International Journal of Stroke最新文献

{"title":"International Care Bundle Evaluation in Cerebral Hemorrhage Research (I-CATCHER): Study protocol for a multicenter, batched, parallel, cluster-randomized trial with a baseline period.","authors":"Trine Apostolaki-Hansson, Menglu Ouyang, Dar Dowlatshahi, Valeria Caso, Alessandro Bufi, Zhe Kang Law, Laurent Billot, Bo Norrving, Craig S Anderson, Teresa Ullberg","doi":"10.1177/17474930251342888","DOIUrl":"10.1177/17474930251342888","url":null,"abstract":"<p><strong>Rationale: </strong>A care bundle approach to the management of spontaneous intracerebral hemorrhage (ICH) has been shown to benefit patients in low- and middle-income countries (LMIC), but uncertainty persists over the specific components and its applicability in high-income countries (HICs).</p><p><strong>Aims: </strong>An international collaborative initiative aimed at determining whether implementation of a care bundle improves functional outcome for patients with ICH in HIC.</p><p><strong>Methods: </strong>An international, multicenter, batched, parallel, cluster-randomized clinical trial focused on implementation and quality improvement for adults with spontaneous ICH ⩽ 24 h of symptom onset. The care bundle includes time- and target-based interventions: early intensive blood pressure lowering, hyperglycemia and pyrexia management, anticoagulation reversal, avoidance of do-not-resuscitate orders, repeat imaging, and referral pathways for intensive care and neurosurgery. An embedded process evaluation will assess the effectiveness and implementation of the care bundle.</p><p><strong>Sample size: </strong>A total of 110 hospitals with 3500 ICH participants is estimated to provide 90% power (α = 0.05) to detect a plausible treatment effect of 0.20 improvement in utility-weighted modified Rankin scale (UW-mRS) scores.</p><p><strong>Outcomes: </strong>The primary outcome is UW-mRS at 6 months. Secondary outcomes include death, functional status, and health-related quality of life. Implementation outcomes include adoption, fidelity, acceptability, sustainability, and integration.</p><p><strong>Discussion: </strong>We aim to provide reliable evidence to accelerate practice change for integration of a multifaceted ICH care bundle as a critical component of acute stroke care worldwide.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov Identifier: NCT06429332.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"891-897"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986934","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":"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.Data access statement:Data are available upon reasonable request by contacting the corresponding author.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"831-842"},"PeriodicalIF":6.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264301/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous thrombolysis in acute ischemic minor stroke: A Danish nationwide cohort study.","authors":"Daniel Harsfort, Jakob Nebeling Hedegaard, Søren Paaske Johnsen, Malalai Musleh, Boris Modrau","doi":"10.1177/17474930251365445","DOIUrl":"10.1177/17474930251365445","url":null,"abstract":"<p><strong>Background and objectives: </strong>In patients with minor stroke, intravenous thrombolysis is recommended only for those with disabling symptoms, yet no standardized definition exists, and the treatment decisions remain subjective. This study aimed to evaluate the effect of thrombolysis in minor stroke using routine care registry data.</p><p><strong>Patients and methods: </strong>A Danish nationwide register-based cohort study included patients with minor stroke (Scandinavian Stroke Scale (SSS) ⩾ 45) from 2011 to 2021. Patients were categorized as having mild strokes (SSS 45-49, approximated National Institutes of Health Stroke Scale (NIHSS) = 5-6) or very mild strokes (SSS 50-58, approximated NIHSS 1-4) to pragmatically distinguish disabling from non-disabling symptoms. Return-to-work, use of homecare, typical stroke complications, recurrent stroke, and mortality were compared in patients treated with and without thrombolysis. Analyses were adjusted for vascular risk factors, demographics, and clinical characteristics using inverse probability of treatment weighting.</p><p><strong>Results: </strong>Among 31,007 included patients, 1910 with mild strokes and 4052 with very mild strokes received thrombolysis. In patients with mild strokes, thrombolysis was associated with a higher rate of return-to-work (adjusted hazard ratio = 1.33), lower risk of pneumonia (adjusted relative risk (aRR) = 0.40), and lower mortality (aRR = 0.58, 0.50, and 0.50 at 30, 90, and 365 days, respectively). In patients with very mild strokes, thrombolysis was not associated with improved outcomes, except lower mortality at 365 days (aRR = 0.78).</p><p><strong>Discussion: </strong>Intravenous thrombolysis was more often associated with better outcomes in patients with mild strokes than in patients with very mild strokes.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251365445"},"PeriodicalIF":8.7,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730915","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 risk of femoral fracture is increased in patients with ischemic stroke and transient ischemic attack-a population-based observational secondary analysis of the Austrian stroke cohort.","authors":"Martin Heidinger, Clemens Lang, Julia Ferrari, Stefan Krebs, Marek Sykora, Rainer Kleyhons, Heinrich Resch, Anel Karisik, Benjamin Dejakum, Kurt Mölgg, Julian Granna, Christian Boehme, Peter Willeit, Michael Knoflach, Georg Schett, Stefan Kiechl, Wilfried Lang","doi":"10.1177/17474930251364071","DOIUrl":"10.1177/17474930251364071","url":null,"abstract":"<p><strong>Background: </strong>An increased risk of femoral fractures after ischemic stroke (IS) and transient ischemic attack (TIA) has been shown previously. However, it remains unclear whether the ischemic cerebral event is directly associated with the risk of femoral fractures.</p><p><strong>Aims: </strong>The aim of this study was (1) to assess the association between the frequency of femoral fractures in patient with IS and TIA, and (2) to compare the risk of femoral fractures to the Austrian general population.</p><p><strong>Methods: </strong>Population-based observational secondary analysis of the Austrian Stroke Cohort to assess the incidence of femoral fractures in the year after IS/TIA compared with the year before, and both intervals compared with the Austrian general population. All patients ⩾20 years treated for IS/TIA in Austria between 1 January 2016 and 31 December 2018 were identified using medical record linkage. Patient trajectories were reconstructed from 1 January 2015 to 31 December 2019 to have a 1-year observational period before and after the event. Femoral fractures within 1 year after IS/TIA compared to 1 year before IS/TIA were analyzed using McNemar test and Cox regression analysis considering sex and age. The 1-year age- and sex-adjusted relative risk of femoral fractures was calculated for patients with IS/TIA and compared to the Austrian general population.</p><p><strong>Results: </strong>A total of 48,996 survivors of IS (n = 34,997) and TIA (n = 13,999) were included. The incidence of femoral fractures increased significantly from the year before the IS/TIA (8.9 per 1000 person-years, 95% CI 7.7-10.2) to the year after the event (11.8 per 1000 person-years, 95% CI 10.1-13.5; <i>p</i> = 0.022). Compared to the Austrian general population including 21.1 million patient-years at risk and 37,436 femoral fractures, the risk of femoral fractures was increased both in the year before (RR 2.08, 95% CI 2.06-2.11) and after (RR 3.52, 95% CI 3.48-3.56) the IS/TIA.</p><p><strong>Conclusion: </strong>The risk of femoral fractures was found to be increased in the year following an IS/TIA, indicating a direct association with the IS/TIA event.Data access statement:Reconstruction of medical record linkage and individual patient trajectory reconstruction were reported previously. Data from individual patient trajectories was used for this analysis.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251364071"},"PeriodicalIF":8.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690189","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":"Sodium-glucose cotransporter 2 inhibitors and stroke risk in patients with diabetes and stroke risk factors: A real-world cohort study.","authors":"Bing-Hua Lin, Hui-Min Huang, Hui-An Lin, Sheng-Feng Lin","doi":"10.1177/17474930251364060","DOIUrl":"10.1177/17474930251364060","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve the cardiovascular outcomes of patients with type 2 diabetes (T2D). However, whether this effect extends to stroke prevention in high-risk patients remains unclear.</p><p><strong>Aims: </strong>This study aims to investigate the effect of SGLT2i in stroke prevention in patients with T2D and concomitant risk factors.</p><p><strong>Methods: </strong>Patients with T2D and various risk factors for stroke were identified from the TriNetX platform from 2013 to 2024. These patients were divided into two cohorts: one treated with SGLT2i, and the other with metformin or dipeptidyl peptidase-4 inhibitors. Propensity score matching was used to balance the patients' demographic characteristics, underlying comorbidities, and antiplatelet and anticoagulant drug use patterns. The primary outcome was the development of ischemic or hemorrhagic stroke or the onset of a transient ischemic attack (TIA) within 1 year. Unadjusted Cox proportional hazards models were applied to estimate hazard ratios (HRs). Sensitivity analyses stratified by age, sex, and hemoglobin A1c (HbA1c) levels were performed, and interaction tests were used to assess potential effect modifiers. In addition, the two cohorts were compared for estimation of numbers needed to treat (NNTs).</p><p><strong>Results: </strong>A total of 3,715,058 patients were identified, of whom 971,727 (26.2%) were SGLT2i users. After matching, 932,419 patients were included in each group. SGLT2i use was associated with a significantly reduced risk of ischemic stroke (HR: 0.84, 95% confidence interval (CI): 0.81-0.87; NNT: 669), hemorrhagic stroke (HR: 0.73, 95% CI: 0.68-0.79; NNT: 1837), and TIA (HR: 0.81, 95% CI: 0.77-0.86; NNT: 1615). The protective effect against ischemic stroke was more pronounced in males and individuals aged over 65 years. Greater benefit was observed in patients with chronic kidney disease (NNT: 466), atrial fibrillation (NNT: 492), and heart failure (NNT: 415). In contrast, the protective effect was attenuated in patients with obesity, among whom SGLT2i use was associated with a modestly increased risk of ischemic stroke after 1 year (HR: 1.05, 95% CI: 1.01-1.09).</p><p><strong>Conclusion: </strong>SGLT2i use is associated with a significant reduction in the risk of stroke among selected T2D patients. SGLT2i may be used as a first-line therapy for diabetes patients with concomitant chronic kidney disease, atrial fibrillation, and heart failure.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251364060"},"PeriodicalIF":8.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690277","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":"Differences in acute ischemic stroke treatment: A cross-sectional study from international Registry of Stroke Care Quality (RES-Q).","authors":"Robert Mikulik, Geraldo Neto, Rupal Sedani, Sebastian F Ameriso, Nargiz Mammadova, Sergey Marchenko, Sheila Martins, Ivan Milanov, Freddy Constanzo, Mario Muñoz, Hrvoje Budincevic, Martin Šrámek, Cristina Ramos, Magd Fouad Zakaria, Janika Kõrv, Georgios Tsivgoulis, Laszlo Szapary, Jeyaraj Pandian, Adin Nulkhasanah, Waleed Batayha, Sabina Medukhanova, Kunduz Karbozova, Evija Miglane, Aleksandras Vilionskis, Hoo Fan Kee, Fernando Gongora-Rivera, Carlos Cantu Brito, Stanislav Groppa, Natalia Ciobanu, Raju Paudel, Carlos Abanto, Maria Epifania Collantes, Maria Cristina San Jose, Adam Kobayashi, Ana Gomes, Cristina Tiu, Nikolay Shamalov, Milija Mijajlovic, Zuzana Gdovinová, Louis Kroon, Sung-Il Sohn, Francisco Moniche, Somchai Towanabut, Sergii Moskovko, Ammar AlOmar, Nguyen Huy Thang, Sandy Middleton, José Domingo Barrientos-Guerra","doi":"10.1177/17474930251364082","DOIUrl":"10.1177/17474930251364082","url":null,"abstract":"<p><strong>Background: </strong>Stroke globally impacts mortality and disability. Compliance with international standards and evidence-based practices for acute stroke management would improve patient outcomes.</p><p><strong>Objectives: </strong>We aimed to present a descriptive analysis of the quality of acute stroke care across different countries using the Registry of Stroke Care Quality (RES-Q).</p><p><strong>Method: </strong>In a cross-sectional study, data from key quality indicators such as Emergency Medical Services (EMS) deployment rates, hospital arrival to imaging time (door-to-imaging: DIT), hospital arrival to thrombolysis time (door-to-needle: DNT), and Stroke Unit Care/Intensive Care Unit (SU/ICU) admission frequencies were examined. The analysis employed descriptive statistics and Spearman correlation tests.</p><p><strong>Results: </strong>Of 334,184 patients from 1130 hospitals in 70 countries, 218,832 patients (65.5%) from 47 countries were diagnosed with acute ischemic stroke after exclusions. The number of patients per country ranged from 226 to 62,080. International variability in care quality was observed: EMS (7-97%); SU/ICU (12-100%); and median DIT (7-41 min); and DNT (20-75 min). IVT rates varied markedly across countries, ranging from <1% to 52%. Higher patient volumes were positively correlated with SU/ICU admission and negatively with DIT and DNT (ρ = 0.10, -0.22, -0.42, respectively).</p><p><strong>Conclusion: </strong>This study demonstrates substantial international variation in the use of quality monitoring in clinical practice as well as in key indicators of acute ischemic stroke care, including intravenous thrombolysis rates and treatment timelines. The extent of variability highlights opportunities for benchmarking and targeted quality improvement efforts across diverse healthcare systems.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251364082"},"PeriodicalIF":8.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690276","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 rising incidence of stroke in the young: Epidemiology, causes and global impact.","authors":"Ahmad Nehme, Linxin Li","doi":"10.1177/17474930251362583","DOIUrl":"10.1177/17474930251362583","url":null,"abstract":"<p><p>Although reductions in stroke incidence have been reported over recent decades particularly in high-income countries, there has been a worrying trend since the start of the 21st century: stroke incidence in younger individuals (<55 years) has not showed a similar decrease as at older ages. In high-income countries, several population-based studies have found an increase in the incidence of stroke at younger ages since 2000, reaching up to 90% in Oxfordshire, UK (2010-2018 vs 1981-1986) and 97% in Cincinnati, USA (2010 vs 1993-1994). A similar picture has also been documented in low- and middle-income countries, both in population-based studies (Joinville, Brazil, 35% increase in 2012-2013 vs 2005-2006) and in the Global Burden of Disease study. The exact reasons for this very different picture seen in younger individuals are unknown. One possibility is that traditional modifiable risk factors are increasingly prevalent and often undertreated at younger ages. However, studies have also found increases in the incidence of young-onset cryptogenic stroke and in people with no traditional modifiable risk factors, suggesting a role for emerging risk factors. Potential culprits might include air pollution, long working hours, psychosocial stress, prior autoimmune diseases, and illicit drug use, although further research is required to determine whether these emerging risk factors are causally related to stroke at younger ages. Without further intervention, the global burden of stroke at younger ages is projected to increase further in the coming years. Therefore, there is an urgent need to better understand the drivers of these time trends in incidence, to potentially alleviate the individual and societal impacts of stroke in the young. In this narrative review, we examine the recent global changes in stroke epidemiology at younger ages, their potential drivers, and their projected consequences.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251362583"},"PeriodicalIF":8.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667653","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":"Outcomes of external ventricular drainage and lumbar drainage in aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis.","authors":"Basel Musmar, Hammam Abdalrazeq, Joanna M Roy, Hamza Adel Salim, Mary-Katharine Pontarelli, Nimer Adeeb, Stavropoula I Tjoumakaris, Michael Reid Gooch, Christina Notarianni, Bharat Guthikonda, Jacques Morcos, Robert H Rosenwasser, Pascal Jabbour","doi":"10.1177/17474930251361211","DOIUrl":"10.1177/17474930251361211","url":null,"abstract":"<p><strong>Background: </strong>Lumbar drainage (LD) and external ventricular drainage (EVD) are used in patients with aneurysmal subarachnoid hemorrhage (aSAH) for cerebrospinal fluid diversion and blood clearance. While both have potential benefits, the relative efficacy and safety of LD versus EVD remain unclear, particularly given their use in differing clinical contexts. This study aims to provide a crude comparison of LD and EVD in the context of aSAH using the most updated and comprehensive meta-analysis.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review and pair-wise meta-analyses of 28 studies (4390 patients). Cohorts were analyzed across three contrasts-LD versus non-LD, EVD versus non-EVD, and LD versus EVD-using random-effects models. Outcomes included rebleeding, clinical vasospasm, delayed ischemic neurological deficit (DIND)/ischemic stroke, functional status (mRS 0-2 early and late; Glasgow Outcome Scale (GOS) ⩽ 2), mortality, infection, and shunt dependency.</p><p><strong>Results: </strong>Compared with non-LD, LD lowered the odds of vasospasm (odds ratio (OR): 0.51, 95% confidence interval (CI): 0.33 to 0.78), DIND/ischemic stroke (OR: 0.55, 0.37 to 0.83), severe disability/vegetative state (GOS ⩽ 2) (OR: 0.28, 0.17 to 0.46), and mortality (OR: 0.59, 0.41 to 0.85) without affecting rebleeding rates. Versus non-EVD, EVD reduced ischemic complications (OR: 0.39, 0.16 to 0.96) but increased infection risk (OR: 11.58, 1.45 to 92.71); vasospasm and rebleeding were similar. Direct comparison showed LD superior to EVD for early functional independence (OR: 1.92, 1.06 to 3.50) and mortality (OR: 0.49, 0.30 to 0.81), while rebleeding, vasospasm, infections, and shunt dependency were similar.</p><p><strong>Conclusion: </strong>LD was associated with lower rates of vasospasm, ischemic complications, severe disability, and mortality compared to non-LD, without increasing rebleeding risk. EVD reduced ischemic complications but was linked to higher infection rates. When directly compared, LD was favored for early functional recovery and survival. These findings should be interpreted in light of differing clinical indications and baseline severity. Further studies are needed.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251361211"},"PeriodicalIF":8.7,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637021","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":"Neuroinflammation in long-term cognitive impairment after aneurysmal subarachnoid hemorrhage.","authors":"Reinier Wp Tack, Nelleke Tolboom, Bas Meyer Viol, Sandeep Sv Golla, Bart Nm van Berckel, Irene C van der Schaaf, Ronald Boellaard, Alberto de Luca, Martine Je van Zandvoort, Johanna Ma Visser-Meily, Elly M Hol, Gabriel Je Rinkel, Mervyn DI Vergouwen","doi":"10.1177/17474930251362004","DOIUrl":"10.1177/17474930251362004","url":null,"abstract":"<p><strong>Background: </strong>Survivors of aneurysmal subarachnoid hemorrhage (aSAH) often have cognitive impairment, which may be caused by long-term inflammation. We aimed to determine whether long-term neuroinflammation or microstructural brain damage is associated with cognitive impairment after aSAH.</p><p><strong>Methods: </strong>In this prospective cohort study, we included patients >3 years after aSAH between 2020 and 2022. Patients underwent neuropsychological evaluation, translocator protein 18 kDA (TSPO) positron emission tomography (PET) imaging using [¹⁸F]DPA-714 to determine neuroinflammation, and brain diffusion kurtosis imaging (DKI) to determine microstructural damage. We compared TSPO PET binding potential, mean kurtosis (MK), kurtosis anisotropy (KA), axial kurtosis (AK), and radial kurtosis (RA) between groups and determined which metric was correlated with individual cognitive tests.</p><p><strong>Results: </strong>We included 27 patients with aSAH; 14 with and 13 without cognitive impairment. Whole-brain TSPO binding potential was similar between groups (mean BP_ND: -0.046 [95% confidence interval (CI): -0.105; 0.013] vs -0.047 [95% CI -0.108; 0.014], p = 0.98) and there were no regional differences. Those with cognitive impairment had a lower whole-brain MK (mean MK 0.70 [95% CI: 0.69-0.72] vs 0.73 [95% CI: 0.72-0.74], p = 0.03) and whole-brain AK (mean AK 0.81 [95% CI: 0.78-0.83] vs 0.86 [0.84-0.87], p = 0.04). Left thalamic MK and AK were correlated with tests of verbal memory (r = 0.60-0.67, p < 0.01), while other correlation tests were non-significant.</p><p><strong>Conclusion: </strong>Our results do not support the hypothesis that long-term cognitive impairment after aSAH is caused by long-term neuroinflammation. Instead, microstructural damage may play a role.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251362004"},"PeriodicalIF":8.7,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between time and severe hypoperfusion with risk of hemorrhagic transformation in stroke patients.","authors":"Umberto Pensato, Nathaniel Rex, Nima Kashani, Amy Yx Yu, Ashutosh P Jadhav, Joung-Ho Rha, Ajit S Puri, Paul Burns, Andrew M Demchuk, Michael D Hill, Mayank Goyal, Johanna M Ospel","doi":"10.1177/17474930251360519","DOIUrl":"10.1177/17474930251360519","url":null,"abstract":"<p><strong>Introduction: </strong>Perfusion imaging studies show a substantially increased risk of hemorrhagic transformation (HT) in severely hypoperfused tissue. Preclinical evidence indicates that ischemic damage is influenced not only by the degree of hypoperfusion but also by the duration of exposure to that hypoperfused state. We aim to investigate the association of time and severe hypoperfusion with parenchymal hematoma (PH) in ischemic stroke and explore whether there is a combined effect of the two variables on PH.</p><p><strong>Methods: </strong>Data are from the ESCAPE-NA1 trial, which evaluated the effect of nerinetide in large vessel occlusion patients treated with thrombectomy. This study included patients with some degree of recanalization (expanded Thrombolysis in Cerebral Infarct [eTICI] > 0) and available baseline CT perfusion. Severe hypoperfusion was defined as at least 1 mL volume of relative cerebral blood flow (rCBF) <20%. We assess 24-h imaging for the presence of PH, according to Heidelberg bleeding criteria. Univariable and multivariable logistic regression analyses, including interaction terms, were used to assess the effect of time and severe hypoperfusion on outcomes.</p><p><strong>Results: </strong>Out of 1105 patients from ESCAPE-NA1, 396 (35.8%) were included. The median age was 70 years (IQR = 59.8-79.2), 202 (51%) were females, and 50 (12.6%) experienced PH. Onset-to-imaging time (adjusted OR 1.04 [95% CI = 1.01-1.06] per 15-min increase) and the presence of severe hypoperfusion (adjusted OR 2.87 [95% CI = 1.47-5.63]) were the only variables associated with PH in multivariable analysis. No significant interaction effect of time and severe hypoperfusion on PH was found. The presence of severe hypoperfusion had a negative predictive value of 98% and a positive predictive value of 39.4% for predicting PH in patients presenting within 3 h and after 6 h from symptom onset, respectively.</p><p><strong>Conclusion: </strong>Both severe hypoperfusion and time affect the risk of hemorrhagic transformation. However, the interaction between these two variables was not statistically significant, indicating that their effects on hemorrhagic transformation risk are not dependent on each other. Analyzing these variables may help identify patients with a leaky, severely compromised blood-brain barrier in the ischemic core-a \"leaky core.\"</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251360519"},"PeriodicalIF":8.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608280","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}