Miao Chai

Background: Whether adjunctive intra‐arterial thrombolysis improves outcomes in patients with acute ischemic stroke due to cardioembolism remains unclear. This study aimed to investigate the efficacy and safety of adjunctive intra‐arterial urokinase in patients with acute ischemic stroke due to cardioembolism who achieved near‐complete to complete reperfusion. Methods: This study was a secondary analysis of the POST‐UK (Adjunctive Intra‐Arterial Urokinase After Near‐Complete to Complete Reperfusion for Acute Ischemic Stroke) trial, which was conducted from November 15, 2022, to March 29, 2024. Patients were randomly assigned to the intra‐arterial urokinase group or the control group. The primary outcome was disability‐free survival at 90 days, defined as a modified Rankin Scale score of 0 to 1. Safety outcomes included 90‐day all‐cause death, symptomatic intracranial hemorrhage and any intracranial hemorrhage within 48 hours. Results: Among 209 patients with cardioembolism (median age 73 [interquartile range, 63–81] years; 45.9% men), 106 were assigned to the control group and 103 to the intra‐arterial urokinase group. Compared with the control group, adjunctive intra‐arterial urokinase significantly increased the odds of disability‐free survival at 90 days (adjusted risk ratio, 1.49 [95% CI, 1.08–2.06]; P =0.01; inverse probability of treatment weighting adjusted risk ratio, 1.47 [95% CI, 1.04–2.09]; P =0.03). No significant differences were found between groups in 90‐day mortality rate, symptomatic intracranial hemorrhage, or any intracranial hemorrhage within 48 hours. Conclusions: In patients with acute ischemic stroke due to cardioembolism who achieved near‐complete to complete reperfusion, adjunctive intra‐arterial urokinase significantly improved disability‐free survival at 90 days without increasing the risk of death or intracranial hemorrhage. Registration: URL: ChiCTR.org.cn; Unique identifier: ChiCTR2200065617.

Background: This study aimed to investigate the association between admission blood urea nitrogen (BUN) and clinical outcomes in patients with large ischemic stroke undergoing endovascular treatment (EVT). Methods: This study was a subgroup analysis of a prospective, multicenter cohort study. 472 patients with large ischemic stroke undergoing EVT from the original database were included. Patients were stratified into three groups based on admission BUN levels. The primary effectiveness outcome was modified Rankin Scale (mRS) score 0–3 at 90 days. Safety outcomes included 90-day mortality and symptomatic intracranial hemorrhage (sICH) within 48 h. Results: A total of 472 patients were included and stratified into three groups: Tertile 1 group (≤5.00 mmol/L), Tertile 2 group (5.01–6.80 mmol/L), and Tertile 3 group (>6.80 mmol/L). Compared with patients in BUN Tertile 1 group, patients in BUN Tertile 3 had significantly lower odds of achieving a favorable outcome (adjusted odds ratio [aOR] 0.54, 95% CI 0.31–0.95, p = 0.032 in Adjusted Model 1), while BUN Tertile 2 group showed no statistical significance. There were no significant differences in mortality and sICH among three groups. Subgroup analysis presented a significant interaction between BUN and age for the primary effectiveness outcome ( P for interaction = 0.036). Conclusion: In patients with large ischemic stroke undergoing EVT, an elevated admission BUN (>6.80 mmol/L) was associated with a lower likelihood of favorable functional outcome at 90 days.

Background: The effectiveness and safety of endovascular treatment ( EVT ) compared with standard medical treatment ( SMT ) for acute basilar artery occlusion in patients with National Institutes of Health Stroke Scale ( NIHSS ) scores ≤10 remain unclear. This study aimed to investigate the effectiveness and safety of EVT versus SMT in patients with acute basilar artery occlusion with NIHSS scores ≤10. Methods: Patients with acute basilar artery occlusion and NIHSS scores ≤10 included in this study were derived from a nationwide prospective registry in China. Patients were divided into the EVT and SMT groups. The primary outcome was the distribution of modified Rankin Scale score at 90 days. Safety outcomes included death at 90 days and symptomatic intracerebral hemorrhage within 48 hours. Results: Among 106 patients, 78 (73.6%) received EVT. The median age was 64 (interquartile range, 59–71) years, and 23 (21.7%) were women. Compared with SMT, EVT was associated with a favorable shift in the distribution of modified Rankin Scale score at 90 days (adjusted odds ratio, 6.22 [95% CI, 2.31–16.73]) and lower 90‐day death (adjusted odds ratio, 0.23 [95% CI, 0.06–0.88]). There was no significant difference in the incidence of symptomatic intracerebral hemorrhage within 48 hours between the 2 groups. At 1‐year follow‐up, functional outcomes continued to favor EVT over SMT. In both groups, as the baseline NIHSS score increased, the probability of achieving favorable outcomes progressively decreased, while the probability of death increased. Conclusions: In patients with acute basilar artery occlusion and NIHSS scores of ≤10, EVT was associated with better functional outcomes and lower mortality rate.

Objective Some patients with large core infarctions who underwent endovascular treatment (EVT) still achieved favorable long-term outcomes despite the absence of neurological improvement in the acute phase. The underlying reasons for this phenomenon remain unclear. This study aimed to investigate the incidence and predictors of delayed neurological improvement (DNI) in this patient population. Methods Patients with large core infarctions who received EVT were derived from a prospective, observational, nationwide multicenter registry. Acute phase neurological improvement (APNI) was defined as a decrease of ≥4 points in the National Institutes of Health Stroke Scale (NIHSS) score between admission and day 5–7. DNI was defined as achieving 90-day favorable outcomes in the absence of APNI. Multivariate logistic regression was used to analyze independent predictors of DNI. Results Among 490 patients with large core infarctions who underwent EVT, 277 (56.5%) did not experience APNI. Of these, 39 (14.1%) patients achieved favorable long-term clinical outcomes and constituted the DNI group. Younger age, male sex, lower baseline NIHSS score, good collateral circulation, and shorter puncture to reperfusion time were independent predictors of DNI. Conclusion DNI occurred in 14.1% of patients with large core infarctions undergoing EVT. Optimizing modifiable factors, such as reducing puncture to reperfusion time and improving collateral circulation, is crucial for enhancing patient outcomes. These findings have important implications for refining clinical management strategies and improving prognosis in this patient population.