Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Intracarotid injection of hyperosmolar mannitol produced a larger infarct than normal saline during the first few hours of distal middle cerebral artery occlusion with a smaller regional plasma volume","authors":"Xia Liu MD ,&nbsp;Harvey R Weiss PhD ,&nbsp;Oak Z Chi MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108403","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108403","url":null,"abstract":"<div><h3>Background</h3><div>Although hyperosmolar mannitol has been used clinically to reduce intracranial pressure, its use in acute ischemic stroke remains controversial. We investigated whether other characteristics of hyperosmolar mannitol such as its effects on cerebral regional plasma volume or blood-brain barrier permeability would affect infarct size when intracranial pressure is zero during the early ischemic stroke.</div></div><div><h3>Methods</h3><div>One hour after a distal middle cerebral artery occlusion with craniotomy which results in essentially zero intracranial pressure, the rats were treated with 25 % mannitol or normal saline via the ipsilateral external carotid artery. Control rats received no treatment. Two hours after middle cerebral artery occlusion, infarct size along with the blood-brain transfer coefficient of ¹⁴C-α-aminoisobutyric acid, and the volume of ³H-dextran distribution were measured to assess blood-brain barrier permeability and plasma volume respectively.</div></div><div><h3>Results</h3><div>At one hour after intracarotid artery injection and two hours after middle cerebral artery occlusion, hyperosmolar mannitol treatment significantly reduced cerebral regional plasma volume in the ischemic cortex (3.0 mL/100 <em>g</em> ± 1.6) compared to normal saline (6.1 mL/100 <em>g</em> ± 1.3, <em>p</em> &lt; 0.0001) or no treatment (4.8 mL/100 <em>g</em> ± 1.2, <em>p</em> &lt; 0.05). Blood-brain barrier permeability was similar regardless of treatments in the ischemic cortex. The percentage of cortical infarcted area relative to total cortical area was significantly higher in the mannitol-treated rats (14.0 % ± 4.5) compared to normal saline treatment (6.6 % ± 1.4, <em>p</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>Our findings suggest that when intracranial pressure effect is excluded, hyperosmolar mannitol may exacerbate neuronal damage in the very early stages of acute ischemic stroke, and that cerebral regional plasma volume plays an important role in neuronal survival.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 9","pages":"Article 108403"},"PeriodicalIF":2.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683963","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":"Comparison of discharge disposition and AHA prehospital stroke compliance among urban, suburban, and rural EMS agencies","authors":"Daria S. Nicke ,&nbsp;Courtney Wham MD ,&nbsp;Ian Espinoza ,&nbsp;Breanna Thrower MS ,&nbsp;Stefan Sillau PhD ,&nbsp;Andra Farcas MD ,&nbsp;Michelle Leppert MD ,&nbsp;Elizabeth Molina Kuna MPH ,&nbsp;Layne Dylla MD, PhD ,&nbsp;the IMPACT Investigators","doi":"10.1016/j.jstrokecerebrovasdis.2025.108402","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108402","url":null,"abstract":"<div><h3>Background</h3><div>Rural community patients with acute stroke fhave worse outcomes compared to those in urban communities. This study determined the associations between agency type (rural, suburban, urban), patient care (compliance with American Heart Association [AHA] guidelines), and patient outcomes (discharge disposition).</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of patients with prehospital impression of suspected stroke and a final diagnosis of an acute stroke or TIA between January 1, 2020 and December 31, 2022. Prehospital agencies were classified by rural-urban commuting area (RUCA) score: urban (RUCA 1), suburban (RUCA 2-3), rural (RUCA 4-10). Descriptive statistics characterized the cohort. Multivariable regression analysis tested the association between agency type and discharge disposition while controlling for age, sex, cardiovascular risk factors, initial NIHSS, in-hospital intervention, and receiving facility type.</div></div><div><h3>Results</h3><div>Urban-, suburban-, and rural-based agencies varied in compliance with the AHA recommendations. Rural agencies had the lowest proportion of encounters with full compliance (2.0 %) compared to suburban (7.0 %) and urban agencies (11.0 %) (<em>p</em> &lt; 0.01). Compared to patients transported by urban agencies, patients transported by suburban agencies had almost twice (1.78 times; 95 % CI, 1.19-2.65) the odds of discharge to hospice or death and 0.56 times (95 % CI, 0.38-0.84) the odds of discharge home after controlling for covariates.</div></div><div><h3>Conclusions</h3><div>Rural EMS agencies had the lowest proportion of full compliance with AHA prehospital stroke guidelines. Acute stroke patients transported by suburban EMS agencies were less likely to be discharged home and more likely to be discharged to death compared to patients transported by urban-based EMS agencies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 9","pages":"Article 108402"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677202","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":"Sleep duration and long-term mortality after stroke: A nationwide analysis","authors":"Sara Hassani MD, MHS, MSCR ,&nbsp;Bruce Ovbiagele MD, MLS, MBA, MAS, MSc, FAHA ,&nbsp;Daniela Markovic MS ,&nbsp;Amytis Towfighi MD, FAHA","doi":"10.1016/j.jstrokecerebrovasdis.2025.108399","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108399","url":null,"abstract":"<div><h3>Background</h3><div>Sleep duration is a key marker of ideal cardiovascular health in the American Heart Association’s new Life’s Essential 8 construct, but studies on outcomes in stroke survivors are scarce. We assessed the association between sleep duration and mortality among self-reported stroke survivors in a nationally representative U.S. sample.</div></div><div><h3>Methods</h3><div>Cross-sectional data (2005–2018) from the National Health and Nutrition Examination Surveys database in patients aged ≥18 (n=42,143) with a self-reported history of stroke (n=1,488) were linked to the 2019 National Death Index to determine the association between nightly sleep duration and mortality. Relationships between sleep duration (short: &lt;7 hrs, normal: 7-8 hrs, long: &gt;8 hrs) and demographic characteristics were assessed. Relationships between sleep duration and mortality (all-cause and cardiovascular causes) were evaluated adjusting for demographic and clinical variables, with multivariable Cox regressions.</div></div><div><h3>Results</h3><div>Among stroke survivors, prevalence of short sleep duration increased with younger age while prevalence of long sleep duration increased with older age (p&lt;0.001). There were no significant sex differences in sleep duration. Long sleep duration was associated with higher all-cause mortality in the unadjusted model (HR 1.82, 1.44-2.31, p&lt;0.0001). After adjustment for co-variates, (HR 1.36, 1.08-1.71, p = 0.01), the association attenuated, but remained significant (HR 1.30, 1.02-1.65, p = 0.03). Sensitivity analysis further verified the reliability of this conclusion. Short sleep duration was not associated with all-cause or cardiovascular mortality after adjusted analyses. There were no significant associations between long sleep duration and cardiovascular mortality.</div></div><div><h3>Conclusion</h3><div>Long sleep duration is independently associated with higher risk, all-cause mortality after stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 9","pages":"Article 108399"},"PeriodicalIF":2.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633900","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":"Case-fatality of acute ischemic stroke in stroke units of Latin American hospitals","authors":"Miguel A. Vences ,&nbsp;Miguel A. Barboza ,&nbsp;Leonardo Augusto Carbonera ,&nbsp;Virgilio E. Failoc-Rojas ,&nbsp;Julieta Rosales ,&nbsp;Pablo Amaya ,&nbsp;Pablo Lavados","doi":"10.1016/j.jstrokecerebrovasdis.2025.108396","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108396","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>The Case-fatality of acute ischemic stroke in stroke units of Latin American hospitals is a multicenter registry from various stroke centers in Latin America, exploring demographic, clinical, imaging, and functional outcomes in acute ischemic stroke (AIS) patients, with the intention of determining case-fatality rates (in-hospital, 30 and 90 days follow up) and analyzing associated risk factors.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using data from hospitalized AIS patients over 18 years of age, collected from 27 centers in 11 Latin American countries between January 1 and December 31, 2022. The effect size was estimated using the hazard ratio (HR) and 95 % confidence intervals (95 % CI) through Cox regression models to assess the association between time to 30-day fatality event and covariates.</div></div><div><h3>Results</h3><div>A total of 2,997 patients were included. The mean age was 68.7 years and 48.1 % were women. In-hospital case-fatality was 9.42 %, 277 patients (10.2 %) died within 30 days, and 90-day case-fatality was relatively close at 353 patients (13.3 %). Complications were reported in 31.3 % of cases, most frequently infections (18.5 %). Age over 75 years (HRa=2.28), hyperglycemia (HRa=1.28), baseline status (HRa=1.61), stroke severity according to NIHSS &gt;26 (HRa=6.11) and the presence of neurological complications (HRa=3.2) were risk factors for 30-day follow up case-fatality in these patients.</div></div><div><h3>Conclusion</h3><div>AIS patients in Latin America stroke centers had an in-hospital case-fatality of 9.42 % and the 30-day case-fatality was 10.2 %. Older age, hyperglycemia, baseline status, stroke severity and neurological complications were the strongest predictors of early case-fatality. The findings underscore the need to optimize stroke management protocols in the region.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 9","pages":"Article 108396"},"PeriodicalIF":2.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621720","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":"From brain to heart: Causality and therapeutic potential in atrial fibrillation","authors":"Kaiyuan Li,&nbsp;Zongyi Xia,&nbsp;Chi Zhou,&nbsp;Zhexun Lian","doi":"10.1016/j.jstrokecerebrovasdis.2025.108394","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108394","url":null,"abstract":"<div><h3>Objective</h3><div>To elucidate the causal relationship between resting-state brain function and atrial fibrillation (AF), and to pinpoint potential genetic targets and therapeutic compounds for AF.</div></div><div><h3>Methods</h3><div>Employing GTEx V8 eQTL and deCODE Genetics pQTL datasets, key genes associated with AF were identified through Mendelian Randomization (MR) and Summary-based Mendelian Randomization (SMR) analyses. Colocalization analysis was subsequently conducted to confirm the shared genetic loci influencing both brain function and AF. In addition, transcriptome differential expression and pathway enrichment analysis were undertaken to delineate the potential molecular mechanism. Drug screening and molecular docking are employed to evaluate the therapeutic efficacy of the candidate compounds.</div></div><div><h3>Results</h3><div>MR Analysis revealed a significant causal relationship between resting-state brain functions of the default mode network (DMN) and central executive network (CEN) and AF. SMR and co-localization analyses identify the WIPF1 gene as a key genetic locus shared with brain function and AF. Candidate compounds C₁₂H₁₂N₄S, C₁₆H₁₅N₅O₂ and C₁₆H₁₃NO₆ showed anti-inflammatory and antibacterial properties, and exhibited good binding affinity in molecular docking, supporting their potential as therapeutic agents.</div></div><div><h3>Conclusions</h3><div>This study reveals a novel genetic association between resting-state brain function and AF and identifies WIPF1 as a potential therapeutic target, offering fresh insights into the study of brain-heart interaction and targeted treatment strategies for AF.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 9","pages":"Article 108394"},"PeriodicalIF":2.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605742","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":"Early CSF inflammatory markers after aneurysmal subarachnoid hemorrhage and their relationship to disease severity and shunt placement","authors":"Jessica Magid-Bernstein MD, PhD ,&nbsp;Jennifer Yan BS ,&nbsp;Alison L. Herman BA ,&nbsp;Zili He MS ,&nbsp;Conor W. Johnson BS ,&nbsp;Hannah Beatty BS ,&nbsp;Rachel Choi MS ,&nbsp;Sofia Velazquez BA ,&nbsp;Gracey Sorensen BS ,&nbsp;Sithmi Jayasundara BS ,&nbsp;Lauren Grychowski BS ,&nbsp;Abdelaziz Amllay MD ,&nbsp;Guido J. Falcone MD, ScD, MPH ,&nbsp;Jennifer Kim MD, PhD ,&nbsp;Nils Petersen MD, PhD, MSc ,&nbsp;Lena O’Keefe MD, MS ,&nbsp;Emily J. Gilmore MD ,&nbsp;Charles Matouk MD ,&nbsp;Kevin N. Sheth MD ,&nbsp;Lauren H. Sansing MD, MS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108395","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108395","url":null,"abstract":"<div><h3>Background</h3><div>The inflammatory response within the central nervous system is a key driver of secondary brain injury after aneurysmal subarachnoid hemorrhage (aSAH). Less is known about the impact that inflammation has on complications like persistent post-hemorrhagic hydrocephalus. To explore the association between inflammation, disease severity, and permanent shunt placement, we characterized the early cytokine profiles of the blood and cerebrospinal fluid (CSF) of patients with aSAH.</div></div><div><h3>Methods</h3><div>Biological samples were collected from aSAH patients admitted to a single-center Neurosciences Intensive Care Unit between 2014 and 2024. Control CSF samples were collected from patients undergoing permanent shunt placement for normal pressure hydrocephalus. A multiplex bead-based immunoassay was used to analyze a panel of cytokines in plasma and CSF samples. Clinical variables, including demographics, disease severity, and permanent shunt placement were collected.</div></div><div><h3>Results</h3><div>Plasma and/or CSF samples were collected from 83 patients (58 aSAH patients, 25 controls). In aSAH patients, C<img>C motif chemokine ligand-2 (CCL2), interleukin-6 (IL-6), granulocyte-colony stimulating factor (G-CSF), interleukin-8 (IL-8), and vascular endothelial growth factor (VEGF) were all elevated in CSF compared to plasma (<em>p</em> &lt; 0.05 for all comparisons) and in the CSF of aSAH patients as compared to controls (<em>p</em> &lt; 0.001 for all comparisons). However, only G-CSF and VEGF were associated with clinical severity at presentation when considering Hunt and Hess score as a dichotomized variable (<em>p</em> = 0.026 and <em>p</em> = 0.043, respectively). In multivariable models adjusted for age, sex, and modified Fisher Scale score, early CSF concentrations of IL-6 and IL-8 were associated with increased need for permanent shunt placement (<em>p</em> = 0.030 and <em>p</em> = 0.040, respectively).</div></div><div><h3>Conclusions</h3><div>Within 72 hours of aSAH, proinflammatory cytokines can be detected at higher concentrations in CSF than in plasma, and at higher concentrations in aSAH patients compared to controls. Early concentrations of certain pro-inflammatory cytokines are associated with increased likelihood of persistent post-hemorrhagic shunt dependent hydrocephalus, independent of initial disease severity. These data support preclinical models of CNS inflammation after aSAH and suggest that early innate inflammation contributes to hydrocephalus.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 9","pages":"Article 108395"},"PeriodicalIF":2.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605721","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":"Mediation by the dietary inflammatory index in the association between the weight-adjusted waist index and stroke: Insights from NHANES 2003–2018","authors":"Zhengjin Luo ,&nbsp;Yufeng Xu","doi":"10.1016/j.jstrokecerebrovasdis.2025.108386","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108386","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a significant risk factor for stroke, and the novel index Weight-Adjusted Waist Index (WWI) provides a more accurate representation of fat distribution, which has been linked to stroke risk. Diet plays a crucial role in modulating systemic inflammation, and the Dietary Inflammatory Index (DII) quantifies the pro-inflammatory potential of dietary intake. However, its role in the relationship between WWI and stroke remains unclear.</div></div><div><h3>Methods</h3><div>We analyzed 13,603 adults (≥20 years) from the National Health and Nutrition Examination Survey (NHANES) 2003–2018. Multivariable logistic regression assessed the association between WWI and stroke risk, with restricted cubic splines (RCS) testing non-linearity. Mediation analysis evaluated DII’s role in the WWI-stroke link. Subgroup and sensitivity analyses ensured result robustness.</div></div><div><h3>Results</h3><div>Higher WWI group was significantly associated with increased stroke risk (OR = 2.35, 95 % CI: 1.33, 4.14, <em>p</em> = 0.004). RCS analysis showed no non-linear relationship (p-non-linear = 0.296). DII was positively correlated with both WWI and stroke. Mediation analysis indicated that DII mediated 6.91 % of the WWI-stroke association (<em>p</em> = 0.004). Subgroup analyses confirmed consistent findings, with significant interactions for sex and alcohol consumption.</div></div><div><h3>Conclusion</h3><div>WWI is positively associated with stroke risk, partially mediated by DII, suggesting that a pro-inflammatory diet contributes to this relationship. Integrating WWI and DII into clinical assessments may refine stroke prevention strategies in at-risk populations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108386"},"PeriodicalIF":2.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144588421","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":"A rare case of bilateral basilar artery webs","authors":"Ziwei Xu Master of Medicine ,&nbsp;Yaoping Shi Master of Medicine ,&nbsp;Shiping Yang Master of Medicine,&nbsp;Ying Li Doctor of Medicine","doi":"10.1016/j.jstrokecerebrovasdis.2025.108393","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108393","url":null,"abstract":"<div><h3>Background</h3><div>Basilar artery web is a rare and under-recognized vascular anomaly that may contribute to posterior circulation ischemic stroke. In limited reports, basilar artery webs have appeared as thin, membrane-like intraluminal defects at various locations along the basilar artery.</div></div><div><h3>Case Presentation</h3><div>A 51-year-old man presented with a 10-day history of involuntary movements in the left upper limb, along with longstanding memory decline and gait instability. He had no history of stroke or cardiovascular disease. Non-contrast computed tomography of the head showed no hemorrhage, and laboratory investigations were not diagnostic. Time-of-flight magnetic resonance angiography revealed severe focal stenosis in the distal basilar artery. High-resolution black-blood magnetic resonance imaging and digital subtraction angiography identified two distinct, thin, smooth, membrane-like intraluminal defects, consistent with basilar artery webs.</div></div><div><h3>Discussion</h3><div>This is the first reported case of two coexisting web-like lesions within the same segment of the basilar artery. Although no definitive infarction was observed, the vascular anomalies may have impaired perforator artery flow or disrupted local hemodynamics, potentially contributing to focal brainstem ischemia.</div></div><div><h3>Conclusion</h3><div>This case expands the current understanding of basilar artery webs and emphasizes the diagnostic value of high-resolution vessel wall imaging. Recognition of this rare anomaly is important for accurate stroke risk assessment and individualized prevention strategies, especially in patients without conventional vascular risk factors.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108393"},"PeriodicalIF":2.0,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579399","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 severity and prognosis in patients on the brink of end-stage chronic kidney disease: K-PLUS registry","authors":"Hirotaka Hayashi M.D. ,&nbsp;Makoto Nakajima M.D. ,&nbsp;Yuichiro Inatomi M.D. ,&nbsp;Tadashi Terasaki M.D. ,&nbsp;Toshiro Yonehara M.D. ,&nbsp;Kuniyasu Wada M.D. ,&nbsp;Yanosuke Kouzaki M.D. ,&nbsp;Kenichiro Yi M.D. ,&nbsp;Yoichiro Hashimoto M.D. ,&nbsp;Mitsuharu Ueda M.D.","doi":"10.1016/j.jstrokecerebrovasdis.2025.108391","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108391","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The association between chronic kidney disease (CKD) grade and stroke severity or prognosis is still controversial. We investigated the relationship between CKD stage and stroke severity on admission and its influence on prognosis.</div></div><div><h3>Methods</h3><div>Using a regional stroke registry, the clinical characteristics of acute ischemic stroke patients were investigated in each CKD stage (G1–G5). The relationship between CKD stage and the National Institutes of Health Stroke Scale (NIHSS) score was examined in stratified analyses under the presence or absence of various factors. Multiple logistic regression analyses to identify predictors for an unfavorable prognosis or death were performed.</div></div><div><h3>Results</h3><div>Of 10,104 patients, 1,056 (10 %) were CKD stage G1, 3,797 (38 %) were stage G2, 4,137 (41 %) were stage G3, 678 (7 %) were stage G4, and 436 (4 %) were stage G5. The NIHSS score was the highest in patients with stage G4 (median, 10; interquartile range, 4–22), compared to those with G1 (3; 1–8), G2 (3; 2–9), G3 (6; 2–16), and G5 (5; 2–14). Similar results were obtained on multiple logistic regression analysis including potential confounders. As to outcome at discharge, a modified Rankin Scale score of ≥3 was more frequently observed in stage G4 patients. However, the independent relationships diminished after multiple logistic regression analyses including stroke severity on admission as an independent variable.</div></div><div><h3>Conclusion</h3><div>Stroke severity on admission was the highest in patients with CKD stage G4 compared to the other stages, which was possibly related to an unfavorable prognosis and mortality.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108391"},"PeriodicalIF":2.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577596","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":"Recombinant human pro-urokinase vs. alteplase within 4.5 hours of acute ischemic stroke: A systematic review and meta-analysis of randomized controlled trials","authors":"Tallal Mushtaq Hashmi MBBS ,&nbsp;Aimen Shafiq MBBS ,&nbsp;Rohma Zia MBBS ,&nbsp;Hadiah Ashraf MBBS ,&nbsp;Muhammad Burhan MBBS ,&nbsp;Mushood Ahmed MBBS ,&nbsp;Ahmad Mesmar MBBS ,&nbsp;Raheel Ahmed MRCP ,&nbsp;Gregg C. Fonarow MD, FACC","doi":"10.1016/j.jstrokecerebrovasdis.2025.108392","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108392","url":null,"abstract":"<div><h3>Background</h3><div>Recombinant human pro-urokinase (rhPro-UK) has emerged as a potential alternative to alteplase for patients with acute ischemic stroke (AIS) presenting within 4.5 hours of symptom onset. This meta-analysis evaluates and compares the efficacy and safety of rhPro-UK with alteplase in this patient population.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted on PubMed, Cochrane and Embase from inception to November 30, 2025, to identify eligible RCTs comparing intravenous rhPro-UK with alteplase in AIS patients treated within 4.5 hours of symptom onset. A random-effects meta-analysis was conducted using RevMan Web.</div></div><div><h3>Results</h3><div>Three RCTs encompassing 2,289 patients (rhPro-UK: 1141; alteplase: 1148) met the inclusion criteria. The pooled analysis demonstrated no significant difference between rhPro-UK and alteplase in achieving excellent functional outcome (mRS 0-1 at 90d: RR = 1.04, 95 % CI = 0.98 to 1.10; <em>P</em> = 0.17) and good functional outcome (mRS 0-2 at 90d: RR = 1.0, 95 % CI = 0.96 to 1.05; <em>P</em> = 0.86). No statistically significant difference was observed for early neurological improvement (RR 1.05, 95 % CI 0.96 to 1.15), symptomatic intracranial hemorrhage (RR = 0.52, 95 % CI = 0.19 to 1.43), all-cause mortality (RR 1.10, 95 % CI 0.64 to 1.91) and severe adverse events (RR = 0.92, 95 % CI = 0.75 to 1.13).</div></div><div><h3>Conclusion</h3><div>This meta-analysis found no statistically significant differences between rhPro-UK and alteplase in terms of functional outcomes, early neurological improvement, or safety profiles in patients with acute ischemic stroke. rhPro-UK shows promise as a cost-effective alternative, but further large-scale RCTs are required to confirm its role in AIS management.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108392"},"PeriodicalIF":2.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579398","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}