Cerebrovascular Diseases最新文献

{"title":"Prevalence of frailty in the TIA clinic and its associations with mortality.","authors":"Amy R Elliott, Amit K Mistri, David Eveson, Jatinder S Minhas, Terence J Quinn, Thompson G Robinson, Lucy C Beishon","doi":"10.1159/000542386","DOIUrl":"https://doi.org/10.1159/000542386","url":null,"abstract":"<p><p>Introduction Frailty is a clinical syndrome of increased vulnerability to stressors. Frailty is associated with adverse outcomes after stroke, but frailty and transient ischaemic attack (TIA) are less well described. Methods Retrospective analysis of patients referred by the emergency department (ED) to TIA clinic (01/01/2016-12/03/2022), linked to hospital records for electronic follow-up. Only those with Clinical Frailty Scale (CFS) recorded within two weeks of clinic were included. Prevalence of frailty was determined based on CFS score >4. Hazard ratios (HR) for mortality were determined through Cox proportional hazard regression, adjusted for prognostic factors. Where repeat CFS data were available, temporal change in frailty was recorded (~15 months). Results Of 1185 patients included, 53.5% (n=634) had frailty. Patients with frailty tended to be older (median age 81 vs 74 years, p<0.001) and female (53.9% vs 39.9% p<0.001). Of 335 diagnosed with TIA following review, 61.2% (n=205) were frail. Prevalence of frailty by clinic diagnosis was: TIA 61.2% (205/335); stroke 46.7% (128/274); other diagnoses 52.3% (301/575). In TIA patients and the whole cohort (WC), frailty (TIA:HR:2.69 [95%CI:1.23-5.87, p=0.013], WC:2.58 [95%CI:1.64-4.08, p<0.001]) and increasing age [HR:1.07 95%CI:1.04-1.12], were predictive of mortality. In stroke patients, only increasing age was predictive of death (HR:1.11 [95%CI:1.04-1.19, p=0.003]). Of 414 patients with repeat CFS, median interval 15 months, median change was +1 point (IQR:0-2). Conclusion Frailty is common in TIA and becomes more common following TIA. Strength of association of frailty with poor outcome was greater for TIA patients than for those with stroke. Routine assessment of frailty may be a useful addition to TIA services.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582166","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":"Race/Ethnic Differences in In-Hospital Mortality after Acute Ischemic Stroke.","authors":"Philip Y Sun, Kendra Lian, Daniela Markovic, Abdullah Ibish, Roland Faigle, Rebecca Fran Gottesman, Amytis Towfighi","doi":"10.1159/000542384","DOIUrl":"https://doi.org/10.1159/000542384","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke mortality has declined, with differential changes by race; stroke is now the 5th leading cause of death overall, but 2nd leading cause of death in Black individuals. Little is known about recent race/ethnic and sex trends in in-hospital mortality after acute ischemic stroke (AIS) and whether system-level factors contribute to possible differences.</p><p><strong>Methods: </strong>Using the National Inpatient Sample, adults (≥18 years) with a primary diagnosis of AIS from 2006 to 2017 (n=643,912) were identified. We assessed in-hospital mortality by race/ethnicity (White, Black, Hispanic, Asian/Pacific Islander [API], other), sex, and age. Hospitals were categorized by proportion of White patients served: \"75% White hospitals\", \"50-75% White hospitals\", and \"<50% White hospitals\". Using survey adjusted logistic regression, the association between race/ethnicity and odds of mortality was assessed, adjusting for key sociodemographic, clinical, and hospital characteristics (e.g., age, comorbidities, stroke severity, do not resuscitate orders, and palliative care).</p><p><strong>Results: </strong>Overall, mortality decreased from 5.0% in 2006 to 2.9% in 2017 (p<0.001). Comparing 2012-2017 to 2006-2011, there was a 68% reduction in mortality odds overall after adjusting for covariates, most prominent in White individuals (69%) and smallest in Black individuals (57%). Compared to White patients, Black and Hispanic patients had lower odds of mortality (adjusted odds ratio (aOR) 0.82, 95% CI 0.78-0.87 and aOR 0.93, 95% CI 0.87-1.00), primarily driven by those >65 years (age x ethnicity interaction p < 0.0001). Compared to White men, Black, Hispanic, and API men, and Black women had lower aOR of mortality. The differences in mortality between White and all the other race/ethnic groups combined were most pronounced in 75% White hospitals (aOR 0.80, 0.74-0.87) compared to 50-75% White hospitals (aOR 0.85, 0.79-0.91) and <50% White hospitals (aOR 0.88, 0.81-0.95; interaction effect: p=0.005).</p><p><strong>Conclusion: </strong>AIS mortality decreased dramatically in recent years in all race/ethnic subgroups. Overall, while individuals of other race/ethnic subgroups had lower mortality odds compared to White individuals, this effect was significantly lower in hospitals serving predominantly White patients compared to those serving minority populations. White patients had higher , mortality than the other race/ethnic groups, a difference that was most striking in hospitals predominantly serving White patients. Further study is needed to understand these differences and to what extent sociocultural, biological, and system-level factors play a role.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582172","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":"Economic and Efficient: Introducing the Bifurcation-Invisible Sign in Endovascular Thrombectomy for Middle Cerebral Artery Occlusions.","authors":"Bingyang Zhao, Congping Wang, Wenzhao Liang, Zhongyu Zhao, Jing Mang","doi":"10.1159/000542388","DOIUrl":"https://doi.org/10.1159/000542388","url":null,"abstract":"<p><p>Introduction Selecting thrombectomy techniques for acute ischemic stroke (AIS) due to large vessel occlusion (LVO) significantly affects outcomes and costs. This study introduces the Bifurcation-Invisible (BI) sign identified on initial microcatheter angiogram in acute middle cerebral artery occlusions before endovascular thrombectomy. We aimed to evaluate whether this sign is associated with better angiographic outcomes using contact aspiration (CA) versus stent retriever (SR). Methods In this study, we reviewed 285 cases of acute M1-segment middle cerebral artery (M1-MCA) occlusions treated with stent retriever (SR) or contact aspiration (CA). Angiographic success was evaluated using modified Thrombolysis In Cerebral Infarction (mTICI) scores after the first attempt, clinical outcomes by 90-day modified Rankin Scale (mRS) scores, and procedural costs were analyzed. Categorical variables were analyzed using χ2 or Fisher's exact test, and continuous variables using Student's t-test or Mann-Whitney U test. Subgroup multivariate logistic analysis and interaction tests were conducted, with post-hoc analysis applying Bonferroni correction. Results BI-positive patients treated with CA had higher first-pass reperfusion rates (mTICI 2b-3: 64.0% vs. 41.3%, p = 0.005; Bonferroni-corrected p = 0.030) and 19.8% lower device costs (p < 0.05) than those treated with SR. BI-positive CA patients had higher first-pass reperfusion rates (mTICI 2b-3: 64.0% vs. 32.1%; p < 0.001; Bonferroni-corrected p = 0.002) and a 39.9% reduction in device costs (p < 0.05) than BI-negative patients. The interaction tests showed significant interactions between the presence of BI and contact aspiration for first-pass reperfusion rates (p = 0.007) and device costs (p ˂ 0.001). Conclusion The BI sign, a refined version of the BSO sign identified via microcatheter angiography, could guide the selection of contact aspiration, improving recanalization rates and reducing costs in MCA occlusions.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582159","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":"Predictive accuracy of clinicians estimates of death and recovery after acute intracerebral hemorrhage: pre-specified analysis in INTERACT3 study.","authors":"Menglu Ouyang, Lu Ma, Xiaoying Chen, Xia Wang, Laurent Billot, Qiang Li, Alejandra Malavera, Xi Li, Paula Muñoz-Venturelli, Asita De Silva, Thang Huy Nguyen, Kolawole W Wahab, Jeyaraj Dural Pandian, Mohammad Wasay, Octavio Marques Pontes-Neto, Carlos Abanto, Antonio Arauz, Chao You, Xin Hu, Lili Song, Craig S Anderson","doi":"10.1159/000541985","DOIUrl":"https://doi.org/10.1159/000541985","url":null,"abstract":"<p><strong>Introduction: </strong>Accurately predicting a patient's prognosis is an important component of decision-making in intracerebral hemorrhage (ICH). We aimed to determine clinicians' ability to predict survival, functional recovery, and return to premorbid activities in patients with ICH.</p><p><strong>Methods: </strong>Pre-specified secondary analysis of the third INTEnsive care bundle with blood pressure Reduction in Acute Cerebral hemorrhage Trial (INTERACT3), an international, multicenter, stepped-wedge cluster randomized controlled trial. Clinician perspectives on prognosis were collected at hospital admission and Day 7 (or before discharge). Prognosis questions were the likelihood of (i) survival at 48 hours and 6 months, (ii) favorable functional outcome (recovery walking and self-care) and (iii) return to usual activities at 6 months. Clinician predictions were compared with actual outcomes.</p><p><strong>Results: </strong>Most clinician participants were from neurosurgery (75%) with a median of 8 working years (IQR 5-14) of experience. Of the 6305 randomized patients who survived 48 hours, 213 (3.4%) were predicted to die (positive predictive value [PPV] 0.99, 95% confidence interval [CI] 0.99-0.99). Of 5435 patients who survived 6 months, 209 (3.8%) were predicted to die (PPV 0.93, 95% CI 0.92-0.93). Predictions on favorable functional outcome (PPV 0.54, 95% CI 0.52-0.56) and satisfied ability to return to usual activities (PPV 0.50, 95% CI 0.49-0.52) were poor. Prediction accuracy varied by working years and region of practice.</p><p><strong>Conclusions: </strong>In patients with ICH, clinician estimates of death are very good but conversely they are poor in predicting higher levels of functional recovery and activities.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459005","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":"Combined Selective Endovascular Brain Hypothermia with Edaravone Dexborneol versus Edaravone Dexborneol Alone for Endovascular Treatment in Acute Ischemic Stroke (SHE): Protocol for A Multicenter, Single-Blind, Randomized Controlled Study.","authors":"Xin Jiang, Lizhang Chen, Jian Wang, Jinghuan Fang, Mengmeng Ma, Muke Zhou, Hongbo Zheng, Fayun Hu, Dong Zhou, Li He","doi":"10.1159/000542011","DOIUrl":"https://doi.org/10.1159/000542011","url":null,"abstract":"<p><p>Introduction Selective endovascular brain hypothermia has been proposed as a potential neuroprotective strategy, however, its effectiveness is still not well established. The primary objective of this trial is to investigate the efficacy and safety of selective endovascular brain hypothermia with Edaravone Dexborneol for endovascular treatment in acute ischemic stroke (AIS). Methods The SHE study is a multi-center, single-blind, randomized controlled clinical trial. Patients with acute anterior circulation ischemic stroke who received endovascular treatment within 24 h after stroke onset and achieved successful recanalization will be enrolled and centrally randomized into combined selective endovascular brain hypothermia with edaravone dexborneol or edaravone dexborneol alone groups in a 1:1 ratio (n=564). Patients allocated to the hypothermia group will receive 300 ml cool saline at 4℃through guiding catheter (30 ml/min) into target vessel within 3 minutes after recanalization and then receive edaravone dexborneol (edaravone dexborneol 15 ml +NS 100 ml ivgtt bid for 10 to 14 days) within 24 hours after admission. The control group will receive 300 ml 37℃saline (30 ml/min) infused into target vessel through guiding catheter and then receive edaravone dexborneol. All patients enrolled will receive standard care according to current guidelines for stroke management. The primary outcome is the proportion of functional independence, defined as a mRS Score 0-2 at 90 days after randomization. Conclusion This is a randomized clinical trial with a large sample size to compare combined selective endovascular brain hypothermia and edaravone dexborneol with edaravone dexborneol alone in patients with acute anterior ischemic stroke. The SHE trial aims to provide further evidence of the benefit of selective endovascular brain hypothermia in AIS patients who received endovascular treatment.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459002","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":"Evaluation of Physiological Variables Determining Time-to-Mortality after Stroke-Associated Pneumonia.","authors":"Amit K Kishore, Calvin Heal, Anna Onochie-Williams, Husam Jamil, Craig J Smith","doi":"10.1159/000540218","DOIUrl":"10.1159/000540218","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke-associated pneumonia (SAP) frequently complicates stroke and is associated with significant mortality. Clinicians often use physiological variables within the National Early Warning Score (NEWS) when diagnosing and prescribing antibiotics for SAP, but little is known of its association with mortality. We investigated the relationship of the NEWS 2 score and its components (respiratory rate, heart rate, temperature, oxygen requirement, oxygen saturation, and alertness level) prior to antibiotic initiation, with time-to-mortality in SAP.</p><p><strong>Methods: </strong>We included patients with SAP (n = 389) from a single hyperacute stroke unit. Diagnosis of SAP was made if pneumonia occurred within 7 days of hospital admission. Kaplan-Meier survival curves were generated to assess NEWS 2 parameters influencing survival at pre-defined time periods (1 year and 5 years). The association of these parameters on time-to-mortality were analysed using multivariable Cox-regression models to account for a set of pre-specified potential confounders.</p><p><strong>Results: </strong>The median age was 80 years (71-87 years) and median NIHSS was 7 (IQR 4-17). Mortality within 1 year was 52.4% and 65.8% within 5 years. In the multivariable analyses, time-to-mortality was independently associated with respiratory rate (heart rate [HR] 1.04, 95% confidence intervals [CI] 1.01-1.08, p = 0.009) and total NEWS 2 score (HR 1.13, 95% CI 1.06-1.21, p < 0.001).</p><p><strong>Conclusions: </strong>In patients with SAP, higher respiratory rate and total NEWS 2 score prior to antibiotic initiation were independently associated with time-to-mortality. Further studies are warranted to identify potential opportunities for intervention and ultimately guide treatment to improve outcomes in SAP patients.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459003","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":"IMPACT OF SEX AND GENDER IN STROKE IN SOUTH-AND-SOUTHEAST ASIA: A RAPID SCOPING REVIEW.","authors":"Rinita Mascarenhas, Dorcas B C Gandhi, Jaime Angeles Sesgundo, Veena Babu, Vinita Elizabeth Mani, Ivy Anne Sebastian","doi":"10.1159/000542010","DOIUrl":"https://doi.org/10.1159/000542010","url":null,"abstract":"<p><strong>Background: </strong>South Asia and Southeast Asia account for more than 40% of the global stroke burden, with differences in stroke risk factors, mortality, and outcomes compared to high-income countries. Socio-cultural norms compound the pre-existing biological risk differences, resulting in a disproportionate burden of stroke in women in this region. This review summarizes the sex and gender differences across the stroke care continuum in South Asia and Southeast Asia over the past 20 years.</p><p><strong>Summary: </strong>Despite a higher incidence of stroke in men than women in South-and-Southeast Asia, women have greater stroke severity and poorer outcomes after stroke. Higher levels of pre-morbid disability and poor physical health at baseline may be contributory. There is a high prevalence of vascular risk factors such as hypertension, dyslipidemia, cardiac sources of embolism, as well as metabolic syndrome and insulin resistance, among the women in this region. Smoking is uncommon among women, however other forms of smokeless tobacco (SLT), such as tobacco leaf and betel nut chewing are more prevalent, especially in the rural areas in these countries. Women are more likely to have delayed presentations to the hospital due to untimely recognition of stroke symptoms, however, with regards to door-to-needle times or intravenous thrombolysis (IVT) rates, we found equivocal data. Wide gaps exist in stroke awareness and healthcare-seeking behaviors, with women more commonly opting for public hospitals and low-cost wards, more likely to discontinue treatment, and less likely to adhere to post-stroke rehabilitation.</p><p><strong>Key findings: </strong>This review exposes the gender lacunae in stroke service provision across South Asia and Southeast Asia while acknowledging the many knowledge gaps in our understanding. Although the biological risk differences are non-modifiable, educational, policy, and economic measures to mitigate socio-cultural barriers are much needed in the region. Sound epidemiological data is needed from more countries to better understand these differences and bridge this gap. It is imperative to advocate and implement policies and programs for stroke care viable for women, cognizant of the gender and cost bias, as well as the interplay of social and cultural structures specific to the regions.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459004","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":"Evaluating the Safety of Stent-Assisted Endovascular Treatment for Unruptured Cerebral Aneurysms in Older Adults: Emphasizing the Role of Antiplatelet Therapy.","authors":"Shoko Fujii, Kyohei Fujita, Sakyo Hirai, Satoru Takahashi, Hirofumi Matsubara, Kenji Shoda, Akira Ishii, Makoto Sakamoto, Ichiro Nakagawa, Toshio Higashi, Shinichi Yoshimura, Kazutaka Sumita, Yukiko Enomoto","doi":"10.1159/000541913","DOIUrl":"https://doi.org/10.1159/000541913","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to compare the outcomes and safety in patients aged ≥75 years and those aged &lt;75 years who underwent stent-assisted endovascular treatment for unruptured cerebral aneurysms, specifically focusing on perioperative antiplatelet therapy (APT).</p><p><strong>Methods: </strong>This multicenter retrospective study comprised patients who underwent stent-assisted coiling (SAC) or flow diverter stent (FDS) placement for unruptured cerebral aneurysms. The primary outcome was defined as the composite outcomes of perioperative thromboembolic events, bleeding events, or death.</p><p><strong>Results: </strong>Among 632 patients, 533 (84.3%) were aged &lt;75 years and 99 (15.6%) were aged ≥75 years. No significant differences were observed in the dual APT duration. The primary outcome occurred in 14.3% of patients aged &lt;75 years and in 14.1% of those aged ≥75 years, with no significant difference (P=1.0). The composites of the primary outcome, including thromboembolic events, bleeding events, and death differed insignificantly. Similar findings were observed when the primary outcomes for SAC (12.7% vs. 11.5%, P=0.95) and FDS (17.5% vs. 18.4%, P=1.0) were analyzed. The 30-day, 1-year, and 2-year cumulative event-free survival rates for the primary outcome were 89.5, 87.2%, and 85.2%, respectively, in patients aged &lt;75 years, and 90.9%, 88.7%, and 87.0%, respectively, in those aged ≥75 years. These trends were similar (log-rank test, P=0.92).</p><p><strong>Conclusion: </strong>No significant differences were observed in the rates of the primary outcomes between patients aged &lt;75 years and those aged ≥75 years. Therefore, refraining from stent-assisted treatment for unruptured aneurysms based solely on age might be inappropriate.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399504","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":"Uric acid levels and cardiovascular and cerebrovascular diseases: a Mendelian randomization study.","authors":"Xiaowen Hou, Kaiwen Cen, Yunfeng Zhu, Zhi Zhu, Zhiyu Zhang, Xu Feng","doi":"10.1159/000541624","DOIUrl":"https://doi.org/10.1159/000541624","url":null,"abstract":"<p><strong>Introduction: </strong>The relationship between uric acid (UA) levels and cardiovascular and cerebrovascular diseases (CCVD) is controversial. A two-sample Mendelian randomization (MR) study was conducted to explore the causal effects of UA levels on CCVD.</p><p><strong>Methods: </strong>Genetic variants strongly associated with UA levels were selected as instrumental variables from the Genome-Wide Association Study (GWAS) dataset. The GWAS data, sourced from the Global Urate Genetics Consortium (GUGC), comprised a sample size of 110,347 individuals. The selected CCVD outcomes included stroke, coronary artery disease (CAD), as well as atrial fibrillation and flutter. The primary analytical approach employed the inverse-variance weighted (IVW) method, supplemented by MR-Egger and weighted median as complementary methods. Sensitivity analysis was performed to test heterogeneity and pleiotropy.</p><p><strong>Results: </strong>The MR analysis results indicated a causal association between UA levels and stroke (OR: 1.002; 95% CI: 1.000-1.003; p = 0.036), CAD (OR: 1.118; 95% CI: 1.044-1.197; p = 0.001), as well as atrial fibrillation and flutter (OR: 1.141; 95% CI: 1.037- 1.256; p = 0.007). The results of MR-Egger and weighted median methods confirmed the direction of the IVW results, enhancing the robustness of the findings. No significant anomalies were detected in the sensitivity analysis.</p><p><strong>Conclusion: </strong>The MR study suggests that UA levels exert causal effects on stroke, CAD, as well as atrial fibrillation and flutter.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380109","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":"Baseline Blood Pressure Was Associated with Hemispheric Cerebral Blood Flow in Acute Small Subcortical Infarcts.","authors":"Zhijiao He, Lan Hong, Yifeng Ling, Siyuan Li, Xinyu Liu, Xinru Wang, Qiang Dong, Xin Cheng","doi":"10.1159/000541700","DOIUrl":"10.1159/000541700","url":null,"abstract":"<p><strong>Introduction: </strong>While increased baseline blood pressure (BP) is a prevalent comorbidity in the acute phase of ischemic stroke, the association between baseline BP and the state of hemispheric perfusion in patients with acute small subcortical infarcts (SSIs) has not been studied in detail. The aim of this study was to investigate the relationship between baseline BP and hemispheric cerebral blood flow (CBF) in acute SSIs.</p><p><strong>Methods: </strong>This retrospective study included 101 patients with acute SSIs. Baseline hemispheric CBF was assessed through co-registration of baseline CT perfusion imaging and follow-up diffusion-weighted imaging. The association between baseline BP, CBF, and different cerebral small vessel disease (CSVD) biomarkers was assessed.</p><p><strong>Results: </strong>Baseline systolic BP (SBP) and diastolic BP (DBP) were negatively associated with contralateral hemispheric CBF after multivariate-adjusted linear analysis (SBP: β = -0.001, 95% CI: -0.002 to 0.000, p = 0.030; DBP: β = -0.002, 95% CI: -0.003∼0.001, p = 0.006). Among other CSVD biomarkers, the presence of any cerebral microbleeds showed a significant association with lower CBF in the contralateral hemisphere of the infarct lesion (r = -0.270, p = 0.035).</p><p><strong>Conclusion: </strong>In patients with acute SSIs, increased baseline BP was associated with reduced CBF in the contralateral hemisphere of the infarct lesion, which probably could be interpreted by the exacerbation of the CSVD burden, suggesting a potential mechanistic link between BP autoregulation dysfunction and the aggravation of neurovascular impairment in SSIs.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371061","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}