Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Real-world safety profile of direct oral anticoagulants (DOACs): Disproportionality analysis of major bleeding events","authors":"Lazzaro di Biase MD, Ph.D ,&nbsp;Adriano Bonura MD ,&nbsp;Pasquale Maria Pecoraro MD ,&nbsp;Vincenzo Di Lazzaro MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108173","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108173","url":null,"abstract":"<div><h3>Background</h3><div>Direct Oral Anticoagulants (DOACs) have revolutionized the management of thrombotic conditions, providing more predictable and manageable anticoagulation compared to traditional vitamin K antagonists. Despite their success, major bleeding events remain a significant concern. This study aims to assess and compare the haemorrhagic risks associated with various DOACs using data from the FDA's Adverse Event Reporting System (FAERS).</div></div><div><h3>Methods</h3><div>A retrospective disproportionality analysis of the FAERS database was conducted, covering the period from January 1, 2015, to December 31, 2023. The study focused on adverse bleeding events reported for DOACs. The Proportional Reporting Ratio (PRR) was calculated for each DOAC to identify disproportionate reporting of haemorrhagic events. Major haemorrhagic events were classified as those leading to hospitalization. The analysis also utilized the Medicare Part D dataset to estimate the usage of specific DOACs from 2015 to 2021.</div></div><div><h3>Results</h3><div>A total of 353,188 haemorrhagic events were identified, with 17,236 (4.9%) attributed to DOACs. The PRR for major haemorrhagic events was highest for Edoxaban at 14.1 (95% CI 13.93-14.85), followed by Dabigatran at 4.0 (95% CI 3.81-4.20), Apixaban at 3.53 (95% CI 3.47-3.61), and Rivaroxaban at 2.11 (95% CI 2.05-2.18). Edoxaban also had the highest PRR for cerebral haemorrhages. Medicare data indicated that Apixaban was the most commonly used DOAC (58.3%), followed by Rivaroxaban (34.5%).</div></div><div><h3>Conclusions</h3><div>Edoxaban shows a significantly higher risk of major and cerebral haemorrhages compared to other DOACs, while Rivaroxaban demonstrates a lower overall risk of haemorrhage. These findings emphasize the need for careful consideration of bleeding risks in DOAC therapy. Continuous post-marketing surveillance is crucial for understanding the safety profiles of DOACs in real-world clinical settings, aiding clinicians and patients in making informed decisions about anticoagulant therapy.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108173"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792845","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":"Postoperative fragmentation and distal migration of Carotid Stent in vascular Eagle Syndrome","authors":"Masahiro Nishihori MD, PhD ,&nbsp;Takashi Izumi MD, PhD ,&nbsp;Shunsaku Goto MD, PhD ,&nbsp;Shinsuke Muraoka MD, PhD ,&nbsp;Hirotaka Kogame MD, PhD ,&nbsp;Ryuta Saito MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108202","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108202","url":null,"abstract":"<div><h3>Objectives</h3><div>Vascular Eagle syndrome (ES) is a rare condition involving vessel compression by an elongated styloid process, leading to neurologic symptoms. Here, we present the case of a patient with a complication of carotid artery stenting for vascular ES and discuss the implications of treatment of this rare condition.</div></div><div><h3>Case description</h3><div>A 35-year-old previously healthy male patient presented with transient aphasia and right-sided hemiparesis following ischemic stroke in left frontal lobe. Digital subtraction angiography revealed a large aneurysm with stenosis of the left cervical internal carotid artery, and computed tomography (CT) demonstrated elongated ipsilateral styloid process. Progressive aneurysm enlargement required coil embolization and carotid artery stenting (CAS). Cervical X-ray obtained 1 year later revealed the fracture and fragmentation of the carotid stent. Imaging studies identified multiple stent fragments dispersed in distal arteries and a dissecting aneurysm with an irregular wall at the site of the stent site. Dynamic cone-beam CT scan without contrast performed during neck movement, revealed that the styloid process tip was adjacent to the stent fracture line, confirming vascular ES. The symptomatic left styloid process was resected, followed by repeat CAS. The dissecting aneurysm was thrombosed post-CAS, and the patient remained asymptomatic without complications at 6-month follow-up.</div></div><div><h3>Conclusion</h3><div>In patients with vascular ES, diagnostic imaging should include dynamic evaluations to assess cervical dynamics and the resection of styloid process is essential to prevent chronic stent fracture.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108202"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856710","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":"Global prevalence and risk factors of delirium among patients following acute stroke: A systematic review and meta-analysis","authors":"Muhammad Amirul Mukminin ,&nbsp;Tu-Hsueh Yeh ,&nbsp;Hui-Chen Lin ,&nbsp;Iftitakhur Rohmah ,&nbsp;Hsiao-Yean Chiu","doi":"10.1016/j.jstrokecerebrovasdis.2024.108221","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108221","url":null,"abstract":"<div><h3>Background and Objective</h3><div>The exact prevalence and risk factors of delirium following stroke at an acute stage remains unclear. We aimed to determine the global prevalence and risk factors of delirium following acute stroke.</div></div><div><h3>Method</h3><div>Observational studies reporting the prevalence of or risk factors for delirium following acute stroke published in the PubMed, Embase, and Scopus databases before April 16, 2024, were identified. Data were extracted by two independent reviewers. A random effects model was used for data analysis.</div></div><div><h3>Results</h3><div>Our meta-analysis included 48 studies on prevalence and 25 studies on risk factors for poststroke delirium. The pooled global prevalence rate of delirium was 24 % (18 %–30 %). Hemorrhagic stroke type, early assessment (within 3 days of stroke onset), older age, and male sex were risk factors for poststroke delirium. Independent factors significantly associated with poststroke delirium (all p &lt; 0.05) were age, dementia, prior stroke, prior total anterior circulation infarct stroke subtype, atrial fibrillation, elevated C-reactive protein levels, aphasia, poor vision, neglect, depression, and the use of urinary catheters and gastric tubes.</div></div><div><h3>Conclusion</h3><div>Approximately a quarter of the included patients with acute stroke experienced delirium. Our findings regarding the risk factors for poststroke delirium can provide an evidence-based approach for future strategies to prevent delirium.</div></div><div><h3>Fundings</h3><div>NSTC, Taiwan (MOST 113-2628-B- 038-00-MY3 and 111-2314-B-038-033-MY3).</div></div><div><h3>Protocol</h3><div>The International Prospective Register of Systematic Reviews (CRD42024518119)</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108221"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933502","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":"Diagnostic yield and therapeutic implications of vascular imaging in acute ischemic stroke: prospective and consecutive study of small vessel versus large vessel ischemia","authors":"Roger E. Kelley M.D. ,&nbsp;Prabandh Buchhanolla M.D. ,&nbsp;Amrita Pandey M.D. ,&nbsp;Monika Thapa M.D. ,&nbsp;Md Ismail Hossain M.Sc. ,&nbsp;Mohammad Alfrad Nobel Bhuiyan Ph.D","doi":"10.1016/j.jstrokecerebrovasdis.2024.108182","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108182","url":null,"abstract":"<div><h3>Introduction</h3><div>To evaluate patients acute cerebral ischemia in order to assess for factors which may help to differentiate patients with small vessel involvement from those with large vessel involvement in an effort to determine diagnostic yield of vascular imaging.</div></div><div><h3>Material and Method</h3><div>We prospectively and consecutively evaluated all acute ischemic stroke patients at our medical center from May 16, 2021 to December 10, 2021. Distinction between small vessel and large vessel involvement was based upon clinical presentation, the results of brain imaging and either computed tomographic angiography, in the vast majority, or magnetic resonance angiography. Patient demographics and risk factors for stroke as well as therapeutic intervention was assessed.</div></div><div><h3>Conclusion and Result</h3><div>Of the 90 patients studied, 59 had large vessel ischemia (66%) with 26 (44%) having large vessel occlusion and one had symptomatic high-grade middle cerebral artery stenosis. Conversely, none of the 31 patients with small vessel presentation (34%) had large vessel occlusion or high-grade stenosis. In addition, 19 out of 59 (32%) large vessel patients compared to 2 of 31 (6%) of the small vessel patients had atrial fibrillation identified as a potential mechanism with a p-value of 0.01 by univariate analysis and 0.17 by multivariate analysis. The routine use of vascular imaging in acute ischemic stroke is of very low yield in small vessel presentation with the presence of potential cardiogenic emboli is also relatively low. Efforts at accelerated identification of a small vessel mechanism, to avoid unnecessary testing, should provide significant value from both a patient management and cost standpoint.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108182"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796526","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":"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}