Stroke最新文献

{"title":"Knowledge Acquisition and Audience Retention in Stroke Education: Results From a Global Study by the World Stroke Organization.","authors":"Laavanya Dharmakulaseelan, Laura Ceci Galanos, Rodrigo Guerrero, Anita Arsovska, Gustavo Saposnik","doi":"10.1161/STROKEAHA.124.049311","DOIUrl":"10.1161/STROKEAHA.124.049311","url":null,"abstract":"<p><strong>Background: </strong>The World Stroke Academy (WSA), the educational platform of the WSO, provides high-quality stroke education to health care professionals worldwide. Understanding the learning needs and preferences of WSA members is crucial for effective knowledge translation. This study aims to (1) assess demographics and professional backgrounds of WSA members, (2) identify preferences in knowledge acquisition, and (3) evaluate audience retention during WSA webinars.</p><p><strong>Methods: </strong>A survey was developed using Qualtrics and distributed via email to all WSA members from May 8 to May 23, 2023. The survey included multiple-choice, rating scale, and ranking questions. Audience retention data were obtained from the latest 6 WSA webinars (May 2023-December 2023). Descriptive variables were reported, and χ² analysis and multinomial regression models were used.</p><p><strong>Results: </strong>A random sample of 1065 WSO members received the survey; 327 initiated it (participation rate, 30.7%), and 236 completed it (completion rate, 72.2%). The mean age (SD) of participants was 46.7 (±11.6) years; 57.2% identified as male. Most respondents were stroke specialist physicians (65.3%) and were based in Europe (35.2%). Online journal articles represented 41.6% of the total time allocated for stroke education, with 17% allocated to webinars. Social media usage patterns showed X (formerly Twitter) as the top choice (34.7%). Age, profession, and location significantly influenced social media platform use. Audience retention was at 50% at the 57-minute mark and 44.3% at the end of webinars.</p><p><strong>Conclusions: </strong>Tailoring WSA webinar content to meet health care professionals' needs and enhancing interactive components can improve audience retention. These insights will guide the future development of the WSA portfolio.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"521-526"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855355","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":"Randomized Study Comparing First-Line Dual Versus Single-Stent Retriever Technique: TWIN2WIN.","authors":"Alejandro Tomasello, Manuel Moreu, Mikel Terceño, Lavinia Dinia, Maria Rosario Barrena Caballo, Manuel Requena, Magda Jablonska, Judith Cendrero, Alan Flores, Santy Ortega, Francesco Diana, David Henandez, Marta de Dios, Marta Rubiera, Alvaro Garcia-Tornel, Federica Rizzo, Marta Olivé, Carlos Pérez-García, Carmen Trejo Gallego, Tomas Carmona, Marc Rodrigo-Gisbert, Carlos Molina, Marc Ribo","doi":"10.1161/STROKEAHA.124.048496","DOIUrl":"10.1161/STROKEAHA.124.048496","url":null,"abstract":"<p><strong>Background: </strong>The double-stent retriever (SR) technique has been described as an effective rescue technique when single-SR fails to induce recanalization. We aimed to assess the safety and efficacy of first-line double-SR in patients with stroke undergoing thrombectomy.</p><p><strong>Methods: </strong>This was a multicenter, randomized, controlled, blinded adjudicated primary outcome study. Patients with a large vessel occlusion stroke within 24 hours after onset and undergoing thrombectomy were included. Upon confirmation of large vessel occlusion on initial angiogram, patients were randomly allocated to receive a first-line strategy: single-SR versus double-SR technique. Investigators could use their technique of choice if further passes were needed. The primary objective was to evaluate the efficacy of double-SR defined as first-pass complete recanalization (expanded Treatment in Cerebral Infarction grade 2c-3) compared with single-SR. First-pass recanalization and final successful recanalization (expanded Treatment in Cerebral Infarction grade 2b50-3) were centrally assessed by a blinded investigator. The safety outcome was the occurrence of a symptomatic intracerebral hemorrhage. The data safety monitoring board stopped the recruitment after a preplanned interim analysis because a predefined efficacy boundary was reached.</p><p><strong>Results: </strong>From April 2022 to October 2023, 108 patients were included: 50 (46%) in the single-SR group and 58 (54%) in the double-SR group. First-pass recanalization was achieved in 12 of 50 patients (24%) allocated to single-SR and 27 of 58 patients (46%) allocated to double-SR (adjusted odds ratio, 2.72 [95% CI, 1.19-6.46]). Substantial reperfusion within 3 attempts was obtained in 42 patients (84%) allocated to single-SR and in 52 patients (89%) allocated to double-SR (adjusted odds ratio, 1.74 [95% CI, 0.5-5.76]). The mean number of passes was 2±1.3 with single-SR and 1.7±1 with double-SR (mean difference, -0.37 [95% CI, -0.9 to 0.06]). A symptomatic intracerebral hemorrhage occurred in 3 patients (6%) allocated to single-SR and in 6 patients (10%) allocated to double-SR (adjusted odds ratio, 1.66 [95% CI, 0.40-8.35]).</p><p><strong>Conclusions: </strong>In patients with stroke undergoing thrombectomy, first-line double-SR is safe and superior to single-SR in achieving first-pass recanalization but not final recanalization. Implications on clinical outcomes should be studied in specifically designed trials.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT05632458.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"326-334"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865245","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 Differences in Participation Restriction in Social Activities Among Older Stroke Survivors: A Nationwide Study.","authors":"Chen Chen, Mathew J Reeves, Lynda D Lisabeth","doi":"10.1161/STROKEAHA.124.048773","DOIUrl":"10.1161/STROKEAHA.124.048773","url":null,"abstract":"<p><strong>Background: </strong>Women experience more poststroke physical activity limitations, but sex differences in social activity participation, an important patient-reported outcome for stroke recovery, remain uncertain.</p><p><strong>Methods: </strong>Incident stroke survivors aged ≥65 years were identified from the US NHATS (National Health and Aging Trends Study), 2011-2022. Participants were asked to report restricted participation in the past month in 2 formal activities (religious services and clubs/classes) and 2 informal activities (visiting friends/family and going out for enjoyment) in the year of stroke onset. Logistic regression was used to assess sex differences in any participation restrictions across the 4 activities and within each activity, without and with adjustment for potential confounders, including sociodemographic, social-environmental, technological- and service environmental, psychological, health condition-related factors, and activity limitations.</p><p><strong>Results: </strong>Among stroke survivors (N=469; 56.6% women; 50.4% of 75-84 years of age), women were more likely to be older, widowed, live alone, not currently driving, have worse physical capacity, and have more activity limitations. Women had a higher unadjusted prevalence of any participation restriction (40.3% versus 29.4%; odds ratio, 1.90 [95% CI, 1.21-2.99]) and restriction in attending religious services (27.5% versus 19.0%; odds ratio, 1.80 [95% CI, 1.08-3.02]). These sex differences were attenuated most after individual adjustment for physical capacity, marital status, and driving mobility, followed by adjustment for comorbidities, living alone, and activity limitations. No significant sex differences were found after simultaneously adjusting for these factors (adjusted odds ratio, 1.36 [95% CI, 0.70-2.65] for any participation restrictions; adjusted odds ratio, 1.36 [95% CI, 0.74-2.49] for restrictions in religious service attendance).</p><p><strong>Conclusions: </strong>Social participation restrictions are prevalent among older stroke survivors, particularly for women, which appears to be attributable to sex differences in social factors and prestroke health. Future interventions targeting vulnerable subgroups, including socially isolated women and women with poorer health, should be considered.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"265-275"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955379","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":"Non-Traumatic Intracranial Hemorrhage and Risk of Incident Dementia in U.S. Medicare Beneficiaries.","authors":"Samuel S Bruce, Anokhi Pawar, Vanessa Liao, Alexander E Merkler, Ava L Liberman, Babak Benjamin Navi, Costantino Iadecola, Hooman Kamel, Cenai Zhang, Santosh B Murthy","doi":"10.1161/STROKEAHA.124.050359","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050359","url":null,"abstract":"<p><p><b>Background:</b> To study the risk of incident dementia after a non-traumatic intracranial hemorrhage in a diverse US population, and evaluate if this risk is different for the subtypes of intracranial hemorrhage. <b>Methods:</b> We performed a retrospective cohort study using both inpatient and outpatient claims data on Medicare beneficiaries between January 1, 2008 and December 31, 2018. The exposure was a new diagnosis of non-traumatic intracranial hemorrhage, defined as a composite of intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and subdural hemorrhage (SDH). The outcome was a first-ever diagnosis of dementia. The exposure and outcomes were identified using validated ICD-9 and ICD-10-CM diagnosis codes. We excluded patients who had prevalent intracranial hemorrhage or dementia, to ensure that only incident cases were counted in our analyses. In the primary analysis, we used Cox regression to study the risk of dementia after intracranial hemorrhage, after adjusting for demographics and comorbidities. In secondary analyses, the risks of dementia in different subtypes of intracranial hemorrhage were studied. <b>Results:</b> Among 2.1 million patients, 14,775 had a diagnosis of intracranial hemorrhage. During a median follow up of 5.6 years (IQR, 3.0-9.1), incident dementia was diagnosed in 2527 (17.1%) patients with an intracranial hemorrhage and 260,691 (12.8%) in those without intracranial hemorrhage. The cumulative incidence rate of dementia was 8.6% (IQR, 8.1-8.9) among patients with an intracranial hemorrhage, and 2.2% (2.0-2.4) in patients without intracranial hemorrhage. In adjusted Cox regression analysis, intracranial hemorrhage was associated with an increased risk of incident dementia (HR, 2.0; CI, 1.9-2.2). In secondary analyses, a higher risk of incident dementia was observed with ICH (HR, 2.4; CI, 2.2-2.5), SAH (HR, 1.99; CI, 1.7-2.2), and SDH (HR, 1.6; CI, 1.4-1.7). <b>Conclusion:</b> In a large heterogeneous cohort of elderly US participants, intracranial hemorrhage was independently associated with a 2-fold increased risk of incident dementia. This elevated risk was consistently observed across subtypes of intracranial hemorrhage.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067579","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":"Predicting Atrial Fibrillation After Stroke by Combining Polygenic Risk Scores and Clinical Features.","authors":"Reinier Wp Tack, Benjamin Yong-Qiang Tan, Jasper Rudolf Senff, Savvina Prapiadou, Tamara N Kimball, Shaan Khurshid, Jeffrey M Ashburner, Sean J Jurgens, Sanjula D Singh, Lu-Chen Weng, Sophia Gunn, Carolina Roselli, Kathryn L Lunetta, Emelia J Benjamin, Patrick T Ellinor, Jonathan Rosand, Ernst Mayerhofer, Steven A Lubitz, Christopher D Anderson","doi":"10.1161/STROKEAHA.124.050123","DOIUrl":"10.1161/STROKEAHA.124.050123","url":null,"abstract":"<p><p><b>Background:</b> Since treatment with anticoagulants can prevent recurrent strokes, identification of patients at risk for incident AF after stroke is crucial. We aimed to investigate whether the addition of AF polygenic risk scores (PRS) to existing clinical risk predictors could improve prediction of AF after stroke. <b>Methods:</b> Patients diagnosed with ischemic stroke at Massachusetts General Hospital between 2003-2017 were included. Clinical AF risk was estimated using the Re-CHARGE-AF model and genetic risk was estimated using a contemporary AF PRS from 1,093,050 variants. Patients were divided into clinical and genetic risk tertiles. Cox proportional hazards models at different follow-up windows were fit, and C-indices and percentile-based Net Reclassification Index (NRI) were used to determine improvement of clinical risk models with the addition of AF PRS. <b>Results:</b> Of 1004 stroke survivors, 900 (90%) were non-Hispanic White, 413 (41%) were female, and the mean age was 67 (SD 14). Of 1004 survivors, 239 (23.8%) had prevalent AF and 87/765 (11.4%) of the remaining patients developed incident AF during 5 years of follow-up. AF PRS was associated with greater risk of incident AF after stroke (HR 1.16 [95% Confidence Interval (CI) 0.94-1.44] per 1 SD increase), although the association was not statistically significant. PRS improved discrimination in the first month (AUC 0.78 [95% CI 0.70-0.82] vs AUC 0.71 [95% CI 0.60-0.82], p = 0.05), with more modest estimates across longer time windows. <b>Conclusion:</b> Addition of an AF PRS to clinical risk models may improve identification of individuals at risk of AF after stroke, particularly within the first month.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067505","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":"Emergent Carotid Stenting During Thrombectomy in Tandem Occlusions Secondary to Dissection: A STOP-CAD Secondary Study.","authors":"João André Sousa, Marc Rodrigo-Gisbert, Liqi Shu, Anqi Luo, Han Xiao, Noor A Mahmoud, Asghar Shah, Ana Luyza Oliveira Santos, Marina Moore, Daniel M Mandel, Mirjam R Heldner, Vasco Barata, Sara Bernardo-Castro, Nils Henninger, Jayachandra Muppa, Marcel Arnold, Ahmad Nehme, Aaron Rothstein, Ossama Khazaal, Josefin E Kaufmann, Stefan T Engelter, Christopher Traenka, Issa Metanis, Ronen R Leker, Christian H Nolte, Malik Ghannam, Edgar A Samaniego, Mohammad AlMajali, Alexandre Y Poppe, Michele Romoli, Jennifer A Frontera, Marialuisa Zedde, Wayneho Kam, Brian Mac Grory, Faddi Ghassan Saleh Velez, Tamra Ranasinghe, James E Siegler, Adeel S Zubair, João Pedro Marto, Piers Klein, Thanh N Nguyen, Mohamad Abdalkader, Gabriel Paulo Mantovani, Alexis N Simpkins, Shayak Sen, Marwa Elnazeir, Shadi Yaghi, Joao Sargento-Freitas, Manuel Requena","doi":"10.1161/STROKEAHA.124.048295","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.048295","url":null,"abstract":"<p><p><b>Background:</b> The optimal endovascular management of cervical carotid dissection causing tandem occlusion remains uncertain. We investigated the impact of emergent carotid stenting during endovascular treatment (EVT) for acute ischemic stroke (AIS) in patients with tandem occlusion secondary to cervical carotid artery dissection. <b>Methods:</b> This was a secondary analysis of patients treated with EVT for AIS due to occlusive carotid artery dissection and tandem occlusion included in the retrospective international Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection (STOP-CAD) study. We compared patients with and without emergent stenting. The primary efficacy and safety outcomes were 90-day functional independence (modified Rankin Scale 0-2) and symptomatic intracranial hemorrhage (sICH) within 24h after EVT. Procedural outcome was successful intracranial recanalization (mTICI 2b/3). We used mixed-effect logistic regression adjusting for site, age, and NIHSS. In additional analyses, we used inverse probability of treatment weighting and adjusted for ASPECTS. <b>Results:</b> Of the 4023 patients enrolled in STOP-CAD, 328 presented with anterior circulation AIS due to tandem occlusion and underwent EVT. The median age was 51 years (interquartile range 44-58), and 96 patients (29.3%) were female. One hundred fifty patients (45.7%) underwent emergent stenting. There was no significant association between stenting and 90-day functional independence (62.0% vs 59.7%; aOR 1.23, 95% CI 0.82-1.86, p=0.315) or sICH (7.3% vs 7.9%; aOR OR 0.95, 95% CI 0.41-2.2, p=0.913). Emergent carotid stenting was associated with successful intracranial recanalization (81.8% vs 76.6% aOR 2.62, 95% CI 1.52-4.5, p<0.001). Results did not meaningfully change in additional analyses. <b>Conclusion:</b> In patients presenting with an acute anterior circulation tandem occlusion secondary to cervical carotid artery dissection, emergent stenting was associated with a higher likelihood of successful intracranial recanalization but not improved functional outcomes or increased sICH. It remains unclear whether emergent stenting led to successful intracranial recanalization or patients with successful intracranial recanalization were more likely to be stented. Randomized trials are warranted.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Thrombosis of Brain Arteriovenous Malformation Draining Veins: Concerns on Nonhemorrhagic Symptoms.","authors":"Fabio Torregrossa, Domingos Coiteiro","doi":"10.1161/STROKEAHA.124.049847","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.049847","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultra-Early Hematoma Expansion Is Associated With Ongoing Hematoma Growth and Poor Functional Outcome.","authors":"Chloe A Mutimer, Teddy Y Wu, Henry Zhao, Leonid Churilov, Bruce C V Campbell, Andrew Cheung, Atte Meretoja, Timothy Kleinig, Philip M C Choi, Henry Ma, Geoffrey C Cloud, Rohan S Grimley, Darshan Shah, Anna Ranta, Karim M Mahawish, Vignan Yogendrakumar, Gagan Sharma, Geoffrey A Donnan, Stephen M Davis, Nawaf Yassi","doi":"10.1161/STROKEAHA.124.050131","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050131","url":null,"abstract":"<p><p><b>Background:</b> There is limited data on ultra-early hematoma growth dynamics and its clinical relevance in primary intracerebral hemorrhage (ICH). We aimed to estimate the incidence of hematoma expansion (HE) within the hyperacute period of ICH, describe hematoma dynamics over time, investigate the associations between ultra-early HE and clinical outcomes after ICH, and assess the effect of tranexamic acid on ultra-early HE. <b>Methods:</b> We performed a planned secondary analysis of the STOP-MSU international multicenter randomized controlled trial. Repeat CT imaging ~1 hour after treatment commencement was encouraged. Patients who underwent re-imaging up to 3 hours from baseline imaging were included in this descriptive study. Hematoma expansion was defined as either a ≥33% or ≥6 ml increase from baseline hematoma volume. <b>Results:</b> We included 105 patients who had 1-hour imaging (median age 66years, 40% female, 53% tranexamic acid). Median time from onset to baseline imaging was 74min (IQR 56-87min), and between baseline and 1-hour imaging was 95min (IQR 74-132min). Forty-one patients (39%) had ultra-early HE. These patients had larger baseline hematoma volumes (15.9ml vs 9.1ml, p=0.03) compared to those with no early HE. Hematoma growth rate significantly reduced over time compared to the onset-to-baseline imaging period (clustered median regression p<0.01). In 92 patients with both 1-hour and 24-hour re-imaging, further HE between the 1-hour and 24-hour imaging was more common in those with ultra-early HE (29%) compared to those without (29% vs 6.6%, p<0.01). Ultra-early HE was associated with poor functional outcomes (mRS 3-6; aOR3.87 [1.21-12.40], p=0.02) and mortality (aOR6.16 [95% CI 2.15-17.68], p<0.01), adjusted for treatment group. There was no observed effect of tranexamic acid treatment on ultra-early hematoma expansion (41% vs. 37%, p=0.65). <b>Conclusion:</b> Most hematoma growth occurs in the ultra-early period. The presence of hyperacute hematoma expansion is associated with ongoing hematoma growth, and poor clinical outcomes, and represents a target for therapeutic intervention.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impaired Resting State Functional Connectivity in CADASIL Mutant Mice.","authors":"Sanem Aslihan Aykan, James Han Lai, Kazutaka Sugimoto, Orhan Aykan, Wai Yee Fung, David Ho, Anne Joutel, Sava Sakadzic, David Y Chung, Cenk Ayata","doi":"10.1161/STROKEAHA.124.049772","DOIUrl":"10.1161/STROKEAHA.124.049772","url":null,"abstract":"<p><p><b>Background:</b> Cerebral autosomal-dominant arteriopathy, subcortical infarcts, and leukoencephalopathy (CADASIL) is the most prevalent monogenic inherited cause of cerebral small-vessel disease. Despite its prevalence, there is currently no proven therapy to prevent or reverse the progression of the disease. <b>Methods:</b> This study aimed to characterize the functional integrity of long white matter tracts in CADASIL transgenic mice, both with and without focal white matter lesions in the corpus callosum added on, utilizing optical resting-state functional connectivity imaging alongside behavioral examinations. Additionally, we examined the efficacy of tocotrienol, a neuroprotective derivative of vitamin E derived from palm oil, which has shown promise in preventing white matter disease progression in clinical trials involving patients with small vessel disease. <b>Results:</b> At baseline, resting-state inter and intrahemispheric functional connectivity was significantly lower in Notch3R169C than in Notch3WT (p=0.004), and the grid walk test revealed a higher number of foot faults in the Notch3R169C group compared to Notch3WT. Sex did not interact with the genotype on the primary outcomes. Introducing a lesion in the corpus callosum compromised functional connectivity and behavior outcomes in both genotypes to a similar extent; lesion volumes did not differ between the genotypes. Tocotrienol treatment did not show any protective effect on any endpoint. <b>Conclusion:</b> These data show impaired resting-state functional connectivity and increased foot faults in the Notch3R169C mutant model of CADASIL. Future work will aim to test therapeutic or preventive interventions in CADASIL mutants using these measures.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of a Novel MRI 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 Z Simonsen, Steven R Messé","doi":"10.1161/STROKEAHA.124.050508","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.050508","url":null,"abstract":"<p><p><b>Background:</b> Endovascular thrombectomy (EVT) dramatically improves clinical outcomes, but the final infarct volume (FIV) on MRI 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 MRI-based metric, infarct density, which leverages post-EVT apparent diffusion coefficient (ADC) as a marker of infarct severity. <b>Methods:</b>A retrospective cohort was derived from a single-center prospective EVT registry. Consecutive anterior circulation EVT patients were included from 2018-2019 who achieved successful reperfusion (mTICI ≥2b). MRI was performed 12-48 hours post-EVT and processed via RAPID to quantify FIV using the ADC <620 threshold. Lesion volume was also collected using ADC <470 threshold, and infarct density was calculated as: (volume <470/volume <620)x100%. 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. ROC analysis quantified model classification performance. <b>Results:</b> Of 319 EVT patients, 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 (aOR 0.99 per 1mL; 95%CI: 0.98-1.00; p=0.03) and infarct density (aOR 0.95 per 1%; 95%CI: 0.94-0.97; p<0.001) were both independently inversely associated with good outcome. The final model incorporating both FIV and infarct density achieved excellent classification performance (AUC 0.87; 95%CI: 0.83-0.91). Removing infarct density from the model diminished its performance (AUC 0.83; 95%CI: 0.78-0.88; p=0.01). <b>Conclusion:</b> ADC-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":""},"PeriodicalIF":7.8,"publicationDate":"2025-01-30","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}