Cerebrovascular Diseases Extra最新文献

{"title":"Machine Learning-Based Risk Stratification for Symptomatic Intracranial Hemorrhage and 3-month Prognosis Following Intravenous Thrombolysis.","authors":"Chia-Wei Lin, Wei-Chun Wang, Jia-Lun Huang, Shih-Hao Wu, Chien-Yu Liu, Chun-Yuan Lin, Charles C N Wang","doi":"10.1159/000552048","DOIUrl":"https://doi.org/10.1159/000552048","url":null,"abstract":"<p><strong>Introduction: </strong>Intravenous thrombolysis (IVT) with tissue-type plasminogen activator (tPA) is a cornerstone of acute ischemic stroke treatment, yet its benefits are limited by the risk of symptomatic intracranial hemorrhage (sICH), a complication associated with substantial morbidity and mortality. Functional recovery is commonly evaluated using the 3-month modified Rankin Scale (mRS). This study aimed to develop predictive models for sICH and 3-month outcomes after tPA and to identify key prognostic variables that may support individualized treatment decisions.</p><p><strong>Methods: </strong>Data from 434 ischemic stroke patients who received tPA at a tertiary medical center over 5.5 years were analyzed. Three supervised classification models were developed and evaluated using five-fold cross-validation. Model performance was assessed using area under the receiver operating characteristic curve (AUC), accuracy, recall, and precision, and was compared with six established scoring tools for predicting post-tPA sICH.</p><p><strong>Results: </strong>The three machine learning models-Logistic Regression (AUC 0.87), Random Forest (AUC 0.82), and XGBoost (AUC 0.89)-outperformed all six conventional scoring tools in predicting post-tPA sICH. The 24-hour NIHSS score was the most influential predictor for both sICH and 3-month outcomes. A history of previous stroke and male sex were associated with higher sICH risk, while increasing age was strongly correlated with poorer 3-month outcomes.</p><p><strong>Conclusion: </strong>The proposed models demonstrated high predictive accuracy for both sICH and 3-month outcomes after tPA and highlighted variables with the greatest prognostic contribution. The 24-hour NIHSS score emerged as the strongest predictor in both tasks. Compared with established sICH scoring tools, these machine learning models provided superior performance, suggesting their potential value as decision-support tools to guide individualized management following thrombolytic therapy.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-18"},"PeriodicalIF":2.1,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Correlation between Inflammatory Markers and Carotid Atherosclerotic Plaque Characteristics.","authors":"Lin Wang, Tong Chen, Chun Yuan, Thomas Hatsukami, Xihai Zhao, Mi Shen, Peiyi Gao, Shengjun Sun, Xingquan Zhao, Binbin Sui","doi":"10.1159/000551280","DOIUrl":"https://doi.org/10.1159/000551280","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to explore the relationship between serum inflammatory biomarkers and the carotid atherosclerotic plaque characteristics, given prior evidence suggesting a key role of inflammation in the development of atherosclerosis.</p><p><strong>Methods: </strong>In this prospective study, patients with carotid atherosclerotic plaque were recruited. Serum high-sensitivity CRP (Hs-CRP), homocysteine (Hcy) concentrations, and neutrophil-to-lymphocyte ratio (NLR) were obtained for all enrolled patients. Carotid atherosclerosis characteristics (such as intraplaque hemorrhage (IPH) and lipid-rich necrotic core (LRNC) were determined by three-dimensional high-resolution vessel wall imaging. The associations between Hs-CRP, Hcy, NLR, and plaque characteristics were assessed.</p><p><strong>Results: </strong>In total, 128 patients (84.4% men; mean age, 58.0 ±8.7 years) were included. Multivariate logistic regression indicated that increased Hs-CRP levels was associated with the presence of LRNC (OR=1.23, 95% CI:1.07-1.40, P=0.003) and IPH (OR=1.26, 95% CI:1.10-1.45, P=0.001). Multivariate linear regression confirmed a significant correlation between Hs-CRP level (β= 3.24, 95% CI: 0.66-5.81, P = 0.014) and the IPH volume. For plaque burden, higher Hs-CRP levels were associated with larger max normalized wall index (NWI) (β = 0.01, 95% CI: 0.00-0.02, P = 0.005) and larger Max wall thickness (WT) (β = 0.08, 95% CI: 0.02-0.14, P =0.006). NLR and Hcy levels did not showed significantly associations with the carotid plaque characteristics.</p><p><strong>Conclusions: </strong>Elevated Hs-CRP levels were found to be closely associated with plaque burden and vulnerable plaque characteristics. The relationship between elevated Hs-CRP and plaque vulnerability highlights its potential role in risk stratification and early intervention strategies. Further validation in larger, multicenter population studies is required to confirm these associations.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-16"},"PeriodicalIF":2.1,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BRIDGING THROMBOLYSIS BEFORE ENDOVASCULAR THERAPY IMPROVES FUNCTIONAL OUTCOMES IN MEDIUM-LARGE CORE STROKE WITHIN 4.5 HOURS: A MULTICENTER PROPENSITY-MATCHED STUDY.","authors":"Thang Huy Nguyen, Thien Quang Le, Trung Quoc Nguyen, Khang Vinh Nguyen, Hang Thi Minh Tran, Hai Quang Duong, Nhan Duc Le, Dung Tri Bach, Lanh Chi Nguyen, Duc Tan Ha, Binh Nguyen Pham, Vu Thanh Tran, Tra Vu Son Le, Anh Thi Kim Nguyen, Thanh Tri Mai, Huong Thi Bich Nguyen, Huy Quang Dang, Thanh Ngoc Nguyen, Thang Ba Nguyen, Anh Le Tuan Truong","doi":"10.1159/000551531","DOIUrl":"10.1159/000551531","url":null,"abstract":"<p><strong>Background and aims: </strong>The benefit of intravenous thrombolysis (IVT) before endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) with medium-large infarct core (MLIC) remains uncertain.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of a prospective multicenter registry in Vietnam (August 2023-September 2024). We included patients with AIS-LVO in the anterior circulation within 4.5 hours of onset, an Alberta Stroke Program Early CT Score (ASPECTS) < 6, and a National Institutes of Health Stroke Scale (NIHSS) ≥ 6 at admission. The primary outcome was functional ambulation (defined as mRS 0-3) at 90 days of follow-up. Secondary outcomes were functional independence (mRS 0-2), mRS shift analysis, and rates of successful reperfusion (modified thrombolysis in cerebral infarction 2b-3). Safety outcomes were defined by symptomatic intracranial hemorrhage (ICH) according to SITS-MOST criteria and 90-day mortality. Outcomes between the bridging therapy and EVT alone groups were compared using propensity score-matched (PSM) analysis.</p><p><strong>Results: </strong>Of 403 MLIC patients undergoing EVT, 148 presented within 4.5 hours, 59 (39.9%) received bridging IVT. After PSM (n=72), with 36 in each group. The median age, proportion of males, baseline ASPECTS, and NIHSS scores were similar between the two groups. The bridging group achieved higher rates of functional ambulation (75% vs 41.7%, OR 4.2, 95% CI 1.54-11.46). Regarding safety, there was no statistically significant difference in symptomatic intracerebral hemorrhage (8.3% vs 11.1%, p = 1.0) or mortality (8.3% vs 19.4%, p = 0.17), though the confidence intervals were wide.</p><p><strong>Conclusions: </strong>Our study suggests that bridging therapy in patients with acute medium-large ischemic core within 4.5 hours of onset results in better functional outcomes than EVT alone without increasing the sICH rate. Further studies are required to assess the safety and efficacy of bridging therapy.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-18"},"PeriodicalIF":2.1,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Prognostic Features of Perioperative Stroke: A Multicenter Retrospective Cohort Study.","authors":"Guo-Dong Wang, Lin-Yuan Zhang, Jia-Min Song, Yu-Lei Zhang, Yao-Yu Ying, Shi-Bin Wen, You-Zhong Li, Gen-Bin Huang, Can-Xiong Wang, Xiao-Hui Tang, Yun-Cheng Wu","doi":"10.1159/000551487","DOIUrl":"https://doi.org/10.1159/000551487","url":null,"abstract":"<p><p>Introduction Perioperative stroke constitutes a major subset of in-hospital stroke. Evidence is lacking on whether procedure-specific risk profiles exist and how they influence functional recovery. We aim to identify distinct clinical features and procedure-specific risk factors associated with perioperative stroke. Methods We retrospectively analyzed a 4-year cohort of patients with in-hospital stroke from 5 tertiary hospitals across China. Clinical data were systematically extracted through electronic medical record review. 90-day functional outcomes were assessed. Multivariate linear regression was performed to identify factors associated with 90-day outcomes in perioperative stroke. Results Out of 1,048,566 hospitalized patients, 166 (0.02%) patients developed in-hospital stroke. Among them, 158 patients completed the 90-day follow-up, with 100 males (63.29%) and a median age of 69 years (IQR, 61-76). 63 (39.87%) had perioperative stroke, with the highest proportion (13.92%) occurring in the cardiology/cardiothoracic surgery departments. Delayed recognition (4 hours [IQR, 1.58-24.00] vs. 2 hours [IQR, 1.00 to 5.50], P=0.020), higher NIHSS score (12 [IQR, 5-30] vs. 9 [IQR, 4-16], P=0.045), and lower proportion of reperfusion therapy (5.56% vs. 28.21%, P=0.003) were observed in patients with perioperative ischemic stroke compared to those with non-perioperative stroke. In subgroup analysis, cardiovascular surgery-related ischemic stroke patients had higher NIHSS score (20 [IQR, 8-35] vs. 8 [IQR, 5-20], P=0.035) and 90-day modified Rankin scale score (4 [IQR, 2-6] vs. 2 [IQR, 1-4], P=0.039) than those non-cardiovascular surgical counterparts. Additionally, they exhibited a trend toward a higher 90-day mortality rate (33.33% vs. 10.71%; OR, 4.17 [95%CI, 1.07 to 20.83]; P=0.052). Conclusion Perioperative in-hospital stroke exhibits distinct clinical characteristics. Cardiovascular-related surgery is associated with worse functional outcomes.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-21"},"PeriodicalIF":2.1,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147460424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity of Nonspecific Stroke Location ICD-10 Subcodes: A Descriptive Study.","authors":"Jason L Hirsch, James F Burke, Raed Hailat, Kevin A Kerber","doi":"10.1159/000549823","DOIUrl":"10.1159/000549823","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to describe imaging characteristics in stroke hospitalizations with nonspecific/unspecified vascular region subcodes and to assess for systematic bias in the use of these subcodes.</p><p><strong>Methods: </strong>We captured first ischemic stroke hospitalizations from 2018 to 2022 at a single stroke center. We reviewed imaging studies to classify a gold standard of vascular region blinded to ICD-10 subcodes in 200 randomly selected hospitalizations: 100 with nonspecific/unspecified subcodes and 100 with specific subcodes oversampled for posterior circulation strokes. We assessed for systematic bias in the use of nonspecific/unspecified subcodes using multilevel logistic regression, with primary provider included as a random intercept. Separate models were applied to the full population of strokes and to those that underwent imaging review.</p><p><strong>Results: </strong>We identified 5,234 first ischemic stroke hospitalizations, of which 2,224 (43%) received a nonspecific/unspecified vascular region subcode. Out of the 100 ICD-10 nonspecific/unspecified stroke location cases that underwent imaging review, 85 had acute infarcts in specific locations: 45 anterior circulation, 40 posterior circulation, and 15 with no infarct. Factors associated with the use of nonspecific/unspecified subcodes were low NIHSS scores and non-neurological specialist but not anterior versus posterior vascular distribution. The proportion of variance explained by the models was modest (pseudo-R2 0.16).</p><p><strong>Conclusions: </strong>Most ischemic stroke hospitalizations coded with nonspecific/unspecified ICD-10 vascular region subcodes had imaging-confirmed infarcts in specific vascular regions. These strokes tended to have a lower NIHSS and were overrepresented by posterior circulation lesions. The modest variance explained in the use of nonspecific/unspecified codes indicates that much of the coding is influenced by random variation or unmeasured factors. Future studies in other healthcare systems are needed to verify these findings and evaluate for other predictors. Researchers using these subcodes should recognize the limitations and incorporate sensitivity analyses to evaluate potential bias in results.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"9-18"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12818899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Incident Atrial Fibrillation after Stroke: A Scoping Review of Clinical Scores, Biomarkers, and AI-Enhanced Strategies.","authors":"João Brainer Clares de Andrade, Ivan Pisa, Nathalia Souza de Oliveira, Rafael Pádua Gomes, Alessandra Braga Cruz Guedes de Morais, Jackeline Viana da Silva, Thales Fagundes Pardini, Thiago Oscar Goulart","doi":"10.1159/000550097","DOIUrl":"10.1159/000550097","url":null,"abstract":"<p><strong>Background: </strong>Incident atrial fibrillation (AF) after ischemic stroke is frequently underdetected despite its implications for anticoagulation and prevention of recurrent events. Multiple strategies - clinical risk scores, serum biomarkers, imaging markers, digital electrocardiographic (ECG) monitoring, and artificial intelligence (AI)-based models - have been proposed to predict or detect post-stroke AF, but their comparative performance and applicability in routine practice remain uncertain.</p><p><strong>Summary: </strong>We conducted a scoping review following PRISMA-ScR guidelines to map evidence on tools for predicting or detecting post-stroke AF in adults without known AF at baseline. We synthesized studies on clinical prediction scores, circulating biomarkers, imaging-derived markers, digital monitoring technologies, and AI-enhanced predictive models. Natriuretic peptides, particularly NT-proBNP and mid-regional pro-atrial natriuretic peptide, demonstrate the most consistent association with incident AF and may improve risk stratification. Imaging markers such as left atrial dimensions and radiomic features show potential but lack robust validation. Digital monitoring modalities - including handheld ECG devices, wearable patch monitors, smartwatches, and implantable loop recorders - differ substantially in diagnostic yield, cost, and feasibility across settings. AI-based approaches using electronic health record data or ECG signals achieve high discrimination in development cohorts but require prospective clinical evaluation. Based on the evidence landscape, we outline a tiered diagnostic pathway integrating clinical scores, biomarker-guided triage, and stepwise ECG monitoring adapted to resource availability.</p><p><strong>Key messages: </strong>Optimal post-stroke AF detection requires a multimodal strategy rather than isolated tools. Natriuretic peptides are the most validated biomarkers. Digital and AI-driven tools may broaden detection capacity but need external validation. A tiered diagnostic pathway may optimize diagnostic yield and resource allocation.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"94-109"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13082775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Artery Dissection Recurrence in an Unselected Danish Cohort.","authors":"Michael Zaucha Sørensen, Jacob Rørbech Marstrand, Sverre Rosenbaum","doi":"10.1159/000549777","DOIUrl":"10.1159/000549777","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous cervical artery dissection (CeAD) is an important cause of ischemic strokes in young adults. The pathophysiology as well as risk factors are largely unknown. Recurrences are considered rare and primarily to occur within the first 3 months. The frequency of asymptomatic recurrences varies in recent studies. This study seeks to determine the risk of all recurrent dissections in an unselected consecutive patient population after initial diagnosis.</p><p><strong>Methods: </strong>Of 218 patients referred between October 2014 and December 2024, 102 were included in the final analysis. Patients' medical records were reviewed to determine demographics, including associated risk factors and antithrombotic treatments used. Reports from relevant imaging at routine follow-up and at repeat admissions were acquired to determine recurrence rates of CeAD and new cases of stroke.</p><p><strong>Results: </strong>Seven (6.9%) patients had CeAD recurrences after the index event, of which 6 occurred after 6 months and 2 (28.6% of recurrences) were asymptomatic. A family history of dissections (RR: 6.9, CI: 1.7; 27.3, p = 0.006) or radiologically verified tortuous cervical arteries (RR: 9.8, CI: 2.8; 34.3, p = 0.0003) were significantly associated with recurrence. By 1-year follow-up, 56 patients had persisting vessel sequelae from the index CeAD. Stroke occurrences after the index CeAD was 2.9% (n = 3) and did not occur in patients with CeAD recurrence. All patients received antithrombotic treatment for at least a year.</p><p><strong>Conclusion: </strong>Recurrence of CeAD and stroke occurrence were low after the index event. CeAD were often asymptomatic and occurred later than previously reported. Long-term, regular follow-up and stroke-preventive treatments are essential to reduce morbidity from repeat CeAD and strokes, especially in patients with relevant family history or known artery tortuosity.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"19-26"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12830001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Clinical Characteristics of Isolated Intraventricular Hemorrhage.","authors":"Yoshito Arakaki, Kaori Miwa, Masayuki Shiozawa, Atsushi Ogawa, Ryoko Inutsuka, Ryo Usui, Soya Iwamoto, Jin Nakahara, Kazunori Toyoda, Masafumi Ihara, Masatoshi Koga","doi":"10.1159/000550860","DOIUrl":"10.1159/000550860","url":null,"abstract":"<p><strong>Introduction: </strong>Isolated intraventricular hemorrhage (IVH) is a rare phenotype of intracerebral hemorrhage (ICH), and its mechanistic basis is poorly understood.</p><p><strong>Methods: </strong>This retrospective study used a prospectively collected single-center database of patients treated between December 2010 and December 2022. Patients with ICH were classified into isolated IVH and intraparenchymal hemorrhage (IPH). The clinical profiles of patients with isolated IVH and IPH were compared.</p><p><strong>Results: </strong>Of 2,310 patients with acute ICH, 41 were excluded because of underlying vascular lesions, trauma, and tumor as possible causes. Of the remaining 2,269 patients, there were 23 patients (1%) with isolated IVH (female 44%; mean age, 73 ± 11 years) and 2,246 (99%) with IPH (43%; 71 ± 13 years). Compared with the IPH group, the isolated IVH group had a higher frequency of diabetes mellitus (35% vs. 16%) and prior anticoagulant use (44% vs. 13%). Diabetes mellitus (adjusted odds ratio: 2.50 [95% confidence interval, 1.03-6.07]) and prior anticoagulant use (3.74 [1.05-13.33]) were independently associated with isolated IVH. Compared with the IPH group, the isolated IVH group had a significantly lower NIHSS score at discharge (median 2 [interquartile range 0-12] vs. 8 [2-18], p = 0.011). Unfavorable outcome, defined as mRS 4-6, was marginally less common at 90 days (27% vs. 47%, p = 0.061) for isolated IVH than for IPH.</p><p><strong>Conclusions: </strong>Compared to IPH, isolated IVH was more frequently associated with prior anticoagulant use and diabetes mellitus and had a tendency for milder neurologic deficits and better functional outcomes.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"87-93"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147491973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Posttreatment Hyperperfusion on Arterial Spin Labeling with Fluid-Attenuated Inversion Recovery Vascular Hyperintensity in Patients with Acute Ischemic Stroke after Endovascular Therapy.","authors":"Wen-Jing Ni, Guang-Chen Shen, Gao Ma, Yue Chu, Zi-Xin Yin, Shan-Shan Lu, Hai-Bin Shi, Fei-Yun Wu, Xiao-Quan Xu","doi":"10.1159/000550385","DOIUrl":"10.1159/000550385","url":null,"abstract":"<p><strong>Introduction: </strong>The prognosis of patients with acute ischemic stroke (AIS) following endovascular therapy (EVT) is largely influenced by the extent of reperfusion. Fluid-attenuated inversion recovery vascular hyperintensity (FVH) is a simple imaging sign which assessed based on fluid-attenuated inversion recovery (FLAIR) images. We aimed to evaluate whether FVH on posttreatment FLAIR can serve as a surrogate imaging marker of cortical hyperperfusion identified by arterial spin labeling (ASL) in patients with AIS after EVT.</p><p><strong>Methods: </strong>We retrospectively enrolled 150 patients with AIS who achieved successful recanalization after EVT. Clinical data and posttreatment magnetic resonance imaging sequences including diffusion-weighted imaging (DWI), FLAIR, and ASL were systematically collected. The 150 patients were categorized into four groups based on DWI and FVH status (A: DWI-, FVH-; B: DWI+, FVH-; C: DWI-, FVH+; D: DWI+, FVH+). Perfusion was evaluated within six predefined Alberta Stroke Program Early CT Score (ASPECTS) regions (M1-M6) per patient, yielding a total of 900 cortical regions analyzed. The perfusion status was evaluated based on visual assessment of absolute cerebral blood flow maps derived from ASL, followed by statistical analysis.</p><p><strong>Results: </strong>Among the 900 cortical territories, 250 (27.78%) were classified as group A, 361 (40.11%) as group B, 55 (6.11%) as group C, and 234 (26.00%) as group D. Inter-rater agreement for evaluating the status of posttreatment FVH was excellent (κ = 0.851). There were significant differences in perfusion characteristics across four groups (p < 0.001). In subgroup analysis, group C exhibited a higher proportion of hyperperfusion compared to group A (21.82% vs. 15.20%), although the difference did not reach significance (p = 0.442), while group D demonstrated a significantly higher percentage of hyperperfusion relative to group B (48.72% vs. 34.34%, p < 0.001).</p><p><strong>Conclusion: </strong>Positive FVH may be associated with post-EVT cortical hyperperfusion in AIS patients following successful revascularization.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"54-62"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging Markers Predict the Short-Term and Long-Term Stroke Recurrence in Symptomatic Intracranial Atherosclerotic Disease.","authors":"Rinta Paul, Anagha Rajiv, Adarsh Anil Kumar, Harini Pavuluri, Soumya Krishnamoorthy, Chandrasekharan Kesavadas, P Sankara Sarma, Shyam Prabhakaran, P N Sylaja","doi":"10.1159/000550480","DOIUrl":"10.1159/000550480","url":null,"abstract":"<p><strong>Introduction: </strong>Symptomatic intracranial atherosclerotic disease (ICAD) is associated with a high risk of stroke recurrence despite aggressive medical management. However, recurrence rates and risk factors are less studied in non-Western settings. The study evaluated the clinical and imaging predictors of early and late stroke recurrence in patients with symptomatic ICAD in India.</p><p><strong>Methods: </strong>This ambispective cohort study enrolled patients with symptomatic ICAD within 1 month of symptom onset from a tertiary stroke care hospital. The intracranial arterial stenosis grade and length, infarct patterns, white matter hyperintensity (WMH), and collateral flow were documented. The primary outcome was recurrent stroke or transient ischemic attack (TIA) within 3 months and 1 year.</p><p><strong>Results: </strong>Of 876 patients with large artery atherosclerosis, 229 patients were included (mean age 59.7 ± 10.2 years; men, 72.9%). At the end of 1-year follow-up, recurrent ischemic stroke or TIA occurred in 55 (24%) patients. Of these, 47 (20.5%) patients had stroke recurrence within 3 months (early), and 14 (6.1%) patients had stroke recurrence after 3 months to 1 year (late). Six patients had both early and late stroke recurrence. A territorial and cortical infarct pattern (p = 0.038), moderate to severe WMH (p = 0.050), hypertension (p = 0.040), diabetes (p = 0.043), and coronary artery disease (p = 0.034) predicted early stroke recurrence. A territorial and cortical infarct pattern (p = 0.026), greater length of stenosis (p = 0.045), diabetes (p = 0.026), and coronary artery disease (p = 0.044) predicted late recurrence. On multivariate analysis, a territorial and cortical infarct pattern (adj. OR: 2.15; 95% CI: 1.09-4.26; p = 0.028) independently predicted early stroke recurrence.</p><p><strong>Conclusion: </strong>A territorial and cortical infarct pattern is an independent predictor of early stroke recurrence, suggesting the role of artery-to-artery embolism and plaque instability as a potential mechanism of early stroke recurrence in patients with symptomatic ICAD.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"63-73"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}