Stroke最新文献

{"title":"Uric Acid Stroke Cerebroprotection Transcended Sex, Age, and Comorbidities in a Multicenter Preclinical Trial.","authors":"Rakesh B Patel, Mariia Kumskova, Hanish Kodali, Ivan Budnik, Vitalii Kuznetsov, Aditi Jain, Abhishek Jha, Daniel Thedens, Nirav Dhanesha, Brijesh Sutariya, Karisma A Nagarkatti, Jessica Lamb, Pradip Kamat, Yanrong Shi, Brooklyn Avery, Takahiko Imai, Xuyan Jin, Anjali Chauhan, Ligia S B Boisserand, Mohammad B Khan, Krishnan Dhandapani, Basavaraju G Sanganahalli, Lauren H Sansing, David C Hess, Raymond C Koehler, Louise D McCullough, Jaroslaw Aronowski, Cenk Ayata, Márcio A Diniz, Patrick D Lyden, Anna M Planas, Angel Chamorro, Anil K Chauhan, Enrique C Leira","doi":"10.1161/STROKEAHA.124.048748","DOIUrl":"10.1161/STROKEAHA.124.048748","url":null,"abstract":"<p><strong>Background: </strong>Past failures in translating stroke cerebroprotection provoked calls for a more rigorous methodological approach, leading to the stroke preclinical assessment network SPAN (Stroke Preclinical Assessment Network), where uric acid (UA) treatment exceeded a prespecified efficacy boundary for the primary functional outcome. Still, successful translation to humans requires confirmation of the effect of UA across key biological variables relevant to patients with stroke.</p><p><strong>Methods: </strong>We measured the effects of intravenous UA treatment (16 mg/kg) versus intravenous saline in groups of animals enrolled in the SPAN network with diverse comorbidities, sex, and age. The masked study drug or placebo was administered during reperfusion in rodents undergoing a transient middle cerebral artery filament occlusion. The primary outcome was the modified corner test index at day 30 poststroke, and numerous secondary outcomes were collected. A modified intention-to-treat population was used in the analysis. We tested for any interactions with sex, age, and comorbidities (obesity-induced hyperglycemia and hypertension).</p><p><strong>Results: </strong>In total, 710 animals were randomized to receive either intravenous UA or saline. After accounting for procedural dropouts and exclusions from treatment, a total of 687 animals were qualified and analyzed, including 458 assigned to UA and 229 to intravenous saline control. UA-treated animals exhibited a better primary functional outcome at day 30 (probability, 0.56 [95% CI, 0.52-0.60]; <i>P</i>=0.006). UA-treated animals also had a better corner test index at day 7 (probability, 0.55 [95% CI, 0.5-0.59]; <i>P</i>=0.035) and a higher survival rate at day 30 (hazard ratio, 1.41 [95% CI, 1.08-1.83]; <i>P</i>=0.011). Brain morphometry at day 2 and 30 was comparable between the treatment groups. The improved functional outcome and survival in UA-treated animals were preserved across different species, sexes, ages, and comorbidities.</p><p><strong>Conclusions: </strong>UA provides ischemic stroke cerebroprotection across key relevant biological variables, making it a promising intervention to be further tested in human clinical trials.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"965-973"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650878","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":"Stroke Mimics at 30 Years: Where We Have Been, Where We Are Now, and Where We Are Going.","authors":"Haroon Khawar, Spencer McFarlane, Richard B Libman","doi":"10.1161/STROKEAHA.124.048067","DOIUrl":"10.1161/STROKEAHA.124.048067","url":null,"abstract":"<p><p>Stroke mimics and chameleons remain a major challenge to the clinician and clinical investigator. Misdiagnosis of stroke can result in significant harm to our patients, as well as unnecessary financial costs to the health care systems internationally. The approach to stroke mimics and chameleons has evolved over time with the development of clinical scales and technology. The combination of these tools with clinical acumen can minimize diagnostic errors to the benefit of patients.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1061-1068"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972197","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":"Spontaneous Thrombosis of Brain Arteriovenous Malformation Draining Veins: Concerns on Nonhemorrhagic Symptoms.","authors":"Fabio Torregrossa, Domingos Coiteiro","doi":"10.1161/STROKEAHA.124.049847","DOIUrl":"10.1161/STROKEAHA.124.049847","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e124-e128"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067509","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":"Ultra-Early Hematoma Expansion Is Associated With Ongoing Hematoma Growth and Poor Functional Outcome.","authors":"Chloe A Mutimer, Teddy Y Wu, Henry Zhao, Leonid Churilov, Bruce C V Campbell, Andrew Cheung, Atte Meretoja, Timothy J Kleinig, Philip M Choi, Henry Ma, Geoffrey C Cloud, Rohan Grimley, Darshan Shah, Annemarei Ranta, Karim Mahawish, Vignan Yogendrakumar, Gagan Sharma, Geoffrey A Donnan, Stephen M Davis, Nawaf Yassi","doi":"10.1161/STROKEAHA.124.050131","DOIUrl":"10.1161/STROKEAHA.124.050131","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There are limited data on ultra-early hematoma growth dynamics and their clinical impact in primary intracerebral hemorrhage (ICH). We aimed to estimate the incidence of hematoma expansion within the hyperacute period of ICH, describe hematoma dynamics over time, investigate the associations between ultra-early hematoma expansion and clinical outcomes after ICH, and assess the effect of tranexamic acid on ultra-early hematoma expansion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a preplanned secondary analysis of the STOP-MSU trial (Stopping Intracerebral Hemorrhage With Tranexamic Acid for Hyperacute Onset Presentation Including Mobile Stroke Units), which compared tranexamic acid with placebo in 201 patients with primary ICH presenting within 2 hours of symptom onset. Repeat computed tomography imaging ≈1 hour after treatment commencement was encouraged (ultra-early reimaging), and patients with this imaging were included in this descriptive study. Imaging analyses were separated into the following time epochs: baseline-the period from onset-to-baseline imaging; ultra-early-the period from baseline imaging to ultra-early reimaging; and interval-the period from ultra-early reimaging to 24-hour reimaging. Hematoma expansion was defined as a ≥33% or ≥6 mL increase from baseline, and functional outcomes were assessed at 90 days (poor functional outcome defined as modified Rankin Scale score of 3-6) using unadjusted logistic regression models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 105 patients who had ultra-early reimaging (median age, 66 years; 40% female). Median onset-to-baseline imaging time was 74 minutes (interquartile range, 56-87 minutes), and baseline-to-ultra-early reimaging time was 95 minutes (interquartile range, 74-132 minutes). Forty-one patients (39%) had ultra-early hematoma expansion. These patients had larger baseline hematomas (15.9 mL versus 9.1 mL, &lt;i&gt;P&lt;/i&gt;=0.03) compared with those with no early hematoma expansion. Hematoma growth rate declined over time (clustered median regression &lt;i&gt;P&lt;/i&gt;&lt;0.01). In 92 patients with imaging at all 3 time points, patients with ultra-early hematoma expansion were more likely to have further interval expansion (9/31 [29%] versus 4/61 [6.6%], &lt;i&gt;P&lt;/i&gt;&lt;0.01). Of the 61 patients without ultra-early hematoma expansion, there were 10 (16.4%) whose total growth from baseline to 24-hour imaging fulfilled the expansion definition. Ultra-early hematoma expansion was associated with poor functional outcomes (unadjusted odds ratio, 3.91 [1.22-12.49]; &lt;i&gt;P&lt;/i&gt;&lt;0.01) and mortality (unadjusted odds ratio, 6.19 [2.17-17.66]; &lt;i&gt;P&lt;/i&gt;&lt;0.01). There was no observed effect of tranexamic acid treatment on ultra-early hematoma expansion (&lt;i&gt;P&lt;/i&gt;=0.65).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In patients with ICH presenting within 2 hours of symptom onset, most hematoma growth occurs in the ultra-early period. The presence of ultra-early hematoma expansion is associated with ongo","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"838-847"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067963","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":"Practicing Stroke Medicine in War Zones.","authors":"Yuriy Flomin, Tarig Fadalla, Aussan Al-Athwari, Francesca Romana Pezzella, Valeria Caso","doi":"10.1161/STROKEAHA.124.047322","DOIUrl":"10.1161/STROKEAHA.124.047322","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e119-e123"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573911","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":"Impaired Resting-State Functional Connectivity in Cerebral Autosomal-Dominant Arteriopathy, Subcortical Infarcts, and Leukoencephalopathy Mutant Mice.","authors":"Sanem Aslihan Aykan, James Han Lai, Kazutaka Sugimoto, Orhan Aykan, Wai Yee Fung, David Ho, Anne Joutel, Sava Sakadzic, David Y Chung, Cenk Ayata","doi":"10.1161/STROKEAHA.124.049772","DOIUrl":"10.1161/STROKEAHA.124.049772","url":null,"abstract":"<p><strong>Background: </strong>Cerebral autosomal-dominant arteriopathy, subcortical infarcts, and leukoencephalopathy is the most prevalent monogenic inherited cause of cerebral small vessel disease. Despite its prevalence, there is currently no proven therapy to prevent or reverse the progression of the disease.</p><p><strong>Methods: </strong>This study aimed to characterize the functional integrity of long white matter tracts in cerebral autosomal-dominant arteriopathy, subcortical infarcts, and leukoencephalopathy transgenic mice expressing R169C mutant <i>Notch3</i> (Notch3^R169C) compared with wild type littermates (Notch3^WT), both with and without a superimposed focal white matter lesion in the corpus callosum, utilizing optical resting-state functional connectivity imaging alongside behavioral examinations. In addition, we examined the efficacy of tocotrienol, a neuroprotective derivative of vitamin E derived from palm oil, which has shown promise in preventing white matter disease progression in clinical trials involving patients with small vessel disease.</p><p><strong>Results: </strong>At baseline, resting-state interhemispheric and intrahemispheric functional connectivity was significantly lower in Notch3^R169C than in Notch3^WT (<i>P</i>=0.004), and the grid walk test revealed a higher number of foot faults in the Notch3^R169C group compared with Notch3^WT. Sex did not interact with the genotype on the primary outcomes. Introducing a lesion in the corpus callosum compromised functional connectivity and behavior outcomes in both genotypes to a similar extent; lesion volumes did not differ between the genotypes. Tocotrienol treatment did not show any protective effect on any end point.</p><p><strong>Conclusions: </strong>These data show impaired resting-state functional connectivity and increased foot faults in the Notch3^R169C mutant model of cerebral autosomal-dominant arteriopathy, subcortical infarcts, and leukoencephalopathy. Future work will aim to test therapeutic or preventive interventions in cerebral autosomal-dominant arteriopathy, subcortical infarcts, and leukoencephalopathy mutants using these measures.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"987-995"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067574","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":"The Kidney-Immune-Brain Axis: The Role of Inflammation in the Pathogenesis and Treatment of Stroke in Chronic Kidney Disease.","authors":"Dearbhla M Kelly, Eoin M Kelleher, Peter M Rothwell","doi":"10.1161/STROKEAHA.124.047070","DOIUrl":"10.1161/STROKEAHA.124.047070","url":null,"abstract":"<p><p>Cardiovascular diseases such as stroke are a major cause of morbidity and mortality for patients with chronic kidney disease (CKD). The underlying mechanisms connecting CKD and cardiovascular disease are yet to be fully elucidated, but inflammation is proposed to play an important role based on genetic association studies, studies of inflammatory biomarkers, and clinical trials of anti-inflammatory drug targets. There are multiple sources of both endogenous and exogenous inflammation in CKD, including increased production and decreased clearance of proinflammatory cytokines, oxidative stress, metabolic acidosis, chronic and recurrent infections, dialysis access, changes in adipose tissue metabolism, and disruptions in intestinal microbiota. This review focuses on the mechanisms of inflammation in CKD, dialysis and associated therapies, its proposed impact on stroke pathogenesis and prognosis, and the potential role of anti-inflammatory agents in the prevention and treatment of stroke in patients with CKD.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1069-1081"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029722","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":"Advances in Diagnosis and Imaging 2025: Benchmarking Reporting Approach for Imaging in Neurological Studies.","authors":"David S Liebeskind, Joanna M Wardlaw","doi":"10.1161/STROKEAHA.125.049866","DOIUrl":"10.1161/STROKEAHA.125.049866","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1058-1060"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537713","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":"Long-Term Cognitive Decline After Subarachnoid Hemorrhage: Pathophysiology, Management, and Future Directions.","authors":"Serhat Aydin, Selçuk Peker","doi":"10.1161/STROKEAHA.124.049969","DOIUrl":"10.1161/STROKEAHA.124.049969","url":null,"abstract":"<p><p>Subarachnoid hemorrhage is a critical neurological condition accounting for about 5% of all strokes, and survivors experience long-term cognitive deterioration and increased risk of dementia. The major processes involved in such decline include early brain injury, delayed cerebral ischemia, neuroinflammation, superficial siderosis, and hydrocephalus. These have emerging treatments that offer promise for the mitigation of effects such as inflammation, iron chelation, and microvascular dysfunction. Genetic predispositions have been associated with post-subarachnoid hemorrhage cognitive outcomes and emphasize a role for personalized care strategies. Management techniques reviewed include long-term cognitive health, such as endovascular coiling and surgical clipping. Other rehabilitation strategies that enhance cognitive reserve and pharmacological interventions are discussed about improving the quality of life in survivors. The review highlights the need for further research into targeted therapies, genetic markers, and innovative approaches to prevent cognitive decline, ultimately aiming to optimize long-term outcomes for individuals affected by subarachnoid hemorrhage.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1106-1111"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543126","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":"Thrombotic Thrombocytopenic Purpura: A Missed Cause in Stroke Prevention Guidelines.","authors":"Adrien Picod, Bérangère S Joly, Agnès Veyradier, Paul Coppo","doi":"10.1161/STROKEAHA.124.049952","DOIUrl":"10.1161/STROKEAHA.124.049952","url":null,"abstract":"<p><p>The 2024 Guidelines for the Primary Prevention of Stroke, recently updated by the American Heart Association and the American Stroke Association, serve as an essential resource for clinicians aiming to reduce the growing impact of cerebrovascular disease. These guidelines emphasize modifiable risk factors and population-specific considerations, covering a range of cardiovascular conditions, including hypertension, diabetes, atherosclerotic disease, and genetic predispositions to stroke. However, a notable omission in these guidelines is the absence of specific recommendations for patients with thrombotic thrombocytopenic purpura. Indeed, these patients are particularly susceptible to stroke, which can be the sole manifestation of the disease. Given the established association between thrombotic thrombocytopenic purpura and ischemic stroke and the effectiveness of preventive interventions, future guidelines should include specific recommendations for patients with thrombotic thrombocytopenic purpura to avert thrombotic events, including stroke. In that regard, ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 repeats, member 13) activity measurement should be considered in the workup of cryptogenic stroke.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1104-1105"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573965","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}