European Stroke Journal最新文献

{"title":"Association of CRP levels and clinical and radiological outcomes in patients with large-vessel occlusion stroke: A MR CLEAN Registry study.","authors":"Yan Wang, Sven Pr Luijten, Daniel Bos, Inge A Mulder, Manon Kappelhof, Willeke F Westendorp, Bart J Emmer, Stefan D Roosendaal, Yvo Bwm Roos, Ido R van den Wijngaard, Robert J van Oostenbrugge, Diederik van de Beek, Jonathan M Coutinho","doi":"10.1177/23969873251357134","DOIUrl":"10.1177/23969873251357134","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammation is important in the pathogenesis of acute ischemic stroke (AIS). The association between CRP and outcomes in patients with large vessel occlusion (LVO) stroke receiving endovascular therapy (EVT) has not been fully elucidated.</p><p><strong>Patients and methods: </strong>We used data from the MR CLEAN Registry (2014-2017), including LVO-AIS patients with intracranial carotid atherosclerotic disease (ICAD), extracranial carotid atherosclerotic disease (ECAD) or atrial fibrillation (AF). The primary outcome was modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included mRS ⩾3 at 90 days, all-cause mortality, successful recanalization, and symptomatic intracranial hemorrhages. CRP was analyzed both dichotomously (>3.0 vs ⩽3.0 mg/L) and continuously, using multivariable regression adjusted for potential confounders.</p><p><strong>Results: </strong>Among 865 included patients (ICAD: 286; ECAD: 154; AF: 425), median CRP level was 3.4 mg/L (IQR: 2.0-6.1) and 446 patients had elevated CRP (>3.0 mg/L). AF patients had higher CRP than ICAD and ECAD patients (4.0-3.0-3.2 mg/L, <i>p</i> = 0.002). CRP >3.0 mg/L was not associated with mRS in the full cohort (acOR 0.983, 95% CI (0.767, 1.260)) or in any etiological subgroups (ICAD: acOR = 0.968, 95% CI (0.626, 1.496), ECAD: acOR = 1.114, 95% CI (0.617, 2.012), AF: acOR = 0.937, 95% CI (0.653, 1.344)). There was also no association between CRP and any of the other outcomes. When analyzed as a continuous variable, CRP was also not associated with any other outcomes.</p><p><strong>Conclusions: </strong>We did not observe an association between CRP levels and clinical and radiological outcomes after LVO stroke.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251357134"},"PeriodicalIF":5.8,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668666","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":"Carotid near-occlusion diagnostics and its consequences: A systematic review.","authors":"Elias Johansson, Intisaar Barud, Sofia Strömberg","doi":"10.1177/23969873251355158","DOIUrl":"10.1177/23969873251355158","url":null,"abstract":"<p><strong>Introduction: </strong>To summarize carotid near-occlusion (CNO) diagnostics and its consequences on epidemiology and management.</p><p><strong>Materials and methods: </strong>A systematic search of PubMed using 19 known synonyms for CNO was performed. Diagnostic analyses of CNO were assessed. Epidemiological and management analyses were based on how the CNO diagnostics was conducted, with diagnostics resembling large trials considered \"good.\"</p><p><strong>Results: </strong>CNO can be diagnosed with several modalities and approaches (interpretation or measurements). Interpretation of angiography is the reference standard but is not feasible for routine use. Of feasible methods, flow measurements with phase-contrast magnetic resonance imaging (PC-MRI) were considerably better than other alternatives when assessed blinded: 90%-100% sensitive and 99%-100% specific and inter-rater kappa 0.98-1.0. CNO was consistently common (30% of ⩾50% stenosis) in studies with \"good\" CNO diagnostics but was also often described as rare. Symptomatic CNO have no benefit with revascularization in studies with \"good\" CNO diagnostics, which foremost applies to the moderate subtype (without full collapse). The more severe CNO subtype (with full collapse) seems to have a very high risk of stroke within the first 2 days, but revascularization performed sufficiently early to prevent this has never been assessed.</p><p><strong>Discussion: </strong>CNO diagnostics is difficult and that CNO is perceived as rare by many is likely due to poor diagnostics. Such poor diagnostics also likely result in unnecessary surgeries for many symptomatic CNOs.</p><p><strong>Conclusion: </strong>CNO is a common variant of carotid stenosis. New diagnostic methods (especially PC-MRI) should be introduced, possibly after validation of its prognostic impact in a randomized trial.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251355158"},"PeriodicalIF":5.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638313","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":"Hemorrhagic transformation after endovascular treatment: Baseline infarct volume is a better predictor than infarct growth rate.","authors":"Mathilde Méot, Fanny Munsch, Bertrand Lapergue, Maeva Kyheng, Igor Sibon, David Planes, Emilien Micard, Bailiang Chen, Jean-Marc Olivot, Grégoire Boulouis, Alain Viguier, Thomas Tourdias, Gaultier Marnat","doi":"10.1177/23969873251357151","DOIUrl":"10.1177/23969873251357151","url":null,"abstract":"<p><strong>Background and objectives: </strong>Hemorrhagic transformation (HT) remains an important issue following ischemic stroke. Efforts have been made to identify predictors of HT, especially imaging features. Among them, the infarct growth rate (IGR) remains underexplored. We investigated the influence of IGR on the risk of subsequent HT in the setting of large vessel occlusion stroke (LVOS) intended for endovascular treatment (EVT) and compared IGR to baseline infarct volume as predictors of HT.</p><p><strong>Methods: </strong>We conducted a secondary analysis of two merged prospectively collected databases (FRAME 2017-2019 and ETIS 2015-2021). Patients presenting with anterior circulation LVOS, a witnessed symptoms onset, baseline MRI within 24 h after symptoms onset and available day 1 imaging (MRI or CT) were included. Posterior circulation LVOS, medium and distal vessel occlusions of the anterior circulation, tandem occlusions and unknown time of stroke onset were excluded. The primary endpoint was the occurrence of any HT detected on day 1 imaging. Secondary endpoint was the occurrence of parenchymal hematoma (defined as PH1 or PH2). Associations between the IGR and the occurrence of any HT and parenchymal hematoma within 24-h after mechanical thrombectomy were assessed using univariable and multivariable logistic regression models.</p><p><strong>Results: </strong>We included 775 patients (mean age 70.5 years (SD 15.1)). The median of IGR was 8.7 ml per hour (IQR 2.8-24.2). A faster IGR was independently associated with a higher risk of any HT (adjusted OR 1.35; 95% CI 1.16-1.57 per one log unit increase). A faster IGR was also associated with an increased risk of parenchymal hemorrhage in univariate analysis (OR 1.35; 95% CI 1.15-1.58), but the association did not remain significant in multivariable analysis including all the other predictors of parenchymal hemorrhage (adjusted OR 1.16 (95% CI 0.96-1.40) per one log unit increase). ROC analyses revealed that baseline infarct volume significantly better predicted any HT and PH occurrence than the IGR (<i>p</i> = 0.019 and <i>p</i> = 0.029 respectively).</p><p><strong>Conclusion: </strong>In patients presenting with anterior circulation LVOS and treated with EVT, the IGR was significantly associated with an increased risk of HT. However, the baseline infarct volume was a stronger predictor of HT than IGR.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251357151"},"PeriodicalIF":5.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638325","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":"Ultra-early computed tomography markers of haematoma expansion: Potential trial targets?","authors":"Chloe A Mutimer, Sameer Sharma, Henry Zhao, Atte Meretoja, Leonid Churilov, Teddy Y Wu, Timothy J Kleinig, Philip M Choi, Andrew Cheung, Jiann-Shing Jeng, Henry Ma, Duy Ton Mai, Huy-Thang Nguyen, Gagan Sharma, Bruce Cv Campbell, Geoffrey A Donnan, Stephen M Davis, Nawaf Yassi","doi":"10.1177/23969873251355938","DOIUrl":"10.1177/23969873251355938","url":null,"abstract":"<p><strong>Introduction: </strong>The predictive value of CT markers of intracerebral haemorrhage (ICH) expansion is time-dependent, but data in the ultra-early period (<2 h from onset) are limited. We aimed to describe the frequency of these CT markers, their association with haematoma volume, haematoma expansion (HE) and functional outcome at 90-days. We also investigated the effect of tranexamic acid on HE in the presence of these markers.</p><p><strong>Patients and methods: </strong>We performed a pooled analysis of individual patient data from the STOP-AUST and STOP-MSU placebo-controlled randomised trials of tranexamic acid, including ICH patients scanned within 2 h of symptom onset. Logistic regression was used to assess the association between CT markers and HE or 90-days functional outcomes (poor outcome defined as mRS3-6).</p><p><strong>Results: </strong>Among 246 patients, the swirl sign (74.3%) was the most frequent CT marker and the blend sign least frequent (7.3%). All markers were associated with increased baseline haematoma volume, and excluding the black hole sign, all were more common in patients with 24-h HE. The blend and spot signs were associated with 24-h HE and heterogenous density, swirl sign, hypodensity and island sign were associated with poor 90-day function outcomes in univariate logistic regression. However, the area under the receiver-operating-characteristic curve was similar for all markers and indicated low discriminative ability (Chi-squared test <i>p</i> = 0.81). A potential benefit of tranexamic acid in HE reduction was observed in patients with the spot sign (interaction <i>p</i> = 0.01)Conclusions:The discriminative utility of CT markers of HE in the early timeframe appears insufficient. There may be an effect of tranexamic acid in spot sign positive patients <2 h from onset.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251355938"},"PeriodicalIF":5.8,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12255656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620798","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":"Association of anesthesia strategies with outcomes in endovascular treatment for distal and medium vessel occlusions: A propensity score-matched analysis of the MR CLEAN registry and meta-analysis.","authors":"Mohamed F Doheim, Robrecht Rmm Knapen, Diederik Wj Dippel, Julie Staals, Jeannette Hofmeijer, Adriaan Cgm van Es, Jonathan M Coutinho, Christiaan van der Leij, Raul G Nogueira, Robert J van Oostenbrugge, Wim H van Zwam","doi":"10.1177/23969873251352406","DOIUrl":"10.1177/23969873251352406","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Recent trials did not demonstrate the benefit of endovascular therapy (EVT) for distal or medium vessel occlusions (DMVOs), raising questions about factors influencing outcomes. Anesthesia choice may play a role, yet its impact remains unclear. This study assessed general anesthesia (GA) versus non-GA in EVT for DMVOs, evaluating procedural, functional, and safety outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and methods: &lt;/strong&gt;Patients undergoing EVT for AIS due to anterior DMVOs in the middle cerebral artery (MCA-M2, M3, M4) and anterior cerebral artery (ACA-A1, A2, A3) from the MR CLEAN registry between March 2014 and December 2018 were included. They were stratified into GA and non-GA groups, with propensity score matching employed to adjust for differences in baseline risk. Primary outcomes included functional outcomes at 90 days, assessed by ordinal regression analysis of modified Rankin Scale (mRS) scores at 90 days, and recanalization rates measured by Thrombolysis in Cerebral Infarction (TICI) scores. Secondary outcomes included dichotomized mRS scores, death at 90 days, and symptomatic intracranial hemorrhage (sICH). A systematic review and meta-analysis of relevant DMVO studies with a random effects model was performed. This study was registered with PROSPERO (CRD42024607294).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 5193 patients in the registry, 657 were eligible for our study, with 506 in the non-GA group, and 151 in the GA group. The median age was 73 years (IQR 64-81) in the non-GA group and 73 years (IQR 61-80) in the GA group (&lt;i&gt;p&lt;/i&gt; = 0.35). The proportion of male patients was 50.2% in the non-GA group and 57.0% in the GA group (&lt;i&gt;p&lt;/i&gt; = 0.15). In the matched cohort (&lt;i&gt;n&lt;/i&gt; = 170), recanalization rates were higher in the GA group compared to the non-GA group (excellent recanalization rates (TICI2c/3): 61.0% vs 32.1%; OR 3.31, 95% CI (1.74-6.29), &lt;i&gt;p&lt;/i&gt; &lt; 0.001). There were no significant differences in the overall distribution of functional outcomes at 90 days (common OR 0.93, 95% CI (0.54-1.56), &lt;i&gt;p&lt;/i&gt; = 0.77). Mortality was comparable between groups (34.1% vs 31.8%; OR 1.11, 95% CI (0.59-2.11), &lt;i&gt;p&lt;/i&gt; = 0.74), and there was no significant difference in sICH (12.9% vs 5.9%; OR 0.42, 95% CI (0.14-1.27), &lt;i&gt;p&lt;/i&gt; = 0.12). The systematic review and meta-analysis included six studies with a total of 3521 patients. The pooled analysis indicated that GA was associated with significantly lower rates of excellent functional outcomes (mRS 0-1: OR 0.74, 95% CI (0.58-0.94), &lt;i&gt;p&lt;/i&gt; = 0.01) and higher mortality (OR 1.36, 95% CI (1.07-1.74), &lt;i&gt;p&lt;/i&gt; = 0.01) compared to the non-GA at 90 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion and conclusion: &lt;/strong&gt;In the MR CLEAN Registry, GA was associated with higher recanalization rates during EVT, but this technical advantage did not translate into improved 90-day functional outcomes. Our meta-analysis further indicated that non-GA strategies were associated with better functi","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251352406"},"PeriodicalIF":5.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601877","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":"B-STARS2: Early contralesional continuous theta burst stimulation (cTBS) to promote upper limb recovery after stroke - Rationale and design of a phase-3 multicentre, randomised, sham-controlled, clinical trial.","authors":"Jord Jt Vink, Tessa A Verhoeff, Willem M Otte, Miriam P van der Meulen, H Bart van der Worp, Johanna Ma Visser-Meily, Rick M Dijkhuizen","doi":"10.1177/23969873251355937","DOIUrl":"10.1177/23969873251355937","url":null,"abstract":"<p><strong>Rationale: </strong>Many stroke survivors have persisting upper limb impairment. In a phase-2 trial, early contralesional continuous theta burst stimulation (cTBS) improved upper limb recovery and functional outcome after stroke, but confirmation of this benefit in a larger, phase-3 trial is required before this can be recommended as standard of care.</p><p><strong>Aim: </strong>We aim to assess whether 10 sessions of cTBS of the contralesional primary motor cortex, combined with regular care upper limb training, started within 3 weeks after stroke onset and continued for 2 weeks, reduces upper limb impairment at 90 days after stroke as compared to sham stimulation.</p><p><strong>Methods and design: </strong>We will perform a multicentre, double-blind, randomised, sham-controlled, clinical trial. Patients with ischaemic stroke or intracerebral haemorrhage and unilateral upper limb paresis will be assigned to receive 10 daily sessions of active or sham cTBS, delivered over the contralesional primary motor cortex, combined with regular care upper limb therapy and started within 3 weeks after stroke onset.</p><p><strong>Outcomes: </strong>The primary outcome is the score of the Fugl-Meyer Upper Extremity (FM-UE) assessment at 90 days after stroke. Secondary outcomes are the FM-UE score at 12 months after stroke and scores on the Action Research Arm Test, Nine Hole Peg Test, modified Rankin Scale, Barthel Index, hand, participation and overall recovery sections of the Stroke Impact Scale and the EuroQol-5D-5L at 90 days and 12 months post-stroke. Additionally, cost-effectiveness, length of stay at the rehabilitation centre, and ipsilesional and contralesional excitability are assessed.</p><p><strong>Sample size: </strong>We will randomise 454 participants 1:1 to active or sham cTBS. The sample size is based on a minimal detectable effect of 6.6 points on the FM-UE scale.</p><p><strong>Discussion: </strong>If cTBS treatment leads to a cost-effective and clinically meaningful additional recovery of at least 6.6 points on the FM-UE scale at 90 days after stroke, then cTBS treatment can be recommended as standard of care.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251355937"},"PeriodicalIF":5.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585248","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":"True versus pseudo-occlusion of the cervical internal carotid artery in acute stroke: A multicenter MR angiography study.","authors":"Christian Heitkamp, Pia Niederau, Arndt-Hendrik Schievelkamp, Nikolaos Ntoulias, Lukas Goertz, David Zopfs, Kai R Laukamp, Thomas Schömig, Jonathan Kottlors, Christian Nelles, Simon Lennartz, Marios-Nikos Psychogios, Franziska Dorn, Uta Hanning, Jens Fiehler, Michael Schönfeld","doi":"10.1177/23969873251355450","DOIUrl":"10.1177/23969873251355450","url":null,"abstract":"<p><strong>Introduction: </strong>Differentiating true from pseudo-occlusion of the cervical internal carotid artery (ICA) in acute ischemic stroke patients undergoing thrombectomy is crucial but challenging. We aimed to investigate the ability of contrast-enhanced magnetic resonance angiography (CE-MRA) to differentiate true from pseudo-occlusion (defined as an isolated thrombus of the intracranial ICA suppressing ascending blood flow) of the cervical ICA in acute ischemic stroke patients.</p><p><strong>Materials and methods: </strong>Multicenter, retrospective analysis of acute ischemic stroke patients with true or pseudo-occlusion of the cervical ICA and subsequent thrombectomy. Patients with preprocedural CE-MRA showing a lack of contrast filling in the cervical ICA on the symptomatic side were included. Six readers (three radiology fellows and three board-certified radiologists) independently evaluated the CE-MRA images for true or pseudo-occlusion of the cervical ICA using a rating scheme. Their assessments were compared with DSA results as the reference standard. Diagnostic accuracy measures, as well as inter- and intra-reader reliability for detecting pseudo-occlusion, were calculated and compared between subgroups.</p><p><strong>Results: </strong>A total of 41 patients were included. The median age was 73 years, and 39% were female. According to the reference standard, 16 of 41 (39%) patients had a pseudo-occlusion of the cervical ICA, while the remainder had a true occlusion. The aggregated sensitivity and specificity from all readers were 72% (95% confidence interval [CI]: 62%-81%) and 86% (95% CI: 79%-91%), respectively. Board-certified radiologists performed better, with a sensitivity of 81% (95% CI: 67%-91%) and specificity of 92% (95% CI: 83%-97%). Overall, inter-reader agreement was moderate (κ = 0.48; 95% CI: 0.31-0.65) and reached substantial agreement within the board-certified radiologists subgroup (κ = 0.65; 95% CI: 0.45-0.85).</p><p><strong>Conclusion: </strong>Differentiating true occlusion from pseudo-occlusion of the cervical ICA using CE-MRA is feasible but requires training in specific imaging characteristics as well as experience in interpreting them, as evidenced by the higher diagnostic accuracy of board-certified radiologists. Correct distinction help in optimal material selection (e.g. size and type of guiding catheter) prior to endovascular treatment.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251355450"},"PeriodicalIF":5.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585249","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":"Development and external validation of the LEAN score to predict late seizures after intracerebral haemorrhage.","authors":"Frederik J Reitsma, Sander Mj van Kuijk, David J Werring, Gargi Banerjee, Charlotte Cordonnier, Olfa Kaaouana, Laurent Puy, Allesandro Biffi, Anand Viswanathan, Robert J van Oostenbrugge, Julie Staals, Rob Pw Rouhl","doi":"10.1177/23969873251350882","DOIUrl":"10.1177/23969873251350882","url":null,"abstract":"<p><strong>Introduction: </strong>Predicting the occurrence of late seizures after intracerebral haemorrhage may help in making clinical decisions about treatment. Currently, the CAVE score is the best performing risk score. We aimed to design a different, pragmatic risk prediction score and compared it to the CAVE score.</p><p><strong>Patients and methods: </strong>The South Limburg (Netherlands) intracerebral haemorrhage registry, consisting of patients with a primary intracerebral haemorrhage in 2004-2009, was used for the derivation cohort. We made a prediction model using Cox proportional hazard analyses; comparisons between models were made with the c-statistic. We validated our model externally in three independent cohorts.</p><p><strong>Results: </strong>Our derivation cohort consisted of 781 patients, of whom 78 (10%) developed late seizures. We found the following independent predictors for late seizures: any neurosurgical procedure, age < 65 years, lobar haemorrhage, and early seizures (occurring within the first week). These formed our new prediction score (LEAN score), which had an optimism-corrected c-statistic of 0.80 (95%-confidence interval 0.78-0.86). The LEAN score predicts late seizure risk as 0.7%, 1.6%, 8.8%, 22.0%, 29.8%, 43.5%, 100% for the increasing score groups respectively. External validation showed comparable optimism-corrected c-statistics for both the LEAN score and the CAVE score.</p><p><strong>Conclusion: </strong>The newly developed LEAN score consists of easily available clinical variables and performs equally to the CAVE score. Additionally, the high risk of late seizures in patients with the maximum LEAN score might make a diagnosis of epilepsy possible according to international guidelines despite these patients only had early seizures.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251350882"},"PeriodicalIF":5.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576646","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":"Anti-beta2-glycoprotein I IgG antibodies are associated with early-onset cryptogenic ischemic stroke.","authors":"Nina Jaakonmäki, Tuukka Helin, Timea Szanto, Marialuisa Zedde, Tomi Sarkanen, Nicolas Martinez-Majander, Juha Sinisalo, Ulla Junttola, Petra Redfors, Bettina von Sarnowski, Ulrike Waje-Andreassen, Pauli Ylikotila, Nilufer Yesilot, Kristina Ryliskiene, Lauri Tulkki, Laura Amaya Pascasio, Radim Licenik, Phillip Ferdinand, Eva Gerdts, Dalius Jatužis, Alessandro Pezzini, Janika Kõrv, Juha Huhtakangas, Ana Catarina Fonseca, Lotta Joutsi-Korhonen, Hugoten Cate, Pekka Jäkälä, Jukka Putaala","doi":"10.1177/23969873251351207","DOIUrl":"10.1177/23969873251351207","url":null,"abstract":"<p><strong>Background: </strong>Previously undetected antiphospholipid antibodies (aPLs) potentially provide explanations for early-onset cryptogenic ischemic stroke (CIS). Prior association studies conducted over a decade ago were inconclusive and not focused on patients with CIS.</p><p><strong>Methods: </strong>SECRETO is a multi-center case-control study enrolling patients aged 18-49 years with imaging-positive acute CIS and 1:1 matched stroke-free controls. Lupus anticoagulant (LA), anticardiolipin (aCL), and anti-beta2-glycoprotein I (aβ2GPI) IgG antibodies were assessed from blood samples taken at two time points (baseline and 12-weeks) from patients and at a single time point from controls. Conditional logistic regression models assessed the association of aPLs, adjusted for age, level of education, and vascular risk factors.</p><p><strong>Results: </strong>A total of 503 patient-control pairs were analyzed. At either time-point, compared to healthy controls, patients had more frequently positive aβ2GPI (patients 11.9% vs controls 2.0%, <i>p</i> < 0.001). There was no significant difference in the presence of positive LA between patients and controls. In the logistic regression model, at either time-point positive aB2GI and aCL were associated with CIS (odds ratio [OR] 11.22, 95% confidence interval [CI] 4.35-28.95 and OR 20.85, 95% CI 204-213.16, respectively). The frequency of patients with positive aβ2GPI or aCL increased from baseline to 12 weeks (<i>p</i> < 0.001), whereas frequency of positive LA results decreased (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Positive aβ2GPI and aCL, but not LA, detected either shortly after stroke or after 12 weeks were associated with early-onset CIS. Notably, after the acute phase, frequencies of positive aβ2GPI and aCL increased, whereas LA showed a reverse trend.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251351207"},"PeriodicalIF":5.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12228635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567978","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":"Temporal patterns, incidence, and predictors of early stroke recurrence in atrial fibrillation.","authors":"Daniel Guisado-Alonso, Elisa Cuadrado-Godia, Ana Rodriguez-Campello, Isabel Fernández-Pérez, Adrià Macias-Gómez, Marta Vallverdú-Prats, Julia Peris-Subiza, Sergio Vidal-Notari, Laia Peraferrer-Montesinos, Jordi Jiménez-Conde, Joan Jiménez-Balado, Eva Giralt-Steinhauer, Angel Ois","doi":"10.1177/23969873251352397","DOIUrl":"10.1177/23969873251352397","url":null,"abstract":"<p><strong>Introduction: </strong>Early recurrence (ER) after an acute stroke event (ASE; ischemic or hemorrhagic) in patients with atrial fibrillation (AF) presents a therapeutic challenge due to the need to balance ischemic prevention with hemorrhagic risk. This study aimed to quantify ER incidence, both ischemic and hemorrhagic, and identify its predictors using real-world data from a prospective registry.</p><p><strong>Patients and methods: </strong>Retrospective analysis of patients with AF, either known or detected within 6 months, who were admitted for a first-ever ASE to a tertiary stroke center between 2005 and 2024. ER was defined as any recurrent event within 6 months. Baseline characteristics, CHA₂DS₂-VASc score, CHADS-VA score, stroke severity, anticoagulation type, AF detection timing, and monitoring duration were recorded. Cox and Fine-Gray models identified independent predictors.</p><p><strong>Results: </strong>Among 1795 patients, 108 (6.0%) experienced ER. The cumulative incidence was 6.3% (95% CI 5.1-7.4), and most events occurred within the first 30 days. Independent predictors included higher CHA₂DS₂-VASc score (sHR = 1.252, <i>p</i> = 0.023), lower initial stroke severity (sHR = 0.918, <i>p</i> < 0.001), concomitant stroke etiologies (sHR = 2.008, <i>p</i> = 0.001), and AF detected within 30 days after stroke (sHR = 1.644, <i>p</i> = 0.026). DOAC use was protective (sHR = 0.484, <i>p</i> = 0.003), while VKA showed a non-significant trend (sHR = 0.637, <i>p</i> = 0.068). Interaction analysis showed increased recurrence risk only in non-anticoagulated patients with AF detected after stroke. These findings were consistent across sensitivity analyses restricted to ischemic stroke, incorporating time-dependent anticoagulation, or comparing CHADS-VA and CHA₂DS₂-VASc scores.</p><p><strong>Conclusions: </strong>ER, predominantly ischemic, occurred mainly within 30 days. Risk factors included AF detection timing, CHA₂DS₂-VASc score, stroke severity, concomitant causes, and anticoagulation status, supporting early risk stratification and DOAC initiation.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251352397"},"PeriodicalIF":5.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12222103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545459","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}