts 3-month functional outcome following acute reperfusion therapy for BAO and may aid in guiding post-procedural care.
背景: 基底动脉闭塞 (BAO) 导致高发病率和死亡率，尽管成功再通。血流恢复和长期功能状态之间的不一致影响了关于进一步积极护理的临床决策。我们试图开发并验证一种实用的预测 BAO 急性再灌注治疗后 3 个月有利结局的预后工具。 方法: 这项回顾性、多中心、观察性研究在美国和欧洲的四个高容量卒中中心进行。进行多变量回归分析以确定有利结局的预测因子 (90 天 mRS 评分 0-2) 并推导出临床适用的预后模型 (卒中血栓切除术后匹兹堡结局-椎基底动脉 (后 VB) 评分)。评价 VB 后评分，并内部验证校准和辨别能力。在 3 个独立中心的患者队列中评估外部效度。 结果: 在 59 例患者的推导队列中，预后良好的独立预测因素包括术后 MRI 显示的脑干梗死体积较小 (p<0.01) 和年龄较小 (p = 0.01)。VB 后评分计算为: 年龄 + (10 × 脑干梗死体积)。在推导队列 (中心 A) 中，VB 后评分表现出极好的区分能力 (AUC = 0.91) 和充分的校准 (p = 0.88)。后 VB 在 3 个外部验证队列中表现同样良好 (中心 B，AUC = 0.89; 中心 C，AUC = 0.78; 中心 D，AUC = 0.80)。总体而言，VB 后评分 <49 与 88% 的良好结局可能性相关，而评分 ≥ 4% 的为 125。 结论: 后 VB 评分有效预测 BAO 急性再灌注治疗后 3 个月的功能结局，可能有助于指导术后护理。
METHODS:BACKGROUND:People with stroke are not meeting recommended levels of physical activity. The modifiable factors associated with post-stroke physical activity levels need to be identified to develop targeted interventions. OBJECTIVE:The objective of this study was to investigate the factors at discharge from inpatient rehabilitation that are associated with physical activity levels at 3 months following discharge. DESIGN:This was a prospective cohort study. METHODS:Sixty-four people with stroke completed baseline assessments at discharge from inpatient rehabilitation and 55 completed the follow-up 3 months later. The candidate factors (i.e. gait speed, balance, strength, cognition, mood and motivation) were measured at discharge. The primary outcome measure at follow-up was walking related activity (measured by wrist-worn accelerometer). Secondary outcome measures were physical activity participation (Activity Card Sort) and intensity of physical activity (International Physical Activity Questionnaire - Short 7 days). Adjusted separate multivariable linear regression models or proportional odds regression models were used to evaluate the associations between candidate factors and physical activity. RESULTS:Gait speed and balance were associated with all aspects of physical activity. Higher level of intrinsic motivation was also associated with higher physical activity participation. Anxiety demonstrated a significant non-linear relationship with physical activity participation. LIMITATIONS:Inclusion of fatigue and individual muscle strength could have provided further insights into associations with steps per day. CONCLUSION:The results demonstrated that better physical function at discharge from inpatient rehabilitation was associated with future increased levels of physical activity. Additionally, higher levels of motivation impacted on increased physical activity participation. The influence of anxiety on physical activity participation requires further exploration. Mixed-method study designs can be utilized to further understand the factors associated with post-stroke physical activity.
METHODS:Cerebral ischemia-reperfusion (I/R) is characterized by initial transient cerebral ischemia followed by reperfusion. Various pathophysiological processes are involved in brain injury and functional recovery during cerebral I/R. There are few studies on dynamic metabolic process after cerebral I/R. The present study was to observe dynamic alteration of brain injury, functional recovery, and metabolites after cerebral I/R in rats and discover potential metabolic markers. The cerebral I/R model was established by middle cerebral artery occlusion (MCAO) for 90 min, following reperfusion in rats. The results of cerebral infarction area, cerebral edema, and behavior test showed that there were dynamic changes in brain injury and functional recovery at different periods after cerebral I/R. Further analysis showed that the brain injury was severe on the first day of cerebral I/R, and there was a significant functional recovery from the 7th day of cerebral I/R, followed by an aggravation trend of brain injury from the days 7 to 28. Furthermore, Matrix-assisted laser desorption ionization mass spectrometry imaging analysis showed that the expression of ATP, glucose, and citric acid on 7th day was the highest during cerebral I/R, which indicated that energy metabolism and oxidative phosphorylation played important roles during cerebral I/R. In addition, the untargeted metabolomic results showed that the level of isocitric acid, the ratio of oxyglutaric acid/glutamic acid, and the level of pyruvic acid associated with the TCA cycle were also the highest on the 7th day during cerebral I/R, which indicated that the transient spontaneous recovery of ischemic brain on the 7th day after ischemia-reperfusion might be related to oxidative phosphorylation and energy metabolism in the brain in this period. In conclusion, the results suggest that some small molecule metabolites participate in the brain injury and functional recovery during cerebral I/R, which is of great significance to the development of therapeutic drugs and diagnostic markers.
METHODS:The aims of this study were to study the effects of miR-2 on cerebral ischemia–reperfusion rats and to explore its further mechanism. Rats were assigned into sham, model, miR-22 control and miR-22 groups. Observation of neurological behaviors at 24 h after operation found that neurological functions were severely damaged in the model and miR-22 control groups and these damages were improved by miR-22. RT-PCR indicated that miR-22 mRNA level in the brain tissue was significantly decreased in the model and miR-22 control groups, but increased in the miR-22 group. TTC staining showed increased percentage of cerebral infarction volume in the model and miR-22 control groups and this increase was reduced by miR-22. Immunohistochemistry showed increased densities of CD34^+ and VEGF^+ microvessels in the cortex in the model and miR-22 control groups, which were further increased in the miR-22 group. ELISA showed increased serum VEGF and Ang-1 levels in the model and miR-22 control groups, which were also further increased in the miR-22 group. Western blot analysis showed increased phosphorylation level of PI3K and Akt in brain tissue in the model and miR-22 control groups, which were further increased in the miR-22 group. Administration of LY294002, a specific PI3K pathway inhibitor, significantly reversed all the effects of miR-22 on rats in the model group. miR-22 exerts its neuroprotective and angiogenic functions via the PI3K/Akt signaling pathway, at least partly, in rats under cerebral ischemia–reperfusion.