Cerebrovascular Diseases最新文献

{"title":"Childhood Developmental Milestones and Risk of Adult Cerebrovascular Disease: The Northern Finland Birth Cohort 1966.","authors":"Milja Kivelä, Ina Rissanen, Eero Kajantie, Marja Ojaniemi, Harri Rusanen, Jouko Miettunen, Markus Paananen","doi":"10.1159/000541702","DOIUrl":"10.1159/000541702","url":null,"abstract":"<p><strong>Introduction: </strong>To the best of our knowledge, no previous studies have examined the relationship between childhood developmental milestones and risk of adulthood cerebrovascular disease (CeVD). We studied whether the risk of adult CeVD is associated with delayed attainment of motor and language milestones.</p><p><strong>Methods: </strong>Within the Northern Finland Birth Cohort 1966, a total of 11,688 persons were followed from birth to either death, moving abroad or 54 years of age. CeVD diagnoses, i.e., ischemic and hemorrhagic strokes and transient ischemic attacks, were extracted from national registers with diagnostic coding based on recommendations of the World Health Organization. Cox proportional hazard models stratified by sex were used to estimate associations of motor development and language milestones between ages 0 and 4 years and adult CeVD women-to-men relative hazard ratios (RHRs) were estimated for each developmental milestone. Analyses were adjusted for family socioeconomic status and birth weight for gestational age.</p><p><strong>Results: </strong>Altogether 498 (4.3%) CeVDs were recorded during follow-up. Among both sexes, later turning from back to tummy was associated with ischemic CeVD in adulthood with an adjusted hazard ratio (aHR) of 1.25 and 95% confidence interval (CI) 1.06-1.46 for men and an aHR: 1.20 (CI: 1.02-1.42) for women per 1 month delay in achievement. Delayed overall motor development, modeled by motor milestone principal component score, was related to increased risk of ischemic CeVD (aHR: 1.50; CI: 1.03-2.19) among men. Later achievement of making sounds was associated with any CeVD (aHR: 2.74; CI: 1.39-5.40) and especially ischemic CeVD (aHR: 3.41; CI: 1.65-7.06) among men with women-to-men RHR's of 0.17 (95% CI: 0.04-0.81) for any CeVD and RHR 0.18 (95% CI: 0.04-0.89) for ischemic stroke indicating risk to be lower in women compared to men.</p><p><strong>Conclusions: </strong>These findings suggest that later achievement of childhood milestones could be a predictor for development of CeVD risk. The results point toward a common neurodevelopmental background and could in part explain lifetime CeVD risk accumulation.</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":"142371062","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":"Frailty and Early Mortality following Intracerebral Hemorrhage.","authors":"Benjamin Lewis, Esmee Dohle, Elizabeth A Warburton, Nicholas R Evans","doi":"10.1159/000541701","DOIUrl":"10.1159/000541701","url":null,"abstract":"<p><strong>Introduction: </strong>Prognostication in spontaneous intracerebral hemorrhage (ICH) is vital for effective clinical decision-making but can be challenging. Frailty - the loss of physiological reserve to withstand stressor events - is a risk factor for poor outcomes after ischemic stroke, yet its role in ICH remains poorly understood. This study investigates whether frailty is independently associated with 28-day mortality following ICH.</p><p><strong>Methods: </strong>A validated pre-stroke frailty index (FI) was measured for individuals presenting with ICH, yielding a FI of 0-1. The relationship between 28-day mortality and FI was assessed using multivariable logistic regression adjusting for age, neurosurgical intervention, National Institutes of Health Stroke Scale (NIHSS), Glasgow Coma Score (GCS), and ICH volume.</p><p><strong>Results: </strong>Forty (34.5%) of 116 individuals with ICH died within 28 days. Frailty was independently associated with 28-day mortality, with each 0.1 increase in FI independently associated with an adjusted odds ratio of death of 1.09 (95% CI: 1.01-1.18). ICH volume was also independently associated with mortality (aOR 1.04, 95% CI: 1.02-1.06 per 10 mL increase). In contrast, age and neurosurgical intervention were not independently associated with mortality in our cohort.</p><p><strong>Conclusion: </strong>Higher pre-stroke frailty is independently associated with early mortality following spontaneous ICH, indicating the potential of frailty evaluation to inform prognostication and clinical decision-making.</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":"142371063","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":"Dose-Dependent Effect of Current Smoking on Enlarged Perivascular Space Identified on Brain Magnetic Resonance Imaging.","authors":"Naoki Omori, Fusao Ikawa, Masaaki Chiku, Naoyuki Kitamura, Hidekazu Tomimoto, Atsuo Aoyama, Yamaguchi Shuhei, Atsushi Nagai","doi":"10.1159/000541657","DOIUrl":"10.1159/000541657","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral small-vessel disease (CSVD) is a common cause of cognitive decline and stroke. Several studies have shown that smoking is a risk factor for CSVD progression. However, the extent to which smoking exacerbates CSVD lesions remains unclear. In this study, we aimed to clarify the association between total smoking exposure and the severity of CSVD in healthy participants.</p><p><strong>Methods: </strong>We analyzed the data of participants aged ≥50 years who underwent brain screening. The participants' age, sex, body mass index, alcohol consumption history, and medical history (hypertension, diabetes mellitus, and dyslipidemia) were investigated. Smoking status was assessed in pack-years, and smokers were classified as current or past smokers. CSVD findings on magnetic resonance imaging were used to evaluate the severity of periventricular hyperintensity (PVH), deep subcortical white matter hyperintensity (DSWMH), and enlarged perivascular spaces (EPVSs). The EPVSs were measured in the basal ganglia and centrum semiovale regions. Multivariable ordinal logistic regression analyses were performed to evaluate the effect of smoking, adjusted for the participants' baseline characteristics.</p><p><strong>Results: </strong>A total of 2,137 participants were included in this study. The mean age of the participants was 58.7 years. The mean pack-years were 20.5 for past smokers and 26.8 for current smokers. Among current smokers, increased pack-years were significantly associated with a high EPVS burden in the basal ganglia (odds ratio: 1.14, 95% confidence interval: 1.00-1.28), whereas no such significant association was found for past smokers. No statistically significant association was found between pack-years and the risks of PVH, DSWMH, or EPVS in the centrum semiovale.</p><p><strong>Conclusion: </strong>Current smoking was associated with a dose-dependent risk of EPVS in the basal ganglia in healthy participants.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342425","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 Feasibility and Validity of Sarcopenia Assessment Using Standard of Care Stroke Imaging.","authors":"Katrina Knight, Niall Finnegan, Aisling Rafter, Daniel Forbes, Douglas Black, Terry Quinn","doi":"10.1159/000541649","DOIUrl":"10.1159/000541649","url":null,"abstract":"<p><strong>Introduction: </strong>Sarcopenia, an age-related syndrome defined by low muscularity, loss of muscle strength, and performance, is increasingly recognized as a potential contributor to disability following acute stroke. It is challenging to assess functionally in the acute post-stroke setting. Radiological assessment of skeletal musculature using standard of care CT neck imaging has recently been described. We sought to determine its feasibility and explore associations between CT-defined sarcopenia, validated frailty and functional indices and outcome at 18 months.</p><p><strong>Methods: </strong>Imaging and clinical data from a prospective cohort study were used. Frailty and functional indices were collected, including the NIH Stroke Scale, Barthel Index for Activities of Daily Living, Fried frailty phenotype, Lawton Instrumental Activities of Daily Living (IADL) Scale, the Frail Non-Disabled (FiND) Questionnaire and pre-stroke modified Rankin Scale. Single transverse slices of neck CT angiograms obtained at the time of acute stroke diagnosis were assessed for skeletal muscle area using ImageJ software; a skeletal muscle index (SMI) was calculated. The relationship between sarcopenia, frailty and functional indices and death or disability at 18 months was assessed using binary logistic regression.</p><p><strong>Results: </strong>Of 86 potentially eligible patients, 73 were included. It was possible to perform skeletal muscle analysis on the CT scans of all included patients. SMI and functional or frailty indices were not closely correlated. SMI alone was independently related to death or disability at 18 months. The addition of SMI to the abbreviated FiND score appeared to strengthen its associations and prognostic value.</p><p><strong>Conclusion: </strong>This study demonstrates initial feasibility of CT-based skeletal muscle assessment in patients with acute stroke. The relationships with functional and frailty measures as well as short term outcomes including the ability to execute activities of daily living are required to be explored and validated in a larger, external cohort.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342428","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":"Epidemiology and Outcomes Associated with Cognitive Frailty and Reserve in a Stroke Population: Systematic Review and Meta-Analysis.","authors":"Lauren Binning, Catriona Basquill, Lucie Tvrda, Terry Quinn","doi":"10.1159/000541670","DOIUrl":"10.1159/000541670","url":null,"abstract":"<p><strong>Introduction: </strong>Cognitive frailty and the related concepts of cognitive reserve and imaging-based brain frailty are of increasing interest in older adult care. However, there is uncertainty regarding their importance within a stroke population. We aimed to establish the prevalence of cognitive frailty and reserve in stroke and determine impact on outcomes.</p><p><strong>Methods: </strong>We conducted a systematic review across multidisciplinary electronic databases using validated search syntax. The protocol for this review has been published (PROSPERO, CRD42023433385). We identified studies on cognitive frailty and cognitive reserve, including studies that used related concepts. We extracted data to inform estimates of prevalence and associations with outcomes of physical function, cognition and quality of life, performing meta-analyses where possible. Risk of bias was assessed using Newcastle-Ottawa tools appropriate to study design.</p><p><strong>Results: </strong>Our search returned 12,095 studies, from which 14 papers met our criteria. No studies described cognitive frailty, and rather studies described cognitive reserve and brain frailty. Cognitive reserve was assessed using proxy measures of education, employment, and leisure time. Four studies used the Cognitive Reserve Index Questionnaire (CRIq) with pooled estimate score of 103.25, 95% CI: 96.87-109.65 (indicating moderate cognitive reserve). Cognitive reserve had varying associations with post-stroke outcomes, three studies (n = 7,759 participants) reporting significant negative association with cognitive measures. Brain frailty was assessed using imaging markers. Across four studies (n = 3,086 participants), pooled prevalence of brain frailty was 73.8%, 95% CI: 72.2-75.3. Higher brain frailty was associated with poorer post-stroke outcomes for majority of studies assessed. Seven studies (50%) were scored as low risk of bias.</p><p><strong>Conclusion: </strong>Attempts to synthesise these data were complicated by inconsistency in terminology and heterogeneity in methods. However, our findings suggest that brain frailty is common in stroke and associated with poorer outcomes. The epidemiology of cognitive frailty and reserve is less well described. All these measures may be useful for prognostication in stroke, but there are multiple areas where more research is needed.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342426","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 Pre-Stroke Frailty on Outcome Three Years after Acute Stroke: The Nor-COAST Study.","authors":"Ragnhild Munthe-Kaas, Stian Lydersen, Terry Quinn, Stina Aam, Sarah T Pendlebury, Hege Ihle-Hansen","doi":"10.1159/000541565","DOIUrl":"10.1159/000541565","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to explore the predictive value of pre-stroke frailty index (FI) on functional dependency and mortality 3 years after stroke.</p><p><strong>Methods: </strong>Based on the Rockwood 36-item FI score, we calculated the pre-stroke FI from medical conditions recorded at baseline in the multicenter prospective Nor-COAST study 2015-2017. Participants with a FI score and a modified Rankin scale (mRS) 0-6 3 years post-stroke were included in this study. We used logistic regression analysis with unfavorable mRS (over 2 vs. 0-2) at 3 years, or dead within 3 years, as dependent variable, and frailty and pre-stroke mRS, one at a time, and simultaneously, as predictors. The analyses were carried out unadjusted and adjusted for the following variables one at a time: Age, sex, years of education, stroke severity at admission, infections treated with antibiotics and stroke progression. We report odds ratio (OR) per 0.10 increase in FI.</p><p><strong>Results: </strong>At baseline, the 609 included patients had mean age 72.8 (standard deviation [SD] 11.8), 261 (43%) were females, and had a FI mean score of 0.16 (SD 0.12), range 0-0.69. During 3 years, 138 (23%) had died. Both the FI, and pre-stroke mRS, were strong predictors for unfavorable mRS (OR 4.1 and 2.7) and dead within 3 years (OR 2.2 and 1.7). Only adjusting for age affected the result. The OR for pre-stroke mRS decreased relatively more than the OR for FI when entered as predictors simultaneously.</p><p><strong>Conclusions: </strong>FI is a stronger predictor than premorbid mRS for prognostication after stroke.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342427","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 &lt; 0.001) and the number (0, 1, ≥2) of lacunes (p &lt; 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":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-09-16","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}

{"title":"Erratum.","authors":"","doi":"10.1159/000541264","DOIUrl":"https://doi.org/10.1159/000541264","url":null,"abstract":"","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280874","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":"High resting heart rate is associated with cardiovascular death in patients with stroke, independent of sex.","authors":"Christine Heuer,Catherine Gebhard,Ashfaq Shuaib,Ulrike Held,Susanne Wegener,","doi":"10.1159/000541317","DOIUrl":"https://doi.org/10.1159/000541317","url":null,"abstract":"BACKGROUNDHigh resting heart rate (HRHR) is a surrogate marker of increased sympathetic outflow. In acute stroke patients, HRHR is more commonly observed in women than in men. We analysed whether HRHR (&gt;86 bpm) adds incremental prognostic value for stroke outcomes in women.METHODSWe analysed data of 6024 patients (2568 women, mean age 68.98 years) with acute ischemic stroke from the Virtual International Stroke Trials Archive (VISTA).RESULTSPatients with HRHR were more often female (45.3 vs 41.8%, p = 0.017), younger (66.0±13.2 vs. 67.8±12.6 years, p&lt;0.001), had higher baseline systolic blood pressure and more often diabetes. The primary composite endpoint of recurrent ischemic stroke, transient ischemic attack, myocardial infarction, or cardiovascular death within 90 days occurred more often in patients with HRHR (19.3 vs. 14.6%, p &lt;0.001). HRHR was associated with worse functional outcome at 90 days as assessed by modified Rankin Scale (mRS90: 3.03±1.98 vs. 2.82±1.94, p = 0.001). As exclusion of deceased patients (mRS90 of 6) resulted in a loss of association of HRHR with mRS90, it can be assumed that HRHR is mainly associated with post-stroke vascular mortality, but not disability. Female sex was not associated with the primary endpoint but with adverse functional outcome measured by mRS90.CONCLUSIONHRHR was associated with adverse events and mortality after stroke. Despite a higher prevalence of HRHR in women, they did not reach the primary endpoint more often. However, women had a worse functional outcome (mRS) three months after stroke, independent of HRHR.","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142175686","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":"Process Evaluation of an Ambulance-Delivered Early Intensive Blood Pressure-Lowering Stroke Trial: Design, Rationale, and Reflection.","authors":"Ruixue Liu, Chen Chen, Feifeng Liu, Yapeng Lin, Hongling Chu, Hueiming Liu, Craig S Anderson, Jie Yang, Gang Li, Lili Song, Menglu Ouyang","doi":"10.1159/000541322","DOIUrl":"10.1159/000541322","url":null,"abstract":"<p><strong>Introduction: </strong>The fourth INTEnsive ambulance-delivered blood pressure Reduction in hyper-ACute stroke Trial (INTERACT4) is a large-scale, multicenter, prospective, randomized, open-label, blinded endpoint assessment trial, initiated in an ambulance in China, aiming at evaluating the effectiveness and safety of prehospital blood pressure (BP) lowering in patients with suspected acute stroke and elevated BP. A prespecified process evaluation is intended to explore the implementation of the trial intervention, provide support to interpret the trial outcomes and put forward suggestions to scale up the intervention in broader settings in the future.</p><p><strong>Methods: </strong>This process evaluation is a mixed-methods design, and follows the Normalization Process Theory (NPT) and the UK Medical Research Council (UK MRC) guidance. Fidelity, reach, acceptability, appropriateness, adoption, sustainability, and relevant contextual factors and mechanisms affecting the implementation of prehospital early intensive BP-lowering treatment will be analyzed. Semi-structured interviews with ambulance staff, ward and emergency department clinicians, and nurses are undertaken to explore perceptions of the intervention, contextual factors, and potential suggestions for future implementation in practice. Data from observational records, surveys, conventional monitoring data, on-site records, and case report forms will be analyzed to understand background care and context.</p><p><strong>Conclusion: </strong>The process evaluation of INTERACT4 will provide insights for the implementation of prehospital early intensive BP-lowering intervention in different health systems and help better explain the trial results for further scale up.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139421","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}