International Journal of Stroke最新文献

{"title":"Safety and outcomes of intravenous thrombolysis in acute ischemic stroke with intracranial artery dissection.","authors":"Shuhei Egashira, Susumu Kunisawa, Masatoshi Koga, Masafumi Ihara, Wataro Tsuruta, Yoshikazu Uesaka, Kiyohide Fushimi, Tatsushi Toda, Yuichi Imanaka","doi":"10.1177/17474930251317326","DOIUrl":"10.1177/17474930251317326","url":null,"abstract":"<p><strong>Background: </strong>Intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) related to underlying intracranial artery dissection (IAD) poses potential risks, including the exacerbation of intramural hematoma and the rupture of the dissected arterial wall. However, the safety of IVT in this specific population remains uncertain.</p><p><strong>Aims: </strong>This study aimed to assess whether IAD is associated with an increased risk of intracranial hemorrhage (ICH) following IVT and to evaluate its impact on functional outcomes.</p><p><strong>Methods: </strong>This retrospective matched-pair cohort study used a nationwide inpatient database that includes discharge abstracts and administrative claims data in Japan. We included adult patients with AIS treated with IVT between July 2010 and July 2024. We excluded patients with carotid or vertebral artery dissections due to difficulties distinguishing between intracranial and extracranial involvement, those lacking premorbid/discharge modified Rankin Scale (mRS) data, and those who received intra-arterial thrombolysis. Patients with IAD were matched 1:4 with non-IAD controls based on age, sex, premorbid mRS, endovascular treatment (EVT), and teaching hospital status. We assessed ICH, functional independence at discharge (mRS = 0-2), and in-hospital mortality using multivariable logistic regression with generalized estimating equations to account for clustering within matched pairs, adjusting for age, sex, premorbid mRS, body mass index, smoking history, hypertension, diabetes mellitus, atrial fibrillation, coagulopathy, Japan Coma Scale, EVT, and teaching hospital status.</p><p><strong>Results: </strong>Of 83,139 patients with AIS treated with IVT, 242 (0.3%) had underlying IAD (median age = 54 (46-67) years; 34% women). These patients were matched with 968 non-IAD controls. IAD was associated with a higher risk of ICH (odds ratio (OR) = 3.18; 95% confidence interval (CI) = 1.26-8.06) and a lower likelihood of functional independence at discharge (OR = 0.51; 95% CI = 0.37-0.72), but not with increased in-hospital mortality (OR = 1.09; 95% CI = 0.50-2.38).</p><p><strong>Conclusion: </strong>Patients with underlying IAD may face an increased risk of ICH and a reduced chance of functional recovery following IVT compared to those without.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251317326"},"PeriodicalIF":6.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005335","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":"Endovascular therapy for large ischemic stroke in directly admitted versus transferred patients: A secondary analysis.","authors":"Man Li, Lina Zheng, Ximing Nie, Mengxing Wang, Xin Liu, Wanying Duan, Zhe Zhang, Miao Wen, Zhonghua Yang, Xiaochuan Huo, Xinyi Leng, Yuesong Pan, Thanh N Nguyen, Zhongrong Miao, Liping Liu","doi":"10.1177/17474930251325085","DOIUrl":"10.1177/17474930251325085","url":null,"abstract":"<p><strong>Background: </strong>Endovascular therapy (EVT) has been proved beneficial in patients with acute large vessel occlusion (LVO) with large infarcts, but it is unknown whether the benefit would be affected by the interhospital-transfer status. We investigated the efficacy of EVT according to the interhospital-transfer status in such patients.</p><p><strong>Methods: </strong>This was a secondary analysis of the ANGEL-ASPECT trial. Patients with acute anterior-circulation LVO and large infarcts, defined by Alberta stroke program early CT score (ASPECTS) 3-5 or infarct core volume 70-100 mL, were enrolled from 46 centers across China and randomized (1:1) to receive EVT with medical management (MM) versus MM alone. We dichotomized patients into two subgroups based on whether admitted directly to the EVT-capable center or transferred from a primary center. The primary outcome was the 90-day modified Rankin Scale (mRS).</p><p><strong>Results: </strong>From October 2020 to May 2022, 456 patients were recruited and one withdrew consent. So, 455 patients were included in this analysis, with 210 (46.2%) in the direct subgroup and 245 (53.8%) in the transfer subgroup. The transfer subgroup had longer median onset-to-arrival time than the direct patients (379 vs 279 mins, <i>p</i> < 0.001), while there was no significant difference in the arrival-to-recanalization time (197 vs 205 mins, <i>p</i> = 0.087) between the two subgroups. A significant ordinal shift of 90-day mRS toward a better functional outcome in EVT than MM (generalized odds ratio [gOR] = 1.67; 95% confidence interval (CI) = 1.03-2.70, <i>p</i> = 0.036 versus gOR = 1.60; 95% CI = 1.02-2.50, <i>p</i> = 0.039) was found in the direct and transfer group, respectively. There was no significant interaction of the two subgroups over the treatment effect of EVT versus MM on the primary outcome (<i>p</i> for interaction = 0.706).</p><p><strong>Conclusions: </strong>In acute anterior-circulation LVO patients with large infarcts, the benefit of EVT compared to MM did not vary by the interhospital-transfer status.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251325085"},"PeriodicalIF":6.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458073","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":"Collaterals and outcomes after endovascular treatment in acute large vessel occlusion: Disparity by stroke etiologies.","authors":"Xinyi Leng, Ximing Nie, Hongyi Yan, Yuesong Pan, Lina Zheng, Yuying Liu, Wanying Duan, Xin Liu, Yufei Wei, Weibin Gu, Xinyi Hou, Thomas W Leung, Zhongrong Miao, David S Liebeskind, Liping Liu","doi":"10.1177/17474930251324463","DOIUrl":"10.1177/17474930251324463","url":null,"abstract":"<p><strong>Background: </strong>Collateral circulation provides compensatory flow to ischemic brain regions in acute large vessel occlusion (LVO), which had been associated with better outcomes after endovascular treatment (EVT).</p><p><strong>Aims: </strong>We aimed to reveal the pre-EVT collateral status and its associations with outcomes after EVT, in patients with acute LVO with different etiologies.</p><p><strong>Methods: </strong>Based on a prospective, multicenter registry, we analyzed patients with acute, intracranial anterior-circulation LVO due to large artery atherosclerosis (LAA) and cardioembolism (CE), who underwent EVT within 24 h. Pre-EVT leptomeningeal collateral status was classified on digital subtraction angiography by ASITN/SIR grading system. Outcomes included good 3-month functional outcome (modified Rankin Scale [mRS] 0-2), 3-month mRS distribution, successful recanalization, early neurological deterioration, symptomatic intracranial hemorrhage (sICH), and 3-month mortality.</p><p><strong>Results: </strong>Among 805 patients (median age 66 years), 450 and 355, respectively, had LVO due to LAA and CE, of whom 57.8% and 56.6% (<i>p</i> = 0.742) had good pre-EVT collaterals. In LAA patients, good collaterals were associated with lower risk of sICH (adjusted odds ratio [OR]= 0.40; 95% CI = 0.17-0.94; <i>p</i> = 0.036) but not functional outcomes. In CE patients, good collaterals were associated with a higher chance of good functional outcome (adjusted OR = 1.55; 95% CI = 0.96-2.51; <i>p</i> = 0.072) and lower mRS at 3 months (adjusted common OR = 0.64; 95% CI = 0.43-0.94; <i>p</i> = 0.021). However, there was no significant CE/LAA and collateral status interaction on any outcome.</p><p><strong>Conclusions: </strong>The study revealed comparable pre-EVT collateral status in patients with LVO due to LAA versus CE who received EVT within 24 h, but the pre-EVT collaterals may have different protective effects for post-EVT outcomes in these two groups of patients.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251324463"},"PeriodicalIF":6.3,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432777","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":"Comparative outcomes of arteriovenous malformations treatment in eloquent versus non-eloquent brain: A multicenter study with propensity-score weighting.","authors":"Basel Musmar, Nimer Adeeb, Hammam Abdalrazeq, Hamza Adel Salim, Joanna M Roy, Assala Aslan, Stavropoula I Tjoumakaris, Christopher S Ogilvy, Mustafa K Baskaya, Douglas Kondziolka, Jason Sheehan, Howard Riina, Sandeep Kandregula, Adam A Dmytriw, Abdallah Abushehab, Kareem El Naamani, Ahmed Abdelsalam, Natasha Ironside, Deepak Kumbhare, Sanjeev Gummadi, Cagdas Ataoglu, Muhammed Amir Essibayi, Abdullah Keles, Sandeep Muram, Daniel Sconzo, Arwin Rezai, Omar Alwakaa, Salem M Tos, Georgios Mantziaris, Min S Park, Sahin Hanalioglu, Ufuk Erginoglu, Johannes Pöppe, Rajeev D Sen, Christoph J Griessenauer, Jan-Karl Burkhardt, Robert M Starke, Laligam N Sekhar, Michael R Levitt, David J Altschul, Neil Haranhalli, Malia McAvoy, Hussein A Zeineddine, Adib A Abla, Elias Atallah, Michael Reid Gooch, Robert H Rosenwasser, Christopher Stapleton, Matthew Koch, Visish M Srinivasan, Peng R Chen, Spiros Blackburn, Ketan Bulsara, Louis J Kim, Omar Choudhri, Bryan Pukenas, Edward Smith, Pascal J Mosimann, Ali Alaraj, Mohammad A Aziz-Sultan, Aman B Patel, Amey Savardekar, Christina Notarianni, Hugo H Cuellar, Michael Lawton, Bharat Guthikonda, Jacques Morcos, Pascal Jabbour","doi":"10.1177/17474930251323503","DOIUrl":"10.1177/17474930251323503","url":null,"abstract":"<p><strong>Background: </strong>Arteriovenous malformations (AVMs) are complex vascular anomalies with a high risk of hemorrhage and neurological deficits, especially when located in eloquent brain regions. The eloquence of an AVM location is a critical factor in the treatment planning, influencing both the risk of complications and long-term functional outcomes. This study aims to compare outcomes between eloquent and non-eloquent AVMs.</p><p><strong>Methods: </strong>This multicenter, retrospective study utilized data from the Multicenter International Study for Treatment of Brain AVMs (MISTA) consortium. Patients with eloquent and non-eloquent AVMs were compared on baseline characteristics, angiographic outcomes, and functional outcomes using the modified Rankin Scale (mRS). Propensity score weighting (IPTW) was applied to adjust for confounding variables.</p><p><strong>Results: </strong>The study included 1013 patients, with 498 (49.2%) AVMs located in eloquent regions and 515 (50.8%) in non-eloquent regions. In unadjusted analysis, eloquent AVMs had lower complete obliteration rates (67.6% vs 79.5%, OR: 0.53, 95% CI: 0.39-0.72, p < 0.001) and higher complication rates (24.5% vs 19.0%, OR: 1.38, 95% CI: 1.02-1.86, p = 0.03) compared to non-eloquent AVMs. After IPTW adjustment, eloquent AVMs continued to show significantly higher odds of overall complications (OR: 1.68, 95% CI: 1.12-2.52, p = 0.01) and symptomatic complications (OR: 1.77, 95% CI: 1.12-2.80, p = 0.01). Secondary analysis within the eloquent group indicated that embolization was linked to an elevated risk of complications. Surgery and radiosurgery showed comparable functional outcomes at last follow-up and complications rates with higher complete obliteration rates in surgery.</p><p><strong>Conclusion: </strong>AVMs in eloquent brain areas present higher risks of complications and lower obliteration rates, emphasizing the need for cautious, individualized treatment planning. Within the eloquent group, embolization increased the risk of complications, while surgery and radiosurgery showed comparable functional outcomes at last follow-up and complication rates with higher complete obliteration rates in surgery. These findings highlight the importance of location in AVM management and support further research focusing on comparing treatment strategies for AVMs in eloquent brain areas.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251323503"},"PeriodicalIF":6.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414087","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 of carotid plaques with high-risk features in embolic stroke of undetermined source: Systematic review and meta-analysis.","authors":"Costanza Maria Rapillo, Alessandro Giuricin, Cristina Sarti, Mascia Nesi, Simona Marcheselli, Ivano Lombardo, Rosario Pascarella, Marialuisa Zedde, Francesco Arba","doi":"10.1177/17474930251317321","DOIUrl":"10.1177/17474930251317321","url":null,"abstract":"<p><strong>Introduction: </strong>Recent evidence suggests a possible role of non-stenotic carotid atherosclerotic plaques in the etiology of embolic stroke of undetermined source (ESUS).</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of prevalence and characteristics of non-stenotic carotid plaques (NSPs) with high-risk features (complicated NSP) in internal carotid artery in unilateral ESUS in the anterior circulation. We searched MEDLINE and Ovid-Embase databases. High-risk features were intraplaque hemorrhage, thickness ⩾ 3 mm, ulceration, and hypodensity. We assessed the risk of bias (RoB), extracted the data, calculated the pooled prevalence and 95% confidence intervals (CI) using Inverse Variance Weighting method, and Random Effect models.</p><p><strong>Results: </strong>We included 16 studies and 1406 patients with different imaging for NSP assessment (1 ultrasound, 11 computed tomography (CT)-angiography, 4 magnetic resonance (MR) angiography). The RoB was moderate to low in most studies. Definition of complicated NSP differed across studies. The combined prevalence of any complicated NSP was 31% (95% CI = 27-36%) ipsilateral and 14% (95% CI = 9-19%) contralateral to the index stroke, the finding of any high-risk NSP was fourfold higher ipsilateral to the index stroke (OR = 3.63; 95% CI = 2.09-6.33). The prevalence of single high-risk features ipsilateral to ESUS was as follows: 35% (95% CI = 30-41%) for thickness ⩾ 3 mm; 24% (95% CI = 8-39%) for ulceration; 45% (95% CI = -2; 93%) for hypodensity, 16% (95% CI = 5-26%) for intraplaque hemorrhage.</p><p><strong>Conclusion: </strong>Complicated NSPs are present in around a third of all ESUS, and are four times more frequent ipsilaterally to the index stroke. Our results confirm the possible causal role in ESUS and highlight the need for greater diagnostic uniformity of plaque at risk.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251317321"},"PeriodicalIF":6.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005334","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":"Andexanet alfa in patients with factor Xa inhibitor-associated intracranial hemorrhage: The prospective observational multicenter ASTRO-DE study.","authors":"Hans-Christoph Diener, Nils Kuklik, Anika Hüsing, Angelika Alonso, Darius G Nabavi, Sven Poli, Maria M Gabriel, Ilko L Maier, Julia Grans","doi":"10.1177/17474930251317385","DOIUrl":"10.1177/17474930251317385","url":null,"abstract":"<p><strong>Background: </strong>Hematoma expansion after intracranial hemorrhage (ICH) in anticoagulated patients significantly influences clinical outcomes and mortality, emphasizing the need for effective reversal agents. Andexanet alfa is a specific reversal agent for factor Xa-associated major bleeding.</p><p><strong>Aims: </strong>The Andexanet alfa: non-interventional study at STROke centers in Germany (Deutschland, DE) (ASTRO-DE) study collected real-world evidence on the effect of andexanet alfa on mitigating hematoma expansion and altering prognosis in rivaroxaban- or apixaban-treated patients with ICH.</p><p><strong>Methods: </strong>ASTRO-DE was a prospective non-interventional cohort study conducted at 25 certified stroke centers in Germany. The primary outcome was the hematoma volume change and the proportion of patients with hematoma growth ⩽33% within 12-72 h or until first control imaging. Secondary endpoints included in-hospital thromboembolic events and mortality up to 90 days.</p><p><strong>Results: </strong>A total of 137 patients (47.4% male, mean age = 80.0 years) with ICH (92.6% spontaneous, 87.4% intracerebral), mean National Institutes of Health Stroke Scale (NIHSS) on admission of 11.2 points, and mean initial hematoma volume of 26.5 mL (median = 14.1 mL) were analyzed. Ninety patients (65.7%) suffered ICH while treated with apixaban and 47 (34.3%) with rivaroxaban. The median time between symptom onset and application of andexanet alfa was 3.3 h, door-to-needle time was 1.1 h. The mean change in hematoma volume until the first control imaging, conducted after a median of 15.6 h, was 2.3 mL (95% confidence interval (CI) = 0.4-4.2), while the change within 12-72 h was 1.8 mL (95% CI = 0.4-3.2). Hematoma growth ⩽33% was achieved in 90.3% of the 93 evaluable patients based on first control imaging and in 90.5% of the 63 evaluable patients, considering only imaging performed within the 12-72 h window. During hospitalization, death occurred in 30/137 patients (21.9%) and 17 thromboembolic events in 11/137 (8.0%) patients. The 90-day mortality was 47/128 (36.7%).</p><p><strong>Conclusion: </strong>ASTRO-DE is the first prospective observational study systematically collecting standardized clinical routine data with andexanet alfa treatment. The study demonstrated favorable hemostasis and minimal mean hematoma volume growth in patients with ICH associated with apixaban or rivaroxaban treatment.</p><p><strong>Data access statement: </strong>Data are available upon reasonable request by contacting the corresponding author.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251317385"},"PeriodicalIF":6.3,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005319","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":"Effects of blood pressure lowering in patients treated with intravenous thrombolysis before endovascular thrombectomy.","authors":"Jaeseob Yun, Kwang Hyun Kim, Jae Wook Jung, Young Dae Kim, JoonNyung Heo, Hyungwoo Lee, Jin Kyo Choi, In Hwan Lim, Soon-Ho Hong, Byung Moon Kim, Dong Joon Kim, Na Young Shin, Bang-Hoon Cho, Seong Hwan Ahn, Hyungjong Park, Sung-Il Sohn, Jeong-Ho Hong, Tae-Jin Song, Yoonkyung Chang, Gyu Sik Kim, Kwon-Duk Seo, Kijeong Lee, Jun Young Chang, Jung Hwa Seo, Sukyoon Lee, Jang-Hyun Baek, Han-Jin Cho, Dong Hoon Shin, Jinkwon Kim, Joonsang Yoo, Minyoul Baik, Kyung-Yul Lee, Yo Han Jung, Yang-Ha Hwang, Chi Kyung Kim, Jae Guk Kim, Chan Joo Lee, Sungha Park, Soyoung Jeon, Hye Sun Lee, Sun U Kwon, Il Hyung Lee, Oh Young Bang, Ji Hoe Heo, Hyo Suk Nam","doi":"10.1177/17474930251315630","DOIUrl":"10.1177/17474930251315630","url":null,"abstract":"<p><strong>Background: </strong>The effects of blood pressure (BP) lowering in patients treated with intravenous tissue plasminogen activator (IV tPA) before endovascular thrombectomy (EVT) are unclear.</p><p><strong>Aims: </strong>This study aims to investigate whether intensive and conventional BP management affects outcomes differently, depending on IV tPA administration before EVT.</p><p><strong>Methods: </strong>In this subgroup analysis of the Outcome in Patients Treated with Intra-Arterial Thrombectomy-Optimal Blood Pressure Control (OPTIMAL-BP; ClinicalTrials.gov Identifier: NCT04205305) trial, patients were divided into groups based on IV tPA use before EVT. Clinical outcomes of intensive (systolic BP target < 140 mm Hg) or conventional BP management (systolic BP target 140-180 mm Hg) were compared among groups. The primary efficacy outcome was a favorable outcome at 3 months (modified Rankin Scale score of 0-2). Primary safety outcomes included symptomatic intracerebral hemorrhage (sICH) within 36 h and stroke-related death within 3 months.</p><p><strong>Results: </strong>Among the 302 patients, the IV tPA group included 98 (32.5%) and the non-IV tPA group comprised 204 subjects (67.5%). In the IV tPA group, intensive BP management significantly lowered the favorable outcome rate (intensive, 27.3% vs. conventional, 51.9%; adjusted odds ratio [aOR], 0.36; 95% confidence interval [CI], 0.13-0.93; <i>p</i> = 0.04). In the non-IV tPA group, the risk difference rate of favorable outcome was not significantly different between intensive and conventional BP management (44.1% vs. 55.9%; aOR, 0.62; 95% CI, 0.31-1.22; <i>p</i> = 0.17). Notably, the proportion of malignant cerebral edema within 36 h in the IV tPA group was significantly higher in the intensive management group (18.2%) than in the conventional management group (1.9%; aOR, 10.72; 95% CI, 1.24-92.29; <i>p</i> = 0.03). sICH and mortality rates were not significantly different between intensive and conventional BP management in either study groups.</p><p><strong>Conclusions: </strong>Intensive BP management worsens 3-month functional outcomes after successful EVT without reducing sICH among patients who received IV tPA before EVT, indicating that BP lowering in this population should be cautious.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251315630"},"PeriodicalIF":6.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005326","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":"Global challenges in the access of endovascular treatment for acute ischemic stroke (global MT access).","authors":"Ahmed Nasreldein, Wan Asyraf, Thanh N Nguyen, Sheila Martins, Vasileios-Arsenios Lioutas, Ahmed Elbassiouny, Mai Duy Ton, Simona Sacco, Mohamed A Micdhadhu, Yimin Chen, Rufus Akinyemi, Espen Saxhaug Kristoffersen, Xiaochuan Huo, Zhongrong Miao, Mohamad Abdalkader, Simon Nagel, Volker Puetz, Gotz Thomalla, Hiroshi Yamagami, Zhongming Qiu, Jelle Demeestere, Adnan I Qureshi, Patrik Michel, Daniel Strbian, Bruce Cv Campbell, Bernard Yan, Abdulhakeem Olorukooba, Hesham E Masoud, Diogo C Haussen, Michael Frankel, Mahmoud H Mohammaden","doi":"10.1177/17474930251314395","DOIUrl":"10.1177/17474930251314395","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy (MT) is the standard of care for eligible acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) since 2015.</p><p><strong>Aim: </strong>Our aim was to determine the key challenges for MT implementation and access worldwide.</p><p><strong>Methods: </strong>We conducted an international online survey consisting of 37 questions, distributed through the World Stroke Organization network and as invited by co-authors between December 2022 and March 2023. The survey included a preamble outlining its purpose, questions on respondent demographics, imaging availability, MT service availability, MT selection criteria, barriers to MT, and training status in each country.</p><p><strong>Results: </strong>We received 526 responses from 89 countries distributed across 7 continents. One hundred and sixteen (22.1%) respondents did not have available MT service, 43 (8.2%) had available MT only during working hours, 362 (68.8%) had 24/7 MT availability. Regarding neuroimaging protocols, 13.5% used non-contrast computed tomography (NCCT) only, 40.1% used NCCT/CT angiography, 37.5% used NCCT/CT angiography/CT perfusion), 0.4% used magnetic resonance imaging (MRI) only, and 7.8% used MRI/MR angiography. The most common reasons for not receiving MT were cost, late presentation, and lack of availability of qualified neurointerventional services within reasonable distance. There were 59.1% of respondents who reported having a well-structured MT training program. Lack of qualified trainers, financial support, support from higher authorities, and lack of collaboration between departments were the most common obstacles against developing a training program.</p><p><strong>Conclusion: </strong>Our study highlights significant variations in MT availability, accessibility, patient selection criteria, and MT service training programs worldwide. Financial costs and a shortage of trained neurointerventionalists were the main challenges in low- and middle-income countries.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251314395"},"PeriodicalIF":6.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949022","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":"World Stroke Organization: Global Stroke Fact Sheet 2025.","authors":"Valery L Feigin, Michael Brainin, Bo Norrving, Sheila O Martins, Jeyaraj Pandian, Patrice Lindsay, Maria F Grupper, Ilari Rautalin","doi":"10.1177/17474930241308142","DOIUrl":"10.1177/17474930241308142","url":null,"abstract":"<p><strong>Background: </strong>Among non-communicable disorders (NCDs), stroke remains the second leading cause of death and the third leading cause of death and disability combined (as expressed by disability-adjusted life-years lost-DALYs) in the world.</p><p><strong>Aims: </strong>The study was aimed to estimate global, regional and nationa burden of stroke and its risk factors from 1990 to 2021.</p><p><strong>Methods: </strong>Finding presented in this paper were derived mainly from the Global Burden of Disease 2021 Study on stroke burden published in The Lancet Neurology 2024:23:973-1003.</p><p><strong>Results: </strong>The estimated global cost of stroke is over US$890 billion (0.66% of the global GDP). From 1990 to 2021, the burden (in terms of the absolute number of cases) increased substantially (70.0% increase in incident strokes, 44.0% deaths from stroke, 86.0% prevalent strokes, and 32% DALYs), with the bulk of the global stroke burden (87.0% of deaths and 89.0% of DALYs) residing in lower-income and lower-middle-income countries (LMICs). Stroke attributable to metabolic risks constituted 69.0% of all strokes, environmental risks constituted 37.0%, and behavioral risks constituted 35.0%.</p><p><strong>Conclusion: </strong>This World Stroke Organization (WSO) Global Stroke Fact Sheet 2025 provides the most updated information that can be used to inform communication with all internal and external stakeholders; all statistics have been reviewed and approved for use by the WSO Executive Committee and leaders from the Global Burden of Disease research group.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"132-144"},"PeriodicalIF":6.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785429","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":"Association of aspirin use with risk of intracerebral hemorrhage in patients without history of stroke or transient ischemic attack in the UK Biobank.","authors":"Zijie Wang, Xueyun Liu, Shanyu Zhang, Xiao Hu, Yanghua Tian, Qi Li","doi":"10.1177/17474930241288367","DOIUrl":"10.1177/17474930241288367","url":null,"abstract":"<p><strong>Background: </strong>The association between aspirin use and the risk of intracerebral hemorrhage (ICH) among individuals without previous stroke events is inconclusive.</p><p><strong>Aim: </strong>We investigated the association between regular aspirin use and ICH risk in middle-aged and older adults without previous stroke or transient ischemic attack (TIA).</p><p><strong>Methods: </strong>This prospective population-based study included participants older than 40 years with no history of stroke or TIA from the UK Biobank. The main exposure was regular aspirin use. Cox regression analyses and propensity score matching analyses estimated the hazard ratios (HRs) for aspirin use for incident fatal and non-fatal ICH. We conducted pre-specified subgroup analyses for selecting individuals at high risk of ICH when using aspirin. Multiple sensitivity analyses were performed to test the robustness of our results.</p><p><strong>Results: </strong>A total of 449,325 participants were included into final analyses (median (IQR) age 58 (50-63) years, 54.6% females), of whom 58,045 reported aspirin use. During a median follow-up of 12.75 (IQR: 12.03-13.47) years, 1557 (0.3%) incident ICH cases were identified, of which 399 (25.6%) were fatal. Aspirin was not associated with increased risk of overall (hazard ratio (HR): 1.11, 95% confidence interval (CI): 0.95-1.27, <i>P</i> = 0.188), fatal (HR: 1.03, 95% CI: 0.78-1.36, <i>P</i> = 0.846) and non-fatal (HR: 1.12, 95% CI: 0.95-1.33, <i>P</i> = 0.186) ICH. Propensity score matching analysis showed similar results. Subgroup analysis indicated that aspirin use in individuals older than 65 years or with concurrent anticoagulant use was correlated with increased risk of ICH.</p><p><strong>Conclusion: </strong>In this large cohort study of middle-aged and older adults without stroke or TIA events, there was no significant association between aspirin use and ICH risk in the real-world setting. However, it is possible that aspirin use in those aged over 65 years and concurrent anticoagulant treatment may increase the risk of ICH.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"175-185"},"PeriodicalIF":6.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287342","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}