Cerebrovascular Diseases Extra最新文献

{"title":"Clinical and Prognostic Features of Perioperative Stroke: A Multicenter Retrospective Cohort Study.","authors":"Guo-Dong Wang, Lin-Yuan Zhang, Jia-Min Song, Yu-Lei Zhang, Yao-Yu Ying, Shi-Bin Wen, You-Zhong Li, Gen-Bin Huang, Can-Xiong Wang, Xiao-Hui Tang, Yun-Cheng Wu","doi":"10.1159/000551487","DOIUrl":"10.1159/000551487","url":null,"abstract":"<p><strong>Introduction: </strong>Perioperative stroke constitutes a major subset of in-hospital stroke. Evidence is lacking on whether procedure-specific risk profiles exist and how they influence functional recovery. We aimed to identify distinct clinical features and procedure-specific risk factors associated with perioperative stroke.</p><p><strong>Methods: </strong>We retrospectively analyzed a 4-year cohort of patients with in-hospital stroke from 5 tertiary hospitals across China. Clinical data were systematically extracted through electronic medical record review. Ninety-day functional outcomes were assessed. Multivariate linear regression was performed to identify factors associated with 90-day outcomes in perioperative stroke.</p><p><strong>Results: </strong>Out of 1,048,566 hospitalized patients, 166 (0.02%) patients developed in-hospital stroke. Among them, 158 patients completed the 90-day follow-up, with 100 males (63.29%) and a median age of 69 years (IQR: 61-76). Sixty-three (39.87%) had perioperative stroke, with the highest proportion (13.92%) occurring in the cardiology/cardiothoracic surgery departments. Delayed recognition (4 h [IQR: 1.58-24.00] vs. 2 h [IQR: 1.00-5.50], p = 0.020), higher NIHSS scores (12 [IQR: 5-30] vs. 9 [IQR: 4-16], p = 0.045), and lower proportion of reperfusion therapy (5.56% vs. 28.21%, p = 0.003) were observed in patients with perioperative ischemic stroke compared to those with non-perioperative stroke. In subgroup analysis, cardiovascular surgery-related ischemic stroke patients had higher NIHSS scores (20 [IQR: 8-35] vs. 8 [IQR: 5-20], p = 0.035) and 90-day modified Rankin scale scores (4 [IQR: 2-6] vs. 2 [IQR: 1-4], p = 0.039) than those non-cardiovascular surgical counterparts. Additionally, they exhibited a trend toward a higher 90-day mortality rate (33.33% vs. 10.71%; OR, 4.17 [95% CI: 1.07 to 20.83]; p = 0.052).</p><p><strong>Conclusion: </strong>Perioperative in-hospital stroke exhibits distinct clinical characteristics. Cardiovascular-related surgery is associated with worse functional outcomes.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"110-122"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13186553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147460424","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":"Dual Antiplatelet Therapy and Very Early Neurological Deterioration after Non-Cardioembolic Stroke According to Stroke Etiology.","authors":"Rosa Sruthy Pereppadan, Sabrina Schärli, Shania Brülisauer, Francesco Valletta, Dimitrios Vlachos, Thomas R Schneider, Victoria Hellstern, Gian Marco De Marchis, Tolga D Dittrich","doi":"10.1159/000552952","DOIUrl":"10.1159/000552952","url":null,"abstract":"<p><strong>Introduction: </strong>Early neurological deterioration after ischemic stroke is associated with worse clinical outcome, yet little is known about the frequency and determinants of neurological worsening during the first 24 h after admission. Dual antiplatelet therapy (DAPT) is recommended early after minor non-cardioembolic stroke to reduce recurrent ischemic events, but its relationship with very early deterioration (vEND) and potential differences across stroke etiologies remain unclear.</p><p><strong>Methods: </strong>We conducted a retrospective single-center cohort study including consecutive adults with non-cardioembolic ischemic stroke admitted to a Swiss tertiary stroke center between 2014 and 2023. vEND was defined as neurological worsening within 24 h using 2 thresholds (NIHSS increase ≥4 points [primary] and ≥2 points [secondary]). Patients were categorized according to antiplatelet strategy (newly initiated DAPT vs. single antiplatelet therapy [SAPT]) and stroke etiology (large artery atherosclerosis [LAA] vs. non-LAA). Associations between antiplatelet therapy and vEND were analyzed using propensity score-weighted logistic regression with stabilized inverse probability of treatment weights and doubly robust adjustment. Adjusted predicted probabilities and risk differences were estimated using marginal standardization.</p><p><strong>Results: </strong>Among 1,207 patients with non-cardioembolic stroke, vEND occurred in 22.2% using the primary definition (NIHSS increase ≥4 points) and in 25.8% using the secondary definition (NIHSS increase ≥2 points). vEND was more frequent in non-LAA than LAA stroke under both definitions (23.5% vs. 17.6% and 26.4% vs. 23.7%, respectively). Patients with LAA were more likely to receive DAPT than those without LAA (33.6% vs. 14.4%, p < 0.001). After weighting and adjustment, the association between antiplatelet therapy and vEND differed by stroke etiology (p_interaction<0.001 [primary] and p_interaction = 0.007 [secondary]). In LAA stroke, DAPT was associated with a numerically lower risk of vEND compared with SAPT (adjusted risk difference [primary definition]: -7.3%, 95% CI: -16.9% to 2.3%). In contrast, among non-LAA stroke patients, DAPT was associated with a higher vEND risk (adjusted risk difference [primary definition]: 16.6%, 95% CI: 7.1%-26.1%). Similar patterns were observed using the secondary vEND definition (NIHSS increase of ≥2 points).</p><p><strong>Conclusion: </strong>Very early neurological deterioration within the first 24 h after non-cardioembolic stroke is common and occurs more frequently in non-LAA stroke. The association between DAPT and vEND appears to differ by stroke etiology. A lower risk was observed in LAA stroke, whereas the higher risk seen in non-LAA stroke likely reflects confounding by indication. Prospective studies are needed to determine whether intensified platelet inhibition may reduce vEND in LAA-related stroke.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"255-263"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621910","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-Associated Infections after Mechanical Thrombectomy: Analysis of the Stroke-Associated INfection afTer Mechanical Thrombectomy (SAINT-MT) Study.","authors":"Charles Berman, Andy Vail, Ioana Iancu, Atri Ghosh, Yamone Swe, Omar Ghorab, Kunal Sareen, Jungim Kwon, Craig J Smith, Amit K Kishore","doi":"10.1159/000553377","DOIUrl":"10.1159/000553377","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the established benefit of mechanical thrombectomy (MT), data on the incidence, risk factors, and longer-term outcomes of stroke-associated infections (SAIs) in this population remain limited. This retrospective, single-centre cohort study evaluated the frequency of SAI, associated variables, and longer-term mortality post-MT.</p><p><strong>Methods: </strong>Data for acute ischaemic stroke patients undergoing MT at Manchester Centre for Clinical Neurosciences were extracted from the Sentinel Stroke National Audit Programme (April 2016-March 2024) and linked to electronic patient records. Routinely collected admission and procedural variables were analysed. Primary outcome measures were the proportion of patients developing SAI and subtypes of SAI post-MT. Multifactorial regression analysis was performed to evaluate associations between clinical variables and SAI and also between SAI and 1-year mortality.</p><p><strong>Results: </strong>Of 589 patients, 179 (30%) developed SAI. Stroke-associated pneumonia (SAP) accounted for 73% of SAI (131 cases, 22% of patients); urinary tract infections comprised 9%. Admission NIHSS, dysphagia, C-reactive protein (CRP), neutrophil-lymphocyte ratio, and premorbid mRS were independently associated with SAI (p < 0.05). Similar associations were observed for SAP, though CRP association was attenuated. Crude 1-year mortality was higher in patients with SAI (34%, 60/179), including those with SAP (36%, 47/131), compared with 12% (49/410) in non-SAI patients. However, multivariable regression did not reach statistical significance.</p><p><strong>Conclusions: </strong>SAI occurred in nearly one-third of patients post-MT, predominantly as SAP. While crude mortality was increased with SAI, adjusted analyses were non-significant. Several variables were independently associated with SAI, enabling opportunities for identification of high-risk patients for enhanced monitoring or preventive strategies.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"240-247"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382882","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":"Hypoperfusion Intensity Ratio as a Predictive Marker in Pre-Endovascular Treatment Perfusion Magnetic Resonance Image for Acute Middle Cerebral Artery Occlusion with Intracranial Atherosclerosis.","authors":"Yoonkyung Lee, Jae-Kwan Cha, Dae-Hyun Kim, Jung Hwa Seo","doi":"10.1159/000552144","DOIUrl":"10.1159/000552144","url":null,"abstract":"<p><strong>Introduction: </strong>Identifying the cause of middle cerebral artery (MCA) occlusion before endovascular treatment in acute ischemic stroke is useful. Hypoperfusion intensity ratio (HIR) is defined as the volumetric ratio of tissue with a time-to-maximum (Tmax) >10 s to that with Tmax >6 s in perfusion magnetic resonance image (MRI). In this study, using perfusion MRI, we hypothesized that HIR could be associated with intracranial atherosclerotic disease (ICAD) in acute MCA occlusion. We also performed machine learning-based feature importance analysis to identify factors associated with the mechanism of acute MCA occlusion.</p><p><strong>Methods: </strong>We analyzed 117 patients with acute MCA occlusion treated with EVT and underwent RAPID MRI between March 2020 and December 2023. Patients were classified into the ICAD and non-ICAD groups. Clinical and imaging parameters were assessed using logistic regression. The cutoff value of HIR was calculated using Youden's index, and its predictive value was compared using the DeLong test. Development of a machine learning algorithm for predicting ICAD using XGBoost (eXtreme Gradient Boosting) and feature importance analysis were performed.</p><p><strong>Results: </strong>A total of 34% were ICAD group with higher low-density lipoprotein cholesterol (LDL-C) levels, mild NIHSS, small DWI size, and low HIR. Late onset-to-puncture time (OTP) (>6 h) (OR: 9.67), no susceptibility vessel sign (SVS; OR: 9.05), no initial AF (OR: 63.67), low HIR (<0.31) (OR: 7.70) were associated with ICAD. Including HIR improved predictive performance (area under the curve [AUC] 0.73 vs. 0.88, p value <0.001). The XGBoost model showed high accuracy (0.92), SHAP value identified HIR, OTP, initial AF, SVS were important factors.</p><p><strong>Conclusion: </strong>HIR is a potential marker to determine the mechanism of acute MCA occlusion. Combined with established clinical and radiological features, it helps in identifying the ICAD-related MCA occlusion before EVT.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"212-220"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148333432","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":"Association between Life Satisfaction and Incident Stroke in Middle-Aged and Older Chinese Adults: A Prospective Cohort Study from the CHARLS.","authors":"Xiuli Wang, Yanhong Zhan, Hongxing Chen","doi":"10.1159/000552659","DOIUrl":"10.1159/000552659","url":null,"abstract":"<p><strong>Introduction: </strong>While conventional risk factors fail to fully explain stroke incidence, psychological well-being has emerged as a potential determinant of cerebrovascular health. The aim of this study was to investigate the prospective association between baseline life satisfaction and incident stroke among middle-aged and older Chinese adults.</p><p><strong>Methods: </strong>About 15,225 participants aged ≥45 years were included from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020). Life satisfaction was assessed at baseline using a single-item 5-point scale. Incident stroke was self-reported in follow-up waves. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for sociodemographic factors, lifestyle behaviors, comorbidities, and depression symptoms. Subgroup analyses were performed by age, gender, comorbidities, BMI, and depression symptoms.</p><p><strong>Results: </strong>Over the follow-up of 9 years, 1,296 participants (8.5%) developed stroke. Higher life satisfaction was associated with a significantly reduced risk of stroke (HR: 0.83; 95% CI: 0.72-0.95). Subgroup analyses indicated that the protective association was more pronounced among older adults, females, participants with chronic conditions (hypertension, diabetes, heart disease), overweight individuals, and those with depression symptoms.</p><p><strong>Conclusions: </strong>Higher life satisfaction was prospectively associated with a lower risk of incident stroke in middle-aged and older Chinese adults. Given the observational design and reliance on self-reported measures, these findings should be interpreted as evidence of association rather than causation. Future studies incorporating repeated assessments of well-being and clinically verified stroke outcomes are warranted.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"171-179"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148007042","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":"Imaging Markers Predict the Short-Term and Long-Term Stroke Recurrence in Symptomatic Intracranial Atherosclerotic Disease.","authors":"Rinta Paul, Anagha Rajiv, Adarsh Anil Kumar, Harini Pavuluri, Soumya Krishnamoorthy, Chandrasekharan Kesavadas, P Sankara Sarma, Shyam Prabhakaran, P N Sylaja","doi":"10.1159/000550480","DOIUrl":"10.1159/000550480","url":null,"abstract":"<p><strong>Introduction: </strong>Symptomatic intracranial atherosclerotic disease (ICAD) is associated with a high risk of stroke recurrence despite aggressive medical management. However, recurrence rates and risk factors are less studied in non-Western settings. The study evaluated the clinical and imaging predictors of early and late stroke recurrence in patients with symptomatic ICAD in India.</p><p><strong>Methods: </strong>This ambispective cohort study enrolled patients with symptomatic ICAD within 1 month of symptom onset from a tertiary stroke care hospital. The intracranial arterial stenosis grade and length, infarct patterns, white matter hyperintensity (WMH), and collateral flow were documented. The primary outcome was recurrent stroke or transient ischemic attack (TIA) within 3 months and 1 year.</p><p><strong>Results: </strong>Of 876 patients with large artery atherosclerosis, 229 patients were included (mean age 59.7 ± 10.2 years; men, 72.9%). At the end of 1-year follow-up, recurrent ischemic stroke or TIA occurred in 55 (24%) patients. Of these, 47 (20.5%) patients had stroke recurrence within 3 months (early), and 14 (6.1%) patients had stroke recurrence after 3 months to 1 year (late). Six patients had both early and late stroke recurrence. A territorial and cortical infarct pattern (p = 0.038), moderate to severe WMH (p = 0.050), hypertension (p = 0.040), diabetes (p = 0.043), and coronary artery disease (p = 0.034) predicted early stroke recurrence. A territorial and cortical infarct pattern (p = 0.026), greater length of stenosis (p = 0.045), diabetes (p = 0.026), and coronary artery disease (p = 0.044) predicted late recurrence. On multivariate analysis, a territorial and cortical infarct pattern (adj. OR: 2.15; 95% CI: 1.09-4.26; p = 0.028) independently predicted early stroke recurrence.</p><p><strong>Conclusion: </strong>A territorial and cortical infarct pattern is an independent predictor of early stroke recurrence, suggesting the role of artery-to-artery embolism and plaque instability as a potential mechanism of early stroke recurrence in patients with symptomatic ICAD.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"63-73"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991200","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":"Rates, Risks, and Routes to Reduce Vascular Dementia: A UK-Wide Multicentre Prospective Observational Cohort Study of Cognition after Stroke - Baseline Data and Statistical Analysis Plan (ISRCTN18274006).","authors":"Philip M Bath, Ellen V Backhouse, Rosalind Brown, Lisa J Woodhouse, Lee J Haywood, Fergus N Doubal, Terence J Quinn, Hugh S Markus, Richard J McManus, John T O Apos Brien, Thompson G Robinson, David J Werring, Nikola Sprigg, Adrian R Parry-Jones, Rhian M Touyz, Steven Williams, Yee-Haur Mah, Hedley C Emsley, Joanna M Wardlaw","doi":"10.1159/000553355","DOIUrl":"10.1159/000553355","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is often followed by vascular cognitive impairment and vascular dementia, the most feared complications of stroke. However, understanding of post-stroke cognitive impairment remains limited.</p><p><strong>Methods: </strong>Rates, risks, and routes to reduce vascular dementia is an observational cohort study of post-stroke cognition. Patients with haemorrhagic or ischaemic stroke, or transient ischaemic attack, were recruited within 6 weeks of stroke from hospitals across the UK. Consent was obtained from patients with capacity or from relatives/friends in those without capacity. The primary outcome is dementia rate and its severity at 2 years assessed using a 7-level ordinal cognition outcome. Final dementia rate will be compared in those with mild stroke/TIA (worst NIHSS ≤7) versus severe stroke (NIHSS >7). Secondary outcomes will include cognitive impairment, function, mood and quality of life, and predictors of cognitive impairment at 1 and 2 years. Data are shown as number (%), median (interquartile range [IQR]), or mean (standard deviation [SD]).</p><p><strong>Results: </strong>We recruited 2,441 patients from 50 hospitals. Of these, 2,432 (99.6%) had a qualifying event of stroke or TIA. The mean age was 68.2 years (SD 13.5), females 979 (40.3%), ethnic minority 170 (7.0%), NIHSS ≤7.1962 (80.7%), onset to recruitment 5 days (IQR 3-13) and diagnosis ICH 192 (7.9%), ischaemic stroke 2,097 (86.2%), TIA 143 (5.9%). The distribution of cognition at baseline (within 6 weeks of onset) was normal 1,300 (53.5%), minor neurocognitive disorder - single domain 351 (14.4%), minor neurocognitive disorder - multi-domain 263 (10.8%), major neurocognitive disorder - mild 387 (15.9%), major neurocognitive disorder - moderate 108 (4.4%), and major neurocognitive disorder - severe 23 (0.1%). Participants with more severe stroke were recruited later (8 [IQR 3-17] vs. 5 [2-11] days, p < 0.001), less likely to have capacity (86.3% vs. 96.8%, p < 0.001) and more likely to have had an intracerebral haemorrhage (12.0% vs. 6.8%, p < 0.001).</p><p><strong>Conclusion: </strong>We provide baseline data with the statistical analysis plan in the supplementary material. The data highlight the substantial under-appreciated cognitive burden of stroke, even in the first few days and weeks after onset.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"221-239"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13466458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354104","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":"Bridging Thrombolysis before Endovascular Therapy Improves Functional Outcomes in Medium-Large Core Stroke within 4.5 Hours: A Multicenter Propensity-Matched Study.","authors":"Thang Huy Nguyen, Thien Quang Le, Trung Quoc Nguyen, Khang Vinh Nguyen, Hang Thi Minh Tran, Hai Quang Duong, Nhan Duc Le, Dung Tri Bach, Lanh Chi Nguyen, Duc Tan Ha, Binh Nguyen Pham, Vu Thanh Tran, Tra Vu Son Le, Anh Thi Kim Nguyen, Thanh Tri Mai, Huong Thi Bich Nguyen, Huy Quang Dang, Thanh Ngoc Nguyen, Thang Ba Nguyen, Anh Le Tuan Truong","doi":"10.1159/000551531","DOIUrl":"10.1159/000551531","url":null,"abstract":"<p><strong>Introduction: </strong>The benefit of intravenous thrombolysis (IVT) before endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) with medium-large infarct core (MLIC) remains uncertain.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of a prospective multicenter registry in Vietnam (August 2023-September 2024). We included patients with AIS large-vessel occlusion in the anterior circulation within 4.5 h of onset, an Alberta Stroke Program Early CT Score (ASPECTS) < 6, and a National Institutes of Health Stroke Scale (NIHSS) ≥ 6 at admission. The primary outcome was functional ambulation (defined as mRS 0-3) at 90 days of follow-up. Secondary outcomes were functional independence (mRS 0-2), mRS shift analysis, and rates of successful reperfusion (modified thrombolysis in cerebral infarction 2b-3). Safety outcomes were defined by symptomatic intracranial hemorrhage (sICH) according to SITS-MOST criteria and 90-day mortality. Outcomes between the bridging therapy and EVT-alone groups were compared using propensity score-matched (PSM) analysis.</p><p><strong>Results: </strong>Of 403 MLIC patients undergoing EVT, 148 presented within 4.5 h, 59 (39.9%) received bridging IVT. After PSM, we analyzed 72 patients, with 36 in each group. The median age, proportion of males, baseline ASPECTS, and NIHSS scores were similar between the two groups. The bridging group achieved higher rates of functional ambulation (75% vs. 41.7%, OR 4.2, 95% CI 1.54-11.46). Regarding safety, there was no statistically significant difference in symptomatic intracerebral hemorrhage (8.3% vs. 11.1%, p = 1.0) or mortality (8.3% vs. 19.4%, p = 0.17), though the confidence intervals were wide.</p><p><strong>Conclusion: </strong>Our study suggests that bridging therapy in patients with acute medium-large ischemic core within 4.5 h of onset results in better functional outcomes than EVT alone without increasing the sICH rate. Further studies are required to assess the safety and efficacy of bridging therapy.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"123-132"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13229497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482062","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 Correlation between Inflammatory Markers and Carotid Atherosclerotic Plaque Characteristics.","authors":"Lin Wang, Tong Chen, Chun Yuan, Thomas Hatsukami, Xihai Zhao, Mi Shen, Peiyi Gao, Shengjun Sun, Xingquan Zhao, Binbin Sui","doi":"10.1159/000551280","DOIUrl":"10.1159/000551280","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to explore the relationship between serum inflammatory biomarkers and the carotid atherosclerotic plaque characteristics, given prior evidence suggesting a key role of inflammation in the development of atherosclerosis.</p><p><strong>Methods: </strong>In this prospective study, patients with carotid atherosclerotic plaque were recruited. Serum high-sensitivity CRP (Hs-CRP), homocysteine (Hcy) concentrations, and neutrophil-to-lymphocyte ratio (NLR) were obtained for all enrolled patients. Carotid atherosclerosis characteristics (such as intraplaque hemorrhage [IPH] and lipid-rich necrotic core [LRNC]) were determined by three-dimensional high-resolution vessel wall imaging. The associations between Hs-CRP, Hcy, NLR, and plaque characteristics were assessed.</p><p><strong>Results: </strong>In total, 128 patients (84.4% men; mean age, 58.0 ± 8.7 years) were included. Multivariate logistic regression indicated that increased Hs-CRP levels were associated with the presence of LRNC (OR = 1.23, 95% CI: 1.07-1.40, p = 0.003) and IPH (OR = 1.26, 95% CI: 1.10-1.45, p = 0.001). Multivariate linear regression confirmed a significant correlation between Hs-CRP level (β = 3.24, 95% CI: 0.66-5.81, p = 0.014) and the IPH volume. For plaque burden, higher Hs-CRP levels were associated with larger max normalized wall index (NWI) (β = 0.01, 95% CI: 0.00-0.02, p = 0.005) and larger Max wall thickness (β = 0.08, 95% CI: 0.02-0.14, p = 0.006). NLR and Hcy levels did not show significant associations with the carotid plaque characteristics.</p><p><strong>Conclusions: </strong>Elevated Hs-CRP levels were found to be closely associated with plaque burden and vulnerable plaque characteristics. The relationship between the elevated Hs-CRP and plaque vulnerability highlights its potential role in risk stratification and early intervention strategies. Further validation in larger, multicenter population studies is required to confirm these associations.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"133-140"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699899","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":"Revisiting the Obesity Paradox: Stroke Subtype-Specific Associations of BMI and WHR with Functional Outcome.","authors":"Priyanka Boettger, Jamschid Sedighi, Martin Juenemann, Tobias Braun, Thomas Karrasch, Michael Buerke, Omar Alhaj Omar","doi":"10.1159/000549790","DOIUrl":"10.1159/000549790","url":null,"abstract":"<p><strong>Introduction: </strong>While obesity is a known risk factor for ischemic stroke, its prognostic value remains uncertain. We examined the independent and combined effects of body mass index (BMI) and waist-to-hip ratio (WHR) on early stroke outcomes across subtypes.</p><p><strong>Methods: </strong>In this prospective cohort study, 714 patients with acute ischemic stroke or transient ischemic attack were enrolled over 6 months. BMI and WHR were assessed on admission. Stroke severity (NIHSS) and functional outcome at discharge (modified Rankin Scale, mRS) were recorded. Stroke etiology was classified using TOAST and ESUS criteria. Multivariable regression and restricted cubic spline models were applied.</p><p><strong>Results: </strong>A U-shaped association emerged between BMI and both stroke severity and recovery, with overweight patients (BMI 25.0-29.9 kg/m2) showing the lowest NIHSS and highest independence rate (mRS 0-2: 65%). Underweight and obese patients had significantly worse outcomes (p < 0.001). WHR was an independent predictor of higher stroke severity (β = +2.8; 95% CI: 2.1-3.5) and poor outcome (OR = 0.70; 95% CI: 0.52-0.94) and added prognostic value when combined with BMI. A sex-specific interaction indicated greater benefit from overweight in women (OR = 1.72; p = 0.02). Subtype analysis revealed a U-shaped BMI association in cardioembolic stroke (p = 0.014) but not in ESUS.</p><p><strong>Conclusions: </strong>BMI and WHR show distinct, nonlinear, and sex- and subtype-specific associations with stroke severity and functional outcome. WHR was a stronger, BMI-independent predictor of prognosis, particularly in non-cardioembolic stroke. These findings challenge the \"obesity paradox\" and support incorporating adiposity phenotypes into individualized stroke risk models.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"27-44"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649637","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}