Intracranial Occlusion in Cryptogenic Stroke Is Not Predictive of Recurrent Ischemic Stroke: A Propensity-Score Matched Analysis of the Cardiac Abnormalities in Stroke Prevention and Risk of Recurrence Study.

IF 5.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Heart Association Pub Date : 2025-10-07 Epub Date: 2025-09-25 DOI:10.1161/JAHA.125.041500

Matthew M Smith, James R Brorson, Elena Badillo Goicoechea, Mary Penckofer, Kelsey Eklund, Christoph Stretz, Christina M Lineback, Farid Khasiyev, Deborah Kerrigan, Skylar Lewis, Hamid Ali, Hassan Aboul-Nour, Adam de Havenon, Collin J Culbertson, Emiliya Melkumova, Dinesh Jillella, Oana M Dumitrascu, Parth Parikh, Charles Doolittle, Ian Yahnke, Anvitha Sathya, Samantha Brown, Jieun Kang, Anna Bowman, Mahan Shahrivari, Cheran Elangovan, Siddharth Sehgal, Kelly L Sloane, Muhammad Alvi, Balaji Krishnaiah, Wayneho Kam, Sachin Kothari, Ahmad Abu Qdais, Mudassir Farooqui, Fadi Nahab, Gustavo Antezana Quintela, Richa Sharma, Neeharika Thottempudi, Simona Nedelcu, Franziska Herpich, Patrick Glover, Dalia Chahien, David S Liebeskind, Guillermo Linares, Jean-Philippe Daniel, Sami Al Kasab, Eesha Singh, Marissa D'Souza, Elizabeth Gaudio, Yasmin Aziz, Shadi Yaghi, Narendra Kala, Monica Sarkar, Eric D Goldstein, Lucia Chen, Russel Van Coevering, Jesse M Thon, Brian Stamm, Sean L Thompson, James E Siegler

{"title":"Intracranial Occlusion in Cryptogenic Stroke Is Not Predictive of Recurrent Ischemic Stroke: A Propensity-Score Matched Analysis of the Cardiac Abnormalities in Stroke Prevention and Risk of Recurrence Study.","authors":"Matthew M Smith, James R Brorson, Elena Badillo Goicoechea, Mary Penckofer, Kelsey Eklund, Christoph Stretz, Christina M Lineback, Farid Khasiyev, Deborah Kerrigan, Skylar Lewis, Hamid Ali, Hassan Aboul-Nour, Adam de Havenon, Collin J Culbertson, Emiliya Melkumova, Dinesh Jillella, Oana M Dumitrascu, Parth Parikh, Charles Doolittle, Ian Yahnke, Anvitha Sathya, Samantha Brown, Jieun Kang, Anna Bowman, Mahan Shahrivari, Cheran Elangovan, Siddharth Sehgal, Kelly L Sloane, Muhammad Alvi, Balaji Krishnaiah, Wayneho Kam, Sachin Kothari, Ahmad Abu Qdais, Mudassir Farooqui, Fadi Nahab, Gustavo Antezana Quintela, Richa Sharma, Neeharika Thottempudi, Simona Nedelcu, Franziska Herpich, Patrick Glover, Dalia Chahien, David S Liebeskind, Guillermo Linares, Jean-Philippe Daniel, Sami Al Kasab, Eesha Singh, Marissa D'Souza, Elizabeth Gaudio, Yasmin Aziz, Shadi Yaghi, Narendra Kala, Monica Sarkar, Eric D Goldstein, Lucia Chen, Russel Van Coevering, Jesse M Thon, Brian Stamm, Sean L Thompson, James E Siegler","doi":"10.1161/JAHA.125.041500","DOIUrl":null,"url":null,"abstract":"Background: Intracranial occlusions in embolic stroke of undetermined source are histopathologically similar to cardiac sources of embolism. Whether patients with embolic stroke of undetermined source and intracranial occlusion benefit from anticoagulation is unknown.Methods: A multicenter retrospective cohort of adults with cryptogenic stroke was queried for patients with proximal or medium/distal vessel occlusion. The primary outcome was recurrent ischemic stroke, which was assessed in unadjusted and adjusted Cox proportional hazards models and repeated following 1:1 propensity score matching and biweight kernel density matching.Results: Of the 2328 patients who were followed over a median of 1.31 years (interquartile range, 0.34-2.85), 999 (42.6%) had an intracranial occlusion. When compared with patients without an intracranial occlusion, those with an occlusion had fewer atherosclerotic vascular risk factors, more severe symptoms, and less severe cerebral microvascular disease. The rate of recurrent stroke was similar between patients with versus without an intracranial occlusion (6.8%/year [95% CI, 5.7-8.2] versus 7.0%/year [95% CI 6.0-8.1]; adjusted hazard ratio [HR], 1.09 [95% CI, 0.77-1.55]). There was no association between occlusion and recurrent stroke in the adjusted propensity score matching (HR, 1.01 [95% CI, 0.64-1.59]) or kernel density models (HR, 0.95 [95% CI, 0.62-1.45]). There was no interaction between occlusion and treatment with anticoagulation, sex, age, or high-risk sources of embolism for the primary outcome in the unmatched and matched analyses.Conclusions: Intracranial occlusion in patients with embolic stroke of undetermined source is not associated with a greater risk of recurrence when compared with patients without an intracranial occlusion. There was no difference in rate of recurrent stroke with anticoagulation when stratified by presence or absence of occlusion.","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041500"},"PeriodicalIF":5.3000,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Heart Association","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/JAHA.125.041500","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/25 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Intracranial occlusions in embolic stroke of undetermined source are histopathologically similar to cardiac sources of embolism. Whether patients with embolic stroke of undetermined source and intracranial occlusion benefit from anticoagulation is unknown.

Methods: A multicenter retrospective cohort of adults with cryptogenic stroke was queried for patients with proximal or medium/distal vessel occlusion. The primary outcome was recurrent ischemic stroke, which was assessed in unadjusted and adjusted Cox proportional hazards models and repeated following 1:1 propensity score matching and biweight kernel density matching.

Results: Of the 2328 patients who were followed over a median of 1.31 years (interquartile range, 0.34-2.85), 999 (42.6%) had an intracranial occlusion. When compared with patients without an intracranial occlusion, those with an occlusion had fewer atherosclerotic vascular risk factors, more severe symptoms, and less severe cerebral microvascular disease. The rate of recurrent stroke was similar between patients with versus without an intracranial occlusion (6.8%/year [95% CI, 5.7-8.2] versus 7.0%/year [95% CI 6.0-8.1]; adjusted hazard ratio [HR], 1.09 [95% CI, 0.77-1.55]). There was no association between occlusion and recurrent stroke in the adjusted propensity score matching (HR, 1.01 [95% CI, 0.64-1.59]) or kernel density models (HR, 0.95 [95% CI, 0.62-1.45]). There was no interaction between occlusion and treatment with anticoagulation, sex, age, or high-risk sources of embolism for the primary outcome in the unmatched and matched analyses.

Conclusions: Intracranial occlusion in patients with embolic stroke of undetermined source is not associated with a greater risk of recurrence when compared with patients without an intracranial occlusion. There was no difference in rate of recurrent stroke with anticoagulation when stratified by presence or absence of occlusion.

查看原文本刊更多论文

隐源性卒中颅内闭塞不能预测缺血性卒中复发：卒中预防和复发风险研究中心脏异常的倾向评分匹配分析

背景：来源不明的栓塞性卒中颅内闭塞在组织病理学上与心脏源性栓塞相似。来源不明的栓塞性脑卒中和颅内闭塞患者是否能从抗凝治疗中获益尚不清楚。方法：对近端或中/远端血管闭塞的成人隐源性卒中患者进行多中心回顾性队列研究。主要结局为复发性缺血性卒中，采用未调整和调整的Cox比例风险模型进行评估，并按照1:1倾向评分匹配和加权核密度匹配进行重复。结果：在中位随访1.31年（四分位数范围0.34-2.85）的2328例患者中，999例（42.6%）发生颅内闭塞。与未颅内闭塞的患者相比，颅内闭塞的患者动脉粥样硬化血管危险因素较少，症状更严重，脑微血管疾病较轻。脑卒中复发率在颅内闭塞患者和未颅内闭塞患者之间相似（6.8%/年[95% CI， 5.7-8.2]和7.0%/年[95% CI 6.0-8.1]；校正风险比[HR]， 1.09 [95% CI, 0.77-1.55]）。在调整倾向评分匹配（HR, 1.01 [95% CI, 0.64-1.59]）或核密度模型（HR, 0.95 [95% CI, 0.62-1.45]）中，闭塞与卒中复发无关联。在未匹配和匹配的分析中，主要结局与抗凝治疗、性别、年龄或高危栓塞源之间没有相互作用。结论：与没有颅内闭塞的患者相比，来源不明的栓塞性卒中患者颅内闭塞与更大的复发风险无关。用抗凝治疗的卒中复发率在有无闭塞分层时没有差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of the American Heart Association CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

1.90%

发文量

1749

审稿时长

12 weeks

期刊介绍： As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice. JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.