Introduction: Successful reperfusion does not always lead to good neurological outcomes and impaired microcirculation can be one of the underlying causes. Intra-arterial alteplase after mechanical thrombectomy (MT) may improve microcirculation contributing to neurological recovery, but prospective randomised studies are still needed to validate its efficacy and safety. We aim to assess the efficacy and safety of intra-arterial alteplase after MT for acute ischaemic stroke (AIS) with large-vessel occlusion (LVO). Methods and analysis: The Intra-arterial Alteplase for Acute Ischaemic Stroke After Mechanical Thrombectomy (PEARL) study is a multicentre, prospective, open-label, blinded-endpoint, randomised controlled trial. We consecutively screen AIS patients with anterior circulation LVO and National Institute of Health Stroke Scale of 6–25, who reach stable expanded Thrombolysis in Cerebral Infarction scores of 2b50-3 on angiography after MT. Eligible participants are 1:1 randomly assigned to the experimental group and the control group. Participants in the experimental group will receive intra-arterial alteplase (0.225 mg/kg and a maximum dose of 20 mg) after MT and standard medical treatment, while those in the control group will receive standard medical treatment alone after the procedure. The primary outcome is the proportion of patients with a 90-day modified Rankin scale of 0–1. A total of 324 participants are required to test the superiority hypothesis with 80% power at a two-tailed significance level of 0.05. Ethics and dissemination: This study has been approved by the Ethics Committee of Sun Yat-sen Memorial Hospital, Sun Yat-sen University (SYSKY-2023-390-02) and will be conducted following the Declaration of Helsinki. Ethical approvals have been obtained separately for all centres participating in the study. Study results will be published in peer-reviewed academic journals. Trial registration number: NCT05856851 .

Aims: We aim to explore the predictive value of admission blood glucose to serum albumin ratio (AAR) for futile recanalization after successful interventional recanalization of acute cerebral infarction.Methods: We retrospectively collected the data of patients suffered from acute cerebral infarction due to anterior circulation large vessel occlusion and received successful interventional recanalization from January 2019 to November 2023. Statistical analysis of clinical data was conducted using SPSS 26.0.Results: A total of 452 patients were included in the study. There were statistically significant differences in mRS score and futile recanalization rates among the three groups of patients at 3 months after surgery according to AAR tertile. In the multiple logistic regression analysis, there were statistically significant differences in Diabetes, grade of NIHSS score at admission, AAR tertiles, good collateral circulation and Pathogenesis. The Receiver Operating Characteristic curve (ROC) curve of AAR predicting futile recanalization was drawn with an AUC of 0.582 and a 95% confidence interval of 0.529–0.634. After combining grade of NIHSS score at admission, AAR tertiles and good collateral circulation, a ROC curve was drawn to predict futile recanalization, with an AUC of 0.907 and a 95% confidence interval of 0.879–0.936.Conclusion: AAR is a new composite indicator for predicting futile recanalization in patients with acute cerebral infarction with anterior circulation large vessel occlusion. The combination of grade of NIHSS score at admission, AAR tertiles and good collateral circulation has a high predictive power for futile recanalization.

Background: Evidence of endovascular treatment (ET) for patients with progressive infarction of the posterior circulation exceeding 24 h is lacking. Objective: To evaluate the efficacy and safety of ET for progressive posterior circulation cerebral infarction. Methods: This retrospective study evaluated the ET for 18 patients with posterior circulation infarction caused by vertebrobasilar artery occlusion from July 2017 to November 2018. The conditions of patients worsened despite receiving intravenous thrombolysis or combination therapy with clopidogrel and aspirin. The time from the onset of cerebral infarction to puncture was >24 h. The preoperative National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and related risk factors of patients at 3 months were analyzed postoperatively. Results: The preoperative NIHSS score was 10.6 (IQR: 6.5), and the time from onset to puncture was 163.5 ± 144.7 h. Postoperative blood flow was modified thrombolysis in cerebral infarction (mTICI) grade 2b or above. During the follow-up period, 1 patient died of basilar artery re-occlusion and pulmonary infection, and 1 died of postoperative hyperperfusion hemorrhage, with a mortality rate of 11.1% (2/18). No recurrent ischemic events were observed in any of the 16 patients during the 3-month follow-up period. The mean mRS score was 1.3 (IQR: 2.3), and 75% patients (12/16) had an mRS score of 0–2. There were no significant differences in age, gender, clinical characteristics, and stroke subtype between patients with mRS scores ≤2 and >2. Conclusion: In patients with progressive posterior circulation cerebral infarction caused by vertebral basilar artery occlusion, ET is effective and safe even if the time from onset to puncture exceeds 24 h.

PURPOSETo study the effect of the embryonic stem cell (ESc) microenvironment in inhibiting mouse glioma cells and its possible mechanism. METHODSGlioblastoma cell line U118 in the brain, was investigated in this study. There were four experimental groups: U118 glioma cells cultured alone as the control group (GB group), U118 cell and ESc co-cultured group(GE group), U118 cell and ESc co-cultured and adding phosphoinositide 3-kinase (PI3K) agonist group (GA group), U118 and temozolomide as the positive control group (GT group); U118 cells were harvested after 72 hours of culture. Cell proliferation, apoptosis, reactive oxygen species (ROS) and vasculogenic mimicry assays, quantitative real-time RT-PCR (qPCR), and western blot (WB) were study, the biological function of U118 glioma cells and the PI3K/AKT signaling pathway were compared the differences between the groups. RESULTSCompared with the GB control group, the GE co-culture group and GT chemotherapy group showed reduced cell proliferation, increased apoptosis, increased ROS, decreased or disappearance of vasculogenic mimicry. Expression of cyclin B and D, significantly reduced, while that of BAX, BCL-2, P53, Caspase3, Gsk-3B, P21, and P27, significantly increased. The expression of PI3K, PDK, AKT, and mTOR, significantly decreased while that of PTEN significantly increased. The expression of positive regulatory factors significantly increased but negative regulatory factors decreased in GA group compared to the GE group. CONCLUSIONThe ESC microenvironment reverse glioma malignancy, partially via inhibition of the PI3K signaling pathway. Our study may have a significant impact and clinical implication on cell therapy in glioma.

The novel coronavirus disease 2019 (COVID‐19) causes severe respiratory illness and is involved in ischemic stroke. Aimed to investigate the inflammatory markers and possible prognosis of COVID‐19‐related ischemic stroke in a special outbreak period after lifting of COVID‐19 control measures in China, we conducted a multicenter retrospective analysis in southern China at three centers in Shenzhen. We included patients diagnosed with acute ischemic stroke or transient ischemic attack after infection with COVID‐19 as the COVID‐19‐related ischemic stroke group and those only diagnosed with acute ischemic stroke or transient ischemic attack as the control group. In this study, the proportion of female patients, admission heart rate, and comorbid coronary heart disease and the proportion of cryptogenic stroke were higher, while the history of prior stroke was lower in the COVID‐19‐related ischemic stroke group. The COVID‐19‐related ischemic stroke group also exhibited elevated levels of monocytes, fibrinogen, alanine aminotransferase, direct bilirubin, monocyte‐to‐lymphocyte ratio (MLR), and fibrinogen‐to‐albumin ratio (FAR) but decreased levels of lymphocytes, albumin, and high‐density lipoprotein. However, there were no statistically significant differences in the modified Rankin scale (mRS), National Institutes of Health Stroke Scale (NIHSS), and mortality rate between the two groups at discharge. Our study is the first to show the alteration in inflammatory markers but no difference in discharge prognosis between the non‐COVID‐19 and the COVID‐19‐related ischemic stroke patients, during China’s COVID‐19 relaxation period.