European Stroke Journal最新文献

{"title":"Intracranial carotid arteriosclerosis and their prognosis in intracerebral hemorrhage.","authors":"Bo-Ching Lee, Hsin-Hsi Tsai, Ya-Fang Chen, Jiann-Shing Jeng, Li-Kai Tsai","doi":"10.1177/23969873241306576","DOIUrl":"10.1177/23969873241306576","url":null,"abstract":"<p><strong>Background: </strong>Intracerebral hemorrhage (ICH) is a manifestations of sporadic cerebral small vessel disease, and the survivors are predisposed to higher long-term risks of vascular events. Intracranial carotid artery calcification (ICAC), a potential marker for arteriosclerosis, is a risk factor for stroke but their roles in ICH is unknown. We aimed to investigate the prevalence and morphological subtypes of ICAC and their associations with long-term vascular events in ICH survivors.</p><p><strong>Materials and methods: </strong>Survivors of spontaneous ICH treated at a single center in Taiwan were included. ICAC was assessed by non-contrast CT; morphology was evaluated and categorized as intimal, internal elastic lamina (IEL), or mixed subtype. Patients were followed up for two years. Associations between calcification subtypes and follow-up events (stroke, cardiovascular event, death) were explored using multivariable Cox regression models.</p><p><strong>Results: </strong>Overall, 462 (80.1%) survivors of ICH had ICAC-223 (38.6%) were categorized as IEL calcification, 216 (37.4%) as intimal calcification, and 23 (4.0%) as mixed type calcification-and 115 patients (19.9%) had no calcification. Patients with IEL calcification were older than patients with intimal or no calcification (<i>p</i> < 0.001). Age (<i>p</i> < 0.001), diabetes (<i>p</i> = 0.010), and reduced renal function (<i>p</i> = 0.001) were independently associated with IEL calcification. During 2-years of follow-up, IEL calcification was not associated with a significant difference in the risk of recurrent ICH (HR=2.8 [0.8‒9.7]), but was associated with higher risks of incident ischemic stroke (HR = 9.0 [1.0‒77.4]), vascular mortality (HR = 13.6 [1.7‒1772.4], and all-cause mortality (HR = 13.9 [1.8‒105.8]).</p><p><strong>Conclusions: </strong>ICAC is common among ICH survivors and the subtype of IEL calcification may potentially have prognostic value for long-term vascular events.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"10 3","pages":"738-747"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041834","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 central adjudication of the score on the modified Rankin Scale in an international, randomized, acute stroke trial.","authors":"Wouter M Sluis, Jeroen C de Jonge, Hendrik Reinink, Alastair Wilson, Lisa J Woodhouse, Jesse Dawson, Kennedy R Lees, Philip M Bath, Hendrik Bart van der Worp","doi":"10.1177/23969873251320207","DOIUrl":"10.1177/23969873251320207","url":null,"abstract":"<p><strong>Introduction: </strong>The modified Rankin Scale (mRS) is the most frequently used primary outcome measure in acute stroke research despite significant interobserver variability in assigning grades. We assessed the use of central blinded adjudication of the mRS based on a video recording of an interview in the PRECIOUS trial.</p><p><strong>Patients and methods: </strong>PRECIOUS was an international, randomized, open-label, clinical trial with blinded outcome assessment of preventive treatment with metoclopramide, paracetamol, and ceftriaxone in elderly patients with acute stroke. Trained local investigators interviewed patients or their representatives and graded functional outcome at 90 days after stroke with the mRS. In each participating country, a video recording of the interview was assessed by three blinded, independent adjudicators. The primary outcome of the present substudy was interobserver agreement between the local mRS score and the median score of the three central adjudicators for patients alive at 90 days, assessed with Cohen's kappa and quadratic weighted kappa statistics. The difference between treatment effect estimates based on local and central adjudication was a secondary outcome.</p><p><strong>Results: </strong>Of 1493 patients enrolled in PRECIOUS, 1471 were included in this analysis. At 90 days, 1117 patients (75.9%) were alive and had both a central and local assessment; 28 participants did not have a central mRS score. Interobserver agreement was seen in 829 (74.2%) patients and was substantial (kappa of 0.68; 95% CI 0.65-0.71). Disagreement occurred more often in patients with a central mRS score of 0-2 (OR 2.24; 95% CI 1.14-4.24). Treatment effects were neutral for all three study drugs and did not differ between central and local adjudication.</p><p><strong>Discussion and conclusion: </strong>Central adjudication of the mRS based on a video recording is feasible in a large international, randomized stroke trial. This ensures blinding of the outcome assessment. In this neutral trial, the impact of central adjudication on the precision of effect size estimates could not be assessed.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"961-967"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450762","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":"Self-reported health status of patients with acute retinal ischemia and stroke related hemianopia.","authors":"David Leander Rimmele, Elina L Petersen, Theresa Schrage, Martin Härter, Levente Kriston, Götz Thomalla","doi":"10.1177/23969873251314715","DOIUrl":"10.1177/23969873251314715","url":null,"abstract":"<p><strong>Background: </strong>We aimed to assess impairments on health-related quality of life, and mental health resulting from Retinal artery occlusion (RAO) with monocular visual field loss and posterior circulation ischemic stroke (PCIS) with full or partial hemianopia using patient-reported outcome measures (PROMs).</p><p><strong>Methods: </strong>In a prospective study, consecutive patients with acute RAO on fundoscopy and PCIS on imaging were recruited during their surveillance on a stroke unit over a period of 15 months. Baseline characteristics were determined from medical records and interviews. Health-related quality of life (PROM Information System 10-Question-Short-Form, PROMIS-10), and mental health symptoms (Patient-Health-Questionnaire-4, PHQ-4) were assessed 3 and 12 months after admission postally and via phone.</p><p><strong>Results: </strong>Ffity-seven patients with RAO and 19 with isolated full or partial hemianopia determined by the NIHSS (median = 2; IQR:0/2) according to PCIS were included. Characteristics of cardiovascular risk factors, and functional status pre-stroke were comparable between the groups. At 3 months, mean ± standard deviation <i>T</i>-scores of PROMIS physical and mental health were 47.1 ± 8.8 and 46.7 ± 8.8 for patients with RAO, and 43.4 ± 9.8 and 43.2 ± 6.2 for PCIS. Compared to 50 ± 10 in the general population, scores after RAO (<i>p</i> = 0.04; <i>p</i> = 0.02) and PCIS (<i>p</i> = 0.01; <i>p</i> < 0.001) were lower in both domains after 3 months. Concerning PCIS, scores in the mental health domain remained decreased at 12 months (<i>p</i> = 0.04). On the PHQ-4, 25% of patients with RAO, and 62% with PCIS scored indicative for anxious and/or depressive syndromes at 3 months.</p><p><strong>Conclusions: </strong>RAO led only to partial and to less persistent mental impairments than PCIS. This suggests that a different approach involving complex visual and neuropsychological treatment over a longer period of time needs to be considered for post-stroke care of PCIS.Trial Registration Information:The trial was submitted at http://www.</p><p><strong>Clinicaltrials: </strong>gov, under NCT03795948.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"837-843"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11765302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042081","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":"European Stroke Organisation (ESO) standard operating procedure for white papers (expert consensus based clinical guidance).","authors":"Diana Aguiar de Sousa, Annaelle Zietz, Marialuisa Zedde, Aristeidis H Katsanos, Linxin Li, Joan Marti-Fabregas, Christian H Nolte, Anna Podlasek, Sven Poli, Jan Purrucker, Melinda B Roaldsen, Peter D Schellinger, Daniel Strbian, Georgios Tsivgoulis, Sofia Tsokani, Areti Angeliki Veroniki, Terence J Quinn","doi":"10.1177/23969873251316430","DOIUrl":"10.1177/23969873251316430","url":null,"abstract":"<p><p>Promoting the highest quality, evidence-based research across Europe is a priority of the European Stroke Organisation (ESO). The ESO Guideline Board communicate and promote evidence-based recommendations for clinical practice through their Guidelines. However, there are many aspects of stroke care where robust scientific evidence may be unavailable or difficult to obtain. Thus, there is a need for practical, consensus guidance, produced following robust, consistent, and transparent methods, that is suitable for high-priority clinical scenarios where evidence is currently lacking. The ESO Guideline Board developed methods for producing practical clinical guidance based on expert consensus in response to this need. These ESO' White Papers' are intended to complement standard ESO Guidelines. Here, we outline the ESO White Papers' standard operating procedure (SOP). We will describe the motivation for creating White Papers, the preferred composition of writing groups and expert consensus panellists, the methods for achieving consensus, and how results will be communicated. To ensure that all voting members have an equal voice, our methods are based upon the Delphi process of repeated rounds of anonymous voting, feedback and review. We hope that the White Papers will add further value to the clinical practice guidance that is offered by ESO. We look forward to receiving suggestions for White Paper topics from the stroke community.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"637-645"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190804","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":"C-reactive protein expression in acute ischemic stroke blood clots: Implications for etiology.","authors":"Wenyi Liu, Cansu Sahin, Nazan Güner Sak, Alice Giraud, Pierluca Messina, Franz Bozsak, Jean Darcourt, Federico Sacchetti, Anne-Christine Januel, Guillaume Bellanger, Jorge Pagola, Jesus Juega, Hirotoshi Imamura, Tsuyoshi Ohta, Laurent Spelle, Vanessa Chalumeau, Uros Mircic, Predrag Stanarčević, Ivan Vukašinović, Marc Ribo, Nobuyuki Sakai, Christophe Cognard, Karen Doyle","doi":"10.1177/23969873251315636","DOIUrl":"10.1177/23969873251315636","url":null,"abstract":"<p><strong>Introduction: </strong>C-reactive protein (CRP) is a prototypic inflammation marker, with elevated levels associated with an increased risk of cerebrovascular events. To determine whether CRP could be a useful biomarker of stroke etiology, we investigated CRP expression in acute ischemic stroke (AIS) clots from large-artery atherosclerosis (LAA), cardio-embolism (CE) and cryptogenic (Crypt) subtypes.</p><p><strong>Patients and methods: </strong>We analysed clot samples from AIS patients (LAA, CE, Crypt; <i>n</i> = 50 each), collected across five stroke centres in France, Serbia, Spain, and Japan between February 2021 and February 2024, as part of the prospective Clotbase International Registry of 460 patients who underwent mechanical thrombectomy. Clot components were assessed using Martius Scarlet Blue staining. CRP expression was examined using immunohistochemistry and its co-localisation with clot components was detected using immunofluorescence. Clinical parameters were compared across etiologies.</p><p><strong>Results: </strong>CRP expression varied significantly among clots. Most clots (65%) had minimal (⩽1%) CRP and 35% showed substantial (>1%) CRP. CE group had significantly more clots with substantial CRP than LAA and Crypt (48% vs 30% and 26%; <i>p</i> = 0.048). Clots with substantial CRP contained more fibrin (28.9%) than those with low CRP (20.6%; <i>p</i> = 0.005). Confocal microscopy showed CRP co-localised with fibrin and white blood cells (WBCs).</p><p><strong>Discussion and conclusion: </strong>Significantly more AIS clots of CE expressed substantial CRP compared to those of LAA and Crypt, suggesting CE strokes may be more strongly linked to inflammation. Clots with substantial CRP expression displayed significantly more fibrin compared to those with minimal CRP expression, suggesting a potential association between inflammation and fibrin-rich clots. Further study of the relationship between CRP, fibrin and WBCs in clots may improve our understanding of the processes of thrombo-inflammation.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"892-901"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256726","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":"Dual versus single antiplatelet therapy in patients with non-cardioembolic acute ischemic stroke and baseline MRI.","authors":"Gian Marco De Marchis, Anna Toebak, Tolga Dittrich, Dimitrios Vlachos, Angela Wang, Eric E Smith, Hardi Mundl, Pablo Colorado, Ashkan Shoamanesh, Robert G Hart","doi":"10.1177/23969873251323180","DOIUrl":"10.1177/23969873251323180","url":null,"abstract":"<p><strong>Introduction: </strong>Dual antiplatelet therapy (DAPT) is superior to single antiplatelet therapy (SAPT) for secondary prevention after minor, non-cardioembolic stroke. We aimed to assess whether DAPT efficacy is modified by large artery atherosclerotic (LAA) etiology, and DAPT safety by stroke size on MRI.</p><p><strong>Patients and methods: </strong>Post hoc analysis of the Phase 2 PACIFIC-STROKE randomized clinical trial, which enrolled patients with non-cardioembolic stroke, all with baseline MRI and compared the Factor XIa inhibitor asundexian with placebo on a background of DAPT or SAPT. We compared patients treated with DAPT versus SAPT. The efficacy endpoint was the rate of recurrent ischemic stroke, the safety endpoint was major or clinically relevant non-major bleeding during follow-up.</p><p><strong>Results: </strong>1590 patients were included, median NIHSS was 2 (interquartile range [IQR] 1-4), 40% received DAPT. Median follow-up was 11.5 months. The efficacy endpoint occurred in 4.4% and 4.8% in the DAPT group and SAPT group, respectively, with the strongest numerical benefit of DAPT over SAPT among patients with NIHSS ⩽ 3 not treated by intravenous thrombolysis. LAA index stroke etiology did not modify DAPT treatment effect. The safety endpoint occurred more often in the DAPT than in the SAPT group (4.6% vs 2.7%), with the numerically lowest risk among patients with NIHSS ⩽ 3 not treated by intravenous thrombolysis. Stroke size did not modify the effect of DAPT on the safety endpoint.</p><p><strong>Discussion and conclusion: </strong>We found no evidence of major treatment effect heterogeneity with DAPT compared with SAPT in patients with and without LAA or by stroke size on MR-DWI.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"766-774"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular therapy versus best medical treatment for symptomatic intracranial atherosclerotic stenosis: A systematic review and meta-analysis.","authors":"Maria-Ioanna Stefanou, Evangelos Panagiotopoulos, Lina Palaiodimou, Aikaterini Theodorou, George Magoufis, Stavros Spiliopoulos, Apostolos Safouris, Odysseas Kargiotis, Klearchos Psychogios, Tatiana Sidiropoulou, Frantzeska Frantzeskaki, Panayiotis D Mitsias, Katharina Feil, Annerose Mengel, Marios Themistocleous, Ulf Ziemann, Georgios Tsivgoulis","doi":"10.1177/23969873251324863","DOIUrl":"10.1177/23969873251324863","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence on endovascular therapy (EVT) for symptomatic intracranial stenosis (sICAS) from randomized-controlled clinical trials (RCTs) is conflicting. While prior RCTs on percutaneous transluminal angioplasty and stenting (PTAS) demonstrated harm or no benefit over best medical treatment (BMT), recent data suggest that submaximal balloon angioplasty with BMT may be superior to BMT alone.</p><p><strong>Patients and methods: </strong>A systematic review and meta-analysis of RCTs was conducted to evaluate the safety and efficacy of elective EVT plus BMT compared to BMT alone for sICAS.</p><p><strong>Results: </strong>Six RCTs (5 on PTAS and 1 on balloon-angioplasty) comprising 1606 patients were included. EVT increased the risk of any stroke or death (RR = 2.68; 95% CI: 1.72-4.19; <i>I</i>² = 0%), ischemic stroke within the territory of the qualifying artery (RR = 2.51; 95% CI: 1.36-4.61; <i>I</i>² = 0%), any ischemic stroke (RR = 1.99; 95% CI: 1.17-3.38; <i>I</i>² = 0%), intracranial hemorrhage (RR = 6.23; 95% CI: 1.92-20.2; <i>I</i>² = 0%), and mortality (RR = 3.52; 95% CI: 1.04-11.88; <i>I</i>² = 0%) within 30 days. No significant benefit from EVT was detected regarding the risk of any stroke or death (RR = 0.29, 95% CI: 0.06-1.38; <i>I</i>² = 68%), ischemic stroke in the territory of the qualifying artery (RR = 0.44, 95% CI: 0.14-1.33; <i>I</i>² = 59%) and mortality (RR = 0.49, 95% CI: 0.16-1.55; <i>I</i>² = 0%) beyond 30 days through 1 year.</p><p><strong>Discussion and conclusion: </strong>EVT is associated with adverse early outcomes, without reducing the risk of long-term stroke recurrence or mortality compared to BMT. Further research is warranted to identify high-risk subgroups who may benefit from EVT for sICAS and refine interventions to minimize periprocedural risks.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"655-664"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626449","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":"Cognitive performance is associated with return to work after ischemic stroke in young adults: The ODYSSEY study.","authors":"Mijntje Mi Schellekens, Esther M Boot, Jamie I Verhoeven, Merel S Ekker, Esmée Verburgt, Maikel Hm Immens, Anne Mertens, Mayte E van Alebeek, Paul Jam Brouwers, Renate M Arntz, Gert W van Dijk, Rob Ar Gons, Inge Wm van Uden, Tom den Heijer, Julia H van Tuijl, Karlijn F de Laat, Anouk Gw van Norden, Sarah E Vermeer, Marian Sg van Zagten, Robert J van Oostenbrugge, Marieke Jh Wermer, Paul J Nederkoorn, Frank G van Rooij, Ido R van den Wijngaard, Paul Lm de Kort, Frank-Erik de Leeuw, Roy Pc Kessels, Anil M Tuladhar","doi":"10.1177/23969873251324400","DOIUrl":"10.1177/23969873251324400","url":null,"abstract":"<p><strong>Introduction: </strong>Limited data exist on cognitive performance and return to work after ischemic stroke, especially in patients under 50 years. We investigated whether cognitive performance in the subacute phase after ischemic stroke in young adults was associated with unemployment and the inability to retain their jobs among those who returned to work.</p><p><strong>Patients and methods: </strong>We conducted a multicenter prospective cohort study between 2013 and 2021, enrolling patients aged 18-49 years with first-ever ischemic stroke. Cognitive assessments were performed within 6 months following the index event, covering seven cognitive domains. We categorized patients with cognitive impairment (<i>Z</i>-score < -1.5 on a domain) and as no/mild or major vascular cognitive disorder (VCD; <i>Z</i>-score < -2.0 in one or more domains). Cognitive performance and other predefined characteristics were chosen to identify factors associated with unemployment and, among patients who returned to work, the inability to maintain employment.</p><p><strong>Results: </strong>Of 525 patients (median age 44.3 [IQR 38.0-47.4] years; 243 women [46.3%]); median follow-up of 6.6 [IQR 4.5-8.2] years), 426 patients (81.1%) returned to work. Sixty-five patients (15.3%) were unable to maintain employment. In multivariable logistic regression analysis, major VCD (OR = 2.0; 95% CI 1.3-3.0; <i>p</i> = 0.002) and cognitive impairment in processing speed (OR = 2.0; 95% CI 1.3-3.3; <i>p</i> = 0.004) were associated with unemployment, but not with the inability to maintain employment.</p><p><strong>Discussion and conclusion: </strong>In young patients after a first-ever ischemic stroke, major VCD and impaired processing speed in the subacute phase after stroke were independently associated with unemployment, but not with the inability to maintain employment.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"784-795"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606623","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":"Hypertension, intracranial arteriosclerosis, and structural brain changes in patients with TIA or ischemic stroke.","authors":"Xi Li, Bernhard P Berghout, Gijs van Rooijen, Mohammad Kamran Ikram, Bob Roozenbeek, Daniel Bos","doi":"10.1177/23969873241307099","DOIUrl":"10.1177/23969873241307099","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertension is a major risk factor of structural brain changes, including atrophy and cerebral small vessel disease. Intracranial arteriosclerosis could be an underlying mechanism between hypertension and structural brain changes. This study investigated whether intracranial carotid artery calcification (ICAC), as a proxy for intracranial arteriosclerosis, explains the association between hypertension and structural brain changes in patients with TIA or ischemic stroke.</p><p><strong>Patients and methods: </strong>About 968 patients (mean age 62.7 years) with TIA or ischemic stroke from a registry who underwent non-contrast CT (NCCT) and CT-angiography (CTA) were included in this study. Presence and volume (mm³) of ICAC were assessed on CTA. Subtypes of ICAC were assessed on NCCT, where ICAC was categorized into intimal and internal elastic lamina (IEL) type calcification. Structural brain changes, indicated by atrophy, periventricular and deep white matter lesions (WML), and lacunes were assessed on NCCT. Mediation analysis was performed using ICAC, ICAC volume, and ICAC subtypes as mediators.</p><p><strong>Results: </strong>ICAC was prevalent in 67.8% of patients, with 52.6% of them exhibiting intimal calcification, and 26.5% exhibiting IEL calcification. Atrophy, periventricular WML, deep WML, and lacunes were present in 48.1%, 56.4%, 43.0% and 17.1% of patients respectively. The presence of ICAC explained 7.1% of the association of hypertension with periventricular WML, 3.6% with deep WML, and 17.6% with lacunes. Hypertension was associated with increased atrophy through ICAC (OR: 1.02, 95% CI: 1.00-1.05). In subgroup analyses, IEL calcification partly explained the association between hypertension and periventricular WML (16.8%), and atrophy (OR: 1.12, 95% CI: 1.02-1.27). Intimal calcification did not explain any association.</p><p><strong>Conclusion: </strong>ICAC partially explained the association between hypertension and atrophy, periventricular and deep WML, and lacunes. Although intimal calcification was more prevalent in ischemic stroke patients, IEL calcification takes the leading role in explaining the association between hypertension and structural brain changes.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"10 3","pages":"804-812"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041822","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":"Rescue stenting after failed mechanical thrombectomy: The RES-CAT study.","authors":"Roger Collet-Vidiella, Pol Camps-Renom, Ana Núñez-Guillén, Helena Quesada, Federica Rizzo, Noelia Rodriguez-Villatoro, Sergio Amaro, Laura Llull, Daniel Santana, Edgardo Estrada, Alan Flores, Mikel Terceño, Saima Bashir, María Hernández-Pérez, Sebastià Remollo, Oriol Barrachina-Esteve, David Cánovas, Elio Vivas, Ana Rodríguez-Campello, Gerard Mauri, Francisco Purroy, Anna Ramos-Pachón, Marina Guasch-Jiménez, Daniel Guisado-Alonso, Luis Prats-Sánchez, Alejandro Martínez-Domeño, Álvaro Lambea-Gil, Garbiñe Ezcurra-Díaz, Jordi Branera-Pujol, José Pablo Martínez-González, Lavinia Dinia, Mercè Salvat-Plana, Natalia Pérez de la Ossa, Carlos A Molina, Pere Cardona, Joan Martí-Fàbregas","doi":"10.1177/23969873241308680","DOIUrl":"10.1177/23969873241308680","url":null,"abstract":"<p><p>IntroductionThe efficacy of intracranial rescue stenting (RS) following failed mechanical thrombectomy (MT) in large-vessel occlusion (LVO) stroke remains uncertain. We aimed to evaluate clinical outcomes of RS in patients with anterior circulation LVO stroke following unsuccessful MT.Patients and methodsWe conducted a retrospective analysis using the Stroke Code Registry of Catalonia (January 2016-March 2022), a prospective, population-based registry including patients treated at 10 comprehensive stroke centers. We compared outcomes between patients who received RS and those who did not after failed MT. The primary outcome was the shift in 90-day functional status, assessed by the modified Rankin Scale (mRS), adjusted for confounders using inverse probability of treatment weighting (IPTW). Secondary outcomes included good (mRS ⩽ 2 or 3 if baseline mRS was 3) and excellent (mRS ⩽ 1) outcomes, ischemic recurrences, hemorrhagic transformation, and 90-day mortality.ResultsOf 601 patients, 69 underwent RS. RS did not significantly impact the 90-day mRS shift (adjusted common odds ratio [acOR] 1.06, [95% CI 0.85-1.32]; <i>p</i> = 0.613). However, RS was associated with higher rates of good (18.8% vs 11.7%; aOR 1.41, [95% CI 1.00-1.99]; <i>p</i> = 0.048) and excellent outcomes (17.4% vs 5.7%; aOR 2.90, [95% CI 1.89-4.43]; <i>p</i> < 0.001). Symptomatic intracranial hemorrhage (9.4% vs 7.4%; <i>p</i> = 0.507) and 90-day mortality (30.4% vs 39.8%; <i>p</i> = 0.135) were similar between groups. Stroke recurrence (4.2% vs 1.7%; <i>p</i> = 0.247) showed no significant difference at 33-month follow-up.Discussion and conclusionRS may increase the likelihood of good and excellent outcomes in anterior LVO stroke after failed MT, without increasing long-term risks. Further randomized trials are warranted for comprehensive validation.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"705-712"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11694265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915887","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}