Stroke最新文献

{"title":"Speech Therapy Combined With Cerebrolysin in Enhancing Nonfluent Aphasia Recovery After Acute Ischemic Stroke: ESCAS Randomized Pilot Study.","authors":"Volker Homberg, Dragoș Cătălin Jianu, Adina Stan, Ștefan Strilciuc, Vlad-Florin Chelaru, Michał Karliński, Michael Brainin, Wolf Dieter Heiss, Dafin F Muresanu, Pamela M Enderby","doi":"10.1161/STROKEAHA.124.049834","DOIUrl":"10.1161/STROKEAHA.124.049834","url":null,"abstract":"<p><strong>Background: </strong>Stroke-induced aphasia significantly impacts communication and quality of life. Despite the standard treatment being speech and language therapy, outcomes vary, highlighting the need for additional therapies. Cerebrolysin, a neuroprotective and neurotrophic agent, has shown potential in stroke management. This study addresses the notable gap in research about the combined use of Cerebrolysin and speech therapy, evaluating their synergistic potential in the treatment of aphasia.</p><p><strong>Methods: </strong>The ESCAS trial (The Efficacy and Safety of Cerebrolysin in the Treatment of Aphasia After Acute Ischemic Stroke), a prospective, randomized-controlled, double-blinded study was conducted in 2 Romanian stroke centers. Participants included those with left middle cerebral artery territory ischemic stroke and nonfluent aphasia, enrolled 3 to 5 days poststroke. Inclusion criteria were right-handedness and Romanian as the mother tongue. Participants received Cerebrolysin or a placebo combined with speech and language therapy in 10-day cycles over 3 intervals, and evaluations were done at baseline, 30, 60, and 90 days respectively. The main outcome measure was Western Aphasia Battery for language function. Changes at days 30, 60, and 90 compared with baseline were quantified, and the effect estimand used was the difference in means between groups. Secondary outcome measurements were the National Institutes of Health Stroke Scale for neurological deficit, the modified Rankin Scale for global disability, and the Barthel Index for activities of daily living.</p><p><strong>Results: </strong>Out of 132 enrolled patients, 123 were included in the intention-to-treat analysis, and 120 in the per-protocol analysis. Overall, both groups showed improvement at subsequent visits compared with the baseline for Western Aphasia Battery and the National Institutes of Health Stroke Scale. The Cerebrolysin group showed greater improvements in Western Aphasia Battery (visit 4 mean increase of 35.579±16.316 [95% CI, 31.289-39.869] points; <i>P</i><0.001) compared with the placebo group (20.774±12.486 [95% CI, 17.603-23.945] points; <i>P</i><0.001), a difference in means of 14.805 (95% CI, 9.521-20.089) points (<i>P</i><0.001). The Cerebrolysin group also showed significant improvements (higher decreases) in National Institutes of Health Stroke Scale scores compared with the placebo group (2.085 [95% CI, 1.076-3.094] points; <i>P</i><0.001). Safety analysis raised no concerns (number of patients with adverse events <i>P</i>=0.105, number of adverse events per patient <i>P</i>=0.134). Additionally, the Cerebrolysin group showed greater improvements in functional independence (Barthel Index) and a trend toward reduced disability (modified Rankin Scale) compared with the placebo group.</p><p><strong>Conclusions: </strong>Cerebrolysin combined with speech and language therapy offers promising potential for enhancing recovery in poststroke n","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"937-947"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433841","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":"Atypical Nonfatal High-Altitude Cerebral Edema With Corpus Callosum Hemorrhage.","authors":"Cesar Jara Silva, Solomon Nittala, Mitali Chansarkar, Brian Jose Villafuerte-Trisolini, Vivek Yedavalli","doi":"10.1161/STROKEAHA.124.049977","DOIUrl":"10.1161/STROKEAHA.124.049977","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e112-e113"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542972","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":"Spatial Transcriptomics and Proteomics Profiling After Ischemic Stroke Reperfusion: Insights Into Vascular Alterations.","authors":"Line Mathilde Brostrup Hansen, Vibeke Secher Dam, Halvor Østerby Guldbrandsen, Christian Staehr, Tina Myhre Pedersen, Joanna Maria Kalucka, Hans Christian Beck, Dmitry D Postnov, Lin Lin, Vladimir V Matchkov","doi":"10.1161/STROKEAHA.124.048085","DOIUrl":"10.1161/STROKEAHA.124.048085","url":null,"abstract":"<p><strong>Background: </strong>More than half of patients with ischemic stroke experience futile reperfusion, increasing the risk of death and disabilities despite a successful recanalization. The reason behind this is debated, and we aim to investigate cerebrovascular changes toward a broader understanding of these conditions. We hypothesize that ischemic stroke reperfusion modifies the expression profile in the microvasculature in a spatial manner toward peri-infarct brain edema and circulatory failure.</p><p><strong>Methods: </strong>We investigated the early (24-hour) changes in spatial gene expression in the brain parenchymal endothelial cells and mural cells following ischemia stroke reperfusion in 13- to 14-week-old C57BL/6JRj male mice (n=5). Ischemia was induced by occlusion of the middle cerebral artery for 60 minutes, and Nissl staining was used to validate infarct size. Spatial transcriptomics complemented by bulk proteomics was conducted in the peri-infarct cortex region and validated with immunohistochemical semiquantification of proteins of interest. To avoid individual biological variations, changes in the peri-infarct cortex region were expressed relatively to the matching contralateral hemisphere region.</p><p><strong>Results: </strong>Ischemic stroke reperfusion impaired the blood-brain barrier integrity through junctional <i>Cldn5</i> (claudin-5) downregulation, changes of the actin cytoskeleton adhesion, and high expression of the proinflammatory <i>Il-6</i> (interleukin-6). Molecules important for extracellular Ca²⁺ influx and intracellular Ca²⁺ release, <i>Cacna1e</i> (R-type Ca^<i>2+</i> <i>channels</i>), <i>Orai2</i>, <i>Ryr3</i>, <i>Itpr1</i>, and <i>Itpka</i> (inositol-trisphosphate 3-kinase A), were markedly reduced. Furthermore, reduced <i>Grm5</i> (glutamate receptor 5) associated with upregulated <i>Nfatc3</i> and <i>Stat3</i> implicates suppression of the contractile phenotype, suggesting reduced poststroke vascular resistance due to loss of mural cell tone. The complete spatial transcriptomics map over the ipsilateral and contralateral hemispheres is available online as a Web tool.</p><p><strong>Conclusions: </strong>Emphasizing the spatial molecular pattern behind blood-brain barrier disruption and loss of the vascular tone in the acute phase following ischemic stroke reperfusion suggests the gene expression contribution for a therapeutic target in ischemia-reperfusion abnormalities.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1036-1047"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573953","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":"Evaluation of Sex-Related Differences in Cerebrovascular Bypass Patency: Review of 357 Direct Cerebral Bypasses.","authors":"Laura Stone McGuire, Tatiana Abou-Mrad, Xinjian Du, Ali Alaraj, Sepideh Amin-Hanjani, Gursant Atwal, Fady T Charbel","doi":"10.1161/STROKEAHA.124.049329","DOIUrl":"10.1161/STROKEAHA.124.049329","url":null,"abstract":"<p><strong>Background: </strong>Demographics and comorbid conditions play a role in vascular health, yet their specific impact on cerebrovascular bypass patency remains unclear.</p><p><strong>Methods: </strong>An institutional database of 357 patients with intracranial bypass procedures between August 2001 and May 2022 was retrospectively reviewed. Patients with bypass for all causes (eg, aneurysm, atherosclerotic disease, moyamoya disease) were included. Medical history, surgical technique, and flow-related measurements (intraoperatively and on quantitative magnetic resonance angiography at follow-up) were compared across biological sex and in relation to bypass patency. Bonferroni correction was applied to the initial analysis (<i>P</i>≤0.00167). The remaining analyses were considered exploratory. Propensity score-matched analysis matched cardiovascular risk factors and compared women and men in bypass patency.</p><p><strong>Results: </strong>Of 357 patients, 141 were men (39.5%) and 216 were women (60.5%) with average age of 49.0±16.7 years and an average follow-up of 1.97 years. Bypass patency at last follow-up was 84.4% (n=114) for men versus 69.2% (n=148) for women (<i>P</i>=0.001). Differences were seen in underlying diagnoses, with more aneurysm and moyamoya cases represented in female sex (<i>P</i><0.001); irrespective of diagnosis, lower patency rates were seen in women when considering bypass for aneurysm (<i>P</i>=0.032), moyamoya disease (<i>P</i>=0.035), and for atherosclerotic disease (<i>P</i>=0.159). Medical comorbidities were seen at higher rates in men, with comorbidity score of 2.7 versus 2.1 (<i>P</i><0.001). Cut flow was higher in men 59.2 versus 51.1 (<i>P</i>=0.028), with no differences in intraoperative bypass flow, cut flow index, or follow-up quantitative magnetic resonance angiography. After removing cases using interposition grafts, similar differences were redemonstrated. Propensity score-matched analysis found women have a 2.71 higher chance of bypass occlusion after adjusting for cut flow index (<i>P</i>=0.017 [95% CI, 1.19-6.18]).</p><p><strong>Conclusions: </strong>Biological sex appears to play a role in bypass patency, across diagnoses. Women were less likely to have patent bypasses at the last follow-up, despite having fewer medical comorbidities than men and despite having similar intraoperative and perioperative flows.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"828-837"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516791","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":"Hematoma Expansion in Intracerebral Hemorrhage: Time Is the Enemy.","authors":"Simon Fandler-Höfler, Santosh B Murthy","doi":"10.1161/STROKEAHA.125.050756","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.050756","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 4","pages":"848-849"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701460","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":"Voxel-Wise Map of Intracerebral Hemorrhage Locations Associated With Worse Outcomes.","authors":"Gaby Abou Karam, Min-Chiun Chen, Dorin Zeevi, Bendix C Harms, Elisa Berson, Victor M Torres-Lopez, Cyprien A Rivier, Ajay Malhotra, Adnan I Qureshi, Guido J Falcone, Kevin N Sheth, Seyedmehdi Payabvash","doi":"10.1161/STROKEAHA.124.048453","DOIUrl":"10.1161/STROKEAHA.124.048453","url":null,"abstract":"<p><strong>Background: </strong>Prior studies on the clinical impact of intracerebral hemorrhage (ICH) location have used visual localization of hematomas to neuroanatomical structures. However, hematomas often cross neuroanatomical structure boundaries with inter-reviewer variability in visual localization. To address these limitations, we applied voxel-wise analysis to identify brain regions where ICH presence is independently predictive of worse outcomes.</p><p><strong>Methods: </strong>We included consecutive patients with acute spontaneous ICH from a comprehensive stroke center in a derivation cohort and validated the results in patients from the control arm of a multicenter clinical trial. Using general linear models, we created and publicly shared a voxel-wise map of brain regions where ICH presence was associated with higher 3-month modified Rankin Scale scores, independent of hematoma volume and clinical risk factors. We also determined the optimal overlap threshold between baseline hematoma and voxel-wise map to categorize ICH location into high versus low risk.</p><p><strong>Results: </strong>Excluding those with missing variables, head computed tomography processing pipeline failure and poor scan quality, 559 of 780 patients were included in derivation (mean age, 69.3±14.5 years; 311 [55.6%] males) and 345 of 500 (mean age, 62.5±12.9 years; 206 [59.7%] males) in validation cohorts. In a voxel-wise analysis, ICH presence in deep white matter, thalami, caudate, midbrain, and pons was associated with worse outcomes. At the patient level, >22% overlap of baseline hematoma with voxel-wise map optimally binarized ICH location to high- versus low-risk categories. In both the derivation and validation cohorts, a high-risk ICH location was independently associated with worse outcomes (higher 3-month modified Rankin Scale score), after adjusting for patients' age, symptom severity at admission, baseline hematoma volume, and the presence of intraventricular hemorrhage, with adjusted odds ratios of 2 ([95% CI, 1.3-3.0] <i>P</i>=0.001) and 1.7 ([95% CI, 1.1-2.9] <i>P</i>=0.027), respectively.</p><p><strong>Conclusions: </strong>We created and publicly shared a voxel-wise map of brain regions where hematoma presence predicts worse outcomes, independent of volume and clinical risk factors.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"868-877"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573975","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":"Validation of a Novel Magnetic Resonance Imaging Biomarker of Infarct Severity to Predict Functional Outcome After Endovascular Thrombectomy.","authors":"Christopher G Favilla, Robert W Regenhardt, Braden Denny, Banafsheh Shakibajahromi, Aman B Patel, Michael T Mullen, Thabele M Leslie-Mazwi, Adam A Dmytriw, Anna K Bonkhoff, Markus D Schirmer, Natalia S Rost, Claus Ziegler Simonsen, Steven R Messé","doi":"10.1161/STROKEAHA.124.050508","DOIUrl":"10.1161/STROKEAHA.124.050508","url":null,"abstract":"<p><strong>Background: </strong>Endovascular thrombectomy (EVT) dramatically improves clinical outcomes, but the final infarct volume (FIV) on magnetic resonance imaging only accounts for a minority of the treatment effect. An imaging biomarker that more strongly correlates with post-EVT functional outcome would be helpful for clinical prognosis and serve as a surrogate outcome measure in trials of EVT-adjuvant therapies. Here, we aimed to validate a novel magnetic resonance imaging-based metric, infarct density, which leverages post-EVT apparent diffusion coefficient as a marker of infarct severity.</p><p><strong>Methods: </strong>A retrospective cohort was derived from a single-center prospective EVT registry. Consecutive patients treated with EVT for anterior circulation large vessel occlusion were included from 2018 to 2019 who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction ≥2b). Magnetic resonance imaging was performed 12 to 48 hours post-EVT and processed via RAPID to quantify FIV using the apparent diffusion coefficient <620 threshold. Lesion volume was also collected using an apparent diffusion coefficient <470 threshold, and infarct density was calculated as: (volume <470/volume <620)×100%. Good outcome was defined as ≤2 on the 90-day modified Rankin Scale. Multivariable logistic regression models quantified the association between clinical/imaging variables and outcome. Receiver operating characteristic analysis quantified model classification performance.</p><p><strong>Results: </strong>Of 319 patients treated with EVT, 272 met inclusion criteria. The mean age was 69±13 years, 41% were female, and 62% achieved a good outcome. After adjusting for clinical and radiographic factors, FIV (adjusted odds ratio, 0.99 per 1 mL [95% CI, 0.98-1.00]; <i>P</i>=0.03) and infarct density (adjusted odds ratio, 0.95 per 1% [95% CI, 0.94-0.97]; <i>P</i><0.001) were both independently inversely associated with good outcome. The final model incorporating both FIV and infarct density achieved excellent classification performance (area under the curve, 0.87 [95% CI, 0.83-0.91]). Removing infarct density from the model diminished its performance (area under the curve, 0.83 [95% CI, 0.78-0.88]; <i>P</i>=0.01).</p><p><strong>Conclusions: </strong>Apparent diffusion coefficient-based infarct density after EVT is independently associated with long-term outcome and provides greater prognostic information than FIV alone. Post-EVT infarct density may be useful in clinical care and as a surrogate outcome measure in trials of EVT-adjuvant therapies.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"926-936"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067992","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":"Global, Regional, and National Burden of Subarachnoid Hemorrhage: Trends From 1990 to 2021 and 20-Year Forecasts.","authors":"Long Gu, Jian Zhou, Lihan Zhang, Chun Li, Kunyang Bao, Fengling Du, Nan Jiang, Jianhua Peng, Yong Jiang","doi":"10.1161/STROKEAHA.124.048950","DOIUrl":"10.1161/STROKEAHA.124.048950","url":null,"abstract":"<p><strong>Background: </strong>Subarachnoid hemorrhage (SAH) is a critical condition that has far-reaching implications for public health systems globally due to its severe consequences and long-term disabilities. This study aims to provide a comprehensive analysis of SAH trends from 1990 to 2021 and project future trends up to 2041, aiding in better understanding and management of its global burden.</p><p><strong>Methods: </strong>We utilized data from the GBD (Global Burden of Disease) 2021 database, using joinpoint regression, frontier, and decomposition analyses to assess changes in SAH burden. Bayesian Age-Period-Cohort modeling was implemented to predict future trends. Our study included populations from 204 countries and territories.</p><p><strong>Results: </strong>From 1990 to 2021, SAH incidence decreased by -1.03% for men and -1.16% for women, while mortality rates declined by -2.56% for men and -2.69% for women. Middle sociodemographic index locations and East Asia experienced substantial declines, particularly among women. However, countries like the Philippines and Turkmenistan showed increasing trends. Population aging and growth significantly contributed to these trends, while epidemiological changes led to reductions in SAH burden. The prediction model forecasts continued decreases in SAH mortality and disability-adjusted life years over the next 20 years, although incidence rates may slightly increase.</p><p><strong>Conclusions: </strong>The global burden of SAH has significantly diminished from 1990 to 2021, with considerable variations across regions, sexes, and countries. Ongoing and future research should prioritize high-risk populations and develop innovative interventions to further decrease SAH incidence and enhance outcomes.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"887-897"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542974","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":"Mechanical Thrombectomy in Prestroke Disability: Data From the Italian Endovascular Stroke Registry.","authors":"Andrea Naldi, Federico D'Agata, Giovanni Pracucci, Valentina Saia, Roberto Cavallo, Davide Castellano, Fabrizio Sallustio, Ilaria Casetta, Enrico Fainardi, Valerio Da Ros, Ilaria Maestrini, Sergio Lucio Vinci, Paolino La Spina, Nicola Limbucci, Patrizia Nencini, Elvis Lafe, Marco Longoni, Sandra Bracco, Rossana Tassi, Stefano Vallone, Guido Bigliardi, Paolo Cerrato, Lucio Castellan, Massimo Del Sette, Roberto Menozzi, Alessandro Pezzini, Stefano Merolla, Stefano Forlivesi, Sergio Nappini, Nicola Davide Loizzo, Andrea Saletti, Cristiano Azzini, Guido Andrea Lazzarotti, Nicola Giannini, Daniele Giuseppe Romano, Rosa Napoletano, Nicola Burdi, Giovanni Boero, Alessio Comai, Elisa Dall'Ora, Nicola Cavasin, Adriana Critelli, Mauro Plebani, Manuel Cappellari, Domenico Sergio Zimatore, Marco Petruzzellis, Francesco Biraschi, Ettore Nicolini, Antioco Sanna, Tiziana Tassinari, Edoardo Puglielli, Alfonsina Casalena, Ivan Gallesio, Delfina Ferrandi, Pietro Filauri, Simona Sacco, Adriana Paladini, Annalisa Rizzo, Michele Besana, Alessia Giossi, Marco Pavia, Paolo Invernizzi, Pietro Amistà, Monia Russo, Marco Filizzolo, Marina Mannino, Gianluca Galvano, Eleonora Lidia Saracco, Mauro Bergui, Salvatore Mangiafico, Danilo Toni","doi":"10.1161/STROKEAHA.124.048997","DOIUrl":"10.1161/STROKEAHA.124.048997","url":null,"abstract":"<p><strong>Background: </strong>The benefits and safety of mechanical thrombectomy (MT) in patients with prestroke disability, classified as modified Rankin Scale (mRS) score of 3 to 4, and anterior circulation stroke remain uncertain. This study aims to evaluate these factors using data from the Italian Registry of Endovascular Treatment in Acute Stroke.</p><p><strong>Methods: </strong>We analyzed data collected between 2015 and 2021, comparing functional outcomes (mRS), symptomatic intracerebral hemorrhage, and recanalization rates (Thrombolysis in Cerebral Infarction) at 90 days post-MT in patients with prestroke mRS score of 3 to 4 versus 0 to 2. A good outcome was defined as no change in the mRS score from baseline. Subgroup analysis was stratified by age.</p><p><strong>Results: </strong>A total of 11.411 (96%) patients with prestroke mRS score of 0 to 2 and 477 (4%) patients with prestroke mRS score of 3 to 4 were included. Compared with patients with a baseline mRS score 0 to 2, those with mRS score 3 to 4 were older (82 versus 75 years; <i>P</i><0.001) and predominantly female (71.7% versus 53%; <i>P</i><0.001). The maintenance of the same mRS score after MT was observed in 100 (23.3%) patients with prestroke mRS score 3 to 4, compared with 2332 (22.1%) patients with mRS score 0 to 2 (<i>P</i>=0.556). Mortality was significantly higher in the mRS score 3 to 4 group (n=159 [37.1%] versus n=1939 [18.4%]; <i>P</i><0.001). Successful recanalization (Thrombolysis in Cerebral Infarction score ≥2b) was lower in the mRS score 3 to 4 group (n=333 [71.6%] versus n=8706 [77.7%]; <i>P</i>=0.002), while no significant differences in symptomatic intracerebral hemorrhage were found. The benefit of MT was maintained in patients aged 80 to 85 and over 85 years with prestroke mRS score 3 to 4, although mortality remained higher.</p><p><strong>Conclusions: </strong>Our data suggest that prestroke disability does not imply less chance of returning to prestroke conditions after MT, even in octogenarians, despite higher mortality and lower recanalization rate. More data are warranted to better understand the benefit of MT in this subgroup of patients.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"850-857"},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573880","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":"Association of Lp(a) With Stroke and Cerebral Injury on MRI: Insights From the HCHS/SOL (Hispanic Community Health Study/Study of Latinos) and Investigation of Neurocognitive Aging MRI (SOL-INCA MRI).","authors":"Akhil Avunoori Chandra, Priscilla Duran Luciano, Katrina Swett, Robert Kaplan, Gregory A Talavera, Melissa Lamar, Wassim Tarraf, Freddie Marquez, Parag H Joshi, Linda Gallo, Daniela Sotres-Alvarez, Morgan Gianola, Martha L Daviglus, Daniel L Labovitz, Hector Gonzalez, Charles DeCarli, Carlos J Rodriguez","doi":"10.1161/STROKEAHA.124.048439","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.048439","url":null,"abstract":"<p><strong>Background: </strong>Lp(a) (lipoprotein[a]) is a risk factor for cardiovascular disease; however, its association with cerebrovascular disease is not as well established.</p><p><strong>Methods: </strong>Data from a population-based cohort of Hispanics/Latinos included 16 333 individuals with baseline Lp(a) levels (nmol/L) and self-reported prevalent stroke or transient ischemic attack (TIA). A subset of 2642 individuals with brain magnetic resonance imaging was also included. Linear and multivariate logistic regression assessed the association of Lp(a) with (1) self-reported stroke or TIA, (2) cerebral injury defined as self-reported stroke or TIA or evidence of a stroke on brain magnetic resonance imaging, (3) white matter hyperintensity volume, and (4) silent brain infarcts. Sampling weights were utilized given the HCHS/SOL (Hispanic Community Health Study/Study of Latinos) complex sample design.</p><p><strong>Results: </strong>Mean age±SE was 41.1±0.3 years, 52.0% female, and median interquartile range (Q₁, Q₃) Lp(a) level of 19.7 (7.3-60.6) nmol/L; brain magnetic resonance imaging subset mean age±SE was 49.9±0.4 years, 56.4% female, and median (interquartile range) Lp(a) level of 21.7 (8.1-62.9) nmol/L. Each unit increase in log-transformed Lp(a) was associated with higher odds of self-reported stroke or TIA (odds ratio, 1.13 [95% CI, 1.01-1.27]; <i>P</i>=0.03). Lp(a) levels in the highest quintile (>77 nmol/L) were significantly associated with higher odds of prevalent stroke or TIA compared with Lp(a) <6 nmol/L (first quintile: odds ratio, 1.74 [95% CI, 1.09-2.77]; <i>P</i>=0.02). The highest proportion of cerebral injury was noted in Q5, while the lowest proportion was noted in Q2. When comparing Lp(a) >77 nmol/L with Lp(a) of 6 to <13 nmol/L (second quintile), a significant association was found between Lp(a) and cerebral injury that persisted after fully adjusted models (odds ratio, 2.03 [95% CI, 1.05-3.93]; <i>P</i>=0.03). Each unit increase in log-Lp(a) was associated with a 0.10 increase in log-white matter hyperintensity (β, 0.10; <i>P</i>=0.005). No significant association was found between Lp(a) and silent brain infarcts.</p><p><strong>Conclusions: </strong>Lp(a) is independently and significantly associated with prevalent stroke/TIA, and white matter hyperintensity, in a large diverse population of Hispanics/Latinos.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754546","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}