Journal of Stroke最新文献

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Smartphone App in Stroke Management: A Narrative Updated Review. 中风管理中的智能手机应用程序:叙述性更新评论。
IF 8.2 1区 医学
Journal of Stroke Pub Date : 2023-05-01 Epub Date: 2023-05-30 DOI: 10.5853/jos.2022.01410.e1
Adriano Bonura, Francesco Motolese, Fioravante Capone, Gianmarco Iaccarino, Michele Alessiani, Mario Ferrante, Rosalinda Calandrelli, Vincenzo Di Lazzaro, Fabio Pilato
{"title":"Smartphone App in Stroke Management: A Narrative Updated Review.","authors":"Adriano Bonura, Francesco Motolese, Fioravante Capone, Gianmarco Iaccarino, Michele Alessiani, Mario Ferrante, Rosalinda Calandrelli, Vincenzo Di Lazzaro, Fabio Pilato","doi":"10.5853/jos.2022.01410.e1","DOIUrl":"10.5853/jos.2022.01410.e1","url":null,"abstract":"The spread of smartphones and mobile-Health (m-health) has progressively changed clinical practice, implementing access to medical knowledge and communication between doctors and patients. Dedicated software called Applications (or Apps), assists the practitioners in the various phases of clinical practice, from diagnosis to follow-up and therapy management. The impact of this technology is even more important in diseases such as stroke, which are characterized by a complex management that includes several moments: primary prevention, acute phase management, rehabilitation, and secondary prevention. This review aims to evaluate and summarize the available literature on Apps for the clinical management of stroke. We described their potential and weaknesses, discussing potential room for improvement. Medline databases were interrogated for studies concerning guideline-based decision support Apps for stroke management and other medical scenarios from 2007 (introduction of the first iPhone) until January 2022. We found 551 studies. Forty-three papers were included because they fitted the scope of the review. Based on their purpose, Apps were classified into three groups: primary prevention Apps, acute stroke management Apps, and post-acute stroke Apps. We described the aim of each App and, when available, the results of clinical studies. For acute stroke, several Apps have been designed with the primary purpose of helping communication and sharing of patients’ clinical data among healthcare providers. However, interactive systems Apps aiming to assist clinicians are still lacking, and this field should be developed because it may improve stroke patients’ management.","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 2","pages":"320-324"},"PeriodicalIF":8.2,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/19/e7/jos-2022-01410-e1.PMC10250870.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9602148","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}
引用次数: 4
Stroke in Women: Still the Scent of a Woman. 女人的中风:仍然是女人的气味。
IF 8.2 1区 医学
Journal of Stroke Pub Date : 2023-01-01 DOI: 10.5853/jos.2023.00094
Jong S Kim
{"title":"Stroke in Women: Still the Scent of a Woman.","authors":"Jong S Kim","doi":"10.5853/jos.2023.00094","DOIUrl":"https://doi.org/10.5853/jos.2023.00094","url":null,"abstract":"pISSN: 2287-6391 • eISSN: 2287-6405 https://j-stroke.org 1 When I was a young professor, I conducted experimental stroke research that involved inducing middle cerebral artery infarction with the use of a thread. At that time, I only used male rats because I heard that due to the complex and fluctuating female physiology, research results may not be consistent if female animals were used. I soon got questions. If this is true, what would be different? Would the infarct size be bigger or smaller in female rats? Would there be a difference in infarct size during the ovulatory and menstrual stages? Can the results obtained from male rats be applied to female human patients? And, would a newly developed medicine be equally effective in women? In this issue of the Journal of Stroke, the two review papers by Yoon and Bushnell, and Ospel and his colleagues focused on “stroke in women,” which reminded me of my old questions. Actually, “stroke in women” is even more complex than “stroke in female rats.” The physiologic changes that occur with age and in response to the surrounding environment are more abrupt and dramatic in women than men, who experience unique events such as puberty, pregnancy, and lactation. Unlike rats, women also experience menopause and long-lasting post-menopausal lives. More importantly, in human society, sex is linked with social-economic-cultural issues in a very complex manner. In general, women are less educated, economically poorer, and have a lower social status than men. Practically, this difference is especially marked and impactful in underdeveloped countries. If only a father can earn money, family members may take care of the father more carefully than the mother. This social discrimination may be one of the reasons why stroke outcomes are worse and the risk factors are less well managed in women than in men. Although the two papers are very informative, they also emphasized how difficult it is to understand “stroke in women” in which sex is closely related to ever-changing physiology and complex socioeconomic issues. Unfortunately, the majority of high-quality scientific papers are from developed countries where sex discrimination is less marked. Hence, “stroke in women” has not gained sufficient interest in the literature, and many important issues remain unclarified. In the movie, “Scent of a Woman,” Al Pacino appreciated the scent of a woman while he danced the tango with her, but could not visualize her due to his blindness. After reading the two papers, you may ask the same questions that I am asking. And yes, we can appreciate the scent of a woman, but when can we see her clearly?","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"1"},"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/23/97/jos-2023-00094.PMC9911854.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10725489","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}
引用次数: 1
Association of Substantia Nigra Degeneration with Poor Neurological Recovery in Basal Ganglia Infarctions. 黑质下变性与基底节脑梗塞神经功能恢复不良的关系
IF 8.2 1区 医学
Journal of Stroke Pub Date : 2023-01-01 Epub Date: 2022-12-06 DOI: 10.5853/jos.2022.02145
Kijeong Lee, HyungWoo Lee, Young Dae Kim, Hyo Suk Nam, Hye Sun Lee, Joonsang Yoo, Sunghee Cho, Ji Hoe Heo
{"title":"Association of Substantia Nigra Degeneration with Poor Neurological Recovery in Basal Ganglia Infarctions.","authors":"Kijeong Lee, HyungWoo Lee, Young Dae Kim, Hyo Suk Nam, Hye Sun Lee, Joonsang Yoo, Sunghee Cho, Ji Hoe Heo","doi":"10.5853/jos.2022.02145","DOIUrl":"10.5853/jos.2022.02145","url":null,"abstract":"","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"169-172"},"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/f9/39/jos-2022-02145.PMC9911844.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9300796","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}
引用次数: 0
Sex and Gender Differences in Stroke and Their Practical Implications in Acute Care. 脑卒中的性别差异及其在急性护理中的实际意义。
IF 8.2 1区 医学
Journal of Stroke Pub Date : 2023-01-01 DOI: 10.5853/jos.2022.04077
Johanna Ospel, Nishita Singh, Aravind Ganesh, Mayank Goyal
{"title":"Sex and Gender Differences in Stroke and Their Practical Implications in Acute Care.","authors":"Johanna Ospel,&nbsp;Nishita Singh,&nbsp;Aravind Ganesh,&nbsp;Mayank Goyal","doi":"10.5853/jos.2022.04077","DOIUrl":"https://doi.org/10.5853/jos.2022.04077","url":null,"abstract":"<p><p>There are several controversies regarding the role of sex and gender in the pathophysiology and management of acute stroke. Assessing the role of sex, i.e., biological/pathophysiological factors, and gender, i.e., sociocultural factors, in isolation is often not possible since they are closely intertwined with each other. To complicate matters even more, the functional baseline status of women and men at the time of their first stroke is substantially different, whereby women have, on average, a poorer reported/ascertained baseline function compared to men. These differences in baseline variables account for a large part of the differences in post-stroke outcomes between women and men. Adjusting for these baseline differences is difficult, and in many cases, residual confounding cannot be excluded. Despite these obstacles, a better understanding of how patient sex and gender differences influence acute stroke and stroke care pathways is crucial to avoid biases and allow us to provide the best possible care for all acute stroke patients. Disregarding patient sex and gender on one hand and ignoring potential confounding factors in sex- and gender-stratified analyses on the other hand, may cause researchers to come to erroneous conclusions and physicians to provide suboptimal care. This review outlines sex- and gender-related factors in key aspects of acute stroke, including acute stroke epidemiology, diagnosis, access to care, treatment outcomes, and post-acute care. We also attempt to outline knowledge gaps, which deserve to be studied in further detail, and practical implications for physicians treating acute stroke patients in their daily practice.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"16-25"},"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/df/f4/jos-2022-04077.PMC9911850.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10725490","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}
引用次数: 5
The Heart Is at Risk: Understanding Stroke-Heart-Brain Interactions with Focus on Neurogenic Stress Cardiomyopathy-A Review. 心脏处于危险之中:以神经源性应激性心肌病为重点了解中风-心-脑之间的相互作用--综述》(The Heart Is at Risk: Understanding Stroke-Heart-Brain Interactions with Focus on Neurogenic Stress Cardiomyopathy-A Review.
IF 6 1区 医学
Journal of Stroke Pub Date : 2023-01-01 Epub Date: 2023-01-03 DOI: 10.5853/jos.2022.02173
Mairi Ziaka, Aristomenis Exadaktylos
{"title":"The Heart Is at Risk: Understanding Stroke-Heart-Brain Interactions with Focus on Neurogenic Stress Cardiomyopathy-A Review.","authors":"Mairi Ziaka, Aristomenis Exadaktylos","doi":"10.5853/jos.2022.02173","DOIUrl":"10.5853/jos.2022.02173","url":null,"abstract":"<p><p>In recent years, it has been convincingly demonstrated that acute brain injury may cause severe cardiac complications-such as neurogenic stress cardiomyopathy (NSC), a specific form of takotsubo cardiomyopathy. The pathophysiology of these brain-heart interactions is complex and involves sympathetic hyperactivity, activation of the hypothalamic-pituitary-adrenal axis, as well as immune and inflammatory pathways. There have been great strides in our understanding of the axis from the brain to the heart in patients with isolated acute brain injury and more specifically in patients with stroke. On the other hand, in patients with NSC, research has mainly focused on hemodynamic dysfunction due to arrhythmias, regional wall motion abnormality, or left ventricular hypokinesia that leads to impaired cerebral perfusion pressure. Comparatively little is known about the underlying secondary and delayed cerebral complications. The aim of the present review is to describe the stroke-heart-brain axis and highlight the main pathophysiological mechanisms leading to secondary and delayed cerebral injury in patients with concurrent hemorrhagic or ischemic stroke and NSC as well as to identify further areas of research that could potentially improve outcomes in this specific patient population.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"39-54"},"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/da/c6/jos-2022-02173.PMC9911836.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10741927","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}
引用次数: 0
Trends in Venous Thromboembolism Readmission Rates after Ischemic Stroke and Intracerebral Hemorrhage. 缺血性脑卒中和脑出血后静脉血栓栓塞再入院率的趋势。
IF 8.2 1区 医学
Journal of Stroke Pub Date : 2023-01-01 DOI: 10.5853/jos.2022.02215
Liqi Shu, Adam de Havenon, Ava L Liberman, Nils Henninger, Eric Goldstein, Michael E Reznik, Ali Mahta, Fawaz Al-Mufti, Jennifer Frontera, Karen Furie, Shadi Yaghi
{"title":"Trends in Venous Thromboembolism Readmission Rates after Ischemic Stroke and Intracerebral Hemorrhage.","authors":"Liqi Shu,&nbsp;Adam de Havenon,&nbsp;Ava L Liberman,&nbsp;Nils Henninger,&nbsp;Eric Goldstein,&nbsp;Michael E Reznik,&nbsp;Ali Mahta,&nbsp;Fawaz Al-Mufti,&nbsp;Jennifer Frontera,&nbsp;Karen Furie,&nbsp;Shadi Yaghi","doi":"10.5853/jos.2022.02215","DOIUrl":"https://doi.org/10.5853/jos.2022.02215","url":null,"abstract":"<p><strong>Background and purpose: </strong>Venous thromboembolism (VTE) is a life-threatening complication of stroke. We evaluated nationwide rates and risk factors for hospital readmissions with VTE after an intracerebral hemorrhage (ICH) or acute ischemic stroke (AIS) hospitalization.</p><p><strong>Methods: </strong>Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database, we included patients with a principal discharge diagnosis of ICH or AIS from 2016 to 2019. Patients who had VTE diagnosis or history of VTE during the index admission were excluded. We performed Cox regression models to determine factors associated with VTE readmission, compared rates between AIS and ICH and developed post-stroke VTE risk score. We estimated VTE readmission rates per day over a 90-day time window post-discharge using linear splines.</p><p><strong>Results: </strong>Of the total 1,459,865 patients with stroke, readmission with VTE as the principal diagnosis within 90 days occurred in 0.26% (3,407/1,330,584) AIS and 0.65% (843/129,281) ICH patients. The rate of VTE readmission decreased within first 4-6 weeks (P<0.001). In AIS, cancer, obesity, higher National Institutes of Health Stroke Scale (NIHSS) score, longer hospital stay, home or rehabilitation disposition, and absence of atrial fibrillation were associated with VTE readmission. In ICH, longer hospital stay and rehabilitation disposition were associated with VTE readmission. The VTE rate was higher in ICH compared to AIS (adjusted hazard ratio 2.86, 95% confidence interval 1.93-4.25, P<0.001).</p><p><strong>Conclusions: </strong>After stroke, VTE readmission risk is highest within the first 4-6 weeks and nearly three-fold higher after ICH vs. AIS. VTE risk is linked to decreased mobility and hypercoagulability. Studies are needed to test short-term VTE prophylaxis beyond hospitalization in high-risk patients.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"151-159"},"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/09/af/jos-2022-02215.PMC9911841.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9158183","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}
引用次数: 0
Cortical Thinning in High-Grade Asymptomatic Carotid Stenosis. 高级别无症状颈动脉狭窄的皮质变薄。
IF 8.2 1区 医学
Journal of Stroke Pub Date : 2023-01-01 DOI: 10.5853/jos.2022.02285
Randolph S Marshall, David S Liebeskind, John Huston Iii, Lloyd J Edwards, George Howard, James F Meschia, Thomas G Brott, Brajesh K Lal, Donald Heck, Giuseppe Lanzino, Navdeep Sangha, Vikram S Kashyap, Clarissa D Morales, Dejania Cotton-Samuel, Andres M Rivera, Adam M Brickman, Ronald M Lazar
{"title":"Cortical Thinning in High-Grade Asymptomatic Carotid Stenosis.","authors":"Randolph S Marshall,&nbsp;David S Liebeskind,&nbsp;John Huston Iii,&nbsp;Lloyd J Edwards,&nbsp;George Howard,&nbsp;James F Meschia,&nbsp;Thomas G Brott,&nbsp;Brajesh K Lal,&nbsp;Donald Heck,&nbsp;Giuseppe Lanzino,&nbsp;Navdeep Sangha,&nbsp;Vikram S Kashyap,&nbsp;Clarissa D Morales,&nbsp;Dejania Cotton-Samuel,&nbsp;Andres M Rivera,&nbsp;Adam M Brickman,&nbsp;Ronald M Lazar","doi":"10.5853/jos.2022.02285","DOIUrl":"https://doi.org/10.5853/jos.2022.02285","url":null,"abstract":"<p><strong>Background and purpose: </strong>High-grade carotid artery stenosis may alter hemodynamics in the ipsilateral hemisphere, but consequences of this effect are poorly understood. Cortical thinning is associated with cognitive impairment in dementia, head trauma, demyelination, and stroke. We hypothesized that hemodynamic impairment, as represented by a relative time-to-peak (TTP) delay on MRI in the hemisphere ipsilateral to the stenosis, would be associated with relative cortical thinning in that hemisphere.</p><p><strong>Methods: </strong>We used baseline MRI data from the NINDS-funded Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis-Hemodynamics (CREST-H) study. Dynamic contrast susceptibility MR perfusion-weighted images were post-processed with quantitative perfusion maps using deconvolution of tissue and arterial signals. The protocol derived a hemispheric TTP delay, calculated by subtraction of voxel values in the hemisphere ipsilateral minus those contralateral to the stenosis.</p><p><strong>Results: </strong>Among 110 consecutive patients enrolled in CREST-H to date, 45 (41%) had TTP delay of at least 0.5 seconds and 9 (8.3%) subjects had TTP delay of at least 2.0 seconds, the maximum delay measured. For every 0.25-second increase in TTP delay above 0.5 seconds, there was a 0.006-mm (6 micron) increase in cortical thickness asymmetry. Across the range of hemodynamic impairment, TTP delay independently predicted relative cortical thinning on the side of stenosis, adjusting for age, sex, hypertension, hemisphere, smoking history, low-density lipoprotein cholesterol, and preexisting infarction (P=0.032).</p><p><strong>Conclusions: </strong>Our findings suggest that hemodynamic impairment from high-grade asymptomatic carotid stenosis may structurally alter the cortex supplied by the stenotic carotid artery.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"92-100"},"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/f1/7d/jos-2022-02285.PMC9911846.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9758513","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}
引用次数: 2
Stroke in Women: A Review Focused on Epidemiology, Risk Factors, and Outcomes. 女性中风:流行病学、危险因素和结果综述。
IF 8.2 1区 医学
Journal of Stroke Pub Date : 2023-01-01 DOI: 10.5853/jos.2022.03468
Cindy W Yoon, Cheryl D Bushnell
{"title":"Stroke in Women: A Review Focused on Epidemiology, Risk Factors, and Outcomes.","authors":"Cindy W Yoon,&nbsp;Cheryl D Bushnell","doi":"10.5853/jos.2022.03468","DOIUrl":"https://doi.org/10.5853/jos.2022.03468","url":null,"abstract":"<p><p>Stroke is a particularly important issue for women. Women account for over half of all persons who experienced a stroke. The lifetime risk of stroke is higher in women than in men. In addition, women have worse stroke outcomes than men. Several risk factors have a higher association with stroke in women than in men, and women-specific risk factors that men do not have should be considered. This focused review highlights recent findings in stroke epidemiology, risk factors, and outcomes in women.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"2-15"},"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/5d/f9/jos-2022-03468.PMC9911842.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10725491","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}
引用次数: 6
Cerebral Edema in Patients with severe Hemispheric Syndrome: Incidence, Risk Factors, and Outcomes-Data from SITS-ISTR. 严重半球综合征患者的脑水肿:发生率、危险因素和结果——来自SITS-ISTR的数据
IF 8.2 1区 医学
Journal of Stroke Pub Date : 2023-01-01 DOI: 10.5853/jos.2022.01956
Irene Escudero-Martínez, Magnus Thorén, Peter Ringleb, Ana Paiva Nunes, Manuel Cappellari, Viiu-Marika Rand, Piotr Sobolewski, Jose Egido, Danilo Toni, Shih-Yin Chen, Nicole Tsao, Niaz Ahmed
{"title":"Cerebral Edema in Patients with severe Hemispheric Syndrome: Incidence, Risk Factors, and Outcomes-Data from SITS-ISTR.","authors":"Irene Escudero-Martínez,&nbsp;Magnus Thorén,&nbsp;Peter Ringleb,&nbsp;Ana Paiva Nunes,&nbsp;Manuel Cappellari,&nbsp;Viiu-Marika Rand,&nbsp;Piotr Sobolewski,&nbsp;Jose Egido,&nbsp;Danilo Toni,&nbsp;Shih-Yin Chen,&nbsp;Nicole Tsao,&nbsp;Niaz Ahmed","doi":"10.5853/jos.2022.01956","DOIUrl":"https://doi.org/10.5853/jos.2022.01956","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cerebral edema (CED) in ischemic stroke can worsen prognosis and about 70% of patients who develop severe CED die if treated conservatively. We aimed to describe incidence, risk factors and outcomes of CED in patients with extensive ischemia.</p><p><strong>Methods: </strong>Oservational study based on Safe Implementation of Treatments in Stroke-International Stroke Treatment Registry (2003-2019). Severe hemispheric syndrome (SHS) at baseline and persistent SHS (pSHS) at 24 hours were defined as National Institutes of Health Stroke Score (NIHSS) >15. Outcomes were moderate/severe CED detected by neuroimaging, functional independence (modified Rankin Scale 0-2) and death at 90 days.</p><p><strong>Results: </strong>Patients (n=8,560) presented with SHS and developed pSHS at 24 hours; 82.2% received intravenous thrombolysis (IVT), 10.5% IVT+thrombectomy, and 7.3% thrombectomy alone. Median age was 77 and NIHSS 21. Of 7,949 patients with CED data, 3,780 (47.6%) had any CED and 2,297 (28.9%) moderate/severe CED. In the multivariable analysis, age <50 years (relative risk [RR], 1.56), signs of acute infarct (RR, 1.29), hyperdense artery sign (RR, 1.39), blood glucose >128.5 mg/dL (RR, 1.21), and decreased level of consciousness (RR, 1.14) were associated with moderate/severe CED (for all P<0.05). Patients with moderate/severe CED had lower odds to achieve functional Independence (adjusted odds ratio [aOR], 0.35; 95% confidence interval [CI], 0.23 to 0.55) and higher odds of death at 90 days (aOR, 2.54; 95% CI, 2.14 to 3.02).</p><p><strong>Conclusions: </strong>In patients with extensive ischemia, the most important predictors for moderate/ severe CED were age <50, high blood glucose, signs of acute infarct, hyperdense artery on baseline scans, and decreased level of consciousness. CED was associated with worse functional outcome and a higher risk of death at 3 months.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"25 1","pages":"101-110"},"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/d0/6f/jos-2022-01956.PMC9911855.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9300797","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}
引用次数: 0
Replacing Alteplase with Tenecteplase: Is the Time Ripe? 替替普酶替代替替普酶:时机成熟了吗?
IF 8.2 1区 医学
Journal of Stroke Pub Date : 2023-01-01 DOI: 10.5853/jos.2022.02880
Nishita Singh, Bijoy K Menon, Adam A Dmytriw, Robert W Regenhardt, Joshua A Hirsch, Aravind Ganesh
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引用次数: 4
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