Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"The role of intravenous tirofiban in patients undergoing endovascular treatment for acute intracranial atherosclerotic occlusion","authors":"Zhiping Bu MD ,&nbsp;Dapeng Sun MD ,&nbsp;Xiaoli Zhang PhD ,&nbsp;Ning Ma MD ,&nbsp;Feng Gao MD ,&nbsp;Dapeng Mo MD ,&nbsp;Qingwei Meng MD ,&nbsp;Zhongrong Miao MD ,&nbsp;ANGEL-ACT study group","doi":"10.1016/j.jstrokecerebrovasdis.2025.108420","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108420","url":null,"abstract":"<div><h3>BACKGROUND AND PURPOSE</h3><div>Previous reports regarding the impact of tirofiban on patients undergoing endovascular treatment for acute ischemic stroke have shown inconsistencies. In this study, we specifically focused on patients with intracranial atherosclerotic disease to evaluate the effectiveness and safety of intravenous tirofiban during endovascular treatment.</div></div><div><h3>METHODS</h3><div>The participants were sourced from the ANGEL-ACT Registry (a prospective multicenter registry study focused on key endovascular treatment techniques and emergency workflow improvement for acute ischemic stroke) and categorized into two groups. The treatment group (IV-tirofiban group, n=254) underwent continuous intravenous administration of tirofiban, whereas the control group (No IV-tirofiban group, n=248) did not receive intravenous tirofiban. A 1:1 propensity score matching (PSM) was subsequently conducted between the two groups. We compared the outcomes between the two groups in both the pre-matched and post-matched populations.</div></div><div><h3>RESULTS</h3><div>The median (interquartile range [IQR]) of 90-day modified Rankin Scale (mRS) score was 3 (0-5) in the control group and 1 (0-4) in the IV-tirofiban group. The adjusted common odds ratio (OR) for the ordinal distribution of the 90-day mRS was 1.61 (95% CI, 1.12-2.31; P=0.010). The rates of excellent outcomes were 42.3% in the control group and 50.4% in the IV-tirofiban group, with an adjusted OR of 1.59 (95% CI, 1.04-2.42; P=0.032). The rates of functional independence were 44.0% in the control group and 53.5% in the IV-tirofiban group, with an adjusted OR of 1.72 (95% CI, 1.13-2.63; P=0.012). The rates of complete recanalization were 52.4% in the control group and 65.4% in the IV-tirofiban group, with an adjusted OR of 1.58 (95% CI, 1.04-2.40; P=0.033). In the analysis of post-matched outcomes, only the outcome of complete recanalization rates differed between the two groups, with an OR of 1.79 (95% CI, 1.09-2.97; P=0.023).</div></div><div><h3>Conclusion</h3><div>The use of intravenous tirofiban as an adjunctive treatment can potentially improve the prognosis of patients undergoing endovascular treatment for intracranial atherosclerotic large vessel occlusion.</div><div>Clinical Trial Registration-URL: <span><span>http://www.clinicaltrials.gov</span><svg><path></path></svg></span>. Unique identifier: NCT03370939.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 10","pages":"Article 108420"},"PeriodicalIF":1.8,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850349","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":"Ischemic stroke in the context of high low-density lipoprotein cholesterol: A 30-year global burden perspective of 204 nations","authors":"Jiling Zhang ,&nbsp;Qiang Zhang ,&nbsp;Xing Wang ,&nbsp;Baodong Wang ,&nbsp;Jingjing Zhou ,&nbsp;Yandan Wu","doi":"10.1016/j.jstrokecerebrovasdis.2025.108418","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108418","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;High levels of low-density lipoprotein cholesterol (LDL-C) have a substantial impact on the onset and progression of ischemic stroke. However, the impact of high LDL-C level on ischemic stroke burden remains to be comprehensively investigated at the global, regional, and national levels. This study aimed to fill this gap by analyzing the trends of ischemic stroke associated with high LDL-C level from 1990 to 2021 using data obtained from the 2021 Global Burden of Disease (GBD) study to provide scientific evidence for policy-making and public health decision-making.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This population-based observational study used epidemiological data on ischemic stroke associated with high LDL-C level from the GBD 2021 study. The disability-adjusted life years (DALYs) and mortality data related to high LDL-C level were stratified by age, sex, country, and the Sociodemographic Index (SDI). The trends of ischemic stroke associated with high LDL-C level from 1990 to 2021 were evaluated using the estimated annual percentage change (EAPC). Hierarchical clustering analysis was conducted to evaluate the burden differences of high-LDL-C–related ischemic stroke across GBD regions. In addition, the Bayesian Age–Period–Cohort (BAPC) model was applied to predict the trends of high-LDL-C–related ischemic stroke for different sexes from 2022 to 2036.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The number of DALYs caused by high-LDL-C–related ischemic stroke increased by 44.55 % globally, rising from 14,512,489.6 in 1990 to 20,977,423.91 in 2021. However, during the same period, the age-standardized DALY rate (ASDR) decreased from 390.89 per 100,000 population to 246.42, with a global EAPC of −1.72 (95 % uncertainty interval [UI] −1.82 to −1.63), which is consistent with the trend of age-standardized mortality rate (ASMR). The number of DALYs and deaths in regions with high-SDI exhibited a downward trend. As the SDI decreased, the age group with the highest number of deaths gradually shifted toward younger ages. The regions with increasing burden included Southern Sub-Saharan Africa, whereas those with substantial declines included high-income regions, such as Asia Pacific, Western Europe, and Australasia. In 2021, North Macedonia demonstrated the highest ASDR. Among countries, Portugal (EAPC of −6.18) and Singapore (EAPC of −6.88) had the most considerable declines. However, a few countries, such as Lesotho, saw an increase in disease burden (EAPC of 2.5). From 2022 to 2036, the ASDR and ASMR of high-LDL-C–related ischemic stroke are projected to significantly decrease for both men and women.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;High LDL-C levels are a significant risk factor for ischemic stroke. From 1990 to 2021, the ASDR and ASMR of ischemic stroke caused by high LDL-C level have exhibited a global downward trend, which is projected to continue in the future. However, owing to population aging, the absolute burden ","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 10","pages":"Article 108418"},"PeriodicalIF":1.8,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805582","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":"Tenecteplase in practice: A rural tele-stroke network’s experience","authors":"Alexander Vorobyev MD (Neurology Chief Resident) ,&nbsp;Marina Buciuc MD, MS (Neurology Resident) ,&nbsp;Kevin Jacks BSN, MPA (Stroke Program Analyst) ,&nbsp;Christina E. Blake BSN, RN, SCRN (Cerebrovascular Program System Director) ,&nbsp;Marrissa Cobiella (Stroke Program Coordinator) ,&nbsp;Sami Al Kasab MD (Associate Professor of Neurology) ,&nbsp;Christine A. Holmstedt DO (Professor of Neurology) ,&nbsp;Ghada A. Mohamed MD, MSc, MSCR (Assistant Professor of Neurology)","doi":"10.1016/j.jstrokecerebrovasdis.2025.108416","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108416","url":null,"abstract":"<div><h3>Background</h3><div>Alteplase (tPA) and Tenecteplase (TNK) are both FDA-approved thrombolytic agents for acute ischemic stroke (AIS) treatment. While TNK showed efficacy and safety in the randomized clinical trials, its real-world utilization and effectiveness in rural populations remain key areas for post-approval evaluation. In August 2023 our academic institution, serving as a statewide telestroke network hub, implemented a system-wide transition from tPA to TNK. This study explores the real-world experience of this transition within a telestroke network in rural South Carolina.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed data from the Medical University of South Carolina (MUSC) Telestroke Network (1 Hub, 16 spoke centers) on patients with confirmed AIS who received thrombolytics between 2022 and 2024. We compared outcomes between patients treated with tPA or TNK and performed subgroup analyses for LVO and spoke center patients. The analysis focused on safety, efficiency metrics, and functional outcomes. Categorical and continuous variables were assessed using Fisher’s exact and Wilcoxon rank-sum tests (<em>p</em> &lt; 0.05).</div></div><div><h3>Results</h3><div>Among 1644 patients with discharge diagnosis of AIS, 302 (18 %) received thrombolytics: TNK (<em>n</em> = 144, 47.7 %) and tPA (<em>n</em> = 158, 52.3 %). Median door-to-needle times were similar (TNK 45 min vs. tPA 42 min, <em>p</em> = 0.6). No statistical differences were observed in symptomatic hemorrhage (4.2 % vs. 1.9 %, <em>p</em> = 0.32), discharge NIHSS, or hospital length of stay. Outcomes at spoke centers were comparable. In LVO transferred patients and treated at the hub, TNK was associated with fewer mechanical thrombectomy passes (median 1 vs. 2, <em>p</em> = 0.046) and higher rates of functional independence at discharge (mRS ≤3: 75.4 % vs. 54.4 %, <em>p</em> = 0.02).</div></div><div><h3>Conclusions</h3><div>The system-wide transition to TNK resulted in similar safety profiles and treatment times, with notable improvements in procedural efficiency and functional outcomes for patients with LVO. These findings support the broader adoption of TNK as a viable alternative to tPA in acute ischemic stroke management, particularly in telestroke networks and rural communities where staffing and infrastructure may be constrained.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 10","pages":"Article 108416"},"PeriodicalIF":1.8,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805584","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":"Stroke and cervical artery dissection and/or aneurysm: 2019-2021 Chilean hospital-based national registry","authors":"Ma Ignacia Allende ,&nbsp;Paula Munoz Venturelli ,&nbsp;Enrico Mazzon ,&nbsp;Alejandro Brunser ,&nbsp;Iris Delgado ,&nbsp;Boris Rebolledo","doi":"10.1016/j.jstrokecerebrovasdis.2025.108417","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108417","url":null,"abstract":"<div><h3>Background</h3><div>Cervical artery dissection is one of the main causes of stroke in young adults, yet the characteristics of patients have been mainly described in Caucasian populations. We aimed to identify patients’ characteristics associated with stroke among cervical artery dissection patients in Chile.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of a national hospital-based database in Chile between 2019 and 2021. Patients with cervical artery dissection or aneurysm (CeDA) were identified using ICD-10 codes I72.0 (carotid artery) and I72.6 (vertebral artery); stroke events were classified using codes I60–I64. We performed multivariable logistic regression to evaluate the association between patients’ characteristics and stroke occurrence. We further performed Poisson regression to assess the impact of the coronavirus pandemic on CeDA admissions.</div></div><div><h3>Results</h3><div>Of 2,647,398 hospital discharges, we identified 597 CeDA patients (mean [SD] age 57 [15] years; female 384, 64 %). Stroke occurred in 233 (37 %) patients, with ischaemic stroke accounting for 71 % of these events. In the multivariable analysis, stroke occurrence was associated with vertebral artery involvement (OR 2.89; 95 %CI 1.76-4.77), atrial fibrillation (2.25; 1.03-4.90), hypertension (1.85; 1.25-2.74), male sex (1.80; 1.24-2.62) and current smoking (1.78; 1.13-2.80). Hospital admissions for CeDA declined in 2020 (rate ratio [RR] 0.69; 95 %CI 0.57–0.85) and 2021 (0.76; 0.63–0.92), compared with 2019.</div></div><div><h3>Conclusions</h3><div>In this Chilean hospital-based database, stroke occurrence among CeDA patients was linked to male sex, vertebral artery involvement, hypertension, current smoking, and atrial fibrillation. Further research is needed to understand the underlying mechanisms and its association with patient prognosis.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 10","pages":"Article 108417"},"PeriodicalIF":1.8,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805583","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":"Discrimination of ischemic versus hemorrhagic stroke type by presenting symptoms or signs: A systematic review and meta-analysis","authors":"Clodagh M McDermott MSc ,&nbsp;Allie Seminer ,&nbsp;Sinéad Comer ,&nbsp;Alfredi Mulihano ,&nbsp;Catriona Reddin MSc ,&nbsp;Conor Judge PhD ,&nbsp;Maria Costello PhD ,&nbsp;Michelle Canavan PhD ,&nbsp;Andrew Smyth PhD ,&nbsp;Paul Hurley PhD ,&nbsp;Finn Krewer PhD ,&nbsp;Martin J O’Donnell PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108413","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108413","url":null,"abstract":"<div><h3>Background</h3><div>Valid discrimination of ischemic and hemorrhagic stroke relies exclusively on neuroimaging. Novel biomarkers in acute stroke present an opportunity to reconsider combination diagnostic approaches with standardized clinical assessment. Our systematic review evaluates diagnostic properties of acute clinical features in determining primary stroke etiology.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and meta-analysis according to PRISMA guidelines. PubMed and EMBASE were searched from inception to 6^th March 2025. Eligibility criteria included cohort, cross-sectional, case-control, or randomised controlled trial; consecutive adults with an acute stroke confirmed by neuroimaging; and one or more acute stroke symptom(s) or sign(s) recorded by stroke subtype. A random-effects model was used to pool odds ratios.</div></div><div><h3>Results</h3><div>A total of 60 studies, (<em>n</em> = 12,879,006; ischemic stroke = 10,814,474; hemorrhagic stroke = 2,064,532), were eligible. Mean age was 70.45 ± 14.36 years and 51.9 % were women. Clinical presenting symptoms/signs associated with significantly higher odds of hemorrhagic stroke (compared to ischemic stroke) included coma (odds ratio 8.81 [95 % confidence interval, 5.02–15.45]), neck stiffness (5.21 [2.22–12.21]), Glasgow Coma Scale ≤8 (4.37 [2.35–8.16]), vomiting (3.86 [2.71–5.49]), altered consciousness (3.55 [2.55–4.95]), headache (3.49 [2.63–4.64]), syncope (2.74 [1.96–3.83]), seizure (2.67 [1.72–4.15]), abnormal plantar response (1.94 [1.24–3.04]) and vertigo/dizziness (1.32 [1.04–1.68]). Clinical symptoms/signs associated with significantly lower odds of hemorrhagic stroke included morning onset (0.41 [0.32–0.54]), facial weakness (0.66 [0.46–0.94]), hemiplegia (0.68 [0.50–0.91]), and ataxia (0.73 [0.61–0.86]).</div></div><div><h3>Conclusion</h3><div>Our review reports substantive differences in prevalence of stroke symptoms and signs between ischemic and hemorrhagic stroke subtypes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 10","pages":"Article 108413"},"PeriodicalIF":1.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between clinicoradiological variables and onset-to-imaging time in acute ischemic stroke: A retrospective study","authors":"Bafrin Abdulmajid ,&nbsp;Laura M. van Poppel ,&nbsp;Charles B.L.M. Majoie ,&nbsp;Bart J. Emmer ,&nbsp;Henk A. Marquering ,&nbsp;MR CLEAN Investigators","doi":"10.1016/j.jstrokecerebrovasdis.2025.108410","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108410","url":null,"abstract":"<div><h3>Background</h3><div>Many acute ischemic stroke (AIS) patients have an unknown onset time. These patients require advanced imaging or are sometimes excluded from treatment. We investigated the associations between clinicoradiological variables, as assessed with non-contrast computed tomography (NCCT) and CT angiography (CTA), and onset-to-imaging time in AIS patients included in the MR CLEAN registry, an endovascular treatment (EVT) registry.</div></div><div><h3>Methods</h3><div>We included 4003 AIS patients from the MR CLEAN Registry. Patients were classified as in the early (≤4.5 h; ≤6 h) or late (&gt;4.5 h; &gt;6 h) onset-to-imaging time windows. Univariable and multivariable logistic regression assessed associations between baseline clinicoradiological variables and onset-to-imaging time. Accuracy was evaluated using receiver operating characteristic (ROC) curve analyses.</div></div><div><h3>Results</h3><div>In multivariable logistic regression, Alberta Stroke Program Early CT Score (ASPECTS) (OR 0.90, 95 % CI 0.84-0.97), presence of leukoaraiosis (OR 1.51, 95 % CI 1.19-1.92), and moderate (OR 2.53, 95 % CI 1.16-5.54) and good (OR 3.90, 95 % CI 1.76-8.66) collateral score were significantly associated with an &gt;4.5 h onset-to-imaging time. ASPECTS (OR 0.89, 95 % CI 0.81-0.98), presence of leukoaraiosis (OR 1.55, 95 % CI 1.14-2.11), and a good (OR 3.31, 95 % CI 1.17-9.39) collateral score were significantly associated with an &gt;6 h onset-to-imaging time. Area under the ROC curves was 0.63 for both the &gt;4.5 h and &gt;6 h time windows.</div></div><div><h3>Conclusion</h3><div>Among AIS patients included in the MR CLEAN registry, lower ASPECTS, presence of leukoaraiosis and a higher collateral score are associated with a late onset-to-imaging time (&gt;4.5 h; &gt;6 h after stroke onset). The accuracy of the association between clinicoradiological variables and onset-to-imaging time is poor.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 9","pages":"Article 108410"},"PeriodicalIF":1.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144771882","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":"Renal dysfunction and outcomes for thrombolysis-treated stroke beyond 4.5 hours: Trace-Ⅲ post hoc analysis","authors":"Lixia Zong MD, PhD ,&nbsp;Liyuan Wang MD ,&nbsp;Aoming Jin PhD ,&nbsp;Yujie Ma MD ,&nbsp;Xueyan Feng MD, PhD ,&nbsp;Hao Wang MD ,&nbsp;Ziran Wang MD ,&nbsp;Hongguo Dai MD ,&nbsp;Fengyuan Che MD ,&nbsp;Lihua Wang MD, PhD ,&nbsp;Li Zhou MD ,&nbsp;Yunyun Xiong MD, PhD ,&nbsp;Yongjun Wang MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108409","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108409","url":null,"abstract":"<div><h3>Objective</h3><div>Concerns regarding bleeding risks have limited the use of intravenous thrombolysis in acute ischemic stroke (AIS) patients with renal dysfunction (RD). This study investigated the impact of RD on the efficacy and safety of Tenecteplase (TNK) thrombolysis in AIS patients with large vessel occlusions (LVO) beyond the 4.5 h window.</div></div><div><h3>Methods</h3><div>This post hoc analysis of the Tenecteplase Reperfusion Therapy in Acute Ischemic Cerebrovascular Events–III (TRACE-III) Trial included 510 patients with LVO (4.5–24 h from onset) randomized to TNK (0.25 mg/kg) or standard medical treatment (SMT). Renal function was categorized as normal (eGFR ≥90 mL/min/1.73 m²), mild (eGFR 60–89), or moderate-to-severe RD (eGFR &lt;60). Primary efficacy outcome was 90-day excellent functional outcome (modified Rankin Scale [mRS] 0-1). Safety outcomes included symptomatic intracerebral hemorrhage (sICH), mortality and moderate or severe bleeding within 90 days. Multivariable regression and linear models were used to assess treatment effects across eGFR strata.</div></div><div><h3>Results</h3><div>In normal renal function patients (<em>n</em> = 410), TNK showed numerically higher excellent outcomes (32.3 % vs. 24.2 %, RR=1.28, 95 % CI 0.94∼1.75) and improved secondary outcomes (neurological improvement, as defined by NIHSS score reduction at 24 h/72 h/7 d and reperfusion rates), albeit with increased sICH (3.2 % vs. 1.1 %, <em>p</em> = 0.05). For mild RD (<em>n</em> = 82), TNK demonstrated a non-significant trend toward better functional outcomes (40.6 % vs. 26.0 %, RR=1.52, 95 % CI 0.78∼2.96). In moderate-to-severe RD (<em>n</em> = 18), outcomes were inconclusive due to limited sample size.</div></div><div><h3>Conclusion</h3><div>TNK may benefit late-window LVO stroke patients with normal or mildly impaired renal function. The risk-benefit profile in moderate-to-severe RD remains uncertain, highlighting the need for larger prospective studies in this high-risk population.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 10","pages":"Article 108409"},"PeriodicalIF":1.8,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763028","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":"Thrombolysis for ischemic stroke at 4.5 to 24 hours: An updated meta-analysis of randomized controlled trials","authors":"Jia-Xin Luo ,&nbsp;Zuo-qiao Li ,&nbsp;Zi-zhen Meng ,&nbsp;Qian Dong ,&nbsp;Xue-yun Liu ,&nbsp;Tian-nan Yang ,&nbsp;Zi-jie Wang ,&nbsp;Xiao-san Wu ,&nbsp;Qi Li","doi":"10.1016/j.jstrokecerebrovasdis.2025.108408","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108408","url":null,"abstract":"<div><h3>Background</h3><div>Only a minority of stroke patients are eligible for intravenous thrombolysis (IVT) within the standard 4.5-hour window. The safety and efficacy of IVT beyond this time frame remain insufficiently researched.</div></div><div><h3>Objective</h3><div>To evaluate the efficacy and safety following IVT in patients with AIS (4.5-24 hours).</div></div><div><h3>Methods</h3><div>The systematic review was registered in PROSPERO (CRD420251019740). Inclusion criteria included randomized clinical trials that examined outcomes, mortality, and complications in patients with AIS comparing IVT vs Best Medical Treatment (BMT). The risk of bias in the included studies was evaluated using the revised tool for assessing risk of bias. Meta-analyses assessed efficacy (excellent outcomes, functional independence) and safety (symptomatic intracranial hemorrhage [sICH], mortality) using a random-effects model.</div></div><div><h3>Results</h3><div>A total of six randomized clinical trials with 1884 initially enrolled patients were included in the analysis. Higher excellent outcome rates were observed in the IVT group (RR, 1.25; 95 % CI, 1.11-1.41). No significant differences were found in functional independence (RR, 1.14; 95 % CI, 0.98-1.32), sICH (RR, 1.91; 95 % CI, 0.85-4.33), or 90-day all-cause mortality (RR, 1.02; 95 % CI, 0.81-1.29). There was considerable heterogeneity among the studies included in the functional independence outcome (I² = 40.8 %, τ² = 0.01); however, no heterogeneity was observed for other outcomes (I² = 0, τ² = 0).</div></div><div><h3>Conclusions and Relevance</h3><div>These findings suggest that IVT with tenecteplase or alteplase may enhance 90-day excellent outcomes in patients with late-window acute ischemic stroke without significantly increasing the risk of sICH or mortality.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 9","pages":"Article 108408"},"PeriodicalIF":1.8,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763029","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":"Female participation in Canadian stroke rehabilitation trials: Comparing trial participants to the inpatient rehabilitation population","authors":"Shannon L. MacDonald MD, MSc ,&nbsp;Amy Y.X. Yu MD MSc ,&nbsp;Mark Bayley MD ,&nbsp;Susan Marzolini PhD, RKin","doi":"10.1016/j.jstrokecerebrovasdis.2025.108407","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108407","url":null,"abstract":"<div><h3>Objectives</h3><div>1) to determine whether the sex distribution and other characteristics of Canadian stroke rehabilitation trial participants differ from the inpatient stroke rehabilitation population in Canada 2) to explore whether trial eligibility criteria may be impacting the proportion of females participating in stroke trials.</div></div><div><h3>Materials and Methods</h3><div>This was a cross-sectional study using Canadian inpatient stroke rehabilitation population and three stroke rehabilitation clinical trials data. Between-group differences in population and trial data were described and a participant to prevalence ratio for females was calculated. Trial eligibility criteria were examined in the context of the inpatient stroke rehabilitation population characteristics to explore whether eligibility criteria may be disproportionately excluding females.</div></div><div><h3>Results</h3><div>There were 201 trial participants (29.4 % female) and 37,047 patients admitted to inpatient stroke rehabilitation (44.8 % female). The overall participant to prevalence ratio for females was 0.66. Females admitted to inpatient stroke rehabilitation were older than males (<em>p</em>&lt;.001), with no sex difference in age in trial participants (<em>p</em>=.114). A significantly smaller proportion of female trial participants had a diagnosis of hypertension compared to females admitted to inpatient rehabilitation (41.4 % vs 66.2 %; <em>p</em> &lt;.001). This difference was not observed for males. Compared to males, females admitted to inpatient rehabilitation more frequently had characteristics (mood disorder, living alone, discharged to long-term care), which may have resulted in their exclusion from ≥1 of the trials.</div></div><div><h3>Conclusions</h3><div>Females enrolled in stroke rehabilitation trials are underrepresented compared to inpatient rehabilitation. Trial eligibility criteria may result in the disproportionate exclusion of females compared to males.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 9","pages":"Article 108407"},"PeriodicalIF":1.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144720849","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":"Connectome reorganization and functional recovery after subarachnoid hemorrhage","authors":"Sarah E. Nelson MD, MPH ,&nbsp;Casey Weiner BS, MSE ,&nbsp;Jun Hua PhD ,&nbsp;Haris I. Sair MD ,&nbsp;Jose I. Suarez MD ,&nbsp;Robert D. Stevens MD, MBA","doi":"10.1016/j.jstrokecerebrovasdis.2025.108406","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108406","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>Magnetic resonance diffusion tensor imaging (DTI) allows inferences on brain connectivity via quantitative mapping of white matter structures. Since white matter tracts may be damaged following aneurysmal subarachnoid hemorrhage (aSAH) and given a critical need for better prognostication in aSAH, we evaluated the association between DTI connectivity measures and functional outcome in this population.</div></div><div><h3>Methods</h3><div>Patients with suspected aSAH enrolled in a prospective observational cohort underwent DTI during their acute hospitalization. A structural connectome was created then sorted into four canonical large-scale networks: default mode network (DMN), executive control network (ECN), salience network (SAL), and whole brain (WB). Clinical and graph features were used separately and in combination to train random forest (RF) and logistic regression classifiers to predict modified Rankin Score (mRS) at discharge and 6 months after discharge (favorable outcome mRS 0-2, unfavorable outcome mRS 3-6).</div></div><div><h3>Results</h3><div>A total of 56 suspected aSAH patients underwent DTI a median of 7 (IQR 3.8-12.3) days after admission. The best performing model for predicting 6-month mRS combined clinical and DTI graph features specific to the SAL network; mean±SEM area under the receiver operator characteristic curve (AUROC) and area under the precision recall curve (AUPRC) were, respectively, 0.94 ± 0.004 and 0.95 ± 0.004 (vs 0.91±0.004 and 0.94±0.004 for clinical only, respectively). Results for clinical+ECN were AUROC 0.92±0.004 and AUPRC 0.94±0.004 and for clinical+DMN AUROC 0.93±0.004 and AUPRC 0.95±0.004.</div></div><div><h3>Discussion</h3><div>Accuracy of prognostication in patients with SAH can be significantly improved by integrating connectivity measures derived from DTI. The highly predictive DTI graph features suggest a dynamic process of structural reorganization occurring in the early phase after aSAH.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 9","pages":"Article 108406"},"PeriodicalIF":1.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719367","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}