Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Letter to the editor regarding “exploring the bidirectional relationships between alzheimer's disease and cerebral small vessel disease: Insights from mendelian randomization”","authors":"Jianming Ke MD, Jin Li MD, Min Yu MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108326","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108326","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108326"},"PeriodicalIF":2.0,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143867889","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}

{"title":"Letter to the editor regarding “Serum uric acid levels and intracerebral hemorrhage: A two-sample Mendelian randomization study”","authors":"Huan Song MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108305","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108305","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108305"},"PeriodicalIF":2.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143850361","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}

{"title":"Estimating individualized effectiveness of receiving successful recanalization for ischemic stroke cases using machine learning techniques","authors":"Vahid Farmani ,&nbsp;Helge Kniep ,&nbsp;Mate E. Maros ,&nbsp;Olga Lyashevska ,&nbsp;Fiona Malone ,&nbsp;Jens Fiehler ,&nbsp;Liam Morris","doi":"10.1016/j.jstrokecerebrovasdis.2025.108324","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108324","url":null,"abstract":"<div><h3>Objectives</h3><div>Directly measuring the causal effect of mechanical thrombectomy (MT) for each ischemic stroke patient remains challenging, as it is impossible to observe the outcomes for both with and without successful recanalization in the same individual. In this study, we aimed to use machine learning to identify characteristics influencing the likelihood of not benefiting from successful recanalization.</div></div><div><h3>Materials &amp; methods</h3><div>A total of 1718 non-reperfused patients (Thrombolysis in Cerebral Infarction [TICI] ≤ 2a) and 10339 reperfused patients (TICI ≥ 2b) were included in the study as nonreperfusion and reperfusion groups, respectively. The primary target variable was probability of poor functional outcome after three months, defined by the modified Rankin Scale score of 3 to 6. Two random forest (RF) models trained on pre-treatment covariates of nonreperfusion and reperfusion groups, were used to predict the probability of poor outcome under unsuccessful and successful recanalization scenarios, respectively. The individual effect of successful recanalization was defined as the difference in predicted probabilities returned by the two models.</div></div><div><h3>Results</h3><div>Strong calibration was achieved by the RF models trained on nonreperfusion group (intercept:0.027, slope: 1.030) and reperfused group (intercept:0.010, slope: 1.017). The average risk reduction under successful recanalization scenario was 22.0 % (95 % CI [21.7 % – 22.3 %]) for the reperfused group and 19.8 % (95 % CI [19.1 % – 20.5 %]) for the nonreperfusion group. Key factors associated with not benefiting from successful recanalization included older age, higher pre-stroke mRS scores and higher National Institutes of Health Stroke Scale score at admission.</div></div><div><h3>Conclusions</h3><div>This study highlights the potential of predictive ML techniques to estimate the individual effect of successful recanalization on ischemic stroke patients undergoing MT.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108324"},"PeriodicalIF":2.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143863663","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}

{"title":"Acute ischemic stroke patient factors associated with poor outcomes in patients with favorable collaterals and successful thrombectomy","authors":"Jamie Kesten BA ,&nbsp;Michael Mlynash MD, MS ,&nbsp;Nicole Yuen MS ,&nbsp;Pierre Seners MD, PhD ,&nbsp;Anke Wouters MD ,&nbsp;Maya Schwartz BS ,&nbsp;Gregory W. Albers MD ,&nbsp;Maarten G. Lansberg MD, PhD ,&nbsp;Jeremy J. Heit MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108311","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108311","url":null,"abstract":"<div><h3>Objectives</h3><div>Favorable arterial collaterals are correlated to favorable outcomes after endovascular thrombectomy (EVT), but many patients still have unfavorable outcomes despite favorable collaterals and successful reperfusion. We determined factors associated with favorable outcome in patients with good collaterals who had successful EVT.</div></div><div><h3>Materials and methods</h3><div>In a post hoc analysis of the prospective CRISP 2 study, we identified patients with good collaterals (Tan≥2) and successful reperfusion (TICI 2b-3). Favorable (mRS 0-2) and unfavorable outcome (mRS 3-6) groups were compared to identify clinical, imaging, and treatment predictors of favorable outcome.</div></div><div><h3>Results</h3><div>92 patients were included. 33.7 % had favorable outcomes. There were no differences in sex (52 % females versus 54 % females; <em>p</em> = 0.821) or age (71 years [IQR 56-79] versus 68 years [IQR 57-79]; <em>p</em> = 0.859) in favorable versus unfavorable groups, respectively. Favorable outcome patients had more frequent intravenous thrombolysis (52 % versus 23 %; <em>p</em> = 0.006), shorter EVT procedures (27 min [IQR 23-40] versus 46 min ([IQR 27-64], and lower baseline NIHSS (12 [IQR 9-15] versus 16 [IQR 12-20]; <em>p</em> = 0.006). There were no differences in the frequency of TICI 3 rates (48 % vs. 38 %; <em>p</em> = 0.325) or first pass effect between the two groups (61 % vs. 57 %; <em>p</em> = 0.719). In a multivariable regression analysis, pre-stroke mRS 1 versus 0 versus (OR 0.15 [95 % CI: 0.03-0.78]; <em>p</em> = 0.024), pre-stroke mRS ≥3 versus 0 (OR 0.04 [95 % CI: 0.002-0.94]; <em>p</em> = 0.046), intravenous thrombolysis administration (OR 3.27 [95 % CI: 1.04-10.33]; <em>p</em> = 0.043) and EVT procedure time (OR for every 5 min 0.98 [95 % CI: 0.81-0.98]; <em>p</em> = 0.022) were modifiable predictors of favorable outcomes.</div></div><div><h3>Conclusions</h3><div>Among patients with good collaterals and successful reperfusion following EVT, favorable outcomes were associated with lower baseline mRS, intravenous thrombolysis administration, and shorter EVT procedure times.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108311"},"PeriodicalIF":2.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855520","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}

{"title":"Joint effect of modifiable risk factors and genetic susceptibility on ischaemic stroke","authors":"Jiao Shang MS ,&nbsp;Yanmei Wu MS ,&nbsp;Lixin Zhang PhD ,&nbsp;Xueting Jiang MS ,&nbsp;Ruiping Zhang MS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108313","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108313","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the effects of modifiable risk factors and genetic susceptibility on ischaemic stroke (IS).</div></div><div><h3>Methods</h3><div>A total of 490365 participants from the UK Biobank, with a 17-year follow-up, were included in this study. Data on 115 modifiable exposures were collected from five domains: early life, environment, lifestyle, socioeconomic status, and physical measures. Additionaly, genetic data were collected. An exposure-wide association analysis was conducted to identify potential risk factors. Risk scores for each domain and genes were calculated. The effect of each domain score on IS and the joint effects among the five domains were analyzed using multi-variate Cox models. The population attributable fraction was estimated to quantize the impact of eliminating unfavorable factors.</div></div><div><h3>Results</h3><div>Sixty-four of the 115 modifiable exposures were found to be significantly associated with the risk of IS (<em>P</em> &lt; 4.35 × 10^-4 for Bonferroni correction). Newly identified factors included maternal smoking and being either overweight or underweight at age 10, which could significantly increase the risk of IS by 4.78 % to 14.74 %, 11.01 % to 23.75 %, and 3.29 % to 12.80 %, respectively. Additionally, exposure to hard water was associated with a decreased risk of IS by 6.96 % to 11.48 % compared to exposure to soft water. The associations varied across domains, with socioeconomic factors accounting for 5.2 % of IS cases, lifestyle accounting for 2.8 %, and physical measures accounting for 2.5 %, representing the top three contributing factors. Overall, it was estimated that 10.6 % to 11.3 % of IS cases could be prevented by eliminating the identified risks.</div></div><div><h3>Conclusions</h3><div>Interactions between risk factors and genetic susceptibility elevated the risk of IS. Risk factors from different domains contributed variably to IS, with socioeconomic factors accounting for the largest proportion.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108313"},"PeriodicalIF":2.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143858995","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}

{"title":"Pre-hospital LVO detection: One size does not fit all","authors":"Christopher G. Favilla MD ,&nbsp;Michael T. Mullen MD ,&nbsp;Soren Konecky PhD ,&nbsp;Tyler McCardell MD ,&nbsp;Ryan A. McTaggart MD ,&nbsp;Grayson L. Baird PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108323","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108323","url":null,"abstract":"<div><div>A range of techniques are being developed with the goal of leverage physiologic data to detect large vessel occlusion (LVO) in the prehospital setting. The output of most every technique is a continuous (or ordinal) variable, but a threshold is applied to yield a simplified binary outcome (<em>i.e.</em>, high-likelihood LVO vs low-likelihood LVO). The mathematically optimal threshold is typically selected to balance sensitivity and specificity. Though intuitive, this approach may not appropriately account for the relative significance of false negatives and false positives. Most importantly, relying on a single threshold is an unnecessary oversimplification, and this one-size-fits-all approach to prehospital LVO detection does not optimally account for the diversity of prehospital systems of care. Here, we use a recently reported technique, optical blood flow imaging, to demonstrate how thresholds can be easily titrated in favor of sensitivity or specificity and thereby provide options that may better serve any given micro-environment.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108323"},"PeriodicalIF":2.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874535","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}

{"title":"Stroke risk prediction in symptomatic anterior circulation ICAD: Analysis of regional QMRA flow from the MYRIAD study","authors":"Sepideh Amin-Hanjani MD ,&nbsp;Theresa Elder MD ,&nbsp;Xinjian Du MD MPH ,&nbsp;Jose G. Romano MD ,&nbsp;David S. Liebeskind MD ,&nbsp;Adam De Havenon MD ,&nbsp;Arindam Rano Chatterjee MD ,&nbsp;Shyam Prabhakaran MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108322","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108322","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial atherosclerotic disease (ICAD) remains a major source of stroke world-wide, with high recurrence risk. Prior evaluation of posterior circulation ICAD patients enrolled in the prospective VERiTAS and MYRIAD studies revealed regional hypoperfusion assessed by large vessel flow measurements using quantitative MRA (QMRA) predicts subsequent stroke risk. We examined whether a similar approach to regional flow assessment predicted stroke risk in anterior circulation ICAD patients in MYRIAD.</div></div><div><h3>Methods</h3><div>MYRIAD enrolled patients with symptomatic 50-99 % stenosis of proximal intracranial artery. The primary outcome was recurrent ischemic stroke in the stenotic artery territory within one year. Flow was measured in the major intracranial arteries at baseline using QMRA. We designated patients as low or normal flow based on an algorithm assessing distal flow and collateral capacity using age-normalized middle cerebral artery (MCA) and hemispheric flows. Thresholds for flow status categorization were tested to determine the optimal algorithm for stroke risk prediction.</div></div><div><h3>Results</h3><div>Of 73 enrolled subjects with symptomatic anterior circulation ICAD, 7 (9.6 %) had recurrent stroke. Z-score thresholds for age-normalized flow were examined, from which we identified an optimal threshold of -1 for the MCA and -0.75 for hemispheric flow. Based on these thresholds, 24 (33 %) patients were categorized as low flow; recurrent stroke occurred in 21 % of low flow vs 4 % of normal flow patients (age adjusted OR 7.2, 95 % CI 1.2-43.2). In the full cohort of 99 subjects with anterior and posterior circulation ICAD, 11 (11.1 %) had recurrent stroke, with a higher recurrent stroke risk in low flow patients (21.4 % vs 7 %, age adjusted OR 3.8, 95 % CI 1.02-14.2).</div></div><div><h3>Conclusions</h3><div>Distal flow status assessed through QMRA regional flow measurement appears to be similarly predictive for recurrent clinical stroke in both the anterior and posterior ciruclation. Identification of high-risk patients has implications for future investigation of therapeutic interventions.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108322"},"PeriodicalIF":2.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143850360","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}

{"title":"The impact and projection of the COVID-19 pandemic on the burden of stroke at global, regional, and national levels: A comprehensive analysis for the Global Burden of Disease Study 2021","authors":"Zijing Gao MD ,&nbsp;Rafeq Agila MD ,&nbsp;Chao You MD,&nbsp;Songping Zheng MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108320","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108320","url":null,"abstract":"<div><h3>Background</h3><div>We aim to estimate impact and projection of the COVID-19 pandemic on the burden of stroke at global, regional, and national levels</div></div><div><h3>Methods</h3><div>Utilizing standardized GBD methodologies, we conducted a comprehensive analysis of the prevalence, incidence, mortality, and disability-adjusted life years (DALYs) associated with stroke across 204 countries and regions spanning the periods from 1990 to 2019, 2019 to 2021, and 1990 to 2021. Our study provides detailed estimates accompanied by corresponding 95% uncertainty intervals (UIs), stratified by age and sex. To elucidate the temporal trends in stroke burden, we calculated the Estimated Annual Percentage Change (EAPC). Additionally, we explored the relationship between stroke burden and sociodemographic index (SDI) levels. The DALYs attributable to various risk factors for stroke were also analyzed. The burden of stroke in the next 20 years was also predicted.</div></div><div><h3>Results</h3><div>From 2019 to 2021, the age-standardized prevalence rates (ASPR), incidence rates (ASIR), mortality rates (ASMR), and DALYs rates for stroke remained stable, diverging from the declining trends observed from 1990 to 2019 and from 1990 to 2021 at global, regional, and national levels, as indicated by both percent change analysis and EAPC analysis. This pattern was similarly reflected in the global burden of intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and ischemic stroke (IS). The changes in the burden of stroke, ICH, and IS from 2019 to 2021 were consistent between males and females. Importantly, the impact of COVID-19 on stroke burden remains substantial, irrespective of variations in the SDI. The IS burden increased in the next 20 years, and more attention should be paid on the stroke burden in young people.</div></div><div><h3>Conclusions</h3><div>Throughout the COVID-19 pandemic, the burden of stroke exhibited a stable trajectory, in contrast to the declining trend observed from 1990 to 2019 and from 1990 to 2021. The increased burden was observed in IS and young people in the next 20 years. These observations highlight the disparities in stroke burden that exist across different levels of socioeconomic development. The longitudinal epidemiological data presented in this study provide valuable insights into the significant shifts brought about by the COVID-19 pandemic, offering crucial information for researchers, policymakers, healthcare professionals, and other stakeholders.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108320"},"PeriodicalIF":2.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839136","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}

{"title":"Safety and efficacy of mechanical thrombectomy in distal medium vessel occlusions: Experience and real-world data from an Italian stroke hub centre","authors":"Michele Alessiani ,&nbsp;Adriano Bonura ,&nbsp;Gianmarco Iaccarino ,&nbsp;Sergio Soeren Rossi ,&nbsp;Marilena Mangiardi ,&nbsp;Maria Cristina Bravi ,&nbsp;Francesca Romana Pezzella ,&nbsp;Gianluca de Rubeis ,&nbsp;Enrico Pampana ,&nbsp;Sabrina Anticoli","doi":"10.1016/j.jstrokecerebrovasdis.2025.108321","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108321","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Distal-medium vessel occlusions (DMVOs) contribute to approximately 25-40 % of cases of ischemic stroke. Intravenous thrombolysis (IVT) achieved a complete recanalization in &lt;50 % of cases. Observational studies have demonstrated comparable efficacy and safety of mechanical thrombectomy (MT) in DMVOs compared to LVOs. Recently published RCTs have shown that MT plus best medical therapy in DMVOs does not improve the outcome compared to best medical therapy alone</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study involving patients with acute ischemic stroke (AIS) and primary or secondary DMVO according to literature classification. DMVOs were defined as occlusion in the A2, A3, distal M2 or its single branch, M3, P2, P3, PICA, SCA and AICA. The primary endpoint was to evaluate the safety and efficacy of MT alone in DMVOs compared to IVT. Efficacy was assessed by considering the change in NIHSS from admission to discharge, 3 months Modified Rankin Scale (mRS), 3 months mortality rate and recanalization rate. Safety was assessed based on haemorrhagic transformation and procedural complications. As a secondary endpoint we compared primary and secondary DMVO to highlight any differences.</div></div><div><h3>Results</h3><div>In primary plus secondary DMVO after propensity score analysis there were no statistically significant differences in efficacy and safety between MT and IVT though a positive trend for NIHSS reduction in the MT group. Sub-analysis of primary DMVO did not show significant differences between the two groups. MT group achieved an excellent recanalization rate with mTICI ≥2b in 95 % of cases and no procedural complications occurred.</div></div><div><h3>Conclusions</h3><div>MT in DMVOs showed an excellent recanalization rate and few procedural complications. New RCTs are needed to compare the efficacy and safety of MT alone versus IVT alone in primary and secondary DMVOs separately.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108321"},"PeriodicalIF":2.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143850359","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}

{"title":"The annual economic burden of patent foramen ovale-associated stroke in the United States","authors":"John J. Volpi ,&nbsp;Scott E. Kasner ,&nbsp;Jet Neervoort ,&nbsp;Lambertus F. Wolters ,&nbsp;Timon Louwsma ,&nbsp;Anne K. Marti ,&nbsp;Erik J. Landaas","doi":"10.1016/j.jstrokecerebrovasdis.2025.108319","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108319","url":null,"abstract":"<div><h3>Background</h3><div>Stroke is the second leading cause of death worldwide and the third leading cause of death and disability combined. Among ischemic strokes, 25 % to 40 % are classified as cryptogenic, with patent foramen ovale (PFO) identified as a potential underlying cause. PFO is found in 25 % of the general population. Despite the significant occurrence of PFO-associated strokes, the associated costs remain largely unexplored.</div></div><div><h3>Aim</h3><div>This study aimed to evaluate the annual economic burden of PFO-associated stroke in the US.</div></div><div><h3>Methods</h3><div>A cost-of-illness study was performed, encompassing the direct and indirect costs of PFO-associated stroke on both society and the healthcare system. The model adopted a top-down approach and a one-year, US societal perspective. A payer perspective and bottom-up costing approach were included as scenario analyses. Data was obtained by a targeted literature review.</div></div><div><h3>Results</h3><div>The societal model, assuming 32.5 % cryptogenic strokes, incurs an annual cost of over $1.3 billion in the US, with over $1.0 billion coming from new strokes and over $300 million from recurrent strokes. The majority of the costs are indirect—50 % from productivity losses due to premature death and 27 % from other productivity losses. Direct costs constitute 23 % of the total. From the payer perspective, the annual costs for PFO-associated strokes in the US were estimated at $302 million, with hospitalization costs comprising 44 %, followed by prescriptions and outpatient care at 19 % and 16 %, respectively.</div></div><div><h3>Conclusion</h3><div>The economic burden of PFO-associated strokes in the US is substantial, exceeding $1.3 billion per year. Different types of medical management or surgical treatments for PFO-associated stroke could lead to gains in both costs and health outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108319"},"PeriodicalIF":2.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143863717","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}