Cerebrovascular Diseases最新文献

{"title":"Functional Outcome Prediction in Japanese Patients with Nonsurgical Intracerebral Hemorrhage: The FSR ICH Score.","authors":"Takuya Kiyohara, Ryu Matsuo, Fumi Irie, Kuniyuki Nakamura, Jun Hata, Yoshinobu Wakisaka, Takanari Kitazono, Masahiro Kamouchi, Tetsuro Ago","doi":"10.1159/000543362","DOIUrl":"10.1159/000543362","url":null,"abstract":"<p><strong>Introduction: </strong>There has been limited research on predicting the functional prognosis of patients with nonsurgical intracerebral hemorrhage (ICH) from the acute stage. The aim of this study was to develop a risk prediction model for the natural course in patients with nonsurgical ICH and to evaluate its performance using a multicenter hospital-based prospective study of stroke patients in Japan.</p><p><strong>Methods: </strong>We consecutively registered a total of 1,017 patients with acute ICH (mean age, 68 years) who underwent conservative treatment and followed them up for 3 months. The study outcome was a poor functional outcome (modified Rankin Scale score, 4-6) at 3 months after ICH onset. To develop the risk prediction model for natural course in patients with nonsurgical ICH, we included the following clinical common factors assessed on admission in daily clinical practice for ICH: age, sex, medical history (hypertension, diabetes mellitus, dyslipidemia, pre-stroke dementia, previous stroke, coronary artery disease, smoking status, alcohol drinking status, oral anticoagulation, and antiplatelet medication), admission status (time from onset to admission, systolic blood pressure, diastolic blood pressure, pulse pressure, plasma glucose levels, severity of the stroke), and neuroradiologic data (ICH location, intraventricular hemorrhage, and hematoma volume). The risk prediction model for poor functional outcome was developed using logistic regression analysis. In addition, the risk prediction model was translated into a point-based simple risk score (FSR ICH score) using the approach in the Framingham Heart Study.</p><p><strong>Results: </strong>At 3 months after the ICH onset, 323 (31.8%) patients developed a poor functional outcome. Age, diabetes mellitus, pre-stroke dementia, NIHSS score on admission, intraventricular hemorrhage, and hematoma volume were included in the risk prediction model. This model demonstrated excellent discrimination (C statistic = 0.884 [95% confidence interval, 0.863-0.905]; optimism-corrected C statistic based on 200 bootstrap samples = 0.877) and calibration (Hosmer-Lemeshow goodness-of-fit test: p = 0.72). The FSR ICH score, a point-based simple risk score, also showed excellent discrimination, with a C statistic of 0.882 (95% CI: 0.861-0.903).</p><p><strong>Conclusions: </strong>We developed a new risk prediction model for 3-month poor functional outcome in patients with nonsurgical ICH using a multicenter hospital-based prospective study in Japan. The current risk prediction model has the potential to be a useful tool for estimating the natural course in patients with nonsurgical ICH, aiding in making treatment decisions, including surgical options, early formulation of rehabilitation plans, and efficient utilization of medical resources.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945390","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":"Cerebral Artery Overexpression of the NMUR1 Gene Is Associated with Moyamoya Disease: A Weighted Gene Co-Expression Network Analysis.","authors":"Samuel D Pettersson, Shunsuke Koga, Shan Ali, Alejandro Enriquez-Marulanda, Philipp Taussky, Christopher S Ogilvy","doi":"10.1159/000538035","DOIUrl":"10.1159/000538035","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to elucidate mechanisms underlying moyamoya disease (MMD) pathogenesis and to identify potential novel biomarkers. We utilized gene co-expression networks to identify hub genes associated with the disease.</p><p><strong>Methods: </strong>Twenty-one middle cerebral artery (MCA) samples from MMD patients and 11 MCA control samples were obtained from the Gene Expression Omnibus (GEO) dataset, GSE189993. To discover functional pathways and potential biomarkers, weighted gene co-expression network analysis (WGCNA) was employed. The hub genes identified were re-assessed through differential gene expression analysis (DGEA) via DESeq2 for further reliability verification. Additional 4 samples from the superficial temporal arteries (STAs) from MMD patients were obtained from GSE141025, and a subgroup analysis stratified by arterial type (MCA vs. STA) DGEA was performed to assess if the hub genes associated with MMD are expressed significantly greater on the affected arteries compared to healthy ones in MMD.</p><p><strong>Results: </strong>WGCNA revealed a predominant module encompassing 139 hub genes, predominantly associated with the neuroactive ligand-receptor interaction (NLRI) pathway. Of those, 17 genes were validated as significantly differentially expressed. Neuromedin U receptor 1 (NMUR1) and thyrotropin-releasing hormone were 2 out of the 17 hub genes involved in the NLRI pathway (log fold change [logFC]: 1.150, p = 0.00028; logFC: 1.146, p = 0.00115, respectively). MMD-only subgroup analysis stratified by location showed that NMUR1 is significantly overexpressed in the MCA compared to the STA (logFC: 1.962; p = 0.00053) which further suggests its possible localized involvement in the progressive stenosis seen in the cerebral arteries in MMD.</p><p><strong>Conclusion: </strong>This is the first study to have performed WGCNA on samples directly affected by MMD. NMUR1 expression is well known to induce localized arterial smooth muscle constriction and, recently, type 2 inflammation which can predispose to arterial stenosis potentially advancing the symptoms and progression of MMD. Further validation and functional studies are necessary to understand the precise role of NMUR1 upregulation in MMD and its potential implications.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-10"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971096","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":"Late Lesion Growth following Endovascular Therapy: Is 24 h Too Early to Assess Acute Infarct Size Including the Effects of Secondary Injury?","authors":"Marie Luby, Amie W Hsia, Carolyn A Lomahan, Victoria Uche, Rachel Davis, Yongwoo Kim, Sana Somani, Shannon Burton, Rainier Cabatbat, Veronica Craft, Jill B De Vis, Malik M Adil, Mariam M Afzal, Leila C Thomas, William Gandler, Evan S McCreedy, John K Lynch, Lawrence L Latour","doi":"10.1159/000536470","DOIUrl":"10.1159/000536470","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Stroke lesion volume on MRI or CT provides objective evidence of tissue injury as a consequence of ischemic stroke. Measurement of \"final\" lesion volume at 24-h following endovascular therapy (post-EVT) has been used in multiple studies as a surrogate for clinical outcome. However, despite successful recanalization, a significant proportion of patients do not experience favorable clinical outcome. The goals of this study were to quantify lesion growth during the first week after treatment, identify early predictors, and explore the association with clinical outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a prospective study of stroke patients at two centers who met the following criteria: (i) anterior large vessel occlusion acute ischemic stroke, (ii) attempted EVT, and (iii) had 3T MRI post-EVT at 24-h and 5-day. We defined \"early\" and \"late\" lesion growth as ≥10 mL lesion growth between baseline and 24-h diffusion-weighted imaging (DWI) and between 24-h DWI and 5-day fluid attenuated inversion recovery imaging, respectively. Complete reperfusion was defined as &gt;90% reduction of the volume of tissue with perfusion delay (Tmax&gt;6 s) between pre-EVT and 24-h post-EVT. Favorable clinical outcome was defined as modified Rankin scale (mRS) of 0-2 at 30 or 90 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;One hundred twelve patients met study criteria with median age 67 years, 56% female, median admit NIHSS 19, 54% received IV or IA thrombolysis, 66% with M1 occlusion, and median baseline DWI volume 21.2 mL. Successful recanalization was achieved in 87%, and 68% had complete reperfusion, with an overall favorable clinical outcome rate of 53%. Nearly two-thirds (65%) of the patients did not have late lesion growth with a median volume change of -0.3 mL between 24-h and 5-day and an associated high rate of favorable clinical outcome (64%). However, ∼1/3 of patients (35%) did have significant late lesion growth despite successful recanalization (87%: 46% mTICI 2b/41% mTICI 3). Late lesion growth patients had a 27.4 mL change in late lesion volume and 30.1 mL change in early lesion volume. These patients had an increased hemorrhagic transformation (HT) rate of 68% with only 1 in 3 patients having favorable clinical outcome. Late lesion growth was independently associated with incomplete reperfusion, HT, and unfavorable outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Approximately 1 out of 3 patients had late lesion growth following EVT, with a favorable clinical outcome occurring in only 1 out of 3 of these patients. Most patients with no early lesion growth had no late lesion growth. Identification of patients with late lesion growth could be critical to guide clinical management and inform prognosis post-EVT. Additionally, it can serve as an imaging biomarker for the development of adjunctive therapies to mitigate reperfusion injury.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Stroke lesion volume on MRI or CT provides objective evidence o","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"129-137"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11347714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139982484","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":"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":"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":"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":"Implementation of Low-Intensity Thrombolysis Monitoring Care in Routine Practice: Process Evaluation of the Optimal Post rtPA-IV Monitoring in Acute Ischemic Stroke Study in the USA.","authors":"Menglu Ouyang, Francisca González, Michelle Montalbano, April Pruski, Stephen Jan, Xia Wang, Brenda Johnson, Debbie V Summers, Pooja Khatri, Alejandra Malavera, Michael Iacobelli, Roland Faigle, Paula Munoz-Venturelli, Francisca Urrutia Goldsack, Diana Day, Thompson G Robinson, Alice C Durham, Ahtasam Ebraimo, Lili Song, Yi Sui, Wan Asyraf Wan Zaidi, Richard I Lindley, Candice Delcourt, Victor Cruz Urrutia, Craig S Anderson, Hueiming Liu","doi":"10.1159/000538136","DOIUrl":"10.1159/000538136","url":null,"abstract":"<p><strong>Introduction: </strong>The ongoing OPTIMISTmain study, an international, multicenter, stepped-wedge cluster randomized trial, aims to determine effectiveness and safety of low-intensity versus standard monitoring in thrombolysis-treated patients with mild-to-moderate acute ischemic stroke (AIS). An embedded process evaluation explored integration and impact of the intervention on care processes at participating US sites.</p><p><strong>Methods: </strong>A mixed-methods approach with quantitative and qualitative data was collected between September 2021 and November 2022. Implementer surveys were undertaken at pre- and post-intervention phases to understand the perceptions of low-intensity monitoring strategy. A sample of stroke care nurses were invited to participate in semi-structured interviews at an early stage of post-intervention. Qualitative data were analyzed deductively using the normalization process theory; quantitative data were tabulated.</p><p><strong>Results: </strong>Interviews with 21 nurses at 8 hospitals have shown low-intensity monitoring was well accepted as there were less time constraints and reduced workload for each patient. There were initial safety concerns over missing deteriorating patients and difficulties in changing established routines. Proper training, education, and communication, and changing the habits and culture of care, were key elements to successfully adopting the new monitoring care into routine practice. Similar results were found in the post-intervention survey (42 nurses from 13 hospitals). Nurses reported time being freed up to provide patient education (56%), daily living care (50%), early mobilization (26%), mood/cognition assessment (44%), and other aspects (i.e., communication, family support).</p><p><strong>Conclusions: </strong>Low-intensity monitoring for patients with mild-to-moderate AIS, facilitated by appropriate education and organizational support, appears feasible and acceptable at US hospitals.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"96-104"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140038749","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":"Intravenous Tenecteplase versus Alteplase before Mechanical Thrombectomy in Patients with Large Vessel Occlusion Stroke: A Systematic Review and Meta-Analysis.","authors":"Mohammed A Almanna, Ziad S Aloraini, Robert W Regenhardt, Adam A Dmytriw, Mohammed A Bayounis, Mohammed A Bin-Mahfooz, Yousef I Alghamdi, Ysmeen T Bucklain, Abdulrahman Y Alhoumaily, Naif M Alotaibi","doi":"10.1159/000536669","DOIUrl":"10.1159/000536669","url":null,"abstract":"<p><strong>Introduction: </strong>The use of alteplase (ALT) bridging to endovascular mechanical thrombectomy (MT) has become the standard approach in treating patients with large vessel occlusion (LVO) stroke. Tenecteplase (TNK) has emerged as an equivalent fibrinolytic agent in treating ischemic stroke due to its remarkable pharmacological characteristics. This study aimed to compare the use of intravenous TNK to ALT bridging to MT in patients with LVO.</p><p><strong>Methods: </strong>We included observational and randomized controlled trials of patients with LVO who received bridging TNK versus ALT before undergoing MT. Efficacy outcomes included functional independence which is indicated by a modified Rankin Scale [mRS] score of 0-2 at 90 days. Radiological outcomes included the rate of successful recanalization post-MT (Modified Treatment in Cerebral Ischemia [mTICI] score of 2b/3) and the rate of pre-MT recanalization, indicated by an mTICI of 2b/3 at the first angiographic assessment. The all-cause mortality at 90 days (mRS of 6) was considered the primary safety outcome, while the symptomatic intracranial hemorrhage rate was reported as an adverse event.</p><p><strong>Results: </strong>We identified 5 comparative observational studies and 1 randomized controlled trial, totaling 4,186 patients with LVO. The crude odds ratio (OR) for post-MT recanalization in patients with LVO who received TNK was comparable to those who received ALT (OR = 1.14; 95% CI: 0.57-2.27, I2 = 54%). The rate of pre-MT recanalization was significantly higher in those given TNK as a bridging therapy to MT compared to those who received ALT (OR = 2.66; 95% CI: 1.60-4.41, I2 = 0%; p <0.001). Functional independence at 90 days was not significantly different between patients with stroke who received TNK and those who were given ALT before MT (OR = 1.41; 95% CI: 0.84-2.35; I2 = 45%). The 90-day mortality was similar between patients with LVO who received TNK and those who were given ALT prior to undergoing MT (OR = 0.74; 95% CI: 0.46-1.21; I2 = 0%).</p><p><strong>Conclusion: </strong>Patients with LVO who received TNK as the primary fibrinolytic agent bridging to MT demonstrated higher rates of pre-MT recanalization, similar rates in post-MT recanalization and equivalent functional independence outcomes at 90 days compared to those who received ALT. The administration of TNK before MT showed comparable results in the 90-day all-cause mortality rate compared to those who received ALT. These results warrant further trials for TNK to be used as a superior fibrinolytic agent to ALT in LVO-MT candidates.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"42-52"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139740477","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 Clinical Factors of In-Hospital Mortality in Women Aged 85 Years or More with Acute Ischemic Stroke.","authors":"Sonia Torres-Riera, Adrià Arboix, Olga Parra, Luís García-Eroles, María-José Sánchez-López","doi":"10.1159/000536436","DOIUrl":"10.1159/000536436","url":null,"abstract":"<p><strong>Introduction: </strong>There are limited data on the outcome of acute ischemic stroke in oldest old women. We assessed clinical risk factors for in-hospital mortality in women aged 85 years or more with acute ischemic stroke.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 506 women aged ≥85 years collected from a total of 4,600 patients with acute cerebral infarction registered in an ongoing 24-year hospital stroke database. The identification of clinical risk factors for in-hospital mortality was the primary endpoint of the study.</p><p><strong>Results: </strong>The mean (± standard deviation) age of the patients was 88.6 ± 3.2 years. Stroke subtypes were cardioembolic infarcts in 37.7% of patients, atherothrombotic infarcts in 30.8%, infarcts of unknown cause and lacunar infarcts in 26.1% each, and infarcts of unusual cause in 11.5%. The in-hospital mortality rate was 20.4% (n = 103). Cardioembolic infarct accounted for 67% of all deaths (n = 69). Sudden stroke onset (OR 1.87, 95% CI 1.14-3.06), altered consciousness (OR 7.05, 95% CI 4.36-11.38), and neurological, cardiac, respiratory, and hemorrhagic events during hospitalization were independent risk factors for death, whereas lacunar infarction was a protective factor (OR 0.10, 95% CI 0.01-0.82).</p><p><strong>Conclusion: </strong>The oldest old age segment of women with acute ischemic infarction is a subgroup of stroke patients with unfavorable prognosis and high in-hospital mortality associated with sudden stroke onset, altered consciousness, and medical complications developed during hospitalization. Lacunar infarction as stroke subtype showed a favorable prognosis.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"11-19"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575206","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":"Opinions over Targets for Blood Pressure Control after Mechanical Thrombectomy in Patients with Acute Ischemic Stroke: Baseline Survey for the ENCHANTED2/MT Trial in China.","authors":"Yunke Li, Yang Zhao, Xiaoxi Zhang, Lingli Sun, Yingfeng Wan, Yongwei Zhang, Pengfei Yang, Lili Song, Jianmin Liu, Craig S Anderson","doi":"10.1159/000537924","DOIUrl":"10.1159/000537924","url":null,"abstract":"<p><strong>Introduction: </strong>Although guidelines recommend a target blood pressure 185-180/105-110 mm Hg after mechanical thrombectomy for acute ischemic stroke, there is limited randomized evidence to support this level. We surveyed candidate institutions about the approach to blood pressure management in this patient group in preparation for inviting them to participate in the Enhanced Blood Pressure Control after Endovascular Thrombectomy for the Acute Ischemic Stroke Trial (ENCHANTED2/MT).</p><p><strong>Methods: </strong>Physicians from a professional network of institutions that met mechanical thrombectomy qualification requirements were invited to participate in an online questionnaire covering basic clinical information as well as questions on blood pressure management.</p><p><strong>Results: </strong>We invited 88 sites to participate with 44 (50%) ultimately joining the trial, and a total of 88 physicians finished the survey. The median number of annual mechanical thrombectomy cases performed per site was 89 (IQR: 65-150). Only 38 (43%) institutions strictly adhere to guidelines when managing the blood pressure of mechanical thrombectomy patients. The most popular blood pressure target for reperfusion patients was 140-160 mm Hg (n = 47, 53%) and <120 mm Hg (n = 28, 32%). Fewer hospital stroke beds (40 [21-57] vs. 60 [39-110], p = 0.01) and lower proportion of elevated blood pressure after mechanical thrombectomy (25% [10-50%] vs. 50% [20-70%], p = 0.02) were related to a more aggressive blood pressure target (<120 mm Hg). Urapidil (n = 82, 93%) and calcium channel blockers (n = 87, 99%) were the most widely used antihypertensive drugs, respectively.</p><p><strong>Conclusion: </strong>According to the survey, unstandardized blood pressure management protocols are performed in mechanical thrombectomy patients at institutions across China, which is different from prior survey from another country. More high-quality studies are needed to guide clinical practice.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"138-144"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139912123","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}