Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Cryptogenic stroke, embolic stroke of unknown source, and the left atrial septal pouch: the role of transesophageal echocardiography","authors":"Jennifer Xu MD ,&nbsp;Jihoon Kang MD ,&nbsp;Jonathan Schilling MD MBA ,&nbsp;Annlia Paganini-Hill PhD ,&nbsp;Marissa Ericson PhD ,&nbsp;Jin Kyung Kim MD PhD ,&nbsp;Mark Fisher MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108384","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108384","url":null,"abstract":"<div><h3>Background</h3><div>Cryptogenic stroke accounts for a substantial proportion of ischemic strokes and often poses a diagnostic challenge due to the limitations of the TOAST classification in identifying atypical mechanisms. The left atrial septal pouch (LASP) is a blind-ended pouch arising from the incomplete fusion of the septum primum and septum secundum and is mutually exclusive with a patent foramen ovale (PFO). LASP is typically diagnosed using transesophageal echocardiography (TEE), an imaging modality not routinely utilized in the evaluation of either cryptogenic stroke or a related entity, embolic stroke of unknown source (ESUS). Consequently, LASP may be underdiagnosed and unrecognized as a potential risk factor. We examined the association between LASP and cryptogenic stroke.</div></div><div><h3>Materials and methods</h3><div>We searched PubMed and EMBASE to identify relevant studies. The association between LASP and cryptogenic stroke was estimated by the odds ratio (OR) (unadjusted) and 95 % confidence interval (CI). Heterogeneity was assessed by χ²-based Q-test.</div></div><div><h3>Results</h3><div>Eight studies with 2,075 participants were used in the meta-analysis. We found a significant association between cryptogenic stroke and the presence of LASP (OR 1.60, 95 % CI 1.27 to 2.02, <em>p</em> &lt; 0.001). No evidence of heterogeneity was found (<em>Q</em> = 6.33, <em>p</em> = 0.50). Seven of the eight studies utilized TEE for LASP detection.</div></div><div><h3>Conclusion</h3><div>This systematic review and meta-analysis supports a relationship between LASP and cryptogenic stroke. Given the limitations of the TOAST criteria and the underutilization of TEE in stroke evaluation of cryptogenic stroke and ESUS, further research is needed to characterize LASP's role in stroke occurrence and to establish targeted prevention strategies in affected patients.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 9","pages":"Article 108384"},"PeriodicalIF":1.8,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487735","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 safety and efficacy of factor XIa inhibitors for the prevention of stroke and thromboembolism: A systematic review and meta-analysis of randomized controlled trials","authors":"Nayab Zahid ,&nbsp;Fatima Iqbal ,&nbsp;Amber Siddique ,&nbsp;Anushah Nadeem ,&nbsp;Waqar Hussain ,&nbsp;Amna Ishaq ,&nbsp;Mansoor Ahmed ,&nbsp;Nauman Lal ,&nbsp;Saad Abdullah ,&nbsp;Humyoun Yousaf ,&nbsp;Uzair Jafar ,&nbsp;Muhammad Ayyan ,&nbsp;Muzammil Farhan ,&nbsp;Muhammad Ameen Noushad ,&nbsp;Raheel Ahmed","doi":"10.1016/j.jstrokecerebrovasdis.2025.108381","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108381","url":null,"abstract":"<div><h3>Background</h3><div>Stroke and thromboembolism remain the leading causes of mortality worldwide. Factor Xia inhibitors (FXIa) might prevent thromboembolism without interfering with hemostasis, thus leading to a lower risk of bleeding than direct oral anticoagulants (DOACs).</div></div><div><h3>Methods</h3><div>We conducted a systematic search using PubMed, Embase, and Clinicaltrials.gov to retrieve randomized controlled trials comparing FXIa inhibitors to placebo or DOACs in patients at risk of stroke or thromboembolism. All statistical analyses were carried out using RevMan 5.4, using a random effects model.</div></div><div><h3>Results</h3><div>Our meta-analysis included 14 RCTs involving 30,952 patients. FXIa inhibitors significantly decreased the risk of major bleeding (RR 0.47, 95% CI: 0.33-0.66, I²= 46%) with no significant change in systemic embolism or thromboembolism (RR 0.83, 95% CI: 0.64-1.07, I²= 70%). There was no significant change between the two groups when assessing the rate of all bleeding events (RR 0.78, 95% CI: 0.55-1.11, I²= 73%), all-cause mortality (RR 0.87, 95% CI: 0.70-1.09, I²= 0%), ischemic stroke (RR 0.99, 95%CI: 0.49-1.98, I²= 86%), myocardial infarction (RR 1.30; 95% CI, 0.54 – 3.13; I² = 68%), and intracranial hemorrhage (RR 0.49, 95% CI: 0.23- 1.05, I²= 9%). The rate of all adverse events (RR 1.05, 95% CI: 0.86-1.29, I²= 79%) and serious adverse events (RR 1.16, 95% CI: 0.86-1.55, I²= 74%) remained comparable between the two groups.</div></div><div><h3>Conclusion</h3><div>In conclusion, FXIa inhibitors show promise as safer anticoagulant agents, demonstrating favorable bleeding outcomes without changing thromboembolism, mortality, or other safety outcomes. The presence of heterogeneity across various subgroups warrants data from further high-quality, large-scale RCTs to establish evidence of its clinical benefit. This is especially important in atrial fibrillation, where conflicting evidence regarding thromboembolism warrants cautious interpretation and further investigation.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108381"},"PeriodicalIF":2.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340797","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 anti-Ro52 antibodies and cerebral small vessel disease with neurological functional outcomes in acute ischemic stroke patients","authors":"Ruojun Wang MD ,&nbsp;Kai Wang MD ,&nbsp;Xue Yang MD ,&nbsp;Shengyi Zhang MD ,&nbsp;Zeqin Ren MD ,&nbsp;Guangxia Yang MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108383","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108383","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigated the association between anti-Ro52 antibodies, cerebral small vessel disease (CSVD) burden, and neurological outcomes in acute ischemic stroke (AIS) patients.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of 127 AIS patients admitted between June 2017 and June 2024. CSVD burden was quantified using a composite score (range: 0-3) based on three neuroimaging markers. Severe CSVD was defined as a score &gt;1. Neurological function was evaluated using the modified Rankin Scale (mRS), where a score &gt;2 at admission and 3 months post-stroke indicated poor outcomes. After propensity score matching, 38 anti-Ro52-positive patients were compared with 38 anti-Ro52-negative controls. Multivariate logistic regression analyses were performed to assess independent associations.</div></div><div><h3>Results</h3><div>Multivariate analysis revealed that anti-Ro52 positivity, advanced age, and hypertension were independently associated with severe CSVD burden (all <em>p</em> &lt; 0.05). Furthermore, anti-Ro52 positivity, higher NIHSS scores, and severe CSVD burden were independently correlated with poor neurological function at admission and 3 months post-stroke (all <em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Our findings demonstrate that anti-Ro52 antibodies are independently associated with severe CSVD burden in AIS patients. Moreover, both anti-Ro52 positivity and CSVD burden are significantly associated with worse neurological outcomes. Our study suggests that anti-Ro52 antibodies may influence stroke severity through the development and progression of CSVD.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108383"},"PeriodicalIF":2.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470444","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":"Tryptophan metabolites as biomarkers to predict the severity and prognosis of acute ischemic stroke patients","authors":"Chuzheng Pan ,&nbsp;Feng Chen ,&nbsp;Yan Yan ,&nbsp;Haiwen Li ,&nbsp;Chengfeng Qiu","doi":"10.1016/j.jstrokecerebrovasdis.2025.108382","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108382","url":null,"abstract":"<div><h3>Objective</h3><div>Ischemic stroke is among the leading causes of mortality and long-term disability worldwide. A growing body of evidence indicates alterations in metabolite levels and enzyme activities associated with the conversion of tryptophan (TRP) throughout the course of cerebral ischemia. In this study we aim to explore the potential relationship between TRP metabolism and clinical prognosis in acute ischemic stroke (AIS) patients of mainland China.</div></div><div><h3>Materials and methods</h3><div>Blood samples were obtained from a cohort of 304 patients diagnosed with AIS. The concentrations of ten TRP metabolites were quantified utilizing liquid chromatography-tandem mass spectrometry (LC-MS/MS). Stroke severity was evaluated upon admission using the National Institutes of Health Stroke Scale (NIHSS). A poor functional outcome was defined as a modified Rankin scale (mRS) &gt; 3, whereas a good functional outcome was defined by mRS ≤ 3 at 3 months post-stroke. LASSO regression and random forest algorithms were then employed to identify key TRP metabolism parameters associated with prognosis.</div></div><div><h3>Results</h3><div>Following the optimization of variable selection through Lasso regression, a prognostic risk model with 7-factors related to AIS was constructed, yielding an AUC of 0.917. Subsequently, a random forest analysis was conducted to establish an 11-factor prognostic risk model, which demonstrated an enhanced AUC of 1.000. Ultimately, three robust parameters related to TRP metabolism were identified. Multivariable logistic regression analysis, adjusted for covariates, revealed that TRP (odds ratio .[OR] = 0.46, 95 % confidence interval .[CI]: 0.26 - 0.76, <em>p</em> = 0.004), the kynurenine (KYN)/TRP ratio (OR = 2.06, 95 % CI: 1.23 - 3.60, <em>p</em> = 0.008), and the kynurenic acid (KYNA)/TRP ratio (OR = 2.15, 95 % CI: 1.23 - 4.12, <em>p</em> = 0.014) were independently associated with poor functional prognosis.</div></div><div><h3>Conclusions</h3><div>The results of this study indicate that TRP metabolism is associated with the severity and prognosis of AIS. The TRP, KYN/TRP ratio and KYNA/TRP ratio may serve as potential biomarkers for 3-month prognostic evaluation.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108382"},"PeriodicalIF":2.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481637","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 secondhand smoke exposure, maternal smoking during pregnancy, and stroke incidence in nonsmokers","authors":"Yi-Ping Huang ,&nbsp;Wei-Dong Fan ,&nbsp;Ying Feng ,&nbsp;Daniel Nyarko Hukportie ,&nbsp;Cui-Yi Jin ,&nbsp;Fu-Rong Li","doi":"10.1016/j.jstrokecerebrovasdis.2025.108379","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108379","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate the independent and combined associations of secondhand smoke (SHS) exposure and maternal smoking during pregnancy with the risk of total stroke and its subtypes, including ischemic and hemorrhagic stroke, among nonsmokers.</div></div><div><h3>Objectives</h3><div>To investigate the independent and combined associations of SHS exposure and maternal smoking during pregnancy with stroke risk in nonsmokers.</div></div><div><h3>Methods</h3><div>A prospective analysis was conducted using 336,640 nonsmoking participants from a nationwide cohort, free from pre-existing cardiovascular disease. SHS exposure was categorized based on hours per week (0, &gt;0–4, &gt;4), and maternal smoking was assessed via participant recall. Outcomes included total stroke, ischemic stroke, and hemorrhagic stroke, identified through hospital records. Cox regression models adjusted for demographic, behavioral, and clinical covariates were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Over a median follow-up of 11.8 years, 5,051 participants experienced strokes. SHS exposure &gt;4 hours/week was associated with increased incident stroke risk (HR 1.34, 95 % CI 1.18–1.52) compared to no exposure. Maternal smoking was associated with a 7 % increase in total stroke risk (HR 1.07, 95 % CI 1.02–1.14). Combined exposure to SHS &gt;4 hours/week and maternal smoking conferred the highest stroke risk (HR 1.57, 95 % CI 1.29–1.90). Subgroup and sensitivity analyses confirmed these findings.</div></div><div><h3>Conclusions</h3><div>SHS exposure and maternal smoking was independently and jointly associated with higher stroke risk, underscoring the need for robust tobacco control policies to mitigate these exposures and their public health impact.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108379"},"PeriodicalIF":2.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328461","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":"Sex differences in etiologies, risk factors, and outcomes among young adult patients with acute ischemic stroke","authors":"Ekta G. Shah DO, MS ,&nbsp;Manish Bhojwani MD, MPH ,&nbsp;Kelly Chang MD ,&nbsp;Deepa Dongarwar BS ,&nbsp;Nicole R. Gonzales MD ,&nbsp;Erica Jones MD ,&nbsp;Audrey Sarah Cohen MS ,&nbsp;Anjail Z. Sharrief MD, MPH","doi":"10.1016/j.jstrokecerebrovasdis.2025.108380","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108380","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of ischemic stroke is increasing among young adults. Several studies have demonstrated sex differences in risk and outcomes; however, findings are inconsistent. We sought to evaluate sex differences in stroke risk factors, etiology, and disposition in a diverse cohort of patients admitted to a comprehensive stroke center for evaluation.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of patients 18-45 years admitted between January 1, 2015 and September 30, 2021 with an acute ischemic stroke. Patient demographics, risk factors, and disposition were extracted from our institutional inpatient stroke registry and inpatient electronic medical record. Stroke etiology was assigned based on record review. Bivariate analyses were conducted between sex and demographic variables, risk factors, stroke etiology, and disposition.</div></div><div><h3>Results</h3><div>Among 785 patients included, 48.9% (n=384) were female and 51.1% (n=401) were male. Female patients had a higher proportion of prior strokes, cardiac/pulmonary shunts, autoimmune disorders, history of migraine headaches, and exogenous hormone use with a higher proportion of ischemic strokes of other etiologies. Male patients had a higher proportion of lower left ventricular ejection fraction, atrial fibrillation, substance use, and obstructive sleep apnea with a higher proportion of ischemic strokes due to small vessel occlusions and cardioembolic sources. There was a comparable proportion of traditional risk factors and strokes secondary to large artery atherosclerosis between the sexes. No sex differences were seen among functional outcomes at discharge; however, female patients had a lower inpatient mortality rate and lower odds of being discharged to skilled nursing facilities/long-term acute care hospitals/acute care facilities compared to male patients.</div></div><div><h3>Conclusions</h3><div>This study supports the known sex differences in stroke risk factors, etiology, and outcomes for ischemic stroke in young patients, showing the relationship also remains applicable in a large, diverse population. Strategies to address these differences could improve stroke classification and stroke prevention efforts, improving outcomes in this age group.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108380"},"PeriodicalIF":2.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307160","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":"Communicating the ethical, legal, and social issues in neurobiobanking and stroke genomic research in Africa: Project intervention tools development and evaluation procedures","authors":"Babatunde R. Ojebuyi PhD ,&nbsp;Ibukun Afolami PhD ,&nbsp;Muyiwa Adigun PhD ,&nbsp;Arti Singh MD ,&nbsp;Carolyn Jenkins DrPH ,&nbsp;Michelle Nichols PhD, RN ,&nbsp;Kolawole Wahab MD, FMCP ,&nbsp;Abiodun Bello MD ,&nbsp;Fred S. Sarfo MBChB, PhD ,&nbsp;Lukman F. Owolabi MD, FMCP ,&nbsp;Rabiu Musbahu MD ,&nbsp;Reginald Obiako MD, FWACP ,&nbsp;Albert Akpalu MBChB, FWACP ,&nbsp;Mayowa Ogunronbi MPH ,&nbsp;Olorunyomi Olorunsogbon MPH ,&nbsp;Benedict Calys-Tagoe MD ,&nbsp;Deborah Adesina RN ,&nbsp;Nathaniel Coleman MPH ,&nbsp;Abdullateef G. Sule MD ,&nbsp;Aliyu Mande HND ,&nbsp;Rufus Akinyemi MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108378","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108378","url":null,"abstract":"<div><h3>Background and Aim</h3><div>Issues concerning appropriate Community Engagement (CE) and communication of research outcomes with stakeholders have received the attention of scholars in different sub-fields of clinical research. However, given its novel nature, especially in Sub-Saharan Africa, CE addressing the ethical, legal, and social implications (ELSI) of neurobiobanking and stroke genomic research has not received much scholarly attention. Therefore, this study was designed as a pioneering effort to report the procedures for developing and evaluating intervention tools for the CE component of the African Neurobiobank for Precision Stroke Medicine ELSI Project.</div></div><div><h3>Methods</h3><div>A community-based participatory research design was adopted. The intervention tools we developed include <em>general advocacy, educative, and training videos focusing on neurobiobanking, stroke genomics and precision stroke medicine in Africa; infographics; and a policy brief.</em> An adapted Doak and Doak’s Suitability Assessment Measure (SAM), the Agency for Healthcare Research and Quality (AHRQ) Patient Education Materials Assessment Tool (PEMAT), and semi-structured interview questions based on Willis’ Cognitive Interviewing Techniques were used to evaluate the suitability, actionability, understandability and cultural appropriateness of the tools.</div></div><div><h3>Results</h3><div>PEMAT mean percentage scores of 71.4 % for actionability and 82.4 % for understandability, and a SAM suitability score of 67.9 % were reported for the videos. Identified weaknesses captured in seven thematic areas after assessment analysis by experts and community members guided the final refinement of the tools.</div></div><div><h3>Conclusion</h3><div>The overall reviewers’ reports and evaluation scores indicate that the intervention tools are generally suitable for community deployment in sub-Saharan Africa. Clinical researchers must partner with key stakeholders, define policy objectives and desired behaviour change, and develop appropriate persuasive communication strategies and tools for community engagement.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108378"},"PeriodicalIF":2.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311201","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":"Sex differences on cerebrovascular complications in hospitalized COVID-19 patients: a meta-analysis","authors":"Bradley Ong MD ,&nbsp;Lea Elora Conda MD, MBA ,&nbsp;Tereynz Paul Mendoza MS ,&nbsp;Adrian V. Hernandez MD, PhD ,&nbsp;Sung-Min Cho DO, MHS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108377","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108377","url":null,"abstract":"<div><h3>Background</h3><div>Although pre-pandemic data suggest a higher stroke incidence in females, recent evidence suggests COVID-19-related strokes disproportionately affect males. Prior studies often analyzed stroke as a composite outcome without stratifying by biologically distinct subtypes. This systematic review and meta-analysis evaluated sex differences in the risk of ischemic and hemorrhagic stroke among hospitalized patients with COVID-19.</div></div><div><h3>Methods</h3><div>We searched MEDLINE and six additional databases from inception to December 2024. We included observational studies enrolling adults (≥18 years) with active COVID-19 infection, hospitalized, and reporting sex-stratified stroke outcomes. Pooled risk ratios (RRs) for each stroke subtype were calculated using random-effects models. We defined RR as the ratio of the cumulative incidence of type of stroke in males over the cumulative incidence of the same type of stroke in females.</div></div><div><h3>Results</h3><div>Seventeen studies comprising 135,481 hospitalized COVID-19 patients (mean age 63.3 years; 48.7% male) met inclusion criteria. Stroke occurred in 1,509 patients (1.1%), with ischemic stroke accounting for 53.9% of cases, unspecified stroke for 30.1%, and hemorrhagic stroke for 16.1%. Males accounted for a greater proportion of stroke cases across all subtypes: 63.1% of ischemic, 69.0% of hemorrhagic, and 59.0% of unspecified strokes. The estimated prevalence of ischemic stroke was 17% in males (95% CI, 15%–20%) versus 9% in females (95% CI, 7%–11%), and hemorrhagic stroke occurred in 4% of males (95% CI, 2%–6%) versus 1% of females (95% CI, 0%–2%). Unspecified stroke occurred in 2% of both sexes (95% CI, 0%–3%). Pooled risk estimates showed that males had a significantly higher risk of any stroke (RR = 1.25; 95% CI,1.05-1.50), driven by an elevated risk of hemorrhagic stroke (RR = 1.64; 95% CI, 1.06-2.54). The increased risk of ischemic stroke in males did not reach statistical significance (RR = 1.18; 95% CI, 0.97–1.44).</div></div><div><h3>Conclusions</h3><div>This is the first meta-analysis to stratify stroke risk by sex and stroke subtype in hospitalized COVID-19 patients. Males were at significantly higher risk for hemorrhagic stroke, suggesting possible sex-specific vulnerability that warrants further studies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108377"},"PeriodicalIF":2.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298062","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":"Identification of neurological text markers associated with risk of stroke","authors":"Anoop Mayampurath PhD ,&nbsp;Avery Rosado BS ,&nbsp;Elida Romo BS ,&nbsp;Philip Silberman MA ,&nbsp;Jay Patel BS ,&nbsp;Samantha Jankowski BS ,&nbsp;Matthew Maas MD, MS ,&nbsp;Jane L. Holl MD, MPH ,&nbsp;Ava L. Liberman MD ,&nbsp;Shyam Prabhakaran MD, MS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108376","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108376","url":null,"abstract":"<div><h3>Background</h3><div>Delayed or missed stroke diagnosis is associated with poor outcomes. We utilized natural language processing of notes from non-neurological emergency department (ED) encounters to identify text phrases indicating stroke presentations that are associated with stroke hospitalization 30 days after ED discharge.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of stroke (case) and gastroenteritis (matched-control) patients at two academic medical centers who had an ED encounter 30 days before index admission diagnosis. Medical concepts were extracted from the ED encounter notes. Statistical analysis was used to detect neurological text markers indicating stroke signs and symptoms using data from one hospital (discovery cohort) and validated in the second (validation cohort). We further compared the coefficients and the predictive performance of an elastic net model of both cohorts.</div></div><div><h3>Results</h3><div>We detected 58 medical concepts with a statistically significant positive association with stroke cases in the discovery cohort of 987 patients (51 % stroke). Expert review was used to combine these medical concepts into 11 text markers indicative of stroke presentations (e.g., coordination, language). Markers demonstrated external validity in terms of positive association when analyzed in the validation cohort of 433 patients (24 % stroke). Elastic net models derived at each center demonstrated equivalence in coefficient magnitudes and predictive performance, demonstrating generalizability.</div></div><div><h3>Conclusion</h3><div>We detected and validated neurologic text markers characteristic of stroke signs and symptoms at an ED encounter 30 days before the stroke diagnosis. The presence of these markers could be used to prompt additional neurologic evaluation to prevent delayed stroke diagnosis.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108376"},"PeriodicalIF":2.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279256","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":"Outcomes of carotid endarterectomy in symptomatic octogenarian patients","authors":"Marcello Lodato ,&nbsp;Rodolfo Pini ,&nbsp;Gianluca Faggioli ,&nbsp;Cristina Rocchi ,&nbsp;Enrico Gallitto ,&nbsp;Andrea Vacirca ,&nbsp;Mauro Gargiulo","doi":"10.1016/j.jstrokecerebrovasdis.2025.108375","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108375","url":null,"abstract":"<div><h3>Introduction</h3><div>Carotid endarterectomy (CEA) is the standard treatment for symptomatic carotid artery stenosis (ipsilateral cerebral ischemic symptoms in the last 3months - SCS) in patients suitable for open surgery. Given the increasing age of the general population, this treatment is performed in octogenarian patients with increasing frequency. However, this population was not included in the historical randomized controlled trials and there is a lack of available data on perioperative complications, specifically the severity of possible postoperative stroke. The aim of this study is to report the outcomes of CEA for SCS in octogenarians and to evaluate the characteristics of postoperative stroke, in comparison to non-octogenarians.</div></div><div><h3>Methods</h3><div>This is a retrospective analysis of patients treated with CEA from 2012 to 2023 for SCS. Patients were divided according to their age in non-octogenarian (&lt;80year-old) and octogenarian (≥80 year-old) and compared according to type of preoperative symptoms and timing of intervention. The primary endpoints of this study were to analyze the postoperative stroke and death rate and to assess the severity of postoperative stroke in octogenarian and non-octogenarian patients using the National Institute of Health Institute of Stroke Scale (NIHSS) classification. Follow-up was performed with yearly clinical visit.</div></div><div><h3>Results</h3><div>A total of 664 symptomatic patients were treated by CEA, 157(24 %) were octogenarian (mean age 84 ± 4) and had similar preoperative characteristics of non-octogenarian except for the distribution of preoperative neurological type of symptoms: transient ischemic attack (TIA) 51 %vs42 %,<em>P</em> = .05, amaurosis fugax (AF) 14 %vs5 %,<em>P</em> = .001; stroke 36 %vs53 %,<em>P</em> = .01. The timing between symptoms and surgery was similar between the octogenarian and non-octogenarian patients 10 ± 8vs8 ± 7 days(<em>P</em> = .22). The overall postoperative rate of stroke and death was 3.1 %, similar between octogenarian and non-octogenarian: 3.7 %vs.3.1 %,<em>P</em> = .39. The type of preoperative symptoms did not affect the outcome between older and younger patients: TIA 3.4 %vs.3.3 %,<em>P</em> = .63; AF 0 %vs0 %,<em>P</em> = .1.0 and stroke 3.5 %vs.3.3 %,<em>P</em> = 1.0. In octogenarian patients stroke and death rate was similar independently on the timing of CEA performance: 3.9 %, if performed within 48h, 3.7 % between 2days and 14 days and 3.4 % after 2 weeks, <em>P</em> = .72. Postoperative stroke rate was similar in the two groups: 15(2.9 %) in non-octogenarians and 5(3 %) in octogenarian patients (<em>P</em> = .1); but moderate/severe stroke (NIHSS ≥ 5) was more frequent in octogenarian patients: 2 % vs 0.4 %, <em>P</em> = .05 The mean follow-up was 68±14 months and at 5-year the ipsilateral stroke free survival was 97.6 % ± 4 % with no differences between octogenarian and non-octogenarian: 95.2 % ± 6 %vs98.1 % ± 3 ","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108375"},"PeriodicalIF":2.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279257","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}