European Stroke Journal最新文献

{"title":"Timing and outcome prediction of intravenous thrombolysis in posterior circulation stroke: Insights from the Austrian Stroke Unit Registry.","authors":"Alexander Tinchon, Dominika Mikšová, Wilfried Lang, Stefan Krebs, Elisabeth Freydl, Christian Baumgartner, Oliver Friedrich, Stefan Oberndorfer, Marek Sykora","doi":"10.1177/23969873251341770","DOIUrl":"10.1177/23969873251341770","url":null,"abstract":"<p><strong>Introduction: </strong>Posterior circulation (PC) stroke is underrepresented in most large-scale trials. While the importance of the onset-to-needle time (ONT) for intravenous thrombolysis (IVT) in anterior circulation stroke is well established, data on PC stroke are lacking. This study aimed to investigate how ONT affects functional outcome after IVT and to identify additional predictors of outcome in PC stroke.</p><p><strong>Patients and methods: </strong>IVT-treated PC stroke patients included in the nationwide Austrian Stroke Unit Registry between 2003 and 2024 were retrospectively analyzed. The primary outcome measure was the excellent (mRS 0-1) and non-excellent (mRS 2-6) functional outcome at 90 days. The secondary outcome measure was the occurrence of severe intracranial hemorrhage (sICH). Associations between ONT as continuous variable, clinical predictors, and functional outcomes were assessed using ordinal and binomial logistic regression models. A cut-off point for the transition from excellent to non-excellent outcome was determined by maximizing the odds ratio metric. The effect of ONT on sICH was analyzed dichotomously in time intervals of 0-150 min and 151-300 min.</p><p><strong>Results: </strong>Of 11,025 eligible patients with PC stroke, 1,359 (12.3%) were treated with IVT, resulting in more frequent excellent functional outcome in patients treated with IVT compared to best medical treatment (BMT) in the ordinal logistic regression (adjusted odds ratio (aOR) 1.31, 95% CI 1.16-1.47, <i>p</i> < 0.001). Correspondingly, binomial logistic regression showed fewer non-excellent functional outcomes in patients treated with IVT compared to BMT (aOR 0.73, 95% CI 0.63-0.85, <i>p</i> < 0.001). The odds of an excellent functional outcome were increased within the first 282 min, with a pronounced treatment benefit in the first 122 min. The transition cut-off point was found to be at 258 min. sICH occurred in 2.8% and was unrelated to ONT (aOR 1.28, 95% CI 0.55-2.91, <i>p</i> = 0.552). Overall, women had lower IVT rates (11.3% vs 13.0%, <i>p</i> = 0.007) and were more likely to experience a non-excellent outcome (aOR 1.31, 95% CI 1.19-1.45, <i>p</i> < 0.001), but had similar functional outcomes compared to men when treated with IVT (aOR 1.03, 95% CI 0.74-1.43, <i>p</i> = 0.883).</p><p><strong>Discussion and conclusion: </strong>A treatment benefit of IVT in PC stroke was observed within 4.5 h of stroke onset, with its maximum within the first 2 h. Women should receive special attention as they may be at a prognostic disadvantage due to lower IVT rates and less favorable overall outcomes.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251341770"},"PeriodicalIF":5.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334078","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":"Large regional variation in endovascular thrombectomy rates for acute ischemic stroke in Sweden.","authors":"Johan Wassélius, Emma Hall, Alex Szolics, Fabian Arnberg, Hozan Radhi, Mia von Euler, Per Wester, Teresa Ullberg, Tobias Cronberg, Nicklas Ennab Vogel, Magnus Esbjörnsson, Fredrik Jonsson, Tommy Andersson, Bo Norrving, Björn M Hansen","doi":"10.1177/23969873251347098","DOIUrl":"10.1177/23969873251347098","url":null,"abstract":"<p><strong>Introduction: </strong>Endovascular thrombectomy (EVT) is a significant improvement in the care of acute ischemic stroke (AIS) patients, but only a small portion of patients receive treatment. Our aim was to analyze EVT implementation in Sweden according to a set of key performance indicators (KPIs) for <i>procedural</i> and <i>implementational effectiveness</i>.</p><p><strong>Methods: </strong>A nationwide prospective registry-based observational study using data from 2018, 2020, and 2022 from the Swedish quality registries for stroke care (Riksstroke and EVAS) and official population statistics. Effectiveness was analyzed using a set of predefined KPIs. To describe procedural and implementation effectiveness in a single comprehensible measure population success rate was derived by multiplying the EVT rate with successful recanalization.</p><p><strong>Results: </strong>Between 2018 and 2022 EVTs in Sweden increased from 874 to 1474 procedures per year. Correspondingly, the EVT rate (EVT/AIS) increased from 4.1% to 7.3%. Implementation was heterogenous with a six-fold difference between the highest and lowest regions. EVT rates were generally highest in regions with comprehensive stroke centers (CSCs). Procedural effectiveness were similar between all CSCs. The population success-rate increased from 3.4% to 6.4% during the period with large differences between CSCs (range 3.4%-12.4%, in 2022).</p><p><strong>Conclusions: </strong>By including KPIs for procedural and implementational effectiveness, it is possible to evaluate EVT implementation for the entire stroke population, which is the ultimate objective for healthcare. The population success-rate is capturing procedural implementation effectiveness in a single measure comprehensible for all stake holders and facilitate comparisons over time and between regions, even between regions with different stroke incidence.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251347098"},"PeriodicalIF":5.8,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310595","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":"Fibrinogen time course in acute ischemic stroke patients treated with intravenous thrombolysis with alteplase or tenecteplase.","authors":"Aikaterini Theodorou, Klearchos Psychogios, Odysseas Kargiotis, Apostolos Safouris, Maria Chondrogianni, Eleni Bakola, Konstantinos Melanis, Stella Fanouraki, Frantzeska Frantzeskaki, Eftihia Polyzogopoulou, Georgios Magoufis, Marios Themistocleous, Lina Palaiodimou, Maria-Ioanna Stefanou, Guillaume Turc, Andrei V Alexandrov, Georgios Tsivgoulis","doi":"10.1177/23969873251345387","DOIUrl":"10.1177/23969873251345387","url":null,"abstract":"<p><strong>Introduction: </strong>Limited data exist on intravenous thrombolysis (IVT) effect on fibrinogen depletion, and on possible associations between low fibrinogen levels and hemorrhagic complications, among acute ischemic stroke (AIS) patients.</p><p><strong>Patients and methods: </strong>We conducted a prospective cohort study evaluating fibrinogen levels prior to IVT and at two prespecified timepoints following IVT end (2 and 24 h). Safety and efficacy outcomes were assessed. Fibrinogen depletion was defined as reduction < 200 mg/dl, or as reduction ⩾ 50% of baseline fibrinogen levels after 2 and 24 h from IVT. Furthermore, we conducted a systematic review and meta-analysis, comparing fibrinogen level changes from baseline to a timeframe of 2-12 h, and to 24 h post-IVT between patients receiving alteplase versus tenecteplase.</p><p><strong>Results: </strong>One hundred and sixteen AIS patients, treated with IVT (alteplase = 81, tenecteplase = 35) were included in this study. Alteplase was associated with higher rates of fibrinogen depletion, observed in 2 (38% vs 0%; <i>p</i>-value < 0.001) and 24 h (26% vs 0%; <i>p</i>-value: 0.002) post-IVT, compared to tenecteplase. Three symptomatic intracranial hemorrhages (sICH) and one major extracranial bleeding were observed in patients receiving alteplase (two out of four with fibrinogen depletion) and one sICH without associated fibrinogen depletion was documented in the tenecteplase subgroup. Major hemorrhagic complications were numerically higher in patients with fibrinogen depletion (6.5% vs 3.5%, <i>p</i> = 0.609). Fibrinogen depletion was documented in 50% of alteplase-treated patients complicated with sICH or major extracranial bleeding and in 0% of respective tenecteplase-treated patients. Two cohorts were included in the meta-analysis. Mean relative changes of fibrinogen levels from baseline to a timeframe of 2-12 h post-IVT (RoM: 9.84; 95% CI: 9.63-10.05) were significantly higher in patients receiving alteplase.</p><p><strong>Discussion and conclusions: </strong>Fibrinogen depletion was observed only in AIS patients receiving alteplase and was associated with numerically higher rates of major hemorrhagic complications. These findings require independent confirmation in larger, international cohort studies.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251345387"},"PeriodicalIF":5.8,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303277","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":"Sex differences in outcomes after endovascular therapy with prior antiplatelet use: A study from the EVA-TRISP registry.","authors":"Roberta Noseda, Federico Rea, Giovanni Bianco, Elias Auer, Mirjam R Heldner, Eike I Piechowiak, Tomas Dobrocky, Patrik Michel, Susanne Wegener, Hakim Baazaoui, Philipp Baumgartner, Sami Curtze, Nicolas Martinez-Majander, Miranda Nybondas, Andrea Zini, Stefano Forlivesi, Matteo Paolucci, Gian Marco De Marchis, Tolga Dittrich, Paul J Nederkoorn, Nabila Wali, Mira Katan, Stefan Engelter, Henrik Gensicke, Simon Trüssel, Alessandro Pezzini, Mauro Magoni, João Pedro Marto, Maria Brás Monteiro, Ronen R Leker, Tamer Jubeh, Visnja Padjen, Carlo W Cereda","doi":"10.1177/23969873251346016","DOIUrl":"10.1177/23969873251346016","url":null,"abstract":"<p><strong>Introduction: </strong>This study assessed sex differences in outcomes after mechanical thrombectomy (MT) with prior antiplatelet use using the EVA-TRISP multinational registry.</p><p><strong>Patients and methods: </strong>A cohort of consecutive patients (2015-2023) treated with MT was analysed by sex and prior antiplatelet use in multivariable logistic regression models. Primary outcomes were in-hospital symptomatic intracranial haemorrhage (sICH) and the 3-month modified Rankin Scale (mRS) score.</p><p><strong>Results: </strong>Among 7472 patients (47.9% females, older than males: 77 vs 72 years, <i>p</i> < 0.0001), sICH rates were similar (females 4.6%, males 4.4%, <i>p</i> = 0.405). The odds of sICH were not influenced by sex (adjusted odds ratio, aOR, 0.99, 95% confidence interval, CI, 0.77-1.28) or prior antiplatelet use (single therapy: aOR 1.28, 95% CI 0.95-1.73; dual therapy: aOR 0.81, 95% CI 0.29-2.31). No significant interactions were found between sex and antiplatelet use (<i>p</i> = 0.73 for single, <i>p</i> = 0.71 for dual therapy). Females had worse 3-month ordinal mRS scores than males (<i>p</i> < 0.0001), but the odds of a higher mRS score were not associated with sex (aOR 1.03, 95% CI 0.93-1.13) or prior antiplatelet use (single: aOR 1.03, 95% CI 0.91-1.16; dual: aOR 1.16, 95% CI 0.82-1.64). No interactions were found between sex and antiplatelet use for mRS (<i>p</i> = 0.78 for single, <i>p</i> = 0.29 for dual therapy).</p><p><strong>Discussion and conclusions: </strong>This study showed that there is no apparent interaction between patient sex and prior use of antiplatelets in relation to safety and functional outcomes of MT. Therefore, there is no reason to support a different decision-making approach by practicing physicians regarding MT in females and males previously taking antiplatelets.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251346016"},"PeriodicalIF":5.8,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303278","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":"Location, size, and risk factors of incident covert brain infarcts in patients with acute non-cardioembolic ischemic stroke: PACIFIC-STROKE trial.","authors":"Robert G Hart, Eric E Smith, Angela Wang, Hardi Mundl, Pablo Colorado, Raed A Joundi, Aristeidis H Katsanos, Mukul Sharma, Ashkan Shoamanesh","doi":"10.1177/23969873251344485","DOIUrl":"10.1177/23969873251344485","url":null,"abstract":"<p><strong>Introduction: </strong>Covert brain infarcts (CBIs) identified by imaging are more frequent than symptomatic ischemic strokes and are usually small and/or involve non-eloquent brain areas. The spectrum of incident CBIs in patients following acute ischemic stroke has not been well characterized.</p><p><strong>Patients and methods: </strong>Exploratory observational cohort study of the size, location, multiplicity and risk factors of incident CBIs identified using serial MRIs in patients with acute non-cardioembolic ischemic stroke participating in the PACIFIC-STROKE trial.</p><p><strong>Results: </strong>Incident CBIs were identified in 16% (220/1358) of participants during the mean 5.6-month interval between MRIs. Single incident CBIs occurred in 150 (68%) of incident CBI patients and multiple CBIs in 70 (32%); 42% (93/220) of incident CBI patients had a single, small, subcortical CBI. There was no clear relationship between the location of incident CBI and the location of index stroke. Significant independent features associated with incident CBI included diabetes (adjusted OR 1.52, 95%CI 1.09-2.12), current tobacco use (adjusted OR 1.50, 95%CI 1.07-2.09), prior stroke/TIA (adjusted OR 1.59, 95%CI 1.08-2.36), carotid artery atherosclerosis (adjusted OR 1.47, 95%CI 1.07-2.02), and diastolic blood pressure (adjusted OR 1.02 per 1 mmHg increase, 95%CI 1.01-1.04).</p><p><strong>Discussion and conclusion: </strong>Incident CBIs in patients following acute non-cardioembolic stroke were frequent, usually small and subcortical, and associated with traditional stroke risk factors. Observations from PACIFIC-STROKE, particularly the absence of correlation between the location of incident CBI and the index infarct and the high frequency of incident small, subcortical CBIs, suggest that incident CBI pathogenesis is complex and heterogeneous in this population.</p><p><strong>Trial registration: </strong>https://clinicaltrials.gov (NCT04304508).</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251344485"},"PeriodicalIF":5.8,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295107","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":"Portable ultra-low-field MRI in acute stroke care: A pilot study.","authors":"Niklas M von Danwitz, Nils C Lehnen, Julius N Meißner, Omid Shirvani Samani, Hannah Asperger, Christian Thielscher, Taraneh Ebrahimi, Julia Layer, Louisa Nitsch, Franziska Dorn, Alexander Radbruch, Felix J Bode, Johannes M Weller, Anne Groteklaes, Gabor C Petzold, Hemmen Sabir, Sebastian Stösser","doi":"10.1177/23969873251344761","DOIUrl":"10.1177/23969873251344761","url":null,"abstract":"<p><strong>Introduction: </strong>Neuroimaging is a prerequisite for treatment of stroke patients, but it is not available all over the globe. Portable ultra-low field (pULF) MRI has the potential to improve access to neuroimaging and thus stroke care worldwide. In a pilot study, we were the first to utilise pULF-MRI in a European tertiary stroke centre and to evaluate its diagnostic value compared to high-field (HF) MRI.</p><p><strong>Patients and methods: </strong>Consecutive patients admitted for suspected ischaemic stroke underwent pULF-MRI using the 0.064 Tesla Swoop^® portable MR imaging system in addition to standard imaging. HF-MRI and pULF-MRI scans were blindly assessed to compare the diagnostic accuracy and imaging-based therapeutic decisions based on pULF-MRI to HF-MRI.</p><p><strong>Results: </strong>Seventeen patients underwent pULF-MRI, 12 of whom had ischaemic lesions on HF-MRI. Ischaemic lesions were detected on pULF-MRI in 8/12 cases. The four infarcts not identified on pULF-MRI were all smaller than 6 mm in diameter. In all cases, a virtual treatment decision based on pULF-MRI by a blinded team matched the actual clinical decisions.</p><p><strong>Conclusion: </strong>This single-centre study demonstrates that pULF-MRI is a promising tool in acute stroke care, providing reliable imaging for treatment decision and follow-up monitoring. pULF-MRI may support acute stroke care if HF-MRI is unavailable and may be particularly helpful in resource-limited settings. Limitations of pULF-MRI include long acquisition times and the lack of vessel imaging and haemorrhage-sensitive sequences.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251344761"},"PeriodicalIF":5.8,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295108","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":"Prevalence of vessel wall abnormalities and the risk of recurrent vascular events in young patients with stroke.","authors":"Esther M Boot, Frederick J A Meijer, Sjoert Pegge, Sjan Teeselink, Mijntje Mi Schellekens, Merel S Ekker, Jamie I Verhoeven, Esmée Verburgt, Maikel Immens, Nina Hilkens, Frank-Erik de Leeuw, Anil M Tuladhar","doi":"10.1177/23969873251343828","DOIUrl":"10.1177/23969873251343828","url":null,"abstract":"<p><strong>Introduction: </strong>We examined the prevalence and the characteristics of vessel wall (VW) lesions in young stroke patients and their relation to recurrent vascular events. We hypothesize that having VW lesions is associated with an increased risk on recurrent vascular events.</p><p><strong>Patients and methods: </strong>Single-center prospective study of participants aged 18-50 years, with a transient ischemic attack (TIA) or ischemic stroke, who underwent high-resolution 3T magnetic resonance imaging (HR-MRI) with VW imaging. We included 10 controls with symptoms diagnosed as stroke mimics. The HR-MRI scans were reviewed by two neuroradiologists blinded for clinical information. Follow-up was conducted via telephone interviews. Recurrent vascular events were defined as TIA, cerebral stroke, myocardial infarctions, revascularization procedures, or vascular death.</p><p><strong>Results: </strong>We included 158 participants (median age: 41.5 years, IQR 33.0-46.4); 75 (47.5%) of whom were women. Of these, 44 (27.8%) participants had 81 VW lesions, primarily characterized by VW enhancement (74.1%). 86.4% of VW lesions were located in the corresponding ischemic territory, and 48.6% showed no MRA abnormalities. Almost half of the VW lesions were found in the rare causes subgroup, while 13.6% of the \"cryptogenic\" subgroup showed VW enhancement. VW lesions were not significantly associated with an increased risk of recurrent vascular events (HR 2.2, 95% CI: 0.7-6.6).</p><p><strong>Conclusion: </strong>One in four young stroke patients have VW lesions, which were not related to an increased risk of recurrent vascular events. VW lesions were seen across all TOAST categories and were not specific to one stroke cause. Further research is needed to investigate the diagnostic and prognostic value of VW lesions in young stroke patients.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251343828"},"PeriodicalIF":5.8,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286804","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":"Tenecteplase in Central Retinal Artery Occlusion Study (TenCRAOS): Protocol for a randomized-controlled trial.","authors":"Stephen J Ryan, Øystein Kalsnes Jørstad, Mona Skjelland, Claus Z Simonsen, Toke Bek, Rolf Ankerlund Blauenfeldt, Petra Ijäs, Arja Laitinen, Andrej N Khanevski, Jørgen Krohn, Eyvind Rødahl, Robin Lemmens, Jelle Demeestere, Catherine Cassiman, Ingvild Nakstad, Kristin Evensen, Tiril Sandell, Steffen Hamann, Louisa M Christensen, Sverre Rosenbaum, Vaidas Matijosaitis, Reda Zemaitiene, Hanne Ellekjær, Dordi Austeng, Thomas C Truelsen, Michael V Mazya, Frank Träisk, Pauli Ylikotila, Ulpu Salmi, Kristian N Jenssen, Håvard Lisether, Cathrine Breivik, Kristina Devik, Lasse-Marius Sandes Honningsvåg, Jurgita Valaikienė, Andrius Cimbalas, Vetle Nilsen Malmberg, Espen Anderson, Sylvie De Raedt, Marcel Ten Tusscher, Noémie Ligot, Deborah Lipski, Fredrik Björck, Annelie Hamrin, Tore Solbakken, Ane Roushan Tharaldsen, Anette Huuse Farmen, Andreas Helgesen, Stein Harald Johnsen, Geir Bertelsen, Åse Hagen Morsund, Erik Holen, Arnstein Tveiten, Henrik B Johannessen, Peter Kelly, Evelyn O'Neill, Ansar Roy, Christina Kefaloykos, Thor Håkon Skattør, Kristian L Kraglund, Lauren Sanders, Peter Vanacker, Daniel Strbian, Morten C Moe, Anne Hege Aamodt","doi":"10.1177/23969873251344199","DOIUrl":"10.1177/23969873251344199","url":null,"abstract":"<p><strong>Rationale: </strong>Central retinal artery occlusion (CRAO) is an ophthalmologic emergency that, without prompt reperfusion, is associated with a high risk of permanent blindness. There is currently no evidence-based, effective treatment for CRAO.</p><p><strong>Methods and design: </strong>TenCRAOS is an investigator-initiated, international, multicenter, randomized controlled, double-dummy, double-blind, phase <i>III</i> trial testing tenecteplase (TNK) 0.25 mg/kg + placebo versus acetylsalicylic acid (ASA) 300 mg + placebo. The target population is patients diagnosed with CRAO and a best-corrected visual acuity (BCVA) of ⩾1.0 logarithm of the minimum angle of resolution (logMAR), corresponding to a decimal BCVA of ⩽0.1 or a fraction BCVA of ⩽6/60, who can be treated within 4.5 h.</p><p><strong>Sample size: </strong>Assuming a difference in proportion of participants reaching the primary endpoint of 20% in the placebo/ASA treatment group versus 50% in the TNK/placebo group, we need 78 participants to reach 80% power to detect the difference on a 5% significance level.</p><p><strong>Outcomes: </strong>The primary outcome is the proportion of participants with BCVA of ⩽0.7 logMAR in the affected eye at 30-day follow-up, corresponding to a decimal BCVA of ⩾0.2 or fraction BCVA of ⩾6/30, representing a clinically relevant improvement of BCVA of ⩾0.3 logMAR (or 15 letters). Secondary efficacy outcomes include proportion of participants with BCVA of ⩽0.5 logMAR, corresponding to a decimal BCVA of ⩾0.32 or fraction BCVA of ⩾ 6/19, self-reported vision-targeted health status, quality of life, and modified Rankin Score at 30 and 90 days. Safety outcomes include symptomatic intracranial hemorrhage, major bleeding, and mortality. Exploratory analyses include assessment with optical coherence tomography with angiography and transorbital ultrasound.</p><p><strong>Discussion: </strong>TenCRAOS intends to assess the efficacy and safety of systemic TNK within 4.5 h of CRAO onset.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251344199"},"PeriodicalIF":5.8,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of white matter lesions on associations between prehospital blood pressure and outcomes in spontaneous intracerebral hemorrhage.","authors":"Kristin Tveitan Larsen, Silje Holt Jahr, Maiken Nordahl Selseth, Trine Lied-Herland, Vigdis Hillestad, Hege Ihle-Hansen, Else Charlotte Sandset, Ole Morten Rønning, Espen Saxhaug Kristoffersen","doi":"10.1177/23969873251343495","DOIUrl":"10.1177/23969873251343495","url":null,"abstract":"<p><strong>Introduction: </strong>There are concerns about the safety of intensive blood pressure (BP) lowering in intracerebral hemorrhage (ICH) patients with white matter lesions (WML). We explored the impact of WML on associations between i) prehospital BP, and ii) BP change, and outcomes in acute, spontaneous ICH.</p><p><strong>Patients and methods: </strong>This retrospective study included consecutive patients with acute spontaneous ICH, admitted 2011-2020. WML on non-contrast computed tomography were categorized as none-to-mild (0-1) or moderate-to-severe (2-3) on the Fazekas scale. The first systolic BP (SBP) and mean arterial pressure (MAP) from the ambulance and admission, and absolute BP change between these time points, were collected. The outcomes were in-hospital mortality, mortality at 180 days, modified Rankin Scale (mRS) scores at 3 months, and hematoma expansion.</p><p><strong>Results: </strong>Of 548 patients, 260 (47%) had moderate-to-severe WML. Compared to patients with none-to-mild WML, these patients had a stronger association between higher prehospital MAP and in-hospital mortality (<i>p</i> interaction 0.017). WML did not modify associations between prehospital BP and other outcomes. WML modified associations between MAP change and in-hospital mortality (<i>p</i> interaction 0.049), MAP change and mRS score 3-6 at 3 months (<i>p</i> interaction 0.032), and SBP change and mRS score 3-6 at 3 months (<i>p</i> interaction 0.022). These outcomes were poorer with greater BP decrease in patients with moderate-to-severe compared to none-to-mild WML.</p><p><strong>Discussion and conclusion: </strong>In acute ICH, WML modified the influence of prehospital BP and BP change on clinical outcomes, with a trend toward worse outcomes associated with higher prehospital BP and greater spontaneous BP decrease.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251343495"},"PeriodicalIF":5.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276255","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":"Frailty's influence on older stroke patients: Neurological outcome and mortality after endovascular treatment in stroke: A national German stroke registry analysis.","authors":"Marlena Schnieder, Hannah Metz, Mathias Baehr, Anna Alegiani, Silke Wunderlich, Christian H Nolte, Arno Reich, João Pinho, Christiane Huber, Gabor Petzold, Steffen Tiedt, Christine Af von Arnim, Jan Liman","doi":"10.1177/23969873251344202","DOIUrl":"10.1177/23969873251344202","url":null,"abstract":"<p><strong>Introduction: </strong>Frailty is a clinical syndrome particular in old patients with an increased risk of adverse health-care events. In geriatric stroke patients who received endovascular treatment, monocentric analyses have demonstrated that frailty affects mortality and functional outcome. We aimed to investigate the impact of frailty in a larger multicentric cohort.</p><p><strong>Patients and methods: </strong>We analyzed the impact of frailty on outcome in patients with stroke who underwent endovascular treatment in seven academic centers contributing to the German Stroke Registry. We calculated the Hospital Frailty Risk Score (HFRS) for all patients aged ⩾ 65 years. Functional outcome was measured by modified Rankin Scale (mRS) 3 months after the stroke event. A regression analysis conducted to assess mortality and functional outcome, adjusted for factors known to influence outcomes.</p><p><strong>Results: </strong>2468 patients fulfilled the inclusion criteria. Median HFRS was 1.1 (IQR 0-2.95) and 449 (18.2%) patients had HFRS > 5. Low, intermediate and high-frailty risk was present in 2009 (71.7%), 389 (15.8%), and 60 (2.44%) respectively. A favorable neurological outcome (mRS 0-2) was achieved in 31.7%, 20.6%, and 13.8% in the low-, moderate, and high-risk-frailty-groups respectively (<i>p</i> < 0.001). Multivariate regression analysis showed a significant associations of HFRS on both mortality (adjusted OR 1.033, 95% CI: 1.004-1.063, <i>p</i> = 0.024) and functional outcome (adjusted OR: 0.962, 95% CI: 0.929-0.997; <i>p</i> = 0.033) after 3 months. However, there was no significant difference in baseline NHISS scores between frail and non-frail patients (14 (IQR 19-19)) vs 15 (IQR 11-19) vs 15 (IQR 10-19); <i>p</i> = 0.295). Besides door-to-groin time (DTN) differed with high frailty-risk patients having the longest DTN times (64 (38-102) vs 67.5 (45-95) vs 80 (54-106); <i>p</i> = 0.020).</p><p><strong>Discussion and conclusion: </strong>We identified frailty as a factor strongly associated with both mortality and functional outcome in ischemic stroke patients undergoing thrombectomy.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251344202"},"PeriodicalIF":5.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267611","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}