International Journal of Stroke最新文献

{"title":"Intensive blood pressure lowering in acute stroke with intracranial stenosis post-thrombectomy: A secondary analysis of the OPTIMAL-BP trial.","authors":"Kwang Hyun Kim, Jaeseob Yun, Jae Wook Jung, Young Dae Kim, JoonNyung Heo, Hyungwoo Lee, Jin Kyo Choi, Il Hyung Lee, In Hwan Lim, Soon-Ho Hong, Minyoul Baik, 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, Kyung-Yul Lee, Yo Han Jung, Yang-Ha Hwang, Chi Kyung Kim, Jae Guk Kim, Chan Joo Lee, Sungha Park, Hye Sun Lee, Sun U Kwon, Oh Young Bang, Ji Hoe Heo, Hyo Suk Nam","doi":"10.1177/17474930241305315","DOIUrl":"10.1177/17474930241305315","url":null,"abstract":"<p><strong>Background: </strong>Intensive blood pressure (BP) management within 24 h after successful reperfusion following endovascular thrombectomy (EVT) is associated with worse functional outcomes than conventional BP management in Asian randomized controlled trials. Given the high prevalence of intracranial atherosclerotic stenosis (ICAS) in Asia, ICAS may influence these outcomes.</p><p><strong>Aims: </strong>We aimed to assess whether ICAS affects the outcomes of intensive BP management after successful EVT.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control trial, which enrolled participants from June 2020 to November 2022. Patients with anterior circulation large vessel occlusion (LVO) were stratified into ICAS-related and embolic LVO groups. Clinical outcomes for intensive (target systolic BP < 140 mm Hg) and conventional BP management (target systolic BP = 140-180 mm Hg) were analyzed in each group. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0 to 2 at 3 months. Safety outcomes included symptomatic intracerebral hemorrhage within 36 h and stroke-related death within 3 months.</p><p><strong>Results: </strong>Among 192 patients, 59 were in the ICAS-related LVO group, and 133 were in the embolic LVO group. In the ICAS-related LVO group, the rate of achieving a favorable outcome at 3 months was 37.5% with intensive BP management and 55.6% with conventional management (adjusted odds ratio (OR) = 0.49 (95% confidence interval (CI) = 0.14 to 1.75); <i>P</i> = 0.27). In the embolic LVO group, these rates were 29.9% and 42.4%, respectively (adjusted OR = 0.64 (95% CI = 0.28 to 1.45); <i>P</i> = 0.29). No significant interaction was found (<i>P</i> for interaction = 0.68). In addition, the ICAS-related LVO group receiving intensive BP management had lower rates of successful reperfusion at 24 h compared to conventional management (67.7% vs. 91.7%; <i>P</i> = 0.03), while no significant difference was found in the embolic LVO group. A significant interaction effect on successful reperfusion at 24 h was observed between ICAS-related and embolic LVO groups (<i>P</i> for interaction = 0.04). No significant differences in safety outcomes were observed between intensive BP management and conventional management within both ICAS-related LVO and embolic LVO groups.</p><p><strong>Conclusions: </strong>ICAS did not significantly affect outcomes of intensive BP management within 24 h after successful EVT. After successful reperfusion by EVT, intensive BP management should be avoided regardless of ICAS presence.</p><p><strong>Data access statement: </strong>The data that support the findings of this study are available from the corresponding author upon reasonable request.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241305315"},"PeriodicalIF":6.3,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710052","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 social networks and functional recovery after stroke.","authors":"Lauri Bishop, Scott C Brown, Hannah E Gardener, Antonio J Bustillo, D Akeim George, Gillian Gordon Perue, Karlon H Johnson, Neva Kirk-Sanchez, Negar Asdaghi, Carolina M Gutierrez, Tatjana Rundek, Jose G Romano","doi":"10.1177/17474930241283167","DOIUrl":"10.1177/17474930241283167","url":null,"abstract":"<p><strong>Background and purpose: </strong>Social determinants of health (SDOH), including social networks, impact disability and quality of life post-stroke, yet the direct influence of SDOH on functional change remains undetermined. We aimed to identify which SDOH predict change on the modified Rankin Scale (mRS) within 90 days after stroke hospitalization.</p><p><strong>Methods: </strong>Stroke patients from the Transitions of Care Stroke Disparities Study (TCSDS) were enrolled from 12 hospitals in the Florida Stroke Registry. TCSDS aims to identify disparities in hospital-to-home transitions after stroke. SDOH were collected by trained interviewers at hospital discharge. The mRS was assessed at discharge, 30- and 90-day post-stroke. Multinomial logistic regression models examined contributions of each SDOH to mRS improvement or worsening (compared to no change) from discharge to 30- and 90-day, respectively.</p><p><strong>Results: </strong>Of 1190 participants, median age was 64 years, 42% were women, 52% were non-Hispanic White, and 91% had an ischemic stroke. Those with a limited social support network had greater odds of functional decline at 30 days (aOR = 1.39, 1.17-1.66), adjusting for age and onset to arrival time and at 90 days (aOR = 1.50, 1.10-2.05) after adjusting for age. Results were consistent after further adjustment for additional SDOH and participant characteristics. Individuals living with a spouse/partner had reduced odds of functional decline at 90 days (aOR = 0.74, 0.57-0.98); however, results were inconsistent with more conservative modeling approaches.</p><p><strong>Conclusion: </strong>The findings highlight the importance of SDOH, specifically having a greater number of individuals in your social network in functional recovery after stroke.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"95-104"},"PeriodicalIF":6.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107458","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":"Female hormonal and reproductive factors and the risk of subarachnoid hemorrhage.","authors":"Fang Cao, Junyu Liu, Yuge Wang, Qingyue He, Yuxin Guo, Junxia Yan","doi":"10.1177/17474930241283377","DOIUrl":"10.1177/17474930241283377","url":null,"abstract":"<p><strong>Background: </strong>Subarachnoid hemorrhage (SAH), primarily caused by rupture of intracranial aneurysm, has a high incidence rate in women. We aimed to evaluate the association between female hormonal and reproductive factors and SAH.</p><p><strong>Methods: </strong>A prospective cohort of 226,469 participants from the UK Biobank was followed for a median period of 14.75 years. Cox proportional hazards models and restricted cubic splines were used to explore the associations between 13 major factors and SAH, including menarche age, menopausal status, age at menopause, reproductive lifespan, pregnancy history, age at first and last live births, number of live births, adverse fertility outcomes, history of oral contraception or hormone-replacement therapy (HRT) use, and surgical history of hysterectomy or bilateral oophorectomy.</p><p><strong>Results: </strong>SAH occurred in 769 of participants during the follow-up period. Both women with a younger age at menarche (< 12 years) and post-menopausal women had a higher SAH risk (hazard ratio (HR), 1.28; 95% confidence interval (CI), 1.06-1.54) and (HR, 1.48; 95% CI, 1.10-1.99), respectively. A higher risk of SAH was identified in those with an earlier age at menopause (< 40 years: HR, 2.09; 95% CI, 1.43-3.06; 40-44 years: HR, 1.68; 95% CI, 1.23-2.29). A shorter reproductive lifespan (< 30 years) was associated with increased SAH risk (HR, 1.64; 95% CI, 1.28-2.11), while a longer reproductive lifespan (> 42 years) showed a protective effect (HR, 0.65; 95% CI, 0.55-0.77). Younger age at first live birth (< 24 years) was associated with SAH (HR, 1.39; 95% CI, 1.13-1.72). Hysterectomy (HR, 2.55; 95% CI, 2.12-3.05) or bilateral oophorectomy (HR, 1.51; 95% CI, 1.14-2.01) also predisposed women to SAH. Age at last live birth, number of live births, pregnancy history, adverse fertility outcomes, and HRT or oral contraceptive use were not associated with SAH.</p><p><strong>Conclusions: </strong>Female hormonal and reproductive factors are important for evaluating SAH risk in women. In particular, earlier menopause is associated with an increased risk of SAH.</p><p><strong>Data access statement: </strong>The data utilized in this study were sourced from a third party and are not publicly accessible. The UK Biobank data that support the findings of this research are available from the UK Biobank (www.ukbiobank.ac.uk), subject to review and approval by the UK Biobank.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"105-115"},"PeriodicalIF":6.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107457","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 stroke registers in Sub-Saharan Africa.","authors":"Daniel Youkee, Mamadu Baldeh, Anthony Rudd, Marina Soley-Bori, Charles DA Wolfe, Gibrilla F Deen, Iain J Marshall","doi":"10.1177/17474930241262936","DOIUrl":"10.1177/17474930241262936","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Stroke registers are recommended as a key priority by the Lancet Neurology World Stroke Organization Commission for Stroke, 2023, and the African Stroke Leaders' Summit, 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;This scoping review aims to map where stroke registers have been implemented in Sub-Saharan Africa (SSA). The article then compares and critiques the methods and definitions used and summarizes key results from the registers. The scoping review searched EMBASE, MEDLINE, and CABI Global Health databases and included all studies with a prospective longitudinal design in SSA, where adult acute stroke was the primary condition studied. Articles were screened against inclusion and exclusion criteria independently by two authors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary: &lt;/strong&gt;We identified 42 unique stroke registers from 48 individual studies. The registers were located in 19 countries, with 19 from East Africa, 15 West Africa, 6 Central Africa, and 2 from Southern Africa. Cumulatively, the registers recruited 12,345 participants with stroke, the median number of participants was 183 (interquartile range (IQR): 121-312), and the range was 50-1018. Only one study was a population-based register, and 41 were hospital-based registers. Of the hospital-based registers, 29 were single site, 10 were conducted at two sites, and 2 at three sites. Twenty-three (54.7%) of the registers were located in the capital city of their respective country, and only one of the hospital-based registers was in a self-described rural area. Length of recruitment ranged from 4 months to 6 years; the median length of recruitment was 12 months. Methodology and definitions were heterogenous between the registers. Only seven (19.4%) registers referenced the WHO STEPwise approach to implementing stroke registers. Twenty-seven (64.3%) registers used the WHO definition of stroke. The mean neuroimaging rate was 84%, and ranged from 0% to 100%. Stroke severity was measured using the National Institute of Health Stroke Scale (NIHSS) in 22 (52.4%) registers, four registers used the Glasgow Coma Scale (GCS), two registers used the miniNIHSS, one used the Scandinavian Stroke Scale, one modified Rankin Scale (mRS), and 11 registers did not report a stroke severity measure. Seventeen (40.5%) registers used the mRS to measure function, six registers used Barthel Index alone, and three registers used both mRS and Barthel Index. Only two registers included a quality-of-life measure, the EQ-5D. Eight registers included a quality-of-care measure, and 26 (61.9%) registers recorded socioeconomic status or a socioeconomic status proxy, most frequently educational attainment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This scoping review found high heterogeneity of methods and definitions used by stroke registers, with low uptake of the WHO stepwise method of stroke surveillance. A drive to standardize methodology would improve the comparability of stroke data in SSA. The shared use of educa","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"21-28"},"PeriodicalIF":6.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293370","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":"Anticoagulation strategy for patients presenting with ischemic strokes while using a direct oral anticoagulant: A systematic review and meta-analysis.","authors":"João Paulo Mota Telles, Giulia Isadora Cenci, Gabriel Marinheiro, Gabriela Borges Nager, Rebeka Bustamante Rocha, Fernanda Ferreira Bomtempo, Eberval Gadelha Figueiredo, Gisele Sampaio Silva","doi":"10.1177/17474930241270443","DOIUrl":"10.1177/17474930241270443","url":null,"abstract":"<p><strong>Background: </strong>While direct-acting oral anticoagulants (DOACs) have established efficacy in reducing the risk of ischemic stroke, they still leave a residual risk of stroke, which may be greater in practice (0.7-2.3%) than in controlled clinical trial settings. This meta-analysis examines four therapeutic approaches following a stroke in patients already on DOACs: continuing with the same DOAC, changing to a different DOAC, increasing the current DOAC dosage, or switching to a vitamin K antagonist (VKA), such as warfarin.</p><p><strong>Methods: </strong>Systematic review of literature from the MEDLINE, Embase, and Cochrane databases, was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The analysis focused on six studies with varied patient demographics, examining as outcomes as recurrent ischemic stroke, intracranial hemorrhage, other bleeding events, and mortality.</p><p><strong>Results: </strong>Six studies comprising 12,159 patients were included, all of them were observational. Patients who remained on their initial DOAC regimen had a lower risk of experiencing ischemic strokes (risk ratio (RR) 0.55; 95% confidence interval (CI) 0.43-0.70; p < 0.001; I² = 0%), intracranial hemorrhage (RR 0.37; 95% CI 0.25-0.55; p < 0.001; I² = 0%), and hemorrhagic events (RR 0.44; 95% CI 0.30-0.63; p < 0.001; I² = 6%) compared to those who were switched to warfarin, with an increase in mortality rates (hazard ratio (HR) 1.85; 95% CI 1.06-3.24; p = 0.03; I² = 84%). In contrast, neither changing to a different DOAC nor adjusting the dose proved to be more effective than the original regimen.</p><p><strong>Conclusion: </strong>Post-stroke adjustments to anticoagulation therapy-whether altering the drug or its dosage-do not yield additional benefits. In addition, the results suggest that warfarin may be less effective than DOACs for preventing stroke recurrence, bleeding complications, and death in this patient population.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"42-52"},"PeriodicalIF":6.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792408","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":"Clusters of parental socioeconomic status in early childhood and inherited risk for cerebrovascular disease until mid-life-Northern Finland Birth Cohort 1966.","authors":"Veronika Hyytiäinen, Leena Ala-Mursula, Petteri Oura, Markus Paananen, Ville Karhunen, Harri Rusanen, Mirjam I Geerlings, Jouko Miettunen, Ina Rissanen","doi":"10.1177/17474930241282521","DOIUrl":"10.1177/17474930241282521","url":null,"abstract":"<p><strong>Background and aims: </strong>The incidence of cerebrovascular disease (CVD) is rising among young adults (< 55 years). The risk for CVD starts to form in early childhood and is comprised of genetic and environmental risk factors. The aim of this study is to investigate the relationship between early family socioeconomic status (SES), inherited risk, and CVD until midlife.</p><p><strong>Methods: </strong>In the Northern Finland Birth Cohort 1966 of 12,058 children, individuals were followed from gestational period up to 54 years. We used previously published early family SES clusters, based on latent class analysis of a wide set of prenatally collected variables. We investigated inherited risk with polygenic risk score (PRS) and parental CVDs during follow-up. The associations of the five distinct clusters, inherited risk, and consequent risk for various types of CVDs until middle age were analyzed with Cox regression. All analyses were conducted first in the whole sample and then stratified by sex as is recommended in cardiovascular studies.</p><p><strong>Results: </strong>During the follow-up of 586,943 person-years, 512 CVDs occurred. No clear association between SES clusters and CVD were found. Higher PRS associated with any CVD (hazard ratio (HR) per 1 SD increase: 1.15; 95% confidence interval (CI): 1.02-1.31), and ischemic CVD (HR: 1.21; 1.05-1.40). We found no combined associations of early family SES and inherited risk for CVD.</p><p><strong>Conclusions: </strong>Inherited risk was associated with the risk for CVD in mid-life in Finnish population. We found no clear connection with early family SES and CVD. Being born to a specific SES group did not increase the effect of inherited risk.</p><p><strong>Data access statement: </strong>NFBC1966 data are available from the University of Oulu, Infrastructure for Population Studies for researchers who meet the criteria for accessing confidential data. In the use of data, we follow the EU general data protection regulation (679/2016) and Finnish Data Protection Act. Permission to use the data can be applied for research purposes from https://www.oulu.fi/nfbc.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"85-94"},"PeriodicalIF":6.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107456","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":"Stroke Measures Analysis of pRognostic Testing-Mortality nomogram predicts long-term mortality after ischemic stroke.","authors":"Tae Jung Kim, Ji Sung Lee, Mi Sun Oh, Ji-Woo Kim, Soo-Hyun Park, Kyung-Ho Yu, Byung-Chul Lee, Byung-Woo Yoon, Sang-Bae Ko","doi":"10.1177/17474930241278808","DOIUrl":"10.1177/17474930241278808","url":null,"abstract":"<p><strong>Background: </strong>Predicting long-term mortality is essential for understanding prognosis and guiding treatment decisions in patients with ischemic stroke. Therefore, this study aimed to develop and validate the method for predicting 1- and 5-year mortality after ischemic stroke.</p><p><strong>Methods: </strong>We used data from the linked dataset comprising the administrative claims database of the Health Insurance Review and Assessment Service and the Clinical Research Center for Stroke registry data for patients with acute stroke within 7 days of onset. The outcome was all-cause mortality following ischemic stroke. Clinical variables linked to long-term mortality following ischemic stroke were determined. A nomogram was constructed based on the Cox's regression analysis. The performance of the risk prediction model was evaluated using the Harrell's C-index.</p><p><strong>Results: </strong>This study included 42,207 ischemic stroke patients, with a mean age of 66.6 years and 59.2% being male. The patients were randomly divided into training (n = 29,916) and validation (n = 12,291) groups. Variables correlated with long-term mortality in patients with ischemic stroke, including age, sex, body mass index, stroke severity, stroke mechanisms, onset-to-door time, pre-stroke dependency, history of stroke, diabetes mellitus, hypertension, coronary artery disease, chronic kidney disease, cancer, smoking, fasting glucose level, previous statin therapy, thrombolytic therapy, such as intravenous thrombolysis and endovascular recanalization therapy, medications, and discharge modified Rankin Scale were identified as predictors. We developed a predictive system named Stroke Measures Analysis of pRognostic Testing-Mortality (SMART-M) by constructing a nomogram using the identified features. The C-statistics of the nomogram in the developing and validation groups were 0.806 (95% confidence interval (CI), 0.802-0.812) and 0.803 (95% CI, 0.795-0.811), respectively.</p><p><strong>Conclusion: </strong>The SMART-M method demonstrated good performance in predicting long-term mortality in ischemic stroke patients. This method may help physicians and family members understand the long-term outcomes and guide the appropriate decision-making process.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"75-84"},"PeriodicalIF":6.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987984","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 treatment effect across ASPECTS in acute ischemic stroke: Analysis from the AcT trial.","authors":"Chitapa Kaveeta, Ibrahim Alhabli, Fouzi Bala, MacKenzie Horn, Faysal Benali, Shelagh B Coutts, Atif Zafar, Olena Bereznyakova, Alexander Khaw, Houman Khosravani, Gary Hunter, Aleksander Tkach, Dar Dowlatshahi, Luciana Catanese, Chrysi Bogiatzi, Ramana Appireddy, Brian H Buck, Richard H Swartz, Tolulope T Sajobi, Mohammed Almekhlafi, Andrew M Demchuk, Aravind Ganesh, Bijoy Menon, Nishita Singh","doi":"10.1177/17474930241273561","DOIUrl":"10.1177/17474930241273561","url":null,"abstract":"<p><strong>Background: </strong>Early ischemic changes on baseline imaging are commonly evaluated for acute stroke decision-making and prognostication.</p><p><strong>Aims: </strong>We assess the association of early ischemic changes on clinical outcomes and whether it differs between intravenous tenecteplase and Alteplase.</p><p><strong>Methods: </strong>Data are from the phase 3, Alteplase compared to Tenecteplase (AcT) trial. Subjects with anterior circulation stroke were included. Early ischemic changes were assessed using the Alberta Stroke Program Early CT score (ASPECTS). Efficacy outcomes included modified Rankin scale (mRS) 0-1, mRS 0-2, and ordinal mRS at 90 days. Safety outcomes included 24-h symptomatic intracerebral hemorrhage (sICH), any hemorrhage on follow-up scan, and 90-day mortality rate. Mixed-effects logistic regression was used to assess the association of ASPECTS (continuous and categorical (0-4 vs 5-7 vs 8-10)) with outcomes and if these associations were modified by thrombolytic type after adjusting for age, sex, and baseline stroke severity.</p><p><strong>Results: </strong>Of the 1577 patients in the trial, 901 patients (56.3%; median age 75 years (IQR 65-84), 50.8% females, median National Institute of Health Stroke Scale (NIHSS) 14 (IQR 17-19)) with anterior circulation stroke were included. mRS 0-1 at 90 days was achieved in 1/14 (0.3%), 43/160 (14.7%), and 252/726 (85.1%) in the ASPECTS 0-4, 5-7, and 8-10 groups respectively. Every one-point decrease in ASPECTS was associated with 2.7% and 1.9% decrease in chances of mRS 0-1 and mRS 0-2 at 90 days, respectively, and 1.9% chances of increase in mortality at 90 days. Subgroup analysis in endovascular thrombectomy (EVT)-treated population showed similar results. Thrombolytic type did not modify this association between ASPECTS and 90-day mRS 0-1 (P-interaction 0.75). There was no significant interaction by thrombolytic type with any other outcomes.</p><p><strong>Conclusion: </strong>Similar to prior studies, we found that every one-point decrease in ASPECTS was associated with poorer clinical and safety outcomes. This effect did not differ between alteplase and tenecteplase.</p><p><strong>Data access statement: </strong>Data shall made available on reasonable request from the PI (BMM).</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"64-74"},"PeriodicalIF":6.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859715","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":"Early neurological deterioration in acute lacunar ischemic stroke: Systematic review of incidence, mechanisms, and prospects for treatment.","authors":"David J Werring, Hatice Ozkan, Fergus Doubal, Jesse Dawson, Nick Freemantle, Ahamad Hassan, Suong Thi Ngoc Le, Dermot Mallon, Rom Mendel, Hugh S Markus, Jatinder S Minhas, Alastair J S Webb","doi":"10.1177/17474930241273685","DOIUrl":"10.1177/17474930241273685","url":null,"abstract":"<p><strong>Background: </strong>Cerebral small vessel disease (CSVD) causes between 25% and 30% of all ischemic strokes. In acute lacunar ischemic stroke, despite often mild initial symptoms, early neurological deterioration (END) occurs in approximately 15-20% of patients and is associated with poor functional outcome, yet its mechanisms are not well understood.</p><p><strong>Aims: </strong>In this review, we systematically evaluated data on: (1) definitions and incidence of END, (2) mechanisms of small vessel occlusion, (3) predictors and mechanisms of END, and (4) prospects for the prevention or treatment of patients with END.</p><p><strong>Summary of review: </strong>We identified 67 reports (including 13,407 participants) describing the incidence of END in acute lacunar ischemic stroke. The specified timescale for END varied from <24 h to 3 weeks. The rate of END ranged between 2.3% and 47.5% with a pooled incidence of 23.54% (95% confidence interval (CI) = 21.02-26.05) but heterogeneity was high (<i>I</i>² = 90.29%). The rates of END defined by National Institutes of Health Stroke Scale (NIHSS) decreases of ⩾1, ⩾2, ⩾3, and 4 points were as follows: 24.17 (21.19-27.16)%, 22.98 (20.48-25.30)%, 23.33 (16.23-30.42)%, and 10.79 (2.09-23.13)%, respectively, with lowest heterogeneity and greatest precision for a cutoff of ⩾2 points. Of the 20/67 studies (30%) reporting associations of END with clinical outcome, 19/20 (95%) reported worse outcomes (usually measured using the modified Rankin score at 90 days or at hospital discharge) in patients with END. In a meta-regression analysis, female sex, hypertension, diabetes, and smoking were associated with END.</p><p><strong>Conclusions: </strong>END occurs in more than 20% of patients with acute lacunar ischemic stroke and might provide a novel target for clinical trials. A definition of an NIHSS ⩾2 decrease is most used and provides the best between-study homogeneity. END is consistently associated with poor functional outcome. Further research is needed to better identify patients at risk of END, to understand the underlying mechanisms, and to carry out new trials to test potential interventions.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"7-20"},"PeriodicalIF":6.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11669265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859714","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":"Lipid-lowering therapies and long-term stroke prevention in East Asians: A systematic review and meta-analysis of randomized controlled trials.","authors":"Bao-Qiang Guo, Hong-Bin Li, Peng-Wei Xu, Bing Zhao","doi":"10.1177/17474930241264686","DOIUrl":"10.1177/17474930241264686","url":null,"abstract":"<p><strong>Background: </strong>Stroke prevention is a pressing global health priority, with reducing elevated lipids recognized as a key strategy. East Asians, constituting more than 1.6 billion individuals and the largest racial group worldwide, are a key demographic in this effort. Yet, the effectiveness of lipid-lowering therapies for stroke prevention in this population remains uncertain.</p><p><strong>Aims and methods: </strong>We conducted a systematic review and meta-analysis of large-scale randomized controlled trials (RCTs) with at least 3 years of follow-up to evaluate the long-term impact of lipid-lowering therapies on stroke incidence in East Asians. We systematically searched four electronic databases up to 11 January 2024. The association was quantified using relative risk (RR) with a 95% confidence interval (CI), and between-study heterogeneity was evaluated using the <i>I</i>² statistic. In addition, we utilized the Cochrane Risk of Bias Tool to assess the risk of bias in each included RCT and applied the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to evaluate the certainty of the evidence.</p><p><strong>Results: </strong>This study incorporated data from nine large-scale RCTs involving 54,354 participants. Our findings of overall analyses revealed that lipid-lowering therapies did not significantly affect the long-term incidence of all strokes (9 RCTs; 54,354 participants; RR = 0.98 (95% CI = 0.87-1.10); <i>P</i> = 0.75), ischemic stroke (7 RCTs; 52,059 participants; RR = 0.91 (95% CI, = 0.79-1.04); <i>P</i> = 0.16), or hemorrhage stroke (7 RCTs; 52,059 participants; RR = 1.24 (95% CI = 0.97-1.59); <i>P</i> = 0.09) in East Asians. Notably, there was no evidence of heterogeneity or publication bias, and the quality of evidence assessed using GRADE methodologies was rated as high. Sensitivity analyses confirmed the robustness of our results, with no single study significantly affecting the overall findings. Furthermore, subgroup analyses consistently supported the conclusions, further bolstering the reliability of our study.</p><p><strong>Conclusions: </strong>Lipid-lowering therapies did not demonstrate any beneficial effects on long-term stroke prevention among East Asians.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"29-41"},"PeriodicalIF":6.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141419107","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}