Acute Cerebrovascular Accident

To assess the effect of endovascular thrombectomy alone compared to intravenous thrombolysis plus endovascular thrombectomy in acute basilar artery occlusion patients within 4.5 hours from onset on efficacy and safety outcomes.

Atrial fibrillation (AF) is the cause of 20% of strokes, and the risk of stroke in a person suffering from this arrhythmia increases by 5 times. Ischemic stroke in patients with AF is often fatal and, compared with stroke of other etiology, leads to the most pronounced disability and more often recurs. Accordingly, the risk of death in patients with AF-related stroke is 2 times higher, and treatment costs increase 1.5 times. The main interventional method of treating AF, available in most medical institutions, is the use of radio frequency and/or cryoenergy to eliminate destructive damage to the left atrium (LA). The aim of this study is to compare two different interventional methods and identify predictors of recurrence in patients with persistent and long-term AF.

Introduction: Endovascular thrombectomy (EVT) is an effective treatment strategy to mitigate the ischemic tissue damage caused by the acute cerebral large-vessel occlusion. However, in clinical practice, nearly half of the patients do not experience adequate neurological improvement despite successful recanalization - a phenomenon termed reperfusion failure or clinically ineffective reperfusion. Given the clinical relevance of this phenomenon and the absence of a standardized imaging diagnostic method to identify it, our project aims to explore the potential role of blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) as novel imaging biomarker for studying reperfusion failure. Study population: Adult patients with acute ischemic stroke of the ICA, MCA or with tandem occlusion who have undergone a successful recanalization, described as mTICI score ≥2b. Objective(s): Primary objective: to longitudinally observe blood flow changes derived from BOLD-CVR imaging following successful endovascular thrombectomy in patients with large-vessel occlusion acute ischemic stroke (LVO-AIS) during the early post-treatment phase and assess their association with clinical outcome 90 days post-EVT. Secondary objective: to compare BOLD-CVR findings with those obtained from the clinical standard dynamic susceptibility contrast (DSC) MR perfusion imaging acquired in the same examination session as well as other imaging techniques included in the standard post-treatment imaging protocol at our institution. Outcomes: Clinical outcomes: * 90-day functional outcome. * Functional outcome at hospital discharge. * Neurological deterioration during hospitalization. * Radiologically confirmed haemorrhagic transformation within the reperfused tissue. * Radiologically confirmed infarct lesion progression within the reperfused tissue. * Additionally, DSC MR perfusion imaging parameters and other standard hemodynamic imaging parameters will be considered as imaging outcomes Study design: Single-center prospective observational cohort study Measurements and procedures: Included patients will undergo a total of 3 BOLD-CVR examinations: 72 hours, 7 days, and 90 days after EVT. Participation in the final examination will mark the end of the subject's involvement in the study. Clinical outcomes will be prospectively collected as per established institutional patient management protocols: during hospitalization, at discharge, and at the cerebrovascular outpatient clinic at 3 months. Number of Participants: Target sample size: 100 patients Given the observational study design and exploratory nature of this project, no sample size calculation can be performed. The provided target sample size (N = 100) has been estimated considering the inclusion of as many consecutive subjects as possible. Study period: 2.5 years The investigators aim to enroll a target sample size of 100 patients over a period of 2.5 years. This translates to an inclusion of 3-4 patients per month, with the last three months allocated for the follow-up of the last included patients. Study Centre: Clinical Neuroscience Center, Department of Neurosurgery, University Hospital Zurich Statistical Considerations: The association between BOLD-CVR findings and clinical outcomes will be investigated using regression analyses.

The goal of this clinical trial is to learn if non-invasive phrenic nerve stimulation works in adult acute cerebral infarction participants undergoing mechanical ventilation. It will also learn about the safety of non-invasive phrenic nerve stimulation. The main questions it aims to answer are： 1. Can non-invasive phrenic nerve stimulation shorten the duration of ventilator use and improve long-term prognosis? 2. What medical problems do participants have when taking non-invasive phrenic nerve stimulation? Researchers will compare non-invasive phrenic nerve stimulation to a sham stimulation to see if non-invasive phrenic nerve stimulation works. Participants will: 1. Receive 14 days of non-invasive phrenic nerve stimulation or sham stimulation 2. Visit the clinic or call for follow-up at 90 days of onset

A multicenter, prospective, open-label, blinded-endpoint, randomized controlled trial to assess the effectiveness and safety of catheter-based focal intracranial hypothermia combined with endovascular reperfusion therapy for patients with acute anterior circulation large artery occlusion.