International Journal of Stroke最新文献

{"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":"https://doi.org/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 hours. 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% (p=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; p=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; p=0.072) and lower mRS at 3 months (adjusted common OR=0.64; 95% CI 0.43-0.94; p=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 hours, 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":"17474930251324463"},"PeriodicalIF":6.3,"publicationDate":"2025-02-16","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":"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 A Salim, Joanna M Roy, Assala Aslan, Stavropoula I Tjoumakaris, Christopher Ogilvy, Mustafa K Baskaya, Douglas Kondziolka, Jason Sheehan, Howard Riina, Sandeep Kandregula, Adam 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 Griessenaur, Jan-Karl Burkhardt, Robert M Starke, Laligam N Sekhar, Michael R Levitt, David Altschul, Neil Haranhalli, Malia McAvoy, Hussein A Zeineddine, Adib A Abla, Elias Atallah, Michael Reid Gooch, Robert H Rosenwasser, Christopher J Stapleton, Matthew Koch, Visish M Srinivasan, Peng Roc Chen, Spiros Blackburn, Ketan Bulsara, Louis J Kim, Omar Choudhri, Bryan Pukenas, Edward Smith, Pascal J Mosimann, Ali Alaraj, Mohammad Ali Aziz-Sultan, Aman B Patel, Amey Rajan Savardekar, Christina Notarianni, Hugo Cuellar, Michael T Lawton, Bharat Guthikonda, Jacques Morcos, Pascal Jabbour","doi":"10.1177/17474930251323503","DOIUrl":"https://doi.org/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 1,013 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":"17474930251323503"},"PeriodicalIF":6.3,"publicationDate":"2025-02-13","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":"Prevalence of carotid plaques with high-risk features in embolic stroke of undetermined source: Systematic review and meta-analysis.","authors":"Costanza Maria Rapillo, Alessandro Giuricin, Cristina Sarti, Mascia Nesi, Simona Marcheselli, Ivano Lombardo, Rosario Pascarella, Marialuisa Zedde, Francesco Arba","doi":"10.1177/17474930251317321","DOIUrl":"10.1177/17474930251317321","url":null,"abstract":"<p><strong>Introduction: </strong>Recent evidence suggests a possible role of non-stenotic carotid atherosclerotic plaques in the etiology of embolic stroke of undetermined source (ESUS).</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of prevalence and characteristics of non-stenotic carotid plaques (NSPs) with high-risk features (complicated NSP) in internal carotid artery in unilateral ESUS in the anterior circulation. We searched MEDLINE and Ovid-Embase databases. High-risk features were intraplaque hemorrhage, thickness ⩾ 3 mm, ulceration, and hypodensity. We assessed the risk of bias (RoB), extracted the data, calculated the pooled prevalence and 95% confidence intervals (CI) using Inverse Variance Weighting method, and Random Effect models.</p><p><strong>Results: </strong>We included 16 studies and 1406 patients with different imaging for NSP assessment (1 ultrasound, 11 computed tomography (CT)-angiography, 4 magnetic resonance (MR) angiography). The RoB was moderate to low in most studies. Definition of complicated NSP differed across studies. The combined prevalence of any complicated NSP was 31% (95% CI = 27-36%) ipsilateral and 14% (95% CI = 9-19%) contralateral to the index stroke, the finding of any high-risk NSP was fourfold higher ipsilateral to the index stroke (OR = 3.63; 95% CI = 2.09-6.33). The prevalence of single high-risk features ipsilateral to ESUS was as follows: 35% (95% CI = 30-41%) for thickness ⩾ 3 mm; 24% (95% CI = 8-39%) for ulceration; 45% (95% CI = -2; 93%) for hypodensity, 16% (95% CI = 5-26%) for intraplaque hemorrhage.</p><p><strong>Conclusion: </strong>Complicated NSPs are present in around a third of all ESUS, and are four times more frequent ipsilaterally to the index stroke. Our results confirm the possible causal role in ESUS and highlight the need for greater diagnostic uniformity of plaque at risk.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251317321"},"PeriodicalIF":6.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005334","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":"B P Brian Berghout, Rüveyda F Soyupak, M Kamran Ikram, Daniel Bos","doi":"10.1177/17474930251322678","DOIUrl":"https://doi.org/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. We therefore 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 TIA. Within the routine diagnostic work-up for stroke, patients underwent cranial 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. Additionally, 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 patients with certain anatomical variants of the intracranial a","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251322678"},"PeriodicalIF":6.3,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Stroke in Patients with Infective Endocarditis: A Systematic Review and Meta-Analysis of Risk Factors.","authors":"Ammar Jumah, Ahmed Mohamedelkhair, Abdelrahman Elfaham, Sávio Batista, Tianwen Ma, Savannah Ngo, Marwan Mashina, Dennis J Mohn, Thomas Vismara, Taylor Reardon, Fatima Chughtai, Gustavo J S Sanchez, Marina Vilardo, Raphael Camerotte, Ahmad Riad Ramadan","doi":"10.1177/17474930251322679","DOIUrl":"https://doi.org/10.1177/17474930251322679","url":null,"abstract":"<p><strong>Background: </strong>Neurological complications in patients with infective endocarditis (IE), such as ischemic and hemorrhagic stroke, are well-described; However, predicting which patients are most likely to experience stroke remains uncertain.</p><p><strong>Aims: </strong>We conducted a systematic review and meta-analysis to identify the factors associated with risk of stroke in patients hospitalized with IE.</p><p><strong>Methods: </strong>A systematic search of Ovid MEDLINE, EMBASE, and Web of Science up to June 27th, 2024 was conducted. Articles evaluating risk of acute ischemic stroke (AIS) or intracranial hemorrhage (ICH) in patients with IE were included. Meta-analysis of odds ratios was feasible for only some predictive factors due to study heterogeneity. Cochrane's Risk of Bias in Non-Randomized Studies of Exposure tool was used for risk-of-bias assessment.</p><p><strong>Summary of review: </strong>Of 3538 studies identified, 35 were included: 9 prospective and 26 retrospective cohort. Staphylococcus aureus infection (odds ratio, 3.05; 95% CI, 1.96-4.73, I2 = 77.2%; 9 studies), and 1 mm increment in vegetation size (odds ratio, 1.26; 95% CI, 1.02-1.55, I2 = 90.1%; 3 studies) were associated with a higher risk of AIS, after adjusting for other covariates. High intensity signals on transcranial Doppler, and comorbidities such as hypertension, atrial fibrillation, and hyperlipidemia were also found to be associated with a higher risk of AIS. The risk of ICH was increased by thrombocytopenia, mycotic aneurysms, prior ICH or AIS, and cerebral microbleeds.</p><p><strong>Conclusions: </strong>Our study has identified factors which are associated with increased stroke risk in IE, and may help physicians predict risk. While echocardiographic and neuroimaging findings may be particularly informative, underlying comorbidities and various laboratory values may also contribute to predicting IE-associated strokes.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251322679"},"PeriodicalIF":6.3,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382497","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":"Andexanet alfa in patients with factor Xa inhibitor-associated intracranial hemorrhage: The prospective observational multicenter ASTRO-DE study.","authors":"Hans-Christoph Diener, Nils Kuklik, Anika Hüsing, Angelika Alonso, Darius G Nabavi, Sven Poli, Maria M Gabriel, Ilko L Maier, Julia Grans","doi":"10.1177/17474930251317385","DOIUrl":"10.1177/17474930251317385","url":null,"abstract":"<p><strong>Background: </strong>Hematoma expansion after intracranial hemorrhage (ICH) in anticoagulated patients significantly influences clinical outcomes and mortality, emphasizing the need for effective reversal agents. Andexanet alfa is a specific reversal agent for factor Xa-associated major bleeding.</p><p><strong>Aims: </strong>The Andexanet alfa: non-interventional study at STROke centers in Germany (Deutschland, DE) (ASTRO-DE) study collected real-world evidence on the effect of andexanet alfa on mitigating hematoma expansion and altering prognosis in rivaroxaban- or apixaban-treated patients with ICH.</p><p><strong>Methods: </strong>ASTRO-DE was a prospective non-interventional cohort study conducted at 25 certified stroke centers in Germany. The primary outcome was the hematoma volume change and the proportion of patients with hematoma growth ⩽33% within 12-72 h or until first control imaging. Secondary endpoints included in-hospital thromboembolic events and mortality up to 90 days.</p><p><strong>Results: </strong>A total of 137 patients (47.4% male, mean age = 80.0 years) with ICH (92.6% spontaneous, 87.4% intracerebral), mean National Institutes of Health Stroke Scale (NIHSS) on admission of 11.2 points, and mean initial hematoma volume of 26.5 mL (median = 14.1 mL) were analyzed. Ninety patients (65.7%) suffered ICH while treated with apixaban and 47 (34.3%) with rivaroxaban. The median time between symptom onset and application of andexanet alfa was 3.3 h, door-to-needle time was 1.1 h. The mean change in hematoma volume until the first control imaging, conducted after a median of 15.6 h, was 2.3 mL (95% confidence interval (CI) = 0.4-4.2), while the change within 12-72 h was 1.8 mL (95% CI = 0.4-3.2). Hematoma growth ⩽33% was achieved in 90.3% of the 93 evaluable patients based on first control imaging and in 90.5% of the 63 evaluable patients, considering only imaging performed within the 12-72 h window. During hospitalization, death occurred in 30/137 patients (21.9%) and 17 thromboembolic events in 11/137 (8.0%) patients. The 90-day mortality was 47/128 (36.7%).</p><p><strong>Conclusion: </strong>ASTRO-DE is the first prospective observational study systematically collecting standardized clinical routine data with andexanet alfa treatment. The study demonstrated favorable hemostasis and minimal mean hematoma volume growth in patients with ICH associated with apixaban or rivaroxaban treatment.</p><p><strong>Data access statement: </strong>Data are available upon reasonable request by contacting the corresponding author.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251317385"},"PeriodicalIF":6.3,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005319","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 haemorrhage in the Nurses' Health Study.","authors":"Frederick Ewbank, Samuel Hall, Benjamin Gaastra, Diederik Bulters","doi":"10.1177/17474930251322372","DOIUrl":"https://doi.org/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 haemorrhage (SAH) have so far provided conflicting results.</p><p><strong>Aims: </strong>The aim of this study was to analyse 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 Nurse's Health Study (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 [0.82, 1.28], p=0.85), aneurysmal SAH (1.04 [0.78, 1.39], p=0.78), or idiopathic SAH (HR 0.94 [0.65, 1.34], p=0.72). The number of acetylsalicylic acid tablets per week was associated with SAH (HR 1.03 [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 [0.99, 1.13], p=0.07).</p><p><strong>Conclusions: </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":"2025-02-08","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":"Efficacy and Safety of intravenous alteplase for unknown onset stroke on prior antiplatelet therapy: post-hoc analysis of the EOS Individual Participant Data.","authors":"Yuma Shiomi, Kaori Miwa, Märit Jensen, Manabu Inoue, Sohei Yoshimura, Naruhiko Kamogawa, Mayumi Fukuda-Doi, Henry Ma, Peter Ringleb, Ona Wu, Lee Schwamm, Stephen M Davis, Geoffrey Donnan, Christian Gerloff, Jin Nakahara, Kazunori Toyoda, Götz Thomalla, Masatoshi Koga","doi":"10.1177/17474930251322034","DOIUrl":"https://doi.org/10.1177/17474930251322034","url":null,"abstract":"<p><strong>Background: </strong>The effects of intravenous alteplase in patients with prior antiplatelet therapy (APT) remain controversial. We aimed to assess the efficacy and safety of imaging-based intravenous alteplase in patients with unknown-onset stroke with prior APT.</p><p><strong>Methods: </strong>Data from randomized controlled trials comparing alteplase with placebo/standard care in patients with unknown-onset acute ischemic stroke from the Evaluation of Unknown Onset Stroke Thrombolysis (EOS) individual patient data meta-analysis collaboration were analyzed. Favorable outcome was defined as a modified Rankin Scale score 0-1 at 90 d poststroke. Safety outcomes included symptomatic intracranial hemorrhage (sICH) at 22-36 h and 90-d mortality.</p><p><strong>Results: </strong>Overall, 780 patients had available baseline data on prior APT. Compared with the no prior APT group (n=523), the prior APT group (n=257) was older (72 years vs. 66 years) and had a higher prevalence of vascular risk factors. There was no interaction between prior APT and treatment effects of alteplase (p for interaction=0.23). In the prior APT patients, 55/125 (45%) patients in the alteplase group and 39/132 (30%) patients in the control group had a favorable outcome (adjusted odds ratio [aOR], 2.07 [95% CI, 1.18-3.64]). The rates of sICH and mortality in the alteplase and control groups were 5.6% and 0.8%, respectively (aOR, 7.78 [0.94-63.37]) and 6.5% and 6.1%, respectively (aOR, 1.12 [0.38-3.36]). In the no prior APT patients, 136 patients (50%) in the alteplase group and 112 patients (45%) in the control group had a favorable outcome (aOR, 1.39 [0.94-2.05]). Safety outcomes were not significantly different between the groups (sICH: 3 [1.1%] vs. 1 [0.4%]; mortality: 13 [4.9%] vs. 3 [1.2%]).</p><p><strong>Conclusions: </strong>Alteplase has consistent efficacy regardless of prior APT in patients with unknown-onset stroke. Additionally, prior APT does not significantly increase the risk of sICH or mortality.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251322034"},"PeriodicalIF":6.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373961","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":"Effects of blood pressure lowering in patients treated with intravenous thrombolysis before endovascular thrombectomy.","authors":"Jaeseob Yun, Kwang Hyun Kim, Jae Wook Jung, Young Dae Kim, JoonNyung Heo, Hyungwoo Lee, Jin Kyo Choi, In Hwan Lim, Soon-Ho Hong, 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, Minyoul Baik, Kyung-Yul Lee, Yo Han Jung, Yang-Ha Hwang, Chi Kyung Kim, Jae Guk Kim, Chan Joo Lee, Sungha Park, Soyoung Jeon, Hye Sun Lee, Sun U Kwon, Il Hyung Lee, Oh Young Bang, Ji Hoe Heo, Hyo Suk Nam","doi":"10.1177/17474930251315630","DOIUrl":"10.1177/17474930251315630","url":null,"abstract":"<p><strong>Background: </strong>The effects of blood pressure (BP) lowering in patients treated with intravenous tissue plasminogen activator (IV tPA) before endovascular thrombectomy (EVT) are unclear.</p><p><strong>Aims: </strong>This study aims to investigate whether intensive and conventional BP management affects outcomes differently, depending on IV tPA administration before EVT.</p><p><strong>Methods: </strong>In this subgroup analysis of the Outcome in Patients Treated with Intra-Arterial Thrombectomy-Optimal Blood Pressure Control (OPTIMAL-BP; ClinicalTrials.gov Identifier: NCT04205305) trial, patients were divided into groups based on IV tPA use before EVT. Clinical outcomes of intensive (systolic BP target < 140 mm Hg) or conventional BP management (systolic BP target 140-180 mm Hg) were compared among groups. The primary efficacy outcome was a favorable outcome at 3 months (modified Rankin Scale score of 0-2). Primary safety outcomes included symptomatic intracerebral hemorrhage (sICH) within 36 h and stroke-related death within 3 months.</p><p><strong>Results: </strong>Among the 302 patients, the IV tPA group included 98 (32.5%) and the non-IV tPA group comprised 204 subjects (67.5%). In the IV tPA group, intensive BP management significantly lowered the favorable outcome rate (intensive, 27.3% vs. conventional, 51.9%; adjusted odds ratio [aOR], 0.36; 95% confidence interval [CI], 0.13-0.93; <i>p</i> = 0.04). In the non-IV tPA group, the risk difference rate of favorable outcome was not significantly different between intensive and conventional BP management (44.1% vs. 55.9%; aOR, 0.62; 95% CI, 0.31-1.22; <i>p</i> = 0.17). Notably, the proportion of malignant cerebral edema within 36 h in the IV tPA group was significantly higher in the intensive management group (18.2%) than in the conventional management group (1.9%; aOR, 10.72; 95% CI, 1.24-92.29; <i>p</i> = 0.03). sICH and mortality rates were not significantly different between intensive and conventional BP management in either study groups.</p><p><strong>Conclusions: </strong>Intensive BP management worsens 3-month functional outcomes after successful EVT without reducing sICH among patients who received IV tPA before EVT, indicating that BP lowering in this population should be cautious.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251315630"},"PeriodicalIF":6.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005326","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":"Global challenges in the access of endovascular treatment for acute ischemic stroke (global MT access).","authors":"Ahmed Nasreldein, Wan Asyraf, Thanh N Nguyen, Sheila Martins, Vasileios-Arsenios Lioutas, Ahmed Elbassiouny, Mai Duy Ton, Simona Sacco, Mohamed A Micdhadhu, Yimin Chen, Rufus Akinyemi, Espen Saxhaug Kristoffersen, Xiaochuan Huo, Zhongrong Miao, Mohamad Abdalkader, Simon Nagel, Volker Puetz, Gotz Thomalla, Hiroshi Yamagami, Zhongming Qiu, Jelle Demeestere, Adnan I Qureshi, Patrik Michel, Daniel Strbian, Bruce Cv Campbell, Bernard Yan, Abdulhakeem Olorukooba, Hesham E Masoud, Diogo C Haussen, Michael Frankel, Mahmoud H Mohammaden","doi":"10.1177/17474930251314395","DOIUrl":"10.1177/17474930251314395","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy (MT) is the standard of care for eligible acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) since 2015.</p><p><strong>Aim: </strong>Our aim was to determine the key challenges for MT implementation and access worldwide.</p><p><strong>Methods: </strong>We conducted an international online survey consisting of 37 questions, distributed through the World Stroke Organization network and as invited by co-authors between December 2022 and March 2023. The survey included a preamble outlining its purpose, questions on respondent demographics, imaging availability, MT service availability, MT selection criteria, barriers to MT, and training status in each country.</p><p><strong>Results: </strong>We received 526 responses from 89 countries distributed across 7 continents. One hundred and sixteen (22.1%) respondents did not have available MT service, 43 (8.2%) had available MT only during working hours, 362 (68.8%) had 24/7 MT availability. Regarding neuroimaging protocols, 13.5% used non-contrast computed tomography (NCCT) only, 40.1% used NCCT/CT angiography, 37.5% used NCCT/CT angiography/CT perfusion), 0.4% used magnetic resonance imaging (MRI) only, and 7.8% used MRI/MR angiography. The most common reasons for not receiving MT were cost, late presentation, and lack of availability of qualified neurointerventional services within reasonable distance. There were 59.1% of respondents who reported having a well-structured MT training program. Lack of qualified trainers, financial support, support from higher authorities, and lack of collaboration between departments were the most common obstacles against developing a training program.</p><p><strong>Conclusion: </strong>Our study highlights significant variations in MT availability, accessibility, patient selection criteria, and MT service training programs worldwide. Financial costs and a shortage of trained neurointerventionalists were the main challenges in low- and middle-income countries.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251314395"},"PeriodicalIF":6.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949022","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}