Background: Minimally invasive surgery for intracerebral hemorrhage (ICH) has been evaluated in clinical trials. Although meta-analyses on this topic have been performed in the past, recent trials have added important information to the results of the comparison. However, little work has been done to compare the effect of MIS and conventional treatment on patient prognosis, especially mortality.Methods: PubMed, EMBASE, Web of Science, Ovid, China National Knowledge Infrastructure, and ClinicalTrials.gov were searched on May 1, 2021, for randomized controlled trials of MIS for spontaneous ICH. The primary outcome was defined as death at follow-up, while the secondary outcome was defined as death in different comparisons between MIS and craniotomy (CT) or medication (Me).Results: The initial search yielded 12 high-quality randomized controlled trials involving 2,100 patients. We analyzed the odds ratios (ORs) for MIS compared with conventional treatment, including Me and conventional CT. The OR and confidence intervals (CIs) of the primary and secondary outcomes were 0.62 (0.45–0.85) for MIS vs. conventional treatment. We also conducted subgroup analyses and found that the ORs and CIs for MIS compared with that of conventional treatment in the short-term follow-up were 0.58 (0.42–0.80), and, in the long-term follow-up, was 0.67 (0.46–0.98); and found that ORs were 0.68 (0.48–0.98) for MIS vs. CT and 0.57 (0.41–0.79) for MIS vs. Me.Conclusions: This meta-analysis demonstrates that certain patients with ICH benefit in short- and long-term follow-up from MIS over other treatments, including open surgery and conventional Me.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/.

Objectives: Insomnia was associated with cerebral structural changes and Alzheimer’s disease. However, associations among cerebral perfusion, insomnia with cerebral small vessel disease (CSVD), and cognitive performance were little investigated.Methods: This cross-sectional study included 89 patients with CSVDs and white matter hyperintensities (WMHs). They were dichotomized into the normal sleep and poor sleep group, according to Pittsburgh sleep quality index (PSQI). Baseline characteristics, cognitive performance, and cerebral blood flow (CBF) were measured and compared between the two groups. The association or correlation between cerebral perfusion, cognition, and insomnia was analyzed using binary logistic regression.Results: Our study found that declined MoCA score (P = .0317) was more prevalent in those with poor sleep. There was a statistical difference in the recall (P = .0342) of MMSE, the delayed recall (P = .0289) of MoCA between the two groups. Logistic regression analysis showed educational background (P < .001) and insomnia severity index (ISI) score (P = .039) were independently correlated with MoCA scores. Arterial spin labeling demonstrated that left hippocampal gray matter perfusion was significantly reduced (P = .0384) in the group with poor sleep. And, negative correlation was found between left hippocampal perfusion and PSQI scores.Conclusions: In the patients with CSVDs, insomnia severity was associated with cognitive decline. Left hippocampal gray matter perfusion was correlated with PSQI scores in CSVDs.

Background: Arterial calcification in the aortic arch, carotid bifurcation, or siphon on computed tomography was associated with cardiovascular disease. The association between arterial calcification prevalence and progression of branch atheromatous disease (BAD) in intracranial artery atherosclerosis was little investigated. Methods: This study included 310 patients with ischemic stroke from one stroke center. Patients were divided into BAD (110) and non-BAD groups (200). Baseline characteristics, lipids, and arterial calcification were measured. The primary outcome was the prevalence of arterial calcification in BAD progression, and the secondary outcome was the prevalence of calcification in arterial stenosis. The association or correlation among calcification prevalence, lipid markers, and BAD progression was analyzed using logistic regression, receiver operating characteristic curve, and linear regression. Results: Our study found that carotid siphon calcification on computed angiography was more prevalent ( P =0.01) in patients with BAD and also more prevalent ( P <0.001) in intracranial artery stenosis, and its computed tomography values could independently predict the symptomatic progression ( P =0.01). Furthermore, a strong linear correlation between oxidized lipid and calcification density was found (beta=−0.73, P =0.0048) in patients with BAD, a subtype (B-type) of intracranial arterial atherosclerotic disease. Conclusions: We found that carotid siphon calcification was associated with BAD and its computed tomography values could predict the symptomatic progression in patients with intracranial arterial atherosclerotic disease and BAD, indicating the important role of carotid calcification in B-type intracranial arterial atherosclerotic disease. Registration: URL: http://www.chictr.org.cn ; Unique identifier: ChiCTR1800018315

The current treatment spontaneous intracerebral hemorrhage (sICH) is limited. To determine the optimal time window for minimally invasive surgery in patients with sICH. sICH patients with a hematom...

The clinical significance and contribution of the lipid profile in atherosclerosis are well established. However, further investigation is needed in stroke patients, particularly regarding apolipoprotein B100 (ApoB100), a novel non-traditional lipid component in the lipid profile. To explore lipid parameters and their impact on stroke outcomes in patients with and without thrombolysis. We prospectively enrolled patients with acute ischemic stroke (AIS) at a single center, including those who did and did not receive thrombolysis. Participants were stratified into improvement (favorable outcome at 2 weeks) and non-improvement groups. Demographic, laboratory, imaging, and clinical scale data were compared between groups. Random forest analyses were used to evaluate the predictive value and importance of individual lipid measures: triglycerides, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), ApoB100, and lipoprotein(a), which better describe the internal characteristics of the profile. Complete data were available for 262 AIS patients, 165 of whom received thrombolysis. Plasma ApoB100 levels were significantly lower in the thrombolysis group (p < 0.001) and decreased ApoB100 levels were independently associated with 2-week stroke improvement (p = 0.009, OR = 0.89, 95% CI: 0.84–0.93). Random-forest feature-importance plots revealed that HDL and ApoB100 (each contributing > 15%) were the strongest lipid predictors of a favorable outcome, outperforming the other lipid variables. We found that thrombolysis is associated with ApoB100 decrease and a decrease in ApoB100 can predict the 2-week functional improvement in stroke. HDL and ApoB100 emerge as more important determinants of favorable AIS outcomes in this machine-learning analysis. These findings warrant external validation in multi-center trials. ChiCTR1800018315, 11/09/2018.