International Journal of Stroke最新文献

{"title":"International practice patterns and perspectives on endovascular therapy for the treatment of cerebral venous thrombosis.","authors":"Benjamin A Brakel, Alexander D Rebchuk, Johanna Ospel, Yimin Chen, Manraj Ks Heran, Mayank Goyal, Michael D Hill, Zhongrong Miao, Xiaochuan Huo, Simona Sacco, Shadi Yaghi, Ton Duy Mai, Götz Thomalla, Grégoire Boulouis, Hiroshi Yamagami, Wei Hu, Simon Nagel, Volker Puetz, Espen Saxhaug Kristoffersen, Jelle Demeestere, Zhongming Qiu, Mohamad Abdalkader, Sami Al Kasab, James E Siegler, Daniel Strbian, Urs Fischer, Jonathan Coutinho, Anita Munckhof, Diana Aguiar de Sousa, Bruce Cv Campbell, Jean Raymond, Xunming Ji, Gustavo Saposnik, Thanh N Nguyen, Thalia S Field","doi":"10.1177/17474930241304206","DOIUrl":"10.1177/17474930241304206","url":null,"abstract":"<p><strong>Background: </strong>Cerebral venous thrombosis (CVT) accounts for 0.5-1% of all strokes. The role of endovascular therapy (EVT) in the management of CVT remains controversial and variations in practice patterns are not well known.</p><p><strong>Aims: </strong>Here, we present a comprehensive, international characterization of practice patterns and perspectives on the use of EVT for CVT.</p><p><strong>Methods: </strong>A comprehensive 42-question survey was distributed to stroke clinicians globally from May to October 2023, asking about practice patterns and perspectives on the use of EVT for CVT.</p><p><strong>Results: </strong>The overall response rate was 31% (863 respondents of 2744 invited) across 61 countries. The majority of respondents (74%) supported the use of EVT for CVT in certain clinical situations. Key considerations for decision-making in using EVT favored clinical over radiographic/procedural factors and included worsening level of consciousness (86%) and worsening neurological deficits (76%). In the past 3 years, 56% of respondents used EVT for the treatment of CVT, with most (49.5%) involved in two to five cases. Among interventionalists, significant variability existed in the techniques used for EVT (<i>p</i> < 0.001), with aspiration thrombectomy (56%) and stent retriever (51%) being the most used overall. Regionally, interventionalists from China predominantly used intra-sinus heparin (56%), while this technique was most commonly ranked as \"never indicated\" throughout the rest of the world (23%). Post-procedure, low molecular weight heparin was the most used anticoagulant (83%), although North American respondents favored unfractionated heparin (37%), while imaging was primarily split between magnetic resonance (71.8%) and computed tomography (65.9%) arteriography or venography.</p><p><strong>Conclusion: </strong>Our survey reveals significant heterogeneity in approaches to EVT for CVT, and provides a comprehensive characterization of indications, techniques, and long-term management used by clinicians internationally. This resource will aid in optimizing patient selection and endovascular treatments for future trials.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241304206"},"PeriodicalIF":6.3,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681805","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":"How tube feeding modes influence anxiety in patients with dysphagia after ischemic stroke: A propensity score-matched, longitudinal study.","authors":"Hongji Zeng, Weijia Zhao, Jing Zeng, Rui Wang, Hong Luo, Changming Wen, Yanbo Liu, Dongjian Li, Xi Zeng","doi":"10.1177/17474930241306916","DOIUrl":"10.1177/17474930241306916","url":null,"abstract":"<p><strong>Background: </strong>Although tube feeding modes have been shown to influence psychological status, the specific mechanism of action and differences between intermittent oro-esophageal tube feeding (IOE) and nasogastric tube feeding (NGT) have yet to be uncovered. This study explored the effect of IOE versus NGT on anxiety in patients with dysphagia after ischemic stroke.</p><p><strong>Methods: </strong>This longitudinal observational study included patients with dysphagia after ischemic stroke who were treated in the Department of Rehabilitation Medicine between February 2022 and June 2024. Questionnaires, scales, and medical records were used to collect data regarding anxiety symptoms, basic information, treatment details, and self-perception on the 1st and 10th day of hospitalization. Propensity Score Matching (PSM) was used to balance potential confounding factors and analyze the association between IOE versus NGT and anxiety symptoms. Path analysis was conducted to explore the specific mechanisms of action.</p><p><strong>Results: </strong>Totally, 2459 participants (55.51% IOE users) were recruited. The IOE users had significantly lower moderate-to-severe anxiety rates than the NGT users (25.88% and 44.42%, <i>p</i> < 0.001). PSM analysis revealed an 8.56% difference in moderate-to-severe anxiety rates between IOE and NGT users. Self-perception of comfort, reflux, dietary schedule, social activity, self-esteem, and daily exercise showed significance as intermediate variables between tube feeding modes and anxiety symptoms in path analysis (all <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Compared to NGT, IOE can alleviate anxiety symptoms in patients with dysphagia after ischemic stroke who were treated in the Department of Rehabilitation Medicine. The relationship between tube feeding modes and anxiety symptoms was mediated by the self-perception of comfort, reflux, dietary schedule, social activity, self-esteem, and daily exercise.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241306916"},"PeriodicalIF":6.3,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754998","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":"Risk of long-term post-stroke dementia using a linked dataset of patients with ischemic stroke without a history of dementia.","authors":"Tae Jung Kim, Ji Sung Lee, Mi Sun Oh, Soo-Hyun Park, Kyung Bok Lee, Yu Kyung-Ho, Byung-Chul Lee, Byung-Woo Yoon, Sang-Bae Ko","doi":"10.1177/17474930241310730","DOIUrl":"https://doi.org/10.1177/17474930241310730","url":null,"abstract":"<p><strong>Background: </strong>Post-stroke dementia (PSD) is a common and disabling sequela of stroke. However, the long-term incidence of PSD after an ischemic stroke and factors which predict its occurrence are incompletely understood. Linkage of large health datasets is being increasing used to study long term outcomes after disease. We used large scale linked data from Korea to determine the long-term incidence of PSD after ischemic stroke, and identify which factors predicted it occurrence.</p><p><strong>Methods: </strong>From January 2008 to December 2014, patients with ischemic stroke (n=37,553) without a history of dementia were included in a linked dataset comprising the claims database of the Health Insurance Review and Assessment Service and the Clinical Research Center for Stroke registry data. The outcome measure was PSD after ischemic stroke. Clinical factors evaluated included vascular risk factors, acute stroke management including reperfusion therapy, antithrombotics, and statins, stroke severity, and educational levels, were evaluated. Results: Among 37,553 patients with ischemic stroke without a history of dementia (mean age: 64.9 years; 61.9% males), 6,052 (16.1%) experienced PSD during a median follow-up period of 5 (interquartile range 3.4-7.0) years. The 10 year estimated cumulative incidence of dementia was 23.5%. Age [hazard ratio (HR) 1.82 per 10 years, 95% confidence interval (CI) 1.75-1.88] and a lower educational level [illiteracy or no education HR 1.65 (CI, 1.44-1.88), 0-3 years 1.53 (CI, 1.31-1.79), 4-6 years 1.60 (CI, 1.43-1.80), 7-9 years 1.32 (CI, 1.16-1.49), 10-12 years 1.17 (CI, 1.04-1.32)] were independently associated with an elevated risk of PSD. Male sex was associated with a significantly lower risk of PSD (HR 0.86, CI 0.79-0.92). Diabetes mellitus (HR 1.21, CI 1.14-1.29), a history of stroke before index stroke (HR 1.31, CI 1.21-1.41), and initial National Institutes of Health Stroke Scale (HR 1.03, CI 1.03-1.04) were independent risk factors for PSD. Regarding medications, the use of anticoagulation and antipsychotic medications after stroke appeared to be associated with increased PSD risk whereas statin therapy was associated with a reduced risk.</p><p><strong>Conclusions: </strong>PSD is common with a 5 and 10 year incidence in patients with ischemic stroke without a history of dementia of 16.1% and 23.5% respectively. Factors associated with PSD include age, female sex, lower educational level, diabetes mellitus, initial stroke severity, antipsychotics and anticoagulants. Further studies are required to determine whether reducing those risk factors which are treatable reduces the incidence of PSD.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241310730"},"PeriodicalIF":6.3,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142836626","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, Maria Luisa 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, Giovanna 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 Pistoia, 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":"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 h, which are classified as Transient ischemic attacks (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-that is, those with ischemic symptoms lasting <24 h-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 (<i>p</i> = 0.178) and after matching (<i>p</i> = 0.518).</p><p><strong>Conclusions: </strong>In our population, patients with transient ischemic symptoms and acute ischemic lesions at brain magnetic resonance imaging (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":"2024-12-16","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, Giovanna 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 transient ischemic attack (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 three 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% vs. 84.4%, risk difference 3.1% (95% confidence interval (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% vs. 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 those who received antiplatelet loading dose.</p><p><strong>Conclusion: </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 the criteria of landmark large clinical trials.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241302991"},"PeriodicalIF":6.3,"publicationDate":"2024-12-16","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":"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. In addition, 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":"2024-12-13","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":"World Stroke Organization and World Hypertension League Position Statement on Hypertension Control Strategies in Prevention and Management of Stroke.","authors":"Jeyaraj Durai Pandian, P N Sylaja, Daniel Lackland, Veena Babu, Naveen Kumar, Ivy Anne Sebastian, Gianfranco Parati, Anderson Craig, Bruce Ovbiagele, Marc Fisher, Sheila Ouriques Martins, Paul K Whelton","doi":"10.1177/17474930241309276","DOIUrl":"https://doi.org/10.1177/17474930241309276","url":null,"abstract":"<p><strong>Background and purpose:-: </strong>The goal of this consensus is to provide a comprehensive set of recommendations regarding hypertension control strategies for the prevention and management of stroke. This document is intended for prehospital care providers, physicians, allied health professionals, and hospital administrators and health care policy makers.</p><p><strong>Methods:-: </strong>Members of the writing group were representatives of the World Stroke Organization and World Hypertension League. The writing group reviewed articles searched from PubMed and Google Scholar using selected search strings. The document was sent to 12 peer reviewers. The writing group considered the feedback from peer reviewers and made revisions accordingly. Every member of the writing group gave their approval of the final document.</p><p><strong>Results:-: </strong>This article details the various techniques for blood pressure (BP) measurement, BP classification, BP and stroke risk, antihypertensive drug therapy for the primary and secondary prevention of stroke, choice of antihypertensive drug therapy, optimal BP targets, non-drug approaches to the prevention of stroke through BP lowering, BP management separately for acute ischemic stroke and spontaneous intracerebral hemorrhage, and the implementation of BP prevention,treatment and control in the community.</p><p><strong>Conclusions:-: </strong>This article provides general recommendations based on currently available evidence to guide healthcare practitioners caring for adults with hypertension to prevent and manage stroke. Future studies are needed to better define approaches to hypertension control in the community and high-risk groups.</p><p><strong>Abbreviations: </strong>BP: Blood Pressure, SBP: Systolic Blood Pressure, HIC: High Income Countries, LMIC: Low and Middle Income Countries, CVD: Cardiovascular diseases, WSO: World Stroke Organization, WHL:World Hypertension League, K: Karotkoff, ABPM: Ambulatory BP measurements, HBPM: Home BP Monitoring, CPG: Clinical practice guidelines, ACC: American College of Cardiology, AHA: American Heart Association, DASH: Dietary Approaches to Stop Hypertension, CCB: calcium channel blockers, ACEI: Angiotensin converting enzyme inhibitors, ARB: angiotensin receptor blockers, SPC: single pill combination, ACCORD BP: Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure trial (ACCORD BP), SPRINT: Systolic Blood Pressure Intervention Trial, RESPECT: Recurrent Stroke Prevention Clinical Outcome Trial , and ESPRIT-:Effects of intensive Systolic blood Pressure lowering treatment in reducing RIsk of vascular evenTs, OPTIMAL-Diabetes: OPtimal Type 2 dIabetes Management, SVIN: Society of Vascular and Interventional Neurology, ICH: intracerebral haemorrhage, NICE-:National Institute for Health and Clinical Excellence.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241309276"},"PeriodicalIF":6.3,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818156","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":"Predictors of poor outcome in acute stroke patients with posterior cerebral artery occlusion and medical management.","authors":"Candice Sabben, Frédérique Charbonneau, Michael Obadia, Davide Strambo, Elodie Ong, Mirjam R Heldner, Hilde Henon, Adrien Ter Schiphorst, Loic Legris, Thomas Agasse-Lafont, Denis Sablot, Nour Nehme, Igor Sibon, Aude Triquenot-Bagan, Valérie Wolff, Cécile Preterre, Charlotte Rosso, Gioia Mione, Roxana Poll, Jeremie Papassin, Andreea Aignatoaie, David Weisenburger-Lile, Yannick Bejot, Solène Moulin, Emmanuel Carrera, Pierre Garnier, Patrik Michel, Pasquale Mordasini, Gregory W Albers, Guillaume Turc, Mikael Mazighi, Pierre Seners","doi":"10.1177/17474930241309533","DOIUrl":"https://doi.org/10.1177/17474930241309533","url":null,"abstract":"<p><strong>Background and aims: </strong>The clinical evolution of acute ischemic stroke patients with isolated proximal posterior cerebral artery (PCA) occlusion treated with medical management alone has been poorly described. We aimed to determine the clinical and radiological factors associated with poor functional outcome in this population.</p><p><strong>Methods: </strong>We conducted a multicenter international retrospective study of consecutive stroke patients with isolated occlusion of the first (P1) or second (P2) segment of PCA admitted within 6hrs from symptoms onset in 26 stroke centers in France, Switzerland and the USA, treated with best medical management alone. Poor functional outcome was defined as a modified Rankin scale (mRS) ≥2 at 3-month or no return to pre-stroke mRS. The associations between pretreatment variables and poor outcome were studied in univariable then multivariable analyses, as well as the association between poor outcome and key follow-up radiological variables.</p><p><strong>Results: </strong>Overall, 585 patients were included. Median age was 74 years (IQR, 63-83), median NIHSS was 6 (3-10), 80% received intravenous thrombolysis (IVT), 22% and 78% had P1 and P2 occlusion, respectively. Poor outcome occurred in 56% of patients. In multivariable analysis focusing on pretreatment variables, age (adjusted OR=1.12 per 5-year increase [95%CI 1.05-1.20]; P=0.001), NIHSS score (aOR=1.12 per each point increase [1.08-1.18]; P<0.001), infarct volume (aOR=1.16 per 5mL increase [1.07-1.25]; P<0.001), and the lack of IVT use (aOR=1.79 [1.10-2.94], P=0.020) were independently associated with poor outcome. Regarding 24-hr follow-up radiological variables, complete recanalization (defined as no clot in the vascular tree at or beyond the primary occlusive lesion, aOR=0.37 95%CI 0.21-0.65, P<0.001) and parenchymal hematoma occurence (aOR=2.37 95%CI 1.01-5.56, P=0.048) were independently associated with poor 3-month outcome.</p><p><strong>Conclusions: </strong>Poor outcome occurred in more than half of medically treated PCA-related acute stroke patients. Facilitating IVT use may improve functional outcome. Therapeutic approaches aimed at enhancing recanalization and reducing hemorrhagic transformation need to be studied in clinical trials.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241309533"},"PeriodicalIF":6.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813064","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":"Extending the Time Window for Tenecteplase by Effective Reperfusion of Penumbral Tissue in Patients with Large Vessel Occlusion (ETERNAL-LVO): Rationale and design of a multicenter, prospective, randomized, open-label, blinded-endpoint, controlled phase 3 trial.","authors":"Vignan Yogendrakumar, Bruce Campbell, Leonid Churilov, Carlos Garcia-Esperon, Philip Choi, Dennis Cordato, Prodipta Guha, Gagan Sharma, Chushuang Chen, Amy McDonald, Vincent Thijs, Abul Mamun, Angela Dos Santos, Anna H Balabanski, Timothy Kleinig, Kenneth Butcher, Michael Devlin, Fintan O'Rourke, Geoffrey Donnan, Stephen M Davis, Christopher Levi, Henry Ma, Mark Parsons","doi":"10.1177/17474930241308660","DOIUrl":"https://doi.org/10.1177/17474930241308660","url":null,"abstract":"<p><strong>Rationale: </strong>The benefit of tenecteplase in the treatment of large vessel occlusion (LVO) patients presenting within 24 hours of symptom onset remains unclear.</p><p><strong>Aim: </strong>To assess the effectiveness and safety of tenecteplase, compared to standard of care, in patients presenting within the first 24 hours of symptom onset with a LVO and target mismatch on perfusion CT.</p><p><strong>Methods and design: </strong>The \"Extending the time window for Tenecteplase by Effective Reperfusion of peNumbrAL tissue in patients with Large Vessel Occlusion\" (ETERNAL-LVO) trial is a prospective, randomized, open-label, blinded endpoint, phase 3, parallel-group, superiority trial with covariate-adjusted 1:1 randomization, and adaptive sample size re-estimation. Patients with an anterior circulation LVO stroke, who present within 24 hours of stroke onset or last known well with a target mismatch on CTP or MRI, will be randomized to tenecteplase (0.25 mg/kg) or standard of care (alteplase 0.90 mg/kg or conservative management at clinician discretion) prior to undergoing endovascular therapy.</p><p><strong>Study outcomes: </strong>The primary outcome is the proportion of patients with a modified Rankin Scale (mRS) of 0-1 (no disability) or return to baseline mRS at 3 months. Secondary and safety outcomes include the proportion of patients with a mRS of 0-2 at 3 months, an ordinal analysis of the mRS at 3 months, the proportion of patients with symptomatic intracerebral haemorrhage (sICH), the proportion of patients with death due to any cause, and the proportion of patients with mRS 5-6 at 3 months (severe disability or death).</p><p><strong>Discussion: </strong>The ETERNAL-LVO trial will build upon the current evidence for tenecteplase in the >4.5-hour window. Specifically, this trial will evaluate tenecteplase in a patient population who have access to endovascular therapy but may incur delays to endovascular therapy commencement or require transfer from a primary to a comprehensive stroke center.</p><p><strong>Trials registration: </strong>ClincialTrials.gov: NCT04454788.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241308660"},"PeriodicalIF":6.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800589","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":"Association between Alcohol Consumption and Stroke in Nigeria and Ghana: A Case-control Study.","authors":"Innocent Ijezie Chukwuonye, Onoja M Akpa, Osahon Asowata, Adekunle Gregory Fakunle, Morenikeji A Komolafe, Odun Joshua Akinyemi, Fred Stephen Sarfo, Albert Akpalu, Kolawole Wahab, Reginald Obiako, Lukman Owolabi, Godwin Osaigbovo, Akinkunmi Okekunle, Okechukwu Ogah, Hemant Tiwari, Carolyn Jenkins, Bimbola Fawale, Donna Arnett, Benedict Calys-Tagoe, Abimbola Olalere, Oladimeji Adebayo, Wisdom Oguike, Philip Adebayo, Oyedunni Arulogun, Lambert Appiah, Phillip O Ibinaiye, Sunday Adeniyi, Oladotun Olalusi, Olayemi Balogun, Rufus Akinyemi, Bruce Ovbiagele, Mayowa Owolabi","doi":"10.1177/17474930241308458","DOIUrl":"https://doi.org/10.1177/17474930241308458","url":null,"abstract":"<p><strong>Background: </strong>The aim of the study was to examine the association between alcohol consumption and stroke in Nigeria and Ghana.</p><p><strong>Methods: </strong>The study is a multicentre, case-control study. Cases included consenting adults 18 years of age and older with acute stroke. The controls were age- and gender-matched, stroke-free adults. Alcohol consumption was self-reported. The participants were classified into three alcohol-drinking status groups, which included abstainers, former drinkers, and current drinkers. The current drinkers were further classified into different alcohol drinking levels, including infrequent drinkers, light drinkers, moderate drinkers, heavy drinkers, and binge drinkers. Conditional logistic regression was used to determine associations between the drinkers' status and stroke, respectively, as well as the association between the different levels of current drinkers and strokes, respectively. Five models were evaluated. Model 1 was unadjusted. Model 2 had adjustments for demographic characteristics. Model 3 included Model 2, lifestyle and psychosocial function adjustments. Model 4 includes Model 3 and dietary factor adjustments. Model 5 included Model 4 and metabolic factor adjustments.</p><p><strong>Results: </strong>A total of 7,368 participants took part in the study. Half were stroke participants, and half were control participants. On the associations between drinking status and strokes, respectively, former drinkers showed no significant association with strokes; however, there were significant associations between current drinkers and strokes in models 1 and 2, and the odds ratio of stroke risk was 1.19 (95% CI: 1.04-1.38; p<0.05) and 1.17 (95% CI: 1.01-1.36; p<0.05), respectively. Regarding the various levels of current drinkers and their association with stroke, no significant association was observed between light drinkers and stroke in model 5. In contrast, moderate drinkers, binge drinkers, and heavy drinkers showed a persistent and significant association with stroke, respectively.</p><p><strong>Conclusion: </strong>There is a significant association between strokes and current alcohol consumption, especially among heavy, binge, and moderate drinkers.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241308458"},"PeriodicalIF":6.3,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791726","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}