Search

Introduction: Functional outcomes after acute ischemic stroke (AIS) are related to initial neurological severity (NS). Therefore, neuroprotective drugs against ischemic injury are promising. Not only statins but also eicosapentaenoic acid (EPA) have neuroprotective effects. Hypothesis: Highly purified EPA (hp-EPA) pre-stroke may reduce NS at the onset of AIS. Methods: We retrospectively included patients with AIS and hyperlipidemia admitted to our institution between July 2012 and March 2019 from the prospectively and consecutively enrolled institutional stroke registry database. Hyperlipidemia was defined as serum values of low-density lipoprotein cholesterol (LDL-C) at arrival ≥140 mg/dl or triglycerides ≥150 mg/dl. We excluded patients: (1) admitted to our institution 24 h after AIS onset, (2) who did not stay in the hospital, and (3) in whom dyslipidemia drugs pre-stroke except the hp-EPA were administered. We collected data on age; sex; pre-stroke statin use, antiplatelets, anticoagulants, antihypertensives, and antidiabetic drugs; serum albumin, glucose, glycated hemoglobin (HbA1c), cholesterol, triglycerides, and c-reactive protein levels; pre-stroke modified Rankin scale and the National Institutes of Health Stroke Scale (NIHSS) scores; stroke subtypes at admission; hospitalizations; and home discharge. We performed a multivariable linear regression analysis to identify significant variables of NIHSS scores at arrival. Results: Of the 2,199 patients with AIS and hyperlipidemia during the study period, 691 met our inclusion and exclusion criteria, their median age was 75 years, and 18 (2.6%) received pre-stroke hp-EPA. In patients with and without pre-stroke EPA use, the median NIHSS scores were one and three, respectively. Multivariable regression analysis showed that the glucose, mRS, age, LDL-C, and anticoagulants increased the NIHSS score, albumin, HbA1c, high-density lipoprotein cholesterol, antihypertensives, antidiabetic drugs, and hp-EPA use decreased the NIHSS score. Conclusion Pre-stroke hp-EPA use reduced NS at the AIS onset in patients with hyperlipidemia and without other dyslipidemia drugs.

BACKGROUND AND PURPOSE: Intracranial hemorrhage due to hyperperfusion syndrome is a severe carotid artery stent placement complication of extremely high-grade stenosis, causing hemodynamic insufficiency. To prevent hyperperfusion syndrome, we attempted intentional residual stent stenosis and implemented “gentle” carotid artery stent placement, defined as carotid artery stent placement using a closed-cell stent coupled with slight balloon predilation, without balloon postdilation. Gradual stent expansion was expected. We investigated the incidence of hyperperfusion syndrome and long-term outcomes after gentle carotid artery stent placement. MATERIALS AND METHODS: We included patients who underwent carotid artery stent placement for extremely high-grade stenosis from January 2015 to March 2019. We defined extremely high-grade stenosis as carotid stenosis with conventional angiographic “slow flow” and a reduced MCA signal intensity on MRA. A reduced MCA signal intensity was defined as MCA with a relative signal intensity of

Background Serum fatty acid (s-FA) compositions and their correlation with serum lipids (s-LPs) such as total cholesterol (T-CHO) and triglycerides (TG) have been reported in healthy young subjects. However, little is known about such features in acute ischaemic stroke (AIS). The aim of our study was to investigate s-FA characteristics and their correlation with AIS in elderly patients. Methods We conducted a cross-sectional study of patients aged 50 years or older who were admitted between September 2015 and March 2017 within 24 h of the first AIS onset. We evaluated concentrations and compositions of s-FAs and their association with s-LPs, age, and ischaemic stroke subtypes, including large-artery atherosclerosis (LAA), small-vessel occlusion (SVO), and cardioembolism (CE) or others. Results One hundred ninety-one patients met our inclusion criteria. Their average age was 74.4 years, mean T-CHO and median TG were 203.4 and 94.5 mg/dl, respectively, and median or mean concentrations of palmitic acid (PA), oleic acid (OlA), linoleic acid (LiA), and docosahexaenoic acid (DHA) were 680.7, 602.5, 795.2, and 136.9 μg/ml, respectively, with mean compositions of 23.7, 21.3, 27.1, and 4.4%, respectively. PA, OlA, and LiA concentrations were weakly negatively associated with age and positively correlated with TG. In LAA or SVO (LAA_SVO) and CE or others (CE_O), mean age was 71.9 and 77.4 years (p p p p p p Conclusions In AIS elderly patients, concentrations, rather than compositions of PA, OlA, and LiA, correlated with age, TG, and ischaemic stroke subtypes. Patients with LAA_SVO were younger and had higher concentrations of PA, OlA, and LiA than those with CE_O. There were no differences in such compositions between LAA_SVO and CE_O.

Objective Carotid artery stenting (CAS) in patients undergoing maintenance hemodialysis is characterized by high complication rates. These patients are excluded from clinical trials of CAS. The purpose of our retrospective study was to investigate the long-term clinical outcomes of CAS in patients undergoing maintenance hemodialysis. Methods CAS was performed under local anesthesia. The technical success rate, periprocedural complications, 30-day major vascular event rate (stroke, myocardial infarction, and/or death), 3-month morbidity and mortality rates, and 5-year survival probability were investigated. Patients Nineteen patients undergoing maintenance hemodialysis were identified. Results The mean age of the patients was 69 years. Periprocedural complications occurred in two patients (confusion following CAS in one and transient hemiparesis in the other). Complete neurological recovery was achieved in both patients. No major cardiovascular events occurred within 30 days after CAS. Asymptomatic intracranial hemorrhage only occurred in one patient, and seven patients died during the follow-up period at a mean of 3.5 years after the procedure (range, 6 months to 8 years). No permanent neurologic deficit remained in the patient with intracranial hemorrhage. The causes of death were cardiovascular disease (n = 4), cancer (n = 2), and pneumonia (n = 1). No patients died of stroke. The 5-year survival probability in patients undergoing maintenance hemodialysis was 57%. Conclusion CAS in maintenance hemodialysis patients may be feasible and effective for the prevention of stroke with proper case selection, appropriate technique and strict perioperative management. The most common causes of death during the follow-up of maintenance hemodialysis patients were diseases other than stroke.

BACKGROUND AND PURPOSE: When the femoral approach for mechanical thrombectomy (MT) in acute ischemic stroke (AIS) is limited, trans-brachial or-radial access is an alternative. However, transbrachial insertion of a 9Fr (outer diameter [OD]) balloon guide catheter (BGC) into the carotid artery is not feasible. Computed tomographic (CT) angiography (CTA) may provide vascular anatomical information for successful insertion. We investigated CTA anatomical features for successful transbrachial insertion of a 9Fr BGC into the carotid artery. MATERIALS AND METHODS: We analyzed AIS patients who underwent CTA and transbrachial MT using a 9Fr BGC between 2014 and 2016. We evaluated the successful insertion rate and CT angiographic anatomical features. RESULTS: Twenty-four patients met our inclusion criteria. We achieved successful insertion in 18 (75%) of 24 cases: 7 (58.3%) of 12 for left carotid arteries and 11 (91.7%) of 12 for right carotid arteries. Successful insertion was achieved in 4 of 4 bovine aortic arch for left carotid occlusion and in 3 of 8 nonbovine aortic arches for left carotid occlusion. We achieved successful insertion in 3 nonbovine cases with takeoff angles ≥23° and failed insertion in 5 cases with takeoff angles

Introduction: Intermittent pneumatic compression (IPC) is commonly used to prevent deep vein thrombosis (DVT) during hospitalization in patients with acute stroke. However, if DVT exists at admission of acute stroke, IPC of the legs with DVT may cause migration of the thrombi resulting in pulmonary emboli. Therefore, whole-leg ultrasonography to detect DVT should be performed at admission; however, it is not always done in many institutions. Therefore, risk factors to estimate DVT presence at admission are necessary. Hypothesis: The frequency of DVT at admission is high, and IPC should not be used in patients with significant factors of DVT presence at admission. Methods: We included patients admitted within 24 h of stroke onset between 2016 and 2019. We collected patient data on age, sex, anthropometric variables, DVT presence by whole-leg ultrasonography, and biomarkers. We evaluated variables with significant differences between groups of DVT presence and absence, excluded variables with multicollinearity, and conducted multiple logistic regression analyses to identify independent discriminants of DVT presence from absence. The threshold values of discriminants were identified by receiver operating characteristic curves. Results: Of 1936 stroke patients, 1461 met our inclusion criteria. DVT was detected in 255 patients (17.5%). Compared to patients without DVT (n=1206), patients with DVT were older, female sex, lower body weight, higher C-reactive protein levels, lower albumin or triglyceride levels, higher National Institutes of Health Stroke Scale score, and higher pre-stroke modified Rankin stroke scale score. Female sex, low albumin, high C-reactive protein, low triglycerides, and old age were independent DVT-presence discriminants. The threshold values of albumin, C-reactive protein, triglycerides, and age were ≤ 37g/L, ≥ 3450 ug/L, ≤ 1.569 mmol/L, and ≥ 79 years, respectively. Conclusion: The DVT-presence frequency of 17.5% at admission was high, and significant DVT-presence factors at admission were female sex, low albumin, high C-reactive protein, low triglyceride levels, and old age. Therefore, in patients with the five significant factors, IPC should be avoided, or whole-leg ultrasonography should be performed before IPC.

Introduction: Hyperglycemia must be improved in acute stroke patients. However, effective treatment has not been established. Hypothesis: Moderate-carbohydrate (carbo) diet and sodium-glucose cotransporter 2 (SGLT2) inhibitors can lower blood glucose level (BGL) safely and soon in patients with oral ingestion and normal renal function. Methods: For the retrospective observational study, we included patients who 1) were admitted within 24 h of stroke onset between Jan 2011 and March 2019, 2) had not undergone insulin therapy, 3) presented hemoglobin A1c ≥ 6.5%, BGL ≥ 11.1 mmol/L, and estimated glomerular filtration rate ≥ 60 mL/min/1.73m2 at admission, 4) took diet and drugs orally during hospitalization, and 5) underwent blood examination on the 6th day. We classified patients into three groups: 60% carbo diet without SGLT2 (C60 group); 40% carbo diet without SGLT2 (C40 group); 40% carbo diet with SGLT2 (C40-SGLT2 group). We calculated daily carbo intake and evaluated sulfonylurea (SU) use during hospitalization, median BGL and median HL at admission and on the 6th day in three groups. Results: Of 5724 stroke patients, 84 patients met our inclusion criteria. There were 26 patients in the C60 group, 22 in the C40 group, and 36 in the C40-SGLT2 group. In three groups, median age was 70, 62, and 68 years, respectively, median body mass index was 24.1, 25.1, and 24.3 kg/m2, respectively, median daily carbo intake was 195, 140, and 140 g (p< 0.0001), respectively, 46%, 9%, and 0% of patients used SU (p< 0.0001), respectively, median BGL at admission were 14.2, 14.6, and 14.4 mmol/L, respectively, median HL at admission were 42.4, 44.1, and 43.3%, respectively, median BGL on the 6th day were 7.9, 8.2, and 6.4 mmol/L (p= 0.0003), respectively, and median HL on the 6th day were 40.5, 41.7, and 40.5%, respectively. BGL on the 6th day was decreased in three groups, and it was the most improved in the C40-SGLT2 group. BGL on the 6th day was not different between C60 and C40 groups; however, SU was seldom used in the C40 group. No dehydration occurred. Conclusion: SU was seldom necessary for the C40 group and unnecessary for the C40-SGLT2 group. SGLT2 inhibitors coupled with 40% carbo-diet lowered BGL safely and soon in patients with oral ingestion and normal renal function.

Introduction: Intermittent pneumatic compression (IPC) is used to prevent deep vein thrombosis (DVT) during hospitalization in patients with acute stroke. However, if existing DVT is not examined during admission, IPC massage of the legs with DVT may cause migration of the thrombi. Hypothesis: The frequency of DVT at acute stroke admission is high and significant factors indicate the presence of DVT at acute stroke admission. Methods: We included patients admitted within 24 hours of stroke onset, between 2017 and 2019. We collected patient data on age, sex, anthropometric variables, DVT presence by whole-leg ultrasonography, and biomarkers such as D-dimer and lipids. Results: Of 1129 stroke patients, 907 met our inclusion criteria. DVT was detected in 159 patients (17.5%). Compared to patients without DVT (n=748), patients with DVT were older, females, with lower body weight, higher D-dimer and C-reactive protein levels, lower albumin or triglyceride (TG) levels, and higher National Institutes of Health Stroke Scale score. Multiple logistic regression analysis showed that sex, D-dimer, and TG were independent DVT-presence variables. Conclusions: DVT occurred in 17.5% of acute stroke patients at admission, and significant DVT-presence factors were female sex, high D-dimer level, and low TG level. Patients with the three significant factors at admission must immediately undergo whole-leg ultrasonography to detect DVT.

Background Intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) have common vascular risk factors; however, ICH often occurs in adults aged Methods We included patients aged 40–69 years who experienced ICH or AIS between August 2016 and July 2019. Patients aged Results Of the 1252 acute stroke patients screened, 74 patients with ICH and 149 patients with AIS met the inclusion criteria. After excluding variables with multicollinearity, SBP, glycated hemoglobin (HbA1c), and eicosapentaenoic acid (EPA) proportion (%) of total fatty acids were identified as independent factors affecting ICH and AIS. The SBP and EPA% threshold values for ICH compared to AIS were ≥ 158 mmHg and ≤ 2.3%, respectively. The HbA1c threshold value for AIS compared to ICH was ≥ 6.1%. Conclusions Systolic blood pressure, HbA1c, and EPA%, were independent factors between ICH and AIS. Patients aged 40–69 years with high SBP and low EPA% were at a higher risk of ICH than AIS, and those with a high HbA1c were at a higher risk of AIS than ICH.

Background Intermittent pneumatic compression (IPC) is commonly used to prevent deep vein thrombosis (DVT) during hospitalization in patients with acute stroke. However, if DVT exists at admission, IPC of the legs with DVT may cause migration of the thrombi, resulting in pulmonary emboli. Whole-leg ultrasonography (wl-US) is a practical tool to detect DVT; however, wl-US is not always performed at admission in all stroke patients. This retrospective cross-sectional study aimed to investigate DVT frequency and identify significant factors indicating the presence of DVT at admission for acute stroke. Methods We included patients admitted within 24 h of stroke onset between 2017 and 2019. Patients who did not undergo blood tests for D-dimer or wl-US within 72 h of arrival were excluded. We collected patient data on age; sex; anthropometric variables; presence of DVT on wl-US; and biomarkers such as D-dimer, high-sensitivity C-reactive protein (hs-CRP), and lipids. Results Of 1129 acute stroke patients, 917 met our inclusion criteria. DVT was detected in 161 patients (17.6 %). Patients with DVT were older; were more likely to be female; had lower body weight; had higher D-dimer and hs-CRP levels; had lower albumin, hemoglobin, and triglyceride levels; and had higher National Institutes of Health Stroke Scale and pre-stroke modified Rankin scale scores than patients without DVT (n = 756). In addition, multiple logistic regression analysis showed that sex (female) and D-dimer levels (≥ 1.52 µg/mL) were independent significant factors for the presence of DVT. Among 161 patients with DVT, 78 (48.4 %) had both these significant factors. Among 756 patients without DVT, 602 (79.6 %) had no or one significant factor. The odds ratio of the presence of DVT in patients with both significant factors was 6.29, using patients without any significant factors as the group for comparison. Conclusions The frequency of DVT is high in acute stroke patients at admission. Female sex and a high D-dimer level were independent significant factors for the presence of DVT. Therefore, in patients with these two significant factors at admission, IPC should be avoided or wl-US should be performed before IPC.

Background/purpose of the study If non-alcoholic fatty liver disease (NAFLD) frequency is very high in stroke patients, NAFLD may be a risk factor for stroke and identifying factors of NAFLD presence may lead to stroke prevention. This retrospective study aimed to investigate whether NAFLD frequency was very high and identify factors associated with NAFLD presence at acute stroke admission. Methods We included stroke patients aged 40 − 79 years who (1) were admitted from 2016 to 2019, within 24 h of onset; (2) underwent abdominal ultrasonography; and (3) underwent blood examination of biomarkers. We evaluated the frequency and significant factors of NAFLD presence. Results Among 1672 stroke patients, 676 patients met our inclusion criteria, and 267 patients (39.5%) had NAFLD. Compared to patients without NAFLD, patients with NAFLD were young; had high anthropometric values; high blood pressure; low aspartate aminotransferase/alanine aminotransferase ratio (AST/ALT) ratio; high levels of liver enzymes, serum albumin, HbA1c, and serum lipids; low-density lipoprotein; high serum level of some fatty acids; and high fatty acid% of palmitic acid (PA) and dihomo-gamma-linolenic acid (DGLA). After excluding variables with multicollinearity, independent NAFLD-presence factors were high body mass index (BMI), low AST/ALT ratio, high serum albumin level, high PA%, and high DGLA level. Conclusions The frequency of NAFLD was high in our patient group. Significant NAFLD-presence factors were high BMI, low AST/ALT ratio, high serum albumin level, high PA%, and high DGLA level. A further study is warranted to determine the effects of the NAFLD-presence factors on stroke onset or prevention.

Introduction: Dietary triglycerides influence fatty acid (FA) serum concentrations and weight percentages (wt%), which may be associated with the onset of intracerebral hemorrhage (ICH) or acute ischemic stroke (AIS). Hypothesis: There are significant differences between FAs at the admission of ICH and AIS. Methods: We included patients admitted between 2016 and 2019 within 24 h of ICH or AIS onset and calculated correlation coefficients between their ages, serum FA concentrations, and FA wt% values. We evaluated differences in age, average blood pressure (ABP), glucose, A1c, serum lipids, and FAs between two groups. Excluding variables with multicollinearity, we performed multiple logistic regression (MLR) analysis to identify independent variables distinguishing ICH from AIS. We estimated the threshold values of independent variables using the area under the curve values derived from the receiver operating characteristic (ROC) curves. Results: Our inclusion criteria were met by 141 of ICH patients and 525 of AIS patients. In the ICH group, age, A1c, and eicosapentaenoic acid (EPA) levels were smaller than those in the AIS group. ABP, high-density lipoprotein cholesterol (HDL-C), myristic acid (MyA), linoleic acid (LiA) concentrations, and MyA wt% were higher than those in the AIS group. MLR analysis between two groups indicated that age, ABP, A1c, HDL-C were independent variables. Serum FA levels were not independent. ROC curves showed that the threshold values of age, ABP, A1c, and HDL-C for ICH onset were ≤ 69 years, ≥ 126.6 mmHg, ≤ 6.0%, and ≥ 1.62 mmol/L, respectively. In 27 patients with age ≤ 69 , ABP ≥ 126.6, A1c ≤ 6.0%, and HDL-C ≥ 1.62 and 87 patients with age > 69 , ABP< 126.6, A1c > 6.0, and HDL-C < 1.62, there were 19 (70.4%) and 9 (10.3%) patients with ICH, the MyA concentrations were 108 and 73 μmol/L (p < 0.001), the LiA concentration were 2,900 and 2,410μmol/L (p < 0.001), and the EPA wt% were 1.4 and 2.0% (p=0.059), respectively. Conclusions: Younger patients with higher ABP, lower A1c, and higher HDL-C suffered from not AIS but ICH, and their MyA and LiA concentrations were higher than older patients without them.

Objectives Angiographic “slow flow” in the middle cerebral artery (MCA), caused by carotid stenosis, may be associated with high oxygen extraction fraction (OEF). If the MCA slow flow is associated with a reduced relative signal intensity (rSI) of the MCA on MR angiography, the reduced rSI may be associated with a high OEF. We investigated whether the MCA slow flow ipsilateral to carotid stenosis was associated with a high OEF and aimed to create a practical index to estimate the high OEF. Methods We included patients who underwent digital subtraction angiography (DSA) and MRA between 2015 and 2019 to evaluate carotid stenosis. MCA slow flow by image count using DSA, MCA rSI, minimal luminal diameter (MLD) of the carotid artery, carotid artery stenosis rate (CASr), and whole-brain OEF (wb-OEF) was evaluated. When MCA slow flow was associated with a high wb-OEF, the determinants of MCA slow flow were identified, and their association with high wb-OEF was evaluated. Results One hundred and twenty-seven patients met our inclusion criteria. Angiographic MCA slow flow was associated with high wb-OEF. We identified MCA rSI and MLD as determinants of angiographic MCA slow flow. The upper limits of MCA rSI and MLD for angiographic MCA slow flow were 0.89 and 1.06 mm, respectively. The wb-OEF was higher in patients with an MCA rSI ≤ 0.89 and ipsilateral MLD ≤ 1.06 mm than patients without this combination. Conclusions The combination of reduced MCA rSI and ipsilateral narrow MLD is a straightforward index of high wb-OEF. Key Points • The whole-brain OEF in patients with angiographic slow flow in the MCA ipsilateral to high-grade carotid stenosis was higher than in patients without it. • Independent determinants of MCA slow flow were MCA relative signal intensity (rSI) on MRA or minimal luminal diameter (MLD) of the carotid stenosis. • The wb-OEF was higher in patients with an MCA rSI ≤ 0.89 and ipsilateral MLD ≤ 1.06 mm than patients without this combination.

Introduction: Intracranial hemorrhage occasionally occurs after carotid revascularization in presents with hemodynamic insufficiency. Positron emission tomography is unavailable in most facilities, and a feasible index is required to identify high-risk patients. Reduced signal intensity (SI) of the middle cerebral artery (MCA) on magnetic resonance angiography (MRA) is associated with postoperative hyperperfusion. Hypothesis: Reduced signal intensity (SI) of the MCA on MRA is associated with decreased regional cerebral blood flow (rCBF) on single-photon emission CT (SPECT) and increased blood-sampling whole-brain oxygen extraction fraction (wb-OEF). Methods: We included patients who: 1) were admitted from 2015 to 2019 for carotid artery stenting (CAS), 2) MRA, and SPECT before CAS, and 3) examined the wb-OEF immediately before CAS. We measured bilateral MCA SI on MRA and defined the MCA relative SI as (SI in the affected MCA)/ (SI in the contralateral MCA). We defined the rCBF% as rCBF in the affected MCA territory against the ipsilateral cerebellum. Before CAS, we sampled blood, measured the arterial oxygen and the venous oxygen content in the dominant-sided jugular vein, and calculated the wb-OEF. We evaluated the correlation between the MCA relative SI, the MCA slow flow, the rCBF%, and the wb-OEF. We estimated the upper limits of the MCA relative SI for the rCBF% < 80% or wb-OEF ≥ 0.40 using the area under the curve (AUC) values derived from the receiver operating characteristic (ROC) curves. Results: During the study period, 150 patients met our inclusion criteria. The MCA relative SI was positively correlated with rCBF% and negatively with the wb-OEF. The ROC curve for the rCBF% < 80% showed that the upper limit of the relative SI was 0.77 (the sensitivity of 53.9%, the specificity of 83.9%, AUC of 0.723). The ROC curve for the wb-OEF ≥ 0.40 showed that the upper limit of the relative SI was 0.95 (the sensitivity of 67.7%, the specificity of 55.2%, AUC of 0.625). Conclusion: Reduced MCA SI on MRA ≤ 0.77 is a practical and feasible index of hemodynamic insufficiency, indicating the decreased rCBF and increased wb-OEF.

Background and Purpose: High blood pressure increases bleeding risk during treatment with antithrombotic medication. The association between blood pressure levels and the risk of recurrent stroke during long-term secondary stroke prevention with thienopyridines (particularly prasugrel) has not been well studied. Methods: This was a post hoc analysis of the randomized, double-blind, multicenter PRASTRO-I trial (Comparison of Prasugrel and Clopidogrel in Japanese Patients With Ischemic Stroke-I). Patients with noncardioembolic stroke were randomly assigned (1:1) to receive prasugrel 3.75 mg/day or clopidogrel 75 mg/day for 96 to 104 weeks. Risks of any ischemic or hemorrhagic stroke, combined ischemic events, and combined bleeding events were determined based on the mean level and visit-to-visit variability, including successive variation, of systolic blood pressure (SBP) throughout the observational period. These risks were also compared between quartiles of mean SBP level and successive variation of SBP. Results: A total of 3747 patients (age 62.1±8.5 years, 797 women), with a median average SBP level during the observational period of 132.5 mm Hg, were studied. All the risks of any stroke (146 events; hazard ratio, 1.318 [95% CI, 1.094–1.583] per 10-mm Hg increase), ischemic stroke (133 events, 1.219 [1.010–1.466]), hemorrhagic stroke (13 events, 3.247 [1.660–6.296]), ischemic events (142 events, 1.219 [1.020–1.466]), and bleeding events (47 events, 1.629 [1.172–2.261]) correlated with increasing mean SBP overall. Similarly, an increased risk of these events correlated with increasing successive variation of SBP (hazard ratio, 3.078 [95% CI, 2.220–4.225] per 10-mm Hg increase; 3.051 [2.179–4.262]; 3.276 [1.172–9.092]; 2.865 [2.042–4.011]; 2.764 [1.524–5.016], respectively). Event rates did not differ between the clopidogrel and prasugrel groups within each quartile of SBP or successive variation of SBP. Conclusions: Both high mean SBP level and high visit-to-visit variability in SBP were significantly associated with the risk of recurrent stroke during long-term medication with either prasugrel or clopidogrel after stroke. Control of hypertension would be important regardless of the type of antiplatelet drugs. Registration: URL: https://www.clinicaltrials.jp ; Unique identifier: JapicCTI-111582.

Introduction: There are few reports about the association of concentrations and proportions of serum fatty acids with age at the onset of acute ischemic stroke (AIS) in elderly patients. Hypothesis: A higher level of saturated FA (SFA) and n-6 polyunsaturated FA (PUFA) cause a younger onset of AIS, and a higher level of n-3 PUFA causes an older onset of AIS. Methods: For the retrospective cross-sectional study, we included patients aged 50 years or older who: 1) were admitted to our institution between August 2016 and July 2019 within 24 hours of AIS onset, and 2) underwent an examination of serum fatty acids. We evaluated concentrations of palmitic acid (PA) and stearic acid (SA) as SFA, oleic acid (OlA) as n-9 PUFA, linoleic acid (LiA), dihomo-gamma-linolenic acid (DGLA), arachidonic acid (AA) as n-6 PUFA on admission. We evaluated the concentration of alpha-linolenic acid (AlA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) as n-3 PUFA on admission. We evaluated the proportion of PA, SA, OlA, LiA, DGLA, AA, AlA, EPA, and DHA on admission. Furthermore, we evaluated their correlations with age at the AIS onset. Results: Three hundred sixty-six patients met our inclusion criteria. Their median average age was 75 years. Age at the onset was negatively correlated with concentrations of PA, SA, OlA, LiA, DGLA, AA, and AlA. Age at the onset was negatively correlated with the proportion of SA, OlA, and DGLA and positively correlated with the proportion of EPA and DHA. Multiple regression analysis showed that DGLA was an independent factor for the younger onset of AIS. Multiple regression analysis showed that DHA proportion was an independent factor for the older onset and that proportions of SA and DGLA were independent factors for the younger onset of AIS. Conclusions: The higher proportion of SA (SFA) and higher concentration and proportion of DGLA (n-6 PUFA) were significantly correlated with the younger onset of AIS, and the higher proportion of DHA (n-3 PUFA) was significantly correlated with the older onset of AIS.

BACKGROUND: The international Randomized, Double-Blind, Evaluation in Secondary Stroke Prevention Comparing the EfficaCy and Safety of the Oral Thrombin Inhibitor Dabigatran Etexilate versus Acetylsalicylic Acid in Patients with Embolic Stroke of Undetermined Source (RE-SPECT ESUS) trial did not demonstrate superiority of dabigatran over aspirin for reduction of recurrent strokes in patients with embolic strokes of undetermined source (ESUS). Based on pre-defined subanalyses, the safety and efficacy of dabigatran vs. aspirin in Japanese patients was assessed.Methods and Results:ESUS patients were randomized to receive either dabigatran (150 or 110 mg twice daily) or aspirin (100 mg once daily). Of 5,390 patients randomized, 594 were Japanese. Most Japanese patients (99.8%) underwent brain magnetic resonance imaging for trial screening, compared to 76.8% of non-Japanese (P

Dietary triglycerides influence the serum concentrations of fatty acids (FA) and their weight percentages (wt%), which might be associated with the age of onset of intracerebral hemorrhage (ICH). We investigated the correlation between serum FA levels and proportions at admission, and the age at onset of ICH. We included patients admitted between 2016 and 2019 within 24 h of the onset of ICH, and calculated the correlation coefficients between their age, serum FA concentration, and FA wt%. We performed multiple linear regression analysis to identify individual FAs related to the age at onset of ICH. Furthermore, we estimated the threshold values of FAs that were independently associated with the age at onset of ICH &lt, 65 years, using receiver operating characteristic curves by logistic regression. Our inclusion criteria were met by 141 patients (mean age, 67 years). The concentration of dihomo-gamma-linolenic acid (DGLA) and the wt% of eicosapentaenoic acid (EPA) were significant independent variables for the age at onset of ICH. The ROC curves for the age of onset &lt, 65 years were &ge, 108.6 &micro, mol/L for DGLA and &le, 1.7% for EPA. Increased DGLA concentration and decreased EPA wt% were significantly associated with young-onset ICH.

Dietary triglycerides influence fatty acid (FA) serum concentrations and weight percentages (wt %), which may be associated with the age of onset of acute ischemic stroke (AIS). We investigated the correlations between serum FA levels and proportions at admission and the age of onset of AIS. We evaluated patients with AIS admitted between 2016 and 2019 within 24 h of AIS onset and calculated the correlation coefficients between their ages, serum FA concentrations, and FA wt % values. Multiple linear regression analysis was performed to identify independent FAs indicating AIS age of onset. Furthermore, we estimated the threshold values of independent FAs for age of onset &lt, 60 years using receiver operating characteristic curves by logistic regression. A total of 525 patients (median age: 75 years) met the inclusion criteria. The concentration of dihomo-gamma-linolenic acid (DGLA) and wt % of docosahexaenoic acid (DHA) were significant independent variables for age of onset of AIS, and receiver operating characteristic curves for age of onset &lt, 60 years showed thresholds of &ge, 117.7 &micro, mol/L for DGLA and &le, 3.7% for DHA. An increased DGLA concentration and decreased DHA wt % were significantly associated with onset of AIS at a younger age.

Background Malnutrition often occurs in acute stroke patients receiving enteral tube feeding (ETF). Unless malnutrition is improved, their clinical outcome is poor. However, strategies to improve malnutrition in these patients have not been established. Branched-chain amino acids (BCAA) may enhance protein synthesis and attenuate inflammation. Our study aimed to investigate whether a leucine enriched BCAA dietary supplement (LEBDs) could quickly increase serum levels of albumin (Alb) or transthyretin (TTR) and decrease high-sensitivity C-reactive protein (CRP) in the development of severe malnutrition within a few days after stroke onset compared to standard BCAA dietary supplement (SBDs). Methods We retrospectively included acute stroke patients who: 1) were admitted between August 2016 and July 2017; 2) underwent ETF for 7 days or longer after admission, and 3) underwent blood examination of Alb, TTR, and CRP on admission, the fifth day and the seventh day. We defined severe malnutrition as severe hypoproteinemia: decrease of TTR to less than 15 mg/dl on the 5th day. In LEBDs and SBDs groups, patients started to receive a dietary supplement containing leucine of 1.44 and 0. 72 g twice a day on the fifth day, respectively. We evaluated Alb (g/dl), TTR (mg/dl), and CRP (mg/dl) on admission, the fifth day, and the seventh day. Results Twenty-nine patients met our inclusion criteria:15 in LEBDs and 14 in SBDs. In LEBDs and SBDs groups, the median Alb was 3.5 and 3.3 g/dl, TTR was 12.7 and 10.7 mg/dl, and CRP was 1.02 and 0.673 mg/dl on admission, respectively. In LEBDs, the median Alb and TTR decreased to 2.6 g/dl and 11.9 mg/dl, and CRP increased to 5.337 mg/dl on the fifth day. On the 7th day, TTR increased, and CRP decreased, although Alb did not improve. In SBDs, the median Alb and TTR decreased to 2.6 g/dl and 9.7 mg/dl, and CRP increased to 4.077 mg/dl on the fifth day. On the 7th day, Alb, TTR, and CRP did not improve. Conclusion In acute stroke patients receiving leucine enriched BCAA dietary supplement, quick improvements in transthyretin and CRP were observed.

Background:Malnutrition often occurs in acute stroke patients receiving enteral tube feeding (ETF). Unless malnutrition is improved, their clinical outcome is poor. However, strategies to improve malnutrition in these patients have not been established. Branched-chain amino acids (BCAA) may enhance protein synthesis and attenuate inflammation. Our study aimed to investigate whether a leucine enriched BCAA dietary supplement (LEBDs) could quickly improve a patient's nutritional status during the early stage of malnutrition. Methods:We retrospectively analyzed acute stroke patients who 1) were admitted between December 2016 and July 2017; 2) underwent ETF for seven days or longer after admission; 3) who underwent blood examination on admission, the 5th day, and seventh day; 4) in whom transthyretin (TTR) was less than 15 mg/dl on the 5th day, and 5) received LEBDs containing 1.44 g leucine per 200 kcal twice a day on the 5th day. We evaluated patients' features, serum albumin (Alb) (g/dl), transthyretin (TTR) (mg/dl), and high sensitive C-reactive protein (CRP) (mg/dl) on admission, the fifth day, and the seventh day. Results:Fifteen patients met our inclusion criteria. Their median age, body mass index (BMI), body weight (BW), serum blood glucose (BG), Alb, TTR, and CRP were 82 years, 21.8 kg/m2, 50 kg, 150 mg/dl, 3.5 g/dl, 12.7 mg/dl, and 1.02 mg/dl, respectively. Their median calorie intake was 1,200 kcal/day. On the 5th day, their median Alb and TTR decreased to 2.6 g/dl (p

Introduction: Non-alcoholic fatty liver disease (NAFLD) is reported to be a predictor of cardiovascular disease (CD). NAFLD is probably associated with stroke in middle and old-aged patients. Hypothesis: In acute stroke patients aged 40-79 years, prevalence of NAFLD on admission is high and its metabolic factors are body mass index (BMI), triglycerides (TG), some fatty acids, blood sugar or HbA1c and aspartate aminotransferase / alanine aminotransferase ratio (AST/ALT ratio) as well as reported in ischemic heart disease. Methods: We included acute stroke patients aged 40-79 years who 1) were admitted from August 2016 to July 2019 within 24 hours of onset, 2) underwent abdominal ultrasonography and 3) took blood examination of serum fatty acids on admission. We evaluated prevalence and associated metabolic factors of non-alcoholic fatty liver disease. Results: Among 1672 acute stroke patients, 676 patients met our inclusive criteria. Their median age was 70 years, 267 patients (39.5%) had NAFLD. In NAFLD and non-NAFLD patients, median age was 68 and 71 years (p2 (p Conclusions: In acute stroke patients aged 40-79 years, prevalence of NAFLD on admission was high and metabolic factors of NAFLD were younger Age, higher BMI, higher serum concentrations of Alb, T-CHO, TG and fatty acids, higher HbA1c and lower AST/ALT ratio.

Background: Compositions of serum fatty acids (s-FAs), such as palmitic acid (PA), oleic acid (OlA), linoleic acid (LiA) and docosahexaenoic acid (DHA), and their correlation with serum lipids (s-LPs), such as total cholesterol (T-CHO) and triglycerides (TG), have been reported in healthy young or middle subjects. However, little is known about s-FAs features in acute ischemic stroke (AIS) patients. Hypothesis: Serum FAs features in AIS elderly patients are different from those in healthy young subjects and concentrations of s-FAs provide different correlation with s-LPs from compositions. Methods: We conducted a cross-sectional study of patients aged 50 years or older who were admitted to our institution between August 2016 and July 2019 within 24 hours of first AIS onset. We evaluated concentrations and compositions of s-FAs and their association with s-LPs, age and ischemic stroke subtype. Results: Three hundred sixty-six patients met our inclusive criteria. Their average age was 74.7 years, median T-CHO and TG were 203.5 and 102 mg/dl, respectively and median concentrations of PA, OlA, LiA and DHA were 642.5, 566.0, 723.0 and 129.8 μg/ml, respectively, and their median or mean compositions were 23.6, 20.9, 26.5 and 4.7 %, respectively. Concentrations of s-FAs had positive correlation with s-LPs. Concentrations of s-LPs and most of s-FAs had negative correlation with age. In stroke subtype of large-artery atherosclerosis or small-vessel occlusion (LAA_SVO) and in stroke subtype of cardioembolism or others (CE_O), mean age was 72.6 and 76.4 years (p Conclusions: In first AIS elderly patients, concentrations of most of s-FAs had positive correlation with s-LPs. In LAA_SVO, patients were younger and their concentrations of s-LPs and most of s-FAs were larger than in CE_O. On the other hand, correlation of s-FAs compositions with s-LPs was not constant and there was little difference of compositions between ischemic stroke subtypes.

Introduction: Level of alertness in acute stroke patients is often deteriorated during hospitalization, even though they can orally eat food on admission and their stroke is not severe. Then, it is difficult to improve their level of alertness. If their level of alertness is not improved, their nutritional status is probably deteriorated. Hypothesis: Dark chocolate 5g tablet containing 86% cacao and 147mg polyphenol can improve level of alertness and prevent deterioration of nutritional status. Methods: We included acute stroke patients for retrospective analysis who 1) were admitted between August 2017 and July 2018, 2) presented alert consciousness on admission and orally eat food then, 3) underwent blood examination on admission, the 3rd day and 7th day, 4) presented mild deterioration of level of alertness during hospitalization and 5) took dark chocolate 5g containing 86% cacao and 147mg polyphenol twice a day. We evaluated patients’ features, Glasgow Coma Scale (GCS) as level of consciousness, albumin (Alb), prealbumin (PreAlb), high-sensitivity C-reactive protein (hs-CRP) on admission, on the initial chocolate day and on the 7th day. Results: Eighteen patients met our inclusive criteria and were analyzed. The median age, GCS score, body mass index, blood glucose (BG), hs-CRP, Alb and PreAlb were 85 years, 14, 21.8 kg/m2, 119 mg/dl, 0.1165 mg/dl, 3.9 g/dl and 20.4 mg/dl, respectively. They started to eat 86% cacao chocolate 5g supplementation twice a day median on the 3rd day. On the 3rd day when chocolate was started, their median GCS score, Alb and PreAlb decreased to13 (p Conclusion: Dark chocolate containing 86% cacao and 147mg polyphenol probably improved level of alertness and prevented further deterioration of nutritional status in patients who could orally eat food.

Introduction: Acute stroke patients have problems with gait disturbance. Independent gait in hospitalized patients is important for early discharge to home. Therefore, we must find factors of disturbing independent gait following acute stroke and intensively treat them. Hypothesis: Impaired trunk control and cognitive function are factors of disturbing early independent gait. Methods: We included acute ischemic stroke patients who were admitted in our hospital from June 2017 to May 2018 and excluded patients with disturbed level of consciousness. We defined a score of 6 (modified Independence) or 7 (complete independence) in the Functional Independence Measure (FIM) as gait independence. We evaluated association of stroke subtypes, Brunnstrom recovery stage (BRS) of upper limbs, fingers and lower limbs, trunk control test (TCT) score and Mini-Mental State Examination (MMSE) score with early gait independence on the 7th day of a stroke onset. Results: One hundred twenty- six patients met our inclusive criteria and we analyzed them. Stroke subtypes had no relation to early gait independence. In gait independent and dependent patients on the 7th day, median BRS score of upper limbs was 5 and 5 (ns), median BRS score of fingers was 5 and5 (ns), median BRS score of lower limbs was 6 and 5 (p Conclusions: Impaired trunk control and muscle weakness of lower limbs were significant factors of disturbing early gait independence.

Introduction: Acute stroke patients have problems with toilet activities. Independent toilet activity in hospitalized patients is important for dischargee to home. Hypothesis: Lower limbs function, trunk control and cognitive function are important factors of early independent toilet activities and discharge to home within 7 days. Methods: We included acute ischemic stroke patients who 1) were admitted from June 2017 to May 2018 and 2) received early rehabilitation treatment. Patients with disturbed level of consciousness were excluded. Functional independence measure (FIM) scale of 6 or 7 was defined as independence and FIM scale of 5 or less as dependence. We evaluated Brunnstrom Recovery Stage (BRS) of arms, fingers and lower limbs, trunk control test (TCT), Mini-Mental State Examination (MMSE) and investigated significant factors of early independent toilet activities and discharge to home within 7 days. Results: One-hundred twenty-four patients met our inclusive criteria. Their average age was 75.8 years, male gender of 63.7%, median BRS of arms, fingers and lower limbs was 5, 5 and 5, median TCT score and MMSE score were 94 and 24.7, respectively. Fifty-three patients were independent in toilet activity and 73 patients were dependent. All patients with independent toilet activity discharged to home within 7 days. In independent and dependent toilet activity patients, an average age was 73.6 and 77.4 (p Conclusion: BRS as lower limbs function, TCT as trunk control and MMSE as cognitive function were important factors of early independent toilet activities and early discharge to home.

Introduction: Four-dimensional computed tomography (CT) angiography (4D-CTA) can visualize time sequential changes of bilateral internal carotid (ICA) and middle cerebral arteries (MCA). Therefore, 4D-CTA could find ICA or MCA occlusion and visualize collateral circulation in case of intracranial artery occlusion. Hypothesis: Four-dimensional CTA covering only 4-cm width with a focus on the intracranial ICA and the MCA can early visualize them because of small volumetric data and evaluate collateral development status to identify candidates of thrombectomy. Methods: We included acute ischemic stroke patients who 1) were admitted from August 2018 to July 2019 due to ICA or MCA occlusion, 2) underwent 4D-CTA covering only 4-cm width on admission and 3) underwent endovascular thrombectomy. We classified collateral status into good, moderate and poor collateral according to opacification of M2 and M3 branches distal to occlusion and evaluated successful recanalization of thrombolysis in cerebral infarction (TICI) grade 2b or 3 and improvement of NIHSS score 7 days after thrombectomy. Results: During the study period, 337 acute ischemic stroke patients were admitted, 92 patients suffered from ICA or MCA occlusion and 23 patients met our inclusive criteria. Median age was 81 years and median ASPECTS was 10. Image reconstruction time of 1,000 images was only 69 seconds and 4D-CTA with only 4-cm width demonstrated MCA occlusion in 14 patients, IC occlusion in 9 patients and collateral status as good in 4 patients, moderate in 13 patients and poor in 6 patients. Median onset-to-recanalization time was 5.2 hours, successful recanalization was achieved in 21 patients (91.3%), median NIHSS score on admission was 20, median 7-day NIHSS score decreased to 6 (p Conclusion: Four-dimensional CTA with only 4-cm width rapidly and appropriately evaluated collateral status to identify candidates of thrombectomy for ICA or MCA occlusion and achieved early neurological improvement following successful recanalization.

Introduction: Non-alcoholic fatty liver disease (NAFLD) is reported to be a predictor of cardiovascular disease (CD). However, prevalence and associated metabolic factors of NAFLD in stroke middle and young-old-aged patients remain unknown. Hypothesis: In middle and young-old-aged stroke patients, prevalence of NAFLD on admission is high and its metabolic factors are body mass index (BMI), serum Albumin, serum glucose or HbA1c, serum total cholesterol (T-CHO) and triglycerides (TG), some serum fatty acids (FA) and aspartate aminotransferase / alanine aminotransferase ratio (AST/ALT ratio) as well as reported in ischemic heart disease. Methods: We included acute stroke patients who 1) were admitted from August 2016 to December 2018 and aged 40-79 years, 2) underwent abdominal ultrasonography and 3) took blood examination on admission. We evaluated prevalence and associated metabolic factors of NAFLD. Results: Among 1400 acute stroke patients, 660 patients met our inclusive criteria. Their median age was 70.5 years, 264 patients (40.0%) had NAFLD. In NAFLD and non-NAFLD patients, median age was 68 and 72 years (p2 (p Conclusions: In acute stroke patients aged 40-79 years, prevalence of NAFLD on admission was high and independent metabolic factors of NAFLD were higher BMI, higher TG, lower AST/ALT ratio and higher Alb.

Introduction: Deep venous thrombosis (DVT) occasionally occurs in lower extremities in stroke patients and possibly causes symptomatic venous thrombosis (VT). To prevent DVT in our stroke center, patients put on both foot pumps and elastic knee stockings after admission. However, in patients who underwent emergency endovascular revascularization via the femoral artery, DVT may often occur because of hemostasis procedures after femoral artery puncture in addition to paralysis and postoperative rest. Hypothesis: Incidence of DVT following endovascular revascularization via the femoral artery probably occurs in the femoral artery ipsilateral to femoral artery puncture. Methods: We included acute stroke patients who 1) were admitted from April 2017 to March 2019, 2) underwent emergency endovascular revascularization via the femoral artery, and 3) underwent lower extremity ultrasonography (le-US) to detect DVT during hospitalization. We investigated incidence of DVT in lower extremity with reference to our Stroke Database. Results: During study period, 56 patients met our inclusive criteria. Their median age was 78.5 years old, female gender was 34 (60.7%) and median hospital stay was 9.0 days. Le-US was conducted about 3.5 days after admission. Le-US detected DVT in 15 patients (26.8%, 15/56). Among them, 10 patients had DVT in the lower thigh vein (17.9%, 10/56) and 5 patients had DVT in the femoral vein ipsilateral to femoral artery puncture (8.9%, 5/56). Hemostasis procedures possibly induced DVT in the femoral vein, although it was uncertain whether hemostasis procedures had some relation to DVT in the lower thigh vein. No symptomatic VT occurred in the 15 patients during hospitalization. Conclusion: Incidence of DVT occurs 8.9% in the femoral vein ipsilateral to femoral artery puncture in the patients after endovascular revascularization. Some strategy is required to prevent any DVT in the femoral artery ipsilateral to femoral artery puncture.

Background and Purpose Spontaneous intracranial arterial dissections are characterized by the sudden disruption of the internal elastic lamina in the intracranial arteries. The purpose of our retrospective study was to investigate whether patients with nontraumatic intracranial arterial dissections had normal endothelial function. Methods The study included symptomatic patients with nontraumatic intracranial arterial dissections who underwent an endothelial function test. Controls were selected from headache patients matched for sex and age. Endothelial function was assessed using flow-mediated dilatation. We investigated patients’ ankle brachial index and pulse wave velocity to determine the degree of atherosclerosis. Patient characteristics, brachial flow-mediated dilatation, ankle brachial index, and pulse wave velocity were compared between the 2 groups. Results During the study period, there were 22 patients with nontraumatic intracranial arterial dissections matched with 22 controls. Clinical characteristics were compared between the groups. Although there were no significant differences in ankle brachial index or pulse wave velocity between the 2 groups, patients with intracranial arterial dissections had lower flow-mediated dilatation values than controls (median flow-mediated dilatation, 3.95% in dissection patients versus 7.3% in controls, P = .0035). Brachial flow-mediated dilatation was impaired in symptomatic patients with nontraumatic intracranial arterial dissections despite the normal ankle brachial index and pulse wave velocity. Conclusions Impaired brachial flow-mediated dilatation is a probable predictor of intracranial arterial dissections.

Background: Serum fatty acids (s-FA) are likely associated with serum lipids parameters (s-LP), such as total cholesterol (T-CHO), LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C) and triglycerides (TG), because fatty acids (FA) are components of lipoproteins. However, little is known about the association of s-FA with s-LP. The aim of our retrospective study was to investigate the association of s-FA with s-LP in Ischaemic stroke patients. Methods: We conducted a cross-sectional study of ischaemic stroke patients aged 50 years or older who 1) were admitted to our institution between September 2015 and March 2017 within 24 hours of stroke onset and 2) took blood examination of s-FA levels of palmitic acid (PA), stearic acid (StA), oleic acid (OlA), linoleic acid (LiA), arachidonic acid (AA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). We evaluated correlation of serum levels or composition percentage (%) of FA with s-LP. Results: One hundred ninety-one patients met our inclusive criteria. Their average age was 74.4 years, BMI was 23.4 kg/m2, T-CHO was 203.4, LDL-C was 121.7, HDL-C was 58.5 and TG was 116.2 mg/dl. Stepwise linear regression analysis showed that LiA and AA were independent positive factors of T-CHO, AA and LiA% were independent positive factors of LDL-C, AA was an independent positive factor of HDL-C, AA% and LiA% were independent inverse factors of HDL-C, and OlA was an independent positive factor of TG. Conclusions: Serum FA had correlation with s-LP in ischaemic stroke patients. The results warrant clinical application of s-FA modification to improve s-LP.

Time-consuming reconstruction of volumetric data by area-detector-computed tomography (ADCT) scanning and narrow coverage of small-row ADCT may hinder volumetric scanning in acute stroke stage. To design a practical protocol of volumetric scanning for thrombectomy using an 80-row ADCT. An imaging protocol that focuses on the middle cerebral arteries by tilting the gantry of an 80-row ADCT with 0.5-mm-thick detectors can shorten the reconstruction time by 1.0-mm thickness scanning without subtraction. The reconstruction time of small volumetric data was 69 second. This practical protocol is applicable before thrombectomy in different stroke centres with narrow-coverage ADCT scanners.