Cerebrovascular Diseases Extra最新文献

{"title":"Recurrent Stroke Prevention Strategies in Patients Receiving Acute Stroke Reperfusion Therapies (CoPrime Study Survey).","authors":"Rezan Ashayeri Ahmadabad, Mohammed Almekhlafi, P N Sylaja, Aviraj Deshmukh, Jesse Dawson, Aleksandra Pikula, Muhammad Shazam Hussain, Yiran Zhang, Negar Asdaghi, Sung-Ii Sohn, Mohammad Wasay, Ashfaq Shuaib, Brian Buck, Mahesh Pundlik Kate","doi":"10.1159/000546654","DOIUrl":"10.1159/000546654","url":null,"abstract":"<p><strong>Introduction: </strong>Patients who have undergone reperfusion treatments, like all ischemic stroke patients, are at risk of recurrent ischemic strokes in the first 90 days. Current guidelines recommend single antiplatelet therapy for secondary prevention at variable time points after the procedure. This study assessed the practices and perspectives of healthcare professionals on the use of dual antiplatelet therapy in patients with non-cardioembolic ischemic stroke who have undergone reperfusion therapy.</p><p><strong>Methods: </strong>We conducted a multinational cross-sectional web-based survey using Qualtrics involving neurologists and non-neurologist stroke physicians (including neurosurgeons, interventional neuroradiologists, and internal medicine physicians). Participants were asked about their current practices and presented with six structured case scenarios to determine their treatment preferences. In the case scenarios, we assessed their willingness to randomize to a clinical trial comparing single versus dual antiplatelets. Multinomial logistic regression analysis was performed to assess the relationship between demographic characteristics and willingness to randomize.</p><p><strong>Results: </strong>A total of 278 clinicians from 26 countries participated in the survey. The most common continent of practice was Asia (155/278; 55.9%). The most common area of practice was neurology (220/278; 79.1%), with most participants having 5-15 years of experience (115/278; 41.5%) and working in comprehensive stroke centers (205/278; 73.9%). Antiplatelet Choice: For a small infarct post-intravenous thrombolysis and endovascular thrombectomy (EVT), 194/278 (69.8%) preferred aspirin, and 49/278 (17.6%) chose a dual antiplatelet strategy with aspirin and clopidogrel. Loading of Antiplatelet: A total of 121/278 (43.5%) indicated they would not administer a loading dose in cases even with small final infarctions. Timing of Antiplatelet Initiation: Preferences varied; 61/278 (21.7%) considered early initiation immediately post-EVT, and 103/278 (37.2%) considered 24 h post-EVT. Willingness to Randomize: A total of 16/278 (77.7%) were willing or would consider randomizing in a clinical trial with dual antiplatelet. On regression analyses, the willingness to randomize was influenced by years of practice and the local volume of reperfusion therapy.</p><p><strong>Conclusion: </strong>Antiplatelet management for secondary stroke prevention in patients with non-cardioembolic ischemic stroke following reperfusion therapy is variable. However, more than three-fourths of participants were willing to consider randomization to a clinical trial exploring the prevention of recurrent stroke after reperfusion therapy.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"162-172"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Symptomatic Intracranial Large Artery Stenoses: A Prospective Cohort Study from the Asian Registry of Intracranial Atherosclerosis.","authors":"Jose C Navarro, Jeyaraj D Pandian, Nijasri C Suwanwela, Tsong-Hai Lee, Kay Sin Tan, Narayanaswamy Venketasubramanian","doi":"10.1159/000543144","DOIUrl":"10.1159/000543144","url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial large artery atherosclerosis (ICAS) is a common cause of stroke in Asia. Prior epidemiological publications on ICAS have largely been single-country reports. This collaborative study involving several Asian countries aims to investigate the characteristics and outcomes of patients with stroke attributable to ICAS.</p><p><strong>Methods: </strong>This is an international, multicenter, observational, prospective cohort study of patients admitted with acute ischemic stroke secondary to ICAS to stroke centers in six Asian countries. Stroke due to ICAS was diagnosed when there was a ≥50% intracranial large artery stenosis ipslateral to a non-lacunar infarct, without significant ipsilateral extracranial stenosis, cardiac cause or other mechanism found for the stroke. Data were collected on patient demographics, vascular risk factors, stroke location, and severity. Outcomes of interest were stroke recurrence and mortality at 12-month follow-up.</p><p><strong>Results: </strong>A total of 356 patients were recruited. Mean age was 62.7 ± 13.8 years, and 39.9% were females. Mean NIHSS on admission was 9 ± 8, with majority of patients having mild (39.3%) or moderate (37.9%) strokes. Stroke recurrence was 6.7% (95% CI: 4.4-9.9%) while mortality rate was 13.2% (95% CI: 9.9-17.2%) within 1 year. The risk of stroke recurrence was associated with increasing age (odds ratio [OR]: 1.04, 95% CI: 1-1.06, p = 0.05) and hypertension (OR: 3.23, 95% CI: 1.09-9.61, p = 0.035). Mortality was associated with age (OR: 1.05, 95% CI: 1.01-1.08, p = 0.006) and NIHSS (OR: 1.12, 95% CI: 1.07-1.17, p < 0.001).</p><p><strong>Conclusions: </strong>This multicenter Asian study demonstrates a high risk of stroke recurrence and mortality among patients with acute stroke due to ICAS. They are associated with age (both), as well as hypertension (for recurrence) and NIHSS (for mortality). Better treatment modalities are needed to reduce the frequency of adverse outcomes in symptomatic ICAS.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"30-38"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Associated Factors of Extracranial Carotid Stenosis in Northern Vietnamese Patients with Transient Ischemic Attack or Ischemic Stroke.","authors":"Mai Duy Ton, Pham Manh Hung, Thanh N Nguyen, Bui Nguyen Tung","doi":"10.1159/000548297","DOIUrl":"10.1159/000548297","url":null,"abstract":"<p><p><p>Introduction: In Vietnam, the incidence of transient ischemic attack (TIA) or ischemic stroke has increased in recent years due to lifestyle changes. Carotid stenosis is a common cause of TIA/ischemic stroke. This study aimed to determine the prevalence and identify risk factors for ipsilateral internal carotid artery (ICA) stenosis in patients with TIA or ischemic stroke.</p><p><strong>Methods: </strong>We recruited consecutive patients admitted to Bach Mai hospital from June/2021 to June/2022 with the diagnosis of TIA/ischemic stroke. The primary outcome was the presence of significant ipsilateral carotid stenosis (≥50%) by using carotid imaging modalities (duplex ultrasonography, computed tomography angiography, or magnetic resonance angiography). Univariable and multivariable logistic regression analyses were performed to identify risk factors associated with 50-99% ICA stenosis.</p><p><strong>Results: </strong>In total, 1,191 consecutive patients with TIA/ischemic stroke were included. Of these, 62 (5.2%, 95% confidence interval [CI]: 4.0-6.6) had 50-99% ipsilateral ICA stenosis. Patients with significant ICA stenosis were more likely to have advanced age, male sex, and prior stroke. In multivariable logistic regression, advanced age (OR 1.49 per 10-year increment; 95% CI: 1.17-1.90, p = 0.001), male sex (OR 4.94; 95% CI: 2.15-11.38, p < 0.001), and prior stroke (OR 2.01; 95% CI: 1.12-3.62, p = 0.02) were risk factors for ICA stenosis.</p><p><strong>Conclusion: </strong>The observed prevalence of extracranial ICA stenosis in TIA/ischemic stroke patients in Vietnam appears to be lower compared to Western nations, yet it is relatively comparable to that of other Asian countries. Male sex, prior stroke, and advanced age constitute significant risk factors for symptomatic ICA stenosis. </p>.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"210-217"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034387","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":"Study on the Effect of Trimethylamine Oxide on Recurrent Cerebral Infarction of Minor Ischaemic Stroke Rats.","authors":"Chen Chen, Ziwei Hou, Hong Liu, Jintao Wang, Jianyong Guo, Ting Yang, Min Wang, Ling Ding","doi":"10.1159/000548183","DOIUrl":"10.1159/000548183","url":null,"abstract":"<p><p><p>Introduction: This study investigates the impact of trimethylamine oxide (TMAO) on recurrent cerebral infarction in minor ischaemic stroke (MIS).</p><p><strong>Methods: </strong>A rat model was used, with dietary choline levels adjusted to vary TMAO levels. TMAO was quantified via liquid chromatography-mass spectrometry, and histological changes in brain and aortic tissues were analysed using HE staining.</p><p><strong>Results: </strong>Data analysis showed that TMAO levels and neurological deficit scores increased progressively across groups, correlating positively with the severity of cerebral and arterial pathology. High choline diets significantly elevated TMAO levels, aggravating infarction and atherosclerosis, while low choline diets reduced these effects.</p><p><strong>Conclusions: </strong>TMAO demonstrated medium-high diagnostic value for neurological deficits, infarction size, and arterial damage. These findings suggest that elevated TMAO levels are linked to worse outcomes in MIS, highlighting the potential of TMAO as a biomarker for diagnosis and prevention of recurrent cerebral infarction. </p>.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"192-201"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation between Neuroimaging Scores and Carotid Artery Ultrasound Features in Cerebral Small Vessel Disease Patients.","authors":"Yun Xu, Yifan Song, Tieqi Tang, Weili Jia, Huijuan Xu, Yu Li, Yu Guo, Xiaorui Wang, Ruihong Liu","doi":"10.1159/000543355","DOIUrl":"10.1159/000543355","url":null,"abstract":"<p><strong>Introduction: </strong>The recently proposed cerebral small vessel disease (CSVD) score system may help capture the overall burden of CSVD. This study aimed to investigate the associations between carotid artery ultrasound features and the burden score and cognitive performance of CSVD patients.</p><p><strong>Methods: </strong>This is a cross-sectional analysis of an ongoing prospective study. From May 2019 to October 2023, 287 patients with at least one neuroimaging marker of CSVD were recruited and underwent carotid ultrasound examination, brain magnetic resonance imaging (MRI) scans, and neuropsychological assessment. Carotid artery properties, including carotid plaque, intima-media thickness (IMT), β stiffness index (β-index), Peterson's elastic modulus (PEM), and pulse wave velocity-β (PWV-β), were calculated. The CSVD score was graded according to MRI evaluation. Participants were classified as having cognitive impairment (CI) or normal cognitive function (NCF) according to Montreal Cognitive Assessment (MoCA) scale.</p><p><strong>Results: </strong>A total of 209 eligible patients were included in the final analysis. A significant difference was revealed regarding the CSVD score between CI and NCF participants (p < 0.001). After adjusted for covariates, increased IMT (OR = 1.11, 95% CI: 1.04-1.37, p = 0.030) and PWV-β (OR = 1.24, 95% CI: 1.09-1.51, p = 0.006) were both associated with the presence of CI. IMT and PWV-β were also associated with worse performance on attention and processing speed (IMT: β = -0.13, p = 0.011; PWV-β: β = -0.21, p = 0.011), and executive function (IMT: β = -0.20, p = 0.024; PWV-β: β = -0.33, p = 0.008). Additionally, PEM was negatively associated with executive function (β = -0.20, p = 0.009). Furthermore, binary logistic regression indicated that IMT (OR = 1.45, 95% CI: 1.18-2.01, p = 0.006), β-index (OR = 1.30, 95% CI: 1.10-1.64, p = 0.008) and PWV-β (OR = 1.23, 95% CI: 1.01-1.89, p = 0.047) were independently related to a moderate to severe CSVD burden score.</p><p><strong>Conclusions: </strong>Carotid artery atherosclerosis and stiffness are associated with the burden score and cognitive performance of CSVD patients. Noninvasive ultrasound parameters of the carotid artery are capable of discriminating high-risk individuals with CSVD.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"93-101"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics of Ischemic Stroke in Japanese Young Adults.","authors":"Tomoyuki Ohara, Naoki Makita, Jun Fujinami, Keiko Maezono-Kandori, Daiki Fukunaga, Eijirou Tanaka, Akihiro Fujii, Hidesato Takezawa, Naoki Tokuda, Takehiro Yamada, Shiori Ogura, Masahiro Makino, Yoshinari Nagakane, Keisuke Imai, Ikuko Mizuta, Toshiki Mizuno","doi":"10.1159/000546037","DOIUrl":"10.1159/000546037","url":null,"abstract":"<p><strong>Introduction: </strong>There are limited data on the characteristics of stroke in young adults in East Asia including Japan. We aimed to clarify the clinical characteristics of ischemic stroke in Japanese young adults.</p><p><strong>Methods: </strong>We prospectively enrolled ischemic stroke patients aged 18-50 years old who were admitted to 5 high-volume stroke centers within 14 days after onset between February 2018 and January 2023. We collected clinical and imaging data based on the study protocol and analyzed them for conventional and specific stroke risk factors, stroke etiology, and clinical outcome.</p><p><strong>Results: </strong>We enrolled 275 subjects (median age, 46 years; men, 71%; full-time workers, 75%; median NIHSS score at admission, 2 points). The major risk factors were dyslipidemia (59%), hypertension (49%), and smoking (32%). Hyperhomocysteinemia, migraine, and antiphospholipid syndrome were found in 21%, 11%, and 5%, respectively. The RNF213 p.R4810K variant was identified in 4.5%. The most common stroke etiologies were small vessel occlusion (26%) and arterial dissection (25%; intracranial in 20% and extracranial in 5%). The stroke recurrence rate was 5% at 3 months. Modified Rankin scale 0-1 at 3 months was observed in 76%, whereas 61% were able to return to their previous full-time work and 31% exhibited symptoms of depression.</p><p><strong>Conclusions: </strong>The leading stroke etiologies in young adults in Japan were small vessel occlusion and intracranial arterial dissection, which differ from those observed in Western countries. Most young stroke patients had a favorable outcome, but some of them encountered problems relating to employment or mental health after their stroke.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"154-161"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Department Workflow Times of Intravenous Thrombolysis with Tenecteplase versus Alteplase in Acute Ischemic Stroke: A Prospective Cohort Study before and during the COVID-19 Pandemic.","authors":"Matias Guzman, Pablo M Lavados, Gabriel Cavada, Alejandro M Brunser, Veronica V Olavarria","doi":"10.1159/000543900","DOIUrl":"10.1159/000543900","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Tenecteplase (TNK) has demonstrated to be non-inferior to alteplase (ALT) for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). There are potential workflow benefits associated with TNK use, aiming to reduce patient length of stay in the emergency department. Our aim was to investigate whether the routine use of TNK during the COVID-19 pandemic influenced workflow times compared to historical use of ALT, while maintaining non-inferior clinical outcomes in a non-drip and ship scenario of a comprehensive stroke center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We included patients with AIS admitted from September 2019 to September 2022 and compared those treated with TNK during the COVID-19 pandemic to those treated with ALT in the period immediately before. We compared emergency department length of stay (EDLOS), door-to-needle time (DTN), door-to-groin puncture time (DTG), clinical and safety outcomes with adjusted general linear regression models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;110 patients treated with TNK and 111 with ALT were included in this study. Mean EDLOS was 251 (SD = 164) min for TNK users versus 240 (SD = 148) min for ALT (p = 0.62). Mean DTN was 43 (SD = 25) min for TNK versus 46 (SD = 27) min for ALT users (p = 0.39). Mean DTN under 60 min was achieved in 86 (78.2%) patients and in 85 (76.5%) patients of the TNK and ALT groups, respectively (p = 1.0). DTN under 45 min was achieved in 65.4% and 58.6% (p = 0.65) of the TNK and ALT groups, respectively. DTG time was 114 (SD = 43) min for TNK versus 111 (58 = SD) min in the ALT group (p = 0.88). DTG under 90 min was achieved in 32% of the TNK group and 35% of the ALT group (p = 0.69). There were no differences in any of the clinical or safety outcomes between groups at 90 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The adoption of TNK during COVID-19 pandemic did not result in a change in EDLOS, DTN, or DTG times when compared to ALT in this cohort. Safety and clinical outcomes were similar between groups. Probably a greater benefit could have been seen in a drip and ship thrombolysis setting. Further research is needed to assess the potential advantages of TNK in drip and ship scenarios of IVT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Tenecteplase (TNK) has demonstrated to be non-inferior to alteplase (ALT) for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). There are potential workflow benefits associated with TNK use, aiming to reduce patient length of stay in the emergency department. Our aim was to investigate whether the routine use of TNK during the COVID-19 pandemic influenced workflow times compared to historical use of ALT, while maintaining non-inferior clinical outcomes in a non-drip and ship scenario of a comprehensive stroke center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We included patients with AIS admitted from September 2019 to September 2022 and compared those treated with TNK during the COVID-19 pandemic to those treated with A","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"102-109"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of Thrombectomy in Vietnamese Stroke Patients Selected through Perfusion Imaging with an Onset Time between 6 and 24 Hours.","authors":"Binh Nguyen Pham, Hang T Minh Tran, An Thai Thanh Nguyen, Huan Nguyen Pham, Anh Tuan Le Truong, Trung Quoc Nguyen, Huong Bich Thi Nguyen, Tri Quang Nguyen, Huy Quoc Do, Tra Vu Son Le, Vu Thanh Tran, Ryan Anh-Quang Nguyen, Huy Nguyen, Thang Ba Nguyen, Thang Huy Nguyen","doi":"10.1159/000542653","DOIUrl":"10.1159/000542653","url":null,"abstract":"<p><strong>Introduction: </strong>Recent trials have demonstrated the remarkable benefit of endovascular treatment (EVT) up to 24 h in patients with large vessel occlusion (LVO) and target mismatch profiles; however, benefits of late-window EVT in Vietnamese population remain poorly understood. This study aims to evaluate the real-world outcomes of EVT in acute ischemic stroke (AIS) patients selected using perfusion imaging within the 6-24-h window.</p><p><strong>Methods: </strong>This is a prospective study of consecutive patients with anterior circulation LVO stroke who underwent EVT within 6-24 h after last known well between August 2022 and March 2024. Patients were selected based on the DAWN/DEFUSE-3 criteria (Perfusion-RAPID, iSchemaView). The primary outcome was the proportion of patients with functional independence at 90 days (modified Rankin Scale score of 0-2). The secondary outcomes were successful reperfusion defined by thrombolysis in cerebral infarction (TICI) ≥2b on the final procedure and subgroup analysis between good (hypoperfusion intensity ratio [HIR] <0.4) and poor collaterals (HIR ≥0.4) groups. Safety outcomes were mortality rate and symptomatic intracranial hemorrhage (sICH).</p><p><strong>Results: </strong>Of 122 enrolled patients, 68% met inclusion criteria of DEFUSE-3 trial, 61% met DAWN trial criteria. Mean age was 66 years, median baseline NIHSS was 13, median time from stroke onset to hospital arrival was 12.55 h (9.50-16.48), and median infarct volume was 11.5 mL. The rate of functional independence at 90 days was 45.9%. Successful reperfusion (TICI score of ≥2b) was achieved by 83.6% of cases. The 90-day mortality rate was 10.7%; sICH was reported in 8 patients (6.6%). Patients with good collaterals had better functional outcome.</p><p><strong>Conclusions: </strong>This real-world observational study suggests that late-window EVT may be safe and effective in eligible Vietnamese patients selected based on perfusion imaging, thus supporting its practical use in this patient population. HIR is a robust indicator of collateral status and could made it a valuable addition to stroke imaging workup in clinical setting.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"9-18"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Features and Treatment Outcomes in Patients in Their Twenties with Ischemic Moyamoya Disease.","authors":"Yutaro Ono, Yosuke Akamatsu, Shizuka Araya, Ryouga Yamazaki, Shunrou Fujiwara, Kohei Chida, Masakazu Kobayashi, Takahiro Koji, Kazunori Terasaki, Kuniaki Ogasawara","doi":"10.1159/000540769","DOIUrl":"10.1159/000540769","url":null,"abstract":"<p><strong>Introduction: </strong>Revascularization surgery is recommended for all pediatric patients with moyamoya disease (MMD) with ischemic symptoms because the brains of such patients are still developing. By contrast, no clear guidelines for selective revascularization surgery in adult patients (30 years or more) with ischemic presentation have been established. Regarding the age of initial onset of ischemic MMD, patients in their 20s are at the bottom of the distribution and this age group may share features with both adult and pediatric patients. The present prospective study aimed to clarify the clinical features and treatment outcomes of patients in their 20s (younger patients) with ischemic MMD compared with patients aged 30-60 years (older patients).</p><p><strong>Methods: </strong>While patients with misery perfusion in the symptomatic cerebral hemisphere on 15O-positron emission tomography underwent combined surgery including direct and indirect revascularizations in the first study period and indirect revascularization alone in the second study period, patients without misery perfusion in that hemisphere received pharmacotherapy alone through the two study periods. Cerebral angiography via arterial catheterization and neuropsychological testing were performed before and after surgery.</p><p><strong>Results: </strong>During 12 years, 12 younger patients were included and comprised 6% of all adult patients (194 patients). The incidence of misery perfusion in the affected hemisphere was significantly higher in younger (12/12 [100%]) than in older patients (57/182 [31%]) (p &lt; 0.0001). No difference in the incidence of cerebral hyperperfusion syndrome and postoperatively declined cognition was seen between younger (2/5 [40%] and 2/5 [40%], respectively) and older (11/36 [31%] and 15/36 [42%], respectively) cerebral hemispheres undergoing combined revascularization surgery. No difference in the incidence of postoperatively formed collateral flows feeding more than one-third of the middle cerebral artery cortical territory on angiograms and postoperatively improved cognition was seen between younger (9/10 [90%] and 6/10 [60%], respectively) and older (18/22 [83%] and 14/22 [64%], respectively) cerebral hemispheres undergoing indirect revascularization surgery alone.</p><p><strong>Conclusion: </strong>Patients in their 20s with ischemic MMD always exhibit misery perfusion in the affected hemisphere, unlike older patients, and sometimes develop cerebral hyperperfusion syndrome after combined revascularization surgery, leading to cognitive decline, similar to older patients. Moreover, indirect revascularization surgery alone forms sufficient collateral circulation and restores cognitive function in patients in their 20s, similar to older patients.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"105-115"},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11521479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Profile of Stroke Chameleons Receiving Intravenous Thrombolysis: Insights from a Single-Center Experience.","authors":"Alejandro M Brunser, Pablo M Lavados, Paula Muñoz-Venturelli, Verónica V Olavarría, Eloy Mansilla, Gabriel Cavada, Maria Elena Trejo, Pablo E González","doi":"10.1159/000542502","DOIUrl":"10.1159/000542502","url":null,"abstract":"<p><strong>Introduction: </strong>In emergency rooms (ERs), 5% of patients experiencing an acute ischemic stroke (AIS) receive an alternative diagnosis; these cases are known as stroke chameleons (SC). The percentage of SC treated with intravenous thrombolysis (IVT) and the characteristics have not been well described. We aimed at investigating the variables associated with the probability receiving IVT.</p><p><strong>Methods: </strong>In this prospective study, we included consecutive patients with SC admitted at the ER of Clínica Alemana between September 2014 and October 2023.</p><p><strong>Results: </strong>Among 1,193 stroke patients; sixty-three (5.2%) corresponded to SC. Ten of these cases (15.8%, 95% CI: 8.8-26.8) were treated with IVT, mean door-to-needle (DTN) time of 85.7 (SD 35) min, median of 73.5 (IQR 62-113) min. SCs who underwent IVT were younger (p = 0.01), with higher NIHSS (p = 0.05). They presented more frequently with altered level of consciousness in the NIHSS (p = 0.01), language abnormities (p = 0.001), and dysarthria (p = 0.01). In multivariate analysis, none of the variables were significantly associated with IVT. A secondary analysis showed that only time to brain imaging was significantly associated with IVT (OR: 0.99; 95% CI: 0.98-0.99; p = 0.01).</p><p><strong>Conclusions: </strong>Almost 1 out of every 7 SC could be treated with IVT but with a prolonged DTN time; the chance of being treated is associated with time to brain imaging.</p><p><strong>Introduction: </strong>In emergency rooms (ERs), 5% of patients experiencing an acute ischemic stroke (AIS) receive an alternative diagnosis; these cases are known as stroke chameleons (SC). The percentage of SC treated with intravenous thrombolysis (IVT) and the characteristics have not been well described. We aimed at investigating the variables associated with the probability receiving IVT.</p><p><strong>Methods: </strong>In this prospective study, we included consecutive patients with SC admitted at the ER of Clínica Alemana between September 2014 and October 2023.</p><p><strong>Results: </strong>Among 1,193 stroke patients; sixty-three (5.2%) corresponded to SC. Ten of these cases (15.8%, 95% CI: 8.8-26.8) were treated with IVT, mean door-to-needle (DTN) time of 85.7 (SD 35) min, median of 73.5 (IQR 62-113) min. SCs who underwent IVT were younger (p = 0.01), with higher NIHSS (p = 0.05). They presented more frequently with altered level of consciousness in the NIHSS (p = 0.01), language abnormities (p = 0.001), and dysarthria (p = 0.01). In multivariate analysis, none of the variables were significantly associated with IVT. A secondary analysis showed that only time to brain imaging was significantly associated with IVT (OR: 0.99; 95% CI: 0.98-0.99; p = 0.01).</p><p><strong>Conclusions: </strong>Almost 1 out of every 7 SC could be treated with IVT but with a prolonged DTN time; the chance of being treated is associated with time to brain imaging.</p>","PeriodicalId":45709,"journal":{"name":"Cerebrovascular Diseases Extra","volume":" ","pages":"193-197"},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629915","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}