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Introduction: Elevated circulatory concentrations of YKL-40 have been reported in patients with ischemic stroke. This study further investigated the association of plasma YKL-40 concentrations at admission and short, long-term prognosis after ischemic stroke. Methods: Based on a prospective, nationwide multicenter registry focusing consecutive patients of ischemic stroke and transient ischemic attack, plasma YKL-40 levels were detected by enzyme-linked immunosorbent assay at admission, and patients were stratified into percentile according to the plasma YKL-40 concentrations. The multivariate Cox or logistic regression model was used to investigate the association of YKL-40 concentration with death and functional outcomes at 3 months, 6 months, and 12 months after ischemic stroke, with potential confounders adjusted. Results: A total of 8,006 first-ever ischemic stroke patients, with the age of 61.7 ± 11.5, were included in this study. The mortality of 0–33%, 34–66%, 67–90%, and 91–100% groups at 12 months follow-up was 0.9%, 2.2%, 4.4%, and 9.4%, respectively (p < 0.0001), and the modified Rankin Scale 3–6 ratio was 6.8%, 10.5%, 15.7%, and 24.0%, respectively (p < 0.0001). In the multivariate regression, after adjusting for potential confounders, 91–100% group had higher risk of death (hazard ratio 2.99, 95% confidence interval 1.75–5.11)and modified Rankin Scale 3–6 (odds ratio 1.42, 95% confidence interval 1.08–1.88) at 12 months since onset of ischemic stroke compared to the 0–33% group. Conclusions: The elevated YKL-40 at admission can potentially help predict death, functional prognosis after ischemic stroke, which may help further studies to explore the potential physiological and pathological mechanism including the effects of vulnerable plaque and collateral circulation.

Introduction: ICAS confers the greatest risk of stroke, but the pathophysiology of stroke mechanismremains unclear. Essentially, plaque rupture is a physical process of structural failuredue to destructive biomechanics, and hypoperfusion is due to low perfusion pressure,which act as 2 major stroke mechanisms in sICAS. Notably, blood pressure (BP)plays key role in determining both biomechanics and perfusion of ICAS. Hypothesis: ICAS could result in significant BP change which may further influence strokemechanism. High local pressure gradient across ICAS may cause plaque rupture andthe subsequent artery-to-artery embolism, whereas low perfusion pressure atpost-stenosis area may restrict perfusion and induce the subsequent borderzoneinfarcts (Fig) . Method: A total of 339 sICAS patients due to 50-99% stenosis in MCA or ICA were includedfrom CNSR3. By Newton-Krylov-Schwarz method, CFD models were built based onTOF-MRA (Fig) . Translesional pressure ratio (PR) across ICAS was calculated as:pressurepoststenotic/pressureprestenotic. SBP gradient was calculated as: SBPх(1-PR),indicating the SBP drop across ICAS. Perfusion pressure at post-stenosis area wascalculated as: MAPхPR. Results: After adjustment, high SBP gradient and low perfusion pressure was shown tocorrelate with cortical infarcts (p=0.041) and borderzone infarcts (borderlinesignificant, p=0.059) (Fig) . Between the 2 parameters, Pearson correlation coefficient=-0.854, p Conclusions: We demonstrated the hemodynamic hypothesis of stroke mechanism in sICAS thatartery-to-artery embolism and hypoperfusion could be attributed to the combinedeffect of blood pressure and translesional PR. Accordingly, a double-edged role of high BP level in sICAS may further surface, which can induce destructivebiomechanics but relieve hypoperfusion simultaneously.

Background: Reliable classification of ischemic stroke (IS) etiological subtypes is required in research and clinical practice, but the predictive properties of these subtypes in population studies with incomplete investigations are poorly understood. Aims: To compare the prognosis of etiologically classified IS subtypes and use machine learning (ML) to classify incompletely investigated IS cases. Methods: In a 9-year follow-up of a prospective study of 512,726 Chinese adults, 22,216 incident IS cases, confirmed by clinical adjudication of medical records, were assigned subtypes using a modified Causative Classification System for Ischemic Stroke (CCS) (large artery atherosclerosis (LAA), small artery occlusion (SAO), cardioaortic embolism (CE), or undetermined etiology) and classified by CCS as “evident,” “probable,” or “possible” IS cases. For incompletely investigated IS cases where CCS yielded an undetermined etiology, an ML model was developed to predict IS subtypes from baseline risk factors and screening for cardioaortic sources of embolism. The 5-year risks of subsequent stroke and all-cause mortality (measured using cumulative incidence functions and 1 minus Kaplan–Meier estimates, respectively) for the ML-predicted IS subtypes were compared with etiologically classified IS subtypes. Results: Among 7443 IS subtypes with evident or probable etiology, 66% had SAO, 32% had LAA, and 2% had CE, but proportions of SAO-to-LAA cases varied by regions in China. CE had the highest rates of subsequent stroke and mortality (43.5% and 40.7%), followed by LAA (43.2% and 17.4%) and SAO (38.1% and 11.1%), respectively. ML provided classifications for cases with undetermined etiology and incomplete clinical data (24% of all IS cases; n = 5276), with area under the curves (AUC) of 0.99 (0.99–1.00) for CE, 0.67 (0.64–0.70) for LAA, and 0.70 (0.67–0.73) for SAO for unseen cases. ML-predicted IS subtypes yielded comparable subsequent stroke and all-cause mortality rates to the etiologically classified IS subtypes. Conclusion: This study highlighted substantial heterogeneity in prognosis of IS subtypes and utility of ML approaches for classification of IS cases with incomplete clinical investigations.

Background: A single index of body mass index (BMI) may not fully address its impact on anti-platelet therapy. We aimed to elucidate the combined impact of BMI and dysglycemia expressed by glycated albumin (GA) on efficacy of clopidogrel-aspirin therapy among minor stroke (MS) or transient ischemic attack (TIA) patients. Results: Patients with overweight/obesity and low GA levels still benefited from clopidogrel-aspirin therapy for stroke recurrence (Hazard ratio [HR]: 0.48, 95 % confidence interval [CI]: 0.28–0.82), so did those with high GA levels but low/normal weight (HR: 0.67, 95 % CI: 0.45–0.99). However, patients with both overweight/obesity and high GA levels did not benefit from clopidogrel-aspirin therapy (HR: 0.89, 95 % CI: 0.59–1.33). Conclusions: Compared with aspirin alone, efficacy of clopidogrel-aspirin therapy for stroke still exists in overweight/obesity patients with normal glycemic control. Methods: In Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events trial, 3044 patients with available baseline GA were recruited. Low/normal weight and overweight/obesity were defined as BMI < 25 kg/m2 and ≥ 25 kg/m2, respectively. Elevated and low GA levels were defined as GA levels > 15.5 % and ≤ 15.5 %, respectively. The primary outcome was stroke recurrence during the 90-day follow-up.

Background: Previous studies showed the inconsistent effects of malnutrition contributing to poor prognosis of stroke. The aim of this study is to explore the effect of malnutrition on 3-month functional prognosis of stroke patients with different stroke severity assessed by the national institute of health stroke scale (NIHSS). Patients with first-ever stroke were consecutively enrolled in a nationwide, multicenter, and prospective registry from March 2007 to January 2008. Methods: Nutritional status was assessed at admission. Malnutrition was defined by any abnormality of 6 nutrition indicators, including body mass index (BMI), mid-upper arm circumference (MUAC), triceps skinfold thickness (TSF), haemoglobin, albumin, and prealbumin. Stroke patients were classified into mild (NIHSS Results: Multivariable analysis showed that malnutrition independently contributed to a higher risk of mRS 3-6 at 3-month for mild stroke patients [odds ratio (OR) 1.86, 95% confidence interval (CI) 1.04-3.34], but didn’t for severe stroke patients (OR 0.91, 95% CI 0.53-1.54) after adjusting for confounders including age, NIHSS, and infection et al. After adjusting for the potential confounders, malnutrition was still an independent risk factor for 3-month poor functional prognosis in mild stroke patients. Conclusion: Further investigation may be needed to illustrate the effects of improving nutritional status on stroke patients.

Aim: YKL-40 is a novel biomarker that is associated with both acute and chronic inflammations. Elevated plasma concentrations of YKL-40 have been reported in patients with ischemic stroke. This study investigated the association of plasma YKL-40 concentrations at admission and short, long-term prognosis after ischemic stroke. Methods: This study is a prespecified biomarker sub-study of the third China National Stroke Registry (CNSR3), which is a prospective,national multi-center of 171 sites concerning consecutive patients of ischemic stroke and TIA within 7 days since onset with specimens collected at baseline. Plasma YKL-40 levels were detected by ELISA and patients were stratified into terciles according to Plasma YKL-40 concentrations. The multivariate Cox regression model was used to investigate the association of YKL-40 concentration and death and recurrence at 3 months, 6 months and 12 months after ischemic stroke, with potential confounders adjusted. Results: A total of 8013 first-ever ischemic stroke patients, with an average of 61.7±11.5 years, were included in this study. The YKL-40 concentrations of lower, middle and upper group were 30.36 ±8.53 mg/L, 64.89±13.49 mg/L, and 164.42±50.35 mg/L respectively. Higher YKL-40 concentration at admission was associated with combination events of death and recurrence, death as well as recurrence at 3-month, 6-month and 12-month since onset of ischemic stroke when compared with lower YKL-40 concentration. However, after adjusting for age, gender, smoking, drinking, hypertension, diabetes, low-density lipoprotein, and C-reactive protein, higher YKL-40 concentration at admission was just statistically associated with combination events and death, but not stroke recurrence at 3-month, 6-month and 12-month when compared with lower YKL-40 concentration (table 1). Conclusions: The elevated YKL-40 at admission was associated with short and long-term death, but not recurrence after ischemic stroke.

Background: Little is known about the contemporary use of hospital treatments for major stroke pathological types in urban and rural areas of China. Methods: The China Kadoorie Biobank recruited >0.5 million adults (mean age 51 years, 59% women) during 2004-08 from ten (five urban, five rural) diverse areas in China. In-hospital medical records were retrieved from 20,229 participants (n=261 hospitals) hospitalised with a first-ever incident stroke over an 11-year follow-up period. Details of hospital management of stroke cases were analysed by sex, age of stroke onset, calendar year, hospital tier, region and other factors. Results: Among the 20,299 first-ever stroke cases, 17,306 (85%) had ischaemic stroke (IS; 7,123 non-lacunar, 6,690 lacunar and 3,493 silent lacunar), 2,623 (13%) had intracerebral haemorrhage (ICH), and 370 (2%) had subarachnoid haemorrhage (SAH). Among IS cases, anti-platelet treatment was used by 64% (65% non-lacunar, 66% lacunar, 56% silent lacunar), lipid-lowering by 50% (52% non-lacunar, 53% lacunar, 43% silent lacunar), blood pressure-lowering by about 42% of all IS subtypes, along with traditional Chinese medicines (TCM) by 59% (50% non-lacunar, 62% lacunar, 74% silent lacunar), with positive trends in use of these treatments by calendar year (Figure 1A), but inverse trends by hospital tier except TCM (Figure 1B). Approximately half of ICH (52.6%) or SAH (50.5%) cases received blood pressure-lowering medication, which did not vary significantly by area. A small proportion of cases with SAH had surgery to insert a coil (7.0%) or clip on aneurysm (5.7%). Interpretation: Among IS cases, use of antiplatelet, lipid-lowering and TCM increased in recent years and exceeded use of blood pressure-lowering treatment. In contrast, about half of all ICH and SAH cases used blood pressure-lowering treatments and there is significant under-use of surgery for SAH cases.

AimCerebrovascular disease is the leading cause of death and disability in China, causing a huge burden among patients and their families. Hence, stroke prevention is critical, especially in the high-risk population. Here, we present the evidence-based guideline suitable for the Chinese population.MethodsLiterature search of PubMed and Cochrane library (from January 1964 to June 2019) was done. After thorough discussion among the writing group members, recommendations were listed and summarised. This guideline was reviewed and discussed by the fellow writing committees of the Chinese Stroke Association’s Stroke.ResultsThis evidence-based guideline was written in three parts: controlling the risk factors of stroke, utilisation of antiplatelet agents and assessing the risks of first-ever stroke. All recommendations were listed along with the recommending classes and levels of evidence.ConclusionsThis guideline provides recommendations for primary prevention of cerebrovascular disease among high-risk population in China. Controlling related risk factors, appropriately using antiplatelet agents, assessing the risk of developing first-ever stroke should help reduce the rate of cerebrovascular disease in China.

Background Multiple methods have been used to analyze fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs) which may represent collaterals in patients with acute ischemic stroke (AIS); however, there is no consensus between methods. Purpose To compare three frequently used FVH methods for predicting early infarct volume and clinical outcome in patients with AIS. Material and Methods Patients with AIS in middle cerebral artery territory were recruited. FVHs were evaluated using extensive FVHs, FVH-diffusion-weighted imaging (DWI) mismatch, and FVH-in/out-DWI. Infarct volume at baseline and day 7 were measured. Early neurological improvement (ENI) was assessed. Good outcomes were defined by modified Rankin Scale scores of 0–2 at 90 days. Results Fifty-one patients were included. ENI was 55.6% in patients with extensive FVHs and 23.3% in those without ( P = 0.024). Patients with extensive FVHs had smaller infarct volume growth at seven days than those without ( P = 0.041). ENI was 48.3% in patients with FVH-DWI mismatch and 15.8% in those without ( P = 0.021). Patients with FVH-DWI mismatch had smaller infarct volumes at seven days than those without ( P = 0.038). Patients with FVH-out-DWI had smaller baseline infarct volumes, smaller seven-day volumes, and smaller infarct growth than those with FVH-in-DWI ( PConclusion Patients with extensive FVHs or FVH-DWI mismatch tend to have early favorable clinical outcome. FVH-out-DWI being associated with smaller infarct growth may also indicate early favorable clinical outcome.

Background: There is some controversy whether stroke history is an independent risk factor for poor prognosis of stroke or not. This study aimed to investigate the difference of mortality, disability and recurrent rate of ischemic stroke patients without and with stroke history, as well as to explore the effect of stroke history on stroke prognosis. Methods: We analyzed patients with ischemic stroke enrolled in the China National Stroke Registry which was a nationwide, multicenter, and prospective registry of consecutive patients with acute cerebrovascular events from 2007 to 2008. Multivariable logistic regression was performed to assess the risk of worse prognosis of stroke history in patients with ischemic stroke. Results: A total of 8181(65.9%) patients without stroke history and 4234(34.1%) patients with stroke history were enrolled in the study. The mortality, recurrence, modified Rankin Scale (mRS) 3-6 rate was 11.4%, 14.7% and 28.5% respectively at 1 year for patients without stroke history, which was significantly lower than that of 17.3%, 23.6%, 42.1% in patients with stroke history, respectively. Multivariable analysis showed that patients with stroke history had higher risk of death [odds ratio (OR) 1.34,95% confidence interval (CI) 1.17-1.54], recurrence (OR 1.47, 95 % CI 1.31-1.65) and mRS 3-6 (OR 1.49,95% CI 1.34-1.66) at 1 year. Conclusion: After adjusting for the potential confounders, stroke history was still an independent risk factor for poor prognosis of ischemic stroke, which further emphasizes the importance of secondary prevention of ischemic stroke. The specific causes of poor prognosis in patients with history of stroke need to be furtherly investigated.

Aim: Hemorrhagic transformation is the major complication of intravenous thrombolysis. Calcification is used widely as an imaging indicator of atherosclerotic burden and cerebrovascular function. The relationship between intracranial calcification and hemorrhagic transformation has not been explored fully. We aimed to identify and quantify calcification in the main cerebral vessels to investigate the correlations between quantitative calcification parameters, hemorrhagic transformation, and prognosis. Methods: Acute, non-cardiogenic, ischemic stroke patients with anterior circulation who received intravenous thrombolysis therapy in the First Hospital of Jilin University were retrospectively and consecutively included. All included patients underwent a baseline CT before intravenous thrombolysis and a follow-up CT at 24 hours. A third-party software, ITK-SNAP, was used to segment and measure the calcification volume. A vascular nonbone component with a CT value > 130 HU was considered calcified. Hemorrhagic transformation was determined based on the ECASS II classification criteria. Results: The study included 242 patients, 214 of whom were identified as having calcification. Thirty-one patients developed hemorrhagic transformation. The calcification volume on the lesion side (0.1ml) was associated with hemorrhagic transformation (p = 0.004, OR= 1.504, 95% CI: 1.140–1.985). Ninety-six patients had poor prognoses. The poor prognosis group had more calcified vessels than the good prognosis group (p = 0.014, OR= 1.477, 95% CI: 1.083–2.015). Conclusions: The arterial calcification volume on the lesion side is associated with hemorrhagic transformation after thrombolysis. The higher the number of calcified vessels, the greater the risk of poor prognosis.

Endovascular treatment (EVT) has been widely used for treating acute ischemic stroke (AIS). However, the safety and efficacy of treating AIS with tirofiban combined with EVT remain controversial. Therefore, we conducted a meta-analysis to evaluate this treatment. Randomized controlled trials and cohort studies that compared treatment with tirofiban combined with EVT and EVT alone were included in our meta-analysis. Those published from inception to March 31, 2020, were searched using the PubMed, Web of Science, Embase, and Cochrane Library databases. Safety was assessed based on symptomatic intracranial hemorrhage (sICH) incidence and 3-month mortality. Efficacy was assessed based on modified Rankin Scale (mRS) scores at 3 months post-EVT and recanalization rates. Data were analyzed using either the random-effects or fixed-effects model based on the heterogeneity of studies. In total, one RCT, six prospective studies, and four retrospective studies (2387 AIS cases) were assessed. Our meta-analysis showed that tirofiban combined with EVT did not increase sICH risk (RR, 1.06; 95%CI, 0.79 to 1.42; P = 0.72) and 3-month mortality (RR, 0.87; 95%CI, 0.74 to 1.04; P = 0.12). Recanalization rates were not significantly different between patients treated with tirofiban combined with EVT and those treated with EVT alone (RR, 1.04; 95%CI, 1.00 to 1.08; P = 0.07), but tirofiban combined with EVT was significantly associated with favorable functional outcomes (mRS score, 0-2) in AIS patients (RR, 1.13; 95%CI, 1.02 to 1.25; P = 0.02). Tirofiban combined with EVT appears to be safe and potentially effective in treating AIS.

Introduction: Recurrent ischemic stroke is more likely to have a worse prognosis. However, it is little known whether recurrent stroke is an independent risk factor for poor prognosis. We aim to investigate the difference of mortality and recurrent rate of first ever and recurrent ischemic strokes, as well as to explore the potential reasons. Method: We analyzed patients with ischemic stroke enrolled in the China National Stroke Registry which was a nationwide, multicenter, and prospective registry of consecutive patients with acute cerebrovascular events from 2007 to 2008. Date including hypertension, diabetes mellitus, hyperlipidemia, heart disease, etc. were obtained from paper-based registry forms. Multivariable analysis using logistic regression was performed to assess the risk of worse prognosis of recurrent ischemic stroke compared to first-ever stroke. Result: A total of 8 181 patients with first-ever stroke and 4 234 patients with recurrent stroke were enrolled in the study. For patients with first-ever stroke, the mortality, recurrence, composite Events(modified Rankin Scale=3-6, which means death or disability) rate is 7.2%, 10.3%, 22.6%, respectively at 3-month; and 9.0%, 13.0%, 29.0% at 6-month; as well as 11.4%, 14.7%, 28.5% at 1 year, respectively. For patients with recurrent stroke, the mortality, recurrence, composite events rate is 10.5%, 16.1%, 30.8% respectively at 3-month, and 13.9%, 20.3%, 41.7% at 6-month, as well as 17.3%, 23.6%, 42.1% at 1 year, respectively. Multivariable analysis showed that patients with recurrent stroke had a higher risk of death, recurrence and disability at 3-month, 6 month and 1 year (table 1). Conclusion: After adjusting for multiple risk factors, recurrent stroke is still an independent risk factor for poor prognosis of ischemic stroke, which further emphasizes the importance of secondary prevention of ischemic stroke, and the specific causes need to be furtherly investigated.

Background and purposeThere is limited nationwide evidence about the standard management characteristics of stroke types and prognosis in China. This study aimed to assess clinical characteristics, in-hospital and after-discharge management characteristics and prognosis for stroke types in China.MethodsA nationwide registry recruited 14 244 imaging-confirmed first-ever incident strokes from 132 hospitals across 31 provinces of China during 2007–2008, recording presenting characteristics, diagnostic procedures and in-hospital treatment. After hospital discharge, patients were followed up for 6 months. Conventional statistical methods were used to examine the patterns of management and prognosis.ResultsOverall, 68.7%, 26.9% and 4.4% were ischaemic stroke (IS), intracerebral haemorrhage (ICH), and subarachnoid haemorrhage (SAH), respectively. Only 20% were managed in a dedicated stroke unit. Among IS, 1.3% received thrombolysis within 3 hours after symptom onset, whereas the proportions of receiving in-hospital antiplatelet therapy, neuroprotective agents and traditional Chinese medicines (TCM) were 88.4%, 69.7% and 70.6%, respectively. For ICH, 63.3% and 36.3% received neuroprotective agents and TCM in hospital, respectively. At discharge, 70.7% and 38.0% of the patients with IS were given antiplatelet and statin therapies, respectively, decreasing to 64.8% and 23.9%, respectively, at 6 months. In-hospital mortality was 3.2%, 9.3% and 10.1% for IS, ICH and SAH, respectively, with a further 8.6%, 18.2% and 22.0%, respectively, died by 6 month. Meanwhile, in-hospital recurrence rate was 2.6%, 1.9% and 7.2% for IS, ICH and SAH, respectively, with a further 8.0%, 5.1% and 7.5%, respectively, recurred by 6 month.ConclusionsIn China, the mortality rate of stroke is lower than that reported from west populations, though most strokes are not managed in specialised stroke unit. There is widespread use of some unproven therapies but limited proven treatments, especially after discharge, leading to unnecessary recurrent risks.

ObjectivesTo compare hospital treatments for major stroke types in Chinese adults by stroke pathological types, sex, age, calendar year, hospital tier, region and other factors.DesignCross-sectional analysis of medical records retrieved from 20 229 stroke cases in the China Kadoorie Biobank.SettingTen diverse areas (five urban, five rural) in China.ParticipantsFirst-incident stroke cases who were recruited during an 11-year follow-up of 0.5M participants in the China Kadoorie Biobank.MethodsElectronic copies of medical records of stroke cases were retrieved for clinical adjudication by local neurologists. Stroke cases were classified as ischaemic stroke (IS) (including lacunar infarction (LACI) and non-LACI (non-LACI)), intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH) and unspecified stroke types.ResultsAmong 20 299 first-ever stroke cases, 17 306 (85%) had IS, 7123 had non-LACI, 6690 had LACI, 3493 had silent LACI, 2623 (13%) had ICH and 370 (2%) had SAH. Among IS cases, antiplatelet treatment was used by 64% (65% non-LACI, 66% LACI, 56% silent LACI), lipid-lowering by 50% (52% non-LACI, 53% LACI, 43% silent LACI) and blood pressure-lowering by ~42% of all IS types, with positive trends in the use of these treatments by calendar year and hospital tier. Among ICH cases, 53% used blood pressure-lowering and 10% used lipid-lowering treatments, respectively. In contrast, traditional Chinese medicines (TCMs) were used by 59% of IS (50% non-LACI, 62% LACI, 74% silent LACI), 38% of ICH and 30% of SAH cases, with positive trends by calendar year and by hospital tier.ConclusionsAmong IS cases, use of antiplatelet and lipid-lowering medications increased in recent years, but use of TCM still exceeded use of blood pressure-lowering treatment. In contrast, blood pressure-lowering treatment was widely used for ICH, but only half of all ICH cases used blood pressure-lowering treatment.

Stroke is a leading cause of morbidity and mortality worldwide. Administration of Netrin-1 during the peri-infarct period has been shown to decrease infarct size in rats; however, the underlying mechanism is unclear. We addressed this question in the present study by inducing stroke in rats via middle cerebral artery occlusion (MCAO), and evaluating the effects of Netrin-1 treatment by neurobehavioral testing, immunocytochemistry, and western blotting. Netrin-1 overexpression increased neurobehavioral test scores and reduced cerebral infarct volume following MCAO via inhibition of the Notch1 signaling pathway. These results demonstrate that early administration of Netrin-1 can is an effective therapeutic approach for improving outcome after stroke. © 2017 Wiley Periodicals, Inc.

The fractional pressure ratio is introduced to quantitatively assess the hemodynamic significance of severe intracranial stenosis. A computational fluid dynamics-based method is proposed to non-invasively compute the FPRCFD and compared against fractional pressure ratio measured by an invasive technique. Eleven patients with severe intracranial stenosis considered for endovascular intervention were recruited and an invasive procedure was performed to measure the distal and the aortic pressure ( Pd and Pa). The fractional pressure ratio was calculated as [Formula: see text]. The computed tomography angiography was used to reconstruct three-dimensional (3D) arteries for each patient. Cerebral hemodynamics was then computed for the arteries using a mathematical model governed by Navier–Stokes equations and with the outflow conditions imposed by a model of distal resistance and compliance. The non-invasive [Formula: see text], [Formula: see text], and FPRCFD were then obtained from the computational fluid dynamics calculation using a 16-core parallel computer. The invasive and non-invasive parameters were tested by statistical analysis. For this group of patients, the computational fluid dynamics method achieved comparable results with the invasive measurements. The fractional pressure ratio and FPRCFD are very close and highly correlated, but not linearly proportional, with the percentage of stenosis. The proposed computational fluid dynamics method can potentially be useful in assessing the functional alteration of cerebral stenosis.

Objective This study aimed to investigate the association between abnormal signs on susceptibility-weighted imaging (SWI) and post-treatment outcome in the early stage in patients with acute ischemic stroke. Methods Thirty-seven patients with middle cerebral artery territory infarction were recruited. Baseline and 24-hour follow-up magnetic resonance imaging was performed. Pre- and 24-hour post-treatment clinical conditions were assessed with the National Institutes of Health Stroke Scale (NIHSS) score. Prominent vessel sign (PVS) on SWI and infarcted areas on diffusion-weighted imaging (DWI) were assessed using the Alberta Stroke Program Early CT (ASPECT) score system. Susceptibility vessel sign (SVS) was evaluated and recorded. The associations between image abnormalities and clinical scores were analyzed. Results PVS was found in 35 patients and SVS in seven patients. The extent of PVS was significantly correlated with the post-treatment DWI ASPECT score (r = 0.79), but not with the post-treatment NIHSS score or the post−pre NIHSS difference score. The presence of SVS was significantly correlated with the post-treatment NIHSS score (r = 0.41). Conclusion PVS might be a useful predictor of early imaging prognosis and infarct growth in patients with acute ischemic stroke. SVS is related to a poor early outcome and could be useful for assessing stroke.

Background There is limited nationwide evidence about the standard short- and long-term management of stroke types and prognosis in China. Methods A nationwide registry recruited 14,244 imaging-confirmed incident strokes from 132 hospitals across 31 provinces of China during 2007-8, recording presenting characteristics, diagnostic procedures, and in-hospital treatment. After hospital discharge, patients were followed up for 12 months. Conventional statistical methods were used to examine the patterns of management and prognosis. Findings Overall, 68.7%, 26.9%, and 4.4% were ischaemic stroke (IS), intracerebral haemorrhage (ICH) , and subarachnoid haemorrhage (SAH) respectively. Only 20% were managed in a dedicated stroke unit. Among IS admitted

To investigate the distribution and features of middle cerebral artery (MCA) atherosclerotic plaques in patients with acute ischaemic strokes using high-resolution magnetic resonance (MR) imaging.Forty-six plaques from 44 MCAs (18 right and 26 left) in patients with acute symptomatic ischaemic strokes were studied. High-resolution MR imaging including tb1 weighted imaging (T1WI), tb2 weighted imaging (T2WI), PD weighted imaging (PDWI) and three-dimensional magnetization-prepared rapid acquisition gradient-echo (MPRAGE) sequences were used to visualise the plaques. The locations of plaques were classified into ventral, distal, superior and inferior wall of the MCA on oblique sagittal images. The thickness, area and signal intensities of plaques were recorded. The stenosis degree of MCA was calculated.Among all 46 plaques, 26 plaques were located at the ventral wall (56.5%), 6 at the dorsal wall (13.0%), 9 at the superior wall (19.6%), and five at the inferior wall (10.9%). The average thickness and area of plaques were 1.37 ± 0.53 mm (range: 0.61-3.20 mm) and 3.80 ± 2.13 mm(2) (range: 1.01-12.2 mm(2)), respectively. No significant differences in plaque thickness (P = 0.464), plaque area (P = 0.107) or stenosis degree (P = 0.563) were noted between different locations. Most of the plaques (44/46) showed iso-intensity on tbl1WI. On tbl2WI and PDWI, 24 plaques showed iso-intensity, 12 plaques showed a slightly high signal intensity (SI), and eight plaques showed a slightly low SI. Intraplaque haemorrhage was found in two plaques, with high SI on tbl1WI and MP-RAGE and high or mixed SI on tbl2WI and PDWI.Middle cerebral artery plaques in patients with acute infarction have certain tendency to locate at ventral and superior walls. Distribution and features of plaques revealed some plaque formation characteristics and would help to understand underlying mechanisms of ischaemic events.

Little is known about the clinical practice of deep venous thrombosis (DVT) prophylaxis in patients with acute ischaemic stroke in China. We examined the factors that impact the adherence rate of DVT prophylaxis in stroke patients from the China National Stroke Registry (CNSR).Records of 12 173 acute ischaemic stroke patients with follow-up admitted to 132 hospitals in CNSR from September 1, 2007 to August 30, 2008 were reviewed. Data from 4643 patients eligible for DVT prophylaxis were analysed. Generalised estimating equations were used to identify the patient's and hospital's factors that impact the practice of DVT prophylaxis.Among 4643 acute ischaemic stroke patients eligible for DVT prophylaxis, the overall adherence rate of DVT prophylaxis was 59·6%. The median hospital prophylaxis rate was 57·8% (inter quartile range: 33·3(70·2%). Venous thromboembolism was found in 1·6% of patients. Factors associated with increased likelihood of practicing DVT prophylaxis in the multivariable model included history of atrial fibrillation (AF) (P = 0·04), receiving rehabilitation evaluation (P 0·001), receiving care in the East (P 0.001) or Central (P = 0.001) regions compared to west regions of China. Increasing age (P = 0.014), NIHSS score on admission (P 0.001), annual stroke discharges (P = 0.001), and the hospital size (P = 0.003) were associated with lower likelihood of DVT prophylaxis.The adherence rate of DVT prophylaxis among non-ambulance patients with acute ischaemic stroke was suboptimal in China. It varied among patients by age, stroke severity, and history of AF, and among hospitals by different locations, number of beds and annual stroke discharges.

Background Histopathological studies have shown significant differences in plaque components and surface conditions between upstream and downstream of the stenosis. It can be deduced that the flow status near the plaques is different from the flow status at the upstream side, stenosis center, or downstream side of the plaque. Purpose To study the hemodynamic parameter distribution in different locations near atherosclerotic plaques in the carotid arteries with different stenosis degrees. Material and Methods Eleven patients were recruited in this study. CE-MRA was performed to obtain the carotid three-dimensional surface data and the stenosis degrees were calculated. The hemodynamic parameters including wall shear stress (WSS), pressure, and velocity near the plaques were obtained by computational fluid dynamic (CFD) method. Local hemodynamics parameters were analyzed and compared between different stenosis degree groups, and between upstream, stenosis center, and downstream sides of plaques. Relative ratio of velocity, WSS, and pressure values in different locations was calculated and compared. Results Fourteen carotid arteries (with 4 mild, 6 moderate, and 4 severe stenosis) were analyzed. Significant differences were found in Pressure max ( P = 0.025), Pressure mean ( P = 0.020), and Pressure min ( P = 0.026) between three stenosis groups. It showed significant differences in Vmin ( P Conclusion Velocity, WSS, pressure, and relative ratio of these parameters have certain trends in distribution around the plaques in the carotid arteries.

Currently, intravenous (IV) thrombolysis within 3 hours from stroke onset is the only approved treatment in acute ischemic stroke (AIS). Although effective, the definition of therapeutic time window and appropriate patient selection still remains controversial. Notably, early endovascular treatment strategies may serve as an adjunct therapy for time window extension in AIS. In this article, we review the safety and efficacy of IV thrombolysis in AIS as it pertains to the optimal time window, the selection of eligible patients, and in combination with endovascular treatment. Combined clinical application of IV thrombolysis and endovascular therapy may improve the therapeutic outcomes for AIS patients.

To investigate the relationship between plaque compositions and stenosis patterns in patients with atherosclerotic plaques at the carotid bifurcation using magnetic resonance (MR) imaging.One hundred and four carotid arteries with stenosis over 50% from 75 symptomatic stroke patients (64 male and 11 female; mean age 58·2±13·3 years) were studied. Plaque compositions were analyzed by high-resolution MR imaging using a 3·0T MR with a surface coil. Stenosis patterns were classified into three types according to contrast-enhanced MR angiography images. Correlations of different components of plaques and stenosis patterns were analyzed.One hundred and four carotid arteries were analyzed. Three stenosis patterns were identified. The prevalences of the three patterns are as follows: type I (total occlusion) at 27·9% (29/104), type II (local plaque with normal distant flow) at 56·7% (59/104), and type III (local plaque with impaired distant flow) at 15·4% (16/104). The contingency coefficients between stenosis pattern and stability, intraplaque hemorrhage (IPH), lipid necrotic core (LNC), and ulcer were 0·383 (P = 0·000), 0·290 (P = 0·008), 0·439 (P = 0·000), and 0·388 (P = 0·000), respectively. Multinomial analysis showed that compared with type III vessels, type I vessels were more likely to contain IPH (P = 0·019) and less likely to contain large LNC (P = 0·001); type II vessels had a greater possibility for containing IPH than type III vessels (P = 0·009); LNC was more likely to be found in type II than in type I vessels (P = 0·000). No significant difference was found in ulceration prevalence between type II and type III vessels (P = 0·058).The current study demonstrated positive associations between stenosis patterns and plaque compositions.

Correspondence Yong-Jun Wang, Neurology Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Tel.: 0086-010-67098351; Fax: 0086-010-67038316; E-mail: yongjunwang111@yahoo.com.cn and Su-Ming Zhang, Neurology Department, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China. Tel.: 0086-027-83612633; Fax: 0086-027-83612633; E-mail: suming_zhang@163.com and Liqun Zhang, Neurology Department, St George’s Hospital, London, UK. Tel.: 44-7837827866; Fax: 44-2087254505; E-mail: lqnzhang@yahoo.com Received 19 October 2011; revision 22 November 2011; accepted 26 November 2011

To find a better way to predict the clinical events caused by carotid vulnerable lesions via comparison study on high-resolution magnetic resonance imaging (MRI) and ultrasonography (US).Twenty-seven symptomatic stroke patients were recruited, all of which were given both high-resolution MRI and US at bilateral carotids. Respective correlations of high-resolution MRI and US outcomes with clinical events were performed and the lesion numbers identified by high-resolution MRI and US were statistically analysed.Six carotid arteries in six patients were excluded because of uninterpretable high-resolution MRI findings or patients' intolerance. In the remaining 48 carotids analysed, the number of carotid with vulnerable/stable lesion was 17/31 by high-resolution MRI and 25/23 by US, respectively. Contingency coefficient was 0.40 between vulnerable lesion by high-resolution MRI and clinical event (p=0.004), and 0.19 (p=0.221) by US and clinical event, respectively. The difference of detected lesion numbers between high-resolution MRI and US was statistically significant p=0.039) through matched chi-square test.High-resolution MRI may be a better way than US in predicting the clinical events caused by carotid vulnerable lesions.

Stroke is a leading cause of morbidity and mortality worldwide. Administration of Netrin-1 during the peri-infarct period has been shown to decrease infarct size in rats; however, the underlying mechanism is unclear. We addressed this question in the present study by inducing stroke in rats via middle cerebral artery occlusion (MCAO), and evaluating the effects of Netrin-1 treatment by neurobehavioral testing, immunocytochemistry, and western blotting. Netrin-1 overexpression increased neurobehavioral test scores and reduced cerebral infarct volume following MCAO via inhibition of the Notch1 signaling pathway. These results demonstrate that early administration of Netrin-1 can is an effective therapeutic approach for improving outcome after stroke. © 2017 Wiley Periodicals, Inc.

The technology of Three-Dimension (3D) reconstruction of medical images has been playing an increasingly important role in modern clinical medicine. With application softwares’ advent, physicians can explore the method of 3D entity reconstruction more conveniently and easily. This paper aims to provide physicians with a feasible method for 3D entity reconstruction of carotid artery. The raw carotid artery images derived from patients undergoing the test of high resolution carotid artery MRI. Then with the aid of the Mimics toolkit, raw images were used to generate the 3D model of carotid blood. Finally, Magics carried out the step of 3D extension and Boolean Operation to produce the 3D model of carotid wall.

Wall shear stress (WSS) has been proved to play a critical role in formation and development of atherosclerotic plaques. Our objective was to quantify local WSS in vivo in normal subjects, and to analyze spatial distribution patterns and determine the temporal gradient of WSS. Seventy-eight CCAs of 42 healthy volunteers at common carotid arteries (CCAs) were studied. Cine phase-contrast MR sequence was used to acquire the flow velocity information. Three-dimensional paraboloid modeling was applied to fit the velocity profiles and WSS values were calculated. Mean WSS value for CCAs was 0.783±0.209, with the range of WSS value from −0.541 to 3.464 N/m2. The 95% confidence interval for mean WSS value in CCA was (0.736–0.830) N/m2. Different WSS spatial distribution patterns were classified into three types according to the location of low WSS values during a cardiac cycle. Mean value of maximum temporal gradient of WSS was 14.12±5.46, with the range from 5.87 to 33.23 N/m2 s−1. Skewed velocity profiles were displayed in most CCAs, indicating the flow patterns in CCA were more complicated than commonly assumed. Obvious inter-subject variation were found in magnitude, spatial distribution and the temporal gradient of WSS in CCAs, and the blood flow patterns as well.