International Journal of Stroke最新文献

{"title":"Intra-arterial Alteplase Thrombolysis After Successful Thrombectomy for Acute Ischemic Stroke in the Posterior Circulation (IAT-TOP): Study protocol and rationale.","authors":"Bin Yang, Xuesong Bai, Tingyu Yi, Haibo Wang, Yifeng Liu, Lin Ma, Sheng Liu, Shaoguang Wu, Liyong Zhang, Ya Peng, Raul G Nogueira, Wenhuo Chen, Liqun Jiao","doi":"10.1177/17474930251313940","DOIUrl":"10.1177/17474930251313940","url":null,"abstract":"<p><strong>Rationale: </strong>The Chemical Optimization of Cerebral Embolectomy (CHOICE) trial suggested that the administration of intra-arterial alteplase after successful endovascular thrombectomy (EVT) may improve neurological outcomes in patients with acute ischemic stroke due to large-vessel occlusion (AIS-LVO) in the anterior circulation. However, the use of adjunctive intra-arterial alteplase following successful EVT in acute posterior circulation stroke remains unexplored.</p><p><strong>Aims: </strong>This study aims to investigate the efficacy and safety of intra-arterial alteplase after successful EVT for AIS-LVO in the posterior circulation.</p><p><strong>Sample size: </strong>To detect an estimated 15% difference in the primary outcome between the two groups, a total of 376 patients will be enrolled. This sample size allows for 80% power and a 5% significance level, with an interim analysis planned after half of the sample (188 patients) has completed a 90-day follow-up.</p><p><strong>Methods and design: </strong>The Intra-arterial Alteplase Thrombolysis After Successful Thrombectomy for Acute Ischemic Stroke in the Posterior Circulation (IAT-TOP) trial is a multicenter, prospective, randomized clinical trial using an open-label treatment design with blinded endpoint assessment (PROBE) conducted in China. Patients with acute basilar artery occlusion will be randomly assigned in a 1:1 ratio to receive either intra-arterial alteplase (0.225 mg/kg; maximum dose, 22.5 mg) or standard care following successful thrombectomy (defined as expanded thrombolysis in cerebral infarction [eTICI] ⩾ 2b50).</p><p><strong>Study outcomes: </strong>The primary outcome is the modified Rankin Scale (mRS) score of 0-2 at 90 days. Key secondary outcomes include changes in eTICI scores after intra-arterial thrombolysis (in the experimental group), mRS 0-3 at 90 days, ordinal shift analysis of mRS at 90 days, early neurological improvement at 48 h, and improvement in National Institutes of Health Stroke Scale (NIHSS) scores at 48 h and 7 days or discharge. Safety outcomes include symptomatic intracranial hemorrhage (sICH) rates at 48 h, 90-day mortality, non-intracranial hemorrhagic complications, and non-hemorrhagic serious adverse events.</p><p><strong>Discussion: </strong>The IAT-TOP trial will provide crucial evidence regarding the potential benefits of adjunctive intra-arterial alteplase in patients with AIS-LVO in the posterior circulation following successful thrombectomy.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05897554.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251313940"},"PeriodicalIF":6.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and risk factors of covert brain infarction: A community-based cross-sectional study.","authors":"Ruinan Zhang, Dongxiao Yao, Xueli Cai, Yanli Zhang, Yingying Yang, Shan Li, Jing Jing, Suying Wang, Yongjun Wang, Yuesong Pan, Yilong Wang","doi":"10.1177/17474930241313435","DOIUrl":"10.1177/17474930241313435","url":null,"abstract":"<p><strong>Background: </strong>Covert brain infarction (CBI) is common and poses a potential and non-negligible burden of disease worldwide. The prevalence and risk factors for CBI have been reported inconsistently in previous studies.</p><p><strong>Aims: </strong>This study aims to ascertain the prevalence and risk factors of CBI and its imaging phenotypes in community-dwelling adults.</p><p><strong>Methods: </strong>The study population was derived from the baseline survey of a population-based cohort from the Polyvascular Evaluation for Cognitive Impairment and Vascular Events study, involving adults aged 50-75 years from Lishui City, Southeast China. The 3.0T magnetic resonance imaging (MRI) was performed to access CBI and detect intracranial and extracranial vascular lesions. The prevalence rates of CBI and three imaging phenotypes were stratified separately by age, sex, atherosclerotic burden, and artery stenosis. The intracranial and extracranial atherosclerotic burden was graded by summing atherosclerosis scores. Multivariable logistic regression with a stepwise selection method was used to identify independent CBI risk factors.</p><p><strong>Results: </strong>A total of 2947 participants (mean age of 61.1 ± 6.6 years, 53.8% women) were included. CBI prevalence among study subjects was 9.6%, and the most common subtype was other chronic infarction (5.6%), followed by cavitatory lesions (4.6%) and acute cerebral infarction (0.5%). In multivariable analysis, older age (odds ratio (OR): 1.59, 95% confidence interval (CI): 1.40-1.83), hypertension (OR: 1.45, 95% CI: 1.08-1.94), higher levels of low-density lipoprotein cholesterol (LDL-C) (OR: 1.17, 95% CI: 1.04-1.32), homocysteine (OR: 1.12, 95% CI: 1.01-1.23) and diastolic blood pressure (DBP) (OR: 1.22, 95% CI: 1.06-1.41), intracranial artery plaque (OR: 1.56, 95% CI: 1.16-2.10), and severe extracranial atherosclerotic burden (OR: 6.57, 95% CI: 1.67-25.79) were associated with a higher CBI odds. There is a linear relationship between age, DBP, LDL-C, and CBI odds, while homocysteine shows a nonlinear relevancy. Age, DBP, homocysteine, and LDL-C elevation increase CBI risk.</p><p><strong>Conclusion: </strong>CBI prevalence in this Chinese community-based population was not low. Age, hypertension, intracranial artery plaque, extracranial atherosclerotic burden, homocysteine, LDL-C, and DBP were found to be the risk factors of CBI.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241313435"},"PeriodicalIF":6.3,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914577","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":"Geo-spatial analysis of acute ischemic stroke reperfusion treatment in India: An assessment of distribution and access to centers.","authors":"Kaiz S Asif, Arun Mitra, Santiago Ortega-Gutierrez, Nabeel Herial, Shashvat Desai, Ashutosh Jadhav, Fawaz Al-Mufti, Adrija Roy, Romil Singh, Grant Brown, Amrou Sarraj, Arun Jose, Anand Alurkar, A P Karapurkar, Arvind Sharma, Vipul Gupta, Gaurav Goel, Dheeraj Khurana, Biplab Das, Jayanta Roy, Deep Das, Rahul Kumar, Gigy Kuruttukulam, Pradeep Kumar Vg, Mv Padma Srivastava, Jeyaraj Pandian, Vikram Huded, Dileep Yavagal, Biju Soman, P N Sylaja","doi":"10.1177/17474930241312598","DOIUrl":"10.1177/17474930241312598","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a leading cause of global mortality and disability, with a disproportionately high burden in low- and middle-income countries. Access to intravenous thrombolysis (IVT) and endovascular treatment (EVT) remains extremely limited.</p><p><strong>Aims: </strong>We evaluated the spatial distribution and geographic accessibility of stroke centers in India.</p><p><strong>Methods: </strong>Data on IVT capable (IVT-C) and EVT capable (EVT-C) stroke centers were collected in March 2021 from thrombectomy devices and pharmaceutical industry providers, respectively. Data were collated and geocoded to compare and calculate zonal statistics and state/union territory (UT) summaries using descriptive statistics. Data on population centers were obtained from the Survey of India website. For estimating driving times, we used the Google Distance Matrix API to find the driving distance between each population center and its nearest stroke facility. Subsequently, population coverages were estimated as a proportion of the population having access to stroke centers for each time interval and based on the population projection for the year 2020 and compared across states.</p><p><strong>Results: </strong>A total of 566 IVT-C stroke centers were spread across 26 states and UTs, of which 361 (63%) were EVT-C. Ten UTs lacked stroke centers. The average stroke centers per million (SCPM) population was 0.41 and 0.26 for IVT-C and EVT-C, respectively. Median distances to the nearest IVT-C and EVT-C centers were 115 km (interquartile range (IQR): 66-175) and 131 km (IQR: 79-198), respectively. Access within 1 h to an IVT-C and an EVT-C center was available to 26.3% and 20.6% of the Indian population, respectively.</p><p><strong>Conclusions: </strong>Access to stroke care in India is poor, with critical regional disparities as reflected by the low SCPM population, long driving times, and a small population with access within the golden hour. There is an urgent need to establish IVT-C and EVT-C stroke centers in the existing poorly served regions of India to increase access and improve outcomes for stroke patients.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241312598"},"PeriodicalIF":6.3,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885770","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":"Fluoxetine and fractures after stroke: an individual patient data meta-analysis of three large randomised controlled trials of fluoxetine for stroke recovery.","authors":"Gillian Elizabeth Mead, Catriona Graham, Erik Lundström, Graeme J Hankey, Maree L Hackett, Laurent Billot, Per Näsman, John Forbes, Martin Dennis","doi":"10.1177/17474930251316164","DOIUrl":"https://doi.org/10.1177/17474930251316164","url":null,"abstract":"<p><strong>Background: </strong>Observational studies have shown that selective serotonin reuptake inhibitors are associated with an increased risk of bone fractures, but the association can be confounded by indication and other sources of systematic bias that can be minimised in randomised controlled trials (RCTs).</p><p><strong>Aim: </strong>Our aim was to report the rate, site, context, and predictors of fractures after stroke, and whether the fractures modified the effect of fluoxetine on modified Rankin score (mRS) at six months in an individual patient data meta-analysis of 5907 patients enrolled in three RCTs of fluoxetine (20mg for six months) for stroke recovery.</p><p><strong>Methods: </strong>We classified fractures by treatment allocation, site (and thus likelihood of osteoporosis) and context, then performed multivariable analyses to explore independent predictors of fractures. We explored whether the trend towards a poorer mRS at 6 months was explained by a fracture excess. Risk of bias was assessed using GRADE.</p><p><strong>Results: </strong>Among 5907 patients randomised at a mean of 6.6 days (SD3.6) post-stroke onset and followed for six months, the number with fractures at 6 months was 93 (3.15%) in the fluoxetine group vs 41 (1.39%) in the control group (difference 1.76%, 95% CI 0.10 to 2.51%). 128 patients with fractures were suitable for further analyses. Of these 102 (80%) were in sites typically affected by osteoporosis; 115 (90%) were associated with falls and one (1%) with a seizure. Independent fracture risk factors were female sex (hazard ratio (HR) 1.96; 95% CI 1.37 to 2.81, p=0.0002), age>70 years (HR 2.30, 95% CI 1.52 to 3.49, p<0.001), previous fractures (HR 0.63 for no previous fractures, 95% CI 0.42 to 0.94, p=0.0227), and randomised treatment (fluoxetine) (HR 2.39; 95% CI 1.64 to 3.49, p<0.001). The common odds ratio for the effect of fluoxetine on mRS at 6 months was unchanged after excluding fracture patients. Risk of bias was high for imprecision.</p><p><strong>Conclusion: </strong>Fractures were more common in the fluoxetine group but the absolute risk of fractures was small and risk estimates were imprecise. Most fractures occurred with a fall, and in osteoporotic locations. Fractures did not modify the effect of fluoxetine on functional outcome.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251316164"},"PeriodicalIF":6.3,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between alcohol consumption and stroke in Nigeria and Ghana: A case-control study.","authors":"Innocent Ijezie Chukwuonye, Onoja Matthew Akpa, Osahon Jeffery Asowata, Adekunle Gregory Fakunle, Morenikeji A Komolafe, Joshua Akinyemi, Fred Stephen Sarfo, Albert Akpalu, Kolawole Wahab, Reginald Obiako, Lukman Owolabi, Godwin O Osaigbovo, Akinkunmi Paul Okekunle, Okechukwu Ogah, Hemant K Tiwari, Carolyn Jekins, Fawale B Michael, Donna Arnett, Benedict Calys-Tagoe, Abimbola Olalere, Oladimeji Adebayo, Wisdom Oguike, Philip Adebayo, Oyedunni Arulogun, Lambert Appiah, Philip O Ibinaiye, Sunday Adeniyi, Oladotun Olalusi, Olayemi Balogun, Rufus Akinyemi, Bruce Ovbiagele, Mayowa Ojo Owolabi","doi":"10.1177/17474930241308458","DOIUrl":"10.1177/17474930241308458","url":null,"abstract":"<p><strong>Background: </strong>The aim of the study was to examine the association between alcohol consumption and stroke in Nigeria and Ghana.</p><p><strong>Methods: </strong>The study is a multicentre, case-control study. Cases included consenting adults 18 years of age and older with acute stroke and controls were age-and -gender -matched stroke -free adults. Alcohol consumption was self-reported. The participants were classified into three alcohol-drinking status, which included abstainers, former drinkers, and current drinkers. The current drinkers were further classified into different alcohol drinking levels, including infrequent, light, moderate, heavy, and binge drinkers. Conditional logistic regression was used to determine associations between the drinking status and stroke, and the association between the different levels of current alcohol consumption and stroke. Five models were evaluated. Model 1 was unadjusted. Model 2 was adjusted for demographic characteristics. Model 3 included Model 2, lifestyle and psychosocial characteristics. Model 4 included Model 3 and dietary characteristics. Model 5 included Model 4 and metabolic characteristics.</p><p><strong>Results: </strong>A total of 7368 participants took part in the study. Half were stroke participants, and half were control participants. On the associations between drinking status and stroke, respectively, former drinkers showed no significant association with stroke. However, a significant association was observed between current drinkers and stroke in Models 1 and 2, with an odds ratio of 1.19 (95% CI: 1.04-1.38; p < 0.05) and 1.17 (95% CI: 1.01-1.36; p < 0.05), respectively. Regarding the various levels of current alcohol drinking and their association with stroke, no significant association was observed between light drinking and stroke in Model 5. In contrast, moderate drinkers, binge drinkers, and heavy drinkers showed a persistent and significant association with stroke respectively.</p><p><strong>Conclusion: </strong>There is a significant association between stroke and current alcohol consumption, especially among heavy, binge, and moderate drinkers.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241308458"},"PeriodicalIF":6.3,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the Black-&-White sign to predict intracerebral hematoma expansion in the multi-center PREDICT study cohort.","authors":"Umberto Pensato, Koji Tanaka, Johanna M Ospel, Richard I Aviv, David Rodriguez-Luna, Micheal D Hill, Carlos A Molina, Yolanda Silva Blas, Jean-Martin Boulanger, Gubitz Gord, Rohit Bhatia, Vasantha Padma, Jayanta Roy, Imanuel Dzialowski, Carlos S Kase, Adam Kobayashi, Dar Dowlatshahi, Andrew M Demchuk","doi":"10.1177/17474930241307466","DOIUrl":"10.1177/17474930241307466","url":null,"abstract":"<p><strong>Background: </strong>Hematoma expansion (HE) occurs in one-fourth to one-third of patients with acute intracerebral hemorrhage (ICH) and is associated with worse outcomes. The co-localization of non-contrast computed tomography (NCCT) hypodensity and computed tomography angiography (CTA) spot sign, the so-called Black-&-White (B&W) sign, has been shown to have high predictive accuracy for HE in a single-center cohort. In this analysis, we aimed to validate the predictive accuracy of the B&W sign for HE in a multicenter cohort.</p><p><strong>Methods: </strong>Acute ICH patients from the multicenter, observational PREDICT study (Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT) were included. Outcomes included HE (⩾6 mL or ⩾33%) and severe HE (⩾12.5 mL or >66%). The association between B&W sign and outcomes was assessed with multivariable regression analyses adjusted for baseline factors.</p><p><strong>Results: </strong>Three hundred four patients were included, with 106 (34.9%) showing HE. The spot sign was present in 76 (25%) patients, the hypodensity sign in 119 (39.1%), and the B&W sign in 29 (9.5%). In the stratum with positive spot signs, patients with B&W signs experienced more frequent HE (79.3% vs 46.8%, p = 0.008), hematoma absolute growth (19.1 mL (interquartile range (IQR) = 6.4-40) vs 3.2 mL (IQR= 0-23.3), p = 0.018), and hematoma relative growth (92% (IQR = 16-151%) vs 24% (IQR= 0-69%), p = 0.038). There was a strong association between B&W sign and HE (adjusted odds ratio (OR) = 7.83 (95% confidence interval (CI) = 2.93-20.91)) and severe HE (adjusted OR = 5.67 (95% CI = 2.41-13.36)). The B&W sign yielded a positive predictive value of 79.3% (IQR = 61.7-90.1) for HE. Inter-rater agreement was moderate (k = 0.54).</p><p><strong>Conclusion: </strong>The B&W sign is associated with an increased likelihood of HE and severe HE by approximately eightfold and fivefold, respectively.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241307466"},"PeriodicalIF":6.3,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should we switch to tenecteplase for all ischemic strokes? Evidence and logistics.","authors":"Keith W Muir","doi":"10.1177/17474930241307098","DOIUrl":"10.1177/17474930241307098","url":null,"abstract":"<p><p>Recent clinical trials provide robust evidence of non-inferiority of tenecteplase 0.25 mg/kg over alteplase 0.9 mg/kg in acute ischemic stroke treated within 4.5 h of time last known well. Aggregate data meta-analysis suggests likely superiority of tenecteplase with respect to excellent (modified Rankin Scale 0 or 1) outcomes at 90 days. Less complex single intravenous bolus administration of tenecteplase brings significant logistical benefits compared to alteplase. Real-world implementation data demonstrate reduced door-to-needle and door-to-puncture times, and potentially improved clinical outcomes. Avoiding the need for infusion pumps and monitoring reduces resource requirements and facilitates inter-hospital transfer. Guidelines favor tenecteplase over alteplase due to its logistical advantages. Transitioning services to tenecteplase requires consideration of education and training for all relevant staff (medical, nursing, pharmacy) and should address physician concerns. Use of stroke-specific tenecteplase 25 mg dose vials is strongly preferable to minimize the chance of dosing errors that might arise from use of cardiac-dose tenecteplase. Some off-label uses of alteplase are supported by positive randomized controlled trial data (wake-up and unknown onset stroke, and imaging-supported late window use 4.5-9 h after onset) while equivalent data for tenecteplase are less conclusive. Trial data comparing tenecteplase to control give relevant safety data for both wake-up / unknown onset stroke and for late time windows, and some efficacy data favor tenecteplase in a late time window. Given the weight of evidence for biologically similar efficacy and safety of tenecteplase 0.25 mg/kg, and potential for dosing errors, retention of alteplase for off-label indications should not be recommended.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241307098"},"PeriodicalIF":6.3,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755000","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":"Indian Trial of Tranexamic acid in Spontaneous Intracerebral Hemorrhage study protocol.","authors":"Jeyaraj Durai Pandian, Atul Phillips, Shweta Jain Verma, Deepti Arora, Aneesh Dhasan, Pheba S Raju, P N Sylaja, Biman Kanti Ray, Uddalak Chakraborty, Jacob Johnson, Praveen Kumar Sharma, Sanjeev Bhoi, Menka Jha, Thomas Iype, Chithra P, Dheeraj Khurana, Sucharita Ray, Dwijen Das, Naurima Kalita, Sweekriti Adhikari, Ashish Sharma, Jayanta Roy, Rajeshwar Sahonta, Sulena Singh, Vikram Chaudhary, Girish Menon, Sanjith Aaron, Deepti Bal, Rajinder K Dhamija, Monali Chaturvedi, Siddarth Maheshwari, Aralikatte Onkarappa Saroja, Karkal R Naik, Neeraj Bhutani, Kailash Dhankhar, Dinesh Sharma, Rohit Bhatia, Sankar Prasad Gorthi, Binod Sarmah, Vijaya Pamidimukkala, Sankaralingam Saravanan, Sunil Narayan, Lakshya J Basumatary, Nagarjunakonda V Sundarachary, Aruna K Upputuri, Ummer Karadan, V G Pradeep Kumar, Rajsrinivas Parthasarathy, Darshan Doshi, Satish Wagh, Tcr Ramakrishnan, Saleem Akhtar, Soaham Desai, N C Borah, Rupjyoti Das, Gaurav Mittal, Agam Jain, Paul J Alapatt, Girish Baburao Kulkarni, Deepak Menon, Pritam Raja, Inder Puri, Vivek Nambiar, Muralidhar Reddy Yerasu, Shyam K Jaiswal, Kapil Zirpe, Sushma Gurav, Sudheer Sharma, S Kumaravelu, Rajesh Benny, Vicky Thakkar, Abhishek Pathak, Madhusudhan Kempegowda, Praveen Chander, Neetu Ramrakhiani, Arya Devi Ks, P Sankara Sarma, Rahul Huilgol, Meenakshi Sharma, Rupinder S Dhaliwal","doi":"10.1177/17474930241307933","DOIUrl":"10.1177/17474930241307933","url":null,"abstract":"<p><strong>Rationale: </strong>Early mortality in intracerebral hemorrhage (ICH) is due to hematoma volume (HV) expansion, and there are no effective treatments available other than reduction in blood pressure. Tranexamic acid (TXA) a hemostatic drug that is widely available and safe can be a cost-effective treatment for ICH, if proven efficacious.</p><p><strong>Hypothesis: </strong>Administration of TXA in ICH patients when given within 4.5 h of symptom onset will reduce early mortality at 30 days.</p><p><strong>Design: </strong>Indian Trial of Tranexamic acid in Spontaneous Intracerebral Haemorrhage (INTRINSIC trial) is a multicenter, randomized, open-label, trial enrolling patients aged more than 18 years presenting with non-traumatic ICH within 4.5 h of symptom onset or when last seen well. Study participants received 2 g of TXA administered within 45 min while control group received standard of care. Intensive blood pressure reduction as per INTERACT 2 protocol is followed is done in both groups. Study plans to recruit 3400 patients. Primary outcome is mortality at day 30. Secondary outcomes are radiological reduction in HV at 24 h from baseline, neurological impairment at day 7 or earlier (if discharged), and assessments of dependency and quality of life at day 90.</p><p><strong>Summary: </strong>If proven to be beneficial, TXA will have a major impact on medical management of ICH.</p><p><strong>Trial registration: </strong>Clinical Trial Registry India (CTRI/2023/03/050224) and Clinical Trials.gov (NCT05836831).</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241307933"},"PeriodicalIF":6.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780284","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":"White matter hyperintensities are independently associated with systemic vascular aging and cerebrovascular dysfunction.","authors":"Alastair Js Webb, Karolina Feakins, Amy Lawson, Catriona Stewart, James Thomas, Osian Llwyd","doi":"10.1177/17474930241306987","DOIUrl":"10.1177/17474930241306987","url":null,"abstract":"<p><strong>Background: </strong>In the Oxford Haemodynamic Adaptation to Reduce Pulsatility trial (OxHARP), sildenafil increased cerebrovascular reactivity but did not reduce cerebral pulsatility, a marker of vascular aging. This analysis of OxHARP tested whether these potentially causative mechanisms were independently associated with the severity of white matter hyperintensities (WMHs).</p><p><strong>Aims: </strong>The aims were to determine independence of the relationship between severity of WMHs with both cerebral pulsatility and cerebrovascular reactivity in the same population.</p><p><strong>Methods: </strong>OxHARP was a double-blind, randomized, placebo-controlled, crossover trial of phosphodiesterase inhibitors in patients with mild-to-moderate WMH and previous minor cerebrovascular events. It determined effects on cerebrovascular pulsatility and reactivity on transcranial ultrasound and reactivity on magnetic resonance imaging (MRI). Associations were determined between baseline ultrasound measures, and averaged MRI measures across follow-up, with the severity of WMH on clinical imaging (Fazekas or modified Blennow scores) and WMH volume in the MRI substudy, by ordinal and linear regression.</p><p><strong>Results: </strong>In 75/75 patients (median 70 years, 78% male), cerebral pulsatility was associated with age (p < 0.001) whereas reactivity on ultrasound was not (p = 0.29). Severity of WMH in all participants was independently associated with decreased cerebrovascular reactivity and increased cerebral pulsatility (pulsatility p = 0.016; reactivity p = 0.03), with a trend to a synergistic interaction (p = 0.075). Reactivity on ultrasound was still associated with WMH after further adjustment for age (p = 0.017), but pulsatility was not (p = 0.31). Volume of WMH in the MRI substudy was also independently associated with both markers on ultrasound (pulsatility p = 0.005; reactivity p = 0.029) and was associated with reduced cerebrovascular reactivity within WMH on MRI (p < 0.0001).</p><p><strong>Conclusion: </strong>WMHs are independently associated with cerebral pulsatility and reactivity, representing complementary potential disease mechanisms and treatment targets.</p><p><strong>Trial registration: </strong>clinicaltrials.org: https://classic.clinicaltrials.gov/ct2/show/NCT03855332.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241306987"},"PeriodicalIF":6.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of poor outcome in acute stroke patients with posterior cerebral artery occlusion and medical management.","authors":"Candice Sabben, Frédérique Charbonneau, Michael Obadia, Davide Strambo, Elodie Ong, Mirjam R Heldner, Hilde Henon, Adrien Ter Schiphorst, Loïc Legris, Thomas Agasse-Lafont, Denis Sablot, Nour Nehme, Igor Sibon, Aude Triquenot-Bagan, Valérie Wolff, Cécile Preterre, Charlotte Rosso, Gioia Mione, Roxana Poll, Jérémie Papassin, Andreea Aignatoaie, David Weisenburger Lile, Yannick Béjot, Solène Moulin, Emmanuel Carrera, Pierre Garnier, Patrik Michel, Pasquale Mordasini, Gregory W Albers, Guillaume Turc, Mikael Mazighi, Pierre Seners","doi":"10.1177/17474930241309533","DOIUrl":"10.1177/17474930241309533","url":null,"abstract":"<p><strong>Background and aims: </strong>The clinical evolution of acute ischemic stroke patients with isolated proximal posterior cerebral artery (PCA) occlusion treated with medical management alone has been poorly described. We aimed to determine the clinical and radiological factors associated with poor functional outcome in this population.</p><p><strong>Methods: </strong>We conducted a multicenter international retrospective study of consecutive stroke patients with isolated occlusion of the first (P1) or second (P2) segment of PCA admitted within 6 h from symptoms onset in 26 stroke centers in France, Switzerland, and the United States, treated with the best medical management alone. Poor functional outcome was defined as a modified Rankin scale (mRS) ⩾2 at 3 months or no return to pre-stroke mRS. The associations between pretreatment variables and poor outcome were studied in univariable and then multivariable analyses, as well as the association between poor outcome and key follow-up radiological variables.</p><p><strong>Results: </strong>Overall, 585 patients were included. The median age was 74 years (interquartile range (IQR) = 63-83), median National Institutes of Health Stroke Scale (NIHSS) was 6 (3-10), 80% received intravenous thrombolysis (IVT), and 22% and 78% had P1 and P2 occlusions, respectively. Poor outcome occurred in 56% of patients. In multivariable analysis focusing on pretreatment variables, age (adjusted odds ratio (OR) = 1.12 per 5-year increase [95% confidence interval (CI) = 1.05-1.20]; <i>p</i> = 0.001), NIHSS score (aOR = 1.12 per each point increase [1.08-1.18]; <i>p</i> < 0.001), infarct volume (aOR = 1.16 per 5 mL increase [1.07-1.25]; <i>p</i> < 0.001), and the lack of IVT use (aOR = 1.79 [1.10-2.94], <i>p</i> = 0.020) were independently associated with poor outcome. Regarding 24-h follow-up radiological variables, complete recanalization (defined as no clot in the vascular tree at or beyond the primary occlusive lesion, aOR = 0.37 [95% CI = 0.21-0.65], <i>p</i> < 0.001) and parenchymal hematoma occurrence (aOR = 2.37 [95% CI = 1.01-5.56], <i>p</i> = 0.048) were independently associated with poor 3-month outcome.</p><p><strong>Conclusions: </strong>Poor outcome occurred in more than half of medically treated PCA-related acute stroke patients. Facilitating IVT use may improve functional outcome. Therapeutic approaches aimed at enhancing recanalization and reducing hemorrhagic transformation need to be studied in clinical trials.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241309533"},"PeriodicalIF":6.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}