Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Safety and efficacy of mechanical thrombectomy in distal medium vessel occlusions: Experience and real-world data from an Italian stroke hub centre","authors":"Michele Alessiani ,&nbsp;Adriano Bonura ,&nbsp;Gianmarco Iaccarino ,&nbsp;Sergio Soeren Rossi ,&nbsp;Marilena Mangiardi ,&nbsp;Maria Cristina Bravi ,&nbsp;Francesca Romana Pezzella ,&nbsp;Gianluca de Rubeis ,&nbsp;Enrico Pampana ,&nbsp;Sabrina Anticoli","doi":"10.1016/j.jstrokecerebrovasdis.2025.108321","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108321","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Distal-medium vessel occlusions (DMVOs) contribute to approximately 25-40 % of cases of ischemic stroke. Intravenous thrombolysis (IVT) achieved a complete recanalization in &lt;50 % of cases. Observational studies have demonstrated comparable efficacy and safety of mechanical thrombectomy (MT) in DMVOs compared to LVOs. Recently published RCTs have shown that MT plus best medical therapy in DMVOs does not improve the outcome compared to best medical therapy alone</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study involving patients with acute ischemic stroke (AIS) and primary or secondary DMVO according to literature classification. DMVOs were defined as occlusion in the A2, A3, distal M2 or its single branch, M3, P2, P3, PICA, SCA and AICA. The primary endpoint was to evaluate the safety and efficacy of MT alone in DMVOs compared to IVT. Efficacy was assessed by considering the change in NIHSS from admission to discharge, 3 months Modified Rankin Scale (mRS), 3 months mortality rate and recanalization rate. Safety was assessed based on haemorrhagic transformation and procedural complications. As a secondary endpoint we compared primary and secondary DMVO to highlight any differences.</div></div><div><h3>Results</h3><div>In primary plus secondary DMVO after propensity score analysis there were no statistically significant differences in efficacy and safety between MT and IVT though a positive trend for NIHSS reduction in the MT group. Sub-analysis of primary DMVO did not show significant differences between the two groups. MT group achieved an excellent recanalization rate with mTICI ≥2b in 95 % of cases and no procedural complications occurred.</div></div><div><h3>Conclusions</h3><div>MT in DMVOs showed an excellent recanalization rate and few procedural complications. New RCTs are needed to compare the efficacy and safety of MT alone versus IVT alone in primary and secondary DMVOs separately.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108321"},"PeriodicalIF":2.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143850359","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 between folate intake, serum folate, and stroke risk: The mediating role of dietary inflammatory index from NHANES 2007-2018","authors":"Yao Jiang ,&nbsp;Ling Meng ,&nbsp;Zhenhua Liu,&nbsp;Qian Wu,&nbsp;Yingqiang Dang,&nbsp;Chongge You","doi":"10.1016/j.jstrokecerebrovasdis.2025.108318","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108318","url":null,"abstract":"<div><h3>Background</h3><div>This study investigates the relationships between folate intake, RBC folate, serum folate levels, and stroke risk, with an emphasis on the mediating roles of the dietary inflammatory index (DII) and systemic immune-inflammation index (SII).</div></div><div><h3>Methods</h3><div>A cross-sectional analysis was conducted using 24,106 participants from NHANES (2007-2018). Associations were assessed with weighted multivariate logistic regression, adjusting for key confounders. Propensity score matching (PSM) was applied, yielding 1,838 matched participants, respectively. Nonlinear relationships were analyzed with restricted cubic splines, and mediation analysis was performed for DII and SII.</div></div><div><h3>Results</h3><div>Post-PSM, folate intake in Q2 (252-350 μg/day), Q3 (350-484 μg/day), and Q4 (&gt; 484 μg/day) was significantly inversely associated with stroke risk (trend <em>P</em> &lt; 0.05), with adjusted ORs of 0.62 (95 % CI: 0.45-0.85), 0.65 (95 % CI: 0.46-0.90), and 0.60 (95 % CI: 0.42-0.86), respectively. Serum folate levels in Q3 (37.0 - 54.8 nmol/L) were also protective (OR: 0.47, 95 % CI: 0.32-0.68, trend <em>P</em> &lt; 0.05). Serum folate levels exhibited a biphasic effect, with the lowest stroke risk at 41.9 nmol/L before PSM and 43.3 nmol/L after PSM. Mediation analysis showed DII mediated 45.2 % of the relationship between folate intake and stroke risk (<em>P</em> = 0.018), while SII's mediation effect was minimal (0.412 %, <em>P</em> = 0.016). No significant interactions were observed between folate intake, serum folate and stratified variables (<em>P</em> &gt; 0.05) after PSM.</div></div><div><h3>Conclusion</h3><div>Higher folate intake lowers stroke risk, with DII playing a significant mediating role, while serum folate presents a biphasic risk pattern. Personalized dietary strategies addressing folate intake and inflammation may be crucial for stroke prevention.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108318"},"PeriodicalIF":2.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851922","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":"Circ_0000215 aggravates cerebral ischemic vertigo by targeting miR-361-3p to promote neuroinflammation and apoptosis","authors":"Shengnan Qi,&nbsp;Feng Li,&nbsp;Lijun Yang,&nbsp;Pengcheng Liu,&nbsp;Linlin Guo","doi":"10.1016/j.jstrokecerebrovasdis.2025.108317","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108317","url":null,"abstract":"<div><h3>Background</h3><div>Vertigo can result from cerebral ischemia (CI). Circular RNA (circRNA)’s role in CI is well-documented. This study focused on the clinical significance and mechanisms of circ_0000215 in CI-induced vertigo.</div></div><div><h3>Methods</h3><div>120 CI patients and 128 control participants were enrolled. During the 90-day follow-up, 32.5 % CI patients reported vertigo. Mice models of CI-induced vertigo and a cellular OGD/R-induced HT22 model were constructed. RT-qPCR analyzed circ_0000215 and miR-361-3p expression. ROC curve analysis evaluated circ_0000215’s predictive value for vertigo in CI. ELISA assessed inflammatory factor levels, while CCK-8 and flow cytometry evaluated cell proliferation and apoptosis. Dual luciferase report and RIP assays confirmed circ_0000215 binding to miR-361-3p.</div></div><div><h3>Result</h3><div>circ_0000215 levels were significantly elevated in CI vertigo patients, mice, and OGD-induced HT22 cells, while miR-361-3p levels were decreased. Elevated circ_0000215 diagnosed CI patients and predicted the occurrence of vertigo. Additionally, Cox regression analysis further confirmed that it is an independent risk factor for CI vertigo. Inhibiting circ_0000215 improved neurologic scores, shortened escape latency, and increased blood flow in vertigo mice, but these effects were reversed by downregulation of miR-361-3p. Moreover, decreasing circ_0000215 levels mitigated OGD/R-induced apoptosis and inflammation, yet these beneficial effects were reversed by miR-361-3p downregulation. Molecularly, circ_0000215 targets miR-361-3p.</div></div><div><h3>Conclusion</h3><div>Elevated circ_0000215 aids CI diagnosis and predicts vertigo. It may promote inflammation and apoptosis by targeting miR-361-3p, contributing to nerve damage in CI.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108317"},"PeriodicalIF":2.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876719","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":"FTO-mediated m6A Demethylation of OTUB1 stabilizes SLC7A11 to alleviate Ferroptosis in cerebral ischemia/reperfusion injury","authors":"Youjin Shen ,&nbsp;Wentao Liu ,&nbsp;Zonghua Zhou ,&nbsp;Jianwen He ,&nbsp;Xiaokun Qi","doi":"10.1016/j.jstrokecerebrovasdis.2025.108316","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108316","url":null,"abstract":"<div><h3>Backgroud</h3><div>Therapeutic strategies for cerebral ischemia/reperfusion (I/R) injury, an important contributor to neurological impairment and disability, exhibit limited efficacy. Reperfusion therapy intensifies neuronal damage by promoting iron deposition, ferroptosis (lipid peroxidation-associated iron-dependent cellular death), and reactive oxygen species (ROS) accumulation.</div></div><div><h3>Methods</h3><div>we investigated the role of the m6A demethylase FTO in modulating ferroptosis during cerebral I/R injury, using middle cerebral artery occlusion/reperfusion (MCAO/R) model rats and neuronal cells subjected to oxygen glucose deprivation/reoxygenation (OGD/R) as in vivo and in vitro experimental platforms, respectively. Neurological scores and cerebral infarction volumes were measured by TTC staining. FTO, OTUB1, and SLC7A11 levels, and FTO demethylase activity, were assessed by qRT-PCR, western blotting, and immunohistochemistry. MeRIP was applied to ascertain the m6A methylation status of OTUB1 mRNA. Apoptotic rates and cell viability were quantitatively aalyzed by flow cytometry and CCK-8 assay, respectively, while brain tissue apoptosis was evaluated using TUNEL staining.</div></div><div><h3>Results</h3><div>MCAO/R rat brains and OGD/R cells showed decreased FTO expression and increased OTUB1 m6A methylation. FTO overexpression upregulated OTUB1 by diminishing m6A methylation, consequently stabilizing SLC7A11 and reducing ferroptosis. FTO or OTUB1 silencing increased ferroptosis, while their co-overexpression enhanced neuroprotective effects. FTO overexpression reduced infarct volume and cell apoptosis, and improved neurological outcomes in vivo.</div></div><div><h3>Conclusions</h3><div>FTO enhanced OTUB1 expression via m6A demethylation, stabilizing SLC7A11, and inhibiting ferroptosis to alleviate cerebral I/R injury. The FTO/OTUB1/SLC7A11 pathway is a viable therapeutic target for ischemic stroke, providing novel perspectives on the molecular mechanisms underlying neuroprotection and proposing innovative m6A-based therapies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108316"},"PeriodicalIF":2.0,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833445","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":"Activation of GPER1 alleviates white matter injury by promoting microglia M2 polarization through EGFR/Stat3 pathway in intracerebral hemorrhage mice","authors":"Xuyang Zhang,&nbsp;Jianchao Mao,&nbsp;Huanhuan Li,&nbsp;Chao Zhang,&nbsp;Hongfei Ge,&nbsp;Jun Zhong","doi":"10.1016/j.jstrokecerebrovasdis.2025.108315","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108315","url":null,"abstract":"<div><h3>Background</h3><div>White matter injury (WMI) is a major pathophysiological process after intracerebral hemorrhage (ICH). G protein-coupled estrogen receptor 1 (GPER1) has been validated to exert a crucial role in regulating neuroinflammation and microglia polarization. Our previous report reveals activation of GPER1 improves the neurological deficits after ICH via inhibition of A1 astrocytes. However, the role of GPER1 on the protection of WMI and modulation of microglia polarization after ICH remains unclear.</div></div><div><h3>Methods</h3><div>In present study, ICH mice model was induced by autologous whole blood injection and <em>in vitro</em> ICH model was established via treatment BV2 cells with FeSO₄. Mice were treated with GPER1 agonist G1, antagonist G15 and BV2 cells were treated with G1, G15 or EGFR inhibitor AG1478. Besides, BV2 conditional medium was used to intervene MO3.13 oligodendrocytes. Immunostaining, immunoblots, transmission electron microscope and PI staining were used to determine the WMI, microglia polarization and potential molecular mechanism after ICH, respectively.</div></div><div><h3>Results</h3><div>Our data showed treatment with G1 ameliorated the WMI on the day 3 after ICH. Besides, activation of GPER1 reduced the release of IL-1β, TNF-α and increased the produce of IL-4, IL-10 as well as shifting microglia from proinflammatory M1 to anti-inflammatory M2 phenotype <em>in vivo</em> and <em>in vitro</em>. Meanwhile, MO3.13 cells treated with BV2 conditional medium validated GPER1 alleviated oligodendrocytes death via mitigating neuroinflammation and modulating microglia polarization. Mechanistic study demonstrated EGFR/Stat3 signaling pathway was involved in the protection of WMI and modulation microglia polarization after ICH.</div></div><div><h3>Conclusion</h3><div>Collectively, our findings demonstrated activation of GPER1 alleviated WMI via modulating microglia M2 polarization after ICH through EGFR/Stat3 signaling pathway.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108315"},"PeriodicalIF":2.0,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143844523","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":"Global trends, disparities, and future projections of ischemic stroke burden attributed to low-fiber diets: An analysis based on GBD 2021","authors":"Jianhong Gao ,&nbsp;Zhenhua Wei ,&nbsp;Zhengyu Wang ,&nbsp;Yun Zhang","doi":"10.1016/j.jstrokecerebrovasdis.2025.108308","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108308","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to analyze the disease burden attributed to ischemic stroke related to low-fiber diets (IFD-IS) from 1990 to 2021, utilizing data from the Global Burden of Disease (GBD) database to identify trends and influencing factors of the disease burden.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive analysis of the number of deaths, Disability-Adjusted Life Years (DALYs), Years of Life Lost (YLLs), and Years Lost due to Disability (YLDs) associated with IFD-IS, covering various regions and populations. Statistical methods, including breakpoint regression, decomposition analysis, health inequality analysis, and forecasting analysis, were employed to assess trends and their correlation with the Sociodemographic Index (SDI).</div></div><div><h3>Results</h3><div>The findings indicate that deaths, DALYs, YLLs, and YLDs related to IFD-IS have gradually increased globally, with a significantly higher burden in males compared to females. Notable regional disparities were observed, particularly with heavier burdens in China and sub-Saharan Africa. Higher SDI regions demonstrated better control over disease burdens, while aging and population growth were the primary factors contributing to the increase. Additionally, the trend of health inequality related to IFD-IS has slightly diminished, although it is projected that the disease burden will continue to rise by 2040.</div></div><div><h3>Conclusion</h3><div>This study underscores the necessity of implementing targeted public health interventions for IFD-IS, particularly in low SDI regions. Enhancing dietary education and resource allocation can significantly mitigate the rising trend of IFD-IS. Ongoing monitoring and research are crucial for formulating effective health policies to address this public health challenge.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108308"},"PeriodicalIF":2.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143820513","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 association between plasma lipids changes and embolization recurrence following intravenous thrombolysis with alteplase in acute ischemic stroke based on lipidomics","authors":"Chuanfeng Shao ,&nbsp;Saizhen Wu ,&nbsp;Tingting Liu ,&nbsp;Ming Zheng ,&nbsp;Xiaoyang Zhi ,&nbsp;Jinli Miao ,&nbsp;Lufeng Hu ,&nbsp;Lingli Ge","doi":"10.1016/j.jstrokecerebrovasdis.2025.108310","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108310","url":null,"abstract":"<div><h3>Background</h3><div>Alteplase is a widely used thrombolytic therapy for acute ischemic stroke (AIS). However, the efficacy of intravenous thrombolysis (IVT) with alteplase varies due to individual factors, and some patients are prone to embolization recurrence (ER) after IVT. The mechanisms underlying these variations are not fully understood.</div></div><div><h3>Methods</h3><div>In this study, we analyzed changes in plasma lipid profiles of AIS patients treated with alteplase based on lipidomics, focusing on the association between plasma lipids changes and embolization recurrence.</div></div><div><h3>Results</h3><div>Our findings revealed significant changes in several lipid species in patients who experienced ER, including triglycerides (TG), diglycerides (DG), phosphatidylcholine (PC), and sphingomyelin (SM). Notably, most TG and DG levels in ER group were significantly upregulated, PC and SM levels were downregulated. However, most PC was upregulated 24 h after IVT treatment, while DG, SM, TG remained downregulated. These differential lipid metabolites are mainly involved in lipid metabolism, immune response inflammation-related, and insulin resistance signaling pathways.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that lipid alterations, particularly in TG, DG, PC, and SM, may be associated with ER after alteplase treatment. However, further studies are needed to elucidate the exact mechanisms through which these lipids influence the onset and recovery of AIS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108310"},"PeriodicalIF":2.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143820514","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":"Letter to the editor regarding “Causal association of inflammation with ischemic stroke and its subtypes: a bidirectional Mendelian randomization study”","authors":"Aidong Li","doi":"10.1016/j.jstrokecerebrovasdis.2025.108309","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108309","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108309"},"PeriodicalIF":2.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143820515","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":"High mimic rate among recipients of intravenous thrombolysis for acute minor ischemic stroke presenting with disabling symptoms","authors":"Saira Afzal,&nbsp;Pramit Mukherjee,&nbsp;Metin Bicen,&nbsp;Mark Orlando,&nbsp;Chetna Dengri,&nbsp;Dixie Reinoso,&nbsp;Ahmed Koriesh,&nbsp;Amre Nouh","doi":"10.1016/j.jstrokecerebrovasdis.2025.108298","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108298","url":null,"abstract":"<div><h3>Background</h3><div>Patients with minor acute ischemic stroke, defined as having an NIHSS score of ≤5, and presenting with disabling symptoms are routinely administered intravenous (IV) thrombolytics. Our study aimed to assess the prevalence of stroke mimics among these patients and compare the characteristics between stroke mimics and true strokes in those who received thrombolytic therapy. Additionally, we evaluated the safety of thrombolytic therapy in stroke mimic patients.</div></div><div><h3>Observation</h3><div>This single-center, retrospective study reviewed patients with NIHSS scores of ≤5 and disabling symptoms who received IV thrombolytics for suspected acute ischemic stroke from March 2018 to March 2023. Univariate analysis compared demographics and characteristics between stroke and stroke mimic groups using Chi-square or Fisher's exact test for categorical variables and Wilcoxon's rank-sum test for continuous variables. Among 61 patients identified, 29 % (n = 18) were classified as stroke mimics. There were no significant differences in age, gender, presenting symptoms. Hypertension, hyperlipidemia and diabetes mellitus was more predominant among stroke patients. Although not statistically significant, the rate of adverse events was higher among stroke patients compared to stroke mimics (9 % vs 0 %, p = 0.30). One patient developed symptomatic intracerebral hemorrhage, two patients experienced asymptomatic intracerebral hemorrhage and one patient had gross hematuria while no adverse events were observed in the stroke mimic group. Stroke mimics were more likely to achieve a good functional outcome at discharge (mRS &lt;1) compared to stroke patients (89 % vs 37 %, p = 0.008). The final discharge diagnoses for stroke mimics included migraine(50 %), toxic-metabolic encephalopathy (27 %), seizures (17 %) and somatoform disorders (5 %). None of the stroke mimic patients experienced adverse events post-IV thrombolysis. In contrast, 1 stroke patient (2 %) developed symptomatic intracranial hemorrhage, two patients (4.6 %) had asymptomatic intracranial hemorrhage and one patient(2 %) had minor extracranial bleeding (gross hematuria)</div></div><div><h3>Conclusions</h3><div>The high percentage of stroke mimics among patients with NIHSS ≤5 despite disabling features suggests a need for improved diagnostic tools to distinguish true strokes from mimics. Importantly, thrombolytic therapy was not associated with significant adverse events in stroke mimic patients, who had a better functional outcome at discharge.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108298"},"PeriodicalIF":2.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797028","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":"Quantification of patent foramen ovale shunt severity by transesophageal echocardiogram and transcranial doppler in routine clinical practice","authors":"Philip Y. Sun ,&nbsp;Jonathan M. Tobis ,&nbsp;Samuel A. Daneshvar ,&nbsp;Rodel C. Alfonso ,&nbsp;David S. Liebeskind ,&nbsp;Jeffrey L. Saver","doi":"10.1016/j.jstrokecerebrovasdis.2025.108306","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108306","url":null,"abstract":"<div><h3>Background</h3><div>The presence of a large physiologic shunt, defined as &gt;20 left atrial microbubbles within 3 cardiac cycles on transesophageal echocardiography (TEE), is a randomized trial-validated indication for patent foramen ovale (PFO) closure in patients with otherwise cryptogenic ischemic stroke. The frequency with which this information is available to treating physicians from clinical TEE reports has not been well-delineated.</div></div><div><h3>Methods</h3><div>Among consecutive ischemic stroke patients, clinical TEE report shunt size characterizations were abstracted and compared to transcranial Doppler (TCD) formal shunt grades in the same patients and to central Core Lab TEE quantified assessments.</div></div><div><h3>Results</h3><div>Among 77 patients, median age was 64 (IQR 56-73), and 33 (43 %) female. On TEE, shunt presence was assessed by bubble study in 60 (78 %), direct Doppler alone in 5 (7 %), and neither in 12 (16 %). Among bubble study patient, a right-to-left shunt (RLS) potentially due to PFO was present in 25 (42 %). RLS severity was quantified on the clinical report in 4 (16 %) patients and only with informal descriptive terms in 21 (84 %) - “small/mild/trace” (13 cases), “moderate/medium” (6), and “large” (1). In the 19 patients also undergoing TCD, RLS severity was quantified in all clinical reports. Shunt severity agreement between clinical TEE reports and TCD quantification was 100 % (3/3) for formally quantified TEE shunts but poor (3/15, 20 %) for the15 TEE reports using informal descriptions. For presence of a large shunt, an indication for PFO closure, clinical TEE with informal descriptions and TCD were incongruent in 5/15 (33 %) of patients.</div></div><div><h3>Conclusions</h3><div>Quantified, evidence-based ratings of PFO shunt severity were present in &lt;1 of every 6 TEE reports, and unquantified, informal size estimates correlated poorly with TCD quantification of shunt severity. Patient management would be aided by inclusion of formal PFO shunt size quantification in all clinical stroke patient TEE reports.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108306"},"PeriodicalIF":2.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788967","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}