Cerebrovascular Diseases Extra最新文献

{"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":"https://doi.org/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 6069 patients in our analysis. Cerebrovascular disease was diagnosed in 85.2% (2576/3022) of women and 88.0% (2681/3047) 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 acknowledgement 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":"1-15"},"PeriodicalIF":2.0,"publicationDate":"2025-02-12","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":"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":"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":"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}

{"title":"Top-of-Basilar Artery Occlusion Thromboembolism in Arrhythmogenic Right Ventricular Cardiomyopathy Treated with Intravenous Thrombolysis and Mechanical Thrombectomy.","authors":"Amirul Asyraf Abdul Ghapar, Khairul Azmi Abd Kadir, Grace Sze Ern Chu, Mei Ling Sharon Tai, Mohamad Imran Idris, Ru Peng New, Imran Zainal Abidin, Khean Jin Goh, Kay Sin Tan","doi":"10.1159/000543418","DOIUrl":"10.1159/000543418","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;This case report illustrates the complexities of arrhythmogenic right ventricular cardiomyopathy (ARVC) and its thromboembolic complications resulting in top-of-basilar artery syndrome. We discuss the case of a 37-year-old male with ARVC who presented with acute onset of dizziness, imbalance, and vomiting, leading to the diagnosis of a top-of-basilar artery occlusion (BAO) which was successfully treated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case presentation: &lt;/strong&gt;This case highlights the diagnostic and acute treatment challenges in BAO due to its non-specific symptoms and emphasizes the critical role of CT angiography in detecting occlusive thrombi for timely intervention. With prompt endovascular thrombectomy and bridging intravenous thrombolysis, complete recanalization was achieved and the patient was discharged with modified Rankin Scale (mRS) of 1. Effective management strategies involve assessing ventricular function, detecting arrhythmias, identifying intracardiac thrombi, and implementing individualized stroke prevention measures, such as using direct oral anticoagulants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study illustrates the necessity of a multidisciplinary approach in optimizing patient outcomes in acute stroke care. Focusing on the rare condition of ARVC and the specific challenge of top-of-BAOs in this case underscores the intricate interplay between cardiovascular and cerebrovascular pathology leading to improved understanding and management of these conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;This case report illustrates the complexities of arrhythmogenic right ventricular cardiomyopathy (ARVC) and its thromboembolic complications resulting in top-of-basilar artery syndrome. We discuss the case of a 37-year-old male with ARVC who presented with acute onset of dizziness, imbalance, and vomiting, leading to the diagnosis of a top-of-basilar artery occlusion (BAO) which was successfully treated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case presentation: &lt;/strong&gt;This case highlights the diagnostic and acute treatment challenges in BAO due to its non-specific symptoms and emphasizes the critical role of CT angiography in detecting occlusive thrombi for timely intervention. With prompt endovascular thrombectomy and bridging intravenous thrombolysis, complete recanalization was achieved and the patient was discharged with modified Rankin Scale (mRS) of 1. Effective management strategies involve assessing ventricular function, detecting arrhythmias, identifying intracardiac thrombi, and implementing individualized stroke prevention measures, such as using direct oral anticoagulants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study illustrates the necessity of a multidisciplinary approach in optimizing patient outcomes in acute stroke care. Focusing on the rare condition of ARVC and the specific challenge of top-of-BAOs in this case underscores the intricate interplay between cardiovascular and cerebrovascular pathology leading to improved u","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"73-80"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11828487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956282","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":"Stroke Epidemiology in Asia.","authors":"Narayanaswamy Venketasubramanian","doi":"10.1159/000543399","DOIUrl":"10.1159/000543399","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a major cause of death and disability globally, with different stroke burdens in different regions. This paper reviews the epidemiology of stroke in Asia.</p><p><strong>Summary: </strong>There is a wide range in age- and sex-standardised stroke incidence, highest in China, lowest in Bhutan. Geographically, incidence is highest in East Asia, lowest in South Asia. Stroke mortality is highest in Papua New Guinea, lowest in Singapore. There are variations in mortality within regions - in East Asia, it is higher in Mongolia and North Korea, lowest in Japan; in South Asia, it is higher in Bangladesh and Pakistan, lowest in Sri Lanka; in Southeast Asia, it is higher in Papua New Guinea and Indonesia, lowest in Singapore. Stroke disability-adjusted life years (DALYs) lost is highest in Papua New Guinea, lowest in Singapore. There is intra-regional variation - in East Asia, it is higher in Mongolia and North Korea, lowest in Japan; in South Asia, higher in Bangladesh and Pakistan, lowest in Sri Lanka; in Southeast Asia, it is highest in Papua New Guinea, lowest in Singapore. Among the stroke subtypes, ischaemic stroke (IS) has the highest incidence, intracerebral haemorrhage (ICH) is second, subarachnoid haemorrhage (SAH) is third. IS incidence is highest in China, lowest in Bhutan. The burden due to ICH is highest in Mongolia; ICH incidence is lowest in Sri Lanka, mortality and DALYs are lowest in Japan. SAH has a high incidence in Japan, Singapore, Brunei, and Republic of Korea. In hospital-based registries, the frequency of ICH was highest in Myanmar, low in Mongolia. Among IS, based on the Trial of Org 10,172 in Acute Stroke Treatment classification, large artery atherosclerosis (LAA) is more frequent in some countries (e.g., China, India, Indonesia, Japan, Pakistan, and Republic of Korea), but small artery occlusion (SAO) in most others (Bangladesh, Nepal, Singapore, Sri Lanka, Taiwan, Thailand, and Vietnam); cardioembolism is third. Of the stroke risk factors, hypertension is the most frequent, diabetes mellitus (DM) is usually second, with varying positions for hyperlipidaemia, smoking, and prior stroke or transient ischaemic attacks, obesity, and insufficient physical activity.</p><p><strong>Key messages: </strong>Asia carries a particularly heavy burden of stroke, higher in some countries. IS is the most common subtype. Among IS, the more common mechanisms are LAA and SAO. Hypertension and DM are the more common risk factors. A greater understanding of stroke epidemiology and risk factors will help in healthcare planning for the prevention and management of stroke.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"81-92"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956361","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":"Intra-Individual Reproducibility of Early and Late C-Reactive Protein and Interleukin-6 in Patients with Non-Severe Ischaemic Stroke and Carotid Atherosclerosis.","authors":"Sarah Gorey, John J McCabe, Sean Collins, Karl McAuley, Rosanna Inzitari, Joe Harbison, Michael Marnane, David J Williams, Peter J Kelly","doi":"10.1159/000540773","DOIUrl":"10.1159/000540773","url":null,"abstract":"<p><strong>Introduction: </strong>Acute and late inflammatory markers including high-sensitivity C-reactive protein (hsCRP) and interleukin-6 (IL-6) are associated with future vascular events after stroke. However, few longitudinal studies exist examining the intra-individual reproducibility of inflammatory biomarker measures at different timepoints after atherosclerotic stroke. We sought to examine the reproducibility of hsCRP and IL-6 in a cohort of patients with minor stroke or transient ischaemic attack (TIA) caused by ipsilateral carotid atherosclerosis.</p><p><strong>Methods: </strong>Two observational cohort studies (DUCASS and BIOVASC) were pooled. Included patients had non-severe ischaemic stroke and ipsilateral internal carotid artery stenosis (≥50%). Patients had bloods drawn within 2 weeks of their index stroke/TIA event which was stored for later analysis. All patients included were followed up at 5 years, and repeat phlebotomy was performed. Bloods were analysed for hsCRP and IL-6 using high-throughput immunochemiluminescence. Difference between baseline and follow-up blood levels and intraclass correlation (ICC) was calculated.</p><p><strong>Results: </strong>Ninety-five participants were included, median age 69 (IQR: 63-77), and 51 (53.7%) had TIA as their presenting event. When biomarkers were dichotomised (for hsCRP <2 mg/L or ≥2 mg/L, and for IL-6 <7.5 pg/mL [median] or ≥7.5 pg/mL), 68.4% (IL-6) and 65.2% (hsCRP) of participants remained in the same risk category (high or low) over time. However, when analysed as a continuous variable, ICC coefficients were low: ICC for IL-6 0.14 (95% CI: -0.06 to 0.33), ICC for hsCRP 0.05 (95% CI: -0.14 to 0.25). ICC increased after removing outliers. Clinical characteristics and treatment were not associated with observed variability.</p><p><strong>Conclusion: </strong>Our results suggest that concordance between early- and late-phase inflammatory marker risk categories is modest, and absolute levels are not highly correlated at early and late timepoints, despite associations at both times with future vascular risk. Investigators should standardise timing of phlebotomy and analysis protocols in future studies of inflammatory biomarkers.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"19-29"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814289","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":"Predictive Value of the Prehospital RACE Scale for Large Vessel Occlusion in Acute Stroke Patients.","authors":"Anh Tuan Le Truong, Hang Thi Minh Tran, Loc Dang Phan, Huong Bich Thi Nguyen, Trung Quoc Nguyen, Tra Vu Son Le, Duc Nguyen Chiem, Huy Nguyen, Thanh N Nguyen, Thang Huy Nguyen","doi":"10.1159/000543260","DOIUrl":"10.1159/000543260","url":null,"abstract":"<p><strong>Introduction: </strong>Prehospital stroke scales have been developed to identify anterior large vessel occlusion (LVO) in acute ischemic stroke (AIS) patients for direct transport to thrombectomy-capable hospitals. However, its performance in a Vietnamese population remains unknown. We aimed to evaluate the predictive value of the Rapid Arterial oCclusion Evaluation (RACE) scale for LVO detection in patients with ischemic stroke presenting within 24 h in Vietnam.</p><p><strong>Methods: </strong>This was a prospective study of patients with AIS admitted at People's 115 Hospital between May 2022 and October 2022. All patients were assessed with the RACE scale with five items: facial palsy (scored 0-2), arm motor function (0-2), leg motor function (0-2), gaze (0-1), and aphasia or agnosia (0-2). LVO was diagnosed by CTA or MRA. Receiver operating characteristic curve, sensitivity, specificity, and accuracy of the RACE scale were analyzed to evaluate its predictive value for LVO.</p><p><strong>Results: </strong>There were 318 patients included. LVO was detected in 121/318 patients (37.6%). The higher the RACE score, the higher the proportion of patients with LVO (p < 0.001). Receiver operating characteristic curves showed capacity to predict LVO of the RACE scale with an area under the curve (AUC) of 0.767. The optimal RACE cutoff was ≥5 with sensitivity = 0.68, specificity = 0.79, positive predictive value = 0.67, negative predictive value = 0.80, and overall accuracy = 0.75. RACE ≥5 had higher sensitivity and same specificity for detecting LVO in AIS patients within 6-h versus 6-24-h window (AUC = 0.79 vs. 0.75, sensitivity = 0.74 vs. 0.65, specificity = 0.79 vs. 0.80, accuracy = 0.77 vs. 0.74).</p><p><strong>Conclusions: </strong>The RACE scale is a simple tool that can accurately identify AIS patients with LVO. This tool may be useful for early detection of LVO patients and should be validated in the prehospital setting in Vietnam.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"39-47"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886295","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}