Cerebrovascular Diseases最新文献

{"title":"Plasma Soluble Angiotensin-Converting Enzyme 2 and Risk of Recurrent Stroke: A Nested Case-Control Analysis.","authors":"Jing Xue, Mingming Shi, Qin Xu, Anxin Wang, Xue Jiang, Jinxi Lin, Xia Meng, Hao Li, Lemin Zheng, Yongjun Wang, Jie Xu","doi":"10.1159/000538245","DOIUrl":"10.1159/000538245","url":null,"abstract":"<p><strong>Introduction: </strong>The angiotensin-converting enzyme 2 (ACE-2) and its shedding product (soluble ACE-2 [sACE-2]) are implicated in adverse cardiovascular outcomes. However, the relationship between sACE-2 and stroke recurrence is unknown. Herein, we examined the relationship of sACE-2 with stroke recurrence in patients with ischemic stroke or transient ischemic attack.</p><p><strong>Methods: </strong>Data were obtained from the Third China National Stroke Registry (CNSR-III). Eligible cases consisted of 494 patients who developed recurrent stroke within 1-year follow-up, and 494 controls were selected using age- and sex-matched with a 1:1 case-control ratio. Conditional logistic regressions were used to evaluate the association between sACE-2 and recurrent stroke. The main outcomes were recurrent stroke within 1 year.</p><p><strong>Results: </strong>Among 988 patients included in this study, the median (interquartile range) of sACE-2 was 25.17 (12.29-45.56) ng/mL. After adjustment for conventional confounding factors, the odds ratio (OR) with 95% confidence interval (CI) in the highest quartile versus the lowest quartile was 1.68 (1.12-2.53) for recurrent stroke within 1-year follow-up. Subgroup analysis showed that the association between elevated plasma level of sACE-2 and stroke recurrence was significant in patients with higher systemic inflammation, as indicated by high-sensitivity C-reactive protein ≥ 2 mg/L (adjusted OR: 2.33 [95% CI, 1.15-4.72]) and neutrophil counts ≥ median (adjusted OR: 2.66 [95% CI, 1.35-5.23]) but not significant in patients with lower systemic inflammation.</p><p><strong>Discussion/conclusion: </strong>Elevated plasma sACE-2 concentration was associated with increased risk of recurrent stroke.</p><p><strong>Introduction: </strong>The angiotensin-converting enzyme 2 (ACE-2) and its shedding product (soluble ACE-2 [sACE-2]) are implicated in adverse cardiovascular outcomes. However, the relationship between sACE-2 and stroke recurrence is unknown. Herein, we examined the relationship of sACE-2 with stroke recurrence in patients with ischemic stroke or transient ischemic attack.</p><p><strong>Methods: </strong>Data were obtained from the Third China National Stroke Registry (CNSR-III). Eligible cases consisted of 494 patients who developed recurrent stroke within 1-year follow-up, and 494 controls were selected using age- and sex-matched with a 1:1 case-control ratio. Conditional logistic regressions were used to evaluate the association between sACE-2 and recurrent stroke. The main outcomes were recurrent stroke within 1 year.</p><p><strong>Results: </strong>Among 988 patients included in this study, the median (interquartile range) of sACE-2 was 25.17 (12.29-45.56) ng/mL. After adjustment for conventional confounding factors, the odds ratio (OR) with 95% confidence interval (CI) in the highest quartile versus the lowest quartile was 1.68 (1.12-2.53) for recurrent stroke within 1-year follow-up. Subgrou","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"105-111"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11793094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Preoperative Cortical Magnetic Susceptibility and Postoperative Changes in the Cerebral Blood Flow on Cognitive Improvement following Carotid Endarterectomy.","authors":"Masahiro Yabuki, Yosuke Akamatsu, Ikuko Uwano, Futoshi Mori, Makoto Sasaki, Kunihiro Yoshioka, Kohei Chida, Masakazu Kobayashi, Shunrou Fujiwara, Kuniaki Ogasawara","doi":"10.1159/000536547","DOIUrl":"10.1159/000536547","url":null,"abstract":"<p><strong>Introduction: </strong>While patients who experience improved cognition following carotid endarterectomy (CEA) typically demonstrate restored brain perfusion after the procedure, it is worth noting that less than 50% of patients in whom postoperative cerebral blood flow (CBF) restoration is achieved actually show improved cognition after postoperatively. This suggests that factors beyond the mere restoration of CBF may play a role in postoperative cognitive improvement. Increased iron deposition in the cerebral cortex may cause neural damage, and quantitative susceptibility mapping (QSM) obtained using magnetic resonance imaging (MRI) quantifies magnetic susceptibility in the cerebral cortex, allowing for the assessment of iron deposition in vivo. The purpose of the present study was to determine whether preoperative cortical magnetic susceptibility as well as postoperative changes in CBF are associated with cognitive improvement after CEA.</p><p><strong>Methods: </strong>Brain MRI with a three-dimensional gradient echo sequence was preoperatively performed in 53 patients undergoing CEA for ipsilateral internal carotid artery stenosis (≥70%), and QSM with brain surface correction and vein removal was obtained. Cortical magnetic susceptibility was measured in the cerebral hemisphere ipsilateral to surgery on QSM. Preoperatively and at 2 months after the surgery, brain perfusion single-photon emission computed tomography and neuropsychological assessments were conducted. Using these collected data, we evaluated alterations in CBF within the affected hemisphere and assessed cognitive improvements following the operation.</p><p><strong>Results: </strong>A logistic regression analysis showed that a postoperative greater increase in CBF (95% confidence interval [CI], 1.06-1.90; p = 0.0186) and preoperative lower cortical magnetic susceptibility (95% CI, 0.03-0.74; p = 0.0201) were significantly associated with postoperatively improved cognition. Although sensitivity, specificity, and positive and negative predictive values with the cutoff value lying closest to the upper left corner of a receiver operating characteristic curve for the prediction of postoperatively improved cognition did not differ between postoperative changes in CBF and preoperative cortical magnetic susceptibility, the specificity and the positive predictive value were significantly greater for the combination of postoperative changes in CBF and preoperative cortical magnetic susceptibility (specificity, 95% CI, 93-100%; positive predictive value 95% CI, 68-100%) than for the former parameter alone (specificity, 95% CI, 63-88%; positive predictive value 95% CI, 20-64%).</p><p><strong>Conclusion: </strong>Preoperative cortical magnetic susceptibility as well as postoperative changes in CBF are associated with cognitive improvement after CEA.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"20-29"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139680664","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":"Advances in Prehospital Management of Intracerebral Hemorrhage.","authors":"Laura Catherine Gioia, George Nunes Mendes, Alexandre Yves Poppe, Christian Stapf","doi":"10.1159/000537998","DOIUrl":"10.1159/000537998","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous acute intracerebral hemorrhage (ICH) is associated with greater stroke-related disability and mortality than acute ischemic stroke. Hematoma expansion (HME), an important treatment target in acute ICH, is time-dependent, with a greater probability of hematoma growth occurring <3 h from ICH onset.</p><p><strong>Summary: </strong>Promising treatment options to reduce HME include early intensive blood pressure reduction and the administration of hemostatic or anticoagulant reversal agents, yet large phase III clinical trials have so far failed to show overwhelming benefit for these interventions in acute ICH. Post hoc analyses provide evidence, however, that the therapeutic benefit of such treatments is enhanced by rapid and ultra-early intervention, likely driven in large part by attenuation of early HME. Clinical trials assessing ultra-rapid treatments (<2 h from ICH onset), including study procedures in the ambulance setting, are currently underway and demonstrate that the prehospital phase is a critical window for ICH management and an indispensable area of ICH research. Mobile stroke units, specialized ambulances equipped with imaging capabilities, can provide confirmatory diagnosis and expedite treatments. Nevertheless, multiple barriers (financial, organizational, geographical among others) hinder worldwide implementation. Emerging portable technologies as well as point-of-care measures of blood biomarkers show promise as feasible adjunct tools to discriminate ICH from acute ischemic stroke in the field and have the potential for widespread accessibility.</p><p><strong>Key messages: </strong>Ultra-early interventions in acute ICH are likely necessary to mitigate the risk of HME, and as such, the prehospital setting is ideal to initiate time-sensitive ICH therapies. Reliable prehospital acute ICH detection is essential to provide disease-specific treatments. Overall, it is imperative that \"Time is Brain\" become the mantra not only for ischemic stroke but for ICH as well, and that the promise of ultra-early therapies for ICH be translated into concrete benefits for patients with this devastating condition.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"184-193"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140058743","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":"Left Atrial Appendage Occlusion versus Direct Oral Anticoagulants in the Prevention of Ischaemic Stroke in Patients with Atrial Fibrillation.","authors":"Sandra Elsheikh, Muath Alobaida, Tommaso Bucci, Benjamin J R Buckley, Dhiraj Gupta, Greg Irving, Andrew M Hill, Gregory Y H Lip, Azmil H Abdul-Rahim","doi":"10.1159/000536546","DOIUrl":"10.1159/000536546","url":null,"abstract":"<p><strong>Introduction: </strong>Existing randomised controlled trials assessing the safety and efficacy of left atrial appendage occlusion (LAAO) in atrial fibrillation (AF) were of relatively small sample size or included patients who could receive oral anticoagulant treatment after device implantation. We compared the outcomes of patients with newly diagnosed AF who received percutaneous LAAO or direct oral anticoagulant (DOAC) treatment, in a large population from a global federated health network (TriNetX).</p><p><strong>Methods: </strong>Patients with AF treated with percutaneous LAAO were matched with those treated with DOAC between December 1, 2010, and October 1, 2018. Outcomes were all-cause mortality, ischaemic stroke, and intracranial haemorrhage (ICH) at 5 years.</p><p><strong>Results: </strong>We included 200 patients with AF, who received either LAAO or DOAC. The risk of all-cause mortality, ischaemic stroke, and ICH at 5 years was not significantly different between the two groups (risk ratio [RR] for all-cause mortality: 1.52, 95% confidence interval (CI): 0.97-2.38, RR for ischaemic stroke: 1.09, 95% CI: 0.51-2.36, and RR for ICH: 1.0, 95% CI: 0.44-2.30).</p><p><strong>Conclusion: </strong>Patients newly diagnosed with AF, eligible for DOAC, showed similar 5-year risk of death, ischaemic stroke, and ICH when comparing those who underwent percutaneous LAAO to those receiving DOAC. Future randomised controlled trials are needed to confirm the findings and advise changes in guidelines.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"81-88"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139680717","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":"Predictors of Early versus Delayed Neurological Deterioration after Thrombolysis for Ischemic Stroke.","authors":"Qiao Han, Shoujiang You, Toshiki Maeda, Yanan Wang, Menglu Ouyang, Qiang Li, Lili Song, Yang Zhao, Xinwen Ren, Chen Chen, Candice Delcourt, Zien Zhou, Yongjun Cao, Chun-Feng Liu, Danni Zheng, Hisatomi Arima, Thompson G Robinson, Xiaoying Chen, Richard I Lindley, John Chalmers, Craig S Anderson, Xia Wang","doi":"10.1159/000539322","DOIUrl":"10.1159/000539322","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to determine predictors of early (END) and delayed neurological deterioration (DND) and their association with the functional outcome in patients with acute ischemic stroke (AIS) who participated in the international Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).</p><p><strong>Methods: </strong>END and DND (without END) were defined as scores of a ≥2-point increase on the National Institutes of Health Stroke Scale (NIHSS) or a ≥1-point decrease on the Glasgow coma scale or death, from baseline to 24 h and 24-72 h, respectively. Multivariable logistic regression models were used to determine independent predictors of END and DND and their association with 90-day outcomes (dichotomous scores on the modified Rankin scale [mRS] of 2-6 vs. 0-1 and 3-6 vs. 0-2 and death).</p><p><strong>Results: </strong>Of 4,496 patients, 871 (19.4%) and 302 (8.4%) patients experienced END and DND, respectively. Higher baseline NIHSS score, older age, large-artery occlusion due to significant atheroma, cardioembolic stroke subtype, hemorrhagic infarction and parenchymatous hematoma within 24 h were all independent predictors for both END (all p ≤ 0.01) and DND (all p ≤ 0.024). Moreover, higher baseline systolic blood pressure (BP) (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.12), higher diastolic BP variability within 24 h (OR 1.07, 95% CI 1.04-1.09), patients from Asia (OR 1.25, 95% CI 1.03-1.52) were the only independent predictors for END. However, Asian ethnicity was negatively associated with DND (OR 0.64, 95% CI 0.47-0.86). Hemorrhagic infarction and parenchymatous hematoma within 24 h were the key predictors of END across all stroke subtypes. END and DND were all associated with a poor functional outcome at 90 days (all p < 0.001).</p><p><strong>Conclusion: </strong>We identified overlapping and unique demographic and clinical predictors of END and DND after thrombolysis for AIS. Both END and DND predict unfavorable outcomes at 90 days.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"175-183"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140944122","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":"Perihaematomal Oedema Evolution over 2 Weeks after Spontaneous Intracerebral Haemorrhage and Association with Outcome: A Prospective Cohort Study.","authors":"Neshika Samarasekera, Karen Ferguson, Adrian Robert Parry-Jones, Mark Rodrigues, James Loan, Tom J Moullaali, Jeremy Hughes, Laura Shoveller, Joanna Wardlaw, Barry McColl, Stuart M Allan, Magdy Selim, John Norrie, Colin Smith, Rustam Al-Shahi Salman","doi":"10.1159/000540099","DOIUrl":"10.1159/000540099","url":null,"abstract":"<p><strong>Introduction: </strong>We know little about the evolution of perihaematomal oedema (PHO) >24 h after ICH onset. We aimed to determine the trajectory of PHO after ICH onset and its association with outcome.</p><p><strong>Methods: </strong>We did a prospective cohort study using a pre-specified scanning protocol in adults with first-ever spontaneous ICH and measured absolute PHO volumes on CT head scans at ICH diagnosis and 3 ± 2, 7 ± 2, and 14 ± 2 days after ICH onset. We used the largest ICH if ICHs were multiple. The primary outcomes were (a) the trajectory of PHO after ICH onset and (b) the association between PHO (absolute volume at the time when most repeat CT head scans were obtained, and change in PHO volume at this time compared with the first CT head scan) and poor functional outcome (modified Rankin scale 3-6 at 90 days). We pre-specified multivariable logistic regression models of this association adjusting analyses for potential confounders: age, GCS, infratentorial ICH location, and intraventricular extension.</p><p><strong>Results: </strong>In 106 participants of whom 49 (46%) were female, with a median ICH volume 7 mL (interquartile range [IQR] 2-22 mL), the trajectory of median PHO volume increased from 14 mL (IQR: 7-26 mL) at diagnosis to 18 mL (IQR: 8-40 mL) at 3 ± 2 days (n = 87), 20 mL (IQR: 8-48 mL) at 7 ± 2 days (n = 93) and 21 mL (IQR: 10-54 mL) at 14 ± 2 days (n = 78) (p = <0.001). PHO volume at each time point was collinear with ICH volume at diagnosis (│r│ >0.7), but the change in PHO volume between diagnosis and each time point was not. Given collinearity, we used total lesion (i.e., ICH + PHO) volume instead of PHO volume in a logistic regression model of its association at each time point with outcome. Increasing total lesion (ICH + PHO) volume at day 7 ± 2 was associated with poor functional outcome (adjusted OR per mL 1.02, 95% CI: 1.00-1.03; p = 0.036), but the increase in PHO volume between diagnosis and day 7 ± 2 was not associated with poor functional outcome (adjusted OR per mL 1.03, 95% CI: 0.99-1.07; p = 0.132).</p><p><strong>Conclusion: </strong>PHO volume increases throughout the first 2 weeks after onset of mild to moderate ICH. Total lesion (ICH + PHO) volume at day 7 ± 2 was associated with poor functional outcome, but the change in PHO volume between diagnosis and day 7 ± 2 was not. Prospective cohort studies with larger sample sizes are needed to investigate these associations and their modifiers.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"298-307"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141476027","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 Prognostic Test Accuracy of the Short and Standard Forms of the Montreal Cognitive Assessment.","authors":"Tamar Abzhandadze, Olga I Berg, Anastasios Mavridis, Elias Lindvall, Terry Quinn, Katharina S Sunnerhagen, Erik Lundström","doi":"10.1159/000540372","DOIUrl":"10.1159/000540372","url":null,"abstract":"<p><strong>Introduction: </strong>Cognitive impairment is a critical concern in stroke care, and international guidelines recommend early cognitive screening. The aim of this study was to determine the prognostic accuracy of both the short and standard forms of the Montreal Cognitive Assessment (MoCA) in predicting long-term cognitive recovery following a stroke.</p><p><strong>Methods: </strong>For this study, we used data from the Efficacy of Fluoxetine - a Randomized Controlled Trial in Stroke (EFFECTS) study, which encompassed stroke patients from 35 Swedish centers over the period from 2014 to 2019. Cognitive assessments were initially conducted at 2-15 days post-stroke, with follow-up data gathered at 6 months. We used the MoCA for objective cognitive evaluation. For assessing subjective cognitive impairment, we used the memory and thinking domain of the Stroke Impact Scale. For psychometric evaluation of the short Swedish version of MoCA (s-MoCA-SWE), we used cross tables and binary logistic regression.</p><p><strong>Results: </strong>The study included 1,141 patients (62.2% men; median [interquartile range; IQR] age, 72.3 [13.2] years; median [IQR] stroke severity, 3.0 [3.0]). At baseline, the prevalence of cognitive impairment was 71.7% according to the s-MoCA-SWE (≤12) and 67.0% according to the MoCA (≤25). The s-MoCA-SWE demonstrated a sensitivity of 92.3% for correctly identifying patients with objective cognitive impairment and 81.5% for identifying those with subjective impairments at 6 months. Although the s-MoCA-SWE had higher sensitivity, the MoCA had a more balanced sensitivity and specificity in detecting both subjective and objective cognitive impairments. In both crude and multivariable models, the s-MoCA-SWE was more strongly associated than the MoCA with cognitive impairment at 6 months.</p><p><strong>Conclusions: </strong>Both the short and standard versions of the MoCA appear to be effective in identifying individuals likely to experience persistent cognitive issues following a stroke. Considering the limited time available in an acute stroke unit, the short-form version may be more practical. Nevertheless, further prospective studies are required to validate these findings.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"308-314"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Middle Meningeal Artery Embolization for Patients with Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis.","authors":"Nabihah Kabir, Busmah Owais, Gabriela Trifan, Fernando Testai","doi":"10.1159/000543041","DOIUrl":"10.1159/000543041","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic subdural hematoma (CSDH) is characterized by the collection of blood beneath the dura mater. Traditional treatments involve surgical drainage of the hematoma, but recurrence rates can be high. A highly vascularized neo-membrane irrigated by the middle meningeal artery (MMA) may be involved in CSDH re-accumulation. We conducted a systematic review and meta-analysis of studies that compared the efficacy and safety of MMA embolization to conventional treatment alone for CSDH.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase Ovid, and <ext-link ext-link-type=\"uri\" xlink:href=\"http://ClinicalTrials.gov\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">ClinicalTrials.gov</ext-link> identified observational and randomized clinical studies comparing MMA embolization to conventional treatment for CSDH. The efficacy outcomes were hematoma recurrence and good functional outcome (as defined by a modified Rankin Scale Score [mRS] of 0-2). Safety outcomes were the rate of major complication and mortality. Heterogeneity among studies were evaluated using the I2 statistic. Analyses were conducted using Cochrane Review Manager Software, with risk ratios (RRs) and 95% confidence intervals (95% CI) presented for key outcomes. Absolute risk reduction (95% CI) of 1,000 patients was also calculated using GRADEpro software.</p><p><strong>Results: </strong>The analysis included data from 13 studies (4 randomized clinical trials [RCTs] and 9 observational studies) with a total number of 2,960 patients (35.3% in the MMA group and 64.7% in the conventional treatment group). Compared to conventional treatment, MMA embolization decreased risk of hematoma recurrence by 59% (13 studies, RR = 0.41, 95% CI: 0.26-0.65; I2 = 49%), for an absolute effect of 116 fewer events/1,000 patients (95% CI: 69-145), with similar risk of major complications (13 studies, RR = 0.88, 95% CI: 0.67-1.15; I2 = 43%) and mortality risk (13 studies, RR = 1.05, 95% CI: 0.67-1.65). In subgroup analyses by study type, pooled results from RCTs showed similar direction effects as those from observational studies for both efficacy and safety outcomes.</p><p><strong>Conclusion: </strong>MMA embolization in CSDH management is a safe and effective approach for CSDH.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834015","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":"Lack of Consensus among Stroke Experts on the Optimal Blood Pressure Target of Acute Ischemic Stroke: Evidence from a National Survey.","authors":"Bing Zhang, Yihan Zhou, Xiaoxi Zhang, Yunke Li, Yang Zhao, Lili Song, Pengfei Yang, Yongwei Zhang, Jianmin Liu","doi":"10.1159/000543043","DOIUrl":"10.1159/000543043","url":null,"abstract":"<p><strong>Introduction: </strong>There remains a lack of consensus among physicians regarding the blood pressure (BP) management strategy for acute ischemic stroke patients; this study sought to determine current practice patterns and extension of consensus among stroke physicians after publications of several randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>An online survey of stroke clinicians registered to the Oriental Conference of Interventional Neurovascology (OCIN) platform and Enhanced Control of Hypertension and Thrombectomy Stroke Study (ENCHANTED2/MT) trail collaborators was conducted to investigate the BP management strategy after mechanical thrombectomy (MT). The survey was sent out in March 2024, extracted within 1 month, and then analyzed comprehensively using descriptive statistics.</p><p><strong>Results: </strong>A total of 351 available responses were collected and analyzed. These participants mostly come from tertiary-level hospitals (90.6%) in 31 provinces in China. During MT, the most popular a BP target was 140-160 mm Hg (36.5%, 128/351) and 120-140 mm Hg (26.8%, 94/351). For patients achieved successful reperfusion, those who achieved expanded treatment in cerebral infarction (eTICI) 3 were expected to maintain BP target of 120-140 mm Hg (56.7%, 199/351) or <120 mm Hg (27.1%, 95/351), while eTICI 2b were wished to 120-140 mm Hg (45.3%, 159/351) or 140-160 mm Hg (38.5%, 135/351). For patients who achieved unsuccessful reperfusion, the most selected BP target was 140-160 mm Hg (40.7%, 143/351). In brief, clinical doctors from China with different experiences have different views on the goals of BP management.</p><p><strong>Conclusions: </strong>The survey highlights inter-institutional variability among stroke experts regarding the optimal BP target for acute ischemic stroke. While a majority of institutions have established standardized protocols for post-MT BP management, further prospective randomized trials are warranted to determine the optimal BP target.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-7"},"PeriodicalIF":2.2,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834032","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":"Sex Differences in Patients with Stroke: A Hospital-Based Multicenter Prospective Study in Brazil.","authors":"Gisele Sampaio Silva, Daniela Laranja Gomes Rodrigues, Monique Bueno Alves, Renata Carolina Acri Nunes Miranda, Georgiana Alvares Andrade Viana, Bento Fortunato Cardoso Dos Santos, Cícera Borges Machado, Claudio Luiz Lottenberg, Miguel Cendoroglo Neto, Renato Tanjoni, João José Freitas de Carvalho","doi":"10.1159/000542940","DOIUrl":"10.1159/000542940","url":null,"abstract":"<p><strong>Introduction: </strong>Global burden of stroke mortality tended to be higher among men. A disproportionate stroke burden has been placed upon women, primarily because of life expectancy, putting a more significant burden in this population. The purpose of this study was to address sex differences in stroke epidemiology and treatment in Fortaleza, Brazil.</p><p><strong>Methods: </strong>Between April 2009 and 2012, data were prospectively gathered from 19 hospitals, following the WHO's Stroke Steps program, stratified by sex assigned at birth.</p><p><strong>Results: </strong>We included 4,679 patients, 2,403 females. Women mean age was 69.1 (±15.2) years and 66.2 (±13.5) years in males (p < 0.01). Females were more often white, while time to hospital admission and CT scan from symptom onset were similar across sexes. Men more commonly presented with motor, speech, and sensory symptoms, whereas women were more likely to present with reduced consciousness and headaches. Additionally, women had higher rates of diabetes and obesity. Men were more frequently smokers and had higher rates of alcohol misuse, as well as a history of heart attacks or strokes. We utilized univariable logistic regression to assess mRS scores at discharge, in scores 0-2 (lesser disability) and scores 3-6 (more significant disability). The dependent variable regards scores that are above 3. Fewer women than men achieved a modified Rankin Score of ≤2 (77.6% versus 81.7%; p < 0.01). Multivariable analysis identified the female gender as an independent predictor of having a higher mRS score at discharge (OR 1.23; 95% CI [1.01-1.51]; p = 0.04).</p><p><strong>Conclusion: </strong>Our study, one of the largest South American epidemiological studies on patients admitted with stroke, highlights the sex-specific nuances in stroke outcomes. Our findings underscore that risk factors for stroke vary significantly between men and women, thereby necessitating tailored preventive strategies.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-7"},"PeriodicalIF":2.2,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834037","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}