Journal of Stroke最新文献

{"title":"Explanatory Power and Prognostic Implications of Factors Associated with Troponin Elevation in Acute Ischemic Stroke.","authors":"Sung-Ho Ahn,&nbsp;Ji-Sung Lee,&nbsp;Mi-Sook Yun,&nbsp;Jung-Hee Han,&nbsp;Soo-Young Kim,&nbsp;Young-Hak Kim,&nbsp;Sang-Hyun Lee,&nbsp;Min-Gyu Park,&nbsp;Kyung-Pil Park,&nbsp;Dong-Wha Kang,&nbsp;Jong S Kim,&nbsp;Sun U Kwon","doi":"10.5853/jos.2022.02012","DOIUrl":"https://doi.org/10.5853/jos.2022.02012","url":null,"abstract":"<p><strong>Background and purpose: </strong>We investigated the impact of comorbidity burden on troponin elevation, with separate consideration of neurological conditions, in patients with acute ischemic stroke (AIS).</p><p><strong>Methods: </strong>This prospective, observational cohort study consecutively enrolled patients with AIS for 2 years. Serum cardiac troponin I was repeatedly measured, and disease-related biomarkers were collected for diagnosis of preassigned comorbidities, including atrial fibrillation (AF), ischemic heart disease (IHD), myocardial hypertrophy (MH), heart failure (HF), renal insufficiency (RI), and active cancer. The severity of neurological deficits and insular cortical ischemic lesions were assessed as neurological conditions. Adjusted associations between these factors and troponin elevation were determined using a multivariate ordinal logistic regression model and area under the receiver operating characteristic curve (AUC). Cox proportional hazards model was used to determine the prognostic significance of comorbidity beyond neurological conditions.</p><p><strong>Results: </strong>Among 1,092 patients (66.5±12.4 years, 63.3% male), 145 (13.3%) and 335 (30.7%) had elevated (≥0.040 ng/mL) and minimally-elevated (0.040-0.010 ng/mL) troponin, respectively. In the adjusted analysis, AF, MH, HF, RI, active cancer, and neurological deficits were associated with troponin elevation. The multivariate model with six comorbidities and two neurological conditions exhibited an AUC of 0.729 (95% confidence interval [CI], 0.698-0.759). In Cox regression, AF, IHD, and HF were associated with adverse cardio-cerebrovascular events, whereas HF and active cancer were associated with mortality.</p><p><strong>Conclusion: </strong>Troponin elevation in patients with AIS can be explained by the burden of comorbidities in combination with neurological status, which explains the prognostic significance of troponin assay.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"141-150"},"PeriodicalIF":8.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/20/d0/jos-2022-02012.PMC9911843.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10725493","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":"Wall Shear Stress Associated with Stroke Occurrence and Mechanisms in Middle Cerebral Artery Atherosclerosis.","authors":"Ho Geol Woo, Hyug-Gi Kim, Kyung Mi Lee, Sang Hee Ha, HangJin Jo, Sung Hyuk Heo, Dae-Il Chang, David S Liebeskind, Bum Joon Kim","doi":"10.5853/jos.2022.02754","DOIUrl":"10.5853/jos.2022.02754","url":null,"abstract":"<p><strong>Background and purpose: </strong>Various mechanisms are involved in the etiology of stroke caused by atherosclerosis of the middle cerebral artery (MCA). Here, we compared differences in plaque nature and hemodynamic parameters according to stroke mechanism in patients with MCA atherosclerosis.</p><p><strong>Methods: </strong>Consecutive patients with asymptomatic and symptomatic MCA atherosclerosis (≥50% stenosis) were enrolled. MCA plaque characteristics (location and plaque enhancement) and wall shear stress (WSS) were measured using high-resolution vessel wall and four-dimensional flow magnetic resonance imaging, respectively, at five points (initial, upstream, minimal lumen, downstream, and terminal). These parameters were compared between patients with asymptomatic and symptomatic MCA atherosclerosis with infarctions of different mechanisms (artery-to-artery embolism vs. local branch occlusion).</p><p><strong>Results: </strong>In total, 110 patients (46 asymptomatic, 32 artery-to-artery embolisms, and 32 local branch occlusions) were investigated. Plaques were evenly distributed in the MCA of patients with asymptomatic MCA atherosclerosis, more commonly observed in the distal MCA of patients with artery-to-artery embolism, and in the middle MCA of patients with local branch occlusion. Maximum WSS and plaque enhancement were more prominent in the minimum lumen area of patients with asymptomatic MCA atherosclerosis or those with local branch occlusion, and were more prominent in the upstream area in those with artery-to-artery embolism. The elevated variability in the maximum WSS was related to stroke caused by artery-to-artery embolism.</p><p><strong>Conclusion: </strong>Stroke caused by artery-to-artery embolism was related to plaque enhancement and the highest maximum WSS at the upstream point of the plaque, and was associated with elevated variability of maximum WSS.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"132-140"},"PeriodicalIF":6.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/fa/jos-2022-02754.PMC9911838.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10725494","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":"Precision Greenness and Stroke/Transient Ischemic Attack in 249,405 US Medicare Beneficiaries.","authors":"Scott C Brown,&nbsp;William W Aitken,&nbsp;Joanna Lombard,&nbsp;Kefeng Wang,&nbsp;Tatjana Rundek,&nbsp;Margaret M Byrne,&nbsp;Matthew Toro,&nbsp;Maria I Nardi,&nbsp;Jack Kardys,&nbsp;Abraham Parrish,&nbsp;José Szapocznik","doi":"10.5853/jos.2022.02922","DOIUrl":"https://doi.org/10.5853/jos.2022.02922","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"173-176"},"PeriodicalIF":8.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8e/68/jos-2022-02922.PMC9911840.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10736169","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 10th Korea-Japan Joint Stroke Conference (KJJSC) at Osaka: The First-Ever and Hopefully, the Last Virtual Conference.","authors":"Kazunori Toyoda,&nbsp;Sohei Yoshimura,&nbsp;Kanta Tanaka,&nbsp;Kuniaki Ogasawara,&nbsp;Joung-Ho Rha","doi":"10.5853/jos.2023.00052","DOIUrl":"https://doi.org/10.5853/jos.2023.00052","url":null,"abstract":"pISSN: 2287-6391 • eISSN: 2287-6405 https://j-stroke.org 177 The first Korea–Japan Joint Stroke Conference (KJJSC) was held in Seoul, Korea in 2002, which was the same year as the 17th Fédération Internationale de Football Association (FIFA) World Cup, also known as Korea–Japan 2002. In 2022, KJJSC celebrated its 20th anniversary (Table 1). Stroke patients in Korea and Japan share some similarities, such as high percentages of small vessel disease, intracranial atherosclerosis, and moyamoya disease, and dietary and lifestyle habits are also comparable. The care system in Korea and Japan are also similar and both countries favor the use of cilostazol for secondary stroke prevention. Thus, it was natural that the core members of the Korean and Japan Stroke Societies (KSS, JSS) proposed the idea of holding regular stroke conferences together. Prof. Jae-Kyu Roh and Prof. Kwang Ho Lee from the KSS and Prof. Yukito Shinohara from the JSS first initiated the idea and pioneered the first joint conference. At the organizers’ meeting of the 9th KJJSC in November 2019, it was determined that the 10th KJJSC in 2021 would be held on-site in Osaka. There was no doubt about the feasibility of an in-person conference at that time. However, when the coronavirus disease 2019 (COVID-19) pandemic swept across the globe, our original plan had to change drastically. We conducted the first-ever virtual KJJSC conference from a small studio in Namba, Osaka, on September 17 (Saturday) and September 18 (Sunday) in 2022. The theme of KJJSC 2022 in Osaka was “New friendship between K & J in the new standard era.” At this conference, six official symposiums were set, and the current conditions of Korea and Japan were compared. For example, four complete or ongoing trials were introduced. The Korean investigators presented the “Outcome in Patients Treated with Intraarterial thrombectomy: optiMAL Blood Pressure control (OPTIMAL-BP)” trial and the “Dual antiplatelet Use for extended period taRgeted to AcuTe Ischemic stroke with presumed atherosclerotic OrigiN (DURATION)” study, while the Japanese researchers discussed the “Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Large IscheMIc core Trial (RESCUE-Japan LIMIT)” trial and the “STroke secondary prevention with catheter ABLation and EDoxaban for patients with non-valvular atrial fibrillation (STABLED)” study. In addition, presentations on machine learning for stroke subtype classification and digital stroke therapies were delivered by Korean speakers, and ring finger protein 213 (RNF213)-related arteriopathy and multi-lineage differentiating stress enduring (Muse) cell therapy were presented by Japanese speakers. Other interesting presentations included “Mechanical thrombectomy and the acute stroke care system,” “Cerebral small vessel disease and cognitive/psychiatric disorders,” “New pharmacotherapy for stroke (such as tenecteplase, nerinetide, factor XIa inhibitors, and prasugrel for stroke),” and “","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"177-178"},"PeriodicalIF":8.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3a/5d/jos-2023-00052.PMC9911837.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10725496","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 Left Atrial or Left Atrial Appendage Thrombus on Stroke Outcome: A Matched Control Analysis.","authors":"JoonNyung Heo,&nbsp;Hyungwoo Lee,&nbsp;Il Hyung Lee,&nbsp;Hyo Suk Nam,&nbsp;Young Dae Kim","doi":"10.5853/jos.2022.02068","DOIUrl":"https://doi.org/10.5853/jos.2022.02068","url":null,"abstract":"Background and Purpose Left atrial or left atrial appendage (LA/LAA) thrombi are frequently observed during cardioembolic evaluation in patients with ischemic stroke. This study aimed to investigate stroke outcomes in patients with LA/LAA thrombus. Methods This retrospective study included patients admitted to a single tertiary center in Korea between January 2012 and December 2020. Patients with nonvalvular atrial fibrillation who underwent transesophageal echocardiography or multi-detector coronary computed tomography were included in the study. Poor outcome was defined as modified Rankin Scale score >3 at 90 days. The inverse probability of treatment weighting analysis was performed. Results Of the 631 patients included in this study, 68 (10.7%) had LA/LAA thrombi. Patients were likely to have a poor outcome when an LA/LAA thrombus was detected (42.6% vs. 17.4%, P<0.001). Inverse probability of treatment weighting analysis yielded a higher probability of poor outcomes in patients with LA/LAA thrombus than in those without LA/LAA thrombus (P<0.001). Patients with LA/LAA thrombus were more likely to have relevant arterial occlusion on angiography (36.3% vs. 22.4%, P=0.047) and a longer hospital stay (8 vs. 7 days, P<0.001) than those without LA/LAA thrombus. However, there was no difference in early neurological deterioration during hospitalization or major adverse cardiovascular events within 3 months between the two groups. Conclusions Patients with ischemic stroke who had an LA/LAA thrombus were at risk of a worse functional outcome after 3 months, which was associated with relevant arterial occlusion and prolonged hospital stay.","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"111-118"},"PeriodicalIF":8.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a1/cc/jos-2022-02068.PMC9911853.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10736171","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":"Neuroimaging of Acute Ischemic Stroke: Multimodal Imaging Approach for Acute Endovascular Therapy.","authors":"Mohamad Abdalkader, James E Siegler, Jin Soo Lee, Shadi Yaghi, Zhongming Qiu, Xiaochuan Huo, Zhongrong Miao, Bruce C V Campbell, Thanh N Nguyen","doi":"10.5853/jos.2022.03286","DOIUrl":"10.5853/jos.2022.03286","url":null,"abstract":"<p><p>Advances in acute ischemic stroke (AIS) treatment have been contingent on innovations in neuroimaging. Neuroimaging plays a pivotal role in the diagnosis and prognosis of ischemic stroke and large vessel occlusion, enabling triage decisions in the emergent care of the stroke patient. Current imaging protocols for acute stroke are dependent on the available resources and clinicians' preferences and experiences. In addition, differential application of neuroimaging in medical decision-making, and the rapidly growing evidence to support varying paradigms have outpaced guideline-based recommendations for selecting patients to receive intravenous or endovascular treatment. In this review, we aimed to discuss the various imaging modalities and approaches used in the diagnosis and treatment of AIS.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"55-71"},"PeriodicalIF":6.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e9/bf/jos-2022-03286.PMC9911849.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10738001","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 Rescue on Reperfusion Damage in Cerebral Infarction by Nelonemdaz (RODIN) Trial: Protocol for a Double-Blinded Clinical Trial of Nelonemdaz in Patients with Hyperacute Ischemic Stroke and Endovascular Thrombectomy.","authors":"Jin Soo Lee,&nbsp;Ji Sung Lee,&nbsp;Byoung Joo Gwag,&nbsp;Dennis W Choi,&nbsp;Chun San An,&nbsp;Hyun Goo Kang,&nbsp;Tae-Jin Song,&nbsp;Seong Hwan Ahn,&nbsp;Chang Hun Kim,&nbsp;Dong-Ick Shin,&nbsp;Sun U Kwon","doi":"10.5853/jos.2022.02453","DOIUrl":"https://doi.org/10.5853/jos.2022.02453","url":null,"abstract":"<p><strong>Background and purpose: </strong>Nelonemdaz (Neu2000) has both selective antagonism against 2B subunit of N-methyl-D-aspartate receptor and antioxidant activity. This drug provides sufficient evidence of neuroprotection in acute cerebral ischemia/reperfusion models. This phase III trial aims to determine this effect in patients.</p><p><strong>Design: </strong>The Rescue on Reperfusion Damage in Cerebral Infarction by Nelonemdaz is a multicenter, double-blinded clinical trial. A total of 496 patients will be randomly assigned into the nelonemdaz (a total of 5,250 mg divided by 10 times for 5 days) and placebo groups. Patients will be included if they have an acute ischemic stroke (National Institutes of Health Stroke Scale score ≥8) caused by intracranial large vessel occlusion in the anterior circulation (Alberta Stroke Program Early CT Score ≥4), and if they are expected to undergo endovascular thrombectomy within 12 hours after stroke onset.</p><p><strong>Endpoints: </strong>The primary endpoint is a favorable shift in the modified Rankin Scale (mRS) score at 90 days after the first dose of drug. The data will be analyzed by the Cochran-Mantel-Haenszel shift test. The secondary endpoints include functional independence (mRS 0-2) at 35 and 90 days, the favorable shift of mRS at 35 days, the proportion of mRS 0 at 35 and 90 days, and the occurrence rates of symptomatic intracranial hemorrhage within 7 days.</p><p><strong>Conclusion: </strong>This trial will clarify the efficacy and safety of nelonemdaz in patients with acute ischemic stroke and endovascular thrombectomy. This study has been registered at ClinicalTrials. gov (NCT05041010).</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"160-168"},"PeriodicalIF":8.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/66/43/jos-2022-02453.PMC9911845.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10738003","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":"Mechanical Thrombectomy for Acute Ischemic Stroke in Metastatic Cancer Patients: A Nationwide Cross-Sectional Analysis.","authors":"Hassan Aboul-Nour,&nbsp;Ahmed Maraey,&nbsp;Ammar Jumah,&nbsp;Mahmoud Khalil,&nbsp;Ahmed M Elzanaty,&nbsp;Hadeer Elsharnoby,&nbsp;Fawaz Al-Mufti,&nbsp;Alex Bou Chebl,&nbsp;Daniel J Miller,&nbsp;Stephan A Mayer","doi":"10.5853/jos.2022.02334","DOIUrl":"https://doi.org/10.5853/jos.2022.02334","url":null,"abstract":"<p><strong>Background and purpose: </strong>Mechanical thrombectomy (MT) is the standard treatment for large vessel occlusion (LVO) acute ischemic stroke. Patients with active malignancy have an increased risk of stroke but were excluded from MT trials.</p><p><strong>Methods: </strong>We searched the National Readmission Database for LVO patients treated with MT between 2016-2018 and compared the characteristics and outcomes of cancer-free patients to those with metastatic cancer (MC). Primary outcomes were all-cause in-hospital mortality and favorable outcome, defined as a routine discharge to home (regardless of whether home services were provided or not). Multivariate regression was used to adjust for confounders.</p><p><strong>Results: </strong>Of 40,537 LVO patients treated with MT, 933 (2.3%) had MC diagnosis. Compared to cancer-free patients, MC patients were similar in age and stroke severity but had greater overall disease severity. Hospital complications that occurred more frequently in MC included pneumonia, sepsis, acute coronary syndrome, deep vein thrombosis, and pulmonary embolism (P<0.001). Patients with MC had similar rates of intracerebral hemorrhage (20% vs. 21%) but were less likely to receive tissue plasminogen activator (13% vs. 23%, P<0.001). In unadjusted analysis, MC patients as compared to cancer-free patients had a higher in-hospital mortality rate and were less likely to be discharged to home (36% vs. 42%, P=0.014). On multivariate regression adjusting for confounders, mortality was the only outcome that was significantly higher in the MC group than in the cancerfree group (P<0.001).</p><p><strong>Conclusion: </strong>LVO patients with MC have higher mortality and more infectious and thrombotic complications than cancer-free patients. MT nonetheless can result in survival with good outcome in slightly over one-third of patients.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"119-125"},"PeriodicalIF":8.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/94/c6/jos-2022-02334.PMC9911847.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10736172","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":"Diabetes and Stroke: What Are the Connections?","authors":"Ofri Mosenzon,&nbsp;Alice Yy Cheng,&nbsp;Alejandro A Rabinstein,&nbsp;Simona Sacco","doi":"10.5853/jos.2022.02306","DOIUrl":"https://doi.org/10.5853/jos.2022.02306","url":null,"abstract":"<p><p>Stroke is a major cause of death and long-term disability worldwide. Diabetes is associated with an increased risk of cardiovascular complications, including stroke. People with diabetes have a 1.5-2 times higher risk of stroke compared with people without diabetes, with risk increasing with diabetes duration. These risks may also differ according to sex, with a greater risk observed among women versus men. Several mechanisms associated with diabetes lead to stroke, including large artery atherosclerosis, cerebral small vessel disease, and cardiac embolism. Hyperglycemia confers increased risk for worse outcomes in people presenting with acute ischemic stroke, compared with people with normal glycemia. Moreover, people with diabetes may have poorer post-stroke outcomes and higher risk of stroke recurrence than those without diabetes. Appropriate management of diabetes and other vascular risk factors may improve stroke outcomes and reduce the risk for recurrent stroke. Secondary stroke prevention guidelines recommend screening for diabetes following a stroke. The diabetes medications pioglitazone and glucagon-like peptide-1 receptor agonists have demonstrated protection against stroke in randomized controlled trials; this protective effect is believed to be independent of glycemic control. Neurologists are often involved in the management of modifiable risk factors for stroke (including hypertension, hyperlipidemia, and atrial fibrillation), but less often in the direct management of diabetes. This review provides an overview of the relationships between diabetes and stroke, including epidemiology, pathophysiology, post-stroke outcomes, and treatments for people with stroke and diabetes. This should aid neurologists in diabetes-related decision-making when treating people with acute or recurrent stroke.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"26-38"},"PeriodicalIF":8.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ea/b9/jos-2022-02306.PMC9911852.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10741929","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":"Endovascular versus Medical Management of Acute Basilar Artery Occlusion: A Systematic Review and Meta-Analysis of the Randomized Controlled Trials.","authors":"Mohamad Abdalkader,&nbsp;Stephanos Finitsis,&nbsp;Chuanhui Li,&nbsp;Wei Hu,&nbsp;Xinfeng Liu,&nbsp;Xunming Ji,&nbsp;Xiaochuan Huo,&nbsp;Fana Alemseged,&nbsp;Zhongming Qiu,&nbsp;Daniel Strbian,&nbsp;Volker Puetz,&nbsp;James E Siegler,&nbsp;Shadi Yaghi,&nbsp;Kaiz Asif,&nbsp;Piers Klein,&nbsp;Yuyou Zhu,&nbsp;Bruce C V Campbell,&nbsp;Hui-Sheng Chen,&nbsp;Simon Nagel,&nbsp;Georgios Tsivgoulis,&nbsp;Zhongrong Miao,&nbsp;Raul G Nogueira,&nbsp;Tudor G Jovin,&nbsp;Wouter J Schonewille,&nbsp;Thanh N Nguyen","doi":"10.5853/jos.2022.03755","DOIUrl":"https://doi.org/10.5853/jos.2022.03755","url":null,"abstract":"<p><strong>Background and purpose: </strong>The optimal management of patients with acute basilar artery occlusion (BAO) is uncertain. We aimed to evaluate the safety and efficacy of endovascular thrombectomy (EVT) compared to medical management (MM) for acute BAO through a meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis of RCTs of patients with acute BAO. We analyzed the pooled effect of EVT compared to MM on the primary outcome (modified Rankin Scale [mRS] of 0-3 at 3 months), secondary outcome (mRS 0-2 at 3 months), symptomatic intracranial hemorrhage (sICH), and 3-month mortality rates. For each study, effect sizes were computed as odds ratios (ORs) with random effects and Mantel-Haenszel weighting.</p><p><strong>Results: </strong>Four RCTs met inclusion criteria including 988 patients. There were higher odds of mRS of 0-3 at 90 days in the EVT versus MM group (45.1% vs. 29.1%, OR 1.99, 95% confidence interval [CI] 1.04-3.80; P=0.04). Patients receiving EVT had a higher sICH compared to MM (5.4% vs. 0.8%, OR 7.89, 95% CI 4.10-15.19; P<0.01). Mortality was lower in the EVT group (35.5% vs. 45.1%, OR 0.64, 95% CI 0.42-0.99; P=0.05). In an analysis of two trials with BAO patients and National Institutes of Health Stroke Scale (NIHSS) <10, there was no difference in 90-day outcomes between EVT versus MM.</p><p><strong>Conclusion: </strong>In this systematic review and meta-analysis, EVT was associated with favorable outcome and decreased mortality in patients with BAO up to 24 hours from stroke symptoms compared to MM. The treatment effect in BAO patients with NIHSS <10 was less certain. Further studies are of interest to evaluate the efficacy of EVT in basilar occlusion patients with milder symptoms.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"81-91"},"PeriodicalIF":8.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0d/1f/jos-2022-03755.PMC9911851.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10725495","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}