International Journal of Stroke最新文献

{"title":"Variations in intracranial arterial anatomy of the circle of Willis and their association with arteriosclerosis in patients with ischemic cerebrovascular disease.","authors":"Bernhard P Berghout, Rüveyda F Soyupak, M Kamran Ikram, Daniel Bos","doi":"10.1177/17474930251322678","DOIUrl":"10.1177/17474930251322678","url":null,"abstract":"<p><strong>Introduction: </strong>An estimated 20-31% of all people are born with a textbook anatomical configuration of the intracranial arteries comprising the Circle of Willis. Individuals with specific anatomical variants may be at elevated risk of intracranial arteriosclerosis, and possibly its sequelae of stroke and dementia, as the distribution of blood flow and pressure is known to be different in variants with missing arteries or arterial segments. Therefore, we studied the association of anatomical variation of intracranial arteries with arteriosclerosis.</p><p><strong>Methods: </strong>Between December 2005 and October 2010, 1126 patients (mean age: 62.3 (SD: ±14.0) years, 48.0% female) were recruited, 59.9% of whom had ischemic stroke and 40.1% a transient ischemic attack (TIA). Within the routine diagnostic work-up for stroke, patients underwent cranial computed tomography (CT) angiography. These images enabled a detailed visualization of intracranial arteries, which allowed for the assessment of the anatomical configuration of the cerebral arteries, the anterior and posterior communicating arteries, the internal carotids, and the vertebrobasilar arteries. In addition, these images facilitated the identification of intracranial arterial calcifications, the defining feature of intracranial arteriosclerosis. Binomial logistic regression models adjusting for age, sex, and ethnicity were constructed to assess associations between intracranial artery variations and presence of intracranial arterial calcifications.</p><p><strong>Results: </strong>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)).</p><p><strong>Conclusion: </strong>The prevalence of arteriosclerosis in the intracranial arteries on CT imaging varies among pat","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"843-851"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collaterals and outcomes after endovascular treatment in acute large vessel occlusion: Disparity by stroke etiologies.","authors":"Xinyi Leng, Ximing Nie, Hongyi Yan, Yuesong Pan, Lina Zheng, Yuying Liu, Wanying Duan, Xin Liu, Yufei Wei, Weibin Gu, Xinyi Hou, Thomas W Leung, Zhongrong Miao, David S Liebeskind, Liping Liu","doi":"10.1177/17474930251324463","DOIUrl":"10.1177/17474930251324463","url":null,"abstract":"<p><strong>Background: </strong>Collateral circulation provides compensatory flow to ischemic brain regions in acute large vessel occlusion (LVO), which had been associated with better outcomes after endovascular treatment (EVT).</p><p><strong>Aims: </strong>We aimed to reveal the pre-EVT collateral status and its associations with outcomes after EVT, in patients with acute LVO with different etiologies.</p><p><strong>Methods: </strong>Based on a prospective, multicenter registry, we analyzed patients with acute, intracranial anterior-circulation LVO due to large artery atherosclerosis (LAA) and cardioembolism (CE), who underwent EVT within 24 h. Pre-EVT leptomeningeal collateral status was classified on digital subtraction angiography by ASITN/SIR grading system. Outcomes included good 3-month functional outcome (modified Rankin Scale [mRS] 0-2), 3-month mRS distribution, successful recanalization, early neurological deterioration, symptomatic intracranial hemorrhage (sICH), and 3-month mortality.</p><p><strong>Results: </strong>Among 805 patients (median age 66 years), 450 and 355, respectively, had LVO due to LAA and CE, of whom 57.8% and 56.6% (<i>p</i> = 0.742) had good pre-EVT collaterals. In LAA patients, good collaterals were associated with lower risk of sICH (adjusted odds ratio [OR]= 0.40; 95% CI = 0.17-0.94; <i>p</i> = 0.036) but not functional outcomes. In CE patients, good collaterals were associated with a higher chance of good functional outcome (adjusted OR = 1.55; 95% CI = 0.96-2.51; <i>p</i> = 0.072) and lower mRS at 3 months (adjusted common OR = 0.64; 95% CI = 0.43-0.94; <i>p</i> = 0.021). However, there was no significant CE/LAA and collateral status interaction on any outcome.</p><p><strong>Conclusions: </strong>The study revealed comparable pre-EVT collateral status in patients with LVO due to LAA versus CE who received EVT within 24 h, but the pre-EVT collaterals may have different protective effects for post-EVT outcomes in these two groups of patients.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"864-873"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary stroke prevention and improvements in acute intracerebral haemorrhage care.","authors":"Hugh S Markus","doi":"10.1177/17474930251356353","DOIUrl":"https://doi.org/10.1177/17474930251356353","url":null,"abstract":"","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"20 7","pages":"772-775"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous thrombolysis improves recanalization results irrespective of the mechanical thrombectomy technique in acute ischemic stroke.","authors":"Pauline Cousin, Giuseppe Scopelliti, Alice le Berre, Joseph Benzakoun, Nicolas Bricout, Laurence Legrand, Guillaume Turc, Charlotte Cordonnier, Catherine Oppenheim, Olivier Naggara, Hilde Henon, Wagih Ben Hassen","doi":"10.1177/17474930251337054","DOIUrl":"10.1177/17474930251337054","url":null,"abstract":"<p><strong>Introduction: </strong>Post hoc analysis of recent trials comparing bridging therapy to endovascular therapy (EVT) alone reported improved recanalization results with bridging therapy. It remains uncertain whether the positive effect of prior intravenous thrombolysis (IVT) is consistent across all mechanical thrombectomy first-line techniques (aspiration, stent-retriever, or combination of both) currently in use. In this study, we aimed to evaluate the consistency of IVT's beneficial impact on different mechanical thrombectomy techniques.</p><p><strong>Methods: </strong>Data were extracted from prospective registries, including consecutive acute ischemic stroke patients treated with EVT between January 2015 and October 2022. Patients included had anterior circulation large vessel occlusion and were treated with EVT, with or without prior IVT. A propensity score-weighted analysis was performed to measure the effect of IVT on recanalization results across different EVT techniques.</p><p><strong>Results: </strong>A total of 2650 patients (mean age 70 ± 15 years, 47% males) were included, 1400 in the bridging group and 1250 in the EVT alone group. Bridging group demonstrated higher rates of successful recanalization (eTICI ⩾ 2B) (odds ratio (OR) = 1.78, 95% confidence interval (CI): [1.52-2.1]). This result was consistent across all EVT first-line techniques: aspiration (OR = 1.81; 95% CI: [1.3-2.6], p = 0.01); stent-retriever (OR = 1.64; 95% CI: [1.2-2.2]) and combined technique (OR = 1.94; 95% CI: [1.6-2.4]). In addition, fewer retrieval attempts were needed in the bridging group (OR = 1.26, 95% CI: [1.04-1.4]), with a consistent effect across different EVT techniques.</p><p><strong>Conclusion: </strong>IVT significantly improves recanalization results of EVT in patients with acute ischemic stroke, regardless of employed mechanical thrombectomy technique.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"883-890"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of addition of oral anticoagulant to standard antiplatelet treatment in patients with ischemic stroke and no indication for oral anticoagulation: Systematic review and meta-analysis.","authors":"Anastasia Adamou, Dimitra Papadimitriou, Davide Strambo, Eleni Korompoki, Patrik Michel, George Ntaios","doi":"10.1177/17474930251337354","DOIUrl":"10.1177/17474930251337354","url":null,"abstract":"<p><strong>Background: </strong>Despite multiple effective secondary prevention strategies, the risk for stroke recurrence remains remarkable, and further ways to mitigate it are warranted. The results of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial could generate the hypothesis that the addition of low-dose oral anticoagulation to the standard antiplatelet treatment could be beneficial for the prevention of stroke recurrence among patients with acute ischemic stroke who have no indication for oral anticoagulation. We aimed to assess this hypothesis with a systematic review and meta-analysis of currently available evidence from randomized controlled trials.</p><p><strong>Methods: </strong>Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines for systematic reviews and meta-analyses, we systematically reviewed MEDLINE, Scopus, and ClinicalTrials.gov until 14 January 2025. Eligible studies included randomized controlled trials including participants with acute ischemic stroke or high-risk transient ischemic attack with no indication for oral anticoagulation, who were randomized to a combination strategy of oral anticoagulation with antiplatelets versus antiplatelets alone. The outcomes studied included recurrent stroke, major hemorrhage, their combination (net clinical benefit outcome), any stroke, and magnetic resonance imaging (MRI)-detected covert brain infarct.</p><p><strong>Results: </strong>Among 1850 screened studies, 4 were eligible including 6893 patients (50.4% women). There were 430 stroke recurrences during an overall follow-up period of 6137 patient-years. Compared to patients assigned to standard antiplatelet treatment, those assigned to the combination strategy had a similar risk of ischemic stroke recurrence (odds ratio (OR) = 0.89, 95% confidence interval (CI) = 0.68-1.17), net clinical benefit outcome (OR = 1.12, 95% CI = 0.88-1.43), any stroke (OR = 0.88, 95% CI = 0.65-1.18), covert brain infarct (OR = 1.06, 95% CI = 0.86-1.31), but a higher risk of major hemorrhage (OR = 2.21, 95% CI = 1.25-3.90).</p><p><strong>Conclusion: </strong>The strategy of combination of oral anticoagulation with antiplatelet treatment should not be chosen in patients with acute ischemic stroke and no indication for oral anticoagulation, unless the results of ongoing trials like the LIBREXIA-Stroke and OCEANIC-Stroke yield different conclusions.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"776-785"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998161","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":"International Care Bundle Evaluation in Cerebral Hemorrhage Research (I-CATCHER): Study protocol for a multicenter, batched, parallel, cluster-randomized trial with a baseline period.","authors":"Trine Apostolaki-Hansson, Menglu Ouyang, Dar Dowlatshahi, Valeria Caso, Alessandro Bufi, Zhe Kang Law, Laurent Billot, Bo Norrving, Craig S Anderson, Teresa Ullberg","doi":"10.1177/17474930251342888","DOIUrl":"10.1177/17474930251342888","url":null,"abstract":"<p><strong>Rationale: </strong>A care bundle approach to the management of spontaneous intracerebral hemorrhage (ICH) has been shown to benefit patients in low- and middle-income countries (LMIC), but uncertainty persists over the specific components and its applicability in high-income countries (HICs).</p><p><strong>Aims: </strong>An international collaborative initiative aimed at determining whether implementation of a care bundle improves functional outcome for patients with ICH in HIC.</p><p><strong>Methods: </strong>An international, multicenter, batched, parallel, cluster-randomized clinical trial focused on implementation and quality improvement for adults with spontaneous ICH ⩽ 24 h of symptom onset. The care bundle includes time- and target-based interventions: early intensive blood pressure lowering, hyperglycemia and pyrexia management, anticoagulation reversal, avoidance of do-not-resuscitate orders, repeat imaging, and referral pathways for intensive care and neurosurgery. An embedded process evaluation will assess the effectiveness and implementation of the care bundle.</p><p><strong>Sample size: </strong>A total of 110 hospitals with 3500 ICH participants is estimated to provide 90% power (α = 0.05) to detect a plausible treatment effect of 0.20 improvement in utility-weighted modified Rankin scale (UW-mRS) scores.</p><p><strong>Outcomes: </strong>The primary outcome is UW-mRS at 6 months. Secondary outcomes include death, functional status, and health-related quality of life. Implementation outcomes include adoption, fidelity, acceptability, sustainability, and integration.</p><p><strong>Discussion: </strong>We aim to provide reliable evidence to accelerate practice change for integration of a multifaceted ICH care bundle as a critical component of acute stroke care worldwide.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov Identifier: NCT06429332.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"891-897"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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.Data access statement:Data are available upon reasonable request by contacting the corresponding author.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"831-842"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264301/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous thrombolysis in acute ischemic minor stroke: a Danish nation-wide cohort study.","authors":"Daniel Harsfort, Jakob Nebeling Hedegaard, Søren Paaske Johnsen, Malalai Musleh, Boris Modrau","doi":"10.1177/17474930251365445","DOIUrl":"https://doi.org/10.1177/17474930251365445","url":null,"abstract":"<p><strong>Background and objectives: </strong>In patients with minor stroke, intravenous thrombolysis is recommended only for those with disabling symptoms, yet no standardised definition exists, and the treatment deci-sions remain subjective. This study aimed to evaluate the effect of thrombolysis in minor stroke using routine care registry data.</p><p><strong>Patients and methods: </strong>Danish nationwide register-based cohort study included patients with minor stroke (Scandinavian Stroke Scale (SSS) ≥45) from 2011-2021. Patients were categorised as having mild strokes (SSS 45-49, approximated NIHSS 5-6) or very mild strokes (SSS 50-58, approximated NIHSS 1-4) to pragmatically distinguish disabling from non-disabling symptoms. Return-to-work, use of homecare, typical stroke complications, recurrent stroke, and mortality were compared in pa-tients treated with and without thrombolysis. Analyses were adjusted for vascular risk factors, de-mographics, and clinical characteristics using inverse probability of treatment weighting.</p><p><strong>Results: </strong>Among 31,007 included patients, 1,910 with mild strokes and 4,052 with very mild strokes received thrombolysis. In patients with mild strokes, thrombolysis was associated with higher rate of return-to-work (adjusted hazard ratio 1.33), lower risk of pneumonia (adjusted relative risk (aRR) 0.40), and lower mortality (aRR 0.58, 0.50, and 0.50 at 30, 90, and 365 days, respectively). In pa-tients with very mild strokes, thrombolysis was not associated with improved outcomes, except lower mortality at 365 days (aRR 0.78).</p><p><strong>Discussion: </strong>Intravenous thrombolysis was more often associated with better outcomes in patients with mild strokes than in patients with very mild strokes.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251365445"},"PeriodicalIF":8.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730915","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":"Diagnosis and Management of Cerebral Amyloid Angiopathy: A Scientific Statement from the International CAA Association and the World Stroke Organization.","authors":"Charlotte Cordonnier, Catharina Klijn, Eric Edward Smith, Rustam Al-Shahi Salman, B K Chwalisz, Ellis van Etten, Ryan T Muir, Fabrizio Piazza, Stefanie Schreiber, Floris H B M Schreuder, Magdy Selim, Ashkan Shoamanesh, Anand Viswanathan, Marieke Wermer, Michael Zandi, Andreas Charidimou, Steven M Greenberg, David Werring","doi":"10.1177/17474930251365861","DOIUrl":"https://doi.org/10.1177/17474930251365861","url":null,"abstract":"<p><p>Cerebral amyloid angiopathy (CAA) is a well-recognized and challenging disease for neurologists and other clinicians caring for the rapidly aging worldwide population. CAA is a major cause of spontaneous lobar intracerebral hemorrhage (ICH), and can also cause transient focal neurological episodes, and convexity subarachnoid hemorrhage, CAA associated ICH has a high mortality, morbidity, and recurrence rate. CAA can affect a wide range of clinical decisions including use of antithrombotic medications, safety for anti-β-amyloid peptide (Aβ) immunotherapy, and need for anti-inflammatory or immunosuppressive treatment. We present guidelines, intended to inform the approach to individuals with suspected CAA, written on behalf of the International CAA Association and the World Stroke Organization (WSO). We cover five areas selected for their relevance to practice: 1) Diagnosis, testing, and prediction of intracerebral hemorrhage risk; 2) Antithrombotic agents and vascular interventions; 3) Vascular risk factors and concomitant medications; 4) Treatment of CAA manifestations; and 5) Diagnosis and treatment of CAA-related inflammation and vasculitis. The statement has been reviewed and approved by the Executive Committee of the WSO, and the International CAA Association.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251365861"},"PeriodicalIF":8.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730914","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":"The risk of femoral fracture is increased in patients with ischemic stroke and transient ischemic attack - a population-based observational secondary analysis of the Austrian stroke cohort.","authors":"Martin Heidinger, Clemens Lang, Julia Ferrari, Stefan Krebs, Marek Sykora, Rainer Kleyhons, Heinrich Resch, Anel Karisik, Benjamin Dejakum, Kurt Moelgg, Julian Granna, Christian Boehme, Peter Willeit, Michael Knoflach, Georg Schett, Stefan Kiechl, Wilfried Lang","doi":"10.1177/17474930251364071","DOIUrl":"https://doi.org/10.1177/17474930251364071","url":null,"abstract":"<p><p>BackgroundAn increased risk of femoral fractures after ischemic stroke (IS) and transient ischemic attack (TIA) has been shown previously. However, it remains unclear whether the ischemic cerebral event is directly associated with the risk of femoral fractures.AimsThe aim of this study was i) to assess the association between the frequency of femoral fractures in patient with IS and TIA (IS/TIA), and ii) to compare the risk of femoral fractures to the Austrian general population.MethodsPopulation-based observational secondary analysis of the Austrian Stroke Cohort to assess the incidence of femoral fractures in the year after IS/TIA compared with the year before, and both intervals compared with the Austrian general population. All patients ≥20 years treated for IS/TIA in Austria between 01.01.2016-31.12.2018 were identified using medical record linkage. Patient trajectories were reconstructed from 01.01.2015-31.12.2019 to have a one-year observational period before and after the event. Femoral fractures within one year after IS/TIA compared to one year before IS/TIA were analysed using McNemar test and Cox regression analysis considering sex and age. The one-year age- and sex-adjusted relative risk of femoral fractures was calculated for patients with IS/TIA and compared to the Austrian general population.ResultsA total of 48 996 survivors of IS (n=34 997) and TIA (n=13 999) were included. The incidence of femoral fractures increased significantly from the year before the IS/TIA (8.9 per 1000 person-years, 95%CI 7.7-10.2) to the year after the event (11.8 per 1000 person-years, 95%CI 10.1-13.5; P = .022). Compared to the Austrian general population including 21.1 million patient-years at risk and 37 436 femoral fractures, the risk of femoral fractures was increased both in the year before (RR 2.08, 95%CI 2.06-2.11) and after (RR 3.52, 95%CI 3.48-3.56) the IS/TIA.ConclusionsThe risk of femoral fractures was found to be increased in the year following an IS/TIA, indicating a direct association with the IS/TIA event.Data access statementReconstruction of medical record linkage and individual patient trajectory reconstruction were reported previously. Data from individual patient trajectories was used for this analysis.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251364071"},"PeriodicalIF":6.3,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690189","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}