Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Changing patterns of stroke and subtypes attributable to smoking from 1990 to 2021 in China and projections to 2050","authors":"Bo Hei ,&nbsp;Jiayu Liu ,&nbsp;Jixia Fang ,&nbsp;Qun Gao ,&nbsp;Bin Wang ,&nbsp;Wu Zhou ,&nbsp;Jingru Zhou","doi":"10.1016/j.jstrokecerebrovasdis.2025.108368","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108368","url":null,"abstract":"<div><h3>Background</h3><div>It is uncertain whether smoking exerts similar effects on the stroke and subtypes. The aim of this study was to assess the long-term trends of stroke and subtypes attributable to smoking in China from 1990 to 2021 and to predict changes to 2050.</div></div><div><h3>Methods</h3><div>Data on stroke and its subtypes mortality attributable to smoking in China were extracted from the Global Burden of Disease (GBD) 2021. Linear regression and age-period-cohort models were used to calculate age-standardised mortality rate (ASMR) trends, and the BAPC (Bayesian age-period-cohort) model was used to predict trends from 2022 to 2050.</div></div><div><h3>Results</h3><div>The changing trend of ASMR on stroke attributable to smoking in China differed among subtypes, with an estimated annual percentage change (EAPC) of -2.40 for intracerebral hemorrhage (ICH); -0.67 for ischemic stroke (IS); -0.65 for subarachnoid hemorrhage (SAH). The local drift curves reflect the average annual percentage change in stroke mortality attributable to smoking in all age groups, with a decreasing trend in stroke and subtypes. The decline in SAH mortality was much greater than for IS and ICH across all age groups. The period rate ratio (PRR) and cohort rate ratio (CRR) varied by subtype, showing the decline for all subtypes. Mortality rates for IS and ICH increase significantly with age; the mortality rate for SAH increases followed by a decrease, peaking in the 65-70 year age group. Finally, the ASMR and ASDR for stroke and subtypes attributable to smoking in China will continue to decline from 2022 to 2050.</div></div><div><h3>Conclusions</h3><div>Our study shows that stroke burden attributable to smoking in China declined from 1990 to 2021 but remained higher than global levels, with continue to decline from 2022 to 2050. IS showed the least reduction, especially among older men. Projections suggest continued improvement, though rising adolescent smoking—particularly among women—poses a threat. Strengthened tobacco control, smoking cessation, and targeted IS prevention, especially in older males, are crucial.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108368"},"PeriodicalIF":2.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251947","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":"Sticky Platelet Syndrome: An important consideration for otherwise unexplained thrombotic events in young stroke patients","authors":"Diana Yang DO ,&nbsp;Anjana Shriram ,&nbsp;Yu Lee Ra ,&nbsp;Cindy Rivas ,&nbsp;Ava Elahi ,&nbsp;Christopher James Gorospe ,&nbsp;Jocelyn Ho ,&nbsp;Benedict Pereira MD ,&nbsp;Shlee Song MD ,&nbsp;Alexis N. Simpkins MD, PhD, MSCR","doi":"10.1016/j.jstrokecerebrovasdis.2025.108364","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108364","url":null,"abstract":"<div><h3>Introduction</h3><div>This case highlights the importance of considering platelet function and aggregability in patients with recurrent ischemic stroke and deep vein thrombosis.</div></div><div><h3>Results</h3><div>We present a case of a 47-year-old man with history of hypertension, hyperlipidemia, and multiple thrombotic events but no family history of clotting events. Over a period of eight years, he was diagnosed with deep vein thrombosis, pulmonary embolism, and occipital lobe, cerebellar, and parietal lobe infarcts. After presenting with new embolic strokes, platelet aggregometry demonstrated hyperactivity to three agonists, including adenosine-diphosphate (ADP)— indicative of Sticky Platelet Syndrome. Repeat platelet aggregometry demonstrated poor response to clopidogrel, so the patient was discharged on triple therapy with aspirin, clopidogrel, and enoxaparin to warfarin bridge. Two years later, the patient was diagnosed with right eye central retinal artery occlusion two months after an outpatient provider discontinued the clopidogrel and switched warfarin to apixaban. He was discharged back on triple therapy with re-initiation of clopidogrel and apixaban switched to warfarin.</div></div><div><h3>Conclusion</h3><div>Thrombosis in unusual sites and despite anticoagulant use, coupled with platelet hyperactivity to ADP, were suggestive of Sticky Platelet Syndrome. Due to lack of testing standardization, diagnosis of a persistent, hyperreactive platelet phenotype remains challenging. However, improvements in diagnostic approaches for Sticky Platelet Syndrome can be highly beneficial in enabling faster treatment with an appropriate antithrombotic regimen, reducing the risk of subsequent thrombotic events.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108364"},"PeriodicalIF":2.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188807","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":"Burden of perceived stress among stroke survivors in Ghana: Insights from a multicentre, cross-sectional study","authors":"Jude Domfeh Darkwah ,&nbsp;Akpalu Albert ,&nbsp;Ansumana Bockarie ,&nbsp;Nana Kwame Ayisi-Boateng ,&nbsp;Emmanuel Konadu ,&nbsp;Rexford Adu-Gyamfi ,&nbsp;Agnes Arthur ,&nbsp;Kwadwo Agyenim-Boateng ,&nbsp;Christiana Neizer ,&nbsp;Timothy Fiattor ,&nbsp;Priscilla Opare-Addo ,&nbsp;Nathaniel Adusei-Mensah ,&nbsp;Raelle Tagge ,&nbsp;Michael Ampofo ,&nbsp;Hilda Kwapong ,&nbsp;Evans MacCready ,&nbsp;Martin Agyei ,&nbsp;John Akassi ,&nbsp;John Humphrey Amuasi ,&nbsp;Samuel Blay Nguah ,&nbsp;Bruce Ovbiagele","doi":"10.1016/j.jstrokecerebrovasdis.2025.108365","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108365","url":null,"abstract":"<div><h3>Introduction</h3><div>Stroke incidence is rising rapidly in low- and middle-income countries, including Ghana. Stroke survivors face significant challenges in daily life, heightening their risk for stress. This study aims to examine the burden of perceived stress and its associated factors among stroke survivors in Ghana.</div></div><div><h3>Methods</h3><div>This cross-sectional study analysed baseline data from 486 recent stroke survivors enrolled within 1 month of stroke onset, across ten hospitals in Ghana. Perceived stress was measured using the 4-item Perceived Stress Scale (PSS-4). Associations between variables and perceived stress were analysed using Fisher's exact test, Wilcoxon rank sum, and Pearson's Chi-squared test. Binary logistic regression was performed to determine factors associated with perceived stress.</div></div><div><h3>Results</h3><div>204 (42.0%) of study participants experienced high perceived stress. Stroke severity (measured by the NIH Stroke Scale) and depression were significantly associated with high perceived stress. For each unit increase in the NIH stroke score, the odds of high perceived stress increased by 14% (AOR = 1.14, 95% CI = 1.08, 1.20; p = 0.001). Survivors with moderate to severe depression were five times more likely to experience high perceived stress compared to those without depression (AOR = 4.75, 95% CI = 1.90, 13.1; p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>4 out of 10 recent Ghanaian stroke survivors experience high psychological stress strongly associated with stroke severity and depression. These findings emphasise the need for integrating psychological support and stress management into comprehensive stroke care programs in Ghana and similar resource-limited settings.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108365"},"PeriodicalIF":2.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188805","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":"Gut microbiota-derived phenylacetylglutamine mitigates neuroinflammation induced by intracerebral hemorrhage in mice","authors":"Weiwei Zhang ,&nbsp;Haopu Lin ,&nbsp;Xuchao He ,&nbsp;Qiuping Gu ,&nbsp;Yan Ma ,&nbsp;Xiongjie Fu ,&nbsp;Linfeng Fan","doi":"10.1016/j.jstrokecerebrovasdis.2025.108357","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108357","url":null,"abstract":"<div><h3>Background</h3><div>Emerging evidence highlights the pivotal role of gut microbiota and its metabolites in the pathogenesis of brain injury following intracerebral hemorrhage (ICH). Microglia-mediated neuroinflammation stands out as a crucial pathophysiological process post-ICH. However, the effects of gut microbiota on microglia-mediated neuroinflammation after ICH remain elusive. This study aims to address three key aspects: 1) the alteration in gut microbiota-related metabolites following ICH. 2) the impact of phenylacetylglutamine (PAGIn), a gut microbiota-derived compound, on microglia-mediated neuroinflammation after ICH, and 3) the detailed mechanism by which PAGIn regulates microglia-mediated neuroinflammation via β2 adrenergic receptor (β2AR) after ICH.</div></div><div><h3>Methods</h3><div>Young male mice were subjected to ICH through the administration of type VII collagenase. Plasma samples were collected for metabolomic profiling on day 3 after ICH. Microglia phenotype and neuroinflammation were assessed after ICH. Brain tissues were collected for bulk RNA sequencing following PAGIn treatment. Behavioral functions were assessed using the cylinder, corner and forelimb placement tests.</div></div><div><h3>Results</h3><div>Following ICH, levels of PAGIn in the plasma, brain tissues decreased. The supplementation of PAGIn exhibited a significant reduction in neuroinflammation, facilitated the transformation of microglia to anti-inflammatory phenotype, and alleviated neurological dysfunction. Furthermore, the protective effects of PAGIn post-ICH were mediated through the regulation of β2AR.</div></div><div><h3>Conclusion</h3><div>Gut microbiota-derived PAGIn played a crucially regulatory role in microglia-mediated neuroinflammation via β2AR after ICH. The supplementation of PAGIn following ICH in mice emerged as a potential therapeutic strategy to mitigate ICH-induced brain injury.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108357"},"PeriodicalIF":2.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188806","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":"Usefulness of non-contrast-enhanced ultrashort echo time magnetic resonance angiography for assessing cerebral aneurysms after woven endobridge device treatment","authors":"Yasuhiko Nariai ,&nbsp;Tomoji Takigawa ,&nbsp;Kazuma Sasaki ,&nbsp;Akio Hyodo ,&nbsp;Kensuke Suzuki","doi":"10.1016/j.jstrokecerebrovasdis.2025.108361","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108361","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Digital subtraction angiography (DSA) is the gold standard follow-up modality for assessing aneurysm occlusion state after Woven EndoBridge (WEB; MicroVention/Terumo, Aliso Viejo, CA, USA) treatment. However, because of the invasiveness of DSA, time-of-flight (TOF) magnetic resonance angiography (MRA) is also used, although it has limited diagnostic accuracy: signal loss in MRA due to the WEB device hinders clear assessment of aneurysm remnants post-treatment. This study aimed to determine whether the non-contrast-enhanced (non-CE) ultrashort echo time (UTE)-MRA sequence, with its ability to reduce metal-induced susceptibility artifacts in MRA, is a reliable follow-up modality to assess aneurysm occlusion status after WEB device treatment.</div></div><div><h3>Materials and methods</h3><div>From June 2024 to February 2025 at our institution, 12 consecutive patients with 14 aneurysms underwent TOF-MRA, UTE-MRA, and DSA for occlusion assessment 6 months after WEB treatment. Angiographic assessments were independently performed by two observers using the WEB Occlusion Scale (WOS). Visibility of the parent vessel at the WEB placement site in TOF-MRA and UTE-MRA was also evaluated.</div></div><div><h3>Results</h3><div>According to DSA, the rates of WOS grade A/B (complete occlusion), C, and D aneurysms were 64.3 %, 28.6 %, and 7.1 %, respectively. Regarding intermodality agreement between TOF-MRA and DSA, the κ coefficient was 0.19, indicative of poor agreement. Intermodality agreement between UTE-MRA and DSA was excellent (κ = 0.88). The parent vessel adjacent to the WEB device tended to be visible more often with UTE-MRA (85.7 %) than with TOF-MRA (50.0 %) (<em>p</em> = 0.10).</div></div><div><h3>Conclusions</h3><div>Non-CE UTE-MRA may be a reliable and less invasive imaging modality after WEB treatment.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108361"},"PeriodicalIF":2.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144177429","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":"Clinical presentation and patient outcomes following endovascular intervention for venous sinus diverticula: A single center experience","authors":"Erin N. Walker BS ,&nbsp;Jaskeerat Gujral ,&nbsp;Om Gandhi ,&nbsp;Sandeep Kandregula MD ,&nbsp;Douglas Bigelow MD ,&nbsp;Michael Ruckenstein MD ,&nbsp;Tiffany Hwa MD ,&nbsp;Jason Brant MD ,&nbsp;Kevin Wong MD ,&nbsp;Omar Choudhri MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108363","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108363","url":null,"abstract":"<div><h3>Introduction</h3><div>Venous diverticula are rare neurovascular anomalies consisting of outpouchings in venous sinus walls, occurring with a prevalence of 23 % in the sigmoid sinus. However, venous diverticula can develop in the transverse sinus and jugular bulb, as well often with skull base bony dehiscence. Debilitating pulsatile tinnitus can be associated with the presence of venous sinus diverticula warranting open or endovascular treatment. We report our experience with patient presentation and outcomes with successful endovascular treatment modalities for diverticula cure.</div></div><div><h3>Materials and Methods</h3><div>23 patient cases with confirmed diagnosis of venous sinus diverticula were reviewed. Diverticula characteristics, procedural details, and outcomes were assessed through descriptive and statistical analysis. From this analysis, prevalence of dehiscence, laterality of diverticula, predominant symptoms at presentation, and treatment modalities were determined.</div></div><div><h3>Results</h3><div>69.6 % (16/23) of patients had a transverse/sigmoid diverticulum and 30.4 % (7/23) had a jugular bulb diverticulum. Ipsilateral stenosis was concurrently observed in 30.4 % (7/23) of patients. Analysis revealed a higher likelihood 60.9 % (14/23) of complete symptom resolution with diverticula located in the sigmoid and transverse sinuses compared to 52.2 % (12/23) in the jugular bulb. Additionally, dominance of venous system was associated with a higher likelihood (<em>p</em> = 0.0528) of symptomatic diverticula occurring in the dominant venous sinus. Treatment for all diverticula patients involved the use of either Precise (Cordis) stents, Luminexx Biliary stents or Zilver (Cook) stents in combination with detachable coils. 30.4 % (7/23) of patients contained venous stenosis and all patients who experienced stenosis had complete symptom resolution following intervention. There were no postoperative complications, and all patients were discharged the following day.</div></div><div><h3>Conclusion</h3><div>Understanding clinical factors that influence venous diverticula presentation and neuro-interventional response is critical to treating and counseling patients. We present twenty-three cases of venous diverticula, contributing to the growing body of venous diverticulum literature. We conclude that venous diverticula are more likely to occur in dominant venous sinuses and respond well to treatment, particularly when located in the transverse or sigmoid sinuses, especially if accompanied by bony dehiscence or stenosis. Additionally, we identify stent-assisted coiling as a safe and reliable treatment approach for treating symptomatic venous sinus diverticula.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108363"},"PeriodicalIF":2.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182956","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":"Revascularization strategies in acute stroke with tandem occlusions: The Impact of Dissection vs. Atherosclerotic etiology on Clinical Outcomes","authors":"Mara Z. Thut ,&nbsp;Gregory Howaldt ,&nbsp;Miklos Krepuska ,&nbsp;Patrick Thurner ,&nbsp;Jawid Madjidyar ,&nbsp;Susanne Wegener ,&nbsp;Christoph Globas ,&nbsp;Andreas R. Luft ,&nbsp;Tilman Schubert ,&nbsp;Zsolt Kulcsar","doi":"10.1016/j.jstrokecerebrovasdis.2025.108362","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108362","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>The endovascular treatment for tandem occlusion (TO) in anterior circulation acute ischemic stroke represents a major challenge. Tandem occlusion involves an intracranial large vessel occlusion combined with a simultaneous occlusion or high-grade stenosis of the ipsilateral extracranial internal carotid artery. Atherosclerotic carotid artery disease (ACAD) and carotid artery dissection (CAD) are the primary causes. This study aims to assess the effect of etiology on clinical and radiological features, patient outcomes, and complications after revascularization procedures.</div></div><div><h3>Materials and Methods</h3><div>A retrospective analysis was performed analyzing TO patients who underwent mechanical thrombectomy and percutaneous transluminal angioplasty and stenting at our comprehensive stroke center from January 2019 to July 2023. The study was conducted using chart review and angiogram analysis. Successful reperfusion, peri‑procedural complications, and functional independence at 90 days were collected as outcome measures.</div></div><div><h3>Results</h3><div>Among the 89 patients, 22 were CAD patients, and 67 were associated with ACAD. CAD patients were significantly younger with a mean age of 55 years compared to 74 years for patients with ACAD (<em>p</em> &lt; 0.001). Additionally, CAD patients exhibited fewer cardiovascular risk factors. Complete revascularization was achieved at a significantly higher rate in CAD patients (72.7 % vs. 40.3 %, <em>p</em> = 0.003). At 90 days post-procedure, CAD patients demonstrated a higher incidence of favorable outcomes (68.2 % vs. 43.2 %, <em>p</em> = 0.038). Multivariate logistic regression analysis identified age as a significant predictor of outcomes (OR = 0.905, 95 % CI: 0.851-0.962, <em>p</em> = 0.001), whereas etiology did not show a statistically significant effect. Furthermore, ACAD patients exhibited a lower incidence of stent occlusion at hospital discharge (3.4 % vs. 25.0 %, <em>p</em> = 0.004).</div></div><div><h3>Conclusion</h3><div>This study on tandem occlusions found that patients with carotid dissection experienced better clinical outcomes than those with atherosclerotic carotid disease, despite a higher rate of stent reocclusion. However, multivariate analysis indicated that the underlying etiology was not an independent predictor of outcome; instead, patient age and initial stroke severity were more influential factors. Given the increased risk of reocclusion, patients with carotid dissection may benefit from a more individualized antithrombotic strategy to maintain stent patency.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108362"},"PeriodicalIF":2.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176430","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":"Evaluation of mediators of seasonal variation in fatal strokes: a multicentre registry‐based cohort study","authors":"Adam Fluck BSc ,&nbsp;Christopher H Fry DSc, FRCSEd ,&nbsp;Brendan Affley MD ,&nbsp;Puneet Kakar MD ,&nbsp;Pankaj Sharma MD ,&nbsp;Gareth I Jones BSc ,&nbsp;Jacqui N Rees BSc ,&nbsp;Julia Tudose BSc ,&nbsp;Yvonne Jones BSc ,&nbsp;Jo S Finch BSc ,&nbsp;Jennifer Davison BSc ,&nbsp;Ellen Bull BSc ,&nbsp;Jonathan Robin MD ,&nbsp;David Fluck MD ,&nbsp;Thang S Han MA, MBBChir, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108360","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108360","url":null,"abstract":"<div><h3>Objectives</h3><div>How seasonal variations influence the incidence of fatal stroke remains unclear. Here, we examined potential mediators of the association between seasons and fatal strokes.</div></div><div><h3>Methods</h3><div>Data were prospectively collected (2014-2016) from the Sentinel Stroke National Audit Programme for admissions to four UK hyperacute stroke units. Relationships between variables were assessed by multivariable logistic regression, adjusted for age, sex and intracranial haemorrhage, and presented as odds ratios (OR) with 95 % confidence intervals (CI). The criteria for conducting a mediation analysis were met if the mediator was a continuous variable and was significantly associated both with the predictor and outcome variables.</div></div><div><h3>Results</h3><div>A total of 3,309 patients (50 % men, mean age=76.7 yr, SD=13.4) were admitted in spring (<em>n</em> = 830), summer (<em>n</em> = 733), autumn (<em>n</em> = 865) and winter (<em>n</em> = 881). There were no seasonal differences in age, sex distribution, co-morbidities (except congestive heart failure in summer) or stroke management. Compared to patients admitted in autumn, those admitted in winter had a greater risk of severe stroke: OR=2.22 (1.50-3.30), fatal stroke: OR=1.48 (1.13-1.93), palliative care: OR=1.85 (1.21-2.81) and pneumonia: OR=1.36 (1.00-1.85). Stroke severity was associated with a greater risk of fatal stroke: adjusted OR=1.14 (1.12-1.15). Mediation analysis revealed that the relationship between winter and fatal stroke was indeed mediated by stroke severity: indirect effect size=0.040 (0.012-0.068).</div></div><div><h3>Conclusions</h3><div>Our findings support evidence of increased incidence of fatal stroke in winter, which could be explained by greater stroke severity at this time. Further research is necessary to elucidate the underlying reason for greater severity of stroke in winter.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108360"},"PeriodicalIF":2.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170191","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":"Hyperemia detection on arterial spin labeling is associated with final infarct volume in stroke post-endovascular therapy","authors":"Carolyn A. Lomahan BS ,&nbsp;Marie Luby PhD ,&nbsp;Georgios Kalarakis MD, PhD ,&nbsp;Amie W. Hsia MD ,&nbsp;John K. Lynch DO, MPH ,&nbsp;Karan P. Nathani MD ,&nbsp;Sana Somani MD ,&nbsp;Leila C. Thomas BSN, MPH ,&nbsp;Fabian Arnberg-Sandor MD, PhD ,&nbsp;Lawrence L. Latour PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108358","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108358","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Patients with acute ischemic stroke (AIS) treated with endovascular therapy (EVT) may develop hyperemia due to loss of relative cerebral blood flow (rCBF) autoregulation. Hyperemia can be detected on two types of MRI perfusion weighted imaging: dynamic susceptibility contrast (DSC) and arterial spin labeling (ASL). The aim of this study was to compare hyperemia on ASL-rCBF to DSC-rCBF post-EVT and explore the association between hyperemia and final infarct volume (FIV).</div></div><div><h3>Methods</h3><div>This is a retrospective analysis of the GUARDS cohort in the ongoing prospective Natural History of Stroke study (ClinicalTrials.gov Identifier: NCT00009243). Patients with AIS who met the following criteria were eligible for this analysis: (i) ≥ 18 years, (ii) no contraindication to 3T MRI, (iii) large vessel occlusion in the anterior circulation, (iv) attempted EVT, and (v) 3T MRI obtained at 24 hours, including DSC-rCBF and ASL-rCBF, and at 5 days post-EVT. Qualitative imaging analysis for hyperemia detection was performed by consensus between two independent raters. Quantitative imaging analysis assessed hyperemic tissue volume, FIV, and Dice coefficients between hyperemia and FIV masks.</div></div><div><h3>Results</h3><div>Forty patients with median (IQR) age of 70 (62-81) years and admission NIHSS 16 (10-21) were included. Hyperemia was identified on ASL-rCBF in 40 % (16) of patients and on DSC-rCBF in 30 % (12). For 9 patients with hyperemia on both modalities, the ASL-rCBF and DSC-rCBF median volumes were 85.7 (19.4-144.9) and 58.1 (26.2-74.0) (<em>p</em> = 0.10). The Dice coefficient for hyperemia on ASL-rCBF and FIV was higher compared to DSC-rCBF, 0.60 (0.54-0.69) versus 0.39 (0.34-0.49).</div></div><div><h3>Conclusion</h3><div>Hyperemia volumes measured on ASL-rCBF, compared to DSC-rCBF, at 24 hours were more associated with FIV at 5 days. Hyperemia may be an indicator of impaired cerebral autoregulation and potential target for adjunctive therapy to mitigate infarct growth.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108358"},"PeriodicalIF":2.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170612","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":"Arterial brain calcium (ABC) volume - A novel radiological marker of atherosclerotic risk and future stroke risk on non-contrast CT","authors":"Arun Kathuveetil MD DM ,&nbsp;Diana Kim MD ,&nbsp;Mankirat Bhogal MD ,&nbsp;Ali Babwani MD ,&nbsp;Mao Ding ,&nbsp;Babawale Arabambi ,&nbsp;Sucharita Ray MD DM ,&nbsp;Ibrahim Alhabli MD ,&nbsp;Aravind Ganesh MD, D Phil (Oxon), FRCPC","doi":"10.1016/j.jstrokecerebrovasdis.2025.108359","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108359","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Coronary calcium is a well-recognized marker of atherosclerotic risk. While intracranial carotid artery calcification has received some attention, calcific disease in other intracranial arteries is not well studied. In this pilot study, we sought to examine the whether the total volume of calcium in the intracranial arteries is associated with established markers of atherosclerosis and stroke risk.</div></div><div><h3>Methods and Methods</h3><div>We examined a subset of 360 consecutive cases in a population-level cohort of 7,745 patients representing all patients diagnosed with ischemic stroke/TIA in an entire Canadian province (Alberta) from 1-April-2016 to 31-March-2017. Trained readers manually segmented visible calcifications in all intracranial arteries on non-contrast CT using ITKSnap. Volumetric data for all segmentations were combined to obtain the total Arterial Brain Calcium (ABC) volume. We related this volume to the total burden of vascular risk factors, number of vessels with intracranial atherosclerotic disease, atherosclerosis burden in different territories using ordinal logistic regressions adjusted for age and sex, and to the 5-year risk of recurrent events using Poisson regressions.</div></div><div><h3>Results</h3><div>Among 360 cases (median age: 68 years, IQR:56-80), ABC volume (median:5.40 mL, 95 % CI:3.05-7.85 mL) increased with age (per-year increase: 66.5 mm³, 95 % CI:37.5-95.5 mm³) and was lower in females (4.22 mL, IQR:0.25-6.37 v/s 6.60 mL, IQR:0.35-8.33, <em>p</em> = 0.0004). ABC volume was independently associated with the burden of intracranial arterial (age/ sex-adjusted common odds-ratio [acOR] per mL increase:1.14, 95 %CI:1.04-1.26) and combined intracranial/carotid/ aortic/ coronary atherosclerosis (acOR:1.18, 95 %CI:1.10-1.27), and vascular risk factors (acOR:1.07, 95 %CI:1.01-1.13). Those with higher ABC volume had a higher risk of recurrent events (IRR:3.20, 95 % CI:1.24-8.25).</div></div><div><h3>Conclusions</h3><div>ABC volume derived from routine non contrast CT scan may be utilised as a novel imaging marker of atherosclerotic burden and merits further validation as a predictive tool in recurrent ischemic stroke/ TIA.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108359"},"PeriodicalIF":2.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170613","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}