No-reflow phenomenon following stroke recanalization therapy: Clinical assessment advances: A narrative review

Kan, Yuan; Li, Sijie; Zhang, Bowei; Ding, Yuchuan; Zhao, Wenbo; Ji, Xunming

doi:10.4103/bc.bc_37_23

Cited by 14 publications

(4 citation statements)

References 56 publications

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“…A significant difference was observed in the median 24-hour NIHSS scores among the 4 groups (P=0.008). In pairwise comparisons, significant differences were observed in the median 24-hour NIHSS scores in comparison to both the NBO-4h (6 [IQR, [4][5][6][7][8][9][10][11][12]) and the NBO-6h (7 [IQR, [5][6][7][8][9][10][11][12]) groups with the control group (11 [IQR, [3][4][5][6][7][8][9][10][11][12][13]; P=0.007 and P=0.010, respectively) and the NBO-2h groups (10 [IQR, 7-14]; P=0.02 and P=0.029, respectively). However, no significant differences were observed between the NBO-2h group and the control group or between the NBO-4h group and the NBO-6h group (Table 3; see pairwise comparisons in Table S1).…”

Section: Secondary Efficacy Outcomesmentioning

confidence: 98%

“…Significant differences in the 7-day NIHSS scores were observed among the 4 groups (P=0.04; Table 3). Pairwise comparisons revealed that the NBO-4h (5 [IQR, [2][3][4][5][6][7][8][9][10][11][12]) and NBO-6h (6 [IQR, 4-10]) groups had significant differences compared with the control group (9 [IQR, [7][8][9][10][11][12]; P=0.018 and P=0.027, respectively). However, there were no significant differences between the NBO-2h group and the control group (P>0.05) or between the NBO-4h group and the NBO-6h group (P>0.05); see pairwise comparisons in Table S1.…”

Section: Secondary Efficacy Outcomesmentioning

confidence: 99%

“…The improvement in the median 72-hour NIHSS score in the NBO-4h (6 [IQR, 4-10]) and NBO-6h (6.5 [IQR, 4-10]) groups was higher than that in the control group (10 [IQR,(7)(8)(9)(10)(11)(12)) and NBO-2h (8 [IQR, 6-10]) groups; however, these differences were not significant (P>0.05; Table 3).…”

Section: Secondary Efficacy Outcomesmentioning

confidence: 99%

“…4,5 This disparity can be attributed to several factors, including the limited salvageable ischemic penumbra during vascular recanalization and the occurrence of reperfusion injury following the reopening of the vessel. [6][7][8] Considering these challenges, we proposed a multistage, sequential treatment approach that builds upon vascular recanalization. This approach aims to optimize protection of the ischemic penumbra before recanalization and to mitigate reperfusion injury after the vessel is reopened.…”

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confidence: 99%

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Normobaric Hyperoxia Combined With Endovascular Treatment Based on Temporal Gradient: A Dose-Escalation Study

Li,

Wang,

Liu

et al. 2024

Stroke

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BACKGROUND: Normobaric hyperoxia (NBO) has neuroprotective effects in acute ischemic stroke. Thus, we aimed to identify the optimal NBO treatment duration combined with endovascular treatment. METHODS: This is a single-center, randomized controlled, open-label, blinded-end point dose-escalation clinical trial. Patients with acute ischemic stroke who had an indication for endovascular treatment at Tianjin Huanhu Hospital were randomly assigned to 4 groups (1:1 ratio) based on NBO therapy duration: (1) control group (1 L/min oxygen for 4 hours); (2) NBO-2h group (10 L/min for 2 hours); (3) NBO-4h group (10 L/min for 4 hours); and (4) NBO-6h group (10 L/min for 6 hours). The primary outcome was cerebral infarction volume at 72 hours after randomization using an intention-to-treat analysis model. The primary safety outcome was the 90-day mortality rate. RESULTS: Between June 2022 and September 2023, 100 patients were randomly assigned to the following groups: control group (n=25), NBO-2h group (n=25), NBO-4h group (n=25), and NBO-6h group (n=25). The 72-hour cerebral infarct volumes were 39.4±34.3 mL, 30.6±30.1 mL, 19.7±15.4 mL, and 22.6±22.4 mL, respectively ( P =0.013). The NBO-4h and NBO-6h groups both showed statistically significant differences (adjusted P values: 0.011 and 0.027, respectively) compared with the control group. Compared with the control group, both the NBO-4h and NBO-6h groups showed significant differences ( P <0.05) in the National Institutes of Health Stroke Scale scores at 24 hours, 72 hours, and 7 days, as well as in the change of the National Institutes of Health Stroke Scale scores from baseline to 24 hours. Additionally, there were no significant differences among the 4 groups in terms of 90-day mortality rate, symptomatic intracranial hemorrhage, early neurological deterioration, or severe adverse events. CONCLUSIONS: The effectiveness of NBO therapy was associated with oxygen administration duration. Among patients with acute ischemic stroke who underwent endovascular treatment, NBO therapy for 4 and 6 hours was found to be more effective. Larger-scale multicenter studies are needed to validate these findings. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05404373.

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Section: Secondary Efficacy Outcomesmentioning

confidence: 98%

Section: Secondary Efficacy Outcomesmentioning

confidence: 99%

Section: Secondary Efficacy Outcomesmentioning

confidence: 99%

mentioning

confidence: 99%

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Normobaric Hyperoxia Combined With Endovascular Treatment Based on Temporal Gradient: A Dose-Escalation Study

Li,

Wang,

Liu

et al. 2024

Stroke

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Intermittent hypoxia training improves cerebral blood flow without cognitive impairment

Zhang,

Wang,

Jin

et al. 2024

Ann Clin Transl Neurol

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ObjectiveBrief exposure to intermittent hypoxia has been shown to potentially induce protective effects in the body. Animal studies suggest that intermittent hypoxia could increase cerebral blood flow and confer resistance to subsequent hypoxic–ischemic injury, yet clinical investigations are limited. This study aimed to evaluate the impact of a moderate short‐term intermittent hypoxia protocol on cerebral blood flow and cognitive performance.MethodsSubjects who met the inclusion criteria were recruited to this study and randomized into the intermittent hypoxia group or the control group, which receives intermittent hypoxia training and sham‐intermittent hypoxia training, respectively. Cerebral hemodynamics, cognitive performance, cerebral perfusion pressure, and oxygen saturation were assessed before and after the intervention.ResultsA total of 100 healthy participants were included in this study. Compared to the control group, the intermittent hypoxia group exhibited higher peak systolic blood flow velocity (108.64 ± 22.53 vs. 100.21 ± 19.06, p = 0.049) and cerebrovascular conduction index (0.74 ± 0.17 vs. 0.66 ± 0.21, p = 0.027), and lower cerebrovascular resistance index (1.41 ± 0.29 vs. 1.54 ± 0.36, p = 0.044) following intermittent hypoxia training. Additionally, within‐group comparisons revealed that intermittent hypoxia training led to increased cerebral blood flow velocity, elevated cerebrovascular conductance index, and decreased cerebrovascular resistance index (p < 0.05). Other indicators including cognitive function, cerebral perfusion pressure, and oxygen saturation did not exhibit significant differences between groups.InterpretationThese findings revealed that intermittent hypoxia may represent a safe and effective strategy for improving cerebral blood flow.

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Diabetes Mellitus and Risk of Future Stroke: Evidence From CHARLS and Mendelian Randomization Analyses

Bai,

Wang,

et al. 2024

Brain and Behavior

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Objectives: This study leveraged the China Health and Retirement Longitudinal Study (CHARLS) to explore the association between diabetes and stroke in middle‐aged and older adults in East Asia and assess the causality of this relationship using Mendelian randomization.Methods: Data from the 2011–2020 CHARLS cohort identified individuals with diabetes at baseline. Stroke incidence was self‐reported through standardized questionnaires. Logistic regression and restricted cubic spline analysis examined the relationship between diabetes and stroke risk alongside nonlinear correlations between glucose levels and stroke. Mendelian randomization clarified the causal link and analyzed the mediating effect between diabetes and stroke using genetic methods.Results: In the study population aged 45 and above, stroke incidence was 5.99% in normoglycemic, 6.82% in prediabetic, and 9.93% in diabetic individuals. Over 7 years, 473 strokes occurred. Diabetes was associated with a 1.35‐fold increased stroke risk compared to normoglycemia (OR = 1.35; 95% CI: 1.03–1.79). Subgroup analyses highlighted higher stroke risks in middle‐aged women, nonsmokers, and nondrinkers. Mendelian randomization supports a genetic causal relationship between diabetes and stroke. Diabetes may indirectly lead to stroke through the mediating effects of hypertension and high cholesterol.Conclusion: The findings confirm a significant association and causal link between diabetes and stroke risk in an East Asian population. In addition, the results indicate that controlling blood glucose in prediabetic individuals reduces stroke risk, with no similar benefits in diabetes.

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No-reflow phenomenon following stroke recanalization therapy: Clinical assessment advances: A narrative review

Cited by 14 publications

References 56 publications

Normobaric Hyperoxia Combined With Endovascular Treatment Based on Temporal Gradient: A Dose-Escalation Study

Normobaric Hyperoxia Combined With Endovascular Treatment Based on Temporal Gradient: A Dose-Escalation Study

Intermittent hypoxia training improves cerebral blood flow without cognitive impairment

Diabetes Mellitus and Risk of Future Stroke: Evidence From CHARLS and Mendelian Randomization Analyses

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