Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Cerebral collateral flow state in acute ischemic stroke correlates with clinical functional outcomes in non-thrombectomy patients","authors":"Smit Shah MD,&nbsp;Stefanie Wood BS,&nbsp;Lawson Logue BS,&nbsp;Jaclyn Meyer BS,&nbsp;Karly Pikel BS,&nbsp;Matthew Germroth BS,&nbsp;Gowri Peethamber MD,&nbsp;Nishanth Kodumuri MD,&nbsp;Forrest Justin Lowe MD,&nbsp;Ravish Kothari MD,&nbsp;Line Rahman MD,&nbsp;Swamy Venkatesh MD, DM,&nbsp;Souvik Sen MD, MS, MPH","doi":"10.1016/j.jstrokecerebrovasdis.2024.108211","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108211","url":null,"abstract":"<div><h3>Introduction</h3><div>Hypoperfusion index ratio (HIR) measured by computerized tomography perfusion (CTP) has been shown to predict collateral flow state in acute ischemic stroke (AIS). Low HIR (&lt;0.4) is indicative of good collateral flow state. This study tested the association between good collateral flow state and stroke severity and clinical outcome at discharge.</div></div><div><h3>Methods</h3><div>Data from AIS patients who underwent CTP during initial stroke evaluation were linked with Get With the Guideline database between 2018 and 2020. Patients with good collateral flow (HIR &lt; 0.4) were compared to those with poor collateral flow (≥0.4). They were stratified based on modified Rankin Score (mRS) at discharge into good (mRS 0-2) or poor (mRS 3-6) outcomes. A collateral score of 0-3 was assigned using CTA's obtained at the time of AIS presentation. We used univariate and multivariable logistic regression analyses to test the association between good collateral flow state and good discharge outcome.</div></div><div><h3>Results</h3><div>CT perfusion data was obtained in 1442 patients. After exclusions, 391 patients (age 69 ± 14, 54% male, 48% white, 52% black/others) remained, of whom 295 (75%) demonstrated good collateral flow and 96 (25%) showed poor collateral flow. Those with good collateral flow were younger (69 ± 14 vs. 71 ± 15, p = 0.25) and lower median NIHSS [7 (25-75%ile 3-13) vs. 14 (25-75%ile 8-20), p &lt; 0.001]. CTA collateral scores demonstrated a significant inverse correlation to HIR. Good collateral flow was associated with good outcome on discharge (OR 2.7, 95% CI 1.4-5.1). The association remained significant after adjustment for demographics and comorbidities (adjusted OR 3.2 (1.7-6.4).</div></div><div><h3>Conclusions</h3><div>In patients presenting with AIS who were non-thrombectomy candidates, good collateral flow state measured by HIR on CTP was associated with good functional outcome at discharge after adjustment for comorbidities.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108211"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886311","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":"Differential outcomes and treatment in non-traumatic carotid versus vertebral cervical artery dissection: A national inpatient sample study","authors":"Elizabeth Lee ,&nbsp;Liqi Shu MD ,&nbsp;Setareh Salehi Omran MD ,&nbsp;Eric D. Goldstein MD ,&nbsp;Nils Henninger MD, PhD, Dr. Med ,&nbsp;Thanh N. Nguyen MD FRCP FSVIN FAHA ,&nbsp;James E. Siegler MD ,&nbsp;Lukas Strelecky ,&nbsp;Farhan Khan MD ,&nbsp;Christoph Stretz MD FAAN ,&nbsp;Karen L. Furie MD MPH ,&nbsp;Shadi Yaghi MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108170","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108170","url":null,"abstract":"<div><h3>Introduction</h3><div>Cervical artery dissection (CAD) involves the carotid or vertebral artery. However, limited studies have compared their clinical features and outcomes.</div></div><div><h3>Methods</h3><div>We examined non-traumatic CAD patients from the National Inpatient Sample (2005-2019). Those diagnosed with both carotid and vertebral artery dissections were excluded. The evaluation included patient demographics, comorbidities, and treatment. Differences between carotid and vertebral dissections were assessed using survey-weighted stepwise backward logistic regression, followed by adjusted multivariable regressions for the primary outcomes of in-hospital mortality and routine discharge (to home or self-care).</div></div><div><h3>Results</h3><div>From 2005 to 2019, we included 123,224 non-traumatic CAD admissions without concurrent vertebral and carotid dissections. There were more carotid dissections than vertebral dissections (67,533 vs. 55,691). Compared to vertebral dissection, carotid dissection was associated with older age (54 [44-66] years vs. 49 [37-62] years, <em>P</em>&lt;0.001), Black race (12.6% vs. 8.8%, <em>P</em>&lt;0.001), White race (73.5% vs. 72.0%, <em>P</em> = 0.024), atrial fibrillation (10.8% vs. 6.3%, <em>P</em>&lt;0.001), aortic dissection (7.7% vs. 0.3%, <em>P</em>&lt;0.001), and fewer concurrent acute ischemic strokes (AIS) (47.8% vs. 56.7%, <em>P</em>&lt;0.001).Within the concurrent AIS group, carotid CAD patients exhibited higher NIHSS (8 [2-17] vs. 2 [0-5], <em>P</em>&lt;0.001), an increased utilization of intravenous thrombolysis (6.7% vs. 2.7% <em>P</em>&lt;0.001), endovascular therapy (13.3% vs. 3.3%, <em>P</em>&lt;0.001), and angioplasties (9.8% vs. 0.3%, <em>P</em>&lt;0.001). Overall, carotid CAD was associated with more inpatient deaths (aOR 1.30, 95% CI 1.04-1.62, <em>P</em>=0.023) and less routine discharges (aOR 0.88, 95% CI 0.79-0.97, <em>P</em>=0.014) than vertebral CAD.</div></div><div><h3>Conclusion</h3><div>Our study underscores distinct comorbidity profiles and treatment patterns between non-traumatic carotid dissection and vertebral dissection groups. These findings advocate for tailored treatment strategies based on dissection type to optimize patient outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108170"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796545","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":"Letter to the Editor Regarding “Investigating the role of gut microbiota in hemorrhagic stroke: Evidence from causal analysis”","authors":"Rizwan Ahmad MBBS ,&nbsp;Saad Khan MBBS ,&nbsp;Ayesha Khan MBBS ,&nbsp;Faraz Arshad MBBS ,&nbsp;Fatima Naveed MBBS","doi":"10.1016/j.jstrokecerebrovasdis.2024.108184","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108184","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108184"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803385","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":"Conicity index and sex differences in relation to carotid plaque instability in Chinese community residents","authors":"Bi Deng MD ,&nbsp;Zeyu Liu MD ,&nbsp;Qin Huang MD ,&nbsp;Xianjing Feng MD ,&nbsp;Di Liao MD ,&nbsp;Fang Yu MD ,&nbsp;Jie Feng MD ,&nbsp;Qing Huang MD ,&nbsp;Yunhai Liu MD ,&nbsp;Jian Xia MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108193","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108193","url":null,"abstract":"<div><h3>Objectives</h3><div>The conicity index (CI), an anthropometric parameter of visceral obesity, has exhibited a strong correlation with the incidence of atherosclerosis and cardiovascular events. This study aimed to explore the relationship between CI and carotid plaque instability, as well as the potential differences between sexes in this context.</div></div><div><h3>Methods</h3><div>Our cross-sectional study included a total of 44,248 participants from the China Stroke High-risk Population Screening and Intervention Program (CSHPSIP), all of whom underwent carotid ultrasound for the evaluation of carotid plaque. Multivariate logistics regression analysis and restricted cubic spline (RCS) curves were employed to examine the association between CI and the prevalence of carotid plaques and unstable plaques. A subgroup analysis was conducted to account for potential confounding variables.</div></div><div><h3>Results</h3><div>Patients belonging to the higher CI quartiles had a greater prevalence of carotid plaque and unstable carotid plaque. After adjusting for confounding factors, each standard deviation (SD) increase in CI was associated with an odds ratio (OR) of 1.06 (95% confidence interval: 1.03–1.08) for carotid plaque and 1.03 (95% confidence interval: 1.00–1.05) for unstable carotid plaque. The RCS analysis revealed an escalating trend in the prevalence of unstable carotid plaque with increasing CI values. However, this observed trend was not evident among female participants. Furthermore, subgroup analysis revealed a more pronounced correlation between CI and carotid plaque instability in individuals with a fasting blood glucose (FBG) of ≥ 7 mmol/L and an unhealthy lifestyle characterized by physical inactivity and current smoking.</div></div><div><h3>Conclusions</h3><div>Our findings demonstrated that CI was significantly associated with carotid plaque and recommend CI as a promising indicator for the initial screening of atherosclerotic plaques in the future.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108193"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824679","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":"Clinical implications of cerebral venous outflow pattern in malignant middle cerebral artery infarction","authors":"Jae-Chan Ryu MD ,&nbsp;Sang-Hun Lee MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108203","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108203","url":null,"abstract":"<div><h3>Background</h3><div>Malignant middle cerebral artery (MCA) infarction is one of the most devastating strokes. However, the role of the cerebral venous outflow pattern in malignant MCA infarction is not well established. We investigated the association between the transverse sinus (TS) shape and functional outcomes in patients with malignant MCA infarction.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients with malignant MCA infarction. Baseline characteristics, clinical variables, and cerebral venous outflow patterns (TS shape) were obtained. Incomplete TS shapes are referred to as unilateral TS hypoplasia, TS aplasia, or TS occlusion. We analyzed the effect of an incomplete TS shape on functional outcomes after malignant MCA infarction. The main outcome assessed was the change in ordinal shifts within the modified Rankin Scale score, indicating a deterioration in the outcome at three months.</div></div><div><h3>Results</h3><div>Among 71 patients with malignant MCA infarction, incomplete TS shapes were observed in 33 (46.5 %). There were no significant differences in the baseline characteristics, vascular risk factors, or factors associated with malignant MCA infarction. Patients with incomplete TS shapes had a higher proportion of unfavorable functional outcomes (5.0 [4.0–5.0] vs. 5.0 [5.0–6.0], P &lt; 0.001). Multivariable ordinal logistic regression analysis showed that patients with incomplete TS shapes (odds ratio = 6.30, 95 % confidence interval = 2.42–17.90, P &lt; 0.001) had a substantial shift towards the unfavorable functional outcome at 3 months.</div></div><div><h3>Conclusions</h3><div>Among patients diagnosed with malignant MCA infarction, those with incomplete TS shapes had poorer functional outcomes and higher mortality rates. This underscores the significant clinical association between cerebrovenous patterns and functional outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108203"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866322","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":"Systematic review and meta-analysis of audits measuring antithrombotic therapy within forty-eight hours for ischemic stroke","authors":"Andy Lim ,&nbsp;Grace Phillips ,&nbsp;Warren Chan ,&nbsp;Shams Albrefkany ,&nbsp;Jeniffer Kim-Blackmore ,&nbsp;Henry Ma ,&nbsp;Thanh Phan","doi":"10.1016/j.jstrokecerebrovasdis.2024.108213","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108213","url":null,"abstract":"<div><h3>Background</h3><div>Meta-analysis of clinical trials supports the use of early antithrombotic medication in ischemic stroke and transient ischemic attack. It is not known whether this therapy is delivered within the 85 % threshold that is acceptable in North America's Get With The Guidelines stroke program.</div></div><div><h3>Aim</h3><div>to investigate the pooled proportion of patients receiving antiplatelet therapy within 48 h of ischemic stroke.</div></div><div><h3>Methods</h3><div>PubMed to November 2022 was searched for studies reporting “stroke”, “audit”, “antithrombotic”, “national” and “registry”. Multilevel random effects meta-analysis was used to cluster studies by country.</div></div><div><h3>Results</h3><div>There were 45 studies describing 1,178,595 patients. The pooled proportion of patients receiving antithrombotic therapy within 48 h was 81.1 %, (95 % CI 74.5, 87.8, <em>p</em> &lt; 0.0001, I²=99.99 %). The high heterogeneity was due to within-country (I²_{Level 3} = 55.4 %) and between-country heterogeneity (I²_{Level 2} = 44.6 %). There was no statistical significance (<em>p</em> = 0.35) between low- to middle- income countries (LMIC) – 81.8 %, (95 % CI 76.1, 87.4, <em>p</em> &lt; 0.01, I²=100 %) and high-income countries (HIC) – 86.8 %, (95 % CI 81.2, 92.3, <em>p</em> &lt; 0.01, I²=99.7 %) nor any difference between contemporary studies (2008 and later) – 86.5 %, (95 % CI 82.3, 90.8, <em>p</em> &lt; 0.01, I²=100 %) – and studies published before 2008 – 69.9 %, (95 % CI 57.4, 82.4, <em>p</em> &lt; 0.01, I²=99.7 %). Sensitivity analysis showed no difference when excluding single centre studies, observations with <em>n</em> &lt; 500, or both. Meta-regression showed proportion of antiplatelet administration at 48 h to increase significantly with subsequent year of publication (β=0.01, 95 % CI 0.00, 0.02, <em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Our key finding is that the majority of countries do not yet provide early antiplatelet therapy at a level acceptable by Get With The Guidelines hospitals.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108213"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900377","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":"The prognostic and diagnostic significance of echocardiographic parameters on acute ischemic stroke","authors":"Bo Yang ,&nbsp;Yanni Wu ,&nbsp;Manli Lu ,&nbsp;Yongjun Cao ,&nbsp;Zhigang Miao ,&nbsp;Liuhui Chang ,&nbsp;Hui Li ,&nbsp;Xia Zhang","doi":"10.1016/j.jstrokecerebrovasdis.2024.108220","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108220","url":null,"abstract":"<div><h3>Objective</h3><div>To comprehensively explore the prognostic significance of transthoracic echocardiography (TTE) and three-dimensional speckle-tracking echocardiography (3D STE) parameters in AIS and their role in distinguishing cardioembolic stroke.</div></div><div><h3>Methods</h3><div>301 acute ischemic stroke (AIS) patients were enrolled. TTE and 3D STE were employed to evaluate cardiac function and structure, also left atrial strain. Patients were categorized into two groups based on functional outcome at discharge and 3 months post-stroke, respectively. Models combining variables related to unfavorable outcome were established, and their predictive efficacy was assessed using receiver operating characteristic (ROC) curves. Additionally, AIS patients were stratified into cardioembolic and non-cardioembolic stroke groups. Logistic regression identified predictors for cardioembolic stroke, and ROC curves assessed their diagnostic performance.</div></div><div><h3>Results</h3><div>We found that a decrease in early diastolic peak velocity of the mitral valve (E value) was independently associated with adverse outcomes at both discharge (<em>P</em> = 0.014, OR = 0.126, 95% CI 0.024-0.657) and 3 months post-stroke in AIS patients (<em>P</em> = 0.004, OR = 0.054, 95% CI 0.007-0.403). Adding E value significantly improved predictive ability for adverse outcome at discharge and 3 months post-onset (0.807 vs. 0.794; 0.834 vs. 0.815). Moreover, left atrial diameter (LAD) [area under the curve (AUC) = 0.705] was the most valuable TTE parameter, and left atrial reservoir circumferential strain (LASr-c) (AUC = 0.766) was the most valuable STE parameter, even among all echocardiographic parameters for prediction of cardioembolic stroke.</div></div><div><h3>Conclusions</h3><div>This study indicates reduced E value was associated with unfavorable outcome at discharge and 3 months post-onset of AIS patients. LAD, especially LASr-c exhibited optimal diagnostic performance on cardioembolic stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108220"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928769","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":"Causal association of inflammation with ischemic stroke and its subtypes: a bidirectional Mendelian randomization study","authors":"FangFang Qian ,&nbsp;XiaoHui Du ,&nbsp;YouHua He","doi":"10.1016/j.jstrokecerebrovasdis.2024.108190","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108190","url":null,"abstract":"<div><h3>Background</h3><div>Emerging evidence underscores a bidirectional relationship between ischemic stroke (IS) and inflammation, yet the causality of this association remains uncertain. We conducted a two-sample bidirectional Mendelian randomization (MR) study aimed at investigating the causal links between inflammation and IS.</div></div><div><h3>Methods</h3><div>Single nucleotide polymorphism from genome-wide association studies of 112 inflammatory cytokines and IS were chosen as instrumental variables. We evaluated the causal effects of inflammatory factors on IS outcomes and examined the mediating effects of risk factors for IS. Additionally, reverse MR analysis was conducted to determine whether the occurrence of IS influenced levels of inflammatory cytokines. Causal associations were assessed using inverse variance weighting, complemented by sensitivity analyses incorporating weighted median and MR-Egger methods.</div></div><div><h3>Results</h3><div>We found associations between genetically predicted plasma levels of 25 inflammatory factors and IS along with its subtypes. MR supports smoking, body mass index, atrial fibrillation, coronary artery disease, heart failure, systolic blood pressure, diastolic blood pressure and type 2 diabetes as risk factors for IS. Notably, coronary artery disease and heart failure seemed to mediate the RANTES, HGF, IL-5 associations with IS. In addition, reverse MR analysis suggested a causal relationship between IS and its subtypes and 19 inflammatory factors.</div></div><div><h3>Conclusion</h3><div>In summary, inflammation was suggestively causally associated with the risk of IS, and inflammatory cytokines had downstream effect on IS. Future studies should explore whether inflammatory factors found to have significant associations with IS risk could be manipulated to reduce IS risk, and the neuroinflammatory mechanisms after IS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108190"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830832","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":"“Mechanical thrombectomy beyond 6 hours for acute ischemic strokes due to M2 occlusions”","authors":"Maria Pereira Coutinho ,&nbsp;Sofia Galego ,&nbsp;Marta Alves ,&nbsp;Ana Papoila ,&nbsp;Isabel Fragata ,&nbsp;Ana Paiva Nunes","doi":"10.1016/j.jstrokecerebrovasdis.2024.108219","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108219","url":null,"abstract":"<div><h3>Background</h3><div>The time frame for mechanical thrombectomy (MT) in acute ischemic stroke (AIS) is enlarging. Guidelines recommend MT until 6 h of symptom onset in M2 segment occlusions (grade IIB). In practice, it is frequently performed later.</div></div><div><h3>Aims</h3><div>To assess the functional prognosis of AIS patients subjected to M2 segment's MT beyond 6 h, compared to standard intervention.</div></div><div><h3>Methods</h3><div>Retrospective cohort study including all consecutive AIS patients subjected to MT of M2 occlusions between 1st January 2018 and 31st December 2020 in St Joseph's Local Health Unit, Lisbon, Portugal. Allocation to standard or extended groups was done according to the symptom-to-puncture time, whether within or beyond 6 h after symptom onset, respectively. The primary outcome was the modified Rankin Scale (mRS) at three months. Secondary outcomes were symptomatic intracranial hemorrhage (sICH) at 24 h and three-month mortality.</div></div><div><h3>Results</h3><div>We included 155 patients, 51.0 % men, median age 76.0 years (P₂₅:69.0;P₇₅:86.0), baseline mRS “0-2” in 84.5 %, mean NIHSS 13.6(6.5). Initial Computed Tomography showed early ischemic changes in 27.1 %. Most patients belonged to the standard group (71.0 %). Groups had similar baseline features. The standard group underwent more frequent (68.2 % vs 44.4 %, <em>p</em> = 0.006) and earlier (2 h02 min, 3 h02 min, <em>p</em> &lt; 0.001) fibrinolysis. Symptom-to-puncture times were 7 h13 min (extended) and 4h01 min (standard), <em>p</em> &lt; 0.001. Outcomes were similar between groups (three months’ mRS [<em>p</em> = 0.578]; sICH [<em>p</em> = 0.720]; three-month mortality [<em>p</em> = 0.422]).</div></div><div><h3>Conclusions</h3><div>Our study suggests similar outcomes in M2 occlusions performing MT before and beyond 6 h of symptom onset, consistent with previous studies. Patients might benefit from widening inclusion criteria for MT in AIS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108219"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907918","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":"Exploring the association between the TyG-WHtR index and the incidence of stroke in the obese population: based on NHANES data from 1998 to 2018","authors":"Liyan Fu ,&nbsp;Qingxuan Xing ,&nbsp;Xiaoqian Wang ,&nbsp;Yaoyao Chen ,&nbsp;Jingjing Kong ,&nbsp;Jin Li ,&nbsp;Baohong Yue","doi":"10.1016/j.jstrokecerebrovasdis.2024.108209","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108209","url":null,"abstract":"<div><h3>Background</h3><div>The TyG index is an emerging low-cost and efficient indicator that is significantly associated with stroke. Multiple studies have confirmed the impact of the TyG index on cerebrovascular diseases. However, the role of indices combining TyG with different obesity factors, such as triglyceride glucose-waist-height ratio (TyG-WHtR) on stroke risk in obese individuals remains unclear. This study utilizes data from the National Health and Nutrition Examination Survey database between 1998 and 2018 to explore the relationship between stroke and the TyG-WHtR index in obese individuals.</div></div><div><h3>Methods</h3><div>This cross-sectional study analyzed data from 5767 obese individuals from the NHANES database between 1998 and 2018. Univariate and multivariate logistic regression analyses were used to study the association between TyG-WHtR and stroke, utilizing continuous variables or categorizing variables based on quartiles. Propensity score matching (PSM) and subgroup analysis stratifying characteristics of TyG-WHtR and stroke were further conducted to study their relationship. Additionally, restricted cubic spline (RCS) analysis was performed to examine the linear relationship between TyG-WHtR and stroke.</div></div><div><h3>Results</h3><div>A total of 5767 participants were included in the statistical analysis, comprising 227 stroke patients and 5540 non-stroke participants. Multivariable logistic regression analysis revealed a positive association between TyG-WHtR and stroke both before and after matching (<em>P</em> &lt; 0.001), with statistically significant differences. Subgroup analysis indicated a statistically significant difference among non-Hispanic white individuals, and RCS analysis showed a non-linear relationship between TyG-WHtR and stroke before matching, but a linear relationship after matching.</div></div><div><h3>Conclusion</h3><div>In obese individuals, a higher TyG-WHtR index is positively associated with stroke risk.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108209"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878447","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}