Mi Yang

Radix/Rhizoma Notoginseng extract (Sanchitongtshu) for ischemic stroke: A randomized controlled study

Agents of sanchi have been widely used as a complementary medicine for stroke in China. Sanchitongshu is a new Chinese patent medicine extracted from sanchi which has stronger anti-platelet activity than other agents of sanchi. Our aim was to investigate the synergistic action of low dose of aspirin combined with sanchitongshu capsule in the treatment of patients with light and moderate ischemic stroke in acute and subacute stages. This was a multi-center, double-blinded, randomized controlled clinical trial conducted in four hospitals in China from July 2004 to 2006. 140 patients of ischemic stroke in anterior cerebral circulation within 30 days of onset were enrolled. Participants were assigned either to receive aspirin (50mg per day) and sanchitongshu capsule (200mg three times a day) or aspirin (50mg per day) and placebo capsule. Low dose of aspirin combined with sanchitongshu capsule significantly ameliorated neurological deficit (increased score of ESS: t=-5.02, p<0.0001) and activities of daily living (increased score of BI: t=-2.4, p=0.0178) after treatment compared with aspirin alone. Adverse reaction which occurred equally in both arms, was light to moderate and disappeared without special treatment. Sanchitongshu capsule, as a complementary medicine to aspirin, was effective in improving outcomes after ischemic stroke. It was a safe drug in our trial.

Inter-rater reliability of the A-S-C-O classification system for ischemic stroke

Atherosclerosis-small vessel disease-cardiac source-other (A-S-C-O) is a new phenotypic system that categorizes stroke according to a combination of etiologic characteristics. The purpose of this study was to establish the inter-rater reliability of ischemic stroke subtyping by applying A-S-C-O criteria to retrospectively reviewed medical records. A total of 419 patients with acute ischemic stroke were classified according to A-S-C-O criteria by two stroke neurologists independently. Inter-rater reliability was assessed by means of the κ statistic. The neurologists agreed on A-S-C-O subtype diagnosis for only 190 of the 419 patients (45.3%). The κ statistics for four stroke phenotypes were: (i) atherosclerosis, 0.786; (ii) small vessel disease, 0.798; (iii) cardiac source, 0.870; and (iv) other causes, 0.860. All p values were <0.001. Ischemic stroke can be reliably described with regard to four etiologic categories using the A-S-C-O system based on a review of medical records, whereas the overall agreement for stroke subtype diagnosis was only moderate.