International Journal of Stroke最新文献

{"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, Bart K Chwalisz, Ellis van Etten, Ryan T Muir, Fabrizio Piazza, Stefanie Schreiber, Floris Hbm Schreuder, Magdy Selim, Ashkan Shoamanesh, Anand Viswanathan, Marieke Wermer, Michael Zandi, Andreas Charidimou, Steven M Greenberg, David Werring","doi":"10.1177/17474930251365861","DOIUrl":"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":"949-967"},"PeriodicalIF":8.7,"publicationDate":"2025-10-01","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":"Impact of atrial fibrillation on outcomes in stroke patients with tandem occlusions treated with thrombectomy: A multicentre study.","authors":"Lucio D'Anna, Matteo Foschi, Mariarosaria Valente, Liqun Zhang, Nina Mansoor, Matthew Fallon, Adelaida Gartner Jaramillo, Fedra Kuris, Antonio Taglialatela, Francesco Toraldo, Filippo Komauli, Massimo Sponza, Vladimir Gavrilovic, Kyriakos Lobotesis, Gian Luigi Gigli, Soma Banerjee, Giovanni Merlino","doi":"10.1177/17474930251330139","DOIUrl":"10.1177/17474930251330139","url":null,"abstract":"<p><strong>Background: </strong>Tandem occlusions, involving simultaneous extracranial and intracranial artery blockages, represent a complex subtype of acute ischemic stroke treated with mechanical thrombectomy (MT). However, to date, the impact of atrial fibrillation (AF) on outcomes in this population remains unclear. This study aimed to evaluate the safety and efficacy of MT in patients with tandem occlusions, comparing those with AF to their counterparts without AF.</p><p><strong>Methods: </strong>We performed a multicentre, retrospective study using inverse probability weighting (IPW) to evaluate the effect of AF on outcomes in tandem occlusion patients treated with MT across three comprehensive stroke centers. The primary outcome was functional independence at 90 days (modified Rankin Scale [mRS] 0-2). Secondary outcomes included recanalization success (Treatment in Cerebral Infarction (TICI) ⩾ 2b), intracranial hemorrhage (ICH), symptomatic ICH (sICH), and 90-day mortality. Subgroup analyses assessed the interaction between AF and clinical or procedural factors.</p><p><strong>Results: </strong>Among 635 patients, 164 (25.8%) had AF (Tandem_AF). Tandem_AF patients had significantly lower rates of favorable 90-day functional outcomes (adjusted risk ratio [aRR] = 0.49; 95% confidence interval (CI): 0.31-0.76; p = 0.001) and higher 90-day mortality (aRR 2.29; 95% CI: 1.47-3.55; p < 0.001) compared to non-AF patients. Rates of successful recanalization, ICH, and sICH were similar between groups. Subgroup analysis revealed worse outcomes for Tandem_AF patients aged ⩾65 years, with National Institute of Health Stroke Scale (NIHSS) 11-42, and those treated with general anesthesia or intravenous thrombolysis.</p><p><strong>Conclusions: </strong>Patients with tandem occlusion and AF undergoing MT showed significantly worse functional and survival outcomes relative to their non-AF counterparts, despite comparable procedural success rates. These findings highlight the critical need for tailored management strategies to mitigate the unique risks associated with AF in this population. Further research is essential to refine therapeutic approaches and improve outcomes for this high-risk group.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"987-998"},"PeriodicalIF":8.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624762","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":"Effect of history of hypertension on efficacy of clopidogrel-aspirin in ischemic stroke.","authors":"Dandan Liu, Hongyi Yan, Ying Gao, Weiqi Chen, S Claiborne Johnston, Pierre Amarenco, Philip M Bath, Xuan Wang, Mengxing Wang, Tingting Wang, Yingying Yang, Jing Jing, Chunjuan Wang, Yongjun Wang, Yuesong Pan, Yilong Wang","doi":"10.1177/17474930251338618","DOIUrl":"10.1177/17474930251338618","url":null,"abstract":"<p><strong>Background: </strong>Patients with different hypertension status could potentially respond differently to the treatment of clopidogrel-aspirin owing to thrombosis, antiplatelet resistance, and platelet reactivity.</p><p><strong>Aims: </strong>The aim of the study is to examine the efficacy and safety of clopidogrel-aspirin in patients with mild ischemic stroke or high-risk transient ischemic attack (TIA) according to different hypertension status.</p><p><strong>Methods: </strong>In the Intensive Statin and Antiplatelet Therapy for Acute High-Risk Intracranial or Extracranial Atherosclerosis (INSPIRES) trial, patients were randomized to either clopidogrel-aspirin or aspirin group. The primary outcome was any new ischemic or hemorrhagic stroke within 90 days. Hypertension status was classified into two categories based on medical history: patients with or without hypertension.</p><p><strong>Results: </strong>Among 6100 patients with complete data of hypertension status, 3915 (64.2%) were men. Clopidogrel-aspirin compared with aspirin was associated with reduced incidence of new stroke in patients without hypertension (hazard ratio (HR): 0.62, 95% confidence interval (CI): 0.44-0.86, <i>p</i> = 0.004), but not in patients with hypertension (HR: 0.87, 95% CI: 0.71-1.07, <i>p</i> = 0.18; <i>p</i> = 0.085 for interaction).</p><p><strong>Conclusions: </strong>In this study, patients without hypertension may have more benefit from receiving treatment with clopidogrel-aspirin than those with hypertension. This finding can be used as an enrichment strategy in the future secondary stroke prevention randomized clinical trials of dual antiplatelet therapy.</p><p><strong>Trial registration: </strong>The INSPIRES trial was registered at http://www.</p><p><strong>Clinicaltrials: </strong>gov (unique identifier: NCT03635749).</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1021-1030"},"PeriodicalIF":8.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005079","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":"Temporal patterns of occult cancer incidence following acute ischemic stroke: A comparative study by stroke etiology.","authors":"Mi Sun Oh, Kyung-Ho Yu, Byung-Chul Lee, Jun Yup Kim, Beom Joon Kim, Jihoon Kang, Moon-Ku Han, Seong-Eun Kim, Jong-Moo Park, Kyusik Kang, Soo Joo Lee, Jae Guk Kim, Jae-Kwan Cha, Dae-Hyun Kim, Tai Hwan Park, Kyungbok Lee, Hong-Kyun Park, Yong-Jin Cho, Keun-Sik Hong, Kang-Ho Choi, Joon-Tae Kim, Dong-Eog Kim, Jay Chol Choi, Kwang-Yeol Park, Keon-Joo Lee, Ji Sung Lee, Sujung Jang, Jae Eun Chae, Juneyoung Lee, Philip B Gorelick, Hee-Joon Bae","doi":"10.1177/17474930251335615","DOIUrl":"10.1177/17474930251335615","url":null,"abstract":"<p><strong>Backgrounds and aims: </strong>This study investigates the temporal patterns of occult cancer incidence among survivors of acute ischemic stroke (AIS), with a focus on variations by underlying stroke etiology.</p><p><strong>Patients and methods: </strong>We analyzed data from a prospective, multicenter stroke registry and a national claims database, identifying AIS patients hospitalized between 2011 and 2013. Patients were categorized by stroke etiology into two groups: unidentified stroke etiology (USE) and identified stroke etiology (ISE). We estimated the occult cancer incidence rates within both groups and the overall AIS cohort. Using Poisson regression, we evaluated variations in cancer incidence over time and by stroke etiology, adjusting for age, sex, and smoking status. We also compared the first-year cancer incidence rate in our cohort to the age-standardized incidence rate (ASIR) in the general Korean population.</p><p><strong>Results: </strong>Among 9759 AIS patients (median follow-up: 4.4 years), 976 occult cancers were diagnosed in 569 patients (5.8%). The first month post-stroke exhibited the highest cancer incidence rates across all groups: 8.3 (overall AIS), 14.3 (USE), and 7.6 (ISE) per 1000 person-months, with rates decreasing rapidly thereafter and stabilizing after 12 months. Compared to beyond 36 months, the adjusted incidence rate ratios within 1 month were 7.1 for overall AIS, 17.6 for USE, and 6.8 for ISE. The heightened risk in the USE group, compared to the ISE group, was significant within 1 month but diminished thereafter. Relative to the general population, the ASIR in this cohort was 1.6 times higher, particularly among men and those in the USE category.</p><p><strong>Conclusion: </strong>Occult cancer incidence is notably high in the early period following AIS, especially among patients with USE. These findings underscore the importance of vigilant cancer screening immediately after a stroke, especially for patients without a clear stroke etiology.Data access statement:Access to the linked data utilized in this research was restricted to authorized researchers and limited to a pre-defined period only. Therefore, it is not possible to guarantee access to the data after the completion of this study, even upon reasonable request.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"1031-1041"},"PeriodicalIF":8.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966373","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":"C-reactive protein elevation and subsequent atrial fibrillation detection after ischemic stroke treated with mechanical thrombectomy: An inverse probability weighting analysis.","authors":"Lucio D'Anna, Gabriele Prandin, Mariarosaria Valente, Liqun Zhang, Paresh Malhotra, Simona Sacco, Matteo Foschi, Raffaele Ornello, Viva Levee, Katherine Chulack, Fahad Sheikh, Feras Fayez, Francesco Toraldo, Domenico Maisano, Caterina Del Regno, Filippo Komauli, Adelaida Gartner Jarmillo, Hakam Al-Karadsheh, Hamza Zahid, Piers Klein, Mohamad Abdalkader, Edoardo Pirera, Paolo Manganotti, Kyriakos Lobotesis, Thanh N Nguyen, Gian Luigi Gigli, Soma Banerjee, Giovanni Merlino","doi":"10.1177/17474930251332489","DOIUrl":"10.1177/17474930251332489","url":null,"abstract":"<p><strong>Background and aims: </strong>Mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke due to large vessel occlusion (LVO). Atrial fibrillation (AF) can be known before the stroke (or prevalent AF) or be newly detected after the stroke (post-stroke AF). Inflammation plays a critical role in the pathogenesis of post-stroke AF, making inflammatory markers valuable for early detection of post-stroke AF. This study investigated the predictive value of C-reactive protein (CRP) and other inflammatory biomarkers in predicting post-stroke AF in acute ischemic stroke patients treated with MT.</p><p><strong>Methods: </strong>This observational multicenter retrospective cohort study included 849 patients with anterior circulation LVO treated with MT across four centers from 2016 to 2023. Patients were divided into post-stroke AF and NO-AF groups, excluding those with prevalent AF. Baseline demographics, clinical and procedural variables, and inflammatory biomarkers, including CRP, were collected at admission and 24-h post-procedure. Baseline characteristics were balanced using inverse probability weighting (IPW). Logistic regression and receiver operating characteristic (ROC) analyses assessed the predictive value of CRP for post-stroke AF.</p><p><strong>Results: </strong>The study included 849 patients with a median age of 66 years (interquartile range (IQR) = 54-76) and 477 (56.2%) were female. Post-stroke AF was detected in 186 (21.9%) patients, while 663 (78.1%) did not experience AF during admission. In the weighted population, CRP levels, both admission and 24-h post-procedure, were higher in post-stroke AF patients. In logistic regression analysis, admission and 24-h CRP levels were associated with increased probability of post-stroke AF, respectively (odds ratio (OR) = 1.01; 95% confidence interval (CI) = 1.00-1.03, p < 0.001) and (OR = 1.02, 95% CI = 1.01-1.03, p < 0.001) following MT. We observed that the model combining age, sex, hypertension, heart failure, alcoholism, coronary artery disease, diabetes mellitus, smoking, previous transient ischemic attack (TIA), and ischemic stroke, and admission CRP (area under the curve (AUC) = 0.723, 95% CI = 0.71-0.74) and 24-h CRP (AUC = 0.704, 95% CI = 0.69-0.72) had good predictive accuracy, with optimal cutoff values of 4.25 for admission CRP and 14.69 for 24-h CRP to detect post-stroke AF. Subgroup analysis indicated CRP predictive relevance, particularly in hypertensive patients.</p><p><strong>Conclusions: </strong>Our findings suggest CRP is associated with post-stroke AF in stroke patients due to LVO, highlighting inflammation's role in AF pathogenesis. Measuring CRP at admission and 24 h may enable early detection and timely anticoagulation. Incorporating CRP into clinical pathways could improve individualized risk assessment, warranting further studies to validate its predictive utility and explore additional markers.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"999-1010"},"PeriodicalIF":8.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12446707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742869","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":"Tenecteplase or alteplase for acute ischemic stroke beyond 4.5 hours of last known well. A pooled analysis of the TETRIS and EVATRISP registries.","authors":"Clémence Liegeois, Valerian Altersberger, Gaspard Gerschenfeld, Stéphane Olindo, Alexander Salerno, Mirjam R Heldner, Nicolas Martinez-Majander, Henrik Gensicke, Stefano Forlivesi, Gian Marco De Marchis, Nicolas Chausson, Petra Cimflova, Fernando Pico, Pierre Seners, Jiyoon Baik, Cristina Hobeanu, Tolga D Dittrich, Gaultier Marnat, Didier Smadja, Sami Curtze, Andrea Zini, Alexandra Maury, Davide Strambo, Sonia Alamowitch, Stefan Engelter, Guillaume Turc","doi":"10.1177/17474930251385744","DOIUrl":"https://doi.org/10.1177/17474930251385744","url":null,"abstract":"<p><p>Background-Intravenous thrombolysis with tenecteplase within 4.5hrs after ischemic stroke is non-inferior to alteplase. However, it is uncertain whether this is also true in patients last known to be well more than 4.5hrs before treatment initiation (LKW >4.5hrs). We aimed to compare tenecteplase and alteplase in this population using data from two large multicenter registries.Methods-Pooled retrospective analysis of acute stroke patients LKW >4.5hrs treated with tenecteplase 0.25 mg/kg (TETRIS registry) or alteplase 0.9 mg/kg (EVATRISP registry plus 4 French centers participating in TETRIS) based on the results of MRI or perfusion CT. Excellent functional outcome at 3 months (mRS 0-1) was the primary outcome. Secondary outcomes were mRS 0-2, shift analysis of the mRS, any intracranial hemorrhage (ICH), symptomatic ICH, and death. Propensity score overlap weighting (PSOW) was used to account for imbalance in baseline characteristics.Results-897 patients (tenecteplase: n=419; alteplase: n=478) were included between 2015 and 2024 (mean age: 74 [IQR:64-84]; median NIHSS 11 [6-17]; unknown stroke onset in 777 [86.6%] patients). At 3 months, mRS 0-1 was achieved in 138 (32.9%) and 178 (37.2%) patients treated with tenecteplase and alteplase, respectively (crude OR 0.83 [95%CI 0.63-1.09]; PSOW-OR 0.92 [95%CI 0.66-1.30]). Compared with alteplase, tenecteplase was not significantly associated with mRS 0-2 (PSOW-OR 0.78 [95%CI 0.56-1.08]) or better functional outcome over the whole range of the mRS (PSOW-common OR 0.83 [95%CI 0.62-1.11]). Tenecteplase was associated with significantly higher odds of any ICH (PSOW-OR: 1.79 [95%CI 1.25-2.57]), but not sICH (PSOW-OR 1.12 [95%CI 0.61-2.05]).Conclusions-The functional outcomes of patients LKW >4.5hrs treated with tenecteplase or alteplase did not significantly differ in this pooled analysis of two observational registries. However, the direction of the associations did not favor tenecteplase over alteplase and therefore more comparative studies -ideally randomized- are needed before routinely switching to tenecteplase in this population.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251385744"},"PeriodicalIF":8.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191581","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 Tirofiban Following Endovascular Therapy for Patients with Acute Large Vessel Occlusion Stroke.","authors":"Lina Zheng, Yaqi Liu, Ximing Nie, Hongyi Yan, Weibin Gu, Xin Liu, Wanying Duan, Zhe Zhang, Jingyi Liu, Yufei Wei, Miao Wen, Zhonghua Yang, Yuesong Pan, Xinyi Leng, Zhongrong Miao, Liping Liu","doi":"10.1177/17474930251386577","DOIUrl":"https://doi.org/10.1177/17474930251386577","url":null,"abstract":"<p><strong>Background: </strong>The role of intravenous (IV) tirofiban administered following endovascular therapy (EVT) for acute ischemic stroke (AIS) due to large vessel occlusion (LVO) remains uncertain.</p><p><strong>Aims: </strong>To investigate the associations of IV tirofiban following EVT with clinical outcomes in patients with acute LVO stroke and to determine whether the associations differ between anterior-circulation stroke (ACS) and posterior-circulation stroke (PCS).MethodsIn this prospective, national, multicenter registry, patients with AIS due to intracranial LVO who underwent EVT within 24 hours of onset were enrolled, and categorized into IV tirofiban and no-IV tirofiban groups. The primary outcome was functional independence at 90 days, defined as a modified Rankin Scale of 0-2. Secondary outcomes included the distribution of 90-day mRS, independent ambulation, symptomatic intracranial hemorrhage (sICH), early neurological deterioration (END) and 90-day mortality. Analyses included univariate and multivariable logistic regression, propensity score matching (PSM, 1:1 ratio).ResultsAmong 1,836 eligible patients (1,342 ACS; 494 PCS), 362 (19.7%) received IV tirofiban following EVT. After PSM, 720, 498 and 196 patients were included in the entire, ACS and PCS cohort, respectively. In the ACS cohort, IV tirofiban was associated with higher odds of functional independence (57.0% vs 43.8%; adjusted odds ratio [aOR] 1.55, 95% CI 1.08-2.22; P=0.02) and a favorable shift in 90-day mRS. In the entire cohort, the association was attenuated after adjustment (aOR 1.33, 95% CI 0.99-1.79; P=0.06). In the PCS cohorts, IV tirofiban was associated with numerically higher functional independence (31.6% vs. 18.4%), but without statistical significance (aOR 1.54, 95% CI 0.74-3.17; P=0.25). No significant differences were found in sICH, END, or 90-day mortality between groups across all cohorts.ConclusionIV tirofiban administration following EVT was associated with improved favorable functional outcomes in AIS patients with anterior-circulation LVO, without increasing the risk of sICH or END, but no significant association was observed in PCS patients. Further randomized controlled trials are warranted to verify these findings.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251386577"},"PeriodicalIF":8.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191676","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":"Stroke Mortality in the United States from 1968 to 2023: A CDC WONDER Analysis.","authors":"Saad Ahmed Waqas, Jazza Aamir, Dua Ali, Zahra Imran, Hussain Salim, Azeem Hassan, Shahzeb Khan, Stephen J Greene, Raheel Ahmed","doi":"10.1177/17474930251384043","DOIUrl":"https://doi.org/10.1177/17474930251384043","url":null,"abstract":"<p><strong>Background: </strong>Stroke remains a leading cause of mortality in the U.S., with evolving epidemiologic patterns over five decades. This study analyzes stroke mortality trends from 1968 to 2023, focusing on disparities across age, sex, race, and geographic regions.</p><p><strong>Methods: </strong>This population-based descriptive study used national mortality data from CDC WONDER. Stroke deaths among individuals aged ≥25 years were identified using ICD codes from 1968 to 2023. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated using U.S. Census data. Temporal trends were analyzed using Joinpoint regression.</p><p><strong>Results: </strong>From 1968 to 2023, 8,933,826 stroke deaths occurred. AAMRs declined from 250.6 (95% CI, 249.5-251.8) in 1968 to 60.0 (95% CI, 59.7-60.3) in 2023, with rapid declines from 1973-1981, slower reductions until 2000, and modest rise post-2011. Males consistently had higher AAMRs than females. Among males, AAMR fell from 268.4 (95% CI, 266.5-270.3) to 60.5 (95% CI, 60.1-61.0), while in females, it declined from 236.8 (95% CI, 235.4-238.2) to 58.7 (95% CI, 58.3-59.1). Racial disparities persisted, with Black individuals having higher AAMRs than White individuals in 2023 (83.2 vs. 58.6). The Southern U.S. had the highest AAMRs, with recent increases post-2011. In 2022-2023, stroke mortality ranged from 37.3 (95% CI, 36.6-37.9) in New York to 92.9 (95% CI, 88.4-97.4) in Delaware. Ischemic stroke AAMR declined from 59.9 (95% CI, 59.3-60.4) to 12.4 (95% CI, 12.3-12.5), with increases observed post-2014. Hemorrhagic stroke AAMR fell from 79.4 (95% CI, 78.7-80.0) to 10.0 (95% CI, 9.9-10.1), with continued decline from 1997 onward.</p><p><strong>Conclusion: </strong>Despite long-term declines, stroke mortality has recently increased, particularly among younger adults, racial minorities, and the Southern U.S. These findings underscore the need for targeted public health interventions to address disparities.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251384043"},"PeriodicalIF":8.7,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112982","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":"Avoiding Gaps After Stroke Unit Care: Impact of Direct Transition to Inpatient Neurorehabilitation on Post-stroke Outcomes.","authors":"Maria Tscherner, Julian Elbischger, Isra Hatab, Natalie Berger, Melanie Haidegger, Simon Fandler-Höfler, Alexander Pichler, Martin Heine, Jan Jagiello, Herbert Koller, Stefan Lilek, Sai Veeranki, Christian Enzinger, Thomas Gattringer, Markus Kneihsl","doi":"10.1177/17474930251384049","DOIUrl":"https://doi.org/10.1177/17474930251384049","url":null,"abstract":"<p><strong>Introduction: </strong>Early initiation of neurorehabilitation (NR) at the stroke unit is recommended and has been associated with improved outcomes. However, ensuring a direct, uninterrupted transition to subsequent inpatient NR remains challenging in clinical practice. This study investigates whether direct transfer to inpatient NR is associated with functional recovery at 3-month post-stroke.</p><p><strong>Methods: </strong>This study is based on prospectively collected registry data of all stroke patients discharged with functional dependence (modified Rankin Scale [mRS] 3-5) from five stroke units in Styria, Austria, between 2012 and 2023. All patients received standardized inpatient NR, either immediately after acute stroke care or-due to limited NR bed availability-following interim care on a general neurological ward without specialized rehabilitation. The primary outcome was a ≥1-point mRS improvement from discharge to the 3-month follow-up. Outcome predictors were analyzed using univariable and multivariable methods.</p><p><strong>Results: </strong>Of 2,497 included patients (median age: 74 years; 44.7% female), 740 (29.6%) were directly transferred to NR after stroke unit care, while 1,757 patients (70.4%) were not, with a median delay to NR of 8 days. Improvement in mRS during follow-up was observed in 1,665 patients (66.7%). In multivariable analysis, direct transfer to NR was independently associated with mRS improvement (adjusted odds ratio 1.57, 95% CI 1.25-1.94) as were younger age, male sex, absence of prior stroke, and lower NIHSS score at discharge.</p><p><strong>Conclusions: </strong>Direct transition from the stroke unit to inpatient NR is associated with a greater likelihood of functional improvement at 3 months post-stroke. These findings support the value of implementing continuous post-stroke rehabilitation pathways.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251384049"},"PeriodicalIF":8.7,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112989","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":"INFLUENZA VACCINATION FOR PREVENTION OF DEATH AND MAJOR CARDIOVASCULAR EVENTS IN PATIENTS WITH A HISTORY OF STROKE: A SUBANALYSIS OF THE VIP-ACS TRIAL.","authors":"Henrique Andrade Fonseca, Gisele Sampaio Silva, Frederico Monfardini, José Carlos Nicolau, Luiz Vicente Rizzo, Otávio Berwanger","doi":"10.1177/17474930251383626","DOIUrl":"https://doi.org/10.1177/17474930251383626","url":null,"abstract":"<p><strong>Background: </strong>An in-hospital double-dose influenza vaccination strategy's effect on preventing major cardiovascular events (MACE) in patients with previous stroke is still uncertain. This study is a prespecified analysis of the vaccine against influenza to avoid cardiovascular events after the Acute Coronary Syndrome (VIP-ACS) trial.</p><p><strong>Methods: </strong>The VIP-ACS trial was a randomized, pragmatic, multicenter, open-label trial with blinded-adjudication endpoints. Adult patients with acute coronary syndrome (ACS) ≤ seven days of hospitalization were randomized to an in-hospital double-dose quadrivalent inactivated influenza vaccine or a standard-dose vaccine at 30 days post-randomization. The primary endpoint was a hierarchical composite of all-cause death, myocardial infarction (MI), stroke, unstable angina, hospitalization for heart failure, urgent coronary revascularization, and hospitalization for respiratory causes, analyzed by the win ratio (WR) method. The secondary endpoint was a hierarchical composite consisting of CV death, MI and stroke (MACE). Patients were followed for 12 months each influenza season.</p><p><strong>Results: </strong>The trial enrolled 1,801 patients (31% female). A total of 67 patients had a history of stroke. There were no significant differences between groups on the primary hierarchical endpoint: 11.4% wins in the double-dose vaccine group vs 12.1% wins in the standard-dose vaccination group (WR:0.97; 95% CI:0.72-1.24; P=0.69) without a history of stroke. However, in-hospital double-dose vaccination favored individuals with previous stroke (WR:2.62; 95% CI:1.10-6.25; P=0.03; 43.9% wins vs. 16.8% wins). Results were consistent for hierarchical MACE (WR:3.01; 95%CI:1.15-7.88; P=0.02; 41.3% wins vs 13.7% wins) in favor of in-hospital double-dose vaccination.</p><p><strong>Conclusions: </strong>After an ACS, in-hospital double-dose influenza vaccination prevents hospitalizations and death compared with standard-dose vaccination at 12 months in individuals with previous strokes.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251383626"},"PeriodicalIF":8.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091798","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}