Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Association between index symptom and timing on perioperative stroke rate in patients undergoing carotid endarterectomy","authors":"Rodolfo Pini ,&nbsp;Gianluca Faggioli ,&nbsp;Gert J de Borst ,&nbsp;Marcello Lodato ,&nbsp;Andrea Vacirca ,&nbsp;Gemmi Sufali ,&nbsp;Enrico Gallitto ,&nbsp;Cristina Rocchi ,&nbsp;Mauro Gargiulo","doi":"10.1016/j.jstrokecerebrovasdis.2025.108441","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108441","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Carotid endarterectomy (CEA) in symptomatic carotid stenosis (SCS) may have a higher risk of perioperative stroke due to disease severity or hemorrhagic conversion. This study aimed to evaluate CEA outcomes for SCS and examine causes of post-operative stroke based on intervention timing and preoperative symptoms.</div></div><div><h3>Methods</h3><div>All CEAs performed for SCS from 2012 to 2023 across two metropolitan hospitals were analyzed. CEAs were performed with general anesthesia, patching, and shunting. Post-operative (30-day) strokes were classified as technical, hemorrhagic, or embolic and were evaluated by timing (&lt;48 h, 48h–2 weeks, &gt;2 weeks) and preoperative symptoms (TIA/amaurosis fugax, minor stroke, moderate-severe stroke, crescendo TIAs/stroke in evolution). Stroke severity was assessed using the modified Rankin Scale (mRS).</div></div><div><h3>Results</h3><div>Among 664 CEAs, post-operative stroke occurred in 3.0 % of cases. Timing significantly influenced stroke rates: 5.7 % &lt;48 h, 4.0 % between 48h–2 weeks, and 1.4 % &gt;2 weeks (<em>P</em> = .04). Preoperative symptoms also affected stroke rates, with highest rates following crescendo TIAs/stroke in evolution (7.5 %, <em>P</em> = .02). Early CEA (&lt;48 h) independently increased stroke risk (odds ratio 5.6, <em>P</em> = .04), and hemorrhagic strokes were associated with &lt;48 h interventions (<em>P</em> = .005). Major strokes occurred in 1.1 % of cases, linked to preoperative symptoms (<em>P</em> = .05), but not intervention timing.</div></div><div><h3>Conclusions</h3><div>CEA for SCS carries an acceptable stroke risk overall, though early intervention (&lt;48 h) increases hemorrhagic stroke risk. Major strokes are more frequent following crescendo TIA/stroke in evolution, with no association to timing.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 11","pages":"Article 108441"},"PeriodicalIF":1.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144919864","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 serum levels and clinical significance of ferroptosis markers in patients with aneurysmal subarachnoid hemorrhage who underwent aneurysm clipping surgery","authors":"Xiaoli Wu,&nbsp;Xiqi Hu,&nbsp;Ying Xia,&nbsp;Bo Wang","doi":"10.1016/j.jstrokecerebrovasdis.2025.108440","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108440","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to explore the association between ferroptosis markers and postoperative prognosis in patients with aneurysmal subarachnoid hemorrhage (aSAH) who underwent aneurysm clipping. Specifically, we evaluated the predictive value of ferroptosis markers in determining post-operative outcomes.</div></div><div><h3>Methods</h3><div>We conducted a prospective observational study involving 210 aSAH patients who underwent aneurysm clipping surgery at our institution from October 2021 to May 2023. Blood samples were collected at postoperative days 1, 3, 7, and 30 to assess the levels of ferroptosis markers (ACSL4, SLC7A11, GPX4) and inflammatory cytokines (CRP, IL-6, TNF-α) using enzyme-linked immunosorbent assay (ELISA). Clinical data were recorded at baseline. Postoperative prognosis was assessed using the modified Rankin Scale (mRS) at 30 days post-surgery. All patients included in the study underwent aneurysm clipping surgery as their primary treatment modality.</div></div><div><h3>Results</h3><div>The serum levels of ACSL4 and IL-6 were significantly higher in the mRS 3-6 group compared to the mRS 0-2 group at all time points. In contrast, SLC7A11 and GPX4 levels were significantly lower in the mRS 3-6 group. Spearman’s correlation analysis revealed a significant negative correlation between ACSL4 and GPX4 and a positive correlation between ACSL4 and IL-6 levels. ROC curve analysis demonstrated that ACSL4 had the highest predictive value for poor postoperative prognosis, with an area under the curve (AUC) of 0.757. Multivariate logistic regression analysis identified aneurysm size, GCS, SLC7A11, ACSL4, GPX4, and IL-6 as independent risk factors for poor postoperative prognosis.</div></div><div><h3>Conclusion</h3><div>Serum ferroptosis markers, particularly ACSL4, along with inflammatory markers, have significant potential in predicting the postoperative prognosis of aSAH patients. These markers could serve as useful biomarkers for early risk stratification and clinical decision-making in aSAH management.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 11","pages":"Article 108440"},"PeriodicalIF":1.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986483","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":"Driving after stroke: A trichotomous logistic regression model to support decision making in uncertain cases","authors":"Gábor Szabó MS ,&nbsp;József Pintér MS ,&nbsp;Roland Molontay MS, PhD ,&nbsp;Gábor Fazekas MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108439","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108439","url":null,"abstract":"<div><h3>Background</h3><div>Assessing fitness to drive after stroke is a complex clinical task, as even mild cognitive deficits can undermine safety. Due to the substantial overlap in cognitive test results between safe and unsafe drivers, binary classification models inevitably carry a risk of misclassification. This study aimed to develop and validate a logistic regression model that introduces a third, indeterminate category – leaving room for clinicians to withhold judgment in uncertain cases and thereby support more cautious, evidence-based decisions.</div></div><div><h3>Methods</h3><div>A total of 115 stroke survivors underwent a standardized neuropsychological evaluation, including assessments of attention, executive function and visuospatial planning. Novel dynamic response time measures were included. Driving fitness was evaluated through a standardized on-road test, which served as the primary outcome. Logistic regression modeling was combined with leave-one-out cross-validation and trichotomous classification to minimize overfitting and manage diagnostic uncertainty.</div></div><div><h3>Results</h3><div>Based on the on-road evaluation, regarded as the gold standard in the field, 70 % of participants were judged to be safe drivers. Our model demonstrated a ROC-AUC value of 0.95 after validation, while 15 % of the cases were classified as indeterminate. The Trail Making Test, Stroop test, Hungarian version of Road Law and Road Craft Knowledge test and the Starry Night Test all contributed to the model’s accuracy.</div></div><div><h3>Conclusion</h3><div>Our logistic regression model allows clinicians to refrain from making unfounded decisions in cases where cognitive test results are inconclusive. In a small proportion of uncertain cases, further assessment is recommended, ideally an on-road test. The model supports more targeted use of on-road evaluations by identifying cases where cognitive test results alone are insufficient.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 11","pages":"Article 108439"},"PeriodicalIF":1.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144917919","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":"Exploring the efficacy and safety of dual antiplatelet therapy in patients with embolic stroke of undetermined source according to stroke risk stratification: Propensity-score matched analysis","authors":"Hyung Jun Kim ,&nbsp;Woo-Keun Seo ,&nbsp;Jong-Won Chung ,&nbsp;Hyun Kyung Kim ,&nbsp;Jang-Hyun Baek ,&nbsp;Hahn Young Kim ,&nbsp;Yang-Ha Hwang ,&nbsp;Sung Hyuk Heo ,&nbsp;Ho Geol Woo ,&nbsp;Hyungjong Park ,&nbsp;Sung-Il Sohn ,&nbsp;Chi Kyung Kim ,&nbsp;Jin-Man Jung ,&nbsp;Sang-Hun Lee ,&nbsp;Jae-Kwan Cha ,&nbsp;Hee-Joon Bae ,&nbsp;Beom Joon Kim ,&nbsp;Bum Joon Kim ,&nbsp;Ji Sung Lee ,&nbsp;Hyo Suk Nam ,&nbsp;Sun Uck Kwon","doi":"10.1016/j.jstrokecerebrovasdis.2025.108438","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108438","url":null,"abstract":"<div><h3>Introduction</h3><div>Dual antiplatelet therapy (DAPT) is widely used for embolic stroke of undetermined source (ESUS) despite limited evidence regarding its efficacy and safety. This study compared DAPT and single antiplatelet therapy (SAPT) in patients with ESUS during hospitalization (first 7 days) and up to 30 days post-stroke, identifying subgroups that benefit most from DAPT.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from 4,505 patients with ESUS enrolled in a multicenter registry from 2014 to 2019. The primary outcome was early neurological deterioration (END) within 7 days of stroke onset, and the secondary outcome was major adverse cardiovascular events (MACE) within 30 days. Propensity score matching (1:1) was applied to balance baseline characteristics, and subgroup analysis was conducted based on Essen stroke risk score (ESRS, ≥3 vs. &lt;3).</div></div><div><h3>Results</h3><div>After matching, 1,835 patients were included in each treatment group for END analysis. In the overall cohort, DAPT did not significantly reduce END compared to SAPT (2.8 % vs. 3.5 %, adjusted OR 0.800; <em>p</em> = 0.202). Similarly, there was no significant difference in 30-day MACE (1.3 % vs. 1.4 %, adjusted HR 1.124; <em>p</em> = 0.512). However, in patients with ESRS ≥3, DAPT was associated with a statistically significant reduction in the risk of END (2.2 % vs. 5.4 %, PS-adjusted OR 0.563; <em>p</em> = 0.036), with no increase in major bleeding.</div></div><div><h3>Conclusion</h3><div>DAPT did not confer benefit in unselected patients with ESUS but was effective in reducing END in high-risk individuals with ESRS ≥3. These findings support a risk-stratified approach to DAPT use in ESUS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 11","pages":"Article 108438"},"PeriodicalIF":1.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933130","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":"Circle of Willis Configuration Is Not Associated with Early Neurological Deterioration in Lacunar Stroke","authors":"Farid Khasiyev ,&nbsp;Maya Pandit ,&nbsp;Minghua Liu ,&nbsp;Randolph S Marshall","doi":"10.1016/j.jstrokecerebrovasdis.2025.108437","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108437","url":null,"abstract":"<div><h3>Background</h3><div>Lacunar strokes, caused by occlusion of small penetrating arteries, account for approximately 25% of all ischemic strokes. Despite often mild initial presentations, up to 30% of patients experience early neurological deterioration (END), a worsening of neurological status within the first 72 hours. Although mechanisms like branch atheromatous disease (BAD), edema, or hemodynamic instability have been implicated, the role of proximal collateral circulation, particularly the Circle of Willis (CoW), in modulating END risk in lacunar stroke remains unclear. This study aimed to investigate the association between CoW anatomical configuration and END in patients with lacunar infarcts.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of 245 patients with acute ischemic stroke attributed to small vessel disease, admitted to a single tertiary care center from 2020 to 2024. Clinical, laboratory, and imaging data were extracted from institutional registries. END was defined as a ≥2-point increase in NIHSS within 72 hours in the absence of other causes. CoW anatomy was assessed via CTA or MRA. Univariate and multivariable logistic regression analyses were used to evaluate predictors of END.</div></div><div><h3>Results</h3><div>Among the 245 patients included, 50 (20.4%) experienced END. Compared to those without END, patients in the END group had a significantly higher prevalence of peripheral artery disease (PAD), higher pulse pressure (PP) and ejection fraction, larger infarct volumes, and a greater frequency of ataxia. No differences were observed in age, sex, race, vascular risk factors (except PAD), or initial NIHSS scores. Radiographically, infarct side (left vs. right), territory (anterior vs. posterior), and CoW configuration, did not differ significantly between groups, except that a fetal PCA was more common in the END group (46% vs. 29.7%, p = 0.03). Multivariable logistic regression identified PAD (OR = 6.54, 95% CI: 1.61–26.57, p = 0.009), infarct volume (OR = 2.25, 95% CI: 1.30–3.91, p = 0.004), and ataxia at presentation (OR = 3.03, 95% CI: 1.40–6.93, p = 0.005) as independent predictors of END. PP showed a borderline association (OR = 1.02, p = 0.083), while the remaining variables, including fetal PCA were not significant.</div></div><div><h3>Conclusions</h3><div>In acute lacunar stroke, END was associated with vascular comorbidities (PAD), clinical signs of strategic pathway disruption (ataxia), and larger infarct volumes, but not with Circle of Willis configuration. These findings suggest that END in small vessel stroke is more strongly influenced by local disease processes and infarct burden than by proximal arterial anatomy. Recognizing these risk factors may help clinicians identify high-risk patients and tailor early monitoring and treatment strategies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 11","pages":"Article 108437"},"PeriodicalIF":1.8,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144911564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between dehydration and stroke, a retrospective cohort study of a large database","authors":"Irene Hamrick ,&nbsp;Wen-Jan Tuan ,&nbsp;Pablo Harker ,&nbsp;Owoicho Adogwa ,&nbsp;Hyacinth I. Hyacinth","doi":"10.1016/j.jstrokecerebrovasdis.2025.108430","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108430","url":null,"abstract":"<div><h3>Background</h3><div>Aging changes contribute to higher rates of dehydration in older adults. We searched a large database to see if there is an association between stroke and dehydration.</div></div><div><h3>Methods</h3><div>A retrospective cohort design utilizing TriNetX, an electronic health record database from 55 United States healthcare organizations with &gt;85 million patients. The study population consisted of adults aged 80 years and older who had healthcare encounters between January 1, 2018 and December 31, 2019, before the pandemic. The dehydration cohort was identified using ICD-10 diagnosis codes and laboratory test results. Outcome measures included one of three stroke types: intracerebral hemorrhage, ischemic stroke, and transient ischemic attack, based on ICD-10 codes. A sub analysis of individuals with diabetes was undertaken.</div></div><div><h3>Results</h3><div>Of 3,125,610 adults, 80 and older, 563,476 were dehydrated. Individuals with diabetes numbered 443,450 and 101,661 were dehydrated. The dehydration cohorts in both populations had a greater percentage of females, non-Hispanic, white individuals, and were slightly older (82.7 vs. 82.4, p &lt;0.001). After controlling for common confounders in propensity score matching, individuals with dehydration were 1.98-3.99 times more likely to develop stroke: intracerebral hemorrhage (OR=3.99, 95% CI=3.41-4.67), ischemic stroke (OR=1.98, 95% CI=1.9-2.07), and TIA (OR=2.88, 95% CI=2.74-3.28). The diabetes group showed: intracerebral hemorrhage (OR=6.76, 95% CI=4-11.42), ischemic stroke (OR=1.97, 95% CI=1.81-2.16), and TIA (OR=2.81, 95% CI=2.33-3.39).</div></div><div><h3>Conclusion</h3><div>A strong association between dehydration and stroke was found. The largest association was with intracerebral hemorrhage. Both physiologic changes of normal aging and medications used to treat cardiovascular stroke risk factors increase older adults’ risk for dehydration. The strength of this study is the propensity risk management of over 3 million older adults (≥80 years). Limitations of this study include the retrospective nature of database evaluation. Future studies should evaluate whether increased hydration status leads to decreased stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 11","pages":"Article 108430"},"PeriodicalIF":1.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986519","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":"Discharge disposition following acute ischemic stroke in the veterans health administration: A retrospective cohort study","authors":"Kimberly J. Waddell PhD, MSCI ,&nbsp;Anthony J. Perkins MS ,&nbsp;Laura J. Myers PhD ,&nbsp;Joanne K. Daggy PhD ,&nbsp;Qinglan Ding PhD ,&nbsp;Ali Sexson MBA ,&nbsp;Stanley E. Taylor MA ,&nbsp;Jason J. Sico MD ,&nbsp;Dawn M. Bravata MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108435","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108435","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to examine the discharge disposition of older adults who were hospitalized for an ischemic stroke in the Veterans Health Administration (VA).</div></div><div><h3>Methods</h3><div>This retrospective cohort evaluation included Veterans, admitted to one of 36 distinct medical centers, who discharged from the acute hospital to home, home with home health services, an inpatient rehabilitation facility (IRF), or skilled nursing facility (SNF). Unadjusted trends in the proportion of discharges to each setting by year was examined using the Cochrane-Armitage test for trend. The association of demographic, clinical, and facility characteristics with discharge disposition were examined using a multinomial logistic regression.</div></div><div><h3>Results</h3><div>The cohort comprised 4,623 older Veterans with a mean (SD) age 75.3 (7.3) years; 72.9% went home, 6.6% discharged to an IRF, and 20.5% discharged to a SNF. There was a significant change in the proportion of patients discharged to a SNF (2019, 24.5%; 2020, 18.7%; and 2021, 19.8%, <em>P =</em> 0.007). Multiple clinical factors were consistently associated with discharge to SNF versus home, IRF versus home, and IRF versus SNF. Age 85 or older was significantly associated with higher odds of discharge to SNF versus home (OR 1.37, 95% CI [1.03, 1.80], P =0.02), and lower odds of discharge to an IRF versus SNF (OR 0.58, 95% CI0.35, 0.95], P=0.03).</div></div><div><h3>Conclusions</h3><div>The clinical presentation of individuals hospitalized for acute ischemic stroke was most strongly and consistently associated with discharge location. Demographic and facility variables were sparsely associated with discharge disposition across all settings.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 10","pages":"Article 108435"},"PeriodicalIF":1.8,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893588","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":"Stroke-related mortality trends among tobacco users in the U.S.: A 21-year retrospective analysis of national data from the CDC WONDER database","authors":"Wajeeh Hassan ,&nbsp;Rayyan Nabi ,&nbsp;Shree Rath ,&nbsp;Areej Javeid ,&nbsp;Dua Ali ,&nbsp;Bakhtawar Haseeb ,&nbsp;Javeria Javeid ,&nbsp;Sabahat Ul Ain Munir Abbasi ,&nbsp;Syed Hashim Ali Inam ,&nbsp;Edwin Serrano ,&nbsp;Raheel Ahmed ,&nbsp;Paul Ferguson","doi":"10.1016/j.jstrokecerebrovasdis.2025.108436","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108436","url":null,"abstract":"<div><h3>Introduction</h3><div>Stroke is a leading cause of mortality, and tobacco use is a significant modifiable risk factor. This study analyzed trends in tobacco-associated stroke mortality in the United States from 1999 through 2023 using CDC WONDER data.</div></div><div><h3>Methods</h3><div>We included adults aged ≥ 25 years with cerebrovascular disease (ICD-10 I60–I69) as the underlying cause of death and tobacco-related disorders (ICD-10 F17.0–F17.9) as contributing causes. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated based on the 2000 U.S. standard population. Rates were stratified by sex, race/ethnicity, urban-rural status, geographic region, state, and ten-year age groups. Joinpoint regression was used to estimate annual and average annual percent changes (APC and AAPC) in mortality trends over time.</div></div><div><h3>Results</h3><div>A total of 157,916 tobacco-related stroke deaths occurred from 1999 to 2023. The AAMRs increased from 0.41 (95 % CI: 0.38–0.44) in 1999 to 3.80 (95 % CI: 3.73–3.87) in 2023 (average APC: 9.65 %, <em>p</em> &lt; 0.0001). Males had higher AAMRs (3.52) than females (2.02), although females experienced a steeper increase from 1999 to 2005 (APC: 41.3 %, 95 % CI: 30.2–53.3). Non-Hispanic Blacks had the highest average AAMR (3.13), followed by Non-Hispanic Whites (2.83) and Hispanics (1.31). Rural areas (3.84) exceeded metropolitan regions (2.38). Regionally, the Midwest had the highest AAMR (3.57); state rates ranged from Oregon (8.0) to California (0.31). By age, the highest crude rates occurred in those aged 75 years and older, particularly in the 85+ group, which showed a sustained upward trend (APC: 4.29 %, 95 % CI: 3.47–5.11).</div></div><div><h3>Conclusion</h3><div>Disparities in tobacco-associated stroke mortality are increasing across demographic and geographic subgroups, underscoring the need for targeted prevention strategies, equitable access to stroke care, and enhanced health literacy.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 10","pages":"Article 108436"},"PeriodicalIF":1.8,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890184","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":"Predicting early hematoma enlargement in spontaneous intracerebral hemorrhage: Hypocalcemia, Hyperglycemia, and CT signs","authors":"Xiaoxue Tan ,&nbsp;Yuzhao Zhu ,&nbsp;Fei Liu ,&nbsp;Tianzhuang Han ,&nbsp;Yuegao Liu","doi":"10.1016/j.jstrokecerebrovasdis.2025.108433","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108433","url":null,"abstract":"<div><h3>Background</h3><div>Spontaneous intracerebral hemorrhage (sICH) is a severe, stroke subtype, and early hematoma enlargement (HE) strongly predicts mortality and disability. This study aimed to investigate the predictive value of hypocalcemia, hyperglycemia, and computed tomography (CT) imaging signs for early HE in sICH.</div></div><div><h3>Methods</h3><div>A total of 238 sICH patients admitted to the First People’s Hospital Affiliated to Shanghai Jiao Tong University from November 2021 to November 2024 were retrospectively included. Patients were divided into the HE group (<em>n</em> = 103) and non-HE group (<em>n</em> = 135) based on HE occurrence. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for HE. Receiver operating characteristic (ROC) curves were used to evaluate the predictive efficiency of biochemical indicators [serum calcium (Ca²⁺), blood glucose (GLU)] and CT signs (blend sign, black hole sign, island sign), and a combined prediction model was constructed.</div></div><div><h3>Results</h3><div>HE patients showed significantly lower Ca²⁺ levels (1.92 mmol/L vs. 2.41 mmol/L, <em>P</em> &lt; 0.001) and higher GLU levels (8.38 mmol/L vs. 6.31 mmol/L, <em>P</em> &lt; 0.001) compared with non-HE patients. Multivariate analysis revealed that hypocalcemia (≤2.24 mmol/L; OR=0.001, <em>P</em> &lt; 0.001), hyperglycemia (≥7.96 mmol/L; OR=1.791, <em>P</em> = 0.006), and expansion-prone hematoma CT signs (OR=2.990, <em>P</em> &lt; 0.001) were independent risk factors for HE. ROC curve analysis indicated that the combined prediction model of Ca²⁺ (AUC=0.853), GLU (AUC=0.752), and CT signs (AUC=0.791) achieved the optimal efficiency for HE prediction (AUC=0.959, sensitivity=98.1 %, specificity=98.4 %).</div></div><div><h3>Conclusion</h3><div>The combination of hypocalcemia (≤2.24 mmol/L), hyperglycemia (≥7.96 mmol/L), and expansion-prone hematoma CT signs significantly improves the accuracy of predicting early HE in sICH, providing a basis for clinical personalized treatment. These findings are of great significance for optimizing risk stratification and intervention strategies in sICH.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 10","pages":"Article 108433"},"PeriodicalIF":1.8,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between triglyceride glucose-weight-adjusted waist index and stroke risk in the general population: A large cross-sectional study from NHANES","authors":"Quanhong Chu ,&nbsp;Yaoyao Shen ,&nbsp;Shimin Liu ,&nbsp;Wei Rao ,&nbsp;An Wen ,&nbsp;Lingfeng Wu ,&nbsp;Wenfeng Cao","doi":"10.1016/j.jstrokecerebrovasdis.2025.108434","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108434","url":null,"abstract":"<div><h3>Background</h3><div>Insulin resistance (IR) is closely associated with stroke risk. The triglyceride glucose-weight-adjusted waist index (TyG-WWI) is a novel biomarker for IR estimation. However, the relationship between the TyG-WWI index and stroke risk in the general population remains unexplored. This study aims to explore the potential relationship between the TyG-WWI index and stroke risk in the general population.</div></div><div><h3>Methods</h3><div>A total of 22,615 participants from the 1999–2018 NHANES programme were included in this study. Multivariate logistic regression models, restricted cubic spline regression, subgroup analyses and sensitivity analysis were performed to explore the relationship between the TyG-WWI index and stroke risk in the general population.</div></div><div><h3>Results</h3><div>Among the 22,615 participants included in the study, 812 participants were identified as stroke patients. After adjusting for multiple confounders, multivariate logistic regression analyses indicated that each SD (standard deviation) increase in the TyG-WWI index was associated with a 15 % increase in the risk of stroke (OR: 1.15, 95 % CI: 1.01–1.32). The further restricted cubic spline analysis demonstrated a positive linear relationship between the TyG-WWI index and stroke risk (<em>p</em> for non-linearity: 0.149). Subgroup analysis showed a more pronounced association between the TyG-WWI index and stroke risk among younger participants and those without coronary heart disease. Finally, sensitivity analysis consistently confirmed the robustness of the study findings.</div></div><div><h3>Conclusions</h3><div>The findings indicate a positive linear relationship between the TyG-WWI index and stroke risk in the general population.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 10","pages":"Article 108434"},"PeriodicalIF":1.8,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890186","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}