International Journal of Stroke最新文献

{"title":"Left atrial appendage occlusion in patients with atrial fibrillation and previous Intracranial Hemorrhage or Cerebral Amyloid Angiopathy: A systematic review and meta-analysis.","authors":"Theodoros Mavridis, Paraschos Archontakis-Barakakis, David-Dimitris Chlorogiannis, Andreas Charidimou","doi":"10.1177/17474930251360076","DOIUrl":"10.1177/17474930251360076","url":null,"abstract":"<p><strong>Background: </strong>Patients with atrial fibrillation (AF) on oral anticoagulation (OAC) who have a history of intracranial hemorrhage (ICrH) or cerebral amyloid angiopathy (CAA) have an elevated risk of ICrH recurrence. Left atrial appendage occlusion (LAAO) has emerged as a potential alternative to OAC for stroke prevention in high-bleeding-risk AF patients. Small observational studies suggest that LAAO may be safe and feasible in patients with ICrH, when using single or dual antiplatelet therapy or short-term OAC post-procedure, though data remain limited. This systematic review and meta-analysis aims to consolidate evidence on the safety and efficacy of LAAO in patients with prior ICrH or CAA.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis examining the safety and efficacy of LAAO in patients with non-valvular AF and prior ICrH and/or CAA. PubMed/MEDLINE and EMBASE (via Scopus) databases were systematically searched from inception until 29 February 2024. Eligible studies included randomized control trials, observational studies, and case series (⩾10 participants) reporting stroke events in patients with AF and previous history of ICrH and/or CAA undergoing LAAO. Pooled incidence rates (IRs) with corresponding 95% confidence intervals (CIs) were calculated for primary outcomes (post-procedural ischemic stroke and recurrent ICrH) and secondary outcomes.</p><p><strong>Results: </strong>Fourteen studies including 1235 patients met inclusion criteria. The pooled average follow-up period was 17.1 months. The pooled IRs for ischemic stroke, recurrent ICrH, and major hemorrhage were 2% (95% CI: 1-3%, I² = 2%), 2% (95% CI: 0.4-3%, I² = 45%) and 3% (95% CI: 1-5%, I² = 54%), respectively. In prespecified subgroup analyses of studies focusing on patients with intraparenchymal hemorrhage and/or CAA, pooled IRs for ischemic stroke, recurrent ICrH, and major hemorrhage IR of 4% (95% CI: 1-8%), 4% (95% CI: 0.4-10%) and 6% (95% CI: 3-12%), respectively.</p><p><strong>Conclusions: </strong>LAAO may be a safe and effective treatment for selected AF patients with a history of ICrH and/or CAA, but the quality of evidence is poor. Future randomized controlled trials are essential to validate LAAO's efficacy and long-term safety.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251360076"},"PeriodicalIF":8.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608281","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":"National and provincial trends of mortality and years of life lost due to stroke in children and adolescents in China, 2005-2020: An analysis of national mortality surveillance data.","authors":"Zixin Wang, Jiamin Li, Zheng Long, Yi Ren, Jiameng Li, Xinyi Wang, Lijun Wang, Junwei Hao, Maigeng Zhou, Peng Yin, Qingfeng Ma","doi":"10.1177/17474930251360105","DOIUrl":"10.1177/17474930251360105","url":null,"abstract":"<p><strong>Background: </strong>Stroke is associated with substantial mortality among children and adolescents, yet evidence on the death burden of stroke in this group in China is scarce.</p><p><strong>Aims: </strong>To assess the trends of mortality and years of life lost (YLL) due to stroke in children and adolescents in China.</p><p><strong>Methods: </strong>We estimated the number and age-standardized rate of death and YLL caused by stroke and its subtypes among children and adolescents aged 0-19 years in China and its provinces from 2005 to 2020, utilizing data from National Mortality Surveillance System.</p><p><strong>Results: </strong>In China, the age-standardized mortality rate due to stroke among children and adolescents aged 0-19 years decreased from 1.40/100,000 to 0.51/100,000 during 2005-2020, and the YLL rate decreased from 116.28/100,000 to 38.79/100,000. During 2005-2020, intracerebral hemorrhage (ICH) consistently showed significantly higher age-standardized mortality rate than ischemic stroke (IS) and subarachnoid hemorrhage (SAH). In 2020, the mortality rate of ICH was 11.35-fold and 4.96-fold greater than that of IS and SAH, respectively (ICH 0.40/100,000, IS 0.04/100,000, SAH 0.08/100,000). Overall, males among children and adolescents exhibited higher age-standardized mortality and YLL rate due to stroke compared to females. Notably, the stroke mortality rate in 15-19 years age group increased by 16.10% during 2005-2020, primarily attributed to the significant increases in mortality rate of ICH and SAH among males in this age group (ICH males 25.51%, SAH males 107.83%). In 2020, Yunnan (1.56/100,000), Tibet (1.54/100,000), and Henan (1.47/100,000) had the highest age-standardized mortality rate of stroke among children and adolescents, while Shanghai, Fujian and Jiangsu had the lowest rates. In addition, a negative association was observed between the age-standardized YLL rates of stroke among individuals aged 0-19 years and the socio-demographic index across 31 provinces in China from 2005 to 2020.</p><p><strong>Conclusion: </strong>In China, the death burden of ICH among children and adolescents was considerably heavier than that of SAH and IS. The rising mortality rate of ICH and SAH among males aged 15-19 years requires greater emphasis. Targeted interventions for stroke in children and adolescents should be expedited to reduce the disease burden in this particular population.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251360105"},"PeriodicalIF":8.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608282","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":"Optimal markers of treatment response to vasodilatory drugs in small vessel disease: An OxHARP trial analysis.","authors":"Alastair J S Webb, Karolina Feakins, Amy Lawson, Catriona Stewart, James Thomas, Osian Llwyd","doi":"10.1177/17474930251360093","DOIUrl":"10.1177/17474930251360093","url":null,"abstract":"<p><strong>Background and aims: </strong>Vasodilating drugs targeting the endothelium could reduce long-term harms due to cerebral small vessel disease (cSVD) but there are no commonly accepted methods to measure short-term disease activity or drug response. In the OxHARP clinical trial, we determined the most sensitive physiological markers of treatment response to sildenafil versus placebo on either transcranial ultrasound (TCD) or magnetic resonance imaging (MRI), and their validity compared to disease severity and other measures of other physiological mechanisms.</p><p><strong>Methods: </strong>In the OxHARP double-blind, randomized, placebo-controlled crossover trial we measured aortic blood pressure, mean flow velocity (MFV), cerebral pulsatility, cerebrovascular conductance index (CVCi = MFV/aortic mean BP), cerebral perfusion (pcASL-MRI) and cerebrovascular reactivity to inhaled CO2 on TCD (CVR-TCD) and MRI in white (CVR-WM), gray (CVR-GM) and white matter hyperintensities (CVR-WMH). Effects of 3 weeks of sildenafil were compared to placebo. Validity of markers were determined by between-visit repeatability (intraclass correlation coefficient (ICC)); associations with CVR-TCD, CVR-WMH and CVR-GM; associations with other markers; the magnitude of response, and sensitivity, to sildenafil.</p><p><strong>Results: </strong>In 69 participants, repeatability was greatest for MFV, pulsatility, CVCi and CVR-WMH (ICC > 0.8), very good for CVR-TCD and GM-perfusion (ICC > 0.7), and good for CVR-GM (ICC > 0.6). CVR-TCD was associated with CVR on MRI (CVR-WMH: r² = 0.12, p = 0.02; CVR-GM: r² = 0.22, p = 0.001), while blood flow measures on TCD (MFV, CVCi) were associated with CVR-TCD and perfusion-MRI (all p < 0.05). All markers were associated with WMH volume and improved by sildenafil, but CVCi was most sensitive, requiring only 20 patients for a crossover trial at 80% power, compared to 26 for GM-perfusion or 84 for CVR-GM.</p><p><strong>Conclusions: </strong>Multiple markers were associated with cSVD, but no single marker reflected all physiological drug effects. CVCi and gray matter perfusion on MRI were the most sensitive markers of disease activity and drug response, although CVR indices may be more specific for endothelial dysfunction.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251360093"},"PeriodicalIF":8.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608283","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":"Long-term outcome of young patients after ischemic stroke or transient ischemic attack: Insights from a multicenter study.","authors":"Daniela Pinter, Jenna Broman, Manuel Leitner, Bettina von Sarnowski, Mohamed Elmegiri, Thomas Gattringer, Melanie Haidegger, Markus Kneihsl, Robert Malinowski, Juha Martola, Stefan Ropele, Ulf Schminke, Turgut Tatlisumak, Christian Enzinger, Jukka Putaala, Karoliina Aarnio, Simon Fandler-Höfler","doi":"10.1177/17474930251359422","DOIUrl":"10.1177/17474930251359422","url":null,"abstract":"<p><strong>Background: </strong>The long-term non-motor outcome of young adults with ischemic stroke (IS) or transient ischemic attack (TIA) is poorly understood.</p><p><strong>Aims: </strong>Therefore, in this observational cohort study, we explored the prevalence of impairment and factors influencing clinical and neuropsychological outcomes and return-to-work a decade post-stroke.</p><p><strong>Methods: </strong>After a median follow-up duration of 10.4 years, 163 patients (median age at index event: 46.0 years, 44.8% female, 121 IS and 42 TIA) of the \"Stroke in Young Fabry Patients study\" attended an in-person follow-up in three European centers. We assessed clinical, neuropsychological, and return-to-work data.</p><p><strong>Results: </strong>A decade post-stroke, most patients (74.8%) showed excellent outcome, scoring 0-1 on the modified Rankin Scale (mRS) and 68.0% had returned to work. However, at follow-up, 27.2% of patients showed cognitive impairment and 27.6% suffered from fatigue. Anxiety and depression were reported by 38.0% and 18.5%, respectively. Even among patients with excellent functional outcome (mRS 0-1), 24.6% showed cognitive problems, 37.7% suffered from anxiety, 22.1% from fatigue, and 12.4% from depression. Female patients had higher rates of anxiety (52.1% vs. 26.7%), fatigue (37.0% vs. 20.0%), and depression (27.4% vs. 11.2%), compared to male patients.In linear regression, female sex was associated with a higher likelihood for anxiety (odds ratio (OR = 2.89, 95% confidence interval (CI) = 0.62-5.16), fatigue (OR = 3.23, CI = 1.52-4.93), and depression (OR = 2.86, CI = 1.12-4.59). Hypertension at follow-up (52.1%) was associated with worse functional outcome (OR = 3.03, CI = 1.32-6.95), while patients smoking at follow-up (20.2%) had higher rates of anxiety (OR = 4.09, CI = 1.21-6.97) and depression (OR = 3.40, CI = 0.87-5.21).</p><p><strong>Conclusions: </strong>Despite excellent functional outcome, many young stroke patients experience neuropsychological impairment, highlighting the need for targeted screening and treatment. Particularly young women are at higher risk for post-stroke depression, anxiety, and fatigue. Hypertension and smoking were modifiable risk factors contributing to worse outcomes in this young stroke cohort.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251359422"},"PeriodicalIF":6.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591236","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":"Plaque features and lenticulostriate artery morphology in unexplained early neurological deterioration in symptomatic MCA stenosis: A 7 T MRI study.","authors":"Yulu Shi, Xiaoyan Bai, Xue Zhang, Xun Pei, Yilong Wang, Binbin Sui","doi":"10.1177/17474930251359747","DOIUrl":"10.1177/17474930251359747","url":null,"abstract":"<p><strong>Background: </strong>A large proportion of early neurological deterioration (END) in stroke due to middle cerebral artery (MCA) stenosis remains unexplained. Unstable plaques on MCA and impaired perforators might contribute to unexplained END.</p><p><strong>Methods: </strong>We included patients with symptomatic MCA stenosis and classified them into three groups according to symptoms: END, stable, and transient ischemic attack (TIA). High-resolution 7 T vessel wall magnetic resonance imaging (MRI) (VW-MRI) and time-of-flight magnetic resonance (MR) angiography (TOF-MRA) were used to investigate MCA plaque features and lenticulostriate artery (LSA) morphology. We compared demographic data, plaque features and LSA morphology between three groups, and used binary logistic regression models to investigate factors that could potentially be related to END.</p><p><strong>Results: </strong>Fifty-two patients (49.46 ± 13.94 years, 39 males) were included in final analyses. Patients in three groups did not differ in age or vascular risk factors. Irregular plaque surface (16/16 vs 12/16 vs 11/20 in END vs stable vs TIA groups, P = 0.008) and plaques adjacent to LSA origin (14/16 vs 10/16 vs 7/20, P = 0.006) were more commonly seen in the END group than the other two groups. On TOF-MRA, TIA patients had more LSA branches (6[1,15] vs 5[1,9] vs 7[4,12] in END vs stable vs TIA groups, P = 0.018) and longer total LSA length (95.37 ± 43.98 vs 92.42 ± 33.10 vs 129.61 ± 38.77 mm, P = 0.012). Larger lesion size, higher LDL level and plaques adjacent to LSA origin were significantly associated with END, before and after the adjustment for age and sex.</p><p><strong>Conclusion: </strong>The 7 T MRA provide precise imaging capabilities for plaque characteristics and LSA in patients with MCA stenosis and END, which could help stratify the risks of END and provide evidence for treatment of ischemic stroke caused by MCA arthrosclerosis.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251359747"},"PeriodicalIF":8.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583922","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":"Periodontal disease is associated with increased stroke risk, an association partially mediated by inflammation.","authors":"Yitong Ling, Hongtao Cheng, Xiaxuan Huang, Shiqi Yuan, Shanyuan Tan, Yonglan Tang, Zihong Bai, Xinya Li, Jianguang Chen, Anding Xu, Jun Lyu","doi":"10.1177/17474930251359776","DOIUrl":"10.1177/17474930251359776","url":null,"abstract":"<p><strong>Background: </strong>Despite evidence linking periodontal disease to stroke risk, research investigating the potential mediating role of inflammatory markers and the modifying influence of genetic susceptibility in this relationship remains limited.</p><p><strong>Aim: </strong>The study aimed to assess the association between self-reported high risk of periodontal disease and stroke, while exploring the potential mediating effects of inflammatory markers and the modifying influence of genetic susceptibility.</p><p><strong>Methods: </strong>Using UK Biobank data, we investigated the association between high risk of periodontal disease and incident stroke using Cox proportional hazards regression models. Participants were classified as having a high risk of periodontal disease if they reported experiencing any of painful gums, bleeding gums, and/or loose teeth. We explored the potential mediating role of inflammatory markers in the observed association through mediation analyses. For genetic analyses, we calculated a genetic risk score (GRS) for stroke using 32 single nucleotide polymorphisms, stratified participants into tertiles, and conducted interaction analyses between GRS and periodontal disease risk with respect to both all stroke and ischemic stroke.</p><p><strong>Results: </strong>The study included 442,648 participants, followed up for a median of 13.7 years. Participants with a high risk of periodontal disease showed significantly increased risk of all stroke (HR = 1.11, 95% CI: 1.05-1.16) and ischemic stroke (HR = 1.11, 95% CI: 1.05-1.18) after adjusting for confounders, but no significant associations were found for hemorrhagic stroke (HR = 1.08, 95% CI: 0.98-1.19). Mediation analyses showed that inflammatory markers partially mediated this relationship, with mediation effects ranging from 0.86% to 8.41% for all stroke and 1.03% to 9.58% for ischemic stroke. Genetic analyses revealed no significant interaction between high risk of periodontal disease and stroke GRS concerning the all stroke risk, but a significant interaction was found for ischemic stroke, with participants having both periodontal disease risk and a high GRS showing the highest risk (HR = 1.19, 95% CI: 1.07-1.32).</p><p><strong>Conclusions: </strong>This study demonstrates a significant association between high periodontal disease risk and increased stroke risk, particularly ischemic stroke, with partial mediation by inflammatory markers and interaction with genetic risk factors.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251359776"},"PeriodicalIF":6.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583921","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":"Predicting long-term movement behavior patterns after stroke: Development of a clinical prediction rule.","authors":"Sophie Pagen, Yvonne Hartman, Camille Biemans, Suzanne Broers, Olaf Verschuren, Johanna Visser-Meily, Martijn Pisters","doi":"10.1177/17474930251359739","DOIUrl":"10.1177/17474930251359739","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Within the first years post-discharge, movement behavior of people with a first-ever stroke often deteriorates, with inactive movement behavior increasing the risk of recurrent cardiovascular events. Early identification of patients at risk of inactive movement behavior is essential for referring the right patients and tailoring movement-behavior change interventions, which could support secondary prevention of recurrent cardiovascular events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;This study aimed to develop and internally validate a clinical prediction rule to identify at hospital discharge people at risk of an inactive movement behavior pattern within the first 2 years following a stroke.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A prospective cohort study was conducted using data from 200 participants with a first-ever stroke (age 67.8 ± 11.5 years; 64% male; median NIHSS = 3), who were discharged to their home environment. Eligible participants were ⩾18 years, pre-stroke independent, ambulatory, and able to communicate. Movement behavior was objectively assessed within 3 weeks, and at 6 months (n = 184, 92%), 1 year (n = 175, 88%), and 2 years (n = 146, 74%) post-discharge. Movement behavior patterns were based on the amount of light and moderate-to-vigorous physical activity (PA) and prolonged sedentary bouts: \"sedentary exercisers\" (active), \"sedentary movers\" (inactive), and \"sedentary prolongers\" (inactive and prolonged sedentary bouts). Baseline characteristics, including demographic, stroke-related, and health-related factors, were used to identify \"sedentary movers and prolongers\" (step 1) and \"sedentary prolongers\" (step 2) by multinominal logistic regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Female sex (B = -1.03, p &lt; 0.001), older age (B = 0.05, p &lt; 0.001), and increased fatigue (B = 0.04, p = 0.003) predicted inactive movement behavior in the first 2 years after discharge. Inactive movement behavior with prolonged sedentary bouts was predicted by \"prolonger\" pattern directly after discharge (B = -3.35, p &lt; 0.001), slower walking speed (B = 0.10, p = 0.003), and lower anxiety levels (B = -0.07, p = 0.057). The final model showed good fit (Quasi-likelihood under Independence Model Criterion (QICC) = 737.02) and acceptable discrimination (area under the curve (AUC) = 0.74). Internal validation confirmed the model's robustness, with a shrinkage factor of 0.96.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;A clinical prediction rule to identify patients at risk of inactive movement behavior post-stroke was developed and internally validated. Early identification based on age, sex, and patient-reported fatigue can facilitate stratification for tailored behavior change interventions aimed at secondary prevention of recurrent cardiovascular events. External validation is required before clinical implementation.Data access statement:The datasets used and/or analyzed in this study are accessible from the corresponding author on reasonable r","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251359739"},"PeriodicalIF":8.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583923","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":"Hyperglycaemia does not modify the efficacy of endovascular therapy in the late time window (6-24 hours).","authors":"Clemens Jba Kersten, Adrienne Am Zandbergen, Susanne Gh Olthuis, Wim H van Zwam, Jeannette Hofmeijer, Bart J Emmer, Jan W Hoving, Robert J van Oostenbrugge, Heleen M den Hertog","doi":"10.1177/17474930251358824","DOIUrl":"10.1177/17474930251358824","url":null,"abstract":"<p><strong>Introduction: </strong>Hyperglycemia is common in ischemic stroke. Admission glucose modifies the effect of endovascular therapy (EVT) in patients with ischemic stroke of the anterior circulation, who are treated 0 to 6 hours since onset. Whether this also applies for late-window EVT (6-24 hours since symptom onset or last known well) is unknown. In this study, we assessed whether admission glucose level and/or hyperglycemia modifies the EVT effect in patients with ischemic stroke of the anterior circulation in the late time window.</p><p><strong>Methods: </strong>We used data from the MR CLEAN LATE trial. The primary outcome measure was the modified Rankin Scale (mRS) score at 90 days. Secondary outcome measures were symptomatic intracranial hemorrhage and mortality at 90 days. Treatment effect modification of EVT by either glucose or hyperglycemia on admission was assessed by multiplicative interaction factors with logistic regression analysis and adjusted for potential confounders. Hyperglycemia was defined as glucose level >7.8 mmol/L on admission.</p><p><strong>Results: </strong>On admission, median glucose was 7.0 mmol/L (IQR 6.0-8.3 mmol/L), and 147 patients (32%) were hyperglycemic. We found no interaction of either hyperglycemia or serum glucose on admission with treatment effect on functional outcome (p = 0.76 and p = 0.79, respectively), symptomatic intracranial hemorrhage (p = 0.29 for hyperglycemia; p = 0.57 for glucose on admission), and for mortality (p = 0.52 for hyperglycemia; p = 0.69 for glucose on admission).</p><p><strong>Conclusion: </strong>We found no evidence for effect modification of EVT by admission glucose level or hyperglycemia in patients with acute ischemic stroke and large-vessel occlusion of the anterior circulation in the late treatment window.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251358824"},"PeriodicalIF":6.3,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553550","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":"Comparison of clinical and imaging features of cerebral small vessel disease associated with heterozygous <i>HTRA1</i> and <i>NOTCH3</i> mutations.","authors":"Yi-Chung Lee, Chih-Hao Chen, Ying-Tsen Chou, Yu-Wen Cheng, Chih-Ping Chung, Ying-Da Chen, Feng-Chi Chang, Sung-Chun Tang, Yi-Chu Liao","doi":"10.1177/17474930251359110","DOIUrl":"10.1177/17474930251359110","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Heterozygous &lt;i&gt;HTRA1&lt;/i&gt; mutations are the second most common cause of monogenic dominant cerebral small vessel disease (&lt;i&gt;HTRA1&lt;/i&gt;-AD-cSVD or CADASIL2), after cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) due to &lt;i&gt;NOTCH3&lt;/i&gt; cysteine-altering mutations. However, there have been few studies of cohorts of &lt;i&gt;HTRA1&lt;/i&gt;-AD-cSVD and whether it can be differentiated clinically and on neuroimaging from CADASIL is unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;This retrospective study aims to characterize and compare the clinical and neuroimaging features of &lt;i&gt;HTRA1&lt;/i&gt;-AD-cSVD with those of CADASIL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We identified 21 unrelated Taiwanese subjects carrying 15 heterozygous &lt;i&gt;HTRA1&lt;/i&gt; variants, all functionally validated as pathogenic through in vitro protease activity assays. &lt;i&gt;HTRA1&lt;/i&gt;-AD-cSVD patients were compared with 406 CADASIL patients, including 44 cases carrying &lt;i&gt;NOTCH3&lt;/i&gt; mutations within the high-risk epidermal growth factor-like repeat domains (EGFr), 358 with moderate-risk EGFr mutations, and 4 with low-risk EGFr mutations. Multivariate regression analyses were conducted with adjustments for age at MRI examination and hypertension.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Stroke occurred in 81.0% of &lt;i&gt;HTRA1&lt;/i&gt;-AD-cSVD patients, and 47.6% exhibited cognitive dysfunction. MRI revealed moderate-to-severe white matter hyperintensity (WMH) in the deep white matter and external capsule (modified Scheltens' scale: 5.3 ± 1.0 and 4.1 ± 1.7), mild WMH in the temporal pole (1.0 ± 1.7), lacunes in 90.5%, ⩾10 cerebral microbleeds (CMBs) in 66.7%, and intracranial hemorrhage (ICH) lesions in 46.7%, indicating susceptibility to both ischemic and hemorrhagic strokes. Patients with &lt;i&gt;HTRA1&lt;/i&gt; loss-of-function mutations or protease domain missense mutations exhibited a higher prevalence of ⩾10 CMBs on SWI/T2* imaging (100% and 83.3%) compared to those with missense mutations outside this domain (20%). Symptom onset occurred earliest in patients with &lt;i&gt;NOTCH3&lt;/i&gt; high-risk EGFr mutations (49.2 ± 10.5 years), followed by those with heterozygous &lt;i&gt;HTRA1&lt;/i&gt; mutations (54.3 ± 10.7 years), and latest in &lt;i&gt;NOTCH3&lt;/i&gt; moderate-risk EGFr mutations carriers (59.7 ± 9.5 years). Temporal pole involvement was most prevalent in &lt;i&gt;NOTCH3&lt;/i&gt; high-risk EGFr mutations (88.6%), followed by &lt;i&gt;NOTCH3&lt;/i&gt; moderate-risk EGFr mutations (32.4%), and least common in heterozygous &lt;i&gt;HTRA1&lt;/i&gt; mutations (28.6%). Even after adjusting for age and hypertension, &lt;i&gt;HTRA1&lt;/i&gt;-AD-cSVD patients exhibited significantly milder temporal pole WMH severity compared to &lt;i&gt;NOTCH3&lt;/i&gt; high-risk EGFr mutation carriers (adjusted &lt;i&gt;p&lt;/i&gt; &lt; 0.001). In addition, ICH lesions were more frequently observed in &lt;i&gt;HTRA1&lt;/i&gt;-AD-cSVD patients (46.7%) than in patients with &lt;i&gt;NOTCH3&lt;/i&gt; high-risk or moderate-risk EGFr mutations (18.2% and 21.2%), although the difference was not statistically s","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930251359110"},"PeriodicalIF":8.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global challenges in the access of endovascular treatment for acute ischemic stroke (global MT access).","authors":"Ahmed Nasreldein, Wan Asyraf, Thanh N Nguyen, Sheila Martins, Vasileios-Arsenios Lioutas, Ahmed Elbassiouny, Mai Duy Ton, Simona Sacco, Mohamed A Micdhadhu, Yimin Chen, Rufus Akinyemi, Espen Saxhaug Kristoffersen, Xiaochuan Huo, Zhongrong Miao, Mohamad Abdalkader, Simon Nagel, Volker Puetz, Gotz Thomalla, Hiroshi Yamagami, Zhongming Qiu, Jelle Demeestere, Adnan I Qureshi, Patrik Michel, Daniel Strbian, Bruce Cv Campbell, Bernard Yan, Abdulhakeem Olorukooba, Hesham E Masoud, Diogo C Haussen, Michael Frankel, Mahmoud H Mohammaden","doi":"10.1177/17474930251314395","DOIUrl":"10.1177/17474930251314395","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy (MT) is the standard of care for eligible acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) since 2015.</p><p><strong>Aim: </strong>Our aim was to determine the key challenges for MT implementation and access worldwide.</p><p><strong>Methods: </strong>We conducted an international online survey consisting of 37 questions, distributed through the World Stroke Organization network and as invited by co-authors between December 2022 and March 2023. The survey included a preamble outlining its purpose, questions on respondent demographics, imaging availability, MT service availability, MT selection criteria, barriers to MT, and training status in each country.</p><p><strong>Results: </strong>We received 526 responses from 89 countries distributed across 7 continents. One hundred and sixteen (22.1%) respondents did not have available MT service, 43 (8.2%) had available MT only during working hours, 362 (68.8%) had 24/7 MT availability. Regarding neuroimaging protocols, 13.5% used non-contrast computed tomography (NCCT) only, 40.1% used NCCT/CT angiography, 37.5% used NCCT/CT angiography/CT perfusion), 0.4% used magnetic resonance imaging (MRI) only, and 7.8% used MRI/MR angiography. The most common reasons for not receiving MT were cost, late presentation, and lack of availability of qualified neurointerventional services within reasonable distance. There were 59.1% of respondents who reported having a well-structured MT training program. Lack of qualified trainers, financial support, support from higher authorities, and lack of collaboration between departments were the most common obstacles against developing a training program.</p><p><strong>Conclusion: </strong>Our study highlights significant variations in MT availability, accessibility, patient selection criteria, and MT service training programs worldwide. Financial costs and a shortage of trained neurointerventionalists were the main challenges in low- and middle-income countries.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"660-668"},"PeriodicalIF":6.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}