European Stroke Journal最新文献

{"title":"Beyond RCTs: Short-term dual antiplatelet therapy in secondary prevention of ischemic stroke and transient ischemic attack.","authors":"Eleonora De Matteis, Raffaele Ornello, Federico De Santis, Matteo Foschi, Michele Romoli, Tiziana Tassinari, Valentina Saia, Silvia Cenciarelli, Chiara Bedetti, Chiara Padiglioni, Bruno Censori, Valentina Puglisi, Luisa Vinciguerra, Maria Guarino, Valentina Barone, Marialuisa Zedde, Ilaria Grisendi, Marina Diomedi, Maria Rosaria Bagnato, Marco Petruzzellis, Domenico Maria Mezzapesa, Pietro Di Viesti, Vincenzo Inchingolo, Manuel Cappellari, Mara Zenorini, Paolo Candelaresi, Vincenzo Andreone, Giuseppe Rinaldi, Alessandra Bavaro, Anna Cavallini, Stefan Moraru, Pietro Querzani, Valeria Terruso, Marina Mannino, Alessandro Pezzini, Giovanni Frisullo, Francesco Muscia, Maurizio Paciaroni, Maria Giulia Mosconi, Andrea Zini, Ruggiero Leone, Carmela Palmieri, Letizia Maria Cupini, Michela Marcon, Rossana Tassi, Enzo Sanzaro, Cristina Paci, Giovanna Viticchi, Daniele Orsucci, Anne Falcou, Susanna Diamanti, Roberto Tarletti, Patrizia Nencini, Eugenia Rota, Federica Nicoletta Sepe, Delfina Ferrandi, Luigi Caputi, Gino Volpi, Salvatore La Spada, Mario Beccia, Claudia Rinaldi, Vincenzo Mastrangelo, Francesco Di Blasio, Paolo Invernizzi, Giuseppe Pelliccioni, Maria Vittoria De Angelis, Laura Bonanni, Giampietro Ruzza, Emanuele Alessandro Caggia, Monia Russo, Agnese Tonon, Maria Cristina Acciarri, Sabrina Anticoli, Cinzia Roberti, Giovanni Manobianca, Gaspare Scaglione, Francesca Pistoia, Alberto Fortini, Antonella De Boni, Alessandra Sanna, Alberto Chiti, Leonardo Barbarini, Marcella Caggiula, Maela Masato, Massimo Del Sette, Francesco Passarelli, Maria Roberta Bongioanni, Danilo Toni, Stefano Ricci, Simona Sacco","doi":"10.1177/23969873241255250","DOIUrl":"10.1177/23969873241255250","url":null,"abstract":"<p><strong>Background and purpose: </strong>Randomized controlled trials (RCTs) proved the efficacy of short-term dual antiplatelet therapy (DAPT) in secondary prevention of minor ischemic stroke or high-risk transient ischemic attack (TIA). We aimed at evaluating effectiveness and safety of short-term DAPT in real-world, where treatment use is broader than in RCTs.</p><p><strong>Methods: </strong>READAPT (REAl-life study on short-term Dual Antiplatelet treatment in Patients with ischemic stroke or Transient ischemic attack) (NCT05476081) was an observational multicenter real-world study with a 90-day follow-up. We included patients aged 18+ receiving short-term DAPT soon after ischemic stroke or TIA. No stringent NIHSS and ABCD² score cut-offs were applied but adherence to guidelines was recommended. Primary effectiveness outcome was stroke (ischemic or hemorrhagic) or death due to vascular causes, primary safety outcome was moderate-to-severe bleeding. Secondary outcomes were the type of ischemic and hemorrhagic events, disability, cause of death, and compliance to treatment.</p><p><strong>Results: </strong>We included 1920 patients; 69.9% started DAPT after an ischemic stroke; only 8.9% strictly followed entry criteria or procedures of RCTs. Primary effectiveness outcome occurred in 3.9% and primary safety outcome in 0.6% of cases. In total, 3.3% cerebrovascular ischemic recurrences occurred, 0.2% intracerebral hemorrhages, and 2.7% bleedings; 0.2% of patients died due to vascular causes. Patients with NIHSS score ⩽5 and those without acute lesions at neuroimaging had significantly higher primary effectiveness outcomes than their counterparts. Additionally, DAPT start >24 h after symptom onset was associated with a lower likelihood of bleeding.</p><p><strong>Conclusions: </strong>In real-world, most of the patients who receive DAPT after an ischemic stroke or a TIA do not follow RCTs entry criteria and procedures. Nevertheless, short-term DAPT remains effective and safe in this population. No safety concerns are raised in patients with low-risk TIA, more severe stroke, and delayed treatment start.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"989-999"},"PeriodicalIF":5.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311991","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":"Quality of early stroke care and long-term mortality in patients with acute stroke: A nationwide follow-up study.","authors":"Heidi Shil Eddelien, Simon Grøntved, Jakob Nebeling Hedegaard, Thordis Thomsen, Christina Kruuse, Søren Paaske Johnsen","doi":"10.1177/23969873241249580","DOIUrl":"10.1177/23969873241249580","url":null,"abstract":"<p><strong>Introduction: </strong>High quality of early stroke care is essential for optimizing the chance of a good patient outcome. The quality of care may be monitored by process performance measures (PPMs) and previous studies have found an association between fulfilment of PPMs and short-term mortality. However, the association with long-term mortality remains to be determined. We aimed to evaluate the association between fulfilment of PPMs and long-term mortality for patients with acute stroke in Denmark.</p><p><strong>Patients and methods: </strong>We used data from Danish health care registers between 2008 and 2020 to identify all patients admitted with incident stroke (haemorrhagic (ICH) or ischaemic stroke). The quality of early stroke care was assessed using 10 PPMs. Mortality was compared using Cox proportional hazard ratios, risk ratios computed using Poisson regression, and standardized relative survival.</p><p><strong>Results: </strong>We included 102,742 patients; 9804 cases of ICH, 88,591 cases of ischaemic stroke, and 4347 cases of unspecified strokes. The cumulative 10-year mortality risk was 56.8%. Fulfilment of the individual PPMs was associated with adjusted hazard rate ratios of death between 0.76 and 0.96. Patients with 100% fulfilment of all PPMs had a lower 10-year post-stroke mortality (adjusted risk ratio 0.90) compared to the patients with 0%-49% fulfilment and a standardized relative survival of 81.3%, compared to the general population.</p><p><strong>Conclusion: </strong>High quality of early stroke care was associated with lower long-term mortality following both ICH and ischaemic stroke, which emphasizes the importance of continued attention on the ability of stroke care providers to deliver high quality of early care.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"1000-1007"},"PeriodicalIF":5.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140852935","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 therapy plus best medical treatment (BMT) versus BMT alone for medIum distal veSsel occlusion sTroke (DISTAL): An international, multicentre, randomized-controlled, two-arm, assessor-blinded trial.","authors":"Psychogios Marios-Nikos, Brehm Alex, Fiehler Jens, Fragata Isabel, Gralla Jan, Katan Mira, Leker Ronen, Machi Paolo, Ribo Marc, Saver Jeffrey L, Strbian Daniel, van Es Adriaan, Zimmer Claus, Rommers Nikki, Balmer Luzia, Fischer Urs","doi":"10.1177/23969873241250212","DOIUrl":"10.1177/23969873241250212","url":null,"abstract":"<p><strong>Rationale: </strong>Whether endovascular therapy (EVT) in addition to best medical treatment (BMT) in people with acute ischemic stroke (AIS) due to a medium distal vessel occlusion (MDVO) is beneficial remains unclear.</p><p><strong>Aim: </strong>To determine if people experiencing an AIS due to an isolated MDVO (defined as the co- or non-dominant M2 segment, the M3 or M4 segment of the middle cerebral artery, the A1, A2, or A3 segment of the anterior cerebral artery or the P1, P2 or P3 segment of the posterior cerebral artery) will have superior outcome if treated with EVT in addition to BMT compared to BMT alone.</p><p><strong>Sample size: </strong>To randomize 526 participants 1:1 to EVT plus BMT or BMT alone.</p><p><strong>Methods and design: </strong>A multicentre, international, prospective, randomized, open-label, blinded-endpoint (PROBE) superiority trial.</p><p><strong>Outcomes: </strong>The primary efficacy endpoint is the distribution of disability levels on the modified Rankin Scale at 90 days. Secondary clinical efficacy outcomes include normalized change in National Institutes of Health Stroke Scale score from baseline to day 1, cognitive outcome at 90 days, and health-related quality of life at 90 days. Safety outcomes include all serious adverse events, symptomatic intracranial hemorrhage within 24 h, and all-cause mortality up to 90 days. Secondary imaging outcomes include successful reperfusion at end of EVT procedure and recanalization of target artery at 24 h.</p><p><strong>Discussion: </strong>DISTAL will inform physicians whether EVT in addition to BMT in people with AIS due to a MDVO is more efficacious than BMT alone.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"1083-1092"},"PeriodicalIF":5.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872958","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":"Nutrition markers and discharge outcome in deep and lobar intracerebral hemorrhage.","authors":"Jonathan Duskin, Nirupama Yechoor, Sanjula Singh, Samantha Mora, Jasper Senff, Christina Kourkoulis, Christopher D Anderson, Jonathan Rosand","doi":"10.1177/23969873241253048","DOIUrl":"10.1177/23969873241253048","url":null,"abstract":"<p><strong>Introduction: </strong>Malnutrition is common in stroke patients and has been associated with poor functional outcomes and increased mortality after stroke. Previous research on nutrition status and post-intracerebral hemorrhage (ICH) outcomes, however, is limited and conflicting.</p><p><strong>Patients and methods: </strong>Monocenter study of patients with spontaneous deep or lobar ICH from a longitudinal cohort enrolling consecutive patients between 1994 and 2022. Nutrition status was assessed using admission body mass index <b>(</b>BMI), albumin, total bilirubin, cholesterol, c-reactive protein, hemoglobin a1c, high-density lipoprotein, hemoglobin, low-density lipoprotein, mean corpuscular volume, alanine transaminase, and triglycerides. Main outcome was favorable discharge outcome (mRS 0-2). Multivariable logistic regression was conducted with adjustment for baseline differences.</p><p><strong>Results: </strong>Among 2170 patients, 1152 had deep and 1018 had lobar ICH. Overweight BMI was associated with higher odds of favorable discharge outcome in all (aOR = 3.01, 95% CI 1.59-5.69, <i>p</i> = 0.001) and lobar (aOR = 3.26, 95% CI 1.32-8.08, <i>p</i> = 0.011) ICH after adjustment for baseline differences. This association did not reach statistical significance in deep (aOR = 2.77, 95% CI 0.99-7.72, <i>p</i> = 0.052) ICH. No lab values were associated with functional outcome in all, deep, or lobar ICH after adjustment.</p><p><strong>Discussion and conclusion: </strong>Overweight BMI was associated with favorable discharge status after ICH. These findings could inform future studies to determine whether overweight BMI has a protective effect in ICH patients.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"1074-1082"},"PeriodicalIF":5.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912995","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":"Artificial intelligence to predict individualized outcome of acute ischemic stroke patients: The SIBILLA project.","authors":"Pietro Caliandro, Jacopo Lenkowicz, Giuseppe Reale, Simone Scaringi, Aurelia Zauli, Christian Uccheddu, Simone Fabiole-Nicoletto, Stefano Patarnello, Andrea Damiani, Luca Tagliaferri, Iacopo Valente, Marco Moci, Mauro Monforte, Vincenzo Valentini, Paolo Calabresi","doi":"10.1177/23969873241253366","DOIUrl":"10.1177/23969873241253366","url":null,"abstract":"<p><strong>Introduction: </strong>Formulating reliable prognosis for ischemic stroke patients remains a challenging task. We aimed to develop an artificial intelligence model able to formulate in the first 24 h after stroke an individualized prognosis in terms of NIHSS.</p><p><strong>Patients and methods: </strong>Seven hundred ninety four acute ischemic stroke patients were divided into a training (597) and testing (197) cohort. Clinical and instrumental data were collected in the first 24 h. We evaluated the performance of four machine-learning models (Random Forest, <i>K</i>-Nearest Neighbors, Support Vector Machine, XGBoost) in predicting NIHSS at discharge both in terms of variation between discharge and admission (regressor approach) and in terms of severity class namely NIHSS 0-5, 6-10, 11-20, >20 (classifier approach). We used Shapley Additive exPlanations values to weight features impact on predictions.</p><p><strong>Results: </strong>XGBoost emerged as the best performing model. The classifier and regressor approaches perform similarly in terms of accuracy (80% vs 75%) and f1-score (79% vs 77%) respectively. However, the regressor has higher precision (85% vs 68%) in predicting prognosis of very severe stroke patients (NIHSS > 20). NIHSS at admission and 24 hours, GCS at 24 hours, heart rate, acute ischemic lesion on CT-scan and TICI score were the most impacting features on the prediction.</p><p><strong>Discussion: </strong>Our approach, which employs an artificial intelligence based-tool, inherently able to continuously learn and improve its performance, could improve care pathway and support stroke physicians in the communication with patients and caregivers.</p><p><strong>Conclusion: </strong>XGBoost reliably predicts individualized outcome in terms of NIHSS at discharge in the first 24 hours after stroke.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"1053-1062"},"PeriodicalIF":5.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082422","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":"Enhancement of STroke REhabilitation with Levodopa (ESTREL): Rationale and design of a randomized placebo-controlled, double blind superiority trial.","authors":"Annaelle Zietz, Josefin E Kaufmann, Karin Wiesner, Sandro Kevin Fischer, Martina Wiegert, Wilma Dj Verhagen-Kamerbeek, Yannik Rottenberger, Anne Schwarz, Nils Peters, Henrik Gensicke, Friedrich Medlin, Jens Carsten Möller, Bartosz Bujan, Leo H Bonati, Marcel Arnold, Sabine Schaedelin, René M Müri, Lars G Hemkens, Patrik Michel, Philippe A Lyrer, Jeremia P Held, Gary A Ford, Andreas R Luft, Christopher Traenka, Stefan T Engelter","doi":"10.1177/23969873241255867","DOIUrl":"10.1177/23969873241255867","url":null,"abstract":"<p><strong>Rationale: </strong>Novel therapeutic approaches are needed in stroke recovery. Whether pharmacological therapies are beneficial for enhancing stroke recovery is unclear. Dopamine is a neurotransmitter involved in motor learning, reward, and brain plasticity. Its prodrug levodopa is a promising agent for stroke recovery.</p><p><strong>Aim and hypothesis: </strong>To investigate the hypothesis that levodopa, in addition to standardized rehabilitation therapy based on active task training, results in an enhancement of functional recovery in acute ischemic or hemorrhagic stroke patients compared to placebo.</p><p><strong>Design: </strong>ESTREL (<u>E</u>nhancement of <u>S</u>troke <u>RE</u>habilitation with <u>Levodopa</u>) is a randomized (ratio 1:1), multicenter, placebo-controlled, double-blind, parallel-group superiority trial.</p><p><strong>Participants: </strong>610 participants (according to sample size calculation) with a clinically meaningful hemiparesis will be enrolled ⩽7 days after stroke onset. Key eligibility criteria include (i) in-hospital-rehabilitation required, (ii) capability to participate in rehabilitation, (iii) previous independence in daily living.</p><p><strong>Intervention: </strong>Levodopa 100 mg/carbidopa 25 mg three times daily, administered for 5 weeks in addition to standardized rehabilitation. The study intervention will be initiated within 7 days after stroke onset.</p><p><strong>Comparison: </strong>Matching placebo plus standardized rehabilitation.</p><p><strong>Outcomes: </strong>The primary outcome is the between-group difference of the Fugl-Meyer-Motor Assessment (FMMA) total score measured 3 months after randomization. Secondary outcomes include patient-reported health and wellbeing (PROMIS 10 and 29), patient-reported assessment of improvement, Rivermead Mobility Index, modified Rankin Scale, National Institutes of Health Stroke Scale (NIHSS), and as measures of harm: mortality, recurrent stroke, and serious adverse events.</p><p><strong>Conclusion: </strong>The ESTREL trial will provide evidence of whether the use of Levodopa in addition to standardized rehabilitation in stroke patients leads to better functional recovery compared to rehabilitation alone.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"1093-1102"},"PeriodicalIF":5.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141296918","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":"Gadolinium leakage into ocular structures as a marker in stroke: A retrospective analysis of the WAKE-UP trial.","authors":"Anke Wouters, Tim Van Assche, Lauranne Scheldeman, Bastian Cheng, Claus Ziegler Simonsen, Martin Ebinger, Norbert Nighoghossian, Keith W Muir, Matthias Endres, Jochen B Fiebach, Salvador Pedraza, Christian Gerloff, Vincent Thijs, Götz Thomalla, Robin Lemmens","doi":"10.1177/23969873241301276","DOIUrl":"https://doi.org/10.1177/23969873241301276","url":null,"abstract":"<p><strong>Introduction: </strong>Blood-brain barrier disruption in acute ischemic stroke is a well described phenomenon associated with hemorrhagic complications. The hyperintense acute reperfusion marker (HARM) represents gadolinium leakage in the cerebrospinal fluid. Gadolinium leakage into ocular structures (GLOS) might represent a dysfunction of the blood-ocular barrier. We aimed to investigate the presence of GLOS in the WAKE-UP trial and its association with HARM, hemorrhagic transformation (HT) and functional outcome.</p><p><strong>Patients and methods: </strong>Randomized patients from the WAKE-UP trial who underwent dynamic susceptibility contrast perfusion weighted imaging at baseline and fluid attenuated inversion recovery (FLAIR) imaging at both baseline and follow-up, were included. We studied the association between GLOS with baseline and outcome variables.</p><p><strong>Results: </strong>We were able to analyze the data of 192/503 (38%) randomized WAKE-UP patients. GLOS was detected in 56 (29%) cases, four times more frequently than HARM (7%). GLOS positive patients were older (73 vs 65 years; <i>p</i> < 0.01), had a lower glomerular infiltration rate (GFR 79.5 vs 87.2 mL/min; <i>p</i> = 0.01), higher white matter hyperintensity volume (15.0 vs 9.9 mL; <i>p</i> < 0.01), less often presented with a large vessel occlusion (27% vs 44%; <i>p</i> = 0.02) and HARM was more often observed (9/56 vs 4/136; <i>p</i> = 0.01). In multivariable analysis the presence of GLOS was not associated with HT nor poor functional outcome (modified Rankin scale 3-6).</p><p><strong>Discussion and conclusion: </strong>GLOS is a relatively common finding in acute ischemic stroke patients and is associated with older age, worse renal function, increased white matter hyperintensity burden and HARM but not with HT or functional outcome.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241301276"},"PeriodicalIF":5.8,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke triage using the FAST-ED score shortens process times in large vessel occlusion strokes in a physician staffed pre-hospital emergency medical (PHEM) system.","authors":"Hanna Illian, Clemens Grimm, Anna Haller, Jan Liman, Marios Nikos Psychogios, Christian Heiner Riedel, Sabine Blaschke, Meike Bettina Göricke, Markus Roessler, Nils Kunze-Szikszay","doi":"10.1177/23969873241301884","DOIUrl":"10.1177/23969873241301884","url":null,"abstract":"<p><strong>Introduction: </strong>The impact of streamlining algorithms for stroke patients on process times in pre-hospital emergency medicine (PHEM) is not well investigated. We analyzed the changes in pre- and in-hospital process times after implementation of a streamlining algorithm in a physician staffed PHEM system.</p><p><strong>Patients: </strong>We conducted a prospective observational study and analyzed process times of adult stroke patients attended by emergency physicians (EP) of the city of Göttingen PHEM service after implementation of a streamlining algorithm including stroke triage using the FAST-ED score. Stroke patients with standard emergency treatment attended before the implementation served as a control group. All patients were transported directly to the University Medical Center Göttingen (UMG) and received endovascular therapy (EVT) and/or systemic thrombolytic therapy.</p><p><strong>Results: </strong>Of 75 suitable patients eligible in the study group, 37 (49.3%) received EVT and were compared to 44 patients in the control group. Pre-hospital process times did not differ significantly. Median door-to-CT time (12 vs 18 min, <i>p</i> = 0.017) and door-to-lysis time (20 vs 24 min, <i>p</i> = 0.005) were significantly shorter in the study group. Door-to-groin time was also shortened in the study group (42 vs 49 min) but not significantly (<i>p</i> = 0.088).</p><p><strong>Discussion and conclusions: </strong>Our findings indicate that a PHEM streamlining algorithm (namely the FAST-ED score) can significantly shorten in-hospital process times without delaying pre-hospital care. This improved coordination between PHEM and in-hospital emergency medicine (IHEM) may enhance neurological outcomes for stroke patients. Further research is needed to confirm these results and assess their applicability in other healthcare settings.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241301884"},"PeriodicalIF":5.8,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717591","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-varying differences in stroke recurrence risk between types of atrial fibrillation based on screening methods and timing of detection.","authors":"Alonso Alvarado-Bolanos, Diana Ayan, Facundo Lodol, Alexander V Khaw, Lauren M Mai, Jennifer L Mandzia, Marko Mrkobrada, Maria Bres-Bullrich, Lorraine Fleming, Corbin Lippert, Meredith Cecile, Rodrigo Bagur, Sebastian Fridman, Luciano A Sposato","doi":"10.1177/23969873241300888","DOIUrl":"10.1177/23969873241300888","url":null,"abstract":"<p><strong>Introduction: </strong>Atrial fibrillation (AF) burden progresses with time. Among ischemic stroke (IS) patients, AF can be detected at different burden progression stages based on the timing and screening method. We hypothesized that AF detected after IS on 12-lead ECGs (ECG-AF) and via 14-day-Holter prolonged cardiac monitoring (AFDAS) are linked to lower IS recurrence risk than AF known before stroke occurrence (KAF) because of being at an earlier progression stage than KAF. Additionally, we posited that IS recurrence risk differences between AF types vary over time due to their differential progression stages.</p><p><strong>Patients and methods: </strong>Retrospective observational cohort study including IS/TIA patients with KAF, ECG-AF, and AFDAS [2018-2021]. Adjusted hazard ratios (aHR) were estimated using multivariable cause-specific Cox proportional-hazard models to compare IS recurrence between ECG-AF versus KAF and AFDAS versus KAF. Proportional hazards assumptions were tested to assess whether IS recurrence risk differences were time-varying.</p><p><strong>Results: </strong>Of 758 AF patients (385 KAF, 236 ECG-AF, 137 AFDAS), 603 received anticoagulation and 59 experienced a recurrent IS after 1441 patient-years of follow-up. No IS recurrence risk differences were observed at the end of follow-up between ECG-AF and KAF (aHR 0.67, 95% CI 0.36-1.26), although ECG-AF showed lower risk only within the first year (aHR 0.15; 95% CI 0.04-0.56). AFDAS exhibited a lower IS recurrence risk than KAF (aHR 0.22, 95% CI 0.08-0.63), without time-varying differences.</p><p><strong>Discussion: </strong>Differences in IS recurrence risk between ECG-AF and KAF varied over time. However, AFDAS showed a consistently lower IS risk than KAF throughout the entire study period.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241300888"},"PeriodicalIF":5.8,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Sex differences in risk factor relationships with subarachnoid haemorrhage and intracranial aneurysms: A Mendelian randomization study\".","authors":"","doi":"10.1177/23969873241296007","DOIUrl":"10.1177/23969873241296007","url":null,"abstract":"","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873241296007"},"PeriodicalIF":5.8,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11584993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695989","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}