Journal of Stroke最新文献

{"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}

{"title":"Carotid Web: An Update Focusing on Its Relationship With Fibromuscular Dysplasia and Therapeutic Strategy.","authors":"Marialuisa Zedde, Maria Simona Stoenoiu, Alexandre Persu, Rosario Pascarella","doi":"10.5853/jos.2025.00626","DOIUrl":"10.5853/jos.2025.00626","url":null,"abstract":"<p><p>Carotid web was described more than 50 years ago as an atypical fibromuscular dysplasia (FMD) subtype with highly supporting pathological evidence as intimal FMD. In the following decades, the transition from catheter angiography or digital subtraction angiography (DSA) to non-invasive imaging techniques and the dramatic decrease in pathological procedures contributed to the gradual loss of this information. Currently, attention on the carotid web has increased due to its association with cryptogenic ischemic stroke. In fact, the underlying hypothesis is that the morphological features of the carotid web may determine a thrombogenic potential with artery-to-artery embolism. The pathology of the carotid web allowed identification of small thrombi embedded in the web pouch, and the features of thrombi endovascularly retrieved from intracranial arteries are very similar. The diagnosis of carotid web is usually made by non-invasive techniques, such as computed tomography angiography, ultrasound, and magnetic resonance imaging, requiring the concordance of two different techniques for confirming the diagnosis. DSA is usually considered in cases of diagnostic uncertainty and when interventional treatment of ischemic stroke or carotid web is considered. Treatment options in symptomatic cases include medical therapy (single or dual antiplatelets) or interventional approach (surgery or stenting), but there are no randomized controlled trials about therapy. The main aim of this review is to present the current knowledge on carotid web, retrieving historical data and angiographic classifications of FMD, as well as to discuss the biological plausibility of the association with stroke in symptomatic cases and the need for an updated classification of FMD, together with prospective data.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 2","pages":"169-183"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266507","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}

{"title":"Aldehyde Dehydrogenase 2 Gene Mutation May Reduce the Risk of Rupture of Intracranial Aneurysm in Chinese Han Population.","authors":"Xiheng Chen, Siming Gui, Dachao Wei, Dingwei Deng, Yudi Tang, Jian Lv, Wei You, Jia Jiang, Jun Lin, Huijian Ge, Peng Liu, Yuhua Jiang, Lixin Ma, Yunci Wang, Ming Lv, Youxiang Li","doi":"10.5853/jos.2024.04098","DOIUrl":"10.5853/jos.2024.04098","url":null,"abstract":"<p><strong>Background and purpose: </strong>Ruptured intracranial aneurysms (RIA) are associated with a mortality rate of up to 40% in the Chinese population, highlighting the critical need for targeted treatment interventions for at-risk individuals. Although the impact of aldehyde dehydrogenase 2 (ALDH2) gene mutations on susceptibility to intracranial aneurysms (IA) is well documented, the potential connection between ALDH2 rs671 single-nucleotide polymorphism (SNP) and RIA remains unexplored. Given the increased prevalence of ALDH2 gene mutations among Chinese Han individuals, it is clinically relevant to investigate the link between ALDH2 rs671 SNP and IA rupture.</p><p><strong>Methods: </strong>A prospective study was conducted on 546 patients diagnosed with IA to investigate the association between ALDH2 rs671 SNP and the risk of IA rupture.</p><p><strong>Results: </strong>The ALDH2 rs671 SNP (ALDH2*2) was significantly more prevalent in patients with unruptured IA (UIA) than in those with RIA (32.56% vs. 18.58%, P=0.004). Multivariate logistic regression analysis revealed that people with the ALDH2 mutation (ALDH2*1/*2 and ALDH2*2/*2 gene type) had a significantly reduced odds ratio (OR=0.49; 95% confidence level [CI] 0.27-0.88; P=0.018) for RIAs. Age-specific subgroup analysis indicated that the ALDH2 mutation provided a stronger protective effect in individuals aged 60 years and above with IA compared to those under 60 years old (OR=0.38 vs. OR=0.52, both P<0.05).</p><p><strong>Conclusion: </strong>The incidence of RIA was significantly higher in individuals with a normal ALDH2 gene (ALDH2*1/*1) than in those with an ALDH2 rs671 SNP (ALDH2*1/*2 or ALDH2*2/*2). ALDH2 rs671 SNP may serve as a protective factor against RIA in the Chinese Han population.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 2","pages":"237-249"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266504","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}

{"title":"Revisiting the Etiology of Cocaine-Related Ischemic Strokes: An Observational Cohort.","authors":"Olivia A Kozel, Sachin A Kothari, Harsh Desai, Anit Behera, Rami Z Morsi, Archit B Baskaran, Neha Sehgal, Shyam Prabhakaran, Tareq Kass-Hout, James E Siegler, Scott J Mendelson","doi":"10.5853/jos.2024.02880","DOIUrl":"10.5853/jos.2024.02880","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 2","pages":"253-256"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266517","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}

{"title":"Residual Inflammatory Risk and Intracranial Atherosclerosis Plaque Vulnerability: Insights From High-Resolution Magnetic Resonance Imaging.","authors":"Ying Yu, Rongrong Cui, Xin He, Xinxin Shi, Zhikai Hou, Yuesong Pan, Mingyao Li, Jiabao Yang, Zhongrong Miao, Yongjun Wang, Rong Wang, Xin Lou, Long Yan, Ning Ma","doi":"10.5853/jos.2024.03251","DOIUrl":"10.5853/jos.2024.03251","url":null,"abstract":"<p><strong>Background and purpose: </strong>This study aimed to investigate the association between residual inflammatory risk (RIR) and vulnerable plaques using high-resolution magnetic resonance imaging (HRMRI) in symptomatic intracranial atherosclerotic stenosis (ICAS).</p><p><strong>Methods: </strong>This retrospective study included 70%-99% symptomatic ICAS patients hospitalized from January 2016 to December 2022. Patients were classified into four groups based on high-sensitivity C-reactive protein (hs-CRP) and low-density lipoprotein cholesterol (LDL-C): residual cholesterol inflammatory risk (RCIR, hs-CRP ≥3 mg/L and LDL-C ≥2.6 mmol/L), RIR (hs-CRP ≥3 mg/L and LDL-C <2.6 mmol/L), residual cholesterol risk (RCR, hs-CRP <3 mg/L and LDL-C ≥2.6 mmol/L), and no residual risk (NRR, hs-CRP <3 mg/L and LDL-C <2.6 mmol/L). Vulnerable plaque features on HRMRI included positive remodeling, diffuse distribution, intraplaque hemorrhage, and strong enhancement.</p><p><strong>Results: </strong>Among 336 included patients, 21, 60, 58, and 197 were assigned to the RCIR, RIR, RCR, and NRR groups, respectively. Patients with RCIR (adjusted odds ratio [aOR], 3.606; 95% confidence interval [CI], 1.346-9.662; P=0.011) and RIR (aOR, 3.361; 95% CI, 1.774-6.368, P<0.001) had higher risks of strong enhancement than those with NRR. Additionally, patients with RCIR (aOR, 2.965; 95% CI, 1.060-8.297; P=0.038) were more likely to have intraplaque hemorrhage compared with those with NRR. In the sensitivity analysis, RCR (aOR, 2.595; 95% CI, 1.201-5.608; P=0.015) exhibited an additional correlation with an increased risk of intraplaque hemorrhage.</p><p><strong>Conclusion: </strong>In patients with symptomatic ICAS, RIR is associated with a higher risk of intraplaque hemorrhage and strong enhancement, indicating an increased vulnerability to atherosclerotic plaques.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 2","pages":"207-216"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266516","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}

{"title":"Switch to Rosuvastatin Plus Ezetimibe From Statin Monotherapy to Achieve Target LDL-Cholesterol Goal: A Multi-Center, Open-Label, Single-Arm Trial.","authors":"Hong-Kyun Park, Jong-Ho Park, Hee-Kwon Park, Kyusik Kang, Keun-Hwa Jung, Beom Joon Kim, Jin-Man Jung, Young Seo Kim, Yong-Seok Lee, Hyo Suk Nam, Yeonju Yu, Juneyoung Lee, Keun-Sik Hong","doi":"10.5853/jos.2024.05015","DOIUrl":"10.5853/jos.2024.05015","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 2","pages":"275-278"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266519","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}

{"title":"The Association of Lipoprotein(a) and Stroke Recurrence: A Systematic Review and Meta-Analysis.","authors":"Lina Palaiodimou, Konstantinos Melanis, Maria-Ioanna Stefanou, Aikaterini Theodorou, Sotirios Giannopoulos, Vaia Lambadiari, Diana Aguiar de Sousa, Simona Sacco, Mira Katan, Gerasimos Siasos, Georgios Tsivgoulis","doi":"10.5853/jos.2024.04623","DOIUrl":"10.5853/jos.2024.04623","url":null,"abstract":"<p><strong>Background and purpose: </strong>Lipoprotein(a) [Lp(a)] is a lipoprotein structurally similar to low-density lipoprotein and is considered a genetically determined risk factor for cardiovascular disease. Although Lp(a) has been linked to ischemic stroke, its role in secondary stroke prevention, particularly in stroke recurrence, remains unclear.</p><p><strong>Methods: </strong>A systematic search of MEDLINE and Scopus databases was conducted to identify randomized controlled trials (RCTs) and observational studies reporting Lp(a) levels in patients with ischemic stroke or transient ischemic attack. The primary outcome was stroke recurrence, and secondary outcomes included poor functional outcome, all-cause mortality, and recurrent vascular events. Pooled odds ratios (ORs) were calculated using a random-effects model.</p><p><strong>Results: </strong>A total of 12 studies, including one RCT post hoc analysis and 11 observational studies, comprising 17,903 patients (mean age 63 years, 38% female), were included. Elevated Lp(a) levels were significantly associated with increased stroke recurrence (OR: 1.69; 95% confidence interval [CI]: 1.09-2.63; P=0.020) and poor functional outcome (OR: 2.09; 95% CI: 1.40-3.11; P<0.001). No significant associations were found between Lp(a) levels and all-cause mortality (OR: 2.20; 95% CI: 0.89-5.43; P=0.088) or recurrent vascular events (OR: 2.66; 95% CI: 0.95-7.44; P=0.063).</p><p><strong>Conclusion: </strong>Elevated Lp(a) levels are linked to increased stroke recurrence and poor functional outcome in stroke patients. Lp(a) may represent a novel therapeutic target in secondary stroke prevention in addition to a promising biomarker.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 2","pages":"161-168"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266532","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}

{"title":"Anticoagulation Failure in Stroke: Causes, Risk Factors, and Treatment.","authors":"Youngbin Choi, Jong S Kim","doi":"10.5853/jos.2025.00206","DOIUrl":"10.5853/jos.2025.00206","url":null,"abstract":"<p><p>Anticoagulation is crucial to reducing the risk of cardioembolic strokes, particularly in vulnerable populations such as patients with atrial fibrillation, artificial heart valves, or left ventricular thrombus. Though successful, anticoagulation failure (the occurrence of an ischemic stroke or systemic embolism while receiving therapy) remains a major stroke-care issue. The reason for anticoagulation failure can be below the required threshold, inability to follow up, drug-drug interactions, preexisting hypercoagulable states, or anticoagulant resistance. This failure undermines stroke prevention and requires tailored management, often requiring more drastic or alternative interventions. This review examines what drives anticoagulation failure and explores predictors of this failure in clinical, imaging, and laboratory data. It also discusses current management techniques for improving control and points to new treatments and possible futures, such as high-resolution imaging and personalized medicine based on biomarkers, to help tackle this critical clinical problem.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 2","pages":"195-206"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266505","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}

{"title":"Impact of Stroke Severity and Vascular Risk Factors on Early Versus Late Anticoagulation in Patients With Stroke and Atrial Fibrillation.","authors":"Masatoshi Koga, Mattia Branca, Daniel Strbian, Takeshi Yoshimoto, Kanta Tanaka, Sohei Yoshimura, Yusuke Yakushiji, Shigeru Fujimoto, Adhiyaman Vedamurthy, Manju Krishnan, Marjaana Tiainen, Jochen Vehoff, Gerli Sibolt, Kosuke Matsuzono, Caterina Kulyk, Silja Räty, Peter Slade, Alexander Salerno, Dimitri Hemelsoet, Thomas Horvath, Takenobu Kunieda, Makoto Nakajima, Hisanao Akiyama, Yasuyuki Iguchi, Manabu Inoue, Masafumi Ihara, Kazunori Toyoda, David Seiffge, Martina Goeldlin, Jesse Dawson, Urs Fischer","doi":"10.5853/jos.2024.05477","DOIUrl":"10.5853/jos.2024.05477","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 2","pages":"284-288"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266510","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}

{"title":"Robotic Stroke Thrombectomy: A Feasibility and Efficacy Study in Flow Models.","authors":"Cameron J Williams, Hal Rice, Bernard Yan, Laetitia de Villiers, Vinicius Carraro do Nascimento, Peter J Mitchell, Nathan W Manning, Leonid Churilov, Mark W Parsons, Stephen M Davis, Geoffrey A Donnan","doi":"10.5853/jos.2024.05057","DOIUrl":"10.5853/jos.2024.05057","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 2","pages":"266-269"},"PeriodicalIF":6.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266518","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}