Cerebrovascular Diseases Extra最新文献

{"title":"Radiation Vasculopathy.","authors":"Hui Meng Chang, Narayanaswamy Venketasubramanian","doi":"10.1159/000546505","DOIUrl":"https://doi.org/10.1159/000546505","url":null,"abstract":"<p><p>Cerebrovascular radiation related vasculopathies can involve vessels of all sizes. Of these, extracranial Carotid and Vertebral Artery radiation induced atherosclerosis are the most commonly encountered radiation vasculopathy in Asia. This is because of the high incidence of oro-naso-pharyngeal cancers in this region, where radiation therapy (RT) is the mainstay treatment. Radiation exposure induces the early and rapid development of atherosclerosis in the extracranial arteries. Studies with Doppler measured Carotid Intima Media Thickness have shown up to 21 fold increase in thickness at 1year over the irradiated arteries, and also in patients without traditional risk factors. The incidence, cumulative incidence and prevalence of carotid artery stenosis (CAS) was higher in irradiated arteries. The risk of developing CAS after RT was 4 times higher, with a higher incidence of CAS observed for every category of stenosis. Meta-analyses revealed a high cumulative incidence of CAS, with a nearly doubling of incidence during the first 3 years of follow up. Radiation associated atherosclerotic disease frequently involved both the Common Carotid Artery (CCA) and Internal Carotid Artery (ICA). Radiation plaques were more likely to be diffuse, and tandem plaques causing >50% stenoses were twice as common. Radiation plaques also had more high-risk features, they were more likely to be non-calcified, echolucent, ulcerated, mobile and have intraplaque hypoechoic foci. There was a significant increase in risk of both ischemic and hemorrhagic strokes, highest amongst patients younger than 40 years old. Risk factors for radiation associated atherosclerosis (RAA) include the method of delivery of RT, total dosage used, field of radiation, and time interval after RT. Complications include carotid blowout syndrome with a reported incidence of 3%-4.4%. Soft tissue necrosis, locally recurrent cancer, mucocutaneous fistulas, local infections, exposed clivus on nasoendoscopic examination and skull base erosion on imaging studies predicted for Carotid blowout. Both Carotid endarterectomy and Carotid Artery Stenting (CASt) have been performed but CASt was preferred due to a \"hostile neck\" from underlying radiation dermopathy and fibrosis, and scarring from prior surgeries. It has been proposed that screening could start as early as 1 year post-RT in higher risk patients, with repeat scans every 3- 5 years, using the non invasive and less expensive Doppler scan. Other radiation related vasculopathies, intracranial aneurysms, intracranial disease or Moyamoya syndrome, cavernomas and microbleeds were less common, and rarely encountered in Asian populations.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-14"},"PeriodicalIF":2.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200385","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":"Recurrent Stroke Prevention Strategies in Patients Receiving Acute Stroke Reperfusion Therapies (CoPrime Study Survey).","authors":"Rezan Ashayeri Ahmadabad, Mohammed Almekhlafi, P N Sylaja, Aviraj Deshmukh, Jesse Dawson, Aleksandra Pikula, Muhammad Shazam Hussain, Yiran Zhang, Negar Asdaghi, Sung-Ii Sohn, Mohammad Wasay, Ashfaq Shuaib, Brian Buck, Mahesh Pundlik Kate","doi":"10.1159/000546654","DOIUrl":"https://doi.org/10.1159/000546654","url":null,"abstract":"<p><strong>Background: </strong>Patients who have undergone reperfusion treatments, like all ischemic stroke patients, are at risk of recurrent ischemic strokes in the first 90 days. Current guidelines recommend single antiplatelet therapy for secondary prevention at variable time points after the procedure. This study aims to survey healthcare professionals to assess practices and perspectives on using dual antiplatelet therapy in patients who have received reperfusion therapies.</p><p><strong>Methods: </strong>We conducted a multinational cross-sectional web-based survey using Qualtrics involving neurologists and non-neurologist stroke physicians (including neurosurgeons, interventional neuroradiologists, and internal medicine physicians). Participants were asked about their current practices and presented with six structured case scenarios to determine their treatment preferences. In the case scenarios, we assessed their willingness to randomize to a clinical trial comparing single versus dual antiplatelets. Multinomial logistic regression analysis was performed to assess the relationship between demographic characteristics and willingness to randomize.</p><p><strong>Results: </strong>278 clinicians from 26 countries participated in the survey. The most common continent of practice was Asia (55.9%), the area of practice was Neurology 79.1%, the years of practice was 5-15 years (41.5%), and the level of stroke center was comprehensive stroke center (73.9%). Antiplatelet Choice: For a small infarct post-IVT and EVT, 69.8% preferred aspirin, and 17.6% chose a dual antiplatelet strategy with aspirin and clopidogrel. Loading of Antiplatelet: 43.5% indicated they would not administer a loading dose in cases even with small final infarctions. Timing of Antiplatelet Initiation: Preferences varied; 21.7% considered early initiation immediately post-EVT, and 37.2% considered 24 hours post-EVT. Willingness to Randomize: 77.7% were willing or would consider randomizing in a clinical trial with dual antiplatelet. On regression analyses, the willingness to randomize was influenced by years of practice and the local volume of reperfusion therapy.</p><p><strong>Conclusions: </strong>Antiplatelet management for secondary stroke prevention following reperfusion therapy is variable. However, more than three-fourths of participants were willing to consider randomization to a clinical trial exploring the prevention of recurrent stroke after reperfusion therapy.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-20"},"PeriodicalIF":2.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200392","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 characteristics of ischemic stroke in Japanese young adults.","authors":"Tomoyuki Ohara, Naoki Makita, Jun Fujinami, Keiko Maezono-Kandori, Daiki Fukunaga, Eijirou Tanaka, Akihiro Fujii, Hidesato Takezawa, Naoki Tokuda, Takehiro Yamada, Shiori Ogura, Masahiro Makino, Yoshinari Nagakane, Keisuke Imai, Ikuko Mizuta, Toshiki Mizuno","doi":"10.1159/000546037","DOIUrl":"https://doi.org/10.1159/000546037","url":null,"abstract":"<p><p>Background and Purpose There is limited data on the characteristics of stroke in young adults in East Asia including Japan. We aimed to clarify the clinical characteristics of ischemic stroke in Japanese young adults. Methods We prospectively enrolled ischemic stroke patients aged 18 to 50 years old who were admitted to 5 high-volume stroke centers within 14 days after onset between February 2018 and January 2023. We collected clinical and imaging data based on the study protocol and analyzed them for conventional and specific stroke risk factors, stroke etiology, and clinical outcome. Results We enrolled 275 subjects (median age, 46 years; men, 71%; full time workers, 75%; median NIHSS score at admission, 2 points). The major risk factors were dyslipidemia (59%), hypertension (49%), and smoking (32%). Hyperhomocysteinemia, migraine, and antiphospholipid syndrome were found in 21%, 11% and 5%, respectively. The RNF213 p.R4810K variant was identified in 4.5%. The most common stroke etiologies were small vessel occlusion (26%) and arterial dissection (25%; intracranial in 20% and extracranial in 5%). The stroke recurrence rate was 5% at 3 months. Modified Rankin scale 0-1 at 3 months was observed in 76%, whereas 61% were able to return to their previous full-time work and 31% exhibited symptoms of depression. Conclusions The leading stroke etiologies in young adults in Japan were small vessel occlusion and intracranial arterial dissection, which differs from those observed in Western countries. Most young stroke patients had a favorable outcome, but some of them encountered problems relating to employment or mental health after their stroke.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-14"},"PeriodicalIF":2.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020935","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":"Direct-Acting Oral Anticoagulant Dabigatran as a Bridging Therapy while Optimizing Warfarin Dosage for Cardioembolic Stroke.","authors":"Narayanaswamy Venketasubramanian, Yohanna Kusuma, Leonard Leong Litt Yeo, Bernard Chan","doi":"10.1159/000543301","DOIUrl":"10.1159/000543301","url":null,"abstract":"<p><strong>Introduction: </strong>Parenteral heparin is widely used as bridging therapy while optimizing oral anticoagulation (OAC). Newer direct-acting OACs (DOACs) attain therapeutic effect very quickly. We report the use of dabigatran as bridging therapy during warfarin optimization for cardioembolic stroke in two patients who opted to receive warfarin for long-term anticoagulation for secondary stroke prevention.</p><p><strong>Case presentations: </strong>Patient A was a 60-year-old man with hypertension, hyperlipidaemia, and gout who was admitted with a sudden onset of left-sided weakness. Clinically, he was alert but had right gaze preference and left-sided hemiplegia. The clinical diagnosis was of a right cortical stroke. He underwent intravenous tPA augmented with sonothrombolysis - the National Institute of Health Stroke Scale (NIHSS) score fell from 7 to 0. Repeat brain scan showed infarcts in the right frontal and parietal lobes. He was found to have atrial fibrillation (AF) and advised anticoagulation. He opted for warfarin with dabigatran bridging which was started on day 2 of his hospital admission. His International Normalized Ratio (INR) exceeded 2 by day 6 of anticoagulation, at which time the bridging dabigatran was stopped, fixed-dose warfarin was continued, and he was discharged well. On subsequent reviews in the clinic, his INR was in the therapeutic range of 2.0-3.0. He had no bleeding or recurrent ischaemic events during follow-up. Patient B was a 78-year-old man with a hypertension, hyperlipidaemia, and diabetes mellitus. He was admitted after he developed difficulty talking and mild right-sided weakness. Clinically, he was alert but had expressive aphasia and mild right-sided upper limb weakness (NIHSS 6). The clinical diagnosis was of a left cortical stroke. The brain scan showed a left posterior frontal and parietal infarct. He was out of the time window for recanalization therapy and was treated conservatively. He was found to have AF and advised anticoagulation. He opted for warfarin with dabigatran bridging which was started on day 1 of his hospital admission. His INR was almost 2 by day 5 of anticoagulation, at which time the bridging dabigatran was stopped and fixed-dose warfarin continued. He declined daily blood taking - his INR 4 days later was in the therapeutic range of 2.0-3.0. He had no bleeding or recurrent ischaemic events. He underwent rehabilitation uneventfully and was discharged well.</p><p><strong>Conclusions: </strong>The use of DOACs such as dabigatran as bridging therapy during optimization of OAC is feasible. Compared to heparin as bridging therapy, DOAC has the advantage of oral administration, lower cost, and possibly lower bleeding risks. This novel practice may be applicable in thrombosis in arterial and venous circulations, e.g., ischaemic stroke, deep venous thrombosis, pulmonary embolism.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"48-55"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878314","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":"Safe Navigation of Guiding Catheters during Stenting for Common Carotid Artery Lesions: The \"No-Touch\" Technique.","authors":"Yohei Takenobu, Noriko Nomura, Mizuha Toyama, Yoshito Sugita, Akihiro Okada, Takeshi Kawauchi, Yukinori Terada, Tao Yang, Manabu Inoue, Kenji Hashimoto","doi":"10.1159/000543398","DOIUrl":"10.1159/000543398","url":null,"abstract":"<p><strong>Introduction: </strong>During carotid artery stenting (CAS), safe navigation of the guiding catheter (GC) is essential for the success of procedures. However, in cases where stenosis or floating thrombi are located in the common carotid artery (CCA), especially for proximal lesions, advancing the GC without touching the lesions is often difficult. We describe a preliminary experience of the \"no-touch\" technique for navigating the GC to the CCA using an inner catheter with a specifically designed shape and stiffness optimized to overcome tortuous anatomy.</p><p><strong>Methods: </strong>We retrospectively reviewed CAS procedures involving the \"no-touch\" technique for treating stenotic lesions in the CCA. A 4-Fr Newton-shaped stiff catheter was positioned in the CCA. Given its high stiffness and dedicated shape, contact with the lesser curvature of the aortic arch absorbed kickback force. Then, a 6-Fr intermediate catheter and an 8- or 9-Fr balloon GC were coaxially advanced in sequence to the target position without guidewire support, ensuring \"no-touch\" with the plaques. Patient characteristics, aortic arch type, lesion location, and periprocedural complications were recorded.</p><p><strong>Results: </strong>The technique was applied to eight procedures (six left-sided lesions) in 7 patients (median age, 76 years; six men) among 53 CAS procedures performed on 49 patients. Lesions were located at the proximal CCA (four procedures) or the carotid bifurcation (four procedures). Three patients had floating thrombi, and four had type III aortic arches. GCs were successfully navigated without touching the lesions in all cases, with no periprocedural complications.</p><p><strong>Conclusion: </strong>The \"no-touch\" technique with a Newton-shaped stiff catheter is useful and feasible for navigating the GC in treating stenotic lesions in the CCA, particularly with tortuous anatomy, proximal lesions, and vulnerable plaques.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"56-61"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933088","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":"Implementing Acute Stroke Services in Sub-Saharan Africa: Steps, Progress, and Perspectives from the Tanzania Stroke Project.","authors":"Sarah Shali Matuja, Christine Tunkl, Tamer Roushdy, Linxin Li, Menglu Ouyang, Faddi G Saleh Velez, Meron Gebrewold, Jatinder S Minhas, Zhe Kang Law, Aristeidis H Katsanos, Teresa Ullberg, Maria Giulia Mosconi, Maria Khan, Matias Alet, Radhika Lotlikar, Alicia Richardson, Bogdan Ciopleias, Mirjam R Heldner, Susanna Maria Zuurbier, Emily Ramage, Selam K Kifelew, Vasileios Lioutas, Marika Demers, Marina Charalambous, Dorcas Gandhi, Urvashy Gopaul, Leonardo Carbonera, Ralph Akyea, Ladius Rudovick, Bahati Wajanga, Semvua Kilonzo, Robert Peck, Mohamed Mnacho, Faraja S Chiwanga, Brighton Mushengezi, Kigocha Okeng'o, Henrika Kimambo, Akili Mawazo, Mohamed Manji, Tumaini Nagu, Paschal Ruggajo, William Matuja, Louise Johnson, Octávio Marques Pontes-Neto, Craig S Anderson, Sheila Cristina Ouriques Martins","doi":"10.1159/000545954","DOIUrl":"10.1159/000545954","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is a leading cause of morbidity and mortality globally, with Africa bearing a disproportionately high burden of poor outcomes. In sub-Saharan Africa, acute stroke care remains inconsistent, with organized stroke units being either absent or rarely available, contributing to the high stroke mortality rates in the region. To address this issue, the Tanzania Stroke Project (TSP) was launched, aimed at establishing acute stroke services at two of the largest tertiary care centers in collaboration with the Tanzanian Ministry of Health, the World Stroke Organization, and Hospital Directorates.</p><p><strong>Methods: </strong>TSP utilized a three-tier implementation approach to establish a more organized stroke care system in two large academic hospitals. Here, we detail the process of this initiative, which took place between August 2023 and August 2024. The three-tier approach included (1) the establishment of stroke registries; (2) the training of healthcare workers (HCWs); and (3) the development of acute stroke protocols and establishment of stroke units at Muhimbili National Hospital-Mloganzila and Bugando Medical Center in Tanzania.</p><p><strong>Results: </strong>In tier one (stroke registry), two comprehensive stroke registries were established, including 460 adults (mean age 60 ± 15 years). Hemorrhagic stroke was the most common subtype, accounting for 59% of cases (n = 269). Premorbid hypertension was the most prevalent risk factor, affecting 81% (n = 373) of the patients. More than half of patients (58%, n = 171) arrived at the hospital after 24 h from stroke symptoms. Only 11% (n = 50/452) had documented swallowing screenings, and among patients with intracerebral hemorrhage, 11% (n = 28/251) achieved the target for blood pressure control, while 47% (n = 99/213) met blood glucose control targets. The in-hospital mortality rate was 27% (n = 93/340). In tier two (training of HCWs), extensive evidence-based mentorship training was provided with higher participation rates among HCWs at Bugando Medical Center compared to Muhimbili National Hospital-Mloganzila (57% [29/51] vs. 23% [7/31], p = 0.002). In tier three (stroke unit protocols), stroke protocols were developed based on the training and current evidence, leading to the establishment of dedicated stroke units at each facility, with a minimum of 8 beds per unit. The full impact of these implementations has yet to be fully assessed.</p><p><strong>Conclusion: </strong>This was the first initiative to implement stroke services at two large tertiary healthcare centers in Tanzania. Our findings highlight the importance of multilevel stakeholder engagement through a 3-tier approach in countries starting to establish stroke services and the need for ongoing quality-of-care monitoring and continuous efforts to sensitize both HCWs and the broader community.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"143-153"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020690","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":"Intracerebral Hemorrhage.","authors":"Tsong-Hai Lee","doi":"10.1159/000542566","DOIUrl":"10.1159/000542566","url":null,"abstract":"<p><strong>Background: </strong>Compared to ischemic stroke, intracerebral hemorrhage (ICH) has higher mortality and more severe disability. Asian such as Chinese and Japanese and Mexican Americans, Latin Americans, African Americans, Native Americans has higher incidences than do white Americans. So, ICH is an important cerebrovascular disease in Asia.</p><p><strong>Summary: </strong>ICH accounts for approximately 10-20% of all strokes. The incidence of ICH is higher in low- and middle-income than high-income countries and is estimated 8-15% in western countries like USA, UK, and Australia, and 18-24% in Japan, Taiwan, and Korea. The ICH incidence increases exponentially with age, and old age especially over 80 years is a major predictor of mortality independent of ICH severity. Females are older at the onset of ICH and have higher clinical severity than males. Modifiable risk factors include blood pressure, smoking, alcohol consumption, lipid profiles, use of anticoagulants, antiplatelet agents, and sympathomimetic drugs. Non-modifiable risk factors constitute old age, male gender, Asian ethnicity, cerebral amyloid angiopathy, cerebral microbleed, and chronic kidney disease. Blood pressure is the most important risk factor of ICH. Imaging markers may help predict ICH outcome, which include black hole sign, blend sign, iodine sign, island sign, leakage sign, satellite sign, spot sign, spot-tail sign, swirl sign, and hypodensities. ICH prognostic scoring system such as ICH scoring system and ICH grading scale scoring system in Chinese and Osaka prognostic score and Naples prognostic score has been used to predict ICH outcome. Early minimally invasive removal of ICH can be recommended for lobar ICH of 30-80 mL within 24 h after onset. Decompressive craniectomy without clot evacuation might benefit ICH patients aged 18-75 years with 30-100 mL at basal ganglia or thalamus. However, clinical studies are needed to investigate the effect of surgery on patients with smaller or larger ICH, ICH in non-lobar locations, and for older patients or patients with preexisting disability. Surgical treatment is usually associated with neurological sequels if survived. For medical treatment, blood pressure lowering should be careful titrated to secure continuous smooth and sustained control and avoid peaks and large variability in systolic blood pressure. Stroke and cancer are the most common causes of death in Asian ICH patients, compared to stroke and cardiac disease in non-Asian patients.</p><p><strong>Key messages: </strong>The incidence and outcome are different between Asian and non-Asian patients, and more clinical studies are needed to investigate the best management for Asian ICH patients.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11658787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668826","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":"The Prevalence of CYP2C19 Polymorphism in Patients with Symptomatic Intracranial Atherosclerosis.","authors":"Songchai Kittipanprayoon, Pongpat Vorasayan, Aurauma Chutinet, Pajaree Chariyavilaskul, Nijasri C Suwanwela","doi":"10.1159/000543331","DOIUrl":"10.1159/000543331","url":null,"abstract":"<p><strong>Introduction: </strong>Clopidogrel and aspirin were proved to have benefit in symptomatic intracranial stenosis. CYP2C19 polymorphism (CYP2C19*1, CYP2C19*2, CYP2C19*3, and CYP2C19*17 alleles) affects efficacy of clopidogrel. Epidemiologic study of CYP2C19 polymorphism has been conducted in Thai population. There was no data showed the frequency of allelic variants of CYP2C19 in Thai symptomatic intracranial stenosis patients. The aim of this study was to determine the prevalence of CYP2C19 polymorphism in symptomatic intracranial stenosis patients.</p><p><strong>Methods: </strong>The study group included 100 Thai symptomatic intracranial stenosis patients. Genotyping of CYP2C19 alleles (CYP2C19*1, CYP2C19*2, CYP2C19*3, and CYP2C19*17 alleles) was carried out by real-time polymerase chain reaction (rt-PCR) technique.</p><p><strong>Results: </strong>The allele frequency of CYP2C19*1, CYP2C19*2, CYP2C19*3, and CYP2C19*17 were 70.5%, 26%, 2.5%, and 1%, respectively. The result showed that 53% of symptomatic intracranial stenosis patients are normal metabolizers, while intermediate and poor metabolizer were 36 and 10 percent, respectively.</p><p><strong>Conclusion: </strong>Almost one-half of Thai symptomatic intracranial stenosis patients were intermediate or poor metabolizers. Usage of combination of aspirin and clopidogrel might not be effective in this group of patients.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"68-72"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922190","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":"Sex Differences in Clinical Presentation of Women and Men Evaluated at a Comprehensive Stroke Center for Suspected Stroke.","authors":"Jordi Kühne Escolà, Bessime Bozkurt, Bastian Brune, Lennart Steffen Milles, Doreen Pommeranz, Philipp Dammann, Yan Li, Cornelius Deuschl, Michael Forsting, Clemens Kill, Christoph Kleinschnitz, Martin Köhrmann, Benedikt Frank","doi":"10.1159/000543835","DOIUrl":"10.1159/000543835","url":null,"abstract":"<p><strong>Introduction: </strong>Understanding sex differences in the clinical presentation of patients with suspected stroke is important to reduce sex-related disparities and improve care. We aimed to characterize presenting symptoms in women and men with suspected stroke evaluated at our comprehensive stroke center.</p><p><strong>Methods: </strong>This was a retrospective analysis of consecutive patients with suspected stroke treated at the University Hospital Essen between January 2017 and December 2021. Patient characteristics, signs and symptoms as well as final diagnoses in women and men were compared. Logistic regression analysis was performed to assess the association of individual symptoms with a diagnosis of cerebrovascular disease.</p><p><strong>Results: </strong>We included 6,069 patients in our analysis. Cerebrovascular disease was diagnosed in 85.2% (2,576/3,022) of women and 88.0% (2,681/3,047) of men (p = 0.002). Aphasia (31.4% vs. 27.7%, p = 0.002), neglect (15.5% vs. 12.8%, p = 0.003), gaze deviation (21.0% vs. 18.8%, p = 0.034), as well as nonfocal symptoms including impairments in consciousness (17.0% vs 14.6%, p = 0.012), orientation (42.5 vs. 36.4%, p < 0.001), and completion of tasks (31.2% vs. 26.0%, p < 0.001) were more common among women. Limb ataxia (8.1% vs. 11.2%, p < 0.001) and dysarthria (44.0% vs. 46.8%, p = 0.030) were less frequent in women. Neglect and gaze deviation were independent positive predictors of cerebrovascular disease in women but not in men.</p><p><strong>Conclusion: </strong>Although clinical presentation was similar in both sexes, cortical and nonfocal symptoms were more common among women with suspected stroke. Awareness of sex differences and acknowledgment of the full clinical picture are important to ensure optimal management for women and men with suspected stroke. Our findings might serve as a target for educational programs in order to improve preclinical stroke detection in patients with predominantly nonfocal or subtle symptoms.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"110-117"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411223","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":"Intracranial Atherosclerotic Stenosis.","authors":"Jeong Yoon Song, Sun U Kwon","doi":"10.1159/000543356","DOIUrl":"10.1159/000543356","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Ischemic stroke is a significant global health problem associated with mortality and disability. Intracranial atherosclerotic stenosis (ICAS) is a leading cause of stroke and contributes to recurrent stroke, especially in the Asian population. ICAS should be distinguished from extracranial atherosclerotic stenosis (ECAS) due to differences in pathophysiology. Understanding the mechanisms of ICAS is crucial for stroke prevention in the Asian population. Traditional vascular risk factors and the degree of the stenosis play an important role in predicting stroke occurrence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary: &lt;/strong&gt;In East Asia, non-atherosclerotic vasculopathies are also often observed in ischemic stroke patients caused by large artery disease, highlighting the importance of identifying the specific etiologies of intracranial artery stenosis. Advances in diagnostic neuroimaging, such as high-resolution MRI (HR-MRI), can be helpful in distinguishing between them. For stroke prevention in patients with both asymptomatic and symptomatic ICAS, intensive management, including strict control of modifiable risk factors and appropriate antiplatelet therapies, is essential. There are no clear guidelines regarding the duration and combination of antiplatelet therapies. However, current recommendations suggest short-term dual antiplatelet therapies for 90 days to reduce the recurrence of stroke in symptomatic severe ICAS (70-99%). Cilostazol is also proposed as a good second-line treatment option, following clopidogrel, which remains the most widely used. In addition, endovascular or surgical interventions could be considered alternatives for a limited subset of symptomatic severe ICAS cases that are hemodynamically unstable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key messages: &lt;/strong&gt;The key messages are as follows: (1) ICAS is a major cause of ischemic stroke, especially in Asian populations. Its distinct pathophysiology, compared to ECAS, requires different treatment strategies for secondary prevention; (2) differentiation of intracranial artery stenosis etiology is essential, and HR-MRI would be a valuable diagnostic tool; (3) stroke prevention includes strict vascular risk factor control and the use of antiplatelet therapies, with short-term DAPT recommended for symptomatic severe ICAS; (4) cilostazol may serve as an effective second-line option for preventing ischemic stroke, while endovascular or surgical interventions may be limited to hemodynamically unstable cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Ischemic stroke is a significant global health problem associated with mortality and disability. Intracranial atherosclerotic stenosis (ICAS) is a leading cause of stroke and contributes to recurrent stroke, especially in the Asian population. ICAS should be distinguished from extracranial atherosclerotic stenosis (ECAS) due to differences in pathophysiology. Understanding the mechanisms of ICAS is crucial for stroke prevention in the Asian population. Tr","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"62-67"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922058","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}