Background: Endovascular therapy (EVT) was the standard treatment for acute ischemic stroke with large vessel occlusion. Prognosis after EVT is always a major concern. Here, we aimed to explore a predictive model for patients after EVT. Method: A total of 156 patients were retrospectively enrolled. The primary outcome was functional dependence (defined as a 90-day modified Rankin Scale score ≤ 2). Least absolute shrinkage and selection operator and univariate logistic regression were used to select predictive factors. Various machine learning algorithms, including multivariate logistic regression, linear discriminant analysis, support vector machine, k-nearest neighbors, and decision tree algorithms, were applied to construct prognostic models. Result: Six predictive factors were selected, namely, age, baseline National Institute of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early CT (ASPECT) score, modified thrombolysis in cerebral infarction score, symptomatic intracerebral hemorrhage (sICH), and complications (pulmonary infection, gastrointestinal bleeding, and cardiovascular events). Based on these variables, various models were constructed and showed good discrimination. Finally, a nomogram was constructed by multivariate logistic regression and showed a good performance. Conclusion: Our nomogram, which was composed of age, baseline NIHSS score, ASPECT score, recanalization status, sICH, and complications, showed a very good performance in predicting outcome after EVT.

Background: The albumin-to-alkaline phosphatase ratio (AAPR) is a predictor of several disease outcomes. However, there is no study about AAPR and acute ischemic stroke outcomes. This study aims to investigate the relationship between AAPR and a 3-month unfavorable outcome in patients with acute ischemic stroke.Methods: This prospective cohort study included 2084 patients with acute ischemic stroke in South Korea. After applying strict exclusion criteria, 1,886 patients were included in our analysis and divided into three groups based on AAPR tertiles. An unfavorable outcome was defined as a 3-month modified Rankin scale (mRS) score > 2. Logistic regression analysis and smooth curve fitting analysis were applied to investigate the relationship between AAPR and unfavorable outcomes. Subgroup analysis was also performed to assess whether influencing factors changed the association between AAPR and unfavorable outcomes.Results: After adjusting for potential confounders, multivariate analysis showed that AAPR was significantly associated with a 3-month unfavorable outcome (OR 0.18, 95% CI 0.09–0.35, p < 0.001). The smooth curve fitting analysis showed a nonlinear relationship between AAPR and a 3-month unfavorable outcome. The infection point was 0.588 according to the recursive method, and the threshold analysis showed when AAPR was ≤0.588, with the per unit increase of AAPR, the 3-month unfavorable outcome risk decreased by 96% (OR 0.04, 95% CI 0.01–0.2, p < 0.001). However, when AAPR was >0.588, there was no negative correlation between AAPR and a 3-month unfavorable outcome (OR 0.33, 95% CI 0.08–1.3, p = 0.112).Conclusion: This study is the first to suggest a non-linear relationship between AAPR and a 3-month unfavorable outcome of acute ischemic stroke. AAPR was negatively correlated with a 3-month unfavorable outcome when AAPR was <0.588.

Rationale: Carotid web, a known source of thrombus for embolic stroke, presents a considerable risk of stroke recurrence. While case reports have demonstrated the safety and effectiveness of mechanical thrombectomy in treating carotid web-related stroke, the need for concurrent carotid artery stenting to prevent recurrent stroke immediately after thrombectomy remains unclear. This study aims to underscore the importance of immediate carotid artery stenting in preventing recurrent stroke following mechanical thrombectomy in patients with carotid web-related stroke. Patient concerns: A 43-year-old woman with acute onset of left limb weakness and slurred speech within 3 hours was admitted to the emergency department. Diagnoses: Computed tomographic angiography confirmed the M1 segment occlusion of the right middle cerebral artery. Interventions: The patient received intravenous thrombolysis in the local hospital and mechanical thrombectomy in our stroke center. Outcomes: Three days post-mechanical thrombectomy, there was a sudden exacerbation of her neurological deficit symptoms. A reexamination via computed tomographic angiography revealed a re-occlusion in M1 segment of the right middle cerebral artery, despite the implementation of stringent anticoagulation therapy for carotid web-related stroke. Lessons: Stroke patients with carotid web had a high risk of stroke recurrence and it was necessary to conduct carotid artery stenting to prevent stroke recurrence secondary to the carotid web immediately after mechanical thrombectomy.

Objective: Research on predictive models for hospital mortality in patients who have survived 24 h following cardiopulmonary resuscitation (CPR) is limited. We aim to explore the factors associated with hospital mortality in these patients and develop a predictive model to aid clinical decision-making and enhance the survival rates of patients post-resuscitation.Methods: We sourced the data from a retrospective study within the Dryad dataset, dividing patients who suffered cardiac arrest following CPR into a training set and a validation set at a 7:3 ratio. We identified variables linked to hospital mortality in the training set using Least Absolute Shrinkage and Selection Operator (LASSO) regression, as well as univariate and multivariate logistic analyses. Utilizing these variables, we developed a prognostic nomogram for predicting mortality post-CPR. Calibration curves, the area under receiver operating curves (ROC), decision curve analysis (DCA), and clinical impact curve were used to assess the discriminability, accuracy, and clinical utility of the nomogram.Results: The study population comprised 374 patients, with 262 allocated to the training group and 112 to the validation group. Of these, 213 patients were dead in the hospital. Multivariate logistic analysis revealed age (OR 1.05, 95% CI: 1.03–1.08), witnessed arrest (OR 0.28, 95% CI: 0.11–0.73), time to return of spontaneous circulation (ROSC) (OR 1.05, 95% CI: 1.02–1.08), non-shockable rhythm (OR 3.41, 95% CI: 1.61–7.18), alkaline phosphatase (OR 1.01, 95% CI: 1–1.01), and sequential organ failure assessment (SOFA) (OR 1.27, 95% CI: 1.15–1.4) were independent risk factors for hospital mortality for patients who survived 24 h after CPR. ROC of the nomogram showed the AUC in the training and validation group was 0.827 and 0.817, respectively. Calibration curves, DCA, and clinical impact curve demonstrated the nomogram with good accuracy and clinical utility.Conclusion: Our prediction model had accurate predictive value for hospital mortality in patients who survived 24 h after CPR, which will be beneficial for assisting in identifying high-risk patients and intervention. Further confirmation of the model's accuracy required external validation data.

Cerebral venous sinus thrombosis (CVST) in pregnancy was common and endovascular treatment (EVT) could be an effective and safe treatment for patients with severe and refractory CVST. However, the efficacy and safety of hybrid EVT (craniotomy + endovascular treatment) for CVST were unknown. We represented a rare case of hybrid EVT through the incision of the superior sagittal sinus in a pregnant woman with CVST who failed to EVT through the femoral vein pathway. A 26-year-old woman, in her second month of pregnancy, complained of a headache for 5 days and aggravation with coma combined with convulsions for 2 days. She was diagnosed with CVST in the local hospital by digital subtraction angiography (DSA) and treated with anticoagulation. She had no history of illness and the biochemical tests were normal. Hybrid EVT (craniotomy + EVT) was attempted after failing to conduct EVT through the femoral vein pathway due to difficulty to reach the target cerebral venous sinus. Briefly, a small hole was made in the frontotemporal head to expose the superior sagittal sinus and a 6F sheath was inserted into 2cm of superior sagittal sinus incision and fixed on the scalp, after repeated aspiration by 5F intermediate catheter and balloon dilatation of stenosis in the right transverse sinus and right sigmoid sinus, the cerebral venous system got successful recanalization. No obvious complications were found and the patient recovered very well after the surgery. Anticoagulation was the standard treatment for CVST. EVT could rapidly restore venous flow and improve the prognosis for refractory and severe CVST. EVT by hybrid surgery through the superior sagittal sinus incision may be safe and effective for desperate patients with severe CVST.