European Stroke Journal最新文献

{"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}

{"title":"Hypoperfusion intensity ratio to differentiate between stroke etiologies in patients with a large vessel occlusion.","authors":"Ari Maruani, Michael Obadia, Louis Fontaine, Julien Savatovsky, Jean-François Albucher, Lionel Calviere, Nicolas Raposo, Christophe Cognard, Alain Viguier, Gregory W Albers, Candice Sabben, Igor Sibon, Jean-Marc Olivot, Pierre Seners","doi":"10.1177/23969873241306264","DOIUrl":"10.1177/23969873241306264","url":null,"abstract":"<p><strong>Background: </strong>Collateral circulation plays a key role in acute ischemic stroke. We sought to determine the association between the arterial collateral status, estimated by the Hypoperfusion Intensity Ratio (HIR) on perfusion MRI, and stroke etiology in anterior circulation large vessel occlusion (LVO).</p><p><strong>Methods: </strong>We retrospectively analyzed anterior circulation LVO acute stroke patients with a baseline perfusion MRI performed within 24 h from symptom onset. To avoid selection bias, patients were chosen from (1) the prospective registry of one comprehensive stroke center that included both thrombectomy-treated and untreated patients with systematic use of perfusion MRI and (2) one prospective thrombectomy study where perfusion MRI was acquired per protocol, but treatment decisions were made blinded to the results. Stroke etiology was evaluated according to the TOAST classification. HIR, defined as the proportion of time-to-maximum (T_max) > 6 s with T_max > 10 s volume, was measured on perfusion imaging. The relationship between stroke etiology (large artery atherosclerosis [LAA]) versus cardioembolism [CE]) and HIR was assessed by bivariate then multivariable binary logistic regression analyses.</p><p><strong>Results: </strong>Among the 310 included patients, stroke etiology was CE in 178 (57%) and LAA in 51 (16%). Patients with CE stroke etiology had higher HIR (0.43 vs 0.31, <i>p</i> < 0.001) than those with LAA etiology. Higher HIR, indicating worse collateral circulation, remained independently associated with CE etiology following adjustment for the main confounders (adjusted OR = 1.5 [95%CI 1.24-1.81] per 0.1-point increase, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>CE etiology is associated with worse collateral circulation in LVO-related acute stroke patients.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"796-803"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11663280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873253","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":"Risk factors, mechanisms, and clinical outcomes of stroke in young adults presenting to a North Central London stroke service: UCL Young Stroke Systematic Evaluation Study (ULYSSES).","authors":"Raafiah Mussa, Gareth Ambler, Hatice Ozkan, Kitti Thiankhaw, Maryam Aboughdir, Imogen Smedley, John Mitchell, Gargi Banerjee, Hans Rolf Jäger, Alex Leff, Richard Perry, Robert J Simister, Arvind Chandratheva, David J Werring","doi":"10.1177/23969873251314360","DOIUrl":"10.1177/23969873251314360","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke incidence in younger adults is increasing worldwide yet few comprehensive studies exist from a UK population. We investigated the risk factors, mechanisms, functional outcome and stroke recurrence rate in a cohort of young adults with stroke.</p><p><strong>Patients and methods: </strong>We included consecutive patients (<55 years) with ischaemic stroke or intracerebral haemorrhage (ICH) admitted to the University College London Hospitals Hyperacute Stroke Unit between 2017 and 2020. Ischaemic stroke was classified using Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria and ICH using modified CLAS-ICH criteria. Multivariable logistic regression was performed to identify predictors of unfavourable functional outcome (modified Rankin Scale [mRS] > 1) at 6 months.</p><p><strong>Results: </strong>Five hundred fifty-two patients were included (median age 47, IQR 41-51; 33% female; 76% ischaemic stroke). Common risk factors included dyslipidaemia (57%), hypertension (40%), and cigarette smoking (34%). Ischaemic stroke was mostly due to cardioembolism (22%). Probable cerebral small vessel disease was the most frequent ICH aetiology (53%). Unfavourable functional outcome was prevalent in 50% at 6 months and was associated with ICH (OR 2.02, 95%CI 1.14-3.58, <i>p</i> = 0.017), female sex (OR 1.62, 95%CI 1.03-2.55, <i>p</i> = 0.037), admission stroke severity (per point increase, OR 1.11, 95%CI 1.07-1.16, <i>p</i> < 0.001) and pre-morbid mRS 2-5 (OR 3.16; 95%CI 1.11-9.03, <i>p</i> = 0.032). 4.4% had a recurrent stroke within 6 months.</p><p><strong>Discussion and conclusion: </strong>Traditional cardiovascular risk factors are common in young adults with stroke. Unfavourable functional outcome is associated with female sex, ICH, severe stroke and pre-morbid disability. These findings can inform national stroke prevention and rehabilitation strategies.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"844-852"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025166","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":"882-891"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","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}

{"title":"Screening tools for malignancy in patients with cryptogenic stroke: Systematic review.","authors":"Maria P Tieck, Constanze Single, Sven Poli, Markus C Kowarik, Ulf Ziemann, Annerose Mengel, Katharina Feil","doi":"10.1177/23969873241310760","DOIUrl":"10.1177/23969873241310760","url":null,"abstract":"<p><p>Up to 20% of patients with cryptogenic ischemic stroke have an occult malignancy at the time of stroke presentation, providing an opportunity for early cancer detection. Despite this significant association, there is currently no consensus in international guidelines on how to systematically screen for malignancy in ischemic stroke patients. This review aims to summarize recent evidence on clinical features and scores, and predictive laboratory tests, that can guide malignancy screening in ischemic stroke patients. Our systemic search included PubMed, MEDLINE and Cochrane databases and yielded a total of 12 studies meeting the inclusion criteria for review. Elevated D-dimer levels and multiple infarcts in different cerebral circulations emerged as key markers. Based on the summarized data, we propose a flowchart for clinical decision-making regarding malignancy screening in patients with ischemic stroke. As the initial steps, we recommend using D-dimers cut-offs and stroke pattern on brain imaging to classify patients according to their risk profile. Based on the identified risk, we recommend a subsequent diagnostic workup addressing the most prevalent cancer types, including gastrointestinal tract, lung adenocarcinoma and gender-related cancer. The clinical implications of early malignancy screening and the need for evidence-based guidelines in cryptogenic stroke are discussed.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"665-674"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504808","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":"Feasibility of telephone and computerized cognitive testing as a secondary outcome in an acute stroke clinical trial: A mixed methods sub-study of the AcT Trial.","authors":"Sajeevan Sujanthan, Pugaliya Puveendrakumaran, Katie N Dainty, Morgan Barense, Krista L Lanctot, Adrian M Owen, Nishita Singh, Brian H Buck, Houman Khosravani, Shelagh B Coutts, Mohammed Almekhlafi, Ramana Appireddy, Aleksander Tkach, Jennifer Mandzia, Heather Williams, Thalia S Field, Alejandro Manosalva, Muzaffar Siddiqui, Gary Hunter, MacKenzie Horn, Fouzi Bala, Michael D Hill, Michel Shamy, Aravind Ganesh, Tolulope Sajobi, Bijoy K Menon, Richard H Swartz","doi":"10.1177/23969873251323171","DOIUrl":"10.1177/23969873251323171","url":null,"abstract":"<p><strong>Introduction: </strong>Post-stroke cognitive impairment is associated with impaired quality of life. Remote testing provides a potential avenue to measure cognitive outcomes efficiently.</p><p><strong>Patients and methods: </strong>Prospective cognitive outcomes were collected at 90-180 days using both telephone MoCA (T-MoCA; range 0-22; <17 impairment) and Creyos, a computerized cognitive battery. Key variables associated with completion were assessed using logistic regressions. Mixed methods brief structured interviews and exit survey were performed to explore barriers to completing computer testing.</p><p><strong>Results: </strong>Of 791 potentially eligible patients (mean age 70 ± 14 years), there was low feasibility of remote cognitive testing, with only 401 (51%) completing the T-MoCA, and 242 (31%) completing Creyos. Our regression models show that age (OR_T-MoCA: 0.95 (95% Confidence Interval (CI): 0.94-0.97); OR_Creyos: 0.95 (95% CI: 0.94-0.96)), functional impairment (mRS 2-5; OR_T-MoCA: 0.55 (95% CI: 0.37-0.81); OR_Creyos: 0.66 (95% CI: 0.44-0.98)), quality of life (EQ-VAS; OR_T-MoCA: 1.02 (95% CI: 1.01-1.03); OR_Creyos: OR:1.02 (95% CI: 1.01-1.03)) and length of hospital stay (OR_T-MoCA: 0.98 (95% CI: 0.96-0.99); OR_Creyos: 0.97 (95% CI: 0.94-0.99)) predicted both telephone and computer cognitive test completion; computer literacy predicted computer test completion (OR_Creyos: 1.12 (95% CI: 1.04-1.21)). In interviews, a preference for accessibility of computerized testing was reported.</p><p><strong>Discussion: </strong>Remote cognitive testing has limited feasibility as a secondary outcome in large acute stroke trials. Patients who are older, with worse quality of life, or severe functional impairment post-stroke are less likely to complete remote cognitive outcomes.</p><p><strong>Conclusion: </strong>Innovative approaches to post-stroke cognitive outcomes in acute stroke trials are needed.Data AccessData available upon request.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"968-977"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606624","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":"946-960"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","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}