Early neurological deterioration (END) is a forecast factor in poor outcomes in minor strokes. END's prevalence and forecast factors in minor strokes caused by small artery occlusion (SAO) are still unclear. We retrospectively analyzed 451 patients with minor stroke (NIHSS ≤ 5) caused by SAO hospitalized within an initial 24 hours at BachMai Hospital's stroke center. END was defined as conditions with an elevated two or more NIHSS points within an initial 72 hours. The primary outcome included the determination of the END incidence. The secondary outcome identified forecast factors for END through multivariate logistic regression analyses, and therapeutic impacts of antiplatelet and thrombolytic treatments. END occurred in 9.5% (43/451) of patients (62.7% male, mean age 63.8±11.8 years). Independent forecast included admission SBP ≥150mmHg (OR=1.99; 95%CI:1.01-3.94;p=0.048), diabetes history (OR=0.58; 95%CI:1.05-4.33;p=0.036), admission blood glucose ≥14mmol/L (OR=2.99; 95%CI:1.05-8.54;p=0.04), and internal capsule infarction (OR=2.23; 95%CI:1.01-4.92;p=0.048). The patients group admitted within 4.5 hours, DAPT has significantly lower END risk compared to SAPT (OR=0.079; 95%CI:0.007-0.939;p=0.04) and altepase (OR=0.013; 95%CI:0.01-0.12;p<0.01). END risk was similar between SAPT and altepase (p=0.074). END is a 9.5% incidence in minor acute ischemic stroke due to SAO. Independent forecasts are admission SBP and blood glucose, diabetes history, and internal capsule infarction. The DAPT group has significantly lower END risk than the SAPT and alteplase groups.

(1) Background: Atrial fibrillation (AF) poses a growing cardiovascular challenge globally, with significant implications in Vietnam. This study aimed to investigate the impact of AF on ischemic stroke/transient ischemic attack (TIA) and clinical outcomes, as well as the utilization of oral anticoagulation (OAC) therapy in Vietnam. (2) Methods: Data from the Registry of Stroke Care Quality (RES-Q) across 66 hospitals in Vietnam between 2017 and 2023 were utilized. Patients diagnosed with ischemic stroke or TIA were included, and clinical characteristics, pre- and post-hospitalization medication, and hospitalized outcomes were examined. (3) Results: Of 94,144 patients, 15.1% had AF. Patients with AF were older and had a higher prevalence of heart failure and more severe strokes. AF was associated with increased mortality during hospitalization and a poorer prognosis. In AF patients, anticoagulation therapy utilization increased from 15.8% pre-hospitalization to 82.4% at discharge, with a preference for direct oral anticoagulants. (4) Conclusions: AF significantly impacts ischemic stroke/TIA outcomes in Vietnam. Pre-hospitalization and anticoagulation therapy utilization were low but improved at discharge. These findings emphasize the need for improved AF management and stroke prevention strategies in developing countries.

Background: Subarachnoid hemorrhage (SAH) due to intracranial dissecting aneurysm is uncommon and may be challenging to secure when conventional clipping, coiling, or parent artery occlusion are not feasible. Flow-diverter stents have recently emerged as a rescue option in ruptured aneurysms, but their use in the acute phase remains controversial. We report a complex vertebrobasilar dissection presenting with aneurysmal SAH that was successfully treated with emergency flow diversion and adjunctive coiling. Case description: A 54-year-old man with untreated hypertension presented comatose with diffuse SAH. CT angiography and digital subtraction angiography demonstrated a dominant right vertebral artery with a long-segment vertebrobasilar dissection, a large ruptured pseudoaneurysm at the vertebrobasilar junction, and a small aneurysm at the ipsilateral PICA origin, with hypoplastic contralateral vertebral artery. The anatomy precluded clipping, coiling alone, or parent vessel sacrifice. After loading doses of aspirin and clopidogrel, a Derivo2 flow-diverter stent was deployed from the proximal basilar artery to the V4 segment of the right vertebral artery, and the ruptured pseudoaneurysm was selectively coiled. Acute distal in-stent thrombosis was managed with balloon angioplasty and intravenous heparin. The patient awoke promptly and was extubated 6 hours later. Follow-up MRI at 12 hours showed a patent stent, complete exclusion of the pseudoaneurysm, and no SAH progression. Conclusion: This case illustrates that emergency flow diversion with adjunctive coiling can be a feasible strategy for ruptured vertebrobasilar dissecting pseudoaneurysms in carefully selected patients when conventional surgical or endovascular strategies are not feasible.

Điều trị tiêu huyết khối cho nhóm người bệnh nhồi máu não nhẹ vẫn còn nhiều tranh cãi. Nghiên cứu của chúng tôi nhằm đánh giá đặc điểm lâm sàng, cận lâm sàng và kết quả điều trị người bệnh nhồi máu não nhẹ được tiêu huyết khối bằng alteplase tại Trung tâm Đột quỵ Bệnh viện Bạch Mai từ tháng 11 năm 2023 đến tháng 11 năm 2024. Nghiên cứu được thiết kết dạng nghiên cứu quan sát, hồi cứu, theo dõi dọc, thu tuyển được 36 người bệnh thỏa mãn trong số 932 người bệnh nhồi máu não nhẹ nhập viện trong 24 giờ đầu của bệnh. Kết quả nghiên cứu cho thấy: tuổi trung bình 66,33±9,37; nam giới chiếm 66,7%; tỉ lệ nhập viện trong 3 giờ đầu chiếm 63,9%; tỉ lệ nhồi máu não vùng hạch nền quanh não thất chiếm 61,1%; tỉ lệ suy giảm thần kinh sớm chiếm 36,1%; tỉ lệ chuyển dạng chảy máu là 2,8%; tỉ lệ tử vong ngày 90 là 2,8%; tỉ lệ đạt kết quả hồi phục chức năng thần kinh tốt mRS 0-1 ngày 90 là 80,6%; một số yếu tố liên quan tới kết quả điều trị tốt là suy giảm thần kinh sớm (OR 0,462 (95% CI 0,257-0,83), p<0,001) và chỉ số LDL_C (OR 0,316 (95% CI 0,11-0,905), p=0,032). Kết luận: Điều trị tiêu huyết khối ở nhóm nhồi máu não nhẹ có thể mang lại tỷ lệ phục hồi chức năng thần kinh cao, tuy nhiên cần lưu ý đến các yếu tố như suy giảm thần kinh sớm và LDL-C để tiên lượng kết quả.

Background/Objectives: Hemorrhagic transformation (HT) is a common complication after mechanical thrombectomy. This study aimed to determine the incidence of and factors associated with HT, evaluate factors associated with sICH, and assess prognostic factors associated with 90-day functional outcome after anterior-circulation thrombectomy. Methods: We retrospectively analyzed 244 consecutive patients with acute ischemic stroke who underwent anterior circulation thrombectomy between June 2022 and May 2023. Clinical, laboratory, imaging, and treatment variables were compared according to HT, sICH, and 90-day functional outcome. Univariate and multivariable logistic regression analyses were performed. Results: HT and sICH occurred in 38.5% and 10.0% of patients, respectively. Cardioembolic etiology was independently associated with HT (adjusted odds ratio [aOR] 2.39, 95% confidence interval [CI] 1.31–4.36) and sICH (aOR 2.79, 95% CI 1.12–6.93). Successful reperfusion (TICI 2b–3) was independently associated with HT (aOR 2.51, 95% CI 1.09–5.77). Among patients with HT, younger age (aOR 0.86, 95% CI 0.78–0.95) and a lower 24-h National Institutes of Health Stroke Scale score (aOR 0.62, 95% CI 0.43–0.88) were independently associated with good functional outcome at 90 days. Conclusions: Cardioembolic etiology and successful recanalization were independently associated with HT, whereas cardioembolic etiology was independently associated with sICH. Among patients with HT, younger age and a lower 24-h neurological deficit were prognostic markers of better functional outcomes.