European Stroke Journal最新文献

{"title":"Self-reported health status of patients with acute retinal ischemia and stroke related hemianopia.","authors":"David Leander Rimmele, Elina L Petersen, Theresa Schrage, Martin Härter, Levente Kriston, Götz Thomalla","doi":"10.1177/23969873251314715","DOIUrl":"10.1177/23969873251314715","url":null,"abstract":"<p><strong>Background: </strong>We aimed to assess impairments on health-related quality of life, and mental health resulting from Retinal artery occlusion (RAO) with monocular visual field loss and posterior circulation ischemic stroke (PCIS) with full or partial hemianopia using patient-reported outcome measures (PROMs).</p><p><strong>Methods: </strong>In a prospective study, consecutive patients with acute RAO on fundoscopy and PCIS on imaging were recruited during their surveillance on a stroke unit over a period of 15 months. Baseline characteristics were determined from medical records and interviews. Health-related quality of life (PROM Information System 10-Question-Short-Form, PROMIS-10), and mental health symptoms (Patient-Health-Questionnaire-4, PHQ-4) were assessed 3 and 12 months after admission postally and via phone.</p><p><strong>Results: </strong>Ffity-seven patients with RAO and 19 with isolated full or partial hemianopia determined by the NIHSS (median = 2; IQR:0/2) according to PCIS were included. Characteristics of cardiovascular risk factors, and functional status pre-stroke were comparable between the groups. At 3 months, mean ± standard deviation <i>T</i>-scores of PROMIS physical and mental health were 47.1 ± 8.8 and 46.7 ± 8.8 for patients with RAO, and 43.4 ± 9.8 and 43.2 ± 6.2 for PCIS. Compared to 50 ± 10 in the general population, scores after RAO (<i>p</i> = 0.04; <i>p</i> = 0.02) and PCIS (<i>p</i> = 0.01; <i>p</i> < 0.001) were lower in both domains after 3 months. Concerning PCIS, scores in the mental health domain remained decreased at 12 months (<i>p</i> = 0.04). On the PHQ-4, 25% of patients with RAO, and 62% with PCIS scored indicative for anxious and/or depressive syndromes at 3 months.</p><p><strong>Conclusions: </strong>RAO led only to partial and to less persistent mental impairments than PCIS. This suggests that a different approach involving complex visual and neuropsychological treatment over a longer period of time needs to be considered for post-stroke care of PCIS.</p><p><strong>Trial registration information: </strong>The trial was submitted at http://www.clinicaltrials.gov, under NCT03795948.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251314715"},"PeriodicalIF":5.8,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11765302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042081","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":"Risk factors, mechanisms, and clinical outcomes of stroke in young adults presenting to a North Central London stroke service: UCL Young Stroke Systematic Evaluation Study (ULYSSES).","authors":"Raafiah Mussa, Gareth Ambler, Hatice Ozkan, Kitti Thiankhaw, Maryam Aboughdir, Imogen Smedley, John Mitchell, Gargi Banerjee, Hans Rolf Jäger, Alex Leff, Richard Perry, Robert J Simister, Arvind Chandratheva, David J Werring","doi":"10.1177/23969873251314360","DOIUrl":"10.1177/23969873251314360","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke incidence in younger adults is increasing worldwide yet few comprehensive studies exist from a UK population. We investigated the risk factors, mechanisms, functional outcome and stroke recurrence rate in a cohort of young adults with stroke.</p><p><strong>Patients and methods: </strong>We included consecutive patients (<55 years) with ischaemic stroke or intracerebral haemorrhage (ICH) admitted to the University College London Hospitals Hyperacute Stroke Unit between 2017 and 2020. Ischaemic stroke was classified using Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria and ICH using modified CLAS-ICH criteria. Multivariable logistic regression was performed to identify predictors of unfavourable functional outcome (modified Rankin Scale [mRS] > 1) at 6 months.</p><p><strong>Results: </strong>Five hundred fifty-two patients were included (median age 47, IQR 41-51; 33% female; 76% ischaemic stroke). Common risk factors included dyslipidaemia (57%), hypertension (40%), and cigarette smoking (34%). Ischaemic stroke was mostly due to cardioembolism (22%). Probable cerebral small vessel disease was the most frequent ICH aetiology (53%). Unfavourable functional outcome was prevalent in 50% at 6 months and was associated with ICH (OR 2.02, 95%CI 1.14-3.58, <i>p</i> = 0.017), female sex (OR 1.62, 95%CI 1.03-2.55, <i>p</i> = 0.037), admission stroke severity (per point increase, OR 1.11, 95%CI 1.07-1.16, <i>p</i> < 0.001) and pre-morbid mRS 2-5 (OR 3.16; 95%CI 1.11-9.03, <i>p</i> = 0.032). 4.4% had a recurrent stroke within 6 months.</p><p><strong>Discussion and conclusion: </strong>Traditional cardiovascular risk factors are common in young adults with stroke. Unfavourable functional outcome is associated with female sex, ICH, severe stroke and pre-morbid disability. These findings can inform national stroke prevention and rehabilitation strategies.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251314360"},"PeriodicalIF":5.8,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025166","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":"Automated extraction of post-stroke functional outcomes from unstructured electronic health records.","authors":"Marta Fernandes, Kaileigh Gallagher, Niels Turley, Aditya Gupta, M Brandon Westover, Aneesh B Singhal, Sahar F Zafar","doi":"10.1177/23969873251314340","DOIUrl":"10.1177/23969873251314340","url":null,"abstract":"<p><strong>Purpose: </strong>Population level tracking of post-stroke functional outcomes is critical to guide interventions that reduce the burden of stroke-related disability. However, functional outcomes are often missing or documented in unstructured notes. We developed a natural language processing (NLP) model that reads electronic health records (EHR) notes to automatically determine the modified Rankin Scale (mRS).</p><p><strong>Method: </strong>We included consecutive patients (⩾18 years) with acute stroke admitted to our center (2015-2024). mRS scores were obtained from the Get With the Guidelines registry and clinical notes (if documented), and used as the gold standard to compare against NLP-generated scores. We used text-based features from notes, along with age, sex, discharge status, and outpatient follow-up to train a logistic regression for prediction of good (0-2) versus poor (3-6) mRS, and a linear regression for the full range of mRS scores. The models were trained for prediction of mRS at hospital discharge and post-discharge. The models were externally validated in a dataset of patients with brain injuries from a different healthcare center.</p><p><strong>Findings: </strong>We included 5307 patients, 5006 in train and test and 301 in validation; average age was 69 (SD 15) and 65 (SD 17) years, respectively; 47% female. The logistic regression achieved an area under the receiver operating curve (AUROC) of 0.94 [CI 0.93-0.95] (test) and 0.94 [0.91-0.96] (validation), and the linear model a root mean squared error (RMSE) of 0.91 [0.87-0.94] (test) and 1.17 [1.06-1.28] (validation).</p><p><strong>Discussion and conclusion: </strong>The NLP-based model is suitable for use in large-scale phenotyping of stroke functional outcomes and population health research.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251314340"},"PeriodicalIF":5.8,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014096","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 systematic review of current national hospital-based stroke registries monitoring access to evidence-based care and patient outcomes.","authors":"Chloe Leigh, Jodie Gill, Zainab Razak, Shirsho Shreyan, Dominique A Cadilhac, Joosup Kim, Natasha A Lannin, Martin Dennis, Moira Kapral, Jeyaraj Pandian, Yudi Hardianto, Beilei Lin, Atte Meretoja, Noor Azah Abd Aziz, Lee Schwamm, Bo Norrving, Lekhjung Thapa, Marshall Dozier, Shyam Kelavkar, Gillian Mead","doi":"10.1177/23969873241311821","DOIUrl":"10.1177/23969873241311821","url":null,"abstract":"<p><strong>Background: </strong>National stroke clinical quality registries/audits support improvements in stroke care. In a 2016 systematic review, 28 registries were identified. Since 2016 there have been important advances in stroke care, including the development of thrombectomy services. Therefore, we sought to understand whether registries have evolved with these advances in care. The aim of this systematic review was to identify current, hospital-based national stroke registries/audits and describe variables (processes, outcome), methods, funding and governance).</p><p><strong>Methods: </strong>We searched four databases (21st May 2015 to 1st February 2024), grey literature and stroke organisations' websites. Initially two reviewers screened each citation; when agreement was satisfactory, one of four reviewers screened each citation. The same process was applied to full texts. If there were no new publications from registries identified in the original 2016 review, we contacted the registry leads. We extracted data using predefined categories on country (including income level), clinical/process variables, methods, funding and governance.</p><p><strong>Results: </strong>We found 37 registries from 31 countries (28 high income, four upper-middle income, five lower-middle income) of which 16 had been identified in 2016 and 21 were new. Twenty-two of the same variables were collected by >50% of registries/audits (mostly acute care, including thrombectomy, and secondary prevention), compared with only four variables in 2016. Descriptions of funding, management, methods of consent and data privacy, follow-up, feedback to hospitals, linkage to other datasets and alignment of variables with guidelines were variably reported. Reasons for apparent termination of some registries was unclear.</p><p><strong>Conclusions: </strong>The total number of stroke registries has increased since 2016, and the number of variables collected has increased, reflecting advances in stroke care. However, some registries appeared to have ceased; the reasons are unclear.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241311821"},"PeriodicalIF":5.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014092","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":"Clinical diagnosis of cerebral amyloid angiopathy related hemorrhage in China: Simplified Edinburgh criteria and Boston criteria version 2.0.","authors":"Mengke Zhang, Ruiwen Che, Xin Liu, Chengbei Hou, Zhongyue Wang, Sen Hu, Shengqi Fu, Yuan Kan, Hailiang Sun, Jianmin Xu, Shiliang Ma, Sijie Li, Changhong Ren, Wenbo Zhao, Milan Jia, Jingang Wang, Chuanjie Wu, Xunming Ji","doi":"10.1177/23969873241309513","DOIUrl":"10.1177/23969873241309513","url":null,"abstract":"<p><strong>Background: </strong>Accurate diagnosis of cerebral amyloid angiopathy (CAA) in surviving patients is indispensable for making treatment decisions and conducting clinical trials. We aimed to evaluate the diagnostic value and clinical utility of the simplified Edinburgh computed tomography (CT) criteria for CAA-related hemorrhage in Chinese patients.</p><p><strong>Methods: </strong>We analyzed 212 patients with lobar hemorrhage who underwent brain CT and magnetic resonance imaging (MRI) from a multicentre cohort. Using the Boston criteria version 2.0 (v2.0) as the gold standard, we assessed the application value of the simplified Edinburgh CT criteria, and investigated whether the Edinburgh CT criteria predict patient outcomes.</p><p><strong>Results: </strong>Patients with probable CAA accounted for 36.6% according to the Boston criteria v2.0. The Edinburgh CT criteria indicated an area under the receiver operating characteristic curves (AUC) of 0.735 for the diagnosis of probable CAA, and it performed better when there was a high-risk threshold of CAA in the decision curve analysis. Patients with a high risk of CAA based on the Edinburgh CT criteria had poorer outcomes at 90-day after adjusting for confounding factors (<i>p</i> = 0.034). Finger-like projections in the Edinburgh CT criteria were associated with lobar microbleeds, cortical superficial siderosis, and multispot white matter hyperintensity according to the Boston criteria.</p><p><strong>Conclusions: </strong>Taking the Boston criteria v2.0 as the gold standard, the Edinburgh CT criteria demonstrated good diagnostic value and predicted outcomes well at 90-day in Chinese patients with lobar hemorrhage. Further studies with larger sample sizes are required to confirm these findings.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241309513"},"PeriodicalIF":5.8,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014100","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":"Time to consider health services dedicated for adults living with cerebral small vessel disease: Report of a ESO scientific seminar.","authors":"Carmen Arteaga-Reyes, Dwaipayan Sen, Salvatore Rudilosso, Eric Jouvent, Dominique Hervé, Arne G Lindgren, Joanna M Wardlaw, Susanna Melkas, Fergus N Doubal","doi":"10.1177/23969873241309506","DOIUrl":"10.1177/23969873241309506","url":null,"abstract":"<p><strong>Purpose: </strong>Cerebral small vessel disease (cSVD) is a highly prevalent disorder leading to physical, cognitive and functional decline. We report key barriers in the management of individuals with cSVD, the potential benefit of cSVD-dedicated health services, and evidence from existing models of care for adults with cSVD.</p><p><strong>Methods: </strong>We examined information from a scientific seminar developed between seven experts in cSVD during the eighth European Stroke Organisation Conference that discussed the optimal health care for adults with cSVD and what health services dedicated to cSVD should include.</p><p><strong>Findings: </strong>Barriers in cSVD care include unrecognised symptoms and modifiable risk factors, heterogeneity of clinical presentations, inefficient inter/intra-clinical services communication/organisation, and uncertainties regarding what assessments/treatments should be routinely done, when and by whom. However, existing health services and research studies suggest models of care in cSVD. Multi-step approaches can be used for identification and aetiological workup in individuals with cSVD, including basic and selected advanced evaluations, for example, monogenic cSVD testing. Although current guidelines for management of cSVD illlustrate limitations, there are recommendations on risk factors and lifestyle considerations, as well as pharmacological and non-pharmacological interventions for people with cSVD.</p><p><strong>Discussion and conclusion: </strong>Existing healthcare models do not provide optimal care for individuals with cSVD. Lack of awareness of heterogeneous clinical presentations and uncertainty in threshold of cSVD 'burden' for referral to specialist multidisciplinary services, are key challenges for health services to overcome. Creating cSVD-dedicated services may prevent underdiagnosing and achieve standardised holistic management to improve outcomes in people with cSVD. However, adequate prevention and early management should be offered at all levels of care.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241309506"},"PeriodicalIF":5.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956881","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":"Statin therapy in ischemic stroke patients with atrial fibrillation: Efficacy and safety outcomes.","authors":"Michele Marvardi, Maurizio Paciaroni, Valeria Caso","doi":"10.1177/23969873241307520","DOIUrl":"10.1177/23969873241307520","url":null,"abstract":"<p><strong>Introduction: </strong>The efficacy and safety of statins for secondary prevention in patients who have experienced a cardioembolic stroke are not well-defined. However, previous observational data reported hyperlipidemia as a risk factor for both ischemic and bleeding complications in patients with AF and previous stroke. Based on these premises, we conducted a sub-analysis of the RAF and RAF-NOAC studies to evaluate the efficacy and safety of statins in secondary prevention in patients with acute ischemic stroke and AF.</p><p><strong>Materials and methods: </strong>We combined patient data from the RAF and RAF-NOAC studies, prospective observational studies conducted across Stroke Units in Europe, the United States, and Asia from January 2012 to June 2016. We included consecutive patients with AF who suffered an acute ischemic stroke with a follow-up of 90 days. Our outcomes were the combined endpoint, including stroke, transient ischemic attack, systemic embolism, symptomatic intracerebral hemorrhage, and major extracranial bleeding. Furthermore, both ischemic and hemorrhagic outcomes were evaluated separately.</p><p><strong>Results: </strong>A total of 1742 patients were included (46% male), and 898 (52%) received statins after the index event, of whom 436 (48.6%) were already taking statins before the index event, 462 (51.4%) started treatment after. At multivariable analysis, statin use was statistically associated with age (OR 0.92, 95% CI 0.97-0.99, <i>p</i> = 0.001), male sex (OR 1.35, 95% CI 1.07-1.70, <i>p</i> = 0.013), anticoagulation (OR 2.53, 95% CI 1.90-3.36, <i>p</i> < 0.0001), hyperlipidemia (OR 5.52, 95% CI 4.28-7.12, <i>p</i> < 0.0001), paroxysmal AF (OR 1.40, 95% CI 1.12-1.75, <i>p</i> = 0.003), leukoaraiosis (OR 1.39, 95% CI 1.11-1.75, <i>p</i> = 0.004) and heart failure (OR 0.72, 95% CI 0.53-0.98, <i>p</i> = 0.034). Statin use was not associated with the combined outcome event (OR 0.84, 95% CI 0.58-1.23, <i>p</i> = 0.3) and ischemic outcome event (OR 1.17, 95% CI 0.73-1.88, <i>p</i> = 0.5) while was associated with a lower risk of hemorrhagic outcome event (OR 0.51, 95% CI 0.28-0.91, <i>p</i> = 0.02).</p><p><strong>Discussion: </strong>Statins protect cerebral arterial vessels (particularly small vessels) from subacute damage due to hypertension, diabetes, and other harmful agents (such as reactive oxygen species, proinflammatory cytokines, etc.) due to their systemic anti-inflammatory and endothelium-protective effects.</p><p><strong>Conclusions: </strong>Our data show that statins seem to protect against global bleeding events in cardioembolic stroke patients; this may be due to the pleiotropic effect of statins. More data are warranted to confirm these findings.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241307520"},"PeriodicalIF":5.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11713940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956880","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":"Prediabetes and diabetes mellitus type II after ischemic stroke.","authors":"Kurt Moelgg, Anel Karisik, Lukas Scherer, Lucie Buergi, Benjamin Dejakum, Silvia Komarek, Julian Granna, Christian Boehme, Raimund Pechlaner, Thomas Toell, Michael Knoflach, Stefan Kiechl, Susanne Kaser, Alexander Egger, Andrea Griesmacher, Lukas Mayer-Suess","doi":"10.1177/23969873241304301","DOIUrl":"https://doi.org/10.1177/23969873241304301","url":null,"abstract":"<p><strong>Introduction: </strong>The progression of diabetes status in post-stroke patients remains under-investigated, particularly regarding new treatments for type II diabetes mellitus (DM II), like glucagon-like peptide 1 receptor agonists (GLP-1-RA) and sodium-glucose co-transporter-2 (SGLT-2) inhibitors, which have not been studied in the post-stroke setting.</p><p><strong>Patients and methods: </strong>Eight hundred eighty-four consecutive ischemic stroke patients recruited to our prospective STROKE-CARD Registry were assessed concerning their glycemic status at baseline (normoglycemia, prediabetes, DM II) and change over time within 1 year follow-up. Multivariate logistic regression was performed to identify factors associated with transitioning from normoglycemia to prediabetes or DM II. Additionally, we reviewed ongoing clinical trials for GLP-1-RA and SGLT-2 inhibitors in the context of acute ischemic stroke.</p><p><strong>Results: </strong>At baseline, 44.6% (<i>n</i> = 394) of individuals had normoglycemia, 33.9% (<i>n</i> = 300) were prediabetic, and 21.5% had DM II (<i>n</i> = 190). After 1 year, normoglycemia decreased by 12.1 percentage points (<i>n</i> = 107), whereas prediabetes and DM II increased by 10.2 percentage (<i>n</i> = 90) points and 1.9 percentage points (<i>n</i> = 17), respectively. Statin therapy was the only significant risk factor for progression. 23.4% (<i>n</i> = 207) of our cohort would have met eligibility criteria for a recent trial on semaglutide in obese non-diabetics with prior cardiovascular disease. However, only one ongoing trial aims at evaluating short-term cardiovascular risk reduction in stroke patients.</p><p><strong>Discussion: </strong>GPrediabetes and DM II are frequent in ischemic stroke patients. Even within an intensified post-stroke disease management setting, a considerable amount of stroke survivors convert to prediabetes or DM II within the first year. Our results demonstrate a notable proportion of patients qualifying inclusion in studies examining the efficacy of GLP-1-RA agonists and SGLT-2 inhibitors in secondary prevention.</p><p><strong>Conclusion: </strong>Given the high prevalence and progression of prediabetes and DM II in stroke survivors, there is a need for clinical trials evaluating the use of GLP-1-RA and SGLT-2 inhibitors in this population.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241304301"},"PeriodicalIF":5.8,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956857","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":"Rescue therapy after failed thrombectomy in medium/distal vessel occlusions: A retrospective analysis of an international, multi-center registry.","authors":"Aikaterini Anastasiou, Alex Brehm, Tomas Dobrocky, Adnan Mujanovic, Marta de Dios Lascuevas, Tomas Carmona Fuentes, Alfonso López-Frías López-Jurado, Blanca Hidalgo Valverde, Ansgar Berlis, Christoph J Maurer, Thanh N Nguyen, Mohamad Abdalkader, Piers Klein, Guillaume Thevoz, Patrik Michel, Marius Kaschner, Daniel Weiss, Andrea M Alexandre, Alessandro Pedicelli, Paolo Machi, Gianmarco Bernava, Shuntaro Kuwahara, Kazutaka Uchida, Jason Wenderoth, Anirudh Joshi, Grzegorz Karwacki, Lehel-Barna Lakatos, Agostino Tessitore, Sergio Lucio Vinci, Amedeo Cervo, Claudia Rollo, Ferdinand Hui, Aaisha Siddiqua Mozumder, Daniele Giuseppe Romano, Gianmarco Flora, Nitin Goyal, Vivek Batra, Violiza Inoa, Christophe Cognard, Matúš Hoferica, Riitta Rautio, Daniel Kaiser, Hanna Alph, Julian Clarke, Nick Hug, Alma Koch, Victor Schulze-Zachau, Nikki Rommers, Mira Katan, Marios-Nikos Psychogios","doi":"10.1177/23969873241311152","DOIUrl":"10.1177/23969873241311152","url":null,"abstract":"<p><strong>Background: </strong>There are limited therapeutic options in cases of failed reperfusion (modified thrombolysis in cerebral infarction [mTICI] score < 2b) after stent-retriever and/or aspiration based endovascular treatment (EVT) for acute ischemic stroke. Despite the absence of data supporting its use, rescue therapy (balloon angioplasty and/or stent implantation) is often utilized in such cases. Studies are limited to large vessel occlusions, while the outcomes and complications after rescue therapy in medium/distal vessel occlusions (MDVOs) have not been reported. This study aims to report the outcomes of rescue therapy in MDVO stroke patients.</p><p><strong>Methods: </strong>We performed an analysis of the \"Blood pressure and Antiplatelet medication management after reScue angioplasty after failed Endovascular treatment in Large and distal vessel occlusions with probable IntraCranial Atherosclerotic Disease\" (BASEL ICAD) retrospective registry. All MDVO stroke patients were included in the analysis.</p><p><strong>Results: </strong>Out of the 718 registry patients, 87 (12.1%) presented with an MDVO. Fifty-six patients (64.4%) showed an occlusion of the M2 segment of the middle cerebral artery. Rescue stenting was performed in 78 patients (89.7%) while balloon angioplasty alone was performed in 9 patients (10.3%). Successful reperfusion (mTICI score ⩾ 2b) was achieved in 73 (83.9%) patients after rescue therapy. Symptomatic intracranial hemorrhage (sICH) occurred in 8 patients (9.2%) and post-treatment stent occlusion in 12 patients (13.8%). Ninety days mortality was 20.7%. Twenty-eight patients (32.2%) achieved functional independence at 90 days (modified Rankin Scale 0-2).</p><p><strong>Conclusion: </strong>Rescue therapy with stenting and/or balloon angioplasty in patients undergoing EVT for isolated MDVO with suspected underlying intracranial atherosclerotic disease is an effective reperfusion strategy but is associated with complications and poor functional outcomes.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241311152"},"PeriodicalIF":5.8,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left ventricular disease as a risk factor for adverse outcomes and stroke recurrence in patients with embolic stroke of undetermined source.","authors":"Angelo Cascio Rizzo, Ghil Schwarz, Andrea Bonelli, Andrea Magi, Elio Clemente Agostoni, Antonella Moreo, Maria Sessa","doi":"10.1177/23969873241311331","DOIUrl":"10.1177/23969873241311331","url":null,"abstract":"<p><strong>Background: </strong>Severe left ventricular (LV) systolic dysfunction (ejection fraction [EF] < 30%) is a known cardiovascular risk factor and a major cause of cardioembolism. However, less severe forms of LV disease (LVD), such as mild-to-moderate LV dysfunction and LV wall motion abnormalities (LVWMAs), are considered potential minor cardiac sources in Embolic Stroke of Undetermined Source (ESUS), but their role is underexplored. This study aims to evaluate the prevalence of LVD in ESUS and its association with adverse vascular events and mortality.</p><p><strong>Methods: </strong>Retrospective, single-center study including consecutive ESUS patients admitted from January 2016 to May 2024. LVD was defined as either global systolic dysfunction (LV ejection fraction 30%-49%) or regional LVWMAs, unrelated to acute or recent (within 4 weeks) myocardial infarction. Univariate and multivariate Cox regression analyses evaluated the association of LVD with a primary composite outcome (including ischemic stroke recurrence, acute coronary events, and all-cause mortality), and its components separately.</p><p><strong>Results: </strong>Among the 556 ESUS patients (median age 71 years [IQR 60-80], 44.6% female), 95 (17.1%) had LVD, including 51 (53.7%) with reduced LVEF (30%-49%), and 81 (85.3%) presenting LVWMAs. During follow-up (median 30 months), LVD(+) patients had significantly higher rates of the composite outcome (41.0% vs 21.3%, <i>p</i> < 0.001), ischemic stroke recurrence (13.7% vs 5.9%, <i>p</i> = 0.007), acute coronary events (7.4% vs 2.4%, <i>p</i> = 0.012), and all-cause mortality (28.4% vs 15.2%, <i>p</i> = 0.002), compared to LVD(-) patients. Multivariate Cox regression analysis showed that LVD independently increased the risk of ischemic stroke recurrence (adjusted HR 2.13, 95%CI 1.08-4.24, <i>p</i> = 0.032) and the composite outcome (aHR 1.92, 95%CI 1.27-2.90, <i>p</i> = 0.002), but not acute coronary events (aHR 1.65; 95%CI 0.54-5.01, <i>p</i> = 0.374), or all-cause mortality (aHR 1.62; 95%CI 0.98-2.70, <i>p</i> = 0.062).</p><p><strong>Conclusions: </strong>LVD is significantly associated with an increased risk of ischemic stroke recurrence and adverse outcomes in ESUS patients. These findings highlight the clinical importance of identifying and optimizing LVD management among ESUS to improve long-term outcomes in this population.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241311331"},"PeriodicalIF":5.8,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}