Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Mendelian randomization assessing causal relationship between fibrinogen levels and ischemic stroke","authors":"Gie Ken-Dror PhD ,&nbsp;Tanya Khanna BSc ,&nbsp;Emily Hills BSc ,&nbsp;Louise Lepert BSc ,&nbsp;Sana Mughal BSc ,&nbsp;Thang Sieu Han PhD ,&nbsp;Pankaj Sharma MD, PhD, FRCP","doi":"10.1016/j.jstrokecerebrovasdis.2024.108199","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108199","url":null,"abstract":"<div><h3>Objective</h3><div>High fibrinogen levels are associated with an increased risk of ischaemic stroke (IS). We used mendelian randomisation (MR) to explore a potential causal relationship.</div></div><div><h3>Materials and Methods</h3><div>Data for assessing the relationship between gene variant, disease and biological levels needed for a MR approach was collected using a meta-analytical approach. Inverse-variance weighted (IVW) approach was used for the main analyses and alternative approach for sensitivity analyses. The relationship between fibrinogen levels and IS was assessed using Odds Ratio (OR), while mean difference (g/L) was used for the relationship between SNP (rs1800790) and fibrinogen levels.</div></div><div><h3>Results</h3><div>The variant <em>FGB</em> rs1800790 SNP was interrogated as an instrumental variable of fibrinogen levels. A meta-analysis with 24 studies (12 case-control and 12 cohort studies, totalling 20,902 cases and 76,510 controls was conducted. Homozygotes (AG) of rs1800790 have 0.14g/L (95%CI: 0.08-0.19, <em>P</em>&lt;0.001) and minor allele (AA) have 0.18g/L (95%CI: 0.01-0.35, <em>P</em>=0.037) higher levels of plasma fibrinogen concentration compared with homozygous for the major allele (GG). The risk of IS was significantly increased in 1-g/L (OR=1.83, 95%CI: 0.92-3.62, <em>P</em>=0.084), or 1-SD of fibrinogen levels (OR=1.39, 95%CI: 1.03-1.87, <em>P</em>=0.030), or above median levels (OR=1.22, 95%CI: 1.02-1.46, <em>P</em>=0.029) or categorical levels tertiles (OR=1.50, 95%CI: 1.26-1.79, <em>P</em>&lt;0.001). Each 1-g/L increase in fibrinogen levels was causally associated with a higher risk of ischemic stroke (OR=2.28, 95%CI: 1.53–3.03, <em>P</em>&lt;0.001) in the Mendelian randomisation analysis.</div></div><div><h3>Conclusions</h3><div>Elevated fibrinogen levels are a causative risk factor for ischaemic stroke with each 1g/L increase doubling its risk.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108199"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824688","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":"Platelet related gene IQGAP1 contributes to the onset and abnormal immune landscape of ischemic stroke patients","authors":"Youle Su ,&nbsp;Bo Chao ,&nbsp;Junhao Ren ,&nbsp;Lian Shuang","doi":"10.1016/j.jstrokecerebrovasdis.2024.108194","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108194","url":null,"abstract":"<div><h3>Introduction</h3><div>Ischemic stroke (IS) is a complex illness resulting from a combination of numerous environmental and genetic risk factors. Recent reports have shed light on the vital role that platelets play in the pathophysiology of IS. Here, we aimed to explore the potential platelet-related genes in IS and investigate the effect of platelet-related genes in the immune microenvironment of IS.</div></div><div><h3>Methods</h3><div>The data of IS were retrieved from the Gene Expression Omnibus database. Firstly, we screened the platelet-related genes that were correlated with the onset of IS using differential expression analysis, enrichment analyses, and protein-protein interaction (PPI) network. Moreover, we analyzed the clinical value and functional information of platelet-related genes in IS. Finally, we explored the correlation between platelet-related genes and immune cells’ infiltration.</div></div><div><h3>Results</h3><div>Ten platelet-related genes that were correlated with the onset of IS were identified, among which <em>IQGAP1</em> was located at the core of the PPI network. <em>IQGAP1</em> was found to be expressed in the normal brain tissue and its expression was significantly elevated in IS samples. The area under the curve (AUC) values for <em>IQGAP1</em> in both the GSE16561 and GSE58294 datasets were close to 1. <em>IQGAP1</em> knockdown might increase OGD/R‑induced HT22 cell viability. Additionally, FoxO signaling pathway, NOD-like receptor signaling pathway, Phagosome and Platelet activation pathways were significantly activated in IS patients with high <em>IQGAP1</em> expression compared to those with low IQGAP1 expression. The IS patients in the <em>IQGAP1</em>^high and <em>IQGAP1</em>^low groups showed dramatically different proportions of immune cells and immune-related functions, and the <em>IQGAP1</em> expression was correlated with the immune cell’ infiltration in IS.</div></div><div><h3>Conclusions</h3><div>In this study, we identified the <em>IQGAP1</em> might serve as a potential diagnostic marker for IS, and the <em>IQGAP1</em> expression was very relevant in determining the immune cell’ infiltration in IS patients.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108194"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824717","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":"Prediction of stroke-associated hospital-acquired pneumonia: Machine learning approach","authors":"Ahmad A. Abujaber RN, MBA, PhD ,&nbsp;Said Yaseen MBBS ,&nbsp;Abdulqadir J. Nashwan RN, MSc, PhD(c) ,&nbsp;Naveed Akhtar MD, PhD ,&nbsp;Yahia Imam MBBS, MD, FRCP Edin, FEBN, MSc. Clinical Neurology, MSc. Stroke Medicine, FESO, FAAN","doi":"10.1016/j.jstrokecerebrovasdis.2024.108200","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108200","url":null,"abstract":"<div><h3>Background</h3><div>Stroke-associated Hospital Acquired Pneumonia (HAP) significantly impacts patient outcomes. This study explores the utility of machine learning models in predicting HAP in stroke patients, leveraging national registry data and SHapley Additive exPlanations (SHAP) analysis to identify key predictive factors.</div></div><div><h3>Methods</h3><div>We collected data from a national stroke registry covering January 2014 to July 2022, including 9,840 patients diagnosed with ischemic and hemorrhagic strokes. Five machine learning models were trained and evaluated: XGBoost, Random Forest, Support Vector Machine (SVM), Logistic Regression, and Artificial Neural Network (ANN). Performance was assessed using accuracy, precision, recall, F1-score, AUC, log loss, and Brier score. SHAP analysis was conducted to interpret model outputs.</div></div><div><h3>Results</h3><div>The ANN model demonstrated superior performance, with an F1-score of 0.86 and an AUC of 0.94. SHAP analysis identified key predictors: stroke severity, admission location, Glasgow Coma score (GCS), systolic and diastolic blood pressure at admission, ethnicity, stroke type, mode of arrival, and age. Patients with higher stroke severity, dysphagia, and those arriving by ambulance were at increased risk for HAP.</div></div><div><h3>Conclusion</h3><div>This study enhances our understanding of early predictive factors for HAP in stroke patients and underlines the potential of machine learning to improve clinical decision-making and personalized care.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108200"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824737","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":"Effects of stroke nurse-led acute stroke management on treatment time benchmarks, intravenous thrombolysis rates, and patient outcomes: A systematic review and meta-analysis","authors":"Ashok Kumar ,&nbsp;Mukesh Kumar ,&nbsp;Priyanka Verma ,&nbsp;Rimesh Pal ,&nbsp;Manisha Nagi ,&nbsp;Karthik Vinay Mahesh ,&nbsp;Divesh Kumar Munjal ,&nbsp;Sukhpal Kaur ,&nbsp;Achala Aggarwal ,&nbsp;Bijaya Kumar Padhi ,&nbsp;Dheeraj Khurana","doi":"10.1016/j.jstrokecerebrovasdis.2024.108216","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108216","url":null,"abstract":"<div><h3>Introduction</h3><div>Multidisciplinary stroke teams, including a stroke nurse, prove effective in delivering optimal acute ischemic stroke (AIS) management. This systematic review and meta-analysis critically synthesize existing studies to assess the impact of stroke nurse involvement on treatment time benchmarks and patient outcomes.</div></div><div><h3>Method</h3><div>Data from various databases constituted the primary sources of literature, and the risk of bias and article quality were evaluated using relevant tools. Primary endpoints were door-to-needle (DTN) time, mortality, and good functional outcomes (mRS 0 – 2) at three months. Secondary endpoints included varied treatment time metrics, IVT rates, and length of hospital stay (LOS).</div></div><div><h3>Results</h3><div>We screened 235 studies published up to September 2023 and ultimately included eight in our analysis. The stroke nurse intervention was significantly associated with a decrease in DTN time (Standard Mean Difference [SMD] = –19.71 min; 95 % CI = [–31.45, –7.97]), reduced three-month mortality rates (Odds Ratio [OR] = 0.56; 95 % CI = [0.37, 0.85]) and improved functional outcomes (OR = 1.33; 95 % CI = [1.03, 1.71]). The IVT rate significantly increased (OR = 1.52; 95 % CI = [1.01, 2.28]) with stroke nurse intervention. However, LOS was comparable (SMD = –0.45 days; 95 % CI = [–1.11, 0.21]) between scenarios with and without stroke nurse involvement.</div></div><div><h3>Conclusions</h3><div>Our study emphasizes the advantages of including stroke nurses in acute stroke teams, leading to reduced treatment times, increased IVT rates, and enhanced patient outcomes. It highlights the importance of inter-professional stroke teams and evidence-based nursing care to ensure equitable access to high-quality stroke care across diverse healthcare settings.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108216"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911086","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":"Correlation between impaired brachial flow-mediated dilation and hemorrhagic transformation after acute reperfusion therapy","authors":"Sangil Park MD, PhD ,&nbsp;Dong Hoon Shin MD, PhD ,&nbsp;Young Bae Lee MD, PhD ,&nbsp;Sang Hee Ha MD, PhD ,&nbsp;Bum Joon Kim MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108191","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108191","url":null,"abstract":"<div><h3>Objective</h3><div>Hemorrhagic transformation (HT) represents a critical complication of reperfusion therapy, often resulting in unfavorable functional outcomes. Our objective was to explore the correlation between endothelial function, assessed through flow-mediated dilation (FMD), and the occurrence of HT in patients undergoing acute reperfusion therapy.</div></div><div><h3>Materials and methods</h3><div>In our retrospective analysis, we investigated patients with emergent large vessel occlusion (ELVO) who underwent acute reperfusion therapy and assessment through FMD, calculated as %FMD = (peak diameter − baseline diameter)/baseline diameter×100. HT was categorized according to the European Cooperative Acute Stroke Study (ECASS) definition. Through multivariate analysis, we explored factors associated with HT, considering stroke mechanisms, and delved into the relationship between FMD and HT.</div></div><div><h3>Results</h3><div>A total of 172 patients were included in this study, with 45.3% experiencing HT. Factors associated with HT included high initial National Institute of Health Stroke Scale (NIHSS) scores [7 (5–10) vs. 10 (8–14); P &lt;0.001], receiving tissue plasminogen activator (tPA) (21.3 vs. 39.7%; P&lt;0.001), undergoing endovascular therapy (EVT) 10.6 vs. 26.9%; P &lt;0.001), and impaired %FMD (6.2±2.5 vs. 4.9±1.8; P = 0.022). In a subgroup analysis of patients with cardioembolism, receiving EVT was significantly associated with HT (reference: tPA only; adjusted odds ratio [aOR] = 7.000; 95% confidence interval, 1.173–41.759; P = 0.033). In those with large artery atherosclerosis (LAA), a higher initial NIHSS score (aOR = 1.274; 1.082–1.499; P = 0.004) and impaired %FMD (aOR = 0.632; 0.402–0.995; P = 0.047) were independently associated with HT.</div></div><div><h3>Conclusions</h3><div>Endothelial dysfunction, indicated by impaired %FMD, emerges as a potential predictor of HT following acute reperfusion therapy, particularly in patients with LAA.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108191"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820227","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":"Acute stroke care coordination in the United States: Variation in state laws for Emergency Medical Services and hospitals","authors":"Zhiqiu Ye PhD ,&nbsp;Siobhan Gilchrist JD, MPH ,&nbsp;Nina Omeaku PhD, JD, MPH ,&nbsp;Sharada Shantharam MPH ,&nbsp;Matthew Ritchey PT, DPT, MPH ,&nbsp;Sallyann M. Coleman King MD, MSc ,&nbsp;Laurence Sperling MD ,&nbsp;Jane L. Holl MD, MPH","doi":"10.1016/j.jstrokecerebrovasdis.2024.108174","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108174","url":null,"abstract":"<div><h3>Background</h3><div>Lack of care coordination between Emergency Medical Services (EMS) and hospitals contributes to delay of acute stroke (AS) treatment. In the United States, states have adopted laws to improve the quality of EMS and hospital care; the degree to which these laws create regulatory incentives to promote care coordination between them is less well known. We examined state variation in attributes of laws that may influence AS care coordination between EMS and hospitals.</div></div><div><h3>Materials and Methods</h3><div>We selected ten law “dyads” across seven domains of EMS and hospital AS care informed by published risk assessments of critical steps for improved door-to-needle time and door-in-door-out time. We assessed concordance in prescriptiveness (degree to which levels were similar) and in adoption (degree to which laws were adopted concurrently) of the laws in effect between January 2002 and January 2018 in the United States.</div></div><div><h3>Results</h3><div>The proportion of states with prescriptiveness concordance ranged from 47 % (e.g., inter-facility transfer agreements, comprehensive, primary stroke center certification) to 75 % (e.g., Continuous Quality Improvement (CQI) for EMS and hospitals). Adoption concordance ranged from 31 % (e.g., inter-facility transfer agreements, Acute Stroke Ready Hospital certification) to 86 % (e.g., CQI for EMS and hospitals). Laws for EMS triage were less prescriptive than laws for stroke center certification in 22 %–35 % of states adopting both laws, depending on stroke center type.</div></div><div><h3>Conclusions</h3><div>Subsequent policy implementation and impact studies may benefit from assessing concordance and prescriptiveness in policy intervention adoption, particularly as a foundation for evaluating delays in AS treatment due to inefficient care coordination.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108174"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792832","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":"Topography of ischemic strokes in cancer-associated non-bacterial thrombotic endocarditis: A single-institution descriptive case series","authors":"Carlee I. Oakley ,&nbsp;Ewa M. Wysokinska ,&nbsp;Alicja Kaminska ,&nbsp;Marwa A. Mohammed ,&nbsp;Patryk Patrzalek ,&nbsp;Damon Houghton ,&nbsp;David Hodge ,&nbsp;Waleed Brinjikji ,&nbsp;James P. Klaas ,&nbsp;Waldemar E. Wysokinski","doi":"10.1016/j.jstrokecerebrovasdis.2024.108171","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108171","url":null,"abstract":"<div><h3>Background</h3><div>Very limited data indicate that patients with stroke from cancer-associated NBTE (Ca-NBTE) exhibit a characteristic pattern of widely distributed ischemic lesions of varying sizes.</div></div><div><h3>Methods</h3><div>An electronic search of Mayo Clinic records (03/31/2002-06/30/2022) with ensuing manual review of brain magnetic resonance imaging (MRI) was performed to identify topographic characteristics of stroke from Ca-NBTE.</div></div><div><h3>Results</h3><div>In 112 patients with Ca-NBTE, 92 (82.1 %) had a stroke and 84 (76.5 %) had an MRI available for analysis (mean age 62.7±9.2, 57 women). 64 (76.2 %) patients had ischemic strokes in both cerebral hemispheres, 10 (11.9 %) had isolated left hemispheric infarcts, and 7 (8.3 %) had isolated right hemispheric infarcts. Strokes involving both the anterior and posterior circulation were seen in 66 (78.6 %) patients. Disseminated small, medium, and large ischemic strokes (Type IV) were seen in 57 (67.8 %), multiple punctate disseminated strokes (Type III) in 14 (16.7 %), multiple strokes in a single vascular territory (Type II) in 7 (8.3 %), and a single ischemic stroke (Type I) in 6 (7.1 %) patients. Strokes were most commonly observed in the middle cerebral artery territories – on the right in 65 (77.4 %) and on the left in 68 (81.0 %) patients. Strokes within the right posterior cerebral artery territory were observed in 54 (64.3 %) and the left posterior cerebral artery territory in 54 (64.3 %) patients. 46 (54.8 %) patients had strokes in the right cerebellum and 50 (59.5 %) had strokes in the left cerebellum. Only 5 patients had strokes in the right brainstem and 3 in the left brainstem.</div></div><div><h3>Discussion</h3><div>Ca-NBTE is most commonly associated with multifocal bihemispheric ischemic strokes of varying sizes involving both the anterior and posterior circulation, but solitary infarcts or infarcts confined to a single vascular territory can also be seen.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108171"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792846","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 stroke meta-metric, Defect-Free Care, was maintained year-over-year within the Florida stroke registry during the COVID-19 pandemic","authors":"David Z. Rose M.D. ,&nbsp;Lili Zhou M.S. ,&nbsp;Karlon H. Johnson MPH ,&nbsp;Charles Schutt M.D. ,&nbsp;Daniel M. Reyes de Jesus M.D. ,&nbsp;Hannah Gardener Sc.D. ,&nbsp;Carolina M. Gutierrez Ph.D. ,&nbsp;Dianne Foster BSN MBA ,&nbsp;Angus Jameson M.D. MPH ,&nbsp;Sebastian Koch M.D. ,&nbsp;Hao Ying MSc ,&nbsp;Ayham Alkhachroum M.D. MSc ,&nbsp;Jose G. Romano M.D. ,&nbsp;Tatjana Rundek M.D., Ph.D. ,&nbsp;Negar Asdaghi M.D., FRCPC","doi":"10.1016/j.jstrokecerebrovasdis.2024.108179","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108179","url":null,"abstract":"<div><h3>Background</h3><div>Resource allocation for stroke care was impacted worldwide by the Coronavirus 2019 (COVID19) pandemic. Regionally, worsened stroke outcomes varied, however comparative year-over-year in-hospital performance metrics from the pandemic are unreported. Therefore, within the large Florida Stroke Registry (FSR), we assessed the pandemic's effects upon the American Heart Association (AHA) Get With The Guidelines (GWTG) ischemic stroke metrics and the meta-metric, Defect-Free Care (DFC).</div></div><div><h3>Methods</h3><div>From March 2017 to February 2021, FSR collected 146,593 patients with a diagnosis of ischemic stroke or TIA (31,940 between 2017-2018; 35,086 between 2018-2019; 39,722 between 2019-2020; 39,845 between 2020-2021). FSR evaluated DFC, intravenous thrombolytic (IVT) use, endovascular therapy (EVT) use, and Door-To-Needle (DTN), Door-To-Computed Tomography (DTCT), and Door-To-Puncture (DTP) times.</div></div><div><h3>Results</h3><div>Pre-pandemic versus pandemic stroke patients’ demographics were similar (49.0 % vs. 48.6 % female, age 70.7±14.3 vs. 70.5±14.1 years, 64.0 % vs. 65.3 % white, 18.6 % vs. 18.8 % black, 17.4 % vs. 16.0 % Hispanic). Pandemic strokes, versus the immediate year pre-pandemic, were significantly more severe (median NIHSS 4 [IQR 8] vs. 3 [7]), utilized emergency medical services more (59.2 % vs. 57.6 %) and were more likely to receive EVT (8.0 % vs. 7.0 %). IVT use, and DTCT and DTP times were unchanged. The meta-metric DFC improved year-over-year, albeit slower during the pandemic [2017/18-2018/19: 70.7 % to 74.9 % (+4.2 %); 2018/19-2019/20: 74.9 % to 82.1 % (+7.2 %); 2019/20-2020/21: 82.1 % to 85.2 % (+3.1 %)].</div></div><div><h3>Conclusions</h3><div>Despite pandemic challenges, the stroke meta-metric DFC improved, albeit more slowly than pre-pandemic years. In this large statewide registry, pandemic patients received EVT more, potentially due to more severe stroke presentations. Stroke care infrastructure preparedness for future pandemics is warranted.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108179"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796555","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":"Smartphone pupillometry with machine learning differentiates ischemic from hemorrhagic stroke: A pilot study","authors":"Anthony J. Maxin BS ,&nbsp;Bernice G. Gulek PhD ,&nbsp;Do H. Lim BA ,&nbsp;Samuel Kim BS ,&nbsp;Rami Shaibani BS ,&nbsp;Graham M. Winston MD ,&nbsp;Lynn B. McGrath MD ,&nbsp;Alex Mariakakis PhD ,&nbsp;Isaac J. Abecassis MD ,&nbsp;Michael R. Levitt MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108198","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108198","url":null,"abstract":"<div><h3>Objectives</h3><div>Similarities between acute ischemic and hemorrhagic stroke make diagnosis and triage challenging. We studied a smartphone-based quantitative pupillometer for differentiation of acute ischemic and hemorrhagic stroke.</div></div><div><h3>Materials and methods</h3><div>Stroke patients were recruited prior to surgical or interventional treatment. Smartphone pupillometry was used to quantify components of the pupillary light reflex (PLR). A synthetic minority oversampling technique (SMOTE) was applied to correct sample size imbalance. Four binary classification model types were trained using all possible combinations of the PLR components with 10-fold cross validation stratified by cohort. Models were evaluated for accuracy, sensitivity, specificity, area under the curve (AUC), and F1 score. The three best-performing models were selected based on AUC. Shapley additive explanation plots were produced to explain PLR parameter impacts on model predictions.</div></div><div><h3>Results</h3><div>Eleven subjects with intraparenchymal hemorrhage and 22 subjects with acute ischemic stroke were enrolled. One way ANOVA demonstrated significant differences between healthy control data, AIS, and IPH in five out of seven PLR parameters. After SMOTE, each class had n=22 PLR recordings for model training. The best-performing model was random forest using a combination of latency, mean and maximum constriction velocity, and mean dilation velocity to discriminate between stroke types with 91.5% (95% confidence interval: 84.1-98.9) accuracy, 90% (82.9-97.1) sensitivity, 93.3% (83-100) specificity, 0.917 (0.847-0.987) AUC, and 90.7% (84.1-97.3) F1 score.</div></div><div><h3>Conclusions</h3><div>Smartphone-based quantitative pupillometry could be useful in differentiating between acute ischemic and hemorrhagic stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108198"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824746","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":"Magnitude of effect of low dose colchicine, a newly food and drug administration approved treatment for stroke prevention","authors":"Erica Escalera BS ,&nbsp;Jeffrey L. Saver MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108186","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108186","url":null,"abstract":"<div><h3>Background</h3><div>As the Food and Drug Administration in June 2023 approved low dose colchicine for primary prevention of stroke and other cardiovascular events, an updated meta-analysis of stroke outcomes in randomized trials would help inform clinical practice.****</div></div><div><h3>Methods</h3><div>Systematic, study-level meta-analysis of randomized clinical trials of long-term colchicine in patients with established atherosclerotic cardiovascular disease (ASCVD, preponderantly primary prevention for stroke) or following non-cardioembolic ischemic stroke/transient ischemic attack (secondary prevention). Heterogeneity was assessed with the I² statistic and Cochrane's Q and potential bias assessed with the Risk of Bias 2.0 scale.</div></div><div><h3>Results</h3><div>Six randomized control trials met selection criteria, enrolling 14,987 patients (7495 colchicine, 7492 placebo), with median follow-up 26.3 months. Colchicine dosage in all trials was 0.5 mg once-daily. Across all trials, colchicine treatment produced a 28 % relative risk reduction in stroke (1.77 % vs 2.54 %, risk ratio (RR)=0.72, 95 %CI: 0.58-0.89; <em>p</em> = 0.003) and a comparable relative reduction on major adverse cardiovascular events. There was potential heterogeneity by subgroup (<em>p_interaction</em> = 0.06), with a stronger relative reduction for stroke in the five ASCVD trials (RR=0.48, 95 %CI:0.30-0.77; <em>p</em> = 0.003) than the non-cardioembolic ischemic stroke/TIA population (RR=0.80, 95 %CI:0.63-1.02; <em>p</em> = 0.07). Colchicine was associated with a small, non-significant increase in all-cause mortality (RR: 1.09; 95 %Cl: 0.85-1.40, <em>p</em> = 0.49) but not cardiovascular death (RR: 0.92; 95 %Cl: 0.65-1.29, <em>p</em> = 0.61).</div></div><div><h3>Conclusion</h3><div>Low-dose colchicine treatment decreases stroke and major adverse cardiovascular event risk in patients with ASCVD and potentially in patients following a non-cardioembolic ischemic stroke/TIA. Among every 1000 patients treated over 2 years, approximately 6.6 strokes and 24 major adverse cardiovascular events are avoided.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108186"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819699","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}