Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Association of lipid accumulation products, or cardiometabolic index with asymptomatic intracranial arterial stenosis: A population-based study in Shandong, China","authors":"Xianglong Kong MS ,&nbsp;Qiao Wang MD ,&nbsp;Hailing Wang MD ,&nbsp;Yumeng Yang MS ,&nbsp;Liying Guo MS ,&nbsp;Shiqing Song MS ,&nbsp;Yuanyuan Zhao MD ,&nbsp;Xiaotong Ma MD ,&nbsp;Xiang Wang MD ,&nbsp;Qinjian Sun MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108273","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108273","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to investigate the association of novel obesity indicators (lipid accumulation product [LAP] and cardiometabolic index [CMI]) with asymptomatic intracranial arterial stenosis (aICAS), particularly in different obesity statuses.</div></div><div><h3>Materials and methods</h3><div>The study included 1994 participants (aged ≥ 40 years) from the Rose Asymptomatic Intracranial Artery Stenosis (RICAS) study, free of stroke or transient ischemic attack. Participants with aICAS were screened using transcranial Doppler ultrasound and diagnosed via magnetic resonance angiography. Multivariate logistic regression and receiver operating characteristic (ROC) curves were used to explore the association of LAP or CMI with aICAS.</div></div><div><h3>Results</h3><div>A total of 146 participants were diagnosed with aICAS. Higher levels of LAP and CMI were associated with aICAS, particularly with moderate-to-severe aICAS. Notably, LAP was significantly associated with aICAS (OR 1.58; 95 % CI, 1.00-2.49; <em>P</em> = 0.048), and was showed the highest area under the curve (AUC, 0.654) among the three indicators (LAP, CMI, and BMI) in underweight and normal weight participants (Body mass index [BMI] ≤23.9 kg/m²). In the obesity population (BMI ≥28.0 kg/m²), CMI was significantly associated with aICAS (OR 1.40; 95 % CI, 1.11-1.77; <em>P</em> = 0.005), and was showed the highest AUC (0.610).</div></div><div><h3>Conclusions</h3><div>This study found a positive association between elevated levels of LAP or CMI and aICAS. Furthermore, LAP was significantly correlated with aICAS in underweight and normal weight individuals, while CMI was associated with aICAS in obesity individuals. Our findings may provide additional risk stratification information for aICAS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108273"},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568854","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":"Seven years of CRAFT: Clinical results of a multicenter cohort of carotid artery relining with the CASPER RX stent","authors":"Ariel Dahan MD, MSc, FRANZCR ,&nbsp;Siddharth M. Kulkarni BA, MD ,&nbsp;Calvin Gan MBBS, FRANZCR ,&nbsp;Davor Pavlin-Premrl MBBS, BMedSci, FRACP ,&nbsp;Kevin Z. Zhou MBBS, BMedSci, FRANZCR ,&nbsp;Yifan Ren MD ,&nbsp;Viktorija Vainauskaite MB, BCh, BAO ,&nbsp;Sara Protto MD ,&nbsp;Justin Moore MD, JD (LLB), PhD, MPH, MBA, FRACS ,&nbsp;Ronil V. Chandra MBBS, FRANZCR ,&nbsp;Winston Chong MBBS, FRANZCR, CCINR ,&nbsp;Lee-Anne Slater FRANZCR, CCINR ,&nbsp;Mohamed Nasra MD ,&nbsp;Ali Khabaza FRANZCR, CCINR, EBIR ,&nbsp;Julian Maingard MBBS, FRANZCR ,&nbsp;Ashu Jhamb MBBS (Hons), FRANZCR ,&nbsp;Hong Kuan Kok MBBS, FRANZCR, FRCR ,&nbsp;Mark D. Brooks MBBS, FRANZCR, CCINR ,&nbsp;Christen D. Barras MBBS, BMedSci, FRANZCR, MMed, PhD ,&nbsp;Hamed Asadi MD, PhD, FRANZCR, CCINR","doi":"10.1016/j.jstrokecerebrovasdis.2025.108271","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108271","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Carotid artery stenting (CAS) is an established treatment for carotid stenosis or occlusion. Use of the dual-layer microporous CASPER RX stent has had mixed results in prior reports. The CaRotid Artery Filtering Technique (CRAFT) uses the distal end of the CASPER stent as an embolic protection device during deployment. We present the largest cohort of patients having undergone CAS with the CASPER stent and report our multicentre experience with CRAFT over the last seven years.</div></div><div><h3>Materials and Methods</h3><div>All patients undergoing CAS at three tertiary neurointerventional centres in Australia from April 2016 to April 2023 were included. Patient demographic, procedural and clinical data were retrospectively collected. All included patients underwent CAS with CASPER stent insertion using CRAFT.</div></div><div><h3>Results</h3><div>215 patients (74 % male, mean age 70) were included in the study. Most patients (89 %) were treated on an emergent basis with 81 % of these representing tandem lesions in acute ischaemic stroke. Median NIHSS score was 12 on admission and 6 post-procedure. 98 % achieved an mTICI score of 2b or higher. Median mRS score was 1 at the time of earliest outpatient follow-up. 90 % of patients received intraprocedural antiplatelet therapy. 10 % suffered symptomatic intracranial haemorrhage and 7 % had stent occlusion. An 8 % all-cause mortality rate was observed.</div></div><div><h3>Conclusion</h3><div>Emergent CAS with the CASPER RX stent and CRAFT is both safe and efficacious, with low rates of stent occlusion and restenosis as well as a low risk of major complication. Given the limited sample of elective patients in our cohort, further studies are required to corroborate the safety profile of CRAFT in elective CAS</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108271"},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568857","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":"National cohort study on cardiometabolic index and incident stroke in middle-aged and older adults in China","authors":"HaiXia He MD ,&nbsp;DanDan Li MD ,&nbsp;LiangYing Liao MD ,&nbsp;Piao He PhD ,&nbsp;GuoHeng Hu PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108270","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108270","url":null,"abstract":"<div><div>Background The Cardiometabolic Index (CMI), a novel marker integrating central obesity and lipid metabolism, serves as a comprehensive indicator of metabolic health. While CMI has been linked to metabolic disorders like diabetes and cardiovascular diseases, its role in predicting stroke risk remains unclear. This study examines the association between CMI and stroke risk in Chinese adults aged 45 and older, highlighting its potential as a predictive tool for public health.</div></div><div><h3>Methods</h3><div>Data from the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Participants were divided into CMI quartiles. Stroke incidence was the primary endpoint. Cox proportional hazards models evaluated the CMI-stroke risk association. Kaplan-Meier curves compared stroke incidence across quartiles, while restricted cubic splines (RCS) assessed non-linear trends. Subgroup analyses verified robustness.</div></div><div><h3>Results</h3><div>Among 7,821 participants (47 % male), 418 strokes (5.3 %) occurred over a mean follow-up of 7 years. Higher CMI was significantly associated with increased stroke risk [HR, 1.153 (95 % CI: 1.048–1.269), <em>P</em> = 0.004]. RCS revealed a non-linear rise in stroke risk with increasing CMI (P for nonlinearity = 0.005). No significant interactions were observed between CMI and subgroups (all <em>P</em> &gt; 0.05).</div></div><div><h3>Conclusion</h3><div>Elevated CMI correlates with higher stroke risk in middle-aged and older Chinese adults. Incorporating CMI into routine assessments could improve early stroke prevention strategies, addressing the increasing burden of cerebrovascular disease in aging populations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108270"},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568856","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":"Hypoxia inducible factor-1alpha expression correlates with inflammatory injury of blood-brain barrier which influences perihaematomal edema after intracerebral hemorrhage","authors":"Jian Wu ,&nbsp;Fuli Yan ,&nbsp;Yiming Li ,&nbsp;Mingang Liang ,&nbsp;Yu Guo ,&nbsp;Mingfei Yang","doi":"10.1016/j.jstrokecerebrovasdis.2025.108269","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108269","url":null,"abstract":"<div><h3>Backround</h3><div>In patients with intracerebral hemorrhage (ICH), perihematomal edema (PHE) significantly worsens the prognosis. This condition leads to the formation of a hypoxic microenvironment surrounding the blood-brain barrier (BBB), which in turn activates hypoxia-inducible factor-1 alpha (HIF-1α), a highly sensitive hypoxia-related transcription factor. Additionally, tumor necrosis factor-alpha (TNF-α) emerges as a promising biomarker for tracking inflammation in the vicinity of the BBB. The integrity of the BBB is maintained by proteins such as zonula occludens-1 (ZO-1), which is crucial for the tight junctions that regulate the barrier's permeability. Understanding these mechanisms is vital for developing targeted therapies to mitigate the effects of ICH.</div></div><div><h3>Object</h3><div>Through the collection and analysis of peripheral blood and tissue samples from ICH patients and animal models at predefined time points, we established the correlation between HIF-1α expression, inflammatory damage to the BBB, and the development of PHE.</div></div><div><h3>Methods</h3><div>Ethical approval was secured from relevant Chinese authorities and the Ethics Committee of Qinghai Provincial People's Hospital. The clinical study included 32 ICH patients, with computerized tomographic scans and blood samples taken at 1, 3, 7, and 14 days post-ICH. HIF-1α and ZO-1 expression, as well as TNF-α levels, were measured using enzyme-linked immunosorbent assay, quantitative real-time polymerase chain reaction, and western blot. In the animal study, 18 adult Sprague Dawley rats were divided into sham, ICH, and HIF-1α Inhibited groups. Lificiguat YC-1 was used to inhibit HIF-1α expression, and samples were collected at the critical change point identified clinically for similar measurements.</div></div><div><h3>Results</h3><div>At 3 days after onset, the highest level of HIF-1α and TNF-α, the lowest level of ZO-1 and the most obvious development in PHE appeared in ICH patients (<em>F</em> ≥ 10.278, <em>P</em> ≤ 0.004). At that day, HIF-1α expression positively correlated with TNF-α levels (<em>r</em> = 0.809, <em>P</em>&lt;0.001); TNF-α negatively correlated with ZO-1 expression (<em>r</em>=-0.840, <em>P</em>&lt;0.001) which negatively correlated with PHE development (<em>r=</em>-0.601, <em>p</em>&lt;0.001). Comparing to sham group and sole ICH group, after HIF-1α expression was inhibited, all the biological indicators level of ICH rats were the lowest (<em>F</em> ≥ 14.953, <em>p</em> ≤ 0.005). Their correlation were the same as that in ICH patients.</div></div><div><h3>Conclusion</h3><div>At 3 days after onset of ICH, HIF-1α expression correlated with inflammatory injury of BBB, which influenced PHE.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108269"},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562489","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":"Multimorbidity in acute ischemic stroke and its impact on short-term mortality: A Chilean nationwide database analysis","authors":"Francisca González MPH PhD(c) ,&nbsp;Ma. Ignacia Allende MD ,&nbsp;Marilaura Nuñez MD PhD(c) ,&nbsp;Iris Delgado PhD ,&nbsp;Paula Jakszyn PhD ,&nbsp;Carlos Delfino MD PhD(c) ,&nbsp;Craig S. Anderson MD PhD ,&nbsp;Paula Muñoz Venturelli MD PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108267","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108267","url":null,"abstract":"<div><h3>Background</h3><div>Multimorbidity predicts a worse prognosis for various diseases but its impact in people after an acute ischemic stroke (AIS) in developing societies is not well established. We aimed to characterize the pattern of multimorbidity and determine its association with in-hospital mortality after AIS in the nationwide Chilean database.</div></div><div><h3>Methods</h3><div>A retrospective analysis of the Diagnosis-Related Groups database for hospitalized adult patients in Chile in 2019 was conducted. Association of multimorbidity, defined as the presence of ≥2 health conditions, in patients with AIS (ICD-10 code I63) on in-hospital mortality was determined in logistic regression models adjusted for confounding variables.</div></div><div><h3>Results</h3><div>Of 1,048,575 recorded ICD-10 codes, there were 10,440 AIS episodes in whom 7,696 (73.7 %) patients had multimorbidity. Age, female sex, and low socioeconomic status were associated with a higher multimorbidity, and the combination of comorbidities differed across age groups. Cardiometabolic multimorbidity was associated with higher in-hospital mortality (odds ratio [OR] 1.39, 95 % confidence interval [CI] 1.16-1.66; p&lt;0.001<em>)</em>. Stage 5 chronic kidney disease combined with ischemic heart disease was the comorbidity with the highest risk of death (OR 4.20, 95 %CI 1.58-11.16; <em>p</em> = 0.004). Obesity, which exhibited a predominance in early to mid-life, had the highest association with mortality when combined with other conditions.</div></div><div><h3>Conclusions</h3><div>Multimorbidity is common in patients with AIS and its components vary by age and sex. Cardiometabolic multimorbidity increases the likelihood of in-hospital mortality. Adopting a multimorbidity-focused approach to stroke care could improve outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108267"},"PeriodicalIF":2.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538173","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":"Elevated initial blood kynurenine is associated with increased odds of post-stroke infection","authors":"Layne Dylla MD, PhD ,&nbsp;Julie A. Reisz PhD ,&nbsp;Sharon N. Poisson MD ,&nbsp;Paco S. Herson PhD ,&nbsp;Lauren H. Sansing MD ,&nbsp;Andrew A. Monte MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108268","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108268","url":null,"abstract":"<div><h3>Objective</h3><div>Post-stroke infection is a leading cause of acute ischemic stroke mortality. Tryptophan metabolites can modulate the immune response. This study assesses the association between tryptophan metabolism and post-stroke infection.</div></div><div><h3>Methods</h3><div>Whole blood from the University of Colorado Emergency Medicine Specimen Bank of acute ischemic stroke patients was collected within 72 hours of last known well. Mass spectrometry determined concentrations of tryptophan metabolites. Multivariate logistic regression modeled the association between post-stroke infection within 30 days and metabolite concentrations, controlling for age, sex, NIH stroke scale score, time to sample collection, smoking status, dysphagia, history of chronic kidney or end stage renal disease, and history of diabetes mellitus.</div></div><div><h3>Results</h3><div>Of 73 subjects, 21 (28.8 %) developed a post-stroke infection. Those with or without a post-stroke infection had similar concentrations of tryptophan, kynurenic acid and quinolinic acid. Those who developed a post-stroke infection had higher mean concentrations of kynurenine (2.3<span><math><mi>μ</mi></math></span>M, standard deviation 1.1<span><math><mi>μ</mi></math></span>M) compared to those who did not develop a post-stroke infection (1.6<span><math><mi>μ</mi></math></span>M , standard deviation 0.6<span><math><mi>μ</mi></math></span>M, <em>p</em> = 0.01). The adjusted odds ratio of a post-stroke infection within 30 days was 3.94 (95 % Confidence Interval 1.40 – 11.11) for every 1μM increase in kynurenine concentration.</div></div><div><h3>Conclusions</h3><div>Increasing circulating kynurenine within 72 hours of ischemic stroke onset is associated with increased odds of developing a post-stroke infection within 30 days of emergency department admission. Understanding the causal mechanism of kynurenine promoting post-stroke infection may yield targeted therapeutics that reduce the morbidity and mortality of ischemic stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108268"},"PeriodicalIF":2.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525174","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":"Residual inflammatory risk is associated with leukoaraiosis in patients with ischemic stroke","authors":"Xiuqun Gong MD ,&nbsp;Yuwen Gang MD ,&nbsp;Zeyu Lu MD ,&nbsp;Qiankun Cai MD ,&nbsp;Min Xue PhD ,&nbsp;Beibei Zhu MD ,&nbsp;Xiaosi Cheng MD ,&nbsp;Chuanqing Yu PhD ,&nbsp;Jun Lu PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108261","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108261","url":null,"abstract":"<div><h3>Objective</h3><div>Emerging evidence has highlighted the clinical significance of residual inflammation risk (RIR) in cardiovascular and cerebrovascular diseases, with studies demonstrating its association with disease recurrence and poor prognosis. This study aimed to investigate the relationship between RIR and leukoaraiosis (LA) severity in patients with ischemic stroke.</div></div><div><h3>Methods</h3><div>In this observational cohort study, we classified patients into four groups based on low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hsCRP) levels: RIR (LDL-C &lt; 2.6 mmol/L and hsCRP ≥ 2 mg/L), residual cholesterol risk (RCR) (LDL-C ≥ 2.6 mmol/L and hsCRP &lt; 2 mg/L), both risk or residual cholesterol and inflammatory risk (RCIR) (LDL-C ≥ 2.6 mmol/L and hsCRP ≥ 2 mg/L) and neither risk (LDL-C &lt; 2.6 mmol/L and hsCRP &lt; 2 mg/L). LA presence and severity were assessed using magnetic resonance imaging (MRI) and graded according to the Fazekas scale. Ordinal logistic regression analyses were performed to evaluate the association between RIR and LA severity.</div></div><div><h3>Results</h3><div>Among 643 enrolled patients, 413 (64.2 %) exhibited LA. The distribution of patients across RIR, RCR, RCIR, and neither risk groups was 28.9 %, 19.8 %, 20.4 %, and 30.9 %, respectively. Comparative analysis revealed that LA patients exhibited significantly higher age (<em>P</em> &lt; 0.001), elevated BMI (<em>P</em> &lt; 0.001), increased hypertension prevalence (<em>P</em> = 0.004), greater RIR proportion (<em>P</em> &lt; 0.001), and higher smoking rates (<em>P</em> = 0.007) compared to non-LA counterparts. Ordinal logistic regression analysis demonstrated that RIR (OR 1.447, 95 % CI 1.044−1.851, <em>P</em> &lt; 0.001) was independently associated with the severity of LA after adjusting for multiple confounding variables. Subgroup analysis stratified by BMI further revealed that RIR (OR 2.994, 95 % CI 2.259−3.730, <em>P</em> &lt; 0.001) was significantly correlated with LA severity in patients with a BMI ≥ 25.0.</div></div><div><h3>Conclusions</h3><div>These findings suggest that RIR may serve as an independent risk factor for LA in patients with ischemic stroke, particularly among those with a BMI ≥25.0.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108261"},"PeriodicalIF":2.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484744","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":"Stroke severity influences correlation of fibrinogen with early neurological deterioration after thrombolytic therapy","authors":"Shuhong Yu MD ,&nbsp;Jijun Shi PhD ,&nbsp;Shiping Guo MD ,&nbsp;Zhiliang Guo PhD ,&nbsp;Guodong Xiao PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108264","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108264","url":null,"abstract":"<div><h3>Background</h3><div>To investigate the relationships between fibrinogen levels at baseline and 24 hours after intravenous thrombolysis (IVT) and early neurological deterioration (END); and to investigate whether stroke severity influences the correlation between fibrinogen and END.</div></div><div><h3>Methods</h3><div>The fibrinogen levels were measured at admission and 24 hours after intravenous thrombolysis (IVT) in 364 consecutive AIS patients. Regression analysis, stratified analyses and interaction tests were utilized to assess the relationship between fibrinogen and END and whether stroke severity (NIHSS&lt;6 vs NIHSS≥6) influences the correlation.</div></div><div><h3>Results</h3><div>Fibrinogen at admission was not independently associated with END after adjusting for potential confounders (OR, 1.00; 95 % CI, 0.66-1.53; <em>P</em> = 0.9874). However, increased fibrinogen levels after IVT were associated with increased risk of END (OR, 1.49; 95 % CI, 1.00-2.21; <em>P</em> = 0.0479). Fibrinogen after IVT was not independently associated with END (OR, 1.12; 95 % CI, 0.26-4.80; <em>P</em> = 0.8737) in patients with NIHSS&lt;6, but was independently associated with END in patients with NIHSS≥6 (OR, 1.90; 95 % CI, 1.15-3.15; <em>P</em> = 0.0120). And the interaction test for NIHSS (NIHSS&lt;6 vs NIHSS≥6) was statistically significant (<em>P</em> = 0.0366). Similar results were still found when we used the median NIHSS score of our study population (&lt;10 vs ≥10) as a stratification criterion (<em>P</em>_interaction = 0.0487).</div></div><div><h3>Conclusions</h3><div>Fibrinogen after IVT but not on admission was independently associated with END. And stroke severity influenced the correlation between fibrinogen after IVT and END.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108264"},"PeriodicalIF":2.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484745","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":"Palliative care for stroke patients: Meeting the Quadruple Aim","authors":"Kennedy M. Boone-Sautter MA,&nbsp;M. Andrea Peterson MSA, BS, RN,&nbsp;Kristyn Vermeesch MA,&nbsp;Aiesha Ahmed MD, MBA","doi":"10.1016/j.jstrokecerebrovasdis.2025.108263","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108263","url":null,"abstract":"<div><h3>Background</h3><div>Stroke patients present health care systems with complex clinical and care needs with high costs of care. Prior to 2022, Corewell Health lacked the palliative care infrastructure to reach and serve the diverse needs of this patient population. Corewell Health-West (CH-W) sought to improve end-of-life care for individuals with serious illness.</div></div><div><h3>Objectives</h3><div>To evaluate the extent to which changes in palliative care practices led to improvements in patient outcomes and cost of care.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of palliative care referrals after hospitalization with primary diagnosis of stroke in the CH-W system from 2021 to 2023. Descriptive analysis was utilized to assess the impact and outcomes for patients pre- and post- system improvements.</div></div><div><h3>Results</h3><div>The emergency department piloted consults directly to palliative which increased from six to seventy-four over a month's time. Stroke patients preferred in-home treatments such as Home Hospice. Fewer patients enrolled in inpatient treatment, such as skilled nursing facilities and inpatient rehab facilities, whose enrollment dropped from 25 % to 11.3 % and 18.3 % to 9.7 % respectively, from 2021 to 2023. Stroke patients enrolled in palliative care experienced lower utilization and costs.</div></div><div><h3>Conclusions</h3><div>After expanding resources and standardizing the referral and criteria process to palliative care, an increase in palliative care utilization was observed. This effort expanded care dispositions for palliative care services, allowing individuals more opportunities to receive palliative care treatment at home rather than inpatient.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108263"},"PeriodicalIF":2.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471233","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":"Immune checkpoint inhibitor-related CNS vasculitis – A systematic review and report of 6 cases","authors":"Mai Erritzøe-Jervild MD ,&nbsp;Simon Nue Møller MD ,&nbsp;Christina Kruuse MD, PhD (Professor) ,&nbsp;Christian Stenør MD (associate Professor)","doi":"10.1016/j.jstrokecerebrovasdis.2025.108265","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108265","url":null,"abstract":"<div><h3>Background</h3><div>Immune checkpoint inhibitors (ICI) represent an important new class of immunotherapy used in cancer treatment. Though effective, immune-related adverse events (irAE) are reported, including cerebral vasculitis (nirVasculitis). In this systematic review, we aim to identify clinical and laboratory features of nirVasculitis and exemplify these in six local clinical cases.</div></div><div><h3>Observations</h3><div>We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent researchers searched, identified, and extracted data from both PubMed and Embase to identify reports on nirVasculitis. Based on current criteria for diagnostic certainty patients were categorized as having definite, probable, or possible nirVasculitis. 20 cases described relevant symptomatology and met our inclusion criteria. Non-small-cell lung cancer (55 %) was the most frequent cancer type. Most cases (95 %) received a programmed death-1 (PD-1) inhibitor. One patient had definite vasculitis, seven probable vasculitis, and twelve possible vasculitis. Signs and symptoms included aphasia (<em>n</em> = 5), loss of consciousness (<em>n</em> = 7), confusion (<em>n</em> = 8), unilateral sensory or motor dysfunction (<em>n</em> = 5), and fever or headache (<em>n</em> = 9). All patients had brain imaging and seventeen underwent a lumbar puncture. Of these, 64.7 % had pleocytosis and 52.9 % elevated protein in cerebrospinal fluid. Nineteen patients received corticosteroids. Eight patients fully or partially recovered. Eight patients died due to nirVasculitis, three to advanced cancer, and one lost to follow-up.</div></div><div><h3>Conclusions</h3><div>There are few clinical reports of nirVasculitis which may be due to underreporting or rarity of complications. Guidelines for diagnostics and reporting may improve awareness and early recognition to initiate important immunosuppressive treatment.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108265"},"PeriodicalIF":2.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473202","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}