Stroke最新文献

{"title":"Oxygen Extraction Fraction on Baseline MRI Predicts Infarction Growth in Successfully Reperfused Patients.","authors":"Mona Asghariahmadabad, Ameera Ismail, Pouya Metanat, Elham Tavakkol, Mersedeh Bahr-Hosseini, Viktor Szeder, Geoffrey P Colby, Jeffrey L Saver, Vivek S Yedavalli, Wade S Smith, Nerissa Ko, Anthony S Kim, Cathra Halabi, Luis E Savastano, David Saloner, Daniel L Cooke, Steven W Hetts, Matthew R Amans, Kazim H Narsinh, S Andrew Josephson, Christopher P Hess, David S Liebeskind, Kambiz Nael","doi":"10.1161/STROKEAHA.125.051270","DOIUrl":"10.1161/STROKEAHA.125.051270","url":null,"abstract":"<p><strong>Background: </strong>In patients with acute ischemic stroke, infarct growth occurs despite successful reperfusion. Oxygen extraction fraction (OEF) has shown promising results in evaluating ischemic tissue viability and can now be quantified from routinely performed dynamic susceptibility contrast perfusion. We aimed to determine the association of OEF alterations within the ischemic tissue on pretreatment magnetic resonance imaging and infarct growth in patients who underwent successful reperfusion.</p><p><strong>Methods: </strong>In this retrospective cohort study from the University of California, Los Angeles, between 2015 and 2020, patients were included if they had anterior circulation large vessel occlusion, achieved successful reperfusion (Thrombolysis in Cerebral Infarction ≥2b), had pretreatment dynamic susceptibility contrast perfusion and posttreatment magnetic resonance imaging within 48 hours from reperfusion. Dynamic susceptibility contrast-derived OEF values were quantified from the segmented ischemic core (apparent diffusion coefficient ≤620×10^-6 mm²/s) and penumbra tissue (time-to-maximum [Tmax] >6 s) on pretreatment magnetic resonance imaging and normalized to contralateral hemisphere (relative oxygen extraction fraction [OEF_r]). Primary outcome was substantial infarct growth ≥10 mL, and secondary outcomes were continuous measures of infarct growth volume and penumbra-to-infarct conversion ratio. The associations between baseline clinical and imaging variables, including OEF_r and outcome measures, were tested by multivariate and regression analysis.</p><p><strong>Results: </strong>Among 89 patients who met inclusion criteria, 33 (37%) patients had infarct growth ≥10 mL. Patients with infarct growth had significantly (<i>P</i><0.0001) lower penumbra-OEF_r values compared with those without infarct growth. There was significant association between penumbra OEF_r and infarct growth (β=-2.9 [95% CI, -5.0 to -0.8]; <i>P</i>=0.007) and similarly for penumbra-to-infarct conversion ratio (β=-10.4 [95% CI, -19.6 to -1.2]; <i>P</i>=0.028).</p><p><strong>Conclusions: </strong>Our results showed penumbra-OEF_r is a promising imaging biomarker for predicting infarct growth in acute ischemic stroke following successful reperfusion. Although elevation of penumbra-OEF_r is protective, patients with lower penumbra-OEF_r values sustained further ischemic injury and infarct growth.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"3024-3033"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776151","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":"Recurrent Ischemic Stroke and Vaginal Estradiol in Women With Prior Ischemic Stroke: A Nationwide Nested Case-Control Study.","authors":"Kimia Ghias Haddadan, Camilla Eckert-Lind, Amani Meaidi, Niklas Dyrby Johansen, Mats Christian Højbjerg Lassen, Kristoffer Grundtvig Skaarup, Jens Ulrik Stæhr Jensen, Christian Torp-Pedersen, Gunnar Gislason, Tor Biering-Sørensen, Daniel Modin","doi":"10.1161/STROKEAHA.125.050986","DOIUrl":"10.1161/STROKEAHA.125.050986","url":null,"abstract":"<p><strong>Background: </strong>Systemic estrogen replacement therapy is contraindicated in women with a history of ischemic stroke due to the risk of stroke recurrence. There are currently no published data available describing the association between vaginal estrogen use and recurrent ischemic stroke in women with a history of ischemic stroke. This study aimed to examine the association between vaginal estradiol tablet use and the rate of recurrent ischemic stroke in women with a history of ischemic stroke.</p><p><strong>Methods: </strong>Using nationwide registers, we conducted a nationwide nested case-control study including all women aged ≥45 years who developed a first ischemic stroke between January 1, 2008, and December 31, 2017, with no history of vaginal estrogen use before stroke diagnosis. Using incidence density sampling, we matched cases with recurrent ischemic stroke 1:1 to controls based on birth year. The index date was defined as the date of recurrent ischemic stroke diagnosis. Exposure to vaginal estradiol tablets was assessed using prescription data and categorized as current use (0-3 months before index), recent use (3-24 months before index), and past use (>24 months before index).</p><p><strong>Results: </strong>From a cohort of 56 642 women with a first-time stroke, we identified 3353 recurrent cases, which were matched by birth year with 3353 controls. The median age was 75 (SD, 12) years. When adjusted for comorbidity, medications, income, and education, exposure to vaginal estradiol tablets was not associated with an increased rate of recurrent ischemic stroke (current use: adjusted hazard ratio, 0.79 [95% CI, 0.52-1.20]; <i>P</i>=0.27; recent use: adjusted hazard ratio, 1.09 [95% CI, 0.73-1.63]; <i>P</i>=0.67; and past use: adjusted hazard ratio, 1.48 [95% CI, 0.95-2.30]; <i>P</i>=0.08).</p><p><strong>Conclusions: </strong>In this nested case-control study, use of vaginal estradiol tablets was not associated with an increased rate of recurrent ischemic stroke in women with a history of ischemic stroke. Based on our findings, vaginal estradiol tablets are not likely to increase the risk of recurrent ischemic stroke in women with prior stroke.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2888-2894"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969752","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":"Influence of Endothelial Progenitor Cells on Outcomes in Cerebrovascular Disease.","authors":"Juan Francisco García Granado, Ayoze Nauzet González Hernández, Francisco Javier Rodríguez Esparragón, Jesús María González Martín, Sara Estefanía Cazorla Rivero, Almudena Raposo Usero","doi":"10.1161/STROKEAHA.125.052464","DOIUrl":"10.1161/STROKEAHA.125.052464","url":null,"abstract":"<p><strong>Background: </strong>Endothelial progenitor cells (EPCs) contribute to vascular repair and may play a critical role in recovery following cerebrovascular disease. This study aimed to evaluate the association between circulating EPC levels and clinical outcomes in patients with ischemic stroke, hemorrhagic stroke, and transient ischemic attack.</p><p><strong>Methods: </strong>We conducted a prospective observational study at Hospital Universitario de Gran Canaria Doctor Negrín (Spain) between September 2023 and June 2024. We evaluated the association between circulating EPC levels and clinical outcomes in 126 patients with cerebrovascular disease (mean age, 70.4±12.9 years; 58.7% male), recruited within 48 hours of symptom onset. EPCs were quantified at admission (<48 hours), day 7, and 12 weeks. The primary outcome was favorable functional status at 3 months (modified Rankin Scale score, 0-2). Secondary outcomes included stroke severity (National Institutes of Health Stroke Scale), hospital stay, and mortality.</p><p><strong>Results: </strong>Higher EPC levels on day 7 were independently associated with favorable functional outcome at 3 months (odds ratio, 0.769 [95% CI, 0.605-0.977]; <i>P</i>=0.032). Significant negative correlations were found between EPCs at day 7 and stroke severity at admission (r=-0.205; <i>P</i>=0.034) and length of hospital stay (r=-0.253; <i>P</i>=0.008). EPCs at day 7 were significantly lower in patients who died during follow-up (mean rank, 44.40 versus 56.34; <i>P</i>=0.004). Subgroup analysis in patients with ischemic stroke confirmed that day-7 EPC levels remained an independent predictor of good outcome (odds ratio, 0.743 [95% CI, 0.570-0.968]; <i>P</i>=0.028), shorter hospitalization (r=-0.278; <i>P</i>=0.006), and survival (U=552.000; <i>P</i>=0.043).</p><p><strong>Conclusions: </strong>EPC levels at day 7 may serve as a prognostic biomarker for recovery and mortality in cerebrovascular disease. These findings suggest a potential therapeutic window targeting endothelial repair mechanisms.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"2914-2927"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790114","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":"Intracranial Involvement of Giant Cell Arteritis Mimicking Intracranial Atherosclerotic Disease.","authors":"Gabriel Hooper, Yoji Hoshina, Yarden Bornovski, Aaron Shoskes","doi":"10.1161/STROKEAHA.125.052026","DOIUrl":"10.1161/STROKEAHA.125.052026","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 10","pages":"e298-e302"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12462886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125970","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":"Targeting Innate Immune Memory for Stroke Prevention and Prognosis.","authors":"Aurora Semerano, Juan F Arenillas, Louise D McCullough, María Ángeles Moro","doi":"10.1161/STROKEAHA.125.049900","DOIUrl":"10.1161/STROKEAHA.125.049900","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 10","pages":"3095-3098"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12462885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126039","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":"October 2025 <i>Stroke</i> Highlights.","authors":"José Rafael Romero, Nicole B Sur","doi":"10.1161/STROKEAHA.125.053298","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.053298","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 10","pages":"2835"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126010","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":"Vessel Wall Imaging of a Possible Intracranial Vertebral Artery Web.","authors":"Wenjie Huang, Kangjie Xu, Haiqiang Jin","doi":"10.1161/STROKEAHA.125.052707","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.052707","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 10","pages":"e238-e239"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126026","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":"Rupture of Dural Arteriovenous Fistula During 3-Dimensional DSA.","authors":"Lunxin Liu, Jian Wang, Fayun Hu, Li He, Chaohua Wang","doi":"10.1161/STROKEAHA.125.052624","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.052624","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 10","pages":"e236-e237"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126030","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":"Proatlantal Intersegmental Artery and Anterior-to-Posterior Strokes Associated With Vulnerable Plaque.","authors":"Jian Wang, Hongbo Zheng, Li He, Fayun Hu","doi":"10.1161/STROKEAHA.125.051880","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.051880","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 10","pages":"e234-e235"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126054","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":"Scientific Writing in the Era of Large Language Models: A Computational Analysis of AI- Versus Human-Created Content.","authors":"Rohan Khera, Aline F Pedroso, Vipina K Keloth, Hua Xu, Gisele S Silva, Lee H Schwamm","doi":"10.1161/STROKEAHA.125.051913","DOIUrl":"10.1161/STROKEAHA.125.051913","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) are artificial intelligence (AI) tools that can generate human expert-like content and be used to accelerate the synthesis of scientific literature, but they can spread misinformation by producing misleading content. This study sought to characterize distinguishing linguistic features in differentiating AI-generated from human-authored scientific text and evaluate the performance of AI detection tools for this task.</p><p><strong>Methods: </strong>We conducted a computational synthesis of 34 essays on cerebrovascular topics (12 generated by large language models [Generative Pre-trained Transformer 4, Generative Pre-trained Transformer 3.5, Llama-2, and Bard] and 22 by human scientists). Each essay was rated as AI-generated or human-authored by up to 38 members of the <i>Stroke</i> editorial board. We compared the collective performance of experts versus GPTZero, a widely used online AI detection tool. We extracted and compared linguistic features spanning syntax (word count, complexity, and so on), semantics (polarity), readability (Flesch scores), grade level (Flesch-Kincaid), and language perplexity (or predictability) to characterize linguistic differences between AI-generated versus human-written content.</p><p><strong>Results: </strong>Over 50% of the stroke experts who reviewed the study essays correctly identified 10 (83.3%) of AI-generated essays as AI, whereas they misclassified 7 (31.8%) of human-written essays as AI. GPTZero accurately classified 12 (100%) of AI-generated and 21 (95.5%) of human-written essays. However, the tool relied on only a few key sentences for classification. Compared with human essays, AI-generated content had lower word count and complexity, exhibited significantly lower perplexity (median, 15.0 versus 7.2; <i>P</i><0.001), lower readability scores (Flesch median, 42.1 versus 26.4; <i>P</i><0.001), and higher grade level (Flesch-Kincaid median, 13.1 versus 14.8; <i>P</i>=0.006).</p><p><strong>Conclusions: </strong>Large language models generate scientific content with measurable differences versus human-written text but represent features that are not consistently identifiable even by human experts and require complex AI detection tools. Given the challenges that experts face in distinguishing AI from human content, technology-assisted tools are essential wherever human provenance is essential to safeguard the integrity of scientific communication.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"3078-3083"},"PeriodicalIF":8.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856359","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}