Leptomeningeal collaterals regulate reperfusion in ischemic stroke and rescue the brain from futile recanalization

So you found something useful to survivor recovery. WHAT THE FUCK ARE YOU DOING TO GET THIS INTERVENTION TO ALL PATIENTS? NOTHING? Then why the fuck are you stroke researchers if you don't help survivors?

Leptomeningeal collaterals regulate reperfusion in ischemic stroke and rescue the brain from futile recanalization

• Nadine Felizitas Binder ¹³
• Mohamad El Amki ¹³
• Chaim Glück
• 
  
• Michael Weller
• Bruno Weber
• Susanne Wegener ¹⁴
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Open AccessPublished:February 26, 2024DOI:https://doi.org/10.1016/j.neuron.2024.01.031

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  LMCs maintain perfusion during stroke
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  Upon recanalization, LMCs allow for a gradual reperfusion
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  In mice with poor LMCs, recanalization causes deleterious hyperperfusion
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  Stroke patients with poor LMCs show fast reperfusion and futile recanalization

Summary

Recanalization is the mainstay of ischemic stroke treatment. However, even with timely clot removal, many stroke patients recover poorly. Leptomeningeal collaterals (LMCs) are pial anastomotic vessels with yet-unknown functions. We applied laser speckle imaging, ultrafast ultrasound, and two-photon microscopy in a thrombin-based mouse model of stroke and fibrinolytic treatment to show that LMCs maintain cerebral autoregulation and allow for gradual reperfusion, resulting in small infarcts. In mice with poor LMCs, distal arterial segments collapse, and deleterious hyperemia causes hemorrhage and mortality after recanalization. In silico analyses confirm the relevance of LMCs for preserving perfusion in the ischemic region. Accordingly, in stroke patients with poor collaterals undergoing thrombectomy, rapid reperfusion resulted in hemorrhagic transformation and unfavorable recovery. Thus, we identify LMCs as key components regulating reperfusion and preventing futile recanalization after stroke. Future therapeutic interventions(What specific person is going to do this research?) should aim to enhance collateral function, allowing for beneficial reperfusion after stroke.

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Optimised ladder‐climbing rehabilitation training for various stroke severity levels in rats

This should easily translate to human testing using stair climbers, even your doctor could set up research on that.

Optimised ladder‐climbing rehabilitation training for various stroke severity levels in rats

Chi‐ChunChen1|Yu‐LinWang2,3,4|Ching‐PingChang5

1. Department of Electronic Engineering, National ChinYi University of Technology, Taichung, Taiwan 

2. Center of General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan 3. College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 

4. Department of Rehabilitation, Chi Mei Medical Center,Tainan,Taiwan 

5. Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan 

Abstract

To develop an optimised rehabilitation training system for various severity strokes in rats.The method provided feedback regarding the rat's measured position to a microprocessor, which adjusted the training speed accordingly and enables the rat to continuously exercise in the middle position of the ladder. This created a cyclic control system that provided various training intensities based on timely evaluations of the ladder climbing capabilities of each rat, thus providing a suitable rehabilitation method for subjects with various stroke severities. The modified neurological severity score, rotarod and cerebral infarction volume results for the 60‐and 90‐min middle cerebral artery occlusion(MCAO) treadmill groups did not differ significantly from those of the control group.Conversely, the cerebral infarction volumes of the ladder climbing rehabilitation groups in the 30‐, 60‐, and 90‐min MCAO were all significantly lower than those of the control group(84.03�23.24vs. 256.77�85.63(mm3), 265.19�41.12versus377.17�90.97(mm3), and 303.80�47.15versus452.68�90.44(mm3) respectively), therebyindicatingthe optimisedladder‐climbingmethodas effective for subjectswithvariousstrokese-verities. Individualdifferencesmay causedifferentexercise capacitiesfor each participant.To accommodatefor theseexercise capacities, an optimisedladder‐climbingrehabilitationtrainingsystemwas proposed,whichprovided trainingaccordingto the physical abilitiesof eachparticipant.

Prophylactic Therapies for Morbidity and Mortality After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Network Meta-Analysis of Randomized Trials

So you found benefits. Where is the protocol located and what is your plan to deliver it to all stroke hospitals?

Prophylactic Therapies for Morbidity and Mortality After Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Network Meta-Analysis of Randomized Trials

Mojtaba Dayyani

,

Behnam Sadeghirad

,

James C. Grotta

,

Samira Zabihyan

,

Saba Ahmadvand

,

Yuting Wang

,

Gordon H. Guyatt

and

Sepideh Amin-Hanjani

Originally published31 Mar 2022https://doi.org/10.1161/STROKEAHA.121.035699Stroke. 2022;53:1993–2005

Abstract

Background:

Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality and morbidity. We aimed to determine the relative benefits of pharmacological prophylactic treatments in patients with aneurysmal subarachnoid hemorrhage by performing a network meta-analysis of randomized trials.

Methods:

We searched Medline, Web of Science, Embase, Scopus, ProQuest, and Cochrane Central to February 2020. Pairs of reviewers independently identified eligible trials, extracted data, and assessed the risk of bias. Eligible trials compared the prophylactic effects of any oral or intravenous medications or intracranial drug-eluting implants to one another or placebo or standard of care in adult hospitalized patients with confirmed aneurysmal subarachnoid hemorrhage. We used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the certainty of the evidence.

Results:

We included 53 trials enrolling 10 415 patients. Nimodipine likely reduces all-cause mortality compared to placebo (odds ratio [OR],0.73 [95% CI, 0.53–1.00]; moderate certainty; absolute risk reduction (ARR), −3.35%). Nimodipine (OR, 1.46 [95% CI, 1.07–1.99]; high certainty; absolute risk increase, 8.25%) and cilostazol (OR, 3.73 [95% CI, 1.14–12.18]; moderate certainty; absolute risk increase, 23.15%) were the most effective treatments in improving disability at the longest follow-up. Compared to placebo, clazosentan (10 mg/kg; OR, 0.39 [95% CI, 0.22–0.68]; high certainty; ARR, −16.65%), nicardipine (OR, 0.48 [95% CI, 0.24–0.94]; moderate certainty; ARR, −13.70%), fasudil (OR, 0.55 [95% CI, 0.31–0.98]; moderate certainty; ARR, −11.54%), and magnesium (OR, 0.66 [95% CI, 0.46–0.94]; high certainty; ARR, −8.37%) proved most effective in reducing the likelihood of delayed cerebral ischemia.

Conclusions:

Nimodipine and cilostazol are likely the most effective treatments in preventing morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage. Clazosentan, nicardipine, fasudil, and magnesium showed beneficial effects on delayed cerebral ischemia and vasospasm but they were not found to reduce mortality or disability. Future trials are warranted to elaborately investigate the prophylactic effects of medications that may improve mortality and long-term functional outcomes, such as cilostazol and clazosentan.

Registration:

URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42019122183.

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Sedentary behavior patterns over 6 weeks among ambulatory people with stroke

Sedentary time is a secondary problem. Because you haven't solved the primary problem of 100% recovery. Work on the correct problem! Your mentors and senior researchers are failing you for not pointing you to the correct research topics.

Sedentary behavior patterns over 6 weeks among ambulatory people with stroke

Topics in Stroke Rehabilitation , Volume 28(7) , Pgs. 537-544.

NARIC Accession Number: J87581.  What's this?
ISSN: 1074-9357.
Author(s): Kringle, Emily A. ; Skidmore, Elizabeth R. ; Terhorst, Lauren ; Hammel, Joy ; Gibbs, Bethany B..
Project Number: 90AR5023, 90RE5018 (formerly H133E140039).
Publication Year: 2021.
Number of Pages: 8.
Abstract: Study analyzed patterns of sedentary behavior over 6 weeks among ambulatory people with subacute and chronic stroke. Data for 39 community-dwelling adults with stroke pooled from two studies were assessed for sedentary behavior at baseline (T0) and week 6 (T1). Sedentary behavior was measured with the activPAL micro3 following a 7-day wear protocol to obtain mean daily total sitting time, sitting time accumulated in bouts ≥30 minutes, number of sit-to-stand transitions, and fragmentation index (sit-to-stand transitions/total sitting hours). Paired samples t-tests were used to calculate mean group differences in sedentary behavior metrics between T0 and T1. Cohen’s d was calculated to describe the magnitude of within-person change between T0 and T1. There were no statistically significant within-person differences between T0 and T1 on mean daily sitting time (Cohen’s d = −0.21), sitting time accumulated in bouts ≥30 minutes (d = −0.27), number of sit-to-stand transitions (d = −0.02), or the fragmentation index (d = −0.11). The results indicated that sedentary behavior metrics were stable over the 6 weeks. The number of sit-to-stand transitions per day and the fragmentation index appeared to be the most stable indicators over 6 weeks. Future research (You don't need future research , you just need to think!)should confirm these findings and identify correlates of sedentary behavior among people with stroke.(My God, you don't understand you haven't gotten them recovered enough to not be sedentary?)
Descriptor Terms: AMBULATION, BEHAVIOR, BODY MOVEMENT, MEASUREMENTS, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Kringle, Emily A. , Skidmore, Elizabeth R. , Terhorst, Lauren , Hammel, Joy , Gibbs, Bethany B.. (2021). Sedentary behavior patterns over 6 weeks among ambulatory people with stroke.  Topics in Stroke Rehabilitation , 28(7), Pgs. 537-544. Retrieved 12/18/2021, from REHABDATA database.

Blood Pressure Trajectory Groups and Outcome After Endovascular Thrombectomy: A Multicenter Study

 So you didn't come up with a protocol but suggested future trials. What a waste of time and money. 

We need a protocol on blood pressure management post stroke. Too high, not good, too low, not good. Otherwise with no protocol your doctor is just guessing, you better hope they guess correctly.

High Systolic BP After EVT for Stroke Tied to Poor Outcomes December 2020

Low Blood Pressure Associated With Increased Risk of Death Following a Stroke

 November 2021

 

The latest waste here:

Blood Pressure Trajectory Groups and Outcome After Endovascular Thrombectomy: A Multicenter Study

 

Nils H. Petersen

,

Sreeja Kodali

,

Can Meng

,

Fangyong Li

,

Cindy Khanh Nguyen

,

Krithika U. Peshwe

,

Sumita Strander

,

Andrew Silverman

,

Alexandra Kimmel

,

Anson Wang

,

Mohammad Anadani

,

Eyad Almallouhi

, … See all authors

Originally published16 Nov 2021https://doi.org/10.1161/STROKEAHA.121.034408Stroke. 2021;0:STROKEAHA.121.034408

Abstract

Background and Purpose:

Elevated blood pressure after endovascular thrombectomy (EVT) has been associated with an increased risk of hemorrhagic transformation and poor functional outcomes. However, the optimal hemodynamic management after EVT remains unknown, and the blood pressure course in the acute phase of ischemic stroke has not been well characterized. This study aimed to identify patient subgroups with distinct blood pressure trajectories after EVT and study their association with radiographic and functional outcomes.

Methods:

This multicenter retrospective cohort study included consecutive patients with anterior circulation large-vessel occlusion ischemic stroke who underwent EVT. Repeated time-stamped blood pressure data were recorded for the first 72 hours after thrombectomy. Latent variable mixture modeling was used to separate subjects into five groups with distinct postprocedural systolic blood pressure (SBP) trajectories. The primary outcome was functional status, measured on the modified Rankin Scale 90 days after stroke. Secondary outcomes included hemorrhagic transformation, symptomatic intracranial hemorrhage, and death.

Results:

Two thousand two hundred sixty-eight patients (mean age [±SD] 69±15, mean National Institutes of Health Stroke Scale 15±7) were included in the analysis. Five distinct SBP trajectories were observed: low (18%), moderate (37%), moderate-to-high (20%), high-to-moderate (18%), and high (6%). SBP trajectory group was independently associated with functional outcome at 90 days (P<0.0001) after adjusting for potential confounders. Patients with high and high-to-moderate SBP trajectories had significantly greater odds of an unfavorable outcome (adjusted odds ratio, 3.5 [95% CI, 1.8–6.7], P=0.0003 and adjusted odds ratio, 2.2 [95% CI, 1.5–3.2], P<0.0001, respectively). Subjects in the high-to-moderate group had an increased risk of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.82 [95% CI, 1–3.2]; P=0.04). No significant association was found between trajectory group and hemorrhagic transformation.

Conclusions:

Patients with acute ischemic stroke demonstrate distinct SBP trajectories during the first 72 hours after EVT that have differing associations with functional outcome. These findings may help identify potential candidates for future blood pressure modulation trials.

Robot-assisted rehabilitation of hand function

What has your stroke hospital done in the 10 years since this came out to assure 100% recovery of the hand? If nothing, WHY THE HELL ARE THEY EVEN CONSIDERED A STROKE HOSPITAL? The status quo in stroke is a complete failure, if your hospital isn't trying to change that they need to disappear.

Robot-assisted rehabilitation of hand function

Balasubramanian, Sivakumar^*; Klein, Julius^*; Burdet, Etienne

Author Information

Current Opinion in Neurology: December 2010 - Volume 23 - Issue 6 - p 661-670

doi: 10.1097/WCO.0b013e32833e99a4

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Abstract

Purpose of review 

Initial work on robot-assisted neurorehabilitation for the upper extremity aimed primarily at training, reaching movements with the proximal sections of the upper extremity. However, recent years have seen a surge in devices dedicated to hand function. This review describes the state of the art and the promises of this novel therapeutic approach.

Recent findings 

Numerous robotic devices for hand function with various levels of complexity and functionality have been developed over the last 10 years. These devices range from simple mechanisms that support single joint movements to mechanisms with as many as 18 degrees-of-freedom (DOF) that can support multijoint movements at the wrist and fingers. The results from clinical studies carried out with eight out of 30 reported devices indicate that robot-assisted hand rehabilitation reduces motor impairments of the affected hand and the arm, and improves the functional use of the affected hand.

Summary 

The current evidence in support of the robot-assisted hand rehabilitation is preliminary but very promising, and provides a strong rationale for more systematic investigations in the future.