European Stroke Journal最新文献

{"title":"European Stroke Organisation (ESO) guideline on motor rehabilitation.","authors":"Margit Alt Murphy, Maria Munoz-Novoa, Charlotte Heremans, Meret Branscheidt, Rosa Cabanas-Valdés, Stefan T Engelter, Christina Kruuse, Gert Kwakkel, Sandra Lakičević, Sofia Lampropoulou, Andreas R Luft, Philippe Marque, Sarah A Moore, Anna Podlasek, Apoorva Malavalli Shankaranarayana, Lisa Shaw, John M Solomon, Cathy Stinear, Eva Swinnen, Andrea Turolla, Geert Verheyden","doi":"10.1177/23969873251338142","DOIUrl":"10.1177/23969873251338142","url":null,"abstract":"<p><p>Motor rehabilitation aims to help people after stroke to gain optimal motor functioning, independence and quality of life. This European Stroke Organisation (ESO) guideline provides updated, evidence-based support for clinical practice in six agreed critical areas: dose for upper limb and gait therapy, high-intensity gait training, effect of therapy transfer package, group versus individual therapy and sit-to-stand training. The guideline was developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Expert consensus statements are provided where a GRADE recommendation cannot be made due to insufficient evidence. For therapy dose, very low quality evidence supports a weak recommendation to provide an additional minimal dose of 20 h of repetitive upper limb practice to improve arm capacity. For gait, expert consensus suggests that an additional minimal dose of 20 h of walking practice could be beneficial for walking capacity. For high-intensity gait training, moderate quality evidence supports a strong recommendation for high-intensity gait training to improve walking endurance in people with chronic stroke and stable cardiovascular status, while low quality evidence supports a weak recommendation for improving walking speed. An expert consensus suggests using a transfer package when providing upper limb task-specific training to enhance transfer to daily life. For group therapy, a weak recommendation based on very low quality evidence suggests that task-specific group-based therapy is non-inferior to individual therapy for improving balance, gait speed and walking endurance. A weak recommendation based on moderate quality evidence suggests additional sit-to-stand training to improve balance.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251338142"},"PeriodicalIF":5.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12098312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120322","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":"European Stroke Organisation (ESO) and European Association of Neurosurgical Societies (EANS) guideline on stroke due to spontaneous intracerebral haemorrhage.","authors":"Thorsten Steiner, Jan C Purrucker, Diana Aguiar de Sousa, Trine Apostolaki-Hansson, Jürgen Beck, Hanne Christensen, Charlotte Cordonnier, Matthew B Downer, Helle Eilertsen, Rachael Gartly, Stefan T Gerner, Leonard Ho, Silje Holt Jahr, Catharina Jm Klijn, Nicolas Martinez-Majander, Kateriine Orav, Jesper Petersson, Andreas Raabe, Else Charlotte Sandset, Floris H Schreuder, David Seiffge, Rustam Al-Shahi Salman","doi":"10.1177/23969873251340815","DOIUrl":"10.1177/23969873251340815","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Spontaneous (non-traumatic) intracerebral haemorrhage (ICH) affects ~3.4 million people worldwide each year, causing ~2.8 million deaths. Many randomised controlled trials and high-quality observational studies have added to the evidence base for the management of people with ICH since the last European Stroke Organisation (ESO) guidelines for the management of spontaneous ICH were published in 2014, so we updated the ESO guideline. This guideline update was guided by the European Stroke Organisation (ESO) standard operating procedures for guidelines and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework, in collaboration with the European Association of Neurosurgical Societies (EANS). We identified 37 Population, Intervention, Comparator, Outcome (PICO) questions and prioritised clinical outcomes. We conducted systematic literature searches, tailored to each PICO, seeking randomised controlled trials (RCT) - or observational studies when RCTs were not appropriate, or not available - that investigated interventions to improve clinical outcomes. A group of co-authors allocated to each PICO screened titles, abstracts, and full texts and extracted data from included studies. A methodologist conducted study-level meta-analyses and created summaries of findings tables. The same group of co-authors graded the quality of evidence, and drafted recommendations that were reviewed, revised and approved by the entire group. When there was insufficient evidence to make a recommendation, each group of co-authors drafted an expert consensus statement, which was reviewed, revised and voted on by the entire group. The systematic literature search revealed 115,647 articles. We included 208 studies. We found &lt;b&gt;strong evidence for&lt;/b&gt; treatment of people with ICH on organised stroke units, and secondary prevention of stroke with blood pressure lowering. We found &lt;b&gt;weak evidence for&lt;/b&gt; scores for predicting macrovascular causes underlying ICH; acute blood pressure lowering; open surgery via craniotomy for supratentorial ICH; minimally invasive surgery for supratentorial ICH; decompressive surgery for deep supratentorial ICH; evacuation of cerebellar ICH &gt; 15 mL; external ventricular drainage with intraventricular thrombolysis for intraventricular extension; minimally invasive surgical evacuation of intraventricular blood; intermittent pneumatic compression to prevent proximal deep vein thrombosis; antiplatelet therapy for a licensed indication for secondary prevention; and applying a care bundle. We found &lt;b&gt;strong evidence against&lt;/b&gt; anti-inflammatory drug use outside of clinical trials. We found &lt;b&gt;weak evidence against&lt;/b&gt; routine use of rFVIIa, platelet transfusions for antiplatelet-associated ICH, general policies that limit treatment within 24 h of ICH onset, temperature and glucose management as single measures (outside of care bundles), prophylactic anti-seizures medicines, and prophylactic use of temperature-lo","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251340815"},"PeriodicalIF":5.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12098356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119977","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":"European Stroke Organisation (ESO) guideline on aphasia rehabilitation.","authors":"Marian C Brady, Claire Mills, Hege Prag Øra, Natalia Novaes, Frank Becker, Fofi Constantinidou, Agnes Flöel, Katharina S Sunnerhagen, Jytte Isaksen, Caroline Jagoe, Luis Mt Jesus, Paola Marangolo, Marcus Meinzer, Ineke van der Meulen, Pauline Campbell, Leonard Ho, Salman Hussain, Katerina Hilari","doi":"10.1177/23969873241311025","DOIUrl":"10.1177/23969873241311025","url":null,"abstract":"<p><p>Evidence of effective aphasia rehabilitation is emerging, yet intervention and delivery varies widely. This European Stroke Organisation guideline adhered to the guideline development standard procedures and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The resulting multi-disciplinary, evidence-based recommendations support the delivery of high-quality stroke-related aphasia rehabilitation. The working group identified 10 clinically relevant aphasia rehabilitation questions and rated outcomes' relevance and importance. Following systematic searching, independent reviewers screened title-abstracts and full-texts for randomised controlled trials of speech-language therapy (SLT) for stroke-related aphasia. Results were profiled using PRISMA. Risk-of-bias was evaluated using the Cochrane Risk-of-Bias 1 tool. We prioritised final-value data. Where possible we conducted meta-analyses (RevMan) using random effects and mean, standardised mean differences (functional communication, quality of life, aphasia severity, auditory comprehension and spoken language outcomes) or odds ratios (adverse events). Using GRADE, we judged quality of the evidence (high-to-very low) and ESO recommendation strength (very strong-to-very weak). Where evidence was insufficient to support recommendations, expert opinions were described. Based on low-quality evidence we recommend the provision of higher total SLT dose (⩾20 h) and suggest higher SLT intensity and frequency to improve outcomes in aphasia rehabilitation. Similarly, we suggest the provision of individually-tailored SLT and digital and group therapy delivery models. Very low-level evidence for transcranial direct current stimulation (tDCS) with SLT informed the expert consensus that such interventions should only be provided in the context of high-quality trials. Evidence-based clinical-research priorities to inform SLT aphasia rehabilitation intervention choice and delivery are highlighted.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241311025"},"PeriodicalIF":5.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12098336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120209","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":"European Stroke Organisation (ESO) guideline on visual impairment in stroke.","authors":"Fiona J Rowe, Lauren R Hepworth, María Begoña Coco-Martin, Celine R Gillebert, Luis Leal-Vega, Anja Palmowski-Wolfe, Eleni Papageorgiou, Stephen James Ryan, Karolina Skorkovska, Anne Hege Aamodt","doi":"10.1177/23969873251314693","DOIUrl":"10.1177/23969873251314693","url":null,"abstract":"<p><p>Visual impairment due to stroke is common. However, controversy exists on how best to screen for visual impairment, the timing at which to screen, and on the optimal management of the varying types of visual impairment. This European Stroke Organisation (ESO) guideline provides evidence-based recommendations to assist clinicians in decision-making on screening methods, timing of screening and assessment and management options in adult stroke survivors. The target audience for this guideline is health care providers involved in stroke care from prehospital screening, in stroke units and rehabilitation centres, ophthalmological departments and community stroke care, and for stroke survivors and care givers. The guideline was developed according to the ESO standard operating procedure and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and, where possible, meta-analyses of the literature, assessed the quality of the available evidence and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations based on the GRADE approach. We found evidence of acceptability and feasibility of early visual screening within 1 week of stroke onset. We describe the accuracy of various vision screening tools at pre-hospital and hyper/acute stages as well as specialist vision assessment. We suggest vision screening in all patients with stroke to improve detection of their visual problems We describe a range of treatment options for visual impairment post-stroke across the typical categories of impaired central vision, ocular stroke (central retinal artery occlusion), eye movements, visual fields, visual neglect and visual perception. This guideline highlights specific areas where robust evidence is lacking and where further definitive randomised controlled trials and diagnostic accuracy studies are required.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251314693"},"PeriodicalIF":5.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12098360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120328","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":"A novel stroke mimic prediction score during in-hospital triage for suspected stroke patients: The Stroke Mimics Score (SMS).","authors":"Irene Scala, Marcello Covino, Pier Andrea Rizzo, Maurizio Bisegna, Davide Marchese, Simone Bellavia, Aldobrando Broccolini, Riccardo Di Iorio, Giacomo Della Marca, Valerio Brunetti, Francesco Franceschi, Mauro Monforte, Paolo Calabresi, Giovanni Frisullo","doi":"10.1177/23969873251338654","DOIUrl":"10.1177/23969873251338654","url":null,"abstract":"<p><strong>Introduction: </strong>Early differential diagnosis between stroke mimics and cerebrovascular events is a major challenge in the Emergency Department (ED). The primary aim of this study was to identify diagnostic predictors of stroke mimics based on parameters acquired during the ED triage of patients with suspected stroke. Secondly, we aimed to develop a diagnostic score for early differential diagnosis. Moreover, we compared the diagnostic accuracy of our score with that of other two validated scores.</p><p><strong>Patients and methods: </strong>We included consecutive patients presenting to the ED of an urban teaching hospital for suspected stroke from 2015 to 2022 in the retrospective derivation cohort and during 2023 in the prospective validation cohort. Cerebrovascular events predictors were identified by logistic regression and were used to develop the Stroke Mimics Score (SMS). The diagnostic performance of SMS was assessed using the area under the receiver operating characteristics curves (AUROC) and the comparison with other diagnostic scores (FABS - Facial droop, Atrial fibrillation, Age, Systolic blood pressure, Seizure, Sensory symptoms- and TMS- TeleStroke Mimic score) was performed through DeLong method and Net Reclassification Index (NRI).</p><p><strong>Results: </strong>About 8648 patients were included in the study, 6998 in the retrospective cohort, and 1650 in the prospective cohort. In the retrospective cohort, 3266 (46.7%) patients had a final diagnosis of stroke mimic. Several variables collected by triage nurses independently predicted cerebrovascular event over stroke mimic diagnosis. The 10-variable SMS had excellent diagnostic performance in both the derivation and validation cohorts [AUROC 0.777 (95% CI: 0.766-0.788) and 0.774 (95% CI: 0.752-0.797), respectively] and outperformed FABS and TMS in all statistical comparisons.</p><p><strong>Discussion and conclusion: </strong>Several clinical variables elicited by triage nurses in the ED help to differentiate cerebrovascular events from stroke mimics in suspected stroke patients. The SMS is an easy-to-use score that could help selecting the best pathway for such patients.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251338654"},"PeriodicalIF":5.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081018","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":"Preoperative BOLD cerebrovascular reactivity correlates with intraoperative STA-MCA bypass flow and influences postoperative CVR improvement.","authors":"Martina Sebök, Vittorio Stumpo, Jacopo Bellomo, Giuseppe Esposito, Christiaan Hendrik Bas van Niftrik, Zsolt Kulcsár, Andreas R Luft, Luca Regli, Jorn Fierstra","doi":"10.1177/23969873251337234","DOIUrl":"https://doi.org/10.1177/23969873251337234","url":null,"abstract":"<p><strong>Introduction: </strong>The superficial temporal artery-middle cerebral artery (STA-MCA) flow augmentation bypass is effective for treating Moyamoya vasculopathy and selected cases of atherosclerotic large vessel disease. Recently, blood oxygen level-dependent cerebrovascular reactivity (BOLD-CVR) has emerged as a novel tool to assess hemodynamic impairment for patient selection and monitoring. This study investigates whether preoperative BOLD-CVR in the affected vascular territory (i.e. middle cerebral artery (MCA) territory) correlates with intraoperative bypass flow and whether intraoperative bypass flow serves as a predictor of postoperative hemodynamic improvement.</p><p><strong>Patients and methods: </strong>We prospectively included patients with symptomatic cerebrovascular steno-occlusive disease who underwent STA-MCA bypass with pre- and postoperative BOLD-CVR imaging and intraoperative bypass flow measurements. Pearson correlation and multivariable regression models assessed the relationships between preoperative hemodynamic status (i.e. preoperative BOLD-CVR), intraoperative bypass flow, and postoperative BOLD-CVR improvement, adjusting for confounders (type of steno-occlusive disease, age, and cerebrovascular risk factors).</p><p><strong>Results: </strong>Forty-three patients (three receiving bilateral bypass) were included. Despite lack of association (<i>p</i> = 0.08) at univariable analysis, multivariable regression analysis revealed that, after correction for known confounders, preoperative CVR in the affected MCA territory was inversely associated with intraoperative bypass flow. For each 0.1 unit (percentage BOLD signal change/mmHg CO2) decrease in preoperative MCA territory CVR, the predicted bypass flow increased by 14.61 mL/min. Preoperative CVR was also the only significant predictor of postoperative CVR, with higher preoperative BOLD-CVR values linked to greater hemodynamic improvement.</p><p><strong>Conclusion: </strong>The severity of preoperative hemodynamic impairment in the affected MCA territory correlates with the increased need for bypass flow, serving as a potential predictor for intraoperative quantitative bypass flow demand once relevant covariates are accounted for. The STA-MCA bypass appears to deliver optimal flow when the cerebrovascular reserve capacity is not fully exhausted.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251337234"},"PeriodicalIF":5.8,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024444","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":"Anticoagulation in atrial fibrillation detected after stroke: Many questions, some answers.","authors":"John J McCabe, Stephen O Brennan","doi":"10.1177/23969873251337666","DOIUrl":"https://doi.org/10.1177/23969873251337666","url":null,"abstract":"","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251337666"},"PeriodicalIF":5.8,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991346","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":"Blood pressure management based on infarct volume after successful endovascular thrombectomy.","authors":"Jae Wook Jung, Kwang Hyun Kim, Jaeseob Yun, Haram Joo, Young Dae Kim, JoonNyung Heo, Hyungwoo Lee, Byung Moon Kim, Dong Joon Kim, Na Young Shin, Bang-Hoon Cho, Seong Hwan Ahn, Hyungjong Park, Sung-Il Sohn, Jeong-Ho Hong, Tae-Jin Song, Yoonkyung Chang, Gyu Sik Kim, Kwon-Duk Seo, Kijeong Lee, Jun Young Chang, Jung Hwa Seo, Sukyoon Lee, Jang-Hyun Baek, Han-Jin Cho, Dong Hoon Shin, Jinkwon Kim, Joonsang Yoo, Minyoul Baik, Yo Han Jung, Yang-Ha Hwang, Chi Kyung Kim, Jae Guk Kim, Il Hyung Lee, Jin Kyo Choi, Chan Joo Lee, Sungha Park, Soyoung Jeon, Hye Sun Lee, Sun U Kwon, Oh Young Bang, Ji Hoe Heo, Hyo Suk Nam","doi":"10.1177/23969873251335204","DOIUrl":"https://doi.org/10.1177/23969873251335204","url":null,"abstract":"<p><strong>Introduction: </strong>While the efficacy of endovascular thrombectomy (EVT) in large core infarcts has been established, the influence of blood pressure (BP) management on functional outcomes based on infarct volume remains unclear.</p><p><strong>Patients and methods: </strong>We conducted a secondary analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control (OPTIMAL-BP) trial, which compared intensive (systolic BP < 140 mmHg) versus conventional (systolic BP 140-180 mmHg) BP management within the first 24 h following successful recanalization. Patients were grouped based on an infarct volume cut-off of 50 ml, assessed 24 h post-EVT. The primary efficacy outcome was functional independence (modified Rankin Scale of 0-2) at 3 months. Change of predicted probability for functional independence between BP managements, as infarct volume varied, was assessed.</p><p><strong>Results: </strong>Of the 300 patients, 222 (74.0%) were in the infarct volume ⩽50 ml group and 78 (26.0%) were in the infarct volume >50 ml group. The conventional management was significantly associated with a higher rate of functional independence in the infarct volume ⩽50 ml group (adjusted odds ratio [AOR], 2.06 [95% CI, 1.12-3.86]). In the infarct volume >50 ml group, the proportion of patients with functional independence was not significantly different between BP managements (AOR, 1.52 [95% CI, 0.46-5.04]). The interaction effect between the infarct volume groups and BP managements was not significant. As infarct volume increased, the difference in predicted probability of functional independence between BP managements decreased.</p><p><strong>Discussion and conclusions: </strong>Conventional BP management showed greater benefits for achieving functional independence at 3 months when infarct volumes were smaller. As infarct volume increased, the impact of BP management strategies on functional outcomes decreased.</p><p><strong>Registration: </strong>ClinicalTrials.gov (NCT04205305).</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251335204"},"PeriodicalIF":5.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040301","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":"National trends in patient characteristics, interventional techniques and outcomes of endovascular treatment for acute ischaemic stroke: Final results of the MR CLEAN Registry (2014-2018).","authors":"Wouter H Hinsenveld, Josje Brouwer, Sanne J den Hartog, Agnetha Bruggeman, Manon Kappelhof, Ivo Gh Jansen, Maxim Jhl Mulder, Kars Cj Compagne, Robert-Jan B Goldhoorn, Hester Lingsma, Geert Lycklama À Nijeholt, Rob Ar Gons, Lonneke Fs Yo, Maarten Uyttenboogaart, Reinoud Bokkers, Bart H van der Worp, Rob H Lo, Wouter Schonewille, Paul Brouwers, Tomas Bulut, Jasper Mm Martens, Jeannette Hofmeijer, Boudewijn Aam van Hasselt, Heleen den Hertog, Sebastiaan F de Bruijn, Lukas C van Dijk, Marianne A van Walderveen, Marieke Wermer, Hieronymus Boogaarts, Ewoud J van Dijk, Julia H van Tuijl, Issam Boukrab, Tobien Ahcml Schreuder, Roeland Heijboer, Anouk D Rozeman, Ludo Fm Beenen, Alida A Postma, Albert J Yoo, Stefan D Roosendaal, Jeannette Bakker, Adriaan Cgm van Es, Sjoerd Jenniskens, Ido Remy van den Wijngaard, Menno Krietemeijer, René van den Berg, Joseph Cj Bot, Sebastiaan Hammer, Marieke Sprengers, Frederick Jan Anton Meijer, Miou S Koopman, Elyas Ghariq, Auke Pa Appelman, Anouk van der Hoorn, Marc P van Proosdij, Bas Fw van der Kallen, Olvert A Berkhemer, Jeroen E Markenstein, Eef J Hendriks, Jo Pp Peluso, Christiaan van der Leij, Lucas Smagge, Saman Vinke, Sjoerd Pegge, Wouter Dinkelaar, Jan Albert Vos, Jelis Boiten, Inger de Ridder, Jonathan Coutinho, Bart J Emmer, Pieter Jan van Doormaal, Bob Roozenbeek, Yvo Bwem Roos, Charles Blm Majoie, Diederik Wj Dippel, Aad van der Lugt, Wim van Zwam, Robert van Oostenbrugge","doi":"10.1177/23969873251334271","DOIUrl":"https://doi.org/10.1177/23969873251334271","url":null,"abstract":"<p><strong>Introduction: </strong>Endovascular thrombectomy (EVT) procedures and workflow have evolved over the years. We examined trends in patient characteristics, EVT techniques and outcomes over 5 years in the Netherlands.</p><p><strong>Patients and methods: </strong>Data from the MR CLEAN Registry (2014-2018) were analysed, including patients treated with EVT for anterior circulation acute ischaemic stroke (AIS). Patients were grouped by year of inclusion except for the linear regression analysis where the inclusion date was used. Baseline predicted probability of poor outcome (modified Rankin Scale (mRS) score 3-6) was calculated using a validated prediction model. Primary outcome was mRS score at 90 days. Secondary outcomes included workflow times, EVT techniques, successful reperfusion (eTICI ⩾ 2B) and symptomatic intracranial haemorrhage (sICH). Time trends were analysed using multivariable regression models (adjusted common odds ratios (acOR) per year).</p><p><strong>Results: </strong>5193 patients were included. Median age increased (from 66 in 2014 to 74 years in 2018 [<i>p</i> < 0.001]). Proportion of patients with pre-stroke dependence (mRS ⩾ 3) increased from 2014 through 2018 (9% to 16%, <i>p</i> < 0.001). Baseline predicted probability of poor outcome did not change (60% vs 66%, <i>p</i> = 0.06). Over time, functional outcomes improved (acOR 1.14 per year, 95%CI: 1.09-1.20); mortality decreased (aOR 0.88 per year, 95%CI: 0.83-0.94). EVT under local anaesthesia increased (from 46% in 2014 to 70% in 2018; aOR 1.15, 95%CI: 1.10-1.22), as did use of direct aspiration (13%-36%; aOR 1.43, 95%CI: 1.35-1.53). Successful reperfusion became more frequent (aOR 1.32 per year, 95%CI: 1.25-1.40), despite needing more attempts (1 in 2014 vs 2 in 2018, aOR 0.93 per year, 95%CI: 0.89-0.98). Incidence of sICH remained unchanged (5% vs 5%, aOR 0.99 per year, 95%CI: 0.89-1.09). Time from emergency room to groin puncture reduced by 7 min per year (95%CI: 5-8).</p><p><strong>Discussion and conclusion: </strong>Enhanced workflow and increased EVT experience may have led to shorter time to treatment and more frequent successful reperfusion, with better functional outcomes over 5 years, despite treating older, more dependent patients.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251334271"},"PeriodicalIF":5.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050289","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":"Effectiveness and safety of dual antiplatelet therapy in patients with minor ischemic stroke or transient ischemic attack and cancer: A secondary analysis of the READAPT study.","authors":"Matteo Foschi, Federico De Santis, Lucio D'Anna, Michele Romoli, Tiziana Tassinari, Valentina Saia, Silvia Cenciarelli, Chiara Bedetti, Chiara Padiglioni, Bruno Censori, Valentina Puglisi, Luisa Vinciguerra, Maria Guarino, Valentina Barone, Marialuisa Zedde, Ilaria Grisendi, Marina Diomedi, Maria Rosaria Bagnato, Marco Petruzzellis, Domenico Maria Mezzapesa, Vincenzo Inchingolo, Manuel Cappellari, Cecilia Zivelonghi, Paolo Candelaresi, Vincenzo Andreone, Giuseppe Rinaldi, Alessandra Bavaro, Anna Maria Cavallini, Maria Grazia Piscaglia, Valeria Terruso, Marina Mannino, Alessandro Pezzini, Giovanni Frisullo, Francesco Muscia, Maurizio Paciaroni, Maria Giulia Mosconi, Andrea Zini, Ruggiero Leone, Carmela Palmieri, Letizia Maria Cupini, Michela Marcon, Rossana Tassi, Enzo Sanzaro, Giulio Papiri, Giovanna Viticchi, Daniele Orsucci, Anne Falcou, Susanna Diamanti, Roberto Tarletti, Patrizia Nencini, Eugenia Rota, Federica Nicoletta Sepe, Delfina Ferrandi, Luigi Caputi, Gino Volpi, Salvatore Laspada, Mario Beccia, Claudia Rinaldi, Vincenzo Mastrangelo, Francesco Di Blasio, Paolo Invernizzi, Giuseppe Pelliccioni, Maria Vittoria De Angelis, Laura Bonanni, Giampietro Ruzza, Emanuele Alessandro Caggia, Monia Russo, Agnese Tonon, Maria Cristina Acciarri, Sabrina Anticoli, Cinzia Roberti, Giovanni Manobianca, Gaspare Scaglione, Francesca Pistoia, Alberto Fortini, Antonella De Boni, Alessandra Sanna, Alberto Chiti, Marcella Caggiula, Maela Masato, Massimo Del Sette, Francesco Passarelli, Maria Roberta Bongioanni, Manuela De Michele, Stefano Ricci, Eleonora De Matteis, Raffaele Ornello, Simona Sacco","doi":"10.1177/23969873251333282","DOIUrl":"https://doi.org/10.1177/23969873251333282","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with ischemic stroke or transient ischemic attack (TIA) and cancer face unique risks of recurrent ischemic events and bleeding. It is unclear whether this increased risk is present even in patients with minor ischemic stroke or transient ischemic attack (TIA) receiving dual antiplatelet therapy (DAPT). This study aimed to evaluate the impact of cancer on the short-term outcomes after DAPT in patients with non-cardioembolic minor ischemic stroke or high-risk TIA.</p><p><strong>Patients and methods: </strong>This was a secondary analysis of the prospective multicentric READAPT study (NCT05476081), including patients with non-cardioembolic minor ischemic stroke (NIHSS ⩽ 5) or high-risk TIA (ABCD2 ⩾4) who initiated DAPT within 48 h of symptom onset. The primary effectiveness outcome was the 90-day risk of new ischemic stroke or other vascular events (TIA, myocardial infarction, death due to vascular causes). Secondary outcomes included 90-day mRS score distribution and all-cause mortality. The primary safety outcome was the 90-day risk of any bleeding, with secondary safety outcomes including 24-h hemorrhagic transformation. We used Inverse Probability Weighting to compare outcomes between patients with and without cancer.</p><p><strong>Results: </strong>From 2278 patients in the READAPT study cohort, we included 1561 patients (mean age 70.3 ± 11.7 years; 65.4% males), of whom 206 (13.2%) had cancer, categorized as either active (27.7%) or in remission (72.3%). After weighting, overall cancer patients had a higher risk of 90-day new ischemic stroke or other vascular events (weighted HR 1.78, 95% CI 1.20-2.63, <i>p</i> = 0.004) and worse 90-day mRS score distribution (OR 1.24, 95% CI 1.10-1.41, <i>p</i> < 0.001) compared to patients without cancer. The 90-day risk of bleeding did not differ between cancer and no-cancer groups overall. When analyzing cancer subgroups, patients with active cancer had significantly higher risk of 90-day ischemic stroke or other vascular (weighted HR 2.75, 95% CI 1.70-4.45, <i>p</i> < 0.001) and any bleeding (weighted HR 2.51, 95% CI 1.27-4.97, <i>p</i> = 0.008) events compared to no-cancer patients. In contrast, patients with cancer in remission had comparable risks to those without cancer. Furthermore, hematological malignancies were associated with a substantially higher risk of 90-day new ischemic stroke or other vascular events compared to solid tumors (weighted HR 8.15, 95% CI 5.06-13.14, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Patients with minor ischemic stroke or high-risk TIA and active cancer have increased risk of ischemic and bleeding events after DAPT. Conversely, patients with cancer in remission have similar outcomes compared to those with no cancer.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251333282"},"PeriodicalIF":5.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12018360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044380","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}