European Stroke Journal最新文献

{"title":"Thrombectomy for medium-sized cerebral vessel occlusion: Size does matter.","authors":"Pekka Virtanen, Silja Räty, Liisa Tomppo, Nina Brandstack, Erno Peltola, Tatu Kokkonen, Mikko Sillanpää, Daniel Strbian","doi":"10.1177/23969873251376862","DOIUrl":"10.1177/23969873251376862","url":null,"abstract":"<p><strong>Introduction: </strong>Randomised controlled trials comparing endovascular thrombectomy (EVT) to medical treatment in patients with medium vessel occlusion (MeVO) suggested neutrality or futility of EVT. We studied whether the size difference between thrombectomy device and the occluded vessel influenced MeVO outcomes.</p><p><strong>Patients and methods: </strong>This was a retrospective single-centre observational study comprising EVT-treated patients with occlusion of the M2 branch of the middle cerebral artery on digital subtraction angiography. The diameter of the occluded M2 was measured and compared to the manufacturer's recommendation for the minimal vessel size. Based on this device-to-vessel size ratio, we divided the patients into three groups: A) ratio ⩽1.0 (device smaller or equals the vessel size), B) 1.0 < ratio ⩽ 1.2 (device larger, difference ⩽20%), and C) ratio >1.2 (device larger, significant difference >20%). The primary outcomes were futility (3-month modified Rankin scale 5 or 6) and symptomatic intracranial haemorrhage (sICH).</p><p><strong>Results: </strong>In the cohort of 146 patients (median age 73; 47.3% women), 58.9% were in group A, 13.7% in group B and 27.4% in group C. Patients in group C had more frequently sICH (20.0%) compared to group A (7.0%) and group B (5.0%), and the highest futility rate (34.2% vs 17.3% vs 25.0%, respectively). In the adjusted analyses, belonging to the group C was associated with sICH (OR 3.32 [1.04-10.64]) and mRS 5-6 (OR 2.84 [1.09-7.37]).</p><p><strong>Discussion and conclusions: </strong>The size of the thrombectomy device relative to the size of the occluded vessel is associated with haemorrhagic complications and futile outcomes.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251376862"},"PeriodicalIF":4.5,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a blood-based lipidomic fat quality score for the risk of ischemic stroke.","authors":"Iolanda Lázaro, Leila Luján-Barroso, Natalia Soldevila-Domenech, Antonio J Amor, Emilio Ortega, Emilio Ros, Maria-José Sánchez, Miguel Rodríguez-Barranco, Maria Dolores Chirlaque, José Maria Huerta, Marcela Guevara, Conchi Moreno-Iribas, Catalina Bonet, Helmut Schröder, Montserrat Fitó, Nathan L Tintle, Nathan Ryder, William S Harris, Antonio Agudo, Aleix Sala-Vila","doi":"10.1177/23969873251367250","DOIUrl":"10.1177/23969873251367250","url":null,"abstract":"<p><strong>Introduction: </strong>Poor-quality diets promote ischemic stroke. Red blood cell fatty acids (RBC-FAs) are objective, long-term biomarkers of diet. In a case-control study nested in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Spain, we developed a blood-based lipidomic fat quality (LFQ) score considering pre-defined RBC-FA diet-related biomarkers, and examined whether LFQ score relates to the risk of ischemic stroke.</p><p><strong>Patients and methods: </strong>We determined the RBC-FAs (<i>n</i> = 438 cases of incident ischemic stroke, <i>n</i> = 438 matched controls). For each participant, we scored 1 for each beneficial metric (C15:0+C17:0; C18:2n-6; C18:3n-3; C20:5n-3; C22:6n-3) ⩾the median of the control group; and 1 for each detrimental metric (C16:0; C16:1n-7; C18:0) <i>n</i> = 2468 participants from the Framingham Offspring Study without ischemic stroke at baseline, 12-year median follow-up, <i>n</i> = 121 cases).</p><p><strong>Results: </strong>In a fully adjusted model, the Odds Ratio (OR) for ischemic stroke was 0.86 (95% confidence interval [CI] = 0.77-0.95) for each 1-unit increase of the LFQ score. Compared to individuals at the lowest category of LFQ score (0-3 points), those at the top category (5-8 points) had lower odds (OR = 0.64, 95% CI = 0.44-0.94). The findings were similar in the Framingham Offspring Study (Hazard Ratio [HR] for each 1-unit increase = 0.83; 95% CI = 0.70-0.99; HR for those at top category = 0.49; 95% CI = 0.29-0.84, compared to those at the lowest category).</p><p><strong>Conclusion: </strong>Low blood-based LFQ scores relate to a high risk of ischemic stroke.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251367250"},"PeriodicalIF":4.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12408540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973945","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":"775-783"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","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":"The 6-months follow-up of the TREAT-CAD trial: Aspirin versus anticoagulation for stroke prevention in patients with cervical artery dissection.","authors":"Stefan T Engelter, Lukas S Enz, Flavia Ravanelli, Josefin E Kaufmann, Henrik Gensicke, Sabine Schaedelin, Andreas R Luft, Christoph Globas, Barbara Goeggel-Simonetti, Urs Fischer, Davide Strambo, Georg Kägi, Krassen Nedeltchev, Timo Kahles, Lars Kellert, Sverre Rosenbaum, Regina von Rennenberg, Alex Brehm, David Seiffge, Susanne Renaud, Tobias Brandt, Hakan Sarikaya, Annaelle Zietz, Johannes Wischmann, Alexandros A Polymeris, Sandro Fischer, Leo H Bonati, Gian Marco De Marchis, Nils Peters, Christian H Nolte, Hanne Christensen, Susanne Wegener, Marios-Nikos Psychogios, Marcel Arnold, Philippe Lyrer, Christopher Traenka","doi":"10.1177/23969873251315362","DOIUrl":"10.1177/23969873251315362","url":null,"abstract":"<p><strong>Introduction: </strong>Cervical artery dissection is a major cause of stroke in the young. The optimal choice and duration of antithrombotic treatment for stroke prevention are debated, particularly beyond 3 months after symptom onset.</p><p><strong>Patients and methods: </strong>TREAT-CAD (<b>TREAT</b>ment of <b>C</b>ervical <b>A</b>rtery <b>D</b>issection) was a randomized controlled trial with blinded outcome assessment comparing non-inferiority of aspirin to anticoagulation (Vitamin-K-antagonists) in participants with symptomatic, Magnetic-Resonance-(MR)-imaging-verified cervical artery dissection. TREAT-CAD could not establish non-inferiority of aspirin to anticoagulation at 3 months. Thereafter participants could continue antithrombotic medication and obtained a standardized assessment of clinical and MR-Imaging outcomes between 3 and 6 months. As crossover to the other treatment arm was possible, we performed an as-treated analysis as main analysis. The main outcomes were new clinical (ischemic stroke, intracranial/major extracranial bleeding, or death) and new MR-Imaging outcomes (ischemic or hemorrhagic brain lesions).</p><p><strong>Results: </strong>Among the 122 participants in the as-treated analysis, 3/93 (3.2%) aspirin-treated participants had new clinical (<i>n</i> = 1) and MRI-outcomes (<i>n</i> = 2) between 3 and 6 months while 1/29 (3.4%) anticoagulated participants had an MRI-outcome (<i>n</i> = 1). All outcome events were hemorrhagic while ischemic events were absent. No deaths occurred. This yields an absolute difference of 0.2% (95% CI -8.0% to 7.5%, <i>p</i> = 1.0).</p><p><strong>Discussion and conclusion: </strong>During the extended follow-up period of a controlled randomized trial comparing aspirin to anticoagulation in cervical artery dissection, outcomes between 3 and 6 months after randomization occurred rarely, similarly often in both groups and were exclusively hemorrhagic events. Thus, studies balancing benefits versus harms of antithrombotic treatment beyond 3 months are warranted.</p><p><strong>Registration: </strong>ClinicalTrials.gov: NCT02046460. https://clinicaltrials.gov/ct2/show/NCT02046460.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"871-881"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256871","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":"Initial intraventricular involvement and early intracerebral hematoma retraction: The \"ventricular washout\".","authors":"Umberto Pensato, Chitapa Kaveeta, Koji Tanaka, Johanna M Ospel, Mohamed A AlShamrani, MacKenzie Horn, Dar Dowlatshahi, Girish Kulkarni, Ericka Teleg, Abdulaziz Sulaiman Al Sultan, Linda Kasickova, Tomoyuki Ohara, Piyush Ojha, Sina Marzoughi, Bijoy K Menon, Mayank Goyal, Andrew M Demchuk","doi":"10.1177/23969873251330186","DOIUrl":"10.1177/23969873251330186","url":null,"abstract":"<p><strong>Introduction: </strong>Intraventricular hematoma (IVH) occurs in approximately 40% of acute intracerebral hemorrhage (ICH) patients and is significantly associated with worse clinical outcomes. According to cerebrospinal fluid dynamics, some blood within the ventricles may circulate through the subarachnoid spaces, leading to its apparent \"disappearance\" on follow-up imaging. We aim to investigate the association between initial IVH involvement and significant early ICH retraction at follow-up imaging.</p><p><strong>Methods: </strong>Data are from the MCAHP (Multiphase CT Angiography Hematoma Prediction) Study, which included consecutive patients with acute ICH investigated with multimodal CT imaging. Patients who underwent surgery before follow-up imaging were excluded. IVH severity was assessed using the IVH score. The primary outcome was significant early ICH retraction, defined as volume decrease (⩾3 ml or ⩾15%) between the initial and follow-up scans. Secondary outcomes included early absolute and relative ICH decrease. Associations between outcomes and initial IVH involvement or IVH score were assessed with logistic regression adjusted for age, baseline NIHSS, initial ICH volume, and onset-to-CT time.</p><p><strong>Results: </strong>Overall, 177 ICH patients were included. The median age was 71 years (IQR = 59-80), 71 (40.1%) patients were female, and 64 (36.2%) presented with initial IVH involvement. Patients with initial IVH, compared to those without, had a larger initial ICH volume (28.5 ml [IQR = 12.7-52.5] vs. 18.9 ml [IQR = 8.1-30.6], <i>p</i> < 0.001) and different ICH location (deep = 54.7% vs 47.8%; lobar = 35.9% vs 46.0%; infratentorial = 7.3% vs 6.2%; <i>p</i> < 0.001). Early ICH retraction was observed in 33 (18.6%) patients: 21 (32.8%) with initial IVH and 10 (10.6%) without initial IVH. There was a significant association between early ICH retraction and initial IVH involvement (adjusted odds ratio [aOR] 4.02 [95% CI = 1.72-9.41]) and IVH score (aOR 1.14 [95% CI = 1.05-1.23] per 1-point increase). Similar results were observed for secondary outcomes.</p><p><strong>Conclusion: </strong>Initial IVH involvement is associated with early ICH retraction - \"intraventricular washout.\" This might result in an underestimation of hematoma expansion occurrence and severity in these patients, with potential implications when evaluating the predictive performance of hematoma expansion markers/scores and the radiological efficacy of hemostatic treatments.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"748-756"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765384","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":"Type 2 diabetes in stroke patients: Impact on outcomes, recurrence, resource use, and costs in France.","authors":"Igor Sibon, Kamel Mohammedi, Nadia Quignot, Stephanie Read, Raissa Kapnang, Artak Khachatryan, Kazue Kikuchi, Hongye Ren, Christine Massien, Lucile Vigié, Sara Larsen, Laurent Fauchier","doi":"10.1177/23969873251319172","DOIUrl":"10.1177/23969873251319172","url":null,"abstract":"<p><strong>Introduction: </strong>Contemporary estimates of the impact of type 2 diabetes (T2D) on stroke outcomes are important for care planning and resource allocation. This retrospective cohort study compared the incidence of stroke and subsequent clinical and economic outcomes following stroke among people with and without T2D.</p><p><strong>Patients and methods: </strong>Data were extracted from a subset of the French Système National des Données de Santé database. Stroke incidence as well as post-stroke clinical outcomes, healthcare resource utilization (HCRU), use of stroke preventative treatments, and costs were compared among people with and without T2D.</p><p><strong>Results: </strong>The study included 10,906 patients hospitalized for stroke including 2141 (19.6%) people with T2D. Age-standardized stroke incidence rates were 3.3 (95% confidence interval [CI] 3.1; 3.6) per 1000 person-years and 2.2 (2.1; 2.3) in people with and without T2D, respectively. Patients with T2D had significantly higher risk of stroke recurrence (adjusted hazard ratio [HR] 1.14, 95% CI: 1.01; 1.30) and mortality (HR 1.16, 95% CI: 1.08; 1.25) than patients without T2D. The proportion of patients with T2D treated with statins decreased from 27.3% pre-stroke to 20.6% post-stroke but remained relatively stable among patients without T2D (from 13.4% to 13.1%). The mean healthcare costs in the 12 months following stroke were higher among patients with T2D than those without (€22,635 vs €18,629).</p><p><strong>Discussion and conclusion: </strong>The incidence and clinical and economic burden of stroke is considerably higher among people with T2D. Further efforts are needed to reduce this disparity.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"911-918"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415819","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":"Cerebral thrombus analysis as a useful diagnostic tool for infective endocarditis in ischemic stroke patients.","authors":"Aurora Semerano, Beatrice Dell'Acqua, Angela Genchi, Francesca Sanvito, Ghil Schwarz, Manuel Alejandro Montano Castillo, Andrea Bergamaschi, Michela Sampaolo, Erica Butti, Giorgia Serena Gullotta, Mariangela Piano, Marco Ripa, Paolo Scarpellini, Andrea Falini, Pietro Panni, Elio Clemente Agostoni, Nicola Clementi, Guillaume Saliou, Steven David Hajdu, Luisa Roveri, Patrik Michel, Gianvito Martino, Massimo Filippi, Davide Strambo, Marco Bacigaluppi","doi":"10.1177/23969873251320449","DOIUrl":"10.1177/23969873251320449","url":null,"abstract":"<p><strong>Introduction: </strong>Infective endocarditis (IE) is a life-threatening condition and a rare cause of ischemic stroke (IS). This study aimed to evaluate the utility of analyzing cerebral thrombi, obtained through endovascular thrombectomy in IS, for the pathological diagnosis of IE.</p><p><strong>Patients and methods: </strong>Cerebral thrombi from three groups of IS patients were compared: definite IE (<i>n</i> = 10), cardioembolic stroke without and with concomitant infection (CE-I^-: <i>n</i> = 30, CE-I⁺: <i>n</i> = 10). We performed histological examination, molecular biology, and microbiological tests on cerebral thrombi, to detect microorganisms and assess their composition.</p><p><strong>Results: </strong>Median age of included patients was 73 years and 50% were females. Hematoxylin & Eosin and Grocott-Gomori Methenamine Silver stains detected microorganisms in all IE cerebral thrombi, and none in the control groups. Thrombus PCR detected relevant microorganism in n = 2/7 IE. Compared to control groups, IE thrombi were characterized by significant lower content of red blood cells (median [IQR]: IE = 7.4 [4.2-26.7], CE-I^- = 49.3 [17-62.6], CE-I⁺ = 57.5 [40.7-60.8], % over thrombus section area [%TSA], <i>p</i> = 0.001), increased von Willebrand Factor (IE = 23.9 [19.1-32], CE-I^- = 11.2 [8.2-12.8], CE-I⁺ = 12.9 [10.7-18.3], %TSA, <i>p</i> = 0.001), cell-dominant pattern of Neutrophil Extracellular Traps (IE = 100%, CE-I^- = 69%, CE-I⁺ = 70%, <i>p</i> ⩽ 0.001), and more frequent sub-acute or chronic thrombus age classification (<i>p</i> ⩽ 0.001). These latter thrombus features displayed good discriminative ability between IE and controls, with AUC values between 0.84 and 0.95.</p><p><strong>Discussion: </strong>Multimodal analysis of cerebral thrombi in IS with suspected IE supports early and definite pathological diagnosis by detecting pathogens and assessing changes in thrombus composition.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"929-939"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434280","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":"713-720"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11700384/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of tirofiban in preventing neurological deterioration in acute ischemic stroke with intracranial artery stenosis: A post hoc analysis of the TREND Trial.","authors":"Jing Wang, Yue Qiao, Sijie Li, Chuanhui Li, Chuanjie Wu, Pingping Wang, Ting Yang, Xunming Ji, Qingfeng Ma, Wenbo Zhao","doi":"10.1177/23969873251319151","DOIUrl":"10.1177/23969873251319151","url":null,"abstract":"<p><strong>Introduction: </strong>The degree of culprit artery stenosis affects the risk of early neurological deterioration (END) after acute ischemic stroke (AIS). The TREND trial demonstrated the efficacy of tirofiban in preventing END in patients with AIS. We aimed to investigate whether the degree of intracranial artery stenosis affects the efficacy of tirofiban in preventing END in patients with AIS.</p><p><strong>Patients and methods: </strong>We conducted a post hoc analysis of the TREND trial, which enrolled patients within 24 h of onset and randomly allocated to receive intravenous tirofiban or oral aspirin. We stratified the stenosis degrees into three subgroups: no stenosis, mild-to-moderate stenosis (stenosis <70%), and severe stenosis or occlusion (stenosis ⩾70%). The primary endpoint is END₄ defined as an increase of the NIHSS ⩾4 within 72 h after randomization. Secondary outcomes include END₂ (defined as an increase of NIHSS ⩾2) within 72 h after randomization, the proportion of mRS 0-1 and 0-2 at 90 days.</p><p><strong>Results: </strong>A total of 296 patients were analyzed. In patients with severe stenosis or occlusion, tirofiban significantly reduced the incidence of END₄ (5.7% vs 30.8%, adjusted OR 0.156, 95% CI 0.028-0.873, adjusted <i>p</i> = 0.034), whereas its effects in preventing END₄ were similar to those of aspirin in patients with no stenosis (2.4% vs 4.6%, adjusted OR 0.193, 95% CI 0.018-2.083, adjusted <i>p</i> = 0.175) or mild-to-moderate stenosis (2.9% vs 10.0%, adjusted OR 0.171, 95% CI 0.015-1.943, adjusted <i>p</i> = 0.155). The <i>p</i> value for interaction between stenosis subgroups and treatment was 0.513. Furthermore, tirofiban significantly reduced the incidence of END₂ in patients with mild-to-moderate stenosis (5.9% vs 22.5%, OR 0.146, 95% CI 0.022-0.951, adjusted <i>p</i> = 0.044) and severe stenosis or occlusion (11.4% vs 43.6%, adjusted OR 0.140, 95% CI 0.036-0.540, adjusted <i>p</i> = 0.004). A significant improvement in favorable outcomes with a 90-day mRS of 0-1 was observed only in patients with mild-to-moderate stenosis (85.3% vs 70.0%, adjusted OR 4.617, 95% CI 1.077-19.798, adjusted <i>p</i> = 0.039).</p><p><strong>Discussion and conclusion: </strong>Tirofiban may significantly reduce the incidence of END in patients with severe arterial stenosis or occlusion. Further studies are required to confirm the effects of intracranial artery stenosis on the benefits of intravenous tirofiban.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov; identifier: NCT04491695.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"919-928"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11829278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415818","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":"Prediction of dementia using CT imaging in stroke (PRODUCTS).","authors":"Melanie Hafdi, Martin Taylor-Rowan, Bogna Drozdowska, Emma Elliott, Lucy McGuire, Edo Richard, Terence J Quinn","doi":"10.1177/23969873251325076","DOIUrl":"10.1177/23969873251325076","url":null,"abstract":"<p><strong>Introduction: </strong>A better understanding of who will develop dementia can inform patient care. Although MRI offers prognostic insights, access is limited globally, whereas CT-imaging is readily available in acute stroke. We explored the prognostic utility of acute CT-imaging for predicting dementia.</p><p><strong>Patients and methods: </strong>We included stroke or transient ischaemic attack (TIA) survivors from participating stroke centres in Scotland. Acute CT-scans were rated using ordinal scales for neurodegenerative and cerebrovascular changes (old infarcts, white matter lesions (WMLs), medial temporal lobe atrophy (MTA), and global atrophy (GA)) and combined together to a 'brain-frailty' score. Dementia status was established at 18-months following stroke or TIA.</p><p><strong>Results: </strong>Among 195 participants, 33% had dementia after 3 years of follow-up. High brain-frailty score (⩾2/4) correlated with higher risk of dementia (HR (95% CI) 6.02 (1.89-19.21)). As individual predictor, severe MTA was most strongly associated with dementia (adjusted HR (95% CI) 2.09 (1.07-4.08)). Other predictors associated with dementia included older age, higher prestroke morbidity (mRS), WMLs, and GA. Integrated in a prediction model with clinical parameters, prestroke mRS, cardiovascular disease, GA, MTA and Abbreviated-Mental-Test were the strongest predictors of dementia (c-statistic: 0.77).</p><p><strong>Discussion and conclusion: </strong>Increased brain-frailty, and its individual components (WMLs, MTA, and GA) are associated with a higher risk of dementia in participants with stroke. Combining clinical and brain-frailty parameters created a moderate dementia prediction model but added little value over clinical parameters in combination with cognitive testing. CT-based brain-frailty may provide better prognostic insights when cognitive testing isn't feasible and for identifying highest-risk individuals for dementia prevention trials to increase trial efficiency.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"978-987"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617350","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}