The latest research: Can't you skip thrombolysis before mechanical thrombus removal after stroke?

*Only for medical professionals to read for reference.
Ding, you have received the latest information from the frontline agents stationed in the brain! Abstract of this article: Recombinant t-PA thrombolysis should still be recommended before mechanical thrombus removal after stroke
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Will the aneurysm break? The new tool predicts accurately! Can't AD be cured? Low-intensity ultrasound is safe and effective! The brain-computer integration system helps paralyzed patients regain hope
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Agents stationed in the front line of the brain should still recommend recombinant t-PA thrombolysis before mechanical thrombus removal after stroke
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Tissue-type plasminogen activator (t-PA) can convert plasminogen into plasmin, and plasmin can degrade fibrin
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The latest research shows that before the mechanical thrombus removal (MT) of stroke, it is still recommended to use t-PA for thrombolysis, so as to get a better opening effect
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At the European Stroke Organization Conference (ESOC) held on September 21, 2021, Dr.
Gralla from the University of Bern, Switzerland, reported the latest research results of the SWIFT DIRECT trial [2]
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The study included 423 patients with acute ischemic stroke caused by vascular occlusion (the internal carotid artery (ICA) or the M1 segment of the middle cerebral artery) from multiple centers in Europe and North America
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All patients were randomly assigned to the MT group or the post-t-PA MT group according to a 1:1 ratio.
The primary end point was a functionally good prognosis at 90 days [(modified Rankin score (mRS) 0-2], and the secondary end point was 90 days.
Mortality, mRS displacement, successful reperfusion, symptomatic and non-symptomatic intracranial hemorrhage
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Figure 1: 2021 ESOC meeting Figure 2: Primary endpoint events Primary endpoint events: 58% of patients in the MT group achieved a 90-day mRS 0-2, and 65% of patients in the MT group achieved a 90-day mRS 0-2 after t-PA
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The risk difference is -7.
3% (95%CI-17%to 2.
1%)
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In addition, the postoperative recanalization rate of the MT group after t-PA was significantly higher than that of the MT group (97% vs 91% P=0.
022)
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Figure 3: The secondary endpoint event Dr.
Gralla introduced.
From the analysis of the results, the 90-day mRS of the two groups are actually good, but the intervention recanalization rate after t-PA is much higher
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Therefore, for patients with large vessel occlusion, there is no reason to skip the thrombolysis step.
We still recommend recombinant t-PA thrombolytic therapy before mechanical thrombus removal in stroke
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Will the aneurysm of the agent on the front line of the brain be broken? The new tool predicts accurately! Unruptured intracranial aneurysm (UIA) occurs in about 3% of the population
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Some aneurysms will rupture, and the ruptured aneurysm is the primary cause of subarachnoid hemorrhage
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On August 30, 2021, JAMA Neurology published an online article titled "Risk of Rupture after Growth of Intracranial Aneurysms".
This study [3] predicts the risk of rupture of growing intracranial aneurysms
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Figure 4: The cover of the paper included untreated patients with unruptured intracranial aneurysms, aged over 18, and each patient had at least one unruptured aneurysm.
There were 15 international cohorts participating in the study
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Long-term follow-up of these aneurysms to detect the growth of the aneurysm
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Aneurysms related to fusiform or arteriovenous malformations were excluded
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Growth is defined as an aneurysm increase of 1 mm or more in one direction during follow-up imaging.
Of the 5166 eligible patients who underwent intracranial aneurysm follow-up, 4827 were excluded because aneurysm growth was not detected, and 27 were excluded due to loss.
They were excluded from the visit, and 312 patients with intracranial aneurysm growth were finally included
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Of the 312 patients enrolled [223 (71%) were women, with an average age of 61], there were a total of 329 growing aneurysms, of which 25 (7.
6%) ruptured
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The absolute risk of rupture after growth was 2.
9% (95% CI, 0.
9-4.
9) at 6 months, 4.
3% (95% CI, 1.
9-6.
7) and 6.
0% (95% CI, 2.
9- 9.
1)
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In a multivariate analysis, the predictors of aneurysm rupture were size (hazard ratio of 7 mm or greater, 3.
1; 95% CI, 1.
4-7.
2), shape (irregular hazard ratio, 2.
9; 95% CI, 1.
3-6.
5 ) And location (middle cerebral artery hazard ratio, 3.
6; 95% CI, 0.
8-16.
3)
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In the three S (size, site, shape) prediction model, the 1-year rupture risk ranges from 2.
1% to 10.
6%
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Figure 5: The three S risk prediction model predicts the risk of aneurysm rupture.
The conclusion of the unruptured aneurysm that grows in the brain is about 1 in every 25 aneurysms that will rupture
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The three-S risk prediction model can be used to assess the absolute risk of rupture during the growth of aneurysms
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The frontline agent in the brain cannot cure AD? Low-intensity ultrasound is safe and effective
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Alzheimer's disease (AD) is a neurodegenerative disease that starts in middle-aged and elderly people.
It has a long course and a high disability rate, and there has been a lack of effective treatments
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Recent studies have found that low-intensity focused ultrasound (FUS) is safe and effective for the treatment of AD
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Figure 6: FUS treatment of AD work diagram.
At the American Association of Neurosurgeons (AANS) in 2021, Dr.
Rezai, executive chairman and co-investigator of the Rockefeller Institute of Neuroscience, West Virginia University, introduced that they used FUS and vein guided by magnetic resonance The combined technology of injecting microbubble contrast agent allows the blood-brain barrier (BBB) ​​to be temporarily opened, and the therapeutic substance can pass through the BBB and enter a specific location to take effect
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The effectiveness of this treatment method has been confirmed in animal models, and patients with mild AD are currently being recruited for clinical trials.
The inclusion criteria are: age 50-85 years old, with a Mini Mental State Examination (MMSE) score of 18 to 26.
His positron emission tomography (PET) result was positive for amyloid (Aβ)
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FUS is related to the reduction of plaque and the improvement of behavior in preclinical trials
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At the AANS meeting [4], Dr.
Rezai presented their research data
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They currently have 15 patients who have received 45 FUS treatments, and the follow-up time is 3-32 months
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All 15 patients in the whole course of treatment, no adverse events, including bleeding, infarction
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The opening of BBB is "short-lived, reversible, and on-demand", usually within 24-48 hours, so the patient is well tolerated and the incidence of adverse events is small
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Two-thirds of patients underwent PET imaging one week after receiving the third treatment
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The results showed that the amyloid plaques in the hippocampus/entorhinal cortex, parietal and frontal lobes in the FUS group were reduced by an average of about 26%
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Cognitive assessment of patients found that compared with AD patients with age, gender, and disease degree, the relative change of MMSE in the FUS group was 2.
2, while that in the AD control group was 3.
8
.

The change in cognitive score in the FUS group was 4.
6, while that in the AD control group was 5.
6
.

Therefore, FUS can improve patients' cognitive decline
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Finally, Dr.
Rezai introduced that because the current sample size is very small, it can only be said that "Compared with the AD control group, FUS treatment is not inferior
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" In the future, we look forward to more patients participating in clinical trials and further exploring the potential of FUS.
FUS is indeed safe and effective, so this technology will also play a huge value in the treatment of brain tumors and certain mental diseases
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The brain-computer integrated system of agents stationed in the front line of the brain helps paralyzed patients regain hope
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The brain-computer interface (BCI) enables people who have lost the ability to move or speak to resume communication
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BCI's portable system can introduce the functions of BCI into the family, and help patients who are paralyzed by spinal cord injury do simple limb movements, so as to maintain the most basic living ability
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Research evidence shows that most of the paralysis is caused by stroke (33.
7%), followed by spinal cord injury (27.
3%) and multiple sclerosis (18.
16%).
Paralyzed patients are severely ill, costly, and bring a serious economic burden to the family and society.

.

In 2021, the American Association of Neurosurgeons (AANS) [5], Dr.
Davis from the Miller School of Medicine, University of Miami, brought their latest research results
.

According to Dr.
Davis, BCI and Brain-Machine Interface (BMI) are communication systems that measure central nervous system (CNS) activity and convert it into a communication system that replaces, restores, enhances, and supplements artificial output.
The output of the central nervous system can be improved through BCI, thereby Change the continuous interaction between the central nervous system and its external or internal environment, and help paralyzed patients perform simple limb movements
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Finally, Dr.
Davis emphasized that how to reasonably transform BCI technology to benefit all paralyzed patients is the direction of future research
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References: [1] https://click.
mail.
medscape.
com/?qs=25741d5428c6bff2fb0c0730361f742d3805a36ee0c5fb9b021182f0973233ac68e62aac878fdfb2b54ff91902ec5bda31a00c91922b4d00f4675902b04bd5fa [2] SOLITAIRE ™ WITH THEINTENTION FOR THROMBECTOMY PLUS INTRAVENOUS T-PA VERSUS DIRECT SOLITAIRE ™ STENT-RETRIEVER THROMBECTOMY IN ACUTE ANTERIOR CIRCULATION STROKE ( SWIFT DIRECT): PLACEHOLDER ABSTRACT.
ESOC2021[3]van der Kamp LT,et al.
Risk of Rupture After Intracranial Aneurysm Growth.
JAMA Neurol 2021 Aug 30[4]https://click.
mail.
medscape.
com/?qs= 25741d5428c6bff27b8912a5196fb8522f236be3bb603246d96d976a3257a0a92ce46326edaae631cb3569badf2a57c9cbe33871ac7e9dbd3218c99529e389ad[5]https://