European Stroke Journal最新文献

{"title":"Intravenous thrombolysis before endovascular treatment in acute vertebrobasilar occlusions: Pooled analysis of the French and German Stroke Registries.","authors":"Raoul Pop, Stephanos Finitsis, Bertrand Lapergue, Marek Sykora, Daniel Strbian, Joshua Mbroh, Xinchen Hui, Florian Hennersdorf, Ulrike Ernemann, Sven Poli, Benjamin Gory","doi":"10.1177/23969873251333652","DOIUrl":"https://doi.org/10.1177/23969873251333652","url":null,"abstract":"<p><strong>Introduction: </strong>Whether intravenous thrombolysis (IVT) provides additional benefit in eligible patients with acute vertebrobasilar occlusion who undergo endovascular treatment (EVT) remains an open question.</p><p><strong>Patients and methods: </strong>We conducted a pooled analysis using data from two national stroke registries, the ETIS registry in France and GSR-ET registry in Germany. Patients who underwent EVT for vertebral and/or basilar artery occlusions from January 2015 to December 2023 were included. The primary efficacy outcome was a favorable shift toward better functional outcomes on modified Rankin Scale (mRS) scores at 90 days. Safety outcomes included 90-days mortality and symptomatic haemorrhagic transformation (sICH). Comparisons between IVT + EVT and direct EVT groups were made combining inverse propensity score matching, probability of treatment weighting (IPTW) and regression models.</p><p><strong>Results: </strong>Among 2028 patients treated during the study period, 797 (39.2%) received IVT before EVT, while 1231 (60.7%) had EVT alone. After IPTW matching, we compared 211 patients treated with IVT + EVT to 260 direct EVT patients. Patients in the IVT + EVT group had a favorable shift across the 90-day mRS distribution (common aOR 1.43 per 1-point mRS improvement, 95% CI 1.01-2.04; <i>p</i> = 0.046), higher odds of 90-day favorable functional outcome (aOR 1.56, 95% CI 1.00-2.44; <i>p</i> = 0.049) and lower odds of 90-day mortality (aOR 0.62, 95% CI 0.39-0.99; <i>p</i> = 0.045). IVT was not associated with increased risk of sICH (aOR 1.65, 95% CI 0.62-4.35; <i>p</i> = 0.313).</p><p><strong>Discussion: </strong>This registry-based study suggests a potential benefit of IVT before EVT in eligible patients with vertebrobasilar occlusions. <b>Conclusion:</b> Randomized clinical trials are necessary to confirm these findings and to validate the benefits of IVT in this clinical context.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251333652"},"PeriodicalIF":5.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12003336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051989","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":"Sex differences in outcomes and time to treatment in stroke patients treated with tenecteplase.","authors":"Marion Yger, Edouard Januel, Thomas Checkouri, Nicolas Chausson, Didier Smadja, Jildaz Caroff, Stéphane Olindo, Gaultier Marnat, Emmanuel Wiener, Fernando Pico, Guillaume Turc, Wagih Ben Hassen, Pierre Seners, Michel Piotin, Frédéric Clarençon, Sonia Alamowitch, Gaspard Gerschenfeld","doi":"10.1177/23969873251332497","DOIUrl":"https://doi.org/10.1177/23969873251332497","url":null,"abstract":"<p><strong>Introduction: </strong>A better understanding of sex-related differences remains key to improve stroke care for women. We aimed to assess the differences of prognosis, symptomatic intracranial hemorrhage (sICH) rates and process times between men and women suffering from ischemic stroke.</p><p><strong>Patients and methods: </strong>We performed a sex-based retrospective analysis of the French Tenecteplase Treatment in Stroke multicentric registry from 2015 to 2021. We assessed sex differences in terms of 3-month good neurological outcome (defined as modified Rankin score ⩽ 2 or back to its pre-stroke value), occurrence of sICH and process times with multivariable logistic regression analyses.</p><p><strong>Results: </strong>1339 consecutive patients (684 women, 655 men) received tenecteplase between 2015 and 2021, among whom 873 underwent thrombectomy. Both groups differed in terms of demographic characteristics, etiology, and unclear onset. In multivariable logistic regression analyses, women and men did not differ in terms of 3-month good neurological outcome (aOR = 0.85 [0.63-1.13]). Women were less likely to have a sICH after tenecteplase (aOR = 0.35 [0.18-0.69]) and more likely to have a stroke of unknown onset (aOR 1.44 [1.07-1.95]), but workflow metrics did not differ once stroke code was triggered.</p><p><strong>Discussion and conclusion: </strong>In our study, we did not find a significant difference between women and men in terms of 3-month good outcome. However, our study size may hinder its detection. Interestingly, we observed that women had a lower rate of sICH after tenecteplase. Women's workflow metrics were similar to men's, except for a higher rate of stroke with an unknown onset.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251332497"},"PeriodicalIF":5.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12003326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018797","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":"Letter to the editor, regarding \"Rescue therapy after failed thrombectomy in medium/distal vessel occlusions: A retrospective analysis of an international, multi-center registry\" recently published by Anastasiou Aikaterini and colleagues.","authors":"Senta Frol, Ahmed Ayad, René Chapot","doi":"10.1177/23969873251332133","DOIUrl":"https://doi.org/10.1177/23969873251332133","url":null,"abstract":"","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251332133"},"PeriodicalIF":5.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040923","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":"Response Letter to Senta Frol et al. regarding our paper, \"Rescue therapy after failed thrombectomy in medium/distal vessel occlusions: A retrospective analysis of an international, multi-center registry\".","authors":"Aikaterini Anastasiou, Mira Katan, Marios-Nikos Psychogios","doi":"10.1177/23969873251332773","DOIUrl":"https://doi.org/10.1177/23969873251332773","url":null,"abstract":"","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251332773"},"PeriodicalIF":5.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050564","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":"Efficacy and safety of intra-arterial thrombolysis following successful endovascular thrombectomy in patients with large vessel occlusion stroke: A meta-analysis.","authors":"Zeni Yang, Wentai Zhang, Yonggang Xu, Yuwei Ding, Chao Liu, Zhiyuan Shen, Jiwei Wu, Yu Guo, Wenmiao Luo","doi":"10.1177/23969873251334047","DOIUrl":"https://doi.org/10.1177/23969873251334047","url":null,"abstract":"<p><strong>Introduction: </strong>The impact of intra-arterial thrombolysis (IAT) following successful endovascular thrombectomy (EVT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) remains uncertain. This study aims to assess the efficacy and safety of IAT as an adjunct to EVT in patients with AIS-LVO.</p><p><strong>Patients and methods: </strong>We searched PubMed, Embase, and Cochrane databases to identify randomized controlled trials (RCTs) that compared EVT + IAT with EVT-only for AIS-LVO. The primary outcome was an excellent functional outcome, defined as a modified Rankin Scale (mRS) score of 0-1 at 90 days. Secondary outcomes included functional independence (mRS 0-2), symptomatic intracranial hemorrhage (sICH), and mortality. The pooled data were analyzed using random-effects models.</p><p><strong>Discussion and conclusion: </strong>A total of four RCTs, involving 1395 patients, were included in the analysis. The results showed that patients who received EVT + IAT had a significantly higher likelihood of achieving an excellent functional outcome at 90 days compared to those who received EVT-only (risk ratio [RR], 1.16; 95% confidence interval [CI], 1.03-1.31). No statistically significant differences were observed between the EVT + IAT and EVT-only groups in terms of 90-day functional independence (RR, 1.03; 95% CI, 0.94-1.13), sICH (RR, 1.30; 95% CI, 0.80-2.13), or 90-day mortality (RR, 0.94; 95% CI, 0.76-1.17).</p><p><strong>Conclusions: </strong>Among patients with AIS-LVO who have undergone successful EVT, the use of adjunct IAT, compared to no additional treatment, was associated with a greater likelihood of achieving an excellent functional outcome at 90 days.</p><p><strong>Systematic review registration: </strong>CRD42024602099.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251334047"},"PeriodicalIF":5.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11996827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040973","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":"Thrombus enhancement sign predicts distal embolization in anterior circulation stroke treated with endovascular thrombectomy.","authors":"Guangchen He, Wenli Zhou, Haitao Lu, Yi Gu, Yueqi Zhu","doi":"10.1177/23969873251332739","DOIUrl":"https://doi.org/10.1177/23969873251332739","url":null,"abstract":"<p><strong>Background: </strong>Distal embolization (DE) is a concerning complication of endovascular treatment (EVT) that is linked to adverse clinical outcomes in acute ischemic stroke (AIS). The thrombus enhancement sign (TES) has been identified as a potential biomarker of occlusion; however, its predictive value for DE remains to be fully clarified.</p><p><strong>Methods: </strong>We retrospectively evaluated data of consecutive patients with large vessel occlusion (LVO) in anterior circulation who underwent EVT between January 2020 and December 2023. Each included patient was underwent baseline non-contrast computed tomography (CT) and CT angiography (CTA). We assessed the incidence of DE and its association with clinical and technical outcomes. The association of DE with patient characteristics, thrombus imaging, and composition features was assessed using univariable and multivariable logistic regression.</p><p><strong>Results: </strong>A total of 308 patients were included in the analysis. Distal embolization occurred in 21.1% (65/308) of patients. Patients with DE had longer recanalization time (58 min vs 46 min; <i>p</i> = 0.002), lower proportion achieving successful reperfusion (86% vs 95%; <i>p</i> = 0.022) and decreased frequency of functional independence (31% vs 45%; <i>p</i> = 0.041). TES was significantly more frequent in the DE group compared to the non-DE group (89% vs 70%, <i>p</i> = 0.001). Histopathological examination revealed that TES-positive thrombi contained a higher fibrin/platelet proportion (50.9% vs 48.2% in TES-negative thrombi, <i>p</i> = 0.009) and fewer erythrocytes (41.7% vs 43.5% in TES-negative thrombi, <i>p</i> = 0.043). In multivariable analysis, TES (OR, 2.76; 95% CI, 1.23-7.10; <i>p</i> = 0.022) was the only independent predictor of DE.</p><p><strong>Discussion and conclusion: </strong>Our study demonstrates that distal embolization is a prevalent complication of EVT that hinders full recanalization and favorable outcomes. The presence of TES on baseline CT imaging could serve as a reliable radiologic predictor of distal embolization after EVT.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251332739"},"PeriodicalIF":5.8,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11994627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004006","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":"Trends in reperfusion treatments, functional outcomes and mortality for first-ever ischaemic stroke in Norway from 2014 to 2021: The Norwegian Stroke Registry.","authors":"Kevin C Elangwe, Ellisiv B Mathiesen, Torunn Varmdal, Bent Indredavik, Agnethe Eltoft","doi":"10.1177/23969873251331482","DOIUrl":"https://doi.org/10.1177/23969873251331482","url":null,"abstract":"<p><strong>Introduction: </strong>Acute ischaemic stroke (AIS) treatment has undergone major changes in the last decades with regards to reperfusion treatment with intravenous thrombolysis (IVT) and mechanical thrombectomy (MT). We analysed temporal trends in reperfusion treatment, functional outcomes and mortality among patients with first-ever AIS.</p><p><strong>Patients and methods: </strong>We included 45,686 first-ever AIS patients registered in the Norwegian Stroke Registry from 2014 to 2021. Temporal trends in reperfusion therapy, functional outcome defined by modified Rankin Scale (mRS) score at 90 days and mortality were assessed in age-and sex-adjusted logistic regression models and in analyses stratified by age and reperfusion treatment.</p><p><strong>Results: </strong>Mean age was 73.8 years and 54.5% were men. The use of reperfusion treatment increased over time (IVT only from 15.5% to 18.1%; MT only from 0.4% to 2.8%; IVT + MT combined, from 0.9% to 3.4%). The proportion of patients achieving mRS 0-2 at 90 days increased from 64.2% to 68.1%. The 90-day mortality decreased from 11.7% to 10.5%. Improvement in 90-day functional outcome was most notable in patients receiving IVT, but was also observed in patients not receiving reperfusion treatment. Patients aged ⩾80 years showed improvement in functional outcome and reduced mortality rate, while less noticeable time trends were observed in patients <80 years.</p><p><strong>Discussion and conclusion: </strong>Reperfusion therapy for first-ever AIS increased significantly over time, concurrent with significant improvements in functional outcome and lower mortality rate. Improvements in outcome were more prominent in the older population. Improved outcome among non-reperfused patients suggest that factors other than reperfusion therapy contribute to these results.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251331482"},"PeriodicalIF":5.8,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11994638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039235","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":"The impact of comorbidity burden on outcomes following endovascular thrombectomy for acute ischemic stroke: A nationwide prospective observational study.","authors":"Emma Hall, Björn Hansen, Mats Pihlsgård, Magnus Esbjörnsson, Bo Norrving, Teresa Ullberg, Johan Wassélius","doi":"10.1177/23969873251332136","DOIUrl":"https://doi.org/10.1177/23969873251332136","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with substantial comorbidity burden are underrepresented in clinical trials on endovascular thrombectomy (EVT), despite being common in clinical routine care. Therefore, analysis of observational data is needed to evaluate how increasing comorbidity burden affects procedural success rate, complication rate, and clinical outcome following EVT.</p><p><strong>Patients and methods: </strong>We conducted a register-based observational study involving pre-stroke functionally independent patients treated with EVT in Sweden 2015-2021. Comorbidity burden was assessed using the Charlson Comorbidity Index (CCI) and categorized as no (CCI 0), moderate (CCI 1), severe (CCI 2), and very severe (CCI ⩾3). The primary outcome was favorable 90-day outcome (modified Rankin Scale 0-2). Secondary outcomes included successful recanalization, and peri- and postoperative complications.</p><p><strong>Results: </strong>Of 4735 included patients, 40% had no comorbidity (CCI 0), 15% had moderate (CCI 1), 21% had severe (CCI 2), and 24% had very severe comorbidity burden (CCI ⩾3). The yearly proportion of patients with very severe comorbidity burden increased from 16% to 30% during the study period. Increasing comorbidity levels were associated with decreased odds ratio (OR) of favorable outcome compared to patients without comorbidity: CCI 1 adjusted OR (aOR) 0.64, 95% CI 0.57-0.85; CCI 2 aOR 0.59, 95% CI 0.47-0.74; and CCI ⩾3 aOR 0.38, 95% CI 0.30-0.47, but there were no significant differences in successful recanalization rates. Patients with CCI 2 had higher OR for perioperative and postoperative complications (OR 1.43, 95% CI 1.09-1.88, and OR 1.41, 95% CI 1.15-1.71), and patients in the CCI ⩾3 group had higher OR of postoperative complications (OR 1.34, 95% CI 1.14-1.67), compared to patients in the CCI 0 group. Successful recanalization was associated with favorable functional outcome in all CCI-groups.</p><p><strong>Discussion and conclusion: </strong>Severe and very severe comorbidity burden are increasingly common among EVT-treated patients in routine healthcare and are linked to poorer outcomes. However, our results suggest that successful EVT is associated with functional independency, also in patients with severe and very severe comorbidity burden.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251332136"},"PeriodicalIF":5.8,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051993","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":"Reliability of CT, DECT, and MRI for the diagnosis of hemorrhagic transformation after thrombectomy.","authors":"William Boisseau, Augustin Lecler, Stanislas Smajda, Pierre Seners, Quentin Holay, Lucy Bernardaud, Oriana Tarabay, Julien Savatovsky, Michel Piotin, Mikael Mazighi, Robert Fahed","doi":"10.1177/23969873251331484","DOIUrl":"https://doi.org/10.1177/23969873251331484","url":null,"abstract":"<p><strong>Introduction: </strong>Computed Tomography (CT) is the main modality used for the diagnosis and classification of hemorrhagic transformation (HT) after thrombectomy, however its reliability has shown limitations. Dual-energy CT (DECT) and magnetic resonance imaging (MRI) have been suggested to enhance the reliability of HT detection and classification, but direct three-way comparison of these modalities is lacking. To measure and compare the reliability of CT, DECT and MRI for the diagnosis, classification, and therapeutic consequences of HT after thrombectomy.</p><p><strong>Patients and methods: </strong>Between June 2017 and September 2019, 66 of 324 patients included in the BP-TARGET trial underwent CT, DECT and MRI scans within 36 h after thrombectomy. Seven readers, including three neurologists, two diagnostic, and two interventional neuroradiologists independently reviewed the images. They were asked for each patient and each imaging modality to score the presence of a hemorrhagic transformation (of any type), the type of hemorrhagic transformation according to the European Cooperative Acute Stroke Study (ECASS), and whether they would start the patient on antiplatelet based on the imaging finding. The readers repeated the same readings 1 month later. Interrater and intrarater agreement were measured using Kappa statistics.</p><p><strong>Results: </strong>There were frequent discrepancies between CT, DECT and MRI scans evaluations. The use of MRI led to an increased rate of HT diagnosis compared to CT and DECT scans. Interrater agreement for ECASS classification was only fair-to-moderate for all three imaging modalities but improved to a substantial level after dichotomization into 0/HI1/HI2 versus PH1/PH2. The interrater agreement for the decision to start antiplatelet therapy was substantial only with CT (κ = 0.636 [0.577-0.694]) and remained moderate with MRI and DECT.</p><p><strong>Conclusion: </strong>In our study, the imaging modality influenced the diagnosis and classification of HT, the management of antiplatelet therapy, and the interrater and intrarater agreement. These findings may guide the choice of imaging modality in research or clinical settings.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251331484"},"PeriodicalIF":5.8,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11994635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050563","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":"Efficacy and safety of antiplatelet therapy for secondary prevention of small subcortical infarction: A systematic review and network meta-analysis.","authors":"Xiao Feng, Junyong Du, Tong Qu, Shabei Xu, Wenhao Zhu","doi":"10.1177/23969873251331470","DOIUrl":"https://doi.org/10.1177/23969873251331470","url":null,"abstract":"<p><strong>Purpose: </strong>Small subcortical infarction (SSI) accounts for approximately 25% of ischemic strokes and shares a comparable recurrence rate of cardiovascular events with other stroke subtypes. This study aimed to evaluate the efficacy and safety of various antiplatelet for secondary prevention of SSI by network meta-analysis (NMA).</p><p><strong>Methods: </strong>We systematically searched Medline, Embase, Cochrane Library, and Web of Science from inception to October 2024 for randomized controlled trials (RCTs). Efficacy outcomes included: incidence of major adverse cardiovascular events (MACEs), rates of any stroke and ischemic stroke recurrence. Safety outcomes included: incidence of intracranial hemorrhage, severe bleeding, any bleeding events, and mortality.</p><p><strong>Findings: </strong>A total of 24 RCTs involving 47,507 SSI patients were included in systematic review. The NMA included 19 RCTs (39,137 patients). The NMA demonstrated that Cilostazol showed the best efficacy in preventing MACEs (surface under the cumulative ranking curve (SUCRA): 90.0%). cilostazol significantly reduced the incidence of MACEs compared to aspirin (OR, 0.66; 95% CI, 0.49-0.89), ticlopidine (OR, 0.65; 95% CI, 0.43-1.00), dipyridamole (OR, 0.61; 95% CI, 0.42-0.90), vorapaxar (OR, 0.51; 95% CI, 0.35-0.74), Sarpogrelate (OR, 0.62; 95% CI, 0.40-0.97), and placebo (OR, 0.51; 95% CI, 0.37-0.71). Regarding safety, aspirin plus clopidogrel and vorapaxar was associated with a significantly increased risk of severe bleeding events compared to the control.</p><p><strong>Discussion and conclusions: </strong>Cilostazol may be the most effective agent for preventing cardiovascular event recurrence. Aspirin plus clopidogrel and vorapaxar may be not recommended due to heightened bleeding risks.</p><p><strong>Registration: </strong>International prospective register of systematic reviews (PROSPERO) - CRD42024607819.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251331470"},"PeriodicalIF":5.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017671","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}