Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Impact of intracranial atherosclerosis burden on vasospasm risk and outcomes in aneurysmal subarachnoid hemorrhage","authors":"Milidu Jayaweera Sc.B/MD candidate ,&nbsp;Alex Hernandez Sc.B candidate ,&nbsp;Ariyaporn Haripottawekul Sc.B candidate ,&nbsp;Christoph Stretz MD ,&nbsp;Karen L. Furie MD-MPH ,&nbsp;Shadi Yaghi MD ,&nbsp;Ali Mahta MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108077","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108077","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral vasospasm is a well-known complication after aneurysmal subarachnoid hemorrhage (aSAH) and occurs more commonly in younger patients. We hypothesized that intracranial atherosclerosis, which is seen predominantly in older patients, affects vasospasm risk. We sought to determine association between intracranial atherosclerosis burden with vasospasm and outcomes in aSAH.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed a cohort of consecutive patients with aSAH admitted to a Comprehensive Stroke Center between 2016 and 2023. Intracranial atherosclerosis burden was quantified by using modified Woodcock (MW) score on CT angiograms. Vasospasm was defined based on transcranial Doppler (TCD) criteria. Poor outcome was defined as 3-month modified Rankin Scale 3–6.</div></div><div><h3>Results</h3><div>We reviewed 392 patients and included 302 (mean age 56.8 years [SD 13.3], 65 % female and 70 % white) in the final analysis. MW scores were measured with excellent intra-rater and inter-rater reliability (Cohen's kappa coefficient 0.9 and 0.83 respectively) ranging from 0 to 3 (mean 0.59, SD 0.83) with higher scores in older patients (beta coefficient 0.019, 95 % CI 0.009–0.028; <em>p</em> &lt; 0.001). Higher MW calcification score was associated with lower risk of vasospasm (OR 0.52 per point increase, 95 % CI 0.36–0.78; <em>p</em> = 0.001). There was an inverse correlation between MW scores and severity of vasospasm (beta coefficient −0.29, 95 % CI −0.48, −0.1; <em>p</em> = 0.003). However, MW score was not independently associated with poor functional outcome (<em>p =</em> 0.62).</div></div><div><h3>Conclusions</h3><div>Intracranial atherosclerosis is a potential mechanism for lower TCD-based vasospasm in older patients with aSAH; however, it may not impact functional outcomes. Larger prospective studies are needed to confirm our findings.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108077"},"PeriodicalIF":2.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142442252","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":"Embolic stroke associated with handheld electric neck massager: A case report and literature review","authors":"Anika Pruthi BS ,&nbsp;Joshua Santucci MD ,&nbsp;Swarna Rajagopalan MD ,&nbsp;Hermann C. Schumacher MD ,&nbsp;Daniel A. Tonetti MD, MS, FAANS","doi":"10.1016/j.jstrokecerebrovasdis.2024.108086","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108086","url":null,"abstract":"<div><h3>Background</h3><div>Handheld neck massagers pose a risk for thromboembolic stroke, a topic that has not been thoroughly explored in the literature.</div></div><div><h3>Case description and literature review</h3><div>We present a case of acute ischemic stroke in a 79-year-old male patient who experienced left upper extremity weakness after using a handheld neck massager. Imaging revealed a ruptured stenotic atherosclerotic plaque at the right internal carotid artery bulb and acute infarcts in the right middle cerebral artery vascular territory. A literature review identified other cases involving handheld massage devices.</div></div><div><h3>Conclusions</h3><div>Neck massager use can contribute to thromboembolic stroke in rare cases when atherosclerotic plaque is present. Recognizing this risk is important for understanding stroke etiology.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108086"},"PeriodicalIF":2.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor regarding “linear positive association of metabolic score for insulin resistance with stroke risk among American adults: A cross-sectional analysis of national health and nutrition examination survey datasets”","authors":"Haoqing Gan ,&nbsp;Lingjia Xu","doi":"10.1016/j.jstrokecerebrovasdis.2024.108068","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108068","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108068"},"PeriodicalIF":2.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441874","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":"The impact of systolic blood pressure reduction on aneurysm re-bleeding in subarachnoid hemorrhage: A systematic review and meta-analysis","authors":"Mohammad Aladawi MD ,&nbsp;Mohamed Elfil MD ,&nbsp;Sherief Ghozy MD ,&nbsp;Zaid R. Najdawi MD ,&nbsp;Hazem Ghaith MD ,&nbsp;Mohammad Alzayadneh MD ,&nbsp;Alejandro A. Rabinstein MD ,&nbsp;Maximiliano A. Hawkes MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108084","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108084","url":null,"abstract":"<div><h3>Background</h3><div>Preventing early aneurysm rebleeding is crucial in the management of aneurysmal subarachnoid hemorrhage (SAH). Lowering systolic blood pressure (SBP) has been proposed as a potential strategy, but the evidence remains inconclusive. This systematic review and meta-analysis aimed to determine if a specific SBP target could reduce the risk of aneurysm rebleeding prior to treatment.</div></div><div><h3>Methods</h3><div>Electronic databases were systematically searched for studies comparing SBP between SAH patients with and without aneurysm rebleeding before surgical treatment. Data on SBP values, patient characteristics, and rebleeding events were extracted. Meta-analyses were performed to pool mean SBP differences and odds ratios (ORs) for rebleeding at different SBP cut-offs.</div></div><div><h3>Results</h3><div>Ten studies were included in the systematic review. Pooled data from the included studies showed that the mean SBP was higher in the rebleeding group (mean difference 5.89, 95 % CI 1.94 to 9.85). SBP ≤160 mmHg was associated with lower rebleeding risk (OR 0.30, 95 % CI 0.14 to 0.65). However, substantial heterogeneity and limitations in study designs and definitions were noted.</div></div><div><h3>Conclusions</h3><div>This meta-analysis suggests that SAH patients with rebleeding may present with higher SBP. However, the findings should be interpreted cautiously due to study limitations. Future prospective studies with standardized definitions and comprehensive data collection are needed to elucidate the complex relationship between blood pressure dynamics and rebleeding risk in SAH.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108084"},"PeriodicalIF":2.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480813","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":"Blockage of p38MAPK in astrocytes alleviates brain damage in a mouse model of embolic stroke through the CX43/AQP4 axis","authors":"Weiping Chen ,&nbsp;Zhiping Wu ,&nbsp;Min Yin ,&nbsp;Yangbo Zhang ,&nbsp;Yiren Qin ,&nbsp;Xu Liu ,&nbsp;Jianglong Tu","doi":"10.1016/j.jstrokecerebrovasdis.2024.108085","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108085","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral edema, a significant complication arising from acute ischemic stroke (IS), has a critical influence on morbidity and mortality. p38MAPK has been shown to promote neuronal apoptosis and brain damage. However, the role of the p38MAPK inhibitor SKF-86002 in protecting against ischemic injury and cerebral edema remains unclear.</div></div><div><h3>Methods</h3><div>Infarct area was examined by TTC staining in middle cerebral artery occlusion (MCAO) mice. Neurological score and brain water content were evaluated. TUNEL and NeuN staining were used to assess neuronal apoptosis and the survival of neurons. Blood–brain barrier (BBB) permeability was determined by Evans blue. Double immunofluorescence staining detected the colocalization of AQP4 and CX43 in astrocytes. IHC staining revealed CX43 and AQP4 expression. EDU staining detected the proliferation of Oxygen and glucose deprivation/reoxygenation (OGD/R)-treated astrocytes. Levels of oxidative stress markers were determined using commercial kits. ELISA was used to assess the secretion of pro-inflammatory factors. RT-qPCR measured the expression of CX43, AQP4 and pro-inflammatory factors. Western blot analyzed the levels of p-p38/p38, AQP4 and CX43. Co-immunoprecipitation (Co-IP) determined the interaction between CX43 and AQP4.</div></div><div><h3>Results</h3><div>SKF-86002 attenuated brain damage, edema, and neuronal apoptosis in MCAO mice. Astrocyte proliferation was suppressed, and oxidative stress and inflammation were alleviated by SKF-86002 treatment. SKF-86002 negatively regulated p38 signaling and the expression of AQP4 and CX43. Additionally, the expression of CX43/AQP4 within astrocytes was modulated by SKF-86002.</div></div><div><h3>Conclusion</h3><div>In summary, SKF-86002 alleviated IS injury and cerebral edema by inhibiting astrocyte proliferation, oxidative stress and inflammation. This effect was associated with the suppression of CX43/AQP4, suggesting that SKF-86002 shows promise as a novel therapeutic approach for preventing IS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108085"},"PeriodicalIF":2.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407155","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 value of quantitative dual-energy CT parameters in predicting delayed haemorrhage after thrombectomy in acute ischaemic stroke","authors":"Feng-Ying Zhu MM ,&nbsp;Ying-Min Chen MD ,&nbsp;Shu-Min Ma MM ,&nbsp;Qiu Shao MM","doi":"10.1016/j.jstrokecerebrovasdis.2024.108083","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108083","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigates the predictive value of dual-energy CT Rho/Z quantitative parameters for delayed hemorrhage post-thrombectomy in patients with acute ischemic stroke</div></div><div><h3>Materials and Methods</h3><div>A retrospective analysis was conducted on 80 patients who underwent dual-energy CT after thrombectomy for acute ischemic stroke. Patients were divided into delayed hemorrhage/no delayed hemorrhage, symptomatic intracranial hemorrhage/asymptomatic intracranial hemorrhage and cerebral parenchymal hematoma/no cerebral parenchymal hematoma groups</div></div><div><h3>Results</h3><div>The quantitative parameters significantly associated with delayed hemorrhage are DEI and Zeff (p &lt; 0.001), with the optimal cutoff values for DEI and Zeff being 0.045 and 9.355, respectively. The quantitative parameters significantly associated with symptomatic intracranial hemorrhage are DEI and Zeff (p &lt; 0.001), with the optimal cutoff values being 0.064 and 9.422, respectively. The parameters significantly associated with cerebral parenchymal hematoma are DEI and Zeff (p &lt; 0.001), with the optimal cutoff values for DEI and Zeff being 0.058 and 9.09, respectively</div></div><div><h3>Conclusion</h3><div>The DEI and Zeff parameters derived from dual-energy CT Rho/Z analysis are valuable in predicting delayed hemorrhage, symptomatic intracranial hemorrhage, and cerebral parenchymal hematoma in patients with acute ischemic stroke following thrombectomy.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108083"},"PeriodicalIF":2.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407161","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":"Global, regional, and national temporal trends in metabolism-related ischemic stroke mortality and disability from 1990 to 2021","authors":"Jian Zhang ,&nbsp;Yue Fan ,&nbsp;Hao Liang ,&nbsp;Jiawen Liu ,&nbsp;Mo Wang ,&nbsp;Guoxuan Luo ,&nbsp;Yong Zhang","doi":"10.1016/j.jstrokecerebrovasdis.2024.108071","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108071","url":null,"abstract":"<div><h3>Background</h3><div>Stroke ranks as the second leading cause of mortality and the third leading cause of disability worldwide. Nonetheless, the evolving burden of ischemic stroke attributable to various metabolic risk factors remains inadequately elucidated. A thorough grasp of these trends is crucial for a nuanced comprehension of stroke epidemiology and the formulation of effective preventive and interventional measures.</div></div><div><h3>Method</h3><div>Based on the Global Burden of Disease, Injury, and Risk Factors Study 2021 (GBD), we analyzed national temporal trends in the burden of metabolism-associated ischemic stroke in 204 countries and territories globally from 1990-2021, as measured by the average annual percentage change (AAPC), using join-point regression models. The burden of disease was assessed using age-standardized (ASR) mortality rates and disability-adjusted life years (DALY) per 100 000 population. Cross-country inequalities in ischemic stroke burden were quantified using standard health equity methods and changes in ischemic stroke burden were projected to 2045.</div></div><div><h3>Results</h3><div>Globally, the ASR for ischemic stroke mortality linked to overall dietary metabolic risk declined by an average of 1.6% annually, while the ASR for disability-adjusted life years saw an average annual decrease of 1.3%. High systolic blood pressure remained a primary contributor to metabolism-related ischemic stroke, accounting for 57.9% of deaths and 58.0% of disability in 2021. Disparities associated with the sociodemographic index (SDI) diminished, with the gap in DALYs between countries with the highest and lowest SDIs narrowing from 592.2 (95% CI: 440.2-744.4) to 480.4 (95% CI: 309.7-651.2) in 2021. Projections indicate a continued decline in overall metabolism-related ischemic stroke deaths, mortality rates, and ASRs through 2045, although an increase in DALYs and ASRs is anticipated within the male population.</div></div><div><h3>Conclusion</h3><div>The global burden of metabolic risk-associated ischemic stroke has generally been decreasing from 2019 to 2021. This study highlights significant challenges in controlling and managing metabolic risk-associated ischemic stroke, including an increase in the number of cases in certain countries and regions, as well as an uneven distribution worldwide. These findings may provide valuable insights for the development of improved public health policies and the rational allocation of healthcare resources.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108071"},"PeriodicalIF":2.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437859","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 between systemic inflammatory markers and all-cause mortality in patients with stroke: A prospective study using data from the UK Biobank","authors":"Aimin Wang MPH ,&nbsp;Fenglin Wang MPH ,&nbsp;Yiming Huang MPH ,&nbsp;Qingxia Cui MS ,&nbsp;Yaqi Xu MPH ,&nbsp;Wenjing Zhang MPH ,&nbsp;Guiya Guo MPH ,&nbsp;Wangchen Song MPH ,&nbsp;Yujia Kong PhD ,&nbsp;Qinghua Wang PhD ,&nbsp;Suzhen Wang PhD ,&nbsp;Fuyan Shi PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108076","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108076","url":null,"abstract":"<div><h3>Background and aims</h3><div>The systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) are novel inflammatory biomarkers used to determine various disease prognoses. However, the effects of these systemic inflammatory markers on all-cause mortality in patients with stroke remain unclear.</div></div><div><h3>Methods</h3><div>We used data from the UK Biobank for this prospective analysis. Overall, 6,020 eligible individuals were included. Over a median follow-up of 13.4 years, 1,233 participants died. We examined the effects of systemic inflammatory markers on all-cause mortality using random survival forest (RSF) and Cox proportional hazards models. Covariate adjustments in the Cox model, selected by RSF, included age, sex, body mass index (BMI), Townsend deprivation index, smoking status, alcohol intake frequency, sleep duration, diabetes, and malignant neoplasms.</div></div><div><h3>Results</h3><div>In the marginal effect plots and restricted cubic spline analysis for systemic inflammatory markers, LMR exhibited a linear negative correlation, NLR showed a linear positive correlation, and SII and PLR demonstrated a U-shaped association. After covariates were adjusted, the all-cause mortality risk increased by 14 % for LMR &lt;4 (hazards ratio [HR]: 1.14, 95 % confidence interval [CI]: 1.01–1.29; <em>p</em>= 0.03), by 26 % for NLR ≥2 (HR: 1.26; 95 % CI: 1.11–1.43; <em>p</em> &lt; 0.001),by 26 % for PLR ≥175 (HR: 1.26; 95 % CI: 1.07–1.47; <em>p</em> &lt; 0.001), and by 31 % for SII ≥526 (HR: 1.31; 95 % CI, 1.16–1.47; <em>p</em>= 0.014). In addition, sensitivity analyses, excluding participants who had been followed-up for &lt;2 years and those with malignant neoplasms, yielded results consistent with those of previous research.</div></div><div><h3>Conclusion</h3><div>SII, NLR, PLR, and LMR significantly correlate with all-cause mortality in stroke patients. Thresholds established by the RSF model could potentially refine prognostic decision-making in stroke care.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108076"},"PeriodicalIF":2.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407154","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":"Cerebral air embolism caused by aspiration pneumonia: A case report","authors":"Takuma Aoki,&nbsp;Tamaki Morisako,&nbsp;Mayu Takahashi,&nbsp;Takahiro Isozumi,&nbsp;Mamoru Murakami","doi":"10.1016/j.jstrokecerebrovasdis.2024.108079","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108079","url":null,"abstract":"<div><div>Herein, we report a rare case of arterial cerebral air embolism (aCAE), that was probably caused by aspiration pneumonia. An 84-year-old-male presented with sudden loss of consciousness. Computed tomography (CT) of the head revealed air shadows along the sulcus of the right frontal and left posterior lobes. The abdominothoracic CT revealed aspiration pneumonia in the right upper lung with cavity formation. His clinical symptoms lessened after the administration of an antiepileptic. Because there was no prior history of any medical treatment, the patient was diagnosed with a noniatrogenic aCAE. Furthermore, in the absence of a right-to-left shunt, we determined that the air embolization was caused by the aspiration pneumonia. aCAE is a rare disease that can lead to miserable conditions. Most of causes aCAE are iatrogenic. However, a few cases of noniatrogenic aCAE have been reported. Some reports have suggested an associated between iatrogenic aCAE and raised intrathoracic pressure, which could lead to air entry into the pulmonary vein via the damaged alveolar wall. Even in noniatrogenic aCAEs, a sudden increase in intrathoracic pressure may cause airflow via the alveolar wall into the pulmonary veins, resulting in aCAE.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108079"},"PeriodicalIF":2.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407156","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":"Evaluating retinal blood vessels for predicting white matter hyperintensities in ischemic stroke: A deep learning approach","authors":"Yuanyuan Zhuo ,&nbsp;Weihao Gao ,&nbsp;Zile Wu ,&nbsp;Lijiao Jiang ,&nbsp;Yan Luo ,&nbsp;Xiaoming Ma ,&nbsp;Zhuo Deng ,&nbsp;Lan Ma ,&nbsp;Jiaman Wu","doi":"10.1016/j.jstrokecerebrovasdis.2024.108070","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108070","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to investigate whether a deep learning approach incorporating retinal blood vessels can effectively identify ischemic stroke patients with a high burden of White Matter Hyperintensities (WMH) using Nuclear Magnetic Resonance Imaging (MRI) as the gold standard.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, we evaluated 263 ischemic stroke inpatients who had acquired both retinal fundus images and MRI images. The primary outcome was the diagnostic WMH on MRI brain, defined as different degrees of the age-related white matter changes (ARWMC) grade (&lt;2 or ≥2). We developed a deep-learning network model with retinal fundus images to estimate WMH.</div></div><div><h3>Results</h3><div>The mean age of the patient cohort was 60.8 years, with 196 individuals (74.5%) being male. The prevalence of risk factors was as follows: hypertension in 237 (90.1%), diabetes in 109 (41.4%), hyperlipidemias in 84 (31.9%), coronary heart disease in 37 (14.1%), hyperhomocysteinemia in 70 (26.6%), and hyperuricemia in 73 (27.8%). Severe WMH defined as global ARWMC grade ≥2 was found in 139 (52.9%) participants. Using binocular fundus images, we achieved an F1 score of 0.811 and a Macro Accuracy of 0.811 in the ARWMC classification task. Additionally, we conducted experiments by progressively occluding fundus images to assess the relationship between different areas of the fundus images and ARWMC prediction.</div></div><div><h3>Interpretation</h3><div>Our study presents a novel deep learning model designed to detect a high burden of WMH using binocular fundus images in ischemic stroke patients. We have conducted initial investigations into the predictive significance of various fundus image areas for WMH identification. These findings underscore the need for broader data collection, further model training, and prospective data validation.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108070"},"PeriodicalIF":2.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407157","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}