Stroke最新文献

{"title":"Racial and Ethnic Disparities in Ischemic Stroke Severity in the National Inpatient Sample Between 2018 and 2021.","authors":"Mahmoud Fayed, Teng J Peng, Lesli E Skolarus, Kevin N Sheth, Ka-Ho Wong, Adam de Havenon","doi":"10.1161/STROKEAHA.124.048532","DOIUrl":"10.1161/STROKEAHA.124.048532","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study is to examine the association between race and ethnicity and ischemic stroke severity in the United States.</p><p><strong>Methods: </strong>We performed an analysis of adult hospital discharges in the National Inpatient Sample from 2018 to 2021 with a primary discharge diagnosis of ischemic stroke. We stratified our cohort based on self-reported race and ethnicity and evaluated stroke severity using the National Institutes of Health Stroke Scale. Age- and sex-adjusted estimates of the National Institutes of Health Stroke Scale were derived from linear regression models.</p><p><strong>Results: </strong>We included 231 396 stroke discharges with a mean National Institutes of Health Stroke Scale of 6.5±7.2. The cohort was 68.1% White, 17.4% Black, 8.2% Hispanic, and 6.3% other. The age- and sex-adjusted National Institutes of Health Stroke Scale for White patients was 6.25 (95% CI, 6.22-6.29), for Black patients was 7.12 (95% CI, 7.05-7.19), for Hispanic patients was 6.86 (95% CI, 6.76-6.97), and for patients of other races and ethnicities was 7.29 (95% CI, 7.18-7.41). Further adjustment for the Charlson Comorbidity Index, socioeconomic factors, and poorly controlled hypertension or diabetes did not significantly alter these findings.</p><p><strong>Conclusions: </strong>In a large, contemporary, and nationally representative sample of patients with acute ischemic stroke, we show an association between non-White race and ethnicity and higher stroke severity. These results are concerning for an underappreciated health disparity in acute ischemic stroke.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1290-1294"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650931","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":"Correction to: Adherence to Physical Activity Recommendations Among Stroke Survivors in the United States.","authors":"Ajith Kumar Vemuri, Seyyed Sina Hejazian, Alireza Vafaei Sadr, Shouhao Zhou, Keith Decker, Jonathan Hakun, Christopher Sciamanna, Vida Abedi, Ramin Zand","doi":"10.1161/STR.0000000000000492","DOIUrl":"https://doi.org/10.1161/STR.0000000000000492","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 5","pages":"e150"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062229","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":"PCNSV With Spinal Cord Involvement: A 40-Year Single-Center Study.","authors":"Carlo Salvarani, Robert D Brown, Teresa J H Christianson, John Huston, Caterina Giannini, Gene G Hunder","doi":"10.1161/STROKEAHA.124.049547","DOIUrl":"10.1161/STROKEAHA.124.049547","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord involvement is infrequently reported in primary central nervous system vasculitis (PCNSV). This study describes the clinical findings, therapeutic responses, and outcomes of spinal cord involvement in a large cohort of patients with PCNSV.</p><p><strong>Methods: </strong>We retrospectively studied 216 consecutive patients with PCNSV evaluated at the Mayo Clinic from 1983 to 2023. Spinal cord involvement was documented by histological examination or imaging. The clinical, laboratory, radiological, and pathological findings, along with management and outcomes, were compared between patients with and without spinal cord involvement.</p><p><strong>Results: </strong>Of 216 patients, 10 (4.6%) had spinal cord involvement, with cerebral involvement in 9 cases. One patient (0.5%) had isolated spinal cord vasculitis. Histological evidence of vasculitis was found in all 10, with necrotizing vasculitis in 5 (50%). Magnetic resonance imaging showed thoracic abnormalities in 8 patients, cervical spine involvement in 2, conus medullaris involvement in 3, and cauda equina enhancement in 4. Compared with the 206 patients without spinal cord involvement, those with spinal cord vasculitis were more likely to present with paraparesis/tetraparesis (<i>P</i><0.001) and necrotizing vasculitis (<i>P</i>=0.01) and less likely with hemiparesis (<i>P</i>=0.006) and granulomatous vasculitis (<i>P</i>=0.03). Patients with spinal cord involvement were more likely to have at least 1 relapse (<i>P</i><0.001) or more (<i>P</i><0.001). No differences between the 2 groups were observed regarding long-term remission, therapy response, and high disability scores (modified Rankin Scale score, 4-6) or death at last follow-up. Spinal cord involvement was associated with meningeal enhancement on brain imaging (odds ratio, 10.50) and the presence of lymphoma (odds ratio, 6.49), specifically Hodgkin lymphoma diagnosed simultaneously with PCNSV. Spinal involvement was negatively associated with increasing age (odds ratio, 0.64) and cerebral infarction on imaging (odds ratio, 0.08).</p><p><strong>Conclusions: </strong>Spinal cord involvement defines a distinct subset of patients with PCNSV.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1149-1158"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664547","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":"Infection in Childhood Arterial Ischemic Stroke: Metagenomic Next-Generation Sequencing Results of the VIPS II Study.","authors":"Mary C Karalius, Prashanth S Ramachandran, Annie Wapniarski, Mary Wang, Maham Zia, Nancy K Hills, Max Wintermark, Charles Grose, Michael M Dowling, Jenny Wilson, Sarah Lee, Melissa Chung, Megan Barry, Huichun Xu, Joseph L DeRisi, Michael R Wilson, Heather J Fullerton","doi":"10.1161/STROKEAHA.124.050548","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050548","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory infection transiently increases risk for childhood arterial ischemic stroke (AIS). We hypothesize that this paradox of a common exposure linked to a rare outcome could be explained by either (1) the infection hypothesis: unusual or multiple pathogens or (2) the host response hypothesis: heterogeneity in the inflammatory response to infection. We leverage metagenomic next-generation sequencing (mNGS), a comprehensive microbial detection tool, to test the first hypothesis.</p><p><strong>Methods: </strong>The VIPS II study (Vascular Effects of Infection in Pediatric Stroke II) prospectively enrolled children with AIS at 22 international sites over 5 years (December 2016 to January 2022). Sites measured prestroke clinical infection via standardized parental interviews and chart abstraction. To assess more broadly the background spectrum of pathogens, a central research laboratory performed mNGS on plasma and oropharyngeal swabs collected within 72 hours of stroke. mNGS was also performed on biological samples from stroke-free children (June 2017 to January 2022), both without (well) and with (ill) documentation of clinical infection.</p><p><strong>Results: </strong>VIPS II enrolled 205 patients with AIS, 95 stroke-free well children, and 47 stroke-free ill children. Clinical infection, most commonly upper respiratory tract infection, was detected in 81 of 205 (40%) of patients. Both plasma and oropharyngeal swab mNGS data were available for 190 of 205 patients with AIS, 91 of 95 stroke-free well children, and 27 of 47 stroke-free ill children. mNGS detected viruses in 27 of 190 (14%) patients with AIS, 9 of 91 stroke-free well children (10%), and 9 of 27 (33%) stroke-free ill children. Most were common upper respiratory viruses. Coinfections were rare. Similar viruses were found in patients with AIS and stroke-free children.</p><p><strong>Conclusions: </strong>mNGS detected a variety of common childhood viruses in both patients with AIS and stroke-free children, suggesting that the type of infection does not explain AIS susceptibility. Rather, the alternative hypothesis regarding an unusual host immune response to common infections in the pathogenicity of AIS should be further explored.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998136","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":"Changes in Wall Enhancement of an Infectious Intracranial Aneurysm After Coil Embolization.","authors":"Yuta Fujiwara, Tomomi Kimiwada, Hiroya Asou, Mizuki Kambara, Kentaro Hayashi","doi":"10.1161/STROKEAHA.124.050600","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050600","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 5","pages":"e135-e136"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982969","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":"Temporal Watershed Infarction.","authors":"Yingying Yang, Donghua Mi, Yilong Wang, Hui Qu","doi":"10.1161/STROKEAHA.124.050498","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050498","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 5","pages":"e133-e134"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044666","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":"May 2025 <i>Stroke</i> Highlights.","authors":"José Rafael Romero","doi":"10.1161/STROKEAHA.125.051712","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051712","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 5","pages":"1115"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039267","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":"Thrombectomy With Low ASPECTS: The Roles of Infarct Volume and Postacute Neurological Status.","authors":"Helge C Kniep, Susanne Gellißen, Götz Thomalla, Martin Bendszus, Laurens Winkelmeier, Gabriel Broocks, Matthias Bechstein, Fabien Subtil, Susanne Bonekamp, Anne Hege Aamodt, Blanca Fuentes, Elke R Gizewski, Michael D Hill, Antonin Krajina, Laurent Pierot, Claus Z Simonsen, Kamil Zeleňák, Rolf A Blauenfeldt, Bastian Cheng, Angélique Denis, Hannes Deutschmann, Franziska Dorn, Fabian Flottmann, Johannes C Gerber, Mayank Goyal, Jozef Haring, Christian Herweh, Silke Hopf-Jensen, Vi Tuan Hua, Märit Jensen, Andreas Kastrup, Christiane Fee Keil, Andrej Klepanec, Egon Kurča, Ronni Mikkelsen, Markus Möhlenbruch, Stefan Müller-Hülsbeck, Nico Münnich, Paolo Pagano, Panagiotis Papanagiotou, Gabor C Petzold, Mirko Pham, Volker Puetz, Jan Raupach, Gernot Reimann, Peter Arthur Ringleb, Maximilian Schell, Eckhard Schlemm, Silvia Schönenberger, Bjørn Tennøe, Christian Ulfert, Kateřina Vališ, Eva Vítková, Dominik F Vollherbst, Wolfgang Wick, Jens Fiehler, Lukas Meyer","doi":"10.1161/STROKEAHA.124.050052","DOIUrl":"10.1161/STROKEAHA.124.050052","url":null,"abstract":"<p><strong>Background: </strong>Recent randomized trials demonstrated the beneficial effect of endovascular therapy in patients with low Alberta Stroke Program Early CT Score. Despite large follow-up infarct volumes, a significantly increased rate of good functional outcomes was observed, challenging the role of infarct volume as a predictive imaging marker. This analysis evaluates the extent to which the effects of endovascular thrombectomy on functional outcomes are explained by (1) follow-up infarct volume and (2) early neurological status in patients with stroke with low Alberta Stroke Program Early CT Score.</p><p><strong>Methods: </strong>TENSION (Efficacy and Safety of Thrombectomy in Stroke With Extended Lesion and Extended Time Window) was a randomized trial conducted from February 2018 to January 2023 across 41 stroke centers. Two hundred fifty-three patients with ischemic stroke due to anterior circulation large vessel occlusion and Alberta Stroke Program Early CT Score of 3 to 5 were randomized to endovascular thrombectomy plus medical treatment or medical treatment alone. All patients with the availability of relevant data points were included in this secondary as-treated analysis. The primary outcome was the 90-day modified Rankin Scale score. Confounder-adjusted mediation analysis was performed to quantify the proportion of the treatment effect on a 90-day modified Rankin Scale score explained by (1) 24-hour follow-up infarct volume and (2) 24-hour National Institutes of Health Stroke Scale scores.</p><p><strong>Results: </strong>One hundred eighty-eight patients were included; thereof, 87 (46%) were female patients. Median age was 72 (interquartile range, 63-79) years. The endovascular thrombectomy cohort had a 20.5 (95% CI, 8.3-33.7) percentage points higher probability of achieving independent ambulation (modified Rankin Scale, 0-3) and a 24.2 (95% CI, 13.4-35.8) percentage points lower mortality at 90 days compared with medical treatment alone. The reduction in 24-hour follow-up infarct volume explained 30% of the treatment effect on functional outcomes, while the 24-hour National Institutes of Health Stroke Scale score explained 61%.</p><p><strong>Conclusions: </strong>In patients with low Alberta Stroke Program Early CT Score, infarct volume demonstrated limited explanatory power for functional outcomes compared with the early neurological status, which may more effectively reflect factors such as the involvement of specific brain regions, disruption of structural networks, and selective neuronal loss.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1116-1127"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701045","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":"High-Dose, High-Intensity Stroke Rehabilitation: Why Aren't We Giving It?","authors":"David J Lin, Steven C Cramer, Pierce Boyne, Pooja Khatri, John W Krakauer","doi":"10.1161/STROKEAHA.124.043650","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.043650","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 5","pages":"1351-1364"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987677","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":"Safety, Functional Disability, Healthcare Utilization, and Quality-of-Life Outcomes in Elderly Receiving Alteplase and Tenecteplase: A Secondary Analysis From the AcT Trial.","authors":"Nishita Singh, Fouzi Bala, Ayoola Ademola, Mohammed Almekhlafi, Shelagh B Coutts, Yan Deschaintre, Houman Khosravani, Brian H Buck, Ramana Appireddy, Francois Moreau, Gord Gubitz, Aleksander Tkach, Luciana Catanese, Dar Dowlatshahi, George Medvedev, Jennifer Mandzia, Aleksandra Pikula, Jai Jai Shankar, Alexandre Y Poppe, Heather Williams, Thalia S Field, Alejandro Manosalva, Muzaffar Siddiqui, Atif Zafar, Oje Imoukhoude, Gary Hunter, Michel Shamy, Andrew Demchuk, Richard H Swartz, Michael D Hill, Tolulope T Sajobi, Bijoy K Menon, Aravind Ganesh","doi":"10.1161/STROKEAHA.124.049512","DOIUrl":"10.1161/STROKEAHA.124.049512","url":null,"abstract":"<p><strong>Background: </strong>Older age has been associated with overall poorer outcomes in acute ischemic stroke. We compared (1) outcomes in various health-related domains among patients <80 years and ≥80 years presenting with acute ischemic stroke and (2) whether outcomes differ between intravenous TNK (tenecteplase) versus alteplase.</p><p><strong>Methods: </strong>Data are from patients included in AcT (Alteplase Compared to Tenecteplase in Patients With Acute Ischemic Stroke), a pragmatic, registry-linked, phase 3 randomized controlled trial comparing TNK with alteplase. Outcomes included functional disability (per 90-day modified Rankin Scale), safety (24-hour symptomatic intracerebral hemorrhage, 90-day mortality rates), health care utilization (discharge destination, length of stay, thrombectomy rate), and quality of life measures (EQ-5D-5L [EuroQol 5-Dimension 5-Level Scale]). With an a priori plan, patients aged <80 years were compared with those ≥80 years at symptom onset. Mixed effects Poisson regression was used to assess (1) the association of age with outcomes and (2) if these associations were modified by thrombolytic administered (TNK versus alteplase), after adjusting for sex, and baseline stroke severity.</p><p><strong>Results: </strong>Of the 1577 patients, 1034 (65.6%; 520: TNK and 514: alteplase) were <80 years and 543 (34.4%; 286: TNK and 257: alteplase) were ≥80 years of age. Baseline characteristics in the 2 groups were similar except for sex 40% female in <80 years group versus 62.8% female in ≥80 years. There was no difference in rates of symptomatic intracranial hemorrhage (3.5% versus 3.1%). Patients in the ≥80 years group had significantly lower rates of excellent functional outcome, return to baseline status, higher mortality, and lower quality-of-life outcomes as compared with the <80 years group. Length of hospital stay was similar between the 2 groups but, patients in the ≥80 years age group had significantly lower rates of endovascular treatment utilization. Type of thrombolytic agent (TNK versus alteplase) did not modify the association between age and primary clinical outcome (<i>P</i>_interaction=0.22).</p><p><strong>Conclusions: </strong>Similar to alteplase, increasing age was associated with poorer functional outcomes with TNK. Rates of angiographic and bleeding outcomes were similar between patients <80 and ≥80 years.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03889249.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1169-1179"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693378","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}