Journal of Stroke最新文献

{"title":"Occupational Risk Factors for Stroke: A Comprehensive Review.","authors":"Munyoung Yang, Hyoungseob Yoo, Seo-Young Kim, Ohwi Kwon, Min-Woo Nam, Kwang Hyun Pan, Mo-Yeol Kang","doi":"10.5853/jos.2023.01011","DOIUrl":"10.5853/jos.2023.01011","url":null,"abstract":"<p><p>For primary prevention, it is important for public health and clinical medicine to identify and characterize modifiable risk factors of stroke. In existing literature, the impact of occupational variables on ischemic and hemorrhagic stroke has been extensively studied. This review summarizes the available data on the significance of occupational variables in stroke. The results of this review suggest that there is sufficient evidence for the relationship between increased risk of stroke and job stress, working in extreme temperatures, long working hours, and/or shift work. The association between long working hours and occupational exposure to noise and chemicals remains inconclusive although several studies have reported this finding. This review will act as a step toward future research and provide information that may serve as a baseline for developing targeted interventions to prevent stroke in the working population.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 3","pages":"327-337"},"PeriodicalIF":8.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/59/2c/jos-2023-01011.PMC10574301.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41182938","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":"Digital Therapeutics With Visual Discrimination Training for Cortical Blindness in Patients With Chronic Stroke.","authors":"Eun-Jae Lee, Dongho Kim, Yong-Hwan Kim, Eun Namgung, Jee-Hyun Lee, Yuka Sasaki, Takeo Watanabe, Dong-Wha Kang","doi":"10.5853/jos.2023.00276","DOIUrl":"10.5853/jos.2023.00276","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 3","pages":"409-412"},"PeriodicalIF":8.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/42/44/jos-2023-00276.PMC10574310.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9957456","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":"Clinical and Safety Outcomes of Endovascular Therapy 6 to 24 Hours After Large Vessel Occlusion Ischemic Stroke With Tandem Lesions.","authors":"Milagros Galecio-Castillo, Mudassir Farooqui, Ameer E Hassan, Mouhammad A Jumaa, Afshin A Divani, Marc Ribo, Michael Abraham, Nils H Petersen, Johanna T Fifi, Waldo R Guerrero, Amer M Malik, James E Siegler, Thanh N Nguyen, Sunil Sheth, Albert J Yoo, Guillermo Linares, Nazli Janjua, Darko Quispe-Orozco, Wondwossen Tekle, Syed F Zaidi, Sara Y Sabbagh, Marta Olivé-Gadea, Tiffany Barkley, Reade De Leacy, Kenyon W Sprankle, Mohamad Abdalkader, Sergio Salazar-Marioni, Jazba Soomro, Weston Gordon, Charoskhon Turabova, Juan Vivanco-Suarez, Aaron Rodriguez-Calienes, Maxim Mokin, Dileep R Yavagal, Tudor Jovin, Santiago Ortega-Gutierrez","doi":"10.5853/jos.2023.00759","DOIUrl":"10.5853/jos.2023.00759","url":null,"abstract":"<p><strong>Background and purpose: </strong>Effect of endovascular therapy (EVT) in acute large vessel occlusion (LVO) patients with tandem lesions (TLs) within 6-24 hours after last known well (LKW) remains unclear. We evaluated the clinical and safety outcomes among TL-LVO patients treated within 6-24 hours.</p><p><strong>Methods: </strong>This multicenter cohort was divided into two groups, based on LKW to puncture time: early window (<6 hours), and late window (6-24 hours). Primary clinical and safety outcomes were 90-day functional independence measured by the modified Rankin Scale (mRS: 0-2) and symptomatic intracranial hemorrhage (sICH). Secondary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2b), first-pass effect, early neurological improvement, ordinal mRS, and in-hospital and 90-day mortality.</p><p><strong>Results: </strong>Of 579 patients (median age 68, 32.1% females), 268 (46.3%) were treated in the late window and 311 (53.7%) in the early window. Late window group had lower median National Institutes of Health Stroke Scale score at admission, Alberta Stroke Program Early Computed Tomography Score, rates of intravenous thrombolysis, and higher rates for perfusion imaging. After adjusting for confounders, the odds of 90-day mRS 0-2 (47.7% vs. 45.0%, adjusted odds ratio [aOR] 0.71, 95% confidence interval [CI] 0.49-1.02), favorable shift in mRS (aOR 0.88, 95% CI 0.44-1.76), and sICH (3.7% vs. 5.2%, aOR 0.56, 95% CI 0.20-1.56) were similar in both groups. There was no difference in secondary outcomes. Increased time from LKW to puncture did not predicted the probability of 90-day mRS 0-2 (aOR 0.99, 95% CI 0.96-1.01, for each hour delay) among patients presenting <24 hours.</p><p><strong>Conclusion: </strong>EVT for acute TL-LVO treated within 6-24 hours after LKW was associated with similar rates of clinical and safety outcomes, compared to patients treated within 6 hours.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 3","pages":"378-387"},"PeriodicalIF":8.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/58/14/jos-2023-00759.PMC10574302.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10257471","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":"Cerebrovascular Events in Older Patients With Patent Foramen Ovale: Current Status and Future Perspectives.","authors":"Julio I Farjat-Pasos, Angel Chamorro, Sylvain Lanthier, Mathieu Robichaud, Siddhartha Mengi, Christine Houde, Josep Rodés-Cabau","doi":"10.5853/jos.2023.01599","DOIUrl":"10.5853/jos.2023.01599","url":null,"abstract":"<p><p>Patent foramen ovale (PFO) closure, along with medical therapy, has emerged as the therapeutic gold standard in younger (<60-year-old) patients with a PFO-related stroke for preventing recurrent events. However, PFO management guidelines lack definite recommendations for older (>60 years) patients with a PFO-related cerebrovascular event, a complex group of patients who were mostly excluded from PFO closure clinical trials. Nevertheless, several studies have shown a higher prevalence of PFO among older patients with cryptogenic stroke, and its presence has been associated with an increased risk of recurrent events. Furthermore, older patients exhibit a higher prevalence of high-risk PFO anatomical features, present inherent age-related risk factors that might increase the risk of paradoxical embolism through a PFO, and have a higher incidence of ischemic events after a PFO-related event. Additionally, observational studies have shown the safety and preliminary efficacy of PFO closure in older PFO-related stroke patients. Yet, higher rates of recurrent cerebrovascular events and new-onset atrial fibrillation were observed in some studies among older patients compared to their younger counterparts. After careful case-by-case evaluation, including the assessment of hidden potential cardioembolic sources of a cryptogenic stroke other than PFO, transcatheter PFO closure might be a safe and effective therapeutic option for preventing recurrent thromboembolic events in patients >60 years with a high-risk PFO-associated stroke. Ongoing trials will provide important insights into the role of PFO closure in the elderly population.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 3","pages":"338-349"},"PeriodicalIF":6.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e6/f9/jos-2023-01599.PMC10574307.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41182935","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":"Anesthetic Management and Outcomes of Endovascular Treatment of Basilar Artery Occlusion: Results From the ATTENTION Registry.","authors":"Chunrong Tao, Guangxiong Yuan, Pengfei Xu, Hao Wang, Peiyang Zhou, Tingyu Yi, Kai Li, Tao Cui, Jun Gao, Rui Li, Jun Sun, Chao Zhang, Li Wang, Tianlong Liu, Jianlong Song, Yamei Yin, Thanh N Nguyen, Qing Li, Wei Hu","doi":"10.5853/jos.2023.00318","DOIUrl":"10.5853/jos.2023.00318","url":null,"abstract":"<p><strong>Background and purpose: </strong>To examine the clinical and safety outcomes after endovascular treatment (EVT) for acute basilar artery occlusion (BAO) with different anesthetic modalities.</p><p><strong>Methods: </strong>This was a retrospective analysis using data from the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) registry. Patients were divided into two groups defined by anesthetic modality performed during EVT: general anesthesia (GA) or non-general anesthesia (non-GA). The association between anesthetic management and clinical outcomes was evaluated in a propensity score matched (PSM) cohort and an inverse probability of treatment weighting (IPTW) cohort to adjust for imbalances between the two groups.</p><p><strong>Results: </strong>Our analytic sample included 1,672 patients from 48 centers. The anesthetic modality was GA in 769 (46.0%) and non-GA in 903 (54.0%) patients. In our primary analysis with the PSM-based cohort, non-GA was comparable to GA concerning the primary outcome (adjusted common odds ratio [acOR], 1.01; 95% confidence interval [CI], 0.82 to 1.25; P=0.91). Mortality at 90 days was 38.4% in the GA group and 35.8% in the non-GA group (adjusted risk ratio, 0.95; 95% CI, 0.83 to 1.08; P=0.44). In our secondary analysis with the IPTW-based cohort, the anesthetic modality was significantly associated with the distribution of modified Rankin Scale at 90 days (acOR: 1.45 [95% CI: 1.20 to 1.75]).</p><p><strong>Conclusion: </strong>In this nationally-representative observational study, acute ischemic stroke patients due to BAO undergoing EVT without GA had similar clinical and safety outcomes compared with patients treated with GA. These findings provide the basis for large-scale randomized controlled trials to test whether anesthetic management provides meaningful clinical effects for patients undergoing EVT.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 3","pages":"399-408"},"PeriodicalIF":8.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/24/98/jos-2023-00318.PMC10574300.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10425901","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":"Dissecting Causal Relationships Between Gut Microbiota, Blood Metabolites, and Stroke: A Mendelian Randomization Study.","authors":"Qi Wang, Huajie Dai, Tianzhichao Hou, Yanan Hou, Tiange Wang, Hong Lin, Zhiyun Zhao, Mian Li, Ruizhi Zheng, Shuangyuan Wang, Jieli Lu, Yu Xu, Ruixin Liu, Guang Ning, Weiqing Wang, Yufang Bi, Jie Zheng, Min Xu","doi":"10.5853/jos.2023.00381","DOIUrl":"10.5853/jos.2023.00381","url":null,"abstract":"<p><strong>Background and purpose: </strong>We investigated the causal relationships between the gut microbiota (GM), stroke, and potential metabolite mediators using Mendelian randomization (MR).</p><p><strong>Methods: </strong>We leveraged the summary statistics of GM (n=18,340 in the MiBioGen consortium), blood metabolites (n=115,078 in the UK Biobank), and stroke (cases n=60,176 and controls n=1,310,725 in the Global Biobank Meta-Analysis Initiative) from the largest genome-wide association studies to date. We performed bidirectional MR analyses to explore the causal relationships between the GM and stroke, and two mediation analyses, two-step MR and multivariable MR, to discover potential mediating metabolites.</p><p><strong>Results: </strong>Ten taxa were causally associated with stroke, and stroke led to changes in 27 taxa. In the two-step MR, Bifidobacteriales order, Bifidobacteriaceae family, Desulfovibrio genus, apolipoprotein A1 (ApoA1), phospholipids in high-density lipoprotein (HDL_PL), and the ratio of apolipoprotein B to ApoA1 (ApoB/ApoA1) were causally associated with stroke (all P<0.044). The causal associations between Bifidobacteriales order, Bifidobacteriaceae family and stroke were validated using the weighted median method in an independent cohort. The three GM taxa were all positively associated with ApoA1 and HDL_PL, whereas Desulfovibrio genus was negatively associated with ApoB/ApoA1 (all P<0.010). Additionally, the causal associations between the three GM taxa and ApoA1 remained significant after correcting for the false discovery rate (all q-values <0.027). Multivariable MR showed that the associations between Bifidobacteriales order, Bifidobacteriaceae family and stroke were mediated by ApoA1 and HDL_PL, each accounting for 6.5% (P=0.028) and 4.6% (P=0.033); the association between Desulfovibrio genus and stroke was mediated by ApoA1, HDL_PL, and ApoB/ApoA1, with mediated proportions of 7.6% (P=0.019), 4.2% (P=0.035), and 9.1% (P=0.013), respectively.</p><p><strong>Conclusion: </strong>The current MR study provides evidence supporting the causal relationships between several specific GM taxa and stroke and potential mediating metabolites.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 3","pages":"350-360"},"PeriodicalIF":8.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f1/42/jos-2023-00381.PMC10574297.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41182936","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":"Patent Foramen Ovale, Old Patients, and Atrial Fibrillation.","authors":"Jong S Kim","doi":"10.5853/jos.2023.03055","DOIUrl":"10.5853/jos.2023.03055","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 3","pages":"325-326"},"PeriodicalIF":8.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6f/e9/jos-2023-03055.PMC10574309.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41182939","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":"Intravenous Tenecteplase for Acute Ischemic Stroke Within 4.5-24 Hours of Onset (ROSE-TNK): A Phase 2, Randomized, Multicenter Study.","authors":"Lu Wang, Ying-Jie Dai, Yu Cui, Hong Zhang, Chang-Hao Jiang, Ying-Jie Duan, Yong Zhao, Ye-Fang Feng, Shi-Mei Geng, Zai-Hui Zhang, Jiang Lu, Ping Zhang, Li-Wei Zhao, Hang Zhao, Yu-Tong Ma, Cheng-Guang Song, Yi Zhang, Hui-Sheng Chen","doi":"10.5853/jos.2023.00668","DOIUrl":"10.5853/jos.2023.00668","url":null,"abstract":"<p><strong>Background and purpose: </strong>Intravenous tenecteplase (TNK) efficacy has not been well demonstrated in acute ischemic stroke (AIS) beyond 4.5 hours after onset. This study aimed to determine the effect of intravenous TNK for AIS within 4.5 to 24 hours of onset.</p><p><strong>Methods: </strong>In this pilot trial, eligible AIS patients with diffusion-weighted imaging (DWI)-fluid attenuated inversion recovery (FLAIR) mismatch were randomly allocated to intravenous TNK (0.25 mg/kg) or standard care within 4.5-24 hours of onset. The primary endpoint was excellent functional outcome at 90 days (modified Rankin Scale [mRS] score of 0-1). The primary safety endpoint was symptomatic intracranial hemorrhage (sICH).</p><p><strong>Results: </strong>Of the randomly assigned 80 patients, the primary endpoint occurred in 52.5% (21/40) of TNK group and 50.0% (20/40) of control group, with no significant difference (unadjusted odds ratio, 1.11; 95% confidence interval 0.46-2.66; P=0.82). More early neurological improvement occurred in TNK group than in control group (11 vs. 3, P=0.03), but no significant differences were found in other secondary endpoints, such as mRS 0-2 at 90 days, shift analysis of mRS at 90 days, and change in National Institutes of Health Stroke Scale score at 24 hours and 7 days. There were no cases of sICH in this trial; however, asymptomatic intracranial hemorrhage occurred in 3 of the 40 patients (7.5%) in the TNK group.</p><p><strong>Conclusion: </strong>This phase 2, randomized, multicenter study suggests that intravenous TNK within 4.5-24 hours of onset may be safe and feasible in AIS patients with a DWI-FLAIR mismatch.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 3","pages":"371-377"},"PeriodicalIF":8.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/57/cf/jos-2023-00668.PMC10574303.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10041956","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":"Association of Unfavorable Social Determinants of Health With Stroke/Transient Ischemic Attack and Vascular Risk Factors in Hispanic/Latino Adults: Results From Hispanic Community Health Study/Study of Latinos.","authors":"Gabriela Trifan, Linda C Gallo, Melissa Lamar, Olga Garcia-Bedoya, Krista M Perreira, Amber Pirzada, Gregory A Talavera, Sylvia W Smoller, Carmen R Isasi, Jianwen Cai, Martha L Daviglus, Fernando D Testai","doi":"10.5853/jos.2023.00626","DOIUrl":"10.5853/jos.2023.00626","url":null,"abstract":"<p><strong>Background and purpose: </strong>Social determinants of health (SDOH) are non-medical factors that may contribute to the development of diseases, with a higher representation in underserved populations. Our objective is to determine the association of unfavorable SDOH with self-reported stroke/transient ischemic attack (TIA) and vascular risk factors (VRFs) among Hispanic/Latino adults living in the US.</p><p><strong>Methods: </strong>We used cross-sectional data from the Hispanic Community Health Study/Study of Latinos. SDOH and VRFs were assessed using questionnaires and validated scales and measurements. We investigated the association between the SDOH (individually and as count: ≤1, 2, 3, 4, or ≥5 SDOH), VRFs and stroke/TIA using regression analyses.</p><p><strong>Results: </strong>For individuals with stroke/TIA (n=388), the mean age (58.9 years) differed from those without stroke/TIA (n=11,210; 46.8 years; P<0.0001). In bivariate analysis, income <$20,000, education less than high school, no health insurance, perceived discrimination, not currently employed, upper tertile for chronic stress, and lower tertiles for social support and language- and social-based acculturation were associated with stroke/TIA and retained further. A higher number of SDOH was directly associated with all individual VRFs investigated, except for at-risk alcohol, and with number of VRFs (β=0.11, 95% confidence interval [CI]=0.09-0.14). In the fully adjusted model, income, discrimination, social support, chronic stress, and employment status were individually associated with stroke/TIA; the odds of stroke/TIA were 2.3 times higher in individuals with 3 SDOH (95% CI 1.6-3.2) and 2.7 times (95% CI 1.9-3.7) for those with ≥5 versus ≤1 SDOH.</p><p><strong>Conclusion: </strong>Among Hispanic/Latino adults, a higher number of SDOH is associated with increased odds for stroke/TIA and VRFs. The association remained significant after adjustment for VRFs, suggesting involvement of non-vascular mechanisms.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 3","pages":"361-370"},"PeriodicalIF":6.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ce/7e/jos-2023-00626.PMC10574305.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10314440","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":"Chronic Lung Parenchymal Disease May Be Causally Associated With Cryptogenic Stroke With Massive Right-to-Left Shunt.","authors":"Jong-Su Kim,&nbsp;Eung-Joon Lee,&nbsp;Han-Yeong Jeong,&nbsp;Keun-Hwa Jung","doi":"10.5853/jos.2023.01074","DOIUrl":"10.5853/jos.2023.01074","url":null,"abstract":"The clinical findings obtained in this study included demographic characteristics and vascular risk factors such as hypertension, diabetes, dyslipidemia, smoking, obesity, and previous history of stroke. Stroke severity was measured using the National Institutes of Health Stroke Scale by well-trained neurologists upon admission and discharge. The risk of paradoxical embolism score was calculated to evaluate the possibility of stroke associated with patent foramen ovale (PFO). The characteristics of magnetic resonance imaging performed within 7 days of the onset of symptoms were classified according to stroke lesion patterns, vascular territories, and angiographic findings. Stroke lesion patterns were categorized as single solitary, single territory multiple, multiple territory scattered, and large territory and/or additional. Vascular territories were categorized as anterior (anterior and middle cerebral arteries), posterior (vertebrobasilar artery), and both. Angiographic findings were categorized according to the presence of major arterial occlusions. Patients whose stroke lesions were not confirmed were classified separately as having a transient ischemic attack. D-dimer levels were assessed using a quantitative D-dimer latex agglutination assay. The size of the left atrium was measured using echocardiography, and measurements exceeding 40 mm were considered indicative of left atrial enlargement. Frequent atrial premature complexes were defined as cases where atrial premature complexes exceeded 1% of all heartbeats. Additional tests performed within 2 weeks of the onset of symptoms to determine the etiology of cryptogenic stroke were as follows: transcranial Doppler (TCD) sonography bubble study, transesophageal echocardiography (TEE), and contrast-enhanced chest computed tomography (CT). The TCD bubble study was performed using a TCD monitoring device (PMD 150; Spencer Technologies, Redmond, WA, USA) and two 2-MHz probes fixed in a metal headframe (Marc 1500; Spencer Technologies). Microembolic signals (MESs) were detected by the monitoring device and probes heading toward the bilateral middle cerebral artery at depths of 40–60 mm through the temporal window. Agitated saline was prepared by mixing two syringes, one with 9 mL of 0.9% saline and the other with 1 mL of air connected by a three-way stopcock, which was injected three times through the antecubital vein. The procedure was performed during the Valsalva maneuver and at rest. MESs were recorded and counted using the computer software embedded in the device. All standardized protocols were performed by skilled sonographers. Right-to-left shunt (RLS) was classified as grade I (1–10 microbubbles), grade II (11–30 microbubbles), grade III (31–100 microbubbles), grade IV (101–300 microbubbles), and grade V (&gt;300 microbubbles); including “shower” or “curtain” shunt patterns, defined as “massive RLS” in this study. In all patients with massive RLS in the TCD bubble study, the presence of PFO ","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 3","pages":"413-416"},"PeriodicalIF":8.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/38/23/jos-2023-01074.PMC10574306.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10145053","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}