Cerebrovascular Diseases Extra最新文献

{"title":"A Retrospective Study of Outcome Predictive Models for Anterior Circulation Stroke Post-Endovascular Thrombectomy: Are CT-Derived Morphomics Useful?","authors":"Constantin Manole, Sahil Shet, Alan O Apos Brien, Eid Kakish, Patrick O Apos Regan, Michael M Maher, Roisin Kelly, Aidan Hegarty, Noel Fanning, David J Ryan","doi":"10.1159/000550274","DOIUrl":"10.1159/000550274","url":null,"abstract":"<p><strong>Introduction: </strong>In acute ischaemic stroke secondary to a large vessel occlusion, endovascular thrombectomy (EVT) is the standard of care. However, prediction of functional outcomes following EVT remains challenging. We sought to determine whether CT-derived morphomic data on body composition can improve outcome prediction following EVT.</p><p><strong>Methods: </strong>A retrospective analysis of anterior circulation stroke patients who underwent EVT between 2021 and 2023 at a single centre was conducted. Demographic, clinical, and morphomic data including neck muscle and fat area and density were collected. Multivariate logistic regression was used to develop pre-procedure and 24-h post-EVT models for predicting 90-day outcomes. A positive outcome was defined as a modified Rankin Scale (mRS) score of ≤2 at 90 days post-EVT. These models were subsequently tested on 2 separate validation cohorts.</p><p><strong>Results: </strong>High pre-procedure ASPECTS scores, lower baseline NIHSS scores, absence of post-procedure haemorrhage, younger age, and early neurological improvement were the strongest predictors of a positive outcome. None of the morphomic variables were significantly correlated with outcome. The 24-h model was highly accurate in predicting post-EVT outcomes in both validation cohorts.</p><p><strong>Conclusion: </strong>CT-derived morphomic variables did not significantly improve prediction of stroke outcomes post-EVT. Clinical and imaging variables (especially 24-h post-procedure data) showed high accuracy in predicting functional outcomes at 90 days.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"180-193"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148253721","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":"Pharyngeal Electrical Stimulation versus None for Post-Stroke Dysphagia: Rationale, Design, and Protocol for the Parallel Group Superiority Pharyngeal Electrical Stimulation for Acute Stroke Dysphagia Trial (PhEAST) (ISRCTN98886991).","authors":"Jacqueline K Benfield, Lisa F Everton, Lisa J Woodhouse, Iris Isheanesu Mhlanga, Corinne Latulipe, Cameron J C Skinner, Amanda Buck, Gemma Squires, Cristina Roadevin, Roxanne Fiddy-Kent, Nazrana Munsif, Gwenllian Wilkinson, Kennedy M Cadman, Tiffany Hamilton, Patrick Smith, Jason P Appleton, Rainer Dziewas, Helle K Iversen, Kailash Krishnan, Karl Matz, Satish Mistry, Craig J Smith, Thorsten Steiner, Nikola Sprigg, Alan A Montgomery, Marilyn James, Timothy J England, Shaheen Hamdy, Philip M Bath","doi":"10.1159/000553643","DOIUrl":"10.1159/000553643","url":null,"abstract":"<p><strong>Introduction: </strong>Acute ischaemic stroke and primary intracerebral haemorrhage are complicated by oropharyngeal dysphagia in more than 50% of patients. Currently, there are no definitive treatments for post-stroke dysphagia (PSD). Pharyngeal electrical stimulation (PES) can drive long-term beneficial changes in the cortical control of swallowing with functionally relevant reorganisation of the swallowing cortex correlating with reduced dysphagia.</p><p><strong>Methods: </strong>The pharyngeal electrical stimulation for acute stroke dysphagia trial (PhEAST) is an international prospective randomised open-label blinded-endpoint parallel-group phase 4 superiority effectiveness trial. A total of 638 patients with PSD and dependency on nasogastric tube feeding are being recruited within 2-31 days of ictus. Participants are recruited from the UK and Austria and randomised to 6 days of optimised PES (given for 10 min each day) vs. no PES on top of standard care. The primary outcome is the dysphagia severity rating scale, an assessment of swallowing impairment, measured locally on day 14 and centrally at day 90 by trained observers masked to treatment and analysed using repeated measures regression analysis. Secondary outcomes include: functional oral intake scale, feeding status scale, international dysphagia diet standardisation initiative scale, presence of a feeding tube, pneumonia, antibiotic use, health-related quality of life, dependency, disability, frailty, mood, cognition, global impact and health economics at days 14, 90, 180, and 365. Safety measures include death and serious adverse events.</p><p><strong>Conclusion: </strong>PhEAST has recruited more than 574 participants from 45 hospitals in the UK and Austria; recruitment will be complete at the end of October 2026. The attached Supplement summarises the protocol and follows the EQUATOR SPIRIT guideline.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"248-254"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13498320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550844","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":"Glyceryl Trinitrate versus Sham in the Treatment of Hyperacute Stroke: The Efficacy of Nitric Oxide in Stroke-2 (ENOS-2) Feasibility Randomised Controlled Trial.","authors":"Lisa J Woodhouse, Iris Mhlanga, Amanda Buck, Lucy Gray, Amanda Hedstrom, Camille Hutchinson, Tiffany Hamilton, Diane Havard, Kailash Krishnan, Timothy J England, Nikola Sprigg, Philip M Bath","doi":"10.1159/000550499","DOIUrl":"10.1159/000550499","url":null,"abstract":"<p><strong>Introduction: </strong>High blood pressure (BP) is associated with a poor outcome after stroke. Trials of transdermal glyceryl trinitrate (GTN), a nitric oxide donor, have suggested that treatment between 3 and 5 h might improve functional outcome.</p><p><strong>Methods: </strong>We randomly assigned hospitalised patients with an acute ischaemic or haemorrhagic stroke to 2 days of transdermal GTN (5 mg/day) or sham, started between 3 and 5 h after onset. The primary feasibility outcome was recruitment rate; proof-of-concept (PoC) was assessed at 90 days by central observers blinded to treatment assignment using the modified Rankin Scale (mRS). Data are number (%), median [interquartile range], or mean (standard deviation). Comparisons were assessed by multiple linear regression.</p><p><strong>Results: </strong>Thirty-nine of an intended 120 participants were recruited. A total of 3,314 people were excluded, commonly related to presentation >5 h of onset or outside of researcher working hours, no eligible symptoms/signs or an unclear onset time. Mean age was 72 (SD 13) years, females were 41%, BP was 161.8 (18.4)/80.8 (14.9) mm Hg, and time from onset at baseline was 216 [186, 251] minutes. The fall in BP over 24 h did not differ between GTN versus sham. mRS at 3 months did not differ between the groups (difference in means, DIM -0.20, 95% confidence intervals -1.30, 0.90; p = 0.72). GTN was associated with improved cognition on the telephone interview of cognition scale (DIM 8.0, 95% CI 1.3, 14.8; p = 0.020). Although headache was more common, GTN was associated with fewer serious adverse events (p = 0.020).</p><p><strong>Conclusion: </strong>Recruitment limitations in this small single-centre trial prevented demonstration of feasibility for patients in the time window of 3-5 h post ictus. GTN demonstrated some evidence of PoC and was safe. A multicentre trial needs to further test this hypothesis.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"74-86"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12975151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145991154","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":"Temporal Profile of Stroke-Associated Pneumonia and Deep Vein Thrombosis after Stroke.","authors":"Runhua Zhang, Huiqing Hou, Xingquan Zhao, Gaifen Liu, Yongjun Wang, Ruijun Ji","doi":"10.1159/000552482","DOIUrl":"10.1159/000552482","url":null,"abstract":"<p><strong>Introduction: </strong>Poststroke complications pose significant challenges in the management of stroke patients and are associated with adverse outcomes. The potential interplay and temporal sequence of stroke-associated pneumonia (SAP) and deep vein thrombosis (DVT) following stroke remain unclear. This study aimed to investigate the association between SAP and DVT and to elucidate temporal sequence of these complications after acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH).</p><p><strong>Methods: </strong>We conducted a study using the in-hospital Medical Complications after Acute Stroke (iMCAS) registry at Beijing Tiantan Hospital from 2014 to 2016. We documented the incidence of SAP and DVT and the time from stroke onset to diagnosis of each complication. A time-dependent Cox regression model was used to evaluate the association between SAP and DVT, and the temporal sequence was compared across AIS, ICH, and SAH.</p><p><strong>Results: </strong>A total of 1,771 patients were included, comprising 1,129 with AIS, 314 with ICH, and 328 with SAH. The incidence of SAP was higher than that of DVT in AIS (7.6% vs. 1.9%), ICH (18.8% vs. 5.7%), and SAH (16.8% vs. 7.9%). SAP occurrence was significantly associated with subsequent DVT development (HR = 3.65, 95% CI: 2.08-6.40, p < 0.001). This association was also confirmed in AIS and ICH. The median time from stroke onset to SAP was 4 days (IQR: 2-6), and to DVT was 8 days (IQR: 5-12). SAP occurred significantly earlier than DVT in all stroke subtypes.</p><p><strong>Conclusion: </strong>SAP was significantly associated with an increased risk of subsequent DVT, with a consistent temporal sequence in which SAP preceded DVT.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"141-150"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975997","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":"Ischemic Lesions in Diffusion-Weighted Imaging after Carotid Artery Stenting: Correlation with Access Route.","authors":"Koji Shimonaga, Yoshito Hirata, Masakazu Mitsunobu, Ryo Ogami, Yoshihiro Kiura, Atsushi Tominaga, Nobutaka Horie","doi":"10.1159/000549798","DOIUrl":"10.1159/000549798","url":null,"abstract":"<p><strong>Introduction: </strong>Despite recent advances in stents and stenting techniques, ischemic complications associated with carotid artery stenting (CAS) remain unresolved. Although plaque characteristics have attracted attention as risk factors, only a few studies have focused on access routes. This study aimed to identify ischemic factors following CAS, including access routes and plaque instability, using computed tomography angiography (CTA).</p><p><strong>Methods: </strong>We retrospectively collected the clinical data of consecutive patients who underwent CAS and preoperative CTA. The access route was evaluated as having aortic plaques and a stenosis at proximal segment lesions beyond carotid plaques (brachiocephalic/common carotid artery). Aortic plaques were further classified based on the presence or absence of calcifications. The outcome was the presence of hyperintense lesions (ipsilateral/non-ipsilateral/bilateral) on postoperative diffusion-weighted imaging (DWI). Multivariate analysis was conducted using two models: aortic plaques (Model 1) and calcified aortic plaques (Model 2).</p><p><strong>Results: </strong>Among the 115 patients who underwent CAS, the mean age was 74.7 years, and 16 (13.9%) were female. Aortic arch plaques were detected in 33 (28.7%) cases, and calcified plaques in 10 (8.7%). Plaques at proximal segment lesions were detected in 27 (23.5%) cases. DWI lesions were detected in 49 (42.6%) cases; 41 (35.7%) on the ipsilateral side, 19 (16.5%) on the non-ipsilateral side, and 11 (9.6%) bilaterally. The following variables were significantly associated in the univariate analysis: age (ipsilateral, p = 0.005; non-ipsilateral, p = 0.007; bilateral, p = 0.005), proximal segment lesions (ipsilateral, p = 0.04; non-ipsilateral, p = 0.002; bilateral, p = 0.02), aortic plaques (non-ipsilateral, p < 0.001; bilateral, p < 0.001), and calcification (non-ipsilateral, p < 0.001; bilateral, p < 0.001). For ipsilateral lesions, proximal segment lesions were associated in both models (Model 1: odds ratio [OR], 4.30; 95% confidence interval [95% CI], 1.5-13.5; p = 0.006, and Model 2: OR: 4.40; 95% CI: 1.6-13.5; p = 0.004). For non-ipsilateral and bilateral lesions, aortic plaques (non-ipsilateral: OR: 5.33; 95% CI: 1.8-16.5; p = 0.002; bilateral: OR, 13.16; 95% CI: 3.0-93.4; p = 0.001) and calcification (non-ipsilateral: OR: 11.55; 95% CI: 2.6-63.0; p = 0.001; bilateral: OR: 18.51; 95% CI: 3.7-106.5; p = 0.0003) were associated in both models.</p><p><strong>Conclusion: </strong>Ischemic lesions are likely to occur after CAS, depending on the access route. CTA, which allows the evaluation of access routes, is a useful modality for predicting ischemic lesions after CAS.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12799230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649656","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":"Endovascular Therapy for Isolated M2 Occlusion in Patients with Ischemic Stroke: A Propensity Score-Matched Analysis.","authors":"Noriyuki Sahara, Go Hashimoto, Kuniyuki Nakamura, Fumi Irie, Takuya Kiyohara, Yoshinobu Wakisaka, Ryu Matsuo, Masahiro Kamouchi, Tetsuro Ago","doi":"10.1159/000552347","DOIUrl":"10.1159/000552347","url":null,"abstract":"<p><strong>Introduction: </strong>Endovascular therapy (EVT) is an established treatment for large vessel occlusion in patients with acute ischaemic stroke; however, its efficacy for medium vessel occlusions, particularly isolated M2 segment occlusions, remains uncertain. As M2 occlusions are relatively proximal among medium vessel occlusions and can cause disabling neurological deficits, clarifying the role of EVT is clinically important. In this study, we aimed to evaluate the efficacy and safety of EVT compared with best medical management (BMM) in patients with acute isolated M2 occlusion using data from a multicentre registry.</p><p><strong>Methods: </strong>We analysed the data of patients from a multicentre stroke registry who had an isolated M2 occlusion, had arrived within 24 h of onset, and were functionally independent before stroke. Data on baseline demographics, vascular risk factors, stroke characteristics, and treatment were collected. Propensity score matching generated 100 well-balanced pairs of EVT- and BMM-treated patients. The primary outcomes were favourable functional outcomes (modified Rankin Scale [mRS] score of 0-2 or 0-1) and mortality at discharge and 3 months. The secondary outcomes included neurological improvement or deterioration and haemorrhagic complications during hospitalisation.</p><p><strong>Results: </strong>Among 594 eligible patients (EVT, n = 118; BMM, n = 476), data from 100 matched pairs were analysed. At 3 months, good functional outcomes (mRS score of 0-2: 49% EVT vs. 46% BMM) and mortality (7% vs. 9%) were comparable, with consistent findings at discharge. EVT was associated with higher rates of any intracranial haemorrhage (46% vs. 21%), although the symptomatic intracranial haemorrhage rates were identical (5%). In exploratory subgroup analyses, a significant interaction with onset-to-door time was observed for mRS score of 0-2 (p = 0.03), whereas no significant interaction was detected for mRS score of 0-1 or mortality.</p><p><strong>Conclusion: </strong>In this multicentre registry of patients with isolated M2 occlusion, EVT was not associated with superior functional outcomes or reduced mortality, compared with BMM. Although exploratory analyses suggested possible heterogeneity of treatment effect according to clinical factors, such as time from onset, these findings should be interpreted cautiously. Overall, the results highlight the heterogeneity of M2 occlusions and underscore the need for adequately powered randomised trials to inform individualised treatment decisions.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"161-170"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057501","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":"Critical Closing Pressure Mediates the Association of Intracranial Artery Calcification with White Matter Hyperintensities.","authors":"Xuelong Li, Gaoxian Zhong, Junru Chen, Xianliang Li, Qingchun Gao, Daniel Bos, Xiangyan Chen","doi":"10.1159/000549535","DOIUrl":"10.1159/000549535","url":null,"abstract":"<p><strong>Introduction: </strong>This study sought to investigate the severity of intracranial artery calcification (IAC) in relation to white matter hyperintensities (WMHs), and whether the association was mediated by cerebral autoregulation (CA).</p><p><strong>Methods: </strong>A total of 144 patients with cerebral small vessel disease were included in this study. The severity of WMH was assessed using Fazekas scores in FLAIR-magnetic resonance imaging images. On non-contrast head computed tomography images, the severity of IAC was measured by IAC scores and further classified as intimal or medial calcification. As proxy of CA, critical closing pressure (CrCP) was determined by analyzing blood pressure-flow velocity relationships in the middle cerebral artery. Mediation analyses were conducted examine the proportion of mediation of CrCP on the association between IAC and WMH.</p><p><strong>Results: </strong>IAC scores were found to be associated with WMH scores (β 0.364; 95% confidence interval [CI], 0.133-0.409; p < 0.001). After multivariable adjustment, a statistically significant association was observed between IAC scores and higher CrCP values (β, 0.329; 95% CI, 0.129-0.528; p = 0.001). Mediation analyses revealed that CrCP partially mediated (10.3%) the association between higher IAC scores and increased WMH severity. The proportion of mediation was driven by a medial calcification pattern (13.9%).</p><p><strong>Conclusion: </strong>This hospital-based study demonstrated the association between higher IAC scores and the severity of WMH in patients with cerebral small vessel disease, which can be partially mediated by CA as indicated by CrCP, especially for the patients with predominantly medial calcification.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"45-53"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145946526","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":"Feasibility of Direct Oral Anticoagulant Dipstick Point-of-Care Testing in Patients with Acute Stroke and Transient Ischaemic Attack.","authors":"Maximilian Ziegler, Kristina Szabo, Carolin Hoyer, Olaf Willmann, Adrian Bursa, Job Harenberg, Uwe Spannagel, Svetlana Hetjens, Christel Weiss, Rolf Kern","doi":"10.1159/000552560","DOIUrl":"10.1159/000552560","url":null,"abstract":"<p><strong>Introduction: </strong>In patients with acute stroke, the plasma concentrations of direct oral anticoagulants (DOACs) need to be known for further treatment decisions. The point-of-care test DOAC Dipstick contains two test pads that determine levels of direct factor Xa (FXA) inhibitors and thrombin (THR) inhibitors in urine samples; thereby determining DOAC plasma levels of >30 ng/mL within 10 min. This study aimed to test the feasibility of using the DOAC Dipstick to detect the presence of DOACs in patients with acute stroke and transient ischaemic attack (TIA) during the early phase of intrahospital stroke management.</p><p><strong>Methods: </strong>Urine samples from patients with acute stroke and TIA with or without DOAC intake were obtained within 8 h after hospitalisation. The urine samples were tested using the DOAC Dipstick. After incubation, colour change on the DOAC Dipstick pads were analysed visually and using a semi-automated reader. Primary endpoints were the success rate of evaluable pad results and time to results after urine sampling.</p><p><strong>Results: </strong>From January 2023 to April 2024, 70 patients were recruited, 66 of whom fulfilled the inclusion criteria (39% female, mean age 73 ± 11.9 years). The median (interquartile range) times from urine sample collection to visual and reader test pad results were 20 (15-26) min and 24 (16-37) min, respectively. The test procedure was uncomplicated in most patients (n = 60). Complications in the test procedure were delays in urine sampling (n = 3), need for repeated testing due to dry strip (n = 2), no visual evaluability of the test result (n = 1), and abnormal urine colour (n = 1). The urine samples of all patients with prior DOAC intake (n = 26) were positive for DOACs while those for all patients without prior DOAC intake (n = 39) were negative for DOACs (1 patient was excluded because the urine sample was not collected in time).</p><p><strong>Conclusion: </strong>The DOAC Dipstick rapidly and reliably detects DOACs in urine samples from patients with acute stroke and TIA.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"194-205"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212799","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":"Machine Learning-Based Risk Stratification for Symptomatic Intracranial Hemorrhage and 3-Month Prognosis following Intravenous Thrombolysis.","authors":"Chia-Wei Lin, Wei-Chun Wang, Jia-Lun Huang, Shih-Hao Wu, Chien-Yu Liu, Chun-Yuan Lin, Charles C N Wang","doi":"10.1159/000552048","DOIUrl":"10.1159/000552048","url":null,"abstract":"<p><strong>Introduction: </strong>Intravenous thrombolysis using tissue-type plasminogen activator (tPA) is widely accepted as a fundamental therapy for acute ischemic stroke. However, its clinical benefit is counterbalanced by the risk of symptomatic intracranial hemorrhage (sICH), a serious complication that can substantially worsen patient outcomes and increase mortality. Functional outcome after stroke is most commonly assessed using the modified Rankin Scale at 3 months. In this study, we sought to construct predictive models for sICH and 3-month outcomes after tPA and to identify key prognostic variables that may support individualized treatment decisions.</p><p><strong>Methods: </strong>We analyzed data from 434 patients with ischemic stroke who received intravenous tPA at a tertiary medical center over a 5.5-year period. Three supervised classification models were constructed and validated using five-fold cross-validation. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, recall, and precision, and the results were compared with those of six commonly used clinical scoring systems for predicting post-tPA sICH.</p><p><strong>Results: </strong>All three machine learning models showed strong discriminatory performance for sICH prediction, with AUC values of 0.87 for logistic regression, 0.82 for random forest, and 0.89 for XGBoost. Each model consistently outperformed the six conventional scoring tools. Among all variables, the 24-h NIHSS score contributed most strongly to the prediction of both sICH and 3-month functional outcomes. In addition, a prior history of stroke and male sex were associated with an increased risk of sICH, whereas older age was closely linked to worse functional outcomes at 3 months.</p><p><strong>Conclusion: </strong>The proposed machine learning models achieved high predictive performance for post-tPA sICH and 3-month outcomes and identified key clinical variables with substantial prognostic importance. Notably, the 24-h NIHSS score emerged as the most influential predictor across models. Compared with existing sICH scoring systems, these models demonstrated superior performance, supporting their potential role as clinical decision-support tools in post-thrombolysis management.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"151-160"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13349371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147783622","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":"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}