Stroke最新文献

{"title":"Preparing for (and Making the Most of) Your Next Scientific Conference.","authors":"Yohane Gadama, Hannah Simba, Hatice Ozkan, Eitzaz Sadiq","doi":"10.1161/STROKEAHA.124.045905","DOIUrl":"10.1161/STROKEAHA.124.045905","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e55-e57"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393484","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":"Menstruation: An Important Indicator for Assessing Stroke Risk and Its Outcomes.","authors":"Alison Seitz, Ami P Raval","doi":"10.1161/STROKEAHA.124.048869","DOIUrl":"10.1161/STROKEAHA.124.048869","url":null,"abstract":"<p><p>In recent years, stroke incidence in older adults has declined strikingly, but stroke in younger women has become more common. Abnormalities of menstruation, the shedding of the uterine lining at the beginning of each menstrual cycle, may offer clues about stroke risk in young and midlife women. Endometrial and structural uterine abnormalities are associated with anemia and may be associated with hypercoagulability, possibly increasing stroke risk. Patient factors that influence both menstruation and stroke risk include coagulopathies, polycystic ovarian syndrome, endometriosis, migraine, and other systemic disorders, in addition to menopause. Environmental and iatrogenic factors that influence both menstruation and stroke risk include hormonal contraceptives, nicotine, xenoestrogens, phytoestrogens, oophorectomy, and hysterectomy. Importantly, secondary stroke prevention can affect menstruation. Our current review presents literature supporting the idea that abnormal menstruation may indicate elevated stroke risk in premenopausal women.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"533-542"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589903","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":"Correction to: Blood Pressure Variability Predicts Poor In-Hospital Outcome in Spontaneous Intracerebral Hemorrhage.","authors":"","doi":"10.1161/STR.0000000000000485","DOIUrl":"https://doi.org/10.1161/STR.0000000000000485","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 2","pages":"e100"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053612","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":"February 2025 <i>Stroke</i> Highlights.","authors":"Nicole B Sur","doi":"10.1161/STROKEAHA.124.050462","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050462","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 2","pages":"255"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053654","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":"Polka Dot Intracerebral Hemorrhage in Leukemia.","authors":"Alexander D Rebchuk, Ashutosh Singhal, Mandeep S Tamber","doi":"10.1161/STROKEAHA.124.049631","DOIUrl":"10.1161/STROKEAHA.124.049631","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e49-e50"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829830","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":"Understanding Noninferiority Trials: What Stroke Specialists Should Know.","authors":"Fabiano Cavalcante, Kilian M Treurniet, Manon Kappelhof, Johannes Kaesmacher, Hester F Lingsma, Jeffrey L Saver, Jan Gralla, Urs Fischer, Charles B Majoie, Yvo B W E M Roos","doi":"10.1161/STROKEAHA.124.048024","DOIUrl":"10.1161/STROKEAHA.124.048024","url":null,"abstract":"<p><p>Noninferiority trials aim to prove that the efficacy, defined in terms of a key clinical outcome, of a new treatment is not meaningfully worse than that of an established active control. Noninferiority trials are important when other aspects of care can be improved, such as convenience, toxicity, costs, and safety (nonefficacy benefits). While the motivation for a noninferiority trial is straightforward, the design, execution, and interpretation of these trials is not a trivial task. Several safeguards that protect superiority trials from incorrect conclusions do not apply or even work in reverse for noninferiority trials. This review aims to provide stroke clinicians and researchers with a general overview of noninferiority trials and a deeper understanding of 10 pitfalls they should consider when designing and interpreting such trials.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"543-552"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915684","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":"Effect of Proximal Blood Flow Arrest During Endovascular Thrombectomy (ProFATE): A Multicenter, Blinded-End Point, Randomized Clinical Trial.","authors":"Permesh Singh Dhillon, Waleed Butt, Anna Podlasek, Pervinder Bhogal, Jeremy Lynch, Thomas C Booth, Norman McConachie, Robert Lenthall, Sujit Nair, Luqman Malik, Tony Goddard, Vinicius Carraro do Nascimento, Emma Barrett, Ketan Jethwa, Kailash Krishnan, Robert A Dineen, Timothy J England","doi":"10.1161/STROKEAHA.124.049715","DOIUrl":"10.1161/STROKEAHA.124.049715","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The effect of temporary blood flow arrest during endovascular thrombectomy for acute ischemic stroke is uncertain due to the lack of evidence from randomized controlled trials. We aimed to investigate whether temporary blood flow arrest during endovascular thrombectomy using a balloon guide catheter improves intracranial vessel recanalization compared with nonflow arrest.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The ProFATE trial (Proximal Blood Flow Arrest During Endovascular Thrombectomy) was a multicenter, randomized, participant- and outcome-blinded trial at 4 thrombectomy centers in the United Kingdom. Adults with acute ischemic stroke due to anterior circulation large vessel occlusion were randomly assigned (1:1) by a central, Web-based program with a minimization algorithm to undergo thrombectomy with temporary proximal blood flow arrest or nonflow arrest during each attempt. The primary outcome was the proportion of participants achieving near-complete/complete vessel recanalization (expanded Thrombolysis in Cerebral Infarction score of 2c or 3) at the end of the thrombectomy procedure, adjudicated by a blinded independent imaging core laboratory. Analyses were performed on the intention-to-treat population, adjusted for age, IV thrombolysis, onset-to-randomization time, Alberta Stroke Program Early CT Score, occlusion site, randomization site, and National Institutes of Health Stroke Scale.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Between October 10, 2021, and June 27, 2023, we recruited 134 participants, of whom 131 participants (mean age, 75 years; 62 [47%] women and 69 [53%] men) were included in the final analysis. Sixty-six participants were allocated to the temporary blood flow arrest group and 65 to the nonflow arrest group. The proportion of participants with an expanded Thrombolysis in Cerebral Infarction 2c/3 score at the end of the endovascular procedure was 74.4% (49/66) in the flow arrest group and 70.8% (46/65) in the nonflow arrest group (adjusted odds ratio, 1.07 [95% CI, 0.45-2.55]; &lt;i&gt;P&lt;/i&gt;=0.88). Among the prespecified secondary efficacy outcomes, a lower rate of emboli to a new vascular territory occurred in the blood flow arrest group compared with the nonflow arrest group (1.5% versus 12.3%; adjusted odds ratio, =0.04 [95% CI, 0.01-0.53]; &lt;i&gt;P&lt;/i&gt;=0.014) and a higher rate of complete recanalization (expanded Thrombolysis in Cerebral Infarction score, 3) after the first attempt in the flow arrest group versus the nonflow arrest group (33.0% versus 15.3%; adjusted odds ratio, =3.80 [95% CI, 1.40-10.01]; &lt;i&gt;P&lt;/i&gt;=0.007). No between-group differences were identified for the remaining procedural or clinical efficacy (modified Rankin Scale at 90 days) or safety outcomes (worsening of the stroke severity at 24 hours, adverse events, symptomatic intracranial hemorrhage, or mortality).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Among patients presenting with anterior circulation large vessel occlusion acute ischemic s","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"371-379"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855352","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":"Natural Evolution of Incomplete Reperfusion in Patients Following Endovascular Therapy After Ischemic Stroke.","authors":"Adnan Mujanovic, Daniel Windecker, Petra Cimflova, Thomas R Meinel, David J Seiffge, Elias Auer, Grégoire Boulouis, Marcel Arnold, Bettina L Serrallach, Roman Rohner, Kevin Janot, Tomas Dobrocky, Michael D Hill, Mayank Goyal, Eike I Piechowiak, Jan Gralla, Urs Fischer, Johannes Kaesmacher","doi":"10.1161/STROKEAHA.124.049641","DOIUrl":"10.1161/STROKEAHA.124.049641","url":null,"abstract":"<p><strong>Background: </strong>A third of endovascularly treated patients with stroke experience incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction [eTICI] <3), and the natural evolution of this incomplete reperfusion remains unknown. We systematically reviewed the literature and performed a meta-analysis on the natural evolution of incomplete reperfusion after endovascular therapy.</p><p><strong>Methods: </strong>A systematic review of MEDLINE, Embase, and PubMed up until March 1, 2024, using a predefined strategy. Only full-text English-written articles reporting rates of either favorable (ie, delayed reperfusion (DR) or no new infarct) or unfavorable progression (ie, persistent perfusion deficit or new infarct) of incompletely reperfused tissue were included. The primary outcome was the rate of DR and its association with functional independence (modified Rankin Scale score, 0-2) at 90 days postintervention. Pooled odds ratios with 95% CIs were calculated using a random-effects model.</p><p><strong>Results: </strong>Six studies involving 950 patients (50.7% female; median age, 71 years; interquartile range, 60-79) were included. Four studies assessed the evolution of incomplete reperfusion on magnetic resonance imaging perfusion imaging, while 2 studies used diffusion-weighted imaging and noncontrast computed tomography imaging, where new infarct was used to denote unfavorable progression. Five studies defined incomplete reperfusion as eTICI 2b50 or 2c. DR occurred in 41% (interquartile range, 33%-51%) of cases 24 hours postintervention. Achieving DR was associated with a higher likelihood of functional independence at 90 days (odds ratio, 2.5 [95% CI, 1.9-3.4]).</p><p><strong>Conclusions: </strong>Nearly half of eTICI <3 patients achieve DR, leading to favorable clinical outcomes. This subgroup may derive limited or potentially harmful effects from pursuing additional reperfusion strategies (eg, intra-arterial lytics or secondary thrombectomy). Accurately predicting the evolution of incomplete reperfusion could optimize patient selection for adjunctive reperfusion strategies at the end of an intervention.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifiers: NCT05499832.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"447-455"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682868","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":"Machine Learning Predictions of Recovery in Bilingual Poststroke Aphasia: Aligning Insights With Clinical Evidence.","authors":"Manuel Jose Marte, Erin Carpenter, Michael Scimeca, Marissa Russell-Meill, Claudia Peñaloza, Uli Grasemann, Risto Miikkulainen, Swathi Kiran","doi":"10.1161/STROKEAHA.124.047867","DOIUrl":"10.1161/STROKEAHA.124.047867","url":null,"abstract":"<p><strong>Background: </strong>Predicting treated language improvement (TLI) and transfer to the untreated language (cross-language generalization, CLG) after speech-language therapy in bilingual individuals with poststroke aphasia is crucial for personalized treatment planning. This study evaluated machine learning models to predict TLI and CLG and identified the key predictive features (eg, patient severity, demographics, and treatment variables) aligning with clinical evidence.</p><p><strong>Methods: </strong>Forty-eight Spanish-English bilingual individuals with poststroke aphasia received 20 sessions of semantic feature-based naming treatment in either their first or second language. Comprehensive language, cognitive, and background bilingual experience assessments were administered pre- and post-treatment. Sixteen curated features spanning demographics, language abilities, cognition, and bilingual experience were used as inputs to 6 machine learning algorithms to predict treatment responders versus nonresponders and CLG vs no CLG.</p><p><strong>Results: </strong>The top 2 machine learning models achieved F1 scores of 0.767±0.153 for TLI and 0.790±0.172 for CLG. Interpretability analyses revealed that aphasia severity in the trained language, education, and cognitive performance were key predictors of TLI. Aphasia severity in the untreated language and cognitive performance emerged as influential features of CLG. These aligned with expectations based on prior literature.</p><p><strong>Conclusions: </strong>For the first time, machine learning models reveal that factors such as patient severity and demographics predict TLI and CLG after therapy in Spanish-English bilingual individuals with poststroke aphasia. Consideration of both treated and untreated language severity, as well as cognitive assessment performance, when forecasting treatment outcomes in an underserved population such Spanish-English stroke survivors, can meaningfully impact their short-term and long-term clinical care.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"494-504"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915581","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":"Correction to: Sonic Hedgehog Signaling Pathway Mediates Cerebrolysin-Improved Neurological Function After Stroke.","authors":"","doi":"10.1161/STR.0000000000000484","DOIUrl":"https://doi.org/10.1161/STR.0000000000000484","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 2","pages":"e99"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053649","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}