Cerebrovascular Diseases最新文献

{"title":"Safety and Efficacy of Moderate vs High Intensity Statin Therapy After Nontraumatic Intracerebral Hemorrhage: A Real-World Evidence Analysis.","authors":"Majd Abualrob, Rand Abdellatif, Abdullah Hussein","doi":"10.1159/000548628","DOIUrl":"https://doi.org/10.1159/000548628","url":null,"abstract":"<p><strong>Background and purpose: </strong>The optimal intensity of statin therapy after nontraumatic intracerebral hemorrhage (ICH) remains controversial. This study aimed to compare safety and efficacy outcomes between moderate- and high-intensity statin therapy in post-ICH patients using real-world data to inform secondary prevention strategies.</p><p><strong>Methods: </strong>In this retrospective analysis of the TriNetX Global Collaborative Network database (a federated electronic health records platform) patients with nontraumatic ICH who initiated statin therapy ≥7 days post-ICH were identified. Moderate-intensity statin therapy was defined as atorvastatin 10-20 mg, simvastatin 20-40 mg, rosuvastatin 5-10 mg, pravastatin 40-80 mg, lovastatin 40 mg, fluvastatin 40-80 mg, or pitavastatin 2-4 mg. High-intensity therapy included atorvastatin 40-80 mg or rosuvastatin 20-40 mg. Primary outcomes included recurrent ICH, ischemic stroke, composite vascular events, and all-cause mortality. Safety outcomes included rhabdomyolysis and hepatic injury.</p><p><strong>Results: </strong>After matching, 8,925 patient pairs were well balanced on baseline demographics and comorbidities. Mean follow-up was 283 days (median 365 days) in both groups.Compared with high-intensity statins, moderate-intensity therapy was associated with lower risks of recurrent ICH (23.4% vs 24.9%; hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.86-0.97; p=0.002), ischemic stroke (7.1% vs 10.2%; HR, 0.68; 95% CI, 0.59-0.78; p<0.001), composite vascular events (15.1% vs 19.5%; HR, 0.74; 95% CI, 0.66-0.82; p<0.001), and all-cause mortality (9.0% vs 10.2%; HR, 0.87; 95% CI, 0.79-0.96; p=0.004). Rates of rhabdomyolysis (0.3% vs 0.4%) and hepatic injury (0.5% vs 0.4%) were low and not significantly different between groups.</p><p><strong>Conclusions: </strong>In this large, real-world analysis, moderate-intensity statins demonstrated statistically significant but modest reductions in recurrent ICH, ischemic stroke, composite vascular events, and all-cause mortality compared with high-intensity statins, without increased adverse events. These findings may support preferential use of moderate-intensity statin therapy in selected post-ICH patients pending confirmation from randomized trials. While these observational findings suggest potential benefits of moderate-intensity statin therapy in selected post-ICH patients, confirmation from randomized controlled trials is needed before definitive clinical recommendations can be made.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-11"},"PeriodicalIF":1.5,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Burden of Ischemic Stroke due to Diet Low in Polyunsaturated Fatty Acids in Global, 1990-2021.","authors":"Dongfeng Wang, Lei Ma, Zhenqiang Li, Gengfan Ye, Maosong Chen","doi":"10.1159/000548110","DOIUrl":"https://doi.org/10.1159/000548110","url":null,"abstract":"<p><strong>Introduction: </strong>Comprehensive global and regional assessments of polyunsaturated fatty acid (PUFA)-related ischemic stroke (IS) burden, including age-sex stratification and temporal trends, remain limited.</p><p><strong>Methods: </strong>Utilizing the Global Burden of Disease (GBD) 2021 database, this study analyzed IS burden attributed to low PUFA diets across 204 countries and territories (1990-2021). Estimated annual percentage changes (EAPCs) for disability-adjusted life years (DALYs) were used to evaluate spatiotemporal trends.</p><p><strong>Results: </strong>Globally, age-standardized DALY rates declined significantly (EAPC: -1.64, 95% CI: -1.75 to -1.54), yet absolute DALY cases rose 1.45-fold. Gender disparities were evident, with steeper declines in females (EAPC: -1.96) than males (EAPC: -1.35). Western sub-Saharan Africa (0.39) and Afghanistan (0.64) had the highest burden, while high-income North America (0.03) and Taiwan, China (0.02) had the lowest. Sub-Saharan Africa (EAPC: -0.21) showed minimal improvement. The significant increase in Lesotho (EAPC: 2.51) contrasting with high-income Asia Pacific (EAPC: -4.35) and South Korea (EAPC: -6.92). The age-specific trend shows that the DALY rate increases with age, reaching its peak in the 75-79 age group. The annual growth rate of DALY for young adults is higher, while the downward trend is more significant for the older person.</p><p><strong>Conclusions: </strong>Despite global progress in age-standardized rates, rising absolute DALYs highlight persistent challenges from demographic shifts and metabolic risks. Region-specific policies targeting dietary PUFA intake, fortified foods, and gender-sensitive interventions are critical to mitigating IS burden.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-11"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heterogeneity in Ischaemic Stroke Diagnostic Classification and Cardiac Monitoring Between the United Kingdom and United States: DiVERT Stroke Sub-study.","authors":"Amit K Kishore, Crystal Sing Chiek Teoh, Kunal Sareen, Bibhu D Mohanty, Marla Hairston, Mirko De Melise, Roberto Carta, Noreli C Franco, Karah B Neisen, David Z Rose","doi":"10.1159/000548286","DOIUrl":"https://doi.org/10.1159/000548286","url":null,"abstract":"<p><strong>Introduction: </strong>The approach to diagnostic classification of ischaemic strokes and post-stroke cardiac monitoring to detect occult atrial fibrillation (AF) differs among healthcare facilities within the United States (US), as shown in the DiVERT Stroke (SeconDary Stroke PreVEntion ThRough Pathway ManagemenT) study. The degree of international neuro-cardio pathway heterogeneity, specifically among the US and the United Kingdom (UK), has not been studied previously.</p><p><strong>Methods: </strong>We conducted a retrospective review of consecutive patients with cryptogenic, large-vessel disease (LVD), and small-vessel disease (SVD) ischaemic strokes at large, certified stroke centres in the US and UK. Qualitative assessments included stroke aetiology determination and post-stroke cardiac monitoring frequency by methodology.</p><p><strong>Results: </strong>Between 2017 and 2020, we identified 881 stroke patients within the UK (189) and US (692) respectively, with significant differences in aetiological classification for cryptogenic (50.8% vs. 33.1%, p<0.001) and LVD (16.9% vs. 37.0%, p<0.001), but not for SVD strokes (32.3% vs. 29.9%, p=0.532). Insertable cardiac monitors (ICM) were significantly less utilised for UK versus US patients (5.9% vs. 10.6%, p=0.049); however, external monitor utilisation (68.8% vs. 66.9%, p=0.628) was similar. Correspondingly, AF was diagnosed significantly less in the UK (1.5% vs 7.5%, p=0.012).</p><p><strong>Conclusion: </strong>Among hospitalised ischaemic stroke patients at comprehensive stroke centres in the US and UK, significant differences exist in aetiological classification, cardiac monitoring and subsequent AF diagnosis. Larger Anglo-American studies may confirm this finding, identify disparities in care, and standardise neuro-cardio pathways internationally to improve outcomes.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-15"},"PeriodicalIF":1.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing In-Hospital Acute Ischemic Strokes: Clinical Profiles and Predictors of Acute Treatment.","authors":"Katrina Hannah Ignacio, Rana Abdalrahman, Chitapa Kaveeta, Mohamad Mehdi, Ameen Alizada, Dana Nicol, Jillian Stang, Robert Moore, Mohamed Alshamrani, Benjamin Agnelli, Jessalyn K Holodinsky, Bijoy Menon, Michael D Hill, Mohammed A Almekhlafi","doi":"10.1159/000548447","DOIUrl":"https://doi.org/10.1159/000548447","url":null,"abstract":"<p><p>Background and Objectives Treatment of in-hospital acute ischemic strokes (AIS) is challenging. We aimed to characterize in-hospital AIS and identify predictors of receiving thrombolysis and thrombectomy. Methods We conducted an analysis of a retrospective cohort study using administrative data and chart review as part of the INPATIENTS study (Comparing In-Hospital and Community-Onset Strokes in Alberta). All in-hospital AIS patients admitted in the province between January 1, 2018 and December 31, 2022 were included. Clinical characteristics and quality of care measures were compared between treated and non-treated patients. We used multivariable logistic regression to identify predictors of acute treatment and assessed model performance using ROC curves and calibration plots. Results Only 7.3% (158 of 2,159) in-hospital AIS patients received thrombolysis or thrombectomy between 2018-2022. Treated patients had higher NIHSS scores (median 12 vs. 8), fewer recent invasive procedures (42% vs. 53%), and were less likely to have altered consciousness (12.0% vs. 52.1%). Common reasons for not receiving thrombolysis included delayed recognition and recent procedures. Treated patients more often received standard stroke evaluation. The final logistic regression model included age, sex, NIHSS, altered consciousness, admitting service, and comorbidities as predictors of treatment. It showed good discrimination (AUC = 0.8371), though calibration issues may affect its generalizability. Discussion In-hospital AIS patients treated with thrombolysis and thrombectomy had more severe strokes, were less likely to have altered consciousness, and more often received standard stroke evaluations than non-treated patients. These differences emphasize the need to better understand barriers and develop new approaches to in-hospital stroke management.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-18"},"PeriodicalIF":1.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telestroke outcomes and challenges in a lower-middle-income country: experience from the Swasthya Ingit Telestroke Program of West Bengal, India.","authors":"Arpan Dutta, Arnab Sarkar, Subhadeep Gupta, Uddalak Chakraborty, Chayan Mondal, Soumozit Banerjee, Deep Das, Debabrata Pulai, Alapan Paul, Snehansu Shekhar Samanta, Sujoy Sarkar, Susanta Chakrabarty, Chinmoy Barik, Diptak Bhowmick, Sanat Kumar Jatua, Snehasis Das, Samiran Misra, Biswajit Ray, Phalguni Das, Binod Das, Barun Das, Avijit Naskar, Dhiraj Roy, Bichitra Biswas, Amit Kumar Das, Dipanjan Das, Aniruddha Sarkar, Rabiul Alam, Kaushik Pal, Kalyan Kumar Das, Samir Kanta Datta, Jishnu Bhattacharya, Somnath Ghosh, Sishir Kumar Naskar, Prasenjit Majumdar, Gautam Ghosh, Amit Dutta, Amit Kumar Ghosh, Souvik Sen, Soumya Ghosh, Nitai Chandra Mandal, Subhransu Sekhar Datta, Asit Kumar Biswas, Swapan Saren, Rahul Kumar, Shashvat M Desai, Ashutosh P Jadhav, Jeyaraj Durai Pandian, Manimoy Bandopadhyay, Biman Kanti Ray","doi":"10.1159/000548264","DOIUrl":"https://doi.org/10.1159/000548264","url":null,"abstract":"<p><strong>Introduction: </strong>A global gap exists in access to standard care for ischemic stroke, including thrombolysis. Most thrombolysis-capable centers in India are located in major cities, making it difficult for many patients to reach them within the golden hour. Telemedicine can help facilitate thrombolysis in remote areas. This study aims to evaluate the outcomes of patients who received thrombolysis under the Swasthya Ingit Telestroke Program in West Bengal, India, and to describe the challenges faced during the program.</p><p><strong>Methods: </strong>This multicentric observational study analyzes secondary data collected from the Swasthya Ingit Telestroke Program. It compares the outcomes of patients who received thrombolysis in 32 hospitals that used teleconsultation (Telemedicine group) with those treated in nine hospitals where patients were thrombolysed under the direct supervision of a neurologist (Direct supervision group). Outcome comparisons included functional independence (modified Rankin scale [mRS] score of 0-2 at 90 days), all-cause mortality within 90 days, and symptomatic intracerebral haemorrhage (sICH).</p><p><strong>Results: </strong>Since the start of the telestroke program in December 2021, 1329 patients have received thrombolysis (1034 in the 'Telemedicine group' and 295 in the 'Direct supervision group') through June 2024. After excluding patients without 90-day follow-up data, 1145 patients were included in the analysis. The two groups showed no significant difference in good functional outcomes (mRS 0-2 at 90 days), mortality, and sICH (p-values of 0.833, 0.73, and 0.61, respectively).</p><p><strong>Conclusion: </strong>Telemedicine in stroke care has enabled thrombolysis in remote and resource-limited areas. Our study further emphasizes the effectiveness of telemedicine in increasing access to stroke reperfusion therapy in a lower-middle-income country. However, limited awareness prevents many ischemic stroke patients from receiving timely treatments like thrombolysis due to delayed arrival at equipped centers. Stroke awareness campaigns are crucial for the optimal utilization of a telestroke network.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-13"},"PeriodicalIF":1.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association between Fasting Remnant Cholesterol and White Matter Hyperintensities in Acute Ischemic Stroke Patients.","authors":"Qi-Wei Yu, Ru-Yang Zhang, Xin-Qi Yan, Hua Zhou, Qian Feng","doi":"10.1159/000548406","DOIUrl":"10.1159/000548406","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to examine the correlation between fasting remnant cholesterol (RC) levels and white matter hyperintensities (WMHs) in patients diagnosed with acute ischemic stroke (AIS).</p><p><strong>Methods: </strong>Patients diagnosed with AIS were enrolled from the Department of Neurology at the affiliated Suzhou Hospital of Nanjing Medical University. The burden of WMHs was evaluated using the Fazekas scale on magnetic resonance imaging. RC was calculated as total cholesterol (TC) - high-density lipoprotein cholesterol (HDL-C) - low-density lipoprotein cholesterol (LDL-C). WMHs severity was categorized using Fazekas scores: low WMHs (0-3 points) and high WMHs (≥4 points). The relationship between RC levels and the burden of WMHs was examined through multivariate logistic regression and restricted cubic spline (RCS) logistic regression analyses. Finally, subgroup analyses were performed.</p><p><strong>Results: </strong>A total of 650 patients with AIS were included in this study. The RC levels in the low-WMHs group were significantly higher than those in the high-WMHs group (t = 3.45, p < 0.05). When RC was treated as a continuous variable for logistic regression analysis, in fully adjusted models, there was a negative correlation between RC and WMHs scores (OR: 0.314, 95% CI: 0.143-0.685, p < 0.05). When RC was categorized, in fully adjusted models, there was a significant inverse association was observed in the highest RC quartile compared with the lowest (OR: 0.598, 95% CI: 0.372-0.961, p < 0.05). Using RCS analysis, when RC was ≥0.57 mmol/L, there was a negative correlation between RC and WMHs scores (OR: 0.179, 95% CI: 0.04-0.554, p < 0.05), and as RC values increased, the WMHs scores decreased. In subgroup analysis, there was a negative correlation between RC and WMHs, especially in males.</p><p><strong>Conclusion: </strong>This study suggests that maintaining RC levels of ≥0.57 mmol/L during the acute phase of AIS may be associated with a reduction in WMHs burden, particularly among males. However, further prospective trials are required to validate its safety and efficacy.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-12"},"PeriodicalIF":1.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promising Therapeutic Targets for Intracranial Aneurysms: A Systematic druggable genome-wide Mendelian Randomization.","authors":"Aierpati Maimaiti, Lin Pan, Yuxin Liu, Mingrui Huang, Weijie Ding, Wenzhuo Yang, Kaijun Sun, Yongxin Wang, Zengliang Wang","doi":"10.1159/000546508","DOIUrl":"https://doi.org/10.1159/000546508","url":null,"abstract":"<p><strong>Background: </strong>Intracranial aneurysm (IA), known as pathological dilation of cerebral arteries,commonly occurring at bifurcating arteries,carries a high risk of severe morbidity and mortality if left untreated.Although the treatment and early diagnosis have significantly improved,the complex pathophysiological process of IA formation presents significant challenges in the development of targeted therapies.Efficient disease-modifying therapies for IA are not yet available.This study aims to utilize the Mendelian randomization (MR) approach to identify potential pharmaceutical targets for preventing and treating IA.</p><p><strong>Methods: </strong>We systematically identified genetic variants associated with 1577 druggable genes utilizing gene expression, DNA methylation, and protein expression quantitative trait loci. Genome-wide association study (GWAS) summary statistics were derived from a meta-analysis concentrating on IA, encompassing 10,754 cases and 306,882 controls.Subsequently, we conducted a TwoSample MR analysis integrating the identified druggable genes to estimate the causal effects on IAs. The robustness of the MR results was additionally validated through sensitivity analyses employing diverse techniques, such as bidirectional MR analysis, Steiger filtering, and Bayesian colocalization.</p><p><strong>Results: </strong>Our study reveals that increased expression of SLC22A5 and SLC22A4 in blood is associated with higher risk of IA and subarachnoid hemorrhage (SAH), while higher expression of NT5C2 is linked to a reduced risk of IA and SAH. Methylation of SLC22A5 is positively correlated with IA prevalence, while NT5C2 methylation shows an inverse correlation. We also found that higher methylation of CHRNA3 is associated with increased IA prevalence. Additionally, increased blood protein expression of HTRA1 is associated with elevated risks of both IA and SAH,the bayesian colocalization analysis further supports the involvement of HTRA1 in both IA and SAH.</p><p><strong>Conclusion: </strong>This large-scale MR analysis pinpointed four druggable target genes associated with IA and SAH, also highlighting HTRA1 as a potential prior druggable protein for medical intervention of IA.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-16"},"PeriodicalIF":1.5,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DNA methylation of the ABCA1 and ABCG1 genes contribute to stroke risk.","authors":"Chan Yang, Li Chen, Juan Li, Xiaowei Liu, Xiaoxia Li, Yuhong Zhang, Yi Zhao","doi":"10.1159/000548066","DOIUrl":"https://doi.org/10.1159/000548066","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is a major cause of death in China. The epigenetic factors, especially the methylation of ABCA1/G1 genes implicated in cholesterol regulation, are being examined to comprehend their association with stroke.</p><p><strong>Methods: </strong>In this nested case-control study, we examined data from the North-west China Cohort (CNC-NX) initial phase, involving 53 pairs of stroke cases and controls. All participants were adults aged ≥18 years. We examined the conditional logistic regression models were used to determine the risk ratio (OR) and 95% confidence interval (95% CI) for stroke occurrence.</p><p><strong>Results: </strong>CpG_10.11.12.13 methylation levels in ABCA1 were associated with stroke risk (OR 0.93, 95% CI: 0.87-0.99), and dynamic changes in CpG_19.20 methylation levels in ABCG1 were associated with stroke risk (OR 1.62, 95% CI: 1.11-2.37). In dynamic methylation, high methylation levels of CpG_19.20 in ABCG1 were associated with a 5.10 times higher risk of stroke compared to low methylation levels (OR 5.10, 95% CI: 1.60-16.30).</p><p><strong>Conclusions: </strong>In a rural population in North-West China, the hypomethylation status of ABCA1 and ABCG1 genes was strongly associated with the incidence of stroke. Significant correlations between CpG_19.20 methylation levels change in ABCG1 and stroke risk.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-18"},"PeriodicalIF":1.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statistical Analysis Plan for a Randomized Controlled Trial of Intensive Blood Pressure Control on Cardiovascular risk Reduction in Patients with Atrial Fibrillation.","authors":"Xiaolei Lin, Chao Jiang, Zhiyan Wang, Hisatomi Arima, Xia Wang, Laurent Billot, Bruce Neal, Anthony Rodgers, Graham S Hillis, Anushka Patel, Qiang Li, Jianzeng Dong, Xin Du, Craig S Anderson, Changsheng Ma","doi":"10.1159/000548288","DOIUrl":"https://doi.org/10.1159/000548288","url":null,"abstract":"<p><strong>Introduction: </strong>Elevated blood pressure (BP) is a key modifiable risk factor for cardiovascular (CV) complications in patients with atrial fibrillation (AF). While current guidelines recommend modest BP targets, the optimal target in AF patients remains uncertain. The Cardiovascular Risk Reduction in Atrial Fibrillation Trial (CRAFT) is a multicenter, prospective, randomized, open-label, blinded-endpoint trial that evaluates whether intensive home systolic BP control (<120 mmHg) is superior to standard BP control (<135 mmHg) in reducing major CV events. The primary outcome is a hierarchical composite of time to CV death, stroke, myocardial infarction, and heart failure hospitalization. A total sample of 1,675 participants provides 80% power to detect a win ratio of 1.50 between groups after a mean of 3 years of follow-up.</p><p><strong>Methods: </strong>This statistical analysis plan (SAP) was developed by the trial statistician and principal investigators, in collaboration with the steering committee and international experts. The SAP specifies the planned analyses of baseline characteristics, patients' intervention, primary and secondary outcomes, subgroup effects, and safety outcomes. Analyses will be conducted on an intention-to-treat (ITT) analysis using the win-ratio method for the primary endpoint, and Cox proportional hazards and Poisson regression for secondary analyses. Sensitivity analyses and strategies for handling missing data are also described.</p><p><strong>Discussion: </strong>A pre-defined SAP was established for the CRAFT trial to ensure a transparent and verifiable analysis. The SAP was finalized prospectively, independent of treatment assignment, with the goal of preserving internal validity and minimizing analytical bias.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-12"},"PeriodicalIF":1.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Worth the Weight? Problems with FDA-Labeled Tenecteplase Dosing for Acute Ischemic Stroke.","authors":"Andrew J Webb, Michael J Schontz, Michael J Erdman","doi":"10.1159/000548222","DOIUrl":"10.1159/000548222","url":null,"abstract":"","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-3"},"PeriodicalIF":1.5,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}