Most Accessed Articles | Extracranial-to-Intracranial Bypass for Pressor Dependent Cerebrovascular Insufficiency: Modified Classification and Representative Case

While some randomized clinical trials have reduced the indications for cerebral revascularization in the secondary prevention of ischemic stroke, a distinct subset of patients with blood pressure augmentation dependent cerebrovascular insufficiency due to large vessel occlusions remains unaddressed. With the recent paradigm shifts in acute ischemic stroke care, the role of extracranial to intracranial (EC-IC) bypass must be re-addressed when endovascular intervention is not a feasible option. We submit a refined classification of cerebrovascular insufficiency with a category called Pressor-Dependent Cerebrovascular Insufficiency (PD-CVI) for whom EC-IC bypass may be indicated. Read out full article here:



Open Access Articles – A Novel Neuroimaging Model to Predict Early Neurological Deterioration After Acute Ischemic Stroke

Journal Name: Current Neurovascular Research

Author(s): Yen-Chu Huang*, Yuan-Hsiung Tsai, Jiann-Der Lee, Jen-Tsung Yang, Yi-Ting Pan.


Objective: In acute ischemic stroke, early neurological deterioration (END) may occur in up to one-third of patients. However, there is still no satisfying or comprehensive predictive model for all the stroke subtypes. We propose a practical model to predict END using magnetic resonance imaging (MRI).

Method: Patients with anterior circulation infarct were recruited and they underwent an MRI within 24 hours of stroke onset. END was defined as an elevation of ≥2 points on the National Institute of Health Stroke Scale (NIHSS) within 72 hours of stroke onset. We examined the relationships of END to individual END models, including: A, infarct swelling; B, small subcortical infarct; C, mismatch; and D, recurrence.

Results: There were 163 patients recruited and 43 (26.4%) of them had END. The END models A, B and C significantly predicted END respectively after adjusting for confounding factors (p=0.022, p=0.007 and p<0.001 respectively). In END model D, we examined all imaging predictors of Recurrence Risk Estimator (RRE) individually and only the “multiple acute infarcts” pattern was significantly associated with END (p=0.032). When applying END models A, B, C and D, they successfully predicted END (p<0.001; odds ratio: 17.5[95% confidence interval: 5.1– 60.8]), with 93.0% sensitivity, 60.0% specificity, 45.5% positive predictive value and 96.0% negative predictive value.

Conclusion: The results demonstrate that the proposed model could predict END in all stroke subtypes of anterior circulation infarction. It provides a practical model for clinical physicians to select high-risk patients for more aggressive treatment to prevent END.

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Neuropharmacological Actions of Metformin in Stroke


Author(s): Jia Jia, Jian Cheng, Jingshu Ni, Xuechu Zhen.




Graphical Abstract:





Increasing epidemiologic evidence suggests that metformin, a well-established AMPK activator and the most favorable first-line anti-diabetic drug, reduces stroke incidence and severity. However, the mechanism for this remains unclear. Moreover, previous experimental studies have reported controversial results about the effects of metformin on stroke outcomes during the acute phase. However, recent studies have consistently suggested that AMPK-mediated microglia/macrophage polarization and angioneurogenesis may play essential roles in metformin-promoted, long-term functional recovery following stroke. The present review summarizes the neuropharmacological actions of metformin in experimental stroke with an emphasis on the recent findings that the cell-specific effects and duration of AMPK activation are critical to the effects of metformin on stroke outcomes.


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World Stroke Day, 2018!



Around 80 million people living in the world today have experienced a stroke and over 50m survivors live with some form of permanent disability as a result. While for many, life after stroke won’t be quite the same, with the right care and support living a meaningful life is still possible. As millions of stroke survivors show us every day, it is possible to get #UpAgainAfterStroke.


Bentham Science publishes articles related to World Stroke Day in its Subscription based journals including:




MOST ACCESSED ARTICLE – The Efficacy and Safety of Pharmacological Treatments for Post-stroke Aphasia

Journal Name: CNS & Neurological Disorders – Drug Targets

Author(s): Xiaoyan Zhang, Bohui Shu, Dongdong Zhang, Lina Huang, Qizhi Fu, Ganqin Du*.




Graphical Abstract:



Background: Aphasia is a common complication after stroke, and traditional speech and language therapy (SLT) has a limited effect on post-stroke aphasia (PSA). While there has been an increasing number of controlled clinical trials on the efficacy of drugs in the treatment of PSA, there have been very few systematic reviews on the efficacy and safety of pharmacological treatments in people with PSA.

Objective: To evaluate the efficacy and safety of pharmacological interventions for PSA.

Methods: The Cochrane Central Register of Controlled Trials (CENTRA), PubMed, Embase, Chinese Journal Full-text Database (CJFD), China Biology Medicine disc (CBMdisc), Wanfang Data and VIP Information System were searched for randomized controlled trials about pharmacological treatments for PSA. Literature screening using the inclusion and exclusion criteria, data extraction and methodological quality assessment of the included studies were completed by two independent reviewers. Methodological quality was considered high for modified Jadad quality scale scores of 4 to 7. RevMan 5.3 software was used to conduct a meta-analysis of high-quality studies.

Results: Fifteen studies (578 participants) satisfied the eligibility criteria for this systematic review. Five trials (277 participants) assessed donepezil, four studies (124 participants) assessed memantine, three studies (72 participants) assessed bromocriptine, one trial (45 patients) evaluated galantamine, one study (21 patients) evaluated amphetamine, and one trial (39 patients) evaluated levodopa. The systematic review showed that donepezil achieved remarkable results in terms of the aphasia quotient (AQ) (SMD 0.82, 95% CI 0.48-1.17, P < 0.00001), repetition ability (SMD 0. 81, 95% CI 0.57-1.06, P < 0.00001), naming ability (SMD 0.56, 95% CI 0.29-0. 84, P < 0.00001), auditory comprehension (SMD 0.85, 95% CI 0.58-1. 13, P< 0.00001) and oral expression (SMD 0.90, 95% CI 0.54-1.26, P < 0.00001). Memantine showed no pronounced improvement in auditory comprehension (SMD 0.35, 95% CI -0.05-0.74, P = 0.09) but did improve the AQ (SMD 0.57, 95% CI 0.09-1.06, P = 0. 02), naming ability (SMD 0.81, 95% CI 0.38-1.25, P = 0.0002), spontaneous speech (SMD 0.76, 95% CI 0. 39- 1.13, P < 0.0001), and repetition ability (SMD 0.37, 95% CI 0.01-0.73, P = 0.04). Bromocriptine showed pronounced improvement in naming ability (SMD -0.20, 95% CI- 0.67-0.26, P = 0.39), verbal fluency (SMD 0.02, 95% CI 0.53-0.56, P = 0.95), and repetition ability (SMD 0.29, 95% CI -0.23-0. 81, P = 0.28). There is limited and inconclusive evidence for galantamine, amphetamine and levodopa.

Conclusion: Current evidence suggests that drugs, such as donepezil and memantine, can improve the prognosis of PSA. Donepezil has a significant effect in improving the ability of auditory comprehension, naming, repetition and oral expression. Memantine has a significant effect in improving the ability of naming, spontaneous speech and repetition. Bromocriptine showed no significant improvements in the treatment of aphasia after stroke. Data regarding galantamine, amphetamine and levodopa in the treatment of aphasia after stroke are limited and inconclusive.



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MOST ACCESSED ARTICLE – Antithrombotic Therapy After TAVR

Journal Name: Current Vascular Pharmacology

Author(s): Tobias Geisler*, Michal Droppa, Karin Muller, Oliver Borst.

Graphical Abstract:



Transvascular Aortic Valve Replacement (TAVR) has emerged as a treatment option in patients with severe aortic stenosis who are inoperable and has recently been evaluated in patients with intermediate surgical risk. The number of procedures is increasing worldwide in parallel with the demographic changes in industrial countries. The risk for cerebral embolism is of main concern and represents a major determinant for prognosis and quality of live after TAVR. The empiric antithrombotic therapy consists of Dual Antiplatelet Therapy (DAPT); However the risk-benefit of this approach is lacking evidence from randomized, placebo-controlled trials regarding choice and duration of antithrombotic treatment. Although anticoagulation is generally not recommended in patients with aortic bioprosthesis without atrial fibrillation, there is current uncertainty whether combination of antiplatelet and anticoagulant therapy or anticoagulation alone might represent a more favorable antithrombotic regimen compared to the current empiric standard of DAPT. In addition, so far undetected atrial fibrillation is highly prevalent in the elderly population undergoing TAVR. In particular, the favorable safety profile of Non-Vitamin K Oral Anticoagulants (NOAC) offers an attractive option. A number of trials are currently underway to investigate the benefit of NOAC in patients with and without atrial fibrillation undergoing TAVR. The present article reviews the available evidence concerning stroke risk in TAVR patients and the current and future role of antithrombotic therapy during and after the procedure.

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EDITOR’S CHOICE – Blood microRNA-15a Correlates with IL-6, IGF-1 and Acute Cerebral Ischemia

JOURNAL: Current Neurovascular Research

AUTHOR(S): Wen-Jing Lu, Li-Li Zeng*, Yang Wang, Yu Zhang, Huai-Bin Liang, Xuan-Qiang Tu, Ji-Rong He,Guo-Yuan Yang


Objective: This study aims to explore the function of blood microRNA-15a (miR-15a) in the pathogenesis of acute cerebral ischemia (AIS).

Methods: Blood samples were collected from healthy control and AIS patients within 72 h after onset. A model of ischemia in human umbilical vein endothelial cells (HUVECs) was established through oxygen and glucose deprivation (OGD). MiR-15a in patients and in cells was measured using real-time quantitative polymerase chain reaction (qPCR). The predicted target of miR-15a such as interleukin-6 (IL-6) and insulin-like growth factors-1 (IGF-1) in plasma was detected by enzyme-linked immunosorbent assay (ELISA). The relations between blood miR-15a and stroke severity, stroke etiology, infarct location, stroke prognosis, predicted targets were analyzed by Statistical Product and Service Solutions (SPSS) software respectively.

Results: Higher miR-15a levels were found in AIS patients and ischemic cells within 72 h, compared to control (p < 0.05). Receiver Operating Characteristic (ROC) analysis showed that blood miR-15a predicted stroke onset with 98.67% specificity. Blood miR-15a had a negative correlation with National Institutes of Health Stroke Scale (NIHSS) scores (r = -0.3695, p < 0.01). The AIS patients with increased miR-15a levels had a better prognosis. MiR-15a was up-regulated in anterior circulation infarction and small-artery atherosclerosis stroke. Plasma levels of IL-6 and IGF-1 were associated with blood miR-15a (r = -0.6051, 0.3231, p < 0.05, respectively).

Conclusion: Blood miR-15a associates with IL-6, IGF-1 and acute cerebral ischemia. It could serve as a potential diagnostic biomarker and therapeutic target for stroke.

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Which is Healthier – Frying or Grilling

This World Food Day, we turn our focus onto a very important debate that has been going on for long but changing little in practice. The debate is about which cooking method is better for health, grilling or frying. Both the methods are popularly used and liked by masses. Grilling is done by placing food (meat or vegetables) on a wire grill kept over or under a source of heat. The food gets cooked through the thermal radiation emitted by the heat source and transmitted by the grill.

Vegetables background

Frying, on the other hand, is done in a frying pan or utensil containing oil or fat. The food is placed in the oil, either shallow or deep, and cooked over a heat source. The temperature of the oil rises extremely high and conducts the heat into the food to be cooked. Frying makes the food crispy, hot and enhances the taste strongly. But does it compromise the nutrition of the food?

Yes. Frying causes the essential vitamins and other nutrients in the food to be destroyed due to high temperature. Further, it adds unhealthy fat into the food as the oil penetrates and increases the cholesterol levels. This is the bad cholesterol that chokes blood vessels, increasing the risk of stroke, cardiovascular diseases and type 2 diabetes. The visible ill effects include weight increase and lethargy in cases.

Grilling, also enhances taste but does not damage the nutrition in food. With it the cholesterol level in foods usually drops instead of rising. The moisture and essential vitamins and minerals are retained and add value to what we are consuming. The grilled food is  more easily digested and does not store in the body as unwanted fat.

It’s high time we change our cooking methods and keep ourselves healthy for long.

World Stroke Day!!

stroke day final

Current Cardiology Reviews-Recent Issue!!

Current Cardiology Reviews, 10 Issue 4

7-10-2014 8-38-24 AM

Fei Lu
University of Minnesota Medical School
Minneapolis, MN 55455

Aims & Scope

Current Cardiology Reviews publishes frontier reviews of high quality on all the latest advances on the practical and clinical approach to the diagnosis and treatment of cardiovascular disease. All relevant areas are covered by the journal including arrhythmia, congestive heart failure, cardiomyopathy, congenital heart disease, drugs, methodology, pacing, and preventive cardiology. The journal is essential reading for all researchers and clinicians in cardiology.


Abstracted & Indexed in:

PubMed Central, Chemical Abstracts, EMBASE, Scopus, EMNursing, Genamics JournalSeek, PubsHub, J-Gate, MEDLINE.

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