Stroke最新文献

{"title":"Outcomes Following Minimally Invasive Surgery for Intracerebral Hemorrhage in the AHA Get With The Guidelines-Stroke Registry.","authors":"Santosh B Murthy, Cenai Zhang, Andrew L A Garton, Brian Mac Grory, Shreyansh Shah, Gregg C Fonarow, Lee H Schwamm, Deepak L Bhatt, Eric E Smith, Guido J Falcone, Seyedmehdi Payabvash, Wendy C Ziai, Jared Knopman, Charles C Matouk, J Mocco, Hooman Kamel, Kevin N Sheth","doi":"10.1161/STROKEAHA.124.048650","DOIUrl":"10.1161/STROKEAHA.124.048650","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of minimally invasive surgery (MIS) in improving outcomes after nontraumatic intracerebral hemorrhage (ICH) remains uncertain, with inconsistent findings from randomized clinical trials. Our objective was to evaluate the real-world impact of MIS on ICH outcomes using a nationally representative cohort.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of patients with a nontraumatic ICH enrolled in the American Heart Association Get With The Guidelines-Stroke Registry between January 1, 2011, and December 31, 2021. We excluded patients with a diagnosis of ischemic stroke or other intracranial hemorrhage subtypes, those who underwent open craniotomy or craniectomy, and patients transferred to another hospital. The exposure was MIS, defined as a composite of stereotactic surgical evacuation and endoscopic surgical evacuation. The primary outcome was in-hospital mortality, while secondary outcomes included functional outcomes at discharge (discharge disposition, ambulatory status, and modified Rankin Scale score). We matched patients who underwent MIS with nonsurgical patients using overlap propensity matching and used multiple logistic regression to study the association between MIS and outcomes.</p><p><strong>Results: </strong>Among 684 467 patients with ICH, 555 964 were included; the mean age was 68 (SD, 15.3) years, and 262 999 (47.3%) were female. MIS was performed in 703 patients of whom 312 had stereotactic surgery and 391 had endoscopic surgery. In the matched cohort, in-hospital deaths occurred in 60 of 446 (13.5%) with MIS and 8321 of 35 361 patients (23.5%) without surgery. In regression analyses, MIS was associated with lower in-hospital mortality (adjusted odds ratio, 0.50 [95% CI, 0.39-0.65]) and favorable discharge disposition (adjusted odds ratio, 1.93 [95% CI, 1.61-2.32]) but not with ambulatory status or functional outcomes. In additional analyses, stereotactic surgery and endoscopic surgery were independently associated with lower mortality.</p><p><strong>Conclusions: </strong>In a large diverse cohort of patients with ICH, MIS was associated with lower in-hospital mortality and favorable discharge disposition. These findings support efforts to understand the durable impact of MIS in patients with ICH.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1441-1450"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773178","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":"New Animated Training and Certification Application for NIHSS.","authors":"Ariana Anderson, Brian White, Marianne Bourgeois, Chase Champagne, Elizabeth Rothermel, John Klein, Joseph Aucoin, Patrick Lyden","doi":"10.1161/STROKEAHA.124.048924","DOIUrl":"10.1161/STROKEAHA.124.048924","url":null,"abstract":"<p><strong>Background: </strong>The National Institutes of Health Stroke Scale is used globally to rate neurological deficits in patients with acute stroke. Originally designed for research use, the scale uses idiosyncratic scoring rules and requires thorough training for proper use. Currently available training and certification systems are timeworn and limited in the range of demonstrated neurological findings. We aimed to develop a new training and certification method to address the limitations of the prior system.</p><p><strong>Methods: </strong>We describe a new animated system that uses state-of-the-art digital motion capture, avatar rendering, and digital animation that enables illustration of all possible scale item responses within a training module. For certification, we created 20 unique case vignettes, which can be viewed from many angles allowing better scoring scenario presentation. Training to use the scale via telemedicine was added. Alpha and beta testing was completed to enhance iterative development. From a penultimate version, we measured interrater agreement among 42 pilot users who each viewed 6 cases. After further improvement, we finalized the application and confirmed interrater agreement in a second sample of 365 consecutive, unselected users viewing 3 cases. Clinometric analysis methods followed our prior studies of the scale.</p><p><strong>Results: </strong>Users agreed the new, animated training module is more engaging and informative than legacy training videos. We compared the new system to the legacy live-video certification system for clinometric reliability. In the confirmatory sample, the intraclass correlation coefficient was 0.979 (97.5% CI, 0.919-0.99). Kappa scores ranged from 0.25 to 0.90 across all 15 scale items. These results are comparable to previous studies.</p><p><strong>Conclusions: </strong>A new, animated training and certification system showed equivalent clinometric properties to legacy systems, providing a reliable method for National Institutes of Health Stroke Scale training and certification. The new system allows modification and reconfiguration if needed to maintain user interest and case novelty.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1422-1427"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804297","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 Growth Factor β1 Protects Against Ischemic Demyelination via Regulating Microglial Lipid Metabolism Pathway.","authors":"Yi Xie, Xinyue Wang, Shuai Liu, Ziyu He, Hang Zhang, Zhiyuan Yu, Minjie Xie, Wei Wang","doi":"10.1161/STROKEAHA.124.048206","DOIUrl":"10.1161/STROKEAHA.124.048206","url":null,"abstract":"<p><strong>Background: </strong>Chronic cerebral hypoperfusion-induced white matter lesions are an important cause of vascular cognitive impairment in aging life. TGF-β1 (transforming growth factor β1) is widely recognized as a multifunctional cytokine participating in numerous pathophysiological processes in the central nervous system. In this study, we aimed to evaluate the neuroprotective potentials of TGF-β1 in ischemic white matter lesions.</p><p><strong>Methods: </strong>A mouse model of bilateral common carotid artery stenosis was established to imitate the ischemic white matter lesions. The agonist of the TGF-β1 pathway was continuously applied via intraperitoneal injection. The Morris water maze test and gait analysis system were used to assess the cognitive and gait disorders in modeling mice. The Luxol fast blue staining, immunofluorescence, and electron microscopy were conducted to determine the severity of demyelinating lesions, microglial activation, and dysfunction of the autophagy-lysosomal pathway in microglia. Furthermore, primary cultured microglia were exposed to extracted myelin debris and TGF-β1 in vitro to explore the underlying mechanisms.</p><p><strong>Results: </strong>As evaluated by behavioral tests, TGF-β1 significantly alleviated the cognitive dysfunction and gait disorder in bilateral common carotid artery stenosis-modeling mice. The demyelinating lesion and remyelination process were also found to be highly improved by activation of the TGF-β1 pathway. The results of immunostaining and electron microscopy showed that TGF-β1 could ameliorate microglial activation and the dysfunction of lipid metabolism in myelin-engulfed microglia. Mechanistically, in primary cultured microglia exposed to myelin debris, administration of TGF-β1 notably mitigated the inflammatory response and accumulation of intracellular lipid droplets via promoting the lipid droplets degradation in the autophagy-lysosomal pathway, as quantified by flow cytometry, immunostaining, Western blot, etc. Yet, the application of autophagy inhibitor 3-methyladenine significantly reversed the above anti-inflammatory effects of TGF-β1.</p><p><strong>Conclusions: </strong>TGF-β1 relieved cognitive deficit, demyelinating lesions, and microglia-mediated neuroinflammation in bilateral common carotid artery stenosis modeling by reducing abnormal lipid droplet accumulation and dysfunction of the autophagy-lysosomal pathway in microglia. Clinically, staged activation of the TGF-β1 pathway may become a potential target and promising treatment for ischemic white matter lesions and vascular cognitive impairment.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1554-1568"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754548","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":"Standalone Middle Meningeal Artery Embolization Versus Conservative Management for Nontraumatic Subdural Hematoma.","authors":"Huanwen Chen, Mihir Khunte, Marco Colasurdo, Ajay Malhotra, Dheeraj Gandhi","doi":"10.1161/STROKEAHA.124.050190","DOIUrl":"10.1161/STROKEAHA.124.050190","url":null,"abstract":"<p><strong>Background: </strong>Recent randomized control trials have demonstrated the efficacy and safety of middle meningeal artery embolization (MMAE) as an adjunct to conventional management for patients with nonacute subdural hematoma (SDH); however, a large majority of trial participants received surgical evacuation as part of the standard of care. Thus, the efficacy and safety of standalone MMAE compared with conservative management (CM) for patients with nonsurgical SDH are unclear.</p><p><strong>Methods: </strong>This was a retrospective cohort study of the 2019 to 2021 Nationwide Readmissions Database in the United States. Patients with nonsurgical nontraumatic SDH were identified, and MMAE patients were matched with similar CM patients using propensity scores calculated from demographics, comorbidities, and initial hospitalization outcomes. Patients were followed up to 300 days. The primary end point was composite surgical rescue or death, and secondary end points included surgical rescue and all-cause mortality by 180 days.</p><p><strong>Results: </strong>A total of 24 465 patients with nonsurgical nontraumatic SDH were identified; 2228 (9.1%) underwent MMAE. After propensity score matching, 6675 patients remained in the CM group and 2217 in the MMAE group. At 180 days, MMAE patients had a significantly lower risk of surgery or death compared with CM (8.2% versus 10.9%; relative risk, 0.75 [95% CI, 0.59-0.96]; <i>P</i>=0.022) and lower risk of death (1.1% versus 3.0%; relative risk, 0.38 [95% CI, 0.17-0.86]; <i>P</i>=0.020). Rates of surgical rescue among MMAE and CM patients at 180 days were similar (7.1% versus 8.4%; relative risk, 0.85 [95% CI, 0.63-1.14]; <i>P</i>=0.27). Time-to-event analyses for the entire 300-day study follow-up period confirmed that while MMAE was associated with a lower cumulative risk of all-cause mortality (hazard ratio, 0.55 [95% CI, 0.35-0.87]; <i>P</i>=0.010), it was not associated with a different risk of surgical rescue (hazard ratio, 1.00 [95% CI, 0.76-1.31]; <i>P</i>=1.00).</p><p><strong>Conclusions: </strong>Standalone MMAE may be beneficial for patients with nonsurgical nontraumatic SDH by reducing the long-term risk of all-cause mortality.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1404-1412"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773179","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":"Does the Burden of CSVD Modify the Efficacy of Dual Antiplatelet Therapy?: A Post Hoc Analysis of the INSPIRES Trial.","authors":"Hang Li, Min Cheng, Ying Gao, Hongyi Yan, Yicong Wang, S Claiborne Johnston, Philip M Bath, Pierre Amarenco, Yingying Yang, Weiqi Chen, Yongjun Wang, Yuesong Pan, Yilong Wang","doi":"10.1161/STROKEAHA.124.049826","DOIUrl":"10.1161/STROKEAHA.124.049826","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of cerebral small vessel disease (CSVD) imaging markers is high, yet their influence on stroke prognosis remains unclear. This study aimed to estimate the effects of CSVD on the efficacy and safety of clopidogrel+aspirin versus aspirin among patients with minor stroke or high-risk transient ischemic attack.</p><p><strong>Methods: </strong>This was a post hoc subgroup analysis of the INSPIRES trial (Intensive Statin and Antiplatelet Therapy for Acute High-Risk Intracranial or Extracranial Atherosclerosis), which was a double-blind, placebo-controlled, 2×2 factorial, and randomized clinical trial conducted at 222 centers in China from September 2018 to October 2022. Patients were classified into CSVD score 0 to 2 and CSVD score ≥3 groups based on a modified CSVD burden score without microbleeds. The primary efficacy and safety outcomes were stroke recurrence and moderate-to-severe bleeding risk within 90-day follow-up. We used Cox proportional hazards models to test the treatment-by-CSVD group interaction for stroke and bleeding risk.</p><p><strong>Results: </strong>A total of 5126 patients (median age, 65 [57-71] years; 3915 [64.2%] males) were enrolled and 2131 (41.57%) had a modified CSVD score ≥3. Patients with CSVD score ≥3 had numerically higher stroke recurrence rate (9.10% versus 8.05%) and lower risk of moderate-to-severe bleeding (0.56% versus 0.80%) than those with CSVD score 0 to 2 within 90 days. Clopidogrel+aspirin versus aspirin reduced stroke recurrence to a similar relative degree in both CSVD score 0 to 2 (adjusted hazard ratio, 0.78 [95% CI, 0.61-1.01]; <i>P</i>=0.06) and CSVD score ≥3 groups (adjusted hazard ratio, 0.82 [95% CI, 0.62-1.09]; <i>P</i>=0.12) with no evidence of statistical interaction (<i>P</i>=0.84). Clopidogrel+aspirin versus aspirin increased bleeding risk to a similar relative degree in both CSVD score 0 to 2 (adjusted hazard ratio, 2.83 [95% CI, 1.52-5.27]; <i>P</i>=0.03) and CSVD score ≥3 groups (adjusted hazard ratio, 2.13 [95% CI, 1.08-4.19]; <i>P</i>=0.22) with no statistical interaction (<i>P</i>=0.68).</p><p><strong>Conclusions: </strong>In this post hoc subgroup analysis, no significant interaction effect was observed between the antiplatelet treatment and the modified CSVD score, suggesting that clopidogrel+aspirin may not provide a significantly different benefit-risk profile across patients with CSVD score 0 to 2 versus CSVD score ≥3.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03635749.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1376-1387"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796517","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":"Neural Mechanisms of Poststroke Urinary Incontinence: Results From an fMRI Study.","authors":"Evgeniy I Kreydin, Aidin Abedi, Luis Morales, Stefania Montero, Priya Kohli, Nhi Ha, David Chapman, Armita Abedi, David Ginsberg, Kay Jann, Richard L Harvey, Charles Y Liu","doi":"10.1161/STROKEAHA.124.048057","DOIUrl":"10.1161/STROKEAHA.124.048057","url":null,"abstract":"<p><strong>Background: </strong>Urinary incontinence after a stroke significantly affects patient outcomes and quality of life. It is commonly associated with uninhibited detrusor contractions, but the underlying neural mechanisms remain poorly understood. This study aimed to explore the brain activity patterns associated with volitional and involuntary bladder contractions in stroke survivors.</p><p><strong>Methods: </strong>This cohort study enrolled 15 stroke survivors with documented urinary incontinence and 9 healthy controls. Participants underwent simultaneous blood oxygen level-dependent functional magnetic resonance imaging of the brain and urodynamics, capturing 25 involuntary and 23 volitional bladder emptying events in patients with stroke and 35 volitional voiding events in healthy individuals. We used general linear modeling in functional magnetic resonance imaging analysis to discern neural activity patterns during these events and in the phases leading up to them, aiming to identify neural mechanisms underlying involuntary versus volitional urinary control. Statistical significance for neuroimaging analyses was set at <i>P</i><0.005 with a minimum cluster size of 25 voxels.</p><p><strong>Results: </strong>During volitional emptying events, both healthy controls and stroke survivors exhibited increases in activation in regions implicated in sensorimotor control and executive decision-making, such as the brainstem, cingulate cortex, prefrontal cortex, and motor areas. In contrast, involuntary emptying events were associated with minimal changes in brain activity, suggesting minimal cortical involvement. Bladder filling preceding volitional contractions was associated with activity in the salience network (insula, anterior cingulate gyrus) in stroke survivors and healthy controls. Conversely, although there was an increase in overall blood oxygen level-dependent signal, activation of the salience network was conspicuously absent during bladder filling preceding involuntary contractions.</p><p><strong>Conclusions: </strong>The findings suggest that the salience network plays an important role in maintaining urinary continence in stroke survivors. The inability to activate the salience network may underpin the pathophysiology of poststroke urinary incontinence. Interventions aimed at modulating this network could potentially ameliorate lower urinary tract symptoms in this patient population.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT05301335.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1516-1527"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038979","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":"American Heart Association Standards for Postacute Stroke Rehabilitation Care.","authors":"Joel Stein, Samuel M Bierner, Steve Dentel, Aly Downs, Mark Kovic, Barbara J Lutz, Madeline Pawloski, Kylie Picou, Janna Pietrzak, Sue Pugh, Kathleen Volkman, Kristy Weissling, Richard Zorowitz, Pamela W Duncan","doi":"10.1161/STROKEAHA.124.048942","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.048942","url":null,"abstract":"<p><p>Evidence-based rehabilitation and secondary prevention interventions improve poststroke functional recovery and reduce secondary complications. However, stroke rehabilitation expertise, processes of care, and educational resources vary among sites where postacute care (PAC) is delivered. The American Heart Association developed quality standards based on the American Heart Association 2016 Guidelines for Adult Stroke Rehabilitation and Recovery to address these gaps. An interdisciplinary PAC standards writing committee identified key areas for PAC: quality improvement, medical management, care coordination, patient/caregiver and personnel education, and program management. Subgroups developed draft standards, combining results from a national landscape survey of PAC sites with clinical practice guidelines. The committee then refined the draft standards using a consensus-based process. American Heart Association staff and PAC sites in Montana convened a learning collaborative to gather feedback and provide gap analyses of the standards relative to current practices. Qualitative input from beta testing in Montana and quantitative results from the nationwide survey and Montana sites were analyzed and used to refine the standards further. The national landscape survey demonstrated that most sites do not meet the proposed standards: stroke program oversight structure (78% fall short), stroke rehabilitation leadership (70%), stroke-specific order sets/protocols (61%), and policies requiring staff stroke education (66%). Regarding Montana findings, 41% of the PAC sites have no mechanisms to identify areas of quality improvement specific to their stroke rehabilitation programs, and 59% do not use standardized tools to ensure that performance improvement initiatives are followed. However, with adequate support and resources, most Montana sites stated that they would be able to meet the proposed standards. We conclude that the Stroke PAC Quality Standards are applicable in PAC settings and provide a pathway to improving access to high-quality care for stroke survivors. Outcome studies are needed to confirm anticipated improvements in medical and functional outcomes.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 6","pages":"1650-1654"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132651","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":"Communicating to Noncommunicating Hydrocephalus With Lumbar Drain Failure After Aneurysmal Subarachnoid Hemorrhage.","authors":"Hadi Sultan, Mohammadmahdi Sabahi, Hamid Borghei-Razavi, Badih Adada, Stanislaw Gwiezdinski, Michal Obrzut","doi":"10.1161/STROKEAHA.125.050276","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.050276","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 6","pages":"e161-e164"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133078","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":"Factors Associated With Stroke Recurrence After Initial Diagnosis of Cervical Artery Dissection.","authors":"Daniel M Mandel, Liqi Shu, Christopher Chang, Naomi Jack, Christopher R Leon Guerrero, Nils Henninger, Jayachandra Muppa, Muhammad Affan, Omair Ul Haq Lodhi, Mirjam R Heldner, Kateryna Antonenko, David Seiffge, Marcel Arnold, Setareh Salehi Omran, Ross Crandall, Evan Lester, Diego Lopez Mena, Antonio Arauz, Ahmad Nehme, Marion Boulanger, Emmanuel Touzé, Joao Andre Sousa, Joao Sargento-Freitas, Vasco Barata, Paulo Castro-Chaves, Maria Teresa Brito, Muhib Khan, Dania Mallick, Aaron Rothstein, Ossama Khazaal, Josefin E Kaufman, Stefan T Engelter, Christopher Traenka, Diana Aguiar de Sousa, Mafalda Soares, Sara Rosa, Lily W Zhou, Preet Gandhi, Thalia S Field, Steven Mancini, Issa Metanis, Ronen R Leker, Kelly Pan, Vishnu Dantu, Karl Baumgartner, Tina Burton, Regina von Rennenberg, Christian H Nolte, Richard Choi, Jason MacDonald, Reza Bavarsad Shahripour, Xiaofan Guo, Malik Ghannam, Mohammad Almajali, Edgar A Samaniego, Sebastian Sanchez, Bastien Rioux, Faycal Zine-Eddine, Alexandre Poppe, Ana Catarina Fonseca, Maria Fortuna Baptista, Diana Cruz, Michele Romoli, Giovanna De Marco, Marco Longoni, Zafer Keser, Kim Griffin, Lindsey Kuohn, Jennifer Frontera, Jordan Amar, James Giles, Marialuisa Zedde, Rosario Pascarella, Ilaria Grisendi, Hipolito Nzwalo, David S Liebeskind, Amir Molaie, Annie Cavalier, Wayneho Kam, Brian Mac Grory, Sami Al Kasab, Mohammad Anadani, Kimberly Kicielinski, Ali Eltatawy, Lina Chervak, Roberto Chulluncuy Rivas, Yasmin Aziz, Ekaterina Bakradze, Thanh Lam Tran, Marc Rodrigo Gisbert, Manuel Requena, Faddi Saleh Velez, Jorge Ortiz Garcia, Varsha Muddasani, Adam de Havenon, Venugopalan Y Vishnu, Sridhara Yaddanapudi, Latasha Adams, Abigail Browngoehl, Tamra Ranasinghe, Randy Dunston, Zachary Lynch, Mary Penckofer, James E Siegler, Silvia Mayer, Joshua Willey, Adeel Zubair, Yee Kuang Cheng, Richa Sharma, João Pedro Marto, Vítor Mendes Ferreira, Piers Klein, Thanh N Nguyen, Syed Daniyal Asad, Zoha Sarwat, Anvesh Balabhadra, Shivam Patel, Thais Secchi, Sheila Martins, Gabriel Mantovani, Young Dae Kim, Balaji Krishnaiah, Cheran Elangovan, Sivani Lingam, Abid Y Qureshi, Sebastian Fridman, Alonso Alvarado-Bolanos, Farid Khasiyev, Guillermo Linares, Marina Mannino, Valeria Terruso, Sofia Vassilopoulou, Vasileios Tentolouris-Piperas, Manuel Martinez Marino, Victor Carrasco Wall, Fransisca Indraswari, Sleiman El Jamal, Shilin Liu, Muhammad Alvi, Farman Ali, Mohammed Sarvath, Rami Z Morsi, Tareq Kass-Hout, Feina Shi, Jinhua Zhang, Dilraj Sokhi, Jamil Said, Newnex Mongare, Alexis N Simpkins, Roberto Gomez, Shayak Sen, Mohammad Ghani, Marwa Elnazeir, Han Xiao, Narendra Kala, Farhan Khan, Christoph Stretz, Nahid Mohammadzadeh, Eric Goldstein, Karen Furie, Shadi Yaghi","doi":"10.1161/STROKEAHA.124.048215","DOIUrl":"10.1161/STROKEAHA.124.048215","url":null,"abstract":"<p><strong>Background: </strong>Patients presenting with cervical artery dissection (CAD) are at risk for subsequent ischemic events. We aimed to identify characteristics that are associated with increased risk of ischemic stroke after initial presentation of CAD and to evaluate the differential impact of anticoagulant versus antiplatelet therapy in these high-risk individuals.</p><p><strong>Methods: </strong>This was a preplanned secondary analysis of the STOP-CAD study (Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection), a multicenter international retrospective observational study (63 sites from 16 countries in North America, South America, Europe, Asia, and Africa) that included patients with CAD predominantly between January 2015 and June 2022. The primary outcome was subsequent ischemic stroke by day 180 after diagnosis. Clinical and imaging variables were compared between those with versus without subsequent ischemic stroke. Significant factors associated with subsequent stroke risk were identified using stepwise Cox regression. Associations between subsequent ischemic stroke risk and antithrombotic therapy type (anticoagulation versus antiplatelets) among patients with identified risk factors were explored using adjusted Cox regression.</p><p><strong>Results: </strong>In all, 4023 patients (mean age was 47.4 years; 44.5% were women) were included. By day 180, subsequent ischemic stroke occurred in 5.3% of the cohort. In adjusted Cox regression, factors associated with increased risk of subsequent ischemic stroke were prior history of ischemic stroke (adjusted hazard ratio [aHR], 7.31 [95% CI, 1.61-33.13]; <i>P</i>=0.010), presentation within 7 days from first symptoms (aHR, 3.04 [95% CI, 1.04-8.91]; <i>P</i>=0.043), infarct on baseline imaging (aHR, 9.85 [95% CI, 3.65-26.58]; <i>P</i><0.001), and occlusive dissection (aHR, 2.34 [95% CI, 1.03-5.34]; <i>P</i>=0.043). Only patients with occlusive dissection demonstrated a reduced risk of subsequent ischemic stroke when treated with anticoagulation versus antiplatelets (aHR, 0.36 [95% CI, 0.16-0.80]; <i>P</i>=0.01).</p><p><strong>Conclusions: </strong>In this post hoc analysis of the STOP-CAD study, several factors associated with subsequent ischemic stroke were identified among patients with CAD. Furthermore, we identified a potential benefit of anticoagulation in patients with CAD with occlusive dissection. These findings require validation by meta-analyses of prior studies to formulate optimal treatment strategies for specific high-risk CAD subgroups.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1413-1421"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720654","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":"FLAIR Vascular Hyperintensities as Imaging Biomarker in Pediatric Acute Ischemic Stroke.","authors":"Natalie L Ullman, Arastoo Vossough, Lauren A Beslow, Rebecca N Ichord, Evelyn K Shih","doi":"10.1161/STROKEAHA.124.048717","DOIUrl":"10.1161/STROKEAHA.124.048717","url":null,"abstract":"<p><strong>Background: </strong>Fluid-attenuated inversion recovery vascular hyperintensities (FVH) are high signal intensities on magnetic resonance imaging resulting from sluggish or stagnant flow through vessels. This investigation describes the prevalence, risk factors, and outcomes associated with FVH in pediatric arterial ischemic stroke (AIS).</p><p><strong>Methods: </strong>Retrospective review of children aged 29 days to 18 years in a single institution stroke registry from 2006 to 2022 with AIS. Magnetic resonance imaging were assessed for large vessel occlusion (LVO), FVH score, modified Alberta Stroke Program Early CT Score, and AIS volume. The association between demographic and imaging factors with the presence of and high FVH burden was assessed using Fisher exact, Pearson χ², or Kruskal-Wallis tests. Wilcoxon rank-sum test evaluated the association of FVH score with the presence of LVO and poor outcome. The relationship between FVH score and age, time to magnetic resonance imaging, stroke volume, modified Alberta Stroke Program Early CT Score, Pediatric National Institutes of Health Stroke Scale, and Pediatric Stroke Outcome Measure score were assessed using Spearman correlation. A multivariable logistic regression was used to evaluate predictors of FVH.</p><p><strong>Results: </strong>In total, 273 patients with AIS were screened, and 83 met the inclusion criteria. Patients were a median age of 11.6 years (range, 1 month-18 years) and 37% were female. FVH were present in 53% of the cohort. Median FVH score was 0 (interquartile range, 0-2) in those without LVO and 5.5 (interquartile range, 3-7) in those with LVO (<i>P</i><0.0001). There was a positive correlation between FVH score and Pediatric National Institutes of Health Stroke Scale (<i>r</i>_s=0.40; <i>P</i>=0.003), modified Alberta Stroke Program Early CT Score (<i>r</i>_s=0.62; <i>P</i><0.0001), stroke volume (<i>r</i>_s=0.58; <i>P</i><0.0001) and Pediatric Stroke Outcome Measure at 1 year (<i>r</i>_s=0.32; <i>P</i>=0.012). In the multivariable logistic regression, older age (odds ratio, 1.38 [95% CI, 1.08-1.77]; <i>P</i>=0.009) and the presence of LVO (odds ratio, 301.97 [95% CI, 10.89-8373.16]; <i>P</i>=0.001) were associated with high FVH burden.</p><p><strong>Conclusions: </strong>FVH are prevalent in children with AIS. FVH are associated with LVO, larger infarct size, and worse outcomes. Further study is needed to determine whether FVH can be used to identify patients who would benefit most from recanalization therapies.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1505-1515"},"PeriodicalIF":7.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731616","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}