European Stroke Journal最新文献

{"title":"Intravenous thrombolysis in young adults with ischemic stroke: A cohort study from the international TRISP collaboration.","authors":"Miranda Nybondas, Nicolas Martinez-Majander, Peter Ringleb, Matthias Ungerer, Christoph Gumbinger, Simon Trüssel, Valerian Altersberger, Jan F Scheitz, Regina von Rennenberg, Christoph Riegler, Charlotte Cordonnier, Andrea Zini, Guido Bigliardi, Francesca Rosafio, Patrik Michel, Nabila Wali, Paul J Nederkoorn, Mirjam Heldner, Marialuisa Zedde, Rosario Pascarella, Visnja Padjen, Ivana Berisavac, Yannick Béjot, Jukka Putaala, Gerli Sibolt, Marjaana Tiainen, Laura Mannismäki, Tuomas Mertsalmi, Elina Myller, Alessandro Pezzini, Ronen R Leker, Georg Kägi, Susanne Wegener, Carlo W Cereda, Annika Nordanstig, George Ntaios, Christian H Nolte, Henrik Gensicke, Stefan T Engelter, Sami Curtze","doi":"10.1177/23969873241304305","DOIUrl":"10.1177/23969873241304305","url":null,"abstract":"<p><strong>Background and aims: </strong>Previous observational data indicate that young adults treated with intravenous thrombolysis (IVT) for acute ischemic stroke have more favorable outcomes and less complications when compared to older adults. Given the limited data on this topic, we aimed to provide more evidence on clinical outcomes and safety in such patients, using a large international thrombolysis registry.</p><p><strong>Methods: </strong>In this prospective multicenter study, we used data from the Thrombolysis in Ischemic Stroke Patients (TRISP) registry from 1998 to 2020. Patients who received endovascular treatment (EVT), as only treatment or in addition to IVT, were not included in this cohort. Using multivariable regression models, we compared thrombolysed young patients aged 18-49 years with those aged ⩾50 years with regards to the following outcomes: favorable outcome in stroke survivors (modified Rankin Scale ⩽2), symptomatic intracranial hemorrhage (sICH) according to European Cooperative Acute Stroke Study II (ECASS II) criteria, and three-months all-cause death.</p><p><strong>Results: </strong>Of the 16,651 IVT treated patients, 1346 (8.1%) were 18-49 years. Young adults in TRISP were more often male (59.6% vs 54.0%), had a lower median NIHSS score on admission, 7 (4-13) versus 8 (5-15), and had less cardiovascular risk factors except for smoking (42.0% vs 19.0%) when compared to older patients. When compared to thrombolysed patients aged ⩾50 years, a favorable functional outcome was more likely in young adults: 81.9% versus 56.4%, aOR 2.30 (1.80-2.95), whilst sICH 1.6% versus 4.6%, aOR 0.45 (0.23-0.90) and death 2.3% versus 14.2%, aOR 0.21 (0.11-0.39) were less likely.</p><p><strong>Conclusions: </strong>Intravenous thrombolysis in young adults is independently associated with higher rates of favorable outcomes and lower rates of complications.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"721-729"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802761","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":"Mortality in ischaemic stroke patients without standard modifiable risk factors: An analysis of the Riksstroke registry.","authors":"James Beharry, Vignan Yogendrakumar, Guilherme W F Barros, Stephen M Davis, Bo Norrving, Gemma A Figtree, Geoffrey Donnan, Mia von Euler, Marie Eriksson","doi":"10.1177/23969873241309516","DOIUrl":"10.1177/23969873241309516","url":null,"abstract":"<p><strong>Introduction: </strong>Little is known of the long-term prognosis of patients with acute ischaemic stroke in the absence of standard modifiable stroke risk factors (SMoRFs). In acute coronary syndromes, patients without modifiable risk factors have a higher mortality rate. We analysed data from the Swedish Stroke Register to determine survival of patients without SMoRFs following an ischaemic stroke.</p><p><strong>Patients and methods: </strong>We identified adult patients with first-presentation acute ischaemic stroke between 2010 and 2020. Patients were considered to possess a SMoRF if they had one of: hypertension, diabetes, hyperlipidaemia, atrial fibrillation or an active smoking history. We compared mortality in patients with and without SMoRFs following first-presentation ischaemic stroke using cox regression models. We also assessed the combined endpoint death and dependency (mRS 3-6) at 3 months via logistic regression models.</p><p><strong>Results: </strong>Of 152,588 patients with ischaemic stroke, hypertension (58.7%) and atrial fibrillation (27.3%) were the most common risk factors. 34,019 patients (22.3%) had no SMoRFs. After a first-presentation ischaemic stroke, patients without SMoRFs had a lower risk of death than patients with one or more SMoRFs (HR 0.58 [95% CI 0.57-0.59]). The absence of SMoRFs was associated with lower odds of death and dependency at 3 months in logistic regression models (OR 0·60 [95% CI 0.58-0.62]).</p><p><strong>Conclusion: </strong>One in five patients with acute ischaemic stroke had no standard modifiable stroke risk factors. These patients have lower risk of death compared to patients with one or more SMoRFs.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"813-821"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11694267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to consider health services dedicated for adults living with cerebral small vessel disease: Report of a ESO scientific seminar.","authors":"Carmen Arteaga-Reyes, Dwaipayan Sen, Salvatore Rudilosso, Eric Jouvent, Dominique Hervé, Arne G Lindgren, Joanna M Wardlaw, Susanna Melkas, Fergus N Doubal","doi":"10.1177/23969873241309506","DOIUrl":"10.1177/23969873241309506","url":null,"abstract":"<p><strong>Purpose: </strong>Cerebral small vessel disease (cSVD) is a highly prevalent disorder leading to physical, cognitive and functional decline. We report key barriers in the management of individuals with cSVD, the potential benefit of cSVD-dedicated health services, and evidence from existing models of care for adults with cSVD.</p><p><strong>Methods: </strong>We examined information from a scientific seminar developed between seven experts in cSVD during the eighth European Stroke Organisation Conference that discussed the optimal health care for adults with cSVD and what health services dedicated to cSVD should include.</p><p><strong>Findings: </strong>Barriers in cSVD care include unrecognised symptoms and modifiable risk factors, heterogeneity of clinical presentations, inefficient inter/intra-clinical services communication/organisation, and uncertainties regarding what assessments/treatments should be routinely done, when and by whom. However, existing health services and research studies suggest models of care in cSVD. Multi-step approaches can be used for identification and aetiological workup in individuals with cSVD, including basic and selected advanced evaluations, for example, monogenic cSVD testing. Although current guidelines for management of cSVD illlustrate limitations, there are recommendations on risk factors and lifestyle considerations, as well as pharmacological and non-pharmacological interventions for people with cSVD.</p><p><strong>Discussion and conclusion: </strong>Existing healthcare models do not provide optimal care for individuals with cSVD. Lack of awareness of heterogeneous clinical presentations and uncertainty in threshold of cSVD 'burden' for referral to specialist multidisciplinary services, are key challenges for health services to overcome. Creating cSVD-dedicated services may prevent underdiagnosing and achieve standardised holistic management to improve outcomes in people with cSVD. However, adequate prevention and early management should be offered at all levels of care.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"675-681"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care ultrasound of the common carotid arteries for detection of large vessel occlusion stroke: Results of the POCUS-LVO study.","authors":"João Pinho, Anna Tyurina, Celina Hartmann, Omar Abu Audeh, Pardes Habib, Ramy Abdelnaby, Oliver Matz, Marc Felzen, Jörg C Brokmann, Martin Wiesmann, Jörg B Schulz, Omid Nikoubashman, Arno Reich","doi":"10.1177/23969873251315337","DOIUrl":"10.1177/23969873251315337","url":null,"abstract":"<p><strong>Introduction: </strong>Distal arterial occlusions can cause measurable changes in the flow wave profile in proximal segments of the feeding artery. Our objective was to study the diagnostic accuracy of point-of-care ultrasound (POCUS) of the common carotid arteries (CCA) for detection of anterior circulation large vessel occlusion (ac-LVO) in patients with suspected stroke.</p><p><strong>Patients and methods: </strong>We conducted a prospective, single-center, observational study of adult patients with suspected stroke admitted in the emergency department. Flow wave profiles of both CCAs were generated by non-specialists using POCUS as soon as possible after admission. ac-LVO was defined as an internal carotid artery or M1 occlusion in CT- or MR-angiography. The diagnostic performances for detection of ac-LVO using flow wave parameters were calculated.</p><p><strong>Results: </strong>Among 283 patients recruited during a 10-month period, 257 patients (91%) had CCA ultrasound images of sufficient quality and were included for analysis. The mean age was 75 years (IQR 62-83), 131 were female (51.0%), median baseline NIHSS was 2 (IQR 0-5). The most frequent final diagnosis was ischemic stroke (49.4%), ac-LVO was present in 30 patients (11.9%). The median duration of POCUS was 3 min (IQR 2-5). Among all flow wave parameters, the highest diagnostic accuracy for ac-LVO detection was found for end-diastolic velocity difference between sides (AUC = 0.90, 95%CI = 0.85-0.93), with a specificity of 83% (95%CI = 78-88%) at a predefined sensitivity threshold of 80%.</p><p><strong>Discussion and conclusion: </strong>POCUS of the CCA in patients with suspected stroke can predict the presence of ac-LVO. These results need to be replicated in a prehospital setting.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"853-861"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068516","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":"995-1002"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","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":"Acute treatment and secondary prevention for patients with minor stroke or transient ischemic attack: A Bayesian network meta-analysis.","authors":"Sitong Guo, Shiran Qin, Dandan Xu, Chunxia Chen, Xiaoyu Chen","doi":"10.1177/23969873241303686","DOIUrl":"10.1177/23969873241303686","url":null,"abstract":"<p><strong>Introduction: </strong>The efficacy of different antiplatelet treatment in minor strokes (MSs) or transient ischemic attacks (TIAs) and that of antiplatelet and intravenous thrombolysis (IVT) in MSs remain controversial.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Web of Science and the Cochrane Library to identify all eligible articles until April 12, 2024. Efficacy outcomes were all-cause mortality, excellent outcome, functional independence and recurrent stroke. Safety outcomes were any types of bleeding and intracerebral hemorrhage (ICH). The associations were calculated for the overall data by using odds ratios (ORs).</p><p><strong>Results: </strong>Twenty three high-quality studies with 10 RCTs and 13 non-RCTs were included, involving 47,135 patients with MSs or TIAs. In MSs or TIAs, dual antiplatelet therapies (DAPTs) significantly improved the modified Rankin Scale (mRS) scores for patients with recurrent stroke, major vascular events and ischemic stroke although it was associated with an increased risk of ICH and bleeding when compared to aspirin. In MSs, compared to IVT, DAPT had a significant advantage in improving the mRMS scores and SAPT and DAPT significantly reduced the risk of any bleeding or sICH. IVT significantly reduced all-cause mortality, although it also increased the risk of sICH and ICH compared to no IVT.</p><p><strong>Conclusions: </strong>In MSs or TIAs, compared to aspirin, DAPTs can effectively prevent the recurrence of post-stroke neurological dysfunction and ischemic events, but it may increase the risk of ICH together with moderate or severe bleeding. Dipyridamole + aspirin resulted in the lowest risk of bleeding. In MSs, compared to IVT, DAPT may be associated with better improvements in neurological function, and it may not increase the risk of bleeding.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"682-693"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11607710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755557","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":"Left ventricular disease as a risk factor for adverse outcomes and stroke recurrence in patients with embolic stroke of undetermined source.","authors":"Angelo Cascio Rizzo, Ghil Schwarz, Andrea Bonelli, Andrea Magi, Elio Clemente Agostoni, Antonella Moreo, Maria Sessa","doi":"10.1177/23969873241311331","DOIUrl":"10.1177/23969873241311331","url":null,"abstract":"<p><strong>Background: </strong>Severe left ventricular (LV) systolic dysfunction (ejection fraction [EF] < 30%) is a known cardiovascular risk factor and a major cause of cardioembolism. However, less severe forms of LV disease (LVD), such as mild-to-moderate LV dysfunction and LV wall motion abnormalities (LVWMAs), are considered potential minor cardiac sources in Embolic Stroke of Undetermined Source (ESUS), but their role is underexplored. This study aims to evaluate the prevalence of LVD in ESUS and its association with adverse vascular events and mortality.</p><p><strong>Methods: </strong>Retrospective, single-center study including consecutive ESUS patients admitted from January 2016 to May 2024. LVD was defined as either global systolic dysfunction (LV ejection fraction 30%-49%) or regional LVWMAs, unrelated to acute or recent (within 4 weeks) myocardial infarction. Univariate and multivariate Cox regression analyses evaluated the association of LVD with a primary composite outcome (including ischemic stroke recurrence, acute coronary events, and all-cause mortality), and its components separately.</p><p><strong>Results: </strong>Among the 556 ESUS patients (median age 71 years [IQR 60-80], 44.6% female), 95 (17.1%) had LVD, including 51 (53.7%) with reduced LVEF (30%-49%), and 81 (85.3%) presenting LVWMAs. During follow-up (median 30 months), LVD(+) patients had significantly higher rates of the composite outcome (41.0% vs 21.3%, <i>p</i> < 0.001), ischemic stroke recurrence (13.7% vs 5.9%, <i>p</i> = 0.007), acute coronary events (7.4% vs 2.4%, <i>p</i> = 0.012), and all-cause mortality (28.4% vs 15.2%, <i>p</i> = 0.002), compared to LVD(-) patients. Multivariate Cox regression analysis showed that LVD independently increased the risk of ischemic stroke recurrence (adjusted HR 2.13, 95%CI 1.08-4.24, <i>p</i> = 0.032) and the composite outcome (aHR 1.92, 95%CI 1.27-2.90, <i>p</i> = 0.002), but not acute coronary events (aHR 1.65; 95%CI 0.54-5.01, <i>p</i> = 0.374), or all-cause mortality (aHR 1.62; 95%CI 0.98-2.70, <i>p</i> = 0.062).</p><p><strong>Conclusions: </strong>LVD is significantly associated with an increased risk of ischemic stroke recurrence and adverse outcomes in ESUS patients. These findings highlight the clinical importance of identifying and optimizing LVD management among ESUS to improve long-term outcomes in this population.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"757-765"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11700389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of current national hospital-based stroke registries monitoring access to evidence-based care and patient outcomes.","authors":"Chloe Leigh, Jodie Gill, Zainab Razak, Shirsho Shreyan, Dominique A Cadilhac, Joosup Kim, Natasha A Lannin, Martin Dennis, Moira Kapral, Jeyaraj Pandian, Yudi Hardianto, Beilei Lin, Atte Meretoja, Noor Azah Abd Aziz, Lee Schwamm, Bo Norrving, Lekhjung Thapa, Marshall Dozier, Shyam Kelavkar, Gillian Mead","doi":"10.1177/23969873241311821","DOIUrl":"10.1177/23969873241311821","url":null,"abstract":"<p><strong>Background: </strong>National stroke clinical quality registries/audits support improvements in stroke care. In a 2016 systematic review, 28 registries were identified. Since 2016 there have been important advances in stroke care, including the development of thrombectomy services. Therefore, we sought to understand whether registries have evolved with these advances in care. The aim of this systematic review was to identify current, hospital-based national stroke registries/audits and describe variables (processes, outcome), methods, funding and governance).</p><p><strong>Methods: </strong>We searched four databases (21st May 2015 to 1st February 2024), grey literature and stroke organisations' websites. Initially two reviewers screened each citation; when agreement was satisfactory, one of four reviewers screened each citation. The same process was applied to full texts. If there were no new publications from registries identified in the original 2016 review, we contacted the registry leads. We extracted data using predefined categories on country (including income level), clinical/process variables, methods, funding and governance.</p><p><strong>Results: </strong>We found 37 registries from 31 countries (28 high income, four upper-middle income, five lower-middle income) of which 16 had been identified in 2016 and 21 were new. Twenty-two of the same variables were collected by >50% of registries/audits (mostly acute care, including thrombectomy, and secondary prevention), compared with only four variables in 2016. Descriptions of funding, management, methods of consent and data privacy, follow-up, feedback to hospitals, linkage to other datasets and alignment of variables with guidelines were variably reported. Reasons for apparent termination of some registries was unclear.</p><p><strong>Conclusions: </strong>The total number of stroke registries has increased since 2016, and the number of variables collected has increased, reflecting advances in stroke care. However, some registries appeared to have ceased; the reasons are unclear.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"646-654"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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":"902-910"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","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":"Endovascular treatment for isolated cervical internal carotid artery occlusion: ETIICA study.","authors":"João Pedro Marto, Christoph Riegler, Pimrapat Gebert, Tilman Reiff, Marek Sykora, Marcin Wiącek, David Pakizer, André Araújo, Adrien Ter Schiphorst, João André Sousa, Arno Reich, Belen Flores Pina, Lukas Mayer-Suess, Cristina Hobeanu, Marialuisa Zedde, João Nuno Ramos, Georgios Tsivgoulis, Pedro Castro, Sven Poli, José Nuno Alves, Anne Dusart, Blanca Fuentes, Herbert Tejada Meza, Jelle Demeestere, Susanne Wegener, Lars Kellert, Patricia Calleja, Cristina Panea, Christoph Vollmuth, Liliana Pereira, Ronen R Leker, Timo Uphaus, Andrea Zini, Henrik Gensicke, Gauthier Duloquin, Taraneh Ebrahimi, Alexander Salerno, Cristina Tiu, Thanh N Nguyen, Sebastian García-Madrona, Marta Bilik, Shadi Yaghi, Halina Sienkiewicz-Jarosz, Michał Karliński, Stefan Krebs, Eva Hurtíková, Nathalia Ferreira, João Sargento-Freitas, João Pinho, Isabel Rodriguez Caamaño, Elke Ruth Gizewski, Pierre Seners, Rosario Pascarella, Klearchos Psychogios, Alexandra Gomez Exposito, Sara Gomes, Flavio Bellante, Jorge Rodríguez-Pardo, Mario Bautista Lacambra, Robin Lemmens, Corinne Inauen, Johannes Wischmann, Fernando Ostos, Vlad Tiu, Karl Georg Haeusler, Miguel Rodrigues, Issa Metanis, Marianne Hahn, Maria Maddalena Viola, Simon Truessel, Yannick Bejot, Louisa Nitsch, Davide Strambo, Elena Oana Terecoasa, Mohamad Abdalkader, Alicia de Felipe, Farhan Khan, Caroline Arquizan, Manuel Ribeiro, Martin Roubec, Izabella Tomaszewska-Lampart, Julia Ferrari, Peter Ringleb, Christian H Nolte","doi":"10.1177/23969873251323488","DOIUrl":"10.1177/23969873251323488","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence regarding the benefit of endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (c-ICA-O) is lacking. We assessed the outcomes and safety of EVT in patients with isolated c-ICA-O.</p><p><strong>Methods: </strong>Retrospective multicenter cohort study of patients with an AIS due to isolated c-ICA-O, within 24-h since last-seen-well. Comparisons were made between EVT and best medical therapy (BMT). The primary outcome was 3-months modified Rankin Scale (mRS) ordinal shift. Secondary outcomes included 3-month favorable outcome (mRS 0-2, or return to pre-stroke mRS), symptomatic intracranial hemorrhage (sICH) and any parenchymal hemorrhage. Outcomes were compared combining inverse probability of treatment weighting with regression models and propensity score matching (PSM) as sensitivity analysis.</p><p><strong>Results: </strong>We analyzed 998 patients (66.2% male, mean age 71.1 ± 13.2 years). 487 (48.8%) patients received EVT and 511 (51.2%) received BMT. Patients receiving EVT had a higher admission NIHSS [13 (7-18) vs 5 (2-13)] compared to BMT. There was no difference between EVT and BMT groups in 3-month mRS shift (adjusted common odds ratio [OR], 1.01 [95% CI 0.76-1.34]) and favorable outcome (adjusted OR [aOR] 1.16 [95% CI 0.84-1.60]). No patient (0%) in the BMT group had sICH versus 1.6% in the EVT group. Parenchymal hemorrhage was numerically higher in EVT patients (2.7% vs 0.6%; aOR 3.85 [95% CI 0.98-15.23]). PSM analysis revealed similar results.</p><p><strong>Discussion and conclusion: </strong>In patients with isolated c-ICA-O, EVT was associated with similar odds of disability and intracranial bleeding compared to BMT. Randomized-controlled clinical trials in patients with isolated c-ICA-O are warranted.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"694-704"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524803","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}