European Stroke Journal最新文献

{"title":"Stroke triage using the FAST-ED score shortens process times in large vessel occlusion strokes in a physician staffed pre-hospital emergency medical (PHEM) system.","authors":"Hanna Illian, Clemens Grimm, Anna Haller, Jan Liman, Marios Nikos Psychogios, Christian Heiner Riedel, Sabine Blaschke, Meike Bettina Göricke, Markus Roessler, Nils Kunze-Szikszay","doi":"10.1177/23969873241301884","DOIUrl":"10.1177/23969873241301884","url":null,"abstract":"<p><strong>Introduction: </strong>The impact of streamlining algorithms for stroke patients on process times in pre-hospital emergency medicine (PHEM) is not well investigated. We analyzed the changes in pre- and in-hospital process times after implementation of a streamlining algorithm in a physician staffed PHEM system.</p><p><strong>Patients: </strong>We conducted a prospective observational study and analyzed process times of adult stroke patients attended by emergency physicians (EP) of the city of Göttingen PHEM service after implementation of a streamlining algorithm including stroke triage using the FAST-ED score. Stroke patients with standard emergency treatment attended before the implementation served as a control group. All patients were transported directly to the University Medical Center Göttingen (UMG) and received endovascular therapy (EVT) and/or systemic thrombolytic therapy.</p><p><strong>Results: </strong>Of 75 suitable patients eligible in the study group, 37 (49.3%) received EVT and were compared to 44 patients in the control group. Pre-hospital process times did not differ significantly. Median door-to-CT time (12 vs 18 min, <i>p</i> = 0.017) and door-to-lysis time (20 vs 24 min, <i>p</i> = 0.005) were significantly shorter in the study group. Door-to-groin time was also shortened in the study group (42 vs 49 min) but not significantly (<i>p</i> = 0.088).</p><p><strong>Discussion and conclusions: </strong>Our findings indicate that a PHEM streamlining algorithm (namely the FAST-ED score) can significantly shorten in-hospital process times without delaying pre-hospital care. This improved coordination between PHEM and in-hospital emergency medicine (IHEM) may enhance neurological outcomes for stroke patients. Further research is needed to confirm these results and assess their applicability in other healthcare settings.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"452-460"},"PeriodicalIF":5.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717591","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":"Intravenous tenecteplase for acute ischemic stroke between 4.5 and 6 h of onset (EXIT-BT2): Rationale and Design.","authors":"Yi-Han Wang, Zhen-Ni Guo, Ming-Rui Chen, Zhi-Guo Yao, Thanh N Nguyen, Jeffrey L Saver, Yi Yang, Hui-Sheng Chen","doi":"10.1177/23969873241258058","DOIUrl":"10.1177/23969873241258058","url":null,"abstract":"<p><strong>Rationale: </strong>To date, the benefit of intravenous thrombolysis for acute ischemic stroke (AIS) patients without advanced neuroimaging selection is confined to within 4.5 h of onset. Our phase II EXIT-BT (Extending the tIme window of Thrombolysis by ButylphThalide up to 6 h after onset) trial suggested the safety, feasibility, and potential benefit of intravenous tenecteplase (TNK) in AIS between 4.5 and 6 h of onset. The EXIT-BT2 trial is a pivotal study undertaken to confirm or refute this signal.</p><p><strong>Aim: </strong>To investigate the efficacy and safety of TNK for AIS between 4.5 and 6 h of onset with or without endovascular treatment.Sample size estimates:A maximum of 1440 patients are required to test the superiority hypothesis with 80% power according to a two-sided 0.05 level of significance, stratified by age, sex, history of diabetes, location of vessel occlusion, baseline National Institute of Health stroke scale score, stroke etiology, and plan for endovascular treatment.</p><p><strong>Design: </strong>EXIT-BT2 is a prospective, randomized, open-label, blinded assessment of endpoint (PROBE), and multi-center study. Eligible AIS patients between 4.5 and 6 h of onset are randomly assigned 1:1 into a TNK group or control group. The TNK group will receive TNK (0.25 mg/kg, a single bolus over 5-10 s, maximum 25 mg). The control group will receive standard medical care in compliance with national guidelines for acute ischemic stroke. Both groups will receive standard stroke care from randomization to 90 days after stroke onset according to national guidelines.</p><p><strong>Outcome: </strong>The primary efficacy endpoint is excellent functional outcome, defined as a modified Rankin Scale score 0-1 at 90 days after randomization, while the primary safety endpoint is symptomatic intracerebral hemorrhage, defined as National Institutes of Health Stroke Scale score increase ⩾4 caused by intracranial hemorrhage within 24 (-6/+12) h after randomization.</p><p><strong>Conclusions: </strong>The results of EXIT-BT2 may determine whether intravenous TNK has a favorable risk/benefit profile in AIS between 4.5 and 6 h of onset.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"624-630"},"PeriodicalIF":5.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large ischemic core defined by visually assessed ASPECTS predicts functional outcomes comparably accurate to automated CT perfusion in the 6-24 h window.","authors":"Tolga D Dittrich, Anh Nguyen, Peter B Sporns, Anna M Toebak, Lilian F Kriemler, Salome Rudin, Annaelle Zietz, Benjamin Wagner, Filip Barinka, Martin Hänsel, Henrik Gensicke, Raoul Sutter, Christian H Nickel, Mira Katan, Nils Peters, Lars Michels, Zsolt Kulcsár, Grzegorz M Karwacki, Marco Pileggi, Carlo Cereda, Susanne Wegener, Leo H Bonati, Marios Psychogios, Gian Marco De Marchis","doi":"10.1177/23969873241286691","DOIUrl":"10.1177/23969873241286691","url":null,"abstract":"<p><strong>Introduction: </strong>Automated CT perfusion (aCTP) is commonly used to select patients with anterior circulation large vessel occlusion (aLVO) for endovascular treatment (EVT). The equivalence of visually assessed Non-contrast CT Alberta Stroke Program Early CT Scores (ASPECTS) and aCTP based selection in predicting favorable functional outcomes remains uncertain.</p><p><strong>Patients and methods: </strong>Retrospective multicenter study of adult aLVO patients from the Swiss Stroke Registry (2014-2021) treated with EVT or best medical treatment 6-24 h after stroke onset. We assessed ASPECTS on non-contrast CT visually and ischemic core volumes on aCTP, defining ASPECTS 0-5 and aCTP CBF < 30% volumes ⩾50 mL as large ischemic cores. We used logistic regression to explore the association between CT modalities and favorable functional outcomes (modified Rankin Scale [mRS] score shift toward lower categories) at 3 months. Receiver operating characteristic (ROC) curve analysis compared the predictive accuracy of visually assessed ASPECTS and aCTP ischemic core for favorable outcomes (mRS 0-2) at 3 months.</p><p><strong>Results: </strong>Of 210 patients, 11.4% had ASPECTS 0-5, and 12.9% aCTP core volumes ⩾50 mL. Within the same model, ASPECTS but not aCTP core volumes were associated with favorable outcomes (ASPECTS: acOR 1.85, 95%CI 1.27-2.70, <i>p</i> = 0.001). The ROC curve analyses showed comparable diagnostic accuracy in predicting favorable functional outcomes (mRS 0-2) at 3 months (ROC areas: ASPECTS 0.80 [95%CI 0.74-0.86] vs aCTP core 0.79 [95%CI 0.72-0.85]).</p><p><strong>Discussion and conclusion: </strong>In patients with aLVO, visually assessed ASPECTS showed at least comparable accuracy to automatically generated CTP core volumes in predicting functional outcomes at 3 months.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"552-559"},"PeriodicalIF":5.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381979","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":"Author Index.","authors":"","doi":"10.1177/23969873251330002","DOIUrl":"https://doi.org/10.1177/23969873251330002","url":null,"abstract":"","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"10 2_suppl","pages":"851-893"},"PeriodicalIF":4.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial.","authors":"Jesper Petersson","doi":"10.1177/23969873251340774","DOIUrl":"10.1177/23969873251340774","url":null,"abstract":"","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":"10 2","pages":"306"},"PeriodicalIF":5.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310596","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":"Searching for biomarkers of atrial cardiomyopathy at high risk of cardioembolism: What are the missing pieces of the puzzle?","authors":"Maurizio Acampa, Pietro Enea Lazzerini","doi":"10.1177/23969873241276357","DOIUrl":"10.1177/23969873241276357","url":null,"abstract":"","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"502-503"},"PeriodicalIF":5.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113256","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 different anesthesia techniques in nonagenarians treated with mechanical thrombectomy for anterior circulation large vessel occlusion: An inverse probability weighting analysis.","authors":"Viva Levee, Mariarosaria Valente, Francesco Bax, Liqun Zhang, Simona Sacco, Matteo Foschi, Raffaele Ornello, Katherine Chulack, Emma Marchong, Fahad Sheikh, Feras Fayez, Caterina Del Regno, Mohammed Aggour, Massimo Sponza, Francesco Toraldo, Razan Algazlan, Kyriakos Lobotesis, Daniele Bagatto, Nina Mansoor, Dheeraj Kalladka, Vladimir Gavrilovic, Cristian Deana, Flavio Bassi, Berry Stewart, Gian Luigi Gigli, Soma Banerjee, Giovanni Merlino, Lucio D'Anna","doi":"10.1177/23969873241293009","DOIUrl":"10.1177/23969873241293009","url":null,"abstract":"<p><strong>Introduction: </strong>There is a lack of evidence for the optimal type of anesthesia technique in patients ⩾ 90 years with acute ischemic stroke undergoing mechanical thrombectomy (MT) as this subgroup of patients was often excluded or under-represented in previous trials. We aimed to compare outcomes between general anesthesia (GA) and non-GA techniques in patients ⩾ 90 years with large vessel occlusion (LVO) undergoing MT.</p><p><strong>Patients and methods: </strong>Our study included patients ⩾ 90 years with anterior circulation LVO, NIHSS ⩾ 6, ASPECTS ⩾ 5 consecutively treated with MT within 6 h after stroke onset in three thrombectomy capable centers between January 1st, 2016 and March 30th, 2023. Inverse probability weighting (IPW) was used to reduce bias by indication of the anesthesia type on study outcomes. We used a weighted ordinal robust logistic regression analysis to explore the primary outcome of modified Rankin Scale (mRS) shift at 90 days in GA versus non-GA treated patients. Secondary outcomes included 90-day mortality, symptomatic intracranial hemorrhage (sICH) and TICI score of 2b, 2c, or 3.ResultsWe included 139 patients ⩾ 90 years treated with MT, 62 were in GA group and 77 in non-GA group. There was a significant shift for worse mRS scores at 90-day in non-GA treated patients (cOR 3.65, 95% CI 1.77-7.77, <i>p</i> = 0.001). The weighted logistic regression showed that non-GA technique was an independent predictor of 90-day mortality (OR 7.49, 95% CI 2.00-28.09; <i>p</i> = 0.003).</p><p><strong>Conclusion: </strong>Our study indicated that nonagenarians with acute ischemic stroke treated with MT without GA have a worse prognosis than their counterparts undergoing MT with GA. Further studies in larger cohorts are warranted to evaluate the optimal type of anesthesia in this patient population.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"379-386"},"PeriodicalIF":5.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548254","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":"Long-term outcomes after first-ever posterior circulation stroke and the prognostic significance of the New England Medical Center Posterior Circulation Registry stroke classification: A prospective study from the Athens Stroke Registry.","authors":"Nikolaos Karvelas, Leonidas Palaiodimos, Dimitrios Karamanis, Dimitrios Sagris, Anna-Maria Louka, Panagiotis Papanagiotou, Eleni Korompoki, George Ntaios, Konstantinos Vemmos","doi":"10.1177/23969873241302657","DOIUrl":"10.1177/23969873241302657","url":null,"abstract":"<p><strong>Background: </strong>There is paucity of data on the long-term outcomes after acute ischemic posterior circulation stroke (PCS). Additionally, the long-term prognostic value of the New England Medical Center-Posterior Circulation Registry (NEMC-PCR) classification of PCS has not been studied.</p><p><strong>Patients and methods: </strong>All consecutive patients with PCS registered in the Athens Stroke Registry between 01/1993 and 12/2012 were prospectively followed for up to 10 years and included in the analysis. The NEMC-PCR criteria were applied to classify them in relation to topography. The main studied outcomes were all cause mortality, stroke recurrence and major adverse cardiovascular events (MACEs).</p><p><strong>Results: </strong>A total of 653 patients with PCS (455 men, mean age 68.06 years) were followed up for 52.8 ± 44.0 months. Seventy-four (11.3%), 219 (33.5%), 335 (51.3%), and 25 (3.8%) patients had proximal, middle, distal, and multiple territories PCS, respectively. During the 10-year follow-up period, 217 patients died (7.6 per 100 patient years), 127 developed recurrent stroke (4.2 per 100 patient years), and 209 had a MACE (7.3 per 100 patient years). The cumulative 10-year mortality was higher in distal and multiple territories PCS compared to middle and proximal PCS (55.6%, 58.8%, 40.0%, 35.5%, respectively, <i>p</i> < 0.001 by log-rank test). Patients with distal location PCS had almost twofold increased 10-year risk of mortality compared to proximal location patients after adjusting for all confounding variables (HR 1.99, 95% CI 1.05-3.77). Per TOAST classification, large artery atherosclerosis was associated with almost two-fold increase in risk of mortality, stroke recurrence and MACEs.</p><p><strong>Discussion and conclusion: </strong>A large proportion of PCS patients experienced 10-year death, stroke and MACE occurrence after PCS. NEMC-PCR topographic classification was found to have significant prognostic value, with distal and middle PCS having worse long-term outcomes than proximal PCS.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"442-451"},"PeriodicalIF":5.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773421","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":"Atrial cardiopathy biomarkers and atrial fibrillation in the ARCADIA trial.","authors":"Hooman Kamel, Mitchell Sv Elkind, Richard A Kronmal, W T Longstreth, Pamela Plummer, Rebeca Aragon Garcia, Joseph P Broderick, Qi Pauls, Jordan J Elm, Fadi Nahab, L Scott Janis, Marco R Di Tullio, Elsayed Z Soliman, Jeff S Healey, David L Tirschwell","doi":"10.1177/23969873241276358","DOIUrl":"10.1177/23969873241276358","url":null,"abstract":"<p><strong>Background: </strong>ARCADIA compared apixaban to aspirin for secondary stroke prevention in patients with cryptogenic stroke and atrial cardiopathy. One possible explanation for the neutral result is that biomarkers used did not optimally identify atrial cardiopathy. We examined the relationship between biomarker levels and subsequent detection of AF, the hallmark of atrial cardiopathy.</p><p><strong>Methods: </strong>Patients were randomized if they met criteria for atrial cardiopathy, defined as P-wave terminal force >5000 μV*ms in ECG lead V₁ (PTFV₁), NT-proBNP >250 pg/mL, or left atrial diameter index (LADI) ⩾3 cm/m². For this analysis, the outcome was AF detected per routine care.</p><p><strong>Results: </strong>Of 3745 patients who consented to screening for atrial cardiopathy, 254 were subsequently diagnosed with AF; 96 before they could be randomized and 158 after randomization. In unadjusted analyses, ln(NT-proBNP) (RR per SD, 1.99; 95% CI, 1.85-2.13), PTFV₁ (RR per SD, 1.15; 95% CI, 1.03-1.28) and LADI (RR per SD, 1.34; 95% CI, 1.20-1.50) were associated with AF. In a model containing all 3 biomarkers, demographics, and AF risk factors, age (RR per 10 years, 1.24; 95% CI, 1.09-1.41), ln(NT-proBNP) (RR per SD, 1.88; 95% CI, 1.67-2.11) and LADI (RR per SD, 1.25; 95% CI, 1.14-1.37) were associated with AF. These three variables together had a c-statistic of 0.82 (95% CI, 0.79-0.85) but only modest calibration. Discrimination was attenuated in sensitivity analyses of patients eligible for randomization who may have been more closely followed for AF.</p><p><strong>Conclusions: </strong>Biomarkers used to identify atrial cardiopathy in ARCADIA were moderately predictive of subsequent AF.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"495-501"},"PeriodicalIF":5.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113253","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 collagen breakdown products as a biomarker for presence and instability of human intracranial aneurysms.","authors":"Katharina Am Hackenberg, Peter Richter, Svetlana Hetjens, Rita Dreier, Thomas Ratliff, Oluwadamilola Akanji, Judith Dremel, Amr Abdulazim, Ibrahim Al Masalmeh, Mansour Alzghloul, Eva Neumaier-Probst, Christoph Groden, Sherry H-Y Chou, Gabriel Je Rinkel, Nima Etminan","doi":"10.1177/23969873241300057","DOIUrl":"10.1177/23969873241300057","url":null,"abstract":"<p><strong>Introduction: </strong>There is an unmet need for improved detection of intracranial aneurysms (IAs) and distinction between stable and unstable (high rupture risk) IAs. Within the IA wall, synthesis and degradation of type I collagen as the main molecular constituent balance each other to maintain IA stability. We hypothesized that collagen breakdown products could serve as molecular markers for IA presence and instability.</p><p><strong>Patients and methods: </strong>This prospective, cross-sectional, single-center study included patients with unstable (growing/symptomatic/ruptured) and stable IAs and controls. We determined C-telopeptide (CTx) and c-terminal telopeptide (ICTP) as breakdown products of type I collagen in arterial and venous blood.</p><p><strong>Results: </strong>We included 107 participants with IAs (52 stable/44 unstable) and 41 controls. The correlation between intra-aneurysmal and venous levels was <i>r</i> = 0.63 (<i>p</i> < 0.001) for ICTP, <i>r</i> = 0.55 (<i>p</i> = 0.001) for CTx. The odds of harboring an IA were five times higher for participants with high compared to low venous levels of collagen breakdown products (ICTP: odds ratio (OR) 4.9 (95% CI 1.1-22.7); CTx: OR 5.3 (95% CI 1.4-20.0)). The OR for having an unstable IA was 9.3 (95% CI 2.1-41.5) for patients with high compared to low venous ICTP levels. The area under the curve for ICTP levels as a marker for IA instability was 0.75.</p><p><strong>Discussion and conclusion: </strong>Increased levels of venous collagen breakdown products, especially ICTP levels, could serve as a biomarker for IA presence and instability and complement current data for management of unruptured IAs on an individual patient level. Future studies with longitudinal data are needed to validate ICTP as a biomarker for high risk IAs.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":" ","pages":"584-591"},"PeriodicalIF":5.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644751","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}