International Journal of Stroke最新文献

{"title":"Intra-arterial Alteplase Thrombolysis After Successful Thrombectomy for Acute Ischemic Stroke in the Posterior Circulation (IAT-TOP): Study protocol and rationale.","authors":"Bin Yang, Xuesong Bai, Tingyu Yi, Haibo Wang, Yifeng Liu, Lin Ma, Sheng Liu, Shaoguang Wu, Liyong Zhang, Ya Peng, Raul G Nogueira, Wenhuo Chen, Liqun Jiao","doi":"10.1177/17474930251313940","DOIUrl":"10.1177/17474930251313940","url":null,"abstract":"<p><strong>Rationale: </strong>The Chemical Optimization of Cerebral Embolectomy (CHOICE) trial suggested that the administration of intra-arterial alteplase after successful endovascular thrombectomy (EVT) may improve neurological outcomes in patients with acute ischemic stroke due to large-vessel occlusion (AIS-LVO) in the anterior circulation. However, the use of adjunctive intra-arterial alteplase following successful EVT in acute posterior circulation stroke remains unexplored.</p><p><strong>Aims: </strong>This study aims to investigate the efficacy and safety of intra-arterial alteplase after successful EVT for AIS-LVO in the posterior circulation.</p><p><strong>Sample size: </strong>To detect an estimated 15% difference in the primary outcome between the two groups, a total of 376 patients will be enrolled. This sample size allows for 80% power and a 5% significance level, with an interim analysis planned after half of the sample (188 patients) has completed a 90-day follow-up.</p><p><strong>Methods and design: </strong>The Intra-arterial Alteplase Thrombolysis After Successful Thrombectomy for Acute Ischemic Stroke in the Posterior Circulation (IAT-TOP) trial is a multicenter, prospective, randomized clinical trial using an open-label treatment design with blinded endpoint assessment (PROBE) conducted in China. Patients with acute basilar artery occlusion will be randomly assigned in a 1:1 ratio to receive either intra-arterial alteplase (0.225 mg/kg; maximum dose, 22.5 mg) or standard care following successful thrombectomy (defined as expanded thrombolysis in cerebral infarction [eTICI] ⩾ 2b50).</p><p><strong>Study outcomes: </strong>The primary outcome is the modified Rankin Scale (mRS) score of 0-2 at 90 days. Key secondary outcomes include changes in eTICI scores after intra-arterial thrombolysis (in the experimental group), mRS 0-3 at 90 days, ordinal shift analysis of mRS at 90 days, early neurological improvement at 48 h, and improvement in National Institutes of Health Stroke Scale (NIHSS) scores at 48 h and 7 days or discharge. Safety outcomes include symptomatic intracranial hemorrhage (sICH) rates at 48 h, 90-day mortality, non-intracranial hemorrhagic complications, and non-hemorrhagic serious adverse events.</p><p><strong>Discussion: </strong>The IAT-TOP trial will provide crucial evidence regarding the potential benefits of adjunctive intra-arterial alteplase in patients with AIS-LVO in the posterior circulation following successful thrombectomy.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05897554.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"750-755"},"PeriodicalIF":6.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926991","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":"Hyperacute stroke care-What's new?","authors":"Hugh S Markus","doi":"10.1177/17474930251348387","DOIUrl":"https://doi.org/10.1177/17474930251348387","url":null,"abstract":"","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"20 6","pages":"632-635"},"PeriodicalIF":6.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475238","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":"636-645"},"PeriodicalIF":8.7,"publicationDate":"2025-07-01","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":"Predicting stroke in patients with infective endocarditis: A systematic review and meta-analysis of risk factors.","authors":"Ammar Jumah, Ahmed Mohamedelkhair, Abdelrahman Elfaham, Savio Batista, Tianwen Ma, Savannah L Ngo, Marwan Mashina, Dennis J Mohn, Thomas Vismara, Taylor Reardon, Fatima Chughtai, Gustavo Js Sanchez, Marina Vilardo, Raphael Camerotte, Ahmad Riad Ramadan","doi":"10.1177/17474930251322679","DOIUrl":"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 the 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 27 June 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. <i>Staphylococcus aureus</i> infection (odds ratio (OR) 3.05; 95% CI, 1.96-4.73, <i>I</i>² = 77.2%; 9 studies) and 1-mm increment in vegetation size (OR, 1.26; 95% CI, 1.02-1.55, <i>I</i>² = 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>Conclusion: </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":"646-659"},"PeriodicalIF":8.7,"publicationDate":"2025-07-01","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":"Validation of the Black-&-White sign to predict intracerebral hematoma expansion in the multi-center PREDICT study cohort.","authors":"Umberto Pensato, Koji Tanaka, Johanna M Ospel, Richard I Aviv, David Rodriguez-Luna, Micheal D Hill, Carlos A Molina, Yolanda Silva Blas, Jean-Martin Boulanger, Gubitz Gord, Rohit Bhatia, Vasantha Padma, Jayanta Roy, Imanuel Dzialowski, Carlos S Kase, Adam Kobayashi, Dar Dowlatshahi, Andrew M Demchuk","doi":"10.1177/17474930241307466","DOIUrl":"10.1177/17474930241307466","url":null,"abstract":"<p><strong>Background: </strong>Hematoma expansion (HE) occurs in one-fourth to one-third of patients with acute intracerebral hemorrhage (ICH) and is associated with worse outcomes. The co-localization of non-contrast computed tomography (NCCT) hypodensity and computed tomography angiography (CTA) spot sign, the so-called Black-&-White (B&W) sign, has been shown to have high predictive accuracy for HE in a single-center cohort. In this analysis, we aimed to validate the predictive accuracy of the B&W sign for HE in a multicenter cohort.</p><p><strong>Methods: </strong>Acute ICH patients from the multicenter, observational PREDICT study (Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT) were included. Outcomes included HE (⩾6 mL or ⩾33%) and severe HE (⩾12.5 mL or >66%). The association between B&W sign and outcomes was assessed with multivariable regression analyses adjusted for baseline factors.</p><p><strong>Results: </strong>Three hundred four patients were included, with 106 (34.9%) showing HE. The spot sign was present in 76 (25%) patients, the hypodensity sign in 119 (39.1%), and the B&W sign in 29 (9.5%). In the stratum with positive spot signs, patients with B&W signs experienced more frequent HE (79.3% vs 46.8%, p = 0.008), hematoma absolute growth (19.1 mL (interquartile range (IQR) = 6.4-40) vs 3.2 mL (IQR= 0-23.3), p = 0.018), and hematoma relative growth (92% (IQR = 16-151%) vs 24% (IQR= 0-69%), p = 0.038). There was a strong association between B&W sign and HE (adjusted odds ratio (OR) = 7.83 (95% confidence interval (CI) = 2.93-20.91)) and severe HE (adjusted OR = 5.67 (95% CI = 2.41-13.36)). The B&W sign yielded a positive predictive value of 79.3% (IQR = 61.7-90.1) for HE. Inter-rater agreement was moderate (k = 0.54).</p><p><strong>Conclusion: </strong>The B&W sign is associated with an increased likelihood of HE and severe HE by approximately eightfold and fivefold, respectively.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"721-730"},"PeriodicalIF":6.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768879","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":"Factors influencing time spent in hospital for unscheduled readmissions after stroke discharge.","authors":"Melanie Turner, David J McLernon, Peter Murchie, Peter Langhorne, Mary-Joan Macleod","doi":"10.1177/17474930251355864","DOIUrl":"10.1177/17474930251355864","url":null,"abstract":"<p><strong>Background and aims: </strong>Unscheduled hospital readmission following stroke is common and has a significant effect on quality of life for patients and their families. However, there is limited evidence on the factors associated with unscheduled hospital readmission time in the first-year post-stroke discharge. This study aims to investigate patient and healthcare system factors associated with unscheduled hospital readmission time in a cohort of first-ever stroke patients in Scotland, UK.</p><p><strong>Methods: </strong>This is a population-level data-linkage study using data on adult stroke patients admitted to hospital between 2010 and 2018, with follow-up to end of 2019. The association between unscheduled hospital readmission time and patient and healthcare system factors was assessed using multivariable zero-inflated negative binomial estimations.</p><p><strong>Results: </strong>Among the 48,040 stroke patients (median age 73 years [interquartile range (IQR) 63-82]; 48.7% female) included in the study, 14,794 (30.8%) had at least one unscheduled readmission in the 1-year post-stroke discharge follow-up (median age 76 years [IQR 66-83]; 51.5% female). Median time spent in hospital as an unscheduled readmission in the 1-year follow-up was 9 days [IQR 3-25]. After adjustment, an increased risk of total unscheduled readmission time was associated with increasing age (≥ 80 years versus < 50 years Incidence Rate Ratio (IRR) 2.23 (95% CI 1.96-2.53)); living alone before stroke (IRR 1.17 (95% CI 1.11-1.24)); stroke severity (most versus least severe IRR 1.14 (95% CI 1.04-1.26)); intracerebral hemorrhage (IRR 1.29 (95% CI 1.18-1.42)); higher Charlson Comorbidity Index (CCI) (⩾3 versus 0 IRR 1.17 (95% CI 1.08-1.26)); higher frailty index (severe versus none IRR 1.16 (1.01-1.35); and longer length of stay for initial stroke admission (>10 days IRR 1.28 (95% CI 1.21-1.36)). Reduced risk of unscheduled readmission time was associated with lower socio-economic deprivation (least versus most deprived IRR 0.91 (95% CI 0.83-0.99)); prior transient ischaemic attack (TIA) (IRR 0.85 (95% CI 0.75-0.96)); and receipt of complete stroke care bundle (IRR 0.94 (95% CI 0.88-0.99)).</p><p><strong>Conclusion: </strong>Increased unscheduled hospital readmission time was associated with several factors including living alone, a higher comorbidity burden, stroke severity, and stroke type. Greater community support for these at-risk patients in terms of living arrangements and more pro-active outpatient management of comorbidities may be needed to reduce unscheduled readmission time following stroke discharge.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251355864"},"PeriodicalIF":6.3,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral venous thrombosis during pregnancy and postpartum: A systematic review and meta-analysis.","authors":"Xiaoming Zhang, Kun Fang, Yiran Zhang, Jiahao Song, Ruolin Wang, Xunming Ji, Ran Meng, Da Zhou","doi":"10.1177/17474930251355751","DOIUrl":"10.1177/17474930251355751","url":null,"abstract":"<p><strong>Background: </strong>Cerebral venous thrombosis (CVT) is a rare but life-threatening condition, particularly among pregnant and postpartum women. However, estimates of its incidence, recurrence, and associated adverse outcomes remain inconsistent. Moreover, the role of antithrombotic prophylaxis in mitigating these risks has not been fully established.</p><p><strong>Objective: </strong>This study aimed to synthesize global evidence on the incidence of CVT during pregnancy and postpartum, evaluate recurrence rates of CVT and noncerebral venous thromboembolism (VTE), assess adverse pregnancy outcomes, and explore the efficacy and safety of antithrombotic prophylaxis in high-risk populations.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five major databases were searched for observational studies reporting CVT incidence, recurrence, or pregnancy outcomes in women with prior CVT or noncerebral VTE, covering the period from 1980 to September 2024, with an updated search completed on May 6, 2025. Data were pooled using random-effects models and heterogeneity was quantified via the <i>I</i>² statistic.</p><p><strong>Results: </strong>Forty-seven studies encompassing 14,218 pregnancies were included. The pooled incidence of postpartum CVT was 7 cases per 100,000 deliveries (95% confidence interval [CI]: 3-15), with significant regional disparities (Asia: 19/100,000; Europe: 3/100,000). The recurrence rate of CVT was 10.2 per 1000 deliveries (95% CI: 5-21), while noncerebral VTE recurred in 15.3 per 1000 pregnancies (95% CI: 8-28). The crude risk of spontaneous abortion was 15.7% (95% CI: 13-19), with higher rates observed in women not receiving prophylaxis. Antithrombotic prophylaxis appeared to reduce the risk of noncerebral VTE recurrence but did not significantly affect CVT recurrence.</p><p><strong>Conclusions: </strong>CVT and noncerebral VTE pose substantial risks during pregnancy, particularly in women with prior thrombotic events. Although antithrombotic prophylaxis may offer partial protection, its benefits must be carefully weighed against potential maternal and fetal risks. These findings underscore the need for individualized management and further research to inform evidence-based clinical guidelines.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251355751"},"PeriodicalIF":6.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475237","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":"Statin use is associated with reduced risk of incident intracerebral hemorrhage: A prospective population-based cohort study.","authors":"Xiao Hu, Zijie Wang, Jincheng Liu, Xueyun Liu, Jiaxin Luo, Zizhen Meng, Tiannan Yang, Qi Li","doi":"10.1177/17474930251351103","DOIUrl":"10.1177/17474930251351103","url":null,"abstract":"<p><strong>Background: </strong>The association between statin use and the risk of incident intracerebral hemorrhage (ICH) remains controversial, with concerns about a potential increased risk of ICH among statin users.</p><p><strong>Aims: </strong>This study aimed to investigate the association between statin use and incident ICH in the general population.</p><p><strong>Methods: </strong>This prospective cohort study utilized data from UK Biobank. Cox proportional regression models were employed to estimate hazard ratios (HRs) for the association between statin use and incident ICH in both unmatched and propensity score-matched (PSM) cohorts, adjusting for sociodemographic characteristics, lifestyle factors, comorbidities, and concurrent medication use.</p><p><strong>Results: </strong>A total of 421,444 participants were included in the final analysis, with a median age of 58.0 years (interquartile range [IQR]: 50.0-63.0), and 53.9% were female. At baseline, 69,272 individuals reported regular statin use. Over a median follow-up period of 12.75 years (IQR: 11.30-14.21), 1533 participants (0.4%) experienced incident ICH. Multivariate Cox regression analyses showed that statin use was significantly associated with a reduced risk of ICH in the fully adjusted model (aHR 0.77; 95% CI 0.66-0.90). This association was significant among individuals without a history of coronary artery disease, stroke or transient ischemic attack (aHR 0.75; 95% CI 0.63-0.89). Potential interaction effects were identified between statin use and age (<i>p</i> for interaction = 0.027 in the total cohort), waist-to-hip ratio, and low-density lipoprotein cholesterol levels (<i>p</i> for interaction = 0.025 and 0.062, respectively, in the PSM cohort) in relation to ICH risk.</p><p><strong>Conclusion: </strong>In this large population-based study, statin use was associated with a reduced risk of incident ICH, providing further evidence for the long-term safety of statin therapy with respect to ICH risk in the general population and across diverse subgroups.Data access statement:UK Biobank database is available on application by approved researchers.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251351103"},"PeriodicalIF":8.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258108","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":"Sex-specific risk prediction models for aneurysmal subarachnoid hemorrhage-A UK Biobank study.","authors":"Ina Rissanen, Vita M Klieverik, Jos P Kanning, Mirjam I Geerlings, Ynte M Ruigrok","doi":"10.1177/17474930251349928","DOIUrl":"10.1177/17474930251349928","url":null,"abstract":"<p><strong>Background: </strong>We recently developed and validated the SMA²SH²ERS risk prediction model for aneurysmal subarachnoid hemorrhage (ASAH) in the general population (c-statistic 0.62; 95% confidence interval [CI] 0.60-0.64). Given that women have higher ASAH incidence than men, and that predictors for ASAH have different effect sizes between sexes, we developed sex-specific risk prediction models.</p><p><strong>Methods: </strong>Data from the prospective UK Biobank Study were used for model development. Participants with ASAH (per hospital-based ICD codes) before baseline or with missing predictor data were excluded. We developed multivariable Cox proportional hazards models for women and men separately to study the association between earlier recognized SMA²SH²ERS predictors and incident ASAH. Predictive performances were assessed with c-statistics and calibration plots and corrected for overfitting using bootstrapping.</p><p><strong>Results: </strong>A total of 246,771 women and 210,085 men were included with median follow-up of 12 years. ASAH incidence rate per 100 000 person years was 16.1 in women, and 10.7 in men. The women-specific model had a c-statistic of 0.63 (95% CI 0.60-0.65) and the mean predicted absolute 10-year ASAH risk was 0.15%. Independent predictors for women were higher age, family history of stroke, former and current smoking, alcohol consumption, and intermediate education. The men-specific model c-statistic was 0.57 (95% CI 0.53-0.60) and the mean 10-year risk 0.10%. Independent predictors for men were higher age, hypertension, and smoking status.</p><p><strong>Conclusion: </strong>The sex-specific models did not perform better than the general SMA²SH²ERS model in women or in men. Further validation studies are needed before clinical use can be recommended.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251349928"},"PeriodicalIF":6.3,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247873","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":"Characteristics and outcomes in patients with in-hospital stroke: Japan stroke data bank.","authors":"Kotaro Usui, Sohei Yoshimura, Shinichi Wada, Kazunori Toyoda, Kaori Miwa, Junpei Koge, Akiko Ishigami, Masayuki Shiozawa, Yoshihiro Miyamoto, Yukako Yazawa, Tomonori Kobayashi, Akira Handa, Naomichi Wada, Tatsuya Mizoue, Kazutoshi Nishiyama, Kazuo Minematsu, Masatoshi Koga","doi":"10.1177/17474930251350055","DOIUrl":"10.1177/17474930251350055","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to clarify the clinical characteristics and outcomes of patients with in-hospital onset ischemic stroke (IOS) compared with those in patients with community-onset ischemic stroke (COS).</p><p><strong>Methods: </strong>Patients from the Japan Stroke Data Bank, a hospital-based multicenter prospective registry, who were diagnosed with acute ischemic stroke (AIS) within 24 h of onset between January 2001 and December 2020 were included in this study. We assessed favorable outcomes at discharge corresponding to a modified Rankin Scale (mRS) score of 0-2, unfavorable outcomes corresponding to an mRS score of 5-6, and mortality. We also examined trends in these outcomes at 4-year intervals over a period of 20 years.</p><p><strong>Results: </strong>Of the 100,865 patients analyzed, 2979 had IOS (1416 women, mean age 77 ± 12 years) and were older than those with COS (n = 97,886; 39,110 women, mean age 74 ± 12 years). Multivariate analysis revealed that younger age, higher premorbid mRS score, absence of stroke history, normotension, congestive heart failure, coronary artery disease, chronic kidney disease, liver disease, malignancy, tendency to bleed, and cardioembolic stroke were positively associated with IOS. Compared with COS, IOS was inversely associated with a favorable outcome (42.1% vs 64.8%, adjusted odds ratio [aOR] 0.72 [95% confidence interval (CI) 0.63-0.82]), positively associated with an unfavorable outcome (mRS 5-6 at discharge; 34.3% vs 15.5%, aOR 1.31 [95% CI 1.16-1.48]), and mortality (11.8% vs 4.6%, aOR 1.59 [95% CI 1.37-1.84]). Over 20 years, the mortality rate significantly decreased in both patients with IOS and COS (<i>p</i> < 0.01 both).</p><p><strong>Conclusion: </strong>IOS is associated with unfavorable outcomes and higher mortality rates during acute hospitalization. The mortality rates in patients with IOS decreased over time, similar to those observed in patients with COS.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251350055"},"PeriodicalIF":6.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234100","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}