Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"The association of SUR1 polymorphisms with acute infarct size: The MRI-GENIE study","authors":"Arlinda Deng MD ,&nbsp;Huichun Xu MD, PhD ,&nbsp;Brady J. Gaynor MS ,&nbsp;John W. Cole MD, MS ,&nbsp;Anne-Katrin Giese MD, PhD ,&nbsp;Markus D. Schirmer PhD ,&nbsp;Patrick F. McArdle PhD ,&nbsp;Braxton D. Mitchell PhD ,&nbsp;Ona Wu PhD ,&nbsp;Natalia S. Rost MD, MPH ,&nbsp;Steven J. Kittner MD, MPH ,&nbsp;MRI-GENIE Investigators","doi":"10.1016/j.jstrokecerebrovasdis.2024.108109","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108109","url":null,"abstract":"<div><h3>Background</h3><div>The sulfonylurea receptor 1 (SUR1) is a known mediator of cerebral edema in large ischemic strokes, however, genetically induced response variability has yet to be evaluated. SUR1, encoded by the ABCC8 gene, is an ion channel regulator in ischemia-induced cerebral edema. Previous studies in severe traumatic brain injury demonstrated four tag single nucleotide polymorphisms (SNPs) of the ABCC8 gene to be associated with cerebral edema and functional outcome. We hypothesized that these four SNPs would also be associated with acute infarct size and functional outcome in non-lacunar ischemic stroke.</div></div><div><h3>Methods</h3><div>Using 2,205 MRI–GENetics Interface Exploration (MRI-GENIE) study subjects with acute non-lacunar ischemic strokes, we evaluated the association between the 4 ABCC8 tag-SNPs and stroke infarct size (as measured in a standardized fashion from MRIs using diffusion-weighted imaging), adjusting for age, sex and population stratification. Modified Rankin scale (mRS) outcome was available at 3-months for a subset of 798 strokes in MRI-GENIE and was evaluated as a dichotomous variable (0-2 vs. 3-6), adjusting for age, sex, stroke severity (baseline NIH Stroke Scale (NIHSS) score), and population stratification.</div></div><div><h3>Results</h3><div>The candidate SNPs, rs7105832, rs2237982, rs11024286, rs4148622, were not statistically associated with DWI (beta = −0.065, −0.057, 0.037, 0.018; <em>p</em> = 0.053, 0.078, 0.28, 0.61) or dichotomous mRS outcome (OR = 0.80, 0.86, 1.14, 0.90; <em>p</em> = 0.117, 0.289, 0.353, 0.502).</div></div><div><h3>Conclusion</h3><div>rs7105832, rs2237982, rs11024286, rs4148622 polymorphisms of the ABCC8 gene did not demonstrate a significant effect on acute ischemic infarct size or 3-month functional outcome. Nonetheless, further studies with delayed imaging and more sensitive outcome measures remain warranted.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108109"},"PeriodicalIF":2.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570201","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 of walking pace and risk of stroke: A two- sample mendelian randomization study in a European ancestry cohort","authors":"Cong Liang ,&nbsp;Xinlin Huang ,&nbsp;Yucui Pu ,&nbsp;Pei Zhang ,&nbsp;Rong Wang PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108104","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108104","url":null,"abstract":"<div><h3>Background</h3><div>Walking pace (WP), a simple physiological indicator, has been found to be strongly associated with a variety of health outcomes in recent years. Among them, the relationship between walking pace and stroke is of particular interest. Given the high morbidity, disability and mortality associated with stroke, identifying modifiable indicators of health, such as walking pace, could help in stroke prevention strategies. However, the causal relationship between WP and stroke risk remains unclear. This study aims to determine the causal relationship between walking pace and risk of stroke using a two-sample Mendelian randomization approach in a European-ancestry population.</div></div><div><h3>Methods</h3><div>In order to evaluate the potential for a causal relationship between WP and stroke in people of European heritage, a two-sample Mendelian randomization (MR) study was carried out. Statistics about the association of single nucleotide polymorphisms (SNPs) with stroke were taken from FinnGen (R8) (n = 284,040), while the UK Biobank genome-wide association studies (GWAS) provided the summary data on the association of SNPs with WP (n = 459,915). The inverse-variance weighted (IVW) method was utilised as the primary strategy to examine the causal connection between WP and stroke. Additionally, complementary analyses were conducted using the MR-Egger and weighted median. In order to identify the potential directional pleiotropy and heterogeneity, the MR-Egger intercept test, the MR-PRESSO test, and Cochran's Q statistic were all carried out. This connection was evaluated using OR with 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>A total of 48 SNPs were identified as valid instrumental variables in our two-sample MR analysis. The result showed that a slower walking pace is associated with a higher risk of stroke (OR = 0.573; 95% CI, 0.383-0.858, <em>P</em> = 0.007). The “leave-one-out” analysis demonstrated that the absence of a single SNP did not affect the robustness of our results. The MR-Egger intercept test indicated that genetic pleiotropy did not introduce bias into the results [intercept = −2.9E−03, SE = 0.008, <em>P</em> = 0.719] and Cochran's Q test revealed no heterogeneity. Therefore, the sensitivity analyses yielded comparable results. Consequently, the results of the sensitivity analyses were consistent.</div></div><div><h3>Conclusion</h3><div>Our MR study revealed that WP is inversely associated with risk of stroke. These results provided evidence that slower WP causally increased the risk of stroke, recommending that patients with lower WP should have a prompt physical examination and targeted interventions to reduce their risk of stroke and enhance their quality of life.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108104"},"PeriodicalIF":2.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565313","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":"White matter lesions as a prognostic marker of recurrence in cryptogenic stroke with high-risk patent foramen ovale","authors":"Shunichi Niiyama MD ,&nbsp;Yuji Ueno MD, PhD ,&nbsp;Naohide Kurita MD, PhD ,&nbsp;Sho Nakajima MD, PhD ,&nbsp;Chikage Kijima MD, PhD ,&nbsp;Kenichiro Hira MD, PhD ,&nbsp;Nobukazu Miyamoto MD, PhD ,&nbsp;Masao Watanabe MD, PhD ,&nbsp;Kazuo Yamashiro MD, PhD ,&nbsp;Takao Urabe MD, PhD ,&nbsp;Nobutaka Hattori MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108048","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108048","url":null,"abstract":"<div><h3>Purpose</h3><div>A high-risk patent foramen ovale (PFO) could be the cause of cryptogenic stroke, and an atrial septal aneurysm (ASA) increases the risk of stroke recurrence in cryptogenic stroke patients with a patent foramen ovale (PFO). Factors related to stroke recurrence according to PFO characteristics have not been fully evaluated.</div></div><div><h3>Methods</h3><div>Data from a multicenter, observational registry of ischemic stroke patients undergoing transesophageal echocardiography were used for this study. Patients were classified into three groups: high-risk PFO, PFO with large shunt (≥20 microbubbles) or ASA; right-to-left shunt (RLS), RLS including PFO with &lt;20 microbubbles or without ASA, or pulmonary arteriovenous fistula; and negative RLS. Cox proportional hazards regression analysis was used to explore the factors related to stroke recurrence in these three groups.</div></div><div><h3>Results</h3><div>In total, 586 patients (185 females; 65.5±13.2 years) were analyzed. In cryptogenic stroke (329 patients) with median follow-up of 4.2 (interquartile range, 1.0–6.1) years, 55 patients had stroke recurrence. The negative RLS, RLS, and high-risk PFO groups included 179, 90, and 60 patients, in which stroke recurrence occurred in 5.3%, 2.5%, and 4.6% per person-year, respectively. In patients with high-risk PFO, the National Institutes of Health stroke scale score (hazard ratio [HR] 1.257 [1.034-1.530]) and periventricular hyperintensity (HR 3.369 [1.103-10.294]) were predictors of stroke recurrence on multivariable Cox hazards analysis, but no factors were related to stroke recurrence in the RLS and negative RLS groups.</div></div><div><h3>Conclusion</h3><div>Periventricular hyperintensity was shown to predict recurrent stroke in patients with a high-risk PFO.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108048"},"PeriodicalIF":2.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548840","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":"Evolution of glucose levels in patients with anterior circulation acute ischemic stroke treated with endovascular therapy using continuous glucose monitoring","authors":"C.J.B.A. Kersten ,&nbsp;A.A.M. Zandbergen ,&nbsp;M.J. Fokkert ,&nbsp;R.J. Slingerland ,&nbsp;I.L.H. Knottnerus ,&nbsp;M. van der Molen ,&nbsp;M.L.B. Wijlens ,&nbsp;J. Hofmeijer ,&nbsp;H.M. den Hertog","doi":"10.1016/j.jstrokecerebrovasdis.2024.108103","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108103","url":null,"abstract":"<div><h3>Introduction</h3><div>Hyperglycemia is common in acute ischemic stroke, and associated with larger infarct volume and unfavorable functional outcome. To identify a subgroup that may benefit from glucose lowering in future studies, we assessed the evolution of glucose levels in the first 24 hrs after admission using continuous glucose monitoring in patients with anterior circulation large vessel occlusion ischemic stroke who underwent endovascular therapy (EVT).</div></div><div><h3>Methods</h3><div>In a prospective two center cohort study, consecutive patients with anterior circulation ischemic stroke, who were eligible for EVT within 24 hrs of symptom onset, were enrolled. Glucose monitoring was performed using a Freestyle Libre Flash 2 device during 24 hrs. We analysed median glucose on admission, time ratio of glucose &gt; 7.8 mmol/L (7.8 time-ratio) and coefficient of variation (% CV), including relations with predefined patient characteristics and outcomes.</div></div><div><h3>Results</h3><div>One hundred and two patients were included in the analyses, with a median stroke-onset-to-measurement-time of 4 hrs. Median glucose on admission was 7.0 mmol/L (IQR 6.0-8.4 mmol/L). Overall, 7.8 time-ratio and % CV were 13% and 4% respectively. In patients who were normoglycemic or hyperglycemic on admission, the glucose variability was small with % CV of 6% and 4% respectively. Hyperglycemia on admission, high HbA1C, successful recanalization, older age, and high NIHSS scores were associated with higher 7.8 time-ratio.</div></div><div><h3>Conclusion</h3><div>Glucose monitoring and studies on effectiveness of glucose lowering may be especially useful in EVT patients with hyperglycemia on admission, high HbA1C, successful recanalization, older age and high initial NIHSS scores.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108103"},"PeriodicalIF":2.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548937","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":"Iatrogenic cerebral amyloid angiopathy: Two case reports to explore clinical heterogeneity and pathological patterns","authors":"Carla Vera-Cáceres MD ,&nbsp;Nerses Nersesyan MD ,&nbsp;Maria Obon MD, Ph.D ,&nbsp;Mikel Terceño MD, Ph.D ,&nbsp;Joaquin Serena MD, Ph.D ,&nbsp;Juan Álvarez-Cienfuegos MD ,&nbsp;Tomàs Xuclà MD ,&nbsp;Saima Bashir MD ,&nbsp;Yolanda Silva MD, Ph.D","doi":"10.1016/j.jstrokecerebrovasdis.2024.107969","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.107969","url":null,"abstract":"<div><h3>Introduction</h3><div>These case reports illustrate Iatrogenic Cerebral Amyloid Angiopathy (iCAA) due to neurosurgical procedures. Recent studies propose prion transmission during neurosurgery as a potential mechanism for β-amyloid seed implantation, linking neurosurgical history to the development of iCAA. The majority of reported cases in the literature have an unfavorable prognosis, with recurrence of intracerebral hemorrahge (ICH) and subsequent death during the first months of follow-up. There is no effective treatment for preventing the progression of the disease.</div></div><div><h3>Results</h3><div>a 41-year-old man with a previous history of left frontotemporal traumatic brain injury and subsequent neurosurgical intervention in childhood was admitted with an ICH leading to the diagnosis of iCAA. The patient's history of exposure, combined with imaging studies and neuropsychological assessments, supported the suspicion of iCAA. Confirmatory PET-CT scans revealed β-amyloid deposits in the cortical regions, aligning with the proposed criteria for iCAA. At the 2-year follow-up, the patient presents an NIHSS of 0 and a Modified Rankin Scale (mRS) of 1. The second case involved a 50-year-old man with a history of surgical treatment for Arnold-Chiari malformation, who developed transient neurological deficits and presented multiple ICH. The patient's history of neurosurgical intervention and the radiological and clinical features supported the diagnosis of probable iAAC. Despite a negative PET-CT result, CSF analysis provided evidence of ß-amyloid accumulation in the CNS. At the 6-year follow-up, the patient presented an NIHSS of 1(hemihypoesthesia) and mRS of 3.</div></div><div><h3>Conclusion</h3><div>iCAA is an emerging pathology probably driven by prion transmission of β-amyloid seed after neurosurgical interventions. It is important to suspect this condition in young patients with ICH and a history of neurosurgical procedure. Recognizing iCAA's clinical and radiological features is crucial for early identification. The diagnosis process is based on demonstrating the accumulation of β-amyloid protein in the central nervous system using PET-CT or cerebrospinal fluid (CSF) studies and also conducting genetics studies. As an evolving pathology without a clear pathophysiology and a potential divergent evolution between phenotypes, establishing standardized diagnostic criteria and a multicenter registry is imperative for a comprehensive understanding of iCAA.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 107969"},"PeriodicalIF":2.0,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548838","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":"In-hospital outcomes of intravenous recombinant tissue plasminogen activator treatment for acute ischemic stroke in patients aged >80 years: Findings from the Chinese Stroke Center Alliance","authors":"Yingyu Jiang ,&nbsp;Chunjuan Wang ,&nbsp;Hongqiu Gu ,&nbsp;Qi Zhou ,&nbsp;Yong Jiang ,&nbsp;Zixiao Li ,&nbsp;Yongjun Wang","doi":"10.1016/j.jstrokecerebrovasdis.2024.108102","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108102","url":null,"abstract":"<div><h3>Background</h3><div>Intravenous (IV) recombinant plasminogen activator (rt-PA) within 4.5 hours of symptom onset has established benefit for patients with acute ischemic stroke (AIS); however, evidence on the use of IV rt-PA in elderly Chinese patients is limited. This study evaluated the patient characteristics and in-hospital clinical outcomes of Chinese patients aged &gt;80 years who received IV rt-PA within 4.5 h of symptom onset, using patients aged 18–80 years as a reference group. (NCT05395351).</div></div><div><h3>Methods</h3><div>This study analyzed adult Chinese patients with AIS who arrived at the hospital within 4.5 hours of symptom onset between August 2015 and July 2019 and were registered in the nationwide, hospital-based Chinese Stroke Center Alliance platform. Patients were categorized by treatment (IV rt-PA versus no IV rt-PA) and age (&gt;80 years versus 18–80 years). In-hospital outcomes were evaluated in IV rt-PA-treated patients. Primary outcome was all-cause mortality during hospitalization; secondary outcomes included proportion of patients with intracranial hemorrhage (ICH) during hospitalization, change in National Institutes of Health Stroke Scale (NIHSS) before and 24 h after IV rt-PA, modified Rankin Scale (mRS) at discharge, proportion of patients with stroke recurrence during hospitalization, and duration of hospital stay.</div></div><div><h3>Results</h3><div>Of 113,035 patients with AIS included in the study, 31,418 patients received IV rt-PA within 4.5 hours after symptom onset (aged &gt;80 years: n=3,332; 18–80 years: n=28,086). Among IV rt-PA-treated patients, all-cause mortality was 2.6 % (95 % CI 2.1–3.2 %) and 0.8 % (95 % CI 0.7–0.9 %) in patients aged &gt;80 years and 18–80 years, respectively. Intracranial hemorrhage occurred in 6.7 % (95 % CI 5.8–7.5 %) and 3.1 % (95 % CI 2.9–3.3 %) of patients; mean±SD change in NIHSS score was 2.8±5.0 and 2.5±4.3; mRS 0–1 at discharge in 42.8 % (95 % CI 40.8 %–44.8 %) and 63.6 % (95 % CI 62.9 %–64.3 %); stroke recurrence in 11.1 % (95 % CI 10.0–12.1 %) and 7.3 % (95 % CI 7.0–7.6 %). Median duration of hospital stay was 11 days in both age groups.</div></div><div><h3>Conclusions</h3><div>Chinese patients aged &gt;80 years with AIS who received IV rt-PA within 4.5 hours after symptom onset had higher all-cause mortality during hospitalization than those aged 18–80 years.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108102"},"PeriodicalIF":2.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548839","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":"Dopamine receptor agonist pramipexole exerts neuroprotection on global cerebral ischemia/reperfusion injury by inhibiting ferroptosis","authors":"Xiaoyu Kang ,&nbsp;Wenzhu Wang ,&nbsp;Yao Zuo ,&nbsp;Yunlei Wang ,&nbsp;Linyao Zhang ,&nbsp;Lixu Liu","doi":"10.1016/j.jstrokecerebrovasdis.2024.108101","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108101","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the mechanism of dopamine receptor agonist pramipexole in exerting neuroprotection on global cerebral ischemia/reperfusion injury (GCI/R).</div></div><div><h3>Material and method</h3><div>Male Sprague-Dawley rats were randomly divided into four groups (n = 36 in each group), and the Pulsinelli's four-vessel occlusion method was used to establish the rat model of GCI/R injury. Pramipexole administration group was intraperitoneally injected with pramipexole 0.5 mg kg^-1 once a day for 14 days. Pramipexole combined with levodopa administration group was intraperitoneally injected with pramipexole 0.5 mg kg^-1 and levodopa 50 mg kg^-1 once a day for 14 days. The mNSS scores and Y maze test were used to evaluate neurological behaviors. Nissl staining and transmission electron microscopy were used to respectively observe hippocampal neurons and mitochondrial ultrastructure. Molecular biological tests including tissue iron concentration, GSH, MDA were used to detect the degree of ferroptosis. Western blotting was used to detect the expression levels of Nrf2, GPX4, X-CT and p53 proteins at 3 days, 7 days and 14 days after GCI/R injury.</div></div><div><h3>Results</h3><div>Pramipexole alone or combined with levodopa for 14 days improved neurological behaviors, improved the morphology of neurons, increased the number of surviving neurons in the hippocampal CA1 region of GCI/R rats, which showed similar neuroprotective effects. Pramipexole alone or combined with levodopa for 14 days restored mitochondrial ultrastructure, decreased tissue iron concentration and MDA concentration, increased GSH concentration in the brain of GCI/R rats, which also induced the relative expressions of Nrf2, GPX4 and X-CT proteins and reduced p53 protein.</div></div><div><h3>Conclusion</h3><div>Pramipexole alone or combined with levodopa exert neuroprotection by inhibiting ferroptosis after GCI/R injury via Nrf2/GPX4/SLC7A11 pathway, and long-term intervention could be applied as an effective therapeutic strategy for neuroprotection against GCI/R injury.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108101"},"PeriodicalIF":2.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570199","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":"Letter to editor regarding “Prevalence of stroke in Bangladesh a systematic review and meta-analysis”","authors":"Aashima Walia ,&nbsp;Muhammed Shabil ,&nbsp;Sanjit Sah","doi":"10.1016/j.jstrokecerebrovasdis.2024.108098","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108098","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108098"},"PeriodicalIF":2.0,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570200","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":"Navigating stroke care: Geospatial assessment of regional stroke center accessibility","authors":"Stephen Halada BS ,&nbsp;Kirsten MM Beyer PhD, MPH ,&nbsp;Yuhong Zhou PhD ,&nbsp;Benjamin W Weston MD, MPH","doi":"10.1016/j.jstrokecerebrovasdis.2024.108093","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108093","url":null,"abstract":"<div><h3>Introduction</h3><div>Reducing time between stroke onset and hospital intervention is crucial for positive outcomes in stroke patients. While EMS utilization decreases time to intervention, many US regions are not within timely proximity to an advanced-care-capable stroke center (ASC), defined as a comprehensive or thrombectomy-capable center. This study aims to utilize geographic methodology to identify regions in Wisconsin with both high stroke mortality and low physical accessibility to certified stroke centers (SCs), particularly ASCs.</div></div><div><h3>Methods</h3><div>Geocoded mortality records for stroke death between 2015 and 2020 were accessed from the Wisconsin Department of Health Services. Indirectly age-standardized mortality ratios (SMRs) were estimated continuously across Wisconsin using adaptive spatial filtering and mortality records at the census block group level; the surface was then averaged by census tract for tract level SMRs. Addresses for SC locations within Wisconsin and bordering states were collected, and drive times from Wisconsin census tract centroids to the nearest SC subtypes were estimated. Drive times and mortality ratios were evaluated at the tract level alongside Rural-Urban Commuting Area (RUCA) codes. Spatial error regression modeling was used to determine RUCA classifications with the highest stroke risk independent of accessibility to stroke centers.</div></div><div><h3>Results</h3><div>Approximately 50%, 68%, and 78% of Wisconsin residents resided within 30, 45, and 60 minutes of an ASC, respectively. Median drive time from census tract centroids to the nearest ASC were highest for rural tracts (<em>M=</em>90 minutes, <em>IQR=</em>68-115) compared to small-town (<em>M=</em>82 minutes, <em>IQR=</em>49-113), micropolitan (<em>M=</em>53 minutes, <em>IQR=</em>43-77), and metropolitan tracts (<em>M=</em>19 minutes, <em>IQR=</em>11-35; <em>p&lt;</em>0.001). Clusters of high stroke SMRs were found in urban centers as well as rural areas irrespective of county declinations. Spatial regression modeling suggested small-town census tracts had the highest SMR irrespective of physical accessibility to care and spatial correlation. In small-town census tracts &gt;45 minutes from the nearest ASC, the median stroke SMR was 1.12 (<em>IQR=</em>0.94-1.40) with 226,000 residents and 150 stroke deaths per year.</div></div><div><h3>Conclusion</h3><div>Small-town areas are associated with both long drive distance to ASC locations and high stroke mortality. Geographical analyses reveal apparent stroke care deserts and may inform strategic allocation of emergency medicine resources and coverage.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108093"},"PeriodicalIF":2.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512871","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":"Response to the Letter to the Editor: Prevalence of stroke in Bangladesh: a systematic review and meta-analysis","authors":"Tonmoy Alam Shuvo,&nbsp;Asma-Ul- Hosna,&nbsp;Kabir Hossain,&nbsp;Sorif Hossain","doi":"10.1016/j.jstrokecerebrovasdis.2024.108099","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108099","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108099"},"PeriodicalIF":2.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512873","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}