International Journal of Stroke最新文献

{"title":"A randomised controlled trial of Scanning Eye trAining as a Rehabilitation Choice for Hemianopia after stroke (SEARCH).","authors":"Fiona Rowe, Ella Brayshaw, Michaela Brown, Kausik Chatterjee, Avril Drummond, Christine Hazelton, Brin Helliwell, Lauren Hepworth, Claire Howard, Stevie Johnson, Carmel Noonan, Catherine Sackley, Laura Wright","doi":"10.1177/17474930251330140","DOIUrl":"https://doi.org/10.1177/17474930251330140","url":null,"abstract":"<p><strong>Background: </strong>Hemianopia is common after stroke. We aimed to evaluate clinical effectiveness of visual scanning training vs sham training, for homonymous hemianopia.</p><p><strong>Design: </strong>Randomised controlled, parallel, double-blind, two-arm trial.</p><p><strong>Methods: </strong>Prospective, multicentre RCT with 34 UK stroke units.</p><p><strong>Participants: </strong>Adult stroke survivors with confirmed stable homonymous hemianopia.</p><p><strong>Inclusion criteria: </strong>Clinically diagnosed stroke, 18+ years, stable hemianopia, >4 weeks and <26 weeks post stroke onset, able to engage in training, informed/proxy consent.</p><p><strong>Interventions: </strong>Arm A (visual scanning training [VST]) or arm B (sham training) for minimum 30 minutes, 7 days per week over 6 weeks. Follow-up to 26 weeks.</p><p><strong>Objective: </strong>Evaluate clinical effectiveness of visual scanning training vs sham training, for homonymous hemianopia.</p><p><strong>Outcomes: </strong>Primary outcome measurement was change in the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) score from baseline to 26 weeks. Secondary outcome measurements were change in the Nottingham Extended Activities of Daily Living (NEADL), EuroQoL (EQ-5D-5L), Brain Injury-related Visual Impairment - Impact Questionnaire (BIVI-IQ), visual field measurement (Esterman programme), visual scanning performance and adverse events from baseline to 26 weeks.</p><p><strong>Randomisation: </strong>Web-based randomisation system stratified by partial/complete hemianopia.</p><p><strong>Blinding: </strong>Participants and primary outcome assessor blinded to treatment allocation.</p><p><strong>Results: </strong>In total, 161 participants were randomised; 80 to the VST group and 81 to the sham group. One participant was randomised in error and two withdrew consent to use data so were not included. Of 158 participants, 78 were in the VST group and 80 in the sham group. No participants were unblinded. All participants began their training allocation. During the first 6 weeks of training, 56 (72%) and 58 (73%) undertook training every day or most days in the VST and sham groups respectively. There were 37 withdrawals from the trial: 18 in the VST group and 19 in the sham group. Both groups were comparable in terms of baseline characteristics.Primary ANCOVA analysis was carried out on 104 participants with VFQ-25 data at both baseline and 26 weeks; sensitivity analysis was undertaken for 120 participants. Estimated mean difference at 26 weeks, adjusting for baseline score and hemianopia type was -4.04 (95%CI: -9.45 to 1.36; p=0.141) for primary analysis and -2.33 (95%CI: -7.42 to 2.75; p=0.365) for sensitivity analysis. There were no significant differences between groups for primary and secondary outcome measure comparisons from baseline to 26 weeks. Adverse events, reported for 20 participants, included eye strain, headache and blurred vision.</p><p><stro","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251330140"},"PeriodicalIF":6.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Atrial Fibrillation on Outcomes in Stroke Patients with Tandem Occlusions Treated with Thrombectomy. A multicentre study.","authors":"Lucio D'Anna, Matteo Foschi, Mariarosaria Valente, Liqun Zhang, Nina Mansoor, Matthew Fallon, Adelaida Gartner, Fedra Kuris, Antonio Taglialatela, Francesco Toraldo, Filippo Komauli, Massimo Sponza, Vladimir Gavrilovic, Kyriakos Lobotesis, Gian Luigi Gigli, Soma Banerjee, Giovanni Merlino","doi":"10.1177/17474930251330139","DOIUrl":"https://doi.org/10.1177/17474930251330139","url":null,"abstract":"<p><strong>Background: </strong>Tandem occlusions, involving simultaneous extracranial and intracranial artery blockages, represent a complex subtype of acute ischemic stroke treated with mechanical thrombectomy (MT). However, to date, the impact of atrial fibrillation (AF) on outcomes in this population remains unclear. This study aimed to evaluate the safety and efficacy of MT in patients with tandem occlusions, comparing those with AF to their counterparts without AF.</p><p><strong>Methods: </strong>We performed a multicentre, retrospective study using inverse probability weighting (IPW) to evaluate the effect of AF on outcomes in tandem occlusion patients treated with MT across three comprehensive stroke centres. The primary outcome was functional independence at 90 days (modified Rankin Scale [mRS] 0-2). Secondary outcomes included recanalization success (TICI ≥2b), intracranial hemorrhage (ICH), symptomatic ICH (sICH), and 90-day mortality. Subgroup analyses assessed the interaction between AF and clinical or procedural factors.</p><p><strong>Results: </strong>Among 635 patients, 164 (25.8%) had AF (TandemAF). TandemAF patients had significantly lower rates of favourable 90-day functional outcomes (adjusted risk ratio [aRR] 0.49 [95% CI 0.31-0.76]; p = 0.001) and higher 90-day mortality (aRR 2.29 [95% CI 1.47-3.55]; p < 0.001) compared to non-AF patients. Rates of successful recanalization, ICH, and sICH were similar between groups. Subgroup analysis revealed worse outcomes for TandemAF patients aged ≥65 years, with NIHSS 11-42, and those treated with general anesthesia or intravenous thrombolysis.</p><p><strong>Conclusions: </strong>Patients with tandem occlusion and AF undergoing MT showed significantly worse functional and survival outcomes relative to their non-AF counterparts, despite comparable procedural success rates. These findings highlight the critical need for tailored management strategies to mitigate the unique risks associated with AF in this population. Further research is essential to refine therapeutic approaches and improve outcomes for this high-risk group.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251330139"},"PeriodicalIF":6.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Illicit Drug Use and Cerebral Microbleeds in Patients with Acute Ischemic Stroke and Transient Ischemic Attack.","authors":"Benjamin Kyle Petrie, Helena Lau, Fe Maria Cajiga-Pena, Saleh Abbas, Brandon Finn, Katie Dam, Anna M Cervantes-Arslanian, Thanh N Nguyen, Hugo Aparicio, David Greer, Jose R Romero","doi":"10.1177/17474930251328524","DOIUrl":"https://doi.org/10.1177/17474930251328524","url":null,"abstract":"<p><strong>Background: </strong>Cerebral microbleeds (CMB) signal cerebral small vessel disease and are associated with ischemic stroke. While illicit drug use (IDU) is linked to cerebral vasculopathy, the association between CMB and IDU is poorly characterized.</p><p><strong>Aims: </strong>Our primary aim was to explore the relationship between IDU and CMB and delineate differences in vascular risk factors between those with and without CMB.</p><p><strong>Methods: </strong>We included 1746 (1614 unique patients) acute ischemic stroke and transient ischemic accident patient admissions from 2009 to 2018 with a readable T2*gradient-echo sequence brain MRI. We retrospectively obtained patient characteristics and IDU data (by history and/or urine toxicology). MRIs were reviewed for CMB and classified topographically as lobar, deep or infratentorial. Univariate analysis was used to assess differences in patient characteristics between those with and without CMB, as well as variation in CMB location by drug category subgrouping. Coprimary multivariate logistic/Poisson regression was used to characterize the association between drug category subgrouping and CMB.</p><p><strong>Results: </strong>We observed IDU in 13.8% (n=241) and CMB presence in 32.9% (n=575) in our predominantly black, middle-aged population. 53.8% of CMB were lobar, 27.3% were deep and 18.8% were infratentorial. Within the IDU group, those with at least one CMB (compared to those without CMB) were older (56.9±11.5 vs. 53.6±10.5, p=0.036), had a lower BMI (26.6±4.4 vs. 28.1±5.9, p=0.039), and were more likely to have CKD (9.5% vs. 3.0%, p=0.033) or have had a previous IS/TIA (41.9% vs. 25.1%, p=0.009). On coprimary analysis, cocaine use was associated with increased CMB number by 0.24 (95% CI: 0.09, 0.38; p=0.001) and opioid use was associated with increased CMB number by 0.31 (95% CI: 0.08, 0.52; p<0.001) controlling for age, sex, hypertension status, and prior ischemic stroke or transient ischemic accident. CMB in the opioid use group were more likely to be deep (40.4% vs. 27.3%, p=0.023) compared to those without opioid use.</p><p><strong>Conclusions: </strong>Our findings support an association between CMB, an early marker of cerebral vasculopathy, and cocaine and opioid use. These results highlight the need for further research into the pathophysiological mechanisms linking illicit drug use to cerebrovascular injury and underscore the importance of targeted interventions in this population.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251328524"},"PeriodicalIF":6.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluoxetine and fractures after stroke: An individual patient data meta-analysis of three large randomized controlled trials of fluoxetine for stroke recovery.","authors":"Gillian Mead, Catriona Graham, Erik Lundström, Graeme J Hankey, Maree L Hackett, Laurent Billot, Per Näsman, John Forbes, Martin Dennis","doi":"10.1177/17474930251316164","DOIUrl":"10.1177/17474930251316164","url":null,"abstract":"<p><strong>Background: </strong>Observational studies have shown that selective serotonin reuptake inhibitors are associated with an increased risk of bone fractures, but the association can be confounded by indication and other sources of systematic bias that can be minimized in randomized controlled trials (RCTs).</p><p><strong>Aim: </strong>Our aim was to report the rate, site, context, and predictors of fractures after stroke, and whether the fractures modified the effect of fluoxetine on modified Rankin scale (mRS) at 6 months in an individual patient data meta-analysis of 5907 patients enrolled in three RCTs of fluoxetine (20 mg for 6 months) for stroke recovery.</p><p><strong>Methods: </strong>We classified fractures by treatment allocation, site (and thus likelihood of osteoporosis), and context, then performed multivariable analyses to explore the independent predictors of fractures. We explored whether the trend toward a poorer mRS at 6 months was explained by a fracture excess. Risk of bias was assessed using GRADE.</p><p><strong>Results: </strong>Among 5907 patients randomized at a mean of 6.6 days (SD 3.6) post-stroke onset and followed for 6 months, the number of fractures at 6 months was 93 (3.15%) in the fluoxetine group versus 41 (1.39%) in the control group (difference 1.76, 95% CI 0.10-2.51). However, 128 patients with fractures were suitable for further analyses. Of these, 102 (80%) were in sites typically affected by osteoporosis; 115 (90%) were associated with falls and 1 (1%) with a seizure. Independent fracture risk factors were female sex (hazard ratio (HR) 1.96; 95% CI 1.37-2.81, p = 0.0002), age > 70 years (HR 2.30, 95% CI 1.52-3.49, p < 0.001), previous fractures (HR 0.63 for no previous fractures, 95% CI 0.42-0.94, p = 0.0227), and randomized treatment (fluoxetine) (HR 2.39; 95% CI 1.64-3.49, p < 0.001). The common odds ratio for the effect of fluoxetine on mRS at 6 months was unchanged after excluding fracture patients. Risk of bias was high for imprecision.</p><p><strong>Conclusion: </strong>Fractures were more common in the fluoxetine group but the absolute risk of fractures was small and risk estimates were imprecise. Most fractures occurred with a fall, and in osteoporotic locations. Fractures did not modify the effect of fluoxetine on functional outcome.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251316164"},"PeriodicalIF":6.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acetylsalicylic acid and subarachnoid hemorrhage in the Nurses' Health Study.","authors":"Frederick Ewbank, Samuel Hall, Benjamin Gaastra, Diederik Bulters","doi":"10.1177/17474930251322372","DOIUrl":"10.1177/17474930251322372","url":null,"abstract":"<p><strong>Background: </strong>Acetylsalicylic acid (aspirin) is known to increase the risk of bleeding throughout the body. However, there is also evidence to suggest that acetylsalicylic acid may have a protective role in the formation and rupture of intracranial aneurysms. Previous studies investigating acetylsalicylic acid and subarachnoid hemorrhage (SAH) have so far provided conflicting results.</p><p><strong>Aims: </strong>The aim of this study was to analyze the Nurse's Health Study (NHS) using serial assessments to evaluate differences in rates of SAH in those participants taking acetylsalicylic acid and those not taking acetylsalicylic acid while considering dose, frequency, and duration as well as different types of SAH.</p><p><strong>Methods: </strong>The NHS is a prospective population-based cohort study of female nurses. Information on acetylsalicylic acid was first reported in 1980 until 2016 and included acetylsalicylic acid use, dose, frequency, and duration. All stroke cases were classified by physicians. Cox proportional-hazards regression models were used to estimate the hazard ratio (HR) associated with acetylsalicylic acid use.</p><p><strong>Results: </strong>A total of 117,648 NHS participants were eligible for analysis with 357 cases of SAH observed over 4,091,239 years of follow-up. There was no association between acetylsalicylic acid use and SAH (HR = 1.02; 95% confidence interval (CI) = [0.82, 1.28], p = 0.85), aneurysmal SAH (1.04; 95% CI = [0.78, 1.39], p = 0.78), or idiopathic SAH (HR = 0.94; 95% CI = [0.65, 1.34], p = 0.72). The number of acetylsalicylic acid tablets per week was associated with SAH (HR = 1.03; 95% CI = [1.00, 1.06], p = 0.02), specifically fatal SAH (HR = 1.04 [1.00, 1.08], p = 0.03). There was no association between frequency and SAH (HR = 1.06; 95% CI = [0.99, 1.13], p = 0.07).</p><p><strong>Conclusion: </strong>There was no evidence to support a protective association between acetylsalicylic acid and either SAH or aneurysmal SAH in female participants. In fact, there was some evidence to suggest increased SAH risk with increased acetylsalicylic acid dose in some but not all analyses.</p><p><strong>Data access statement: </strong>Data are available by request from the Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251322372"},"PeriodicalIF":6.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early penumbral FLAIR changes predict tissue fate in patients with large vessel occlusions.","authors":"Lauranne Scheldeman, Pierre Seners, Anke Wouters, Patrick Dupont, Soren Christensen, Michael Mlynash, Caroline Arquizan, Adrien Ter Schiphorst, Vincent Costalat, Hilde Henon, Martin Bretzner, Jean-François Albucher, Christophe Cognard, Jean-Marc Olivot, Jeremy J Heit, Gregory W Albers, Maarten G Lansberg, Robin Lemmens","doi":"10.1177/17474930241289235","DOIUrl":"10.1177/17474930241289235","url":null,"abstract":"<p><strong>Background: </strong>In patients with an acute ischemic stroke, the penumbra is defined as ischemic tissue that remains salvageable when reperfusion occurs. However, the expected clinical recovery congruent with penumbral salvage is not always observed.</p><p><strong>Aims: </strong>We aimed to determine whether the magnetic resonance imaging (MRI)-defined penumbra includes irreversible neuronal loss that impedes expected clinical recovery after reperfusion.</p><p><strong>Methods: </strong>In the prospective French Acute Multimodal Imaging Study to Select Patients for Mechanical Thrombectomy (FRAME) and an observational cohort of patients with large vessel occlusions undergoing endovascular treatment, we quantified penumbral integrity by fluid-attenuated inversion recovery (FLAIR) changes. We studied the influence of recanalization status on the evolution of penumbral FLAIR changes and studied penumbral FLAIR changes as predictor of tissue fate and functional outcome on the 90-day modified Rankin Scale (mRS).</p><p><strong>Results: </strong>Recanalization status did not modify the evolution of rFLAIR signal intensity (SI) over time in the total cohort, but was associated with lower SI in the FRAME subset (b = -0.06, p for interaction = 0.04). Median rFLAIR SI was higher at baseline in the subsequently infarcted penumbra compared to the salvaged (ratio = 1.07, standard deviation (SD) = 0.07 vs 1.03, SD = 0.06 p < 0.0001, n = 150). The severity and extent of rFLAIR SI changes did not predict 90-day functional outcome in univariate (p = 0.09) and multivariate logistic regression (p = 0.4).</p><p><strong>Conclusions: </strong>Recanalization status did not influence the evolution of penumbral FLAIR changes. FLAIR SI changes in the baseline penumbra were associated with tissue fate, but not functional outcome.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"310-318"},"PeriodicalIF":6.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early reperfusion in patients with acute retinal artery occlusion: A multicenter prospective study.","authors":"Youssef Abdelmassih, Martine Mauget-Faÿsse, Pierre Seners, Dan Milea, Gabriel Hallali, Jessica Guillaume, Augustin Lecler, Catherine Vignal, Yannick Le Mer, Michel Paques, Sophie Bonnin, Michael Obadia","doi":"10.1177/17474930241306692","DOIUrl":"10.1177/17474930241306692","url":null,"abstract":"<p><strong>Background: </strong>The visual outcome after central retinal artery occlusion (CRAO) is poor, but its relationship with early reperfusion (ER) is poorly known. We evaluated the incidence of ER in acute CRAO or branch retinal artery occlusion (BRAO), and its association with clinical outcome.</p><p><strong>Methods: </strong>In this prospective observational multicenter study, we included patients with acute CRAO or macula-involving BRAO presenting within 24 hours from symptom onset. ER was evaluated within 24 hours after the initial clinical evaluation using indocyanine green angiography (ICGA). The primary outcome was the best-corrected visual acuity (BCVA) at 1 month.</p><p><strong>Results: </strong>In all, 70 patients were enrolled, of whom 63 (90%) had CRAO. Median age was 71 years (interquartile range: 67-77), 63% were male, median time from symptom onset to presentation was 5.3 hours (interquartile range: 3.1-15.1), and 17% received intravenous fibrinolysis. ER was identified in 34 patients (49%), of whom 21 (30%) achieved complete reperfusion (100% filling of the 55° ICGA field). Patients with ER were less likely to have hypertension and diabetes mellitus (<i>p</i> < 0.001 and <i>p</i> = 0.046, respectively). At the 1-month follow-up, BCVA was significantly better in ER patients (median BCVA 1.3 logMAR vs 1.7 logMAR, <i>p</i> = 0.001), with greater benefit with complete reperfusion (<i>p</i> for trend < 0.001). ER was also associated with improved visual field and quality of life at the 1-month follow-up (both <i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>ER occurred in almost 50% of the patients and was associated with improved visual outcomes and quality of life. Therapies that increase ER in CRAO will likely improve clinical outcomes.</p><p><strong>Clinical trial registration: </strong>This study was registered on ClinicalTrials.gov (identifier <b>NCT03049514</b>); https://classic.clinicaltrials.gov/ct2/show/NCT03049514.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"338-346"},"PeriodicalIF":6.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of time from symptom onset to puncture, and puncture to reperfusion, in endovascular therapy in the late time window (>6 h).","authors":"Agathe Sadeler, Stephanos Finitsis, Jean-Marc Olivot, Sebastien Richard, Gaultier Marnat, Igor Sibon, Lionel Calviere, Christophe Cognard, Mikael Mazighi, Jean-Philippe Desilles, Bertrand Lapergue, Ruben Tamazyan, Mathieu Zuber, Benjamin Gory, Benjamin Maïer","doi":"10.1177/17474930241300073","DOIUrl":"10.1177/17474930241300073","url":null,"abstract":"<p><strong>Background: </strong>Increased time from symptom onset to puncture (TSOP) and time from puncture to reperfusion (TPTR) are associated with worse outcome in ischemic stroke patients treated with endovascular therapy (EVT) in the early time window (<6 h). However, these associations are less described in the late window (>6 h), where patients may benefit from EVT because of a more favorable imaging profile (late window paradox). We sought to compare the effect of these timeframes between these two periods on efficacy and safety outcomes.</p><p><strong>Methods: </strong>The ETIS (Endovascular Treatment in Ischemic Stroke) registry is an ongoing, prospective, observational study in 21 centers that perform EVT in France. We included adult patients with an anterior occlusion, successfully treated by EVT (modified treatment in cerebral ischemia (mTICI) 2b-3) between January 2015 and June 2023, with a known time of stroke onset. The cohort was divided into two groups according to the TSOP (⩽6 h vs >6 h). Primary outcome was favorable outcome (modified Rankin Scale 0-2 at 90 days).</p><p><strong>Results: </strong>In total, 7516 patients were included, with 5936 patients being treated ⩽6 h and 1580 >6 h. In the early window, TSOP and TPTR were associated with worse outcomes at 90 days (adjusted odds ratio (aOR) = 0.68 per hour; 95% confidence interval (CI) = 0.64-0.73; <i>p</i> < 0.001 and aOR = 0.92 per 10-min increment; 95% CI = 0.90-0.94, <i>p</i> < 0.001, respectively). TSOP was not associated with worse outcomes at 90 days in the late window (<i>p</i> = 0.955), but TPTR was associated with worse outcomes (aOR = 0.91 per 10-min increment; 95% CI = 0.86-0.96, <i>p</i> = 0.001), every 10 additional minutes in TPTR being associated with a 1.7% (95% CI = 0.6-2.7) decreased probability of favorable outcome.</p><p><strong>Conclusion: </strong>Only EVT procedural time is associated with unfavorable outcomes at 90 days in late window patients. These results highlight how the late window paradox may end at the start of EVT and underscore the need for timely management, particularly for the EVT, even for late window patients with a presumed more favorable imaging profile.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"357-366"},"PeriodicalIF":6.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142580983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive blood pressure lowering in acute stroke with intracranial stenosis post-thrombectomy: A secondary analysis of the OPTIMAL-BP trial.","authors":"Kwang Hyun Kim, Jaeseob Yun, Jae Wook Jung, Young Dae Kim, JoonNyung Heo, Hyungwoo Lee, Jin Kyo Choi, Il Hyung Lee, In Hwan Lim, Soon-Ho Hong, Minyoul Baik, Byung Moon Kim, Dong Joon Kim, Na-Young Shin, Bang-Hoon Cho, Seong Hwan Ahn, Hyungjong Park, Sung-Il Sohn, Jeong-Ho Hong, Tae-Jin Song, Yoonkyung Chang, Gyu Sik Kim, Kwon-Duk Seo, Kijeong Lee, Jun Young Chang, Jung Hwa Seo, Sukyoon Lee, Jang-Hyun Baek, Han-Jin Cho, Dong Hoon Shin, Jinkwon Kim, Joonsang Yoo, Kyung-Yul Lee, Yo Han Jung, Yang-Ha Hwang, Chi Kyung Kim, Jae Guk Kim, Chan Joo Lee, Sungha Park, Hye Sun Lee, Sun U Kwon, Oh Young Bang, Ji Hoe Heo, Hyo Suk Nam","doi":"10.1177/17474930241305315","DOIUrl":"10.1177/17474930241305315","url":null,"abstract":"<p><strong>Background: </strong>Intensive blood pressure (BP) management within 24 h after successful reperfusion following endovascular thrombectomy (EVT) is associated with worse functional outcomes than conventional BP management in Asian randomized controlled trials. Given the high prevalence of intracranial atherosclerotic stenosis (ICAS) in Asia, ICAS may influence these outcomes.</p><p><strong>Aims: </strong>We aimed to assess whether ICAS affects the outcomes of intensive BP management after successful EVT.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control trial, which enrolled participants from June 2020 to November 2022. Patients with anterior circulation large vessel occlusion (LVO) were stratified into ICAS-related and embolic LVO groups. Clinical outcomes for intensive (target systolic BP < 140 mm Hg) and conventional BP management (target systolic BP = 140-180 mm Hg) were analyzed in each group. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0 to 2 at 3 months. Safety outcomes included symptomatic intracerebral hemorrhage within 36 h and stroke-related death within 3 months.</p><p><strong>Results: </strong>Among 192 patients, 59 were in the ICAS-related LVO group, and 133 were in the embolic LVO group. In the ICAS-related LVO group, the rate of achieving a favorable outcome at 3 months was 37.5% with intensive BP management and 55.6% with conventional management (adjusted odds ratio (OR) = 0.49 (95% confidence interval (CI) = 0.14 to 1.75); <i>P</i> = 0.27). In the embolic LVO group, these rates were 29.9% and 42.4%, respectively (adjusted OR = 0.64 (95% CI = 0.28 to 1.45); <i>P</i> = 0.29). No significant interaction was found (<i>P</i> for interaction = 0.68). In addition, the ICAS-related LVO group receiving intensive BP management had lower rates of successful reperfusion at 24 h compared to conventional management (67.7% vs. 91.7%; <i>P</i> = 0.03), while no significant difference was found in the embolic LVO group. A significant interaction effect on successful reperfusion at 24 h was observed between ICAS-related and embolic LVO groups (<i>P</i> for interaction = 0.04). No significant differences in safety outcomes were observed between intensive BP management and conventional management within both ICAS-related LVO and embolic LVO groups.</p><p><strong>Conclusions: </strong>ICAS did not significantly affect outcomes of intensive BP management within 24 h after successful EVT. After successful reperfusion by EVT, intensive BP management should be avoided regardless of ICAS presence.</p><p><strong>Data access statement: </strong>The data that support the findings of this study are available from the corresponding author upon reasonable request.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"328-337"},"PeriodicalIF":6.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing stroke safety and efficacy through early tirofiban administration after intravenous thrombolysis: The multicenter, randomized, placebo-controlled, double-blind ASSET IT trial protocol.","authors":"Chunrong Tao, Tianlong Liu, Jun Sun, Yuyou Zhu, Rui Li, Li Wang, Chao Zhang, Jianlong Song, Xiaozhong Jing, Thanh N Nguyen, Raul G Nogueira, Jeffrey L Saver, Wei Hu","doi":"10.1177/17474930241299666","DOIUrl":"10.1177/17474930241299666","url":null,"abstract":"<p><strong>Background: </strong>Intravenous thrombolysis (IVT) is the cornerstone treatment for the acute ischemic stroke (AIS) within 4.5 h after onset. Current guidelines recommend administering antiplatelet medications 24 h after IVT. However, vascular reocclusion is a common occurrence after IVT. Tirofiban, a platelet glycoprotein IIb/IIIa antagonist, can help deter macrovascular reocclusion, prevent microvascular thrombosis, and enhance cerebral blood flow.</p><p><strong>Objective: </strong>This trial aims to assess whether early administration of tirofiban can improve clinical outcomes in patients with AIS who received IVT.</p><p><strong>Methods and design: </strong>The Advancing Stroke Safety and Efficacy through Early Tirofiban Administration after Intravenous Thrombolysis (ASSET IT) Trial is an investigator-initiated, randomized, placebo-controlled, double-blind, multicenter study. Up to 832 eligible patients will be consecutively randomized in a 1:1 ratio to receive either intravenous tirofiban or placebo over a period of 2 years across 38 stroke centers in China.</p><p><strong>Outcomes: </strong>The primary endpoint is excellent functional status at day 90, defined as a modified Rankin Score of 0-1. Primary safety endpoints include symptomatic intracerebral hemorrhage at 24 h and mortality at 90 days.</p><p><strong>Trial registry number: </strong>NCT06134622 (clinicaltrials.gov).</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"373-377"},"PeriodicalIF":6.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}