Severe ischemic stroke is characterized by severe neurological deficits, sometimes accompanied by cardiovascular and respiratory dysfunction, which could lead to severe disability and death. This article reviews the national and international trials of reperfusion treatment for severe ischemic stroke in recent 20 years, and summarizes relevant clinical guidelines and expert consensuses. In general, intravenous thrombolysis is not restricted for patients with severe neurological deficits, but should be cautiously considered for patients with large infarction. Patients with large vessel occlusion could benefit from endovascular treatment, and whilst prevention and treatment for brain edema are important for patients with very large infarction. For patients who have received reperfusion therapies, the target for the management of blood pressure should incorporate the status of recanalization and a stable level of blood pressure should be maintained.
Objective To investigate the clinical efficacy and safety of intravenous thrombolysis bridging endovascular thrombectomy (EVT) in patients with acute cardioembolic stroke. Methods We retrospectively included patients with cardioembolic stroke who were admitted within 24 h after onset of stroke symptoms and had received EVT in the Department of Neurology, West China Hospital of Sichuan University between January 2017 and December 2021. Based on whether they had received intravenous thrombolysis, the patients were divided into bridging therapy group and direct EVT group. The primary outcome was unfavorable outcome by 3 months, defined as a modified Rankin Scale (mRS) score of 3 to 6. The secondary outcomes included intracranial hemorrhage during hospitalization and 3-month death. Multivariable logistic regression was performed to assess the treatment effect on the primary outcome after adjusting for confounding factors. Results A total of 285 patients were enrolled. Among them, 174 (61.1%) were female, the median age was 74 years (interquartile range 64-80 years), and the median time from stroke onset to admission was 4.0 h (interquartile range 3.0-5.0 h). Compared to patients in the direct EVT group (n=202), patients in the bridging therapy group (n=83) had a lower rate of unfavorable functional outcome (55.4% vs 68.3%, P=0.039) by 3 months, while the incidences of intracranial hemorrhage (47.0% vs. 39.6%, P=0.251) and 3-month death (20.5% vs. 30.7%, P=0.080) were comparable between the two groups. After adjusting for confounding factors, the bridging therapy improved 3-month functional outcomes over direct EVT [odds ratio=0.482, 95% confidence interval (0.249, 0.934), P=0.031]. Conclusion In patients with acute cardioembolic stroke, intravenous thrombolysis bridging endovascular treatment can significantly improve 3-month functional outcomes without increasing the risk of intracranial hemorrhage.
Objective To explore the clinical and imaging features of patients with acute dizziness and assess their associations with 3-month prognosis. Methods We enrolled adult patients with a chief complaint of acute dizziness, who were admitted to the Neurological Clinic at the Emergency Department of West China Hospital, Sichuan University between January 1st and May 31st 2022. We collected clinical and imaging features at baseline for each patient. The primary outcome was recurrent dizziness within 3 months after index dizziness. Secondary outcome was stroke within 3 months after index dizziness. Results A total of 1 322 patients who visited the Neurological Clinic were included, of which 617 (46.7%) had a chief complaint of acute dizziness. Among 222 patients who performed emergent brain and neck CT angiography, 1 patient presented with intracerebral haemorrhage. Among the remaining 221 patients, 206 patients completed 3-month follow-up, with 76 patients reported recurrent dizziness and 7 patients had stroke (6 ischaemic, 1 hemorrhagic). The multivariate logistic regression showed that chronic dizziness duration and parenchymal hypodensity on brain CT were each associated with a higher risk of recurrent dizziness. Compared with those who did not report stroke, the stroke patients were more likely to present with hypertension, headache symptoms, and exhibit parenchymal hypodensity on baseline CT (P<0.05). Conclusions In patients with acute dizziness, those with chronic dizziness duration and parenchymal hypodensity on baseline CT were associated with a higher risk of 3-month recurrent dizziness. Acute dizziness patients experiencing 3-month stroke often have hypertension, headache symptoms, and parenchymal hypodensity on baseline CT.