European Stroke Journal最新文献

{"title":"Target mismatch criteria in acute ischemic stroke patients with distal-medium vessel occlusion.","authors":"Giorgio Busto, Andrea Morotti, Ilaria Casetta, Francesco Arba, Guido Fanfani, Francesco Impagliazzo, Francesco Loverre, Andrea Ginestroni, Umberto Pensato, Alessandro Padovani, Enrico Fainardi","doi":"10.1177/23969873251362205","DOIUrl":"10.1177/23969873251362205","url":null,"abstract":"<p><strong>Introduction: </strong>The efficacy of endovascular treatment (EVT) in ischemic stroke patients with distal-medium vessel occlusion (DMVO) remains unclear. We evaluated whether CT-perfusion target mismatch criteria (TMC) could predict functional independence in patients with M2 non- or codominant middle cerebral artery DMVO.</p><p><strong>Materials and methods: </strong>This retrospective study analyzed consecutive patients with M2 DMVO receiving EVT and imaged with multimodal CT study protocol within 24 h from onset. A receiver operating characteristic curve analysis was used to identify the infarct core volume cutoff to predict functional independence (modified Rankin Scale 0-2 at 3-months). This parameter was subsequently considered as part of TMC together with penumbra volume ⩾ 10 mL and mismatch ratio ⩾1.2. The association between TMC and functional independence was tested with logistic regression.</p><p><strong>Results: </strong>A total of 115 patients with M2 were included. Infarct core volume had good discriminative ability for functional independence (AUC 0.75; 95%CI 0.64-0.84) and the best cut-off value was ⩽30 mL (77% sensitivity, 61% specificity, 69% positive predictive value, 70% negative predictive value). TMC were independently associated with functional independence (OR [odds ratio] = 6.50, 95%CI = 2.37-17.77, <i>p</i> < 0.001), excellent outcome (modified Rankin scale 0-1 at 3-months, OR = 3.28, 95%CI = 1.30-8.31, <i>p</i> = 0.012) and final infarct volume (<i>B</i> = -35.52, <i>p</i> = 0.004). After including interaction terms, a significant treatment effect on functional independence was observed between successful recanalization and TMC (OR = 3.82, 95%CI = 1.64-8.89, <i>p</i> = 0.002).</p><p><strong>Discussion and conclusion: </strong>In patients with M2 non- or codominant DMVO receiving EVT, TMC identified as core volume ⩽30 mL, penumbra volume ⩾ 10 mL, and mismatch ratio ⩾ 1.2, were associated with better functional outcome. Our findings suggest that functional independence after EVT was not directly related to successful recanalization, which is indeed effective only in patients with a favorable baseline imaging profile, including a small infarct core size, and in the presence of small penumbra volumes.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251362205"},"PeriodicalIF":4.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822868","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":"Circulating cytokine levels and 5-year vascular recurrence after stroke: A multicenter prospective cohort study.","authors":"Lanyue Zhang, Mohamad Ali Antabi, Jana Mattar, Omar El Bounkari, Rong Fang, Karin Waegemann, Felix J Bode, Sebastian Stösser, Peter Hermann, Thomas G Liman, Christian H Nolte, Benno Ikenberg, Kathleen Bernkopf, Wenzel Glanz, Daniel Janowitz, Annika Spottke, Michael Wolfgang Görtler, Silke Wunderlich, Inga Zerr, Gabor C Petzold, Matthias Endres, Jürgen Bernhagen, Martin Dichgans, Marios K Georgakis","doi":"10.1177/23969873251360145","DOIUrl":"10.1177/23969873251360145","url":null,"abstract":"<p><strong>Background and objectives: </strong>Anti-inflammatory therapies are tested in randomized trials for secondary stroke prevention. Detecting inflammatory biomarkers that predict vascular recurrence could optimize patient selection for these trials.</p><p><strong>Methods: </strong>In a multicenter prospective cohort study, we measured plasma levels of 22 inflammatory cytokines in 486 acute stroke patients (474 ischemic strokes and 12 intracerebral hemorrhages; median age 68 years, 34% female, median 3 days post-stroke onset). Patients were followed for over 5 years through telephone and in-person interviews to record the occurrence of the following outcomes: (1) recurrent stroke or transient ischemic attack (TIA; primary outcome); (2) a composite of recurrent vascular events (stroke, TIA, acute coronary syndrome, hospital admission due to heart failure, and death; secondary outcome). Associations between cytokine levels and these outcomes were analyzed using Cox proportional hazards models adjusted for demographic and vascular risk factors.</p><p><strong>Results: </strong>During the 5-year follow-up period, 59 patients (12.1%) experienced recurrent stroke or TIA, and 118 (24.3%) experienced recurrent vascular events. After adjustments for demographic and vascular risk factors, and correction for multiple comparisons, higher plasma levels of CD62E (adjusted Hazard Ratio (aHR)/SD increment: 1.63, 95%CI 1.22-2.20) and MIF (aHR: 1.56, 95%CI 1.18-2.06) in the acute phase after stroke were statistically significantly associated with increased risk of recurrent stroke or TIA. The associations followed a dose-response pattern across quartiles of CD62E and MIF levels. Adding baseline CD62E and MIF levels to models including age, sex, vascular risk factors, and baseline C-reactive protein (CRP) levels led to significant improvements in the prediction of 5-year risk of recurrent stroke or TIA (ΔC-index 0.030-0.050).</p><p><strong>Conclusion: </strong>Among stroke patients, higher baseline levels of CD62E and MIF improved prediction of 5-year risk of recurrent stroke or TIA on top of vascular risk factors and CRP levels. Whether assessment of these cytokines could improve patient selection for secondary prevention trials of anti-inflammatory treatments, should be explored in future studies.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251360145"},"PeriodicalIF":4.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822867","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":"Once- versus twice-daily direct oral anticoagulants after ischemic stroke in atrial fibrillation - A post-hoc analysis of the ELAN trial.","authors":"Alexandros A Polymeris, Jean-Benoît Rossel, Masatoshi Koga, Daniel Strbian, Adhiyaman Vedamurthy, Manju Krishnan, Mattia Branca, Thomas Meinel, Espen Saxhaug Kristoffersen, Takeshi Yoshimoto, Kanta Tanaka, Takenobu Kunieda, Yusuke Yakushiji, Jochen Vehoff, Kosuke Matsuzono, Peter Slade, Jelle Demeestere, Alexander Salerno, Nicoletta G Caracciolo, Dimitri Hemelsoet, Stefan T Engelter, Elias Auer, Thomas Horvath, David J Seiffge, Martina Goeldlin, Jesse Dawson, Urs Fischer","doi":"10.1177/23969873251360974","DOIUrl":"10.1177/23969873251360974","url":null,"abstract":"<p><strong>Introduction: </strong>Whether the risk-benefit profile of once-daily versus twice-daily direct oral anticoagulants (DOAC) differs after atrial fibrillation(AF)-associated ischemic stroke is unclear. We explored this in a post-hoc analysis of ELAN trial data (NCT03148457).</p><p><strong>Patients and methods: </strong>We compared the risk of the primary outcome (recurrent ischemic stroke, systemic embolism, intracranial hemorrhage (ICH), major extracranial bleeding, vascular death) from treatment initiation to the trial's 90-day follow-up in participants treated with once-daily or twice-daily DOAC after AF-associated stroke using Firth's logistic and Cox proportional hazards regression in unadjusted, inverse-probability-of-treatment-weighted and augmented-inverse-probability-weighted models to address confounding. Secondary outcomes were the primary outcome components and non-major bleeding. We calculated the net clinical benefit (NCB) of twice-daily over once-daily DOAC by subtracting the weighted rate of excess bleeding attributable to twice-daily DOAC from the rate of excess ischemic events possibly prevented by twice-daily DOAC.</p><p><strong>Results: </strong>We analyzed 1890/2013 (94%) participants (median age 77 years, 45% female), of whom 384 (20%) received once-daily and 1506 (80%) twice-daily DOAC. The primary outcome occurred in 64 (3.4%) participants, and did not differ between DOAC types in logistic (OR_unadjusted 0.89 (95% CI 0.50-1.66); OR_weighted 1.34 (0.71-2.79); OR_augmented 1.45 (0.81-3.21); twice-daily vs once-daily DOAC) nor in Cox models. We identified no clear differences in any secondary outcome. NCB analysis revealed a near-neutral net effect of twice-daily versus once-daily DOAC (+0.28 to +0.67 weighted events possibly prevented/100 person-months for ICH weights 1.5-3.3).</p><p><strong>Discussion and conclusion: </strong>The risk-benefit profile of once-daily versus twice-daily DOAC after AF-associated ischemic stroke does not seem to differ.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251360974"},"PeriodicalIF":4.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12339485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817885","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":"Presenting symptoms and diagnostic accuracy of prehospital stroke scales for patients with suspected mild minor stroke.","authors":"Helge Fagerheim Bugge, Mona Guterud, Karianne Larsen, Mathias Toft, Maren Ranhoff Hov, Else Charlotte Sandset","doi":"10.1177/23969873251360592","DOIUrl":"10.1177/23969873251360592","url":null,"abstract":"<p><strong>Introduction: </strong>Identifying patients with minor stroke is challenging in the prehospital setting due to subtle symptoms. The majority of studies evaluating prehospital stroke scales include patients with high median NIHSS at admission. ParaNASPP, a stepped-wedge cluster-randomized controlled trial found that prehospital NIHSS identified more patients with minor symptoms. Further knowledge on presenting symptoms of patients with suspected minor stroke, and the accuracy of prehospital stroke scales on minor stroke is needed.</p><p><strong>Methods: </strong>A post-hoc analysis of data from the ParaNASPP trial describes prehospital presenting signs and symptoms of patients with suspected mild minor stroke. We defined mild minor stroke as NIHSS 0-2 at hospital admission. Furthermore, we reconstructed and evaluated nine prehospital stroke scales (NIHSS, FAST/CPSS, BE-FAST, LAPSS, MASS, MedPacs, PreHAST, and sNIHSS-EMS) in patients with mild minor stroke.</p><p><strong>Results: </strong>Four hundred and thirty-one patients in the ParaNASPP trial had NIHSS 0-2 at hospital admission. Of these, 152 (35%) were discharged from hospital with a stroke diagnosis. When examined by paramedics, stroke patients presented with speech disturbance, facial palsy, and motor weakness in arm or leg, while stroke mimics presented with dizziness, headache, and nausea/vomiting. NIHSS had the highest sensitivity (95%) and lowest specificity (16%), while LAPSS had the lowest sensitivity (42%) and highest specificity (80%) in the patients with suspected mild minor stroke. The remaining scales had sensitivity between 67% and 93%, and specificity between 23% and 67%.</p><p><strong>Conclusions: </strong>In patients with mild minor stroke, substantial overlap in presentation between stroke and stroke mimics makes triage challenging. Prehospital stroke scales provide either high sensitivity or specificity. Competence and training of paramedics in when and how to use, and interpret, these scales is key for recognizing and correctly triaging stroke patients.The ParaNASPP trial was registered at Clinicaltrials.gov with registration number NCT04137874.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251360592"},"PeriodicalIF":4.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12339492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817886","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":"Successful reperfusion for better outcomes in medium vessel occlusion: Penumbral salvage versus infarct volume reduction.","authors":"Guangchen He, Tingyu Yi, Jiangshan Deng, Liming Wei, Haitao Lu, Dinglai Lin, Xiaohui Lin, Yan Zhang, Guihua Miao, Da Liang, Wenhuo Chen, Jingye Wang, Yueqi Zhu","doi":"10.1177/23969873251360492","DOIUrl":"10.1177/23969873251360492","url":null,"abstract":"<p><strong>Background: </strong>The benefits of endovascular thrombectomy (EVT) over medical treatment for medium vessel occlusion (MeVO) remain uncertain. Understanding how vascular reperfusion leads to favorable outcomes is crucial. This study examines whether penumbra salvage and infarct volume reduction quantify EVT benefits in MeVO patients and assesses their impact on clinical improvement post-reperfusion.</p><p><strong>Methods: </strong>We conducted a multicenter, observational study analyzing MeVO patients who underwent thrombectomy and received multimodal CT imaging from January 2020 to June 2024. EVT efficacy was evaluated by measuring follow-up infarct volume (FIV) on CT scans 24-48 h post-procedure and calculating the penumbra salvage index (PSI). PSI is the ratio of salvaged tissue volume (difference between baseline delay time (DT) >3 s volume and FIV) to baseline DT >3 s volume. Mediation analysis assessed PSI and FIV's contributions to successful reperfusion and functional outcomes.</p><p><strong>Results: </strong>Of 338 patients, 241 (72%) achieved successful reperfusion. Median FIV was 21 mL (IQR 12-32 mL), and median PSI was 0.68 (IQR 0.50-0.82). Successful reperfusion was linked to a 0.10 increase in PSI (95% CI: 0.05-0.15, <i>p</i> < 0.001) and a 4.36 mL reduction in FIV (95% CI: 1.31-7.20, <i>p</i> = 0.005). Successful reperfusion predicted improved outcomes, with an adjusted odds ratio (aOR) of 1.92 (95% CI: 1.08-3.47, <i>p</i> = 0.020) for excellent outcomes (modified Rankin Scale (mRS) score 0-1) and an aOR of 1.70 (95% CI: 1.01-2.89, <i>p</i> = 0.024) for functional independence (mRS score 0-2). PSI and FIV accounted for 44% and 16%, respectively, of the effect of reperfusion on excellent outcomes.</p><p><strong>Conclusions: </strong>In acute MeVO patients, penumbra salvage significantly mediates the beneficial relationship between reperfusion and excellent clinical outcomes, more so than infarct volume reduction.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251360492"},"PeriodicalIF":4.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12307323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733916","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":"Oxiracetam and physical activity in preventing cognitive decline after stroke: A multicenter, randomized controlled trial.","authors":"Jae-Sung Lim, Joung-Ho Rha, Jong-Ho Park, Kyungbok Lee, Dae-Il Chang, Sung Hyuk Heo, Yeong Bae Lee, Jee-Hyun Kwon, Eung-Gyu Kim, Jay Chol Choi, Man-Seok Park, Kyung-Hee Cho, Jae-Kwan Cha, Mi Sun Oh, Byung-Chul Lee, Hahn Young Kim, Kyungmi Oh, Hyun-Young Park, Sanghak Yi, Tai Hwan Park, Jae-Hyeok Heo, Keun-Hwa Jung, Chulho Kim, Soo Joo Lee, Jae Guk Kim, Dong-Eog Kim, Jong-Moo Park, Kyusik Kang, Jun Hong Lee, Jong-Won Chung, Kwang-Yeol Park, Won-Jin Moon, Hyuntae Park, Seongryu Bae, Yeonwook Kang, Hannah Jung, Juneyoung Lee, Hee-Joon Bae","doi":"10.1177/23969873251350141","DOIUrl":"https://doi.org/10.1177/23969873251350141","url":null,"abstract":"<p><strong>Introduction: </strong>This multicenter, double-blind, placebo-controlled trial, commissioned by South Korea's Ministry of Food and Drug Safety, evaluated the effect of oxiracetam for preventing post-stroke cognitive impairment (PSCI) and explored potential interaction with physical activity using neuroimaging.</p><p><strong>Patients and methods: </strong>Patients at high risk of PSCI, reporting subjective cognitive decline ⩾3 months after stroke, were randomized 1:1 to receive oxiracetam or placebo for 36 weeks. Physical activity was tracked via wrist-worn actigraphy. Coprimary endpoints were changes in Mini-Mental State Examination (MMSE) and Clinical Dementia Rating-Sum of Boxes (CDR-SB). Secondary outcomes included neuropsychological assessments and resting-state functional magnetic resonance imaging network metrics.</p><p><strong>Results: </strong>Of 500 enrolled participants (mean age 68.9 years; median 32 months post-stroke), 457 completed the study. There were no statistically significant differences between groups in changes in MMSE (oxiracetam: +0.13 ± 2.27 vs placebo: +0.27 ± 2.09; <i>p</i> = 0.49) or CDR-SB scores (-0.14 ± 0.70 vs -0.08 ± 0.80; <i>p</i> = 0.38). No evidence of interaction was observed between oxiracetam and physical activity. Exploratory analyses suggested favorable trends in functional segregation and CDR-SB scores among highly active oxiracetam participants.</p><p><strong>Discussion and conclusion: </strong>Oxiracetam did not demonstrate benefit in preventing PSCI in high-risk patients. These findings support the recent regulatory decision to suspend its use in South Korea.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251350141"},"PeriodicalIF":4.5,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12303921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973880","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":"The mini-Oxford cognitive screen (Mini-OCS): A very brief cognitive screen for use in chronic stroke.","authors":"Sam S Webb, Luning Sun, Eugene Yee Hing Tang, Nele Demeyere","doi":"10.1177/23969873251358811","DOIUrl":"https://doi.org/10.1177/23969873251358811","url":null,"abstract":"<p><strong>Introduction: </strong>No stroke-specific cognitive screen currently exists for community-dwelling chronic stroke survivors, with primary care and community settings relying on dementia tools which often do not consider specific post-stroke impairments. The Oxford Cognitive Screen (OCS) was developed for use in acute stroke, but its administration time is prohibitive for brief screening. Here, we aimed to develop, standardise and psychometrically validate the Mini-Oxford Cognitive Screen (Mini-OCS), a brief (<8 min) cognitive screen aimed for use in chronic stroke.</p><p><strong>Method: </strong>Existing full OCS data for 464 English participants who were ⩾6 months post-stroke were analysed for the possibility of a short-form. Theoretical choices were made to adapt the short-form to be suitable for use in chronic stroke. The Mini-OCS was then completed by 164 neurologically healthy controls (<i>M</i>_age = 68.66; SD = 12.18, <i>M</i>_years of education 15.40; SD = 3.64, 61% female), and 89 chronic stroke survivors (<i>M</i>_age = 69.86; SD = 14.83, <i>M</i>_years education = 14.29; SD = 4.01, 44.94% female, <i>M</i>_days since stroke = 597.02; SD = 881.12, 78.57% ischaemic, Median NIHSS = 6.5 (IQR = 4-11)). In addition, the original OCS, the Montreal Cognitive Assessment, and an extended neuropsychological battery were administered. Psychometric properties of the Mini-OCS were evaluated via construct validity and retest reliability.</p><p><strong>Findings: </strong>Normative data for the Mini-OCS is provided and known-group discrimination demonstrates increased sensitivity in the memory and executive function domains compared to the OCS. The Mini-OCS further met all appropriate benchmarks for evidence of retest reliability and construct validity.</p><p><strong>Discussion and conclusion: </strong>The Mini-OCS is a short-form standardised cognitive screening tool with initial evidence of good psychometric properties for use in a chronic stroke population.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251358811"},"PeriodicalIF":4.5,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12301230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973562","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":"Association of CRP levels and clinical and radiological outcomes in patients with large-vessel occlusion stroke: A MR CLEAN Registry study.","authors":"Yan Wang, Sven Pr Luijten, Daniel Bos, Inge A Mulder, Manon Kappelhof, Willeke F Westendorp, Bart J Emmer, Stefan D Roosendaal, Yvo Bwm Roos, Ido R van den Wijngaard, Robert J van Oostenbrugge, Diederik van de Beek, Jonathan M Coutinho","doi":"10.1177/23969873251357134","DOIUrl":"10.1177/23969873251357134","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammation is important in the pathogenesis of acute ischemic stroke (AIS). The association between CRP and outcomes in patients with large vessel occlusion (LVO) stroke receiving endovascular therapy (EVT) has not been fully elucidated.</p><p><strong>Patients and methods: </strong>We used data from the MR CLEAN Registry (2014-2017), including LVO-AIS patients with intracranial carotid atherosclerotic disease (ICAD), extracranial carotid atherosclerotic disease (ECAD) or atrial fibrillation (AF). The primary outcome was modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included mRS ⩾3 at 90 days, all-cause mortality, successful recanalization, and symptomatic intracranial hemorrhages. CRP was analyzed both dichotomously (>3.0 vs ⩽3.0 mg/L) and continuously, using multivariable regression adjusted for potential confounders.</p><p><strong>Results: </strong>Among 865 included patients (ICAD: 286; ECAD: 154; AF: 425), median CRP level was 3.4 mg/L (IQR: 2.0-6.1) and 446 patients had elevated CRP (>3.0 mg/L). AF patients had higher CRP than ICAD and ECAD patients (4.0-3.0-3.2 mg/L, <i>p</i> = 0.002). CRP >3.0 mg/L was not associated with mRS in the full cohort (acOR 0.983, 95% CI (0.767, 1.260)) or in any etiological subgroups (ICAD: acOR = 0.968, 95% CI (0.626, 1.496), ECAD: acOR = 1.114, 95% CI (0.617, 2.012), AF: acOR = 0.937, 95% CI (0.653, 1.344)). There was also no association between CRP and any of the other outcomes. When analyzed as a continuous variable, CRP was also not associated with any other outcomes.</p><p><strong>Conclusions: </strong>We did not observe an association between CRP levels and clinical and radiological outcomes after LVO stroke.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251357134"},"PeriodicalIF":5.8,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12276205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668666","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":"Carotid near-occlusion diagnostics and its consequences: A systematic review.","authors":"Elias Johansson, Intisaar Barud, Sofia Strömberg","doi":"10.1177/23969873251355158","DOIUrl":"10.1177/23969873251355158","url":null,"abstract":"<p><strong>Introduction: </strong>To summarize carotid near-occlusion (CNO) diagnostics and its consequences on epidemiology and management.</p><p><strong>Materials and methods: </strong>A systematic search of PubMed using 19 known synonyms for CNO was performed. Diagnostic analyses of CNO were assessed. Epidemiological and management analyses were based on how the CNO diagnostics was conducted, with diagnostics resembling large trials considered \"good.\"</p><p><strong>Results: </strong>CNO can be diagnosed with several modalities and approaches (interpretation or measurements). Interpretation of angiography is the reference standard but is not feasible for routine use. Of feasible methods, flow measurements with phase-contrast magnetic resonance imaging (PC-MRI) were considerably better than other alternatives when assessed blinded: 90%-100% sensitive and 99%-100% specific and inter-rater kappa 0.98-1.0. CNO was consistently common (30% of ⩾50% stenosis) in studies with \"good\" CNO diagnostics but was also often described as rare. Symptomatic CNO have no benefit with revascularization in studies with \"good\" CNO diagnostics, which foremost applies to the moderate subtype (without full collapse). The more severe CNO subtype (with full collapse) seems to have a very high risk of stroke within the first 2 days, but revascularization performed sufficiently early to prevent this has never been assessed.</p><p><strong>Discussion: </strong>CNO diagnostics is difficult and that CNO is perceived as rare by many is likely due to poor diagnostics. Such poor diagnostics also likely result in unnecessary surgeries for many symptomatic CNOs.</p><p><strong>Conclusion: </strong>CNO is a common variant of carotid stenosis. New diagnostic methods (especially PC-MRI) should be introduced, possibly after validation of its prognostic impact in a randomized trial.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251355158"},"PeriodicalIF":5.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638313","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":"Hemorrhagic transformation after endovascular treatment: Baseline infarct volume is a better predictor than infarct growth rate.","authors":"Mathilde Méot, Fanny Munsch, Bertrand Lapergue, Maeva Kyheng, Igor Sibon, David Planes, Emilien Micard, Bailiang Chen, Jean-Marc Olivot, Grégoire Boulouis, Alain Viguier, Thomas Tourdias, Gaultier Marnat","doi":"10.1177/23969873251357151","DOIUrl":"10.1177/23969873251357151","url":null,"abstract":"<p><strong>Background and objectives: </strong>Hemorrhagic transformation (HT) remains an important issue following ischemic stroke. Efforts have been made to identify predictors of HT, especially imaging features. Among them, the infarct growth rate (IGR) remains underexplored. We investigated the influence of IGR on the risk of subsequent HT in the setting of large vessel occlusion stroke (LVOS) intended for endovascular treatment (EVT) and compared IGR to baseline infarct volume as predictors of HT.</p><p><strong>Methods: </strong>We conducted a secondary analysis of two merged prospectively collected databases (FRAME 2017-2019 and ETIS 2015-2021). Patients presenting with anterior circulation LVOS, a witnessed symptoms onset, baseline MRI within 24 h after symptoms onset and available day 1 imaging (MRI or CT) were included. Posterior circulation LVOS, medium and distal vessel occlusions of the anterior circulation, tandem occlusions and unknown time of stroke onset were excluded. The primary endpoint was the occurrence of any HT detected on day 1 imaging. Secondary endpoint was the occurrence of parenchymal hematoma (defined as PH1 or PH2). Associations between the IGR and the occurrence of any HT and parenchymal hematoma within 24-h after mechanical thrombectomy were assessed using univariable and multivariable logistic regression models.</p><p><strong>Results: </strong>We included 775 patients (mean age 70.5 years (SD 15.1)). The median of IGR was 8.7 ml per hour (IQR 2.8-24.2). A faster IGR was independently associated with a higher risk of any HT (adjusted OR 1.35; 95% CI 1.16-1.57 per one log unit increase). A faster IGR was also associated with an increased risk of parenchymal hemorrhage in univariate analysis (OR 1.35; 95% CI 1.15-1.58), but the association did not remain significant in multivariable analysis including all the other predictors of parenchymal hemorrhage (adjusted OR 1.16 (95% CI 0.96-1.40) per one log unit increase). ROC analyses revealed that baseline infarct volume significantly better predicted any HT and PH occurrence than the IGR (<i>p</i> = 0.019 and <i>p</i> = 0.029 respectively).</p><p><strong>Conclusion: </strong>In patients presenting with anterior circulation LVOS and treated with EVT, the IGR was significantly associated with an increased risk of HT. However, the baseline infarct volume was a stronger predictor of HT than IGR.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"23969873251357151"},"PeriodicalIF":5.8,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638325","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}