Journal of Stroke最新文献

{"title":"Varying Rates of Hospital Reperfusion Therapy for Stroke: Insights From Analysis of National Stroke Audit Data.","authors":"Jong-Moo Park, Hong-Kyun Park, Seong-Eun Kim, Yong-Jin Cho, Jun Yup Kim, Beom Joon Kim, Kwang-Yeol Park, Kyung Bok Lee, Soo Joo Lee, Hyunji Oh, Jonguk Kim, Byung Cheol Lee, In Ok Bae, Gui Ok Kim, Ji Sung Lee, Juneyoung Lee, Philip B Gorelick, Hee-Joon Bae","doi":"10.5853/jos.2025.00360","DOIUrl":"https://doi.org/10.5853/jos.2025.00360","url":null,"abstract":"<p><strong>Background and purpose: </strong>Disparities in stroke care exist globally. While reperfusion therapy is a standard treatment for acute ischemic stroke, variations in its implementation may exist across hospitals.</p><p><strong>Methods: </strong>We analyzed data from 75,870 patients admitted to 247 acute stroke care hospitals across South Korea, sourced from the Acute Stroke Quality Assessment Program (2013-2018) by the Health Insurance Review and Assessment Service. The primary metric of interest was the hospital reperfusion therapy rate (RTR)-the proportion of patients who received intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT) among those potentially eligible for these therapies and had onset-to-arrival times ≤6 hours and initial National Institutes of Health Stroke Scale scores ≥4. We analyzed correlations between hospital RTRs, adjusted for age, sex, onset-to-arrival time, initial stroke severity, and hospital characteristics.</p><p><strong>Results: </strong>Of the 10,513 patients eligible for reperfusion therapy, the overall RTR was 52.9%. The average hospital RTR was 34.8% with a median (interquartile range) of 37.5% (9.8-56.2). Hospitals with a greater number of beds and higher monthly stroke volume exhibited higher hospital RTRs. Factors such as monthly stroke volume, stroke unit availability, and monthly IVT and EVT case volume independently influenced hospital RTRs. Notably, hospitals with higher RTRs demonstrated reduced 1-year mortality, irrespective of stroke volume.</p><p><strong>Conclusion: </strong>In a large national sample of acute stroke care hospitals, there was significant variability in hospital RTRs, with those having higher stroke volumes typically showing higher hospital RTRs. Additionally, an inverse correlation between hospital RTRs and 1-year mortality highlights the clinical importance of improving RTRs.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning-Based Automatic Classification of Stroke Size in Patients With Atrial Fibrillation.","authors":"Hokyu Kim, Joon-Tae Kim, Hoyoun Lee, Do Yeon Kim, Han-Gil Jeong, Keon-Joo Lee, Beom Joon Kim, Moon-Ku Han, Kang-Ho Choi, Dong-Ick Shin, Dong-Eog Kim, Jong-Moo Park, Kyusik Kang, Jae Guk Kim, Soo Joo Lee, Mi Sun Oh, Kyung-Ho Yu, Byung-Chul Lee, Hong-Kyun Park, Keun-Sik Hong, Yong-Jin Cho, Jay Chol Choi, Sung-Il Sohn, Jeong-Ho Hong, Tai Hwan Park, Jee-Hyun Kwon, Wook-Joo Kim, Jun Lee, Wi-Sun Ryu, Hee-Joon Bae","doi":"10.5853/jos.2025.00423","DOIUrl":"https://doi.org/10.5853/jos.2025.00423","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying Venous Capacity to Evaluate Potential Cytoprotection in Acute Ischemic Stroke.","authors":"Francesco Favruzzo, Chuanlong Li, Ryan Apfel, Jolie Friedman, Mert Erdenizmenli, Claudio Baracchini, David S Liebeskind","doi":"10.5853/jos.2025.01081","DOIUrl":"https://doi.org/10.5853/jos.2025.01081","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clopidogrel May Be Superior to Aspirin as Maintenance Antiplatelet Monotherapy in Patients With Non-Cardioembolic Ischemic Stroke.","authors":"Jisu Jung, Ja-Hae Kim, Jae-Won Seo, Hak-Ro Lee, Hyun-Soo Kim, Man-Seok Park, Kang-Ho Choi","doi":"10.5853/jos.2025.02040","DOIUrl":"https://doi.org/10.5853/jos.2025.02040","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to Consider Pharmacologic Management of Unruptured Intracranial Aneurysms?","authors":"Yeon Soo Kim, Sungbin Hwang, Mi Hyeon Kim, Boseong Kwon, Yunsun Song, Deok Hee Lee","doi":"10.5853/jos.2025.01662","DOIUrl":"https://doi.org/10.5853/jos.2025.01662","url":null,"abstract":"<p><p>The increasing detection rate of unruptured intracranial aneurysms (UIAs) using advanced imaging underscores the need for alternative management strategies beyond surgical and endovascular interventions. Although these procedures have improved substantially, they still carry procedural risks, high costs, and psychological burdens related to continuous surveillance. This review aimed to suggest the potential role of pharmacological therapy in mitigating aneurysm progression and the risk of rupture. We first reviewed the key pathophysiological mechanisms-endothelial dysfunction, hemodynamic stress, inflammation, and thrombosis-contributing to UIA growth and instability. We then listed and examined a range of pharmacological agents, including antihypertensives, lipidlowering drugs, anti-inflammatory compounds, antioxidants, and novel candidates, summarizing both the preclinical and observational evidence supporting their use. While these findings are encouraging, current clinical data do not support broad, standardized treatment guidelines. Further prospective or randomized studies are required to clarify the safety, efficacy, and feasibility of using these agents in routine practice. By highlighting the rationale for pharmacological interventions and identifying key knowledge gaps, this review underscores the importance of an integrative management approach, encompassing medication, lifestyle modification, and vigilant monitoring, to better address patient needs and ultimately improve outcomes in UIA care.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Specific Hemodynamic Simulation for Predicting Stroke Laterality in Cardiac Embolism.","authors":"Mahbod Issaiy, Diana Zarei, David S Liebeskind, Pouria Moshayedi","doi":"10.5853/jos.2025.01571","DOIUrl":"https://doi.org/10.5853/jos.2025.01571","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cardioembolic sources account for 20%-30% of acute ischemic strokes (AIS), often with high morbidity. Conventional imaging confirms etiology retrospectively but lacks insight into the dynamic behavior of embolic transport. We aimed to predict stroke laterality by integrating patient-specific computational fluid dynamics (CFD) simulations with robust Bayesian logistic regression modeling.</p><p><strong>Methods: </strong>Eight patients (median age 77.5 years; 2 females) with anterior circulation AIS of confirmed cardiac origin underwent high-resolution computed tomography angiography. Vascular geometries were segmented to generate CFD models simulating physiologic pulsatile flow. In each cardiac cycle, 1,000 massless particles were released at the aortic inlet. Two features were derived: x1 (long-term embolic bias over 10 seconds) and x2 (short-term embolic bias during the first cardiac cycle). These were used as predictors in a robust Bayesian logistic regression model.</p><p><strong>Results: </strong>The right internal carotid artery (ICA) received more embolic particles (mean 34/s) than the left ICA (mean 28/s). Patients with right-sided strokes had higher x1 (median 0.27 vs. -0.44) and lower x2 (median -0.82 vs. 0.56) than those with left-sided strokes. The model yielded posterior mean coefficients of 1.51 (95% credible interval [CrI]: -0.46 to 4.11) for x1 and -1.96 (95% CrI: -4.88 to 0.20) for x2, achieving complete separation of stroke patients by laterality in this pilot cohort.</p><p><strong>Conclusion: </strong>The combination of CFD-based embolic modeling and Bayesian analysis accurately predicted stroke laterality in cardioembolic AIS, exposing distinct patient-specific embolic transport dynamics.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of MicroRNAs in Thrombus and Future Vascular Events Among Patients With Stroke.","authors":"Jeong-Min Kim, Hae-Bong Jeong, Younjoo Moon, Sungguan Hong, Taek-Kyun Nam, Hyun-Ho Choi, Keun-Hwa Jung, Kwang-Yeol Park, Reeree Lee, Ju Won Seok, Hye Ryoun Kim","doi":"10.5853/jos.2025.00150","DOIUrl":"https://doi.org/10.5853/jos.2025.00150","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":" ","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Progression in Patients With Ischemic Stroke Associated With Intracranial Vertebrobasilar Artery Dissection.","authors":"Hung-Yu Liu, Feng-Chi Chang, Shih-An Tang, Ronda Lun, Chih-Ping Chung","doi":"10.5853/jos.2024.05638","DOIUrl":"https://doi.org/10.5853/jos.2024.05638","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Ischemic Stroke in the Incarcerated: Comparison of Treatment Rates and Clinical Outcomes With the United States General Population.","authors":"Alis J Dicpinigaitis, Mill Etienne, Thanh N Nguyen, Ameer E Hassan, Priyank Khandelwal, Pankajavalli Ramakrishnan, Gabor Toth, Mohammad El-Ghanem, Krishna Amuluru, Viktor Szeder, Jonathan Crow, Karol Budohoski, Zurab Nadareishvilli, Kaustubh Limaye, Fazeel Siddiqui, Hamza Shaikh, Nishita Singh, Hesham E Masoud, Tariq Kass-Hout, Sushanth Aroor, Shashvat Desai, Santiago Ortega-Gutierrez, Kaiz Asif, Dileep Yavagal, Fawaz Al-Mufti","doi":"10.5853/jos.2025.00619","DOIUrl":"https://doi.org/10.5853/jos.2025.00619","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiplatelet Use Prior to Anticoagulant Initiation in Patients With Atrial Fibrillation-Related Ischemic Stroke: An ELAN Trial Analysis.","authors":"Alexandros A Polymeris, Masatoshi Koga, Daniel Strbian, Adhiyaman Vedamurthy, Manju Krishnan, Mattia Branca, Thomas Horvath, Martina Goeldlin, Gek Shim, Christoph Gumbinger, Liqun Zhang, Espen Saxhaug Kristoffersen, Philippe Desfontaines, Peter Vanacker, Angelika Alonso, Sven Poli, Ana Paiva Nunes, Nicoletta G Caracciolo, Markus Kneihsl, Timo Kahles, Daria Giudici, Silja Räty, Marjaana Tiainen, Jesse Dawson, Urs Fischer","doi":"10.5853/jos.2024.04322","DOIUrl":"10.5853/jos.2024.04322","url":null,"abstract":"<p><strong>Background and purpose: </strong>Antiplatelets are often used before direct oral anticoagulant (DOACs) initiation after an acute ischemic stroke related to atrial fibrillation (AF), but the evidence is weak. Here, we explored the risks and benefits of this approach.</p><p><strong>Methods: </strong>A post-hoc analysis of ELAN (Early versus Late Initiation of Direct Oral Anticoagulants in Post-ischemic Stroke Patients with Atrial Fibrillation) trial data (NCT03148457) was conducted to compare the risk of recurrent ischemic stroke, systemic embolism, major bleeding (extracranial or intracranial hemorrhage [ICH]), and vascular death within 30 days (as a composite and as individual outcomes) in participants treated with and without antiplatelets before DOAC initiation after an AF-associated ischemic stroke. We used both logistic and cause-specific Cox proportional hazards regression in inverse probability of treatment weighted models to account for confounding. We calculated the net benefit of antiplatelet use by subtracting the weighted rate of excess bleeding events attributable to antiplatelets from the rate of excess ischemic events possibly prevented by antiplatelets.</p><p><strong>Results: </strong>Among 2,013 participants (median age 77 years, 45.5% female), 1,090 (54.1%) used antiplatelets, and 70 (3.5%) experienced the composite outcome. Antiplatelet use was not associated with the composite outcome (inverse probability of treatment weighted odds ratio [ORweighted] 1.06, 95% confidence interval [CI] 0.66-1.72; inverse probability of treatment weighted hazard ratio [HRweighted] 1.06, 95% CI 0.65-1.72), but showed a lower risk of ischemic stroke recurrence (ORweighted 0.58 [0.30-1.08], HRweighted 0.57 [0.30-1.10]), and a higher risk of major bleeding (ORweighted 1.76 [0.56-6.63], HRweighted 1.88 [0.56-6.39]). Its net benefit was +0.57 (95% CI -1.25 to +2.34) to +0.30 (-1.82 to +2.27) weighted events/100 person-months for ICH weights 1.5 to 3.1.</p><p><strong>Conclusion: </strong>Following an AF-associated ischemic stroke, we found a lower risk of recurrence and no signs of net harm with antiplatelet use before DOAC initiation, despite an increased risk of bleeding.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 2","pages":"217-227"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}