Cerebrovascular Diseases最新文献

{"title":"Efficacy and Safety of Middle Meningeal Artery Embolization for Patients with Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis.","authors":"Nabihah Kabir, 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":"737-745"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","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":"Prevalence of Frailty in the Transient Ischaemic Attack Clinic and Its Associations with Mortality.","authors":"Lucy Beishon, 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":"10.1159/000542386","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>We conducted a 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 2 weeks of clinic were included. Prevalence of frailty was determined based on CFS score ≥4. Hazard ratios (HRs) 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).</p><p><strong>Results: </strong>Of 1,185 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 as follows: 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% confidence interval (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]). For 414 patients with repeat CFS, the median interval was 15 months and the median change was +1 point (inter-quartile range: 0-2).</p><p><strong>Conclusion: </strong>Frailty is common in TIA and becomes more common following TIA. The strength of the 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":" ","pages":"694-702"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","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":"Kendra Lian, Philip Y Sun, Kendra Lian, Daniela Markovic, Abdullah Ibish, Roland Faigle, Rebecca Fran Gottesman, Amytis Towfighi","doi":"10.1159/000542384","DOIUrl":"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 < 0.01). 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 × ethnicity interaction p < 0.01). 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 < 0.01).</p><p><strong>Conclusion: </strong>AIS mortality has 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. Further study is needed to understand these differences and to what extent sociocultural, biological, and system-level factors play a role. Category: Health services, quality improvement, and patient-centered outcomes were the elements used to categorize the study sample.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"681-693"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500278/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Miller Fisher's Rules and Digital Health: The Best of Both Worlds.","authors":"Joao Brainer Andrade, George Nunes Mendes, Gisele Sampaio Silva","doi":"10.1159/000539323","DOIUrl":"10.1159/000539323","url":null,"abstract":"<p><strong>Background: </strong>Professor Fisher's legacy, defined by meticulous observation, curiosity, and profound knowledge, has established a foundational cornerstone in medical practice. However, the advent of automated algorithms and artificial intelligence (AI) in medicine raises questions about the applicability of Fisher's principles in this era. Our objective was to propose adaptations to these enduring rules, addressing the challenges and leveraging the opportunities presented by digital health.</p><p><strong>Summary: </strong>The adapted rules we propose advocate for the harmonious integration of traditional bedside manners with contemporary technological advancements. The judicious use of advanced devices for patient examination, recording, and sharing, while upholding patient confidentiality, is pivotal in modern practice and academic research. Additionally, the strategic employment of AI tools at the bedside, to aid in diagnosis and hypothesis generation, underscores their role as valued complements to clinical reasoning. These adapted rules emphasize the importance of continual learning from experience, literature, and colleagues, and stress the necessity for a critical approach toward AI-derived information, which further consolidates clinical skills. These aspects underscore the perpetual relevance of Professor Fisher's rules, advocating not for their replacement but for their evolution. Thus, a balanced methodology that adeptly utilizes the strengths of AI and digital tools, while steadfastly maintaining the core humanistic values, arises as essential in the modern practice of medicine.</p><p><strong>Key messages: </strong>A commitment between traditional medical wisdom and modern technological capabilities may enhance medical practice and patient care. This represents the future of medicine - a resolute commitment to progress and technology, while preserving the essence of medical humanities.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"228-235"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175014","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 and Gender Publications in Brain Health: A Mapping Review of the Asia-Pacific Region.","authors":"Megan Heffernan, Mark Woodward, Deidre Anne De Silva, Christopher Chen, Craig S Anderson, Christine Kremer, Katie Harris, Else Charlotte Sandset, Maria Teresa Ferretti, Valeria Caso, Cheryl Carcel","doi":"10.1159/000537946","DOIUrl":"10.1159/000537946","url":null,"abstract":"<p><strong>Introduction: </strong>Reporting of sex and gender analysis in medical research has been shown to improve quality of the science and ensure findings are applicable to women and men. There is conflicting evidence on whether efforts by funding agencies and medical journals to encourage reporting of sex and gender analysis have resulted in tangible improvements. This study mapped the inclusion of sex and gender analysis in stroke and dementia research conducted in the Asia-Pacific region.</p><p><strong>Methods: </strong>A systematic search for Asia-Pacific stroke and dementia research was conducted in PubMed and papers included from the period 2012 to 2022. Eligible studies were reviewed for inclusion of a primary sex or gender focus and categorized by type of sex and gender analysis. Author gender was determined using an algorithm and its associations with inclusion of sex and gender analysis were examined.</p><p><strong>Results: </strong>Total Asia-Pacific publications increased from 109 in 2012 to 313 in 2022, but the rate of studies with a primary sex or gender focus did not increase significantly (R2 = 0.06, F(1, 9) = 0.59, p = 0.46). Australia, China, India, Japan, and South Korea produced the most publications over the study period and were the only countries with at least 50 publications. The impact of author gender was mixed, with female first authorship associated with inclusion of sex or gender analysis and last female authorship associated with studies having a primary sex or gender focus.</p><p><strong>Conclusions: </strong>In the Asia-Pacific, brain health research is currently centred around high-income countries, and efforts are needed to ensure research findings are applicable throughout the region. While there was a general increase in brain health publications over the last decade, the rate of sex and gender analysis was unchanged. This demonstrates that even with efforts in some countries in place, there is currently a lack of progress in the Asia-Pacific region to produce more research focussing on sex and gender analysis.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"89-95"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971097","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 Relation between Vascular Risk Factors and Flow in Cerebral Perforating Arteries: A 7 Tesla MRI Study.","authors":"Laurien Onkenhout, Tine Arts, Doeschka Ferro, Sanne Kuipers, Eline Oudeman, Thijs van Harten, Matthias J P van Osch, Jaco Zwanenburg, Jeroen Hendrikse, Geert Jan Biessels, L Jaap Kappelle","doi":"10.1159/000537709","DOIUrl":"10.1159/000537709","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral perforating arteries provide blood supply to the deep regions of the brain. Recently, it became possible to measure blood flow velocity and pulsatility in these small arteries. It is unknown if vascular risk factors are related to these measures.</p><p><strong>Methods: </strong>We measured perforating artery flow with 2D phase-contrast 7 Tesla MRI at the level of the centrum semiovale (CSO) and the basal ganglia (BG) in seventy participants from the Heart Brain Connection study with carotid occlusive disease (COD), vascular cognitive impairment (VCI), or no actual cerebrovascular disease. Vascular risk factors included hypertension, diabetes, hyperlipidemia, and smoking.</p><p><strong>Results: </strong>No consistent relations were found between any of the vascular risk factors and either flow velocity or flow pulsatility, although there was a relation between lower diastolic blood pressure and higher pulse pressure and higher cerebral perforator pulsatility (p = 0.045 and p = 0.044, respectively) at the BG level. Results were similar in stratified analyses for patients with and without a history of cardiovascular disease, or only COD or VCI.</p><p><strong>Conclusion: </strong>We conclude that, cross-sectionally, cerebral perforating artery flow velocity and pulsatility are largely independent of the presence of common vascular risk factors in a population with a mixed vascular burden.</p><p><strong>Introduction: </strong>Cerebral perforating arteries provide blood supply to the deep regions of the brain. Recently, it became possible to measure blood flow velocity and pulsatility in these small arteries. It is unknown if vascular risk factors are related to these measures.</p><p><strong>Methods: </strong>We measured perforating artery flow with 2D phase-contrast 7 Tesla MRI at the level of the centrum semiovale (CSO) and the basal ganglia (BG) in seventy participants from the Heart Brain Connection study with carotid occlusive disease (COD), vascular cognitive impairment (VCI), or no actual cerebrovascular disease. Vascular risk factors included hypertension, diabetes, hyperlipidemia, and smoking.</p><p><strong>Results: </strong>No consistent relations were found between any of the vascular risk factors and either flow velocity or flow pulsatility, although there was a relation between lower diastolic blood pressure and higher pulse pressure and higher cerebral perforator pulsatility (p = 0.045 and p = 0.044, respectively) at the BG level. Results were similar in stratified analyses for patients with and without a history of cardiovascular disease, or only COD or VCI.</p><p><strong>Conclusion: </strong>We conclude that, cross-sectionally, cerebral perforating artery flow velocity and pulsatility are largely independent of the presence of common vascular risk factors in a population with a mixed vascular burden.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"121-128"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11793086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139717327","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":"Gamma Knife Stereotactic Radiosurgery for Cerebral Cavernous Malformations: Meta-Analysis of Reconstructed Time-to-Event Data.","authors":"Gustavo da Fontoura Galvão, Gabriel Verly, Matheus Duque Bessa, Bernardo Lisboa Galvão Santos, Pablo Valença, Flávio Sampaio Domingues, Marcello Reis da Silva, Jorge Marcondes","doi":"10.1159/000539079","DOIUrl":"10.1159/000539079","url":null,"abstract":"<p><strong>Introduction: </strong>Cavernomas are vascular lesions with a genetic heritage that can be spotted on the central nervous system. Whenever these lesions are localized in eloquent regions, surgical resection is not recommended. In this type of situation, Gamma Knife stereotactic radiosurgery (GKSRS) could be a feasible option for treating patients. Thus, we aimed to explore the outcomes associated with this procedure.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis of reconstructed time-to-event data based on Kaplan-Meier curves. A thorough search was conducted on PubMed, Cochrane, Web of Science, and Embase databases targeting papers that provided information regarding hemorrhagic outcomes associated with GKSRS through Kaplan-Meier curves.</p><p><strong>Results: </strong>After a systematic search in the specific databases, seven studies were included in this review. Notably, a total of 1,071 patients had 1,104 cavernomas treated by GKSRS. Assessment of short-term and long-term post-procedure outcomes was performed, with the estimated overall events-free rate at 2 years being 89.8% (95% CI: 87.7-91.5), while, at 10 years, the estimated overall events-free rate was 71.3% (95% CI: 67.2-75.1).</p><p><strong>Conclusion: </strong>GKSRS seems to be a good alternative for the control of symptomatic events in early and long-term follow-up, despite the need for further investigation provided by future studies.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"196-207"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847579","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":"Outcome of Mechanical Thrombectomy for Acute Basilar Artery Occlusion in Patients with Intracranial Atherosclerotic Disease.","authors":"Huong Bich Thi Nguyen, Trung Quoc Nguyen, Vu Thanh Tran, Tra Son Vu Le, Anh Tuan Le Truong, Binh Nguyen Pham, Sang Hung Nguyen, Anit Kiran Behera, Thanh Thien Nguyen, Thang Ba Nguyen, Thanh N Nguyen, Thang Huy Nguyen","doi":"10.1159/000539112","DOIUrl":"10.1159/000539112","url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial atherosclerotic disease (ICAD) has been identified as a major cause of acute basilar artery occlusion (BAO).This study compared the characteristics and treatment outcomes in acute BAO patients with and without ICAD.</p><p><strong>Methods: </strong>A prospective cohort study was conducted at 115 People's Hospital, Ho Chi Minh city, Vietnam from August 2021 to June 2023. Patients with acute BAO who underwent endovascular treatment within 24 h from symptom onset were included (thrombectomy alone or bridging with intravenous alteplase). The baseline characteristics and outcomes were analyzed and compared between patients with and without ICAD. Good functional outcome was defined as mRS ≤3 at 90 days.</p><p><strong>Results: </strong>Among the 208 patients enrolled, 112 (53.8%) patients were categorized in the ICAD group, and 96 (46.2%) in the non-ICAD group. Occlusion in the proximal segment of the basilar artery was more common in patients with ICAD (55.4% vs. 21.9%, p < 0.001), whereas the distal segment was the most common location in the non-ICAD group (58.3% vs. 10.7%, p < 0.001). Patients in the ICAD group were more likely to undergo treatment in the late window, with a higher mean onset-to-treatment time compared to the non-ICAD group (11.6 vs. 9.5 h, p = 0.01). In multivariable logistic regression analysis, distal segment BAO was negatively associated with ICAD (aOR 0.13, 95% CI: 0.05-0.32, p < 0.001), while dyslipidemia showed a positive association (aOR 2.44, 95% CI: 1.15-5.17, p = 0.02). There was a higher rate for rescue stenting in the ICAD compared to non-ICAD group (15.2% vs. 0%, p < 0.001). However, no significant differences were found between the two groups in terms of good outcome (45.5% vs. 44.8%, p = 0.91), symptomatic hemorrhage rates (4.5% vs. 8.3%, p = 0.25), and mortality (42% vs. 50%, p = 0.25).</p><p><strong>Conclusion: </strong>ICAD was a common etiology in patients with BAO. The location segment of BAO and dyslipidemia were associated with ICAD in patients with BAO. There was no difference in 90-day outcomes between BAO patients with and without ICAD undergoing endovascular therapy.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"30-41"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140851512","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":"Extended Computed Tomography Angiography for the Successful Diagnosis of Cardioaortic Thrombus in Acute Ischemic Stroke and TIA: Study Protocol for a Randomized Controlled Trial.","authors":"Luciano A Sposato, Diana Ayan, Mobeen Ahmed, Sebastian Fridman, Jennifer L Mandzia, Facundo F Lodol, Maged Elrayes, Sachin Pandey, Rodrigo Bagur","doi":"10.1159/000540034","DOIUrl":"10.1159/000540034","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiac imaging is one of the main components of the etiological investigation of ischemic strokes. However, basic and advanced cardiac imaging remain underused in most stroke centers globally. Computed tomography angiography (CTA) of the supra-aortic and intracranial arteries is the most frequent imaging modality applied during the evaluation of patients with acute ischemic stroke to identify the presence of a large vessel occlusion. Recent evidence from retrospective observational studies has shown a high detection of cardiac thrombi, ranging from 6.6 to 17.4%, by extending a CTA a few cm below the carina to capture cardiac images. However, this approach has never been prospectively compared against usual care in a randomized controlled trial. The Extended Computed Tomography Angiography for the Successful Screening of Cardioaortic Thrombus in Acute Ischemic Stroke and TIA (DAYLIGHT) prospective, randomized, controlled trial evaluates whether an extended CTA (eCTA) + standard-of-care stroke workup results in higher detection rates of cardiac and aortic source of embolism compared to standard-of-care CTA (sCTA) + standard-of-care stroke workup.</p><p><strong>Methods: </strong>DAYLIGHT is a single-center, prospective, randomized, open-blinded endpoint trial, aiming to recruit 830 patients with suspected acute ischemic stroke or transient ischemic attack (TIA) being assessed under acute code stroke at the emergency department or at a dedicated urgent stroke prevention clinic. Patients are randomized 1:1 to eCTA versus sCTA. The eCTA expands image acquisition caudally, 6 cm below the carina. All patients receive standard-of-care cardiac imaging and diagnostic stroke workup. The primary efficacy endpoint is the diagnosis of a cardioaortic thrombus after at least 30 days of follow-up. The primary safety endpoint is door-to-CTA completion time. The diagnosis of a qualifying ischemic stroke or TIA is independently adjudicated by a stroke neurologist, blinded to the study arm allocation. Patients without an adjudicated ischemic stroke or TIA are excluded from the analysis. The primary outcome events are adjudicated by a board-certified radiologist with subspecialty training in cardiothoracic radiology and a cardiologist with formal training in cardiac imaging. The primary analysis is performed according to the modified intention-to-diagnose principle and without adjustment by logistic regression models. Results are presented with odds ratios and 95% confidence intervals.</p><p><strong>Conclusion: </strong>The DAYLIGHT trial will provide evidence on whether extending a CTA to include the heart results in an increased detection of cardioaortic thrombi compared to standard-of-care stroke workup.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"415-424"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141455593","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":"Motor Function Is Associated with Cerebral Small Vessel Disease and Can Predict Mortality and Poor Functional Outcome.","authors":"Megumi Hosoya, Sono Toi, Misa Seki, Takao Hoshino, Yasuto Sato, Hiroshi Yoshizawa, Mutsumi Iijima, Kazuo Kitagawa","doi":"10.1159/000540639","DOIUrl":"10.1159/000540639","url":null,"abstract":"<p><strong>Introduction: </strong>The primary objective of this study was to elucidate the predictive role of subtle motor impairment evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) Part III on mortality and functional outcome. The secondary objective was to evaluate the association of motor impairment with small vessel disease (SVD) severity.</p><p><strong>Methods: </strong>We derived data from a Japanese cohort of patients with evidence of SVD who were enrolled from 2015 to 2019, and followed until 2023. The present study included 586 participants who agreed for UPDRS Part III evaluation. The severity of white matter hyperintensities (WMHs) and the presence of lacunes were evaluated. Cox proportional hazard models and multiple logistic regression analysis were used to examine the association between UPDRS Part III score and all-cause death and functional outcome defined by the modified Rankin Scale (mRS) score at the last visit, respectively.</p><p><strong>Results: </strong>The median age was 71 years, and the median UPDRS Part III score was 2. The UPDRS Part III score was associated with the severity of WMH (r = 0.225, p < 0.001) and the number (0, 1, ≥2) of lacunes (p < 0.001). During a mean follow-up period of 4.8 years, 29 patients died. The Cox proportional hazard analysis revealed that high UPDRS Part III scores (≥5) were associated with a higher risk of all-cause death compared to low (score 0) and middle (score 1-4) scores (adjusted hazard ratio 3.04; 95% confidence interval, 1.50-7.34, p = 0.005). In multivariate logistic analysis, high UPDRS Part III scores were associated with poor functional outcome (mRS of ≥3) compared with low and middle scores after adjusting for confounding factors (adjusted odds ratio 1.86; 95% confidence interval 1.02-3.41, p = 0.043).</p><p><strong>Conclusions: </strong>Subtle motor impairment was associated with the severity of WMH and number of lacunes and could predict mortality and poor functional outcome independently of vascular risk factors and severity of WMH and lacunes.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"489-498"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280875","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}