International Journal of Stroke最新文献

{"title":"Illicit drug use and cerebral microbleeds in patients with acute ischemic stroke and transient ischemic attack.","authors":"Benjamin K Petrie, Helena Lau, Fe Maria Cajiga-Pena, Saleh Abbas, Brandon Finn, Katie Dam, Anna M Cervantes-Arslanian, Thanh N Nguyen, Hugo J Aparicio, David Greer, Jose Rafael Romero","doi":"10.1177/17474930251328524","DOIUrl":"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 magnetic resonance imaging (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 body mass index (26.6 ± 4.4 vs 28.1 ± 5.9, p = 0.039), and were more likely to have chronic kidney disease (9.5% vs 3.0%, p = 0.033) or have had a previous ischemic stroke/transient ischemic attack (41.9% vs 25.1%, p = 0.009). On coprimary analysis, cocaine use was associated with increased CMB number by 0.24 (95% confidence interval (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 IDU to cerebrovascular injury and underscore the importance of targeted interventions in this population.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"874-882"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","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":"Do self-management interventions improve self-efficacy and health-related quality of life after stroke? A systematic review.","authors":"Elizabeth A Lynch, Katie Nesbitt, Aarti Gulyani, Raymond J Chan, Niranjan Bidargaddi, Dominique A Cadilhac, Billie Bonevski, Fiona Jones, Liam P Allan, Erin Godecke, Rebecca Barnden, Emily Brogan, Thoshenthri Kandasamy, Stacy Larcombe, Lemma N Bulto, Coralie English","doi":"10.1177/17474930251340286","DOIUrl":"10.1177/17474930251340286","url":null,"abstract":"<p><strong>Introduction: </strong>Self-management interventions are recommended after stroke in many international guidelines to improve health-related quality of life (HRQoL). Self-efficacy, a person's confidence in their abilities, is widely considered to underpin individuals' abilities to self-manage their health.</p><p><strong>Aims: </strong>To synthesize evidence on the effectiveness of self-management programs for improving self-efficacy or HRQoL in stroke survivors.</p><p><strong>Summary of review: </strong>The protocol was registered with the International Prospective Register of Systematic Reviews (CRD42023440168). We searched databases including Medline, Emcare, Scopus, Cochrane Library, CINAHL, and trial registries from inception to 13/12/2024. Only randomized controlled trials (RCTs) comparing the effect of a self-management intervention to no/another intervention for survivors of stroke on self-efficacy or HRQoL were included. Risk of bias was assessed using the Cochrane Collaboration criteria. Meta-analyses for self-efficacy and HRQoL were performed using random effect model. From 13,608 abstracts screened, 44 randomized controlled trials involving 5931 participants were included. Median time post-stroke of recruited participants ranged from 14 days to 3 years. Time required to deliver the interventions ranged from 45 min to 72 h. Self-management interventions in all included trials had multiple components, predominantly education (N = 40, 91%) and goal setting (N = 39, 89%). Interventions were delivered to individual survivors of stroke (N = 18, 41%), groups of survivors (N = 15, 34%), both individual and group delivery to survivors (N = 5, 11%) and individually to survivor-carer dyads (N = 6, 14%). Interventions were delivered entirely face-to-face (N = 28, 64%), entirely by phone or video-conferencing (N = 7, 16%) or a combination of these delivery modes (N = 9, 20%). There was low certainty evidence that self-management programs compared to no intervention did not significantly improve self-efficacy on pooled effect sizes (SMD 0.08, 95%CI -0.02 to 0.18). There was moderate certainty evidence that self-management programs had a marginal significant effect on HRQoL (SMD 0.07, 95% CI 0.01 to 0.13). Limitations to the review include marked variation between included studies in the interventions delivered, and outcome measures used, targeted behaviors and time since stroke.</p><p><strong>Conclusion: </strong>Self-management programs varied markedly in content and dose. There is low-certainty evidence that currently designed self-management programs do not significantly improve self-efficacy. There is moderate certainty evidence that self-management programs have a small effect on HRQoL after stroke.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"786-800"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971431","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":"Long-term functional outcomes among patients surviving aneurysmal subarachnoid hemorrhage: The KOSCO study.","authors":"Ho Seok Lee, Min Kyun Sohn, Jongmin Lee, Deog Young Kim, Yong-Il Shin, Gyung-Jae Oh, Yang-Soo Lee, Min Cheol Joo, So Young Lee, Min-Keun Song, Junhee Han, Jeonghoon Ahn, Young-Hoon Lee, Dae Hyun Kim, Young-Taek Kim, Yun-Hee Kim, Won Hyuk Chang","doi":"10.1177/17474930251320566","DOIUrl":"10.1177/17474930251320566","url":null,"abstract":"<p><strong>Background and objectives: </strong>Aneurysmal subarachnoid hemorrhage (aSAH) remains a significant global health concern, and therefore, understanding their functional outcomes is essential. The aim of this study was to investigate the 1-year functional outcomes of patients with aSAH.</p><p><strong>Methods: </strong>We retrospectively analyzed data of patients with aSAH from the Korean Stroke Cohort for Functioning and Rehabilitation study, up to 1 year post-onset. The cohort data were collected twice. The first data was collected from August 2012 through May 2015, and the second data was collected from January to December in 2020, from nine different hospitals. Assessments were performed from 7 days to 1 year. Disability, measured by modified Rankin Scale (mRS), was analyzed in terms of good outcome (mRS 0 or 1) and mortality. In addition, functional level was further assessed using Functional Independence Measure (FIM) in aSAH survivors at 1 year post-onset. A subgroup analysis was conducted, with participants further classified into two groups: one with mild-to-moderate disability (mRS 0-3) and another with severe disability (mRS 4 or 5), as reported 7 days after onset. Multiple imputation method was used to handle missing data. In addition, mixed-effects model was used to analyze the trajectory of FIM.</p><p><strong>Results: </strong>A total of 517 patients with aSAH were included. Of these, 246 (47.6%) showed mild-to-moderate disability and 271 (52.4%) showed severe disability at 7 days. At 1 year after onset, the mortality rate was 6.0% and the good outcome was reported in 76.2% of patients. In aSAH survivors at 1 year, FIM showed a significant improvement over time, with a significant difference demonstrated between the subgroups. Age, initial clinical severity, and cognitive function at 7 days were also identified as significant covariates.</p><p><strong>Conclusions: </strong>The majority of patients reporting mild-to-moderate disability at 7 days exhibited good functional outcome, and even among those with severe disability, there was a favorable outcome with continuous improvement in their functional levels. Therefore, proper assessments and effective management should be employed to achieve favorable functional outcomes among aSAH survivors.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"821-830"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074640","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.Data access statement: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":"812-820"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","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":"Mobile health delivered physical activity after mild stroke or transient ischemic attack: Is it feasible and acceptable?","authors":"Charlotte Thurston, Sophia Humphries, Lucian Bezuidenhout, Sverker Johansson, Lisa Holmlund, Lena von Koch, Coralie English, David Moulaee Conradsson","doi":"10.1177/17474930251315628","DOIUrl":"10.1177/17474930251315628","url":null,"abstract":"<p><strong>Background and aims: </strong>Physical activity is a key component of secondary stroke prevention. Mobile health (mHealth) interventions show promise for enhancing post-stroke physical activity, but most studies have combined mHealth with onsite services. This study evaluated the feasibility and acceptability of a fully digitalized mHealth intervention for physical activity among individuals post-stroke or transient ischemic attack (TIA) in Sweden.</p><p><strong>Methods: </strong>In this two-arm feasibility randomized controlled trial, adults with stroke or TIA were randomized to one of the following 6-month interventions: (1) the experiment group, receiving mHealth-delivered supervised exercise (two sessions weekly during months 1 to 3, one session weekly during months 4 to 6) and behavioral change techniques for physical activity (including two individual counseling and six follow-up sessions) or (2) the control group, receiving two mHealth-delivered individual counseling and three follow-up sessions. Feasibility (reach, retention, adherence, fidelity, safety) and acceptability were assessed according to pre-specified progression criteria.</p><p><strong>Results: </strong>Of 114 participants, 105 (92%) completed the 6-month intervention and 102 (89%) completed the 12-month follow-up assessment. The intervention reached individuals from 20 of 21 Swedish regions. Sixty-eight percent of participants had a stroke (of which 96% were mild), 64% were female, and the average age was 71 years (standard deviation = 9). Ninety-five percent were born in Sweden, had a high level of education (61%), and an average daily step count of 6451 steps. Completion of outcome measures included digital questionnaires (98%), sensor-derived physical activity (92%), and blood pressure monitoring (97%). A total of 1781 supervised exercise sessions were delivered to the experiment group, with an adherence rate of 76%, and adherence to individual counseling and follow-up sessions was 96%. Ninety-five adverse events were recorded, of which 16 were related to the intervention (predominantly pain or muscle soreness) but non-serious. Overall satisfaction with the mobile app was 71%, and 76% of the experiment group believed the app could partly replicate in-person visits.</p><p><strong>Conclusion: </strong>The mHealth intervention was overall feasible and acceptable; however, there is a need to develop recruitment procedures to increase diversity of included participants regarding socioeconomic status and physical activity level, prior to a phase 3 trial.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT05111951).</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"801-811"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970731","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":"Comparative outcomes of arteriovenous malformations treatment in eloquent versus non-eloquent brain: A multicenter study with propensity-score weighting.","authors":"Basel Musmar, Nimer Adeeb, Hammam Abdalrazeq, Hamza Adel Salim, Joanna M Roy, Assala Aslan, Stavropoula I Tjoumakaris, Christopher S Ogilvy, Mustafa K Baskaya, Douglas Kondziolka, Jason Sheehan, Howard Riina, Sandeep Kandregula, Adam A Dmytriw, Abdallah Abushehab, Kareem El Naamani, Ahmed Abdelsalam, Natasha Ironside, Deepak Kumbhare, Sanjeev Gummadi, Cagdas Ataoglu, Muhammed Amir Essibayi, Abdullah Keles, Sandeep Muram, Daniel Sconzo, Arwin Rezai, Omar Alwakaa, Salem M Tos, Georgios Mantziaris, Min S Park, Sahin Hanalioglu, Ufuk Erginoglu, Johannes Pöppe, Rajeev D Sen, Christoph J Griessenauer, Jan-Karl Burkhardt, Robert M Starke, Laligam N Sekhar, Michael R Levitt, David J Altschul, Neil Haranhalli, Malia McAvoy, Hussein A Zeineddine, Adib A Abla, Elias Atallah, Michael Reid Gooch, Robert H Rosenwasser, Christopher Stapleton, Matthew Koch, Visish M Srinivasan, Peng R Chen, Spiros Blackburn, Ketan Bulsara, Louis J Kim, Omar Choudhri, Bryan Pukenas, Edward Smith, Pascal J Mosimann, Ali Alaraj, Mohammad A Aziz-Sultan, Aman B Patel, Amey Savardekar, Christina Notarianni, Hugo H Cuellar, Michael Lawton, Bharat Guthikonda, Jacques Morcos, Pascal Jabbour","doi":"10.1177/17474930251323503","DOIUrl":"10.1177/17474930251323503","url":null,"abstract":"<p><strong>Background: </strong>Arteriovenous malformations (AVMs) are complex vascular anomalies with a high risk of hemorrhage and neurological deficits, especially when located in eloquent brain regions. The eloquence of an AVM location is a critical factor in the treatment planning, influencing both the risk of complications and long-term functional outcomes. This study aims to compare outcomes between eloquent and non-eloquent AVMs.</p><p><strong>Methods: </strong>This multicenter, retrospective study utilized data from the Multicenter International Study for Treatment of Brain AVMs (MISTA) consortium. Patients with eloquent and non-eloquent AVMs were compared on baseline characteristics, angiographic outcomes, and functional outcomes using the modified Rankin Scale (mRS). Propensity score weighting (IPTW) was applied to adjust for confounding variables.</p><p><strong>Results: </strong>The study included 1013 patients, with 498 (49.2%) AVMs located in eloquent regions and 515 (50.8%) in non-eloquent regions. In unadjusted analysis, eloquent AVMs had lower complete obliteration rates (67.6% vs 79.5%, OR: 0.53, 95% CI: 0.39-0.72, p < 0.001) and higher complication rates (24.5% vs 19.0%, OR: 1.38, 95% CI: 1.02-1.86, p = 0.03) compared to non-eloquent AVMs. After IPTW adjustment, eloquent AVMs continued to show significantly higher odds of overall complications (OR: 1.68, 95% CI: 1.12-2.52, p = 0.01) and symptomatic complications (OR: 1.77, 95% CI: 1.12-2.80, p = 0.01). Secondary analysis within the eloquent group indicated that embolization was linked to an elevated risk of complications. Surgery and radiosurgery showed comparable functional outcomes at last follow-up and complications rates with higher complete obliteration rates in surgery.</p><p><strong>Conclusion: </strong>AVMs in eloquent brain areas present higher risks of complications and lower obliteration rates, emphasizing the need for cautious, individualized treatment planning. Within the eloquent group, embolization increased the risk of complications, while surgery and radiosurgery showed comparable functional outcomes at last follow-up and complication rates with higher complete obliteration rates in surgery. These findings highlight the importance of location in AVM management and support further research focusing on comparing treatment strategies for AVMs in eloquent brain areas.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"852-863"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414087","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":"Variations in intracranial arterial anatomy of the circle of Willis and their association with arteriosclerosis in patients with ischemic cerebrovascular disease.","authors":"Bernhard P Berghout, Rüveyda F Soyupak, M Kamran Ikram, Daniel Bos","doi":"10.1177/17474930251322678","DOIUrl":"10.1177/17474930251322678","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;An estimated 20-31% of all people are born with a textbook anatomical configuration of the intracranial arteries comprising the Circle of Willis. Individuals with specific anatomical variants may be at elevated risk of intracranial arteriosclerosis, and possibly its sequelae of stroke and dementia, as the distribution of blood flow and pressure is known to be different in variants with missing arteries or arterial segments. Therefore, we studied the association of anatomical variation of intracranial arteries with arteriosclerosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Between December 2005 and October 2010, 1126 patients (mean age: 62.3 (SD: ±14.0) years, 48.0% female) were recruited, 59.9% of whom had ischemic stroke and 40.1% a transient ischemic attack (TIA). Within the routine diagnostic work-up for stroke, patients underwent cranial computed tomography (CT) angiography. These images enabled a detailed visualization of intracranial arteries, which allowed for the assessment of the anatomical configuration of the cerebral arteries, the anterior and posterior communicating arteries, the internal carotids, and the vertebrobasilar arteries. In addition, these images facilitated the identification of intracranial arterial calcifications, the defining feature of intracranial arteriosclerosis. Binomial logistic regression models adjusting for age, sex, and ethnicity were constructed to assess associations between intracranial artery variations and presence of intracranial arterial calcifications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;An incomplete Circle of Willis, defined by aplasia of any arterial segment, was present in 875 (77.7%) patients. The most common variation found was aplasia of the right posterior communicating artery, in 52.0% of patients. Men more often presented with an incomplete anatomy as compared to women (adjusted odds ratio: 1.36 (95% CI = 1.02-1.81)). Intracranial artery calcification was present in 59.2% of patients. Incompleteness of the intracranial arteries was not associated with the presence of any intracranial artery calcification (0.95 (0.68-1.34)). However, specific variants were associated with specific locations of intracranial artery calcification: The prevalence of vertebrobasilar artery calcification was lower among those with fetal-type posterior cerebral artery compared to individuals with a normal posterior cerebral artery (0.61 (0.38-0.99)). The prevalence of vertebrobasilar artery calcification was higher among those with a-/hypoplasia of both posterior communicating arteries as compared to those with normal posterior communicating arteries (1.63 (1.00-2.66)). Furthermore, patients with a-/hypoplastic left A1-segments had a higher prevalence of right internal carotid artery calcification as compared to people with a normal left A1-segment (2.30 (1.00-5.26)).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The prevalence of arteriosclerosis in the intracranial arteries on CT imaging varies among pat","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"843-851"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382500","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":"Collaterals and outcomes after endovascular treatment in acute large vessel occlusion: Disparity by stroke etiologies.","authors":"Xinyi Leng, Ximing Nie, Hongyi Yan, Yuesong Pan, Lina Zheng, Yuying Liu, Wanying Duan, Xin Liu, Yufei Wei, Weibin Gu, Xinyi Hou, Thomas W Leung, Zhongrong Miao, David S Liebeskind, Liping Liu","doi":"10.1177/17474930251324463","DOIUrl":"10.1177/17474930251324463","url":null,"abstract":"<p><strong>Background: </strong>Collateral circulation provides compensatory flow to ischemic brain regions in acute large vessel occlusion (LVO), which had been associated with better outcomes after endovascular treatment (EVT).</p><p><strong>Aims: </strong>We aimed to reveal the pre-EVT collateral status and its associations with outcomes after EVT, in patients with acute LVO with different etiologies.</p><p><strong>Methods: </strong>Based on a prospective, multicenter registry, we analyzed patients with acute, intracranial anterior-circulation LVO due to large artery atherosclerosis (LAA) and cardioembolism (CE), who underwent EVT within 24 h. Pre-EVT leptomeningeal collateral status was classified on digital subtraction angiography by ASITN/SIR grading system. Outcomes included good 3-month functional outcome (modified Rankin Scale [mRS] 0-2), 3-month mRS distribution, successful recanalization, early neurological deterioration, symptomatic intracranial hemorrhage (sICH), and 3-month mortality.</p><p><strong>Results: </strong>Among 805 patients (median age 66 years), 450 and 355, respectively, had LVO due to LAA and CE, of whom 57.8% and 56.6% (<i>p</i> = 0.742) had good pre-EVT collaterals. In LAA patients, good collaterals were associated with lower risk of sICH (adjusted odds ratio [OR]= 0.40; 95% CI = 0.17-0.94; <i>p</i> = 0.036) but not functional outcomes. In CE patients, good collaterals were associated with a higher chance of good functional outcome (adjusted OR = 1.55; 95% CI = 0.96-2.51; <i>p</i> = 0.072) and lower mRS at 3 months (adjusted common OR = 0.64; 95% CI = 0.43-0.94; <i>p</i> = 0.021). However, there was no significant CE/LAA and collateral status interaction on any outcome.</p><p><strong>Conclusions: </strong>The study revealed comparable pre-EVT collateral status in patients with LVO due to LAA versus CE who received EVT within 24 h, but the pre-EVT collaterals may have different protective effects for post-EVT outcomes in these two groups of patients.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"864-873"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432777","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":"Secondary stroke prevention and improvements in acute intracerebral haemorrhage care.","authors":"Hugh S Markus","doi":"10.1177/17474930251356353","DOIUrl":"https://doi.org/10.1177/17474930251356353","url":null,"abstract":"","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"20 7","pages":"772-775"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649443","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":"Intravenous thrombolysis improves recanalization results irrespective of the mechanical thrombectomy technique in acute ischemic stroke.","authors":"Pauline Cousin, Giuseppe Scopelliti, Alice le Berre, Joseph Benzakoun, Nicolas Bricout, Laurence Legrand, Guillaume Turc, Charlotte Cordonnier, Catherine Oppenheim, Olivier Naggara, Hilde Henon, Wagih Ben Hassen","doi":"10.1177/17474930251337054","DOIUrl":"10.1177/17474930251337054","url":null,"abstract":"<p><strong>Introduction: </strong>Post hoc analysis of recent trials comparing bridging therapy to endovascular therapy (EVT) alone reported improved recanalization results with bridging therapy. It remains uncertain whether the positive effect of prior intravenous thrombolysis (IVT) is consistent across all mechanical thrombectomy first-line techniques (aspiration, stent-retriever, or combination of both) currently in use. In this study, we aimed to evaluate the consistency of IVT's beneficial impact on different mechanical thrombectomy techniques.</p><p><strong>Methods: </strong>Data were extracted from prospective registries, including consecutive acute ischemic stroke patients treated with EVT between January 2015 and October 2022. Patients included had anterior circulation large vessel occlusion and were treated with EVT, with or without prior IVT. A propensity score-weighted analysis was performed to measure the effect of IVT on recanalization results across different EVT techniques.</p><p><strong>Results: </strong>A total of 2650 patients (mean age 70 ± 15 years, 47% males) were included, 1400 in the bridging group and 1250 in the EVT alone group. Bridging group demonstrated higher rates of successful recanalization (eTICI ⩾ 2B) (odds ratio (OR) = 1.78, 95% confidence interval (CI): [1.52-2.1]). This result was consistent across all EVT first-line techniques: aspiration (OR = 1.81; 95% CI: [1.3-2.6], p = 0.01); stent-retriever (OR = 1.64; 95% CI: [1.2-2.2]) and combined technique (OR = 1.94; 95% CI: [1.6-2.4]). In addition, fewer retrieval attempts were needed in the bridging group (OR = 1.26, 95% CI: [1.04-1.4]), with a consistent effect across different EVT techniques.</p><p><strong>Conclusion: </strong>IVT significantly improves recanalization results of EVT in patients with acute ischemic stroke, regardless of employed mechanical thrombectomy technique.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"883-890"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996479","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}