Journal of Stroke最新文献

{"title":"Thrombectomy With Bridging Thrombolytic May Benefit Asian Patients More Than Non-Asian Patients: Insights From DIRECT-SAFE Sub-Analysis.","authors":"James L Barker, Oshi Swarup, Yohanna Kusuma, Leonid Churilov, Geoffrey Donnan, Stephen M Davis, Peter J Mitchell, Bernard Yan","doi":"10.5853/jos.2024.02005","DOIUrl":"10.5853/jos.2024.02005","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 1","pages":"118-121"},"PeriodicalIF":6.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364997","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 Treatment for Acute Posterior Circulation Tandem Lesions: Insights From the BASILAR and PERSIST Registries.","authors":"Wei Li, Mohamed F Doheim, Zhongming Qiu, Tan Wang, Zhibin Chen, Wenjie Zi, Qingwu Yang, Haitao Guan, Hongyu Qiao, Wenhua Liu, Wei Hu, Xinfeng Liu, Jinbo Huang, Zhongkui Han, Zhonglun Chen, Zhenqiang Zhao, Wen Sun, Raul G Nogueira","doi":"10.5853/jos.2024.03055","DOIUrl":"10.5853/jos.2024.03055","url":null,"abstract":"<p><strong>Background and purpose: </strong>Limited evidence exists on the effectiveness of endovascular treatment (EVT) for acute posterior circulation tandem lesion (PCTL). This study aimed to explore the role of extracranial vertebral artery (VA) stenting in patients with PCTL stroke undergoing EVT.</p><p><strong>Methods: </strong>Individual patient data were pooled from the BASILAR (EVT for Acute Basilar Artery Occlusion Study) and PERSIST (Posterior Circulation Ischemic Stroke) registries. Patients with PCTLs who underwent EVT were included in the present cohort and divided into the stenting and nonstenting groups based on the placement of extracranial VA stents. The primary efficacy outcome was the modified Rankin Scale (mRS) scores at 90 days and 1 year. Safety outcomes included 24-hour symptomatic intracranial hemorrhage (sICH) and all-cause mortality at 90 days and 1 year post-surgery.</p><p><strong>Results: </strong>A combined dataset of 1,320 patients with posterior circulation artery occlusion, including 263 (19.9%) with tandem lesions, of whom 217 (median age, 65 years; 82.9% male) met the inclusion criteria for the analysis. The stenting group had 84 (38.7%) patients, while the non-stenting group had 133 (61.3%). After adjustment for the potential confounders, extracranial VA stenting was associated with favorable shifts in mRS scores at both 90 days (adjusted common odds ratio [OR], 2.30; 95% confidence interval [CI], 1.23-4.28; P<0.01) and 1 year (adjusted OR [aOR], 2.04; 95% CI [1.05-3.97]; P=0.04), along with lower rate of mortality at both 90 days (aOR, 0.45; 95% CI [0.21-0.93]; P=0.01) and 1 year (aOR, 0.36; 95% CI [0.16-0.79]; P=0.01), with no significant difference in sICH incidence (aOR, 0.35; 95% CI [0.06-1.98]; P=0.24).</p><p><strong>Conclusion: </strong>Extracranial VA stenting during EVT may improve functional outcomes and reduce mortality in patients with PCTL strokes.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 1","pages":"75-84"},"PeriodicalIF":6.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364522","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 Onset-to-Door Time on Endovascular Therapy for Basilar Artery Occlusion.","authors":"Tianlong Liu, Chunrong Tao, Zhongjun Chen, Lihua Xu, Yuyou Zhu, Rui Li, Jun Sun, Li Wang, Chao Zhang, Jianlong Song, Xiaozhong Jing, Adnan I Qureshi, Mohamad Abdalkader, Thanh N Nguyen, Raul G Nogueira, Jeffrey L Saver, Wei Hu","doi":"10.5853/jos.2024.03874","DOIUrl":"10.5853/jos.2024.03874","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 1","pages":"140-143"},"PeriodicalIF":6.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364526","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":"Predictive Modeling of Symptomatic Intracranial Hemorrhage Following Endovascular Thrombectomy: Insights From the Nationwide TREAT-AIS Registry.","authors":"Jia-Hung Chen, I-Chang Su, Yueh-Hsun Lu, Yi-Chen Hsieh, Chih-Hao Chen, Chun-Jen Lin, Yu-Wei Chen, Kuan-Hung Lin, Pi-Shan Sung, Chih-Wei Tang, Hai-Jui Chu, Chuan-Hsiu Fu, Chao-Liang Chou, Cheng-Yu Wei, Shang-Yih Yan, Po-Lin Chen, Hsu-Ling Yeh, Sheng-Feng Sung, Hon-Man Liu, Ching-Huang Lin, Meng Lee, Sung-Chun Tang, I-Hui Lee, Lung Chan, Li-Ming Lien, Hung-Yi Chiou, Jiunn-Tay Lee, Jiann-Shing Jeng","doi":"10.5853/jos.2024.04119","DOIUrl":"10.5853/jos.2024.04119","url":null,"abstract":"<p><strong>Background and purpose: </strong>Symptomatic intracranial hemorrhage (sICH) following endovascular thrombectomy (EVT) is a severe complication associated with adverse functional outcomes and increased mortality rates. Currently, a reliable predictive model for sICH risk after EVT is lacking.</p><p><strong>Methods: </strong>This study used data from patients aged ≥20 years who underwent EVT for anterior circulation stroke from the nationwide Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke (TREAT-AIS). A predictive model including factors associated with an increased risk of sICH after EVT was developed to differentiate between patients with and without sICH. This model was compared existing predictive models using nationwide registry data to evaluate its relative performance.</p><p><strong>Results: </strong>Of the 2,507 identified patients, 158 developed sICH after EVT. Factors such as diastolic blood pressure, Alberta Stroke Program Early CT Score, platelet count, glucose level, collateral score, and successful reperfusion were associated with the risk of sICH after EVT. The TREAT-AIS score demonstrated acceptable predictive accuracy (area under the curve [AUC]=0.694), with higher scores being associated with an increased risk of sICH (odds ratio=2.01 per score increase, 95% confidence interval=1.64-2.45, P<0.001). The discriminatory capacity of the score was similar in patients with symptom onset beyond 6 hours (AUC=0.705). Compared to existing models, the TREAT-AIS score consistently exhibited superior predictive accuracy, although this difference was marginal.</p><p><strong>Conclusion: </strong>s The TREAT-AIS score outperformed existing models, and demonstrated an acceptable discriminatory capacity for distinguishing patients according to sICH risk levels. However, the differences between models were only marginal. Further research incorporating periprocedural and postprocedural factors is required to improve the predictive accuracy.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 1","pages":"85-94"},"PeriodicalIF":6.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364914","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":"Reinforcement of Transdural Angiogenesis: A Novel Approach to Treating Ischemic Stroke With Cerebral Perfusion Impairment.","authors":"Ji Man Hong, Hee Sun Shin","doi":"10.5853/jos.2024.02810","DOIUrl":"10.5853/jos.2024.02810","url":null,"abstract":"<p><p>Cerebral hypoperfusion plays a critical role in early neurological deterioration and long-term outcomes in patients with acute ischemic stroke, which remains a major global health challenge. This review explored transdural angiogenesis as a promising therapeutic strategy to restore cerebral perfusion in patients with ischemic stroke. The multiple burr hole procedure has been preliminarily used as an indirect revascularization method to induce transdural arteriogenesis. Theoretically, its efficacy could be enhanced by combining it with angiogenic boosters, such as erythropoietin. Recent clinical and preclinical studies have revealed that this combination therapy promotes angiogenesis and arteriogenesis, leading to successful revascularization across the dura mater and improved cerebral blood flow. This strategy may be particularly beneficial for high-risk patients with recurrent ischemic events, such as those with moyamoya disease or intracranial arterial occlusion, representing an effective strategy when conventional medical treatments are insufficient. This review highlights the potential of transdural angiogenesis enhancement as a novel intervention for ischemic stroke, offering an alternative to thrombolysis or endovascular treatment, particularly in acute stroke patients with impaired cerebral perfusion. This approach has the potential to bridge the treatment gap for patients outside the therapeutic window for acute stroke interventions. Although further research is required to refine this technique and validate its efficacy in broader clinical settings, early results have revealed promising outcomes at reducing stroke-related complications and improving patient prognosis. This review indicates that this novel strategy may offer hope for managing ischemic stroke and related conditions associated with significant cerebral hypoperfusion.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 1","pages":"30-40"},"PeriodicalIF":6.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364991","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":"Hemorrhagic Complications Following Endovascular Treatment for Atherothrombotic Large Vessel Occlusion.","authors":"Satoru Fujiwara, Kazutaka Uchida, Tsuyoshi Ohta, Nobuyuki Ohara, Michi Kawamoto, Hiroshi Yamagami, Kazunori Toyoda, Yuji Matsumaru, Yasushi Matsumoto, Kenichi Todo, Mikito Hayakawa, Seigo Shindo, Shinzo Ota, Masafumi Morimoto, Masataka Takeuchi, Hirotoshi Imamura, Hiroyuki Ikeda, Kanta Tanaka, Hideyuki Ishihara, Hiroto Kakita, Takanori Sano, Hayato Araki, Tatsufumi Nomura, Mikiya Beppu, Fumihiro Sakakibara, Manabu Shirakawa, Shinichi Yoshimura, Nobuyuki Sakai","doi":"10.5853/jos.2024.01935","DOIUrl":"10.5853/jos.2024.01935","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 1","pages":"149-153"},"PeriodicalIF":6.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364525","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 Hypertension and Subclinical Organ Damage With Mortality Due to Stroke and Its Subtypes.","authors":"Kenichi Ariyada, Kazumasa Yamagishi, Toshimi Sairenchi, Tomomi Kihara, Hiroyasu Iso, Fujiko Irie","doi":"10.5853/jos.2024.01683","DOIUrl":"10.5853/jos.2024.01683","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"27 1","pages":"144-148"},"PeriodicalIF":6.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364474","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":"Global Estimates of Reported Vaccine-Associated Ischemic Stroke for 1969-2023: A Comprehensive Analysis of the World Health Organization Global Pharmacovigilance Database.","authors":"Jaehyeong Cho,Jaeyu Park,Hyesu Jo,Yesol Yim,Ho Geol Woo,Jiyeon Oh,Dong Keon Yon","doi":"10.5853/jos.2024.01536","DOIUrl":"https://doi.org/10.5853/jos.2024.01536","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"89 1","pages":""},"PeriodicalIF":8.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262393","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":"Ethnic Differences in the Safety and Efficacy of Tenecteplase Versus Alteplase for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.","authors":"Jin Hean Koh,Claire Yi Jia Lim,Lucas Tze Peng Tan,Ching-Hui Sia,Kian Keong Poh,Vijay Kumar Sharma,Leonard Leong Litt Yeo,Andrew Fu Wah Ho,Teddy Wu,William Kok-Fai Kong,Benjamin Yong Qiang Tan","doi":"10.5853/jos.2024.01284","DOIUrl":"https://doi.org/10.5853/jos.2024.01284","url":null,"abstract":"Background and PurposeTenecteplase is a thrombolytic agent with pharmacological advantages over alteplase and has been shown to be noninferior to alteplase for acute ischemic stroke in randomized trials. However, evidence pertaining to the safety and efficacy of tenecteplase in patients from different ethnic groups is lacking. The aim of this systematic review and metaanalysis was to investigate ethnicity-specific differences in the safety and efficacy of tenecteplase versus alteplase in patients with acute ischemic stroke.MethodsFollowing an International Prospective Register of Systematic Reviews (PROSPERO)- registered protocol (CRD42023475038), three authors conducted a systematic review of the PubMed/MEDLINE, Embase, Cochrane Library, and CINAHL databases for articles comparing the use of tenecteplase with any thrombolytic agent in patients with acute ischemic stroke up to November 20, 2023. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Two independent authors extracted data onto a standardized data collection sheet. A pairwise meta-analysis was conducted in risk ratios (RR).ResultsFrom 34 studies (59,601 participants), the rate of complete recanalization was significantly higher (P<0.01) in Asian (RR: 1.91, 95% confidence interval [CI]: 1.30 to 2.80) versus Caucasian patients (RR: 0.99, 95% CI: 0.87 to 1.14). However, Asian patients (RR: 1.18, 95% CI: 0.87 to 1.62) had significantly higher (P=0.01) rates of mortality compared with Caucasian patients (RR: 1.10, 95% CI: 1.00 to 1.22). Caucasian patients were also more likely to attain a modified Rankin Scale (mRS) score of 0 to 2 at follow-up (RR: 1.14, 95% CI, 1.10 to 1.19) compared with Asian (RR: 1.00, 95% CI, 0.95 to 1.05) patients. There was no significant difference in the rate of symptomatic intracranial hemorrhage (P=0.20) and any intracranial hemorrhage (P=0.83) between Asian and Caucasian patients.ConclusionTenecteplase was associated with significantly higher rates of complete recanalization in Asian patients compared with Caucasian patients. However, tenecteplase was associated with higher rates of mortality and lower rates of mRS 0 to 2 in Asian patients compared with Caucasian patients. It may be beneficial to study the variations in response to tenecteplase among patients of different ethnic groups in large prospective cohort studies.","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"32 1","pages":""},"PeriodicalIF":8.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269749","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":"Inpatient Outcomes of Cerebral Venous Thrombosis in Patients With Malignancy Throughout the United States.","authors":"Sima Vazqez,Ankita Das,Eris Spirollari,Paige Brabant,Bridget Nolan,Kevin Clare,Jose F Dominguez,Neha Dangayach,Krishna Amuluru,Shadi Yaghi,Ji Chong,Chaitanya Medicherla,Halla Nuoaman,Neisha Patel,Stephan A Mayer,Chirag D Gandhi,Fawaz Al-Mufti","doi":"10.5853/jos.2023.04098","DOIUrl":"https://doi.org/10.5853/jos.2023.04098","url":null,"abstract":"Background and PurposeCerebral venous thrombosis (CVT) is associated with a high degree of morbidity and mortality. Our objective is to elucidate characteristics, treatments, and outcomes of patients with cancer and CVT (CA-CVT).MethodsThe 2016-2019 National Inpatient Sample (NIS) database was queried for patients with a primary diagnosis of CVT. Patients with a currently active diagnosis of malignancy (CA-CVT) were then identified. Demographics and comorbidities were compared between CA-CVT and CVT patients. Subgroup analyses explored patients with hematopoietic cancer and non-hematopoietic cancers. Stroke severity and treatment were explored. Inpatient outcomes studied were discharge disposition, length of stay, and mortality.ResultsBetween 2016 and 2019, 6,140 patients had a primary diagnosis code of CVT, and 370 (6.0%) patients had a coexisting malignancy. The most common malignancy was hematopoietic (n=195, 52.7%), followed by central nervous system (n=40, 10.8%), respiratory (n=40, 10.8%), and breast (n=40, 10.8%). These patients tended to be older than non-CA-CVT and were more likely to have coexisting comorbidities. CA-CVT patients had higher severity scores on the International Study of Cerebral Vein and Dural Sinus Thrombosis Risk Score (ISCVT-RS) and increased complications. In a propensity-score matched cohort, there were no differences in inpatient outcomes.ConclusionMalignancy occurs in 6% of patients presenting with CVT and should be considered a potential comorbidity in instances where clear causes of hypercoagulabilty have not been identified. Malignancy was linked to higher mortality rates. Nonetheless, after adjusting for the severity of CVT, the outcomes for inpatients with cancer-associated CVT were comparable to those without cancer, indicating that the increased mortality associated with malignancy is probably due to more severe CVT conditions.","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"30 1","pages":""},"PeriodicalIF":8.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262391","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}