Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Early CSF inflammatory markers after aneurysmal subarachnoid hemorrhage and their relationship to disease severity and shunt placement","authors":"Jessica Magid-Bernstein MD, PhD ,&nbsp;Jennifer Yan BS ,&nbsp;Alison L. Herman BA ,&nbsp;Zili He MS ,&nbsp;Conor W. Johnson BS ,&nbsp;Hannah Beatty BS ,&nbsp;Rachel Choi MS ,&nbsp;Sofia Velazquez BA ,&nbsp;Gracey Sorensen BS ,&nbsp;Sithmi Jayasundara BS ,&nbsp;Lauren Grychowski BS ,&nbsp;Abdelaziz Amllay MD ,&nbsp;Guido J. Falcone MD, ScD, MPH ,&nbsp;Jennifer Kim MD, PhD ,&nbsp;Nils Petersen MD, PhD, MSc ,&nbsp;Lena O’Keefe MD, MS ,&nbsp;Emily J. Gilmore MD ,&nbsp;Charles Matouk MD ,&nbsp;Kevin N. Sheth MD ,&nbsp;Lauren H. Sansing MD, MS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108395","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108395","url":null,"abstract":"<div><h3>Background</h3><div>The inflammatory response within the central nervous system is a key driver of secondary brain injury after aneurysmal subarachnoid hemorrhage (aSAH). Less is known about the impact that inflammation has on complications like persistent post-hemorrhagic hydrocephalus. To explore the association between inflammation, disease severity, and permanent shunt placement, we characterized the early cytokine profiles of the blood and cerebrospinal fluid (CSF) of patients with aSAH.</div></div><div><h3>Methods</h3><div>Biological samples were collected from aSAH patients admitted to a single-center Neurosciences Intensive Care Unit between 2014 and 2024. Control CSF samples were collected from patients undergoing permanent shunt placement for normal pressure hydrocephalus. A multiplex bead-based immunoassay was used to analyze a panel of cytokines in plasma and CSF samples. Clinical variables, including demographics, disease severity, and permanent shunt placement were collected.</div></div><div><h3>Results</h3><div>Plasma and/or CSF samples were collected from 83 patients (58 aSAH patients, 25 controls). In aSAH patients, C<img>C motif chemokine ligand-2 (CCL2), interleukin-6 (IL-6), granulocyte-colony stimulating factor (G-CSF), interleukin-8 (IL-8), and vascular endothelial growth factor (VEGF) were all elevated in CSF compared to plasma (<em>p</em> &lt; 0.05 for all comparisons) and in the CSF of aSAH patients as compared to controls (<em>p</em> &lt; 0.001 for all comparisons). However, only G-CSF and VEGF were associated with clinical severity at presentation when considering Hunt and Hess score as a dichotomized variable (<em>p</em> = 0.026 and <em>p</em> = 0.043, respectively). In multivariable models adjusted for age, sex, and modified Fisher Scale score, early CSF concentrations of IL-6 and IL-8 were associated with increased need for permanent shunt placement (<em>p</em> = 0.030 and <em>p</em> = 0.040, respectively).</div></div><div><h3>Conclusions</h3><div>Within 72 hours of aSAH, proinflammatory cytokines can be detected at higher concentrations in CSF than in plasma, and at higher concentrations in aSAH patients compared to controls. Early concentrations of certain pro-inflammatory cytokines are associated with increased likelihood of persistent post-hemorrhagic shunt dependent hydrocephalus, independent of initial disease severity. These data support preclinical models of CNS inflammation after aSAH and suggest that early innate inflammation contributes to hydrocephalus.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 9","pages":"Article 108395"},"PeriodicalIF":2.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605721","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":"Mediation by the dietary inflammatory index in the association between the weight-adjusted waist index and stroke: Insights from NHANES 2003–2018","authors":"Zhengjin Luo ,&nbsp;Yufeng Xu","doi":"10.1016/j.jstrokecerebrovasdis.2025.108386","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108386","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a significant risk factor for stroke, and the novel index Weight-Adjusted Waist Index (WWI) provides a more accurate representation of fat distribution, which has been linked to stroke risk. Diet plays a crucial role in modulating systemic inflammation, and the Dietary Inflammatory Index (DII) quantifies the pro-inflammatory potential of dietary intake. However, its role in the relationship between WWI and stroke remains unclear.</div></div><div><h3>Methods</h3><div>We analyzed 13,603 adults (≥20 years) from the National Health and Nutrition Examination Survey (NHANES) 2003–2018. Multivariable logistic regression assessed the association between WWI and stroke risk, with restricted cubic splines (RCS) testing non-linearity. Mediation analysis evaluated DII’s role in the WWI-stroke link. Subgroup and sensitivity analyses ensured result robustness.</div></div><div><h3>Results</h3><div>Higher WWI group was significantly associated with increased stroke risk (OR = 2.35, 95 % CI: 1.33, 4.14, <em>p</em> = 0.004). RCS analysis showed no non-linear relationship (p-non-linear = 0.296). DII was positively correlated with both WWI and stroke. Mediation analysis indicated that DII mediated 6.91 % of the WWI-stroke association (<em>p</em> = 0.004). Subgroup analyses confirmed consistent findings, with significant interactions for sex and alcohol consumption.</div></div><div><h3>Conclusion</h3><div>WWI is positively associated with stroke risk, partially mediated by DII, suggesting that a pro-inflammatory diet contributes to this relationship. Integrating WWI and DII into clinical assessments may refine stroke prevention strategies in at-risk populations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108386"},"PeriodicalIF":2.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144588421","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":"A rare case of bilateral basilar artery webs","authors":"Ziwei Xu Master of Medicine ,&nbsp;Yaoping Shi Master of Medicine ,&nbsp;Shiping Yang Master of Medicine,&nbsp;Ying Li Doctor of Medicine","doi":"10.1016/j.jstrokecerebrovasdis.2025.108393","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108393","url":null,"abstract":"<div><h3>Background</h3><div>Basilar artery web is a rare and under-recognized vascular anomaly that may contribute to posterior circulation ischemic stroke. In limited reports, basilar artery webs have appeared as thin, membrane-like intraluminal defects at various locations along the basilar artery.</div></div><div><h3>Case Presentation</h3><div>A 51-year-old man presented with a 10-day history of involuntary movements in the left upper limb, along with longstanding memory decline and gait instability. He had no history of stroke or cardiovascular disease. Non-contrast computed tomography of the head showed no hemorrhage, and laboratory investigations were not diagnostic. Time-of-flight magnetic resonance angiography revealed severe focal stenosis in the distal basilar artery. High-resolution black-blood magnetic resonance imaging and digital subtraction angiography identified two distinct, thin, smooth, membrane-like intraluminal defects, consistent with basilar artery webs.</div></div><div><h3>Discussion</h3><div>This is the first reported case of two coexisting web-like lesions within the same segment of the basilar artery. Although no definitive infarction was observed, the vascular anomalies may have impaired perforator artery flow or disrupted local hemodynamics, potentially contributing to focal brainstem ischemia.</div></div><div><h3>Conclusion</h3><div>This case expands the current understanding of basilar artery webs and emphasizes the diagnostic value of high-resolution vessel wall imaging. Recognition of this rare anomaly is important for accurate stroke risk assessment and individualized prevention strategies, especially in patients without conventional vascular risk factors.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108393"},"PeriodicalIF":2.0,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579399","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 severity and prognosis in patients on the brink of end-stage chronic kidney disease: K-PLUS registry","authors":"Hirotaka Hayashi M.D. ,&nbsp;Makoto Nakajima M.D. ,&nbsp;Yuichiro Inatomi M.D. ,&nbsp;Tadashi Terasaki M.D. ,&nbsp;Toshiro Yonehara M.D. ,&nbsp;Kuniyasu Wada M.D. ,&nbsp;Yanosuke Kouzaki M.D. ,&nbsp;Kenichiro Yi M.D. ,&nbsp;Yoichiro Hashimoto M.D. ,&nbsp;Mitsuharu Ueda M.D.","doi":"10.1016/j.jstrokecerebrovasdis.2025.108391","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108391","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The association between chronic kidney disease (CKD) grade and stroke severity or prognosis is still controversial. We investigated the relationship between CKD stage and stroke severity on admission and its influence on prognosis.</div></div><div><h3>Methods</h3><div>Using a regional stroke registry, the clinical characteristics of acute ischemic stroke patients were investigated in each CKD stage (G1–G5). The relationship between CKD stage and the National Institutes of Health Stroke Scale (NIHSS) score was examined in stratified analyses under the presence or absence of various factors. Multiple logistic regression analyses to identify predictors for an unfavorable prognosis or death were performed.</div></div><div><h3>Results</h3><div>Of 10,104 patients, 1,056 (10 %) were CKD stage G1, 3,797 (38 %) were stage G2, 4,137 (41 %) were stage G3, 678 (7 %) were stage G4, and 436 (4 %) were stage G5. The NIHSS score was the highest in patients with stage G4 (median, 10; interquartile range, 4–22), compared to those with G1 (3; 1–8), G2 (3; 2–9), G3 (6; 2–16), and G5 (5; 2–14). Similar results were obtained on multiple logistic regression analysis including potential confounders. As to outcome at discharge, a modified Rankin Scale score of ≥3 was more frequently observed in stage G4 patients. However, the independent relationships diminished after multiple logistic regression analyses including stroke severity on admission as an independent variable.</div></div><div><h3>Conclusion</h3><div>Stroke severity on admission was the highest in patients with CKD stage G4 compared to the other stages, which was possibly related to an unfavorable prognosis and mortality.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108391"},"PeriodicalIF":2.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577596","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":"Recombinant human pro-urokinase vs. alteplase within 4.5 hours of acute ischemic stroke: A systematic review and meta-analysis of randomized controlled trials","authors":"Tallal Mushtaq Hashmi MBBS ,&nbsp;Aimen Shafiq MBBS ,&nbsp;Rohma Zia MBBS ,&nbsp;Hadiah Ashraf MBBS ,&nbsp;Muhammad Burhan MBBS ,&nbsp;Mushood Ahmed MBBS ,&nbsp;Ahmad Mesmar MBBS ,&nbsp;Raheel Ahmed MRCP ,&nbsp;Gregg C. Fonarow MD, FACC","doi":"10.1016/j.jstrokecerebrovasdis.2025.108392","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108392","url":null,"abstract":"<div><h3>Background</h3><div>Recombinant human pro-urokinase (rhPro-UK) has emerged as a potential alternative to alteplase for patients with acute ischemic stroke (AIS) presenting within 4.5 hours of symptom onset. This meta-analysis evaluates and compares the efficacy and safety of rhPro-UK with alteplase in this patient population.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted on PubMed, Cochrane and Embase from inception to November 30, 2025, to identify eligible RCTs comparing intravenous rhPro-UK with alteplase in AIS patients treated within 4.5 hours of symptom onset. A random-effects meta-analysis was conducted using RevMan Web.</div></div><div><h3>Results</h3><div>Three RCTs encompassing 2,289 patients (rhPro-UK: 1141; alteplase: 1148) met the inclusion criteria. The pooled analysis demonstrated no significant difference between rhPro-UK and alteplase in achieving excellent functional outcome (mRS 0-1 at 90d: RR = 1.04, 95 % CI = 0.98 to 1.10; <em>P</em> = 0.17) and good functional outcome (mRS 0-2 at 90d: RR = 1.0, 95 % CI = 0.96 to 1.05; <em>P</em> = 0.86). No statistically significant difference was observed for early neurological improvement (RR 1.05, 95 % CI 0.96 to 1.15), symptomatic intracranial hemorrhage (RR = 0.52, 95 % CI = 0.19 to 1.43), all-cause mortality (RR 1.10, 95 % CI 0.64 to 1.91) and severe adverse events (RR = 0.92, 95 % CI = 0.75 to 1.13).</div></div><div><h3>Conclusion</h3><div>This meta-analysis found no statistically significant differences between rhPro-UK and alteplase in terms of functional outcomes, early neurological improvement, or safety profiles in patients with acute ischemic stroke. rhPro-UK shows promise as a cost-effective alternative, but further large-scale RCTs are required to confirm its role in AIS management.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108392"},"PeriodicalIF":2.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579398","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":"Dystypia following left lenticulostriate artery cerebral infarction: A case report with MR Tractography and SPECT analysis","authors":"Ryohei Yasugi ,&nbsp;Takakuni Maki ,&nbsp;Atsushi Shima ,&nbsp;Akihiro Shimotake ,&nbsp;Kaede Tanaka ,&nbsp;Keita Ueda ,&nbsp;Toshiya Murai ,&nbsp;Nobukatsu Sawamoto ,&nbsp;Akio Ikeda ,&nbsp;Ryosuke Takahashi ,&nbsp;Riki Matsumoto","doi":"10.1016/j.jstrokecerebrovasdis.2025.108389","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108389","url":null,"abstract":"<div><h3>Objectives</h3><div>To report a rare case of dystypia—a selective typing impairment—following a subcortical infarction, and to explore its neural correlates using clinical and imaging data.</div></div><div><h3>Case Presentation</h3><div>A 65-year-old right-handed man with proficient typing ability developed sudden difficulty typing during a web conference. He showed intact language comprehension, naming, and motor function, but exhibited romanization errors and touch-typing difficulties without agraphia, apraxia, or aphasia, while the Frontal Assessment Battery revealed impaired verbal fluency.</div></div><div><h3>Imaging Findings</h3><div>MRI revealed an acute infarct in the left putamen and corona radiata. Diffusion-weighted imaging with tractography showed partial involvement of the fronto-striatal tract connecting the putamen to the supplementary motor area. SPECT demonstrated hypoperfusion in the left frontal and parietal cortices.</div></div><div><h3>Conclusion</h3><div>This case suggests that disruption of the fronto-striatal tract may impair typing ability, even in the absence of classical language deficits. Subcortical lesions can cause highly selective cognitive-motor dysfunctions, and combined clinical and imaging approaches are key to understanding such atypical post-stroke presentations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108389"},"PeriodicalIF":2.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577595","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":"Closing the gap: Early experience from a new Endovascular Thrombectomy service in regional and rural North Queensland, Australia","authors":"Muhammad Usman Manzoor ,&nbsp;Abdul Shaik ,&nbsp;Awais Farid ,&nbsp;Ramon Luis Navarro Balbuena ,&nbsp;Ravindra Urkude ,&nbsp;Yasir Khattak ,&nbsp;Nerida Myers ,&nbsp;Lori Mackay ,&nbsp;Firas Alnidawi ,&nbsp;Rufus Corkill","doi":"10.1016/j.jstrokecerebrovasdis.2025.108390","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108390","url":null,"abstract":"<div><h3>Background</h3><div>Endovascular clot retrieval is the standard of care for acute ischemic stroke caused by large vessel occlusion. However, access to mechanical thrombectomy remains limited in rural and regional areas, where patients often require transfer to urban centres. These delays are directly associated with poorer clinical outcomes. To address this disparity, a mechanical thrombectomy service was established at a regional tertiary hospital in North Queensland, Australia. This study aims to evaluate the safety and clinical outcomes of mechanical thrombectomy in a regional setting.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on all consecutive patients who underwent mechanical thrombectomy at Townsville University Hospital (TUH), Queensland, Australia, between March 2022 and February 2024. Patients were categorized into two groups—local (TUH) and interhospital transfer—based on their initial presentation. Clinical outcomes, procedural success, and complications were assessed.</div></div><div><h3>Results</h3><div>A total of 120 patients (mean age: 71 years; 51 % male) underwent mechanical thrombectomy. Of these, 48 (40 %) presented locally, while 72 (60 %) were interhospital transfers. A good functional outcome (mRS 0–2 at 90 days) was achieved in 56 patients (47 %). Procedural success (mTICI score 2b–3) was observed in 106 patients (88 %), while 14 patients (12 %) experienced procedure-related complications.</div></div><div><h3>Conclusion</h3><div>The establishment of a mechanical thrombectomy service at TUH has significantly improved access to stroke intervention for regional and rural populations in North Queensland. Our early experience demonstrates clinical outcomes comparable to those reported in large multicentre thrombectomy trials, confirming the feasibility and safety of delivering this service in a regional setting.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 9","pages":"Article 108390"},"PeriodicalIF":2.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577594","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":"More than half of patients with wake-up stroke have slept through their stroke onset","authors":"Lynette Andreasyan,&nbsp;Jeffrey L. Saver","doi":"10.1016/j.jstrokecerebrovasdis.2025.108388","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108388","url":null,"abstract":"<div><h3>Background</h3><div>Conventional time-from-onset decision-making for use of reperfusion therapies in acute ischemic stroke is challenged by patients with wake-up strokes (WUS) in whom onset time is uncertain. Management of these patients, including use of advanced imaging to make “tissue-clock” rather than “time-clock” treatment decisions, and development of wearable technologies to detect stroke onset during sleep, would be aided by delineation of how often WUS patients had onset long before or shortly before awakening.</div></div><div><h3>Methods</h3><div>We performed a meta-analysis of studies comparing diffusion weighted imaging–fluid-attenuated inversion recovery (DWI-FLAIR) mismatch frequencies in patients with WUS compared with patients with clear onset time stroke (COS). Differences in FLAIR-DWI mismatch frequency between WUS and COS patients in matched time intervals from first symptom detection were analyzed in a novel manner to derive the timepoints during sleep of stroke onset in WUS patients.</div></div><div><h3>Results</h3><div>Two studies of WUS and COS patients met selection criteria, collectively enrolling 443 patients (201 WUS, 242 COS). For COS patients, mismatch frequency declined gradually as time from first symptom detection increased: &lt;2 h 60 %; 2-3 h 53 %; 3-4 h 41 %; 4-5 h 37 %; 5-6 h 11 %. In contrast, for WUS patients, &lt;2 h patients had similar mismatch rates to &lt;2 h COS patients but mismatch then declined precipitously in all later time windows: &lt;2 h 50 %; 2-3h13 %; 3-4 h 13 %; 4-5 h 6 %; 5-6 h 12 %. The lower mismatch rate indicated that 56.5 % of WUS patients had stroke onset long (2-8 h) before awakening and 43.5 % had stroke onset shortly (0-2 h) before awakening.</div></div><div><h3>Conclusions</h3><div>A majority of wake-up stroke patients stayed asleep for 2-8 hours after stroke onset, while a minority awoke at the time of or soon after onset. These findings can inform multimodal imaging strategies and wireless stroke detection technology development programs for patients with wake-up stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108388"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562636","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 hidden cost of being uninsured: Stroke mortality after mechanical thrombectomy","authors":"Alexander T. Lyons BS ,&nbsp;Jordan Davis MS ,&nbsp;Anthony E. Bishay BS ,&nbsp;Akshay Bhamidipati MD ,&nbsp;Michael Longo MD ,&nbsp;Seoiyoung Ahn MD ,&nbsp;Gabriel Bendfeldt MD ,&nbsp;Lakshmi Suryateja Gangavarapu BA ,&nbsp;Emma Ye BA ,&nbsp;Nishit Mummareddy MD ,&nbsp;Naveed Kamal MD ,&nbsp;Michael T. Froehler MD, PhD ,&nbsp;Rohan V. Chitale MD ,&nbsp;Matthew R. Fusco MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108387","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108387","url":null,"abstract":"<div><h3>Introduction</h3><div>The impact of insurance status on mortality and functional outcomes has yet to be examined in Mechanical Thrombectomy (MT) patients, despite research on socioeconomic status.</div></div><div><h3>Objective</h3><div>Herein we describe the effects of insurance status on MT outcomes while controlling for other components of socioeconomic status like race, gender, and area deprivation index (ADI).</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study of 395 patients undergoing MT at a single comprehensive stroke center between 2018 and 2022. Patients were grouped based on presence of insurance on admission. Univariate and multivariate analysis were conducted examining the following outcome variables: length of stay (LoS), readmission within 90 days, good functional outcomes measured as a modified Rankin score at 90 days&lt;3, and death.</div></div><div><h3>Results</h3><div>A total of 44/395 (11.1 %) patients were uninsured. Uninsured patients were significantly younger on average (59.5 ± 18.2 years compared to 67.1 ± 14.7 years (<em>p</em> = 0.010)) On multivariate analysis, insured status was associated with improved mortality rates (OR: 0.33; 95 % CI: 0.11-0.93; <em>p</em> = 0.035). On univariate analysis, insured status did not have a significant effect on favorable functional outcome (OR:1.15; 95 % CI:0.56-2.34; <em>p</em> = 0.70), LoS (OR:1.23; 95 % CI:0.66-2.32; <em>p</em> = 0.511) or readmission rate (OR:1.66; 95 % CI:0.38-7.31; <em>p</em> = 0.50). Discharge disposition neared significance, with 50 % of insured patients being discharged to a rehabilitation facility, while only 29.3 % of uninsured patients were discharged similarly (<em>p</em> = 0.06).</div></div><div><h3>Conclusion</h3><div>Lack of insurance is associated with increased mortality following MT after controlling for other socioeconomic variables and may be an important marker of outcomes in AIS patients.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108387"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562637","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":"Genetic liability to depression and cerebral small vessel disease: A mendelian randomization study","authors":"Mengmeng Wang ,&nbsp;Iyas Daghlas ,&nbsp;Ning Wei","doi":"10.1016/j.jstrokecerebrovasdis.2025.108385","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108385","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>To investigate the association of genetic liability to depression with cerebral small vessel disease (cSVD).</div></div><div><h3>Methods</h3><div>Genetic instruments for liability to depression were obtained from a meta-analysis of genome-wide association studies of depression (371,184 cases and 978,703 controls). Mendelian randomization (MR) was used to examine the associations of genetic liability to depression with cSVD clinical outcomes (small vessel stroke [SVS], deep intracerebral hemorrhage [ICH]) and radiographic measures (white matter hyperintensity [WMH] volume, cerebral microbleeds [CMBs], and burden of perivascular spaces [PVS]). The primary analysis was performed using the random-effects inverse-variance weighted method. Sensitivity analyses were conducted to examine the robustness of results to violations of assumptions of MR assumptions.</div></div><div><h3>Results</h3><div>Genetic liability to depression was associated with a higher risk of SVS (odds ratio [OR], 1.36; 95 % confidence interval [CI], 1.14-1.62; <em>P</em> = 5.4 × 10^-4) and deep ICH (OR, 1.82; 95 % CI, 1.14–2.89; <em>P</em> = 0.012). Consistent with this finding, genetic liability to depression was associated with higher WMH volume (β, 0.09; 95 % CI, 0.02–0.16; <em>P</em> = 0.017), but not with CMBs or PVS (<em>P</em> &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>This study supports a potential causal effect of genetic liability to depression on cSVD. Further investigation is warranted to explore mechanisms and therapeutic implications.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108385"},"PeriodicalIF":2.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144489704","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}