Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Association of peripheral blood inflammatory biomarkers and poor clinical outcomes in adult stroke patients with moyamoya disease","authors":"Xiaoju Wu ,&nbsp;Rilan Huang ,&nbsp;Shanghua Su ,&nbsp;Xiaoling Li ,&nbsp;Xiaozuo Lin ,&nbsp;Pingkai Wang ,&nbsp;Zhaoju Hong ,&nbsp;Ruoxi Zheng ,&nbsp;Yinan Zeng ,&nbsp;Chaojue Huang ,&nbsp;Man Luo","doi":"10.1016/j.jstrokecerebrovasdis.2025.108351","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108351","url":null,"abstract":"<div><h3>Purpose</h3><div>Stroke is the common manifestation of moyamoya disease (MMD). The study aimed to explore the correlation between inflammatory biomarkers and the poor clinical outcomes in adult stroke patients with MMD.</div></div><div><h3>Patients and methods</h3><div>The retrospective study included adult patients with MMD who were admitted to the First Affiliated Hospital of Guangxi Medical University from June 2012 to November 2023. Functional outcomes were assessed using the modified Rankin Scale (mRS) score. We assessed the area under the curves (AUC) for platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII) and neutrophil-to-albumin ratio (NAR) in predicting the poor clinical outcomes.</div></div><div><h3>Results</h3><div>Overall 201 eligible MMD patients including 29 subjects without stroke, 97 subjects with ischemic stroke and 75 subjects with hemorrhagic stroke were collected. In MMD patients with ischemic stroke, those with poor outcomes had significantly higher levels of SII and NAR. The AUCs of SII and NAR were respectively 0.667 and 0.684, while the AUC for joint application was 0.683. In MMD patients with hemorrhagic stroke, those with poor outcomes had significantly higher levels of PLR, NLR, MLR, SII, and NAR. And the AUCs were respectively 0.678, 0.727, 0.643, 0.751, 0.744, while the AUC for joint application of these inflammatory biomarkers was 0.793, higher than a single indicator.</div></div><div><h3>Conclusion</h3><div>Higher SII and NAR levels were associated with poor clinical outcomes in MMD patients with ischemic stroke. Higher PLR, NLR, MLR, SII, and NAR levels were associated with poor clinical outcomes in MMD patients with hemorrhagic stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108351"},"PeriodicalIF":2.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096785","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":"Epidemiological trends and forecasts in stroke at global, regional and national levels","authors":"Nannan Qian ,&nbsp;Chengcheng Lu ,&nbsp;Taohua Wei ,&nbsp;Wenming Yang ,&nbsp;Han Wang ,&nbsp;Huaizhen Chen ,&nbsp;Jun Li ,&nbsp;Sihuan Zhu ,&nbsp;Weiqi Wang ,&nbsp;Ningshu Shao","doi":"10.1016/j.jstrokecerebrovasdis.2025.108347","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108347","url":null,"abstract":"<div><h3>Background</h3><div>Stroke, characterized as ischemic or hemorrhagic, leads to severe morbidity, mortality, and recurrence. This research analyzed stroke epidemiological trends from 1990-2021.</div></div><div><h3>Methods</h3><div>The Global Burden of Disease database provided stroke data including incidence, mortality, and disability-adjusted life-years (DALYs). Age-standardized rates (ASRs) and Estimated Annual Percent Changes (EAPC) measured incidence and mortality shifts. The sociodemographic index (SDI) was explored alongside stroke burden. Forecasting of stroke trends until 2035 utilized the Bayesian age-period-cohort (BAPC) model. The factors influencing the variability of stroke burden were subjected to decomposition analysis for a more in-depth examination. Additionally, frontier analysis was employed to visually illustrate the opportunities for alleviating burden in each nation or region, taking into account their respective stages of development.This study utilized the slope index of inequality (SII) and the concentration index, as defined by the World Health Organization (WHO), to assess absolute and relative inequalities in disease burden.</div></div><div><h3>Results</h3><div>From 1990-2021, global stroke incidence increased by 15.03 %, with an overall decline in age-standardized incidence rate (ASIR). Lower in females than males, the incidence rise was larger in females. Stroke mortality declined by 2.60 % overall, with a rise in male mortality and decrease in female mortality. DALYs increased, with a 10.67 % decline by rate per 100,000 people. Eastern Europe, Central Asia, and East Asia experienced the highest incidence rates, with the greatest ASIR decline in the high-income Asia Pacific region. The decomposition analysis revealed a notable rise in Disability-Adjusted Life Years (DALYs) within the middle Socio-Demographic Index (SDI) quintile region, where factors such as aging and population growth were identified as primary contributing elements. Additionally, the frontier analysis indicated that nations or regions categorized within higher SDI quintiles are likely to exhibit greater potential for improvement. Projections for 2035 anticipate increased stroke cases alongside further ASIR and ASMR declines. Cross-country inequality analysis suggests that both absolute and relative health inequalities associated with the stroke burden have escalated during the period from 1990 to 2021.</div></div><div><h3>Conclusion</h3><div>Despite rising global stroke incidence and DALYs, decreases were seen in ASIR and ASMR since 1990. Incidence rates increased most quickly in females, with regional variation observable. High systolic blood pressure remained a key risk factor. Future efforts should target prevention and treatment to mitigate sex, age, and regional stroke disparities.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108347"},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089631","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":"Statin initiation and early stroke recurrence in the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke Trial (POINT) trial population","authors":"Elham Azizi MD ,&nbsp;Shyam Prabhakaran MD,&nbsp;James R. Brorson MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108349","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108349","url":null,"abstract":"<div><h3>Background</h3><div>Benefits of statin therapy in reducing the long-term risk of ischemic stroke are well-established, but the immediate protective effect of statin therapy on risks of early stroke recurrence after an initial ischemic event are not established.</div></div><div><h3>Methods</h3><div>In this secondary analysis of POINT data, we evaluated the effects of statins on early stroke recurrence (within 7 days) and recurrence over 90 days. We also examined the effect of early statin initiation in the subgroup of subjects not on statins prior to the index event, using logistic and proportional hazards models.</div></div><div><h3>Results</h3><div>In the POINT trial, 175 of 267 (65.5 %) of ischemic stroke recurrences were early (within 7 days). Baseline statin treatment at the time of study entry was associated with decreased odds of early ischemic stroke recurrence in adjusted logistical regression analysis (OR 0.70, 95 % CI 0.50–0.99, <em>P</em> = 0.04), an effect only marginally significant in adjusted Cox proportional hazard analyses (HR 0.72, 95 % CI 0.52–1.01, <em>P</em> = 0.05). In the subset of subjects not taking statin medications at baseline, initiation of statin treatment had no significant protective effect against early stroke recurrence (adjusted HR 0.80, 95 % CI 0.54–1.20, <em>P</em> = 0.28).</div></div><div><h3>Conclusions</h3><div>In the POINT trial population, prior treatment with statin was marginally associated with decreased odds of early recurrence of stroke. However initiating statin treatment had no detectable effect in reducing risk of early stroke recurrence. The POINT trial provides no evidence for an immediate protective effect of statin initiation against early stroke recurrence.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108349"},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144072484","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":"Is the association between visit- to- visit heart rate variability and cardiovascular disease mediated by arteriopathy as measured by carotid intima- media thickness?","authors":"Johanna Härtl ,&nbsp;Dirk Sander ,&nbsp;Ikenberg David Ikenberg ,&nbsp;Georg Schmidt ,&nbsp;Bernhard Hemmer ,&nbsp;Silke Wunderlich ,&nbsp;Bernhard Nimmrichter ,&nbsp;Klaus Pürner ,&nbsp;Alexander Hapfelmeier","doi":"10.1016/j.jstrokecerebrovasdis.2025.108348","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108348","url":null,"abstract":"<div><h3>Background</h3><div>Visit-to-visit heart rate variation (HRV-VV) is associated with mortality and cardiovascular events. Mechanisms of the interaction between HRV-VV and vascular disease are not clearly understood. Our study aimed to evaluate the association between HRV-VV and carotid intima-media thickness (IMT) and their potential impact on cardiovascular disease development.</div></div><div><h3>Methods</h3><div>The study population is derived from a cohort of elderly patients enrolled in the primary-care-based INtervention project on cerebroVAscular diseases and Dementia in the community of Ebersberg (INVADE). We included all patients with a follow-up of eight years and five follow-up visits in regular two-year intervals. HRV-VV was defined by the standard deviation of between-visit measurements (SD). Uni- and multivariable regression models were used to identify associations between HRV-VV, IMT, and a combined cardiovascular endpoint of new onset stroke and myocardial infarction.</div></div><div><h3>Results</h3><div>2815 patients were included in the study. HRV-VV was positively associated with IMT in multivariable analysis (<em>p</em> = 0.026). Every SD HRV-VV of 10 bpm was associated with a change of IMT of 18 ± 8 µm. Furthermore, HRV-VV showed a numerical and positive association with the combined cardiovascular endpoint (<em>p</em> = 0.07), while a simultaneous increase in HRV-VV and IMT increased the likelihood more than either factor alone (<em>p</em> = 0.009).</div></div><div><h3>Conclusion</h3><div>HRV-VV showed a positive association with IMT, a surrogate marker for early arteriopathy. Both parameters furtherly demonstrated a synergistic impact on the likelihood of cardiovascular disease development. Given its widespread availability by continuous monitoring with wearables, HRV-VV may provide a potentially modifiable medical target for personalized cardiovascular risk stratification.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108348"},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086951","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":"Examination of pediatric hemorrhagic stroke incidence: A systematic review and meta-analysis","authors":"Dieu Nguyen MPH ,&nbsp;Sze Wan Cheung MPH ,&nbsp;Yutong Liu MHE ,&nbsp;Mark T. Mackay PhD ,&nbsp;Belinda Stojanovski ,&nbsp;Marj Moodie DrPH ,&nbsp;Lan Gao PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108344","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108344","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric hemorrhagic stroke (HS) poses a significant burden. We aimed to examine the incidence rate of pediatric hemorrhagic stroke globally.</div></div><div><h3>Method</h3><div>This systematic review and meta-analysis searched Medline via Ovid, Embase, EBCOHOST, Scopus and Google Scholar up to 6 March 2024 for observational studies included pediatrics’ incidence rate of hemorrhagic stroke (PROSPERO: CRD42022312643). The screening process, data extraction, and quality assessment were undertaken by two reviewers. A random-effects model was used for the incidence rate meta-analysis while meta-regression and bias assessment were performed in Stata SE18.</div></div><div><h3>Results</h3><div>Twenty-two articles of 6315 records were included in the narrative synthesis. Twelve articles were included in the meta-analysis. The reported incidence rate in neonates (aged 0-28 days) ranged from 0.08 to 1.1 per 1,000 live births in three studies. In older pediatric population (aged ≤ 20 years), the incidence rate ranged from 0.59 to 5.1, 0.25 to 1.5 and 0.25 to 0.6 per 100,000 persons-years for all HS (<em>n</em> = 13), intracerebral hemorrhage (ICH) (<em>n</em> = 5) and subarachnoid hemorrhage (SAH) (<em>n</em> = 3), respectively. Meta-analysis showed a pooled incidence rate for all hemorrhagic stroke (<em>n</em> = 1810) of 1.45 (1.03, 2.04) per 100,000 person-years, <em>I²</em> = 96.99 %. Studies that excluded traumatic injury had a lower incidence rate than those that included traumatic injury in the incidence rate calculation (1.22 vs 2.34 per 100,000 person-years, respectively).</div></div><div><h3>Conclusions</h3><div>The difference between incidence rates was detected between subgroups of HS (i.e., traumatic cases vs no traumatic cases). Further research is warranted to examine the impact of etiology on the incidence rate of stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108344"},"PeriodicalIF":2.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942661","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 evaluation of electrical cardioversion in the presence left ventricular thrombus","authors":"M Marwan Dabbagh MD ,&nbsp;Saqer Alkharabsheh MD ,&nbsp;Mohamed Khayata MD ,&nbsp;Patrick Collier MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108336","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108336","url":null,"abstract":"<div><h3>Background</h3><div>Electrical cardioversion is an effective and safe procedure for most patients. While left atrial thrombus is an absolute contraindication for an elective cardioversion, there is limited data on cardioversion in patients with left ventricular thrombus (LVT). We sought to better study the safety of cardioversion in this population.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all patients with the diagnosis of LVT on transthoracic echocardiogram (TTE) at our institution from 2010 to 2019. Patients were included in the study if they had undergone cardioversion and had had a TTE 4 weeks prior or 2 days after cardioversion showing left ventricular thrombus. Medical charts were reviewed for embolic events within three months after cardioversion.</div></div><div><h3>Results</h3><div>Out of 764 patients, 39 were included in the study. The mean age was 60 ± 14 years. The reasons for cardioversion were atrial fibrillation/flutter (<em>n</em> = 14), ventricular arrhythmia (<em>n</em> = 14), and defibrillation threshold testing during defibrillator placement (<em>n</em> = 11). The mean time interval between the TTE and the cardioversion was 6 ± 6.3 days. The mean left ventricular ejection fraction was 24 %±10 %. The LVT was mobile (<em>n</em> = 3), fixed (<em>n</em> = 36). During a clinical follow-up period of 81±17 days, 29 patients (74 %) were treated with warfarin, 2 patients (5 %) with a direct oral anticoagulant, and 8 patients (21 %) with antiplatelet therapy alone. No patient had an embolic complication during the follow-up.</div></div><div><h3>Conclusion</h3><div>Within the limitations of this study, cardioversion in patients with LVT appeared to be safe. Further larger studies are needed.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108336"},"PeriodicalIF":2.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143942712","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 neutrophil-to-lymphocyte ratio is associated with functional outcome among single small subcortical infarction: Mediating effects of white matter hyperintensities","authors":"Yue Wu ,&nbsp;Jin Hu ,&nbsp;Yutie Zhao ,&nbsp;Dongshen Ju ,&nbsp;Shudong Cao ,&nbsp;Jintao Guo ,&nbsp;Weihua Song ,&nbsp;Ran Mo ,&nbsp;Shaoyuan Lei ,&nbsp;Yifan Wu ,&nbsp;Yingting Zuo ,&nbsp;Shujuan Meng ,&nbsp;Ziying Jiang ,&nbsp;Gaoting Ma ,&nbsp;Lianmei Zhong ,&nbsp;Yansu Guo","doi":"10.1016/j.jstrokecerebrovasdis.2025.108341","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108341","url":null,"abstract":"<div><h3>Background</h3><div>Increasing evidence indicated that neutrophil-to-lymphocyte ratio (NLR) was correlated with unfavorable functional outcome in ischemic stroke. However, limited studies have explored the relationship between NLR and single small subcortical infarction (SSSI). This study aims to investigate the link between NLR and functional outcome in patients with SSSI and assess whether white matter hyperintensities (WMH) mediates the relationship between NLR and unfavorable functional prognosis.</div></div><div><h3>Methods</h3><div>This research analyzed data from patients with SSSI in a Chinese cohort study. The primary outcome was unfavorable functional outcome (modified Rankin Scale score of 2-6) at 90 days after ischemic stroke onset, and the secondary outcome was unfavorable functional outcome at discharge. The relationship between NLR and functional outcome was analyzed using restricted cubic spline (RCS) and multivariable logistic regression. A mediation analysis was conducted to examine the link between NLR and unfavorable functional outcome mediated by WMH.</div></div><div><h3>Results</h3><div>Among the 513 patients with SSSI included in the study, unfavorable functional outcome was seen in 145 (28.3 %) patients at the 90-day follow-up and 156 patients (30.4 %) at discharge. After controlling for confounding variables, elevated NLR levels were found to be linked with unfavorable functional outcome both at 90 days and at discharge. Mediation analyses indicated that overall WMH significantly mediated the relationship between NLR and unfavorable functional outcome at 90 days and discharge, with mediation proportions of 29.6 % and 24.2 %, respectively. Periventricular WMH accounted for 36.4 % and 32.1 % of the mediation effects, respectively.</div></div><div><h3>Conclusion</h3><div>Elevated NLR independently increased the risk of unfavorable functional outcome in individuals with SSSI. In patients with SSSI, WMH partially mediated the relationship between NLR and unfavorable functional outcome.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108341"},"PeriodicalIF":2.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026751","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":"Enlarged perivascular spaces and clinical outcome of acute ischemic stroke patients receiving intravenous thrombolysis","authors":"Yu Gu MD ,&nbsp;Henlin Zhao MD ,&nbsp;Chunyan Lei MD, PhD,&nbsp;Ansong Jin MD,&nbsp;Wen Jiang MD,&nbsp;Qionghua Deng MD,&nbsp;Xinglong Yang MD, PhD,&nbsp;Xiaoyan Zhu MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108342","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108342","url":null,"abstract":"<div><h3>Background</h3><div>Enlarged perivascular spaces (EPVS) is one of the main imaging features of cerebral small vessel disease (CSVD). Previous studies have shown that hypertension and advanced age were important risk factors for the occurrence and development of EPVS. We aim to explore the correlation between the severity of EPVS at centrum semiovale and basal ganglia and the early and long-term outcome of acute ischemic stroke (AIS) patients receiving intravenous thrombolysis.</div></div><div><h3>Methods</h3><div>AIS who received intravenous thrombolysis at the First Affiliated Hospital of Kunming Medical University were retrospectively collected. Demographic data, stroke risk factors, laboratory test results and head imaging data were collected. The number of EPVS in centrum semiovale and basal ganglia of patients in cranial magnetic resonance imaging (MRI) was counted by visual quantification method. Logistic regression analysis was used to evaluate the independent risk factors affecting the prognosis.</div></div><div><h3>Results</h3><div>A total of 196 subjects were included in this study. The proportion of patients with poor clinical outcome at 90 days was higher in patients with moderate-to-severe centrum semiovale EPVS than in those with no-to-mild EPVS (42.9 % vs 18.7 %, <em>P</em>=0.031). Similarly, patients with moderate-to-severe EPVS in the basal ganglia region had a significantly poor clinical outcome at 90 days (51.7 % vs 18.3 %, <em>P</em>=0.001). Moderate to severe basal ganglia EPVS (OR=2.661, 95 %CI: 1.070-6.618, <em>P</em>=0.035), hyperlipidemia (OR=3.011, 95 %CI: 1.147-7.902, <em>P</em>=0.025) and a higher baseline NIHSS score before thrombolysis (OR=1.194, 95 %CI: 1.071-1.331, <em>P</em>=0.001) were independent risk factors for poor clinical outcome at 90 days. Early neurological improvement (OR=0.220, 95 %CI 0.093-0.520, <em>P</em>=0.001) was associated with a reduced risk of poor clinical outcomes at 90 days.</div></div><div><h3>Conclusions</h3><div>Moderate-to-severe EPVS in basal ganglia were an independent risk factor for poor clinical outcome at 90 days in AIS patients with intravenous thrombolysis. Therefore, the severity of EPVS in the basal ganglia region can serve as an imaging marker to predict the 90-day clinical outcome of AIS patients treated with intravenous thrombolysis.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108342"},"PeriodicalIF":2.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143931325","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":"Factors associated with increased atrial fibrillation detection in patients with embolic stroke of undetermined source","authors":"Jia-Yi Wang MD ,&nbsp;Stephanie Vu MD ,&nbsp;Matthew McGuinness MD ,&nbsp;Ryan Barrette MD ,&nbsp;Stephen Trudeau MD ,&nbsp;Hayley Price MD ,&nbsp;Peter Zimetbaum MD ,&nbsp;Magdy Selim MD, PhD ,&nbsp;Jennifer Dearborn-Tomazos MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108343","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108343","url":null,"abstract":"<div><h3>Background</h3><div>Studies suggest that longer duration of cardiac monitoring after embolic stroke of undetermined source (ESUS) yields higher detection rates for atrial fibrillation (AF). A common strategy for cardiac monitoring after ESUS starts with a 14-day surface monitor, which is easier to administer, and lower cost compared to implantable monitoring. We tested whether cardiac markers associated with higher likelihood of AF detection can be used to identify patients with ESUS who are more likely to benefit from initial short-term monitoring.</div></div><div><h3>Methods</h3><div>We adjudicated stroke etiology from patients with acute ischemic stroke discharged from a tertiary care medical center with 14-day surface cardiac monitor (ZioPatch®) between January 2019 and September 2023. The primary outcome was ≥30 seconds of AF on surface monitoring. Predictors included ECG and echocardiographic markers associated with AF in a general population identified during hospitalization. Associations were analyzed using Chi-squared or Fisher’s exact tests and age-adjusted logistic regression.</div></div><div><h3>Results</h3><div>We identified 415 patients with ESUS (mean age 67.2 years, 49.9% female). 4.3% (n=18/415) developed AF after a median of 13.8 days (IQR 13-15.8) of monitoring. 9.6% (n=8/83) of patients with enlarged left atrial dimension &gt;4cm and 8.0% (n=9/113) of patients with mitral valve regurgitation developed AF. Significantly more patients with AF had a combination of enlarged left atrial dimension and/or mitral valve regurgitation (36.8% with AF vs 61.1% without AF, p=0.037). Adjusting for age, enlarged left atrial dimension remained significantly associated with increased odds of detection of AF (OR 3.17, 95% CI 1.20-8.36).</div></div><div><h3>Conclusions</h3><div>In patients with ESUS, the rate of AF detection using a surface 14-day cardiac monitor was low. However, the likelihood of detecting AF was higher among patients with enlarged left atrial dimension and mitral valve regurgitation, suggesting this group may benefit most from an initial short-term monitoring strategy.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108343"},"PeriodicalIF":2.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928392","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":"Effects of hyperbaric oxygen combined with Danhong injection on 90-day functional independence and the 1-year recurrence rate in patients with ischemic stroke: A matched cohort study","authors":"Mo Zheng ,&nbsp;Yun Xu","doi":"10.1016/j.jstrokecerebrovasdis.2025.108339","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108339","url":null,"abstract":"<div><h3>Background</h3><div>Both hyperbaric oxygen therapy and Danshen (Salvia miltiorrhiza) injection have shown potential therapeutic effects on ischemic stroke, but the impact of their combination on long-term functional outcomes and recurrence risk has not been systematically evaluated. This study aimed to assess the effects of hyperbaric oxygen combined with Danhong injection on 90-day functional independence and the 1-year recurrence rate in patients with ischaemic stroke.</div></div><div><h3>Methods</h3><div>This study employed a retrospective matched cohort design and collected data from patients with ischemic stroke treated at our hospital between January 2018 and December 2022. After 1:1 propensity score matching, 80 patients were included in each group. The intervention group received hyperbaric oxygen therapy (2.0–2.5 ATA, once daily for 10 sessions) combined with Danhong injection (20 ml/day for 14 consecutive days) in addition to standard treatment; the control group received standard treatment only. The primary outcome was 90-day functional independence (mRS ≤2); secondary outcomes included the 1-year stroke recurrence rate, NIHSS score improvement, and others.</div></div><div><h3>Results</h3><div>The percentage of 90-day functional independence in the intervention group (72.5 %) was significantly greater than that in the control group (53.8 %) (<em>P</em> = 0.014), with a relative risk ratio of 1.35 (95 % CI: 1.06–1.71). Multivariate analysis revealed that combined therapy was independently associated with 90-day functional independence (adjusted OR = 2.28, 95 % CI: 1.19–4.37; <em>P</em> = 0.013). The 1-year stroke recurrence rate in the intervention group (7.6 %) was significantly lower than that in the control group (16.5 %) (<em>P</em> = 0.042), with an adjusted hazard ratio of 0.46 (95 % CI: 0.22–0.94, <em>P</em> = 0.033). Subgroup analysis revealed that patients aged &lt;65 years, those with NIHSS scores ranging from 4–15, those with small-artery occlusion or large-artery atherosclerosis stroke, and those who began treatment within 24 hours benefited more significantly. The combined therapy was well tolerated, with no serious adverse events.</div></div><div><h3>Conclusion</h3><div>Hyperbaric oxygen combined with Danhong injection significantly improved 90-day functional independence and reduced the 1-year recurrence risk in patients with ischaemic stroke, particularly in specific patient subgroups. This combined treatment strategy provides a new therapeutic option for comprehensive stroke management.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108339"},"PeriodicalIF":2.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025515","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}