European Stroke Journal最新文献

{"title":"Dual versus single antiplatelet therapy in patients with non-cardioembolic acute ischemic stroke and baseline MRI.","authors":"Gian Marco De Marchis, Anna Toebak, Tolga Dittrich, Dimitrios Vlachos, Angela Wang, Eric E Smith, Hardi Mundl, Pablo Colorado, Ashkan Shoamanesh, Robert G Hart","doi":"10.1177/23969873251323180","DOIUrl":"10.1177/23969873251323180","url":null,"abstract":"<p><strong>Introduction: </strong>Dual antiplatelet therapy (DAPT) is superior to single antiplatelet therapy (SAPT) for secondary prevention after minor, non-cardioembolic stroke. We aimed to assess whether DAPT efficacy is modified by large artery atherosclerotic (LAA) etiology, and DAPT safety by stroke size on MRI.</p><p><strong>Patients and methods: </strong>Post hoc analysis of the Phase 2 PACIFIC-STROKE randomized clinical trial, which enrolled patients with non-cardioembolic stroke, all with baseline MRI and compared the Factor XIa inhibitor asundexian with placebo on a background of DAPT or SAPT. We compared patients treated with DAPT versus SAPT. The efficacy endpoint was the rate of recurrent ischemic stroke, the safety endpoint was major or clinically relevant non-major bleeding during follow-up.</p><p><strong>Results: </strong>1590 patients were included, median NIHSS was 2 (interquartile range [IQR] 1-4), 40% received DAPT. Median follow-up was 11.5 months. The efficacy endpoint occurred in 4.4% and 4.8% in the DAPT group and SAPT group, respectively, with the strongest numerical benefit of DAPT over SAPT among patients with NIHSS ⩽ 3 not treated by intravenous thrombolysis. LAA index stroke etiology did not modify DAPT treatment effect. The safety endpoint occurred more often in the DAPT than in the SAPT group (4.6% vs 2.7%), with the numerically lowest risk among patients with NIHSS ⩽ 3 not treated by intravenous thrombolysis. Stroke size did not modify the effect of DAPT on the safety endpoint.</p><p><strong>Discussion and conclusion: </strong>We found no evidence of major treatment effect heterogeneity with DAPT compared with SAPT in patients with and without LAA or by stroke size on MR-DWI.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251323180"},"PeriodicalIF":5.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504806","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 central adjudication of the score on the modified Rankin Scale in an international, randomized, acute stroke trial.","authors":"Wouter M Sluis, Jeroen C de Jonge, Hendrik Reinink, Alastair Wilson, Lisa J Woodhouse, Jesse Dawson, Kennedy R Lees, Philip M Bath, Hendrik Bart van der Worp","doi":"10.1177/23969873251320207","DOIUrl":"10.1177/23969873251320207","url":null,"abstract":"<p><strong>Introduction: </strong>The modified Rankin Scale (mRS) is the most frequently used primary outcome measure in acute stroke research despite significant interobserver variability in assigning grades. We assessed the use of central blinded adjudication of the mRS based on a video recording of an interview in the PRECIOUS trial.</p><p><strong>Patients and methods: </strong>PRECIOUS was an international, randomized, open-label, clinical trial with blinded outcome assessment of preventive treatment with metoclopramide, paracetamol, and ceftriaxone in elderly patients with acute stroke. Trained local investigators interviewed patients or their representatives and graded functional outcome at 90 days after stroke with the mRS. In each participating country, a video recording of the interview was assessed by three blinded, independent adjudicators. The primary outcome of the present substudy was interobserver agreement between the local mRS score and the median score of the three central adjudicators for patients alive at 90 days, assessed with Cohen's kappa and quadratic weighted kappa statistics. The difference between treatment effect estimates based on local and central adjudication was a secondary outcome.</p><p><strong>Results: </strong>Of 1493 patients enrolled in PRECIOUS, 1471 were included in this analysis. At 90 days, 1117 patients (75.9%) were alive and had both a central and local assessment; 28 participants did not have a central mRS score. Interobserver agreement was seen in 829 (74.2%) patients and was substantial (kappa of 0.68; 95% CI 0.65-0.71). Disagreement occurred more often in patients with a central mRS score of 0-2 (OR 2.24; 95% CI 1.14-4.24). Treatment effects were neutral for all three study drugs and did not differ between central and local adjudication.</p><p><strong>Discussion and conclusion: </strong>Central adjudication of the mRS based on a video recording is feasible in a large international, randomized stroke trial. This ensures blinding of the outcome assessment. In this neutral trial, the impact of central adjudication on the precision of effect size estimates could not be assessed.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251320207"},"PeriodicalIF":5.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450762","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":"23969873251320449"},"PeriodicalIF":5.8,"publicationDate":"2025-02-16","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":"Carotid Artery Stenting during Endovascular treatment of acute ischemic Stroke (CASES) study protocol for a multicenter randomized clinical trial.","authors":"Louise Maes, Theodora Van Elk, Anne van der Meij, Femke Roelofs, Kris Bogaerts, Reinoud Ph Bokkers, Gert J de Borst, Heleen M den Hertog, Diederik Wj Dippel, Olivier François, Noémie Ligot, Hester F Lingsma, Charles Blm Majoie, Jo Pp Peluso, Illario Tancredi, Ido R van den Wijngaard, Aad van der Lugt, Laetitia Yperzeele, Clark J Zeebregts, Paul J Nederkoorn, Robin Lemmens, Maarten Uyttenboogaart","doi":"10.1177/23969873251319941","DOIUrl":"10.1177/23969873251319941","url":null,"abstract":"<p><strong>Background: </strong>The optimal acute management of patients with acute ischemic stroke and a tandem lesion, defined as intracranial large vessel occlusion (LVO) with concomitant carotid artery stenosis or occlusion, remains unclear. Our aim is to assess the efficacy and safety of immediate carotid artery stenting (CAS) compared to delayed management in patients undergoing endovascular treatment (EVT) for acute ischemic stroke due to tandem lesions.</p><p><strong>Study design: </strong>CASES is a phase 3 multicenter prospective randomized open-label blinded endpoint (PROBE) non-inferiority clinical trial. Patients with a computed tomography angiography proven intracranial LVO in the anterior circulation and ipsilateral proximal carotid artery stenosis (⩾50%) or occlusion of presumed atherosclerotic origin will be randomized to either immediate CAS during EVT or to EVT followed by a deferred strategy, which may include carotid endarterectomy (CEA), CAS, or medical management. CASES will be conducted in 27 EVT centers in Belgium and the Netherlands. A total of 600 patients will be included.</p><p><strong>Study outcomes: </strong>The primary outcome is the score on the modified Rankin Scale (mRS) at 90 days. Secondary outcomes include excellent (mRS 0-1) and good (mRS 0-2) functional outcome at 90 days, stroke severity measured with the National Institutes of Health Stroke Scale (NIHSS) at 24 h and 5-7 days, recanalization, infarct volume at 24 h, ischemic stroke recurrence, carotid artery re-occlusion, symptomatic intracranial hemorrhage, and mortality.</p><p><strong>Summary: </strong>This study will provide high-quality randomized data on the efficacy and safety of immediate CAS in patients undergoing EVT for acute ischemic stroke due to a tandem lesion.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT06511089; ISRCTN 14956654.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251319941"},"PeriodicalIF":5.8,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434278","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":"Adiposity and domain-specific stroke recovery: A Mendelian randomization study.","authors":"Mengmeng Wang, Iyas Daghlas, Chad M Aldridge, Zhizhong Zhang, Yi Ren","doi":"10.1177/23969873251319916","DOIUrl":"10.1177/23969873251319916","url":null,"abstract":"<p><strong>Introduction: </strong>While adiposity is an established risk factor for incident ischemic stroke, its influence on functional recovery after stroke is uncertain. We leveraged Mendelian randomization (MR) to examine the causal effects of body mass index (BMI) and waist-to-hip ratio (WHR) on post-stroke motor, cognitive, and global recovery.</p><p><strong>Materials and methods: </strong>Genetic proxies for BMI and WHR were obtained from a genome-wide association study (GWAS) meta-analysis of the GIANT consortium and the UK Biobank (<i>n</i> = 806,834). The primary outcomes were longitudinal trajectories of three National Institutes of Health Stroke Scale (NIHSS) measures assessed over a 2-year period: motor function subscores, cognitive performance subscores, and total NIHSS scores (as a measure of global recovery). Genetic associations with these stroke recovery outcomes were obtained from a GWAS conducted within the VISP trial of mild ischemic stroke (<i>n</i> = 1270). MR effects were estimated using the inverse-variance weighted method.</p><p><strong>Results: </strong>A 1-standard deviation (SD) increase (~4.8 kg/m²) in genetically predicted BMI associated with lower odds of post-stroke motor improvement (OR = 0.37, 95% CI = 0.19-0.72; <i>p</i> = 0.003). Similarly, a genetically predicted increase in BMI was associated with worse cognitive (β = -0.12, 95% CI = -0.21, -0.03; <i>p</i> = 0.009) and global recovery (β = -0.36, 95% CI = -0.59, -0.13; <i>p</i> = 0.002). Associations between genetically predicted WHR and post-stroke recovery were directionally concordant but were not statistically significant (<i>p</i> > 0.05).</p><p><strong>Discussions and conclusions: </strong>Human genetic evidence suggests that elevated adiposity negatively impacts multiple post-stroke outcomes, including motor function, cognition, and overall recovery. The biological pathways underlying these associations warrant further investigation.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251319916"},"PeriodicalIF":5.8,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11830152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426357","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":"Outcomes of arteriovenous malformation patients with multiple versus single feeders: A multicenter retrospective study with propensity-score matching.","authors":"Basel Musmar, Nimer Adeeb, Hammam Abdalrazeq, Joanna M Roy, Stavropoula I Tjoumakaris, Hamza Adel Salim, Douglas Kondziolka, Jason Sheehan, Christopher S Ogilvy, Howard Riina, Sandeep Kandregula, Adam A Dmytriw, Kareem El Naamani, Ahmed Abdelsalam, Natasha Ironside, Deepak Kumbhare, Cagdas Ataoglu, Muhammed Amir Essibayi, Abdullah Keles, Sandeep Muram, Daniel Sconzo, Arwin Rezai, Omar Alwakaa, Salem M Tos, Ufuk Erginoglu, Johannes Pöppe, Rajeev D Sen, Christoph J Griessenauer, Jan-Karl Burkhardt, Robert M Starke, Mustafa K Baskaya, Laligam N Sekhar, Michael R Levitt, David J Altschul, Malia McAvoy, Assala Aslan, Abdallah Abushehab, Christian Swaid, Adib A Abla, Saman Sizdahkhani, Sravanthi Koduri, Elias Atallah, Spyridon Karadimas, M Reid Gooch, Robert H Rosenwasser, Christopher Stapleton, Matthew Koch, Visish M Srinivasan, Peng R Chen, Spiros Blackburn, Joseph Cochran, Omar Choudhri, Bryan Pukenas, Darren Orbach, Edward Smith, Pascal J Mosimann, Ali Alaraj, Mohammad A Aziz-Sultan, Aman B Patel, Hugo H Cuellar, Michael Lawton, Bharat Guthikonda, Jacques Morcos, Pascal Jabbour","doi":"10.1177/23969873251319924","DOIUrl":"10.1177/23969873251319924","url":null,"abstract":"<p><strong>Introduction: </strong>The impact of multiple feeding arteries on clinical outcomes of cerebral arteriovenous malformations (AVMs) is not well understood. This study aims to compare outcomes between AVMs with multiple versus single feeding arteries.</p><p><strong>Patients and methods: </strong>Data from the Multicenter International Study for Treatment of Brain AVMs (MISTA) consortium were analyzed. Propensity score matching (PSM) was used to balance cohorts. Subgroup analysis was conducted for ruptured and unruptured AVMs and different treatment options, and multivariable logistic regression was applied to assess the impact of feeding artery origin.</p><p><strong>Results: </strong>Among 953 patients, 661(69.4%) had multiple feeding arteries, and 292 (30.6%) had a single feeding artery. After PSM, which included 422 matched patients (211 in each group), the differences in obliteration rates (68.7% vs 74.8%, OR 0.73, 95% CI: 0.48-1.12, <i>p</i> = 0.16) and symptomatic complications (15.6% vs 11.8%, OR 1.37, 95% CI: 0.78-2.41, <i>p</i> = 0.25) were not significant. Subgroup analysis comparing ruptured and unruptured AVMs and different treatment options showed no significant differences across all subgroups. Multivariable analysis identified PICA feeders as significantly associated with increased odds of all complications (OR 7.33, 95% CI: 2.14-25.1, <i>p</i> = 0.002).</p><p><strong>Discussion and conclusion: </strong>AVMs with a single feeding artery were more likely to present with rupture, but no significant differences in obliteration rates or complications were observed between the groups after PSM. These findings suggest that while the number of feeding arteries may influence the initial presentation, it does not appear to impact overall treatment success or patient prognosis. Further prospective studies are needed to confirm these findings.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251319924"},"PeriodicalIF":5.8,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11830163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426374","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":"23969873251319172"},"PeriodicalIF":5.8,"publicationDate":"2025-02-14","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":"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":"23969873251319151"},"PeriodicalIF":5.8,"publicationDate":"2025-02-14","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":"Predictors and outcome of deterioration during admission in patients with cerebral venous thrombosis.","authors":"Margarida Ferro, Sofia Bettencourt, Mafalda Soares, Mariana Baptista, Cláudia Marques-Matos, Isabel Fragata, Ana Paiva Nunes, Diana Aguiar de Sousa","doi":"10.1177/23969873251315340","DOIUrl":"10.1177/23969873251315340","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral venous thrombosis (CVT) is a less common stroke subtype. While long term outcome factors have been extensively studied, short term deterioration remains poorly understood.</p><p><strong>Patients and methods: </strong>We conducted a 10-years retrospective analysis at a high-volume tertiary center, including consecutive patients diagnosed with CVT. The primary outcome was early deterioration (ED), defined as decrease in Glasgow Coma Scale, <i>de novo</i> or worsening of focal deficit, death from neurological cause, new or enlarged parenchymal lesions or subarachnoid hemorrhage during hospitalization. Multivariable logistic regression analysis was performed to identify factors associated with ED.</p><p><strong>Results: </strong>We included 138 patients (81.2% female, median age 42.0 years (IQR 29.3-49.0)). Forty-five (32.6%) patients had ED, with 33 (23.9%) showing clinical deterioration and 35 of 104 (33.7%) imaging worsening. Variables selected from the multivariate model for association with ED were aphasia (OR 4.63, 95% CI 1.61-13.32), motor deficits (OR 2.34, 95% CI 0.97-5.61), and parenchymal lesion (OR 3.65, 95% CI 1.38-9.67). Twenty-seven patients underwent endovascular treatment after deterioration. Patients in the ED group had worse functional outcome at discharge, 6 and 12 months (<i>p</i> < 0.001).</p><p><strong>Discussion: </strong>One third of patients in this cohort experienced ED. Patients with aphasia, motor deficit, or parenchymal brain lesion at baseline were at higher risk. These patients performed worse at long term follow-up.</p><p><strong>Conclusion: </strong>We identified predictors of ED in patients with CVT. These patients should be carefully monitored. These findings may inform the design of future clinical trials aimed at evaluating additional therapeutic interventions in the acute phase.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251315340"},"PeriodicalIF":5.8,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391711","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":"First ischemic stroke in young adults: Sex and age-related differences in stroke rates, risk factors, and etiologies.","authors":"Thomas R Schneider, Tolga D Dittrich, Timo Kahles, Mira Katan, Andreas R Luft, Marie-Luise Mono, Manuel Bolognese, Marcel Arnold, Mirjam Heldner, Patrik Michel, Elisabeth Dirren, Biljana Rodic, Carlo W Cereda, Nils Peters, Leo H Bonati, Susanne Renaud, Andrea M Humm, Friedrich Medlin, Sylvan Albert, Rolf Sturzenegger, Alexander A Tarnutzer, Philip Siebel, Markus Baumgärtner, Christian Berger, Pasquale Mordasini, Jochen Vehoff, Krassen Nedeltchev, Gian Marco De Marchis","doi":"10.1177/23969873251317347","DOIUrl":"10.1177/23969873251317347","url":null,"abstract":"<p><strong>Introduction: </strong>Sex differences in stroke incidence, vascular risk factors (VRFs), and etiologies among young adults remain underexplored, particularly regarding age-related patterns.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed young adults (18-55 years) with first-ever ischemic stroke treated at certified acute stroke units/centers between 2014 and 2022, using Swiss Stroke Registry data. Stroke rates (per 100,000 person-years), VRFs, and etiologies were assessed by age and sex.</p><p><strong>Results: </strong>Among 3,995 stroke patients, stroke rates were similar between sexes until age 35, after which men showed a more pronounced exponential increase. This rise was particularly notable in patients with elevated BMI and ⩾2 VRFs. The proportion of patients with ⩾2 VRFs rose with age (18-35: 22%; 36-50: 48%; 51-55: 63%). While no statistically significant differences in VRF profiles were observed between men and women aged 18-35, men accumulated VRFs about five years earlier than women, leading to a higher prevalence of multiple VRFs in men aged 36-50, with the gap narrowing in the 51-55 group. Stroke etiologies shifted with age: patent foramen ovale and cervical artery dissection predominated in younger patients, while large artery atherosclerosis, small vessel disease, and strokes of undetermined etiology increased with age, with notable sex differences.</p><p><strong>Discussion and conclusions: </strong>This study highlights sex and age differences in ischemic stroke rates, VRFs, and etiologies among adults under 55 years. After 35, stroke rates rose more sharply in men, paralleling their higher VRF burden. These findings emphasize the importance of early management of VRFs-including overweight-to mitigate stroke risk.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251317347"},"PeriodicalIF":5.8,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366302","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}