European Stroke Journal最新文献

{"title":"Initiation of direct oral anticoagulation after reperfusion therapy in ischemic stroke in clinical practice: Results from Sits-International Stroke Registry.","authors":"Malin Säflund, Marius Matusevicius, Jose A Egido, José Manuel Ferro, Janika Kõrv, Maurizio Melis, André Peeters, Marco Petruzzellis, Viiu-Marika Rand, Aleksandras Vilionskis, Diana Melancia, Diana Aguiar de Sousa, Michael V Mazya, Tiago Moreira, Niaz Ahmed","doi":"10.1177/23969873251325978","DOIUrl":"10.1177/23969873251325978","url":null,"abstract":"<p><strong>Introduction: </strong>Data is limited on the safety of early initiation of direct oral anticoagulation (DOAC) treatment after acute ischemic stroke (AIS) receiving reperfusion therapy in patients with atrial fibrillation (AF). We investigated the timing of DOAC initiation and its association with safety and outcomes.</p><p><strong>Materials and methods: </strong>We included AIS patients receiving reperfusion therapy with AF diagnosis (prevalent or new) registered in the Safe Implementation of Treatments in Stroke international registry during 2013-2024. Safety outcomes were hemorrhage and death. Secondary outcomes were recurrent AIS, any embolism and functional independence (modified Rankin Scale [mRS] 0-2) at 3 months. We performed descriptive statistics and multivariable analysis for DOAC initiation time as an ordinal variable (0-3, 4-7, and 8-100 days after stroke onset) and its association with outcomes. Explorative analyses were performed to investigate factors associated with DOAC initiation time, as a continuous or ordinal variable.</p><p><strong>Results: </strong>In total, 13,389 patients had data on DOAC initiation time, and 7861 patients had new event data by 3-month follow-up. We observed 0.1% intracranial hemorrhage, 0.4% major extracranial hemorrhage, 1.1% recurrent ischemic stroke, and 0.2% systemic embolism. At 3 months, 4.8% patients had died, and functional independence was seen in 60.9%. In multivariable analyses, DOAC initiation after stroke onset was not associated with any outcomes. Higher 24 h NIHSS and lower pre-stroke mRS score were associated with delayed DOAC initiation.</p><p><strong>Conclusion: </strong>DOAC initiation time was not associated with any outcomes in AIS patients who received reperfusion therapy. Severe stroke symptoms at 24 h were associated with delayed DOAC initiation. The low incidence of safety outcomes and missing data in this study should lead to cautious interpretations of these results.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251325978"},"PeriodicalIF":5.8,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of dementia using CT imaging in stroke (PRODUCTS).","authors":"Melanie Hafdi, Martin Taylor-Rowan, Bogna Drozdowska, Emma Elliott, Lucy McGuire, Edo Richard, Terence J Quinn","doi":"10.1177/23969873251325076","DOIUrl":"10.1177/23969873251325076","url":null,"abstract":"<p><strong>Introduction: </strong>A better understanding of who will develop dementia can inform patient care. Although MRI offers prognostic insights, access is limited globally, whereas CT-imaging is readily available in acute stroke. We explored the prognostic utility of acute CT-imaging for predicting dementia.</p><p><strong>Patients and methods: </strong>We included stroke or transient ischaemic attack (TIA) survivors from participating stroke centres in Scotland. Acute CT-scans were rated using ordinal scales for neurodegenerative and cerebrovascular changes (old infarcts, white matter lesions (WMLs), medial temporal lobe atrophy (MTA), and global atrophy (GA)) and combined together to a 'brain-frailty' score. Dementia status was established at 18-months following stroke or TIA.</p><p><strong>Results: </strong>Among 195 participants, 33% had dementia after 3 years of follow-up. High brain-frailty score (⩾2/4) correlated with higher risk of dementia (HR (95% CI) 6.02 (1.89-19.21)). As individual predictor, severe MTA was most strongly associated with dementia (adjusted HR (95% CI) 2.09 (1.07-4.08)). Other predictors associated with dementia included older age, higher prestroke morbidity (mRS), WMLs, and GA. Integrated in a prediction model with clinical parameters, prestroke mRS, cardiovascular disease, GA, MTA and Abbreviated-Mental-Test were the strongest predictors of dementia (c-statistic: 0.77).</p><p><strong>Discussion and conclusion: </strong>Increased brain-frailty, and its individual components (WMLs, MTA, and GA) are associated with a higher risk of dementia in participants with stroke. Combining clinical and brain-frailty parameters created a moderate dementia prediction model but added little value over clinical parameters in combination with cognitive testing. CT-based brain-frailty may provide better prognostic insights when cognitive testing isn't feasible and for identifying highest-risk individuals for dementia prevention trials to increase trial efficiency.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251325076"},"PeriodicalIF":5.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular therapy versus best medical treatment for symptomatic intracranial atherosclerotic stenosis: A systematic review and meta-analysis.","authors":"Maria-Ioanna Stefanou, Evangelos Panagiotopoulos, Lina Palaiodimou, Aikaterini Theodorou, George Magoufis, Stavros Spiliopoulos, Apostolos Safouris, Odysseas Kargiotis, Klearchos Psychogios, Tatiana Sidiropoulou, Frantzeska Frantzeskaki, Panayiotis D Mitsias, Katharina Feil, Annerose Mengel, Marios Themistocleous, Ulf Ziemann, Georgios Tsivgoulis","doi":"10.1177/23969873251324863","DOIUrl":"10.1177/23969873251324863","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence on endovascular therapy (EVT) for symptomatic intracranial stenosis (sICAS) from randomized-controlled clinical trials (RCTs) is conflicting. While prior RCTs on percutaneous transluminal angioplasty and stenting (PTAS) demonstrated harm or no benefit over best medical treatment (BMT), recent data suggest that submaximal balloon angioplasty with BMT may be superior to BMT alone.</p><p><strong>Patients and methods: </strong>A systematic review and meta-analysis of RCTs was conducted to evaluate the safety and efficacy of elective EVT plus BMT compared to BMT alone for sICAS.</p><p><strong>Results: </strong>Six RCTs (5 on PTAS and 1 on balloon-angioplasty) comprising 1606 patients were included. EVT increased the risk of any stroke or death (RR = 2.68; 95% CI: 1.72-4.19; <i>I</i>² = 0%), ischemic stroke within the territory of the qualifying artery (RR = 2.51; 95% CI: 1.36-4.61; <i>I</i>² = 0%), any ischemic stroke (RR = 1.99; 95% CI: 1.17-3.38; <i>I</i>² = 0%), intracranial hemorrhage (RR = 6.23; 95% CI: 1.92-20.2; <i>I</i>² = 0%), and mortality (RR = 3.52; 95% CI: 1.04-11.88; <i>I</i>² = 0%) within 30 days. No significant benefit from EVT was detected regarding the risk of any stroke or death (RR = 0.29, 95% CI: 0.06-1.38; <i>I</i>² = 68%), ischemic stroke in the territory of the qualifying artery (RR = 0.44, 95% CI: 0.14-1.33; <i>I</i>² = 59%) and mortality (RR = 0.49, 95% CI: 0.16-1.55; <i>I</i>² = 0%) beyond 30 days through 1 year.</p><p><strong>Discussion and conclusion: </strong>EVT is associated with adverse early outcomes, without reducing the risk of long-term stroke recurrence or mortality compared to BMT. Further research is warranted to identify high-risk subgroups who may benefit from EVT for sICAS and refine interventions to minimize periprocedural risks.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251324863"},"PeriodicalIF":5.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of telephone and computerized cognitive testing as a secondary outcome in an acute stroke clinical trial: A mixed methods sub-study of the AcT Trial.","authors":"Sajeevan Sujanthan, Pugaliya Puveendrakumaran, Katie N Dainty, Morgan Barense, Krista L Lanctot, Adrian M Owen, Nishita Singh, Brian H Buck, Houman Khosravani, Shelagh B Coutts, Mohammed Almekhlafi, Ramana Appireddy, Aleksander Tkach, Jennifer Mandzia, Heather Williams, Thalia S Field, Alejandro Manosalva, Muzaffar Siddiqui, Gary Hunter, MacKenzie Horn, Fouzi Bala, Michael D Hill, Michel Shamy, Aravind Ganesh, Tolulope Sajobi, Bijoy K Menon, Richard H Swartz","doi":"10.1177/23969873251323171","DOIUrl":"10.1177/23969873251323171","url":null,"abstract":"<p><strong>Introduction: </strong>Post-stroke cognitive impairment is associated with impaired quality of life. Remote testing provides a potential avenue to measure cognitive outcomes efficiently.</p><p><strong>Patients and methods: </strong>Prospective cognitive outcomes were collected at 90-180 days using both telephone MoCA (T-MoCA; range 0-22; <17 impairment) and Creyos, a computerized cognitive battery. Key variables associated with completion were assessed using logistic regressions. Mixed methods brief structured interviews and exit survey were performed to explore barriers to completing computer testing.</p><p><strong>Results: </strong>Of 791 potentially eligible patients (mean age 70 ± 14 years), there was low feasibility of remote cognitive testing, with only 401 (51%) completing the T-MoCA, and 242 (31%) completing Creyos. Our regression models show that age (OR_T-MoCA: 0.95 (95% Confidence Interval (CI): 0.94-0.97); OR_Creyos: 0.95 (95% CI: 0.94-0.96)), functional impairment (mRS 2-5; OR_T-MoCA: 0.55 (95% CI: 0.37-0.81); OR_Creyos: 0.66 (95% CI: 0.44-0.98)), quality of life (EQ-VAS; OR_T-MoCA: 1.02 (95% CI: 1.01-1.03); OR_Creyos: OR:1.02 (95% CI: 1.01-1.03)) and length of hospital stay (OR_T-MoCA: 0.98 (95% CI: 0.96-0.99); OR_Creyos: 0.97 (95% CI: 0.94-0.99)) predicted both telephone and computer cognitive test completion; computer literacy predicted computer test completion (OR_Creyos: 1.12 (95% CI: 1.04-1.21)). In interviews, a preference for accessibility of computerized testing was reported.</p><p><strong>Discussion: </strong>Remote cognitive testing has limited feasibility as a secondary outcome in large acute stroke trials. Patients who are older, with worse quality of life, or severe functional impairment post-stroke are less likely to complete remote cognitive outcomes.</p><p><strong>Conclusion: </strong>Innovative approaches to post-stroke cognitive outcomes in acute stroke trials are needed.Data AccessData available upon request.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251323171"},"PeriodicalIF":5.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive performance is associated with return to work after ischemic stroke in young adults: The ODYSSEY study.","authors":"Mijntje Mi Schellekens, Esther M Boot, Jamie I Verhoeven, Merel S Ekker, Esmée Verburgt, Maikel Hm Immens, Anne Mertens, Mayte E van Alebeek, Paul Jam Brouwers, Renate M Arntz, Gert W van Dijk, Rob Ar Gons, Inge Wm van Uden, Tom den Heijer, Julia H van Tuijl, Karlijn F de Laat, Anouk Gw van Norden, Sarah E Vermeer, Marian Sg van Zagten, Robert J van Oostenbrugge, Marieke Jh Wermer, Paul J Nederkoorn, Frank G van Rooij, Ido R van den Wijngaard, Paul Lm de Kort, Frank-Erik de Leeuw, Roy Pc Kessels, Anil M Tuladhar","doi":"10.1177/23969873251324400","DOIUrl":"10.1177/23969873251324400","url":null,"abstract":"<p><strong>Introduction: </strong>Limited data exist on cognitive performance and return to work after ischemic stroke, especially in patients under 50 years. We investigated whether cognitive performance in the subacute phase after ischemic stroke in young adults was associated with unemployment and the inability to retain their jobs among those who returned to work.</p><p><strong>Patients and methods: </strong>We conducted a multicenter prospective cohort study between 2013 and 2021, enrolling patients aged 18-49 years with first-ever ischemic stroke. Cognitive assessments were performed within 6 months following the index event, covering seven cognitive domains. We categorized patients with cognitive impairment (<i>Z</i>-score < -1.5 on a domain) and as no/mild or major vascular cognitive disorder (VCD; <i>Z</i>-score < -2.0 in one or more domains). Cognitive performance and other predefined characteristics were chosen to identify factors associated with unemployment and, among patients who returned to work, the inability to maintain employment.</p><p><strong>Results: </strong>Of 525 patients (median age 44.3 [IQR 38.0-47.4] years; 243 women [46.3%]); median follow-up of 6.6 [IQR 4.5-8.2] years), 426 patients (81.1%) returned to work. Sixty-five patients (15.3%) were unable to maintain employment. In multivariable logistic regression analysis, major VCD (OR = 2.0; 95% CI 1.3-3.0; <i>p</i> = 0.002) and cognitive impairment in processing speed (OR = 2.0; 95% CI 1.3-3.3; <i>p</i> = 0.004) were associated with unemployment, but not with the inability to maintain employment.</p><p><strong>Discussion and conclusion: </strong>In young patients after a first-ever ischemic stroke, major VCD and impaired processing speed in the subacute phase after stroke were independently associated with unemployment, but not with the inability to maintain employment.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251324400"},"PeriodicalIF":5.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular treatment for isolated cervical internal carotid artery occlusion: ETIICA study.","authors":"João Pedro Marto, Christoph Riegler, Pimrapat Gebert, Tilman Reiff, Marek Sykora, Marcin Wiącek, David Pakizer, André Araújo, Adrien Ter Schiphorst, João André Sousa, Arno Reich, Belen Flores Pina, Lukas Mayer-Suess, Cristina Hobeanu, Marialuisa Zedde, João Nuno Ramos, Georgios Tsivgoulis, Pedro Castro, Sven Poli, José Nuno Alves, Anne Dusart, Blanca Fuentes, Herbert Tejada Meza, Jelle Demeestere, Susanne Wegener, Lars Kellert, Patricia Calleja, Cristina Panea, Christoph Vollmuth, Liliana Pereira, Ronen R Leker, Timo Uphaus, Andrea Zini, Henrik Gensicke, Gauthier Duloquin, Taraneh Ebrahimi, Alexander Salerno, Cristina Tiu, Thanh N Nguyen, Sebastian García-Madrona, Marta Bilik, Shadi Yaghi, Halina Sienkiewicz-Jarosz, Michał Karliński, Stefan Krebs, Eva Hurtíková, Nathalia Ferreira, João Sargento-Freitas, João Pinho, Isabel Rodriguez Caamaño, Elke Ruth Gizewski, Pierre Seners, Rosario Pascarella, Klearchos Psychogios, Alexandra Gomez Exposito, Sara Gomes, Flavio Bellante, Jorge Rodríguez-Pardo, Mario Bautista Lacambra, Robin Lemmens, Corinne Inauen, Johannes Wischmann, Fernando Ostos, Vlad Tiu, Karl Georg Haeusler, Miguel Rodrigues, Issa Metanis, Marianne Hahn, Maria Maddalena Viola, Simon Truessel, Yannick Bejot, Louisa Nitsch, Davide Strambo, Elena Oana Terecoasa, Mohamad Abdalkader, Alicia de Felipe, Farhan Khan, Caroline Arquizan, Manuel Ribeiro, Martin Roubec, Izabella Tomaszewska-Lampart, Julia Ferrari, Peter Ringleb, Christian H Nolte","doi":"10.1177/23969873251323488","DOIUrl":"10.1177/23969873251323488","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence regarding the benefit of endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (c-ICA-O) is lacking. We assessed the outcomes and safety of EVT in patients with isolated c-ICA-O.</p><p><strong>Methods: </strong>Retrospective multicenter cohort study of patients with an AIS due to isolated c-ICA-O, within 24-h since last-seen-well. Comparisons were made between EVT and best medical therapy (BMT). The primary outcome was 3-months modified Rankin Scale (mRS) ordinal shift. Secondary outcomes included 3-month favorable outcome (mRS 0-2, or return to pre-stroke mRS), symptomatic intracranial hemorrhage (sICH) and any parenchymal hemorrhage. Outcomes were compared combining inverse probability of treatment weighting with regression models and propensity score matching (PSM) as sensitivity analysis.</p><p><strong>Results: </strong>We analyzed 998 patients (66.2% male, mean age 71.1 ± 13.2 years). 487 (48.8%) patients received EVT and 511 (51.2%) received BMT. Patients receiving EVT had a higher admission NIHSS [13 (7-18) vs 5 (2-13)] compared to BMT. There was no difference between EVT and BMT groups in 3-month mRS shift (adjusted common odds ratio [OR], 1.01 [95% CI 0.76-1.34]) and favorable outcome (adjusted OR [aOR] 1.16 [95% CI 0.84-1.60]). No patient (0%) in the BMT group had sICH versus 1.6% in the EVT group. Parenchymal hemorrhage was numerically higher in EVT patients (2.7% vs 0.6%; aOR 3.85 [95% CI 0.98-15.23]). PSM analysis revealed similar results.</p><p><strong>Discussion and conclusion: </strong>In patients with isolated c-ICA-O, EVT was associated with similar odds of disability and intracranial bleeding compared to BMT. Randomized-controlled clinical trials in patients with isolated c-ICA-O are warranted.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251323488"},"PeriodicalIF":5.8,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening tools for malignancy in patients with cryptogenic stroke: Systematic review.","authors":"Maria P Tieck, Constanze Single, Sven Poli, Markus C Kowarik, Ulf Ziemann, Annerose Mengel, Katharina Feil","doi":"10.1177/23969873241310760","DOIUrl":"10.1177/23969873241310760","url":null,"abstract":"<p><p>Up to 20% of patients with cryptogenic ischemic stroke have an occult malignancy at the time of stroke presentation, providing an opportunity for early cancer detection. Despite this significant association, there is currently no consensus in international guidelines on how to systematically screen for malignancy in ischemic stroke patients. This review aims to summarize recent evidence on clinical features and scores, and predictive laboratory tests, that can guide malignancy screening in ischemic stroke patients. Our systemic search included PubMed, MEDLINE and Cochrane databases and yielded a total of 12 studies meeting the inclusion criteria for review. Elevated D-dimer levels and multiple infarcts in different cerebral circulations emerged as key markers. Based on the summarized data, we propose a flowchart for clinical decision-making regarding malignancy screening in patients with ischemic stroke. As the initial steps, we recommend using D-dimers cut-offs and stroke pattern on brain imaging to classify patients according to their risk profile. Based on the identified risk, we recommend a subsequent diagnostic workup addressing the most prevalent cancer types, including gastrointestinal tract, lung adenocarcinoma and gender-related cancer. The clinical implications of early malignancy screening and the need for evidence-based guidelines in cryptogenic stroke are discussed.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241310760"},"PeriodicalIF":5.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual versus single antiplatelet therapy in patients with non-cardioembolic acute ischemic stroke and baseline MRI.","authors":"Gian Marco De Marchis, Anna Toebak, Tolga Dittrich, Dimitrios Vlachos, Angela Wang, Eric E Smith, Hardi Mundl, Pablo Colorado, Ashkan Shoamanesh, Robert G Hart","doi":"10.1177/23969873251323180","DOIUrl":"10.1177/23969873251323180","url":null,"abstract":"<p><strong>Introduction: </strong>Dual antiplatelet therapy (DAPT) is superior to single antiplatelet therapy (SAPT) for secondary prevention after minor, non-cardioembolic stroke. We aimed to assess whether DAPT efficacy is modified by large artery atherosclerotic (LAA) etiology, and DAPT safety by stroke size on MRI.</p><p><strong>Patients and methods: </strong>Post hoc analysis of the Phase 2 PACIFIC-STROKE randomized clinical trial, which enrolled patients with non-cardioembolic stroke, all with baseline MRI and compared the Factor XIa inhibitor asundexian with placebo on a background of DAPT or SAPT. We compared patients treated with DAPT versus SAPT. The efficacy endpoint was the rate of recurrent ischemic stroke, the safety endpoint was major or clinically relevant non-major bleeding during follow-up.</p><p><strong>Results: </strong>1590 patients were included, median NIHSS was 2 (interquartile range [IQR] 1-4), 40% received DAPT. Median follow-up was 11.5 months. The efficacy endpoint occurred in 4.4% and 4.8% in the DAPT group and SAPT group, respectively, with the strongest numerical benefit of DAPT over SAPT among patients with NIHSS ⩽ 3 not treated by intravenous thrombolysis. LAA index stroke etiology did not modify DAPT treatment effect. The safety endpoint occurred more often in the DAPT than in the SAPT group (4.6% vs 2.7%), with the numerically lowest risk among patients with NIHSS ⩽ 3 not treated by intravenous thrombolysis. Stroke size did not modify the effect of DAPT on the safety endpoint.</p><p><strong>Discussion and conclusion: </strong>We found no evidence of major treatment effect heterogeneity with DAPT compared with SAPT in patients with and without LAA or by stroke size on MR-DWI.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251323180"},"PeriodicalIF":5.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of central adjudication of the score on the modified Rankin Scale in an international, randomized, acute stroke trial.","authors":"Wouter M Sluis, Jeroen C de Jonge, Hendrik Reinink, Alastair Wilson, Lisa J Woodhouse, Jesse Dawson, Kennedy R Lees, Philip M Bath, Hendrik Bart van der Worp","doi":"10.1177/23969873251320207","DOIUrl":"10.1177/23969873251320207","url":null,"abstract":"<p><strong>Introduction: </strong>The modified Rankin Scale (mRS) is the most frequently used primary outcome measure in acute stroke research despite significant interobserver variability in assigning grades. We assessed the use of central blinded adjudication of the mRS based on a video recording of an interview in the PRECIOUS trial.</p><p><strong>Patients and methods: </strong>PRECIOUS was an international, randomized, open-label, clinical trial with blinded outcome assessment of preventive treatment with metoclopramide, paracetamol, and ceftriaxone in elderly patients with acute stroke. Trained local investigators interviewed patients or their representatives and graded functional outcome at 90 days after stroke with the mRS. In each participating country, a video recording of the interview was assessed by three blinded, independent adjudicators. The primary outcome of the present substudy was interobserver agreement between the local mRS score and the median score of the three central adjudicators for patients alive at 90 days, assessed with Cohen's kappa and quadratic weighted kappa statistics. The difference between treatment effect estimates based on local and central adjudication was a secondary outcome.</p><p><strong>Results: </strong>Of 1493 patients enrolled in PRECIOUS, 1471 were included in this analysis. At 90 days, 1117 patients (75.9%) were alive and had both a central and local assessment; 28 participants did not have a central mRS score. Interobserver agreement was seen in 829 (74.2%) patients and was substantial (kappa of 0.68; 95% CI 0.65-0.71). Disagreement occurred more often in patients with a central mRS score of 0-2 (OR 2.24; 95% CI 1.14-4.24). Treatment effects were neutral for all three study drugs and did not differ between central and local adjudication.</p><p><strong>Discussion and conclusion: </strong>Central adjudication of the mRS based on a video recording is feasible in a large international, randomized stroke trial. This ensures blinding of the outcome assessment. In this neutral trial, the impact of central adjudication on the precision of effect size estimates could not be assessed.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251320207"},"PeriodicalIF":5.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral thrombus analysis as a useful diagnostic tool for infective endocarditis in ischemic stroke patients.","authors":"Aurora Semerano, Beatrice Dell'Acqua, Angela Genchi, Francesca Sanvito, Ghil Schwarz, Manuel Alejandro Montano Castillo, Andrea Bergamaschi, Michela Sampaolo, Erica Butti, Giorgia Serena Gullotta, Mariangela Piano, Marco Ripa, Paolo Scarpellini, Andrea Falini, Pietro Panni, Elio Clemente Agostoni, Nicola Clementi, Guillaume Saliou, Steven David Hajdu, Luisa Roveri, Patrik Michel, Gianvito Martino, Massimo Filippi, Davide Strambo, Marco Bacigaluppi","doi":"10.1177/23969873251320449","DOIUrl":"10.1177/23969873251320449","url":null,"abstract":"<p><strong>Introduction: </strong>Infective endocarditis (IE) is a life-threatening condition and a rare cause of ischemic stroke (IS). This study aimed to evaluate the utility of analyzing cerebral thrombi, obtained through endovascular thrombectomy in IS, for the pathological diagnosis of IE.</p><p><strong>Patients and methods: </strong>Cerebral thrombi from three groups of IS patients were compared: definite IE (<i>n</i> = 10), cardioembolic stroke without and with concomitant infection (CE-I^-: <i>n</i> = 30, CE-I⁺: <i>n</i> = 10). We performed histological examination, molecular biology, and microbiological tests on cerebral thrombi, to detect microorganisms and assess their composition.</p><p><strong>Results: </strong>Median age of included patients was 73 years and 50% were females. Hematoxylin & Eosin and Grocott-Gomori Methenamine Silver stains detected microorganisms in all IE cerebral thrombi, and none in the control groups. Thrombus PCR detected relevant microorganism in n = 2/7 IE. Compared to control groups, IE thrombi were characterized by significant lower content of red blood cells (median [IQR]: IE = 7.4 [4.2-26.7], CE-I^- = 49.3 [17-62.6], CE-I⁺ = 57.5 [40.7-60.8], % over thrombus section area [%TSA], <i>p</i> = 0.001), increased von Willebrand Factor (IE = 23.9 [19.1-32], CE-I^- = 11.2 [8.2-12.8], CE-I⁺ = 12.9 [10.7-18.3], %TSA, <i>p</i> = 0.001), cell-dominant pattern of Neutrophil Extracellular Traps (IE = 100%, CE-I^- = 69%, CE-I⁺ = 70%, <i>p</i> ⩽ 0.001), and more frequent sub-acute or chronic thrombus age classification (<i>p</i> ⩽ 0.001). These latter thrombus features displayed good discriminative ability between IE and controls, with AUC values between 0.84 and 0.95.</p><p><strong>Discussion: </strong>Multimodal analysis of cerebral thrombi in IS with suspected IE supports early and definite pathological diagnosis by detecting pathogens and assessing changes in thrombus composition.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251320449"},"PeriodicalIF":5.8,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}