International Journal of Stroke最新文献

{"title":"Clinical and safety outcomes following endovascular treatment for large ischemic core stroke with Alberta Stroke Program Early Computed Tomography Score 3-5 in the 12-to 24-h time window.","authors":"Trung Quoc Nguyen, Khang Vinh Nguyen, Hang Thi Minh Tran, Binh Nguyen Pham, Anh Le Tuan Truong, Thien Quang Le, Hai Quang Duong, Trung Thanh Nguyen, Binh Thi Thanh Do, Lanh Chi Nguyen, Duc Tan Ha, Tran Tran Ngoc Nguyen, Dung Tri Bach, Nhi Thanh Nguyen, Vu Thanh Tran, Tra Vu Son Le, Huy Quoc Do, Huong Thi Bich Nguyen, Huy Quoc Huynh, Huy Quang Dang, Duc Nguyen Chiem, Thai Nguyen Thanh Pham, Hanh Thi My Doan, Dinh Chau Bao Hoang, Trinh Thi Kim Ngo, Hung Minh Dang, Bang Phan, Yimin Chen, Thanh N Nguyen, Thang Ba Nguyen, Thang Huy Nguyen","doi":"10.1177/17474930251367867","DOIUrl":"10.1177/17474930251367867","url":null,"abstract":"<p><strong>Introduction: </strong>Although the efficacy and safety of endovascular treatment (EVT) for large-core ischemic stroke have been proven, most trials used perfusion imaging or included early-window patients, limiting generalizability to the late window, particularly in developing countries.</p><p><strong>Aim: </strong>We aimed to evaluate the safety and functional outcomes of EVT in large-core stroke patients treated between 12 and 24 h (late window) from last known well (LKW).</p><p><strong>Methods: </strong>We conducted a prospective, multicenter observational study across four comprehensive stroke centers in Vietnam, enrolling consecutive patients who underwent EVT within 24 h of symptom onset between August 2023 and September 2024. Large core was defined by an Alberta Stroke Program Early CT Score (ASPECTS) of 3 to 5 on non-contrast computerized tomography (NCCT) or diffusion-weighted magnetic resonance imaging (DWI-MRI). Patients who underwent EVT within 12-24 h after LKW were compared to those treated before 12 h (early window). Primary and safety outcomes were independent ambulation (90-day modified Rankin scale (mRS) = 0-3) and symptomatic intracranial hemorrhage (sICH). Secondary outcomes were 90-day mRS 0-2, ordinal mRS, successful reperfusion (modified Thrombolysis in Cerebral Infarction score ⩾2b, early neurological deterioration (END)), and 90-day mortality.</p><p><strong>Results: </strong>Of 1872 patients receiving EVT, 343 with large ischemic cores (median age = 64.0 years, 33.8% female) were included, with 103 (30.0%) treated in the 12- to 24-h window. Compared to early-window patients, late-window patients had lower rates of intravenous thrombolysis (2.9% vs. 32.9%, p < 0.001), higher brain MRI use (51.5% vs. 16.2%, p < 0.001), and longer pre-treatment imaging-to-groin puncture times (106 vs. 77 min, p < 0.001). After adjusting for confounders, there were no significant differences in 90-day mRS 0-3 (56.3% vs. 55.0%, adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI) = 0.39-1.28, p = 0.26), ordinal mRS (aOR = 1.21, 95% CI = 0.78-1.90, p = 0.39), and sICH (aOR = 1.12, 95% CI = 0.32-3.50, p = 0.85). Other secondary outcomes were also similar.</p><p><strong>Conclusion: </strong>In patients with anterior circulation large vessel occlusion stroke and low ASPECTS, EVT at 12-24 h versus <12 h from symptom onset showed no significant differences in clinical or safety outcomes. Larger trials are needed to confirm these findings, especially in developing regions.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251367867"},"PeriodicalIF":8.7,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799011","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":"Clinical features, including atypical symptoms, associated with acute cerebral ischaemia on DWI-MRI in suspected TIA and minor stroke.","authors":"Patrick C Gallogly, Jasmine Hassan, Caitlin Lee, John Cousins, Jonathan Best, H Rolf Jäger, Davis J Werring, Arvind Chandratheva","doi":"10.1177/17474930251368895","DOIUrl":"10.1177/17474930251368895","url":null,"abstract":"<p><strong>Background and aims: </strong>The diagnosis of transient ischaemic attack (TIA) and minor stroke can be challenging. Current diagnostic criteria for TIA disqualify atypical clinical presentations which may nevertheless be associated with objective cerebral ischaemia on diffusion weighted imaging-magnetic resonance imaging (DWI-MRI). We aimed to (1) ascertain the proportion of DWI-positive patients with atypical clinical presentations and (2) identify clinical factors predicting DWI positivity.</p><p><strong>Methods: </strong>We retrospectively reviewed case notes of consecutive patients with suspected TIA or minor stroke undergoing MRI at our comprehensive stroke center. We identified clinical factors predicting DWI positivity using multivariable logistic regression.</p><p><strong>Results: </strong>We included 1615 patients. Of 442 (27.4%) who were DWI-positive, 38.5% had atypical presentations; common symptoms included headache (present in 17%), unsteadiness (15%), positive sensory symptoms (11%), presyncope (10%), confusion (9%), and vertigo (8%). Symptoms independently associated with DWI positivity included weakness (odds ratio (OR): 1.30, 95% confidence interval (CI): 1.01-1.67), dysarthria (OR: 2.05, CI: 1.56-2.70), and ataxia (OR: 3.76, CI: 2.27-6.21). Fluctuating symptoms (present in 21.5%) predicted DWI positivity (OR: 1.37, CI: 1.04-1.81), but sudden onset (80.1%) did not (OR: 1.05, CI: 0.80-1.38). Risk factors associated with DWI positivity included increasing age (OR: 1.02/year, CI: 1.01-1.02), hypertension (OR: 1.61, CI: 1.23-2.11), diabetes (OR: 1.40, CI: 1.04-1.90), and smoking (OR: 1.67, CI: 1.17-2.37). DWI-positive patients had significantly more risk factors (mean 2.65 vs 1.95 p = <0.001).</p><p><strong>Conclusion: </strong>Over one-third of people with MRI-DWI-confirmed TIA or minor stroke present with atypical symptoms. MRI-DWI is essential to diagnose cerebral ischaemia in patients with atypical symptoms, particularly in those with vascular risk factors.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251368895"},"PeriodicalIF":8.7,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799012","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":"Estimating annual deaths from stroke in adults under 70 years of age in Freetown Sierra Leone: A comparative analysis of a hospital-based stroke register and a population-based verbal autopsy study.","authors":"Daniel Youkee, Marina Soley-Bori, Gibrilla Fadlu Deen, Prabhat Jha, Anteneh Assalif, Charles Wolfe, Catherine Sackley, Zainab Conteh, Julia Fox-Rushby, Iain Marshall","doi":"10.1177/17474930251367517","DOIUrl":"10.1177/17474930251367517","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In Sub-Saharan Africa (SSA), most stroke epidemiological data comes from hospital-based registers, which are prone to selection bias, and data may be unrepresentative of stroke burden at the population level. The degree of incompleteness and bias in hospital-based registers has been assessed in high-income countries but not in an SSA country.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;The study describes and compares estimates of annual deaths from stroke under 70 years of age, from a hospital-based stroke register and a population-based verbal autopsy (VA) study. We describe the sociodemographic and clinical differences between patients captured and those missed by a hospital-based register and estimate the completeness of a hospital-based register in Sierra Leone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We compared people under 70 years of age who died from stroke in the Stroke in Sierra Leone (SISLE) prospective longitudinal hospital-based register to the Healthy Sierra Leone (HEAL-SL) population-based VA study which sampled 2.5% of households in the Western Area. We included participants from SISLE and HEAL-SL who died within the same dates (1st May 2019 until 30th September 2021) and geographical area. We conducted data linkage using probabilistic matching and manual clerical review by two authors. To assess selection bias, we used univariable analysis to identify variables associated with capture by the hospital register. To estimate annual deaths from stroke, two-source capture-recapture analysis was conducted using the Lincoln-Petersen-Chapman estimator. Estimates of completeness were adjusted for undermatching and for the positive predictive value of VA for stroke diagnosis. Deaths rates from stroke were calculated as deaths per 100,000 individuals, with population estimates sourced from the 2021 Mid-term Population and Housing Census.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 345 participants were identified in the SISLE dataset, 46 in the VA dataset, and 4 in both datasets. Excluding individuals captured in both datasets, individuals identified by VA had a mean age of 58 years compared to 55 years in SISLE (&lt;i&gt;p&lt;/i&gt; = 0.07), 59.5% were male compared to 50.7% in SISLE (&lt;i&gt;p&lt;/i&gt; = 0.28), and 52.3% had no formal education compared to 39.0% (&lt;i&gt;p&lt;/i&gt; = 0.09) in SISLE. Individuals identified by VA were more likely to be employed 36.7% vs 59.5% (&lt;i&gt;p&lt;/i&gt; = 0.002), were less likely to have sought formal healthcare 48.5% vs 100% (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), more likely to have died suddenly 14.3% vs 4.1% (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), and less likely to have died in hospital 19.0% vs 67.5%. Estimates of annual deaths from stroke using capture-recapture methods ranged from 41 to 106/100,000. The completeness of SISLE register for fatal stroke ranged from 10.6% (95% CI: 9.6%-11.7%) to 27.2% (95% CI: 24.8%-30.0%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;In this setting, a hospital-based stroke register underestimated deaths from stroke in adults younger than 7","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251367517"},"PeriodicalIF":8.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784306","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":"Decompressive craniectomy versus best medical treatment alone for spontaneous intracerebral hemorrhage: A systematic review and meta-analysis.","authors":"Rafael Reis de Oliveira, Yasmin Picanço Silva, Yusuf-Zain Ansari, Mariana Letícia de Bastos Maximiano, Leonardo B O Brenner, Iago Nathan Simon Petry, Mariana Lee Han, Júlia Dos Santos Monteiro, Raphael Leal Dias da Silva, Laiana Neves Cordeiro Cavalcanti, Ocílio Ribeiro Gonçalves, Walter Fagundes","doi":"10.1177/17474930251367367","DOIUrl":"10.1177/17474930251367367","url":null,"abstract":"<p><strong>Background: </strong>While managing spontaneous intracerebral hemorrhage (sICH) has advanced, achieving favorable outcomes remains challenging. Recent studies suggest that decompressive craniectomy (DC) may offer benefits over conservative treatment, consisting of the best medical treatment (BMT) in certain sICH cases.</p><p><strong>Aim: </strong>This study aims to compare DC to BMT alone for sICH regarding functional neurological outcomes, mortality, and length of hospitalization.</p><p><strong>Methods: </strong>Randomized and observational studies were identified comparing surgery (DC) to conservative management alone for patients with sICH. The outcomes analyzed were modified Rankin Scale (mRS), mortality at 30 days, 90 days, and overall mortality, and length of hospital stay. The odds ratio (OR) and mean difference (MD) were calculated for binary and continuous outcomes.</p><p><strong>Results: </strong>Our analysis included eight studies (n = 743), with 345 patients undergoing surgery and 398 undergoing conservative management. BMT alone was associated with a poor neurological function (mRS of 5-6) (OR = 0.44; 95% CI = 0.24-0.78; p-value = 0.005; I² = 39.8%), while the rate of good neurological function (mRS = 0-4) was superior in the surgical cohort (OR = 2.29; 95% CI = 1.28-4.10; p = 0.005; I² = 39.8%), despite the lack of statistical significance for mRS 0-2 (OR = 1.25; 95% CI = 0.47-3.33; p = 0.66; I² = 0%) and mRS 0-3 (OR = 1.43; 95% CI = 0.82-2.51; p = 0.21; I² = 0%). Conservative management was associated with higher mortality at 30 days (OR = 0.36; 95% CI = 0.19-0.66; p-value = 0.001; I² = 0%), at 90 days (OR = 0.35; 95% CI = 0.14-0.86; p = 0.022; I² = 68.7%), and at last follow-up (OR = 0.33; 95% CI = 0.21-0.52; p-value < 0.001; I² = 34.8%). Length of hospital stay was superior in the DC cohort, but without statistical significance (MD = 16.05; 95% CI = -3.24 to 35.34; p-value = 0.1; I² = 92.9%).</p><p><strong>Conclusions: </strong>In patients with sICH, decompressive craniectomy shows potential for reducing mortality and improving neurological function compared to BMT alone. Further randomized studies, with improved methods, are needed to increase the quality of evidence.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251367367"},"PeriodicalIF":8.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784305","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 systolic blood pressure and infarct growth after thrombectomy for acute stroke: A retrospective observational study.","authors":"Yuki Sakamoto, Junya Aoki, Yuji Nishi, Sotaro Shoda, Michika Sakamoto, Kentaro Suzuki, Takehiro Katano, Akihito Kutsuna, Ryutaro Kimura, Kaito Watanabe, Chinatsu Sakuragi, Takashi Shimoyama, Kazumi Kimura","doi":"10.1177/17474930251367828","DOIUrl":"10.1177/17474930251367828","url":null,"abstract":"<p><strong>Background: </strong>The optimal blood pressure control strategy after mechanical thrombectomy (MT) is not well understood, especially for patients with successful recanalization. We hypothesized that low systolic blood pressure (SBP) after MT is associated with infarct growth (IG), even in patients with successful recanalization.</p><p><strong>Aims: </strong>The aim of the present study was to clarify the relationships between IG and SBP parameters in patients treated with MT.</p><p><strong>Method: </strong>Consecutive acute stroke patients who underwent emergent MT from September 2014 through December 2019 were retrospectively enrolled. Diffusion-weighted imaging (DWI) was performed on admission and approximately 24 h after the procedure. IG was calculated as the difference between infarct volume on 24-h DWI and initial DWI. SBP from recanalization to 24-h DWI was used. The associations between IG and SBP parameters, including maximum, minimum, and mean SBPs and coefficient of variation (CV) of SBPs, were evaluated with multiple regression analyses.</p><p><strong>Results: </strong>A total of 377 MT cases (225 male (60%), median age = 76 (interquartile range (IQR) = 68-83) years, median National Institutes of Health Stroke Scale (NIHSS) score = 17 (10-23), median onset to initial DWI time = 131 (79-350) min) were enrolled in this study. Successful recanalization modified the association between SBP parameters and IG (p for interaction < 0.05). In cases with successful recanalization (n = 314), SBP was recorded 7007 times between recanalization and 24-h follow-up magnetic resonance imaging (MRI). Minimum SBP from recanalization to 24-h DWI (standardized coefficient = -0.144, 95% confidence interval (CI) -0.269 to -0.019, p = 0.024, i.e. low minimum SBP was associated with higher IG) and CV of SBP (0.122, 0.003 to 0.241, p = 0.045) were independently associated with IG, even after adjusting for various factors including age, sex, initial NIHSS score, baseline infarct volume, and symptomatic intracerebral hemorrhage.</p><p><strong>Conclusion: </strong>Minimum SBP and CV of SBP after recanalization were associated with IG in consecutive acute stroke patients who underwent successful MT. IG is a sensitive imaging marker for evaluating the effect of post-procedural SBP, and extremely low SBP after MT should be avoided to mitigate IG.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251367828"},"PeriodicalIF":8.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784304","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":"Quantification of brain tissue injury and prediction of prognosis using serum GFAP and UCH-L1: A multicenter prospective cohort study.","authors":"Zhen-Ni Guo, Yang Qu, Reziya Abuduxukuer, Hang Jin, Peng Zhang, Zi-Duo Shen, Han Zhang, Xiang-Yu Zheng, Yu Zhang, Yu-Mei Chen, Yang Zheng, Zhi-Mei Yuan, Jing Yao, Ya-Li Wang, Miao Zhang, Yang Li, Yan-Qiu Gu, Li-Li Zhao, Chen-Peng Dong, Yongfei Jiang, Zhong-Rui Pei, Wen-Tong Song, Zhuang-Hong Shi, Yang Dong, Yingbin Qi, Ying-Kui Li, Li Li, Xin Sun, Thanh N Nguyen, Chao Li, Yi Yang","doi":"10.1177/17474930251366103","DOIUrl":"10.1177/17474930251366103","url":null,"abstract":"<p><strong>Background: </strong>It remains unclear whether the serum levels of the brain injury biomarkers (glial fibrillary acidic protein [GFAP] and ubiquitin C-terminal hydrolase-L1 [UCH-L1]) can be used to quantitatively evaluate brain tissue injury and predict prognosis in patients with intravenous thrombolysis (IVT).</p><p><strong>Aim: </strong>This study investigates the association between serum GFAP and UCH-L1 levels with functional outcomes in patients receiving IVT.</p><p><strong>Methods: </strong>Patients were prospectively enrolled from 16 hospitals. We measured serum GFAP and UCH-L1 levels 24 hours after IVT. Infarct volume, hemorrhagic transformation (HT), and short- and long-term prognostic indicators were evaluated. GFAP and UCH-L1 cutoff levels for predicting 3-month unfavorable outcomes were derived, and a biomarker-based model was established and subjected to internal and external validation.</p><p><strong>Results: </strong>This study included 1028 patients. Higher GFAP and UCH-L1 levels were independently associated with larger infarct volume, HT, higher 24-hour and 7-day National Institutes of Health Stroke Scale scores, and 3-month modified Rankin Scale scores. The cutoff levels for GFAP and UCH-L1 (116 and 292 pg/mL, respectively) predicted patients with 3-month unfavorable outcomes with a specificity and positive predictive value (PPV) of 97.56% (95% confidence interval [CI], 94.51-99.00) and 88.68% (95% CI, 76.28-95.31), respectively, in the training cohort. In the testing and validation cohorts, specificity was 97.83% (95% CI, 91.62-99.62) and 96.90% (95% CI, 91.77-99.00), respectively, and PPV was 90.00% (95% CI, 66.87-98.25) and 75.00% (95% CI, 47.41-91.67), respectively. Furthermore, the biomarker-based nomogram model showed good predictability of 3-month prognosis in the different cohorts.</p><p><strong>Conclusions: </strong>Serum GFAP and UCH-L1 levels can be used to quantitatively evaluate brain tissue injury and predict the prognosis of patients with IVT.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251366103"},"PeriodicalIF":8.7,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768656","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":"Racial/ethnic disparities among individuals with unruptured and ruptured cerebral aneurysms: Insights from the All of Us Research Program.","authors":"Joanna M Roy, Basel Musmar, Keenan Piper, Lucas Ghanem, Caitlin Ritz, Spyridon Karadimas, Sravanthi Koduri, Stavropoula I Tjoumakaris, M Reid Gooch, Robert H Rosenwasser, Pascal Jabbour","doi":"10.1177/17474930251367208","DOIUrl":"10.1177/17474930251367208","url":null,"abstract":"<p><strong>Background and objectives: </strong>Race and ethnicity have been shown to affect healthcare outcomes among patients diagnosed with cerebral aneurysms. Our study analyzes baseline demographics, lifestyle, healthcare resource utilization, and perception of health status among patients with ruptured and unruptured cerebral aneurysms based on race and ethnicity.</p><p><strong>Methods: </strong>This was a cross-sectional study that utilized survey data and electronic health record (EHR) data from the All of Us Research Program. Patients with unruptured and ruptured aneurysms were identified using ICD-9/10 codes. Cohorts were classified into three categories based on self-reported race/ethnicity: Black, Hispanic, or White.</p><p><strong>Results: </strong>A total of 2975 patients with unruptured cerebral aneurysms and 1498 ruptured cerebral aneurysms were included. Black and Hispanic patients with cerebral aneurysms reported lower income, education, and employment rates, in addition to higher rates of daily cigarette smoking compared to White patients (P < 0.001). After adjusting for confounders, Hispanic patients reported higher odds of being unable to afford specialist care (odd ratio (OR) = 1.86 [1.02-3.37], P = 0.04) and follow-up care (OR = 2.76 [1.52-5.00], P < 0.001), while Black patients reported higher odds of being unable to afford prescription medications (OR = 1.55 [1.03-2.33], P = 0.03) compared to White patients. Black and Hispanic patients reported lower odds of feeling respected by their healthcare provider (OR = 0.45 [0.21-0.94], P = 0.03 and OR = 0.32 [0.15-0.67], P < 0.01), demonstrated lower confidence in completing medical forms independently (OR = 0.58 [0.37-0.89], P = 0.01 and OR = 0.31 [0.20-0.47], P < 0.001) and were more likely to consider their provider's race/religion important compared to White patients (OR = 2.09 [1.51-2.88], P < 0.001 and OR = 2.28 [1.56-3.34], P < 0.001).</p><p><strong>Discussion: </strong>Our study identified disparities in baseline characteristics, healthcare access, and perception of health status among racial/ethnic minorities with unruptured and ruptured aneurysms. Future research could emphasize on addressing these disparities by ensuring more equitable access to healthcare.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251367208"},"PeriodicalIF":8.7,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768657","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":"Population attributable fractions of established, social-psychological, and reproductive risk factors for stroke among women: Evidence from UK Biobank.","authors":"Weidi Sun, Leying Hou, Jing Wu, Shiyi Shan, Peige Song","doi":"10.1177/17474930251365865","DOIUrl":"10.1177/17474930251365865","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a leading cause of death and disability worldwide, with women facing unique risks due to a combination of well-established, under-recognized, and female-specific factors.</p><p><strong>Aims: </strong>This prospective cohort study aimed to quantify the population attributable fractions (PAFs) of stroke with distinct risk factor profiles and to explore disparities across age strata.</p><p><strong>Methods: </strong>Data were from 239,200 women recruited in the UK Biobank. Following the framework established by the Lancet Women and Cardiovascular Disease Commission, stroke risk factors were sorted into three categories, including eight well-established risk factors, four social-psychological risk factors, and 11 reproductive factors. The Cox regression model with correction of multiple comparisons was used to assess their associations with incident stroke and its subtypes. PAFs were calculated to estimate the attributable stroke burden for individual risk factors, each risk factor category, and all risk factors combined. Age-stratified analyses were further conducted.</p><p><strong>Results: </strong>During a median follow-up of 13.8 years, 4580 (1.9%) women developed incident stroke. Hypertension served as the leading individual risk factor (PAF 23.3%, 95% confidence interval [CI] = 20.1%, 26.4%). Under the assumption of multiplicative effect, well-established risk factors accounted for 32.8% of stroke cases, followed by social-psychological factors (15.2%) and reproductive factors (6.3%). The overall PAF (95% CI) of total stroke with all risk factors combined was 47.6% (47.6%, 47.7%) or 40.2% (40.1%, 40.2%) with multiplicative or additive effect. Across the age groups, the highest total stroke PAFs for overall risk factors (51.9%) and well-established risk factors (37.0%) were observed among women aged 60-65 years. For reproductive factors, the highest PAFs were observed among women aged 60-65 years (9.2%) and ⩾65 years (4.5%).</p><p><strong>Conclusion: </strong>While the conventional risk factors contributed to the greatest stroke burden, the potential benefit of addressing issues related to unfavorable social-psychological conditions and adverse reproductive profiles should not be neglected. Integrated and targeted prevention strategies are in urgent need to protect women's cardio-cerebrovascular health throughout the lifespan.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251365865"},"PeriodicalIF":8.7,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768655","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":"Do self-management interventions improve self-efficacy and health-related quality of life after stroke? A systematic review.","authors":"Elizabeth A Lynch, Katie Nesbitt, Aarti Gulyani, Raymond J Chan, Niranjan Bidargaddi, Dominique A Cadilhac, Billie Bonevski, Fiona Jones, Liam P Allan, Erin Godecke, Rebecca Barnden, Emily Brogan, Thoshenthri Kandasamy, Stacy Larcombe, Lemma N Bulto, Coralie English","doi":"10.1177/17474930251340286","DOIUrl":"10.1177/17474930251340286","url":null,"abstract":"<p><strong>Introduction: </strong>Self-management interventions are recommended after stroke in many international guidelines to improve health-related quality of life (HRQoL). Self-efficacy, a person's confidence in their abilities, is widely considered to underpin individuals' abilities to self-manage their health.</p><p><strong>Aims: </strong>To synthesize evidence on the effectiveness of self-management programs for improving self-efficacy or HRQoL in stroke survivors.</p><p><strong>Summary of review: </strong>The protocol was registered with the International Prospective Register of Systematic Reviews (CRD42023440168). We searched databases including Medline, Emcare, Scopus, Cochrane Library, CINAHL, and trial registries from inception to 13/12/2024. Only randomized controlled trials (RCTs) comparing the effect of a self-management intervention to no/another intervention for survivors of stroke on self-efficacy or HRQoL were included. Risk of bias was assessed using the Cochrane Collaboration criteria. Meta-analyses for self-efficacy and HRQoL were performed using random effect model. From 13,608 abstracts screened, 44 randomized controlled trials involving 5931 participants were included. Median time post-stroke of recruited participants ranged from 14 days to 3 years. Time required to deliver the interventions ranged from 45 min to 72 h. Self-management interventions in all included trials had multiple components, predominantly education (N = 40, 91%) and goal setting (N = 39, 89%). Interventions were delivered to individual survivors of stroke (N = 18, 41%), groups of survivors (N = 15, 34%), both individual and group delivery to survivors (N = 5, 11%) and individually to survivor-carer dyads (N = 6, 14%). Interventions were delivered entirely face-to-face (N = 28, 64%), entirely by phone or video-conferencing (N = 7, 16%) or a combination of these delivery modes (N = 9, 20%). There was low certainty evidence that self-management programs compared to no intervention did not significantly improve self-efficacy on pooled effect sizes (SMD 0.08, 95%CI -0.02 to 0.18). There was moderate certainty evidence that self-management programs had a marginal significant effect on HRQoL (SMD 0.07, 95% CI 0.01 to 0.13). Limitations to the review include marked variation between included studies in the interventions delivered, and outcome measures used, targeted behaviors and time since stroke.</p><p><strong>Conclusion: </strong>Self-management programs varied markedly in content and dose. There is low-certainty evidence that currently designed self-management programs do not significantly improve self-efficacy. There is moderate certainty evidence that self-management programs have a small effect on HRQoL after stroke.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"786-800"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Illicit drug use and cerebral microbleeds in patients with acute ischemic stroke and transient ischemic attack.","authors":"Benjamin K Petrie, Helena Lau, Fe Maria Cajiga-Pena, Saleh Abbas, Brandon Finn, Katie Dam, Anna M Cervantes-Arslanian, Thanh N Nguyen, Hugo J Aparicio, David Greer, Jose Rafael Romero","doi":"10.1177/17474930251328524","DOIUrl":"10.1177/17474930251328524","url":null,"abstract":"<p><strong>Background: </strong>Cerebral microbleeds (CMB) signal cerebral small vessel disease and are associated with ischemic stroke. While illicit drug use (IDU) is linked to cerebral vasculopathy, the association between CMB and IDU is poorly characterized.</p><p><strong>Aims: </strong>Our primary aim was to explore the relationship between IDU and CMB and delineate differences in vascular risk factors between those with and without CMB.</p><p><strong>Methods: </strong>We included 1746 (1614 unique patients) acute ischemic stroke and transient ischemic accident patient admissions from 2009 to 2018 with a readable T2*gradient-echo sequence brain magnetic resonance imaging (MRI). We retrospectively obtained patient characteristics and IDU data (by history and/or urine toxicology). MRIs were reviewed for CMB and classified topographically as lobar, deep, or infratentorial. Univariate analysis was used to assess differences in patient characteristics between those with and without CMB, as well as variation in CMB location by drug category subgrouping. Coprimary multivariate logistic/Poisson regression was used to characterize the association between drug category subgrouping and CMB.</p><p><strong>Results: </strong>We observed IDU in 13.8% (n = 241) and CMB presence in 32.9% (n = 575) in our predominantly black, middle-aged population. 53.8% of CMB were lobar, 27.3% were deep, and 18.8% were infratentorial. Within the IDU group, those with at least one CMB (compared to those without CMB) were older (56.9 ± 11.5 vs 53.6 ± 10.5, p = 0.036), had a lower body mass index (26.6 ± 4.4 vs 28.1 ± 5.9, p = 0.039), and were more likely to have chronic kidney disease (9.5% vs 3.0%, p = 0.033) or have had a previous ischemic stroke/transient ischemic attack (41.9% vs 25.1%, p = 0.009). On coprimary analysis, cocaine use was associated with increased CMB number by 0.24 (95% confidence interval (CI): 0.09, 0.38; p = 0.001) and opioid use was associated with increased CMB number by 0.31 (95% CI: 0.08, 0.52; p < 0.001) controlling for age, sex, hypertension status, and prior ischemic stroke or transient ischemic accident. CMB in the opioid use group were more likely to be deep (40.4% vs 27.3%, p = 0.023) compared to those without opioid use.</p><p><strong>Conclusions: </strong>Our findings support an association between CMB, an early marker of cerebral vasculopathy, and cocaine and opioid use. These results highlight the need for further research into the pathophysiological mechanisms linking IDU to cerebrovascular injury and underscore the importance of targeted interventions in this population.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"874-882"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605089","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}