Cerebrovascular Diseases Extra最新文献

{"title":"Epidemiology of Aneurysmal Subarachnoid Hemorrhage in Shiga Prefecture, Japan: A Population-Based Study from the Shiga Stroke and Heart Attack Registry.","authors":"Satoshi Shitara, Akiko Harada, Sachiko Tanaka-Mizuno, Naoyuki Takashima, Takako Fujii, Hisatomi Arima, Makoto Urushitani, Kazuhiko Nozaki, Katsuyuki Miura, Kazumichi Yoshida","doi":"10.1159/cee/acdag003","DOIUrl":"https://doi.org/10.1159/cee/acdag003","url":null,"abstract":"<p><strong>Introduction: </strong>Population-based data describing aneurysm location and treatment patterns in aneurysmal subarachnoid hemorrhage (SAH) remain limited in Japan. We aimed to describe the epidemiological characteristics of aneurysmal SAH using a large population-based stroke registry.</p><p><strong>Methods: </strong>We conducted a descriptive epidemiological study using the Shiga Stroke and Heart Attack Registry, an ongoing population-based registry covering approximately 1.4 million residents of Shiga Prefecture, Japan. Among 1,056 patients with first-ever SAH identified between 2011 and 2015, 819 patients with aneurysmal SAH were included after excluding patients with multiple aneurysms in whom the ruptured lesion could not be identified and those with insufficient imaging information. Patient characteristics, aneurysm locations, treatment patterns, and discharge outcomes were summarized descriptively.</p><p><strong>Results: </strong>The most common aneurysm locations were the middle cerebral artery (MCA) (26.0%), posterior communicating artery (PComA) (23.4%), and anterior communicating artery (AcomA) (22.8%). Overall, 426 patients underwent surgical clipping, 279 underwent endovascular treatment, and treatment selection differed according to aneurysm location. Surgical clipping predominated for MCA aneurysms, whereas endovascular treatment was more frequently performed for vertebrobasilar aneurysms.</p><p><strong>Conclusions: </strong>This population-based registry demonstrated a predominance of MCA, PComA, and AComA aneurysms, distinct treatment patterns according to aneurysm location, and a marked female predominance among patients with aneurysmal SAH in Shiga Prefecture, Japan. These findings provide population-based reference data for understanding the epidemiology and clinical management of aneurysmal SAH in Japan.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116258","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":"Improving Accuracy of Intracerebral Hemorrhage Volume Measurement Using Three-Dimensional Modeling and Physical Displacement.","authors":"Jessica Garcia-Chan, Hassan Abdal, Muhammad Abubakar Ayub, Dawit Measho, Anna Bashmakov, Rachel Aubert, DaiWai M Olson, Parth Upadhyaya","doi":"10.1159/cee/acdag002","DOIUrl":"https://doi.org/10.1159/cee/acdag002","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate intracerebral hemorrhage (ICH) volume measurement is critical for prognostication, but the widely used ABC/2 method may lack accuracy for irregular hematomas. Our group evaluated the feasibility of three dimensional (3D) printed ICH phantoms as a physical reference standard for validating hemorrhage volume measurement methods.</p><p><strong>Methods: </strong>In this retrospective feasibility study, 21 non-contrast head computed tomography (CT) studies showing intracranial hemorrhages from two publicly available datasets were converted from segmentation masks into stereolithography files and fabricated as 3D printed phantoms. Hematoma volumes were calculated using manual ABC/2 estimations and custom software segmentation volumetry, with Bland-Altman analysis used to assess interrater agreement. These were compared to 3D phantom volumetry with method comparison using the Wilcoxon signed-rank test and correlation using Spearman coefficients.</p><p><strong>Results: </strong>Median hematoma volume by ABC/2 was 4.4 mL (IQR 1.4-12) mL, segmentation software derived volume was 4.39 mL (IQR 2.1-5.94) mL, and 3D phantom volumetry was 4.0 mL (IQR 2-5) mL. There was no significant difference between ABC/2 measurement and 3D phantom volumetry (p=.16) with weak correlation (Spearman rho=0.39; p=.08) whereas segmentation derived volumes differed from 3D phantom measurements (p=.01) with a strong correlation (Spearman rho = 0.97; p<.001). Correlation between ABC/2 and segmentation volumetry was also weaker (rho=0.41; p=.06).</p><p><strong>Conclusions: </strong>3D printed ICH phantoms are a feasible and reproducible platform for validating hemorrhage volumetry. Phantom-determined volumes showed closer alignment with segmentation-based measurements than with ABC/2 measurements, supporting their use as a reference standard for evaluating current and emerging ICH volume measurement techniques.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082319","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":"Research-Evidence-Practice Gaps in Post-stroke Neuro-recovery Pharmacological Therapies in Asia.","authors":"Hou Chang Chiu, Yangchen Yangchen, Dayangku Siti Nur Ashikin Pengiran Tengah, Navuth Na Chum, Yapeng Lin, Wing-Chi Fong, Vijaya Pamidimukkala, Jeyaraj Durai Pandian, Girianto Tjandrawidjaja, Shinichiro Uchiyama, Mi-Sun Oh, Saysavath Keosodsay, Kay Sin Tan, Amarbayasgalan Ravdan, Phyu Phyu Lay, Lekhjung Thapa, Maimoona Siddiqui, Jose C Navarro, Hui Meng Chang, Udaya K Ranawaka, Tsong-Hai Lee, Lung Chan, Duangnapa Roongpiboonsopit, Nijasri C Suwanwela, Thang Huy Nguyen, Narayanaswamy Venketasubramanian","doi":"10.1159/000553635","DOIUrl":"https://doi.org/10.1159/000553635","url":null,"abstract":"<p><strong>Background: </strong>Our recently-published systematic-search-and-review identified eight registered treatments with level A or B-R evidence of improving neuro-recovery after a stroke. In this study, we aimed to assess their availability, usage, and recommendation in national guidelines in different Asian countries or regions.</p><p><strong>Methods: </strong>We conducted a survey on availability, estimated usage in stroke patients, inclusion in local stroke guidelines, and if they believed more clinical trials were necessary for nimodipine, edaravone, cinepazide, clomethiazole, selective-serotonin reuptake inhibitors (SSRIs), MLC601/MLC901, cerebrolysin and panax notoginseng among leading neurologists from 21 countries or regions in Asia.</p><p><strong>Results: </strong>Nimodipine and SSRIs are the most widely available across countries or regions in Asia. National stroke guidelines uniformly recommend nimodipine for SAH, while SSRIs are indicated and used for post-stroke depression. Edaravone, MLC601/ MLC901, cerebrolysin and panax notoginseng are available in about a third to half of the countries or regions surveyed, while cinepazide and clomethiazole are generally unavailable. Even when available, usage is low particularly when not in the national guidelines. Further clinical trials are often desired on treatments that are not widely available or in the guidelines.</p><p><strong>Conclusion: </strong>We found research-evidence-practice gaps in several post-stroke treatments for neuro-recovery, particularly in terms of availability and inclusion in clinical guidelines. Bridging the gap between research and practice will be crucial to improve patient outcome.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-14"},"PeriodicalIF":2.1,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621874","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":"Demographic Refinement and Atrial Fibrillation Type in Stroke Risk Stratification beyond CHA₂DS₂ VASc.","authors":"Karim M Mahawish, Rita V Krishnamurthi, Suzanne Barker-Collo, Annamarei Ranta, Derrick Bennett, Irene Suilen Zeng, Valery Feigin, Harvey White","doi":"10.1159/000553393","DOIUrl":"10.1159/000553393","url":null,"abstract":"<p><strong>Introduction: </strong>The CHA₂DS₂ VASc score is widely used for stroke risk stratification in atrial fibrillation (AF). Efforts to improve prediction using demographic refinements have uncertain incremental value, particularly in multi-ethnic populations. We evaluated whether demographic modification or AF type provides additional discriminatory value.</p><p><strong>Methods: </strong>We conducted a retrospective nested case-control study of patients with AF diagnosed prior to the fifth Auckland Regional Community Stroke Study (September 2020-August 2021). Cases with ischaemic stroke or transient ischaemic attack were identified from this population-based registry with central adjudication. Controls were randomly selected from the National Minimum Dataset, stratified by ethnicity. Predictors included CHA₂DS₂ VASc components, demographic refinements (alternative age transformations, ethnicity, and exclusion of sex), and AF type. The primary baseline model was a multivariable logistic regression model using standard CHA₂DS₂ VASc predictors as covariates. The traditional point-based CHA₂DS₂ VASc score was evaluated separately for comparison. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>The study included 1,908 patients (300 cases). A logistic regression model using standard CHA₂DS₂ VASc predictors demonstrated moderate discrimination {AUC 0.68 (95% confidence interval [CI]: 0.65-0.71)}. The traditional point-based CHA₂DS₂ VASc score showed lower discrimination (AUC 0.63 [95% CI: 0.60-0.66]; ΔAUC +0.05; p = 0.0003). Demographic refinements did not improve discrimination (ΔAUC ≤ 0.01). Addition of AF type modestly increased discrimination (AUC 0.71; ΔAUC +0.03; p = 0.015), with greater improvement in non-anticoagulated patients (ΔAUC +0.05).</p><p><strong>Conclusion: </strong>Demographic refinements, including ethnicity, provide limited incremental value beyond CHA₂DS₂ VASc, whereas AF type offers a modest discriminatory signal. This finding is hypothesis-generating and requires external validation before clinical implementation is considered.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"206-211"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377580","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":"Beyond Stenosis: Prevalence and the Characteristics of Nonstenotic Carotid Plaques in Embolic Stroke of Undetermined Source.","authors":"Manuraj Natarajan, Adarsh Anil Kumar, Asish Vijayaraghavan, Santhosh Kannoth, Sapna Erat Sreedharan, Arya Devi Karuthedathu Mana Sanal Kumar, Padmavathy Narayanan Sylaja","doi":"10.1159/cee/acdag001","DOIUrl":"10.1159/cee/acdag001","url":null,"abstract":"<p><strong>Introduction: </strong>Nonstenotic carotid plaques, despite being considered low risk for stroke, are increasingly recognized to contribute to embolic strokes of undetermined source (ESUS). Emerging evidence indicates that rather than the degree of stenosis, high-risk plaque characteristics like plaque irregularity and intraplaque hemorrhage may increase the embolic risk. We analyzed the prevalence and characteristics of nonstenotic carotid plaques in ESUS and their implications for stroke recurrence risk.</p><p><strong>Methods: </strong>We retrospectively identified 274 patients with ESUS between 2012 and 2022. The computed tomography angiograms were analyzed for nonstenotic carotid plaques (<50% stenosis, as per NASCET criteria) by blinded neuroradiologists. The infarct patterns and plaque characteristics were evaluated. The stroke recurrences at 3 months and 1 year were noted.</p><p><strong>Results: </strong>The mean age of the study population was 57.99 ± 12.86 years, and 65.3% were males. The nonstenotic plaques (30-50% stenosis) were more common on the symptomatic side of stroke (13.3% vs. 7.3%, p = 0.026). Plaques with irregularity were also more frequent on the symptomatic side (16.4% vs. 9.7%, p = 0.023). Patients with symptomatic nonstenotic plaques had a higher incidence of embolic (25% vs. 5%, p = 0.000) and watershed infarcts (16.7% vs. 4.6%, p = 0.005). The stroke recurrence risk and mortality at 3 months and 1 year did not differ between the 2 groups.</p><p><strong>Conclusion: </strong>In this single-center retrospective study, nonstenotic carotid plaques with 30-50% stenosis were more prevalent on the symptomatic side, suggesting a potential role in stroke mechanism. The higher rates of embolic and watershed infarcts and the presence of plaque irregularity on the symptomatic side support this association.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"264-272"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702600","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":"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}