European Stroke Journal最新文献

{"title":"Location, size, and risk factors of incident covert brain infarcts in patients with acute non-cardioembolic ischemic stroke: PACIFIC-STROKE trial.","authors":"Robert G Hart, Eric E Smith, Angela Wang, Hardi Mundl, Pablo Colorado, Raed A Joundi, Aristeidis H Katsanos, Mukul Sharma, Ashkan Shoamanesh","doi":"10.1177/23969873251344485","DOIUrl":"10.1177/23969873251344485","url":null,"abstract":"<p><strong>Introduction: </strong>Covert brain infarcts (CBIs) identified by imaging are more frequent than symptomatic ischemic strokes and are usually small and/or involve non-eloquent brain areas. The spectrum of incident CBIs in patients following acute ischemic stroke has not been well characterized.</p><p><strong>Patients and methods: </strong>Exploratory observational cohort study of the size, location, multiplicity and risk factors of incident CBIs identified using serial MRIs in patients with acute non-cardioembolic ischemic stroke participating in the PACIFIC-STROKE trial.</p><p><strong>Results: </strong>Incident CBIs were identified in 16% (220/1358) of participants during the mean 5.6-month interval between MRIs. Single incident CBIs occurred in 150 (68%) of incident CBI patients and multiple CBIs in 70 (32%); 42% (93/220) of incident CBI patients had a single, small, subcortical CBI. There was no clear relationship between the location of incident CBI and the location of index stroke. Significant independent features associated with incident CBI included diabetes (adjusted OR 1.52, 95%CI 1.09-2.12), current tobacco use (adjusted OR 1.50, 95%CI 1.07-2.09), prior stroke/TIA (adjusted OR 1.59, 95%CI 1.08-2.36), carotid artery atherosclerosis (adjusted OR 1.47, 95%CI 1.07-2.02), and diastolic blood pressure (adjusted OR 1.02 per 1 mmHg increase, 95%CI 1.01-1.04).</p><p><strong>Discussion and conclusion: </strong>Incident CBIs in patients following acute non-cardioembolic stroke were frequent, usually small and subcortical, and associated with traditional stroke risk factors. Observations from PACIFIC-STROKE, particularly the absence of correlation between the location of incident CBI and the index infarct and the high frequency of incident small, subcortical CBIs, suggest that incident CBI pathogenesis is complex and heterogeneous in this population.</p><p><strong>Trial registration: </strong>https://clinicaltrials.gov (NCT04304508).</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251344485"},"PeriodicalIF":5.8,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295107","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":"Portable ultra-low-field MRI in acute stroke care: A pilot study.","authors":"Niklas M von Danwitz, Nils C Lehnen, Julius N Meißner, Omid Shirvani Samani, Hannah Asperger, Christian Thielscher, Taraneh Ebrahimi, Julia Layer, Louisa Nitsch, Franziska Dorn, Alexander Radbruch, Felix J Bode, Johannes M Weller, Anne Groteklaes, Gabor C Petzold, Hemmen Sabir, Sebastian Stösser","doi":"10.1177/23969873251344761","DOIUrl":"10.1177/23969873251344761","url":null,"abstract":"<p><strong>Introduction: </strong>Neuroimaging is a prerequisite for treatment of stroke patients, but it is not available all over the globe. Portable ultra-low field (pULF) MRI has the potential to improve access to neuroimaging and thus stroke care worldwide. In a pilot study, we were the first to utilise pULF-MRI in a European tertiary stroke centre and to evaluate its diagnostic value compared to high-field (HF) MRI.</p><p><strong>Patients and methods: </strong>Consecutive patients admitted for suspected ischaemic stroke underwent pULF-MRI using the 0.064 Tesla Swoop^® portable MR imaging system in addition to standard imaging. HF-MRI and pULF-MRI scans were blindly assessed to compare the diagnostic accuracy and imaging-based therapeutic decisions based on pULF-MRI to HF-MRI.</p><p><strong>Results: </strong>Seventeen patients underwent pULF-MRI, 12 of whom had ischaemic lesions on HF-MRI. Ischaemic lesions were detected on pULF-MRI in 8/12 cases. The four infarcts not identified on pULF-MRI were all smaller than 6 mm in diameter. In all cases, a virtual treatment decision based on pULF-MRI by a blinded team matched the actual clinical decisions.</p><p><strong>Conclusion: </strong>This single-centre study demonstrates that pULF-MRI is a promising tool in acute stroke care, providing reliable imaging for treatment decision and follow-up monitoring. pULF-MRI may support acute stroke care if HF-MRI is unavailable and may be particularly helpful in resource-limited settings. Limitations of pULF-MRI include long acquisition times and the lack of vessel imaging and haemorrhage-sensitive sequences.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251344761"},"PeriodicalIF":5.8,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295108","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":"Prevalence of vessel wall abnormalities and the risk of recurrent vascular events in young patients with stroke.","authors":"Esther M Boot, Frederick J A Meijer, Sjoert Pegge, Sjan Teeselink, Mijntje Mi Schellekens, Merel S Ekker, Jamie I Verhoeven, Esmée Verburgt, Maikel Immens, Nina Hilkens, Frank-Erik de Leeuw, Anil M Tuladhar","doi":"10.1177/23969873251343828","DOIUrl":"10.1177/23969873251343828","url":null,"abstract":"<p><strong>Introduction: </strong>We examined the prevalence and the characteristics of vessel wall (VW) lesions in young stroke patients and their relation to recurrent vascular events. We hypothesize that having VW lesions is associated with an increased risk on recurrent vascular events.</p><p><strong>Patients and methods: </strong>Single-center prospective study of participants aged 18-50 years, with a transient ischemic attack (TIA) or ischemic stroke, who underwent high-resolution 3T magnetic resonance imaging (HR-MRI) with VW imaging. We included 10 controls with symptoms diagnosed as stroke mimics. The HR-MRI scans were reviewed by two neuroradiologists blinded for clinical information. Follow-up was conducted via telephone interviews. Recurrent vascular events were defined as TIA, cerebral stroke, myocardial infarctions, revascularization procedures, or vascular death.</p><p><strong>Results: </strong>We included 158 participants (median age: 41.5 years, IQR 33.0-46.4); 75 (47.5%) of whom were women. Of these, 44 (27.8%) participants had 81 VW lesions, primarily characterized by VW enhancement (74.1%). 86.4% of VW lesions were located in the corresponding ischemic territory, and 48.6% showed no MRA abnormalities. Almost half of the VW lesions were found in the rare causes subgroup, while 13.6% of the \"cryptogenic\" subgroup showed VW enhancement. VW lesions were not significantly associated with an increased risk of recurrent vascular events (HR 2.2, 95% CI: 0.7-6.6).</p><p><strong>Conclusion: </strong>One in four young stroke patients have VW lesions, which were not related to an increased risk of recurrent vascular events. VW lesions were seen across all TOAST categories and were not specific to one stroke cause. Further research is needed to investigate the diagnostic and prognostic value of VW lesions in young stroke patients.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251343828"},"PeriodicalIF":5.8,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286804","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":"Tenecteplase in Central Retinal Artery Occlusion Study (TenCRAOS): Protocol for a randomized-controlled trial.","authors":"Stephen J Ryan, Øystein Kalsnes Jørstad, Mona Skjelland, Claus Z Simonsen, Toke Bek, Rolf Ankerlund Blauenfeldt, Petra Ijäs, Arja Laitinen, Andrej N Khanevski, Jørgen Krohn, Eyvind Rødahl, Robin Lemmens, Jelle Demeestere, Catherine Cassiman, Ingvild Nakstad, Kristin Evensen, Tiril Sandell, Steffen Hamann, Louisa M Christensen, Sverre Rosenbaum, Vaidas Matijosaitis, Reda Zemaitiene, Hanne Ellekjær, Dordi Austeng, Thomas C Truelsen, Michael V Mazya, Frank Träisk, Pauli Ylikotila, Ulpu Salmi, Kristian N Jenssen, Håvard Lisether, Cathrine Breivik, Kristina Devik, Lasse-Marius Sandes Honningsvåg, Jurgita Valaikienė, Andrius Cimbalas, Vetle Nilsen Malmberg, Espen Anderson, Sylvie De Raedt, Marcel Ten Tusscher, Noémie Ligot, Deborah Lipski, Fredrik Björck, Annelie Hamrin, Tore Solbakken, Ane Roushan Tharaldsen, Anette Huuse Farmen, Andreas Helgesen, Stein Harald Johnsen, Geir Bertelsen, Åse Hagen Morsund, Erik Holen, Arnstein Tveiten, Henrik B Johannessen, Peter Kelly, Evelyn O'Neill, Ansar Roy, Christina Kefaloykos, Thor Håkon Skattør, Kristian L Kraglund, Lauren Sanders, Peter Vanacker, Daniel Strbian, Morten C Moe, Anne Hege Aamodt","doi":"10.1177/23969873251344199","DOIUrl":"10.1177/23969873251344199","url":null,"abstract":"<p><strong>Rationale: </strong>Central retinal artery occlusion (CRAO) is an ophthalmologic emergency that, without prompt reperfusion, is associated with a high risk of permanent blindness. There is currently no evidence-based, effective treatment for CRAO.</p><p><strong>Methods and design: </strong>TenCRAOS is an investigator-initiated, international, multicenter, randomized controlled, double-dummy, double-blind, phase <i>III</i> trial testing tenecteplase (TNK) 0.25 mg/kg + placebo versus acetylsalicylic acid (ASA) 300 mg + placebo. The target population is patients diagnosed with CRAO and a best-corrected visual acuity (BCVA) of ⩾1.0 logarithm of the minimum angle of resolution (logMAR), corresponding to a decimal BCVA of ⩽0.1 or a fraction BCVA of ⩽6/60, who can be treated within 4.5 h.</p><p><strong>Sample size: </strong>Assuming a difference in proportion of participants reaching the primary endpoint of 20% in the placebo/ASA treatment group versus 50% in the TNK/placebo group, we need 78 participants to reach 80% power to detect the difference on a 5% significance level.</p><p><strong>Outcomes: </strong>The primary outcome is the proportion of participants with BCVA of ⩽0.7 logMAR in the affected eye at 30-day follow-up, corresponding to a decimal BCVA of ⩾0.2 or fraction BCVA of ⩾6/30, representing a clinically relevant improvement of BCVA of ⩾0.3 logMAR (or 15 letters). Secondary efficacy outcomes include proportion of participants with BCVA of ⩽0.5 logMAR, corresponding to a decimal BCVA of ⩾0.32 or fraction BCVA of ⩾ 6/19, self-reported vision-targeted health status, quality of life, and modified Rankin Score at 30 and 90 days. Safety outcomes include symptomatic intracranial hemorrhage, major bleeding, and mortality. Exploratory analyses include assessment with optical coherence tomography with angiography and transorbital ultrasound.</p><p><strong>Discussion: </strong>TenCRAOS intends to assess the efficacy and safety of systemic TNK within 4.5 h of CRAO onset.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251344199"},"PeriodicalIF":5.8,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of white matter lesions on associations between prehospital blood pressure and outcomes in spontaneous intracerebral hemorrhage.","authors":"Kristin Tveitan Larsen, Silje Holt Jahr, Maiken Nordahl Selseth, Trine Lied-Herland, Vigdis Hillestad, Hege Ihle-Hansen, Else Charlotte Sandset, Ole Morten Rønning, Espen Saxhaug Kristoffersen","doi":"10.1177/23969873251343495","DOIUrl":"10.1177/23969873251343495","url":null,"abstract":"<p><strong>Introduction: </strong>There are concerns about the safety of intensive blood pressure (BP) lowering in intracerebral hemorrhage (ICH) patients with white matter lesions (WML). We explored the impact of WML on associations between i) prehospital BP, and ii) BP change, and outcomes in acute, spontaneous ICH.</p><p><strong>Patients and methods: </strong>This retrospective study included consecutive patients with acute spontaneous ICH, admitted 2011-2020. WML on non-contrast computed tomography were categorized as none-to-mild (0-1) or moderate-to-severe (2-3) on the Fazekas scale. The first systolic BP (SBP) and mean arterial pressure (MAP) from the ambulance and admission, and absolute BP change between these time points, were collected. The outcomes were in-hospital mortality, mortality at 180 days, modified Rankin Scale (mRS) scores at 3 months, and hematoma expansion.</p><p><strong>Results: </strong>Of 548 patients, 260 (47%) had moderate-to-severe WML. Compared to patients with none-to-mild WML, these patients had a stronger association between higher prehospital MAP and in-hospital mortality (<i>p</i> interaction 0.017). WML did not modify associations between prehospital BP and other outcomes. WML modified associations between MAP change and in-hospital mortality (<i>p</i> interaction 0.049), MAP change and mRS score 3-6 at 3 months (<i>p</i> interaction 0.032), and SBP change and mRS score 3-6 at 3 months (<i>p</i> interaction 0.022). These outcomes were poorer with greater BP decrease in patients with moderate-to-severe compared to none-to-mild WML.</p><p><strong>Discussion and conclusion: </strong>In acute ICH, WML modified the influence of prehospital BP and BP change on clinical outcomes, with a trend toward worse outcomes associated with higher prehospital BP and greater spontaneous BP decrease.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251343495"},"PeriodicalIF":5.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276255","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":"Frailty's influence on older stroke patients: Neurological outcome and mortality after endovascular treatment in stroke: A national German stroke registry analysis.","authors":"Marlena Schnieder, Hannah Metz, Mathias Baehr, Anna Alegiani, Silke Wunderlich, Christian H Nolte, Arno Reich, João Pinho, Christiane Huber, Gabor Petzold, Steffen Tiedt, Christine Af von Arnim, Jan Liman","doi":"10.1177/23969873251344202","DOIUrl":"10.1177/23969873251344202","url":null,"abstract":"<p><strong>Introduction: </strong>Frailty is a clinical syndrome particular in old patients with an increased risk of adverse health-care events. In geriatric stroke patients who received endovascular treatment, monocentric analyses have demonstrated that frailty affects mortality and functional outcome. We aimed to investigate the impact of frailty in a larger multicentric cohort.</p><p><strong>Patients and methods: </strong>We analyzed the impact of frailty on outcome in patients with stroke who underwent endovascular treatment in seven academic centers contributing to the German Stroke Registry. We calculated the Hospital Frailty Risk Score (HFRS) for all patients aged ⩾ 65 years. Functional outcome was measured by modified Rankin Scale (mRS) 3 months after the stroke event. A regression analysis conducted to assess mortality and functional outcome, adjusted for factors known to influence outcomes.</p><p><strong>Results: </strong>2468 patients fulfilled the inclusion criteria. Median HFRS was 1.1 (IQR 0-2.95) and 449 (18.2%) patients had HFRS > 5. Low, intermediate and high-frailty risk was present in 2009 (71.7%), 389 (15.8%), and 60 (2.44%) respectively. A favorable neurological outcome (mRS 0-2) was achieved in 31.7%, 20.6%, and 13.8% in the low-, moderate, and high-risk-frailty-groups respectively (<i>p</i> < 0.001). Multivariate regression analysis showed a significant associations of HFRS on both mortality (adjusted OR 1.033, 95% CI: 1.004-1.063, <i>p</i> = 0.024) and functional outcome (adjusted OR: 0.962, 95% CI: 0.929-0.997; <i>p</i> = 0.033) after 3 months. However, there was no significant difference in baseline NHISS scores between frail and non-frail patients (14 (IQR 19-19)) vs 15 (IQR 11-19) vs 15 (IQR 10-19); <i>p</i> = 0.295). Besides door-to-groin time (DTN) differed with high frailty-risk patients having the longest DTN times (64 (38-102) vs 67.5 (45-95) vs 80 (54-106); <i>p</i> = 0.020).</p><p><strong>Discussion and conclusion: </strong>We identified frailty as a factor strongly associated with both mortality and functional outcome in ischemic stroke patients undergoing thrombectomy.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251344202"},"PeriodicalIF":5.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267611","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":"Patterns and predictors of delayed functional independence and dependence after thrombectomy in large vessel occlusion stroke: A multicenter analysis.","authors":"Niklas M von Danwitz, Felix J Bode, Omid Shirvani Samani, Hannah Asperger, Taraneh Ebrahimi, Johannes Kaesmacher, Julia Layer, Nils Lehnen, Louisa Nitsch, Julius N Meissner, Svenja Odensass, Sebastian Stösser, Christian Thielscher, Mousa Zidan, Franziska Dorn, Gabor C Petzold, Johannes M Weller","doi":"10.1177/23969873251342048","DOIUrl":"10.1177/23969873251342048","url":null,"abstract":"<p><strong>Introduction: </strong>Predicting functional outcomes following endovascular treatment (EVT) for large-vessel occlusion stroke (LVOS) is challenging. Some patients achieve functional independence (modified Rankin Scale (mRS) 0 -2) at 90 days despite being dependent at discharge, termed delayed functional independence (DFI), while others lose independence after discharge, termed delayed functional dependence (DFD). This study explores patterns and predictors of DFI and DFD in LVOS patients undergoing EVT.</p><p><strong>Patients and methods: </strong>We analyzed anterior circulation LVOS patients from the prospective multicenter German Stroke Registry. Multivariable logistic regression models identified independent predictors of DFI and DFD.</p><p><strong>Results: </strong>Of 5909 patients, 2346 were independent at discharge, with 16.1% experiencing DFD at 90 days. DFD was associated with older age (median 78 vs 69 years, <i>p</i> < 0.001), female sex (61.4% vs 46.1%, <i>p</i> < 0.001), and greater stroke severity. Variables associated with DFD in multivariable analysis included older age, female sex, higher premorbid and discharge mRS, higher NIHSS at discharge, and absence of IV thrombolysis. Of 3563 patients dependent at discharge, 20.6% achieved DFI. DFI patients were younger (median 71 vs 77 years, <i>p</i> < 0.001), less likely female (38.7% vs 52.6%, <i>p</i> < 0.001) and had lower admission NIHSS, better pre-stroke functional status, higher ASPECTS and more frequent successful recanalization. Variables associated with DFI in multivariable analysis included younger age, male sex, better pre-stroke functional status, lower stroke severity and successful recanalization.</p><p><strong>Discussion and conclusion: </strong>Both DFD and DFI are frequent in clinical practice, with higher DFD and lower DFI rates in women, which warrants further investigation. Understanding these predictors can enhance individualized patient counseling and management strategies.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251342048"},"PeriodicalIF":5.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276256","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":"Three-year adherence to secondary prevention and vascular risk control after ischemic stroke.","authors":"Erlend Fagerli, Hanne Ellekjær, Olav Spigset, Ingvild Saltvedt, Mari Nordbø Gynnild","doi":"10.1177/23969873251329210","DOIUrl":"https://doi.org/10.1177/23969873251329210","url":null,"abstract":"<p><strong>Introduction: </strong>Long-term adherence to secondary prevention after ischemic stroke remains unclear. This study aimed to evaluate medication adherence, attainment of vascular treatment targets, and clinical characteristics that influence target achievement 3 years post-stroke.</p><p><strong>Patients and methods: </strong>We included 665 home-dwelling ischemic stroke patients from the Norwegian Cognitive Impairment After Stroke study, admitted between May 2015 and March 2017 (<i>n</i> = 431 were followed for 3 years). Medication adherence was assessed using the 4-item Morisky Medication Adherence Scale, medication persistence, and guideline-based treatment targets: blood pressure (BP) < 140/90 mmHg, LDL cholesterol (LDL-C) < 2.0 mmol/L, and hemoglobin A1c (HbA1c) ⩽ 53 mmol/mol.</p><p><strong>Results: </strong>At discharge, prescription rates were 97% for antithrombotics, 67% for antihypertensives, 88% for lipid-lowering drugs (LLD), and 10% for antidiabetics. Three years later, persistence rates were 97%, 91%, 83%, and 94%, respectively, with 73% reporting high medication adherence. Target achievement rates were 42% for BP, 47% for LDL-C, and 75% for HbA1c among diabetic patients. Younger age was associated with better BP control (OR 0.974 per year, 95% CI 0.957-0.992). Women had poorer LDL-C control (OR 0.55, 95% CI 0.33-0.91). More LLD (OR 1.25, 95% CI 1.14-1.37) and higher comorbidity (OR 1.26, 95% CI 1.10-1.44) were associated with improved LDL-C control.</p><p><strong>Conclusion: </strong>Control of risk factors remained unsatisfactory 3 years after ischemic stroke, despite relatively high persistence and adherence rates. Improved focus on implementing optimal secondary prevention for Norwegian stroke patients is necessary.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251329210"},"PeriodicalIF":5.8,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227185","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":"Assessment of patent foramen ovale closure in elderly patients with cryptogenic transient ischemic attack or stroke: Efficacy, safety, and potential age-related benefit.","authors":"Chi-Sheng Wang, Yu-Hsuan Wu, Yun-Ching Fu, Sheng-Ling Jan, Ming-Chih Lin, Chiann-Yi Hsu, Po-Lin Chen","doi":"10.1177/23969873251341764","DOIUrl":"10.1177/23969873251341764","url":null,"abstract":"<p><strong>Introduction: </strong>The efficacy and safety of patent foramen ovale closure (PFOC) in cryptogenic stroke (CS) patients aged ⩾ 60 remain controversial. This study evaluates the efficacy and safety of PFOC in elderly (aged ⩾ 60) versus non-elderly (aged < 60) patients and examines potential age-related benefit.</p><p><strong>Patients and methods: </strong>A hospital-based cohort study (January 2013-June 2023) compared the efficacy and safety between PFOC and non-PFOC groups in patient with CS or cryptogenic TIA. The primary efficacy outcome was recurrent ischemic stroke, and safety outcomes included procedure-related adverse events and periprocedural atrial fibrillation (AF). Subgroup analyses, including various age ranges, were performed for the elderly group.</p><p><strong>Results: </strong>Among 239 patients (mean age 57.2 years), 120 were elderly. During a mean follow-up of 3.1 years, the PFOC group had significantly fewer recurrent ischemic stroke than the non-PFOC group (adjusted hazard ratio (AHR): 0.10, 95% CI: 0.03-0.29, <i>p</i> = 0.001). The risk reduction was similar in elderly (AHR: 0.11, <i>p</i> = 0.004) and non-elderly (AHR: 0.10, <i>p</i> = 0.005) patients (<i>p</i> for interaction = 0.337). Safety outcomes were comparable across age groups, including younger elderly (60-70) and older elderly (⩾70). No life-threatening complications occurred; one patient required additional intervention. Subgroup analysis indicated significant risk reduction for patients aged ⩾ 65 (AHR: 0.01, <i>p</i> = 0.012) but not for those aged 60-65 (AHR: 0.24, <i>p</i> = 0.071).</p><p><strong>Discussion and conclusion: </strong>PFO closure is safe and effective in elderly patients with CS. Advanced age should not be a contraindication for PFOC, as older patients may potentially derive more significant benefits from the procedure.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251341764"},"PeriodicalIF":5.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12133781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209865","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 of major vascular events in patients without traditional risk factors after transient ischemic attack or minor ischemic stroke: An international prospective cohort.","authors":"Shinichiro Uchiyama, Takao Hoshino, Kazuo Minematsu, Marie-Laure Meledje, Hugo Charles, Gregory W Albers, Louis R Caplan, Geoffrey A Donnan, José M Ferro, Michael G Hennerici, Carlos Molina, Peter M Rothwell, Lawrence Ks Wong, Pierre Amarenco","doi":"10.1177/23969873241300071","DOIUrl":"10.1177/23969873241300071","url":null,"abstract":"<p><strong>Introduction: </strong>To investigate the clinical characteristics in patients without traditional risk factors (TRFs) after transient ischemic attack or minor ischemic stroke, who were recruited in the TIAregistry.org.</p><p><strong>Patients and methods: </strong>A total of 3847 patients were analyzed. TRFs included hypertension, diabetes, hypercholesterolemia, current smoking, and atrial fibrillation. Background characteristics and outcomes at 1 and 5 years in patients without TRFs were compared to those in patients with TRFs. The primary outcome was major cardiovascular event (MACE), which was non-fatal stroke, non-fatal acute coronary syndrome, or vascular death. To evaluate the causes, we applied the ASCOD (atherosclerosis, small vessel disease, cardiac pathology, other causes or dissection) grading system.</p><p><strong>Results: </strong>One-year risk of MACE (5.3% vs 6.3%, hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.53-1.31) was comparable between patients without TRFs (<i>n</i> = 402) and those with TRFs (<i>n</i> = 3445). Five-year risk of MACE was significantly lower in patients without TRFs than in those with TRFs (7.9% vs 13.9%, HR 0.57, 95% CI 0.39-0.82). In patients without TRFs, causal atherosclerosis was a potent risk factor (HR 5.67, 95% CI 2.68-12.02) and ipsilateral extra- or intra-cranial arterial stenosis was only significant predictor of MACE (interaction <i>p</i> = 0.0046) at 5 years.</p><p><strong>Conclusion and discussion: </strong>The 5-year risk of MACE was lower in patients without TRFs than those with TRFs, although a certain level of risk persisted in the absence of TRFs. The most significant predictor of MACE in patients without TRFs was arterial stenosis.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"531-540"},"PeriodicalIF":5.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683061","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}