Dramatic Recovery in Acute Ischemic Stroke Is Associated With Arterial Recanalization Grade and Speed

Mazighi, Mikaël; Meseguer, Elena; Labreuche, Julien; Serfaty, Jean-Michel; Laissy, Jean-Pierre; Lavallée, Philippa C.; Cabrejo, Lucie; Guidoux, Céline; Lapergue, Bertrand; Klein, Isabelle; Olivot, Jean‐Marc; Rouchaud, Aymeric; Desilles, Jean‐Philippe; Schouman-Claeys, É.; Amarenco, Pierre

doi:10.1161/strokeaha.112.658849

Cited by 38 publications

(28 citation statements)

References 19 publications

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“…Previous studies found DR in 20-40% of patients with MCA strokes submitted to IV thrombolysis [1][2][3], and we hypothesize the DR frequency we found is in the lower end of this range because we also included patients with ICA occlusions.…”

Section: Discussionmentioning

confidence: 67%

“…Recanalization was one of the first described independent predictors of DR, confirmed by transcranial Doppler (TCD) [1,3], angiography and MR-angiography studies [2,4], but not every patient with successful vessel recanalization after stroke achieves DR or even a good clinical outcome. Early TCD studies showed a trend for DR patients to be treated earlier [1].…”

Section: Discussionmentioning

confidence: 99%

“…Dramatic recovery (DR), the early and stable clinical improvement after recanalization therapies in the setting of acute ischemic stroke [1], has been reported to occur in 20-40% of patients with middle cerebral artery (MCA) stroke, submitted to intravenous (IV) thrombolysis [1][2][3]. Frequency varies depending on the definition of DR, hindering comparisons.…”

Section: Introductionmentioning

confidence: 99%

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Dramatic recovery after IV thrombolysis in anterior circulation ischemic stroke: Predictive factors and prognosis

Rocha

Pinho

Varanda

et al. 2014

Clinical Neurology and Neurosurgery

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a b s t r a c tBackground and purpose: Dramatic recovery (DR) after thrombolysis is dependent of vessel recanalization and is predictive of favorable clinical outcome. Successful recanalization is not equivalent to DR. Our objective was to assess its frequency and evaluate clinical and biochemical predictors and their prognosis. Methods: We analyzed prospectively registered data from January 2007 to September 2012. All patients with anterior circulation stroke and NIHSS ≥ 10 were included. Improvement of ≥10 or a score ≤3 24 h after thrombolysis was defined as DR. Results: In the 230 patients included, DR frequency was 23% (53 patients). DR group had lower admission NIHSS (14 vs 17, p = 0.024), less total anterior circulation infarcts (p = 0.009), more partial anterior circulation infarcts (p = 0.003) and lower blood glucose on admission (118 vs 128 mg/dL, p = 0.013). All patients with DR had an Alberta Stroke Program Early CT Score (ASPECTS) ≥7, vs 89.3% without DR (p = 0.013). Arterial recanalization, defined as hyperdense middle cerebral artery sign disappearance on control CT, was more frequent in the DR group (68.4% vs 14.1%, p < 0.001). Intracranial hemorrhage on 24 h-control CT scan was less frequent in the DR group (p < 0.001). Multinomial logistic regression analysis showed that ASPECTS score was an independent predictor of DR (OR = 2.35, 95%CI = 1.32-4.16, p = 0.003) and CT evidence of recanalization was independently associated with DR (OR = 11.60, 95%CI, 3.02-44.53, p < 0.001). Conclusion: DR is a frequent occurrence. ASPECTS score is an independent predictor of DR, which is also independently associated with CT evidence of middle cerebral artery recanalization.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dramatic recovery after IV thrombolysis in anterior circulation ischemic stroke: Predictive factors and prognosis

Rocha

Pinho

Varanda

et al. 2014

Clinical Neurology and Neurosurgery

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“…[9][10][11] In this context, prompt revascularization of stroke is associated with improved outcome. [12][13][14] For instance in humans, elevated levels of vascular endothelial growth factor (VEGF) are observed after stroke, and increased microvascular density correlates with a better outcome. 15,16 In animal models, intracerebral injections of proangiogenic factors greatly enhance motor functions.…”

mentioning

confidence: 99%

G-Protein–Coupled Receptor 91 and Succinate Are Key Contributors in Neonatal Postcerebral Hypoxia-Ischemia Recovery

Hamel

Sanchez

Duhamel

et al. 2014

ATVB

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Objective-Prompt post-hypoxia-ischemia (HI) revascularization has been suggested to improve outcome in adults and newborn subjects. Other than hypoxia-inducible factor, sensors of metabolic demand remain largely unknown. During HI, anaerobic respiration is arrested resulting in accumulation of carbohydrate metabolic intermediates. As such succinate readily increases, exerting its biological effects via a specific receptor, G-protein-coupled receptor (GPR) 91. We postulate that succinate/GPR91 enhances post-HI vascularization and reduces infarct size in a model of newborn HI brain injury. Approach and Results-The Rice-Vannucci model of neonatal HI was used. Succinate was measured by mass spectrometry, and microvascular density was evaluated by quantification of lectin-stained cryosection. Gene expression was evaluated by real-time polymerase chain reaction. Succinate levels rapidly increased in the penumbral region of brain infarcts. GPR91 was foremost localized not only in neurons but also in astrocytes. Microvascular density increased at 96 hours after injury in wild-type animals; it was diminished in GPR91-null mice leading to an increased infarct size. Stimulation with succinate led to an increase in growth factors implicated in angiogenesis only in wild-type mice. To explain the mode of action of succinate/GPR91, we investigated the role of prostaglandin E 2 -prostaglandin E receptor 4, previously proposed in neural angiogenesis. Succinate-induced vascular endothelial growth factor expression was abrogated by a cyclooxygenase inhibitor and a selective prostaglandin E receptor 4 antagonist. This antagonist also abolished succinate-induced neovascularization. Conclusions-We uncover a dominant metabolic sensor responsible for post-HI neurovascular adaptation, notably succinate/ GPR91, acting via prostaglandin E 2 -prostaglandin E receptor 4 to govern expression of major angiogenic factors. We propose that pharmacological intervention targeting GPR91 could improve post-HI brain recovery. [20][21][22] Yet, their mode of action has generally remained inexplicable, until membrane-bound receptors that are specifically activated by these metabolites have been identified. 23 In this context, succinate has been shown to contribute to the developmental and possibly aberrant retinal neovascularization presumably through actions on G-protein-coupled receptor (GPR) 91 independent of hypoxia-inducible factor activation 24 ; accordingly, siRNAand shRNA-GPR91 interfere with developmental angiogenesis and partly with abnormal preretinal neovascularization. Nonstandard Abbreviations and Acronyms EP4prostaglandin E receptor 4 GPR G-protein-coupled receptor HI hypoxia-ischemia VEGF Vascular endothelial growth factor Figure 1. Succinate accumulates in the penumbral region after cerebral hypoxia-ischemia (HI) where G-protein-coupled receptor (GPR) 91 is expressed in neurons and astrocytes. A, GPR91 colocalizes with NeuN (i) and glial fibrillary acidic protein (GFAP) (ii) in the rat cerebral cortex. Rabbit anti-GPR91 was used to l...

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“…U terapiji akutnog ishemijskog moždanog udara (AIMU) za očuvanje vitalnosti moždanog tkiva najznačajnija je brza restauracija cerebralnog krvnog protoka, koja se najčešće sprovodi intravenskom primenom rekombinantnog tkivnog aktivatora plazminogena (rtPA) u "terapijskom prozoru" od 4,5 h nakon početka simptoma (6). Uspešnost lečenja zavisi od niza faktora, a najvažniji su stepen i brzina uspostavljanja rekanalizacije i nastanak hemoragične transformacije infarkta (7). Rezultati studije koja je posmatrala ishod bolesnika lečenih intravenskom trombolizom kroz procenu neurološkog deficita, funkcionalnosti i stopu smrtnosti govore u prilog tome da je 3 meseca nakon njene primene jedna trećina bolesnika bila bez ili sa minimalnim neurološkim deficitom, 50-70% bolesnika je bilo funkcionalno nezavisno, dok je smrtnost iznosila 7-14% (8).…”

Section: Uvodunclassified

Efficacy and safety of intravenous thrombolysis in young adults with acute ischemic stroke

Arsenijević¹,

Blagojevic²,

Jovanović³

2017

Med podmladak

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Introduction: Stroke in young people has a major socioeconomic impact, since up to 30% of young patients may die or have permanent sequelae with expected longer survival than older patients. Aim: The aim is to investigate the efficacy and safety of intravenous thrombolysis in the young adults with acute ischemic stroke (AIS) comparing to elderly patients. Material and Methods: A total of 403 patients suffering from AIS treated with intravenous thrombolysis, were divided by age into two groups: patients aged 18 to 45 (n = 59) and patients older than 45 years (n = 344). The functional outcome, assessed by modified Rankin scale (mRS), was used as a measure of therapy efficacy, and the presence of symptomatic intracerebral hemorrhage (sICH) and mortality as a measure of thrombolysis safety. The follow-up period was 3 months after stroke onset. Results: There were no difference between two groups of patients in excellent functional outcome (mRS ≤ 1) (p = 0.149) and good functional outcome (mRS ≤ 2) (p = 0.156), while the rate of death was significantly lower in the group of younger patients (18-45 years 5.2% vs. > 45 years 17.0% , p = 0.019). Also, there was no statistically significant difference in the presence and type of sICH between these 2 groups of patients. Conclusion: There is no significant difference in good and excellent functional outcome, as well as the incidence of sICH in young adult patients with AIS treated with intravenous thrombolysis, compared to the older patients. The fatal outcome is lower in the group of younger AIS patients.

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Dramatic Recovery in Acute Ischemic Stroke Is Associated With Arterial Recanalization Grade and Speed

Cited by 38 publications

References 19 publications

Dramatic recovery after IV thrombolysis in anterior circulation ischemic stroke: Predictive factors and prognosis

Dramatic recovery after IV thrombolysis in anterior circulation ischemic stroke: Predictive factors and prognosis

G-Protein–Coupled Receptor 91 and Succinate Are Key Contributors in Neonatal Postcerebral Hypoxia-Ischemia Recovery

Efficacy and safety of intravenous thrombolysis in young adults with acute ischemic stroke

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