Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Presentation, treatment and outcomes of acute basilar artery occlusion: A retrospective analysis.","authors":"Nikita Chhabra, Cumara B O'Carroll, Han Wang, Adnan Shahid, Amir A Mbonde, Rachel E Carlin, Oana M Dumitrascu, Gyanendra Kumar, Josephine F Huang, Eugene L Scharf, Chia-Chun Chiang","doi":"10.1016/j.jstrokecerebrovasdis.2024.108153","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108153","url":null,"abstract":"<p><strong>Introduction: </strong>We aim to assess the clinical presentation, treatment, and outcomes in patients with acute basilar artery occlusion (BAO) after receiving medical management (MM) (including IV thrombolysis, antiplatelet, anticoagulation) and endovascular therapy (EVT) (including intra-arterial thrombolysis, stent placement, mechanical thrombectomy).</p><p><strong>Methods: </strong>This is a retrospective cohort study including all adult patients treated at three Mayo Clinic stroke centers with acute BAO from 2008 to 2021. Chart review was conducted to extract details of presentation, treatment, and outcome. Comparisons of treatment outcomes between patients treated with MM and EVT were analyzed and include changes of modified Rankin Scale (mRS) and NIHSS score change from admission to discharge.</p><p><strong>Results: </strong>A total of 182 patients were included in our final analysis: 95 in the MM group and 87 in the EVT group. There was a statistically significant difference in favorable functional outcome at discharge (mRS 0-3) favoring the MM group compared to EVT group (56.0 % vs 34.9 %; OR 0.42, p = 0.005) and the difference remained significant in multivariate analysis (OR 0.38, p = 0.048). There were significantly increased odds of having NIHSS improvement of >5 points (OR 3.94 p < 0.001), and 10 points (OR 3.92 p < 0.001) in patients treated with EVT compared to MM.</p><p><strong>Conclusion: </strong>Our data demonstrates that although in general patients who received EVT had lower odds of having favorable outcomes at discharge, they were also more likely to have NIHSS score improvement of >5 and 10 points from presentation to discharge compared to MM, suggesting EVT could be beneficial in some patients.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108153"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774147","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 plasma thrombomodulin level is associated with a decreased risk of cognitive impairment after ischemic stroke.","authors":"Yu He, Xinyue Chang, Yi Liu, Jiawen Fei, Xiaoli Qin, Beiping Song, Quan Yu, Mengyao Shi, Daoxia Guo, Jing Chen, Aili Wang, Tan Xu, Jiang He, Yonghong Zhang, Zhengbao Zhu","doi":"10.1016/j.jstrokecerebrovasdis.2024.108172","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108172","url":null,"abstract":"<p><strong>Background: </strong>Thrombomodulin, a thrombin receptor with anticoagulant, anti-inflammatory, and cytoprotective properties, has been suggested to play a pivotal role in ischemic stroke. However, the association of plasma thrombomodulin with post-stroke cognitive impairment (PSCI) remains unclear. We aimed to prospectively investigate the associations of plasma thrombomodulin with PSCI among ischemic stroke patients in a multicenter cohort study.</p><p><strong>Methods: </strong>We measured plasma thrombomodulin levels at baseline among 615 ischemic stroke patients from a preplanned ancillary study of the CATIS (China Antihypertensive Trial in Acute Ischemic Stroke). We used Montreal Cognitive Assessment (MoCA) to evaluate cognitive function at 3-month follow-up after ischemic stroke, and PSCI was defined as MoCA score <23.</p><p><strong>Results: </strong>Plasma thrombomodulin was inversely associated with PSCI, and the adjusted odds ratio of PSCI for the highest versus lowest quartile of thrombomodulin was 0.50 (95 % CI: 0.28-0.92, P_trend=0.026). Each standard deviation increment of log-transformed thrombomodulin was associated with a 23 % (odds ratio: 0.77, 95 % CI: 0.62-0.97, P=0.029) decreased risk of PSCI. In addition, plasma thrombomodulin could significantly improve the risk reclassification of PSCI beyond established risk factors (net reclassification index: 25.04 %, 95 % CI: 7.20 %-42.87 %, P=0.007; integrated discrimination improvement: 1.13 %, 95 % CI: 0.18 %-2.09 %, P=0.020).</p><p><strong>Conclusions: </strong>High plasma thrombomodulin levels were associated with a decreased risk of PSCI among ischemic stroke patients. Our findings suggest that plasma thrombomodulin might be a predictive biomarker and potential therapeutic target for PSCI.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108172"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the sEH rs751141 polymorphism and the risk of ischemic stroke and hypertension: A systematic review and meta-analysis.","authors":"Zongshan Fan, Zidong Mao, Mengya Liu, Bingbing Fu, Xiao Yuan, Lai Wang","doi":"10.1016/j.jstrokecerebrovasdis.2024.108176","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108176","url":null,"abstract":"<p><strong>Objective: </strong>To systematically evaluate the association between the rs751141 polymorphism in soluble epoxide hydrolase (sEH) and the risk of ischemic stroke and hypertension.</p><p><strong>Methods: </strong>We searched PubMed, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Chongqing VIP for eligible studies published through March 2024. Studies were selected based on inclusion and exclusion criteria. The quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS) and Joanna Briggs Institute (JBI) tools. Data extraction and meta-analysis were performed using STATA software version 12.</p><p><strong>Results: </strong>Twelve case-control studies were included, seven investigating the association of sEH rs751141 polymorphism with ischemic stroke risk, and five examining its association with hypertension risk. The pooled odds ratios (OR) and 95% confidence intervals for the allelic, dominant, and recessive models of ischemic stroke risk were 1.167 (1.045-1.303, p = 0.006), 1.381 (1.104-1.883, p = 0.041), and 0.856 (0.753-0.9751, p = 0.019), respectively. For hypertension risk, the pooled OR values and 95% confidence intervals were 1.343 (1.229-1.467, p < 0.001), 1.537 (1.254-1.885, p < 0.001), and 0.715 (0.64-0.80, p < 0.001), respectively.</p><p><strong>Conclusion: </strong>Carriers of the G allele of the sEH rs751141 polymorphism are at an increased risk for ischemic stroke and hypertension, while the A allele appears to have a protective effect against these conditions.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108176"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792842","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":"Risk of ischemic stroke in patients with pulmonary embolism and patent foramen ovale: A systematic review and meta-analysis.","authors":"Tiago O Lucas, Eduardo B Schaustz, Isabelle J R Dos Reis, Clara G Lopes, Vanessa S Mendoça, Jorge I F Salluh, Cleverson N Zukowski, Rodrigo B Serafim","doi":"10.1016/j.jstrokecerebrovasdis.2024.108157","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108157","url":null,"abstract":"<p><strong>Objective: </strong>Patients with acute pulmonary hypertension during an acute pulmonary embolism (PE) can develop stroke due to paradoxical embolism in the presence of a patent foramen ovale (PFO). We evaluated the current evidence regarding the risk of ischemic stroke and mortality in patients with PE and a PFO.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis of studies found on PubMed, the Cochrane Library, Embase, SCOPUS, and the BVS portal. We included full-length reports, prospective observational cohorts, and clinical trials of adult patients (aged ≥18 years) diagnosed with PE and investigating the presence of PFO and new ischemic brain injuries. This study is registered with PROSPERO (CRD42023467133).</p><p><strong>Results: </strong>The initial search identified 1398 articles. After applying exclusion criteria, only 8 articles remained, including a total of 1197 individuals with PE, among whom PFO was identified in 318 patients. Ischemic stroke occurred in 62/318 (19.5 %) individuals in the PFO group and in 40/879 (4.5 %) individuals in the non-PFO group. The prevalence of ischemic stroke in the PFO group was higher than in the non-PFO group in all eight studies. The meta-analysis showed that PFO was significantly associated with ischemic stroke in patients with PE compared to those without PFO (odds ratio 5.36, 95 % CI 3.20-8.99, p < 0.00001; I² = 0 %). Three studies also reported higher mortality in the PFO group.</p><p><strong>Conclusion: </strong>Patent foramen ovale is a common condition in patients with acute PE and is associated with a higher incidence of ischemic stroke and increased mortality.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108157"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prognostic and diagnostic significance of echocardiographic parameters on acute ischemic stroke.","authors":"Bo Yang, Yanni Wu, Manli Lu, Yongjun Cao, Zhigang Miao, Liuhui Chang, Hui Li, Xia Zhang","doi":"10.1016/j.jstrokecerebrovasdis.2024.108220","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108220","url":null,"abstract":"<p><strong>Objective: </strong>To comprehensively explore the prognostic significance of transthoracic echocardiography (TTE) and three-dimensional speckle-tracking echocardiography (3D STE) parameters in AIS and their role in distinguishing cardioembolic stroke.</p><p><strong>Methods: </strong>301 acute ischemic stroke (AIS) patients were enrolled. TTE and 3D STE were employed to evaluate cardiac function and structure, also left atrial strain. Patients were categorized into two groups based on functional outcome at discharge and 3 months post-stroke, respectively. Models combining variables related to unfavorable outcome were established, and their predictive efficacy was assessed using receiver operating characteristic (ROC) curves. Additionally, AIS patients were stratified into cardioembolic and non-cardioembolic stroke groups. Logistic regression identified predictors for cardioembolic stroke, and ROC curves assessed their diagnostic performance.</p><p><strong>Results: </strong>We found that a decrease in early diastolic peak velocity of the mitral valve (E value) was independently associated with adverse outcomes at both discharge (P = 0.014, OR = 0.126, 95% CI 0.024-0.657) and 3 months post-stroke in AIS patients (P = 0.004, OR = 0.054, 95% CI 0.007-0.403). Adding E value significantly improved predictive ability for adverse outcome at discharge and 3 months post-onset (0.807 vs. 0.794; 0.834 vs. 0.815). Moreover, left atrial diameter (LAD) [area under the curve (AUC) = 0.705] was the most valuable TTE parameter, and left atrial reservoir circumferential strain (LASr-c) (AUC = 0.766) was the most valuable STE parameter, even among all echocardiographic parameters for prediction of cardioembolic stroke.</p><p><strong>Conclusions: </strong>This study indicates reduced E value was associated with unfavorable outcome at discharge and 3 months post-onset of AIS patients. LAD, especially LASr-c exhibited optimal diagnostic performance on cardioembolic stroke.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108220"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928769","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":"Timing of anticoagulation for patients with atrial fibrillation after acute ischemic stroke: Systematic review and meta-analysis.","authors":"Omar M Al-Janabi, Anas Odeh, Aryan Gajjar, Avi Misra, Yamama M Mahmood, Amira M Taha, Rishabh Gupta, Sherief Ghozy, Alejandro A Rabinstein, David F Kallmes","doi":"10.1016/j.jstrokecerebrovasdis.2024.108159","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108159","url":null,"abstract":"<p><strong>Background: </strong>Patients with acute ischemic stroke (AIS) in the setting of atrial fibrillation (Afib) will need to start/resume anticoagulation (AC) as it is the mainstay for secondary stroke prevention. Several studies have compared the safety and outcomes of starting/resuming AC in early or late start windows (ESW or LSW) but there is no consensus in clinical practice on the optimal timing of anticoagulation. This meta-analysis aims to compare the safety and outcome measures after resuming AC in the ESW versus LSW in patients with Afib after AIS.</p><p><strong>Methods: </strong>Following the PRISMA guidelines, a comprehensive systematic review was conducted using PubMed, Embase, Web of Science, and Scopus. Studies meeting inclusion criteria underwent rigorous risk of bias assessment using the ROBINS-I tool. We compared the safety and outcome measures after resuming AC in the ESW versus LSW in patients with Afib after AIS. Using the R software version 4.3.1, meta-analyses were conducted employing random-effect models.</p><p><strong>Results: </strong>This meta-analysis included data derived from 7 studies (2 randomized controlled trials and 5 prospective observational studies). Rates of recurrent ischemic stroke/transient ischemic attack (TIA) in patients who started AC in the ESW were comparable to those who started AC in the LSW (OR 0.72, 95 % CI 0.49-1.04; p = 0.083). Similarly, the rates of symptomatic intracranial hemorrhage (sICH) and mortality were comparable between the patients who started AC in the ESW versus LSW (OR 1.66, 95 % CI 0.43-6.47; p = 0.464) and (OR 0.88, 95 % CI 0.65-1.19; p = 0.402), respectively. Finally, using available data from 5 studies, rates of major bleeding were comparable as well between the patients who started AC in ESW versus LSW (OR 0.99, 95 % CI 0.50-1.96; p = 0.970).</p><p><strong>Conclusion: </strong>Among patients with Afib and AIS who are starting AC in the ESW versus LSW, there were no differences in the outcome measures, specifically stroke/TIA, sICH, mortality, or major bleeding.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108159"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774701","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":"Mediating effect of social support in the relationship of symptom burden and fear of disease progression in stroke patients.","authors":"Ranran Liu, Jing Liu, Jingyuan Song, Ying Peng, Guoliang Jin, Jinghui Li","doi":"10.1016/j.jstrokecerebrovasdis.2024.108215","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.108215","url":null,"abstract":"<p><strong>Aims: </strong>To investigate the current status and influencing factors of fear of disease progression in stroke patients, and to analyze the mediating effect of social support between symptom burden and the fear of disease progression.</p><p><strong>Methods: </strong>A cross-sectional study recruited 235 stroke patients in a convenience sample from the neurology department of a tertiary hospital in China. The general information questionnaire, social support rating scale, stroke symptom experience scale, and fear of progression questionnaire short form were utilized for the survey. This study adheres to STROBE reporting guidelines.</p><p><strong>Results: </strong>The fear of disease progression score in stroke patients was 29.11 (6.72). Results from the multivariable analysis indicated that patients without a family history of stroke (β = -0.09, 95% CI (-2.37, -0.15)), elderly patients (≥ 65) (β = -0.26, 95% CI (-4.88, -2.32)), hypertensive patients (β = 0.10, 95% CI (0.40, 2.63)), and patients with balanced budgets (β = -0.13, 95% CI (-3.58, -0.28)) exhibited lower levels of fear of disease progression. Unemployment (β = 0.21, 95% CI (1.72, 4.54)), patients experiencing heavy symptom burden (β = 0.56, 95% CI (4.86, 6.67)), and those with low social support (β = -0.28, 95% CI (-0.42, -0.22)) had a higher level of fear of disease progression. Social support (β = 0.14, 95% CI (0.08, 0.20)) mediated the correlation between symptom burden and fear of disease progression.</p><p><strong>Conclusions: </strong>Stroke patients have moderate to low levels of fear of disease progression. Nursing staff should provide more social support to patients with heavier symptom burdens to reduce their fear of disease progression.</p><p><strong>Impact: </strong>Healthcare providers and caregivers can reduce the fear of disease progression in stroke patients with high symptom burden by increasing their level of social support. This study can help promote the mental health of stroke patients.</p><p><strong>Patient or public contribution: </strong>No patient or public contribution.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108215"},"PeriodicalIF":2.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916353","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":"Effects of stroke nurse-led acute stroke management on treatment time benchmarks, intravenous thrombolysis rates, and patient outcomes: A systematic review and meta-analysis.","authors":"Ashok Kumar, Mukesh Kumar, Priyanka Verma, Rimesh Pal, Manisha Nagi, Karthik Vinay Mahesh, Divesh Kumar Munjal, Sukhpal Kaur, Achala Aggarwal, Bijaya Kumar Padhi, Dheeraj Khurana","doi":"10.1016/j.jstrokecerebrovasdis.2024.108216","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108216","url":null,"abstract":"<p><strong>Introduction: </strong>Multidisciplinary stroke teams, including a stroke nurse, prove effective in delivering optimal acute ischemic stroke (AIS) management. This systematic review and meta-analysis critically synthesize existing studies to assess the impact of stroke nurse involvement on treatment time benchmarks and patient outcomes.</p><p><strong>Method: </strong>Data from various databases constituted the primary sources of literature, and the risk of bias and article quality were evaluated using relevant tools. Primary endpoints were door-to-needle (DTN) time, mortality, and good functional outcomes (mRS 0 - 2) at three months. Secondary endpoints included varied treatment time metrics, IVT rates, and length of hospital stay (LOS).</p><p><strong>Results: </strong>We screened 235 studies published up to September 2023 and ultimately included eight in our analysis. The stroke nurse intervention was significantly associated with a decrease in DTN time (Standard Mean Difference [SMD] = -19.71 min; 95 % CI = [-31.45, -7.97]), reduced three-month mortality rates (Odds Ratio [OR] = 0.56; 95 % CI = [0.37, 0.85]) and improved functional outcomes (OR = 1.33; 95 % CI = [1.03, 1.71]). The IVT rate significantly increased (OR = 1.52; 95 % CI = [1.01, 2.28]) with stroke nurse intervention. However, LOS was comparable (SMD = -0.45 days; 95 % CI = [-1.11, 0.21]) between scenarios with and without stroke nurse involvement.</p><p><strong>Conclusions: </strong>Our study emphasizes the advantages of including stroke nurses in acute stroke teams, leading to reduced treatment times, increased IVT rates, and enhanced patient outcomes. It highlights the importance of inter-professional stroke teams and evidence-based nursing care to ensure equitable access to high-quality stroke care across diverse healthcare settings.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108216"},"PeriodicalIF":2.0,"publicationDate":"2024-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between non-verbal cognitive assessment and stroke recovery via screening test for aphasia and dysarthria.","authors":"Kentaro Araki, Yoshiyuki Hirano, Kohei Kurita, Eiji Shimizu","doi":"10.1016/j.jstrokecerebrovasdis.2024.108217","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108217","url":null,"abstract":"<p><strong>Objective: </strong>Non-verbal Screening Test for Aphasia and Dysarthria scores correlate with post-stroke cognitive function; however, their correlations with activities of daily living dependency and home discharge (cognitive function-associated outcomes) remain unclear. We investigated the correlation of these scores with activities of daily living dependency and home discharge outcomes.</p><p><strong>Materials and methods: </strong>Disability levels and functional outcomes of 278 inpatients with brain injury (age: 72.8 ± 13.0 years) were evaluated using the modified Rankin Scale. Patients were grouped according to activities of daily living dependency (independent [n = 96; modified Rankin Scale score≤2]) and non-home discharge (n = 126) status. Factors predicting home discharge were analyzed using univariate and multivariate logistic regression analyses.</p><p><strong>Results: </strong>Cognitive impairment was more prevalent in the activities of daily living-dependent group than in the independent group (odds ratio: 6.34 [95 % confidence interval: 3.57-11.52]; p < 0.001) and in the non-home discharge than in the home discharge group (2.78 [1.65-4.73]; p < 0.001). Non-verbal test scores correlated moderately with activities of daily living independence and home discharge. Age, modified Rankin Scale score, cognitive impairment, and the Screening Test for Aphasia and Dysarthria scores were significantly associated with home discharge in univariate analyses. Only modified Rankin Scale and non-verbal test scores were significantly associated with home discharge in multivariate analysis (p < 0.001).</p><p><strong>Conclusions: </strong>Non-verbal test scores were significantly associated with activities of daily living independence and home discharge in patients with stroke. The non-verbal test, being less influenced by communicative disorders, offers a novel tool for estimating cognitive function.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108217"},"PeriodicalIF":2.0,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907919","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":"\"Mechanical thrombectomy beyond 6 hours for acute ischemic strokes due to M2 occlusions\".","authors":"Maria Pereira Coutinho, Sofia Galego, Marta Alves, Ana Papoila, Isabel Fragata, Ana Paiva Nunes","doi":"10.1016/j.jstrokecerebrovasdis.2024.108219","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108219","url":null,"abstract":"<p><strong>Background: </strong>The time frame for mechanical thrombectomy (MT) in acute ischemic stroke (AIS) is enlarging. Guidelines recommend MT until 6 h of symptom onset in M2 segment occlusions (grade IIB). In practice, it is frequently performed later.</p><p><strong>Aims: </strong>To assess the functional prognosis of AIS patients subjected to M2 segment's MT beyond 6 h, compared to standard intervention.</p><p><strong>Methods: </strong>Retrospective cohort study including all consecutive AIS patients subjected to MT of M2 occlusions between 1st January 2018 and 31st December 2020 in St Joseph's Local Health Unit, Lisbon, Portugal. Allocation to standard or extended groups was done according to the symptom-to-puncture time, whether within or beyond 6 h after symptom onset, respectively. The primary outcome was the modified Rankin Scale (mRS) at three months. Secondary outcomes were symptomatic intracranial hemorrhage (sICH) at 24 h and three-month mortality.</p><p><strong>Results: </strong>We included 155 patients, 51.0 % men, median age 76.0 years (P₂₅:69.0;P₇₅:86.0), baseline mRS \"0-2\" in 84.5 %, mean NIHSS 13.6(6.5). Initial Computed Tomography showed early ischemic changes in 27.1 %. Most patients belonged to the standard group (71.0 %). Groups had similar baseline features. The standard group underwent more frequent (68.2 % vs 44.4 %, p = 0.006) and earlier (2 h02 min, 3 h02 min, p < 0.001) fibrinolysis. Symptom-to-puncture times were 7 h13 min (extended) and 4h01 min (standard), p < 0.001. Outcomes were similar between groups (three months' mRS [p = 0.578]; sICH [p = 0.720]; three-month mortality [p = 0.422]).</p><p><strong>Conclusions: </strong>Our study suggests similar outcomes in M2 occlusions performing MT before and beyond 6 h of symptom onset, consistent with previous studies. Patients might benefit from widening inclusion criteria for MT in AIS.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108219"},"PeriodicalIF":2.0,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907918","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}