Cerebrovascular Diseases Extra最新文献

{"title":"Increasing Temporal Trends in the Frequency of Methamphetamine-Associated Intracerebral Hemorrhage in the Philippines.","authors":"Bonifacio C Pedregosa Ii, Steven G Villaraza, Cyrus G Escabillas, Gabriel Alejandro B Baroque, Zenyros Faith A Sabellano, Kelsey C Dayrit, Anne Marie Joyce Tenorio-Javier, Herminigildo H Gan, Romulo U Esagunde, Jose C Navarro","doi":"10.1159/000548522","DOIUrl":"https://doi.org/10.1159/000548522","url":null,"abstract":"<p><strong>Introduction: </strong>Methamphetamine is an established risk factor for intracerebral hemorrhage (ICH). Despite growing concerns over its abuse, particularly in the Philippines, region-specific data on its neurological consequences remain lacking. This study aimed to investigate the temporal trends in the frequency of methamphetamine-associated ICH (Meth-ICH) in the Philippines.</p><p><strong>Methods: </strong>Consecutive patients presenting with ICH at the Philippine National Specialty Center for Brain and Spine Care between 2018 and 2024 were retrospectively included. Meth-ICH cases were identified through positive urine toxicology tests at the time of admission. Frequency counts of total ICH and Meth-ICH cases were used to calculate the proportion of Meth-ICH cases for each year. Temporal trends were assessed using the two-sided Cochrane-Armitage test for trend, and by analyzing absolute and relative changes in proportions.</p><p><strong>Results: </strong>Of the 1,652 ICH patients included, 116 (7.02%) tested positive for methamphetamine. The proportion of Meth-ICH cases increased 11.82-fold over the seven-year study period, rising from 1.49% (4/268, 95% confidence interval [CI]: 1.15% to 1.83%) in 2018 to 17.58% (74/421, 95% CI: 14.04% to 21.12%) in 2024. Between 2018 and 2021, no significant changes were observed in the number and proportion of Meth-ICH cases. A non-significant upward trend was noted between 2021 and 2022, with a relative change in proportion of 67.30% (95% CI: -86.57% to 231.17%; p = .635). A significant increase in the proportion of Meth-ICH cases was seen between 2022 and 2024, with relative changes in proportion of 310.70% (95% CI: 213.70% to 407.70%; p = .003) from 2022 to 2023, and 100.80% (95% CI: 5.89% to 207.69%; p = .001) from 2023 to 2024.</p><p><strong>Conclusion: </strong>There was an increasing trend in the frequency of Meth-ICH cases in the Philippines from 2018 to 2024, with a significant and sustained surge beginning in 2022. Comprehensive evidence-based public health strategies are urgently needed, particularly in regions with high rates of methamphetamine use.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-14"},"PeriodicalIF":2.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151362","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":"Prevalence and Associated Factors of Extracranial Carotid Stenosis in Northern Vietnam Patients with Transient Ischemic Attack or Ischemic Stroke.","authors":"Mai Duy Ton, Pham Manh Hung, Thanh N Nguyen, Bui Nguyen Tung","doi":"10.1159/000548297","DOIUrl":"https://doi.org/10.1159/000548297","url":null,"abstract":"<p><strong>Background: </strong>In Vietnam, the incidence of transient ischemic attack (TIA) or ischemic stroke has increased in recent years due to lifestyle changes. Carotid stenosis is a common cause of TIA/ischemic stroke. This study aimed to determine the prevalence and identify risk factors for ipsilateral internal carotid artery (ICA) stenosis in patients with transient ischemic attack (TIA) or ischemic stroke.</p><p><strong>Methods: </strong>We recruited consecutive patients admitted to Bach Mai hospital from 06/2021 to 06/2022 with the diagnosis of TIA/ischemic stroke. The primary outcome was the presence of significant ipsilateral carotid stenosis (≥50%) by using carotid imaging modalities (duplex ultrasonography, computed tomography angiography or magnetic resonance angiography). Univariable and multivariable logistic regression analyses were performed to identify risk factors associated with 50-99% ICA stenosis.</p><p><strong>Results: </strong>In total, 1191 consecutive patients with TIA/ischemic stroke were included. Of these, 62 (5.2%, 95% confidence interval (CI): 4.0-6.6) had 50-99% ipsilateral ICA stenosis. Patients with significant ICA stenosis were more likely to have advanced age, male sex and prior stroke. In multivariable logistic regression, advanced age (OR 1.49 per 10-year increment; CI 95%: 1.17 -1.90, p= 0,001), male sex (OR 4.94 ; CI 95%: 2.15 - 11.38, p < 0.001), and prior stroke (OR 2.01; CI 95%: 1.12 -3.62, p = 0.02) were risk factors for ICA stenosis.</p><p><strong>Conclusion: </strong>The observed prevalence of extracranial ICA stenosis in TIA/ischemic stroke patients in Vietnam appears to be lower compared to Western nations, yet it is relatively comparable to that of other Asian countries. Male sex, prior stroke and advanced age constitute significant risk factors for symptomatic ICA stenosis.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034387","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":"Analysis of Prognostic Factors for Survival in Patients with Trousseau Syndrome Initially Presenting with Acute Ischemic Stroke.","authors":"Xianjin Ke, Xian Wu, Guoquan Feng, Deqiang Wang, Kai Niu, Ying Zhu, Bo Sun","doi":"10.1159/000548109","DOIUrl":"https://doi.org/10.1159/000548109","url":null,"abstract":"<p><strong>Introduction: </strong>Trousseau syndrome (TS) represents a significant vascular thromboembolic event in cancer patients and has progressively gained attention as a critical clinical concern in recent years. The aim of this study is to investigate the survival status and prognostic factors in patients with TS whose initial clinical manifestation was acute ischemic stroke (AIS).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 24 TS patients hospitalized at the Affiliated Hospital of Jiangsu University between 2018 and 2024. Data collected included demographic characteristics, tumor staging, complete blood count, C-reactive protein (CRP), coagulation function, blood biochemistry analyses, tumor markers, National Institutes of Health Stroke Scale (NIHSS) scores, Modified Rankin Scale (mRS), and treatment regimen. Based on the temporal sequence of AIS onset relative to tumor diagnosis, patients were categorized into two groups: the AIS-TS (AIS as initial symptom with Trousseau syndrome, n = 9) group and the NAIS-TS (AIS was not as initial symptom with Trousseau syndrome, n = 15) group. Survival follow-up was performed via outpatient visits and telephone interviews. Kaplan-Meier survival analysis was used to compare survival rates between the two groups with Log-rank tests for statistical comparisons. Univariate Cox regression analysis was initially conducted to screen potential prognostic factors, followed by multivariate Cox regression analysis for variables with P < 0.1.</p><p><strong>Results: </strong>Kaplan-Meier survival analysis revealed that the overall survival rate of the AIS-TS group was significantly lower than that of the NAIS-TS group (Log-rank χ² = 5.07, P = 0.024). Multivariate Cox regression analysis indicated that after adjusting for confounding factors, D-dimer index (DDI) (HR = 1.17, 95% CI 1.05 - 1.31, P = 0.004), carcinoembryonic antigen (CEA) (HR = 1.04, 95% CI 1.02 - 1.06, P = 0.001) and female gender (HR = 4.80, 95% CI 1.42 - 16.23, P = 0.012), were independent risk factors for all-cause mortality in TS patients.</p><p><strong>Conclusion: </strong>TS patients presenting with AIS as the initial symptom exhibited shorter survival time and poorer prognoses. Female gender, elevated DDI and elevated CEA levels were identified as significant prognostic indicators influencing poor survival and prognosis in TS patients, potentially establishing a foundation for future prognostic evaluations in TS patients.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034328","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":"Study on the effect of trimethylamine oxide on recurrent cerebral infarction of minor ischaemic stroke rats.","authors":"Chen Chen, Ziwei Hou, Hong Liu, Jintao Wang, Jianyong Guo, Ting Yang, Min Wang, Ling Ding","doi":"10.1159/000548183","DOIUrl":"https://doi.org/10.1159/000548183","url":null,"abstract":"<p><strong>Background: </strong>This study investigates the impact of trimethylamine oxide (TMAO) on recurrent cerebral infarction in minor ischemic stroke (MIS).</p><p><strong>Methods: </strong>A rat model was used, with dietary choline levels adjusted to vary TMAO levels. TMAO was quantified via liquid chromatography-mass spectrometry (LC-MS), and histological changes in brain and aortic tissues were analyzed using HE staining.</p><p><strong>Results: </strong>Data analysis showed that TMAO levels and neurological deficit scores increased progressively across groups, correlating positively with the severity of cerebral and arterial pathology. High-choline diets significantly elevated TMAO levels, aggravating infarction and atherosclerosis, while low-choline diets reduced these effects.</p><p><strong>Conclusions: </strong>TMAO demonstrated medium-high diagnostic value for neurological deficits, infarction size, and arterial damage. These findings suggest that elevated TMAO levels are linked to worse outcomes in MIS, highlighting the potential of TMAO as a biomarker for diagnosis and prevention of recurrent cerebral infarction.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-21"},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034337","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":"Stroke in Young Adults in Asia.","authors":"Kay Sin Tan, Tsong Hai Lee, Shinichiro Uchiyama, Udaya K Ranawaka, Phyu Phyu Lay, Yangchen, Narayanaswamy Venketasubramanian","doi":"10.1159/000547683","DOIUrl":"https://doi.org/10.1159/000547683","url":null,"abstract":"<p><p>Stroke in Young Adults in Asia Background Stroke in young adults is a worldwide problem with long term physical and socioeconomic implications. The largest burden of disease is expected to impact Asia. Stroke in young adults is defined broadly as strokes occurring between the ages of 18-49 and include ischaemic stroke and intracerebral haemorrhage. The objective of this review is to focus on the important aspects of epidemiology, risk factors, genetic contributions as well as evaluation, management and outcome of stroke in young adults within the Asian context. Summary This publication is an overview of recent literature from many countries in Asia. Population and hospital level data offer insight into common and unique aetiologies of pre-mature ischaemic stroke and intracerebral haemorrhage in young adults. In young adults, prognosis and outcomes were worse in intracerebral haemorrhage compared to ischaemic stroke. Stroke prevention should be emphasized while rapid access to acute stroke reperfusion and interventional therapies can benefit younger patients. More research should be performed in young adults with stroke in order to reduce the short and long term mortality in both stroke subtypes, improve primary as well as secondary prevention and define further the role of next generation sequencing for cryptogenic stroke. Key Messages Stroke in young adults in Asia reveal the interplay between complex genetic factors, traditional risk factors and unique aetiologies. Socioeconomic status and healthcare access are other important factors affecting the care of these patients.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-21"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776445","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020690","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":"Intracranial Atherosclerotic Stenosis.","authors":"Jeong Yoon Song, Sun U Kwon","doi":"10.1159/000543356","DOIUrl":"10.1159/000543356","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Summary: </strong>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.</p><p><strong>Key messages: </strong>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.</p><p><strong>Background: </strong>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}

{"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}