Journal of Stroke & Cerebrovascular Diseases最新文献

{"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}

{"title":"Major cardiovascular events and all-cause mortality after ischemic stroke in central Norway – A three-year prospective multicenter study","authors":"Ailan Phan ,&nbsp;Bent Indredavik ,&nbsp;Stian Lydersen ,&nbsp;Torunn Askim ,&nbsp;Torgeir Wethal","doi":"10.1016/j.jstrokecerebrovasdis.2025.108356","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108356","url":null,"abstract":"<div><h3>Background</h3><div>A substantial decline in the incidence of stroke and ischemic heart disease during the last decade is probably due to improved preventive treatment and a reduction in cardiovascular risk factors. Updated estimates on long-term outcomes following first-ever ischemic stroke are therefore limited.</div></div><div><h3>Purpose</h3><div>To assess the incidence of major cardiovascular events and all-cause mortality three years post-stroke, and to evaluate the impact of modifiable cardiovascular and other prognostic factors.</div></div><div><h3>Methods</h3><div>MIDNOR STROKE is a multicenter prospective study including patients with first-ever ischemic stroke admitted to stroke units in Central Norway during 2015-2017. Data were collected during the hospital stay. Information on major cardiovascular events and survival three years post-stroke was retrieved from national medical registries. Competing risk models were used to analyze cardiovascular events. All-cause mortality was analyzed by using Kaplan-Meier and Cox regression.</div></div><div><h3>Results</h3><div>Among 787 included participants, the cumulative incidence of major cardiovascular events was 15.0 % (95 % CI: 12.0–17.0 %), with recurrent stroke as the most common event. The all-cause mortality rate was 18.0 % (95 % CI: 15.0–20.0 %). Coronary artery disease was associated with a higher risk of major vascular events HR: 1.59, 95 % CI: 1.06, 2.38) and all-cause death (HR: 1.66, 95 % CI: 1,11, 2.50). NIHSS at day 1 predicted all-cause mortality (HR: 1.08, 95 % CI: 1.05, 1.10).</div></div><div><h3>Conclusion</h3><div>Three-year survival rates post-stroke were higher compared to previous reports; however, the risk of major cardiovascular events remains substantial, affecting 15 % of stroke survivors within three years.</div><div>Reducing cardiac disease risk and interventions aimed at minimizing stroke severity may improve long-term stroke outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108356"},"PeriodicalIF":2.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145365","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":"Patient reported outcomes of cerebral venous thrombosis compared to ischemic stroke","authors":"Hyunjun Ahn BS ,&nbsp;Yadi Li MEd ,&nbsp;Brittany Lapin PhD, MPH ,&nbsp;Maximos McCune BA ,&nbsp;Irene Katzan MD, MS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108354","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108354","url":null,"abstract":"<div><h3>Purpose</h3><div>Although both cerebral venous thrombosis (CVT) and ischemic stroke involve cerebrovascular flow disruption, they differ in pathophysiology, clinical features, and outcomes. This study compared patient-reported outcomes (PROs) and their trajectories over time between CVT and ischemic stroke patients.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients hospitalized for CVT or ischemic stroke who completed at least one of the following PRO in cerebrovascular clinic between January 2019 and April 2024: Patient Health Questionnaire-9, PROMIS Global Health, Neuro-QoL cognitive function, and PROMIS scales for pain interference, physical function, social role satisfaction, fatigue, self-efficacy and sleep disturbance. CVT patients were matched (1:3) with ischemic stroke patients by propensity scores. PROs were compared over time using mixed-effects models.</div></div><div><h3>Results</h3><div>Of 72 CVT and 2,533 ischemic stroke patients, 69 CVT and 196 ischemic stroke patients were included after matching (average age 47.5 ± 17.0 years, 62.6% female, median modified Rankin score 1). Brain tissue injury occurred in 30.6% of CVT patients. Both groups exhibited comparable PROs, but CVT patients reported worse pain interference, and worsening PROMIS global mental health and health-related quality of life over time compared to ischemic stroke patients.</div></div><div><h3>Conclusions</h3><div>Despite favorable functional outcomes and lower rates of brain injury, CVT patients had worse or comparable PROs in severity and patterns compared to the subset of ischemic stroke patients with similar baseline characteristics. Traditional clinical assessments may not fully capture the impact of CVT, and a holistic care approach addressing broader spectrum of outcomes, in addition to vascular pathology, could be beneficial.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108354"},"PeriodicalIF":2.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116174","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":"Associations of the Hs-CRP/HDL-C ratio with stroke among US adults: Evidence from NHANES 2015–2018","authors":"Qinghui Feng ,&nbsp;Chanchan Miao ,&nbsp;Xuejun Gao","doi":"10.1016/j.jstrokecerebrovasdis.2025.108353","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108353","url":null,"abstract":"<div><h3>Background</h3><div>The high-sensitivity C-reactive protein (Hs-CRP)-to-high-density lipoprotein cholesterol (HDL-C) ratio, which integrates insights into inflammation and lipid metabolism, serves as a comprehensive indicator. The association between this ratio and stroke prevalence is endeavored to be explored in this research.</div></div><div><h3>Methods</h3><div>Drawing on information gathered during the 2015-2018 cycles of the NHANES, the association between the Hs-CRP/HDL-C ratio and stroke was examined through multivariate logistic regression. Additionally, subgroup analysis, interaction test, and restricted cubic spline (RCS) were carried out. Multiple machine learning methods were used to identify the key factors affecting stroke and combined with Shap interpretable models to determine the degree of influence of the key factors. Finally, the results of the logistic regression analysis are used to construct a predictive model, which is represented using a nomogram.</div></div><div><h3>Results</h3><div>This research sample comprised 8,064 participants, yielding a stroke prevalence of 4.04%. A positive correlation was shown between the Hs-CRP/HDL-C ratio and stroke (OR: 1.17, 95% CI: 1.02, 1.35). Interaction tests demonstrated that younger participants were more sensitive to higher Hs-CRP/HDL-C ratios, with a significant interaction in stroke. The RCS analysis indicated a nonlinear association between the exposure variable and to outcome variable. The AUC &gt; 0.8 for a random forest model and an XGBoost model demonstrated their strong predictive value. Ultimately, the generated predictive model is a visual nomogram with an AUC of 0.799.</div></div><div><h3>Conclusion</h3><div>The results of the study showed a positive correlation between Hs-CRP/HDL and the prevalence of stroke, with higher Hs-CRP/HDL levels associated with a higher likelihood of stroke. As a stroke prediction model incorporating Hs-CRP/HDL, the nomogram may play a significant role in the early identification of high-risk populations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108353"},"PeriodicalIF":2.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129679","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":"TyG-BMI and TyG/BMI %: valuable evaluation tools for predicting unfavorable prognosis in ischemic stroke patients with large vessel occlusion after endovascular therapy","authors":"Jianru Li ,&nbsp;Shandong Jiang ,&nbsp;Peizheng Guo ,&nbsp;Weibo lin ,&nbsp;Jun Yu ,&nbsp;Liang Xu ,&nbsp;Xu Li ,&nbsp;Xianyi Chen ,&nbsp;Bin Fang ,&nbsp;Cong Qian ,&nbsp;Jing Xu ,&nbsp;Zhongju Tan ,&nbsp;Chaohui Jing ,&nbsp;Gao chen","doi":"10.1016/j.jstrokecerebrovasdis.2025.108352","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108352","url":null,"abstract":"<div><h3>Background</h3><div>Insulin resistance (IR) indices, such as triglyceride-glucose (TyG) and TyG with body mass index (TyG-BMI), are strongly associated with all-cause mortality (ACM) from ischemic or hemorrhagic stroke. However, the relationship between IR indices and adverse outcomes of ischemic stroke patients remains unclear, and no studies have explored whether the TyG/BMI ratio is more predictive than TyG-BMI.</div></div><div><h3>Methods</h3><div>In this study, we calculated four IR-related indicators and followed up regularly to assess modified Rankin Scale (mRS) scores. Multivariate logistic regression analyses were used to explore the associations of these indicators with adverse outcomes at 3 and 12 months. Restrictive cubic splines (RCS) evaluated the dose-effect relationships. Subgroup analyses assessed the prognostic efficacy of TyG-BMI and TyG/BMI %, with favorable outcomes defined as mRS scores of 0–2.</div></div><div><h3>Results</h3><div>Of the 823 patients, 603 were included in the study cohort, with 331 (54.89 %) unable to live independently at 3 months (mRS&gt;2). Among the four IR indexes, lower TyG-BMI and higher TyG/BMI % were significantly associated with poor prognosis after EVT, particularly at 12 months, showing linear or S-shaped dose-response relationships. TyG-BMI and TyG/BMI % improved the accuracy and efficiency of predicting prognosis at 3 and 12 months by enhancing IDI and NRI. In subgroup analyses, TyG/BMI % was effective across most subgroups, except for sex, indicating broad applicability in managing stroke outcomes.</div></div><div><h3>Conclusion</h3><div>Both TyG-BMI and TyG/BMI % were significantly associated with prognosis of patients with AIS-LVO after EVT, particularly at the 12-month follow-up. Notebly, TyG/BMI % exhibited a more favorable trend in predictive performance and risk stratification capability.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108352"},"PeriodicalIF":2.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121949","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":"Sleepiness, fatigue, and obstructive sleep apnea in stroke patients","authors":"Jeppe Suusgaard MD ,&nbsp;Anders Sode West MD PhD ,&nbsp;Rune Frandsen MD PhD ,&nbsp;Helle Klingenberg Iversen MD DMSc ,&nbsp;Christina Kruuse MD DMSc ,&nbsp;Katrin Rauen MD DMSc ,&nbsp;Belle Mia Ingerslev Loft PhD ,&nbsp;Camilla Dysted RN ,&nbsp;Poul Jørgen Jennum MD DMSc","doi":"10.1016/j.jstrokecerebrovasdis.2025.108345","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108345","url":null,"abstract":"<div><h3>Objectives</h3><div>Obstructive sleep apnea (OSA) impacts approximately 70 % of stroke patients, often causing fatigue and sleepiness. Although continuous positive airway pressure (CPAP) reduces sleepiness, systematic OSA screening is not standard in post-stroke care, and the effect of untreated OSA on fatigue is unclear. This study investigated changes in sleepiness and fatigue among OSA patients following ischemic stroke or transient ischemic attack (TIA) who underwent CPAP treatment.</div></div><div><h3>Methods</h3><div>This prospective multi-center cohort study, ischemic stroke and TIA patients were screened for OSA using respiratory polygraphy. CPAP-eligible patients (Apnea-Hypopnea Index ≥15) were assessed with the Epworth Sleepiness Scale (ESS) and Visual Analogue Scale–Fatigue (VAS–F) at baseline and seven to eight months post-stroke. CPAP compliance was classified into high (≥70 %), moderate (50–69 %), and low (&lt;50 %) compliance based on nights using CPAP more than four hours per night. Poisson regression models analyzed differences in ESS and VAS–F between compliance groups, with low-compliance as the reference.</div></div><div><h3>Results</h3><div>Of 2605 patients, 1518 (mean age: 70 ± 12 years; 61 % male) were screened, and 648 were CPAP-eligible. At follow-up, 333 patients were assessed (49 % lost to follow-up). Sleepiness significantly decreased in the high-compliance group compared to low-compliance (<em>p</em> &lt; 0.001). Fatigue levels decreased across all compliance groups, but no differences were observed between groups.</div></div><div><h3>Conclusions</h3><div>High CPAP compliance in post-stroke or TIA patients with OSA was associated with a reduction in sleepiness but not fatigue. These findings support the recommendation to systematically screen post-stroke patients for OSA and encourage CPAP compliance to mitigate sleepiness.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108345"},"PeriodicalIF":2.0,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113299","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":"Various sociodemographic variables on acute and inpatient stroke care","authors":"Glenn Goodwin DO ,&nbsp;Henry Yelkin DO ,&nbsp;McHenry Mauger MS ,&nbsp;David Filippi MD ,&nbsp;Ayah Badawy ,&nbsp;Jonghoon Chang MS ,&nbsp;Benjamin Leicht DO ,&nbsp;Erin Marra MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108350","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108350","url":null,"abstract":"<div><h3>Background</h3><div>Key factors affecting stroke outcomes include swift diagnosis and early treatment, however, disparities in symptom recognition, particularly in minority groups, impact timely care. This study examines the influence of patient characteristics on stroke metrics, focusing on factors such as age, sex, ethnicity, race, insurance status, and language preference.</div></div><div><h3>Methods</h3><div>We conducted a multicenter, retrospective study using the National Hospital Corporation of America (HCA) database, analyzing 37,956 acute ischemic stroke (AIS) cases from 170 HCA hospitals between 2017 and 2022. We evaluated the impact of demographic and patient-specific factors on tPA administration rates, time-to-tPA (TtPA), and hospital length of stay (LOS). Statistical methods included odds ratios, one-way ANOVA, mixed-effects models, and negative binomial regression.</div></div><div><h3>Results</h3><div>Factors affecting tPA administration included age, sex, and insurance status. Patients aged 45 and older and those with Medicaid or Medicare were less likely to receive tPA. NIH Stroke Scale (NIHSS) scores significantly influenced tPA administration rates and TtPA. Language preference did not impact tPA administration rates or TtPa, but non-English speakers experienced longer hospital stays. Hispanic and Black patients also had longer LOS compared to non-Hispanic and White patients, respectively.</div></div><div><h3>Conclusion</h3><div>This study underscores the need for targeted interventions to address disparities in stroke management and outcomes. Future research should explore the underlying causes of these differences and develop strategies to enhance stroke care equity across diverse patient populations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108350"},"PeriodicalIF":2.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103491","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}