Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"The relationship between fibrous cap status or plaque surface morphology and intraplaque hemorrhage volume over time: The PARISK Study","authors":"Mohamed Kassem ,&nbsp;Tahnee Gorissen ,&nbsp;Mohammad Albenwan ,&nbsp;Juul Bierens ,&nbsp;Dianne H.K. van Dam-Nolen ,&nbsp;Madieke I. Liem ,&nbsp;Paul A.M. Hofman ,&nbsp;Joachim E Wildberger ,&nbsp;Jeroen Hendrikse ,&nbsp;Werner Mess ,&nbsp;Paul J. Nederkoorn ,&nbsp;Daniel Bos ,&nbsp;Patty Nelemans ,&nbsp;Robert J. van Oostenbrugge ,&nbsp;M. Eline Kooi","doi":"10.1016/j.jstrokecerebrovasdis.2025.108283","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108283","url":null,"abstract":"<div><h3>Background</h3><div>Carotid intraplaque hemorrhage (IPH) is a strong predictor of stroke, but factors contributing to IPH development are incompletely understood. Therefore, we investigate the longitudinal relationship between a thin/ruptured fibrous cap (TRFC)/disrupted plaque surface and IPH volume.</div></div><div><h3>Methods</h3><div>116 ischemic TIA/stroke patients with ipsilateral carotid plaques underwent baseline and two-year follow-up MRI. IPH and fibrous cap status (thick versus TRFC) on MRI and disruption of the plaque surface (smooth versus fissure/ulceration) on CTA were assessed.</div></div><div><h3>Results</h3><div>In the TRFC and disrupted plaque surface groups, the median IPH volume (tended) to decrease during follow-up (baseline: 97.3 IQR: [3.2-193.3] mm³ versus follow-up: 29.7 [0.0-115.1] mm³, <em>p</em> = 0.09, and baseline: 25.1 [0.0-166.2] mm³ versus follow-up: 11.2 [0.0-68.3] mm³, <em>p</em> = 0.04, respectively). In the group with a thick fibrous cap/smooth plaque surface, the median IPH volumes were zero at baseline and follow-up. The risk of IPH progression was higher in the TRFC/disrupted plaque groups (risk ratio (RR): 2.9 and 2.0, respectively) than in patients with a thick fibrous cap/smooth plaque surface.</div></div><div><h3>Conclusion</h3><div>TIA/stroke patients with a TRFC/disrupted plaque showed a net decrease in IPH volume over time, indicating plaque healing in some patients, but patients with a TRFC/disrupted plaque are still at increased risk for IPH progression.</div></div><div><h3>Trial registration</h3><div>ClinicalTrials.gov NCT01208025.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108283"},"PeriodicalIF":2.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600976","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":"Multiomics analysis demonstrated a strong correlation between lipid-mediated chronic kidney disease and stroke: Potential benefits of affected patient cohorts","authors":"Yan-song Liu ,&nbsp;Jian-hang Zhang ,&nbsp;Jia-yue Han ,&nbsp;Yu-yan Long ,&nbsp;Yu-chen Liu ,&nbsp;Kai-ni Mao ,&nbsp;Yu-jing Feng ,&nbsp;Zhi-guang Song ,&nbsp;Si-min Peng ,&nbsp;Shi-min Tan ,&nbsp;Si-le Cai ,&nbsp;Jing-yi Yang ,&nbsp;Li-hua Lin ,&nbsp;Wan-ying Song ,&nbsp;Hua Li ,&nbsp;Wang-hua Liu","doi":"10.1016/j.jstrokecerebrovasdis.2025.108285","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108285","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with chronic kidney disease (CKD) exhibit a disproportionately elevated risk of stroke, frequently compounded by renal impairment. Therapeutic strategies for stroke based on Traditional Chinese Medicine's 'kidney–brain axis' theory demonstrate clinical efficacy, indicating that there may be a potential association between chronic kidney disease and stroke, which needs further exploration and verification.</div></div><div><h3>Methods</h3><div>In this study, databases such as GEO, NHANES, and GWAS were used to collect data related to CKD and stroke. GEO gene data enrichment analysis was used to explore possible mediating factors between CKD and stroke. NHANES clinical data were used to verify the GEO data analysis results. Mendelian randomization was used to confirm the causal relationship between CKD and stroke and verify the association effect of mediating factors in these two diseases.</div></div><div><h3>Results</h3><div>Cross-gene analysis and transcription factor analysis of GEO data revealed that lipid-related pathways may have a mediating effect on the relationship between CKD and stroke. Logistic regression analysis based on NHANES data revealed that changes in LDL-C, HDL-C, TC, and TG can affect the occurrence of stroke. Mendelian randomization analysis was used to determine the causal relationship between CKD and stroke and verified the mediating effects of lipid factors, such as LDL-C, HDL-C, TC, and TG, indicating that LDL-C, HDL-C, TC, and TG may be potential mediating factors for these two diseases. Our findings highlight the clinical relevance of lipid pathways in bridging CKD and stroke. By integrating predictive biomarkers and multi-level diagnostics, this study paves the way for AI-driven precision medicine in stroke prevention. Specifically, machine learning approaches could enhance risk stratification of high-risk CKD cohorts, enabling tailored interventions such as lipid-lowering therapies and personalized monitoring protocols. These strategies align with emerging paradigms in healthcare benefits and population-specific management.</div></div><div><h3>Conclusion</h3><div>This study provides new insights into the interactive relationship between CKD and stroke and provides a scientific basis for the process of syndrome differentiation and the treatment of stroke under the guidance of the \"kidney–brain correlation\". Moreover, the influence of mediating factors related to lipid metabolism on the occurrence of these two diseases was investigated, which deepened researchers' understanding of the potential association mechanism between the two diseases.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108285"},"PeriodicalIF":2.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626023","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":"Blood pressure misclassification among stroke survivors followed in a comprehensive stroke prevention clinic","authors":"M. Carter Denny MD, MPH ,&nbsp;Maha Almohamad PhD, MS ,&nbsp;Emmanuel Ebirim MD ,&nbsp;Adriana Morell MD ,&nbsp;Munachi Okpala DNP, MBA, MSN, APRN ,&nbsp;Kevin O. Hwang MD, MPH ,&nbsp;Sean Savitz MD ,&nbsp;Anjail Sharrief MD, MPH","doi":"10.1016/j.jstrokecerebrovasdis.2025.108282","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108282","url":null,"abstract":"<div><h3>Background</h3><div>Hypertension is the most important modifiable risk factor for secondary stroke prevention; however, blood pressure (BP) remains uncontrolled for at least 50 % of stroke survivors following an incident stroke. Accurate in-clinic assessment of BP is important for appropriate medication titration. We evaluated misclassification of clinic BP control in a racially diverse stroke clinic population using two BP measurement methods.</div></div><div><h3>Observations</h3><div>We followed ischemic stroke, intracerebral hemorrhage, and transient ischemic attack patients after hospital discharge in a comprehensive stroke clinic. Casual BP was obtained using a standard office automated machine, attended by a medical assistant. BP was also measured with an unattended automated office BP (AOBP) machine and was categorized as concordant control, concordant uncontrolled, pseudoresistant hypertension, and masked uncontrolled. Multinomial logistic regression was used to assess relationships between demographic/clinical variables and misclassification categories, controlling for confounders. Among 216 patients, mean age was 59.5 (SD 12.9); 57 % were male, and by race, 50.5 % were non-Hispanic Black/ African American, 21.3 % Hispanic, and 25.5 % non-Hispanic White. BP control was misclassified by casual office BP for 27.3 % of patients. Race was significantly associated with misclassification in regression analysis. The odds ratio for masked uncontrolled compared to concordant controlled BP was 12.2 (95 % CI 1.5, 99.2) for non-Hispanic Black/ African American and 9.9 (95 % CI 1.1, 87.4) for Hispanic compared to non-Hispanic White patients.</div></div><div><h3>Conclusions</h3><div>These findings highlight barriers to assessment of BP control using standard office measurements among stroke survivors. Accurate BP measurement tools, including AOBP, home BP, and ambulatory BP monitoring, should be utilized to optimize BP treatment after stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108282"},"PeriodicalIF":2.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588126","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":"Risk of ischemic stroke in korean patients with Cancer: Insights from national health insurance data","authors":"Juwang Moon ,&nbsp;Ji Min Ryu MD ,&nbsp;Choyun Jeong ,&nbsp;Seung Jae Lee PhD ,&nbsp;Jong Seung Kim MD, PhD ,&nbsp;Hyun Goo Kang MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108281","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108281","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to compare the cumulative incidence of ischemic stroke between patients with and without cancer, estimate the hazard ratio of stroke in patients with cancer compared to those without cancer, and compare our results with those of other nationwide studies.</div></div><div><h3>Materials and Methods</h3><div>We recruited 91,424 patients diagnosed with cancer from the Korean National Health Insurance Service database between 2011 and 2015 and enrolled 182,848 controls. These participants were followed up for 5 years. We estimated the hazard ratios for ischemic stroke occurrence in the patient groups for all cancer types and nine specific cancer types during follow-up at 6 months and 1, 3, and 5 years.</div></div><div><h3>Results</h3><div>For all cancer types, except colorectal, gallbladder, bile duct, and head and neck cancers, the slope of the cumulative increase in ischemic stroke in the early period was higher than that in longer follow-up durations. Ischemic stroke risk was elevated after the 6-month follow-up in patients with cancer compared to patients without cancer (95% confidence interval [CI]: 1.56–1.94). Over 3–5 years, Ischemic stroke risk increased in patients with lung (CI: 1.56–2.04), pancreatic (CI: 1.33–1.95), and liver cancers (CI: 1.07–1.39), compared to cancer-free individuals, whereas no significant increase was observed in patients with thyroid (CI: 0.79–1.13), stomach (CI: 0.92–1.17), colorectal (CI: 0.69–1.48), gallbladder (CI: 0.91–9.89), bile duct (CI: 0.39–3.50), and head and neck (CI: 0.26–74.30) cancers.</div></div><div><h3>Conclusion</h3><div>Our findings regarding stomach, colorectal, and liver cancers differ from the results of Western studies. Conducting a nationwide study within each country, rather than applying findings from other countries, is preferable for predicting and preventing ischemic stroke development in patients with cancer when using insurance-based data.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108281"},"PeriodicalIF":2.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143576935","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":"Effect of electrical stimulation in the treatment on patients with foot drop after stroke: a systematic review and network meta-analysis","authors":"Wang He MD ,&nbsp;Li Yaning MD ,&nbsp;Yu Shaohong DD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108279","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108279","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically evaluate the efficacy of electrical stimulation (ES) in the treatment of patients with foot drop (FD) after stroke, and to compare the efficacy of different types of ES.</div></div><div><h3>Data sources</h3><div>We searched 5 English database (PubMed, Web of Science, Embase, Cochrane Library and Scopus) and 4 Chinese databases (China National Knowledge Infrastructure (CNKI), SinoMed (CBM), VIP and Wanfang Data) from inception to June, 2024.</div></div><div><h3>Data synthesis</h3><div>Traditional meta-analysis and network meta-analysis were performed using RevMan5.4 software and Stata 14.0 software respectively. A total of 37 RCTs were included, involving 2309 patients. The results of the traditional meta-analysis showed that compared with CRT, ES combined with CRT was effective in improving the range of motion (ROM) of ankle dorsiflexion in patients with FD after stroke and significantly improved the fugl-meyer assessment of lower extremity (FMA-LE) scores. For patients with FD with different disease duration, the subgroup analysis results showed that the ES improved the ROM of ankle dorsiflexion of patients in recovery phases (1-6 months) better than those in the acute phases (≤ 1 month) and sequelae phases (≥ 6 months), but the overall results of the three groups were not significantly different. The ES improved the lower limb motor function of patients in the recovery phases better than those in the acute phases, and the efficacy was not significant in patients in the sequelae phases (P &gt; 0.05). The results of network meta-analysis showed that the best probability of improving the dorsiflexion angle of the ankle was electroacupuncture (EA) &gt; transcranial direct current stimulation (tDCS) &gt; transcutaneous electrical nerve stimulation (TENS) &gt; functional electrical stimulation (FES) &gt; neuromuscular electrical stimulation (NMES) &gt; electromyographic biofeedback therapy (EMGBFT) &gt; conventional rehabilitation therapy (CRT); the best probability of improving the dorsiflexion angle of the ankle was EA &gt; EMGBFT &gt; tDCS &gt; FES &gt; TENS &gt; NMES &gt; CRT.</div></div><div><h3>Conclusions</h3><div>The current evidence showed that the ES combined with CRT can effectively improve the ROM of ankle dorsiflexion and lower limb motor function in patients with FD after stroke, especially the patients in recovery phases. Among the different types of ES, EA had the best effect than other types of ES.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108279"},"PeriodicalIF":2.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588127","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":"Predictors of perioperative stroke in patients with Ischemic-type moyamoya disease treated with surgical revascularization: A retrospective multicenter study","authors":"Basel Musmar MD ,&nbsp;Joanna M. Roy MD ,&nbsp;Hammam Abdalrazeq MD ,&nbsp;Elias Atallah MD ,&nbsp;Kareem El Naamani MD ,&nbsp;Ching-Jen Chen MD ,&nbsp;Roland Jabre MD ,&nbsp;Hassan Saad MD ,&nbsp;Jonathan A. Grossberg MD ,&nbsp;Adam A. Dmytriw MD, MPH, MSc ,&nbsp;Aman B. Patel MD ,&nbsp;Mirhojjat Khorasanizadeh MD ,&nbsp;Christopher S Ogilvy MD ,&nbsp;Ajith J. Thomas MD ,&nbsp;Andre Monteiro MD ,&nbsp;Adnan Siddiqui MD ,&nbsp;Gustavo M. Cortez MD ,&nbsp;Ricardo A. Hanel MD,PhD ,&nbsp;Guilherme Porto MD ,&nbsp;Alejandro M. Spiotta MD ,&nbsp;Pascal Jabbour MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108277","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108277","url":null,"abstract":"<div><h3>Introduction</h3><div>Moyamoya disease (MMD) is a chronic cerebrovascular disorder characterized by progressive stenosis or occlusion of the internal carotid arteries and the development of collateral moyamoya vessels. Surgical revascularization is commonly used to prevent future ischemic events in ischemic-type MMD, but there remains a high rate of stroke perioperatively. This study aims to analyze the predictive factors for perioperative stroke in patients with ischemic-type MMD undergoing surgical revascularization using a large multicenter database.</div></div><div><h3>Methods</h3><div>We conducted a multicenter retrospective study in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. This study included patients with ischemic-type MMD who underwent surgical revascularization across 13 academic institutions in North America. Data were collected and analyzed on a per-hemisphere basis, covering patient demographics, disease characteristics, procedural details, and outcomes. Statistical analyses were performed using Stata (V.17.0), comparing baseline characteristics, and using univariable and multivariable logistic regression to identify predictors of perioperative stroke.</div></div><div><h3>Results</h3><div>A total of 301 patients with ischemic-type MMD underwent surgical revascularization, with 34 patients (11.3 %) experiencing perioperative stroke. Patients who experienced perioperative stroke had a mean age of 43.6 years (SD 14.0) compared to 40.0 years (SD 13.9) in those without perioperative stroke (<em>P</em> = 0.16). Hypertension was significantly more prevalent in the perioperative stroke group (73.5 % vs. 47.9 %, <em>P</em> = 0.005). Current smoking was also more common in the perioperative stroke group (55.8 % vs. 38.2 %, <em>P</em> = 0.04). Multivariate logistic regression identified hypertension (OR 2.32, 95 % CI 1.01 to 5.37, <em>P</em> = 0.04) and current smoking (OR 2.28, 95 % CI 1.04 to 4.97, <em>P</em> = 0.03) as significant independent predictors of perioperative stroke.</div></div><div><h3>Conclusion</h3><div>Hypertension and smoking were significant predictors of perioperative stroke in patients with ischemic-type MMD undergoing surgical revascularization. These findings emphasize the importance of managing risk factors in ischemic-type MMD. Further prospective studies are needed to validate these findings.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108277"},"PeriodicalIF":2.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587727","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":"HBCOC attenuates cerebral ischemia-reperfusion injury in mice by inhibiting the inflammatory response and autophagy via TREM-1/ERK/NF-κB","authors":"Rongyuan Li ,&nbsp;Qin Li ,&nbsp;Congmin Yang ,&nbsp;Hanlin Liu ,&nbsp;Yijun Xiao ,&nbsp;Pengyu Yang ,&nbsp;Gu Gong ,&nbsp;Wei Wu","doi":"10.1016/j.jstrokecerebrovasdis.2025.108280","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108280","url":null,"abstract":"<div><h3>Objective</h3><div>Hemoglobin-based carbon monoxide carrier (HBCOC) can dissociate carbon monoxide and ameliorate organ damage by inhibiting inflammation and oxidative stress. In this study, we evaluated its effect on cerebral ischemia-reperfusion injury in mice and explored its potential mechanism.</div></div><div><h3>Methods</h3><div>A middle cerebral artery occlusion/reperfusion (MCAO/R) mouse model was established using the wire embolization method, and HBCOC or equivalent normal saline was administered via the tail vein during reperfusion. HE staining and TEM were used to observe the injury in the tissue. The levels of IL-1β, IL-6, TNF-α were detected by ELISA and RT-qPCR, meantime, western blotting were used to detect expressions of TREM-1, ERK, NF-κB,LC3 and P62.</div></div><div><h3>Results</h3><div>We found that the HBCOC treatment alleviated nerve injury and reduced the cerebral infarction area caused by ischemia-reperfusion, simultaneously lowered the expression of IL-1β, IL-6, and TNF-α in plasma and brain tissues. HBCOC suppressed the levels of LC3II, lysosomes, and autophagy in the brain, suggesting potent inhibition of autophagy. Mechanistic analysis indicated that the expression of TREM-1/ERK/NF-κB pathway-related proteins and mRNA was higher in the saline group than that in the HBCOC group. HBCOC combined with the targeting TREM-1 receptor inhibitors LP17 inhibited the expression of the TREM-1 protein, further reducing the release of inflammatory factors and autophagy, restoring nerve function and infarct area after reperfusion, and exerting an overall protective effect against cerebral reperfusion injury. In summary, our results indicated that HBCOC alleviated cerebral ischemia-reperfusion injury in mice and inhibited inflammation and autophagy via TREM-1.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108280"},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586907","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":"Differences in subacute motor recovery after intracerebral haemorrhage and ischaemic stroke: Analysis using the VISTA database cohort","authors":"Ulrike Hammerbeck ,&nbsp;Philippe Balancy ,&nbsp;Matthew Gittins ,&nbsp;Adrian Parry-Jones","doi":"10.1016/j.jstrokecerebrovasdis.2025.108266","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108266","url":null,"abstract":"<div><h3>Background</h3><div>Motor impairment is a significant contributor to disability after stroke, but recovery is often incomplete. Whether motor recovery differs between intracerebral haemorrhage (ICH), a subgroup of stroke with far worse outcomes, and ischaemic stroke is not clear.</div></div><div><h3>Methods</h3><div>We performed a retrospective observational longitudinal cohort study using individual patient-level data from the Virtual International Stroke Trials Archive (VISTA) database (ICH n=892, ischaemic stroke n=6912). Differences in motor recovery to 90-days were examined between ICH and ischaemic stroke patients with mixed effect regression models adjusted for <em>a priori</em> determined confounders. Motor weakness was measured by NIHSS face, arm and leg sum with secondary analyses of total NIHSS, and NIHSS language score.</div></div><div><h3>Results</h3><div>Recovery was observed in all NIHSS domains for both stroke types to 30-days (NIHSS_motor <em>b</em>=-2.78, 95%CI -2.89,-2.68; NIHSS_total <em>b</em>=-5.74, 95%CI -5.92,-5.56; NIHSS_language <em>b</em>=-0.28 95%CI -0.31,-0.24) and 90-days (NIHSS_motor <em>b</em>=-3.62, 95%CI -3.69,-3.54<em>;</em> NIHSS_total <em>b</em>=-7.17, 95%CI -7.30,-7.05; NIHSS_language <em>b</em>=-0.74, 95%CI -0.78,-0.71). Baseline impairment between groups was well matched with only motor impairment being slightly greater in ICH; NIHSS_motor mean(SD)=13.0 (5.3) vs 12.3 (5.4). To 30-days the extent of recovery was not different between stroke types but recovery to 90-days was greater in ICH for motor and statistically significant for total NIHSS score (<em>b</em>=-0.35, 95%CI -0.71,-0.002). Ischaemic stroke survivors recovered more in NIHSS language domain.</div></div><div><h3>Conclusions</h3><div>Timing and extent of recovery is different between stroke types. Motor recovery in ICH is greater and occurs later. Therefore, the assumption that most recovery occurs within 30-days and proportionality of recovery should be revisited in this population.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108266"},"PeriodicalIF":2.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577110","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":"Is there diurnal variation in neuroprotective and thrombolytic therapy effect upon acute cerebral ischemia outcome?","authors":"Fatima Pariona-Vargas MD ,&nbsp;Katherine T. Mun MD ,&nbsp;Eng H. Lo PhD ,&nbsp;Sidney Starkman MD ,&nbsp;Nerses Sanossian MD ,&nbsp;Mersedeh Bahr Hosseini MD ,&nbsp;Samuel Stratton MD ,&nbsp;Marc Eckstein MD ,&nbsp;Robin A. Conwit MD ,&nbsp;David S. Liebeskind MD ,&nbsp;Latisha K. Sharma MD ,&nbsp;Neal M. Rao MD ,&nbsp;Kristina Shkirkova MD ,&nbsp;Gilda Avila ,&nbsp;May A. Kim-Tenser MD ,&nbsp;Jeffrey L. Saver MD ,&nbsp;FAST-MAG Investigators","doi":"10.1016/j.jstrokecerebrovasdis.2025.108278","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108278","url":null,"abstract":"<div><h3>Background</h3><div>Preclinical studies have found marked diurnal/circadian variation in the effect of neuroprotective agents in acute ischemic stroke. However, the presence of diurnal variation in treatment outcomes after neuroprotective therapy has not been analyzed in human clinical trials and variation after thrombolytic therapy has been under-studied.</div></div><div><h3>Methods</h3><div>We analyzed patients with acute cerebral ischemia enrolled in the Field Administration of Stroke Therapy – Magnesium (FAST-MAG) randomized trial of magnesium sulfate started in the ambulance within two hours of stroke onset (last known well time). Patients with stroke onset times during daytime (07:00–22:59) and nighttime (23:00–06:59) were compared for variation in magnesium neuroprotective effect, thrombolysis effect, supportive care effect upon early neurologic course and three-month functional outcomes.</div></div><div><h3>Results</h3><div>Among 1235 acute cerebral ischemia patients, final diagnoses were acute ischemic stroke in 83.6 % and transient ischemic attack in 16.4 %. Time of onset was daytime in 1147 (92.8 %) and nighttime in 88 (7.2 %). Thrombolytic therapy was administered to 473 (38.3 %). Patients with night onset had longer onset to paramedic (median 32.5 vs 23 min); longer onset to Emergency Department arrival (median 70 vs 58 min); and higher prehospital systolic blood pressure (mean 162 vs 155 mm Hg). Among patients receiving thrombolysis, magnesium was associated with increased early neurological deterioration during night-time (50.0 % vs 23.1 %) but not day-time (21.1 % vs 22.4 %), p=0.03. However, no similar diurnal variation in magnesium or thrombolysis effects were noted for other early or three-month functional outcomes.</div></div><div><h3>Conclusions</h3><div>Among acute cerebral ischemia patients, efficacy, safety, neuroprotective agent, and thrombolytic response outcomes were largely unmodified by witnessed onset during active versus inactive phase clock times. These findings suggest biologic wake-sleep state rather than chronologic clock time is the driver of known circadian rhythmicity in stroke course.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108278"},"PeriodicalIF":2.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586840","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":"Comparative risk of dementia in diabetic stroke patients prescribed SGLT2 vs. DPP-4 inhibitors: A propensity-matched retrospective cohort study","authors":"Pei-Chun Chiang MD ,&nbsp;Cheng-Yang Hsieh MD, PhD ,&nbsp;Sheng-Feng Sung MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108276","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108276","url":null,"abstract":"<div><h3>Objective</h3><div>Diabetes is a significant risk factor for both stroke and dementia. This study aimed to compare the risk of incident dementia between sodium-glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors in diabetic patients with a history of ischemic stroke.</div></div><div><h3>Materials</h3><div>We conducted a propensity-matched retrospective cohort study using observational data from the TriNetX global federated health research network. Patients aged 18 years or older with type 2 diabetes (T2D) and a history of ischemic stroke, newly prescribed either an SGLT2 or DPP-4 inhibitor from July 1, 2013, to June 30, 2024, were included. Propensity score matching was employed to balance baseline characteristics between treatment groups. The primary outcome was incident dementia, with secondary outcomes including degenerative and vascular dementia.</div></div><div><h3>Results</h3><div>After propensity score matching, each group consisted of 15901 patients. Over a mean follow-up of 2.52 years, SGLT2 inhibitor use was associated with lower risks of overall dementia (hazard ratio [HR] 0.66; 95% confidence interval [CI] 0.59–0.74), degenerative dementia (HR 0.68; 95% CI 0.60–0.76), and vascular dementia (HR 0.59, 95% CI 0.49–0.70) compared to DPP-4 inhibitor use. These findings remained consistent across various sensitivity and subgroup analyses.</div></div><div><h3>Conclusions</h3><div>In diabetic patients with a history of ischemic stroke, initiating SGLT2 inhibitors, compared to DPP-4 inhibitors, is associated with a lower risk of incident dementia. This association was observed for both degenerative and vascular dementias. These findings support the preferential use of SGLT2 inhibitors in this high-risk population, warranting further investigation through randomized clinical trials.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108276"},"PeriodicalIF":2.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574712","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}