Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Efficacy of high-frequency peripheral magnetic stimulation in treating patients with persistent hiccups post-stroke: A retrospective study","authors":"Fengxia Zhang ,&nbsp;Yuexiu Lei ,&nbsp;Zhan Zhang","doi":"10.1016/j.jstrokecerebrovasdis.2025.108262","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108262","url":null,"abstract":"<div><h3>Background</h3><div>This study retrospectively evaluated the efficacy and safety of peripheral magnetic stimulation for treating persistent hiccups in patients after stroke.</div></div><div><h3>Methods</h3><div>In this retrospective study, we categorized patients with persistent hiccups post-stroke admitted to the Rehabilitation Medicine Department of Wuhan University People's Hospital between May 2022 to August 2023 into two groups. The experimental group received 10 Hz peripheral magnetic stimulation targeting the phrenic nerve, whereas the control group received a daily intramuscular injection of 10 mg metoclopramide. Treatment efficacy over a 3-day period, hiccup scores before and after treatment, and overall clinical efficacy were compared between the two groups.</div></div><div><h3>Results</h3><div>Seventeen patients diagnosed with persistent hiccups post-stroke were included, with nine in the control group and eight in the experimental group. There were no significant differences between the two groups in terms of the number of hiccups, hiccup scores, or age prior to treatment. After 3 days of treatment, the clinical efficacy was 55.56 % for the control group and 100 % for the experimental group (<em>P</em> = 0.01). Three patients in the control group experienced adverse reactions, whereas no adverse reactions were observed in the experimental group (<em>P</em> = 0.036).</div></div><div><h3>Conclusions</h3><div>High-frequency peripheral magnetic stimulation may be more effective and associated with fewer adverse effects than metoclopramide injections for patients with intractable post-stroke hiccups. Our findings suggest a novel therapeutic strategy for managing persistent hiccups following a stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108262"},"PeriodicalIF":2.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470001","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":"Association between fibrinogen and cognitive impairment in patients with ischemic cerebrovascular disease","authors":"Keying Wu ,&nbsp;Jing Wang ,&nbsp;Xiuwen Li PhD ,&nbsp;Zhiyao Xin MD ,&nbsp;Wanxin Wang PhD ,&nbsp;Lan Guo PhD ,&nbsp;Fenfen He PhD ,&nbsp;Bin Jiang MD ,&nbsp;Chenyao Kang MD ,&nbsp;Yunliang Xie MD ,&nbsp;Qian Li MD ,&nbsp;Xiaojie Wang MD ,&nbsp;Ciyong Lu PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108227","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108227","url":null,"abstract":"<div><h3>Objectives</h3><div>Fibrinogen has been reported as a potential risk factor for vascular dementia (VaD). However, the association between fibrinogen and cognition in patients with ischemic cerebrovascular disease (ICVD) has not been studied adequately. We aimed to examine the association of fibrinogen with cognitive impairment among patients with ICVD and to test whether white matter hyperintensities (WMH) and brain atrophy play a role under the association.</div></div><div><h3>Methods</h3><div>In this case-control study, ICVD patients were recruited from the Neurology Department. Cognitive function was assessed using the Montreal Cognitive Assessment. WMH and brain atrophy were quantified by brain magnetic resonance imaging (MRI). The associations of fibrinogen with cognition and MRI markers were investigated by conditional logistic regression models and generalized additive models.</div></div><div><h3>Results</h3><div>The risk of cognitive impairment increased with each unit increase in fibrinogen (<em>AOR</em> = 1.92, 95 % <em>CI</em> = 1.06 - 3.48). Individuals with fibrinogen levels &gt; 4 g/L presented a substantially higher risk of cognitive impairment than those with fibrinogen levels of 2-4 g/L (<em>AOR</em> = 5.72, 95 % <em>CI</em> = 1.22- 26.82). Fibrinogen was negatively correlated with global cognitive function (<em>r_s</em> = -0.235) and visuospatial/executive function (<em>r_s</em> = -0.251). A negative correlation between fibrinogen and normal-appearing white matter (NAWM) volume was observed (<em>r_s</em> = -0.282).</div></div><div><h3>Conclusions</h3><div>Fibrinogen is associated with cognitive impairment among patients with ICVD, and significantly negatively impacts global cognitive function and visuospatial/executive function. Furthermore, the negative correlation between fibrinogen and NAWM volume supports further exploration of potential mechanistic paths.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108227"},"PeriodicalIF":2.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426644","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":"Vertebral artery involvement in giant cell arteritis: Symptoms, treatment and outcome","authors":"Johann Lambeck ,&nbsp;Axel Schläger ,&nbsp;Nils Venhoff ,&nbsp;Cornelius Weiller ,&nbsp;Christoph Strecker ,&nbsp;Matthias Reinhard","doi":"10.1016/j.jstrokecerebrovasdis.2025.108260","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108260","url":null,"abstract":"<div><h3>Background</h3><div>Giant cell arteritis (GCA) of the vertebral artery (VA) is a rare but serious cause of ischemic stroke, however, the long-term clinical and sonographic course of GCA patients with VA involvement (VA+) is poorly understood.</div></div><div><h3>Methods</h3><div>All patients with suspected GCA who were consecutively referred to our ultrasound (US) lab over a 12-year-period were analyzed. US examination (GCA-specific) of the cranial and cervical arteries was performed. Patients with a positive US diagnosis of GCA were identified, and further analysis was restricted to VA+ patients. Follow-up data were extracted from our hospital database.</div></div><div><h3>Results</h3><div>Among the 785 patients screened for GCA, 220 showed typical US-based findings for GCA, 74 (34 %) of whom were VA+. Fourteen VA+ patients (19 %) had vertebrobasilar ischemia at presentation (11 stroke, 3 TIA). Cerebral ischemia was more frequent in patients with severe compared to moderate VA occlusive disease (35 % vs 9 %; <em>p</em> = 0.0099, OR = 5.39, 95 % CI 1.50–9.42). Two patients died from severe initial stroke. Follow-up data were available for 34 VA+ patients (46 % of all VA+ patients; median period, 740 days), where 13 (38 %) displayed stable US alterations to the VA, 14 (41 %) a regression and 7 (21 %) a progression of stenosis. Four patients (12 %) had vertebrobasilar re-stroke, 3 of them within 30days of treatment initiation.</div></div><div><h3>Conclusion</h3><div>One-third-of patients with cranial GCA were VA+, 19 % of whom had vertebrobasilar stroke, of which most had severe VA occlusive disease. Significant rates of stenosis progression and recurrent stroke therefore call for early intensive immunosuppressive treatment.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 4","pages":"Article 108260"},"PeriodicalIF":2.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394630","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":"Exploring the bidirectional relationships between alzheimer's disease and cerebral small vessel disease: Insights from mendelian randomization","authors":"Jihong Shang MD,&nbsp;Tian Liu MD,&nbsp;Wen Gong MD,&nbsp;Ying Zhao MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108259","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108259","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to elucidate the bidirectional causal relationships between Alzheimer's disease (AD), cerebral small vessel disease (CSVD), and the effect of inflammatory cytokines on AD and CSVD using Mendelian randomization (MR).</div></div><div><h3>Method</h3><div>We employed publicly available summary-level data from genome-wide association studies for AD, CSVD, and 91 inflammatory cytokines. Genetic variants strongly associated with each risk factor were selected as instrumental variables. The inverse variance weighted (IVW) method was primarily used for causal inference, with sensitivity analyses including MR-Egger and weighted median estimators.</div></div><div><h3>Results</h3><div>MR analysis revealed that genetically predicted CSVD significantly increased the risk of AD (odds ratio [OR] = 1.035, 95% CI, 1.015–1.056, P = 0.001). Conversely, AD did not significantly influence CSVD risk (OR = 0.878, 95% CI, 0.701–1.100, P = 0.257). Among inflammatory cytokines, Axin1 (OR = 1.082, 95% CI, 1.009–1.159, P = 0.026) and bNGF (OR = 1.061, 95% CI, 1.001–1.125, P = 0.048) increased AD risk, while CD5 (OR = 0.937, 95% CI, 0.887–0.991, P = 0.022) and CXCL11 (OR = 0.951, 95% CI, 0.912–0.992, P = 0.019) decreased AD risk. FGF19 (OR = 0.560, 95% CI, 0.405–0.773, P &lt; 0.001) and TNFSF14 (OR = 0.744, 95% CI, 0.580–0.954, P = 0.020) were protective against CSVD.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that CSVD may increase AD risk, while specific inflammatory cytokines exhibit differential associations with these conditions. Targeting vascular health and inflammation may offer promising therapeutic avenues for managing neurodegenerative diseases.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 4","pages":"Article 108259"},"PeriodicalIF":2.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392417","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":"Survey on neurological monitoring practices and clinician perspectives in acute stroke care","authors":"Alison McLoughlin ,&nbsp;Caroline Watkins ,&nbsp;Philippa Olive ,&nbsp;Christopher Price ,&nbsp;Catherine Elizabeth Lightbody","doi":"10.1016/j.jstrokecerebrovasdis.2025.108247","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108247","url":null,"abstract":"<div><h3>Aims</h3><div>To examine current practice and views regarding neurological assessment and monitoring across stroke services in the United Kingdom.</div></div><div><h3>Methods</h3><div>A cross-sectional survey of UK secondary care stroke services was conducted between December 2019 and September 2021.</div></div><div><h3>Results</h3><div>The response rate was 80 % (<em>n</em> = 125/156 services). Glasgow Coma Scale was the most frequently used routine neurological assessment (96 %). Variation in frequency, duration and response to monitoring was evident across all stroke types. Medical escalation was the most frequent response to neurological deterioration (99 %). Respondents acknowledged the importance of neurological monitoring, inadequacies of common tools, and supported further work to improve assessments and response protocols.</div></div><div><h3>Conclusion</h3><div>The extent of variation in clinical practice of neurological assessment and monitoring across the UK was unknown. Variation was found to be greater than anticipated. There is a need, and desire for, stroke type scenario-specific monitoring and standardised response guidance in acute stoke care. Introducing standardised care in this area would strengthen clinical protocols and could remove unwarranted variation in patient care ultimately improving outcomes.</div></div><div><h3>Funding</h3><div>Alison McLoughlin, Doctoral Research Fellow DRF-2018-11-ST2-074 was funded by the National Institute for Health and Care Research (NIHR) for this research. Some of the authors are funded by the NIHR Applied Research Collaboration North West Coast. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108247"},"PeriodicalIF":2.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392419","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":"Evaluating the strengths and limitations of structured modified rankin scale validation studies – A systematic review","authors":"Shuait Nair BSFS,&nbsp;Jordyn Hurly BS,&nbsp;Deanna Saylor MD MHS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108242","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108242","url":null,"abstract":"<div><h3>Background</h3><div>Variations in performance of structured modified Rankin Scale (mRS) questionnaires in people with stroke within different cultural and language settings have not been systematically assessed. We systematically reviewed all studies of structured mRS questionnaires compared to in-person unstructured mRS evaluation scores.</div></div><div><h3>Methods</h3><div>We searched PubMed and Web of Science for studies that evaluated structured mRS questionnaires against in-person unstructured mRS evaluations among people with stroke. Studies were analyzed for country of investigation, mRS self-assessment modality, care setting (inpatient vs outpatient), concordance between structured and unstructured mRS scores, and risk of bias.</div></div><div><h3>Results</h3><div>We identified 13 structured mRS questionnaire validation studies across all continents except Africa. The telephone mRS questionnaire was most commonly used. Average time between unstructured and structured assessments was 14 days. The weighted kappa agreement between structured and in-person unstructured scores ranged from moderate to very good (K<em>_w</em> range: 0.56-0.90), though unweighted kappa scores were significantly lower (K range: 0.27-0.68). Discrepancies between structured and in-person unstructured scores tended to result from patients at the scale extremes. Patients with good mRS outcomes (mRS ≤2) tended to rate themselves better on structured questionnaires than their clinicians rated them on unstructured evaluations while those with poor outcomes (mRS ≥3) tended to rate themselves worse than their clinicians. Major limitations across studies included sampling bias in inpatient settings, time delays between in-person unstructured and structured mRS assessments, and differences in the formatting of unstructured mRS assessments.</div></div><div><h3>Conclusion</h3><div>While structured mRS questionnaire validation studies have generally displayed good agreement with in-person unstructured outcomes, significant discrepancies exist for patients with very poor and very good outcomes. Future studies should limit time between mRS assessments and better understand reasons for differences in structured and unstructured assessments. Further, data on validity of structured mRS tools are lacking from much of the world, especially Africa.</div></div><div><h3>Primary Funding</h3><div>1K01TW011771-01A1 (Saylor)</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108242"},"PeriodicalIF":2.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374931","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":"Direct oral anticoagulants compared to aspirin for embolic stroke of undetermined source: A comprehensive meta-analysis","authors":"Natalia Arturo M.D. ,&nbsp;Aishwarya Koppanatham M.B.B.S. ,&nbsp;Paweł Chochoł M.D. ,&nbsp;Aisha Rizwan Ahmed M.B.B.S. ,&nbsp;Andrei V. Alexandrov MD ,&nbsp;Thomas C. Varkey M.D, M.B.A, M.Ed","doi":"10.1016/j.jstrokecerebrovasdis.2025.108256","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108256","url":null,"abstract":"<div><h3>Background</h3><div>The use of anticoagulation for stroke prevention in embolic stroke of undetermined source (ESUS) is hypothesized to be beneficial over conventional antiplatelet use. However, randomized controlled trials (RCTs) have not found clear benefits, even when assessing cardioembolic <em>enriching</em> features. This study aimed to perform a meta-analysis exploring the efficacy and safety of direct oral anticoagulants (DOACs) following ESUS.</div></div><div><h3>Methods</h3><div>PubMed, Scopus, and Cochrane Central were systematically searched for studies comparing DOACs versus aspirin after ESUS. The primary outcome was stroke recurrence, and the safety outcome was major bleeding. A random-effects model was used for the analyses. Statistical analysis was performed using Review Manager Web 8.0.0 (RevMan Web).</div></div><div><h3>Results</h3><div>14,582 patients were included from 9 studies, of which 4 were RCTs. 7,341 (50.3 %) received DOACs as secondary prevention. For stroke recurrence, there was noted non-statistically significant trends towards benefit for DOACs (OR 0.93; 95 % CI 0.81–1.06; <em>p</em> = 0.29; I² = 34 %). No differences were found for major bleeding (HR 1.57; 95 % CI 0.86–2.86; <em>p</em> = 0.15; I² = 63 %). Among the atrial cardiomyopathy subgroup, no benefit was observed (OR 0.88; 95 % CI 0.50–1.55; <em>p</em> = 0.67; I² = 39 %).</div></div><div><h3>Conclusion</h3><div>There is insufficient evidence to recommend the use of DOACs over aspirin following ESUS for the prevention of stroke recurrence. Nevertheless, the fears of increased bleed risks were also not seen. Further efforts should be directed towards identifying potential embolic sources and the population that benefit from OAC.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 4","pages":"Article 108256"},"PeriodicalIF":2.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349125","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":"Quality indicators of stroke care in Colombia based on the RES-Q registry","authors":"Hernán Bayona ,&nbsp;Pablo Amaya ,&nbsp;José Luis Bustos ,&nbsp;Liliana M Giraldo-Tapias ,&nbsp;Andrés Betancourt ,&nbsp;Catalina Vallejo ,&nbsp;Julián Rivillas ,&nbsp;Natalia Llanos-Leyton ,&nbsp;Katherine Mantilla ,&nbsp;Tony Fabián Álvarez ,&nbsp;Carlos Martinez ,&nbsp;Jaime Eduardo Rodriguez Orozco ,&nbsp;Claudio Jimenez ,&nbsp;Javier Torres ,&nbsp;Carolina Isaza ,&nbsp;Juliana Coral ,&nbsp;H. Mauricio Patiño-Rodriguez ,&nbsp;Hugo Macareno ,&nbsp;Daniel Mantilla ,&nbsp;Ángel Basilio Corredor-Quintero ,&nbsp;Mario Muñoz-Collazos","doi":"10.1016/j.jstrokecerebrovasdis.2025.108249","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108249","url":null,"abstract":"<div><h3>Objectives</h3><div>This study seeks to outline the epidemiological patterns and quality of care indicators of ischemic stroke in Colombia. It serves as a pioneering effort, offering crucial national-level insights to inform evidence-based stroke policies in Colombia.</div></div><div><h3>Materials and Methods</h3><div>Using data from the Registry of Stroke Care-Quality (RES-Q) spanning the years 2017 to 2021, a multicenter descriptive study was conducted in Colombia. A survival analysis using Kaplan-Meier curves was planned for the time from symptom onset to hospital arrival, hospital stay and mortality, stratified by pre-established geographic regions.</div></div><div><h3>Results</h3><div>A total of 7,963 patients were included in 4 geographic regions: Amazon, Andean, Caribbean and Pacific. The main data provider was the Andean region with 6,402 patients (80.3 %). 49 % were women. The median age was 72 years (IQR 61-81). The NIHSS scale was a median of 7 IQR (3-15). 14.5 % (994) received intravenous thrombolysis therapy. The door to needle time was 53 min IQR (36-70). 53 % were hospitalized in a standard bed, 41 % in intensive care/stroke unit. 33.4 % patients had a Rankin score at discharge between 0-2.</div></div><div><h3>Conclusion</h3><div>First study conducted using RES-Q data at the national level in Colombia. A reduction of door-to-needle times by at least 50 % compared to historical levels is evident. Low reperfusion rates persist. Secondary prevention measures are needed with the implementation of national stroke policies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108249"},"PeriodicalIF":2.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374935","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":"Female Sex is associated with reduced thrombolytic administration in an Australian Stroke Cohort: A multicentre retrospective cohort study","authors":"Rudy Goh ,&nbsp;Felix Ng ,&nbsp;Jim Jannes ,&nbsp;Timothy Kleinig ,&nbsp;Annabel Sorby-Adams ,&nbsp;Britt Suann ,&nbsp;Stephen Bacchi","doi":"10.1016/j.jstrokecerebrovasdis.2025.108255","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108255","url":null,"abstract":"<div><h3>Background</h3><div>Female patients with AIS may not receive thrombolytic equitably.</div></div><div><h3>Aims</h3><div>We examined whether there were sex differences in the likelihood of receiving thrombolytic in South Australian AIS patients.</div></div><div><h3>Methods</h3><div>In a retrospective cohort study, consecutive patients admitted to metropolitan stroke units within South Australia between January 2019 to December 2023 with AIS without contraindication to thrombolytic were included. Multivariable logistic regression was used to determine the relevance of demographic, clinical, imaging and service delivery parameters associated with intravenous thrombolytic non-administration.</div></div><div><h3>Results</h3><div>A total of 3484 patients were included (1519 (43.59 %) female), of whom 744 (21.35%), including 304 (20.01%) females and 440 (22.39%) males received intravenous thrombolytic. A trend towards thrombolytic non-administration was observed in females during univariate analysis (OR 1.15, 95% CI 0.98-1.36, <em>p=</em>0.09). Female sex was associated with reduced odds of receiving thrombolytic in multivariate analysis (aOR 1.38, 95% CI 1.09-1.59). Other major factors associated with not receiving thrombolysis included lack of code stroke activation (OR 20.43, 95% CI 9.19-58.09), symptom onset-to-door time above 4.5 hours (OR 5.89, 95% CI 3.90-9.28), ‘wake up’ stroke (OR 3.72, 95% CI 2.90-4.82), in hospital stroke (OR 3.13, 95% CI 1.48-7.47), NIHSS below 5 (OR 2.61, 95% CI 2.05-3.33) and CT perfusion not performed (OR 2.58, 95% CI 1.76-3.87. Mediation analysis demonstrated a significant partial mediation effect of female sex on thrombolytic non-administration via CT perfusion imaging non-performance.</div></div><div><h3>Conclusion</h3><div>This study identified female sex was associated with a reduced likelihood of receiving thrombolytic in AIS. Further studies to determine the reason for these disparities are required.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 4","pages":"Article 108255"},"PeriodicalIF":2.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143304026","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":"Suboptimal medication possession ratio is associated with recurrent ischemic stroke in a veteran population","authors":"Kyle C. Kern MD MS ,&nbsp;Alexander Crossley MPH ,&nbsp;Naomi Wu PharmD ,&nbsp;Katherine T. Mun MD ,&nbsp;Sunita Dergalust PharmD ,&nbsp;Jason D. Hinman MD PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108257","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108257","url":null,"abstract":"<div><h3>Objectives</h3><div>Recurrent stroke results in higher disability and mortality but might be mitigated through interventions that improve medication adherence. The medication possession ratio (MPR) is an objective proxy for adherence that may provide an individualized risk assessment for recurrent stroke.</div></div><div><h3>Methods</h3><div>This is a retrospective, longitudinal cohort study of patients with recent ischemic stroke or TIA referred to a Veterans Affairs vascular neurology outpatient clinic between 2010 and 2016. We calculated average MPR quartile for four medication classes used for secondary stroke prevention by reviewing pharmacy and medical records following an incident cerebral ischemic event. Traditional stroke risk factors were quantified using the Framingham Stroke Risk Profile (FSRP) score. We hypothesized that lower average MPR would relate to higher recurrent stroke risk more than FSRP or stroke etiological classification.</div></div><div><h3>Results</h3><div>For 255 patients with stroke or TIA, 57 (22.4 %) patients had recurrent stroke during a median follow-up period of 5.0 years (IQR 2.0). Compared to optimal average MPR, each quartile lower average MPR was associated with higher cumulative incidence of recurrent stroke (subhazard ratio 1.63, 95 %CI: 1.24 to 2.14, p&lt;0.001) while accounting for the competing risk of death and covarying for FSRP. Neither FSRP nor stroke etiology were associated with recurrent stroke. However, higher baseline systolic blood pressure starting at 132 mm Hg was independently associated with stroke recurrence.</div></div><div><h3>Conclusions</h3><div>MPR is an effective proxy measurement to assess risk of recurrent stroke. Systems-based and individualized interventions to improve medication adherence are needed to reduce recurrent stroke rates in VA populations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 4","pages":"Article 108257"},"PeriodicalIF":2.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374937","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}