Stroke最新文献

{"title":"Prevalence of High-Risk CTA-Based Carotid Plaque-RADS Subtypes in Patients With Embolic Stroke of Undetermined Source.","authors":"Jae W Song, Huy Q Phi, Manisha Koneru, Quy Cao, Jeremy Rubin, Yu Sakai, Lamya Ibrahim, Sonya E Zhou, John H Woo, Scott E Kasner, Luca Saba, Brett L Cucchiara","doi":"10.1161/STROKEAHA.124.048305","DOIUrl":"10.1161/STROKEAHA.124.048305","url":null,"abstract":"<p><strong>Background: </strong>A modified computed tomography angiography (CTA)-based Carotid Plaque Reporting and Data System (Plaque-RADS) classification was applied to a cohort of patients with embolic stroke of undetermined source to test whether high-risk Plaque-RADS subtypes are more prevalent on the ipsilateral side of stroke. With the widespread use of CTA for stroke evaluation, a CTA-based Plaque-RADS would be valuable for generalizability.</p><p><strong>Methods: </strong>A retrospective observational cross-sectional study was conducted at a single integrated health system comprised of 3 hospitals with a comprehensive stroke center between October 1, 2015, and April 1, 2017. Patients with unilateral anterior circulation stroke and <50% carotid stenosis on CTA were retrospectively identified. Maximum plaque thickness and ulceration were assessed by a neuroradiologist blinded to the stroke side. A semiautomated segmentation software measured intraplaque hemorrhage volumes. Modified CTA-based Plaque-RADS classification was defined as (1) no plaque, (2) plaque thickness <3 mm, (3) plaque thickness ≥3 mm or ulcerated, and (4) plaque with intraplaque hemorrhage >50 mm³ irrespective of plaque thickness. High-risk plaque subtypes (Plaque-RADS 3 and 4) were compared with low-risk subtypes (Plaque-RADS 1 and 2).</p><p><strong>Results: </strong>Ninety-four patients (55% women; median age, 66 years) were included. CTA-based Plaque-RADS categories for plaques ipsilateral to the stroke side were as follows: (1) 14.9%, (2) 42.6%, (3) 41.5%, and (4) 1.1%. Carotid plaques contralateral to stroke side were Plaque-RADS: (1) 21.3%, (2) 46.8%, (3) 31.9%, and (4) 0%. When compared with the contralateral side, plaques ipsilateral to the stroke side were significantly associated with high-risk Plaque-RADS subtypes in a mixed-effects logistic model adjusting for age and sex (adjusted odds ratio, 2.10 [95% CI, 1.20-3.71]; <i>P</i>=0.01).</p><p><strong>Conclusions: </strong>Carotid plaque ipsilateral to the stroke side was significantly associated with CTA-based high-risk Plaque-RADS subtypes in an embolic stroke of undetermined source cohort. A CTA-based Plaque-RADS classification may be useful for identifying potentially causative carotid plaque phenotypes in patients with embolic stroke of undetermined source.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"737-740"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029721","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":"Proteins Involved in Endothelial Function and Inflammation Are Implicated in Cerebral Small Vessel Disease.","authors":"Zihan Sun, Eric L Harshfield, Frank-Erik de Leeuw, Stephen Burgess, Adam S Butterworth, Niels P Riksen, Ziad Mallat, Hugh S Markus","doi":"10.1161/STROKEAHA.124.049079","DOIUrl":"10.1161/STROKEAHA.124.049079","url":null,"abstract":"<p><strong>Background: </strong>Endothelial dysfunction and inflammation have been implicated in the pathophysiology of cerebral small vessel disease (SVD). However, whether they are causal, and if so which components of the pathways represent potential treatment targets, remains uncertain.</p><p><strong>Methods: </strong>Two-sample Mendelian randomization (MR) was used to test the association between the circulating abundance of 996 proteins involved in endothelial dysfunction and inflammation and SVD. The genetic instruments predicting protein levels were obtained from the Iceland 36K (n=35 892) and the UK Biobank Proteomics (n=34 557) cohorts, both of which were longitudinal studies with follow-up from 2000 to 2023 and 2006 to 2023, respectively. SVD was represented by lacunar stroke (n=6030 cases) and 5 neuroimaging features (white matter hyperintensities [n=55 291], diffusion tensor imaging metrics: mean diffusivity [n=36 460] and fractional anisotropy [n=36 533], extensive white matter perivascular space burden [n=9324 cases], and cerebral microbleeds [n=3556 cases]). Among the proteins supported by causal evidence from the MR, cross-sectional analysis was performed to assess their associations with cognitive performance; survival analysis with Fine-Gray models was applied to examine their associations with incident all-cause dementia and stroke within the UK Biobank Proteomics cohort.</p><p><strong>Results: </strong>MR suggested COL2A1 (collagen type II α-1 chain) was associated with lacunar stroke (odds ratio, 0.89 [95% CI, 0.86-0.91]; <i>P</i>=5×10^-5). Moreover, 12 proteins related to endothelial function and inflammation were associated with neuroimaging features of SVD. Cross-sectional analyses showed 5 of the 13 proteins (EPHA2 [ephrin type-A receptor 2], METAP1D [methionine aminopeptidase 1D, mitochondrial], FLT4 [vascular endothelial growth factor receptor 3], COL2A1, and TIMD4 [T-cell immunoglobulin and mucin domain-containing protein 4]) were associated with cognitive performance with effects concordant with their MR findings. Survival analyses with the Fine-Gray models indicated that 5 of the 13 proteins (EPHA2, METAP1D, FLT4, APOE [apolipoprotein E], and PDE5A [cGMP-specific 3',5'-cyclic phosphodiesterase]) were associated with the risk of all-cause dementia or stroke independent of age and sex, consistent with their MR evidence.</p><p><strong>Conclusions: </strong>Our findings suggest that endothelial-platelet activation and complement-mediated regulation of inflammation play roles in SVD and identify potential therapeutic targets and pathways.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"692-704"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7617319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011883","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":"Comparison of Noncontrast Computed Tomography, Multiphase Computed Tomography Angiography, and Computed Tomography Perfusion to Assess Infarct Growth Rate in Acute Stroke.","authors":"Umberto Pensato, Salome L Bosshart, Alexander Stebner, Dar Dowlatshahi, Oh Young Bang, Demetrios J Sahlas, Thalia S Field, Volker Puetz, Brian H Buck, Michael D Hill, Mayank Goyal, Andrew M Demchuk, Johanna M Ospel","doi":"10.1161/STROKEAHA.124.047680","DOIUrl":"10.1161/STROKEAHA.124.047680","url":null,"abstract":"<p><strong>Background: </strong>Infarct growth rate is remarkably heterogeneous in acute ischemic stroke, reflecting diverse clinical-physiological phenotypes. We compared different methods of estimating infarct growth rate in patients with acute ischemic stroke undergoing thrombectomy using multimodal computed tomography (CT) stroke imaging.</p><p><strong>Methods: </strong>Secondary analysis of the international ESCAPE-NA1 trial (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischemic Stroke) which evaluated the effect of nerinetide in patients with large vessel occlusion undergoing thrombectomy. Infarct growth rate was estimated leveraging each component of multimodal stroke CT imaging: (1) 10 minus baseline Alberta Stroke Program Early CT Score (ASPECTS) divided by hours elapsed from symptom onset on noncontrast CT (ASPECTS decay per hour); (2) collateral status on multiphase CT angiography (mCTA), and (3) hypoperfusion intensity ratio on CT perfusion. Patients were dichotomized into intermediate and slow progressors (since fast progressors were likely to be excluded from ESCAPE-NA1 based on trial enrollment criteria) according to median ASPECTS decay, presence of good versus moderate/poor mCTA collaterals, and median hypoperfusion intensity ratio, respectively. Associations between progressor phenotypes and 90-day modified Rankin Scale score were assessed across neuroimaging modalities using adjusted logistic regression analyses.</p><p><strong>Results: </strong>Among 1105 patients enrolled in ESCAPE-NA1 between 2017 and 2019, 619 (56.0%) were assessed for progressor phenotypes using noncontrast CT, 1084 (98.1%) with mCTA, and 415 (37.6%) with CT perfusion. Median ASPECTS decay per hour was 1.05 (interquartile range, 0.05-1.85), 188/1084 (17%) patients had good collateral status on mCTA, and the median hypoperfusion intensity ratio was 0.44 (interquartile range, 0.28-0.59). Intermediate progressors showed worse functional outcomes compared with slow progressors only in CT perfusion strata: adjusted common odds ratio for modified Rankin Scale ordinal shift analysis of 1.69 (95% CI, 1.14-2.49). No significant association between progressor phenotypes and 90-day modified Rankin Scale was seen when the noncontrast CT and the mCTA approaches were used.</p><p><strong>Conclusions: </strong>Stroke progressor phenotypes based on CT perfusion criteria (using the hypoperfusion intensity ratio approach) were associated with clinical outcomes, while stroke progressor phenotypes based on noncontrast CT (ASPECTS decay) and mCTA (collateral status) criteria were not.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"657-666"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383271","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":"Three-Dimensional Curvature of the Cervical Carotid Artery Predicts Long-Term Neurovascular Risk in Loeys-Dietz Syndrome.","authors":"Jin Vivian Lee, Anna L Huguenard, Alan C Braverman, Ralph G Dacey, Joshua W Osbun","doi":"10.1161/STROKEAHA.124.048028","DOIUrl":"10.1161/STROKEAHA.124.048028","url":null,"abstract":"<p><strong>Background: </strong>Although the relationship between cervical carotid tortuosity and cardiovascular risk in patients with Loeys-Dietz syndrome has been studied, it is unclear whether cervical carotid tortuosity influences the risk of neurovascular events.</p><p><strong>Methods: </strong>This is a single-institution retrospective cohort study. Cervical carotid tortuosity and morphology were assessed in patients with Loeys-Dietz syndrome who underwent baseline computed tomography/magnetic resonance imaging of the cervical and cerebral arteries from 2010 to 2022. The primary end point was a composite of adverse neurovascular events (multiple vessel cervical artery dissection, ischemic stroke, intracerebral hemorrhage, and any neurovascular intervention) at 5- and 10-year follow-ups. Independent risk factors were identified using univariate and multivariate logistic regression analyses. Single-variable predictors of 5- and 10-year outcomes were analyzed via receiver operating curve analyses. Cutoff values were determined per the Youden J index. Stratification analyses were performed for ages <60 and ≥60 years.</p><p><strong>Results: </strong>Of 105 eligible participants, 63 were included (mean age, 40±17 years; 52% female). During a mean follow-up of 8.7±4.1 years, 23 (37%) developed an adverse neurovascular event. Five-year follow-up was achieved in 86% and 10-year follow-up in 48%. Carotid total absolute curvature (TAC; <i>P</i>=0.008), coiling morphology (<i>P</i>=0.012), and <i>TGFBR1/2</i> genetic variant (<i>P</i>=0.037) were independently associated with 5-year events. Stratification analyses revealed that the age group <60 years was more vulnerable to high TAC (unadjusted odds ratio, 7.2 [95% CI, 2.0-25.4]; <i>P</i>=0.002). Baseline TAC was the only independent predictor of adverse events at 5 years (area under the curve, 0.84; <i>P</i><0.001) and 10 years (area under the curve, 0.75; <i>P</i>=0.007) in this age group. An optimal threshold for predicting neurovascular events was TAC ≥16.5. None were predictive in the age group ≥60 years.</p><p><strong>Conclusions: </strong>Cervical carotid tortuosity is associated with a long-term increased risk of neurovascular events in Loeys-Dietz syndrome. Angiographic findings of high-risk features such as increased TAC and coiling morphology may help to identify neurovascular vulnerability noninvasively at an early stage.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"667-677"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383275","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":"<i>Ide</i> Copy Number Variant Does Not Influence Stroke Severity in 2 C57BL/6J Mouse Models nor in Humans: An Exploratory Study.","authors":"Marco Foddis, Sonja Blumenau, Susanne Mueller, Clemens Messerschmidt, Clarissa Rocca, Alistair T Pagnamenta, Katarzyna Winek, Matthias Endres, Andreas Meisel, Arianna Tucci, Jose Bras, Rita Guerreiro, Dieter Beule, Ulrich Dirnagl, Celeste Sassi","doi":"10.1161/STROKEAHA.124.049575","DOIUrl":"10.1161/STROKEAHA.124.049575","url":null,"abstract":"<p><strong>Background: </strong>Contrary to the common belief, the most commonly used laboratory C57BL/6J mouse inbred strain presents a distinctive genetic and phenotypic variability, and for several traits, the genotype-phenotype link remains still unknown. Recently, we characterized the most important stroke survival factor such as brain collateral plasticity in 2 brain ischemia C57BL/6J mouse models (bilateral common carotid artery stenosis and middle cerebral artery occlusion) and observed a Mendelian-like fashion of inheritance of the posterior communicating artery (PcomA) patency. Interestingly, a copy number variant (CNV) spanning <i>Ide</i> locus was reported to segregate in an analogous Mendelian-like pattern in the C57BL/6J colonies of the Jackson Laboratory. Given <i>IDE</i> critical role in vascular plasticity, we hypothesized <i>Ide</i> CNV may have explained PcomA variability in C57BL/6J inbred mice.</p><p><strong>Methods: </strong>We applied a combination of techniques (T2-weighted magnetic resonance imaging, time-of-flight angiography, cerebral blood flow imaging, and histology) to characterize the collaterome in 77 C57BL/6J bilateral common carotid artery stenosis, middle cerebral artery occlusion, naive, and sham mice and performed on these Taqman genotyping, exome sequencing, and RNA sequencing. We then investigated the hypothesis that <i>IDE</i> structural variants (CNVs, gain/loss of function mutations) may have influenced the cerebrovascular phenotype in a large cohort of 454 040 cases and controls (UK Biobank, Genomics England).</p><p><strong>Results: </strong>We detected an <i>Ide</i> CNV in a bilateral common carotid artery stenosis mouse with 2 patent PcomAs (minor allele frequency, 1.3%), not segregating with the PcomA patency phenotype. In addition, 2 heterozygous <i>IDE</i> CNVs, resulting in loss of function were found in 1 patient with hereditary ataxia, a patient with hereditary congenital heart disease, and 2 healthy individuals (minor allele frequency 9×10^-6). Moreover, we report 4 <i>IDE</i> loss of function point mutations (p.Leu5X, p.Met394ValfsX29, p.Pro14SerfsX26, p.Leu889X, minor allele frequency 0.02%) present also in controls or inherited from healthy parents.</p><p><strong>Conclusions: </strong><i>Ide</i> CNV and loss of function variants are rare, do not crucially influence PcomA variability in C57BL/6J inbred mice, and do not cause a vascular phenotype in humans.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"725-736"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047949","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":"Language and Attention Networks Have Distinct Roles in Language Improvement Following an Intensive Comprehensive Aphasia Program.","authors":"Evan Houldin, Edna M Babbitt, Rosalind Hurwitz, Marwan N Baliki, Leora R Cherney","doi":"10.1161/STROKEAHA.124.047683","DOIUrl":"10.1161/STROKEAHA.124.047683","url":null,"abstract":"<p><strong>Background: </strong>Attention is known to play an important role in language, and attentional deficits have been associated with language impairments in people with aphasia (PWA). A prior study by our laboratory indicated that behavioral measures for PWA participating in an intensive comprehensive aphasia program (ICAP) clustered into 1 language and 1 attention-related factor, with each factor correlated with independent resting state functional connectivity (rsFC) networks. The present study includes additional attention measures and participants to better assess the relationship between attention, language, and rsFC.</p><p><strong>Methods: </strong>PWA participated in 120 hours of ICAP therapy over 4 weeks, between April 2018 and August 2022. Participants were evaluated with the Western Aphasia Battery and Conners' Continuous Performance Test, pre- and post-ICAP. rsFC data were collected during functional magnetic resonance imaging scans pre- and post-ICAP. Principal component analysis identified behavioral score associations pre- and post-ICAP. FC matrices and graph measures were evaluated for both PWA and healthy controls.</p><p><strong>Results: </strong>Twenty-three PWA participated (19 included in the final analysis). Data for 179 age and sex-matched healthy controls were taken from a public data set. The principal component analysis indicated 1 language and 2 attention-related principal components (PCs). The attention PCs were labeled Attention Accuracy and Attention Rate, in accordance with their best-associated behavioral measures. Importantly, each PC was associated with distinct networks, including higher-order networks, so-called because of their involvement in higher-order cognition. Notably, the language PC was significantly correlated with the ventral attention-memory-retrieval network rsFC (<i>r</i>=0.67, <i>P</i>=0.003) and the default mode-frontoparietal network rsFC (<i>r</i>=-0.56, <i>P</i>=0.019). Attention Accuracy was significantly correlated with cingulo-opercular-subcortical network rsFC (<i>r</i>=0.60, <i>P</i>=0.011). Attention Rate was significantly negatively correlated with visual-somatomotor network rsFC (<i>r</i>=-0.74, <i>P</i>=0.0007).</p><p><strong>Conclusions: </strong>This study supports the notion that language improvements for PWAs participating in an ICAP are associated with distinct network changes. Importantly, these networks are not restricted to language networks but also include attention, and task-control networks.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"705-715"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011944","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":"Thrombolysis for Ischemic Stroke Beyond the 4.5-Hour Window: A Meta-Analysis of Randomized Clinical Trials.","authors":"Ahmet Günkan, Marcio Yuri Ferreira, Marina Vilardo, Luca Scarcia, Jhon E Bocanegra-Becerra, Leonardo Januario Campos Cardoso, Luis F Fabrini Paleare, Gustavo de Oliveira Almeida, Gabriel Semione, Christian Ferreira, Gabriele Ciccio, Adnan Mujanovic, Pascal Jabbour, Yafell Serulle, Thanh N Nguyen, Jean-Claude Baron","doi":"10.1161/STROKEAHA.124.048536","DOIUrl":"10.1161/STROKEAHA.124.048536","url":null,"abstract":"<p><strong>Background: </strong>A minority of patients with stroke qualify for intravenous thrombolysis (IVT) within 4.5-hour window. The safety and efficacy of IVT beyond this period have not been well studied.</p><p><strong>Methods: </strong>We systematically searched MEDLINE, Embase, Cochrane, and ClinicalTrials.gov for relevant randomized clinical trials. Randomized clinical trials comparing IVT versus standard medical care in patients with ischemic stroke beyond 4.5 hours of symptom onset or last known well without mechanical thrombectomy (MT) were included. Primary outcomes were excellent (modified Rankin Scale score of 0-1) and good (modified Rankin Scale score of 0-2) functional outcomes at 90 days, symptomatic intracerebral hemorrhage (sICH), and death at 90 days. Pooled odds ratios (ORs) with 95% CIs were calculated using a random-effects model. Heterogeneity was assessed by <i>Q</i> test and quantified by <i>I</i>² values.</p><p><strong>Results: </strong>Eight randomized clinical trials (1742 patients; mean age, 69.8±9 years, 63.5% men) were included. Compared with standard medical care, IVT achieved higher rates of excellent (OR, 1.43 [95% CI, 1.17-1.75]; <i>Q</i>=2.30; <i>P</i>=0.94; <i>I</i>²=0%) and good functional outcomes (OR, 1.36 [95% CI, 1.12-1.66]; <i>Q</i>=2.07; <i>P</i>=0.96; <i>I</i>²=0%) at 90 days but also increased sICH rates (OR, 4.25 [95% CI, 1.67-10.84], <i>Q</i>=0.48; <i>P</i>=0.99; <i>I</i>²=0%). Mortality at 90 days did not significantly differ between treatment groups (OR, 1.28 [95% CI, 0.87-1.89]; <i>Q</i>=4.63; <i>P</i>=0.59; <i>I</i>²=0%). Subanalyses yielded numerically higher odds of excellent functional outcomes when patients were selected with perfusion imaging (3 studies, OR, 1.45 [95% CI, 1.08-1.94]) compared with diffusion-weighted imaging-fluid-attenuated inversion recovery mismatch (3 studies, OR, 1.34 [95% CI, 0.94-1.91]) and when treated with tenecteplase (3 studies, OR, 1.47 [95% CI, 1.06-2.04]) compared with alteplase (5 studies, OR, 1.38 [95% CI, 1.08-1.78]).</p><p><strong>Conclusions: </strong>IVT for ischemic stroke beyond 4.5 hours, without MT, led to increased odds of excellent and good functional outcomes compared with standard medical care, despite higher odds of sICH, and a nonsignificant numerical increase in mortality.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"580-590"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067766","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":"Socioeconomic Status and Stroke: A Review of the Latest Evidence on Inequalities and Their Drivers.","authors":"Camila Pantoja-Ruiz, Rufus Akinyemi, Diego I Lucumi-Cuesta, Daniel Youkee, Eva Emmett, Marina Soley-Bori, Wasana Kalansooriya, Charles Wolfe, Iain J Marshall","doi":"10.1161/STROKEAHA.124.049474","DOIUrl":"10.1161/STROKEAHA.124.049474","url":null,"abstract":"<p><p>The latest research on socioeconomic status (SES) and stroke continues to demonstrate that individuals with low SES are at a higher risk of stroke, receive lower-quality care, and experience poorer outcomes. Despite growing evidence on the impact of SES on stroke, gaps remain in understanding the underlying mechanisms and the influence of SES in different contexts, particularly in low- and middle-income countries. This narrative review builds upon our previous reviews from 2006 to 2015, focusing on studies published since 2015 to update on the influence of SES on stroke. Reports from nationwide or population-based observational studies in the past decade have confirmed that these inequalities persist globally and have provided new evidence on their mechanisms. In high-income countries, inadequate control of cardiovascular risk factors (hypertension, diabetes, obesity, and dyslipidemia) among lower socioeconomic groups has been found to explain much of the inequality in stroke risk. Exposure to particulate air pollution (both environmental and indoor from solid fuel cooking) synergizes with cardiovascular risk factors, especially hypertension, as major causes in low- and middle-income countries. Lower SES is persistently associated with disparities in care and increased poststroke disability and mortality. Lower SES also exacerbates other causes of health inequality among women, ethnic minorities, and migrants. Addressing stroke inequalities requires an interdisciplinary approach. Targeting cardiovascular risk factors, providing equitable quality of acute and rehabilitative stroke care, enacting legislative measures, and implementing societal changes remain leading global priorities.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"794-805"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855358","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":"Usefulness of Myelin Quantification Using Synthetic Magnetic Resonance Imaging for Predicting Outcomes in Patients With Acute Ischemic Stroke.","authors":"Megumi Toko, Tomohisa Nezu, Futoshi Eto, Shiro Aoki, Tomohiko Ohshita, Hiroki Ueno, Yuji Akiyama, Hirofumi Maruyama","doi":"10.1161/STROKEAHA.124.049851","DOIUrl":"10.1161/STROKEAHA.124.049851","url":null,"abstract":"<p><strong>Background: </strong>Synthetic magnetic resonance imaging (MRI) is an innovative MRI technology that enables the acquisition of multiple quantitative values, including T1 and T2 values, proton density, and myelin volume, in a single scan. Although the usefulness of myelin measurement with synthetic MRI has been reported for assessing several diseases, investigations in patients with stroke have not been reported. We aimed to explore the utility of myelin quantification using synthetic MRI in predicting outcomes in patients with acute ischemic stroke.</p><p><strong>Methods: </strong>Patients with acute ischemic stroke (n=101) with a premorbid modified Rankin Scale score ≤2 were enrolled. We performed MRI with a 3 T scanner, acquiring synthetic MRI data in addition to data acquired using the routine protocol; we measured total myelin volume (TMV) using synthetic MRI software. After hospitalization, a synthetic MRI was performed when the patient's condition was stable, with a median of 7 days from onset to MRI. We examined the factors related to good stroke outcomes (defined by a modified Rankin Scale score of ≤2 at 3 months).</p><p><strong>Results: </strong>Patients with larger TMV were younger, were more frequently male, and had higher body mass index. In addition, TMV was associated with the severity of white matter hyperintensities and total small vessel burden scores. The patients with good outcomes (n=66) had larger TMVs than those without (144.85±22.19 versus 126.62±21.81 mL, <i>P</i><0.001). Multivariable analysis revealed that the TMV quartiles were independently associated with good functional outcomes (odds ratio, 2.54 [95% CI, 1.12-6.70]; <i>P</i>=0.025) after adjusting for baseline clinical characteristics including initial stroke severity, acute brain infarct volume, and brain parenchymal volume.</p><p><strong>Conclusions: </strong>A large TMV quantified using synthetic MRI was independently associated with good functional outcomes after adjusting for several confounding factors. TMV, which suggests the validity of myelin quantification, might be a useful indicator for predicting stroke outcomes.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"649-656"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979643","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":"Transforming Early Stroke Care Through Mobile Stroke Treatment Unit Rendezvous With Rural Emergency Medical Services.","authors":"Nicolle W Davis, Mahmoud Fayed, Evan Hardee, David Lykens, Jeannette M Hester, Ashley E Magnuson, Amita Singh, Teng J Peng, Anna Khanna","doi":"10.1161/STROKEAHA.124.048633","DOIUrl":"10.1161/STROKEAHA.124.048633","url":null,"abstract":"<p><strong>Background: </strong>Mobile stroke units, also sometimes called Mobile Stroke Treatment Units (MSTUs) are changing the paradigm of acute stroke care and are considered to be an extension of the time is brain concept. Of the <20 active Mobile Stroke Programs in the United States, most are rooted in urban settings. In July 2023, the first MSTU in Florida was launched in Alachua County, implementing a unique and innovative rendezvous process with rural emergency medical services (EMS). We compared stroke outcome metrics between the MSTU, including rendezvous patients, and the standard process of EMS to the emergency department (ED).</p><p><strong>Methods: </strong>We performed a retrospective analysis of patients with acute stroke evaluated in the MSTU and those transported to the ED by the standard EMS stroke alert process at an academic Comprehensive Stroke Center between July 25, 2023 and May 31, 2024. Patient demographic and acute stroke metrics were extracted to complete univariate and multivariate logistic regression analysis.</p><p><strong>Results: </strong>Across all 3 groups, both MSTU patients with (n=76) and without (n=291) rendezvous compared with EMS-to-ED patients (n=807), had significantly shorter mean dispatch-to-door times (29.4 versus 28.5 versus 73.2 minutes, respectively; <i>P</i><0.01), dispatch-to-needle times (41.3 versus 44.6 versus 104.1 minutes, respectively; <i>P</i><0.01), and dispatch-to-puncture (92.7 versus 81.9 versus 138.0 minutes, respectively; <i>P</i><0.01). In rural counties, MSTU rendezvous patients (n=76) compared with EMS-to-ED patients (n=206), had shorter mean dispatch-to-door and dispatch-to-needle times (41.3 versus 97.8 minutes, respectively; <i>P</i><0.001). After adjusting for age and sex, these differences remained significant (odds ratio, 1.21 [95% CI, 1.07-1.37]; <i>P</i><0.01 and odds ratio, 1.80 [95% CI, 1.07-3.04]; <i>P</i>=0.03, respectively).</p><p><strong>Conclusions: </strong>Our study demonstrates the effectiveness of MSTUs in Florida and establishes that the MSTU rendezvous process significantly improves timely stroke care in underserved rural counties.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"741-744"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067889","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}