International Journal of Stroke最新文献

{"title":"Associations between fluid-attenuated inversion recovery vessel hyperintensities and Alberta stroke program early CT score and clinical outcomes in stroke patients with unknown time of onset: A sub-analysis from a randomized controlled trial.","authors":"Manabu Inoue, Naruhiko Kamogawa, Masatoshi Koga, Sohei Yoshimura, Mayumi Fukuda-Doi, Kaori Miwa, Makoto Sasaki, Junya Aoki, Kazumi Kimura, Masafumi Ihara, Kazunori Toyoda","doi":"10.1177/17474930251377522","DOIUrl":"10.1177/17474930251377522","url":null,"abstract":"<p><strong>Background and aims: </strong>FLAIR vessel hyperintensities (FVH)-Alberta Stroke Program Early CT Score (ASPECTS) is an imaging marker but its clinical implications remain unclear. We estimated the correlation between FVH-ASPECTS and clinical outcomes in patients with wake-up stroke or unknown time of stroke onset.</p><p><strong>Methods: </strong>The THrombolysis for Acute Wake-up and Unclear-onset Strokes with Alteplase at 0.6 mg/kg (THAWS) trial was a multicenter, randomized controlled trial conducted at 40 sites in Japan between 2014 and 2018. Patients with unknown stroke onset and diffusion-weighted imaging (DWI)-FLAIR mismatch were randomly assigned to receive either intravenous alteplase (0.6 mg/kg) or standard medical treatment. FVH-ASPECTS, a semiquantitative scoring system assessing FVH prominence in the seven cortical ASPECTS regions, was evaluated for its association with favorable outcomes (modified Rankin Scale 0-2 at 90 days). The optimal FVH-ASPECTS threshold was determined using receiver operating characteristic (ROC) analysis and its correlation with favorable outcomes was assessed.</p><p><strong>Results: </strong>Among 131 patients (mean age, 76 ± 13 years; 42% women), 71 received alteplase and 60 did not. Median NIHSS score was 7 (interquartile range [IQR] 4-13), and median FVH-ASPECTS was 4 (IQR 2-4). ROC analysis identified FVH-ASPECTS 3 or more as predictive of favorable outcomes (sensitivity 80%, specificity 51%, area under the ROC curve [AUC] 0.717). A significant correlation was observed between FVH-ASPECTS 3 or more and favorable outcomes (adjusted odds ratio [OR] 4.50, 95% confidence interval [CI] 1.89-10.75; p < 0.001).</p><p><strong>Conclusion: </strong>FVH-ASPECTS could offer an indicator for achieving favorable clinical outcomes among stroke patients with unknown time of onset, with a threshold of 3 or more.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251377522"},"PeriodicalIF":8.7,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954353","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 association between rheumatoid arthritis and stroke risk by serologic status and stroke subtypes.","authors":"Alicia Shin, Seonyoung Kang, Jinhyung Jung, In Young Cho, Kyungdo Han, Seonghye Kim, Se Yun Kim, Dong Wook Shin, Hyungjin Kim","doi":"10.1177/17474930251377174","DOIUrl":"10.1177/17474930251377174","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) has been associated with an increased stroke risk, but associations by serostatus (seropositive RA (SPRA) vs seronegative RA (SNRA)) and with subtypes of stroke (ischemic stroke (IS) or hemorrhagic stroke (HS)) are not well established. In addition, it is not well-known whether the use of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) are associated with altered stroke risk.</p><p><strong>Methods: </strong>This nationwide cohort study used the Korean National Health Insurance Service database and included participants who were first diagnosed with RA in the period 2010-2017 with no previous history of stroke, and who had a health checkup within 2 years before the index date (45,175 RA patients). They were compared (1:3 ratio) with non-RA controls matched by age and sex (135,525 non-RA controls).</p><p><strong>Results: </strong>Patients with RA had a significantly higher risk of both IS (adjusted hazard ratio (aHR) = 1.47, 95% confidence interval (CI) = 1.36-1.58) and HS (aHR = 1.31, 95% CI = 1.15-1.50) compared to controls. SPRA patients showed higher risk for both IS (aHR = 1.56, 95% CI = 1.43-1.69 SPRA vs aHR = 1.23, 1.08-1.41 SNRA) and HS (aHR = 1.40, 95% CI = 1.21-1.62 SPRA vs aHR = 1.09, 95% CI = 0.86-1.38 SNRA). No difference in stroke risk was observed between bDMARDs users and non-users (aHR = 1.66 for users, aHR = 1.41 for non-users). However, potential differences were noted with tsDMARDs use (aHR = 0.81 for users vs aHR = 1.43 for non-users), although not statistically significant.</p><p><strong>Conclusion: </strong>Patients with RA are at significantly greater risk for both IS and HS compared to those without RA, and SPRA patients showed higher risk than SNRA patients. Further studies are required to determine the potential of tsDMARDs in the prevention of stroke in RA.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251377174"},"PeriodicalIF":8.7,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of five strategies to improve stroke action awareness in Spanish-speaking adults: A randomized comparison.","authors":"Juan Manuel Marquez-Romero, Karen Itzel Sánchez-Ramírez, Carlos David Pérez-Malagón, Jannett Padilla-López, Gary A Ford, Jing Zhao, Renyu Liu","doi":"10.1177/17474930251378229","DOIUrl":"10.1177/17474930251378229","url":null,"abstract":"<p><strong>Background and aims: </strong>Improving stroke action awareness is challenging in non-English-speaking populations. In this study, we evaluated the effectiveness of five Spanish-language educational tools in improving recognition and making an emergency response to stroke symptoms among Spanish-speaking adults in Mexico.</p><p><strong>Methods: </strong>Spanish-speaking participants were recruited from public spaces. Individuals with a history of stroke were excluded. Participants were randomly assigned to receive an educational session tailored to one of five stroke awareness tools (RAPIDO, DALE, CAMALEON, CORRE, and ICTUS 911). Stroke knowledge was assessed using the Stroke Awareness Questionnaire before the educational intervention and after 6-9 days of follow-up. The primary outcome was the change in the proportions of correctly identified stroke symptoms. Secondary outcomes included changes in participants' achievement of adequate stroke knowledge in individual FAST domains and their understanding of the appropriate actions to take after identifying stroke symptoms.</p><p><strong>Results: </strong>In data from 435 participants, all strategies improved stroke symptom recognition and risk factor awareness, although no statistically significant differences were observed in the primary outcomes. Changes ranged from 0.35 (DALE) to 0.49 (CAMALEON) for Facial Weakness, the symptom with the largest improvement, and from 0.00 (CAMALEON, CORRE, RAPIDO) to 0.15 (DALE) for Problems with Vision, the symptom with the smallest improvement. For the secondary outcomes, increases in adequate stroke knowledge ranged from 0.18 (CORRE, DALE) to 0.31 (ICTUS 911); between-group comparisons were statistically significant (p = 0.027). Improvements in appropriate action after symptom recognition ranged from 0.09 (RAPIDO) to 0.29 (ICTUS 911), with significant differences across groups (p = 0.034).</p><p><strong>Conclusions: </strong>This study shows that brief educational interventions can improve stroke symptom recognition and intended response in Spanish-speaking adults. Among five strategies, ICTUS 911 yielded the largest short-term gains, supporting its potential utility. Further research is needed to assess long-term effectiveness and broader applicability.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251378229"},"PeriodicalIF":8.7,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954336","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":"Natural History and Outcomes of Deep-seated Brain Arteriovenous Malformations: a Propensity Score Matched Analysis Using Nationwide Multicenter Prospective Registry Data.","authors":"Chengzhuo Wang, Bin Wang, Heze Han, Li Ma, Ruinan Li, Zhipeng Li, Haibin Zhang, Kexin Yuan, Anqi Li, Qinghui Zhu, Yongenbo Su, Dezhi Gao, Hengwei Jin, Youxiang Li, Shibin Sun, Yuanli Zhao, Yu Chen, Xiaolin Chen","doi":"10.1177/17474930251375831","DOIUrl":"10.1177/17474930251375831","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to evaluate the natural history of deep-seated brain arteriovenous malformation (AVMs), as well as the risk-benefit outcomes of interventional treatment versus conservative management.</p><p><strong>Materials & methods: </strong>Patients with deep-seated AVMs were selected from a nationwide prospective multicenter registry study in China (the MATCH study), and univariate and multivariate analyses were conducted to identify factors associated with AVM rupture. In the analysis of outcomes, propensity score matching (PSM) was performed between the interventional and conservative treatment groups, adjusting for baseline differences. The primary outcomes were hemorrhagic stroke or death, while the secondary outcomes focused on obliteration rates and neurological status. Subgroup and sensitivity analyses were conducted, incorporating various study designs to assess the robustness and consistency of the results.</p><p><strong>Results: </strong>Among 4,286 consecutive AVM cases registered from August 2011 to December 2021, 1,057 (24.7%) were classified as deep-seated AVMs. The natural annualized rupture risk before the treatment decision is 5.58%. The independent risk factors for rupture included diffuse lesions (aOR: 1.79 [1.29-2.49]), single drainage (aOR: 1.88 [1.20-2.93]), and drainage stenosis (aOR: 2.33 [1.44-3.75]). In the analysis of outcomes, 883 cases maintained continuous follow-up (128 conservative management, 755 intervention). After PSM, there were 119 cases in each group. After a median follow-up duration of 4.34 (1.72, 7.23) years in the intervention group, 47.93% achieved complete obliteration, with an annualized rupture risk of 4.82%. Compared to conservative management, intervention was associated with a higher rate of hemorrhagic stroke or death (AR: 3.85 [1.84-5.86] per 100 person-year, P<0.001; HR: 4.862 [1.869-12.651], P<0.001) and higher obliteration rates (OR: 108.56 [14.57-809.01], P<0.001). No significant differences were observed in terms of neurological functional outcomes. In a further analysis stratified by interventional strategies, embolization and multimodality treatment significantly increased the risk of hemorrhagic stroke or death compared with conservative treatment (embolization: HR: 4.414 [95%CI, 1.642-11.867]; multimodality treatment: HR, 6.238 [95%CI, 2.146-18.136]), while microsurgical resection and stereotactic radiosurgery did not. Subgroup and sensitivity analyses showed consistent trends, though with slight differences in statistical power.</p><p><strong>Conclusion: </strong>This study indicates that in deep-seated AVMs, interventional treatment is associated with an increased risk of hemorrhagic stroke or death. However, the negative effect may result from the adverse effects of embolization and multimodality treatment, whereas microsurgical resection and stereotactic radiosurgery did not.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251375831"},"PeriodicalIF":8.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954118","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":"High-density lipoprotein cholesterol levels and their impact on outcomes in acute ischemic stroke patients treated with mechanical thrombectomy.","authors":"Lucio D'Anna, Matteo Foschi, Mariarosaria Valente, Simona Sacco, Caterina Del Regno, Ilaria De Negri, Francesco Toraldo, Alessandro Mare, Massimo Sponza, Vladimir Gavrilovic, Kyriakos Lobotesis, Edoardo Pirera, Gian Luigi Gigli, Soma Banerjee, Giovanni Merlino","doi":"10.1177/17474930251374791","DOIUrl":"10.1177/17474930251374791","url":null,"abstract":"<p><strong>Background: </strong>High-density lipoprotein cholesterol (HDL-C) is traditionally considered protective in cardiovascular disease, but its role in acute ischemic stroke (AIS) remains unclear, particularly in patients undergoing mechanical thrombectomy (MT). This study aimed to assess the association between HDL-C levels and clinical outcomes in AIS patients treated with MT for anterior circulation large vessel occlusion (LVO).</p><p><strong>Methods: </strong>We conducted a multicentre, observational, post hoc analysis of AIS patients treated with MT between January 2016 and March 2023 across three stroke centers. HDL-C levels at admission were categorized, and outcomes included 90-day functional dependence (mRS: 3-6), symptomatic intracranial hemorrhage (sICH), hemorrhagic transformation, and 90-day mortality. We used logistic regression with restricted cubic splines to define an HDL-C threshold associated with increased risk and applied inverse probability weighting (IPW) to adjust for confounding.</p><p><strong>Results: </strong>Among 2166 patients (median age: 71 years; 52.3% female), HDL-C levels > 1.33 mmol/L were independently associated with a higher risk of poor functional outcome at 90 days (risk ratio (RR): 1.72, 95% confidence interval (CI): 1.55-1.90), increased odds of sICH (RR: 2.3, 95% CI: 1.64-3.12), and higher mRS shift (OR: 2.10, 95% CI: 1.79-2.46). Subgroup analyses revealed significant sex-specific differences, with women at greater risk of adverse outcomes at higher HDL-C levels.</p><p><strong>Conclusion: </strong>Elevated HDL-C levels (>1.33 mmol/L) are associated with worse functional outcomes and increased hemorrhagic complications following MT for anterior circulation AIS.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251374791"},"PeriodicalIF":8.7,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954380","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":"CREGS-2 - A multinational, high-quality comparative effectiveness study of Cerebrolysin in moderate acute ischemic stroke.","authors":"Milan R Vosko, Daniel Sanak, Youngrok Do, Jarungchai S Vatanagul, Tamer Roushdy, Natan Bornstein, Johannes C Vester, Michael Brainin","doi":"10.1177/17474930251375439","DOIUrl":"https://doi.org/10.1177/17474930251375439","url":null,"abstract":"<p><strong>Background: </strong>The main objective of the Cerebrolysin REGistry Study in Stroke 2 (C-REGS2) was to systematically record the routine clinical use of Cerebrolysin in patients with moderate ischemic stroke (IS) following the principles of a prospective controlled effectiveness study (CES) to compare its effectiveness in terms of functional recovery to patients treated with standard therapy alone.</p><p><strong>Methods: </strong>C-REGS2 used an open label, prospective controlled comparative effectiveness design aligning with the Target Trial Emulation Framework (TTEF) and the GRACE principles for high-quality observational studies based on the principles of high-quality comparative effectiveness research (HQCER) to capture treatment effects in clinical practice. The study was conducted in 16 countries worldwide between April 2018 and April 2024. Moderate IS was defined as baseline NIH Stroke Scale (NIHSS) score 8-15. Treatment modalities and concomitant medications were according to local standards. The methodology included rigorous pre-specified analysis and tight risk-based centralized monitoring, to ensure minimal enrollment bias, maximize data quality and overall reliability of trial results.The compared patient groups were standardised using a restricted cohort design and non-parametric multilevel stratification following the Good Research for Comparative Effectiveness (GRACE) principles. The primary endpoint was ordinal analysis of the modified Rankin Scale (mRS) at 90 days after stroke onset. Secondary endpoints were the ordinal NIH Stroke Scale (NIHSS) at day 21 and 90 after stroke onset, the ordinal mRS at 21 days after IS, the proportion of patients with excellent recovery (mRS 0-1) as well as the proportion of patients with functional independence (mRS 0-2) at 90 days after stroke onset and the ordinal analysis of Montreal Cognitive Assessment (MoCA) scale at 90 days after IS.</p><p><strong>Results: </strong>Out of 1865 enrolled patients, the target population (TP) comprised 1769 patients (1021 Cerebrolysin-treated and 748 controls). The median NIHSS at baseline was 10.0. Median Cerebrolysin dose was 30 ml, median treatment duration was 10 days. Cerebrolysin was superior to standard therapy in the primary endpoint independently to prior thrombolysis (MW 0.6157; CI 0.5910 to 0.6404; P<0.0001) as well as in all secondary endpoints: mRS at day 21 (MW 0.6065, 95% CI 0.5811-0.6319, P<0.0001), NIHSS at day 21 (MW 0.5792; 95% CI 0.5576-0.6008; P<0.0001) and NIHSS at day 90 (MW 0.5781; CI 0.5561-0.6002; P<0.0001). Additional pre-specified secondary endpoints (proportion of patients with excellent recovery and functional independence) showed moderate superiority for Cerebrolysin. The ordinal MoCA showed superiority for Cerebrolysin in the TP (MW 0.5530; CI 0.5282-0.5778; P<0.0001) with more pronounced effects in the subgroup with cognitive impairments at baseline (Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251375439"},"PeriodicalIF":8.7,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954283","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":"Multi-population genome-wide association study identifies multiple novel loci associated with asymptomatic intracranial large artery stenosis.","authors":"Minghua Liu, Farid Khasiyev, Antonio Spagnolo-Allende, Danurys L Sanchez, Howard Andrews, Qiong Yang, Alexa Beiser, Ye Qiao, Jose Rafael Romero, Tatjana Rundek, Adam M Brickman, Jennifer J Manly, Mitchell Sv Elkind, Sudha Seshadri, Christopher Chen, Oscar H Del Brutto, Saima Hilal, Bruce A Wasserman, Giuseppe Tosto, Myriam Fornage, Jose Gutierrez","doi":"10.1177/17474930251374471","DOIUrl":"10.1177/17474930251374471","url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial large artery stenosis (ILAS) is one of the most common causes of stroke worldwide and is associated with the risk for future vascular events. Asymptomatic ILAS is a frequent finding on neuroimaging and shares many risk factors with atherosclerotic vascular disease. Whether asymptomatic ILAS is driven by genetic variants is not well-understood.</p><p><strong>Methods: </strong>This study included 4960 participants from seven geographically diverse population-based cohorts (34% Whites, 16% African Americans, 22% Hispanics, 24% Asians, 5% native Ecuadorians). We defined asymptomatic ILAS as luminal stenosis >50% in any large brain artery using time-of-flight magnetic resonance angiography.</p><p><strong>Results: </strong>A genome-wide association study revealed one variant in <i>RP11-552D8.1</i> (rs75615271; odds ratio (OR), 1.22 (1.11-1.33); <i>p</i> = 4.85×10^-8) associated with global ILAS at genome-wide significance (<i>p</i> < 5×10^-8). Gene-based association analysis identified a gene-set enriched in chr1q32 region, including <i>NEK2</i>, <i>LPGAT1</i>, <i>INTS7</i>, <i>DTL</i>, and <i>TMEM206</i>, in global ILAS (<i>p</i> = 1.34 ×10^-7) and anterior ILAS (<i>p</i> = 1.77 ×10^-8).</p><p><strong>Discussion and conclusion: </strong>This study reveals one variant rs75615271 and a gene-set enriched in chr1q32 region associated with asymptomatic ILAS in a multi-population. Further functional studies may help elucidate the role that this variant plays in the pathophysiology of asymptomatic ILAS.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251374471"},"PeriodicalIF":8.7,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954083","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":"Interaction of CYP2C19 with the effect of clopidogrel in secondary prevention of major ischemic events: Systematic review and meta-analysis.","authors":"Femke Cc Kremers, Jochem van den Biggelaar, Hester F Lingsma, Ron Hn van Schaik, Bob Roozenbeek, Diederik Wj Dippel","doi":"10.1177/17474930251372371","DOIUrl":"10.1177/17474930251372371","url":null,"abstract":"<p><strong>Background and aims: </strong>Clopidogrel may be a less effective antiplatelet agent for secondary prevention after cardiovascular events in carriers of the CYP2C19 Loss of Function (LoF) allele. Randomized controlled trials (RCTs) of clopidogrel in patients with known CYP2C19 carrier status have provided inconsistent results. This meta-analysis aims to pool evidence on the effect of different antiplatelet strategies on outcomes according to CYP2C19 LoF status.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of RCTs to evaluate the interaction of CYP2C19 LoF allele on clopidogrel versus placebo or other antiplatelet agents in patients with cardiovascular disease or transient ischemic attack (TIA) or ischemic stroke. Primary outcomes were major adverse cardiovascular events (MACEs) including ischemic stroke, with major bleeding events assessed as a safety outcome. Random effects analysis estimated pooled odds ratios for LoF carriers and non-carriers.</p><p><strong>Results: </strong>Fifteen RCTs with 35,189 participants in total were included. When all interaction effects are pooled, the occurrence of MACE was 1.29 times higher in LoF variant carriers compared to non-carriers for clopidogrel treatment (p-interaction = 0.01). Risk of MACE was 1.20 times higher in LoF carriers compared to non-carriers when clopidogrel was compared to placebo (p-interaction = 0.13). In TIA or minor stroke patients, the interaction effect was 1.63 times larger (p-interaction = 0.02). Clopidogrel was less effective than prasugrel for MACE occurrence (1.57 times higher, p-interaction = 0.02) and ticagrelor (1.21 times higher, p-interaction = 0.19) in CYP2C19 LoF variant carriers. Bleeding outcomes were similar across groups.</p><p><strong>Conclusion: </strong>Clopidogrel is less effective in patients with CYP2C19 LoF genotype and cardiovascular disease, minor stroke, or TIA. The size and direction of the interaction warrant further research into the role of LoF genotypes and the cost-effectiveness of genetic testing. Prasugrel may be a more effective alternative for CYP2C19 LoF carriers.Registration-URL:https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021242993.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251372371"},"PeriodicalIF":8.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954286","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":"Intracranial arterial calcification as a marker of stroke risk and worse stroke outcomes in adults: A systematic review and meta-analysis.","authors":"Sandra Elsheikh, Stephen McKeever, Greg J Irving, Andrew M Hill, Gregory Yh Lip, Azmil H Abdul-Rahim","doi":"10.1177/17474930251372693","DOIUrl":"10.1177/17474930251372693","url":null,"abstract":"<p><strong>Background: </strong>Intracranial arterial calcification (ICAC) is common, but data on its impact on future stroke risk and outcomes remain limited. We conducted a systematic review and meta-analysis to investigate the association of ICAC with stroke risk and outcomes.</p><p><strong>Methods: </strong>We searched three multidisciplinary databases from inception to July 2025. We selected studies that investigated incidence of stroke and its outcomes in patients with ICAC. We assessed the studies' risk of bias using the Newcastle Ottawa Quality Assessment Scale. Statistical analysis was conducted using Cochrane Review Manager (RevMan 5.4).</p><p><strong>Results: </strong>After reviewing 660 citations, we selected 94 studies for full-text screening. We extracted data from a total of 20 studies, reporting outcomes on 14,599 patients. Overall, the risk of bias was low. The included studies were heterogeneous, with varying outcomes assessed and differing measures of associations reported. ICAC was associated with an increased risk of ischaemic stroke, with a pooled odds ratio (OR) of 2.28 (95% confidence interval (CI): 1.39-3.73), and one study reported a hazard ratio (HR) of 1.49 (95% CI: 1.24-1.78). ICAC also showed a trend toward increased mortality, with a pooled OR 1.40 (95% CI: 0.96-2.05) and high heterogenicity across the studies (I² = 65%). The pooled HR per 1-standard deviation (1-SD) increase in ICAC was 1.25 (95% CI: 1.10-1.42), with low heterogenicity (I² = 1%) between 2 studies reporting the HR.</p><p><strong>Conclusions: </strong>ICAC is significantly associated with an increased risk of stroke as well as a trend toward increased mortality (PROSPERO ID: CRD42023414813).</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251372693"},"PeriodicalIF":8.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144954002","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":"A scoping review of community-based stroke rehabilitation in low-resource settings.","authors":"Yudi Hardianto, Elizabeth Lynch, Andi Masyitha Irwan, Thoshenthri Kandasamy, Tara Purvis, Michele L Callisaya, Richard I Lindley, Dorcas Gandhi, Ning Liu, Noor Azah Abd Aziz, Jeyaraj Pandian, Dominique A Cadilhac","doi":"10.1177/17474930251368899","DOIUrl":"10.1177/17474930251368899","url":null,"abstract":"<p><strong>Background: </strong>There is a need for accessible and affordable rehabilitation services in low-resource settings (low- and middle-income countries) to support the increasing number of survivors of stroke.</p><p><strong>Aims: </strong>To synthesize existing literature on the delivery of community-based stroke rehabilitation programs in low-resource settings.</p><p><strong>Summary of review: </strong>We followed the PRISMA Scoping Review guidelines. Seven databases (including MEDLINE, PsycINFO, and CINAHL) were searched to identify relevant articles published between January 2012 and December 2024. Studies were considered if they included physical rehabilitation strategies as part of a community-based rehabilitation program for individuals with stroke aged ⩾18 years in low-resource settings. Titles, abstracts, and full texts were screened by multiple authors for inclusion. A predefined template that covered physical rehabilitation strategies, setting, providers, frequency, session duration, and program duration was used for data extraction. Results were synthesized narratively. After screening 2892 abstracts, 25 studies were included from 11 countries throughout Asia, Africa, and South America. Most studies were carried out in middle-income countries, with only one study taking place in a low-income country (Uganda). Over half of the studies (n = 16) were randomized controlled trials (RCTs). The physical rehabilitation programs were primarily delivered at home, in person, by a single healthcare professional, typically a physiotherapist or nurse. Session duration was not specified for more than half of the studies. Where reported, sessions were 1 h or less, usually occurring at least once weekly over a 2-to-3-month period. Over 36 different outcome measures were identified, with the Barthel Index being the most common (48%). Overall, 10 RCTs showed a statistically significant difference between intervention and control groups, while five RCTs had no significant difference at the post-intervention outcome evaluation. None of the included publications reported costs or cost-effectiveness data.</p><p><strong>Conclusion: </strong>Community-based rehabilitation programs in low-resource settings differ in their physical rehabilitation strategies and characteristics. While the evidence base in this field is growing, the lack of cost-effectiveness evaluations means there is limited guidance to inform investment in, or optimization of, these multi-component, community-based programs.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251368899"},"PeriodicalIF":8.7,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799010","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}