Latest News on Ischemic Stroke Research: Jan – 2020

Tissue Plasminogen Activator for Acute Ischemic Stroke

BACKGROUND: therapy for acute ischaemic stroke has been approached cautiously because there have been high rates of intracerebral hemorrhage in early clinical trials. We performed a randomized, double-blind trial of intravenous recombinant tissue urokinase (t-PA) for ischaemic stroke after recent pilot studies suggested that t-PA was beneficial when treatment was begun within three hours of the onset of stroke.

METHODS: The trial had two parts. Part 1 (in which 291 patients were enrolled) tested whether t-PA had clinical activity, as indicated by an improvement of 4 points over base-line values within the score of the National Institutes of Health stroke scale (NIHSS) or the resolution of the neurologic deficit within 24 hours of the onset of stroke. Part 2 (in which 333 patients were enrolled) used a worldwide test statistic to assess clinical outcome at three months, consistent with scores on the Barthel index, modified Rankin scale, Glasgow outcome scale, and NIHSS. [1]

Morning increase in onset of ischemic stroke.

The time of onset of ischaemic stroke decided for 1,167 of 1,273 patients during the gathering of knowledge by four academic hospital centers between June 30, 1983, and June 30, 1986. More strokes occurred in awake patients from 10:00 AM to noon than during the other 2-hour interval. The incidence of stroke onset declined steadily during the rest of the day and early evening. The onset of stroke is least likely to occur within the late evening, before midnight. [2]

Endovascular Treatment for Acute Ischemic Stroke

BACKGROUND: In patients with ischaemic stroke , endovascular treatment leads to a better rate of recanalization of the affected arteria cerebri than systemic intravenous therapy . However, comparison of the clinical efficacy of the 2 approaches is required .

METHODS: We randomly assigned 362 patients with acute ischaemic stroke , within 4.5 hours after onset, to endovascular therapy (intraarterial thrombolysis with recombinant tissue urokinase [t-PA], mechanical clot disruption or retrieval, or a mixture of those approaches) or intravenous t-PA. Treatments were to tend as soon as possible after randomization. the first outcome was survival freed from disability (defined as a modified Rankin score of 0 or 1 on a scale of 0 to six , with 0 indicating no symptoms, 1 no clinically significant disability despite symptoms, and 6 death) at 3 months. [3]

Oligodendrocyte precursor cells transplantation protects blood–brain barrier in a mouse model of brain ischemia via Wnt/β-catenin signaling

Blood–brain barrier damage may be a critical pathological feature of ischaemic stroke . Oligodendrocyte precursor cells are involved in maintaining blood–brain barrier integrity during the event . However, whether oligodendrocyte precursor cell could sustain blood–brain barrier permeability during ischemic brain injury is unknown. Here, we investigate whether oligodendrocyte precursor cell transplantation protects blood–brain barrier integrity and promotes ischaemic stroke recovery. man ICR mice (n = 68) underwent 90 min transient middle arteria cerebri occlusion. After ischemic assault, these mice received stereotactic injection of oligodendrocyte precursor cells (6 × 105). [4]

Headache Attributed to Acute Ischemic Stroke in Chinese Patients: A Single Center Study

Aims: during this pilot study we aimed to research prevalence, characteristics and possible mechanisms of headache in acute ischaemic stroke from a Chinese tertiary hospital.

Methodology: Five hundred and fifteen patients with acute ischaemic stroke from Chinese PLA General Hospital were retrospectively investigated. Headache prevalence, features and correlations with several clinical parameters (age, sex, vascular risk factors, atherosclerosis, artery stenosis, infarct locations, presumed etiology consistent with TOAST criteria) were analyzed. [5]

Reference

[1] National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group, 1995. Tissue plasminogen activator for acute ischemic stroke. New England Journal of Medicine, 333(24). (Web Link)

[2] Marler, J.R., Price, T.R., Clark, G.L., Muller, J.E., Robertson, T., Mohr, J.P., Hier, D.B., Wolf, P.A., Caplan, L.R. and Foulkes, M.A., 1989. Morning increase in onset of ischemic stroke. Stroke, 20(4), (Web Link)

[3] Ciccone, A., Valvassori, L., Nichelatti, M., Sgoifo, A., Ponzio, M., Sterzi, R. and Boccardi, E., 2013. Endovascular treatment for acute ischemic stroke. New England Journal of Medicine, 368(10), (Web Link)

[4] Oligodendrocyte precursor cells transplantation protects blood–brain barrier in a mouse model of brain ischemia via Wnt/β-catenin signaling
Liping Wang, Jieli Geng, Meijie Qu, Fang Yuan, Yuyang Wang, Jiaji Pan, Yongfang Li, Yuanyuan Ma, Panting Zhou, Zhijun Zhang & Guo-Yuan Yang
Cell Death & Disease volume 11, (Web Link)

[5] Chen, X., Su, H., Zhang, M., Chen, Z. and Yu, S. (2017) “Headache Attributed to Acute Ischemic Stroke in Chinese Patients: A Single Center Study”, Journal of Advances in Medicine and Medical Research, 24(6), (Web Link)

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