Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"P2Y12 inhibitors plus aspirin versus aspirin alone in patients with ischemic cerebrovascular events: An updated meta-analysis of randomized controlled trials","authors":"Hilária Saugo Faria (medical student) ,&nbsp;Rian Barreto Arrais Rodrigues de Morais (medical student) ,&nbsp;Elísio Bulhões (medical student) ,&nbsp;Lucas Cael Azevedo Bendaham (medical student) ,&nbsp;Ocílio Ribeiro Gonçalves (medical student) ,&nbsp;João Lucas de Magalhães Leal Moreira (medical student) ,&nbsp;Victor Gonçalves Soares (medical student) ,&nbsp;Marianna Leite (medical student) ,&nbsp;Christian Ferreira (medical doctor) ,&nbsp;Márcio Yuri Ferreira (medical doctor) ,&nbsp;Yafell Serulle (medical doctor)","doi":"10.1016/j.jstrokecerebrovasdis.2024.108180","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108180","url":null,"abstract":"<div><h3>Background</h3><div>The efficacy and safety of P2Y12 inhibitors (P2Y12i) with aspirin in patients with non-cardioembolic ischemic cerebrovascular events remains a topic of ongoing debate. Therefore, we conducted an updated meta-analysis to compare these drugs with aspirin alone.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing the two treatment regimens in patients with ischemic cerebrovascular events. Primary outcomes were all-cause mortality, severe bleeding, and stroke recurrence. We performed subgroup analyses stratified by National Institutes of Health Stroke Scale (NIHSS). Risk ratios (RRs) with 95 % confidence intervals were calculated using a random effects model. R software (version 4.3.2) was used for statistical analyses.</div></div><div><h3>Results</h3><div>Fifteen studies were included, comprising 38,851 patients, of whom 19,483 (50.1 %) received P2Y12i plus aspirin. Follow-up ranged from 7 days to 3.4 years. P2Y12i plus aspirin significantly reduced stroke recurrence (RR 0.78; 95 % CI = 0.71-0.87; <em>p</em> &lt; 0.05), but increased the incidence of all-cause mortality (RR 1.38; 95 % CI = 1.11-1.72; <em>p</em> &lt; 0.05) and severe bleeding (RR 2.07; 95 % CI 1.61 to 2.66; <em>p</em> &gt; 0.05) compared with aspirin. There was no significant difference between groups in all-cause mortality in patients with NIHSS ≤3 or ≤10.</div></div><div><h3>Conclusion</h3><div>P2Y12i plus aspirin reduced stroke recurrence, but increased all-cause mortality and severe bleeding in patients with non-cardioembolic ischemic events. There was no difference between groups in all-cause mortality in patients with NIHSS scores ≤3 or ≤10.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108180"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928648","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":"Compromised cerebrovascular reactivity related to presence of white matter hyperintensities in cryptogenic stroke with right-to-left shunts","authors":"Huizhen Song MM ,&nbsp;Shuang Zhang MM ,&nbsp;Qianqian Xie MD ,&nbsp;Zhoujie Zhu MM ,&nbsp;Linger Li MM ,&nbsp;Hongqin Zhao MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108223","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108223","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigates cerebrovascular reactivity (CVR) changes in cryptogenic stroke (CS) patients with right-to-left shunts (RLS) and evaluates the relationship between CVR and white matter hyperintensities (WMHs).</div></div><div><h3>Methods</h3><div>The breath-holding index (BHI), representing CVR, was measured from the middle cerebral artery (MCA) using the breath-holding method. WMHs were defined as clearly hyperintense areas on 3T magnetic resonance imaging (MRI), assessed separately as periventricular hyperintensities (PVH) and deep white matter hyperintensities (DWMH). RLS was diagnosed based on a contrast-enhanced transcranial Doppler (c-TCD) examination.</div></div><div><h3>Results</h3><div>Among 260 CS patients and 128 controls, BHI was significantly lower in CS groups (0.68±0.27 vs. 0.83±0.31, <em>P</em>&lt;0.001), particularly in those with RLS (0.64±0.28 vs. 0.71±0.25,<em>P</em> = 0.030). CS patients with WMHs exhibited lower BHI than those without WMHs (0.50±0.22 vs.0.60±0.35, <em>P</em> = 0.012), and PVH showed lower BHI compared to DWMH (0.45±0.24 vs.0.58±0.16, <em>P</em> = 0.003). A negative correlation was found between WMH severity and BHI (0.60±0.35 vs.0.51±0.21 vs.0.48±0.20 vs.0.38±0.28, <em>P</em> = 0.025). Reduced BHI was an independent risk factor for WMHs (OR = 0.283; 95 % CI = 0.081-0.995, <em>P</em> = 0.049).</div></div><div><h3>Conclusion</h3><div>CS patients, especially those with RLS, show reduced CVR, which correlates with the location and severity of WMHs. These findings suggest that RLS may significantly contribute to WMH development in CS patients.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108223"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958876","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":"Long-term cerebrovascular outcomes of patients undergoing percutaneous patent foramen ovale closure in observational studies: a systematic review and meta-analysis","authors":"Areeba Asghar MSc ,&nbsp;Luxshikka Canthiya BSc ,&nbsp;Ani Khachatrian ,&nbsp;Varnita Vishwanath BSc ,&nbsp;Eduardo Flores-Umanzor MD, PhD ,&nbsp;Ashley Farrell MLIS AHIP ,&nbsp;Yeva Sahakyan MD MPH MSc ,&nbsp;Jonah Himelfarb MD ,&nbsp;Eric M. Horlick MDCM ,&nbsp;Lusine Abrahamyan MD MPH PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108189","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108189","url":null,"abstract":"<div><h3>Objectives</h3><div>Patent foramen ovale (PFO) closure is recommended for patients who experience a cryptogenic stroke attributable to PFO. Although few randomized control trials (RCTs) have captured long-term effectiveness of PFO closure, observational data has been abundant. This is the first systematic review of observational studies determining incidence of long-term adverse outcomes in adults who underwent transcatheter PFO closure, with comparisons to findings from RCTs.</div></div><div><h3>Methods</h3><div>Medline, Cochrane, and Embase databases were searched from inception to October 2023. Only observational studies with ≥4 years of mean or median follow-up were included. A meta-analysis was conducted to calculate the incidence of recurrent stroke after PFO closure.</div></div><div><h3>Results</h3><div>After reviewing 2,432 records, 13 prospective and 12 retrospective cohort studies were included. Average follow-up lengths ranged from 4 to 12.3 years, and sample sizes from 75 to 1,533 participants. The average age ranged between 43.5-63.0, and 24.0-72.8% patients had an atrial septal aneurysm. The incidence of stroke was 0.34 per 100 person-years (I² = 67%). This was similar to rates from four RCTs that were used for comparison (0.35 per 100 person-years, I²= 51%). There was a significant improvement in heterogeneity once the study with one of the largest follow-up was removed.</div></div><div><h3>Conclusions</h3><div>Real-world PFO closure studies with long-term follow-up report similar outcomes as RCTs which is important considering the exclusion of several important populations from trials. Future observational studies should include more rigorous reporting of follow-up strategies and explore different long-term adverse outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108189"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820237","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":"Knowledge, attitude, and practice of stroke patients' family members towards stroke rehabilitation: A cross-sectional study","authors":"Dongdong Li ,&nbsp;Hui Guo ,&nbsp;Yiwen Sun ,&nbsp;Zhijun Zhang ,&nbsp;Huilin Liu","doi":"10.1016/j.jstrokecerebrovasdis.2024.108177","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108177","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to explore the knowledge, attitude, and practice (KAP) among family members of stroke patients regarding stroke rehabilitation.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted on the family members of stroke patients at the China Rehabilitation Research Center from February 15 to May 2, 2024. This study collected demographic data and KAP scores through a self-designed questionnaire.</div></div><div><h3>Results</h3><div>The study enrolled 517 family members, of which 344 (66.54%) were male. The mean scores for knowledge, attitude, and practice were 12.01 ± 5.46 (possible range: 0-20), 49.40 ± 4.96 (possible range: 11-55), and 41.93 ± 7.49 (possible range: 10-50), respectively. Correlation analyses demonstrated a significant positive relationship between knowledge and attitude (r = 0.501, P &lt; 0.001), knowledge and practice (r = 0.471, P &lt; 0.001), and attitude and practice (r = 0.441, P &lt; 0.001). Structural Equation Modeling indicated that showed that knowledge directly affected attitude (β = 0.481, P = 0.004) and practice (β = 0.351, P = 0.009), and attitude directly affected practice (β = 0.244, P = 0.007). Additionally, knowledge indirectly affected practice through attitude (β = 0.117, P = 0.006).</div></div><div><h3>Conclusions</h3><div>This study identified significant gaps in knowledge, despite generally positive attitudes and proactive practices among family members of stroke patients regarding stroke rehabilitation. This highlights the necessity for tailored educational programs for family members to address these knowledge gaps.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108177"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792844","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":"Quantification of leptomeningeal collateral blood flow in hypertensive rats during ischemic stroke","authors":"Magdalena Litman MPharm ,&nbsp;Kristy Martin BSc (Hons) ,&nbsp;Neil J Spratt FRACP, PhD ,&nbsp;Daniel J Beard PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108195","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108195","url":null,"abstract":"<div><h3>Objectives</h3><div>There is increasing evidence that poor leptomeningeal collateral blood flow in hypertensive animals is due to increased vascular myogenic tone, indicating that therapies to enhance collateral blood flow during ischemic stroke may be particularly effective. To develop such therapies, we need a greater understanding of the factors that regulate collateral blood flow in the setting of hypertension. Therefore, we aimed to quantify blood flow velocity, diameter and absolute blood flow in individual collateral vessels in an ischemic stroke model in spontaneously hypertensive rats (SHRs) and determine which factors had the greatest influence on blood flow.</div></div><div><h3>Materials and methods</h3><div>We quantified collateral flow velocity and vessel diameter and calculated absolute collateral blood flow in SHRs (<em>n</em> = 5) during 70 min of middle cerebral artery occlusion (MCAO), using a fluorescent microsphere method.</div></div><div><h3>Results</h3><div>Average collateral blood flow significantly increased post-occlusion relative to baseline (pre-MCAO: 16.8 ± 7.1nL/min vs. post-MCAO: 146.4 ± 37.7nL/min, <em>p</em> = 0.02). Within animal linear regression analysis showed a strong positive correlation between changes in collateral blood flow versus changes in collateral diameter during stroke (<em>r</em> = 0.7–0.99, <em>p</em> = 0.3–0.002). In contrast, collateral blood flow was only weakly correlated with collateral blood flow velocity during stroke (<em>r</em> = −0.03–0.97, <em>p</em> = 0.9–0.1).</div></div><div><h3>Conclusions</h3><div>Collateral blood flow and velocity significantly increased post-occlusion. Collateral flow was strongly influenced by vessel diameter, likely because of marked baseline vasoconstriction of collaterals which is flow-limiting.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108195"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824743","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":"Mendelian randomization and mediation examination of the immune cell-mediated link between sphingomyelin and stroke","authors":"Cong Xu ,&nbsp;Yonghong Xu ,&nbsp;Jianglei Ma ,&nbsp;Guangming Wang","doi":"10.1016/j.jstrokecerebrovasdis.2024.108205","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108205","url":null,"abstract":"<div><h3>Objective</h3><div>The study established a direct link between stroke and sphingomyelin. The precise biology underlying this connection is yet unknown, though. As a result, we decided to investigate the potential causal relationship between Sphingomyelin and genetic vulnerability to stroke, as well as the potential mediating function that immune cells may play in this process, using Mendelian randomization (MR) approaches.</div></div><div><h3>Methods</h3><div>A published genome-wide association study (GWAS) dataset of European populations served as the foundation for the MR Study. The inverse variance weighting (IVW) model is the main technique. Four additional statistical techniques (MR Egger, Weighted median, Simple mode, and Weighted mode) were also employed to enhance the verification process. Reverse MR Analysis was utilized to reinforce the findings, and heterogeneity and horizontal pleipotency were assessed. Additionally, this study looked into potential immune cell mediating roles in the causal link between sphingomyelin and stroke using two-step MR techniques.</div></div><div><h3>Result</h3><div>The IVW metod's results indicated that sphingomyelin genetic susceptibility was linked to a high risk of stroke (OR = 1.045 [95 %CI, 1.004–1.087; <em>P</em> = 0.031). Additionally, the statistical result of SSC−A on CD8br and stroke was IVW [<em>P</em> = 0.007, OR(95 % CI) 1.020 (1.005–1.034)], which was proportionate to the increased risk of stroke. A lower incidence of stroke IVW is linked to CD45 on CD8br [<em>P</em> = 0.004, OR(95 % CI) 0.993 (0.988-0.998)]. Furthermore, our results imply that SSC−A on CD8br and CD45 on CD8br contribute to the causative relationship between sphingomyelin and stroke. The percentages of conciliation are 5.38 %, 22.7 %, 33.5 %), and 0.000999, 0.0152, 0.0132, respectively.</div></div><div><h3>Conclusion</h3><div>We confirmed the effect of sphingomyelin on stroke and conducted in-depth studies. SSC−A on CD8br and CD45 on CD8br is latent stroke mediators associated with sphingomyelin. Through two-step mediated Mendelian randomization analysis, we provide new insights into the etiology and treatment of stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108205"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873491","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":"Screening prediction models using artificial intelligence for moderate-to-severe obstructive sleep apnea in patients with acute ischemic stroke","authors":"Huan-Jan Lin MD ,&nbsp;Tian-Hsiang Huang PhD ,&nbsp;Hui-Ci Huang ,&nbsp;Pao-Li Hsiao MD ,&nbsp;Wen-Hsien Ho PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108214","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108214","url":null,"abstract":"<div><h3>Background</h3><div>Obstructive sleep apnea (OSA) is common after stroke. Still, routine screening of OSA with polysomnography (PSG) is often unfeasible in clinical practice, primarily because of how limited resources are and the physical condition of patients. In this study, we used several artificial intelligence techniques to predict moderate-to-severe OSA and identify its features in patients with acute ischemic stroke.</div></div><div><h3>Methods</h3><div>A total of 146 patients with acute ischemic stroke underwent PSG screening for OSA. Their baseline demographic characteristics, including age, sex, body mass index (BMI), Epworth Sleepiness Scale (ESS) score, and stroke risk factors, were recorded. Logistic regression analysis was conducted to identify significant features associated with moderate-to-severe OSA in patients with stroke. These significant features were used with six machine learning and ensemble learning algorithms, namely decision tree, support vector machine, random forest, extreme gradient boosting (XGBoost), adaptive boosting (AdaBoost), and gradient boosting, to compare the performance of several predictive models.</div></div><div><h3>Results</h3><div>Multivariate logistic regression analysis revealed that age, sex, BMI, neck circumference, and ESS score were significantly associated with the presence of moderate-to-severe OSA. According to the machine learning and ensemble learning results, the XGBoost model achieved the highest performance, with an area under the receiver operating characteristic curve of 0.89 and an accuracy and F1 score of 0.80.</div></div><div><h3>Conclusion</h3><div>This study identified key factors contributing to moderate-to-severe OSA in patients with ischemic stroke. The XGBoost model exhibited high predictive performance, indicating it has potential as a supporting tool for decision-making in health-care settings.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108214"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900376","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":"LDL-cholesterol lowering agents (statins and PCSK9 inhibitors) and the risk of intracerebral hemorrhage: A network meta-analysis","authors":"Wangwen Li M.M. ,&nbsp;Chuyue Wu M.D, Ph.D. ,&nbsp;Wenkui Li M.M. ,&nbsp;Li Li M.M.","doi":"10.1016/j.jstrokecerebrovasdis.2025.108224","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108224","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Statin therapy reduces the risk of ischemic stroke; however, certain studies have observed an increased incidence of intracerebral hemorrhage (ICH). Moreover, proprotein convertase subtilisin/kexin type 9(PCSK-9) inhibitors have emerged as a powerful class of lipid-lowering medications, potentially with a lower propensity for causing hemorrhagic events. To investigate this matter further, we conducted a network meta-analysis of randomized controlled trials (RCTs) involving statins and PCSK-9 inhibitors that reported occurrences of ICH.</div></div><div><h3>Methods</h3><div>We performed a literature search of Medline, Web of Science, and The Cochrane Library from database inception until August 2023. All randomized controlled trials of statin therapy and PCSK-9 inhibitors that reported ICH or hemorrhagic stroke were included. The primary outcome variable was ICH. The risk of bias of each included study was assessed by using the Cochrane Handbook for Systematic Reviews of Interventions. We performed network meta-analysis to compare and rank statin and PCSK-9 inhibitors therapies. This study is registered (2023110026. <span><span>inplasy.com</span><svg><path></path></svg></span>).</div></div><div><h3>Results</h3><div>A total of 26251 citations were identified by the search, and 38 potentially eligible articles were included. In total, data from 271411 individuals were analyzed. The data showed that there was not a significant increased risk of intracerebral hemorrhage for all statins and PCSK-9 inhibitors compared with placebo. atorvastatin and rosuvastatin were associated with a lower risk of death than placebo (ORs ranging between 0.79 and 0.82). For risk of intracerebral hemorrhage and mortality. there was not a significant increased risk among all drugs.</div></div><div><h3>Conclusions</h3><div>LDL-Cholesterol lowering agents (statins and PCSK-9 inhibitors) was not associated with a significant increased risk of ICH. Our network meta-analysis provides strong evidence for the safety of statins and PCSK-9 inhibitors, but more studies are needed to further validate this conclusion.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108224"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928767","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":"Stimulant use disorder and the likelihood of stroke: Analysis of a national database in the United States","authors":"Akash Venkataramanan MD ,&nbsp;Divya Nayar MD ,&nbsp;Sama Almasri MD ,&nbsp;Thirumalaivasan Dhasakeerthi MD ,&nbsp;Sowmya Jayachandran MD ,&nbsp;Suryansh Bajaj MD ,&nbsp;Cheran Elangovan MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108178","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108178","url":null,"abstract":"<div><h3>Background</h3><div>Stimulant use has been associated with an increased risk of stroke, though data on clinical characteristics and exact risk are limited. This retrospective case-control study examines stroke risk in individuals with stimulant use disorder using data from a national U.S. database.</div></div><div><h3>Methods</h3><div>Data was obtained from the 2019 National Readmission Database (NRD) using ICD-10 codes to identify relevant diagnoses. A multivariate logistic regression analyzed the impact of stimulant use disorder on stroke admission odds, adjusting for alcohol use disorder, tobacco use, diabetes, hypertension, dyslipidemia, age, insurance status, and median income. Outcomes like total hospitalization charge, length of stay, and in-hospital mortality were assessed with multivariate regression. Gender-specific analyses were also conducted. Statistical significance was set at p &lt; 0.05.</div></div><div><h3>Results</h3><div>A total of 4,821 adults with stimulant use disorder and stroke were compared to 542,618 stroke patients without stimulant use disorder. Patients with stimulant use disorder (PWSU) had significantly higher odds of hemorrhagic and ischemic stroke admissions, especially hemorrhagic strokes in women. PWSU with hemorrhagic strokes also had higher odds of in-hospital mortality.</div></div><div><h3>Conclusions</h3><div>Stimulant use disorder is associated with higher odds of admission for stroke, especially in women with an overall elevated mortality from hemorrhagic strokes. These findings underscore the need for further research and emphasize the importance of stroke prevention and treatment in individuals with stimulant use disorder.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108178"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796540","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":"Biomarkers for the detection of covert atrial fibrillation after ischemic stroke: NT-proBNP or BNP?","authors":"Hiroshi Shiroto MD, PhD. ,&nbsp;Joji Hagii MD.","doi":"10.1016/j.jstrokecerebrovasdis.2025.108239","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108239","url":null,"abstract":"<div><h3>Background</h3><div>Atrial fibrillation often leads to ischemic stroke. For secondary prevention, clinicians typically switch from antiplatelet to anticoagulant therapy for patients with confirmed atrial fibrillation. This study examined the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP) for detecting covert paroxysmal atrial fibrillation (PAF) in patients with ischemic stroke (PWIS).</div></div><div><h3>Methods</h3><div>We enrolled 438 patients with acute stroke in sinus rhythm on admission from July 2021 to March 2023 and measured their NT-proBNP and BNP levels to evaluate their association with PAF detection. Data analysis included logistic regression, receiver operating characteristic curves, and integrated discrimination improvement (IDI).</div></div><div><h3>Results</h3><div>Among our 438 enrolled participants, 43 (9.8%) were in the PAF group and the remaining were in the non-PAF group. PAF group patients were older than those in the non-PAF group (PAF group vs. non-PAF group; 84 [78–89] vs. 79 [71–85] years) and had higher levels of both NT-proBNP (581.0 [264.5–1,234.5] vs. 168.0 [76.0–412.5] pg/mL) and BNP (186.0 [100.4–313.0] vs. 56.4 [26.9–118.0] pg/mL). The PAF group also had a higher prevalence of chronic heart failure (30% vs. 10%). Both biomarkers were independent predictors of PAF detection, and there was no significant difference in their predictive accuracy for PAF. However, BNP had a slight advantage in the IDI score over NT-proBNP (−0.03 [−0.05 to −0.01]).</div></div><div><h3>Conclusion</h3><div>NT-proBNP and BNP can both effectively predict covert PAF in PWIS in sinus rhythm. Thus, either biomarker should be incorporated into treatment planning strategies for these patients.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 6","pages":"Article 108239"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124017","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}