Xuxing Liao

Ischemic stroke and myocardial infarction (MI) are among the leading causes of morbidity and mortality globally. Recent research has increasingly highlighted the significant interrelation between these two vascular events, emphasizing shared pathophysiological mechanisms, overlapping risk factors, and complex clinical outcomes. This review explores the multifaceted relationship between ischemic stroke and MI, focusing on their common underlying mechanisms, including atherosclerosis, thromboembolism, inflammation, and endothelial dysfunction. Both conditions often co-occur due to their shared risk factors, such as hypertension, diabetes, and smoking, leading to compounded health risks for affected individuals. This review aims to synthesize current evidence on the epidemiological, pathophysiological, and clinical interrelationships between ischemic stroke and myocardial infarction, highlighting practical clinical implications and areas for future research. Although ischemic stroke and myocardial infarction primarily affect distinct organ systems, atypical presentations and shared systemic effects can occasionally complicate diagnosis. Cardiac complications are common in acute ischemic stroke, while stroke-like symptoms may arise in patients with acute MI, especially when silent infarctions occur. This diagnostic challenge underscores the need for advanced neuroimaging and cardiac imaging modalities, alongside biomarkers like D-dimer, BNP, and troponins, to enhance early detection and guide therapeutic decisions. Therapeutic strategies for patients with both conditions must be comprehensive, combining acute management with long-term secondary prevention. While antiplatelet therapy, thrombolysis, and anticoagulation are essential in the acute phase, long-term management involves a focus on controlling cardiovascular risk factors, such as blood pressure and cholesterol, and promoting lifestyle modifications. The role of interdisciplinary care—particularly collaboration between cardiology and neurology—is essential for improving outcomes and minimizing complications. The intersection of ischemic stroke and MI presents significant clinical challenges but also opportunities for enhanced patient management. Integrated diagnostic approaches, personalized treatments, and further research into molecular mechanisms are vital for improving the prognosis of individuals affected by both conditions.

The relationship between muscle strength improvement and ischemic stroke outcome following endovascular therapy (EVT) for emergency treatment of patients has not been well studied. We developed the prognostic value of the change in muscle strength scores on the Medical Research Council (MRC) scale within 24 hours of EVT as a predictor of EVT outcomes. We retrospectively analyzed prospectively collected data from 142 consecutive patients with ischemic stroke who underwent EVT between August 2018 and February 2022 at a comprehensive stroke center. Early muscle strength improvement (EMSI) was defined as 3 levels of muscle strength improvement on the MRC scale or improvement to grade 4 or 5 of lower-limb muscle strength (LLMS) 24 ± 8 h after EVT. A favorable outcome was defined as a 3-months outcome of the modified Rankin scale (mRS) 0% to 2. 84.2% of EMSI patients had a favorable outcome, in comparison to only 21.2% of non-EMSI patients (P < .001). Similarly, 47.1% of patients died at 3-months in the non-EMSI group, while a significantly lower mortality (8.8%) was observed in the EMSI group (P < .001). LLMS 24 hours post-EVT was significantly associated with 90-day outcomes (P < .001). Early muscle strength improvement in the emergency setting may be a useful predictor of a desired functional outcome in patients with large-vessel occlusion stroke following EVT.

Background: Bempedoic acid (BA), an oral synthetic dicarboxylic acid derivative, has been widely used to treat patients with hyperlipidemia who are intolerant to statins. Both clinical and preclinical studies have reported the protective effects of BA against hyperlipidemia. However, the mechanisms of BA for hyperlipidemia treatment remain largely obscured. This study aimed to evaluate the effects of BA on hyperlipidemia and investigate the mechanism underlying its correlation with gut microbiota and serum metabolite regulation.Methods: Four-week-old male C57BL/6J mice were fed a high-fat diet (HFD) and treated with BA daily for 20 weeks. Biochemical changes of serum were assessed, covering lipid metabolism, inflammation, and endothelial function. Moreover, 16S rRNA sequencing of gut microbiota as well as untargeted metabolomics analysis of serum were performed.Results: The results showed that BA exerted potent efficacy against hyperlipidemia by attenuating serum lipid profiles, inhibiting vascular inflammation, and improving endothelial function. 16S rRNA sequencing revealed that BA improved the disorder of gut microbiota biodiversity. Specifically, BA significantly enriched the abundance of Akkermansia, Bacteroides, Roseburia, Faecalibacterium and Uncultured_bacterium_f_Muribaculaceae, which were closely associated with BA’s therapeutic effects. Serum metabolomics analysis indicated that BA recovered the disturbances of serum metabolic phenotypes. A total of 20 differential metabolites were significantly regulated by BA treatment, suggesting that BA might exert effects by ameliorating relevant metabolic pathways, including bile acid biosynthesis, glycerophospholipid metabolism, β-oxidation of fatty acids and sphingolipid metabolism.Conclusion: Taken together, the present study demonstrated that BA could inhibit the development of hyperlipidemia, and its protective effects may be related to alterations in gut microbiota composition and changes in serum metabolite abundances.

Background and purpose: Stroke is a leading cause of morbidity and mortality worldwide. Endovascular therapy (EVT) has been established as a gold standard option to treat acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) presenting within 6 h of symptom onset. However, there is a paucity of information regarding patient outcome and mortality in patients presenting in late time window within 6 to 24 h. In this study, we aimed to assess for predictors of outcomes in late window stroke patients following EVT.Methods: We analyzed data from 202 patients treated with EVT from four comprehensive stroke centers. All patients were above 18 years of age and had symptoms onset of 6–24 h. mRS of 0–2 after three months was defined as favorable outcome.Results: Patients with favorable outcome had lower median age (p = 0.003), lower pre-EVT National Institute of Health Stroke Scale (NIHSS) score (p = 0.000), lower diabetes mellitus (p = 0.041), stroke history (p = 0.041), parenchymal hematoma (PH) (p = 0.000) and fewer attempts to achieve successful recanalization (p = 0.001). Multivariate regression analysis found age (p = 0.007), diabetes mellitus (p = 0.022), successful recanalization (mTICI≥2b) (p = 0.006), NIHSS at onset (p = 0.000), and PH1 + PH2 Heidelberg bleeding classification (p = 0.009) as predictors of functional outcome.Conclusion: Age, diabetes mellitus history, baseline NIHSS score, successful recanalization, and PH are predictors of 90-day functional outcome of late-window ischemic stroke patients undergoing EVT.

Naoxintong Capsule (NXT), a renowned traditional Chinese medicine (TCM) formulation, has been broadly applied in China for more than 30 years. Over decades, accumulating evidences have proven satisfactory efficacy and safety of NXT in treating cardiovascular and cerebrovascular diseases (CCVD). Studies have been conducted unceasingly, while this growing latest knowledge of NXT has not yet been interpreted properly and summarized comprehensively. Hence, we systematically review the advancements in NXT research, from its chemical constituents, quality control, pharmacokinetics, to its profound pharmacological activities as well as its clinical applications in CCVD. Moreover, we further propose specific challenges for its future perspectives: 1) to precisely clarify bioactivities of single compound in complicated mixtures; 2) to evaluate the pharmacokinetic behaviors of NXT feature components in clinical studies, especially drug-drug interactions in CCVD patients; 3) to explore and validate its multi-target mechanisms by integrating multi-omics technologies; 4) to re-evaluate the safety and efficacy of NXT by carrying out large-scale, multicenter randomized controlled trials. In brief, this review aims to straighten out a paradigm for TCM modernization, which help to contribute NXT as a piece of Chinese Wisdom into the advanced intervention strategy for CCVD therapy.

Introduction: Endovascular thrombectomy (EVT) is the standard of care for patients with large-vessel occlusion acute ischemic stroke (AIS). There may be differing recanalization effectiveness based on patients’ sex, and understanding such variations can improve patient outcomes by adjusting for differences. We aimed to assess the sex differences in outcome after EVT for patients with AIS. Methods: We retrospectively analyzed 250 consecutive AIS patients who underwent EVT from July 2019 to February 2022 across two large comprehensive tertiary care stroke centers in China. Outcomes of male patients were compared to females, where poor outcome was defined as a modified Rankin score (mRS) of 3–6 at 90 days. Results: Male patients had higher rates of symptomatic intracranial hemorrhage (sICH) (12.50% vs. 4.05%, p = 0.042) and higher hospitalization costs (114,541.08 vs. 105,790.27 RMB, p = 0.024). Male patients also had a longer median onset-to-needle time (ONT) (146.00 [104.00, 202.00] versus 120.00 [99.25, 144.75], p = 0.026). However, there were no differences in hospitalization length (p = 0.251), 90-day favorable outcome (p = 0.952), and 90-day mortality (p = 0.931) between the sexes. Conclusion: Female patients had lower hospitalization costs and sICH rates than males after EVT for AIS. Identifying such differences and implementing measures, including adaptations to workflow optimization, would help to reduce the ONT and last known normal-to-puncture time seen in males to improve patient outcomes. Despite such variations, favorable outcomes and mortality are similar in female and male AIS patients.

Objective: Atrial fibrillation is one of the major risk factors of ischemic stroke. Endovascular thrombectomy (EVT) has become the standard treatment for acute ischemic stroke with large vessel occlusion. However, data regarding the impact of AF on the outcome of patients with acute ischemic stroke treated with mechanical thrombectomy are controversial. The aim of our study was to determine whether atrial fibrillation modifies the functional outcome of patients with anterior circulation acute ischemic stroke receiving EVT.Methods: We reviewed 273 eligible patients receiving EVT from January 2019 to January 2022 from 3 comprehensive Chinese stroke centers, of whom 221 patients were recruited. Demographics, clinical, radiological and treatment characteristics, safety outcomes, and functional outcomes were collected. Modified Rankin scale (mRS) score ≤ 2 at 90 days was defined as a good functional outcome.Results: In our cohort, 79 patients (35.74%) were eventually found to have AF. Patients with AF were elder (70.08 ± 11.72 vs. 61.82 ± 13.48 years, p = 0.000) and less likely to be males (54.43 vs. 73.94%, p = 0.03). The significant reperfusion rate (modified thrombolysis in cerebral infarction 2b-3) was 73.42 and 83.80% in patients with and without AF, respectively (p = 0.064). The good functional outcome (90-day modified Rankin scale: 0 to 2) rate was 39.24 and 44.37% in patients with and without AF, respectively (p = 0.460) after adjusting multiple confounding factors. There was no difference in the presence of symptomatic intracerebral hemorrhage between the two groups (10.13 vs. 12.68%, p = 0.573).Conclusion: Despite their older age, AF patients achieved similar outcomes as non-AF patients with anterior circulation occlusion treated with endovascular therapy.

Background and objective: The hyperdense middle cerebral artery sign (HMCAS) is observed in a proportion of patients with acute ischemic stroke (AIS). This sign reflects the presence of an intravascular thrombus rich in red blood cells. Several studies have demonstrated that HMCAS increases the risk of poor outcomes in AIS patients treated with IV thrombolysis or no reperfusion therapy; however, whether HMCAS predicts a poor outcome in patients treated with endovascular thrombectomy (EVT) is less clear. We aimed to evaluate the functional outcome by the modified Rankin scale (mRS) at 90 days and technical challenges in patients with HMCAS undergoing EVT.Methods: We studied 143 consecutive AIS patients with middle cerebral artery M1 segment or internal carotid artery + M1 occlusions who underwent EVT.Results: There were 73 patients (51%) with HMCAS. Patients with HMCAS had a higher frequency of cardioembolic stroke (p = 0.038); otherwise, no other baseline difference was observed. No differences in functional outcomes (mRS) at 90 days (p = 0.698), unfavorable outcomes (mRS > 2) (p = 0.929), frequency of symptomatic intracranial hemorrhage (p = 0.924), and mortality (mRS-6) (p = 0.736) were observed between patients with and without HMCAS. In patients with HMCAS, EVT procedures were 9 min longer, requiring a higher number of passes (p = 0.073); however, optimal recanalization scores (modified thrombolysis in cerebral infarction: 2b-3) were equally achieved by both groups.Conclusion: Patients with HMCAS treated with EVT do not have a worse outcome at 3 months compared with no-HMCAS patients. Patients with HMCAS required a greater number of thrombus passes and longer procedure times.

Background: Stroke is one of the leading causes of mortality across the world. However, there is a paucity of information regarding mortality rates and associated risk factors in patients with acute ischemic stroke (AIS) undergoing endovascular thrombectomy (EVT). In this study, we aimed to clarify these issues and analyzed previous publications related to mortality in patients treated with EVT.Methods: We analyzed the survival of 245 consecutive patients treated with mechanical thrombectomy for AIS for which mortality information was obtained. Early mortality was defined as death occurring during hospitalization after EVT or within 7 days following hospital discharge from the stroke event.Results: Early mortality occurred in 22.8% of cases in this cohort. Recanalization status (modified thrombolysis in cerebral infarction, mTICI) (p = 0.002), National Institute of Health Stroke Scale Score (NIHSS) score 24-h after EVT (p < 0.001) and symptomatic intracerebral hemorrhage (sICH) (p < 0.001) were independently associated with early mortality. Age, sex, cardiovascular risk factors, NIHSS score pre-treatment, Alberta Stroke Program Early CT Score (ASPECTS), stroke subtype, site of arterial occlusion and timing form onset to recanalization did not have an independent influence on survival. Non-survivors had a shorter hospitalization (p < 0.001) but higher costs related to their hospitalization and outpatient care.Conclusion: The recanalization status, NIHSS score 24-h after EVT and sICH were predictors of early mortality in AIS patients treated with EVT.