Prediction of delayed cerebral ischemia followed aneurysmal subarachnoid hemorrhage. A machine-learning based study

动脉瘤性蛛网膜下腔出血后迟发性脑缺血的预测。基于机器学习的研究

Delayed Cerebral Ischemia (DCI) is a significant complication following aneurysmal subarachnoid hemorrhage (aSAH) that can lead to poor outcomes. Machine learning techniques have shown promise in predicting DCI and improving risk stratification. Our study highlights the potential of machine learning models in predicting the occurrence of DCI in patients with aSAH. The multilayer perceptron model showed excellent performance, indicating its utility in risk stratification and clinical decision-making. However, further validation and refinement of the models are necessary to ensure their generalizability and applicability in real-world settings. Machine learning techniques have the potential to enhance patient care and improve outcomes in aSAH, but their implementation should be accompanied by careful evaluation and validation.

迟发性脑缺血 (DCI) 是动脉瘤性蛛网膜下腔出血 (aSAH) 后的严重并发症，可导致不良预后。机器学习技术在预测DCI和改善风险分层方面显示出了希望。我们的研究强调了机器学习模型在预测aSAH患者DCI发生方面的潜力。多层感知器模型显示出出色的性能，表明其在风险分层和临床决策中的实用性。但是，有必要对模型进行进一步的验证和完善，以确保其在现实世界中的通用性和适用性。机器学习技术具有增强患者护理和改善aSAH结果的潜力，但其实施应伴随着仔细的评估和验证。

REF: Azzam AY, Vaishnav D, Essibayi MA, et al. Prediction of delayed cerebral ischemia followed aneurysmal subarachnoid hemorrhage. A machine-learning based study. J Stroke Cerebrovasc Dis. 2024;33(4):107553. doi:10.1016/j.jstrokecerebrovasdis.2023.107553 PMID: 38340555

Safety and efficacy profile of off-label use of the Pipeline Embolization Device: A systematic review and meta-analysis

标签外使用PED的安全性和有效性: 系统评价和荟萃分析

The off-label utilization of the Pipeline Embolization Device (PED) is a common practice in numerous medical centers globally. Therefore, we conducted a systematic review and meta-analysis to evaluate the overall outcomes of this off-label usage of PEDs. Off-label use of PEDs can be a safe and effective treatment option for intracranial aneurysms. However, there is a need for more prospective, high-quality, non-industry-funded registry studies and randomized trials to test the efficacy and safety of off-label usage of PEDs and to expand its indications.

PED的标签外使用 (PED) 是全球许多医疗中心的常见做法。因此，我们进行了系统回顾和荟萃分析，以评估ped的这种非标签使用的总体结果。PEDs的标示外使用可能是颅内动脉瘤的安全有效的治疗选择。然而，需要更多的前瞻性，高质量，非行业资助的注册研究和随机试验，以测试PEDs标签外使用的有效性和安全性，并扩大其适应症。

REF: Senol YC, Orscelik A, Bilgin C, et al. Safety and efficacy profile of off-label use of the Pipeline Embolization Device: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2024;33(4):107586. doi:10.1016/j.jstrokecerebrovasdis.2024.107586 PMID: 38242183 PMCID: PMC10939757

Automated evaluation of collateral circulation for outcome prediction in acute ischemic stroke

侧支循环自动评估在急性缺血性卒中预后预测中的应用

The assessment of collateral circulation in acute ischemic stroke management is essential. Modern tools, such as Brainomix's e-CTA, powered by artificial intelligence, provide detailed insights into collateral assessment. This retrospective study aims to identify factors contributing to favorable collateral status and compare outcomes between patients with good collaterals (grade 3) and fair collaterals (grade 0-2). Automated collateral assessment through e-CTA is a valuable tool in acute ischemic stroke evaluation. Good e-CTA collateral score serve as a promising imaging biomarker, guiding informed clinical decisions during Stroke Unit hospitalizations. This study highlights the relationship between collaterals and stroke outcomes and underscores the potential for AI-driven tools to enhance stroke care management.

急性缺血性卒中管理中侧支循环的评估至关重要。现代工具，如Brainomix的e-cta，由人工智能驱动，为抵押品评估提供了详细的见解。这项回顾性研究旨在确定导致侧支状态良好的因素，并比较侧支良好 (3级) 和侧支公平 (0-2级) 患者的结局。通过e-cta进行的自动侧支评估是评估急性缺血性中风的有价值的工具。良好的e-cta抵押品评分可作为有希望的成像生物标志物，在卒中住院期间指导明智的临床决策。这项研究强调了侧支与中风结果之间的关系，并强调了人工智能驱动工具增强中风护理管理的潜力。

REF: Scavasine VC, Stoliar GA, Teixeira BCA, Zétola VHF, Lange MC. Automated evaluation of collateral circulation for outcome prediction in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2024;33(4):107584. doi:10.1016/j.jstrokecerebrovasdis.2024.107584 PMID: 38246577

Aneurysmal subarachnoid hemorrhage occurring during sleep: Clinical characteristics and risk factors

睡眠中发生动脉瘤性蛛网膜下腔出血的临床特征及危险因素

Aneurysmal subarachnoid hemorrhage (aSAH) is known to be triggered by several specific human activities. Sleep, by contrast, has not been considered a triggering activity for aSAH, and clinical characteristics of patients who sustain aSAH during sleep have rarely been reported in the literature. The current results indicate that risk factors may exist for aSAH occurring during sleep. Further investigations on how comorbidities such as diabetes, antiplatelet use and sleep apnea affect human hemodynamic and hemostatic parameters during sleep is warranted to better understand those relationships.

已知动脉瘤性蛛网膜下腔出血 (aSAH) 是由几种特定的人类活动引发的。相比之下，睡眠尚未被认为是aSAH的触发活动，并且在睡眠期间维持aSAH的患者的临床特征在文献中很少报道。目前的结果表明，在睡眠期间发生aSAH的风险因素可能存在。需要进一步研究糖尿病，抗血小板药物使用和睡眠呼吸暂停等合并症如何影响睡眠期间人类的血液动力学和止血参数，以更好地了解这些关系。

REF: Inamasu J, Akiyama T, Akaji K, et al. Aneurysmal subarachnoid hemorrhage occurring during sleep: Clinical characteristics and risk factors. J Stroke Cerebrovasc Dis. 2024;33(4):107591. doi:10.1016/j.jstrokecerebrovasdis.2024.107591 PMID: 38266691

Endovascular thrombectomy for acute ischemic stroke in Saudi Arabia: A single-center experience

沙特阿拉伯急性缺血性卒中的血管内血栓切除术: 单中心经验

This study aimed to investigate the outcomes of endovascular thrombectomy-treated patients in King Fahad Medical City, Riyadh, Saudi Arabia. The number of patients who underwent endovascular thrombectomy has increased over time. The treatment outcomes and mortality were comparable with those of previous endovascular thrombectomy registries despite the high prevalence of DM, lower ASPECT score, and prolonged onset-to-recanalization time.

本研究旨在调查沙特阿拉伯利雅得国王法哈德医疗城接受血管内血栓切除术治疗的患者的结局。接受血管内血栓切除术的患者数量随着时间的推移而增加。尽管DM的患病率较高，ASPECT评分较低且发作至再通时间延长，但治疗结果和死亡率与先前的血管内血栓切除术相当。

REF: Alhazmi H, Ameen OK, Almalki Z, et al. Endovascular thrombectomy for acute ischemic stroke in Saudi Arabia: A single-center experience. J Stroke Cerebrovasc Dis. 2024;33(4):107552. doi:10.1016/j.jstrokecerebrovasdis.2023.107552 PMID: 38277959

Evolution pattern estimated by computed tomography perfusion post-thrombectomy predicts outcome in acute ischemic stroke

血栓切除术后计算机断层扫描灌注估计的演变模式可预测急性缺血性卒中的预后

Computed tomography perfusion (CTP) and computed tomography angiography (CTA) have been recommended to select acute ischemic stroke (AIS) patients for endovascular thrombectomy (EVT) but are not widely used for post-treatment evaluation. We aimed to observe abnormalities in CTP and CTA before and after EVT and evaluate post-EVT CTP and CTA as potential tools for improving clinical outcome prediction. The addition of pretreatment and post-treatment CTP information to purely clinical NIHSS scores might help to improve the efficacy for good outcome prediction after EVT.

计算机断层扫描灌注 (CTP) 和计算机断层扫描血管造影 (CTA) 已被推荐用于选择急性缺血性卒中 (AIS) 患者进行血管内血栓切除术 (EVT)，但尚未广泛用于治疗后评估。我们旨在观察EVT前后CTP和CTA的异常，并评估EVT后CTP和CTA作为改善临床结果预测的潜在工具。将治疗前和治疗后的CTP信息添加到纯粹的临床NIHSS评分中可能有助于提高EVT后良好结果预测的功效。

REF: Dai X, Yan C, Yu F, et al. Evolution pattern estimated by computed tomography perfusion post-thrombectomy predicts outcome in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2024;33(4):107555. doi:10.1016/j.jstrokecerebrovasdis.2024.107555 PMID: 38281386

Validation of Vascular Location Subcodes for Acute Ischemic Stroke by the International Classification of Diseases-10

国际疾病分类-10对急性缺血性卒中血管定位子编码的验证

Vascular region of infarct is part of the International Classification of Diseases-10 (ICD-10) coding scheme for ischemic stroke. These data could potentially be used for studies about vascular location, such as comparisons of anterior versus posterior circulation stroke. The objective of this study was to evaluate the validity of these subcodes. We found that ICD-10 classification of vascular location in routine practice correlates strongly with gold-standard localization for hospitalized ischemic stroke and supports validity in differentiating posterior versus anterior circulation. At a more granular vascular level, the location reliability was excellent, although limited data were available for some subcodes.

梗塞的血管区域是缺血性中风的国际疾病分类-10 (ICD-10) 编码方案的一部分。这些数据可能用于血管位置的研究，例如前循环与后循环中风的比较。这项研究的目的是评估这些子代码的有效性。我们发现，常规实践中血管位置的ICD-10分类与住院缺血性卒中的金标准定位密切相关，并支持区分后循环和前循环的有效性。在更粒状的血管水平上，尽管某些子代码的可用数据有限，但位置可靠性极佳。

REF: Hirsch JL, Burke JF, Kerber KA. Validation of Vascular Location Subcodes for Acute Ischemic Stroke by the International Classification of Diseases-10. J Stroke Cerebrovasc Dis. 2024;33(4):107590. doi:10.1016/j.jstrokecerebrovasdis.2024.107590 PMID: 38281583

Multicenter exploration of tenecteplase transition factors: A quantitative analysis

tenecteplase转换因子的多中心探索: 定量分析

Tenecteplase (TNK) is gaining recognition as a novel therapy for acute ischemic stroke (AIS). Despite TNK offering a longer half-life, time and cost saving benefits and comparable treatment and safety profiles to Alteplase (ALT), the adoption of TNK as a treatment for AIS presents challenges for hospital systems. Understanding common barriers and facilitators to TNK adoption can assist acute care hospitals deciding to implement TNK as a treatment for AIS. These findings will be used to design a TNK adoption Toolkit, utilizing implementation science techniques, to address identified obstacles and to leverage facilitators.

Tenecteplase (TNK) 作为急性缺血性卒中 (AIS) 的一种新的治疗方法正在获得认可。尽管TNK提供了更长的半衰期，节省时间和成本的益处以及与阿替普酶 (ALT) 相当的治疗和安全性，但采用TNK作为AIS的治疗方法对医院系统提出了挑战。了解采用TNK的常见障碍和促进者可以帮助急诊医院决定实施TNK作为AIS的治疗方法。这些发现将用于设计TNK采用工具包，利用实施科学技术，解决已发现的障碍并利用促进者。

REF: Prasad S, Jones EM, Gebreyohanns M, et al. Multicenter exploration of tenecteplase transition factors: A quantitative analysis. J Stroke Cerebrovasc Dis. 2024;33(4):107592. doi:10.1016/j.jstrokecerebrovasdis.2024.107592 PMID: 38266690

Prospective study on ultrasound-guided stellate ganglion block improves cerebral blood flow in patients with stroke

超声引导下星状神经节阻滞改善脑卒中患者脑血流的前瞻性研究

The effect of routine internal medicine and stroke rehabilitation treatment was not good. To confirm that ultrasound-guided stellate ganglion block (SGB) can improve cerebral blood flow in patients with stroke, Transcranial Doppler (TCD) and carotid ultrasound were used to monitor the cerebral blood flow parameters of ultrasound-guided SGB in patients with stroke. Ultrasound-guided stellate ganglion block could improve local cerebral blood flow and vascular compliance in patients with stroke, and reduce vascular resistance.

常规内科及脑卒中康复治疗效果不佳。为证实超声引导下星状神经节阻滞 (SGB) 可改善脑卒中患者的脑血流，采用经颅多普勒 (TCD) 和颈动脉超声监测脑卒中患者超声引导下SGB的脑血流参数。超声引导下星状神经节阻滞可改善脑卒中患者局部脑血流量和血管顺应性，降低血管阻力。

REF: Sun L, Wu G, Zhou Y, Deng A, Chen Z. Prospective study on ultrasound-guided stellate ganglion block improves cerebral blood flow in patients with stroke. J Stroke Cerebrovasc Dis. 2024;33(4):107593. doi:10.1016/j.jstrokecerebrovasdis.2024.107593 PMID: 38290686