Stroke最新文献

{"title":"Delay in Carotid Web Diagnosis Remains Common and Associated With an Increased Risk of Stroke Recurrence.","authors":"Pauline Poirette, Nicolas Chausson, Jean Papaxanthos, Maeva Kyheng, Julien Labreuche, Didier Smadja, Nicolas Gaillard, Aissatou Signate, Julien Joux, Michael Obadia, Pauline Renou, Aurélie Boyer, Jean-Philippe Desilles, Marion Boulanger, Emmanuelle Robinet-Borgomano, François Zhu, Sebastien Richard, Cédric Turpinat, Anne Landais, Hubert Desal, Benoit Guillon, Alain Viguier, Matthias Lamy, Christian Denier, Alderic Lecluse, Cecile Malrain, Aïcha Lyoubi, Quentin Holay, Quentin Bourgeois, Dhouha Chaari, Stephane Olindo, Gaultier Marnat","doi":"10.1161/STROKEAHA.124.050238","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050238","url":null,"abstract":"<p><strong>Background: </strong>Carotid web is a rare and likely underrecognized cause of ischemic stroke, particularly in young patients. Given the high risk of recurrence, diagnostic delays may have serious consequences. This study aimed to assess the incidence and impact of delayed carotid web diagnosis after a first ischemic event.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using data from the French ongoing multicenter prospective CAROWEB (Carotid Web registry). We included patients with a first-ever ischemic stroke or transient ischemic attack in the anterior circulation, attributed to an ipsilateral carotid web with no other identifiable cause, between September 2013 and April 2023. Patients with missing data on the date of the first ischemic event or carotid web diagnosis, or with prior stroke history, were excluded. Participants were categorized into early diagnosis (≤30 days) and delayed diagnosis (>30 days) groups. Factors associated with diagnostic delay were investigated through univariable and multivariable analyses. Stroke recurrence was evaluated using Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>Of 280 patients in the registry, 225 met the inclusion criteria. A delayed diagnosis occurred in 57 patients (25.3%). Independent predictors of diagnostic delay included lower initial National Institutes of Health Stroke Scale score (odds ratio, 0.92; <i>P</i>=0.002), stroke occurring before 2019 (odds ratio, 0.19; <i>P</i><0.001), and the absence of computed tomography angiography in the initial work-up (odds ratio, 0.20; <i>P</i><0.001). Stroke recurrence was significantly higher in the delayed group (3.6 versus 0.38 per 100 patient-years). After adjusting for the National Institutes of Health Stroke Scale and year of stroke onset, delayed diagnosis was associated with a 5-fold increased risk of recurrence (aHR, 5.02; <i>P</i>=0.014).</p><p><strong>Conclusions: </strong>Delayed carotid web diagnosis remains common, especially in minor strokes, in the absence of early computed tomography angiography, and in events before 2019. Such delays are associated with a significantly increased risk of stroke recurrence, highlighting the need for early vascular imaging in ischemic stroke evaluation.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04431609.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042570","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 Exposure to Ambient Particulate Matter and Structural Brain Changes in Older Adults.","authors":"Giulia Grande, Bolin Wu, Jing Wu, Grégoria Kalpouzos, Erika J Laukka, Tom Bellander, Debora Rizzuto","doi":"10.1161/STROKEAHA.124.048096","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.048096","url":null,"abstract":"<p><strong>Background: </strong>Accumulating evidence links air pollution exposure to late-life cognitive deterioration. Whether air pollution alters brain structure remains poorly understood. Thus, we aimed to quantify the association between long-term exposure to particulate matter ≤2.5 µm and ≤10 µm (PM_2.5 and PM₁₀, respectively) and late-life brain structural changes.</p><p><strong>Methods: </strong>In the Swedish National Study on Aging and Care in Kungsholmen, Stockholm, 555 participants free from dementia underwent brain magnetic resonance imaging (MRI) scans at baseline and after 6 years (cohorts <78 years) or after 3 and 6 years (cohorts aged ≥78 years). After the exclusion of participants with neurological conditions (including previous stroke) and suboptimal MRI quality, we had 457 participants with available repeated MRI examinations, where total brain tissue volume, ventricles, hippocampus, and white matter hyperintensities volumes were assessed. PM_2.5 and PM₁₀ have been assessed since 1990 using dispersion models at residential addresses. Brain volumes have been standardized using baseline mean and SD. Long-term exposure to PM_2.5 and PM₁₀ in relation to the baseline and longitudinal brain MRI volumes were tested through multiadjusted (age, sex, educational level, smoking, socioeconomic status, and neighborhood household mean income) linear regression models.</p><p><strong>Results: </strong>At study entry, the mean (SD) age of the participants was 70 (SD, 8.9) years and 41% were males. Individuals who before baseline had been exposed to levels of PM_2.5 or PM₁₀ above the median (8.5 and 14.9 μg/m³, respectively) had smaller total brain tissue volume (β, -0.20 [95% CI, -0.33 to -0.06] and β, -0.14 [95% CI, -0.28 to -0.01], respectively) at baseline than those with lower PM_2.5 and PM₁₀ levels. Participants exposed during the follow-up to PM_2.5>8.7 μg/m³ had on average an annual shrinkage of total brain tissue volume of 0.22 (95% CI, -0.43 to -0.01) and an annual increase of 0.25 (95% CI, 0.07-0.43) of the white matter hyperintensities as compared with participants exposed to PM_2.5<8.7 μg/m³. No association was detected between PM₁₀ and an annual rate of change in brain MRI volumes.</p><p><strong>Conclusions: </strong>Long-term exposure to comparatively low levels of PM_2.5 was associated with a greater load of structural brain changes, encompassing brain atrophy and vascular pathology. These findings, in a dementia- and cerebrovascular disease-free sample, underscore the importance of addressing air pollution as a modifiable risk factor for late-life cognitive decline, and highlight the need for targeted interventions to prevent its detrimental effects on brain integrity.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015019","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":"Sex-Related Differences in Endovascular Treatment Outcomes for Acute Large Infarcts: The ANGEL-ASPECT Subanalysis.","authors":"Dapeng Sun, Xin Guo, Li Ling, Liwen Jiao, Thanh N Nguyen, Mohamad Abdalkader, Yuesong Pan, Mengxing Wang, Gang Luo, Baixue Jia, Xu Tong, Ning Ma, Feng Gao, Dapeng Mo, Raynald, Xiaochuan Huo, Zhongrong Miao","doi":"10.1161/STROKEAHA.124.050025","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050025","url":null,"abstract":"<p><strong>Background: </strong>The outcomes of endovascular therapy (EVT) across sexes for large infarcts remain unclear. This study aimed to evaluate the impact of sex on the outcomes of EVT or medical management for patients with large infarcts.</p><p><strong>Methods: </strong>In this secondary analysis of the ANGEL-ASPECT (Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients With a Large Infarct Core) randomized controlled trial conducted at 46 stroke centers across China between October 2, 2020, and May 18, 2022, we compared baseline characteristics and clinical outcomes between males and females, and each cohort further divided into EVT and medical management groups. The primary outcome was the 90-day modified Rankin Scale score distribution. Safety outcomes included symptomatic intracranial hemorrhage within 48 hours and mortality within 90 days.</p><p><strong>Results: </strong>There were 176 of 455 patients enrolled in the ANGEL-ASPECT trial who were female. There were 54.0% (95/176) of females and 48.4% (135/279) of males who underwent EVT. The treatment effect of EVT did not vary in both sexes with large infarcts (all <i>P</i>>0.05 for interaction). Compared with medical management, EVT improved 90-day functional outcomes for both males (3 [2-5] versus 4 [3-5]; common odds ratio, 1.94 [95% CI, 1.27-2.97]; <i>P</i>=0.002) and females (4 [3-6] versus 5 [4-6]; common odds ratio, 2.50 [95% CI, 1.41-4.45]; <i>P</i>=0.002). The symptomatic intracranial hemorrhage rate was not different in both treatment groups across both sexes (males, 5.2% versus 2.8%; odds ratio, 2.05 [95% CI, 0.56-7.50]; <i>P</i>=0.278; females, 7.4% versus 2.5%; odds ratio, 2.89 [95% CI, 0.55-15.14]; <i>P</i>=0.210).</p><p><strong>Conclusions: </strong>In patients with large ischemic core, the treatment effect of EVT did not differ between females and males, with better outcomes with EVT versus medical management, without an increased risk of symptomatic intracranial hemorrhage. These findings emphasize the need for equal attention and care for both sexes with large infarcts in clinical practice.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04551664.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049524","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":"Exposure to Multiple Metals and Cerebral White Matter Hyperintensity in Chinese Population: A Cross-Sectional Study.","authors":"Jianing Wang, Hao-Long Zeng, Ying Hui, Feipeng Cui, Yudiyang Ma, Linxi Tang, Meiqi Xing, Lei Zheng, Ning Chen, Xinru Zhao, Dankang Li, Run Liu, Shuohua Chen, Liming Cheng, Shouling Wu, Zhenchang Wang, Yaohua Tian","doi":"10.1161/STROKEAHA.124.050048","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050048","url":null,"abstract":"<p><strong>Background: </strong>Evidence about the impact of multiple metal exposure on brain neuroimaging metrics remains limited. We aim to investigate the effects of single and mixed metal exposure on white matter hyperintensities (WMHs).</p><p><strong>Methods: </strong>This cross-sectional study included 1183 subjects without stroke history from the META-KLS (Multi-modality Medical Imaging Study Based on Kailuan Study), which is an existing prospective cohort in Tangshan, China. Plasma metal levels, including Mg, Ca, V, Mn, Co, Ni, Cu, Zn, As, Se, Rb, Cs, Tl, Pb, and Cd, were measured using an inductively coupled plasma mass spectrometer. Ordinal and binary logistic regression models were used to examine the effects of metal exposure on the WMH burden, deep white matter hyperintensity, and periventricular white matter hyperintensity. All metal concentrations were naturally log-transformed to reduce skewness and were analyzed as both continuous and tertile forms. Weighted quantile sum regression, quantile-based g-computation model, and Bayesian Kernel Machine Regression were used in the metal mixture analysis.</p><p><strong>Results: </strong>Compared with the first tertile, the adjusted odds ratios and 95% CIs for the WMH burden in the third tertile were 1.57 (1.05-2.34) for As, 2.01 (1.28-3.18) for Cu, 1.68 (1.14-2.50) for V, 1.61 (1.07-2.44) for Cs, and 1.56 (1.04-2.34) for Tl (all <i>P</i> for trend<0.05). Additionally, Pb, Se, and Mg showed significant positive associations with WMH burden exclusively in continuous analysis, with odds ratios of 1.27 (1.02-1.56) for Pb, 1.32 (1.07-1.61) for Se, and 1.27 (1.04-1.55) for Mg for per interquartile range increase in Ln-transformed metal concentrations. The weighted quantile sum index revealed a significant positive correlation with WMH burden risk (each interquartile range increment in the weighted quantile sum index was associated with 60% higher odds for WMH burden [95% CI, 1.09-2.34]). The primary contributors to the weighted quantile sum index were As (39.4%), followed by Pb (12.5%) and Cu (11.3%). The bivariate exposure-response relationships suggested potential interactions between As and Cu, as well as As and Co.</p><p><strong>Conclusions: </strong>There were positive associations between individual exposures to As, Pb, Cu, V, Se, Cs, Tl, and Mg, and mixed metal exposure with WMH burden among the Chinese population, strengthening the evidence of detrimental effects of specific metals on brain health.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986522","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":"Individualized MRI-Based Stroke Prediction Score Using Plaque Vulnerability for Symptomatic Carotid Artery Disease Patients (IMPROVE).","authors":"Kelly P H Nies, Luc J M Smits, Sander M J van Kuijk, Akram A Hosseini, Dianne H K van Dam-Nolen, Robert M Kwee, Yoshitaka Kurosaki, Iris Rupert, Paul J Nederkoorn, Pim A de Jong, Daniel Bos, Sen Yamagata, Dorothee P Auer, Andreas Schindler, Tobias Saam, Robert J van Oostenbrugge, M Eline Kooi","doi":"10.1161/STROKEAHA.124.050020","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050020","url":null,"abstract":"<p><strong>Background: </strong>In symptomatic carotid stenosis, treatment decisions are currently primarily based on stenosis degree. We developed a clinical prediction model (Individualized Magnetic Resonance Imaging-Based Stroke Prediction Score Using Plaque Vulnerability for Patients With Symptomatic Carotid Artery Disease [IMPROVE]) incorporating the strong predictor, intraplaque hemorrhage on magnetic resonance imaging, stenosis degree, and risk factors to identify patients with high stroke risk.</p><p><strong>Methods: </strong>IMPROVE was developed on data from 5 cohorts of 760 patients with symptomatic carotid disease on optimal medical treatment. Inclusion criteria included a recent transient ischemic attack/stroke (<6 months), magnetic resonance imaging-based information on intraplaque hemorrhage, no atrial fibrillation, and no immediate revascularization. IMPROVE was based on Cox regression using 5 expert-selected predictors and converted to 3-year ipsilateral ischemic stroke risk after internal validation. IMPROVE-based stratification was compared with care-as-usual using illustrative cutoffs: high risk was defined in IMPROVE as ≥ median 3-year IMPROVE risk, whereas in care-as-usual, it was ≥50% carotid stenosis.</p><p><strong>Results: </strong>Sixty-five ipsilateral ischemic strokes occurred during a median follow-up of 1.2 years (interquartile range, 0.5-4.1). The IMPROVE model includes 5 predictors (hazard ratio [95% CI]: degree of stenosis [<50%: reference, 50%-69%: 4.54 (2.46-8.38), 70%-99% stenosis: 7.42 (3.45-15.95)]), presence of intraplaque hemorrhage [5.61 (2.92-10.77)], classification of last event [ocular: reference, cerebral: 3.72 (1.11-12.52)], male sex [1.26 (0.64-2.48)], and age [1.14 (0.84-1.55)] per 10-year increase). Internal validation revealed good accuracy (C statistic, 0.82 [95% CI, 0.77-0.87]) and no evidence of miscalibration (calibration slope, 0.93). Sensitivity for the illustrative IMPROVE cutoff was 92.6% (90.7-94.5) versus 80.6% (77.8-83.4) for care-as-usual. Specificity was 54.2% (50.7-57.8) for IMPROVE versus 52.9% (49.3-56.4) for care-as-usual. Patients stratified by IMPROVE as high risk had a higher incidence of ipsilateral ischemic stroke (24.0%) compared with the care-as-usual classification (20.7%). Among patients classified as lower-risk by IMPROVE and care-as-usual, 2.1% and 5.3%, respectively, experienced an ipsilateral ischemic stroke during follow-up.</p><p><strong>Conclusions: </strong>Using the presence of intraplaque hemorrhage on magnetic resonance imaging and 4 conventional parameters, the IMPROVE model provides accurate individual stroke risk estimates, which may facilitate stratification for revascularization after external validation.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032383","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 Outcomes of Vagus Nerve Stimulation Paired With Upper Extremity Rehabilitation After Stroke.","authors":"Teresa J Kimberley, Steven C Cramer, Steven L Wolf, Charles Liu, Perman Gochyyev, Jesse Dawson","doi":"10.1161/STROKEAHA.124.050479","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050479","url":null,"abstract":"<p><strong>Background: </strong>Persistent upper extremity (UE) impairment is common after stroke. Durable treatment benefits for chronic ischemic stroke are needed. The purpose of this report is to determine the long-term effects of vagus nerve stimulation paired with rehabilitation on impairment, activity, and participation in people with UE impairment after ischemic stroke.</p><p><strong>Methods: </strong>This is a post hoc analysis of data from the VNS-REHAB (A Pivotal Randomized Study Assessing Vagus Nerve Stimulation [VNS] During Rehabilitation for Improved Upper Limb Motor Function After Stroke) randomized clinical trial. Here, we report unblinded, partial crossover, and pooled 1-year outcomes. Initially, 108 participants across 19 sites with chronic ischemic stroke and moderate-to-severe UE impairment were enrolled in VNS-REHAB. Participants received 18 sessions of in-clinic intensive task-specific rehabilitation and 3 months of self-initiated home-based exercise with either real (active) or sham (control) vagus nerve stimulation. Thereafter, Control participants crossed over to receive in-clinic therapy paired with active stimulation. All participants performed home-based exercises paired with self-initiated active stimulation for 1 year. The Fugl-Meyer Assessment UE, Wolf Motor Function Test, and participation outcomes were assessed through 12 months.</p><p><strong>Results: </strong>Seventy-four participants (69%; 51 male; age, mean±SD, 59.6±8.9) completed 1-year follow-up and provided pooled data through 1 year. At 1 year, compared with baseline, there were improvements in impairment (Fugl-Meyer Assessment UE, 5.23 [95% CI, 4.08-6.39]; <i>P</i><0.001) activity (Wolf Motor Function Test, 0.50 [95% CI, 0.41-0.59]; <i>P</i><0.001) and patient-reported outcomes (Motor Activity Log-Quality of Movement: 0.64 [95% CI, 0.46-0.82], <i>P</i><0.001; Motor Activity Log-Amount of Use: 0.64 [95% CI, 0.46-0.82], <i>P</i><0.001; Stroke Impact Scale-Activities of Daily Living: 7.43 [95% CI, 5.09-9.77], <i>P</i><0.001; Stroke Impact Scale-Hand: 17.89 [95% CI, 14.16-21.63], <i>P</i><0.001; EQ-5D: 5.76 [95% CI, 2.08-9.45], <i>P</i><0.05; and Stroke Specific-Quality of Life: 0.29 [95% CI, 0.19-0.39], <i>P</i><0.001) compared with baseline.</p><p><strong>Conclusions: </strong>People treated with paired vagus nerve stimulation maintained improvements in UE impairment, activity, participation, and quality-of-life measures at 1 year. Paired vagus nerve stimulation is a Food and Drug Administration-approved, beneficial treatment option for long-term benefit in individuals with chronic UE limitations after ischemic stroke.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03131960.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985999","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":"Elevated Remnant Cholesterol Improves the Prognosis of Patients With Ischemic Stroke and Malnutrition: A Cohort-Based Study.","authors":"Huicong Niu, Yong Wang, Ning Yang, Min Chu, Xueyu Mao, Daosheng Wang, Jing Zhao","doi":"10.1161/STROKEAHA.124.048785","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.048785","url":null,"abstract":"<p><strong>Background: </strong>The mechanism of the lipid paradox remains uncertain, and malnutrition may be 1 explanation. In this prospective cohort study, we explored the associations between baseline remnant cholesterol (RC) concentrations and clinical outcomes in patients with ischemic stroke, stratified by nutritional status.</p><p><strong>Methods: </strong>Patients with ischemic stroke in a single-center prospective cohort (Shanghai, China) from January 2018 to December 2022 were studied. Individuals were classified into 3 groups based on their Controlling Nutritional Status score. Poor outcome and all-cause mortality during up to 3 months of follow-up were compared among patients with varied nutritional status and RC levels utilizing multivariate logistic regression analyses, RC splines, and subgroup analyses.</p><p><strong>Results: </strong>A total of 6892 patients with ischemic stroke were enrolled in the cohort, of which 5257 patients were included in the present study (without malnutrition: 2418 [46.0%]; mild malnutrition: 2516 [47.9%]; moderate-severe malnutrition: 323 [6.1%]). The median age was 69±12 years, and 3398 (64.6%) were male. Patients with moderate-severe malnutrition had the highest risks of poor outcome (198 [61.3%]; <i>P</i><0.001) and all-cause mortality (106 [32.8%]; <i>P</i><0.001) during the 3-month follow-up. A higher baseline RC level was an independent protective factor for adverse outcomes in patients with any degree of malnutrition (<i>P</i><0.05), which was not observed in patients without malnutrition. In addition, compared with the moderate-severely malnourished with RC <0.471 mmol/L, the adjusted odds ratios for poor outcome and all-cause mortality were 0.805 (95% CI, 0.450-1.438) and 0.898 (0.502-1.607) for participants with 0.471 to 0.632 mmol/L, 0.259 (0.095-0.704) and 0.222 (0.061-0.810) for 0.633 to 0.868 mmol/L, and 0.160 (0.037-0.689) and 0.202 (0.042-0.967) for ≥0.869 mmol/L, respectively.</p><p><strong>Conclusions: </strong>The lipid paradox was only observed in the malnourished patients with ischemic stroke. Strict lipid reduction therapy is still recommended for patients without malnutrition. However, when treating patients at any risk of malnutrition, the improvement of nutritional status may be more crucial.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032261","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":"Sitting Time, Leisure-Time Physical Activity, and Risk of Mortality Among US Stroke Survivors: A Prospective Cohort Study From the NHANES 2007 to 2018.","authors":"Chuanchuan Yu, Yalin Cao, Qifang Liu, Hongwen Tan, Guiling Xia, Baolin Chen, Fawang Du, Kui Lu, Gustavo Saposnik","doi":"10.1161/STROKEAHA.124.049672","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.049672","url":null,"abstract":"<p><strong>Background: </strong>Stroke survivors are highly sedentary and engage in minimal physical activity. This study aimed to investigate the independent and joint effects of daily sitting time and leisure-time physical activity on survival among stroke survivors.</p><p><strong>Methods: </strong>The nationally representative cohort included 1446 stroke survivors (weighted population, 6 968 723) from the National Health and Nutrition Examination Survey from 2007 to 2018. Mortality data were obtained through December 31, 2019. Leisure-time physical activity was categorized as inactive (0 min/wk), insufficiently active (1 to <150 min/wk), and sufficiently active (≥150 min/wk). Daily sitting time was categorized as <6, 6 to <8, and ≥8 h/d. Survival analyses of all-cause and specific mortality were performed by weighted Cox proportional hazards regression models.</p><p><strong>Results: </strong>This cohort study comprised 55.0% females, 68.7% non-Hispanic White, and had a weighted mean (SE) age of 64.6 (0.5) years. Overall, 70.3% were inactive, 42.3% sat at least 8 h/d, and 34.9% were both inactive and sat at least 8 h/d. During a median of 5.2 years of follow-up, 494 deaths occurred, including 171 associated with cardiovascular disease (CVD) and 323 associated with non-CVD. Active stroke survivors had a lower risk of all-cause (hazard ratio [HR], 0.26 [95% CI, 0.17-0.40]), CVD (HR, 0.26 [95% CI, 0.13-0.53]), and non-CVD (HR, 0.26 [95% CI, 0.15-0.46]) mortality compared with inactive stroke survivors. Sitting at least 8 h/d was associated with higher risks of all-cause (HR, 1.50 [95% CI, 1.13-1.99]) and non-CVD (HR, 1.61 [95% CI, 1.18-2.20]) mortality compared with sitting <6 h/d. In the joint analyses, stroke survivors who were inactive or insufficiently active and sat for at least 8 h/d had the highest risks of all-cause (HR, 3.73 [95% CI, 2.07-6.73]), CVD (HR, 3.32 [95% CI, 1.33-8.29]), and non-CVD (HR, 3.91 [95% CI, 1.70-8.95]) mortality when compared with those who were active and sat for <6 h/d. When stratifying by leisure-time physical activity, daily sitting time was not associated with mortality among active stroke survivors. These observations were confirmed in sensitivity analyses.</p><p><strong>Conclusions: </strong>This study highlights the potential benefits of enhancing leisure-time physical activity and reducing sitting time to lower mortality rates among stroke survivors.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034759","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":"Sexual Health After a Stroke: A Topical Review and Recommendations for Health Care Professionals.","authors":"Wendy Dusenbury, Susan Barnason, Stephanie Vaughn, Anne Leclaire, Tiny Jaarsma, Michelle Camicia","doi":"10.1161/STROKEAHA.124.044723","DOIUrl":"10.1161/STROKEAHA.124.044723","url":null,"abstract":"<p><p>The devastating physical, emotional, and social effects of stroke can disrupt all aspects of life for the stroke survivor. Ensuring that survivor and caregiver needs are met after a stroke is essential in ongoing care to ensure optimal quality of life. Despite health care professionals making significant strides in poststroke symptom management, education, and rehabilitative support, the common poststroke symptom of sexual dysfunction is rarely addressed. Multiple barriers across health care settings and systems have contributed to this gap. The purpose of this article is to provide evidence that supports the importance of addressing sexual health by health care providers with the stroke survivor and their partner as they transition through the recovery process. We have the following recommendations to optimize care and quality of life for stroke survivors: (1) comprehensive sex education must include information on healthy sex and sexuality for people with neurological disabilities; (2) rehabilitation programs offered in postacute settings should include a structured culturally sensitive interprofessional sexual rehabilitation component that addresses sexuality of the stroke survivor in collaboration with their intimate partners; (3) sexual rehabilitation programs should be tailored for each person based on a thorough assessment of the person's health literacy and learning needs; and (4) the American Heart Association should develop an extensive toolkit for health care providers and survivors that is easily and readily available to the public. Health care providers, survivors, and their partners have a stake in optimal stroke recovery. Sexuality and sexual function are important quality of life indicators thus conversations addressing issues must be included as part of the recovery process. This discussion is best initiated by a health care provider to address system barriers and misconceptions across care transitions. Likewise, survivors and their partners must be encouraged to take ownership to address sexuality issues and initiate the conversation with their health care partners to achieve full recovery.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"1312-1322"},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670863","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":"Gestational Diabetes and Risk of Stroke Among US Black Women.","authors":"Shanshan Sheehy, Hugo J Aparicio, Nuo N Xu, Vasileios-Arsenios Lioutas, Julie G Shulman, Lynn Rosenberg","doi":"10.1161/STROKEAHA.124.050517","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050517","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of evidence on whether gestational diabetes (GDM) is a risk factor for cerebral vascular disease for Black women and lack of data on incident stroke as end point.</p><p><strong>Methods: </strong>We conducted a large prospective cohort study of Black women across the United States and assessed the association between self-reported history of GDM and incident stroke. The study began when participants became parous or enrolled in 1995. We followed up 41 143 parous Black women who were free of cerebral vascular disease or cancer and followed up until incident stroke, death, or the end of 2021. Our exposure was self-reported history of GDM, and outcome was incident stroke. Multivariable Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% CIs, adjusting for major known risk factors for stroke.</p><p><strong>Results: </strong>A total of 1495 incident stroke cases were identified among 41 143 Black women from 1995 until 2021 (881 505 person-years of follow-up). Black women with a history of GDM had a consistent 1.4-fold increased risk of stroke compared with those with a healthy pregnancy (age-adjusted HR, 1.44 [95% CI, 1.14-1.82]; multivariable HR, 1.41 [95% CI, 1.11-1.79]). Compared with healthy parous women with neither GDM nor type 2 diabetes, women with a history of both had a 2.6-fold increased stroke risk (multivariable HR, 2.59 [95% CI, 1.88-3.57]); women with only type 2 diabetes have 2-fold increased stroke risk (multivariable HR, 2.04 [95% CI, 1.79-2.32]); women with a history of GDM but no progression to type 2 diabetes do not have an increased risk of stroke (multivariable HR, 1.22 [95% CI, 0.86-1.73]).</p><p><strong>Conclusions: </strong>In this large prospective study of Black women, a vulnerable population at high risk for stroke, a history of GDM increased stroke incidence by 41%. There was no elevated risk of stroke for Black women with a history of GDM and no progression to type 2 diabetes, while the stroke risk increased by 2.6-fold for Black women with GDM and progression to type 2 diabetes. Our results highlight the importance of consideration of history of GDM for stroke early prevention, especially Black women with progression to T2DM after GDM.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027211","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}