Cerebrovascular Diseases Extra最新文献

{"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":"<p><strong>Introduction: </strong>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.</p><p><strong>Case presentation: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Introduction: </strong>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.</p><p><strong>Case presentation: </strong>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.</p><p><strong>Conclusion: </strong>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":"Focal Cerebral Arteriopathy of the Young: Clinical Profile, Outcomes, and Utility of High-Resolution Vessel Wall Imaging.","authors":"Ankith Bhasi, Naveen Kumar Paramasivan, Adarsh Anil Kumar, Rohith Maraludevanapura Govindaiah, Chandrasekharan Kesavadas, Jayadevan Enakshy Rajan, Sapna Erat Sreedharan, Padmavathy Narayanan Sylaja","doi":"10.1159/000545955","DOIUrl":"10.1159/000545955","url":null,"abstract":"<p><strong>Introduction: </strong>The data on focal cerebral arteriopathy (FCA) in young adults are limited to very few series, and the role of high-resolution magnetic resonance vessel wall imaging (MRVWI) has not been adequately explored.</p><p><strong>Methods: </strong>FCA was defined as unilateral, unifocal nonprogressive stenosis/irregularity of the distal internal carotid artery (ICA) or its proximal branches. All young patients aged 18-55 years admitted to our institute between 2010 and 2022 were retrospectively reviewed, and functional outcomes were quantified using the modified Rankin scale.</p><p><strong>Results: </strong>We identified 10 patients (9 males) with FCA giving an incidence rate of 2.8 per 1,000 person-years. Nine patients had an ischemic presentation (transient ischemic attacks = 5, minor strokes = 3, and major stroke = 1), while 1 patient had a cortical subarachnoid hemorrhage. The supraclinoid ICA and proximal middle cerebral artery (MCA) were the most common segments involved. Nine patients were treated with antiplatelets, and 3 received additional steroids. All cases underwent MRVWI, with concentric wall enhancement noted in most (80%). Follow-up imaging showed improvement in stenosis in 2 patients and a reduction in vessel wall enhancement in 3 patients. Except for the patient with a major stroke, all others had excellent short- and long-term outcomes with no recurrence of ischemic events. The presence of vessel wall enhancement did not predict short- or long-term outcomes.</p><p><strong>Conclusion: </strong>FCA is a rare cause of young stroke that preferentially involves the supraclinoid ICA and proximal MCA with excellent outcomes. MRVWI can be useful in ruling out mimics, but the presence of contrast enhancement did not predict outcome.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"137-142"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044309","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":"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":"Stroke from Infection.","authors":"Aurauma Chutinet, Chutibhorn Charnnarong, Nijasri C Suwanwela","doi":"10.1159/000544986","DOIUrl":"10.1159/000544986","url":null,"abstract":"<p><strong>Background: </strong>Stroke related to infections represents a less common but significant cause, particularly in low- and middle-income countries. This review examines the pathophysiology of stroke from infections, involving both direct and indirect mechanisms.</p><p><strong>Summary: </strong>Bacterial infections such as tuberculous meningitis and infective endocarditis can directly cause strokes through local inflammation, arteritis, and septic embolism. Viral infections like Varicella zoster virus and HIV increase stroke risk through chronic immune activation, vasculopathy, and endothelial dysfunction. Parasitic infections, particularly malaria and neurocysticercosis, can cause strokes via vascular occlusion and inflammatory responses. Fungal infections like aspergillosis and mucormycosis can lead to strokes through vasculitis and direct invasion of the CNS.</p><p><strong>Key messages: </strong>Understanding the mechanisms by which various infectious agents contribute to stroke pathogenesis is essential for developing targeted therapeutic strategies and improving patient outcomes. Further research is needed to establish effective prevention and treatment for infection-related strokes, especially in low- and middle-income countries.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"118-129"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606220","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":"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}

{"title":"Automated Identification of Stroke Thrombolysis Contraindications from Synthetic Clinical Notes: A Proof-of-Concept Study.","authors":"Bing Yu Chen, Fares Antaki, Marco Gonzalez, Ken Uchino, Samer Albahra, Scott Robertson, Sidonie Ibrikji, Eric Aube, Andrew Russman, Muhammad Shazam Hussain","doi":"10.1159/000545317","DOIUrl":"10.1159/000545317","url":null,"abstract":"<p><strong>Introduction: </strong>Timely thrombolytic therapy improves outcomes in acute ischemic stroke. Manual chart review to screen for thrombolysis contraindications may be time-consuming and prone to errors. We developed and tested a large language model (LLM)-based tool to identify thrombolysis contraindications from clinical notes using synthetic data in a proof-of-concept study.</p><p><strong>Methods: </strong>We generated 150 synthetic clinical notes containing randomly assigned thrombolysis contraindications using LLMs. We then used Llama 3.1 405B with a custom prompt to generate a list of thrombolysis contraindications from each note. Performance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and F1 score.</p><p><strong>Results: </strong>A total of 150 synthetic notes were generated using five different models: ChatGPT-4o, Llama 3.1 405B, Llama 3.1 70B, ChatGPT-4o mini, and Gemini 1.5 Flash. On average, each note contained 241.6 words (SD 110.7; range 80-549) and included 1.5 contraindications (SD 1.1; range 0-5). Our tool achieved a sensitivity of 90.9% (95% CI: 86.3%-94.3%), specificity of 99.2% (95% CI: 98.8%-99.5%), PPV of 87.7% (95% CI: 82.7%-91.7%), NPV of 99.4% (95% CI: 99.1%-99.6%), accuracy of 98.7% (95% CI: 98.2%-99.0%), and an F1 score of 0.892. Among the false positives, 24 (86%) were due to the inclusion of irrelevant contraindications, and 4 (14%) resulted from repetitive information. No hallucinations were observed.</p><p><strong>Conclusion: </strong>Our LLM-based tool may identify stroke thrombolysis contraindications from synthetic clinical notes with high sensitivity and PPV. Future studies will validate its performance using real EMR data and integrate it into acute stroke workflows to facilitate faster and safer thrombolysis decision-making.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"130-136"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651205","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":"Outcomes of Symptomatic Intracranial Large Artery Stenoses: A Prospective Cohort Study from the Asian Registry of Intracranial Atherosclerosis.","authors":"Jose C Navarro, Jeyaraj D Pandian, Nijasri C Suwanwela, Tsong-Hai Lee, Kay Sin Tan, Narayanaswamy Venketasubramanian","doi":"10.1159/000543144","DOIUrl":"10.1159/000543144","url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial large artery atherosclerosis (ICAS) is a common cause of stroke in Asia. Prior epidemiological publications on ICAS have largely been single-country reports. This collaborative study involving several Asian countries aims to investigate the characteristics and outcomes of patients with stroke attributable to ICAS.</p><p><strong>Methods: </strong>This is an international, multicenter, observational, prospective cohort study of patients admitted with acute ischemic stroke secondary to ICAS to stroke centers in six Asian countries. Stroke due to ICAS was diagnosed when there was a ≥50% intracranial large artery stenosis ipslateral to a non-lacunar infarct, without significant ipsilateral extracranial stenosis, cardiac cause or other mechanism found for the stroke. Data were collected on patient demographics, vascular risk factors, stroke location, and severity. Outcomes of interest were stroke recurrence and mortality at 12-month follow-up.</p><p><strong>Results: </strong>A total of 356 patients were recruited. Mean age was 62.7 ± 13.8 years, and 39.9% were females. Mean NIHSS on admission was 9 ± 8, with majority of patients having mild (39.3%) or moderate (37.9%) strokes. Stroke recurrence was 6.7% (95% CI: 4.4-9.9%) while mortality rate was 13.2% (95% CI: 9.9-17.2%) within 1 year. The risk of stroke recurrence was associated with increasing age (odds ratio [OR]: 1.04, 95% CI: 1-1.06, p = 0.05) and hypertension (OR: 3.23, 95% CI: 1.09-9.61, p = 0.035). Mortality was associated with age (OR: 1.05, 95% CI: 1.01-1.08, p = 0.006) and NIHSS (OR: 1.12, 95% CI: 1.07-1.17, p < 0.001).</p><p><strong>Conclusions: </strong>This multicenter Asian study demonstrates a high risk of stroke recurrence and mortality among patients with acute stroke due to ICAS. They are associated with age (both), as well as hypertension (for recurrence) and NIHSS (for mortality). Better treatment modalities are needed to reduce the frequency of adverse outcomes in symptomatic ICAS.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"30-38"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865775","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":"Correlation between Neuroimaging Scores and Carotid Artery Ultrasound Features in Cerebral Small Vessel Disease Patients.","authors":"Yun Xu, Yifan Song, Tieqi Tang, Weili Jia, Huijuan Xu, Yu Li, Yu Guo, Xiaorui Wang, Ruihong Liu","doi":"10.1159/000543355","DOIUrl":"10.1159/000543355","url":null,"abstract":"<p><strong>Introduction: </strong>The recently proposed cerebral small vessel disease (CSVD) score system may help capture the overall burden of CSVD. This study aimed to investigate the associations between carotid artery ultrasound features and the burden score and cognitive performance of CSVD patients.</p><p><strong>Methods: </strong>This is a cross-sectional analysis of an ongoing prospective study. From May 2019 to October 2023, 287 patients with at least one neuroimaging marker of CSVD were recruited and underwent carotid ultrasound examination, brain magnetic resonance imaging (MRI) scans, and neuropsychological assessment. Carotid artery properties, including carotid plaque, intima-media thickness (IMT), β stiffness index (β-index), Peterson's elastic modulus (PEM), and pulse wave velocity-β (PWV-β), were calculated. The CSVD score was graded according to MRI evaluation. Participants were classified as having cognitive impairment (CI) or normal cognitive function (NCF) according to Montreal Cognitive Assessment (MoCA) scale.</p><p><strong>Results: </strong>A total of 209 eligible patients were included in the final analysis. A significant difference was revealed regarding the CSVD score between CI and NCF participants (p < 0.001). After adjusted for covariates, increased IMT (OR = 1.11, 95% CI: 1.04-1.37, p = 0.030) and PWV-β (OR = 1.24, 95% CI: 1.09-1.51, p = 0.006) were both associated with the presence of CI. IMT and PWV-β were also associated with worse performance on attention and processing speed (IMT: β = -0.13, p = 0.011; PWV-β: β = -0.21, p = 0.011), and executive function (IMT: β = -0.20, p = 0.024; PWV-β: β = -0.33, p = 0.008). Additionally, PEM was negatively associated with executive function (β = -0.20, p = 0.009). Furthermore, binary logistic regression indicated that IMT (OR = 1.45, 95% CI: 1.18-2.01, p = 0.006), β-index (OR = 1.30, 95% CI: 1.10-1.64, p = 0.008) and PWV-β (OR = 1.23, 95% CI: 1.01-1.89, p = 0.047) were independently related to a moderate to severe CSVD burden score.</p><p><strong>Conclusions: </strong>Carotid artery atherosclerosis and stiffness are associated with the burden score and cognitive performance of CSVD patients. Noninvasive ultrasound parameters of the carotid artery are capable of discriminating high-risk individuals with CSVD.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"93-101"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923708","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":"Clinical Characteristics of Ischemic Stroke in Japanese Young Adults.","authors":"Tomoyuki Ohara, Naoki Makita, Jun Fujinami, Keiko Maezono-Kandori, Daiki Fukunaga, Eijirou Tanaka, Akihiro Fujii, Hidesato Takezawa, Naoki Tokuda, Takehiro Yamada, Shiori Ogura, Masahiro Makino, Yoshinari Nagakane, Keisuke Imai, Ikuko Mizuta, Toshiki Mizuno","doi":"10.1159/000546037","DOIUrl":"10.1159/000546037","url":null,"abstract":"<p><strong>Introduction: </strong>There are limited data on the characteristics of stroke in young adults in East Asia including Japan. We aimed to clarify the clinical characteristics of ischemic stroke in Japanese young adults.</p><p><strong>Methods: </strong>We prospectively enrolled ischemic stroke patients aged 18-50 years old who were admitted to 5 high-volume stroke centers within 14 days after onset between February 2018 and January 2023. We collected clinical and imaging data based on the study protocol and analyzed them for conventional and specific stroke risk factors, stroke etiology, and clinical outcome.</p><p><strong>Results: </strong>We enrolled 275 subjects (median age, 46 years; men, 71%; full-time workers, 75%; median NIHSS score at admission, 2 points). The major risk factors were dyslipidemia (59%), hypertension (49%), and smoking (32%). Hyperhomocysteinemia, migraine, and antiphospholipid syndrome were found in 21%, 11%, and 5%, respectively. The RNF213 p.R4810K variant was identified in 4.5%. The most common stroke etiologies were small vessel occlusion (26%) and arterial dissection (25%; intracranial in 20% and extracranial in 5%). The stroke recurrence rate was 5% at 3 months. Modified Rankin scale 0-1 at 3 months was observed in 76%, whereas 61% were able to return to their previous full-time work and 31% exhibited symptoms of depression.</p><p><strong>Conclusions: </strong>The leading stroke etiologies in young adults in Japan were small vessel occlusion and intracranial arterial dissection, which differ from those observed in Western countries. Most young stroke patients had a favorable outcome, but some of them encountered problems relating to employment or mental health after their stroke.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"154-161"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020935","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":"Safety and Efficacy of Thrombectomy in Vietnamese Stroke Patients Selected through Perfusion Imaging with an Onset Time between 6 and 24 Hours.","authors":"Binh Nguyen Pham, Hang T Minh Tran, An Thai Thanh Nguyen, Huan Nguyen Pham, Anh Tuan Le Truong, Trung Quoc Nguyen, Huong Bich Thi Nguyen, Tri Quang Nguyen, Huy Quoc Do, Tra Vu Son Le, Vu Thanh Tran, Ryan Anh-Quang Nguyen, Huy Nguyen, Thang Ba Nguyen, Thang Huy Nguyen","doi":"10.1159/000542653","DOIUrl":"10.1159/000542653","url":null,"abstract":"<p><strong>Introduction: </strong>Recent trials have demonstrated the remarkable benefit of endovascular treatment (EVT) up to 24 h in patients with large vessel occlusion (LVO) and target mismatch profiles; however, benefits of late-window EVT in Vietnamese population remain poorly understood. This study aims to evaluate the real-world outcomes of EVT in acute ischemic stroke (AIS) patients selected using perfusion imaging within the 6-24-h window.</p><p><strong>Methods: </strong>This is a prospective study of consecutive patients with anterior circulation LVO stroke who underwent EVT within 6-24 h after last known well between August 2022 and March 2024. Patients were selected based on the DAWN/DEFUSE-3 criteria (Perfusion-RAPID, iSchemaView). The primary outcome was the proportion of patients with functional independence at 90 days (modified Rankin Scale score of 0-2). The secondary outcomes were successful reperfusion defined by thrombolysis in cerebral infarction (TICI) ≥2b on the final procedure and subgroup analysis between good (hypoperfusion intensity ratio [HIR] <0.4) and poor collaterals (HIR ≥0.4) groups. Safety outcomes were mortality rate and symptomatic intracranial hemorrhage (sICH).</p><p><strong>Results: </strong>Of 122 enrolled patients, 68% met inclusion criteria of DEFUSE-3 trial, 61% met DAWN trial criteria. Mean age was 66 years, median baseline NIHSS was 13, median time from stroke onset to hospital arrival was 12.55 h (9.50-16.48), and median infarct volume was 11.5 mL. The rate of functional independence at 90 days was 45.9%. Successful reperfusion (TICI score of ≥2b) was achieved by 83.6% of cases. The 90-day mortality rate was 10.7%; sICH was reported in 8 patients (6.6%). Patients with good collaterals had better functional outcome.</p><p><strong>Conclusions: </strong>This real-world observational study suggests that late-window EVT may be safe and effective in eligible Vietnamese patients selected based on perfusion imaging, thus supporting its practical use in this patient population. HIR is a robust indicator of collateral status and could made it a valuable addition to stroke imaging workup in clinical setting.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"9-18"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677192","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}