Based on the unclear safety and effectiveness of direct balloon angioplasty as a first-line treatment for patients with acute ischemic stroke caused by large artery atherosclerosis (LAA), our paper would center on investigating the safety and effectiveness of this novel strategy. A consecutive series of acute ischemic stroke patients due to intracranial atherosclerosis and short thrombus who underwent thorough direct balloon angioplasty from October 2019 to March 2021 were enrolled. The primary end point included arterial recanalization (modified Thrombolysis in Cerebral Infarction [mTICI]: 2b-3), and 90-day functional independence (modified Rankin Scale[mRS]: 0-2). The secondary end point was symptomatic intracerebral hemorrhage (sICH) and perioperative restenosis and re-occlusion of offending vessel. 68 patients were included. Mean time from onset to groin puncture was 342.5 min and 50 min for groin puncture to successful recanalization. 61 (89.7%) patients achieved successful recanalization and 41 (60.3%) acquired functional independence. 11 (16.0%) patients experienced ICH and only 3 (4.4%) for sICH. 8 (11.8%) patients developed symptomatic restenosis or re-occlusion within seven days after the operation. In addition, 16 (23.5%) patients received rescue stenting and 3 (18.8%) of this subgroup appeared immediate intra-stent thrombosis. Direct balloon angioplasty may be a safe and effective method for the treatment of stroke caused by intracranial large arteriosclerosis occlusion.

The effectiveness and safety of intravenous thrombolysis before mechanical thrombectomy (MT) in large cerebral infarctions remains uncertain. This study compares bridging MT, which includes intravenous thrombolysis, to direct MT without it. Data from 298 patients with anterior circulation large cerebral infarctions, assessed via non-enhanced CT (ASPECTS 0-5), who underwent MT in two-center cohort studies, were analyzed. Primary outcomes focused on independent ambulation (modified Rankin Scale scores 0-3) at 90 days post-stroke. Safety outcomes included parenchymal hemorrhage (PH) rates and mortality. We conducted a sensitivity analysis considering the timing from symptom onset to imaging within 4.5 hours. Additionally, a meta-analysis of 17 studies involving 3527 patients assessed the interventions' effectiveness and safety, with further scrutiny of high-quality studies (Newcastle-Ottawa Scale ratings 7-9) to increase robustness of results. No significant differences were found in 90-day independent ambulation between the bridging MT and the direct MT group (adjusted odds ratio [aOR] 1.15, 95% CI 0.68-1.94). Rates of PH and mortality were also similar across groups. These outcomes were consistent in the subgroup imaged within 4.5 hours of symptom onset. The meta-analysis supported these outcomes, showing no improvement in ambulation (aOR 1.16, 95% CI 0.82-1.64) or reduction in PH with bridging MT. Further analysis of high-quality studies supported these results. The cohort study and meta-analysis provide Class II evidence indicating no significant differences in functional outcomes or hemorrhagic risks between bridging and direct MT for large cerebral infarctions. This suggests that direct MT might be a viable alternative to bridging MT.

Exposure to Migraine may be one of the risk factors for the onset of rheumatoid arthritis (RA), while the relationship between the two is debatable. In this study, the connection between migraine and the risk of RA was investigated using a systematic review and meta-analysis of the pertinent literature. Up to July 2022, the PubMed, EMBASE, Web of Science (WOS), and scopus databases were employed to search for observational studies on the risk of RA in migraineurs. The effect sizes were pooled using a random-effects model or a fixed-effects model. Out of 2345 records, 5 studies (3 case and control studies and 2 cohort studies) were identified and included in the meta-analysis. According to a pooled analysis, migraine sufferers had a higher chance of developing RA (pooled adjusted effect estimate: 1.94, 95% confidence interval: 1.74–2.17; p < 0.01). Migraine can be legitimately regarded as a risk factor for RA since this study demonstrated a relationship between migraine and RA. This conclusion should be treated with caution due to low power and precision. Rigorous design and larger sample sizes of studies are needed to verify the findings.

Despite successful recanalization, there remain many patients suffering bad outcome after endovascular treatment, especially for occlusion at the distal portion of internal carotid artery. The goal of the current study was to investigate the value of collateral circulation in predicting malignant events after endovascular treatment in acute ischemic stroke-terminal internal carotid artery (AIS-TICA) patients. The records of forty-one patients with AIS-TICA as confirmed by digital subtraction angiography and subjected to mechanical thrombectomy were reviewed. On the basis of the collateral circulation grading system (ACG) from the American Society of Interventional and Therapeutic Neuroradiology/American Society of Interventional Radiology (ASITN/SIR), class of leptomeningeal compensation were evaluated as grade 0 to 4. Factors for malignant events were evaluated by retrospectively univariate analysis. Moreover, analysis of correlation was performed between collateral circulation and malignant events. Malignant events were defined as a malignant middle cerebral artery infarction or parenchymal hemorrhage 2. Of the 41 subjects, 13 (31.71%) had postoperative malignant events. Though 36 (87.80%) of the patients had a complete recanalization, only 17 patients (41.46%) showed good outcomes with modified Rankin score≤2 at 3 months. 9 (21.95%) deaths occurred in the hospital. Besides, patients in the malignant group had significantly higher scores on the National Institute of Health stroke scale (P = 0.032) and lower anterior circulation compensation (P = 0.000). Furthermore, correlation analysis showed that probability of malignant events was negatively correlated with anterior circulation compensation (rs = -0.534, P = 0.000). The leptomeningeal compensation of anterior circulation can be predicted whether a malignant event will occur after endovascular treatment in AIS-TICA patients. The probability of malignant events is significantly increased if the anterior circulation collateral compensation score is 0-1.

Background. Migraine is a frequently observed neurological disease in patients with systemic lupus erythematosus. However, the relationship between these two conditions is still a subject of controversy. Objectives. Our aim was to investigate the association between migraine and the risk of developing systemic lupus erythematosus through a meta-analysis of case-control studies. Methods. Following the Preferred Reporting Project for Systematic Reviews and Meta-Analysis statement, we conducted a comprehensive search of the following literature databases, including PubMed, Embase, and Web of Science, to identify relevant articles published up to June 2022 using the keywords “migraine” and “systemic lupus erythematosus” as subject headings. If heterogeneity was expected to be low (%), the pooled analysis was performed using a fixed-effects model calculated by the Mantel-Haenszel method. Analysis in this study was conducted using R software (http://www.r-project.org). Results. Six case-control experimental studies involving 908 participants were included in the meta-analysis. The overall combined relative risk of developing systemic lupus erythematosus in patients with migraine, compared to the control group, was 1.69 (95% confidence interval (CI): 1.26 to 2.27). The analysis revealed minimal evidence of heterogeneity and publication bias. Conclusions. Based on our meta-analysis, there is suggestive evidence that patients with migraine may have an elevated risk of developing systemic lupus erythematosus attacks.