International Journal of Stroke最新文献

{"title":"Anticoagulation Usage and Thrombolytic Therapy in Subjects with Atrial Fibrillation Associated Ischaemic Stroke.","authors":"Joe Harbison, Joan McCormack, Olga Brych, Ronan Collins, Niamh O'Connell, Peter J Kelly, Tim Cassidy","doi":"10.1177/17474930241303836","DOIUrl":"https://doi.org/10.1177/17474930241303836","url":null,"abstract":"<p><strong>Background: </strong>Atrial Fibrillation (AF) causes up to 20% of ischaemic strokes and 30% in some populations such as those over 80 years. Previous research in our population showed that widespread adoption of Direct Oral Anticoagulant (DOAC) prophylaxis had not been associated with a reduction in AF associated stroke prevalence but there was a considerable rate of breakthrough stroke in patients receiving anticoagulation and anticoagulation rate may be affected by increasing use of DOACs.</p><p><strong>Aims: </strong>We undertook a more detailed study using the Irish National Audit of Stroke (INAS) to determine the characteristics of anticoagulation practice in AF associated stroke, particularly breakthrough stroke, adherence to prescribing guidelines and effect on thrombolysis rate.</p><p><strong>Methods: </strong>Data from INASwere analysed for the period 2017-2022 inclusive as part of a cross-sectional, cohort study. Data on pre stroke, and discharge disability (modified Rankin Score (mRS)) were collected in addition to age, sex, length of stay and thrombolysis rate. An enhanced dataset with additional questions about adherence with prescription, reasons for non-concordance and International Normalized Ratio (INR) control for receiving Warfarin was collected for 2022 was also considered separately. Comparisons for continuous / quantitative data were made using Student's t tests and for proportional data using Pearson's Chi Square statistics and logistic regression analysesResults. Complete AF Data were available on 22485 of 26829 strokes admitted over this period. Of these strokes with AF data, 19260 (85.6%) were ischaemic, mean age was 71.8 and 57.1% male. AF was found in 5321 of these ischaemic strokes and this AF was identified pre-stroke in 2835 in 2835 (53.3%). 80.4% of patients with known AF had been prescribed anticoagulation. The population with previously unknown AF were significantly younger on average than those on anticoagulation (76.8 years vs. 79.1 years (p<0.0001, t-test)), or those with AF and not anticoagulated; 78.8 years (p<0.0001), they were also much more likely to have received thrombolysis (17.3 % vs. 4.0% (Chi Sq, p<0.0001)). Of patients receiving DOACs, only 52 received thrombolysis (2.9%) compared with 37 (8.5%) of the VKA Group (Chi Sq 29.0 p<0.0001). Or regression analysis, anticoagulation was not associated with differences in excellent outcome (mRS 0 or 1) achieved (OR 1.064, p=0.41) or with mortality. (OR 1.014, p=0.89). There were 4999 strokes in 2022, 4272 (85.4%) were ischaemic and 1270 (29.7%) of ischaemic strokes were AF associated. Of the 557 AF associated ischaemic strokes anticoagulated at presentation, 84.6% were prescribed DOACs. Forty-eight (9.5%) had their anticoagulation paused and 40 admitted to poor compliance (7.9%).</p><p><strong>Conclusion: </strong>Nearly half of people with AF identified had not previously had the arrhythmia detected pre-stroke. Those admitted with known AF were ","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241303836"},"PeriodicalIF":6.3,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647801","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":"Transient brain ischemic symptoms and the presence of ischemic lesions at neuroimaging - Results from the READAPT study.","authors":"Raffaele Ornello, Matteo Foschi, Federico De Santis, Michele Romoli, Tiziana Tassinari, Valentina Saia, Silvia Cenciarelli, Chiara Bedetti, Chiara Padiglioni, Bruno Censori, Valentina Puglisi, Luisa Vinciguerra, Maria Guarino, Valentina Barone, Marialuisa Zedde, Ilaria Grisendi, Marina Diomedi, Maria Rosaria Bagnato, Marco Petruzzellis, Domenico Maria Mezzapesa, Pietro Di Viesti, Vincenzo Inchingolo, Manuel Cappellari, Mara Zenorini, Paolo Candelaresi, Vincenzo Andreone, Giuseppe Rinaldi, Alessandra Bavaro, Anna Cavallini, Stefan Moraru, Pietro Querzani, Valeria Terruso, Marina Mannino, Umberto Scoditti, Alessandro Pezzini, Giovanni Frisullo, Francesco Muscia, Maurizio Paciaroni, Maria Giulia Mosconi, Andrea Zini, Ruggiero Leone, Carmela Palmieri, Letizia Maria Cupini, Michela Marcon, Rossana Tassi, Enzo Sanzaro, Cristina Paci, Giovanni Viticchi, Daniele Orsucci, Anne Falcou, Susanna Diamanti, Roberto Tarletti, Patrizia Nencini, Eugenia Rota, Federica Nicoletta Sepe, Delfina Ferrandi, Luigi Caputi, Gino Volpi, Salvatore La Spada, Mario Beccia, Claudia Rinaldi, Vincenzo Mastrangelo, Francesco Di Blasio, Paolo Invernizzi, Giuseppe Pelliccioni, Maria Vittoria De Angelis, Laura Bonanni, Giampietro Ruzza, Emanuele Alessandro Caggia, Monia Russo, Agnese Tonon, Maria Cristina Acciarri, Sabrina Anticoli, Cinzia Roberti, Giovanni Manobianca, Gaspare Scaglione, Francesca Pistola, Alberto Fortini, Antonella De Boni, Alessandra Sanna, Alberto Chiti, Leonardo Barbarini, Maela Masato, Massimo Del Sette, Francesco Passarelli, Maria Roberta Bongioanni, Danilo Toni, Stefano Ricci, Simona Sacco, Eleonora De Matteis","doi":"10.1177/17474930241302691","DOIUrl":"https://doi.org/10.1177/17474930241302691","url":null,"abstract":"<p><strong>Background: </strong>According to the literature, about one third of patients with brain ischemic symptoms lasting <24 hours, which are classified as TIAs according to the traditional \"time-based\" definition, show the presence of acute ischemic lesions at neuroimaging. Recent evidence has shown that the presence of acute ischemic lesions at neuroimaging may impact on the outcome of patients with transient ischemic symptoms treated with dual antiplatelet treatment (DAPT). This uncertainty is even more compelling in recent years as short-term DAPT has become the standard treatment for any non-cardioembolic TIA or minor ischemic stroke.</p><p><strong>Methods: </strong>This is a pre-specified subgroup analysis from a prospective multicenter real-world study (READAPT). The analysis included patients with time-based TIA - i.e. those with ischemic symptoms lasting <24 hours - who started DAPT. In the whole population, we assessed the presence of acute brain ischemic lesions at neuroimaging and their association with the ABCD2 score. To assess the impact of acute brain ischemic lesions on 90-day prognosis, we performed a propensity score matching of patients with and without those lesions. We adopted a primary effectiveness outcome which was a composite of new stroke/TIA events and death due to vascular causes at 90 days.</p><p><strong>Results: </strong>We included 517 patients - 324 (62.7%) male - with a median (interquartile range - IQR) age of 74 (IQR 65-81) years; 144 patients (27.9%) had acute brain ischemic lesions at neuroimaging. The proportion of patients with brain ischemic lesions did not vary according to the ABCD2 score. At follow-up, 4 patients with brain ischemic lesions (2.8%) and 21 patients without lesions (5.6%) reported the primary effectiveness outcome, which was similar between the groups before (p=0.178) and after matching (p=0.518).</p><p><strong>Conclusions: </strong>In our population, patients with transient ischemic symptoms and acute ischemic lesions at brain MRI had a risk of recurrent ischemic events similar to those without lesions. The risk of recurrent ischemic events was low in both groups.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241302691"},"PeriodicalIF":6.3,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667867","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":"Real-world comparison of dual versus single antiplatelet treatment in patients with non-cardioembolic mild-to-moderate ischemic stroke: a propensity matched analysis.","authors":"Matteo Foschi, Raffaele Ornello, Lucio D'Anna, Eleonora De Matteis, Federico De Santis, Valentina Barone, Marilina Viola, Maria Giulia Mosconi, Diletta Rosin, Michele Romoli, Tiziana Tassinari, Silvia Cenciarelli, Bruno Censori, Marialuisa Zedde, Marina Diomedi, Marco Petruzzellis, Vincenzo Inchingolo, Manuel Cappellari, Paolo Candelaresi, Alessandra Bavaro, Anna Cavallini, Maria Grazia Piscaglia, Valeria Terruso, Alessandro Pezzini, Giovanni Frisullo, Francesco Muscia, Andrea Zini, Ruggiero Leone, Carmela Palmieri, Letizia Maria Cupini, Michela Marcon, Rossana Tassi, Enzo Sanzaro, Giulio Papiri, Giovanni Viticchi, Daniele Orsucci, Anne Falcou, Susanna Diamanti, Roberto Tarletti, Patrizia Nencini, Eugenia Rota, Federica Nicoletta Sepe, Luigi Caputi, Gino Volpi, Salvatore La Spada, Mario Beccia, Vincenzo Mastrangelo, Paolo Invernizzi, Giuseppe Pelliccioni, Maria Vittoria De Angelis, Laura Bonanni, Giampietro Ruzza, Emanuele Alessandro Caggia, Monia Russo, Agnese Tonon, Maria Cristina Acciarri, Sabrina Anticoli, Cinzia Roberti, Gaspare Scaglione, Francesca Pistoia, Chiara Alessi, Antonella De Boni, Alessandra Sanna, Alberto Chiti, Leonardo Barbarini, Maela Masato, Massimo Del Sette, Francesco Passarelli, Maria Roberta Bongioanni, Manuela De Michele, Stefano Ricci, Mariarosaria Valente, Gian Luigi Gigli, Giovanni Merlino, Maurizio Paciaroni, Maria Guarino, Simona Sacco","doi":"10.1177/17474930241302991","DOIUrl":"10.1177/17474930241302991","url":null,"abstract":"<p><strong>Background: </strong>Short-term dual antiplatelet treatment (DAPT) is superior to single antiplatelet treatment (SAPT) for secondary prevention in non-cardioembolic minor ischemic stroke and high-risk TIA. As the real-world use of DAPT is broader than in trials, it is important to clarify its benefit/risk profile in a diverse population.</p><p><strong>Methods: </strong>Post-hoc analysis of prospectively collected data from the READAPT cohort and 3 prospective stroke registries including patients with mild-to-moderate (National Institute of Health Stroke Scale [NIHSS] score 0-10) ischemic stroke receiving early DAPT or SAPT. The primary effectiveness outcome was 90-day return to pre-stroke neurological functioning using modified Rankin Scale (mRS) score. Secondary effectiveness outcomes were 90-day mRS shift, new ischemic stroke/TIA, vascular and all-cause death, 24-h early neurological improvement or deterioration. The safety outcome was 90-day intracranial hemorrhage.</p><p><strong>Results: </strong>We matched 1008 patients treated with DAPT and 1008 treated with SAPT. Compared to SAPT, patients treated with DAPT showed higher likelihood of 90-day primary effectiveness outcome (87.5% versus 84.4%, risk difference 3.1% [95%CI 0.1%-6.1%];p=0.047, risk ratio 1.03 [95%CI 1.01-1.07];p=0.043) and higher rate of 24-h early neurological improvement (25.3% versus 15.4%, risk difference 9.9% [95%CI 6.4%-13.4%];p<0.001, risk ratio 1.65 [95%CI 1.37-1.97];p<0.001). No differences were observed for other study outcomes. Subgroup analysis confirmed benefit of DAPT over SAPT for primary effectiveness outcome in patients with moderate stroke, those treated with intravenous thrombolysis and who received antiplatelet loading dose.</p><p><strong>Conclusions: </strong>Our findings suggest that DAPT use might be safe and more effective than SAPT even in the real-world and in patients who do not strictly fulfill criteria of landmark large clinical trials.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241302991"},"PeriodicalIF":6.3,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647805","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":"ECG-based machine learning model for AF identification in patients with first ischemic stroke.","authors":"Chih-Chieh Yu, Yu-Qi Peng, Chen Lin, Chia-Hsin Chiang, Chih-Min Liu, Yenn-Jiang Lin, Lian-Yu Lin, Men-Tzung Lo","doi":"10.1177/17474930241302272","DOIUrl":"https://doi.org/10.1177/17474930241302272","url":null,"abstract":"<p><strong>Background: </strong>The recurrence rate of strokes associated with atrial fibrillation (AF) can be substantially reduced through the administration of oral anticoagulants. However, previous studies have not demonstrated a clear benefit from the universal application of oral anticoagulants in patients with embolic stroke of undetermined source. Timely detection of AF remains a challenge in patients with stroke.</p><p><strong>Aim: </strong>This study aims to develop a convolutional neural network (CNN) model to accurately identify patients with AF using a 12-lead sinus-rhythm electrocardiogram (ECG) recorded around the time of the first ischemic stroke. Additionally, this study also evaluates the model's ability to predict future occurrence of AF.</p><p><strong>Methods: </strong>A CNN model was trained with ECG data from patients at Taipei Veterans General Hospital. External validation was performed on ischemic stroke patients from National Taiwan University Hospital. The model's performance was assessed for detecting AF at the stroke event and predicting future AF occurrences.</p><p><strong>Results: </strong>The model demonstrated an area under curve (AUC) of 0.91 for internal validation and 0.69 for external validation in identifying AF at the stroke event, with sensitivity and negative predictive value both achieving 97%. Kaplan-Meier survival analysis of patients without a prior diagnosis of AF revealed a significant increase in future AF incidence among the high-risk group identified by the model (adjusted hazard ratio: 4.06; 95% confidence interval: 2.74-6.00).</p><p><strong>Conclusions: </strong>The CNN model effectively identifies AF in stroke patients using 12-lead ECGs and predicts future AF events, facilitating early anticoagulation therapy and potentially reducing recurrent stroke risk. Further prospective studies are warranted to confirm these findings.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241302272"},"PeriodicalIF":6.3,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620704","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":"Author Index.","authors":"","doi":"10.1177/17474930241293178","DOIUrl":"https://doi.org/10.1177/17474930241293178","url":null,"abstract":"","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"19 2_suppl","pages":"499-519"},"PeriodicalIF":6.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647808","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":"Sleep disorders as both risk factors for, and a consequence of, stroke: A narrative review.","authors":"Lukas Mayer-Suess, Abubaker Ibrahim, Kurt Moelgg, Matteo Cesari, Michael Knoflach, Birgit Högl, Ambra Stefani, Stefan Kiechl, Anna Heidbreder","doi":"10.1177/17474930231212349","DOIUrl":"10.1177/17474930231212349","url":null,"abstract":"<p><strong>Background and purpose: </strong>Sleep disorders are increasingly implicated as risk factors for stroke, as well as a determinant of stroke outcome. They can also occur secondary to the stroke itself. In this review, we describe the variety of different sleep disorders associated with stroke and analyze their effect on stroke risk and outcome.</p><p><strong>Methods: </strong>A search term-based literature review (\"sleep,\" \"insomnia,\" \"narcolepsy,\" \"restless legs syndrome,\" \"periodic limb movements during sleep,\" \"excessive daytime sleepiness\" AND \"stroke\" OR \"cerebrovascular\" in PubMed; \"stroke\" and \"sleep\" in ClinicalTrials.gov) was performed. English articles from 1990 to March 2023 were considered.</p><p><strong>Results: </strong>Increasing evidence suggests that sleep disorders are risk factors for stroke. In addition, sleep disturbance has been reported in half of all stroke sufferers; specifically, an increase is not only sleep-related breathing disorders but also periodic limb movements during sleep, narcolepsy, rapid eye movement (REM) sleep behavior disorder, insomnia, sleep duration, and circadian rhythm sleep-wake disorders. Poststroke sleep disturbance has been associated with worse outcome.</p><p><strong>Conclusion: </strong>Sleep disorders are risk factors for stroke and associated with worse stroke outcome. They are also a common consequence of stroke. Recent guidelines suggest screening for sleep disorders after stroke. It is possible that treatment of sleep disorders could both reduce stroke risk and improve stroke outcome, although further data from clinical trials are required.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"490-498"},"PeriodicalIF":6.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11134986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54229121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying the optimal time period for detection of atrial fibrillation after ischaemic stroke and TIA: An updated systematic review and meta-analysis of randomized control trials.","authors":"Mrinal Thakur, Ahmed Alsinbili, Rahul Chattopadhyay, Elizabeth A Warburton, Kayvan Khadjooi, Isuru Induruwa","doi":"10.1177/17474930231215277","DOIUrl":"10.1177/17474930231215277","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is a major risk factor for ischaemic stroke (IS) and transient ischaemic attack (TIA). The timely detection of first-diagnosed or \"new\" AF (nAF) would prompt a switch from antiplatelets to anticoagulation to reduce the risk of stroke recurrence; however, the optimal timing and duration of rhythm monitoring to detect nAF remains unclear.</p><p><strong>Aims: </strong>We searched MEDLINE, PubMed, Cochrane database, and Google Scholar to undertake a systematic review and meta-analysis of randomized controlled trials (RCT) between 2012 and 2023 investigating nAF detection after IS and TIA. Outcome measures were overall detection of nAF (control; (usual care) compared to intervention; (continuous cardiac monitoring >72 h)) and the time period in which nAF detection is highest (0-14 days, 15-90 days, 91-180 days, or 181-365 days). A random-effects model with generic inverse variance weights was used to pool the most adjusted effect measure from each trial.</p><p><strong>Summary of review: </strong>A total of eight RCTs investigated rhythm monitoring after IS, totaling 5820 patients. The meta-analysis of the studies suggested that continuous cardiac monitoring was associated with a pooled odds ratio of 3.81 (95% CI 2.14 to 6.77), compared to usual care (control), for nAF detection. In the time period analysis, the odds ratio for nAF detection at 0-14 days, 15-90 days, 91-180 days, 181-365 days were 1.79 (1.24-2.58); 2.01 (0.63-6.37); 0.98 (0.16-5.90); and 2.92 (1.30-6.56), respectively.</p><p><strong>Conclusion: </strong>There is an almost fourfold increase in nAF detection with continuous cardiac monitoring, compared to usual care. The results also demonstrate two statistically significant time periods in nAF detection; at 0-14 days and 6-12 months following monitoring commencement. These data support the utilization of different monitoring methods to cover both time periods and a minimum of 1 year of monitoring to maximize nAF detection in patients after IS and TIA.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"499-505"},"PeriodicalIF":6.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72014237","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":"Cerebral microbleeds and asundexian in non-cardioembolic ischemic stroke: Secondary analyses of the PACIFIC-STROKE randomized trial.","authors":"Pargol Balali, Robert G Hart, Eric E Smith, Feryal Saad, Pablo Colorado, Robin Lemmens, Gian Marco De Marchis, Valeria Caso, Lizhen Xu, Laura Heenan, Stuart J Connolly, Hardi Mundl, Ashkan Shoamanesh","doi":"10.1177/17474930231216339","DOIUrl":"10.1177/17474930231216339","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and aims: &lt;/strong&gt;Cerebral microbleeds are magnetic imaging resonance (MRI) markers of hemorrhage-prone cerebral small vessel disease that predict future risk of ischemic stroke and intracranial hemorrhage (ICrH). There exist concerns about the net benefit of antithrombotic therapy in patients with microbleeds. We aimed to investigate the effects of an oral factor-XIa inhibitor (asundexian), that is hypothesized to inhibit thrombosis without compromising hemostasis, on the development of new microbleeds over time and interactions between microbleeds and asundexian treatment on clinical outcomes. We additionally assessed associations between baseline microbleeds and the risks of clinical and neuroimaging outcomes in patients with non-cardioembolic ischemic stroke.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a secondary analysis of the PACIFIC-STROKE, international, multi-center Phase 2b double-blind, randomized clinical trial. PACIFIC-STROKE enrolled patients aged ⩾ 45 years with mild-to-moderate non-cardioembolic ischemic stroke who presented within 48 h of symptom onset for whom antiplatelet therapy was intended. Microbleeds were centrally adjudicated, and participants with an interpretable T2*-weighted sequence at their baseline MRI were included in this analysis. Patients were randomized to asundexian (10/20/50 mg daily) versus placebo plus standard antiplatelet treatment. Regression models were used to estimate the effects of (1) all pooled asundexian doses and (2) asundexian 50 mg daily on new microbleed formation on 26-week MRIs. Cox proportional hazards or regression models were additionally used to estimate interactions between treatment assignment and microbleeds for ischemic stroke/transient ischemic attack (TIA) (primary outcome), and ICrH, all-cause mortality, hemorrhagic transformation (HT), and new microbleeds (secondary outcomes).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 1746 participants (mean age, 67.0 ± 10.0; 34% female) with baseline MRIs, 604 (35%) had microbleeds. During a median follow-up of 10.6 months, 7.0% (n = 122) had ischemic stroke/TIA, 0.5% (n = 8) ICrH, and 2.1% (n = 37) died. New microbleeds developed in 10.3% (n = 155) of participants with adequate follow-up MRIs and HT in 31.4% (n = 345). In the total sample of patients with adequate baseline and 26-week follow-up MRIs (n = 1507), new microbleeds occurred in 10.2% of patients assigned to any asundexian dose and 10.5% of patients assigned to placebo (OR, 0.96; 95% CI, 0.66-1.41). There were no interactions between microbleeds and treatment assignment for any of the outcomes (p for interaction &gt; 0.05). The rates of new microbleeds, HT, and ICrH were numerically less in patients with microbleeds assigned to asundexian relative to placebo. The presence of microbleeds was associated with a higher risk of HT (aOR, 1.6; 95% CI, 1.2-2.1) and new microbleeds (aOR, 4.4; 95% CI, 3.0-6.3).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Factor XIa inhibition with asundexian ","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"526-535"},"PeriodicalIF":6.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11134999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72209194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrence of cervical artery dissection: A systematic review and meta-analysis.","authors":"Elizabeth Lounsbury, Naomi Niznick, Ranjeeta Mallick, Brian Dewar, Alexandra Davis, Dean A Fergusson, Dar Dowlatshahi, Michel Shamy","doi":"10.1177/17474930231201434","DOIUrl":"10.1177/17474930231201434","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cervical artery dissection (CAD) involving the carotid or vertebral arteries is an important cause of stroke in younger patients. The purpose of this systematic review is to assess the risk of recurrent CAD.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted on studies in which patients experienced radiographically confirmed dissections involving an extracranial segment of the carotid or vertebral artery and in whom CAD recurrence rates were reported.</p><p><strong>Results: </strong>Data were extracted from 29 eligible studies (n = 5898 patients). Analysis of outcomes was performed by pooling incidence rates with random effects models weighting by inverse of variance. The incidence of recurrent CAD was 4% overall (95% confidence interval (CI) = 3-7%), 2% at 1 month (95% CI = 1-5%), and 7% at 1 year in studies with sufficient follow-up (95% CI = 4-13%). The incidence of recurrence associated with ischemic events was 2% (95% CI = 1-3%).</p><p><strong>Conclusions: </strong>We found low rates of recurrent CAD and even lower rates of recurrence associated with ischemia. Further patient-level data and clinical subgroup analyses would improve the ability to provide patient-level risk stratification.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"388-396"},"PeriodicalIF":6.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10964388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10143957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting inflammation to reduce recurrent stroke.","authors":"Annaelle Zietz, Sarah Gorey, Peter J Kelly, Mira Katan, John J McCabe","doi":"10.1177/17474930231207777","DOIUrl":"10.1177/17474930231207777","url":null,"abstract":"<p><strong>Background: </strong>Approximately one in four stroke patients suffer from recurrent vascular events, underlying the necessity to improve secondary stroke prevention strategies. Immune mechanisms are causally associated with coronary atherosclerosis. However, stroke is a heterogeneous disease and the relative contribution of inflammation across stroke mechanisms is not well understood. The optimal design of future randomized control trials (RCTs) of anti-inflammatory therapies to prevent recurrence after stroke must be informed by a clear understanding of the prognostic role of inflammation according to stroke subtype and individual patient factors.</p><p><strong>Aim: </strong>In this narrative review, we discuss (1) inflammatory pathways in the etiology of ischemic stroke subtypes; (2) the evidence on inflammatory markers and vascular recurrence after stroke; and (3) review RCT evidence of anti-inflammatory agents for vascular prevention.</p><p><strong>Summary of review: </strong>Experimental work, genetic epidemiological data, and plaque-imaging studies all implicate inflammation in atherosclerotic stroke. However, emerging evidence also suggests that inflammatory mechanisms are also important in other stroke mechanisms. Advanced neuroimaging techniques support the role of neuroinflammation in blood-brain barrier dysfunction in cerebral small vessel disease (cSVD). Systemic inflammatory processes also promote atrial cardiopathy, incident and recurrent atrial fibrillation (AF). Although several inflammatory markers have been associated with recurrence after stroke, interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) are presently the most promising markers to identify patients at increased vascular risk. Several RCTs have shown that anti-inflammatory therapies reduce vascular risk, including stroke, in coronary artery disease (CAD). Some, but not all of these trials, selected patients on the basis of elevated hsCRP. Although unproven after stroke, targeting inflammation to reduce recurrence is a compelling strategy and several RCTs are ongoing.</p><p><strong>Conclusion: </strong>Evidence points toward the importance of inflammation across multiple stroke etiologies and potential benefit of anti-inflammatory targets in secondary stroke prevention. Taking the heterogeneous stroke etiologies into account, the use of serum biomarkers could be useful to identify patients with residual inflammatory risk and perform biomarker-led patient selection for future RCTs.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"379-387"},"PeriodicalIF":6.7,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10964390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41135966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}