Background and PurposeMeasuring the extent of the collateral blood vessels using computed tomography (CT) angiography source images may promote tissue survival and functional gain in acute ischemic stroke patients who are candidates for endovascular recanalization treatment.MethodsOf 5,558 acute stroke patients registered in a prospective clinical stroke registry, 104 met the selection criteria of endovascular recanalization treatment for internal cerebral artery or middle cerebral artery main-stem (M1) occlusions and presented for treatment ≤4 hours after the event. Using CT angiography source images, two independent and blinded reviewers measured the extent of collateral circulations at four regions, with good interrater reliability. The functional recovery at 3 months after stroke was used as an outcome variable.ResultsCases with a sufficient collateral circulation at the Sylvian fissure showed significantly increased likelihood of having a modified Rankin Scale score of ≤2 at 3 months after stroke (adjusted odds ratio=3.03, 95% confidence interval=1.19–7.73, p=0.02), but the association became nonsignificant after adding the infarct volume to the model (p=0.65). The association between leptomeningeal convexity collaterals and functional recovery was no longer significant after adjusting for the infarct volume (p=0.28). The natural indirect effect of infarct volume on functional recovery was significant for both the Sylvian fissure (p=0.03) and leptomeningeal convexity (p=0.02) collaterals.ConclusionsThe extent of collateral circulation at the Sylvian fissure was significantly associated with functional recovery, which may be mediated via the volume of the final infarction.

We synthesized peptide-resin conjugates (1 and 2) by immobilizing β-sheet antibacterial peptide and α helical antibacterial peptide on PEG-PS resin, respectively. Conjugate 1 showed considerable antibacterial activity in various conditions, whereas conjugate 2 did not exhibit antibacterial activity. The growths of various bacteria were inhibited by conjugate 1 even at lower concentrations than MIC. Conjugate 1 killed bacteria at MIC and had a potent synergistic effect with current antibacterial agents such as vancomycin and tetracycline, respectively. Overall results indicate that polymer surface modification using antibacterial β sheet peptide is a powerful way to prevent microbial contamination on polymer surfaces.

Background: Despite its clinical importance in the Koreans, the status of recanalization therapy for acute occlusion of the intracranial cerebral arteries has not been reported yet. Methods: Using a nationwide stroke registry, a consecutive series of 642 patients with symptomatic occlusion of intracranial arteries were identified among 3028 who were hospitalized within 12 h of stroke onset at 10 participating centers between 2010 and 2011. Demographics, clinical characteristics, clinical outcomes, and type of recanalization therapy were described. Results: The mean age was 68.6 years (57.2% males, median baseline NIHSS 12). MCA was most commonly affected vessel (65.1%), followed by intracranial ICA (15.3%), PCA (14.2%), basilar artery (11.1%), and ACA (5.1%). Recanalization therapy was applied in 307 patients (47.8%); intravenous thrombolysis only (IVT) in 45.9%, and endovascular treatment (ET) in 54.1%. Intravenous thrombolysis treatment preceded ET in 69.9%. Doses of tPA were 0.6mg/kg in 22.3% and 0.9mg/kg in 77.7%. Recanalization therapy according to occluded vessels and onset-to-arrival time is described in the Table. Recanalization by IAT as seen on angiography was complete (thrombolysis in cerebral infarction [TICI] grade 3) in 29.5% and partial (TICI grade 2A or 2B) in 50.6%. Solitaire were applied to 48.8% of patients with ET and recanalization rate was 86.4%, and Penumbra were applied to 15.1% and recanalization rate (TICI grade 2A~3) was 76.0%. Favorable outcome (modified Rankin Scale, 0-2) was achieved in 39.4% of those with IVT and in 35.4% of those with ET, and symptomatic hemorrhagic transformation occurred in 8.5% and 12.0%, respectively. Conclusion: This study shows that a considerable proportion of patients with symptomatic occlusion of intracranial cerebral arteries are treated by endovascular approach. Efficacy and safety of endovascular approach in this setting should be tested by randomized clinical trials.

Introduction: Statin has the potential to be effective in the early phase of recanalization. However it is largely unknown in which group, when, and at what doses statin use is beneficial after recanalization. Methods: From a total of 7663 stroke cases of Seoul National University Bundang Hospital between July 2007 and Dec 2015, we collected eligible cases with the following inclusion criteria; (1) Lesion-documented ischemic stroke (N=6151); (2) received recanalization treatment (N=908). We excluded cases with missing in (1) the time information (N=26) and (2) modified Rankin Score (mRS) at 3 months (N=1). We gathered the exact timing, type, dose of statin use from a database of electronic bar-code medication administration system. Multivariable ordinal logistic regression was performed for mRS at 3 months (improved outcome). Results: Of the 881 analyzable cases (male, 58%; mean age, 68.9; median initial NIHSS score, 12), recanalization treatment consisted of 33% of IV-only, 33% of IA-only and 34% of combined IV-IA strategies. Stroke mechanisms were 26% of large artery atherosclerosis (LAA), 49% of cardioembolism (CE) and 25% of non-LAA/CE. Statins were administered in the acute phase (within 7 days) in 68% (n=598) patients (<24 hours in 35% [n=307] and 24-72 hours in 43% [n=170]). High intensity statins (atorvastatin 40-80 mg or rosuvastatin 20 mg) were used in 72% (n=429) and low-to-moderate intensity statins in 28% (n=169). Multivariable analyses revealed acute statin (within 7 days) was associated with improved outcome, especially in patients with IA treatment or when used within 24 hours. Low-to-moderate intensity statin was associated with improved outcome, but high intensity statin was not. Conclusions: Acute statin use after recanalization treatment may positively influence functional outcome, more in patients with IA treatment or when used within 24 hours. Low-to-moderate intensity statin may be as beneficial as high intensity statin after recanalization.

Background: Majority of hemorrhagic transformation (HTf) occurs within 24 hours after IV or IA treatment, and earlier antithrombotics may be useful in preventing early reocclusions or ischemic neurologic deteriorations. However, the safety of early antithrombotics ≤24-hour after recanalization treatment is not sufficiently evaluated. Methods: From a total of 6777 stroke cases who admitted to Seoul National University Bundang Hospital between July 2007 and March 2015, the authors collected eligible cases with the following inclusion criteria; (1) Lesion-documented ischemic strokes (N=5451); (2) received recanalization treatments (N=792). We excluded 72 cases with (1) missing in the time information (N=19), (2) ultraearly bleeding complications (N=41), (3) extremely grave prognosis (N=5), and (4) surgical treatment (N=7). We systemically gathered the exact timing of antithrombotics use from a database of electronic bar-code medication administration system. Results: Of the 720 analyzable cases, male was 57% (n=407), mean age was 68.9 ± 12.8, and median NIHSS score was 12 [7 - 19] point. Recanalization treatment was consisted of 34% (n=243) of IV-only, 32% (=231) of IA-only, and 34% (n=246) of combined IV-IA strategies. Outcomes after stroke was as following; 218 (30%) any HTf, 31 (4%) symptomatic HTf, and 266 (37%) mRS score 0 - 1 at 3 months. In this population, antithrombotics were initiated within 24 hours after recanalization treatment in 64% (n=458) of cases and within 12 hours in 24% (n=170) of patients. Multivariable analyses revealed that early initiation of antithrombotics within 24 hours after recanalization treatment was significantly associated with lower odds of having any HTf (adjusted OR, 0.69; 95% CI, 0.48 - 0.98). Early initiation was not significantly associated with symptomatic HTf (0.71; 0.34 - 1.46) and mRS score 0 - 1 at 3 months after stroke (1.41; 0.97 - 2.06). Conclusions: Earlier initiation of antithrombotics within 24 hours after recanalization treatment may not increase hemorrhagic complications after stroke. Further clinical research is warranted to clarify which subgroup of stroke patients will benefit of earlier antithrombotics.