Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Effect of associated mirror therapy on the less affected hand in patients with subacute stroke: a pilot randomized controlled trial","authors":"Jinyang Zhuang PhD ,&nbsp;Bingyuan Cheng BS ,&nbsp;Beibei Shu BS ,&nbsp;Li Ding PhD ,&nbsp;Jie Jia PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108374","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108374","url":null,"abstract":"<div><h3>Background</h3><div>The ipsilesional hand after stroke has been shown to exhibit a minor deficit, impacting bimanual activities. This study investigates the effect of associated mirror therapy (AMT) on the less affected hand dexterity and explores the relationship between bilateral hand recovery poststroke.</div></div><div><h3>Methods</h3><div>An assessor-blinded, pilot randomized controlled study was conducted. Patients were assigned to the AMT or control group, receiving 30-minute training per time, five times a week for four weeks. The primary outcome was the ipsilesional Box and Block Test (BBT_I). The secondary outcomes included the contralesional Box and Block Test (BBT_C), Fugl-Meyer Assessment for Upper Extremity and Hand (FMA_UE and FMA_H), and Functional Independent Measure (FIM). Assessments were conducted at baseline, after 2-week, and 4-week treatment.</div></div><div><h3>Results</h3><div>All patients showed improved BBT_I, FMA_H, and FIM scores in the latter two weeks compared to the first two weeks (all <em>P</em>&lt;0.05). The AMT group had higher FMA_H and FIM scores than the control group (<em>P</em>&lt;0.001). Although the difference in BBT_I scores was insignificant (<em>P</em>=0.064), the AMT group performed better. Significant interaction effects were found in BBT_C and FMA_UE scores. The AMT group showed greater improvements in BBT_C and FMA_UE scores in 2-week and 4-week interventions than the control group (all P &lt;0.05). Compared to the first two weeks, the AMT group showed improvements in FMA_UE and BBT_C scores during the last two weeks, while the control group only improved in FMA_UE scores (<em>P</em>&lt;0.05). No correction was found in BBT_C and BBT_I change scores between bilateral hand recovery in either group during the first and the latter two weeks.</div></div><div><h3>Conclusions</h3><div>AMT improves affected upper limb and hand motor impairment, hand dexterity, and daily activities, potentially enhancing dexterity in the less affected hand poststroke. There is no relationship between bilateral hand recovery during 4-week inpatient rehabilitation of subacute stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108374"},"PeriodicalIF":2.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278058","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":"Trends and Disparities in In-Hospital Mortality Among Ischemic Stroke Patients During the COVID-19 Era: A Nationwide Study (2016–2022)","authors":"Mian Urfy MD ,&nbsp;Mariam Tariq Mir MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108367","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108367","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>The COVID-19 pandemic disrupted stroke systems of care, but its impact on in-hospital mortality and disparities among ischemic stroke patients remains unclear. We examined nationwide trends in stroke mortality before and during the COVID-19 era, with a focus on demographic and socioeconomic disparities.</div></div><div><h3>Methods</h3><div>We used the National Inpatient Sample (2016–2022) to identify adult hospitalizations with a primary diagnosis of ischemic stroke. Crude in-hospital mortality rates were calculated annually and stratified by sex, age group, race/ethnicity, and insurance status. Multivariable logistic regression was used to estimate adjusted odds of in-hospital mortality, controlling for year, age, sex, race/ethnicity, payer, and comorbidities.</div></div><div><h3>Results</h3><div>Among 950,518 ischemic stroke admissions, in-hospital mortality rose from 6.32% in 2019 to 8.24% in 2021—a 30% relative increase during the COVID-19 era. Mortality was highest among patients aged ≥85 years (11.1%), males (7.2%), and those with self-pay status (OR 2.33 vs. Medicare). Crude mortality increased most among Hispanic (+36.1%), American Indian/Alaska Native (+35.5%), and Black patients (+26.7%). After adjustment, the odds of in-hospital death remained significantly elevated in 2020 (OR 1.05), 2021 (OR 1.17), and 2022 (OR 1.09) compared to 2016. Regional disparities were also observed, with the greatest adjusted mortality increases in the Northeast and West. Race-stratified models confirmed disproportionately higher pandemic-era mortality among minority groups</div></div><div><h3>Conclusion</h3><div>In-hospital stroke mortality rose significantly during the COVID-19 era, with disproportionately greater increases among racial and ethnic minority groups and socioeconomically vulnerable patients. These findings underscore the need for equity-focused interventions in stroke systems of care.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108367"},"PeriodicalIF":2.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144278077","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":"Continuous temperature monitoring in patients with spontaneous intracerebral hemorrhage: insights into temperature patterns and variability","authors":"Kornelia Laichinger MD ,&nbsp;Annerose Mengel MD ,&nbsp;Maria-Ioanna Stefanou MD ,&nbsp;Sophia Kindzierski MD ,&nbsp;Constanze Single MD ,&nbsp;Lena S. Geiger MD ,&nbsp;Till-Karsten Hauser MD ,&nbsp;Ulf Ziemann MD ,&nbsp;Markus Krumbholz MD ,&nbsp;Katharina Feil MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108366","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108366","url":null,"abstract":"<div><h3>Background</h3><div>Spontaneous intracerebral hemorrhage (ICH) is frequently associated with autonomic nervous system dysfunction, potentially leading to temperature dysregulations.</div></div><div><h3>Methods</h3><div>This retrospective study analysis temperature and variability indices standard deviation (SD), coefficient of variation (CV) and successive variability (SV) continuously monitored over the first 96 hours post-admission in 261 ICH patients. Functional outcomes included the modified Rankin Scale (mRS) at discharge and 90-day follow-up.</div></div><div><h3>Results</h3><div>Elevated temperature occurred in 69 patients (26.4 %) and was associated with higher admission National Institutes of Health Stroke Scale (NIHSS) scores (<em>p</em> = 0.003), early hematoma expansion (<em>p</em> = 0.012), longer ICU stays (<em>p</em> &lt; 0.001), and worse functional outcomes at discharge (<em>p</em> = 0.039) and follow-up (<em>p</em> = 0.045). Patients with elevated temperature exhibited greater SD variability, while SV remained similar. Subgroups with intraventricular (<em>p</em> = 0.033), or larger hemorrhages (<em>p</em> = 0.019) were predisposed to elevated temperature and higher SD variability. Logistic regression revealed that younger age, lower premorbid mRS, and lower NIHSS at admission were significant predictors of good 90-day outcomes (e.g., OR 0.352, CI 0.226–0.548, <em>p</em> &lt; 0.001 for premorbid mRS). Intraventricular hemorrhage significantly reduced the likelihood of recovery (OR 0.289, CI 0.123–0.682, <em>p</em> = 0.005 for 0–24 h). Elevated temperature showed a trend toward worse outcomes (OR 2.445, 95 %CI 0.994–6.011, <em>p</em> = 0.051), and increased temperature variability (SD) was independently associated with poor outcomes in the first 24 hours (OR 0.090, CI 0.009–0.956, <em>p</em> = 0.046).</div></div><div><h3>Conclusions</h3><div>Elevated temperature and early temperature variability within the first 24 hours are associated with worse functional outcomes in ICH patients, highlighting the importance of targeted thermoregulation strategies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108366"},"PeriodicalIF":2.0,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144261645","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 relationship between flavonols intake and stroke in the elderly: a cross-sectional study from NHANES (2007-2010 and 2017-2018)","authors":"Xuehua Cheng ,&nbsp;Ting Peng ,&nbsp;Li Han","doi":"10.1016/j.jstrokecerebrovasdis.2025.108373","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108373","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Stroke is a common fatal and disabling disease in the elderly. We investigated the correlation and potential benefits of dietary intake of flavonoid compounds and their subclasses in elderly stroke patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) for the cycles 2007-2010 and 2017-2018. Dietary flavonoids intake was calculated based on food frequency questionnaires (FFQ) through a 24-hour dietary recall. To explore the relationship between flavonoids intake and their subclasses with stroke prevalence, we employed multivariable logistic regression models, adjusting for relevant covariates. Restricted cubic splines (RCS) and generalized additive models (GAMs) were applied to explore potential nonlinear relationships between flavonols subclasses and stroke prevalence. Multivariable logistic regression models were conducted both for the overall population and stratified by flavonols subclasses intake. Additionally, we utilized Bayesian kernel machine regression (BKMR) to evaluate the overall effect of flavonols intake levels on stroke status, accounting for potential interaction and correlation between subclasses. Given the high correlation among flavonols subclasses, we incorporated a hierarchical variable selection approach using a Markov Chain Monte Carlo (MCMC) algorithm. Finally, we analyzed the XGBoost model by applying SHAP (SHapley Additive exPlanations) values to assess the specific contribution of different flavonoids intake to stroke.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Including 3,806 elderly stroke patients, the study revealed an inverse relationship between dietary flavonoids and their subclasses and stroke prevalence. After adjusting for potential confounders, it was found that higher quartiles of flavonols intake were associated with lower stroke prevalence. Specifically, with each unit increase in flavonols (Q4) intake, the odds of stroke in the elderly decreased by 61 % (OR=0.390, 95 % CI [0.209-0.728]; &lt;em&gt;P&lt;/em&gt; = 0.005). Similar results were observed for the subclasses of flavonols. Subgroup analyses indicated that age and poverty index ratio (PIR) were effect modifiers in the relationship between flavonols intake and stroke. We further examined the intake levels of dietary flavonols subclasses such as isorhamnetin, kaempferol, myricetin, and quercetin and their association with stroke status stratified by population characteristics. In addition to age and PIR, hyperlipidemia and body mass index (BMI) were found to be the most common significant influencing factors in the relationship between flavonols subclasses and stroke prevalence. Furthermore, RCS revealed a “U”-shaped nonlinear relationship between flavonols, including their quercetin and kaempferol subclasses, and stroke, whereas the relationship between stroke and myricetin was linear. Our study also assessed the overall impact of dietary flavonols subcla","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108373"},"PeriodicalIF":2.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144254995","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 plain water intake and stroke among American adults: National health and nutrition examination survey 1999-2020","authors":"Yahui Pan ,&nbsp;Yanzhen Sun ,&nbsp;Xiaohua Pan ,&nbsp;Yongchao Yin ,&nbsp;Qianqian Liu","doi":"10.1016/j.jstrokecerebrovasdis.2025.108372","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108372","url":null,"abstract":"<div><h3>Background</h3><div>Stroke is a leading cause of disability and mortality. While plain water intake has been linked to stroke-related risk factors—including hypertension, diabetes, and obesity—its direct relationship with stroke remains unclear. This study aimed to evaluate the association between plain water intake and stroke.</div></div><div><h3>Methods</h3><div>We analyzed data from adults aged over 20 years who participated in the National Health and Nutrition Examination Survey between 1999 and 2020. Information on stroke status, plain water intake, and other relevant variables was collected. We used weighted logistic regression models, restricted cubic spline analysis, stratified analysis with interaction testing, threshold effect analysis, and sensitivity analyses to evaluate the association.</div></div><div><h3>Results</h3><div>A total of 29,489 participants were included, of whom 1,268 (3.18 %) reported having been diagnosed with stroke. Significant differences in stroke prevalence and participant characteristics were observed across quartiles of water intake (<em>P</em> &lt; 0.001). Multivariable regression indicated a negative association between plain water intake and stroke risk in all adjusted models. The relationship followed an l-shaped curve, with an inflection point at approximately 1,382.86 mL/day (non-linearity, <em>P</em> = 0.005). For those consuming ≤1,382.86 mL/day, the odds ratio for stroke was 0.97 (95 % CI: 0.93 – 0.99, <em>P</em> = 0.03). Subgroup, interaction, and sensitivity analyses supported the stability of the results.</div></div><div><h3>Conclusion</h3><div>The association between plain water intake and stroke among U.S. adults follows an L-shaped curve, with an inflection point near 1,382.86 mL/day. Further research is warranted to investigate the mechanisms underlying this association.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108372"},"PeriodicalIF":2.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259887","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":"Atrial premature complex burden as a risk stratification predictor of paroxysmal atrial fibrillation and embolic stroke","authors":"Jin Un Kim ,&nbsp;Alice Snell ,&nbsp;Peter Kabunga ,&nbsp;Md Shajedur Rahman Shawon ,&nbsp;Saeedur Rahman","doi":"10.1016/j.jstrokecerebrovasdis.2025.108369","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108369","url":null,"abstract":"<div><h3>Introduction</h3><div>Investigating the aetiology of cryptogenic stroke is challenging. Occult paroxysmal atrial fibrillation (pAF) is likely a significant contributor, but is often missed by standard 24 h cardiac monitoring. Atrial premature complexes (APC) are markers of atrial myopathy and predictors of AF. We employ 14-day ambulatory cardiac monitoring as a novel monitoring modality to assess the association between APC burden and pAF. In the absence of pAF detection, APC burden may be a useful surrogate marker for risk stratification in patients with embolic stroke.</div></div><div><h3>Methods</h3><div>We retrospectively collected data from April 2022 to October 2023 on adults (≥18 years) with confirmed or suspected stroke or transient ischemic attack (TIA) who underwent 14-day cardiac monitoring using Zio XT® (iRhythm Technologies, UK). Patients with 100 % atrial fibrillation (AF) burden were excluded.</div></div><div><h3>Results</h3><div>A total of 454 patients (male: 268, 59 %; median age: 67 years [IQR: 56–76]) were included. 29 were diagnosed with pAF. In adjusted analysis, APC runs &gt;20 was associated with a 270 % increase in the odds of pAF (OR: 3.70, 95 % CI: 1.47–9.36, <em>p</em> &lt; 0.01), with APC runs &gt;110 showing the strongest association (OR: 7.71, 95 % CI: 2.49–23.86, <em>p</em> = 0.04). High APC burden showed a strong correlation with radiologically embolic appearing strokes with increasing strength of association with higher APC run counts [APC runs &gt;20 was associated with 265 % increased odds of embolic stroke (OR: 3.65, 95 % CI: 2.06-6.46, <em>p</em> &lt; 0.01)]. Age and hypertension were significant predictors of pAF, while obesity and smoking were not significant.</div></div><div><h3>Discussion</h3><div>The presence and burden of APC run are strongly associated with embolic strokes. High APC burden displays similar aetiological stroke presentation to those with pAF. This appears to be distinct from those with low APC burden, where the majority had alternative identified aetiology. This is likely due to downstream consequences of atrial myopathy. In the absence of pAF, APC identification may be important in the diagnostic and therapeutic considerations of cryptogenic stroke patients.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108369"},"PeriodicalIF":2.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251946","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":"Factors associated with adverse outcomes following perioperative stroke after noncardiac surgery","authors":"Jaycee R. Farmer MSc ,&nbsp;Jason M. Sutherland PhD ,&nbsp;Thalia S. Field MD, FRCPC ,&nbsp;Daniel I. McIsaac MD, FRCPC ,&nbsp;Adrian W. Gelb MD, FRCPC ,&nbsp;Lily W. Zhou MD, FRCPC ,&nbsp;Terri Sun MD, FRCPC ,&nbsp;Stephan K.W. Schwarz MD, PhD, FRCPC ,&nbsp;Alana M. Flexman MD, MBA, FRCPC","doi":"10.1016/j.jstrokecerebrovasdis.2025.108346","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108346","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative stroke is associated with high rates of adverse outcomes. Our objective was to identify factors associated with 30-day mortality, adverse discharge, and length of hospital stay following perioperative stroke among noncardiac surgical patients, and to analyze trends in these outcomes from 2005 to 2020.</div></div><div><h3>Study design</h3><div>A retrospective cohort study of noncardiac perioperative stroke patients was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2005-2020). Data included patient demographics, comorbidities, stroke, and surgical variables. Elastic net penalization identified variables associated with 30-day mortality (primary outcome), adverse discharge (death or non-home facility) and length of hospital stay in multivariable models.</div></div><div><h3>Results</h3><div>We identified 14,386 patients with perioperative stroke. Strokes occurred a median [interquartile range] of 5 days [2 days to 12 days] after surgery, 24.6 % (<em>N</em> = 3,540) of patients died, and 39.8 % (<em>N</em> = 4,773) were discharged to a non-home facility. Factors significantly associated with 30-day mortality included age, body mass index, postoperative complications, stroke closer to surgery and perioperative blood transfusion (c-statistic = 0.749, 95 % CI 0.739 to 0.758). We did not identify significant changes in mortality and adverse discharge over the study period.</div></div><div><h3>Conclusion</h3><div>Several factors were significantly associated with increased risk of poor outcome following perioperative stroke, including potentially modifiable factors such as perioperative anemia, and transfusion. Further research is warranted to identify mechanisms and possible interventions to improve outcome in this population.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108346"},"PeriodicalIF":2.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221375","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":"Early versus delayed direct oral anticoagulant initiation in nonvalvular atrial fibrillation–associated acute ischemic stroke: A systematic review and meta-analysis","authors":"Ekdanai Uawithya ,&nbsp;Weerawat Saengphatrachai ,&nbsp;Karan Srisurapanont ,&nbsp;Kulsatree Praditukrit ,&nbsp;Chitapa Kaveeta","doi":"10.1016/j.jstrokecerebrovasdis.2025.108371","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108371","url":null,"abstract":"<div><h3>Background</h3><div>Early initiation of direct oral anticoagulants (DOACs) after acute ischemic stroke (AIS) in patients with nonvalvular atrial fibrillation (NVAF) can prevent early recurrent AIS but may increase the risk of intracerebral hemorrhage (ICH). The appropriate DOAC initiation time remains uncertain. This systematic review and meta-analysis aimed to determine the optimal timing for DOAC initiation following NVAF-associated AIS.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase, Scopus, and the Cochrane Library from inception to March 2025. Eligible studies were randomized controlled trials and prospective cohort studies examining the effects of DOAC initiation timing in patients with NVAF-associated AIS. The primary outcome was the pooled risk ratio for a composite measure of ischemic and hemorrhagic events. Secondary outcomes were the pooled risk ratios for symptomatic ICH, recurrent AIS, major extracranial bleeding, and mortality. Subgroup analyses examined patients initiating DOACs within 3 days of stroke onset and compared outcomes based on baseline stroke severity (NIHSS &lt; 5 vs ≥ 5).</div></div><div><h3>Results</h3><div>Eleven studies from ten cohorts (12,388 participants) met the inclusion criteria. No significant differences were found between early and delayed DOAC initiation for the composite outcomes or for any secondary endpoint. Subgroup analyses revealed a nonsignificant increase in ICH risk among patients with early treatment and higher stroke severity (NIHSS ≥ 5). No significant differences in early ischemic stroke rate were observed in both subgroups.</div></div><div><h3>Conclusions</h3><div>Early DOAC initiation appears to be safe following NVAF-associated AIS, including in patients with moderate stroke severity. However, the rate of early recurrent ischemic stroke remains comparable between early and delayed initiation groups.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108371"},"PeriodicalIF":2.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251948","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":"Changing patterns of stroke and subtypes attributable to smoking from 1990 to 2021 in China and projections to 2050","authors":"Bo Hei ,&nbsp;Jiayu Liu ,&nbsp;Jixia Fang ,&nbsp;Qun Gao ,&nbsp;Bin Wang ,&nbsp;Wu Zhou ,&nbsp;Jingru Zhou","doi":"10.1016/j.jstrokecerebrovasdis.2025.108368","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108368","url":null,"abstract":"<div><h3>Background</h3><div>It is uncertain whether smoking exerts similar effects on the stroke and subtypes. The aim of this study was to assess the long-term trends of stroke and subtypes attributable to smoking in China from 1990 to 2021 and to predict changes to 2050.</div></div><div><h3>Methods</h3><div>Data on stroke and its subtypes mortality attributable to smoking in China were extracted from the Global Burden of Disease (GBD) 2021. Linear regression and age-period-cohort models were used to calculate age-standardised mortality rate (ASMR) trends, and the BAPC (Bayesian age-period-cohort) model was used to predict trends from 2022 to 2050.</div></div><div><h3>Results</h3><div>The changing trend of ASMR on stroke attributable to smoking in China differed among subtypes, with an estimated annual percentage change (EAPC) of -2.40 for intracerebral hemorrhage (ICH); -0.67 for ischemic stroke (IS); -0.65 for subarachnoid hemorrhage (SAH). The local drift curves reflect the average annual percentage change in stroke mortality attributable to smoking in all age groups, with a decreasing trend in stroke and subtypes. The decline in SAH mortality was much greater than for IS and ICH across all age groups. The period rate ratio (PRR) and cohort rate ratio (CRR) varied by subtype, showing the decline for all subtypes. Mortality rates for IS and ICH increase significantly with age; the mortality rate for SAH increases followed by a decrease, peaking in the 65-70 year age group. Finally, the ASMR and ASDR for stroke and subtypes attributable to smoking in China will continue to decline from 2022 to 2050.</div></div><div><h3>Conclusions</h3><div>Our study shows that stroke burden attributable to smoking in China declined from 1990 to 2021 but remained higher than global levels, with continue to decline from 2022 to 2050. IS showed the least reduction, especially among older men. Projections suggest continued improvement, though rising adolescent smoking—particularly among women—poses a threat. Strengthened tobacco control, smoking cessation, and targeted IS prevention, especially in older males, are crucial.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108368"},"PeriodicalIF":2.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251947","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":"Sticky Platelet Syndrome: An important consideration for otherwise unexplained thrombotic events in young stroke patients","authors":"Diana Yang DO ,&nbsp;Anjana Shriram ,&nbsp;Yu Lee Ra ,&nbsp;Cindy Rivas ,&nbsp;Ava Elahi ,&nbsp;Christopher James Gorospe ,&nbsp;Jocelyn Ho ,&nbsp;Benedict Pereira MD ,&nbsp;Shlee Song MD ,&nbsp;Alexis N. Simpkins MD, PhD, MSCR","doi":"10.1016/j.jstrokecerebrovasdis.2025.108364","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108364","url":null,"abstract":"<div><h3>Introduction</h3><div>This case highlights the importance of considering platelet function and aggregability in patients with recurrent ischemic stroke and deep vein thrombosis.</div></div><div><h3>Results</h3><div>We present a case of a 47-year-old man with history of hypertension, hyperlipidemia, and multiple thrombotic events but no family history of clotting events. Over a period of eight years, he was diagnosed with deep vein thrombosis, pulmonary embolism, and occipital lobe, cerebellar, and parietal lobe infarcts. After presenting with new embolic strokes, platelet aggregometry demonstrated hyperactivity to three agonists, including adenosine-diphosphate (ADP)— indicative of Sticky Platelet Syndrome. Repeat platelet aggregometry demonstrated poor response to clopidogrel, so the patient was discharged on triple therapy with aspirin, clopidogrel, and enoxaparin to warfarin bridge. Two years later, the patient was diagnosed with right eye central retinal artery occlusion two months after an outpatient provider discontinued the clopidogrel and switched warfarin to apixaban. He was discharged back on triple therapy with re-initiation of clopidogrel and apixaban switched to warfarin.</div></div><div><h3>Conclusion</h3><div>Thrombosis in unusual sites and despite anticoagulant use, coupled with platelet hyperactivity to ADP, were suggestive of Sticky Platelet Syndrome. Due to lack of testing standardization, diagnosis of a persistent, hyperreactive platelet phenotype remains challenging. However, improvements in diagnostic approaches for Sticky Platelet Syndrome can be highly beneficial in enabling faster treatment with an appropriate antithrombotic regimen, reducing the risk of subsequent thrombotic events.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108364"},"PeriodicalIF":2.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188807","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}