Journal of Investigative Medicine最新文献

{"title":"Efficacy of Papaverine to Prevent Radial Artery Spasm During Transradial Cerebral Angiography (PASS): rationale and design.","authors":"Dong Pan, Jingwen Yang, Mengqi Liu, Yongteng Xu, Jiyun Feng, Huawen Li, Weili Luo, Baixuan He, Songhua Xiao, Xinguang Yang, Yamei Tang","doi":"10.1136/svn-2024-003659","DOIUrl":"https://doi.org/10.1136/svn-2024-003659","url":null,"abstract":"<p><strong>Rationale: </strong>Radial artery spasm (RAS) is a common complication during transradial cerebral angiography (TRA), but currently, the optimal prevention strategy is not well established. Papaverine has anti-vasospasm, sedative and analgesic effects. However, the efficacy of papaverine in preventing RAS during TRA remains unknown.</p><p><strong>Aims: </strong>To assess the efficacy of papaverine in preventing RAS during TRA.</p><p><strong>Sample size estimates: </strong>240 participants will provide 80% power at a two-tailed significance level of 0.05 to test the superiority hypothesis with the assumption that the incidence of RAS is 4% and 14.62% in the intervention and control groups, respectively, allowing for a 5% drop-out rate.</p><p><strong>Methods and design: </strong>The Efficacy of Papaverine to Prevent Radial Artery Spasm During Transradial Cerebral Angiography is a multicentre, randomised, placebo-controlled, double-blind trial. Eligible participants scheduled for TRA are 1:1 randomised to the intervention group and the control group. The intervention group will be slowly injected with 10 mL of papaverine hydrochloride solution through the successfully implanted radial artery sheath and continuously dripped papaverine hydrochloride solution through the artery sheath during the procedure, and the control group will be given normal saline in the same manner.</p><p><strong>Study outcome: </strong>The primary outcome is the incidence of RAS during the procedure. The operator assessed RAS based on a questionnaire addressing the following five signs: persistent forearm pain, pain response on catheter manipulation, pain response to introducer withdrawal and difficult catheter manipulation after being 'trapped' by the radial artery with considerable resistance on withdrawal of the introducer. RAS was indicated by the presence of at least two of these five signs or by the presence of just one when the operator considered it necessary to administer other spasmolytic agents.</p><p><strong>Trial registration number: </strong>NCT05861765.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and impact of brain lesions and cognitive impairment after CABG with moderate or severe cerebral artery stenosis seen on low-field MRI.","authors":"Guitao Zhang, Yingjian Pei, Fei Xu, Yao Feng, Qilin Zhou, Yinghua Zhou, Wei Feng, Shujuan Li","doi":"10.1136/svn-2025-004132","DOIUrl":"https://doi.org/10.1136/svn-2025-004132","url":null,"abstract":"<p><strong>Objective: </strong>The study aimed to assess the incidence and impact of brain lesions and cognitive impairment after coronary artery bypass grafting (CABG) in patients with moderate-to-severe cerebral artery stenosis using low-field MRI.</p><p><strong>Methods: </strong>110 patients with moderate-to-severe cerebral artery stenosis who underwent CABG between November 2023 and May 2024 were enrolled. Postoperative brain lesions were evaluated using low-field MRI. Cognitive decline was defined as a reduction of ≥3 points in the Montreal Cognitive Assessment score from baseline. Risk factors associated with postoperative brain lesions and cognitive impairment were identified in univariate and multivariate logistic regression analyses.</p><p><strong>Results: </strong>A total of 110 patients were enrolled, with a mean age of 65±7 years and 22 (20.0%) were female. New brain lesions were identified in 24 patients (21.8%). Logistic regression analysis identified operation time (OR 1.014, 95% CI 1.003 to 1.025, p=0.013) to be independently associated with brain lesions. 22.2% of the patients (20/90) experienced postoperative cognitive decline. New brain lesions were independently associated with cognitive decline (OR 4.651, 95% CI 1.158 to 18.676, p=0.030), particularly the new brain lesions impairing orientation ability (OR 4.534, 95% CI 1.438 to 14.289, p=0.010).</p><p><strong>Conclusions: </strong>Low-field MRI has proven effective in detecting new brain lesions after CABG. Both postoperative new brain lesions and CABG operation were significant contributors to cognitive decline.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tongxinluo capsule in the treatment of cerebral small vessel disease: protocol of a randomised, double-blind, placebo-controlled, multicentre clinical study (TOPS-CSVD).","authors":"Yingzhe Wang, Xiaodi Xie, Jun Xu, Peng Lei, Kai Wang, Junjian Zhang, Jintai Yu, Mei Cui, Qiang Dong","doi":"10.1136/svn-2024-003929","DOIUrl":"https://doi.org/10.1136/svn-2024-003929","url":null,"abstract":"<p><strong>Background: </strong>Tongxinluo capsule has demonstrated multiple beneficial effects on microcirculation, endothelial cells and inflammation. However, evidence supporting their efficacy in improving vascular cognitive decline is limited. This trial aims to investigate the potential benefits of Tongxinluo capsules in Chinese patients with cerebral small vessel disease (CSVD) who have been diagnosed with mild cognitive impairment.</p><p><strong>Design: </strong>Thistrail is a randomised, double-blind, placebo-controlled, multicentre study involving 1052 individuals aged 50-80 years with MRI-confirmed CSVD and a diagnosis of mild cognitive impairment. Participants were randomly assigned in a 1:1 ratio to receive either Tongxinluo capsules or placebo. The treatment period spans 12 months, with follow-up assessments conducted every 3 months to collect cognitive scale results and other relevant data.</p><p><strong>Study outcome: </strong>The primary outcome of this clinical trial is the change in the Vascular Dementia Assessment Scale-cognitive subscale from baseline to 12 months. The primary safety outcome focuses on the incidence of adverse vital signs, including abnormalities in body temperature, heart rate, respiration and blood pressure.</p><p><strong>Discussion: </strong>This trial has the potential to offer novel insights into the management of cognitive decline associated with CSVD through the application of traditional Chinese medicine.</p><p><strong>Trial registration number: </strong>NCT06061692.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Head-down position after reperfusion improves cerebral ischaemic injury in rat.","authors":"Qiong Wu, Nan-Nan Zhang, Ji-Ru Cai, Yi-Na Zhang, Hui-Sheng Chen","doi":"10.1136/svn-2025-004409","DOIUrl":"https://doi.org/10.1136/svn-2025-004409","url":null,"abstract":"<p><strong>Background and aims: </strong>Preclinical and clinical studies found that head-down position (HDP) during ischaemic phase improved neurological function of acute ischaemic stroke, but the effect of HDP after reperfusion has never been investigated. This study aimed to investigate whether HDP after reperfusion can ameliorate cerebral ischaemic injury in rats.</p><p><strong>Methods: </strong>The middle cerebral artery occlusion/reperfusion (MCAO/R) model was established in rats, and different HDP interventions were performed. Survival rate, haemorrhage transformation rate, neurological deficit scores, infarct volume, weight loss and brain oedema were measured at 24 hours after surgery to explore the cerebroprotective effect of HDP. Immunohistochemistry, ELISA and western blot were used to determine the possible mechanisms.</p><p><strong>Results: </strong>Compared with MCAO/R group, HDP -20° immediately after reperfusion with 1 hour duration exerted a significant cerebroprotective effect including reducing brain infarction and oedema, and improving neurological impairment, with a favourable safety profile such as less haemorrhagic transformation and death. These protective effects were not observed under other HDP intervention conditions. Mechanistically, this HDP procedure may exert its effects by regulating microglial polarisation, inhibiting microglial activation and neuroinflammation, reducing brain oedema and blood-brain barrier (BBB) disruption, suppressing apoptosis and improving neurological function.</p><p><strong>Conclusion: </strong>This is the first study to demonstrate the cerebroprotective effect of HDP -20° with 1 hour duration immediately after reperfusion in MCAO/R model rats, which involved inhibition of neuroinflammation and apoptosis as well as protection of BBB.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for cervical artery dissection: a systematic review with meta-analysis.","authors":"Wilco Jacobs, Debbie S Wright, Katherine Pohlman, Rob Rosenbaum, Barbara A Hutten, Gwendolyne Gm Scholten-Peeters, Scott Haldeman, Johannes Cf Ket, Sidney M Rubinstein","doi":"10.1136/svn-2025-004186","DOIUrl":"https://doi.org/10.1136/svn-2025-004186","url":null,"abstract":"<p><strong>Background: </strong>Cervical artery dissection (CAD) is a rare cause of stroke. This is an update of an earlier systematic review, which focuses on the risk of CAD in the general population. The objective was to identify the risk factors for CAD.</p><p><strong>Methods: </strong>A comprehensive search was conducted in MEDLINE, EMBASE and Web of Science on 20 September 2024. Observational studies (cohort, case-control studies and case-crossover studies) that studied patients with CAD and a control group were included. Risk of bias was assessed with the ROBINS-E tool, and certainty of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). The results were stratified by healthy controls (primary analyses) and other control groups, notably ischaemic non-CAD stroke (secondary analyses).</p><p><strong>Findings: </strong>In total, 128 study reports were identified, of which 54 used one or more healthy control groups. Of these reports, 49 (91%) used a case-control design. The risk of bias was generally high (93%). For the following categories, effects were identified: (1) genetic factors or factors with a familial predisposition: migraine, methylenetetrahydrofolate reductase (MTHFR), TT homozygosity, matrix metalloproteinases (MMP) concentration, and connective tissue disorders; (2) external factors: recent infection, winter or autumn-winter season and oral contraceptive use; (3) minor trauma; (4) cardiovascular factors: hypertension, hypercholesterolaemia, relative vasodilatation of internal carotid, coronary artery disease and other cardiac diseases. For other risk factors (5), there were no significant pooled estimates. The certainty of the evidence was moderate for migraine and MTHFR TT, low for minor trauma and very low certainty for all others.</p><p><strong>Interpretation: </strong>This is the first review that comprehensively examined the risk of CAD in the general population. Genetic factors, cardiovascular risk factors, recent infection and minor trauma are risk factors for CAD. Caution is needed in interpretation as the evidence is overall low to very low certainty, except for migraine and MTHFR TT homozygosity.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CerebrAlcare Pills on CereBral Small VesseL DiseasE (CABLE) trial: rationale and design.","authors":"Mengyuan Zhou, Yutian Gong, Shangrong Han, Meiping Wang, Wenping Gu, Hui-Sheng Chen, Wenxu Zheng, Kai Feng, Dan Wang, Hang Li, Zhidong Zheng, Yuesong Pan, Weiqi Chen, Yilong Wang","doi":"10.1136/svn-2024-003756","DOIUrl":"https://doi.org/10.1136/svn-2024-003756","url":null,"abstract":"<p><strong>Rationale: </strong>Cerebral small vessel disease (CSVD) is responsible for 25% of ischaemic strokes and 45% of dementia cases. Currently, therapies targeting individual mechanisms have not shown significant efficacy. As CSVD involves multiple pathophysiological mechanisms, Cerebralcare pills, a traditional Chinese medicine with multiple pharmacological mechanisms, may be effective in treating cognitive dysfunction in CSVD.</p><p><strong>Aims: </strong>The objective of this study was to assess the efficacy of Cerebralcare pills in improving cognitive dysfunction (measured by Montreal Cognitive Assessment (MoCA)) in patients with CSVD.</p><p><strong>Sample size estimates: </strong>A sample size of 114 patients with CSVD (57 in each group) will allow 2.74 points (with an SE of 0.56 points) difference between two groups on the MoCA score with 5% significance, 80% power and assuming a 10% dropout rate.</p><p><strong>Methods and design: </strong>This is a randomised double-blind, multicentre, placebo-controlled trial involving individuals with mild cognitive impairment (MoCA score ranging from 16 to 24) associated with CSVD. CSVD was defined by the presence of white matter hyperintensities consistent with lacunar infarcts or the presence of more than two vascular risk factors. Participants were randomised 1:1 to orally take 5 g of Cerebralcare pills or placebo twice a day for 6 months.</p><p><strong>Study outcomes: </strong>The primary outcome measure is the change in MoCA score at 6 months. Secondary outcome measures include the assessment of clinical manifestations, cognitive performance, conventional MRI markers, blood-brain barrier permeability and proteomics over a follow-up period of 6 months and 12 months.</p><p><strong>Discussion: </strong>The objective of this trial is to evaluate the efficacy of Cerebralcare pills in improving cognitive dysfunction associated with CSVD. Additionally, the trial aims to provide insights into the pathological processes involved in this condition.</p><p><strong>Trial registration number: </strong>NCT05578521.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and prevalence of vascular cognitive impairment in China: a systematic review and meta-analysis.","authors":"Su Zhen Liang, Shenyu Li, Ao Guan, Ruijia Xu, Mingxia Wei, Yingzhe Wang, Weiwei Shen, Yanfeng Jiang, Tiejun Zhang, Mei Cui","doi":"10.1136/svn-2025-004436","DOIUrl":"https://doi.org/10.1136/svn-2025-004436","url":null,"abstract":"<p><strong>Objective: </strong>Given China's rapid population ageing and substantial stroke burden, understanding the epidemiology of vascular cognitive impairment (VCI) is critical. This study aimed to systematically evaluate VCI prevalence and incidence in China from 1980 to 2023, and explore demographic and geographic disparities.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of 81 observational studies (73 on prevalence, 10 on incidence) was conducted, analysing data from 784 846 participants for prevalence. Data were extracted from multiple databases, and studies were selected based on predefined inclusion criteria. Meta-analysis was performed using random-effects models due to high heterogeneity (I²>90%). Machine learning models (including gradient boosting machine, random forest) were employed to assess associations between demographic factors and VCI prevalence, with SHapley Additive exPlanations analysis for interpretability.</p><p><strong>Results: </strong>Overall pooled prevalence was estimated at 1.54% (95% CI: 1.14% to 1.93%), varying significantly with age, education and region, peaking at 2.91% in those ≥80 years. Temporal trends revealed increasing prevalence from 1980 to 2023, while incidence was estimated at 0.29 per 100 person-years (95% CI: 0.21% to 0.41%), with regional disparities. Machine learning identified age, sex and survey period as key determinants of prevalence, aligning with meta-regression findings.</p><p><strong>Conclusions: </strong>VCI poses a growing burden in China, particularly among older and less-educated populations. This analysis provides the most comprehensive assessment of VCI in China to date, underscoring demographic and regional variations. These findings highlight the need for targeted public health strategies, improved diagnostics and lifestyle interventions to address the growing burden of VCI, particularly amidst China's ageing population. Future longitudinal research integrating clinical data, biomarkers and potentially neuroimaging is warranted to better understand VCI progression and refine intervention efficacy.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differentiating central fever from infectious fever in intracerebral haemorrhage.","authors":"Felix Hess, Enayatullah Baki, Julian McGinnis, Tun Wiltgen, Hannah Scholz, Kathleen Bernkopf, Gerhard Schneider, Jan S Kirschke, Dominik Sepp, Bernhard Hemmer, Silke Wunderlich, Mark Mühlau","doi":"10.1136/svn-2025-004441","DOIUrl":"https://doi.org/10.1136/svn-2025-004441","url":null,"abstract":"<p><strong>Background: </strong>In addition to infectious fever, stroke-related disturbances in thermoregulation, referred to as central fever, are frequently observed in patients with stroke, particularly in those with intracerebral haemorrhage (ICH). Rapid identification of the underlying cause of fever is crucial for treatment decisions. This study aims to identify clinical, laboratory and radiological parameters that differentiate central fever from infectious fever in patients with ICH.</p><p><strong>Methods: </strong>We included 547 ICH patients in this retrospective, single-centre cohort study. Fever was defined as a body temperature exceeding 38.3°C for at least 2 consecutive days. Central fever was characterised by the absence of an infection diagnosis, cultured pathogens and any other identified cause of fever. CT scans were assessed visually and with a 3D nn-UNet for segmentation and subsequent quantification of all ICH components. Voxel-based lesion-symptom mapping was performed to identify lesion locations related to central fever. Univariate analyses and multiple logistic regression were conducted.</p><p><strong>Results: </strong>Fever occurred in 213 patients: 54 with central fever, 156 with infectious fever and 3 with other causes. Central fever was linked to higher scores on the National Institutes of Health Stroke Scale and worse outcomes (p<0.01). It had an earlier onset (median day 2 (1-3) vs 6 (4-9) p<0.01) and was more frequent in patients with lesions affecting the left midbrain and hypothalamic region (p<0.01). In contrast, infectious fever was associated with higher levels of infectious parameters (ie, C reactive protein, procalcitonin and leucocyte count). Its early onset (p<0.001) and affection of the left hypothalamic region (OR=9.7 (1.6 to 58.837), p=0.013) emerged as independent predictors of central fever.</p><p><strong>Conclusions: </strong>Early onset and hypothalamic involvement are the strongest indicators of central fever, which may help guide evidence-based treatment decisions for patients with fever following ICH.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of new intracranial haemorrhage, ischaemic stroke and survival with dual antiplatelet therapy regimen or duration after endovascular treatment for ruptured cerebral aneurysm.","authors":"Pang-Shuo Perng, Yu Chang, Ming-Tsung Chuang, Chia-En Wong, Yuan-Ting Sun, Hao-Kuang Wang, Jung-Shun Lee, Liang-Chao Wang, Chih-Yuan Huang","doi":"10.1136/svn-2025-004362","DOIUrl":"https://doi.org/10.1136/svn-2025-004362","url":null,"abstract":"<p><strong>Background: </strong>Dual antiplatelet therapy (DAPT) is often necessary following endovascular treatment for ruptured cerebral aneurysms; however, the optimal drug combination and treatment duration remain uncertain.</p><p><strong>Method: </strong>Patients with subarachnoid haemorrhage secondary to ruptured cerebral aneurysms were identified from the TriNetX database. Subjects were categorised based on DAPT regimen (aspirin+clopidogrel vs aspirin+ticagrelor) and duration (≥1 month, ≥3 months, ≥6 months). Propensity score matching was performed, and outcomes including new onset intracranial haemorrhage, ischaemic stroke and overall survival were compared.</p><p><strong>Results: </strong>A total of 2775 patients were included in the regimen analysis, with 725 matched in each group. At the 1-month follow-up, the ORs for new intracranial haemorrhage and ischaemic stroke in the aspirin+clopidogrel group were 1.11 (95% CI 0.71 to 1.75) and 0.97 (95% CI 0.59 to 1.59), respectively, with no significant differences at mid-term or long-term follow-up. However, survival analysis revealed a statistically significant difference at the 6-month follow-up favouring the clopidogrel group (OR 0.65; 95% CI, 0.44 to 0.97). In the duration analysis, 465 patients were matched for the 1-month versus 3-month groups, and 355 for the 3-month versus 6-month groups. ORs for ischaemic stroke were 1.06 (95% CI 0.67 to 1.67) and 1.24 (95% CI 0.76 to 2.01), respectively. No significant differences in survival were observed based on log-rank tests.</p><p><strong>Conclusion: </strong>Our real-world data analysis revealed no significant differences in ischaemic or haemorrhagic outcomes between the aspirin+clopidogrel and aspirin+ticagrelor regimens. However, the observed differences in survival suggest the need for more refined patient selection strategies. In addition, the appropriate duration of DAPT is still unknown, although our results suggest that a shorter DAPT duration may offer comparable safety and efficacy.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of endovascular interventions for cerebral venous thrombosis in Japan: a nationwide retrospective study.","authors":"Atsushi Senda, Hiroshi Suginaka, Koji Morishita, Kiyohide Fushimi","doi":"10.1136/svn-2024-003639","DOIUrl":"10.1136/svn-2024-003639","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral venous thrombosis (CVT) is a rare but serious disease. Despite anticoagulation being the cornerstone therapy, some patients experience worsening disease, necessitating alternative treatment. Endovascular treatment is an anticipated option with an uncertain clinical relevance. The aim of this study was to assess the clinical effects and efficacy of endovascular therapy and identify patient populations that may benefit from treatment.</p><p><strong>Patients and methods: </strong>This retrospective study examined patient data from April 2014 to March 2022 that were extracted from a nationwide Japanese Diagnosis Procedure Combination database. The primary outcome was in-hospital mortality. The secondary outcomes included modified Rankin Scale (mRS) scores and post-hospitalisation complications of cerebral infarction and intracranial haemorrhage. Severity was adjusted using a generalised linear mixed model, and propensity-score matching was employed to compare outcomes between treatment groups.</p><p><strong>Results: </strong>The study included 2901 patients; 240 patients in the endovascular treatment group were matched with 240 patients in the standard treatment group. After adjusting for background factors, endovascular treatment did not improve in-hospital mortality (adjusted OR 1.45; 95% CI 0.74 to 2.16) or the mRS score (adjusted OR 0.89, 95% CI 0.56 to 1.23). No subpopulations that could benefit from endovascular treatment were identified. Post-hospitalisation cerebral infarction and intracranial haemorrhage did not increase with endovascular treatment (0.8% in the endovascular treatment group vs 1.2% in the standard treatment group).</p><p><strong>Conclusion: </strong>Endovascular treatment showed no significant benefit for patients with CVT, indicating that treatment guidelines need to be refined. Our findings can guide clinical decisions and suggest the necessity of further research on potential benefits in specific subpopulations.</p>","PeriodicalId":48733,"journal":{"name":"Journal of Investigative Medicine","volume":" ","pages":"462-471"},"PeriodicalIF":4.9,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}