Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, July 6, 2022

Three Dimensional-Arterial Spin Labeling Evaluation of Improved Cerebral Perfusion After Limb Remote Ischemic Preconditioning in a Rat Model of Focal Ischemic Stroke

Has your hospital implemented remote ischemic conditioning yet? WHAT THE FUCK ARE THEY WAITING FOR?

Why does your board of directors allow such incompetence in themselves and the stroke staff to continue for years at a time?

 

Three Dimensional-Arterial Spin Labeling Evaluation of Improved Cerebral Perfusion After Limb Remote Ischemic Preconditioning in a Rat Model of Focal Ischemic Stroke

Tianxiu Zheng1, Xiaolan Lai2, Jiaojiao Lu3, Qiuyan Chen1 and Dingtai Wei1*
  • 1Department of Radiology, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, China
  • 2Department of Hematology, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, China
  • 3Department of Central Laboratory, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, China

Purpose: To investigate the application value of 3D arterial spin labeling (3D-ASL) for evaluating distal limb ischemic preconditioning to improve acute ischemic stroke (AIS) perfusion.

Materials and Methods: A total of 40 patients with AISs treated in our hospital from January 2020 to December 2020 were recruited, and 15 healthy individuals who were examined in our hospital during the same period were included as the control group; all of these participants were scored on the National Institutes of Health Stroke Scale (NIHSS) and examined by MRI. Sequences included conventional sequences, diffusion-weighted imaging (DWI), magnetic resonance angiography (MRA), and 3D-ASL, and cerebral infarct volume and cerebral blood flow (CBF) in the area of the infarct lesion were measured. After 3 months of treatment, patients with AIS were scored on the modified Rankin Scale (mRS) and divided into good prognosis and poor prognosis groups. In total, 55 adult male Sprague–Dawley rats were divided randomly into three groups: 20 in the middle cerebral artery occlusion (MCAO) group, 20 in the MCAO + limb remote ischemic preconditioning (LRP) group, and 15 in the sham group. In total, 48 h after the procedures, conventional MRI, DWI, and 3D-ASL sequence data were collected, and 2,3,5-trphenyltetrazolium chloride monohydrate (TTC) staining and behavioral scoring were performed. CBF was recorded in the infarct lesion area and the corresponding contralateral area, and the affected/contralateral relative values (rCBF) were calculated to compare the differences in rCBF between different groups. The pathological changes in brain tissues were observed by HE staining, and the expression of vascular endothelial growth factor (VEGF) and platelet endothelial cell adhesion molecule-1 (PECAM-1/CD31) in brain tissues was detected by immunofluorescence and real-time quantitative polymerase chain reaction (RT-qPCR). The protein expression of VEGF was detected by western blotting.

Results: Hypertension and internal carotid atherosclerosis are high-risk factors for ischemic stroke, and CBF values in the infarct area are significantly lower than those in the corresponding areas on the contralateral side. NIHSS and mRS scores and CBF values have higher specificity and sensitivity for the prognosis of patients with AIS. LRP significantly reduces the infarct area, improves behavioral deficits in rats with cerebral ischemia, reduces neurological injury and histological damage, protects vascular structures, and promotes neovascularization. In addition, 3D-ASL showed a significant increase in brain tissue perfusion in the ischemic area after LRP, and the expression of VEGF and CD31 showed a significant positive correlation with CBF values.

Conclusion: Three dimensional (3D) ASL can be used to evaluate LRP to improve stroke perfusion, and its protective effect may be closely related to LRP-induced vascular regeneration.

Introduction

Stroke is a common clinical condition, and the incidence of ischemic stroke is as high as 80%, mainly caused by occlusion or stenosis of the blood supply to brain tissue (Moretti et al., 2015).

A large number of studies have confirmed that limb remote ischemic preconditioning (LRP) has a clear ischemic protective effect (Du et al., 2020), but its mechanism is still unclear (Ren et al., 2015; Liang et al., 2019; Basalay et al., 2020). Vascular endothelial growth factor (VEGF), as a potent growth factor with neuroprotective and angiogenic effects, has become a potential therapeutic target (Wang et al., 2020).

Imaging is a common auxiliary examination method for cerebrovascular diseases and can assist in the diagnosis of diseases through structural brain imaging and functional brain imaging. Cerebral blood flow (CBF) provides an immediate response to the hemodynamic changes in brain tissue, and cerebral perfusion imaging is the main method for obtaining CBF currently. Conventional perfusion imaging requires injection of contrast or radiotracer and is invasive to the patient. With the continuous development of technology, new imaging techniques have been introduced (Shang et al., 2018). The three-dimensional (3D) arterial spin labeling (3D-ASL) is a new rapid, non-invasive, contrast-free perfusion MRI technique that reflects the perfusion level of brain tissue by CBF (Wong et al., 2014; Zhang et al., 2015). The most important advantage of this method is the capability of reproducibly quantitative measurement of CBF values in vivo without the introduction of external contrast agents, making this method outperform than traditional contrast push technique and strikingly useful in reflecting the physiopathologic alterations of the cerebral blood (Cutajar et al., 2014; Naresh et al., 2016). Currently, it is mainly used to assess cerebrovascular lesions (Liu et al., 2021), neurodegenerative diseases (Joseph, 2021), and tumors as an aid to diagnosis (Kong et al., 2017) and pre-operative assessment (Lu et al., 2017), and no reports have been published on the use of 3D-ASL for evaluating distal limb ischemic preconditioning (IPC) to improve ischemic stroke perfusion.

Therefore, the present study investigated the value of 3D-ASL magnetic resonance cerebral perfusion imaging for evaluating IPC in distal limb ischemia to improve ischemic stroke perfusion and investigated whether the neuroprotective effect of LRP could be achieved by modulating VEGF.

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