Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"The neutrophil-to-lymphocyte ratio is associated with functional outcome among single small subcortical infarction: Mediating effects of white matter hyperintensities","authors":"Yue Wu ,&nbsp;Jin Hu ,&nbsp;Yutie Zhao ,&nbsp;Dongshen Ju ,&nbsp;Shudong Cao ,&nbsp;Jintao Guo ,&nbsp;Weihua Song ,&nbsp;Ran Mo ,&nbsp;Shaoyuan Lei ,&nbsp;Yifan Wu ,&nbsp;Yingting Zuo ,&nbsp;Shujuan Meng ,&nbsp;Ziying Jiang ,&nbsp;Gaoting Ma ,&nbsp;Lianmei Zhong ,&nbsp;Yansu Guo","doi":"10.1016/j.jstrokecerebrovasdis.2025.108341","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108341","url":null,"abstract":"<div><h3>Background</h3><div>Increasing evidence indicated that neutrophil-to-lymphocyte ratio (NLR) was correlated with unfavorable functional outcome in ischemic stroke. However, limited studies have explored the relationship between NLR and single small subcortical infarction (SSSI). This study aims to investigate the link between NLR and functional outcome in patients with SSSI and assess whether white matter hyperintensities (WMH) mediates the relationship between NLR and unfavorable functional prognosis.</div></div><div><h3>Methods</h3><div>This research analyzed data from patients with SSSI in a Chinese cohort study. The primary outcome was unfavorable functional outcome (modified Rankin Scale score of 2-6) at 90 days after ischemic stroke onset, and the secondary outcome was unfavorable functional outcome at discharge. The relationship between NLR and functional outcome was analyzed using restricted cubic spline (RCS) and multivariable logistic regression. A mediation analysis was conducted to examine the link between NLR and unfavorable functional outcome mediated by WMH.</div></div><div><h3>Results</h3><div>Among the 513 patients with SSSI included in the study, unfavorable functional outcome was seen in 145 (28.3 %) patients at the 90-day follow-up and 156 patients (30.4 %) at discharge. After controlling for confounding variables, elevated NLR levels were found to be linked with unfavorable functional outcome both at 90 days and at discharge. Mediation analyses indicated that overall WMH significantly mediated the relationship between NLR and unfavorable functional outcome at 90 days and discharge, with mediation proportions of 29.6 % and 24.2 %, respectively. Periventricular WMH accounted for 36.4 % and 32.1 % of the mediation effects, respectively.</div></div><div><h3>Conclusion</h3><div>Elevated NLR independently increased the risk of unfavorable functional outcome in individuals with SSSI. In patients with SSSI, WMH partially mediated the relationship between NLR and unfavorable functional outcome.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108341"},"PeriodicalIF":2.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026751","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":"Enlarged perivascular spaces and clinical outcome of acute ischemic stroke patients receiving intravenous thrombolysis","authors":"Yu Gu MD ,&nbsp;Henlin Zhao MD ,&nbsp;Chunyan Lei MD, PhD,&nbsp;Ansong Jin MD,&nbsp;Wen Jiang MD,&nbsp;Qionghua Deng MD,&nbsp;Xinglong Yang MD, PhD,&nbsp;Xiaoyan Zhu MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108342","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108342","url":null,"abstract":"<div><h3>Background</h3><div>Enlarged perivascular spaces (EPVS) is one of the main imaging features of cerebral small vessel disease (CSVD). Previous studies have shown that hypertension and advanced age were important risk factors for the occurrence and development of EPVS. We aim to explore the correlation between the severity of EPVS at centrum semiovale and basal ganglia and the early and long-term outcome of acute ischemic stroke (AIS) patients receiving intravenous thrombolysis.</div></div><div><h3>Methods</h3><div>AIS who received intravenous thrombolysis at the First Affiliated Hospital of Kunming Medical University were retrospectively collected. Demographic data, stroke risk factors, laboratory test results and head imaging data were collected. The number of EPVS in centrum semiovale and basal ganglia of patients in cranial magnetic resonance imaging (MRI) was counted by visual quantification method. Logistic regression analysis was used to evaluate the independent risk factors affecting the prognosis.</div></div><div><h3>Results</h3><div>A total of 196 subjects were included in this study. The proportion of patients with poor clinical outcome at 90 days was higher in patients with moderate-to-severe centrum semiovale EPVS than in those with no-to-mild EPVS (42.9 % vs 18.7 %, <em>P</em>=0.031). Similarly, patients with moderate-to-severe EPVS in the basal ganglia region had a significantly poor clinical outcome at 90 days (51.7 % vs 18.3 %, <em>P</em>=0.001). Moderate to severe basal ganglia EPVS (OR=2.661, 95 %CI: 1.070-6.618, <em>P</em>=0.035), hyperlipidemia (OR=3.011, 95 %CI: 1.147-7.902, <em>P</em>=0.025) and a higher baseline NIHSS score before thrombolysis (OR=1.194, 95 %CI: 1.071-1.331, <em>P</em>=0.001) were independent risk factors for poor clinical outcome at 90 days. Early neurological improvement (OR=0.220, 95 %CI 0.093-0.520, <em>P</em>=0.001) was associated with a reduced risk of poor clinical outcomes at 90 days.</div></div><div><h3>Conclusions</h3><div>Moderate-to-severe EPVS in basal ganglia were an independent risk factor for poor clinical outcome at 90 days in AIS patients with intravenous thrombolysis. Therefore, the severity of EPVS in the basal ganglia region can serve as an imaging marker to predict the 90-day clinical outcome of AIS patients treated with intravenous thrombolysis.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108342"},"PeriodicalIF":2.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143931325","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":"Factors associated with increased atrial fibrillation detection in patients with embolic stroke of undetermined source","authors":"Jia-Yi Wang MD ,&nbsp;Stephanie Vu MD ,&nbsp;Matthew McGuinness MD ,&nbsp;Ryan Barrette MD ,&nbsp;Stephen Trudeau MD ,&nbsp;Hayley Price MD ,&nbsp;Peter Zimetbaum MD ,&nbsp;Magdy Selim MD, PhD ,&nbsp;Jennifer Dearborn-Tomazos MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108343","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108343","url":null,"abstract":"<div><h3>Background</h3><div>Studies suggest that longer duration of cardiac monitoring after embolic stroke of undetermined source (ESUS) yields higher detection rates for atrial fibrillation (AF). A common strategy for cardiac monitoring after ESUS starts with a 14-day surface monitor, which is easier to administer, and lower cost compared to implantable monitoring. We tested whether cardiac markers associated with higher likelihood of AF detection can be used to identify patients with ESUS who are more likely to benefit from initial short-term monitoring.</div></div><div><h3>Methods</h3><div>We adjudicated stroke etiology from patients with acute ischemic stroke discharged from a tertiary care medical center with 14-day surface cardiac monitor (ZioPatch®) between January 2019 and September 2023. The primary outcome was ≥30 seconds of AF on surface monitoring. Predictors included ECG and echocardiographic markers associated with AF in a general population identified during hospitalization. Associations were analyzed using Chi-squared or Fisher’s exact tests and age-adjusted logistic regression.</div></div><div><h3>Results</h3><div>We identified 415 patients with ESUS (mean age 67.2 years, 49.9% female). 4.3% (n=18/415) developed AF after a median of 13.8 days (IQR 13-15.8) of monitoring. 9.6% (n=8/83) of patients with enlarged left atrial dimension &gt;4cm and 8.0% (n=9/113) of patients with mitral valve regurgitation developed AF. Significantly more patients with AF had a combination of enlarged left atrial dimension and/or mitral valve regurgitation (36.8% with AF vs 61.1% without AF, p=0.037). Adjusting for age, enlarged left atrial dimension remained significantly associated with increased odds of detection of AF (OR 3.17, 95% CI 1.20-8.36).</div></div><div><h3>Conclusions</h3><div>In patients with ESUS, the rate of AF detection using a surface 14-day cardiac monitor was low. However, the likelihood of detecting AF was higher among patients with enlarged left atrial dimension and mitral valve regurgitation, suggesting this group may benefit most from an initial short-term monitoring strategy.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108343"},"PeriodicalIF":2.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928392","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 hyperbaric oxygen combined with Danhong injection on 90-day functional independence and the 1-year recurrence rate in patients with ischemic stroke: A matched cohort study","authors":"Mo Zheng ,&nbsp;Yun Xu","doi":"10.1016/j.jstrokecerebrovasdis.2025.108339","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108339","url":null,"abstract":"<div><h3>Background</h3><div>Both hyperbaric oxygen therapy and Danshen (Salvia miltiorrhiza) injection have shown potential therapeutic effects on ischemic stroke, but the impact of their combination on long-term functional outcomes and recurrence risk has not been systematically evaluated. This study aimed to assess the effects of hyperbaric oxygen combined with Danhong injection on 90-day functional independence and the 1-year recurrence rate in patients with ischaemic stroke.</div></div><div><h3>Methods</h3><div>This study employed a retrospective matched cohort design and collected data from patients with ischemic stroke treated at our hospital between January 2018 and December 2022. After 1:1 propensity score matching, 80 patients were included in each group. The intervention group received hyperbaric oxygen therapy (2.0–2.5 ATA, once daily for 10 sessions) combined with Danhong injection (20 ml/day for 14 consecutive days) in addition to standard treatment; the control group received standard treatment only. The primary outcome was 90-day functional independence (mRS ≤2); secondary outcomes included the 1-year stroke recurrence rate, NIHSS score improvement, and others.</div></div><div><h3>Results</h3><div>The percentage of 90-day functional independence in the intervention group (72.5 %) was significantly greater than that in the control group (53.8 %) (<em>P</em> = 0.014), with a relative risk ratio of 1.35 (95 % CI: 1.06–1.71). Multivariate analysis revealed that combined therapy was independently associated with 90-day functional independence (adjusted OR = 2.28, 95 % CI: 1.19–4.37; <em>P</em> = 0.013). The 1-year stroke recurrence rate in the intervention group (7.6 %) was significantly lower than that in the control group (16.5 %) (<em>P</em> = 0.042), with an adjusted hazard ratio of 0.46 (95 % CI: 0.22–0.94, <em>P</em> = 0.033). Subgroup analysis revealed that patients aged &lt;65 years, those with NIHSS scores ranging from 4–15, those with small-artery occlusion or large-artery atherosclerosis stroke, and those who began treatment within 24 hours benefited more significantly. The combined therapy was well tolerated, with no serious adverse events.</div></div><div><h3>Conclusion</h3><div>Hyperbaric oxygen combined with Danhong injection significantly improved 90-day functional independence and reduced the 1-year recurrence risk in patients with ischaemic stroke, particularly in specific patient subgroups. This combined treatment strategy provides a new therapeutic option for comprehensive stroke management.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108339"},"PeriodicalIF":2.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025515","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 factors for hemodynamic depression after carotid artery stenting: A system review and meta analysis","authors":"Xiaowei Liu ,&nbsp;Bei Pan ,&nbsp;Yunsen Zhang ,&nbsp;Xiyuan Deng ,&nbsp;Xin Liu ,&nbsp;Keyu Chen ,&nbsp;Liu Du ,&nbsp;Yongxiu Yang ,&nbsp;Kehu Yang","doi":"10.1016/j.jstrokecerebrovasdis.2025.108340","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108340","url":null,"abstract":"<div><h3>Purpose</h3><div>Hemodynamic depression (HD) regularly occurs during carotid artery stenting(CAS) for treating carotid stenosis and it could result in adverse clinical events. This review aimed to clarify the incidence and risk factors for HD.</div></div><div><h3>Methods</h3><div>We searched four comprehensive databases for studies that reported the incidence or risk factors for HD during CAS. We used a modified version of Newcastle-Ottawa scale to assess the risk of bias in the included studies. We pooled the prevalence rates of HD and related risk factors from individual studies with a generic inverse variance weighted using the randomized effects model. We reported the results using OR with 95 % CI. Funnel plots and Egger’s tests were used to assess the publication bias.</div></div><div><h3>Results</h3><div>Our meta-analysis enrolled 53 articles and revealed that the incidence of HD was 35 %. Patients who had diabetes (OR = 1.28, 95 % CI: 1.07 to 1.54), stenosis-to-bifurcation &lt;10 mm (OR = 2.11, 95 % CI: 1.29 to 3.48), stenosis involving the carotid bulb (OR = 1.9, 95 % CI: 1.07 to 3.38), calcified plaque (OR = 2.06, 95 % CI: 1.32 to 3.22), eccentric plaque (OR = 1.47, 95 % CI: 1.05 to 2.05), severe stenosis (OR = 1.64, 95 % CI: 1.1 to 2.43), contralateral stenosis (OR = 2.02, 95 % CI: 1.18 to 3.46), open-cell stents (OR = 1.5, 95 % CI: 1.04 to 2.15), and bilateral stenting (OR = 2.32, 95 % CI: 1.56 to 3.44) showed a higher risk of HD.</div></div><div><h3>Conclusions</h3><div>Diabetes, stenosis-to-bifurcation &lt;10 mm, stenosis involving the carotid bulb, calcified plaque, eccentric plaque, severe stenosis, contralateral stenosis, open-cell stents, and bilateral carotid stenting were associated with HD during CAS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108340"},"PeriodicalIF":2.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937557","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":"Comparative analysis of morphological and hemodynamic parameters in stable anterior communicating and middle cerebral artery aneurysms","authors":"Jozsef Nagy ,&nbsp;Zoltan Major ,&nbsp;Julia Maier ,&nbsp;Gabriel Seebach ,&nbsp;Wolfgang Fenz ,&nbsp;Stefan Thumfart ,&nbsp;Michael Giretzlehner ,&nbsp;Andreas Gruber ,&nbsp;Philip-Rudolf Rauch MD ,&nbsp;Matthias Gmeiner","doi":"10.1016/j.jstrokecerebrovasdis.2025.108335","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108335","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigates morphological, hemodynamic and structural mechanical factors influencing aneurysm rupture behavior, specifically focusing on Middle Cerebral Artery (MCA) and Anterior Communicating Artery (ACOMM) aneurysms, using computational fluid dynamics (CFD) and fluid-structure interaction (FSI) analyses.</div></div><div><h3>Methods</h3><div>Data from 116 patients with aneurysms located in the MCA and ACOMM, including 81 ruptured and 35 stable aneurysms. Aneurysms were modeled with FSI methods to examine key parameters: aneurysm angle, wall shear stress, and equivalent Mises stress as well as additional parameters. Statistical analyses were conducted using the Mann-Whitney U-test to identify significant differences in these parameters between the two locations in stable and ruptured aneurysms. In a further step univariate and multivariate regression analysis was performed.</div></div><div><h3>Results</h3><div>Results indicated no significant differences in the assessed parameters between ruptured MCA and ACOMM aneurysms. However, stable ACOMM aneurysms exhibited a larger aneurysm angle, lower wall equivalent stress as well as lower ratio of maximum WSS in the aneurysms and the parent vessel when compared to MCA aneurysms, indicating that ACOMM aneurysms may rupture at lower stresses possibly due to their higher aneurysm angle. Regression analysis underlines the statistical power of aneurysm angle.</div></div><div><h3>Conclusions</h3><div>These findings highlight morphological and hemodynamic differences in stable aneurysms across MCA and ACOMM locations. Stable MCA aneurysms appear to tolerate higher wall stress values compared to ACOMM aneurysms, leading to greater susceptibility to rupture in ACOMM aneurysms at stress levels where MCA aneurysms can remain stable. This study underscores the importance of considering morphological, hemodynamic and structural mechanical factors as well as the distinction between stable and ruptured aneurysms, to improve the accuracy of rupture risk.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108335"},"PeriodicalIF":2.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928391","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":"Efficacy and safety of tenecteplase administration in extended time window for acute ischemic stroke: An updated meta-analysis of randomized controlled trials","authors":"Moazzma Ifzaal MBBS ,&nbsp;Sharib Afzal Bughio MD ,&nbsp;Syed Ali Farhan Abbas Rizvi MBBS ,&nbsp;Maryam Muzaffar MBBS ,&nbsp;Rubia Ali MBBS ,&nbsp;Moeen Ikram MBBS ,&nbsp;Meer Murtaza MBBS ,&nbsp;Agha Muhammad Wali Mirza MBBS ,&nbsp;Hasaan Haider Ans MD ,&nbsp;Lavinia Bucataru MBBS ,&nbsp;Armghan Haider Ans MD ,&nbsp;Raheel Ahmed MRCP ,&nbsp;Mushood Ahmed MBBS ,&nbsp;Muhammad Ayyan MBBS ,&nbsp;Muhammad Aemaz Ur Rehman MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108338","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108338","url":null,"abstract":"<div><h3>Background</h3><div>Data regarding the efficacy and safety of tenecteplase (TNK) in patients with acute ischemic stroke (AIS) who present outside the standard treatment window are limited. This study aims to evaluate the role of TNK at a dose of 0.25 mg/kg, in treating AIS patients in an extended time window.</div></div><div><h3>Methods</h3><div>Searches were performed up to February 15, 2025 in PubMed, Embase, and Cochrane Library to include randomized-controlled trials (RCTs) comparing TNK (0.25 mg/kg) to no thrombolysis in AIS patients presenting after 4.5 hours of symptom onset or wake-up AIS. The primary efficacy outcomes included a 3-month excellent functional outcome (mRS ⩽1), and a good functional outcome (mRS ⩽2). Secondary safety outcomes assessed included symptomatic intracranial hemorrhage (sICH), any ICH, and 3-month all-cause death. A random-effects model was used to calculate summary estimates.</div></div><div><h3>Results</h3><div>6 RCTs were included (<em>n</em> = 1,955 patients) in the meta-analysis. The pooled analysis demonstrated a significantly improved excellent functional outcome on 90 days (OR = 1.35, 95 % CI: 1.12 to 1.64) with TNK administration compared to control. No statistically significant association was observed for the two groups regarding good functional outcome (OR = 1.16, 95 % CI: 0.94 to 1.44), all-cause death (OR = 1.11, 95 % CI: 0.82 to 1.49), sICH (OR = 1.79, 95 % CI: 0.94 to 3.39), and any ICH (OR = 1.21, 95 % CI: 0.96 to 1.53).</div></div><div><h3>Conclusion</h3><div>TNK administration in an extended time window for AIS patients leads to favorable neurological outcomes with a good safety profile.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108338"},"PeriodicalIF":2.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143904319","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 cardiometabolic index and risk of stroke: A systematic review and meta-analysis","authors":"Prakasini Satapathy ,&nbsp;Muhammed Shabil ,&nbsp;Mahalaqua Nazli Khatib ,&nbsp;Subbulakshmi Ganesan ,&nbsp;Mandeep Kaur ,&nbsp;Manish Srivastava ,&nbsp;Amit Barwal ,&nbsp;G.V. Siva Prasad ,&nbsp;Pranchal Rajput ,&nbsp;Syed Rukshar ,&nbsp;Kamal Kundra ,&nbsp;Kratika Sharma ,&nbsp;Diptismitha Jena ,&nbsp;Frederick Sidney Correa ,&nbsp;Abhinav Rathour ,&nbsp;Ganesh Bushi ,&nbsp;Rachana Mehta ,&nbsp;Sanjit Sah ,&nbsp;Shilpa Gaidhane ,&nbsp;Shailesh Kumar Samal","doi":"10.1016/j.jstrokecerebrovasdis.2025.108337","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108337","url":null,"abstract":"<div><h3>Background</h3><div>Stroke remains a leading cause of morbidity and mortality worldwide, contributing significantly to public health burdens. Cardiovascular and metabolic risk factors such as diabetes, hypertension, obesity, and dyslipidaemia are strongly associated with an increased risk of stroke. The cardio-metabolic index (CMI), which integrates these factors into a single measure, has emerged as a potential predictor of stroke. This systematic review and meta-analysis intended to examine the link between CMI and risk of stroke, offering an in-depth evaluation of its predictive value</div></div><div><h3>Methods</h3><div>A systematic search was conducted in PubMed, Embase, and Web of Science until 10 December 2024. The inclusion criteria focused on observational studies (cohort, cross-sectional, and case-control) that reported original data on the association of CMI and stroke risk. Data extraction was standardized, and quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using a random effects model in R software version 4.4</div></div><div><h3>Results</h3><div>From 545 articles initially retrieved, with 5 studies met inclusion criteria, encompassing over 100,000 participants. Meta-analysis showed a significant association between elevated CMI and stroke risk with a pooled RR of 1.66 (95 % CI: 1.25 to 2.20). A subgroup analysis of cohort studies yielded a pooled HR of 1.63 (95 % CI: 1.21 to 2.21). There was no significant heterogeneity across studies (I² = 0 %).</div></div><div><h3>Conclusion</h3><div>Our findings demonstrated a strong association between elevated CMI and an increased risk of stroke. CMI, by integrating multiple cardiovascular and metabolic factors, serves as a comprehensive predictor of stroke risk. Incorporating CMI into routine health screenings could enhance early identification and prevention efforts, ultimately aiding in the reduction of stroke incidence.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108337"},"PeriodicalIF":2.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052000","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 impact of nutritional and inflammatory status on mortality in stroke patients: Results from NHANES 2005-2018","authors":"Xi Yang,&nbsp;Huaiyu Sun,&nbsp;Shuai Hou,&nbsp;Wuqiong Zhang,&nbsp;Hongmei Meng","doi":"10.1016/j.jstrokecerebrovasdis.2025.108334","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108334","url":null,"abstract":"<div><h3>Background</h3><div>Stroke significantly impacts global health, being a primary cause of disability, dementia, and mortality. The interplay of nutritional deficiency and systemic inflammation plays a pivotal role in determining stroke outcomes. While the Prognostic Nutritional Index (PNI) and the Advanced Lung Cancer Inflammation Index (ALI) have been recognized for their prognostic value in various diseases, their relevance in stroke prognosis necessitates further exploration.</div></div><div><h3>Methods</h3><div>This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018, analyzing 908 stroke survivors to examine the associations between PNI, ALI, and mortality outcomes. Weighted Cox proportional hazards models were applied to assess the associations, controlling for demographic and health-related variables. Kaplan–Meier curves and restricted cubic splines were used to evaluate survival differences and non-linear relationships, respectively. Additionally, subgroup and sensitivity analyses were conducted to verify the robustness of the associations.</div></div><div><h3>Results</h3><div>In our cohort, elevated PNI was associated with significantly lower risks of all-cause mortality (Hazard Ratio [HR]: 0.53, 95 % Confidence Interval [CI]: 0.37–0.75, <em>p</em> &lt; 0.001) and cardiovascular mortality (HR: 0.60, 95 % CI: 0.38–0.94, <em>p</em> = 0.028). Similarly, higher ALI levels correlated with a reduced risk of all-cause mortality (HR: 0.53, 95 % CI: 0.37–0.72, <em>p</em> &lt; 0.001), though its impact on cardiovascular mortality did not reach statistical significance after adjustment. Subgroup analysis revealed that gender, age, and diabetes status modulated the relationship between PNI/ALI and mortality outcomes, with significant interactions observed especially in diabetic patients (PNI: P for interaction = 0.025 and ALI: P for interaction = 0.007).</div></div><div><h3>Conclusions</h3><div>This study confirms that higher PNI and ALI are associated with lower all-cause mortality in stroke survivors. Elevated PNI also reduces cardiovascular mortality risk. Gender, age, and diabetes status influence these associations. These findings highlight the importance of monitoring nutritional and inflammatory status in stroke recovery.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108334"},"PeriodicalIF":2.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912068","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 factors for recanalization after coil embolization for cerebral aneurysms: importance of the first coil and prediction model","authors":"Ken Aoki ,&nbsp;Hiroyasu Nagashima ,&nbsp;Yuichi Murayama","doi":"10.1016/j.jstrokecerebrovasdis.2025.108333","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108333","url":null,"abstract":"<div><h3>Background</h3><div>Endovascular coil embolization for cerebral aneurysms is a well-established treatment; however, postoperative recanalization remains a risk. This study aimed to clarify risk factors for cerebral aneurysm recanalization after coil embolization and to develop a predictive model for assessing risks.</div></div><div><h3>Methods</h3><div>This retrospective study included patients with cerebral saccular aneurysms who underwent initial coil embolization at our hospital in Tokyo, Japan between 2012 and 2023. The following cases were excluded: follow-up of &lt;1 year, re-treatment and use of bioactive coils. Outcomes included aneurysm characteristics and postoperative Raymond–Roy Occlusion Classification (RROC). Univariate and multivariate Cox proportional hazards models were used to identify independent predictors. A simplified risk score was constructed using LASSO logistic regression and β-coefficients from multivariable analysis. Internal validity was assessed by bootstrap resampling. External validation was performed using an independent cohort and model performance was evaluated in terms of discrimination and calibration.</div></div><div><h3>Results</h3><div>Among the 150 patients with aneurysms, 79 were analyzed after applying exclusion criteria. Multivariate analysis identified four independent predictors of recanalization: rupture status, aneurysm size ≥7 mm, RROC without class I, and first volume embolization ratio &lt;8 %. These variables were incorporated into an integer-based risk score ranging from 0 to 7. The model demonstrated strong discrimination in the internal validation cohort (C-statistic: 0.89), which remained acceptable in the external validation cohort (C-statistic: 0.81, 95 % CI: 0.74–0.89). Risk stratification showed increasing recanalization rates of 1.8 %, 13.5 %, and 41.5 % in low- (0–2), intermediate- (3–4), and high-risk (5–7) groups, respectively. Calibration in the external cohort showed slight overestimation of risk in high-score patients.</div></div><div><h3>Conclusion</h3><div>This study identified four significant risk factors for recanalization after coil embolization and proposed a practical, externally validated risk score. The model provides clinically relevant risk stratification and may support individualized follow-up strategies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 7","pages":"Article 108333"},"PeriodicalIF":2.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902122","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}