Cerebrovascular Diseases Extra最新文献

{"title":"Relative Hypotension is Not Associated with Rapid Progressor Phenotype in Anterior Circulation Large-Vessel Occlusion Acute Ischaemic Stroke: A Retrospective Cohort Study.","authors":"Rudy Goh, Felix Ng, Stephen Bacchi, Jim Jannes, Timothy Kleinig","doi":"10.1159/000549560","DOIUrl":"10.1159/000549560","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to determine whether relative hypotension, defined as a systolic blood pressure (SBP) threshold of <140 mm Hg or 160 mm Hg at the time of neuroimaging, was associated with rapid infarct progressor phenotype, as defined by a high hypoperfusion intensity ratio on MISTAR imaging software (DT6/DT2 >0.318) during anterior circulation large-vessel occlusion (LVO) acute ischaemic stroke (AIS).</p><p><strong>Methods: </strong>In a retrospective cohort study, consecutive patients admitted to a metropolitan comprehensive stroke centre within South Australia between January 2017 and January 2024 with anterior circulation LVO AIS were included. LVO was defined as either carotid terminus or M1 occlusion. Univariable and multivariable logistic regressions were performed.</p><p><strong>Results: </strong>A total of 477 patients were included (253 [53.0%] female), of whom 163 (34.2%) had an elevated hypoperfusion intensity ratio (HIR). Hypotension, as defined by either SBP of <160 mm Hg (odds ratio [OR]: 1.2, 95% CI: 0.8-1.8) or SBP of <140 mm Hg (OR 1.7, 95% CI 0.8-1.7), was not associated with elevated HIR. Insular cortex ischaemia (OR: 6.1, 95% CI: 1.7-38.9) and ischaemic heart disease (OR: 2.0, 95% CI: 1.3-3.1) were associated with elevated HIR. Smoking history (OR: 0.5, 95% CI: 0.3-0.9) and obesity (OR: 0.4, 95% CI: 0.2-0.8) were associated with lower HIR.</p><p><strong>Conclusion: </strong>Relative hypotension was not significantly associated with rapid infarct progressor phenotype in anterior circulation LVO AIS. Insular cortex ischaemia and ischaemic heart disease were associated with rapid progression phenotype, whilst smoking history and obesity were associated with slower progression phenotype. Further mechanistic studies to elucidate how systemic comorbidities and regional brain vulnerability contribute to infarct evolution are needed.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"242-248"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12695117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safe Navigation of Guiding Catheters during Stenting for Common Carotid Artery Lesions: The \"No-Touch\" Technique.","authors":"Yohei Takenobu, Noriko Nomura, Mizuha Toyama, Yoshito Sugita, Akihiro Okada, Takeshi Kawauchi, Yukinori Terada, Tao Yang, Manabu Inoue, Kenji Hashimoto","doi":"10.1159/000543398","DOIUrl":"10.1159/000543398","url":null,"abstract":"<p><strong>Introduction: </strong>During carotid artery stenting (CAS), safe navigation of the guiding catheter (GC) is essential for the success of procedures. However, in cases where stenosis or floating thrombi are located in the common carotid artery (CCA), especially for proximal lesions, advancing the GC without touching the lesions is often difficult. We describe a preliminary experience of the \"no-touch\" technique for navigating the GC to the CCA using an inner catheter with a specifically designed shape and stiffness optimized to overcome tortuous anatomy.</p><p><strong>Methods: </strong>We retrospectively reviewed CAS procedures involving the \"no-touch\" technique for treating stenotic lesions in the CCA. A 4-Fr Newton-shaped stiff catheter was positioned in the CCA. Given its high stiffness and dedicated shape, contact with the lesser curvature of the aortic arch absorbed kickback force. Then, a 6-Fr intermediate catheter and an 8- or 9-Fr balloon GC were coaxially advanced in sequence to the target position without guidewire support, ensuring \"no-touch\" with the plaques. Patient characteristics, aortic arch type, lesion location, and periprocedural complications were recorded.</p><p><strong>Results: </strong>The technique was applied to eight procedures (six left-sided lesions) in 7 patients (median age, 76 years; six men) among 53 CAS procedures performed on 49 patients. Lesions were located at the proximal CCA (four procedures) or the carotid bifurcation (four procedures). Three patients had floating thrombi, and four had type III aortic arches. GCs were successfully navigated without touching the lesions in all cases, with no periprocedural complications.</p><p><strong>Conclusion: </strong>The \"no-touch\" technique with a Newton-shaped stiff catheter is useful and feasible for navigating the GC in treating stenotic lesions in the CCA, particularly with tortuous anatomy, proximal lesions, and vulnerable plaques.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"56-61"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing Acute Stroke Services in Sub-Saharan Africa: Steps, Progress, and Perspectives from the Tanzania Stroke Project.","authors":"Sarah Shali Matuja, Christine Tunkl, Tamer Roushdy, Linxin Li, Menglu Ouyang, Faddi G Saleh Velez, Meron Gebrewold, Jatinder S Minhas, Zhe Kang Law, Aristeidis H Katsanos, Teresa Ullberg, Maria Giulia Mosconi, Maria Khan, Matias Alet, Radhika Lotlikar, Alicia Richardson, Bogdan Ciopleias, Mirjam R Heldner, Susanna Maria Zuurbier, Emily Ramage, Selam K Kifelew, Vasileios Lioutas, Marika Demers, Marina Charalambous, Dorcas Gandhi, Urvashy Gopaul, Leonardo Carbonera, Ralph Akyea, Ladius Rudovick, Bahati Wajanga, Semvua Kilonzo, Robert Peck, Mohamed Mnacho, Faraja S Chiwanga, Brighton Mushengezi, Kigocha Okeng'o, Henrika Kimambo, Akili Mawazo, Mohamed Manji, Tumaini Nagu, Paschal Ruggajo, William Matuja, Louise Johnson, Octávio Marques Pontes-Neto, Craig S Anderson, Sheila Cristina Ouriques Martins","doi":"10.1159/000545954","DOIUrl":"10.1159/000545954","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is a leading cause of morbidity and mortality globally, with Africa bearing a disproportionately high burden of poor outcomes. In sub-Saharan Africa, acute stroke care remains inconsistent, with organized stroke units being either absent or rarely available, contributing to the high stroke mortality rates in the region. To address this issue, the Tanzania Stroke Project (TSP) was launched, aimed at establishing acute stroke services at two of the largest tertiary care centers in collaboration with the Tanzanian Ministry of Health, the World Stroke Organization, and Hospital Directorates.</p><p><strong>Methods: </strong>TSP utilized a three-tier implementation approach to establish a more organized stroke care system in two large academic hospitals. Here, we detail the process of this initiative, which took place between August 2023 and August 2024. The three-tier approach included (1) the establishment of stroke registries; (2) the training of healthcare workers (HCWs); and (3) the development of acute stroke protocols and establishment of stroke units at Muhimbili National Hospital-Mloganzila and Bugando Medical Center in Tanzania.</p><p><strong>Results: </strong>In tier one (stroke registry), two comprehensive stroke registries were established, including 460 adults (mean age 60 ± 15 years). Hemorrhagic stroke was the most common subtype, accounting for 59% of cases (n = 269). Premorbid hypertension was the most prevalent risk factor, affecting 81% (n = 373) of the patients. More than half of patients (58%, n = 171) arrived at the hospital after 24 h from stroke symptoms. Only 11% (n = 50/452) had documented swallowing screenings, and among patients with intracerebral hemorrhage, 11% (n = 28/251) achieved the target for blood pressure control, while 47% (n = 99/213) met blood glucose control targets. The in-hospital mortality rate was 27% (n = 93/340). In tier two (training of HCWs), extensive evidence-based mentorship training was provided with higher participation rates among HCWs at Bugando Medical Center compared to Muhimbili National Hospital-Mloganzila (57% [29/51] vs. 23% [7/31], p = 0.002). In tier three (stroke unit protocols), stroke protocols were developed based on the training and current evidence, leading to the establishment of dedicated stroke units at each facility, with a minimum of 8 beds per unit. The full impact of these implementations has yet to be fully assessed.</p><p><strong>Conclusion: </strong>This was the first initiative to implement stroke services at two large tertiary healthcare centers in Tanzania. Our findings highlight the importance of multilevel stakeholder engagement through a 3-tier approach in countries starting to establish stroke services and the need for ongoing quality-of-care monitoring and continuous efforts to sensitize both HCWs and the broader community.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"143-153"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial Atherosclerotic Stenosis.","authors":"Jeong Yoon Song, Sun U Kwon","doi":"10.1159/000543356","DOIUrl":"10.1159/000543356","url":null,"abstract":"<p><strong>Background: </strong>Ischemic stroke is a significant global health problem associated with mortality and disability. Intracranial atherosclerotic stenosis (ICAS) is a leading cause of stroke and contributes to recurrent stroke, especially in the Asian population. ICAS should be distinguished from extracranial atherosclerotic stenosis (ECAS) due to differences in pathophysiology. Understanding the mechanisms of ICAS is crucial for stroke prevention in the Asian population. Traditional vascular risk factors and the degree of the stenosis play an important role in predicting stroke occurrence.</p><p><strong>Summary: </strong>In East Asia, non-atherosclerotic vasculopathies are also often observed in ischemic stroke patients caused by large artery disease, highlighting the importance of identifying the specific etiologies of intracranial artery stenosis. Advances in diagnostic neuroimaging, such as high-resolution MRI (HR-MRI), can be helpful in distinguishing between them. For stroke prevention in patients with both asymptomatic and symptomatic ICAS, intensive management, including strict control of modifiable risk factors and appropriate antiplatelet therapies, is essential. There are no clear guidelines regarding the duration and combination of antiplatelet therapies. However, current recommendations suggest short-term dual antiplatelet therapies for 90 days to reduce the recurrence of stroke in symptomatic severe ICAS (70-99%). Cilostazol is also proposed as a good second-line treatment option, following clopidogrel, which remains the most widely used. In addition, endovascular or surgical interventions could be considered alternatives for a limited subset of symptomatic severe ICAS cases that are hemodynamically unstable.</p><p><strong>Key messages: </strong>The key messages are as follows: (1) ICAS is a major cause of ischemic stroke, especially in Asian populations. Its distinct pathophysiology, compared to ECAS, requires different treatment strategies for secondary prevention; (2) differentiation of intracranial artery stenosis etiology is essential, and HR-MRI would be a valuable diagnostic tool; (3) stroke prevention includes strict vascular risk factor control and the use of antiplatelet therapies, with short-term DAPT recommended for symptomatic severe ICAS; (4) cilostazol may serve as an effective second-line option for preventing ischemic stroke, while endovascular or surgical interventions may be limited to hemodynamically unstable cases.</p><p><strong>Background: </strong>Ischemic stroke is a significant global health problem associated with mortality and disability. Intracranial atherosclerotic stenosis (ICAS) is a leading cause of stroke and contributes to recurrent stroke, especially in the Asian population. ICAS should be distinguished from extracranial atherosclerotic stenosis (ECAS) due to differences in pathophysiology. Understanding the mechanisms of ICAS is crucial for stroke prevention in the Asian population. Tr","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"62-67"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11801852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracerebral Hemorrhage.","authors":"Tsong-Hai Lee","doi":"10.1159/000542566","DOIUrl":"10.1159/000542566","url":null,"abstract":"<p><strong>Background: </strong>Compared to ischemic stroke, intracerebral hemorrhage (ICH) has higher mortality and more severe disability. Asian such as Chinese and Japanese and Mexican Americans, Latin Americans, African Americans, Native Americans has higher incidences than do white Americans. So, ICH is an important cerebrovascular disease in Asia.</p><p><strong>Summary: </strong>ICH accounts for approximately 10-20% of all strokes. The incidence of ICH is higher in low- and middle-income than high-income countries and is estimated 8-15% in western countries like USA, UK, and Australia, and 18-24% in Japan, Taiwan, and Korea. The ICH incidence increases exponentially with age, and old age especially over 80 years is a major predictor of mortality independent of ICH severity. Females are older at the onset of ICH and have higher clinical severity than males. Modifiable risk factors include blood pressure, smoking, alcohol consumption, lipid profiles, use of anticoagulants, antiplatelet agents, and sympathomimetic drugs. Non-modifiable risk factors constitute old age, male gender, Asian ethnicity, cerebral amyloid angiopathy, cerebral microbleed, and chronic kidney disease. Blood pressure is the most important risk factor of ICH. Imaging markers may help predict ICH outcome, which include black hole sign, blend sign, iodine sign, island sign, leakage sign, satellite sign, spot sign, spot-tail sign, swirl sign, and hypodensities. ICH prognostic scoring system such as ICH scoring system and ICH grading scale scoring system in Chinese and Osaka prognostic score and Naples prognostic score has been used to predict ICH outcome. Early minimally invasive removal of ICH can be recommended for lobar ICH of 30-80 mL within 24 h after onset. Decompressive craniectomy without clot evacuation might benefit ICH patients aged 18-75 years with 30-100 mL at basal ganglia or thalamus. However, clinical studies are needed to investigate the effect of surgery on patients with smaller or larger ICH, ICH in non-lobar locations, and for older patients or patients with preexisting disability. Surgical treatment is usually associated with neurological sequels if survived. For medical treatment, blood pressure lowering should be careful titrated to secure continuous smooth and sustained control and avoid peaks and large variability in systolic blood pressure. Stroke and cancer are the most common causes of death in Asian ICH patients, compared to stroke and cardiac disease in non-Asian patients.</p><p><strong>Key messages: </strong>The incidence and outcome are different between Asian and non-Asian patients, and more clinical studies are needed to investigate the best management for Asian ICH patients.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"1-8"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11658787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in Clinical Presentation of Women and Men Evaluated at a Comprehensive Stroke Center for Suspected Stroke.","authors":"Jordi Kühne Escolà, Bessime Bozkurt, Bastian Brune, Lennart Steffen Milles, Doreen Pommeranz, Philipp Dammann, Yan Li, Cornelius Deuschl, Michael Forsting, Clemens Kill, Christoph Kleinschnitz, Martin Köhrmann, Benedikt Frank","doi":"10.1159/000543835","DOIUrl":"10.1159/000543835","url":null,"abstract":"<p><strong>Introduction: </strong>Understanding sex differences in the clinical presentation of patients with suspected stroke is important to reduce sex-related disparities and improve care. We aimed to characterize presenting symptoms in women and men with suspected stroke evaluated at our comprehensive stroke center.</p><p><strong>Methods: </strong>This was a retrospective analysis of consecutive patients with suspected stroke treated at the University Hospital Essen between January 2017 and December 2021. Patient characteristics, signs and symptoms as well as final diagnoses in women and men were compared. Logistic regression analysis was performed to assess the association of individual symptoms with a diagnosis of cerebrovascular disease.</p><p><strong>Results: </strong>We included 6,069 patients in our analysis. Cerebrovascular disease was diagnosed in 85.2% (2,576/3,022) of women and 88.0% (2,681/3,047) of men (p = 0.002). Aphasia (31.4% vs. 27.7%, p = 0.002), neglect (15.5% vs. 12.8%, p = 0.003), gaze deviation (21.0% vs. 18.8%, p = 0.034), as well as nonfocal symptoms including impairments in consciousness (17.0% vs 14.6%, p = 0.012), orientation (42.5 vs. 36.4%, p < 0.001), and completion of tasks (31.2% vs. 26.0%, p < 0.001) were more common among women. Limb ataxia (8.1% vs. 11.2%, p < 0.001) and dysarthria (44.0% vs. 46.8%, p = 0.030) were less frequent in women. Neglect and gaze deviation were independent positive predictors of cerebrovascular disease in women but not in men.</p><p><strong>Conclusion: </strong>Although clinical presentation was similar in both sexes, cortical and nonfocal symptoms were more common among women with suspected stroke. Awareness of sex differences and acknowledgment of the full clinical picture are important to ensure optimal management for women and men with suspected stroke. Our findings might serve as a target for educational programs in order to improve preclinical stroke detection in patients with predominantly nonfocal or subtle symptoms.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"110-117"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prevalence of CYP2C19 Polymorphism in Patients with Symptomatic Intracranial Atherosclerosis.","authors":"Songchai Kittipanprayoon, Pongpat Vorasayan, Aurauma Chutinet, Pajaree Chariyavilaskul, Nijasri C Suwanwela","doi":"10.1159/000543331","DOIUrl":"10.1159/000543331","url":null,"abstract":"<p><strong>Introduction: </strong>Clopidogrel and aspirin were proved to have benefit in symptomatic intracranial stenosis. CYP2C19 polymorphism (CYP2C19*1, CYP2C19*2, CYP2C19*3, and CYP2C19*17 alleles) affects efficacy of clopidogrel. Epidemiologic study of CYP2C19 polymorphism has been conducted in Thai population. There was no data showed the frequency of allelic variants of CYP2C19 in Thai symptomatic intracranial stenosis patients. The aim of this study was to determine the prevalence of CYP2C19 polymorphism in symptomatic intracranial stenosis patients.</p><p><strong>Methods: </strong>The study group included 100 Thai symptomatic intracranial stenosis patients. Genotyping of CYP2C19 alleles (CYP2C19*1, CYP2C19*2, CYP2C19*3, and CYP2C19*17 alleles) was carried out by real-time polymerase chain reaction (rt-PCR) technique.</p><p><strong>Results: </strong>The allele frequency of CYP2C19*1, CYP2C19*2, CYP2C19*3, and CYP2C19*17 were 70.5%, 26%, 2.5%, and 1%, respectively. The result showed that 53% of symptomatic intracranial stenosis patients are normal metabolizers, while intermediate and poor metabolizer were 36 and 10 percent, respectively.</p><p><strong>Conclusion: </strong>Almost one-half of Thai symptomatic intracranial stenosis patients were intermediate or poor metabolizers. Usage of combination of aspirin and clopidogrel might not be effective in this group of patients.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"68-72"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Prognostic Factors for Survival in Patients with Trousseau Syndrome Initially Presenting with Acute Ischemic Stroke.","authors":"Xianjin Ke, Xian Wu, Guoquan Feng, Deqiang Wang, Kai Niu, Ying Zhu, Bo Sun","doi":"10.1159/000548109","DOIUrl":"10.1159/000548109","url":null,"abstract":"<p><p><p>Introduction: Trousseau syndrome (TS) represents a significant vascular thromboembolic event in cancer patients and has progressively gained attention as a critical clinical concern in recent years. The aim of this study was to investigate the survival status and prognostic factors in patients with TS whose initial clinical manifestation was acute ischemic stroke (AIS).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 24 TS patients hospitalized at the Affiliated Hospital of Jiangsu University between 2018 and 2024. Data collected included demographic characteristics, tumor staging, complete blood count, C-reactive protein, coagulation function, blood biochemistry analyses, tumor markers, National Institutes of Health Stroke Scale scores, modified Rankin Scale, and treatment regimen. Based on the temporal sequence of AIS onset relative to tumor diagnosis, patients were categorized into two groups: the AIS-TS (AIS as an initial symptom with TS, n = 9) group and the NAIS-TS (AIS was not as an initial symptom with TS, n = 15) group. Survival follow-up was performed via outpatient visits and telephone interviews. Kaplan-Meier survival analysis was used to compare survival rates between the two groups with log-rank tests for statistical comparisons. Univariate Cox regression analysis was initially conducted to screen potential prognostic factors, followed by multivariate Cox regression analysis for variables with p < 0.1.</p><p><strong>Results: </strong>Kaplan-Meier survival analysis revealed that the overall survival rate of the AIS-TS group was significantly lower than that of the NAIS-TS group (log-rank χ2 = 5.07, p = 0.024). Multivariate Cox regression analysis indicated that after adjusting for confounding factors, D-dimer index (DDI) (HR = 1.17, 95% CI: 1.05-1.31, p = 0.004), carcinoembryonic antigen (CEA) (HR = 1.04, 95% CI: 1.02-1.06, p = 0.001), and female sex (HR = 4.80, 95% CI: 1.42-16.23, p = 0.012) were independent risk factors for all-cause mortality in TS patients.</p><p><strong>Conclusion: </strong>TS patients presenting with AIS as the initial symptom exhibited shorter survival time and poorer prognoses. Female sex, elevated DDI, and elevated CEA levels were identified as significant prognostic indicators influencing poor survival and prognosis in TS patients, potentially establishing a foundation for future prognostic evaluations in TS patients. </p>.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"202-209"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034328","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 in Young Adults in Asia.","authors":"Kay Sin Tan, Tsong Hai Lee, Shinichiro Uchiyama, Udaya K Ranawaka, Phyu Phyu Lay, Yangchen, Narayanaswamy Venketasubramanian","doi":"10.1159/000547683","DOIUrl":"10.1159/000547683","url":null,"abstract":"<p><p><p>Background: Stroke in young adults is a worldwide problem with long-term physical and socioeconomic implications. The largest burden of disease is expected to impact Asia. Stroke in young adults is defined broadly as strokes occurring between the ages of 18 and 49 and includes ischaemic stroke (IS) and intracerebral haemorrhage (ICH). The objective of this review was to focus on the important aspects of epidemiology, risk factors, genetic contributions, as well as evaluation, management, and outcome of stroke in young adults within the Asian context. Summary: This publication is an overview of recent literature from many countries in Asia. Population and hospital-level data offer insight into common and unique aetiologies of pre-mature IS and ICH in young adults. In young adults, prognosis and outcomes were worse in ICH compared to IS. Stroke prevention should be emphasized, while rapid access to acute stroke reperfusion and interventional therapies can benefit younger patients. More research should be performed in young adults with stroke in order to reduce the short- and long-term mortality in both stroke subtypes, improve primary as well as secondary prevention, and define further the role of next-generation sequencing for cryptogenic stroke. Key Messages: Stroke in young adults in Asia reveals the interplay between complex genetic factors, traditional risk factors, and unique aetiologies. Socioeconomic status and healthcare access are other important factors affecting the care of these patients. </p>.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"181-191"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke Epidemiology in Asia.","authors":"Narayanaswamy Venketasubramanian","doi":"10.1159/000543399","DOIUrl":"10.1159/000543399","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a major cause of death and disability globally, with different stroke burdens in different regions. This paper reviews the epidemiology of stroke in Asia.</p><p><strong>Summary: </strong>There is a wide range in age- and sex-standardised stroke incidence, highest in China, lowest in Bhutan. Geographically, incidence is highest in East Asia, lowest in South Asia. Stroke mortality is highest in Papua New Guinea, lowest in Singapore. There are variations in mortality within regions - in East Asia, it is higher in Mongolia and North Korea, lowest in Japan; in South Asia, it is higher in Bangladesh and Pakistan, lowest in Sri Lanka; in Southeast Asia, it is higher in Papua New Guinea and Indonesia, lowest in Singapore. Stroke disability-adjusted life years (DALYs) lost is highest in Papua New Guinea, lowest in Singapore. There is intra-regional variation - in East Asia, it is higher in Mongolia and North Korea, lowest in Japan; in South Asia, higher in Bangladesh and Pakistan, lowest in Sri Lanka; in Southeast Asia, it is highest in Papua New Guinea, lowest in Singapore. Among the stroke subtypes, ischaemic stroke (IS) has the highest incidence, intracerebral haemorrhage (ICH) is second, subarachnoid haemorrhage (SAH) is third. IS incidence is highest in China, lowest in Bhutan. The burden due to ICH is highest in Mongolia; ICH incidence is lowest in Sri Lanka, mortality and DALYs are lowest in Japan. SAH has a high incidence in Japan, Singapore, Brunei, and Republic of Korea. In hospital-based registries, the frequency of ICH was highest in Myanmar, low in Mongolia. Among IS, based on the Trial of Org 10,172 in Acute Stroke Treatment classification, large artery atherosclerosis (LAA) is more frequent in some countries (e.g., China, India, Indonesia, Japan, Pakistan, and Republic of Korea), but small artery occlusion (SAO) in most others (Bangladesh, Nepal, Singapore, Sri Lanka, Taiwan, Thailand, and Vietnam); cardioembolism is third. Of the stroke risk factors, hypertension is the most frequent, diabetes mellitus (DM) is usually second, with varying positions for hyperlipidaemia, smoking, and prior stroke or transient ischaemic attacks, obesity, and insufficient physical activity.</p><p><strong>Key messages: </strong>Asia carries a particularly heavy burden of stroke, higher in some countries. IS is the most common subtype. Among IS, the more common mechanisms are LAA and SAO. Hypertension and DM are the more common risk factors. A greater understanding of stroke epidemiology and risk factors will help in healthcare planning for the prevention and management of stroke.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"81-92"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}