European Stroke Journal最新文献

{"title":"Prediabetes and diabetes mellitus type II after ischemic stroke.","authors":"Kurt Moelgg, Anel Karisik, Lukas Scherer, Lucie Buergi, Benjamin Dejakum, Silvia Komarek, Julian Granna, Christian Boehme, Raimund Pechlaner, Thomas Toell, Michael Knoflach, Stefan Kiechl, Susanne Kaser, Alexander Egger, Andrea Griesmacher, Lukas Mayer-Suess","doi":"10.1177/23969873241304301","DOIUrl":"10.1177/23969873241304301","url":null,"abstract":"<p><strong>Introduction: </strong>The progression of diabetes status in post-stroke patients remains under-investigated, particularly regarding new treatments for type II diabetes mellitus (DM II), like glucagon-like peptide 1 receptor agonists (GLP-1-RA) and sodium-glucose co-transporter-2 (SGLT-2) inhibitors, which have not been studied in the post-stroke setting.</p><p><strong>Patients and methods: </strong>Eight hundred eighty-four consecutive ischemic stroke patients recruited to our prospective STROKE-CARD Registry were assessed concerning their glycemic status at baseline (normoglycemia, prediabetes, DM II) and change over time within 1 year follow-up. Multivariate logistic regression was performed to identify factors associated with transitioning from normoglycemia to prediabetes or DM II. Additionally, we reviewed ongoing clinical trials for GLP-1-RA and SGLT-2 inhibitors in the context of acute ischemic stroke.</p><p><strong>Results: </strong>At baseline, 44.6% (<i>n</i> = 394) of individuals had normoglycemia, 33.9% (<i>n</i> = 300) were prediabetic, and 21.5% had DM II (<i>n</i> = 190). After 1 year, normoglycemia decreased by 12.1 percentage points (<i>n</i> = 107), whereas prediabetes and DM II increased by 10.2 percentage (<i>n</i> = 90) points and 1.9 percentage points (<i>n</i> = 17), respectively. Statin therapy was the only significant risk factor for progression. 23.4% (<i>n</i> = 207) of our cohort would have met eligibility criteria for a recent trial on semaglutide in obese non-diabetics with prior cardiovascular disease. However, only one ongoing trial aims at evaluating short-term cardiovascular risk reduction in stroke patients.</p><p><strong>Discussion: </strong>GPrediabetes and DM II are frequent in ischemic stroke patients. Even within an intensified post-stroke disease management setting, a considerable amount of stroke survivors convert to prediabetes or DM II within the first year. Our results demonstrate a notable proportion of patients qualifying inclusion in studies examining the efficacy of GLP-1-RA agonists and SGLT-2 inhibitors in secondary prevention.</p><p><strong>Conclusion: </strong>Given the high prevalence and progression of prediabetes and DM II in stroke survivors, there is a need for clinical trials evaluating the use of GLP-1-RA and SGLT-2 inhibitors in this population.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"822-828"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956857","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":"Vessel wall enhancement and high-sensitivity CRP as prognostic markers in intracranial atherosclerotic stroke: A prospective cohort study.","authors":"Seunghee Na, Taewon Kim, Jaseong Koo, Yun Jeong Hong, Seong-Hoon Kim","doi":"10.1177/23969873251317341","DOIUrl":"10.1177/23969873251317341","url":null,"abstract":"<p><strong>Introduction: </strong>Eccentric vessel wall enhancement (EVWE) and high-sensitivity C-reactive protein (hs-CRP) are inflammatory biomarkers associated with atherosclerotic disease. We investigated their prognostic value in patients with acute ischemic stroke receiving guideline-adherent medical treatment.</p><p><strong>Patients and methods: </strong>In this prospective observational cohort study, patients with acute ischemic stroke attributed to intracranial arterial disease (ICAD) underwent vessel wall MRI and hs-CRP testing. The study included intracranial cases of both large artery atherosclerosis (LAA) and small vessel occlusion (SVO). The primary outcome was subsequent ischemic stroke during the follow-up period. The median follow-up duration was 21 months. Kaplan-Meier survival and Cox regression analysis was used to determine the associations between EVWE, hs-CRP levels, and subsequent ischemic stroke.</p><p><strong>Results: </strong>Among 191 patients, 81 (42.4%) had EVWE. EVWE positivity showed a trend toward a lower risk of subsequent ischemic stroke compared to EVWE negativity (HR 0.32, 95% CI 0.12-0.87; <i>p</i> = 0.061). Hs-CRP levels were not associated with recurrent stroke risk. The combination of EVWE positivity and low hs-CRP levels (<1.25 mg/l) was associated with a favorable outcome, while EVWE negativity and high hs-CRP levels (⩾1.25 mg/l) were associated with an unfavorable outcome (HR 0.143, 95% CI 0.04-0.50; <i>p</i> = 0.031).</p><p><strong>Discussion: </strong>In this observational study of patients with intracranial atherosclerotic stroke receiving optimal medical therapy, EVWE positivity appeared to be associated with a trend toward lower risk of recurrent stroke, though this relationship requires further validation.</p><p><strong>Conclusion: </strong>The combination of EVWE and hs-CRP status might potentially offer prognostic information, with preliminary data suggesting that EVWE positivity and low hs-CRP levels could be associated with more favorable outcomes in patients receiving guideline-adherent medical treatment. These preliminary findings suggest a possible role for combining imaging and serum inflammatory biomarkers in risk stratification, though larger prospective studies are needed to confirm these associations.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"862-870"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11791967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123065","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":"Outcomes of bypass surgery in asymptomatic moyamoya angiopathy: A multicenter study with propensity-score weighting.","authors":"Basel Musmar, Hammam Abdalrazeq, Joanna M Roy, Nimer Adeeb, Elias Atallah, Kareem El Naamani, Ching-Jen Chen, Roland Jabre, Hassan Saad, Jonathan A Grossberg, Adam A Dmytriw, Aman B Patel, Mirhojjat Khorasanizadeh, Christopher S Ogilvy, Ajith J Thomas, Andre Monteiro, Adnan Siddiqui, Gustavo M Cortez, Ricardo A Hanel, Guilherme Porto, Alejandro M Spiotta, Anthony J Piscopo, David M Hasan, Mohammad Ghorbani, Joshua Weinberg, Shahid M Nimjee, Kimon Bekelis, Mohamed M Salem, Jan-Karl Burkhardt, Akli Zetchi, Charles Matouk, Brian M Howard, Rosalind Lai, Rose Du, Rawad Abbas, Abdelaziz Amllay, Alfredo Munoz, Nabeel A Herial, Stavropoula I Tjoumakaris, Michael Reid Gooch, Christina Notarianni, Bharat Guthikonda, Robert H Rosenwasser, Pascal Jabbour","doi":"10.1177/23969873251365504","DOIUrl":"https://doi.org/10.1177/23969873251365504","url":null,"abstract":"<p><strong>Introduction: </strong>Asymptomatic moyamoya angiopathy (MMA) is increasingly detected through noninvasive imaging; however, its optimal management remains controversial. This multicenter retrospective cohort study compared outcomes in asymptomatic versus symptomatic MMA patients undergoing surgical revascularization.</p><p><strong>Patients and methods: </strong>A total of 475 patients treated with bypass surgery across multiple academic centers were included, with 56 (11.8%) classified as asymptomatic and 419 (88.2%) as symptomatic. Baseline demographics, surgical characteristics, and outcomes-including perioperative stroke, intraoperative complications, and follow-up stroke events-were collected. Asymptomatic MMA was defined as the absence of any prior ischemic or hemorrhagic stroke, seizures, or other neurological symptoms at the time of diagnosis. Both unadjusted analyses and propensity score weighting using inverse probability of treatment weighting (IPTW) were performed to adjust for potential confounders.</p><p><strong>Results: </strong>In the unadjusted analysis, asymptomatic patients had significantly lower rates of all perioperative strokes (1.7% vs 11.4%; <i>p</i> = 0.05) and intraoperative complications (1.7% vs 11.2%; <i>p</i> = 0.05) compared to symptomatic patients. Additionally, follow-up stroke rates were lower in the asymptomatic group (1.7% vs 11.2%; <i>p</i> = 0.05). After IPTW adjustment, the reduction in intraoperative complications (OR: 0.08, 95% CI: 0.01-0.64; <i>p</i> = 0.01) and follow-up stroke rates (OR: 0.12, 95% CI: 0.01-0.91; <i>p</i> = 0.04) persisted, while differences in overall perioperative stroke were not statistically significant.</p><p><strong>Conclusion: </strong>Bypass surgery in selected asymptomatic MMA patients is associated with reduced intraoperative complications, and fewer follow-up stroke rates. These findings support the careful consideration of surgical intervention in asymptomatic patients, emphasizing the importance of patient selection for optimal outcomes.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251365504"},"PeriodicalIF":4.5,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12398466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973856","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":"Conventional versus advanced imaging selection for endovascular treatment of basilar artery occlusion strokes.","authors":"Huanwen Chen, Marco Colasurdo, Hidetoshi Matsukawa, Conor Cunningham, Ilko Maier, Sami Al Kasab, Pascal Jabbour, Joon-Tae Kim, Stacey Quintero Wolfe, Ansaar Rai, Robert M Starke, Marios-Nikos Psychogios, Edgar A Samaniego, Nitin Goyal, Shinichi Yoshimura, Hugo Cuellar, Jonathan A Grossberg, Ali Alawieh, Ali Alaraj, Mohamad Ezzeldin, Daniele G Romano, Omar Tanweer, Justin Mascitelli, Isabel Fragata, Adam Polifka, Fazeel Siddiqui, Joshua Osbun, Roberto Crosa, Charles Matouk, Min S Park, Michael R Levitt, Waleed Brinjikji, Mark Moss, Travis Dumont, Ergun Daglioglu, Richard Williamson, Pedro Navia, Reade De Leacy, Shakeel Chowdhry, David J Altschul, Alejandro M Spiotta, Peter Kan","doi":"10.1177/23969873251364973","DOIUrl":"https://doi.org/10.1177/23969873251364973","url":null,"abstract":"<p><strong>Introduction: </strong>Endovascular thrombectomy (EVT) is an effective treatment for basilar artery occlusion (BAO) stroke in select patients. While there is a growing body of literature suggesting that advanced imaging modalities such as computed tomography perfusion (CTP) and magnetic resonance (MR) may not be necessary for selecting anterior circulation large vessel occlusion stroke patients for EVT, whether advanced imaging may be superior to conventional imaging (non-contrast CT and CT angiography) in identifying good treatment candidates among BAO patients is less clear.</p><p><strong>Patients and methods: </strong>This was a multicenter retrospective cohort study of BAO EVT patients treated from 2013 to 2022 in the Stroke Thrombectomy and Aneurysm Registry. Patients selected for EVT by advanced imaging (CTP or MR) were matched with those selected by conventional imaging using propensity score matching (PSM) accounting for possible confounders. Primary outcome was functional independence at 90 days. Other outcomes include bedridden state or death at 90-days and symptomatic intracranial hemorrhage (sICH).</p><p><strong>Results: </strong>268 patients were included. 150 patients were selected for BAO EVT by conventional imaging, 86 by CTP, and 32 by MR. Patients selected by advanced imaging were significantly older than those selected by conventional imaging (median age 71 vs 64 years, <i>p</i> = 0.001); patient characteristics were otherwise similar between cohorts. After PSM, 90-day outcomes were similar between the two cohorts (<i>p</i> = 0.56), with similar rates of functional independence (39.4% vs 35.1%, <i>p</i> = 0.65), bedridden state or death (40.4% vs 44.7%, <i>p</i> = 0.66), and sICH (3.3% vs 5.7%, <i>p</i> = 0.49) for conventional and advanced imaging groups, respectively. Results were similar across treatment time windows (all <i>p</i> > 0.05).</p><p><strong>Conclusions: </strong>Selecting patients for basilar EVT using conventional versus advanced imaging did not result in different clinical outcomes, regardless of treatment time windows. Conventional imaging appears sufficient as a first-line tool for selecting basilar EVT patients in routine clinical practice.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251364973"},"PeriodicalIF":4.5,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973816","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 DWI-FLAIR mismatch assessment in stroke using DWI only.","authors":"Joseph Benzakoun, Lauranne Scheldeman, Anke Wouters, Bastian Cheng, Martin Ebinger, Matthias Endres, Jochen B Fiebach, Jens Fiehler, Ivana Galinovic, Keith W Muir, Norbert Nighoghossian, Salvador Pedraza, Josep Puig, Claus Z Simonsen, Vincent Thijs, Götz Thomalla, Emilien Micard, Bailiang Chen, Bertrand Lapergue, Grégoire Boulouis, Alice Le Berre, Jean-Claude Baron, Guillaume Turc, Wagih Ben Hassen, Olivier Naggara, Catherine Oppenheim, Robin Lemmens","doi":"10.1177/23969873251362712","DOIUrl":"https://doi.org/10.1177/23969873251362712","url":null,"abstract":"<p><strong>Introduction: </strong>In Acute Ischemic Stroke (AIS), mismatch between Diffusion-Weighted Imaging (DWI) and Fluid-Attenuated Inversion-Recovery (FLAIR) helps identify patients who can benefit from thrombolysis when stroke onset time is unknown (15% of AIS). However, visual assessment has suboptimal observer agreement. Our study aims to develop and validate a Deep-Learning model for predicting DWI-FLAIR mismatch using solely DWI data.</p><p><strong>Patients and methods: </strong>This retrospective study included AIS patients from ETIS registry (derivation cohort, 2018-2024) and WAKE-UP trial (validation cohort, 2012-2017). DWI-FLAIR mismatch was rated visually. We trained a model to predict manually-labeled FLAIR visible areas (FVA) matching the DWI lesion on baseline and early follow-up MRIs, using only DWI as input. FVA-index was defined as the volume of predicted regions. Area under the ROC curve (AUC) and optimal FVA-index cutoff to predict DWI-FLAIR mismatch in the derivation cohort were computed. Validation was performed using baseline MRIs of the validation cohort.</p><p><strong>Results: </strong>The derivation cohort included 3605 MRIs in 2922 patients and the validation cohort 844 MRIs in 844 patients. FVA-index demonstrated strong predictive value for DWI-FLAIR mismatch in baseline MRIs from the derivation (<i>n</i> = 2453, AUC = 0.85, 95%CI: 0.84-0.87) and validation cohort (<i>n</i> = 844, AUC = 0.86, 95%CI: 0.84-0.89). With an optimal FVA-index cutoff at 0.5, we obtained a kappa of 0.54 (95%CI: 0.48-0.59), 70% sensitivity (378/537, 95%CI: 66-74%) and 88% specificity (269/307, 95%CI: 83-91%) in the validation cohort.</p><p><strong>Discussion and conclusion: </strong>The model accurately predicts DWI-FLAIR mismatch in AIS patients with unknown stroke onset. It could aid readers when visual rating is challenging, or FLAIR unavailable.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251362712"},"PeriodicalIF":4.5,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973807","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":"Limitations to causal inference in observational studies of PFO closure.","authors":"Iyas Daghlas","doi":"10.1177/23969873251368726","DOIUrl":"https://doi.org/10.1177/23969873251368726","url":null,"abstract":"","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251368726"},"PeriodicalIF":4.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973932","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":"Patent foramen ovale closure in elderly patients: Addressing challenges in real-world study and clarifying methodology.","authors":"Chi-Sheng Wang, Po-Lin Chen","doi":"10.1177/23969873251369443","DOIUrl":"https://doi.org/10.1177/23969873251369443","url":null,"abstract":"","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251369443"},"PeriodicalIF":4.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973643","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":"Functional outcome, return to work and quality of life in patients with non-aneurysmal subarachnoid hemorrhage.","authors":"Wouter J Dronkers, Menno R Germans, René Post, Bert A Coert, Jonathan M Coutinho, René van den Berg, William Peter Vandertop, Dagmar Verbaan","doi":"10.1177/23969873251362012","DOIUrl":"10.1177/23969873251362012","url":null,"abstract":"<p><strong>Introduction: </strong>Non-aneurysmal, non-traumatic subarachnoid hemorrhage (nSAH) refers to cases where a causative aneurysm cannot be identified. We studied 6-months' outcomes in nSAH patients.</p><p><strong>Patients and methods: </strong>From a prospective SAH registry of all nSAH patients admitted between 2012 and 2023, relevant complications and outcomes were collected. Functional outcome and return-to-work at 6 months were assessed using the modified Rankin Scale (mRS), quality of life with the EuroQol-5Dimensions (EQ-5D) and Hospital Anxiety and Depression Scale (HADS), and an institutional 14-item questionnaire for assessment of residual symptoms.</p><p><strong>Results: </strong>325 consecutive nSAH patients were included (192 non-perimesencephalic, non-aneurysmal subarachnoid hemorrhage (NPSAH); 133 perimesencephalic subarachnoid hemorrhage (PMSAH)). 303 (93%; 180 NPSAH and 123 PMSAH) were available at follow-up (7 patients died). Favorable functional outcome (mRS-score 0-2) was reported in 271 (89%) patients and did not differ between NPSAH- and PMSAH. One hundred forty-one (77%) patients returned to work, whereas only 71 (39%) patients reached their previous level of work. PMSAH patients were more likely to return to work (68/96 (71%) NPSAH and 73/87 (84%) PMSAH, respectively, <i>p</i> = 0.036). Furthermore, PMSAH patients were more likely to fully return to work (<i>p</i> = 0.028). The mean (SD) EQ-5D and EQ-VAS scores were 0.827 (0.184) and 74 (16), respectively. The HADS-A and -D scores were deviant (score > 7 points) in 53 (23%) and 48 (21%) patients, respectively. Only 39 patients (16%) denied experiencing residual symptoms. Increased fatigue (<i>n</i> = 164; 68%), increased concentration difficulties (<i>n</i> = 130; 54%), and increased forgetfulness (<i>n</i> = 121; 50%) were the most frequently reported residual symptoms.</p><p><strong>Discussion and conclusion: </strong>This study reveals that the majority of nSAH patients reports residual symptoms and did not return to their previous level of work at 6 months follow-up, despite a favorable functional outcome. These findings nuance the perception of a good outcome, as suggested in previous studies, warranting further research on possible rehabilitative interventions and counseling in these patients.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251362012"},"PeriodicalIF":4.5,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12350299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838171","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":"Safety of endovascular therapy in ischemic stroke patients ⩾90 years: A cohort study from the EVA-TRISP collaboration.","authors":"Jasmine Jost, Lukas Enz, Martina B Goeldlin, Philipp Baumgartner, Davide Strambo, Nabila Wali, Nicolas Martinez-Majander, Georg Kägi, Laura Vandelli, Christoph Riegler, Danna Krupka, Matteo Paolucci, Mauro Magoni, Giovanni Bianco, Hamza Jubran, Dejana R Jovanovic, Tomas Klail, Laura P Westphal, Alexander Salerno, Leon A Rinkel, Laura Mannismäki, Tolga Dittrich, Livio Picchetto, Regina von Rennenberg, Miguel Serôdio, Stefano Forlivesi, Dikran Mardighian, Carlo W Cereda, Ronen R Leker, Visnja Padjen, Mira Katan, Marios-Nikos Psychogios, Urs Fischer, Tomas Dobrocky, Mirjam R Heldner, Patrik Michel, Paul J Nederkoorn, Sami Curtze, Gian Marco De Marchis, Guido Bigliardi, Christian H Nolte, João Pedro Marto, Andrea Zini, Alessandro Pezzini, Susanne Wegener, Marcel Arnold, Stefan T Engelter, Henrik Gensicke","doi":"10.1177/23969873251360607","DOIUrl":"10.1177/23969873251360607","url":null,"abstract":"<p><strong>Introduction: </strong>Data on safety of endovascular therapy (EVT) in the very elderly are scarce. Using data from a large prospective EVT registry, we aimed at providing better evidence for EVT decision-making in patients aged 90 years and older.</p><p><strong>Patients and methods: </strong>In this multicentre observational study from the EVA-TRISP collaboration outcomes were compared between patients aged ⩾90 years with those aged <90 years using multivariate logistic regression analysis and reporting odds ratios and 95% confidence intervals. Outcomes were occurrence of poor functional outcome in survivors (modified Rankin Scale (mRS) 3-5 if pre-stroke mRS 0-2 and mRS higher than pre-stroke mRS if pre-stroke mRS 3-5), mortality at 3 months after stroke, unsuccessful recanalization (mTICI 0-2a) and symptomatic intracranial hemorrhage (sICH, defined by ECASS-II-/III-criteria).</p><p><strong>Results: </strong>Of 13,306 eligible patients, 892 were ⩾90 years old (6.7%). The very elderly had a higher median National Institutes of Health Stroke Scale (NIHSS) on admission (16 vs 14) and were more likely to have a pre-stroke mRS of 3-5 (38.0% vs 8.7%). The odds of poor functional outcome (OR_adjusted 2.35 (95%-CI 1.87-2.97); 61.6% vs 38.7%), death (OR_adjusted 3.04 (95%-CI 2.60-3.55); 53.9% vs 21.3%) and unsuccessful recanalization (OR_adjusted 1.34 (95%-CI 1.14-1.57); 32.4% vs 27.2%) were higher in patients aged ⩾90 years. The odds of sICH did not differ (OR_adjusted 0.92 (95%-CI 0.66-1.28); 5.1% vs 5.0%).</p><p><strong>Discussion and conclusion: </strong>EVT-treated stroke patients ⩾90 years had higher odds of poor functional outcome, mortality and unsuccessful recanalization than younger patients. However, the probability of sICH after EVT was not increased. The decision in favor of or against EVT in the very elderly should not be based on age alone.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251360607"},"PeriodicalIF":4.5,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12350292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838180","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}