European Stroke Journal最新文献

{"title":"Editorial.","authors":"Aristeidis Katsanos","doi":"10.1177/23969873251369574","DOIUrl":"10.1177/23969873251369574","url":null,"abstract":"","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"10 3","pages":"636"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041891","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":"Automated extraction of post-stroke functional outcomes from unstructured electronic health records.","authors":"Marta Fernandes, Kaileigh Gallagher, Niels Turley, Aditya Gupta, M Brandon Westover, Aneesh B Singhal, Sahar F Zafar","doi":"10.1177/23969873251314340","DOIUrl":"10.1177/23969873251314340","url":null,"abstract":"<p><strong>Purpose: </strong>Population level tracking of post-stroke functional outcomes is critical to guide interventions that reduce the burden of stroke-related disability. However, functional outcomes are often missing or documented in unstructured notes. We developed a natural language processing (NLP) model that reads electronic health records (EHR) notes to automatically determine the modified Rankin Scale (mRS).</p><p><strong>Method: </strong>We included consecutive patients (⩾18 years) with acute stroke admitted to our center (2015-2024). mRS scores were obtained from the Get With the Guidelines registry and clinical notes (if documented), and used as the gold standard to compare against NLP-generated scores. We used text-based features from notes, along with age, sex, discharge status, and outpatient follow-up to train a logistic regression for prediction of good (0-2) versus poor (3-6) mRS, and a linear regression for the full range of mRS scores. The models were trained for prediction of mRS at hospital discharge and post-discharge. The models were externally validated in a dataset of patients with brain injuries from a different healthcare center.</p><p><strong>Findings: </strong>We included 5307 patients, 5006 in train and test and 301 in validation; average age was 69 (SD 15) and 65 (SD 17) years, respectively; 47% female. The logistic regression achieved an area under the receiver operating curve (AUROC) of 0.94 [CI 0.93-0.95] (test) and 0.94 [0.91-0.96] (validation), and the linear model a root mean squared error (RMSE) of 0.91 [0.87-0.94] (test) and 1.17 [1.06-1.28] (validation).</p><p><strong>Discussion and conclusion: </strong>The NLP-based model is suitable for use in large-scale phenotyping of stroke functional outcomes and population health research.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"829-836"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adiposity and domain-specific stroke recovery: A Mendelian randomization study.","authors":"Mengmeng Wang, Iyas Daghlas, Chad M Aldridge, Zhizhong Zhang, Yi Ren","doi":"10.1177/23969873251319916","DOIUrl":"10.1177/23969873251319916","url":null,"abstract":"<p><strong>Introduction: </strong>While adiposity is an established risk factor for incident ischemic stroke, its influence on functional recovery after stroke is uncertain. We leveraged Mendelian randomization (MR) to examine the causal effects of body mass index (BMI) and waist-to-hip ratio (WHR) on post-stroke motor, cognitive, and global recovery.</p><p><strong>Materials and methods: </strong>Genetic proxies for BMI and WHR were obtained from a genome-wide association study (GWAS) meta-analysis of the GIANT consortium and the UK Biobank (<i>n</i> = 806,834). The primary outcomes were longitudinal trajectories of three National Institutes of Health Stroke Scale (NIHSS) measures assessed over a 2-year period: motor function subscores, cognitive performance subscores, and total NIHSS scores (as a measure of global recovery). Genetic associations with these stroke recovery outcomes were obtained from a GWAS conducted within the VISP trial of mild ischemic stroke (<i>n</i> = 1270). MR effects were estimated using the inverse-variance weighted method.</p><p><strong>Results: </strong>A 1-standard deviation (SD) increase (~4.8 kg/m²) in genetically predicted BMI associated with lower odds of post-stroke motor improvement (OR = 0.37, 95% CI = 0.19-0.72; <i>p</i> = 0.003). Similarly, a genetically predicted increase in BMI was associated with worse cognitive (β = -0.12, 95% CI = -0.21, -0.03; <i>p</i> = 0.009) and global recovery (β = -0.36, 95% CI = -0.59, -0.13; <i>p</i> = 0.002). Associations between genetically predicted WHR and post-stroke recovery were directionally concordant but were not statistically significant (<i>p</i> > 0.05).</p><p><strong>Discussions and conclusions: </strong>Human genetic evidence suggests that elevated adiposity negatively impacts multiple post-stroke outcomes, including motor function, cognition, and overall recovery. The biological pathways underlying these associations warrant further investigation.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"940-945"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11830152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initiation of direct oral anticoagulation after reperfusion therapy in ischemic stroke in clinical practice: Results from Sits-International Stroke Registry.","authors":"Malin Säflund, Marius Matusevicius, Jose A Egido, José Manuel Ferro, Janika Kõrv, Maurizio Melis, André Peeters, Marco Petruzzellis, Viiu-Marika Rand, Aleksandras Vilionskis, Diana Melancia, Diana Aguiar de Sousa, Michael V Mazya, Tiago Moreira, Niaz Ahmed","doi":"10.1177/23969873251325978","DOIUrl":"10.1177/23969873251325978","url":null,"abstract":"<p><strong>Introduction: </strong>Data is limited on the safety of early initiation of direct oral anticoagulation (DOAC) treatment after acute ischemic stroke (AIS) receiving reperfusion therapy in patients with atrial fibrillation (AF). We investigated the timing of DOAC initiation and its association with safety and outcomes.</p><p><strong>Materials and methods: </strong>We included AIS patients receiving reperfusion therapy with AF diagnosis (prevalent or new) registered in the Safe Implementation of Treatments in Stroke international registry during 2013-2024. Safety outcomes were hemorrhage and death. Secondary outcomes were recurrent AIS, any embolism and functional independence (modified Rankin Scale [mRS] 0-2) at 3 months. We performed descriptive statistics and multivariable analysis for DOAC initiation time as an ordinal variable (0-3, 4-7, and 8-100 days after stroke onset) and its association with outcomes. Explorative analyses were performed to investigate factors associated with DOAC initiation time, as a continuous or ordinal variable.</p><p><strong>Results: </strong>In total, 13,389 patients had data on DOAC initiation time, and 7861 patients had new event data by 3-month follow-up. We observed 0.1% intracranial hemorrhage, 0.4% major extracranial hemorrhage, 1.1% recurrent ischemic stroke, and 0.2% systemic embolism. At 3 months, 4.8% patients had died, and functional independence was seen in 60.9%. In multivariable analyses, DOAC initiation after stroke onset was not associated with any outcomes. Higher 24 h NIHSS and lower pre-stroke mRS score were associated with delayed DOAC initiation.</p><p><strong>Conclusion: </strong>DOAC initiation time was not associated with any outcomes in AIS patients who received reperfusion therapy. Severe stroke symptoms at 24 h were associated with delayed DOAC initiation. The low incidence of safety outcomes and missing data in this study should lead to cautious interpretations of these results.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"988-994"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634896","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}