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Background and Purpose: Early recanalization of occluded intracranial arteries predicts favorable outcome in acute ischemic stroke (AIS) patients treated with intravenous alteplase therapy within 4.5 hours from stroke onset. Prior studies have shown recanalization of large vessel occlusion (LVO) with alteplase ranging from 0% for internal carotid artery and 33% for distal blood vessels. We performed an analysis to examine the characteristics of stroke patients and the location of LVO that predicts early recanalization in patients treated with intravenous alteplase alone. Methods: This single-center, retrospective study solely included AIS patients with LVO who were transferred to our institution for mechanical thrombectomy evaluation after treated with alteplase at a primary stroke center between January 2019 and January 2021. Recanalization was identified by repeated computed tomographic angiography (CTA) or digital subtraction angiography (DSA) at our institution upon arrival. Results: One hundred and six patients were included in the analysis, 15 (14.1%) patients had partial or complete recanalization of LVO. Cardioembolic was the most common cause of ischemic stroke (46%), followed by large vessel atherosclerosis (33%) in this group. They were more likely to have a medical history of hypertension (73.3% vs. 59.3%), better baseline function as measured by pre-modified Rankin Score 0-2 (73.3% vs. 68.1%), and receive early treatment (105 minutes vs. 135 minutes), compared to their counterparts with no recanalization. Proximal and distal middle cerebral artery had the same rate of recanalization in this cohort. Conclusion: The highest incidence of early recanalization of occluded intracranial arteries was found in cardioembolic strokes with middle cerebral artery being the most common location of recanalization. Early recanalization with intravenous alteplase was also associated with improved functional recovery at discharge.

Lacunar strokes (LS) are ischemic strokes of the small perforating arteries of deep gray and white matter of the brain. Frailty has been associated with greater mortality and attenuated response to treatment after stroke. However, the effect of frailty on patients with LS has not been previously described.To analyze the association between frailty and outcomes in LS.Patients with LS were selected from the National Inpatient Sample (NIS) 2016-2019 using the International Classification of Disease, 10Of 48,980 patients with LS, 10,830 (22.1%) were severely frail. Severely frail patients were more likely to be older, have comorbidities, and pertain to lower socioeconomic status categories. Severely frail patients with LS had worse clinical stroke severity and increased rates of complications such as urinary tract infection (UTI) and pneumonia (PNA). Additionally, severe frailty was associated with unfavorable outcomes and increased HRU.Severe frailty in LS patients is associated with higher rates of complications and increased HRU. Risk stratification based on frailty may allow for individualized treatments to help mitigate adverse outcomes in the setting of LS.

Background Mechanical thrombectomy (MT) is the gold standard treatment for large vessel occlusion (LVO). A vital factor that might influence MT outcomes is the use of intravenous thrombolysis (IVT). A few clinical trials in this domain thus far have not yielded consistent outcomes. We conducted this meta-analysis to synthesize collective evidence in this regard. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines were followed, and we performed a comprehensive literature search of four databases (PubMed, Scopus, Web of Science, Cochrane CENTRAL). For outcomes constituting continuous data, the mean difference (MD) and its standard deviation (SD) were pooled. For outcomes constituting dichotomous data, the frequency of events and the total number of patients were pooled as the risk ratio (RR). Results Seven clinical trials with a total of 2317 patients are included in this meta-analysis. Six trials are randomized, and one trial was nonrandomized. No significant differences were found between MT plus IVT and MT alone in successful recanalization (RR 1.04, 95% Confidence Interval (CI) [0.92 to 1.17], P = 0.53), 90-day functional independence (RR 1.03, 95% CI [0.90 to 1.19], P = 0.65), symptomatic intracranial hemorrhage (sICH) (RR 1.22, 95% CI [0.84 to 1.75], P = 0.30), or mortality (RR 0.94, 95% CI [0.76 to 1.18], P = 0.61). Conclusion The current evidence does not favor either MT plus IVT or MT alone for LVO except for the procedural time. More trials are needed in this regard, and certain factors should be considered when comparing the two approaches.

Introduction: Door-to-needle time (DTN) is associated with outcome in acute ischemic stroke (AIS) patients who are eligible to receive intravenous tissue plasminogen activator (IV tPA). Various factors have been shown to impact DTN time including patient-related factors such as initial refusal or management of hypertension, hospital-related factors such as laboratory tests; and system-related factors all potentially affecting clinical outcomes. Neurological deficits such as aphasia could potentially affect DTN through various mechanisms including difficulty in obtaining accurate last known well time (LKWT), discussing risks vs benefits of IV tPA, etc. We sought to investigate the association between aphasia as a presenting neurological deficit and DTN. Methods: This was a retrospective chart review of prospectively collected data through Get-with-the-Guidelines from 7/17 to 6/18 at our comprehensive stroke center. Data regarding patient demographics, medical history, last known well time (LKWT), arrival time, door-to-CT time, treatment time, admission National Institutes of Health stroke scale (NIHSS), pre-stroke modified Rankin scale (mRS) were analyzed. Pearson chi-square test was performed to determine association between aphasia and DTN time. Results: Out of 110 patients (mean age 72 years; 59% women) who received IV tPA; 40% had aphasia as part of their clinical presentation. Patients with aphasia were older (76 vs 69 years) and had higher admission NIHSS (13 vs 6). DTN times did not differ significantly between patients presenting with aphasia vs other neurological deficits (44 vs 45 minutes; p=0.84). No difference was observed between door-to-CT time (16 vs 18 minutes) and LKWT-to-treatment time (138 vs 142 minutes). Conclusion: We did not find significant differences in tPA treatment times in patients with AIS based on the presence or absence of aphasia. Although aphasia could present challenges in the evaluation of patients with AIS, the increased severity of neurological deficits inherent to aphasia may lead to a faster work flow. A small sample size is a major limitation of our study. Further research into the influence of aphasia and other presenting neurological symptoms on DTN is warranted.

Monosomy 1p36 is a newly delineated multiple congenital anomalies/mental retardation syndrome characterized by mental retardation, growth delay, epilepsy, congenital heart defects, characteristic facial appearance, and precocious puberty. It is now considered to be one of the most common subtelomeric micro-deletion syndromes. This article reports new findings of choroid plexus hyperplasia and dextrocardia with situs solitus in a patient who had deletion of chromosome 1p26.33 with a brief review of the literature.