International Journal of Stroke最新文献

{"title":"Prognosis of Incidentally Detected Asymptomatic Intracranial Atherosclerotic Stenosis: A Prospective Hospital-Based Cohort Study.","authors":"Yiyang Liu, Yinxi Zou, Huanyu Zhou, Manqiu Ding, Ningyuan Liu, Haoyao Guo, Yuelun Zhang, Yuexuan Dai, Xin Li, Yinghuan Hu, Caiyan Liu, Shan Gao, Yan Xu, Wei-Hai Xu","doi":"10.1177/17474930251383855","DOIUrl":"https://doi.org/10.1177/17474930251383855","url":null,"abstract":"<p><strong>Background: </strong>Asymptomatic intracranial atherosclerotic stenosis (ICAS) is frequently identified in stroke screening programs, particularly in Asian populations. However, the prognosis and management strategies for incidentally detected asymptomatic ICAS in hospital-based, stroke-free populations remain unclear.</p><p><strong>Aims: </strong>This study aimed to investigate the incidence of symptomatic transition and associated long-term prognostic evolution in this population, providing evidence to inform primary stroke prevention.</p><p><strong>Methods: </strong>We conducted a prospective cohort study that included 1004 patients with asymptomatic ICAS (≥ 50%) screened by transcranial Doppler ultrasound (TCD) between January 2016 and May 2022, with follow-up through August 2023. Using the Fine and Gray competing risk model, we analyzed the incidence of symptomatic transition, defined as a first-ever ischemic stroke or transient ischemic attack occurring within the ICAS territory. Post-transition outcomes, including recurrent stroke, major adverse cardiovascular events (MACE), disability (modified Rankin Scale score > 2), and patient-reported cognitive decline (Everyday Cognition-12 score ≥ 2), were evaluated by comparative analysis.</p><p><strong>Results: </strong>Over a median follow-up of 3.7 years (IQR 2.4-5.2), 43 (4.3%) patients with asymptomatic ICAS experienced a symptomatic transition under routine clinical surveillance, yielding a 5-year cumulative transition rate of 5.6%. After adjusting for potential confounders, hypertension (HR 3.33, 95% CI 1.25-8.87) and hyperlipidemia (HR 2.71, 95% CI 1.28-5.74) were independent predictors of the transition. Through extended follow-up, post-transition risks significantly increased for ischemic stroke (hazard ratio [HR] 3.37, 95% CI 1.17-9.68), MACE (HR 4.48, 1.83-10.99), disability (odds ratio [OR] 4.80, 2.17-10.64), and patient-reported cognitive decline (OR 3.43, 1.19-9.94).</p><p><strong>Conclusions: </strong>Asymptomatic ICAS detected by TCD incidentally in hospital-based, stroke-free populations carries a substantial risk of symptomatic transition and subsequent adverse outcomes. These findings underscore the prognostic importance of identifying asymptomatic ICAS clinically and highlight the necessity for intensive vascular risk factor management in this under-recognized group to guide primary stroke prevention strategies.Data access statement:Data from this study are available and can be accessed upon request.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251383855"},"PeriodicalIF":8.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091741","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 associated with Early Neurological Deterioration in Minor Distal Medium Vessel Acute Ischemic Stroke: A Multinational Multicenter Study.","authors":"Dhairya A Lakhani, Hamza A Salim, Vivek Yedavalli, Basel Musmar, Fathi Milhem, Nimer Adeeb, Tobias Djamsched Faizy, Motaz Daraghma, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Kuhn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Leonard Yeo, Benjamin Yq Tan, Robert Regenhardt, Jeremy Heit, Nicole Mariantonia Cancelliere, Aymeric Rouchaud, Jens Fiehler, Sunil A Sheth, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Thomas Marrota, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frederic Clarencon, James E Siegler, Thanh N Nguyen, Ricardo Varela, Amanda Baker, Muhammed Amir Essibayi, David Altschul, Nestor Gonzalez, Markus Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Stracke, Constantin Hecker, Gaultier Marnat, Hamza Shaikh, Christoph Griessenaur, David S Liebeskind, Alessandro Pedicelli, Andrea Alexandre, Illario Tancredi, Erwah Kalsoum, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Max Wintermark, Adrien Guenego, Adam Dmytriw","doi":"10.1177/17474930251381946","DOIUrl":"https://doi.org/10.1177/17474930251381946","url":null,"abstract":"<p><strong>Background: </strong>Patients with acute ischemic stroke secondary to distal and medium vessel occlusion (AIS-DMVO) and minor strokes present a challenge in determining the most appropriate emergent treatment. Factors leading to early neurological deterioration (END) in this patient population are understudied, but END is known to result in poor functional outcomes. Therefore, we aimed to investigate the factors contributing to END in minor AIS-DMVO cases.</p><p><strong>Methods: </strong>We included patients with AIS-DMVO and minor strokes from 37 sites across North America, Asia, and Europe. Minor stroke was defined as a baseline National Institutes of Health Stroke Scale (NIHSS) score of ≤ 5. The primary outcome measure, END, was defined as a shift of ≥ 4 points in the NIHSS score at day one after treatment compared to baseline. Univariable and multivariable logistic regression analyses were performed to identify factors associated with END.</p><p><strong>Results: </strong>Among 559 consecutive patients with DMVO and minor strokes, END was reported in 68 patients. In multivariable analysis, mechanical thrombectomy (MT) was independently associated with higher odds of END (aOR 2.37; 95% CI: 1.12-5.02; p = 0.02), while intravenous thrombolysis (IVT) was associated with lower odds of END (aOR 0.46; 95% CI: 0.26-0.81; p = 0.008). However, the association between MT and END was no longer statistically significant in the IPTW-adjusted analysis (OR 1.65; 95% CI: 0.69-3.98; p = 0.26). Hypertension and antiplatelet use at baseline were also independently associated with END. Among MT-treated patients, successful and excellent recanalization and first-pass effect were protective against END.</p><p><strong>Conclusion: </strong>MT was associated with END in patients with minor AIS-DMVO, although this association was not significant after IPTW adjustment. IVT was independently associated with reduced risk of END. These findings support careful patient selection and further study in randomized trials.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251381946"},"PeriodicalIF":8.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069531","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":"Diagnostic Yield of Cardiac Computed Tomography in Detecting High-Risk Cardioaortic Embolic Sources: A Retrospective Cohort Study.","authors":"Khansa Abdelazim Ahmed Osman, Sherief Ghozy, Michael Liu, Marwa A Mohammed, Phillip M Young, Deena M Nasr","doi":"10.1177/17474930251381131","DOIUrl":"https://doi.org/10.1177/17474930251381131","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke remains a leading cause of morbidity and mortality worldwide. Cardioembolic sources account for a significant proportion of these events, necessitating accurate identification of underlying structural heart abnormalities. Traditionally, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have been utilized for this purpose, although both have limitations. Cardiac computed tomography (CCTA) has emerged as a potential alternative, offering non-invasive imaging with high sensitivity and specificity for detecting intracardiac thrombi.</p><p><strong>Objective: </strong>This study aimed to evaluate the diagnostic yield of CCTA compared to TTE and TEE in detecting high-risk cardioaortic sources of embolism, including left ventricular (LV) thrombus, left atrial (LA) thrombus, valvular thrombus, and ulcerated aortic plaques, in patients with ischemic stroke.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center cohort study at Mayo Clinic, Rochester, MN, including 426 ischemic stroke patients who underwent CCTA within 30 days of stroke onset between March 2019 and June 2023. We compared the diagnostic yields of CCTA, TTE, and TEE in detecting structural cardiac sources of embolism.</p><p><strong>Results: </strong>The overall diagnostic yield of CCTA for detecting high-risk cardioaortic sources was 15.5%. Specifically, CCTA identified LV thrombus in 2.3% of patients, LA thrombus in 4.0%, valvular thrombus in 2.8%, and ulcerated aortic plaques in 7.0%. In comparative analysis, CCTA demonstrated a higher yield than TTE (16.0% vs. 3.5%, P<0.001) and a comparable yield to TEE (25.3% vs. 20.7%, P=0.47) in detecting these sources.</p><p><strong>Conclusions: </strong>CCTA proved to be a viable option for identifying high-risk structural sources of cardioembolism in ischemic stroke patients. Its non-invasive nature, coupled with the ability to perform imaging soon after stroke onset, underscores its clinical utility. However, further prospective and blinded studies are required to validate these findings and fully establish the efficacy of CCTA in this context.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251381131"},"PeriodicalIF":8.7,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145053600","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 live herpes-zoster vaccine and stroke risk: A population-based nested case-control study.","authors":"Amir Yahav, Doaa Ryan, Jonathan Naftali, Anat Arbel, Ronza Najjar-Debbiny, Nili Stein, Ofra Barnett-Griness, Eitan Auriel, Walid Saliba","doi":"10.1177/17474930251380184","DOIUrl":"10.1177/17474930251380184","url":null,"abstract":"<p><strong>Background: </strong>Evidence on the role of herpes-zoster (shingles) vaccination in reducing stroke risk is inconsistent and limited, particularly concerning intracerebral hemorrhage (ICH). We aimed to examine the association between zoster live vaccine (ZVL) and overall stroke, as well as its main subtypes.</p><p><strong>Methods: </strong>We conducted a population-based nested case-control study using the database of Israel's largest healthcare provider. The underlying cohort consisted of individuals aged 50 years or older, regardless of prior stroke status, from 2015 to 2022, with follow-up through June 2023. Stroke cases diagnosed during follow-up were matched with controls based on age, sex, population sector, and index date. ZVL exposure was defined as the prior filling of a prescription of the vaccine.</p><p><strong>Results: </strong>Among 37,027 matched case-control pairs, ZVL was associated with significantly reduced odds of stroke, with an adjusted odds ratio (OR) of 0.65 (95% confidence interval (CI), 0.58-0.72) for overall stroke, 0.65 (95% CI, 0.58-0.73) for ischemic stroke, and 0.64 (95% CI, 0.47-0.89) for ICH. The protective association with overall stroke decreased as time since vaccination increased; adjusted OR of 0.56 (0.48-0.65) within the first 2.5 years, 0.71 (95% CI, 0.58-0.87) after 2.5 to 5 years, and 0.81 (95% CI, 0.65-1.01) after 5 years. The association between ZVL and stroke was modified by age and sex, with a stronger association in individuals younger than 65 years (<i>p</i> for interaction = 0.004) and males (<i>p</i> for interaction = 0.031).</p><p><strong>Conclusions: </strong>ZVL is associated with a reduced risk of both ischemic stroke and ICH. The protective association appears to decrease over time and to be stronger in males and younger individuals.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251380184"},"PeriodicalIF":8.7,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006123","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":"Associations between endothelial inflammatory markers and cerebral small vessel disease in a community-based population.","authors":"Zhang Xia, Lingling Jiang, Xueli Cai, Jing Jing, Shan Li, Mengxing Wang, Suying Wang, Xuan Wang, Tiemin Wei, Yongjun Wang, Yuesong Pan, Yilong Wang","doi":"10.1177/17474930251380170","DOIUrl":"10.1177/17474930251380170","url":null,"abstract":"<p><strong>Background: </strong>Endothelial inflammation is involved in cerebral small vessel disease (CSVD) pathogenesis. Vascular cell adhesion molecule 1 (VCAM-1) and intercellular adhesion molecule 1 (ICAM-1) are biomarkers of endothelial inflammation.</p><p><strong>Aims: </strong>This study investigated the association of VCAM-1 and ICAM-1 with the presence of CSVD and CSVD burden.</p><p><strong>Methods: </strong>This cross-sectional study included community residents from the Polyvascular Evaluation for Cognitive Impairment and Vascular Events (PRECISE) study. Fasting venous blood was drawn to assay VCAM-1 and ICAM-1. Cognition was assessed by the Montreal Cognitive Assessment (MoCA). Cognitive impairment was defined as MoCA scores < 26. White matter hyperintensity, lacunes, cerebral microbleeds, and enlarged perivascular spaces were evaluated in a 3.0T MRI scanner. CSVD burden was rated according to the criteria of Wardlaw's (score 0-4) and Rothwell's (score 0-6), and classified into four grades. Presence of CSVD was defined as CSVD burden score ⩾ 1.</p><p><strong>Results: </strong>This study included 2596 participants with a mean age of 61.2 ± 6.7 years and 50.9% of males. Elevated VCAM-1 was associated with increased odds of presence of CSVD (Rothwell: odds ratio (OR) = 1.16, 95% confidence interval (CI): 1.06-1.26, <i>P</i> = 0.001), higher CSVD burden (Wardlaw: common OR (cOR) = 1.11, 95% CI: 1.02-1.21, <i>P</i> = 0.02; Rothwell: cOR = 1.16, 95% CI: 1.07-1.25, <i>P</i> < 0.001), and presence of cognition-impaired CSVD (Rothwell: OR = 1.15, 95% CI: 1.05-1.25, <i>P</i> = 0.003). VCAM-1 improved net reclassification index and integrated discrimination improvement for the presence of CSVD (Rothwell) and cognition-impaired CSVD (Rothwell). However, ICAM-1 was not associated with CSVD and did not improve prediction of CSVD.</p><p><strong>Conclusion: </strong>Endothelial inflammation, especially VCAM-1, was associated with the presence of CSVD and higher CSVD burden.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251380170"},"PeriodicalIF":8.7,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006110","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":"Increased risk of suicide after stroke: A population-based matched cohort study.","authors":"Manav V Vyas, Claire de Oliveira, Gustavo Saposnik, Peter C Austin, Amy Yx Yu, Olivia Haldenby, Jiming Fang, Corinne E Fischer, David Lipson, Fatima Quraishi, Moira K Kapral, Venkat Bhat","doi":"10.1177/17474930251379165","DOIUrl":"10.1177/17474930251379165","url":null,"abstract":"<p><strong>Background and objectives: </strong>We examined the timing of suicide after stroke, the sociodemographic factors associated with the risk of suicide, and whether major depression modified the stroke-suicide association.</p><p><strong>Methods: </strong>We conducted a population-based retrospective cohort study of all adults in Ontario hospitalized for stroke between January 1, 2008, and December 31, 2017, who were matched 1:1 to controls from the general Ontario population on age, sex, neighborhood-level income, rurality, and comorbidities. Suicide, a composite of deliberate self-harm or death by suicide, was ascertained based on hospitalizations and emergency department visits. Cause-specific hazard models were used to evaluate the association between stroke and suicide, and major depression was treated as a time-varying covariate. Cause-specific hazard models evaluated the association between sociodemographic factors and suicide in stroke survivors. The modifying effect of major depression was assessed by adding an interaction term between stroke and major depression.</p><p><strong>Results: </strong>We included 64,719 matched pairs of patients with stroke and general population controls (45.4% female, mean age 71.4 years). In the 627,774 person-years follow-up, 436 cases and controls had an episode of self-harm or died by suicide, with 203 (67.4%) events in stroke survivors occurring after the first year. Compared to matched controls, stroke survivors had a higher rate of suicide (11.1 vs 3.2 per 10,000 person-years, hazard ratio (HR) 2.87; 2.35-3.51). The association between stroke and suicide did not vary by the presence of major depression (P_{stroke*depression} = 0.51). Suicide rates were elevated in younger stroke survivors (HR_{18-40 vs} _⩾ _{80 years} 4.34; 2.48-7.61), those living in low-income neighborhoods (HR_{lowest vs highest quintile} 1.88; 1.30-2.70), and those with major depression (HR 12.3; 7.63-19.7).</p><p><strong>Discussion: </strong>The elevated rate of suicide after stroke persists beyond one year, highlighting the need for long-term screening for suicidality, especially in younger stroke survivors and those residing in low-income neighborhoods and with major depression after stroke.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251379165"},"PeriodicalIF":8.7,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006167","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":"Detecting acute ischemic lesions using mobile, low-field MRI in TIA and minor stroke in the emergency room.","authors":"Yue Suo, Wanliang Du, Xuewei Xie, Qianmei Jiang, Zhe Zhang, Yuyuan Xu, Ning Wei, Wanlin Zhu, Nan Qi, Ning Wang, Bingshan Xue, Yihuai Wang, Yong Jiang, Xia Meng, Zixiao Li, Xingquan Zhao, Hao Li, Yongjun Wang, Jing Jing","doi":"10.1177/17474930251378850","DOIUrl":"10.1177/17474930251378850","url":null,"abstract":"<p><strong>Background: </strong>Using mobile low-field magnetic resonance imaging (MRI) in the emergency department to detect cerebral infarction(s) in patients with minor ischemic stroke (MIS) and transient ischemic attack (TIA) has not yet been thoroughly reported.</p><p><strong>Aim: </strong>We aimed to evaluate the performance of mobile low-field (0.23T) MRI in detecting acute ischemic infarction in MIS or TIA patients within 72 h of symptom onset and compare it to computed tomography (CT) in those scanned within 24 h. We also aimed to analyze predictors of DWI-positive lesions on mobile MRI.</p><p><strong>Methods: </strong>This prospective observational cohort consecutively included patients with MIS (National Institutes of Health Stroke Scale (NIHSS) ⩽ 5) or TIA who underwent mobile low-field MRI within 72 h of symptom onset in the emergency department of a tertiary general hospital. The MRI protocol included localizer, axial T1-weighted fluid-attenuated inversion recovery (FLAIR), axial T2-weighted FLAIR, axial T2-weighted fast spin-echo, hematoma-enhanced inversion recovery (HEIR), and diffusion-weighted imaging (DWI) with apparent diffusion coefficient sequences. The total acquisition time is 10 min 28 s. Two raters, blinded to clinical information and CT findings, interpreted the MRI images for acute infarction. Multivariable logistic regression identified predictors of DWI positivity. The primary outcome was restricted diffusion (acute infarction) on the brain low-field MRI scan. We analyzed patients who underwent head CT scan within 24 h of low-field MRI to compare the detection rates of acute infarction between low-field MRI and head CT.</p><p><strong>Results: </strong>A total of 974 patients (564 men and 410 women; mean (standard deviation, SD) age, 61.3 (14.9) were enrolled. New ischemic lesions were detected by low-field MRI on the DWI sequence in 37.4% (338 in 974) of patients. Among them, 304 underwent head CT within 24 h of the low-field MRI scan; CT identified new ischemic lesions in only 122 (40.1%) of these. Higher NIHSS score (hazard ratio, 1.36 (95% confidence interval (CI), 1.21-1.54); <i>p</i> < 0.01), longer onset to imaging time (hazard ratio, 1.33 (95% CI, 1.10-1.63); <i>p</i> < 0.01), aphasia (hazard ratio, 2.24 (95% CI, 1.36-3.71); <i>p</i> < 0.01), and hemiplegia (hazard ratio, 2.50 (95% CI, 1.76-3.55); <i>p</i> < 0.01) were independently associated with DWI positivity on mobile low-field MRI. Female sex (hazard ratio, 0.57 (95% CI, 0.42-0.79); <i>p</i> < 0.01) and non-focal symptoms were negatively associated with DWI positivity.</p><p><strong>Conclusion: </strong>Mobile low-field MRI provides a safe, efficient, and accessible imaging solution for MIS and TIA evaluation in emergency settings and detects more acute infarctions than non-contrast head CT. Higher NIHSS score, longer onset to imaging time and focal clinical features were independently associated with DWI positivity.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251378850"},"PeriodicalIF":8.7,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992600","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":"Young adults with ischemic stroke in Argentina: A national multicenter retrospective registry analysis (JACARANDA).","authors":"Fabio Gonzalez, Juan I López, Flavia Tamagnini, Pablo Bonardo, Norberto Cotti, Agustina Zavattieri, Luciana Carobolante, Carlos A Arias, Maria V Acosta, Natalia Balian, Marianela L Armaretti, Ignacio A Mena, Leonardo Gonzalez, Sandra Lepera, Santiago Claverie, Tomas D Monclá, Brain C Ureña, Patricio I Apaza, Nicole Farcy, Carolina Kerz, Adriana Luraschi, Eric Ludvik, Ignacio S Padilla, Santiago F Rea, Guillermo Bizantino, Gustavo Da Prat, Camila Antelo, Gustavo Domeniconi, Andrea Ávila, Cecilia Ferreyra, Maria L Espinosa, Luciano Cristani, Sol Lazzaneo, Marcelo Chaves, Ivana Bergagna, Priscila Galliussi, Ana Diego, Santiago Pigretti, Jorgelina Guyon, Gabriela Orzuza, Erika Torres, Alfredo Palavecino, Guadalupe Bruera, Pablo Lammertyn, Juan Jairala, Clarisa Cea, Camila Firpo, Yobana Lazarte, Sandra Mosconi, Diego Tapia, Jeronimo Cossio, Julio Fernández, María S Fernández, Gabriel Persi, Guido De Paul, Marlom H Apaza, Pilar S de Paz, Maria Caballero, Juan Cirio, Julieta Rosales, Matias Lopez, Manuel Chasco, Josefina Barber-Otero, Matias J Alet","doi":"10.1177/17474930251378281","DOIUrl":"10.1177/17474930251378281","url":null,"abstract":"<p><strong>Background: </strong>Young adults account for up to 15% of all ischemic strokes, yet data from Latin America remain scarce. Understanding their clinical profile and outcomes is essential to inform targeted interventions and public health strategies. We aimed to characterize demographics, vascular risk factors, stroke etiology, access to acute reperfusion therapies, and 90-day outcomes in Argentine patients aged 18-50 years with ischemic stroke.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter cohort study including consecutive patients aged 18-50 years with ischemic stroke, enrolled between January 2015 and December 2023 across 26 centers in Argentina. Primary outcomes were functional dependence (modified Rankin scale (mRS) 3-5), stroke recurrence, and all-cause mortality at 90 days.</p><p><strong>Results: </strong>Among 18,934 ischemic stroke patients, 1422 (7.5%) were young adults. Median age was 43 years (interquartile range (IQR) 36-47), and 53.7% (n = 763) were male. The most prevalent risk factors were hypertension (31.0% (n = 441)), smoking (29.3% (n = 417)), and obesity (18.8% (n = 267)). Median National Institute of Health Stroke Scale (NIHSS) on admission was 3 (IQR 1-8). Acute reperfusion therapy was administered in 18.9% (n = 269). Stroke etiology remained undetermined in 50.4% (n = 717) of cases; within this group, 26.1% (n = 312) fulfilled criteria for embolic stroke of undetermined source (ESUS), and 17.8% (n = 198) were cryptogenic strokes associated with patent foramen ovale. Arterial dissection accounted for 56.6% (n = 193) of other determined causes. At 90 days, functional dependence was observed in 12.1% (n = 110), stroke recurrence in 3.9% (n = 37), and mortality in 4.8% (n = 44).</p><p><strong>Conclusion: </strong>In Argentina, nearly 1 in 13 ischemic strokes occurs in young adults. Despite generally mild presentations, functional dependence and mortality remain substantial. The high rate of undetermined etiology underscores the need for standardized diagnostic protocols in this population, whose strokes carry a disproportionate individual and societal burden due to their early onset.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251378281"},"PeriodicalIF":8.7,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992666","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 World Stroke Organization future leaders program: Building leadership capacity in global stroke care.","authors":"Leonardo Augusto Carbonera, Ana Cláudia de Souza, Vasileios-Arsenios Lioutas, Jatinder S Minhas, Ivy Sebastian, Ahmed Nasreldein, Julia Shapranova, Hugh Markus, Christopher Chen, Werner Hacke, Valeria Caso","doi":"10.1177/17474930251378047","DOIUrl":"10.1177/17474930251378047","url":null,"abstract":"<p><strong>Background: </strong>Leadership development is essential to advancing stroke care globally. The World Stroke Organization (WSO) Future Stroke Leaders Program (FSLP) was established to identify and support global early-career professionals in stroke care worldwide. The program offers structured leadership training, mentorship, and seed funding for implementation projects. Selection criteria prioritize diversity, leadership potential, and institutional support. The article describes the design and implementation of the WSO FSLP and evaluates its contribution to stroke care advancement, professional development, and global collaboration.</p><p><strong>Methods: </strong>This is a descriptive narrative of the WSO FSLP, based on program documentation, participant surveys, and public databases. Programmatic key performance indicators (KPIs) aligned with WSO's strategic goals were used to track impact.</p><p><strong>Results: </strong>Among 56 participants in the first two cohorts, selected from over 35 countries, engagement with the WSO FSLP contributed to improved access to and delivery of care by developing stroke services in underserved areas, enhancing publication output, and supporting active involvement in international policy and advocacy efforts. Participants reported career advancement, increased research engagement, and expanded collaborative networks as a direct result of their participation in the program.</p><p><strong>Conclusions: </strong>The WSO FSLP is a model for developing global stroke leadership. Its impact spans clinical innovation, academic research, and policy influence, guiding implementation. Continued program adaptation to the changing international landscape, alumni engagement, and long-term impact evaluation will help sustain and scale worldwide contributions to stroke care equity.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251378047"},"PeriodicalIF":8.7,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954155","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":"Large-scale genetic study identifies shared genetic regions between cerebrovascular and neurodegenerative diseases.","authors":"Akhilesh Shailendra Khamkar, Smriti Jha, Ajay Kumar Bakhla, Ganesh Chauhan","doi":"10.1177/17474930251377513","DOIUrl":"10.1177/17474930251377513","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebrovascular diseases (CeVD) and neurodegenerative diseases (NDs) are two major neurological disorders, which are associated with increasing global morbidity and mortality. Population-based studies have indicated a complex link between CeVD and ND. However, the shared genetic etiology between these disease conditions remains less explored.</p><p><strong>Methods: </strong>We conducted genome-wide genetic correlation analysis and investigated the shared genetic architecture through pleiotropy analysis between ND and CeVD, like stroke and its subtypes, to understand shared genetic factors and biological mechanisms. Publicly available large-scale genome-wide association studies (GWAS) summary statistics data of cross-ancestry, European, and South Asian (SAS) ancestry were analyzed using methods implemented in the tools linkage disequilibrium score regression (LDSC), PLeiotropic Analysis under COmposite null hypothesis (PLACO), and Bayesian-based method of colocalization (COLOC).</p><p><strong>Results: </strong>We detected 116 shared genetic loci consisting of 770 lead pleiotropic single nucleotide polymorphisms (SNPs) (ND-CeVD P-range: 4.81×10^-8 to 4.57×10^-16) and 40 shared causal genetic regions (ND-CeVD PP.H4-range: 0.70-0.9, posterior probability of H4 (PP.H4) ⩾ 0.7) between multiple CeVD and ND pairs. The genetic regions near <i>ICA1L, HLA-DQA1, HLA-DRB1, MIR297, and PITX2</i> genes were identified as highly pleiotropic across multiple CeVD-ND pairs. We report <i>ERGIC1</i> (5q35.1) for the first time as a shared causal genetic locus between Amyotrophic Lateral Sclerosis and small vessel stroke. The genetic risk score of stroke derived from the SAS population of the GIGASTROKE study was associated with ND (P-range = 2.23×10^-28 to 0.02), despite a small sample size compared to other ethnic groups, indicating high penetrance.</p><p><strong>Conclusion: </strong>The shared genetic loci and pathway analysis in this study provide new genes and pathways shared between ND and CeVD, which may help in a better understanding of disease mechanisms in these neurological diseases.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251377513"},"PeriodicalIF":8.7,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954028","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}