Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Effect of stroke etiology on treatment-related outcomes in young adults with large vessel occlusion: Results from a retrospective cohort study","authors":"Kriti Bhayana MD ,&nbsp;J. Will Handshoe MD ,&nbsp;Yadi Li MEd ,&nbsp;Nicolas R Thompson MS ,&nbsp;Maariyah Kharal BS ,&nbsp;Hiba Saleem BS ,&nbsp;Ehaab Saleem ,&nbsp;Andrew T. Schuster BA ,&nbsp;Benjamin Coors MD ,&nbsp;Maria Martucci MD ,&nbsp;M. Shazam Hussain MD ,&nbsp;G. Abbas Kharal MD, MPH","doi":"10.1016/j.jstrokecerebrovasdis.2024.108027","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108027","url":null,"abstract":"<div><h3>Introduction</h3><div>Large vessel occlusion-acute ischemic stroke (LVO-AIS) is infrequent in young adults and exhibits distinct stroke mechanisms compared to older adults. This study sought to evaluate the impact of varying stroke etiologies on treatment-related outcomes in young adults with LVO-AIS, an aspect that remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients aged 18-50 presenting with AIS from January 2017 to December 2021 within our multi-center stroke network. Patients with LVO on CTA/MRA at presentation were included. We assessed demographics, stroke etiology (TOAST classification), and treatment-related outcomes. Based on intervention received, patients were divided into 5 groups [IV-thrombolysis (IVT) only, Mechanical Thrombectomy (MT) only, IVT+MT, no treatment, unsuccessful MT].</div></div><div><h3>Results</h3><div>Among 1210 AIS patients, 220 with LVO were included. The median age was 42 (36, 46). 75 (34.1 %) patients underwent successful MT (46.7 % received IVT+MT). 26 (11.8 %) received IVT only, 110 (50 %) received neither intervention, and 9 (4.1 %) underwent unsuccessful MT. Per TOAST, 17.4 % had large artery atherosclerosis (LAA), 19.2 % cardio-embolism, 28.6 % stroke of other etiology, and 34.7 % had undetermined etiology. Favorable thrombectomy outcomes (TICI 2b/2c/3) were observed in 87.2 %. Discharge NIH Stroke Scale (NIHSS) scores improved for patients with IVT+MT in all TOAST categories except LAA.</div></div><div><h3>Conclusions</h3><div>Young adults with LVO-AIS had good outcomes irrespective of stroke etiology, except LAA, which was associated with a higher discharge NIHSS. Moreover, 50 % of young adults in our study received no intervention, a quarter of those owing to delayed presentation. Further studies are needed to identify barriers in seeking acute treatment in young adults with LVO-AIS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108027"},"PeriodicalIF":2.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300910","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}

{"title":"Corrigendum to Genetic association between long non-coding RNA MIAT polymorphism and ischemic stroke susceptibility in the Chinese population","authors":"Fengning Guo,&nbsp;Nuan Wang,&nbsp;Chunyu Yu,&nbsp;Youmin Fan,&nbsp;Dan Chen","doi":"10.1016/j.jstrokecerebrovasdis.2024.108009","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108009","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 11","pages":"Article 108009"},"PeriodicalIF":2.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300908","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":"Cost-effectiveness analysis of transthoracic echocardiographic assessment in patients with ischemic stroke or TIA of undetermined cause","authors":"Gerlinde van der Maten MD, PhD ,&nbsp;Xavier G.L.V. Pouwels PhD ,&nbsp;Matthijs F.L. Meijs MD, PhD ,&nbsp;Clemens von Birgelen MD, PhD ,&nbsp;Heleen M. den Hertog MD, PhD ,&nbsp;Hendrik Koffijberg PhD ,&nbsp;ATTEST investigators","doi":"10.1016/j.jstrokecerebrovasdis.2024.108013","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108013","url":null,"abstract":"<div><h3>Background</h3><div>The multicenter ATTEST study recently assessed 1084 patients with ischemic stroke or transient ischemic attack (TIA) of undetermined cause and found that routine transthoracic echocardiography (TTE) detects abnormalities with treatment implications (i.e., major cardiac sources of embolism) in only 1 % of patients, of whom most (91 %) also had major electrocardiographic (ECG)-abnormalities. In this study, we performed a cost-effectiveness analysis of different TTE strategies.</div></div><div><h3>Methods</h3><div>We compared the cost-effectiveness of three strategies of TTE assessment: (1) TTE in all patients; (2) TTE only in patients with major ECG-abnormalities; and (3) TTE not performed. Input data were derived from ATTEST and systematic literature reviews. A Markov model was developed that simulated recurrent ischemic stroke or TIA and intracranial and gastro-intestinal bleeding complications in patients with ischemic stroke or TIA of undetermined cause. Primary outcome was the additional costs per additional quality-adjusted life-year (QALY) from a Dutch societal perspective.</div></div><div><h3>Results</h3><div>Performing TTE only in patients with major ECG-abnormalities led to 0.0083 additional QALYs and €108 additional costs per patient as compared with not performing TTE (€12,987/QALY). Performing TTE in all patients resulted in 0.0005 additional QALYs and €422 additional costs per patient as compared with performing TTE only in case of major ECG-abnormalities (€805,336/QALY).</div></div><div><h3>Conclusions</h3><div>In patients with ischemic stroke or TIA of undetermined cause, a strategy of performing TTE only in patients who also had major ECG-abnormalities resulted in the most favorable ratio of additional costs per additional QALY. This supports performing TTE only in patients, who also have major ECG-abnormalities.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108013"},"PeriodicalIF":2.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300909","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}

{"title":"Prevalence of stroke in Bangladesh: A systematic review and meta-analysis","authors":"Tonmoy Alam Shuvo,&nbsp;Asma-Ul- Hosna,&nbsp;Kabir Hossain,&nbsp;Sorif Hossain","doi":"10.1016/j.jstrokecerebrovasdis.2024.108017","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108017","url":null,"abstract":"<div><h3>Background</h3><div>Stroke is a major health concern in Bangladesh due to its high incidence and effect on rates of morbidity and death. The morbidity due to stroke in Bangladesh is indeed increasing. This study aimed to find the pooled prevalence of stroke in Bangladesh.</div></div><div><h3>Methods</h3><div>An extensive search was conducted using PubMed, MEDLINE, and Google Scholar databases. I² and Q-tests were employed to evaluate the heterogeneity. A random-effects model and subgroup analysis were performed due to the significant heterogeneity. We used Egger's test and funnel plot to look at publication bias. Meta-regression was carried out to analyze how different study variables influenced the effect estimates and to explore sources of heterogeneity across studies. The GRADE approach was used to evaluate the overall quality of the evidence, and the Joanna Briggs Institute tool was used to assess the risk of bias. Sensitivity analysis was conducted to evaluate the robustness of the meta-analysis results. STATA version 17 was used for analysis.</div></div><div><h3>Results</h3><div>We selected eleven (n = 1577293) studies that met the inclusion criteria for the final synthesis. In Bangladesh, the overall pooled prevalence of stroke was 1.10 % (95 % CI: 0.70–1.51). Subgroup analysis showed that the prevalence of stroke was 1.14 % (95 % CI: 0.58–1.70) from 2005 to 2014 and 1.04 % (95 % CI: 0.40–1.68) from 2015 to 2024.</div></div><div><h3>Conclusion</h3><div>Stroke prevalence in Bangladesh is significantly high. The country's healthcare system faces adequate stroke prevention and treatment challenges. Improving healthcare services and public health education are crucial to addressing this increasing public health issue.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108017"},"PeriodicalIF":2.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300915","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":"Association between elevated lipoprotein(a) levels and vulnerability of carotid atherosclerotic plaque: A systematic review","authors":"Fernando Garagoli MD,&nbsp;Walter Masson MD,&nbsp;Leandro Barbagelata MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108020","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108020","url":null,"abstract":"<div><h3>Background</h3><div>The role of lipoprotein(a) [Lp(a)] as a potential risk factor for atherosclerotic arterial disease has been extensively studied. However, the available data regarding its association with the vulnerability of carotid atherosclerotic plaque is limited. The main objective of the present systematic review was to assess the association between elevated Lp(a) levels and carotid vulnerable plaque features.</div></div><div><h3>Methods</h3><div>This systematic review adhered to PRISMA guidelines, conducting a comprehensive literature search to identify studies examining the association between Lp(a) levels and vulnerability of carotid atherosclerotic plaque. Experimental or observational studies were eligible, without language, country, or publication type restrictions.</div></div><div><h3>Results</h3><div>Nine studies including 2058 patients were eligible for this systematic review. Five cross-sectional studies, 3 prospective/retrospective cohorts, and 1 subanalysis of a randomized controlled trial were analyzed. Two cross-sectional studies that compared Lp(a) levels between patients with and without vulnerable carotid plaque showed discordant results. Nevertheless, all the studies that evaluated the prevalence or incidence of vulnerable carotid plaque according to Lp(a) levels showed a positive association. Similarly, one study found a significant correlation between vulnerability of carotid plaque and Lp(a) levels.</div></div><div><h3>Conclusion</h3><div>Almost all studies analyzed in the present review showed a positive association between elevated Lp(a) levels and carotid vulnerable plaque features. However, further research is needed to clarify this issue.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108020"},"PeriodicalIF":2.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300906","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":"Understanding physician preferences about combined thrombolysis and thrombectomy in patients with large vessel occlusion: An international cross-sectional survey","authors":"A.Z. Siddiqi ,&nbsp;N. Kashani ,&nbsp;Adam A. Dmytriw ,&nbsp;D. Yavagal ,&nbsp;G. Saposnik ,&nbsp;M. Tymianski ,&nbsp;C. Adams ,&nbsp;M.D. Hill ,&nbsp;Dar Dowlatshahi ,&nbsp;Aristeidis H Katsanos ,&nbsp;B.K. Menon ,&nbsp;A. Ganesh ,&nbsp;N. Singh","doi":"10.1016/j.jstrokecerebrovasdis.2024.108022","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108022","url":null,"abstract":"<div><h3>Background</h3><div>A recently published individual participant-level meta-analysis found that EVT alone was not non-inferior to combined intravenous thrombolysis (IVT) and EVT. Our aim was to determine factors that influence physicians’ treatment choice of IVT-alone versus EVT-alone versus a combined approach.</div></div><div><h3>Methods</h3><div>We performed an international, structured, invite-only survey among physicians treating patients presenting with AIS. Respondents were asked 16 multiple choice questions. Fourteen questions involved the respondent being provided with a clinical scenario. In each scenario, a patient was presenting with an AIS with LVO, varying a single clinical or imaging feature.</div></div><div><h3>Results</h3><div>A total of 282 stroke physicians (mean age 46 years, 75 % males) participated in the survey. In LVO stroke, eligible for both IVT and EVT, without other qualifiers, 220 (85.9 %) respondents chose to pursue a combined approach. For age over 80 years, 191 (74 %) participants opted for combined approach, which decreased to 121 (48.2 %) with dementia and 148 (57.4 %) if the patient was on dual anti-platelet therapy (DAPT). Of respondents choosing combination therapy in a patient above the age of 80, only 105 (56.8 %) would pursue the same in a patient with dementia. For imaging factors, 177 (72.8 %) opted for a combined approach for intracranial carotid occlusion, which decreased to 160 (65.3 %) in tandem occlusions. Overall, 88 (38 %) respondents agreed to the statement “I am uncomfortable with uncertainty in patient care”.</div></div><div><h3>Conclusions</h3><div>In a typical patient with AIS due to LVO, most respondents still choose a combined revascularization approach but discrepancy in decision-making increases in complex scenarios.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108022"},"PeriodicalIF":2.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300918","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}

{"title":"MORe PREcISE: Longitudinal patient reported outcome measures in stroke at 3 and 6 months.","authors":"Amber E Corrigan MBBS BSc ,&nbsp;Marie AG Verstraete MBChB ,&nbsp;Ben Carter PhD ,&nbsp;Alexander Smith MA MRCOT ,&nbsp;Anna Pennington BSc ,&nbsp;Jonathan Hewitt MBBS PhD MSc FRCP (Glas)","doi":"10.1016/j.jstrokecerebrovasdis.2024.108023","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108023","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Post-stroke morbidity is common, but little is known about the burden on patients’ lives from their own perspective. Understanding morbidity from the point of view of the patient may support targeted intervention in post-stroke recovery. This study used a stroke specific Patient Reported Outcome Measure (PROM) containing Mental health (MH) and Physical Health (PH) domains and 5 stroke specific questions. We aimed to consider trends over a 6-month period and further assess the association between the MH and PH measures and common clinical measures.</div></div><div><h3>Methods</h3><div>A multicenter prospective cohort study was conducted at 19 hospital sites across England and Wales. Patients were enrolled from August 2018 to September 2019. Clinical measures and PROMs were assessed at three timepoints: acutely following the index stroke, at 3 and 6-months post-stroke. Clinical measures and PROMs were assessed in each of these points.</div></div><div><h3>Results</h3><div>Physical health PROM domains show significant gradual improvement across the study period (χ² 42.6312, p&lt;0.0001), whereas cognitive function domains (χ² 3.7849, p&lt;0.875) did not echo this trend. All clinical measures (GAD-7, PHQ9, MoCA, MRS) were associated with poorer PROM MH outcomes, (aMD -4.4, CI -0.59, -0.29, <em>p</em>≤0.001, aMD -0.45, CI -0.59, -0.32, <em>p</em>=&lt;0.001, aMD 0.75, CI 0.56, 0.95, aMD -1.91, CI -2.41, -1.47, <em>p</em>≤0.001). Clinical measures of disability, as per the MRS, are associated with poor PROM PH scores (aMD -0.57, 95% CI -0.94, -0.20, <em>p</em>=0.003).</div></div><div><h3>Conclusions</h3><div>This research indicates there is unmet cognitive burden in stroke survivors. PROMs may be able to measure unmet more discretely than common clinical tools that are used post-stroke. Further research and guidance on how to integrate PROMs into current clinical frameworks is essential.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108023"},"PeriodicalIF":2.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300913","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}

{"title":"Mediators of sex-specific differences in rates of stroke mimics among patients treated with intravenous thrombolysis: A nationwide analysis of 174,995 patients","authors":"Huanwen Chen MD ,&nbsp;Mihir Khunte BS ,&nbsp;Marco Colasurdo MD ,&nbsp;Seemant Chaturvedi MD ,&nbsp;Ajay Malhotra MD ,&nbsp;Dheeraj Gandhi MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108021","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108021","url":null,"abstract":"<div><h3>Introduction</h3><div>Women are at higher risk of stroke mimics; however, the underlying reasons are unclear.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study of the 2016–2020 National Inpatient Sample database, we identified patients treated with intravenous thrombolysis (IVT). Demographic information, vascular risk factors, comorbidities, and presence of known risk factors for stroke mimics (seizures, migraines, demyelinating diseases, psychiatric illnesses, and functional neurological disorders [FND]) were identified using ICD-10 codes. Rates of no cerebral infarction (NCI) were compared between men and women. Mediation analyses were conducted to identify significant drivers of sex-specific differences in the rate of NCI.</div></div><div><h3>Results</h3><div>174,995 IVT-treated patients were identified; 41,605 (23.8 %) had NCI. Female patients had significantly higher rates of NCI compared to men (26.2 % vs. 20.9 %, <em>p</em> &lt; 0.001). Women had significantly higher rates of stroke mimic risk factors (seizures, migraines, demyelinating disease, anxiety, depression, FND, and electrolyte derangements; all <em>p</em> &lt; 0.001). Mediation analyses revealed that 39.8 %, 19.1 % of female sex's association with higher rates of NCI were mediated by higher rates of migraines and FND among women, respectively (both <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>IVT-treated women were more likely to have NCI than men. This relationship was largely mediated by higher rates of migraine and FND among women.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108021"},"PeriodicalIF":2.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300912","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":"Causal role of thyroid function in functional outcome after ischemic stroke: A Mendelian randomization study","authors":"Yuxin Lin ,&nbsp;Ren Guo ,&nbsp;Si Cao ,&nbsp;Ge Gao ,&nbsp;Youjie Zeng","doi":"10.1016/j.jstrokecerebrovasdis.2024.108019","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108019","url":null,"abstract":"<div><h3>Background</h3><p>Previous observational studies have suggested that thyroid function may be associated with functional outcome after ischemic stroke (IS). Nevertheless, the causal relationship remains unclear. This study aimed to explore the causal effect of thyroid function [thyroid-stimulating hormone (TSH), free thyroxine (FT4), hyperthyroidism, and hypothyroidism] on functional outcome (based on the modified Rankin scale) after IS by two-sample Mendelian randomization (MR) analysis.</p></div><div><h3>Methods</h3><p>Inverse variance weighted (IVW) was the primary method for evaluating causal associations. In addition, six additional MR methods (MR-Egger regression, weighted median, maximum likelihood, simple mode, weighted mode, and MR-PRESSO) were employed to supplement IVW. Furthermore, various sensitivity tests were conducted to assess the reliability: (i) Cochrane's Q test for assessing heterogeneity; (ii) MR-Egger intercept test and MR-PRESSO global test for evaluating horizontal pleiotropy; (iii) leave-one-out sensitivity test for determining stability.</p></div><div><h3>Results</h3><p>The results of IVW indicated that elevated TSH levels significantly improved functional outcome after IS (OR = 0.74, 95 % CI: 0.57-0.97, P = 0.028). In addition, six additional MR methods suggested parallel results. However, no causal effect of FT4, hyperthyroidism, and hypothyroidism on functional outcome after IS was identified. In addition, sensitivity tests demonstrated the reliability of the MR analyses, suggesting that the MR analysis was not influenced by significant heterogeneity and horizontal pleiotropy.</p></div><div><h3>Conclusions</h3><p>Our MR study supported that elevated TSH levels might improve functional outcome after IS. Therefore, regular monitoring and maintenance of stable TSH levels may benefit patients recovering from IS.</p></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108019"},"PeriodicalIF":2.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142271398","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":"Intracranial atherosclerotic disease and neurodegeneration: a narrative review and plausible mechanisms","authors":"Dixon Yang MD, MS ,&nbsp;Laurel Cherian MD, MS ,&nbsp;Konstantinos Arfanakis PhD ,&nbsp;Julie A Schneider MD, MS ,&nbsp;Neelum T Aggarwal MD ,&nbsp;Jose Gutierrez MD, MPH","doi":"10.1016/j.jstrokecerebrovasdis.2024.108015","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108015","url":null,"abstract":"<div><h3>Introduction</h3><div>Intracranial atherosclerotic disease (ICAD) of the large cerebral arteries, a leading cause of stroke worldwide, is increasingly implicated in cognitive impairment and neurodegeneration among the general population; however, the underlying pathophysiologic mechanisms in this relationship remain unknown.</div></div><div><h3>Methods</h3><div>In this narrative review, we aim to provide an overview of the epidemiology and pathophysiology of ICAD, the evidence that relates ICAD to neurodegeneration, putative mechanisms, and future research directions. We synthesized available evidence on PubMed up to August 2024.</div></div><div><h3>Results and Conclusions</h3><div>ICAD, a common cause of stroke, is characterized as a chronic, inflammatory, fibroproliferative disease of the cerebral large arteries. Numerous lines of evidence have related ICAD to clinical, neuroimaging, and pathology-based markers of cognitive impairment and Alzheimer's disease; however, little data exists on plausible pathophysiological links. Based on ongoing and adjacent work, we hypothesize hypoperfusion, arterial stiffness, and inflammation to play a role, but further research is needed. Conventional classification of ICAD often infers from symptomatic coronary artery disease and relies on degree of luminal stenosis, but unique anatomic features of the intracranial circulation may be relevant and a more comprehensive description that includes arterial wall features and plaque morphology may be needed to fully understand its relationship with cognitive impairment and neurodegeneration.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108015"},"PeriodicalIF":2.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300911","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}