International Journal of Stroke最新文献

{"title":"Sex, Gender, and Stroke Recovery: Functional Limitations and Inpatient Care Needs in Canadian and European Survivors.","authors":"Yusheng Zhou,Teresa Gisinger,Simon D Lindner,Valeria Raparelli,Colleen M Norris,Alexandra Kautzky-Willer,Louise Pilote","doi":"10.1177/17474930241288033","DOIUrl":"https://doi.org/10.1177/17474930241288033","url":null,"abstract":"BACKGROUNDStroke is a leading cause of long-term disability among survivors. Past literature already investigated the biological sex differences in stroke outcome, still limited work on gender differences is published. Therefore, the study aimed at investigating whether biological sex and sociocultural gender of survivors play a role as determinants of disability and quality of life among stroke survivors across Europe and Canada.METHODSData were gathered from the European Health Information Survey (EHIS, n=316,333) and Canadian Community Health Survey (CCHS, n=127,462) datasets. Main outcomes of interest were disability, assessed through evaluating the impairment of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (iADL), and inpatient care needs, such as hospitalization or institutionalization. Multivariate logistic regression models were utilized to identify factors independently associated with outcomes. Federated analysis was conducted for cross-country comparisons. Data were adjusted for the country-specific Gender Inequality Index (GII), with higher score corresponding to more gender inequality towards femalesResults: Female survivors showed greater impairments in iADL (OR=1.73, 95% CI 1.53 - 1.96) and ADL (OR=1.25, 95% CI 1.09-1.44), without a corresponding increase in inpatient care needs. Socioeconomic factors such as marital status and income level were significant predictors of disability, with low income and being single/divorced associated with higher risks. The impact of sex was more pronounced in countries with higher GII, indicating the influence of gender inequality on stroke outcomes.INTERPRETATIONThe findings highlight the significant impact of biological sex and gender-related social determinants on post-stroke disability, with female sex and unfavorable socioeconomic conditions being associated with worse outcomes.","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"79 1","pages":"17474930241288033"},"PeriodicalIF":6.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250249","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":"Cerebral vasculitis as the clinical manifestation of neuroborreliosis: pattern of vascular pathology and prognostic factors of outcome.","authors":"Yaroslav Winter,Ole Simon,Annette Spreer,Ahmed E Othman,Sebastian Altmann,Moritz Brandt,Kristian Barlinn,Tobias Back,Arda Civelek,Jan-Philipp Bach,Julia Schiffer,Christian Dresel,Sven Meuth,Stefan Bittner,Sergiu Groppa,Tobias Brummer","doi":"10.1177/17474930241287326","DOIUrl":"https://doi.org/10.1177/17474930241287326","url":null,"abstract":"BACKGROUNDNeuroborreliosis is a tick-borne condition that affects the central and/or peripheral nervous system. Cerebral infarction associated with neuroborreliosis-related vasculitis has been reported in only a handful of cases. Therefore, specific patterns of vascular pathology and prognostic outcome factors in these patients are still incompletely understood.AIMSTo determine the pattern of vascular pathology and prognostic outcome factors in patients with neuroborreliosis-related vasculitis.METHODSWe performed a longitudinal multicenter study between 1997 and 2022 in five academic study sites in Germany with a cumulative reference area of 1,620,000 inhabitants. All patients diagnosed with neuroborreliosis-associated cerebral vasculitis were included. The evaluation of clinical parameters, including NIH Stroke Scale (NIHSS), disability ranking (modified Rankin Scale, mRS), and neuroimaging with the estimation of patterns of vascular involvement were performed at admission as well as after three and twelve months. Linear regression analysis was used to identify the independent predictors of recurrent strokes, involvement of posterior circulation or multiple vessels.RESULTSPatients with neuroborreliosis-related vasculitis (n=51) were relatively young (mean age: females: 60±11 years; male patients: 60±8 years) and displayed a predominance of vascular events within the posterior circulation (60.8%). A history of smoking was linked to recurrent strokes/TIA (64.7% vs. 23.5%; p=0.006), strokes in multiple territories (100% vs. 35.9%; p<0.0001), and posterior circulation events (64.5% vs. 30.0%, p=0.017), whereas other cardiovascular risk factors showed no significant differences. Linear regression analysis further confirmed smoking's significant association with recurrent strokes/ transient ischemic attacks (B: 0.412; p=0.002), multiple territory strokes/TIA (B: 0.467; p=0.033), and posterior circulation events (B: 0.317; p=0.033).CONCLUSIONA thorough CSF examination for neuroborreliosis is crucial, especially in younger stroke patients, particularly those experiencing posterior circulation ischemic events. Smoking-cessation should be prompted in patients with neuroborreliosis-associated cerebral vasculitis.","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"65 1","pages":"17474930241287326"},"PeriodicalIF":6.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250250","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":"Vascular cognitive impairment and dementia: Mechanisms, treatment, and future directions","authors":"Vincent Chung Tong Mok, Yuan Cai, Hugh S Markus","doi":"10.1177/17474930241279888","DOIUrl":"https://doi.org/10.1177/17474930241279888","url":null,"abstract":"Worldwide, around 50 million people live with dementia, and this number is projected to triple by 2050. It has been estimated that 20% of all dementia cases have a predominant cerebrovascular pathology, while perhaps another 20% of vascular diseases contribute to a mixed dementia picture. Therefore, the vascular contribution to dementia affects 20 million people currently and will increase markedly in the next few decades, particularly in lower- and middle-income countries.In this review, we discuss the mechanisms of vascular cognitive impairment (VCI) and review management. VCI refers to the spectrum of cerebrovascular pathologies that contribute to any degree of cognitive impairment, ranging from subjective cognitive decline, to mild cognitive impairment, to dementia. While acute cognitive decline occurring soon after a stroke is the most recognized form of VCI, chronic cerebrovascular disease, in particular cerebral small-vessel disease, can cause insidious cognitive decline in the absence of stroke. Moreover, cerebrovascular disease not only commonly co-occurs with Alzheimer’s disease (AD) and increases the probability that AD pathology will result in clinical dementia, but may also contribute etiologically to the development of AD pathologies.Despite its enormous health and economic impact, VCI has been a neglected research area, with few adequately powered trials of therapies, resulting in few proven treatments. Current management of VCI emphasizes prevention and treatment of stroke and vascular risk factors, with most evidence for intensive hypertension control. Reperfusion therapies in acute stroke may attenuate the risk of VCI. Associated behavioral symptoms such as apathy and poststroke emotionalism are common. We also highlight novel treatment strategies that will hopefully lead to new disease course-modifying therapies. Finally, we highlight the importance of including cognitive endpoints in large cardiovascular prevention trials and the need for an increased research focus and funding for this important area.","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"190 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250251","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":"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":"17474930241278808"},"PeriodicalIF":6.3,"publicationDate":"2024-09-15","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":"Clinical characteristics, in-hospital management, and outcomes among patients hospitalized for acute ischemic stroke in rural vs. urban hospitals in China: a nationwide hospital-based study","authors":"Zhikai Zhu, Yingyu Jiang, Xin Yang, Chunjuan Wang, Yingxi Chen, Zixiao Li, Yongjun Wang, Yong Jiang, Hong-Qiu Gu","doi":"10.1177/17474930241286709","DOIUrl":"https://doi.org/10.1177/17474930241286709","url":null,"abstract":"BackgroundEfforts to improve rural stroke care have intensified in China. However, high-quality comprehensive data on the differences in care and outcomes between urban and rural hospitals are limited.MethodsWe analyzed data on patients with acute ischemic stroke hospitalized in the China Stroke Center Alliance hospitals from 2015 to 2022. The in-hospital management measures assessed included nine acute and five discharge management measures. Outcomes evaluated included death or discharge against medical advice (DAMA), major adverse cardiovascular events (MACE), disability at discharge, and in-hospital complications.ResultsWe enrolled 1,583,271 patients with acute ischemic stroke from 1,930 hospitals, comprising 1 086 (56.3%) rural sites with 735 452 patients and 844 (43.7%) urban sites with 847 891 patients. Patients in rural hospitals demonstrate suboptimal management measures compared to those in urban hospitals, including lower rates of intravenous recombinant tissue plasminogen activator within 4.5 h (26.0% vs. 28.3%; difference, -2.3% [-2.5% to -2.0%]), endovascular treatment (0.6% vs. 1.9%; difference, -1.3% [-1.3% to -1.2%]), vessel assessment (88.5% vs. 92.0%; difference, -3.5% [95% CI, -3.6% to -3.4%]), and anticoagulants for atrial fibrillation at discharge (42.9% vs. 47.7%; difference, -4.8% [95% CI, -5.4% to -4.2%]). Overall, the rural-urban disparity in in-hospital outcomes was small. Rural patients had a slightly higher rate of in-hospital death/DAMA (9.0% vs. 8.0%; aOR, 1.22 [95% CI, 1.20–1.23]; aRD, 1.3% [95% CI, 1.2%–1.4%]) and a slightly lower rate of complications (10.9% vs. 13.0%; aOR, 0.83 [95% CI, 0.82–0.84]; aRD, -1.3% [95% CI, -1.3%–1.3%]). No notable rural-urban differences were observed in MACE and disability at discharge.ConclusionsPatients in rural hospitals demonstrated suboptimal management measures and had higher rates of in-hospital death/DAMA compared to those in urban hospitals. Prioritizing the allocation of health resources to rural hospitals is essential to improve healthcare quality and outcomes.Data access statementThe data supporting the findings of this study are available from the corresponding author upon reasonable request.","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"33 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268395","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":"17474930241273561"},"PeriodicalIF":6.3,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Trends and Practice Variation in Early Repair of the Ruptured Aneurysm Among Patients with Aneurysmal Subarachnoid Hemorrhage in the United States, 2012-2019","authors":"wei chen, Jing Chen, Dong Li","doi":"10.1177/17474930241285728","DOIUrl":"https://doi.org/10.1177/17474930241285728","url":null,"abstract":"Background: Early repair of the ruptured cerebral aneurysm (RRCA), preferably within 24 hours of onset, is endorsed by clinical guideline as the preferred management strategy for patients with aneurysmal subarachnoid hemorrhage (aSAH). However, a comprehensive picture of this guideline-recommended usage in contemporary clinical practice is not available.Aims: This study aimed to characterize trends over time and practice variation in the implementation of an early RRCA strategy among patients with aSAH in a large, national representative data.Methods: Using data from the 2012-2019 National Inpatient Sample, we measured trends in the proportion of early RRCA, defined as within day 1 of admission, overall, and by demographic and geographical subgroups. Additionally, we created multilevel regression models to quantify hospital-level variation in the early RRCA rates.Results: We identified 82,615 aSAH hospitalizations (mean age, 56.1 years; 68.9% women) undergoing RRCA and, among these, 84.0% (95% CI, 83.4-84.7%) receiving early RRCA. The proportion of early RRCA increased steadily from 82.5% in 2012 to 85.8% in 2019 (P for trend &lt;0.001). The proportion of patients receiving early RRCA across geographic regions ranged from 78.7% to 87.9%, with a median (IQR) of 84.2% (83.0-86.1%). In contrast, the delivery of early RRCA varied widely among hospitals, with a median (IQR) rate of 86.1% (75.0-100.0%) and a range from 0 to 100.0%. The median odds ratio for the early use of RRCA treatment was 1.24 (95% CI, 1.21-1.27) in 2019, indicating 24% increased odds of implementing early RRCA if moving from a lower-use to a higher-use hospital.Conclusions: Most patients in the United States with aSAH received early RRCA treatment and exhibited an upward trend over the recent 8-year period. However, substantial variation in access to early RRCA was been observed across population subgroups, particularly at the hospital level. Future efforts are necessary to identify further sources of this variation and to develop initiatives that could represent an opportunity to optimize guideline-based quality of care in aSAH management.","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"29 1","pages":"17474930241285728"},"PeriodicalIF":6.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142177258","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":"Prehospital stroke detection scales: A head-to-head comparison of 7 scales in patients with suspected stroke.","authors":"Luuk Dekker, Walid Moudrous, Jasper D Daems, Ewout Fh Buist, Esmee Venema, Marcel Dj Durieux, Erik W van Zwet, Els Llm de Schryver, Loet Mh Kloos, Karlijn F de Laat, Leo Am Aerden, Diederik Wj Dippel, Henk Kerkhoff, Ido R van den Wijngaard, Marieke Jh Wermer, Bob Roozenbeek, Nyika D Kruyt","doi":"10.1177/17474930241275123","DOIUrl":"10.1177/17474930241275123","url":null,"abstract":"<p><strong>Background: </strong>Several prehospital scales have been designed to aid paramedics in identifying stroke patients in the ambulance setting. However, external validation and comparison of these scales are largely lacking.</p><p><strong>Aims: </strong>To compare all published prehospital stroke detection scales in a large cohort of unselected stroke code patients.</p><p><strong>Methods: </strong>We conducted a systematic literature search to identify all stroke detection scales. Scales were reconstructed with prehospital acquired data from two observational cohort studies: the Leiden Prehospital Stroke Study (LPSS) and PREhospital triage of patients with suspected STrOke (PRESTO) study. These included stroke code patients from four ambulance regions in the Netherlands, including 15 hospitals and serving 4 million people. For each scale, we calculated the accuracy, sensitivity, and specificity for a diagnosis of stroke (ischemic, hemorrhagic, or transient ischemic attack (TIA)). Moreover, we assessed the proportion of stroke patients who received reperfusion treatment with intravenous thrombolysis or endovascular thrombectomy that would have been missed by each scale.</p><p><strong>Results: </strong>We identified 14 scales, of which 7 (CPSS, FAST, LAPSS, MASS, MedPACS, OPSS, and sNIHSS-EMS) could be reconstructed. Of 3317 included stroke code patients, 2240 (67.5%) had a stroke (1528 ischemic, 242 hemorrhagic, 470 TIA) and 1077 (32.5%) a stroke mimic. Of ischemic stroke patients, 715 (46.8%) received reperfusion treatment. Accuracies ranged from 0.60 (LAPSS) to 0.66 (MedPACS, OPSS, and sNIHSS-EMS), sensitivities from 66% (LAPSS) to 84% (MedPACS and sNIHSS-EMS), and specificities from 28% (sNIHSS-EMS) to 49% (LAPSS). MedPACS, OPSS, and sNIHSS-EMS missed the fewest reperfusion-treated patients (10.3-11.2%), whereas LAPSS missed the most (25.5%).</p><p><strong>Conclusions: </strong>Prehospital stroke detection scales generally exhibited high sensitivity but low specificity. While LAPSS performed the poorest, MedPACS, sNIHSS-EMS, and OPSS demonstrated the highest accuracy and missed the fewest reperfusion-treated stroke patients. Use of the most accurate scale could reduce unnecessary stroke code activations for patients with a stroke mimic by almost a third, but at the cost of missing 16% of strokes and 10% of patients who received reperfusion treatment.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241275123"},"PeriodicalIF":6.3,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912758","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 lifetime economic model of mortality and secondary care use for patients discharged from hospital following acute stroke.","authors":"Peter J McMeekin, Stephen McCarthy, Andrew McCarthy, Jennifer Porteous, Michael Allen, Anna Laws, Phil White, Martin A James, Gary A Ford, Lisa Shaw, Christopher I Price","doi":"10.1177/17474930241284447","DOIUrl":"https://doi.org/10.1177/17474930241284447","url":null,"abstract":"BackgroundThe long-term health-economic consequences of acute stroke are typically extrapolated from short-term outcomes observed in different studies, using models based on assumptions about longer-term morbidity and mortality. Inconsistency in these assumptions and the methods of extrapolation can create difficulties when comparing estimates of life-time cost-effectiveness of stroke care interventions.AimsTo develop a long-term model consisting of a set of equations to estimate the life-time effects of stroke care interventions to promote consistency in extrapolation of short-term outcomes.MethodsData about further admissions and mortality was provided for acute stroke patients discharged between 2013 and 2014 from a large English service. This was combined with data from UK life tables to create a set of parametric equations in a model that use age, sex, and modified Rankin Scores to predict the life-time risk of mortality and secondary care resource utilisation including ED attendances, non-elective admissions, and elective admissions. A cohort of 1,509 (male 51%; mean age 74) stroke patients had median follow-up of seven years and represented 7,111 post-discharge patient years. A logistic model estimated mortality within twelve months of discharge and a Gompertz model was used over the remainder of the lifetime. Hospital attendances were modelled using a Weibull distribution. Non-elective and elective bed days were both modelled using a log-logistic distribution.ResultsMortality risk increased with age, dependency, and male sex. Although the overall pattern was similar for resource utilisation, there were different variations according to dependency and gender for ED attendances and non-elective/elective admissions. For example, 65-year-old women with a discharge mRS of 1 would gain an extra 6.75 life years compared to 65-year-old women with a discharge mRS of 3. Over their lifetime, 65-year-old women with a discharge mRS of 1 would experience 0.09 less ED attendances, 2.12 less non-elective bed days and 1.28 additional elective bed days than 65-year-old women with a discharge mRS of 3.ConclusionsUsing long-term follow-up publicly available data from a large clinical cohort, this new model promotes standardised extrapolation of key outcomes over the life course, and potentially can improve the real-world accuracy and comparison of long-term cost-effectiveness estimates for stroke care interventions.Data Assess StatementData is available upon reasonable request from third parties.","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"37 1","pages":"17474930241284447"},"PeriodicalIF":6.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142177259","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":"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":"17474930241273685"},"PeriodicalIF":6.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}