Neurologist最新文献_第4页

Propensity Score Matching Analysis on Risk Factors and Their Diagnostic Value of Frailty in Elderly Patients With Cerebral Infarction. 老年脑梗死患者虚弱危险因素的倾向评分匹配分析及其诊断价值。

IF 1.1 4区医学

Neurologist Pub Date : 2025-04-10 DOI: 10.1097/NRL.0000000000000624

Weiqi Gong, Wenlong Yuan, Miaomiao Zhai, Hua Jiang

{"title":"Propensity Score Matching Analysis on Risk Factors and Their Diagnostic Value of Frailty in Elderly Patients With Cerebral Infarction.","authors":"Weiqi Gong, Wenlong Yuan, Miaomiao Zhai, Hua Jiang","doi":"10.1097/NRL.0000000000000624","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000624","url":null,"abstract":"Objectives: Cerebral infarction is an acute ischemic cerebrovascular disease; elderly patients with cerebral infarction often have frailty syndrome. Therefore, the aim of this study was to analyze the risk factors and their diagnostic value of frailty in elderly patients with cerebral infarction.Methods: In this retrospective cohort study, the medical records (from October 2017 to September 2020) of patients with cerebral infarction (n=395) were analyzed. According to different frailty statuses, patients were divided into the health group (n=166) and the prefrailty group (n=229). The diagnostic value of various parameters for the occurrence of pre-frailty was assessed by the receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). The risk factors were analyzed by single-factor and multi-factor analyses.Results: Interleukin-6 (IL-6, P<0.001), C-reactive protein (CRP), prealbumin (PA, P<0.001), albumin (ALB, P<0.001), and brain natriuretic peptide (BNP, P<0.001) had higher diagnostic value for the occurrence of prefrailty in elderly patients with cerebral infarction. Single-factor and multi-factor analysis results revealed that the length of stay (LOS), comorbidity with nervous system diseases, high Charlson comorbidity index (CCI), high National Institute of Health stroke scale score, IL-6, BNP, ALB, PA, and creatine kinase might risk the factors for prefrailty occurrence (P<0.05). After the elimination of interference factors, LOS, high CCI, IL-6, and ALB were confirmed to be key risk factors for the occurrence of prefrailty (P<0.05).Conclusion: LOS, high CCI, IL-6, and ALB are the underlying risk factors for the occurrence of prefrailty in elderly patients with cerebral infarction, which provides a theoretical basis for clinical disease diagnosis.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Exploring Seizure Risks in Cerebral Venous Sinus Thrombosis Based on Thrombosis Site. 基于血栓部位探讨脑静脉窦血栓形成的癫痫发作风险。

IF 1.1 4区医学

Neurologist Pub Date : 2025-04-07 DOI: 10.1097/NRL.0000000000000625

Ali Amini Harandi, Helia Jafari Khaljiri, Nafiseh Jahangiri Zarkani, Hossein Pakdaman, Nika Khalili

{"title":"Exploring Seizure Risks in Cerebral Venous Sinus Thrombosis Based on Thrombosis Site.","authors":"Ali Amini Harandi, Helia Jafari Khaljiri, Nafiseh Jahangiri Zarkani, Hossein Pakdaman, Nika Khalili","doi":"10.1097/NRL.0000000000000625","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000625","url":null,"abstract":"Objectives: Cerebral venous sinus thrombosis (CVST) often leads to seizures, potentially worsening prognosis. This study aimed to assess the relationship between specific occlusion sites and seizure occurrence.Methods: We retrospectively analyzed 154 patients diagnosed with CVST in 3 major hospitals in Tehran. Medical records detailing sinus involvement, seizure occurrence, and baseline characteristics were reviewed. Statistical analyses included the χ2 or the Fisher exact tests, followed by binomial logistic regression to identify independent predictors. Model performance was evaluated using receiver operating characteristic (ROC) curves.Results: The study included 102 women (66.2%) and 52 men (33.8%), with a mean age of 36.4±10.8 years. A total of 35 patients (22.7%) experienced seizures, predominantly generalized tonic-clonic (85.7%). Superior sagittal sinus (SSS) involvement was strongly associated with seizures (odds ratio=3.056, P=0.006), while left transverse sinus involvement showed a marginally significant inverse relationship in univariate analysis (P=0.027), which became nonsignificant in the multivariate model (P=0.056). Trolard vein thrombosis was rare but associated with a high seizure rate (3/4 cases). The ROC for the final model showed moderate predictive ability (AUC=0.676).Conclusion: SSS thrombosis significantly predicted seizures in Iranian CVST patients. Although rare, trolard vein involvement may carry a substantial seizure risk. These findings underscore the importance of precise imaging and individualized treatment plans for high-risk CVST patients. By illuminating the role of SSS and trolard vein, this study highlights the need for prospective trials to refine clinical decision-making.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Extracorporeal Counterpulsation Therapy Enhances Neurological Outcomes in Patients Experiencing Acute Ischemic Stroke. 体外反搏治疗提高急性缺血性脑卒中患者的神经预后。

IF 1.1 4区医学

Neurologist Pub Date : 2025-03-19 DOI: 10.1097/NRL.0000000000000616

Jiaxuan Li, Xinhui Jia, Xinyi Chen, Jie Hu, Xun He, Yueyu Zhang, Yi Tang, Juncang Wu

{"title":"Extracorporeal Counterpulsation Therapy Enhances Neurological Outcomes in Patients Experiencing Acute Ischemic Stroke.","authors":"Jiaxuan Li, Xinhui Jia, Xinyi Chen, Jie Hu, Xun He, Yueyu Zhang, Yi Tang, Juncang Wu","doi":"10.1097/NRL.0000000000000616","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000616","url":null,"abstract":"Objective: The aim of this study was to assess the effects of extracorporeal counterpulsation therapy (ECP) on the short-term outcomes of patients with acute ischemic stroke in the mid-stroke phase.Methods: A total of 171 patients with acute ischemic stroke from the Department of Neurology at our hospital were selected and randomly assigned to 2 groups: 84 patients in the ECP group and 87 patients in the control group. Both groups received standard medication and rehabilitation. In addition, extracorporeal counterpulsation was incorporated into the treatment for the ECP group. At the conclusion of the treatment and after 90 days, both groups were evaluated based on the NIHSS and MRS scores.Results: No statistically significant differences were detected between the NIHSS and MRS scores of the 2 groups before and following treatment (P>0.05). However, on the 90th day, the NIHSS and MRS scores of the ECP group were significantly lower than those of the comparison group (P<0.05). The difference in the proportion of patients with NIHSS scores ≤1 between the 2 groups was 20.8%, whereas the absolute difference in MRS scores was 14.1%.Conclusion: Extracorporeal counter therapy effectively enhances neurological function in patients with ischemic stroke, thereby improving their ability to perform activities of daily living and overall prognosis.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Unilateral Weakness Caused By Spinal Cord Infarction in a Renal Transplant Recipient. 肾移植受者脊髓梗死引起的单侧虚弱。

IF 1.1 4区医学

Neurologist Pub Date : 2025-03-19 DOI: 10.1097/NRL.0000000000000611

Seul Bi Kim, Seung Min Kim, Byoung-Soo Shin, Hyun Goo Kang

{"title":"Unilateral Weakness Caused By Spinal Cord Infarction in a Renal Transplant Recipient.","authors":"Seul Bi Kim, Seung Min Kim, Byoung-Soo Shin, Hyun Goo Kang","doi":"10.1097/NRL.0000000000000611","DOIUrl":"https://doi.org/10.1097/NRL.0000000000000611","url":null,"abstract":"Introduction: Spinal cord infarction has various clinical presentations, depending on the vascular territory involved at the spinal cord level. The most common symptom is bilateral weakness. However, unilateral hemiparesis can occur if the sulcal artery is involved. Stroke is the most common and serious cerebrovascular complication associated with kidney transplantation. Clinically asymptomatic renal transplant recipients may experience increased intima-media thickening, which is significantly associated with an increased prevalence of cerebrovascular diseases.Case report: Herein, we report the case of a 64-year-old adult male with a history of kidney transplantation who presented with sudden-onset right-sided hemiparesis. The patient presented with right shoulder pain, right fingertip paresthesia, and recent dysuria, necessitating catheterization. T2-weighted magnetic resonance imaging at the C2-C3 level revealed hyperintensity corresponding to the right sulcal artery. Diffusion-weighted imaging revealed hyperintensities corresponding to T2 signal abnormalities, with a decreased apparent diffusion coefficient. The patient was diagnosed with cervical spinal cord infarction involving the right sulcal artery at the C2-C3 level. Subsequently, pulsed intravenous methylprednisolone and dual antiplatelet treatment (aspirin and clopidogrel) were administered. The patient showed a rapid and marked improvement in neurological function within 3 days.Conclusion: The patient in this case report initially presented with unilateral hemiparesis. The symptoms mimicked those of stroke, making accurate diagnosis challenging. This case highlights the need to consider spinal cord infarction in the differential diagnosis of patients presenting with unilateral hemiparesis. In addition, our findings suggest that spinal cord infarction may be a long-term complication in kidney transplant recipients.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ethnicity as a Risk Factor for Early Neurological Deterioration: A Post Hoc Analysis of the Secondary Prevention of Small Subcortical Strokes Trial. 种族是早期神经功能恶化的危险因素：对皮质下脑卒中二级预防试验的事后分析。

IF 1.1 4区医学

Neurologist Pub Date : 2025-03-01 DOI: 10.1097/NRL.0000000000000605

Eric D Goldstein, Sabrina Q R Liew, Liqi Shu, Alicia Rocha, Shadi Yaghi

{"title":"Ethnicity as a Risk Factor for Early Neurological Deterioration: A Post Hoc Analysis of the Secondary Prevention of Small Subcortical Strokes Trial.","authors":"Eric D Goldstein, Sabrina Q R Liew, Liqi Shu, Alicia Rocha, Shadi Yaghi","doi":"10.1097/NRL.0000000000000605","DOIUrl":"10.1097/NRL.0000000000000605","url":null,"abstract":"Objectives: Nearly 25% of those with a small vessel stroke will develop early neurological deterioration (END). The objectives of this study were to identify clinical risk factors for small vessel stroke-related END and its associated impact on functional outcomes in an ethnically diverse data set.Methods: We performed a post hoc analysis of the \"Secondary Prevention of Small Subcortical Strokes\" trial. The primary outcome was END defined as progressive or stuttering stroke-related neurological symptoms. Standard descriptive and inferential statistical methods were used for analysis. Functional outcomes are reported by modified Rankin Scale score and analyzed by the Wilcoxon signed-rank test.Results: In all, 69 participants met the inclusion criteria; 21 (30%) had END. Of the cohort, Spanish, Hispanic, or Latino ethnicity (grouping per trial definition) most frequently developed END [11 (52.4%) vs 4 (8.3%), P < 0.001] with a higher adjusted likelihood of END (odds ratio: 14.1, 95% CI: 2.57-76.7, P = 0.002). Black or African-American race less commonly had END [3 (14.3%) vs 21 (43.8%), P = 0.03] but lost significance after adjustment (odds ratio: 1.46, 95% CI: 0.26-8.17, P = 0.67) due to powering. END was associated with a higher mean modified Rankin Scale (2.06 ± 0.94 vs 1.17 ± 0.79, P = 0.006) but did not differ in the shift analysis.Conclusions: We found that Spanish, Hispanic, or Latino ethnicity was the most consistent risk factor for END though it was without meaningful functional outcome differences.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"116-120"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Efficacy for Hypertensive Intracerebral Hemorrhage Between Neuroendoscopic Surgery and Conservative Treatment: A Retrospective Observational Study. 神经内镜手术与保守治疗对高血压性脑出血的疗效：一项回顾性观察研究。

IF 1.1 4区医学

Neurologist Pub Date : 2025-03-01 DOI: 10.1097/NRL.0000000000000597

Guojin Huo, Yanping Lan, Yi Feng, Xiang Gao, Chen Chen

{"title":"The Efficacy for Hypertensive Intracerebral Hemorrhage Between Neuroendoscopic Surgery and Conservative Treatment: A Retrospective Observational Study.","authors":"Guojin Huo, Yanping Lan, Yi Feng, Xiang Gao, Chen Chen","doi":"10.1097/NRL.0000000000000597","DOIUrl":"10.1097/NRL.0000000000000597","url":null,"abstract":"Objectives: This study aims to investigate the efficacy of neuroendoscopic surgery in the treatment of hypertensive intracerebral hemorrhage (HICH).Methods: A total of 193 patients diagnosed with HICH were divided into 2 groups in this study: the observation group (n=101) received neuroendoscopic surgery, whereas the control group (n=92) underwent conservative treatment. Then, the outcomes between these 2 groups were compared and assessed.Results: In the pretreatment phase, there were no significant differences in the levels of inflammation and neurological function scores between these 2 groups ( P >0.05). After 3 months of treatment, the observation group displayed significantly shorter median hospital stay, lower average hospital costs, and faster hematoma resorption time, along with reduced levels of tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), interleukin (IL)-6 and IL-8, aquaporin-4 (AQP4), macrophage migration inhibitory factor (MIF), matrix metalloproteinase-9 (MMP-9), granulocyte macrophage colony stimulating factor (GM-CSF), Nerve Deficiency Scale (NDS), Graeb score, and national institute of health stroke scale (NIHSS) compared with the control group ( P <0.05). In addition, the observation group exhibited higher rate of hematoma clearance and better glasgow outcome scale (GOS) score compared with the control group ( P <0.05). The effective treatment rate in the observation group was notably superior to that in the control group (89.11% vs. 73.91%, P <0.05).Conclusions: Neuroendoscopic surgery is an effective treatment for HICH, with alleviating the inflammatory response and enhancing the neurological function. The treatment shows promising outcomes and justifies extensive implementation.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"109-115"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Syncope Induced by Dynamic Head and Shoulder Motion in the Setting of Left Subclavian Stenosis. 左锁骨下狭窄患者动态头肩运动诱发晕厥。

IF 1.1 4区医学

Neurologist Pub Date : 2025-03-01 DOI: 10.1097/NRL.0000000000000607

Forrest W Fearington, Katarina Alajbegovic, Jonathan M Scott, Waleed Brinjikji, Carmen R Holmes, Muhib Khan

{"title":"Syncope Induced by Dynamic Head and Shoulder Motion in the Setting of Left Subclavian Stenosis.","authors":"Forrest W Fearington, Katarina Alajbegovic, Jonathan M Scott, Waleed Brinjikji, Carmen R Holmes, Muhib Khan","doi":"10.1097/NRL.0000000000000607","DOIUrl":"10.1097/NRL.0000000000000607","url":null,"abstract":"Introduction: Dynamic vertebral artery insufficiency is a rare vascular phenomenon characterized by insufficient flow of the posterior cerebral circulation induced by dynamic motion of the head. Prior case reports have been limited to vertebral artery occlusion by cervical osteophytes or other structural impingements.Case report: In this case report, we discuss the unusual case of a 61-year-old female with a history of vertigo, diplopia, nystagmus, and left subclavian stenosis admitted to the hospital for syncope elicited by a left head turn and left shoulder raise. Transcranial Doppler (TCD) ultrasound and angiography showed evidence of dynamic vertebrobasilar insufficiency elicited by a left-head turn. Percutaneous stenting of the left subclavian artery led to the resumption of normal vessel flow as assessed by TCD and the resolution of the patient's symptoms.Conclusions: This case highlights an unusual cause of dynamic vertebrobasilar insufficiency induced by head turn and/or left shoulder raise due to subclavian stenosis, diagnosed by TCD and angiography, and successfully treated with subclavian artery stenting.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"121-122"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diffusion-Weighted Imaging-Based Radiomics Features and Machine Learning Method to Predict the 90-Day Prognosis in Patients With Acute Ischemic Stroke. 基于弥散加权成像的放射组学特征和机器学习方法预测急性缺血性脑卒中患者90天预后。

IF 1.1 4区医学

Neurologist Pub Date : 2025-03-01 DOI: 10.1097/NRL.0000000000000599

Guirui Li, Yueling Zhang, Jian Tang, Shijian Chen, Qianqian Liu, Jian Zhang, Shengliang Shi

{"title":"Diffusion-Weighted Imaging-Based Radiomics Features and Machine Learning Method to Predict the 90-Day Prognosis in Patients With Acute Ischemic Stroke.","authors":"Guirui Li, Yueling Zhang, Jian Tang, Shijian Chen, Qianqian Liu, Jian Zhang, Shengliang Shi","doi":"10.1097/NRL.0000000000000599","DOIUrl":"10.1097/NRL.0000000000000599","url":null,"abstract":"Objectives: The evaluation of the prognosis of patients with acute ischemic stroke (AIS) is of great significance in clinical practice. We aim to evaluate the feasibility and effectiveness of diffusion-weighted imaging (DWI) image-based radiomics features and machine learning methods in predicting 90-day prognosis among patients with AIS.Patients and methods: We enrolled a total of 171 patients with AIS in this study, including 134 patients with a good prognosis and 37 patients with a poor prognosis, and collected the patients' clinical and DWI image data. Radiomics features from manually sketched ischemic lesions were extracted using the Pyradiomics package of Python, and the best radiomics features were selected by a t test and the least absolute shrinkage and selection operator. The radiomics model and clinical model were constructed using support vector machine and logistic regression, respectively, and the predictive performance of each model was evaluated.Results: We selected 9 features from a total of 851 radiomics features to build the final radiomics model. For predicting the poor prognosis of patients with AIS, the area under the curves, accuracy, sensitivity and specificity of the clinical model, radiomics model in the training set and radiomics model in the testing set were 0.865, 0.930 and 0.906, 81.3%, 92.0% and 90.0%, 81.1%, 76.0% and 75.0%, and 81.3%, 97.0% and 95.0%, respectively.Conclusions: DWI image-based radiomics features and machine learning methods can accurately predict the 90-day prognosis of patients with AIS, and the radiomics model is superior to the clinical model in predicting prognosis.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":"30 2","pages":"93-101"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Outcomes and Antithrombotic Regimens in Nonvalvular Atrial Fibrillation Patients With Acute Ischemic Stroke and Competing Large-Artery Atherosclerosis. 急性缺血性卒中合并大动脉粥样硬化的非瓣膜性心房颤动患者的预后和抗血栓治疗方案

IF 1.1 4区医学

Neurologist Pub Date : 2025-03-01 DOI: 10.1097/NRL.0000000000000590

Sufang Xue, Risu Na, Jing Dong, Xue Qiu, Min Wei, Qi Kong, Qiujia Wang, Fangyu Li, Yan Wang

{"title":"Outcomes and Antithrombotic Regimens in Nonvalvular Atrial Fibrillation Patients With Acute Ischemic Stroke and Competing Large-Artery Atherosclerosis.","authors":"Sufang Xue, Risu Na, Jing Dong, Xue Qiu, Min Wei, Qi Kong, Qiujia Wang, Fangyu Li, Yan Wang","doi":"10.1097/NRL.0000000000000590","DOIUrl":"10.1097/NRL.0000000000000590","url":null,"abstract":"Objectives: This study aimed to investigate the outcomes and effectiveness of different antithrombotic regimens at discharge in nonvalvular atrial fibrillation (NVAF) patients with acute ischemic stroke (AIS) and competing large artery atherosclerosis (LAA) mechanisms.Methods: In an observational study, we retrospectively analyzed the clinical and follow-up data of NVAF patients with AIS from January 2018 to December 2021 (NCT04080830). The subjects were grouped into 2 groups based on the presence or absence of competing LAA mechanisms. Stroke severity, short-term prognosis, and ischemic recurrence (a composite of ischemic stroke/TIA, myocardial infarction, or systemic embolism after index stroke), were compared between the 2 groups. Antithrombotic regimens at discharge were further categorized into antiplatelet and anticoagulant subgroups to analyze their effectiveness.Results: Five hundred-one NVAF patients with AIS (129 with and 372 without competing LAA mechanisms) were included. Compared with the other group, the group with competing LAA mechanisms had a higher proportion of patients with a nondisabling mRS score (P <0.001), lower mortality rates at the 90-day follow-up ( P =0.048), and higher 180-day ischemic outcomes ( P =0.023). Subgroup analysis showed that the ischemic outcomes were not significantly different ( P =0.166) between the anticoagulant and antiplatelet subgroups in patients with competing LAA mechanisms. In contrast, it was numerically higher in the anticoagulant subgroup.Conclusion: NVAF patients with AIS due to competing LAA mechanisms had mild severity and a comfortable short-term prognosis; however, these patients had a higher risk of ischemic events. The optimal antithrombotic regimens in these patients remain unclear, and stroke mechanisms should be considered.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":" ","pages":"102-108"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Multiphase CTA Collateral Score to Identify Intracranial Atherosclerotic Stenosis-Related Large Vessel Occlusion. 多期CTA侧支评分识别颅内动脉粥样硬化性狭窄相关大血管闭塞。

IF 1.1 4区医学

Neurologist Pub Date : 2025-03-01 DOI: 10.1097/NRL.0000000000000592

Jiajie Xia, Chuanjian Tu, Hui Qian, Zhiwei Gu, Dagang Song, Lei Xu

{"title":"Multiphase CTA Collateral Score to Identify Intracranial Atherosclerotic Stenosis-Related Large Vessel Occlusion.","authors":"Jiajie Xia, Chuanjian Tu, Hui Qian, Zhiwei Gu, Dagang Song, Lei Xu","doi":"10.1097/NRL.0000000000000592","DOIUrl":"10.1097/NRL.0000000000000592","url":null,"abstract":"Objective: Identification of acute ischemic stroke with large vessel occlusion (AIS-LVO) etiology is crucial for effective revascularization therapy. As collaterals are pivotal in maintaining cerebral perfusion in intracranial atherosclerotic stenosis (ICAS), we investigated whether multiphase CT angiography (mCTA) collateral score can be a diagnosis marker of ICAS-related LVO.Methods: We reviewed clinical and imaging data from 92 patients who presented with AIS-LVO and underwent mCTA (57 ICAS-related LVO and 35 embolic LVO). Logistic regression was used to identify ICAS-related LVO. The diagnostic accuracy of the mCTA collateral score for identifying ICAS-related LVO was determined using receiver operating characteristic (ROC) analysis.Results: Compared with patients with embolic LVO, those with ICAS-related LVO had a high median mCTA collateral score (4 vs. 3; P<0.0001). The multinomial logistic regression analysis revealed a significant increase in the mCTA collateral score (OR: 3.717, 95% CI: 2.009-6.876, P<0.0001) in patients with ICAS-related LVO. ROC analysis revealed that the optimal cutoff point of the mCTA collateral score to diagnosis the ICAS-related LVO was 3.5, the area under the curve (AUC) was 0.817 (95% CI: 0.736-0.899; P<0.0001), sensitivity was 80.7%, and specificity was 74.3%. Further analysis revealed that patients with a 4 to 5 mCTA collateral score exhibited a significantly higher median modified Rankin Scale (mRS) at discharge compared with those with a 0 to 3 score (P=0.0464).Conclusions: The mCTA collateral score may be associated with ICAS-related LVO and could be beneficial in identifying the etiology of AIS-LVO.","PeriodicalId":49758,"journal":{"name":"Neurologist","volume":"30 2","pages":"87-92"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11864043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0