Cerebrovascular Diseases最新文献

{"title":"Let's Code! How Can Programming Logic Make a Vascular Neurologist Even Better?","authors":"João Brainer Clares de Andrade, Thales Pardini Fagundes","doi":"10.1159/000547830","DOIUrl":"https://doi.org/10.1159/000547830","url":null,"abstract":"<p><strong>Introduction: </strong>As digital health and artificial intelligence (AI) become integral to medicine, there is a growing need for physicians to develop computational thinking skills. In vascular neurology, a specialty reliant on algorithmic decision-making and complex data interpretation, programming logic (PL) offers a powerful cognitive framework. This review argues that PL can enhance diagnostic precision, clinical efficiency, and data-driven reasoning.. By aligning core programming structures-such as conditional statements, loops, and data abstraction-with clinical workflows, neurologists can improve protocol adherence, patient monitoring, and anatomical localization.</p><p><strong>Methods: </strong>This narrative review aims to examine how programming logic concepts can enhance clinical reasoning, workflow organization, and data handling in vascular neurology. A non-systematic selection of relevant literature and expert insights was used to support the theoretical discussion.</p><p><strong>Review: </strong>Programming logic parallels medical reasoning through multiple mechanisms. Concepts such as conditional statements mirror diagnostic algorithms, guiding step-by-step decision-making in acute stroke management. Loop structures reflect the iterative nature of patient monitoring, where repeated neurological assessments are performed based on evolving clinical conditions. Data structuring principles help neurologists organize complex information, improving the analysis of patient registries and clinical trial datasets. Furthermore, debugging methods encourage physicians to systematically re-evaluate diagnoses when patients deviate from expected recovery pathways, refining clinical hypotheses based on new evidence. The modularity principle aligns with stroke care strategies, allowing neurologists to divide complex treatment plans into manageable components spanning acute intervention, secondary prevention, rehabilitation, and long-term outpatient follow-up.. Pattern recognition skills developed through coding are directly applicable to identifying clinical syndromes, neuroimaging findings, and complications. Furthermore, familiarity with programming languages like Python or R enhances a neurologist's ability to manage and analyze clinical data, critically appraise AI-driven evidence, and contribute to the design of error-reducing digital workflows.</p><p><strong>Conclusion: </strong>While not a substitute for clinical intuition, programming literacy is a complementary skill set that strengthens methodical thinking, innovation, and adaptability. Fostering these skills can improve patient care across the continuum of stroke management, optimize system-level outcomes, and empower neurologists to critically evaluate and co-create the next generation of digital health tools.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-8"},"PeriodicalIF":1.5,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871676","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":"Empowering Healthcare Professionals: Preventing Non-Communicable Vascular Diseases in the Transgender Community.","authors":"Daniela Laranja Gomes Rodrigues, Bianca Lopes Rosa, Ana Cláudia de Souza, Gisele Sampaio Silva","doi":"10.1159/000547079","DOIUrl":"10.1159/000547079","url":null,"abstract":"<p><strong>Background: </strong>The health disparities faced by transgender and gender-diverse (TGD) individuals in accessing healthcare, particularly in the context of non-communicable diseases (NCDs) and cerebrovascular diseases, are a significant public health concern.</p><p><strong>Summary: </strong>This article highlights the importance of the early identification of NCDs and cerebrovascular diseases in TGD populations, emphasizing the need for culturally competent care and comprehensive healthcare strategies. Gender-affirming hormone therapy plays a crucial role in the health of transgender individuals. Yet, it is associated with increased cardiovascular risk, particularly among transgender females undergoing estrogen therapy. Studies show a higher prevalence of hypertension, hypercholesterolemia, prediabetes, and smoking in the TGD population, reinforcing the need for regular cardiovascular monitoring and targeted preventive strategies. Early identification of NCDs and cerebrovascular disease signs and symptoms is essential in mitigating long-term health complications and improving patient outcomes. Proactive screening and timely interventions can enhance quality of life, reduce healthcare disparities, and contribute to more cost-effective care strategies. Strengthening the integration of diagnostic tools and promoting inclusive healthcare policies will foster greater trust and engagement between transgender individuals and healthcare providers.</p><p><strong>Key messages: </strong>Overall, this article underscores the need for inclusive healthcare policies and practices that address the unique healthcare needs of TGD individuals, improve health outcomes, and reduce disparities within this vulnerable population.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-8"},"PeriodicalIF":1.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854707","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":"Antihypertensive Drugs after Thrombectomy in Acute Ischemic Stroke with Poor Collateral Are Associated with Unfavorable Outcome.","authors":"Wen Yin, Hongye Xu, Jiaming Mao, Xiaoxi Zhang, Hongjian Shen, Wenjin Yang, Xiongfeng Wu, Fang Shen, Xuan Zhu, Yihan Zhou, Yongwei Zhang, Jianmin Liu, Lijun Wang, Pengfei Yang","doi":"10.1159/000547827","DOIUrl":"10.1159/000547827","url":null,"abstract":"<p><strong>Introduction: </strong>The impact of antihypertensive drugs on functional outcome in patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT) remains controversial and may vary with collateral status (CS). We aimed to investigate the joint effect of CS and antihypertensive drugs on functional outcome in patients with AIS.</p><p><strong>Methods: </strong>We retrospectively analyzed anterior circulation large-vessel occlusion AIS patients who underwent EVT in our hospital between January 2018 and December 2022. The patients were dichotomized to good CS, reflected by hypoperfusion index ratio (HIR) ≤0.4, and poor CS, reflected by HIR >0.4. Functional outcome was assessed using modified Rankin Scale (90d mRS). The primary outcome was defined as the 90d mRS > 2. The association between antihypertensive drugs within 48 h after EVT and functional outcome was evaluated. Furthermore, the interaction between HIR and antihypertensive drugs was measured.</p><p><strong>Results: </strong>A total of 372 patients were included. The proportion of patients receiving antihypertensive drugs was comparable between the good CS and poor CS group (51% vs. 56%, p = 0.285). Antihypertensive drugs were significantly associated with higher odds ratio (OR) of unfavorable outcome {OR 3.83 (95% confidence interval [CI], 2.12-6.90); p < 0.001} in poor CS group. No correlation was found in good CS group (p = 0.159). The interaction between antihypertensive drugs and baseline CS was statistically significant (P_interaction = 0.040, adjusted P_interaction = 0.029).</p><p><strong>Conclusion: </strong>The association between antihypertensive drugs and functional outcome varied based on the CS. These findings suggest that antihypertensive drugs should be used with caution in AIS patients with poor CS after EVT.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-11"},"PeriodicalIF":1.5,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793596","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":"Influence of Multiple Long-Term Conditions on Outcome after Thrombolysis for Acute Ischaemic Stroke: Secondary Analysis of the ENCHANTED Trial.","authors":"Xinwen Ren, Yang Zhao, Menglu Ouyang, Qiang Li, Chen Chen, Shoujiang You, Thompson G Robinson, Richard I Lindley, Hisatomi Arima, Xiaoying Chen, John Chalmers, Craig S Anderson, Lili Song, Xia Wang","doi":"10.1159/000547769","DOIUrl":"10.1159/000547769","url":null,"abstract":"<p><strong>Introduction: </strong>The influence of multiple long-term conditions on the outcomes from acute ischaemic stroke (AIS) is not well defined. This study aimed to determine the association of multiple long-term conditions in participants of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).</p><p><strong>Methods: </strong>ENCHANTED was an international, multicentre, 2 × 2 quasi-factorial, open, randomized controlled, blinded endpoint assessed trial that assessed the effectiveness and safety of intensive blood pressure lowering and low-dose thrombolysis against standard of care in adults with AIS. Multiple long-term condition was defined as two or more coexisting chronic conditions according to medical history. The primary outcome was function recovery (distribution of scores on the modified Rankin scale) and mortality at 90 days post-randomization. Associations were estimated in multivariate logistic regression models, and an assessment of heterogeneity was undertaken in subgroups including age, sex, baseline systolic blood pressure, and clinical features.</p><p><strong>Results: </strong>In 4,566 AIS participants (mean age 66.7 years, 37.8% female), those with multiple long-term conditions were older, more often female, and had more severe neurological impairment. Multiple long-term conditions increased the odds of poor functional outcome (adjusted odds ratio [aOR] 1.16, 95% confidence interval [CI]: 1.03-1.30; p = 0.020) and mortality (aOR 1.35, 95% CI: 1.04-1.76; p = 0.024). The association between multiple long-term conditions and mortality/functional outcome was consistent across all subgroups.</p><p><strong>Conclusion: </strong>Individuals with multiple long-term conditions have higher odds of poor functional outcome and death after thrombolytic treatment for AIS.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":1.5,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793597","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":"Trajectory of Hematoma Growth and Functional Recovery after Intracerebral Hemorrhage: A Latent Class Analysis of Blood Pressure in Acute Stroke Collaboration Data.","authors":"Menglu Ouyang, Shoujiang You, Tom J Moullaali, Candice Delcourt, Else Charlotte Sandset, Lisa Woodhouse, Zhe Kang Law, Hisatomi Arima, Ken Butcher, Leon Stephen Edwards, Salil Gupta, Wen Jiang, Sebastian Koch, John Potter, Adnan I Qureshi, Thompson G Robinson, Rustam Al-Shahi Salman, Jeffrey L Saver, Nikola Sprigg, Joanna Wardlaw, Craig S Anderson, Philip M Bath, John Philip Chalmers, Xia Wang","doi":"10.1159/000547678","DOIUrl":"10.1159/000547678","url":null,"abstract":"<p><strong>Introduction: </strong>Moderate blood pressure (BP) reduction reduces hematoma growth, but this has not been shown to translate into improved functional recovery after intracerebral hemorrhage (ICH). This study aimed to define patient profiles according to hematoma growth and functional recovery patterns, and explore the prognostic factors of the patterns.</p><p><strong>Methods: </strong>Analysis of the Blood Pressure in Acute Stroke Collaboration (BASC) dataset involved randomized controlled trials of early BP lowering in acute ICH. Latent class analysis was used to identify patient profiles by hematoma volume change from baseline to 24 h on outcome trajectories. Clinical outcomes include functional outcomes measured according to modified Rankin Scale (mRS) and serious adverse events at follow-up (usually 90 days). Generalized linear mixed models were used with adjustment of source trial as a random effect for clustering to identify the prognostic factors.</p><p><strong>Results: </strong>Among 6,221 participants from BASC, 2,450 patients (mean age 64.1 + 13.1 years, female 36.7%) were included. Baseline hematoma volumes (mL) were 6.8, 13.2, 27.1, and 59.2, respectively, for each class identified by patient profiles: no growth with favorable outcome (52.1%, median growth 0.2 [IQR -0.4 to 1.1] mL, median mRS 2 [IQR 1 to 2]), mild growth with disability (32.6%, 0.8 [-0.8 to 4.6] mL, mRS 4 [4 to 5]), moderate growth with death or disability (13.2%, 11.2 [4.9 to 27.0] mL, mRS 4 [3 to 6]), and large growth with death (2.1%, 35.2 [12.8 to 81.2] mL, mRS 6 [6 to 6]). Patients with moderate growth were younger and more likely to undergo neurosurgery than those in the mild or large growth groups. Baseline hematoma volume was the only significant factor associated with all the hematoma pattern groups.</p><p><strong>Conclusions: </strong>Patients with moderate growth were younger and more likely to receive neurosurgery than those in the mild or large growth groups. Baseline hematoma volume is the most important factor for hematoma growth and clinical outcome.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":1.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788348","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":"Association between Serum Gamma-Glutamyl Transferase Levels and Polyvascular Atherosclerotic Plaques and Stenosis: A Cross-Sectional Study.","authors":"Anqi Zhang, Yufan Liu, Lerong Mei, Yanli Zhang, Yuesong Pan, Bihong Zhu","doi":"10.1159/000547701","DOIUrl":"10.1159/000547701","url":null,"abstract":"<p><strong>Introduction: </strong>Serum gamma-glutamyl transferase (GGT) was associated with cardiovascular disease. However, limited research has explored the relationship between GGT and polyvascular atherosclerosis.</p><p><strong>Methods: </strong>This study is based on the baseline cross-sectional survey of the Polyvascular Evaluation for Cognitive Impairment and Vascular Events (PRECISE) study, a population-based cohort study. Serum GGT levels were categorized into quartiles. Atherosclerotic plaques and stenosis were evaluated using magnetic resonance imaging and computed tomography angiography. The extent of atherosclerotic plaques and stenosis was assessed based on the number of these 8 vascular sites (e.g., intracranial, extracranial, coronary, subclavian, aortic, renal, iliofemoral, and peripheral arteries) and was classified as affected vascular sites as zero, one, two-three, or four-eight extensive atherosclerotic sites. The correlation of GGT with the presence and extent of plaques and stenosis was assessed by binary logistic and ordinal logistic regression models.</p><p><strong>Results: </strong>A total of 3,046 participants were included with a mean age of 61.2 ± 6.7 years. GGT levels were associated with the presence (Q4 vs. Q1, odds ratio [OR] 2.14; 95% confidence interval [CI] 1.35-3.39) and the extent (common odds ratio [cOR], 2.08; 95% CI, 1.68-2.57) of atherosclerotic plaques and the presence (OR, 1.57; 95% CI, 1.24-2.00) and extent (cOR, 1.64; 95% CI, 1.30-2.06) of atherosclerotic stenosis after adjusting for age, sex, smoking, and alcohol consumption. However, associations were not significant after further adjusting for body mass index, low-density lipoprotein cholesterol, hypertension, diabetes mellitus, dyslipidemia, and medication history.</p><p><strong>Conclusion: </strong>GGT levels were associated with the presence and burden of atherosclerotic plaques and stenosis but not after adjusting some metabolism-related factors.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-10"},"PeriodicalIF":1.5,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783604","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":"Transcranial Doppler in the Era of Personalized Medicine: An Important Tool for the Assessment of Cerebrovascular Function.","authors":"Ricardo C Nogueira, Lucy C Beishon, Pedro Castro, Jurgen A H R Claassen, Jatinder S Minhas","doi":"10.1159/000547676","DOIUrl":"10.1159/000547676","url":null,"abstract":"<p><strong>Background: </strong>Transcranial Doppler (TCD) and transcranial color-coded duplex sonography (TCCS) have been referred to as the \"brain stethoscope\" as they provide real-time monitoring of both hemodynamic parameters and the structural image of the vessel and neighboring tissues. Its use has made important contributions to the field, with the ability to monitor important variables such as cerebral blood velocity to study cerebrovascular function. Although the use of B-mode with color-coded imaging allows identification of the vessel of interest in a more user-friendly approach compared to non-imaging TCD, TCD has unique functions that are complementary to TCCS studies. The aim of this review was to introduce these unique functions of TCD and discuss scenarios where the use of TCD would be justified without the combined use of TCCS.</p><p><strong>Summary: </strong>Due to its portability and noninvasive nature, TCD is a reliable option for monitoring cerebrovascular conditions; with the ability to perform long periods of monitoring via a dedicated head frame or band. This provides an opportunity to monitor cerebrovascular function which could be named TCD functional monitoring (TCD fm). Importantly, TCD can be used to evaluate the main mechanisms involved in cerebral blood flow regulation such as cerebral autoregulation (CA) and neurovascular coupling (NVC). CA refers to the ability of the brain to maintain CBF despite changes in systemic arterial blood pressure. NVC evaluates the CBF response to local cerebral metabolism and neural activation. Both mechanisms are important in physiological and pathological conditions. Understanding and monitoring cerebrovascular regulation could develop new insights to design personalized treatments which may lead to better prognosis and outcome for patients. Moreover, TCD fm may be implemented for microembolism detection during long periods of recording, enhancing the ability to detect embolic activity. All these unique applications of TCD strengthen the importance of the method. Furthermore, several functions of TCCS could be accomplished using TCD, which is less expensive when compared to modern TCCS devices, and therefore is a reasonable option for low-income countries.</p><p><strong>Key messages: </strong>TCD has utilities that are not covered by TCCS and considering the economic impact of broadening its use in specific areas, such as those with resource limitations, it is a reasonable option for the standard method for evaluation of cerebrovascular function. Further research is needed to combine these two modalities to provide a solution to the current limitations of using TCD and TCCS in isolation.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774739","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":"Intra-Arterial Fibrinolysis post Successful Endovascular Reperfusion for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.","authors":"Jiayi Zhang, Tong Meng, Zhibo Deng, Wenyi Zhong, Yuanyuan Li, Zhengzhou Yuan","doi":"10.1159/000547702","DOIUrl":"10.1159/000547702","url":null,"abstract":"<p><strong>Introduction: </strong>Acute ischemic stroke (AIS) due to large vessel occlusion (LVO) remains a leading cause of disability and mortality. While endovascular thrombectomy (EVT) achieves high macrovascular reperfusion rates, residual microvascular obstruction may possibly contribute to poor outcome. This systematic review and meta-analysis assesses the efficacy and safety of intra-arterial fibrinolysis (IAF) administered post successful EVT.</p><p><strong>Methods: </strong>Following a PROSPERO-registered protocol (CRD420250642689), we systematically analyzed four randomized controlled trials (RCTs, n = 1,392) and presented one observational study (n = 81) separately comparing EVT alone versus EVT plus IAF in AIS-LVO patients achieving successful reperfusion (mTICI ≥2b50). Primary outcomes included 90-day functional independence (mRS 0-1, 0-2), while secondary outcomes evaluated mortality and hemorrhagic complications.</p><p><strong>Results: </strong>IAF mildly improved the rate of excellent functional outcomes (mRS 0-1: RR 1.17, 95% CI: 1.03-1.32, p < 0.05) but did not enhance overall functional independence (mRS 0-2: RR 1.03, 95% CI: 0.94-1.13, p = 0.56). No significant differences were observed in 90-day mortality (RR 0.93, 95% CI: 0.75-1.16, p = 0.54) or symptomatic intracranial hemorrhage (RR 1.28, 95% CI: 0.79-2.06, p = 0.32). Any intracranial hemorrhage incidence was higher but no significant difference (RR 1.89, 95% CI: 0.73-4.90, p = 0.19).</p><p><strong>Conclusion: </strong>Adjunctive IAF following successful EVT may enhance the likelihood of excellent functional recovery without increasing mortality or major hemorrhagic risks. However, it still has some limitations such as specific obstruction positions, IAF types, IAF dosage, etc. Further high-quality RCTs are warranted to refine patient selection and optimize IAF protocols.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":1.5,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752518","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":"Age-Specific Impact of Procedural Time on Outcomes after Endovascular Therapy for Large Vessel Occlusion: Insights from the K-NET Registry.","authors":"Kentaro Tatsuno, Toshihiro Ueda, Masataka Takeuchi, Masafumi Morimoto, Yoshifumi Tsuboi, Ryoo Yamamoto, Shogo Kaku, Satoshi Takaishi, Noriko Usuki, Yasuyuki Kaga, Hidetaka Onodera, Hidemichi Ito, Yoshihisa Yamano","doi":"10.1159/000547677","DOIUrl":"10.1159/000547677","url":null,"abstract":"<p><strong>Introduction: </strong>Although endovascular treatment (EVT) for large vessel occlusion (LVO) generally yields better outcomes in younger patients compared to older individuals, the efficacy of this intervention and the age-related variations in factors influencing outcomes remain insufficiently elucidated. This study aimed to compare the outcomes of EVT between younger and older patients and to investigate the factors associated with favorable outcomes, with a particular focus on the relationship between procedural time and clinical results.</p><p><strong>Method: </strong>The K-NET Registry comprised 3,187 EVT cases. For this analysis, 2,381 patients were included based on the following criteria: (1) a pre-stroke modified Rankin Scale score of 0-2, and (2) occlusion of the internal carotid artery or middle cerebral artery (M1 or M2). Patients were stratified into three age groups: <60 years (251 patients), 60-79 years (1,186 patients), and ≥80 years (944 patients). This stratification allowed for the evaluation of baseline characteristics, treatment outcomes, and factors associated with favorable outcomes. Procedural time was defined as the interval from puncture to successful recanalization.</p><p><strong>Results: </strong>The proportion of women was higher in the <60 years group compared to the other age groups, while the prevalence of hypertension and dyslipidemia was significantly lower. Regarding stroke subtypes, intracranial artery stenosis/occlusion and arterial dissection were significantly more frequent in the <60 years group compared to the 60-79 and ≥80 years groups. The initial National Institutes of Health Stroke Scale (NIHSS) scores were significantly lower in the <60 years group. The median procedural time was 54 min, 44 min, and 49 min for the <60, 60-79, and ≥80 years groups, respectively, with the <60 years group demonstrating the longest duration. However, recanalization rates did not differ significantly among the three groups. The proportion of patients achieving favorable outcomes was significantly different among the age groups: 68.5%, 54.3%, and 30.8%, respectively. Independent factors associated with favorable outcomes across all groups included lower initial NIHSS scores, ASPECTS ≥6, and successful recanalization. While procedural time was not a significant factor for the <60 years group, it was a significant predictor in the 60-79 and ≥80 years groups.</p><p><strong>Conclusion: </strong>In EVT for LVO, NIHSS score, ASPECTS, and successful recanalization were independent predictors of favorable outcomes, irrespective of age. Although procedural time does not directly represent the full therapeutic time window, our findings indicate that prolonged puncture-to-recanalization time was significantly associated with worse outcomes in patients aged ≥60 years. These findings suggest that minimizing procedural time is especially critical in older populations, whereas younger patients may have greater tolerance for pr","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-10"},"PeriodicalIF":1.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741306","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 Efficacy and Safety of Intra-Arterial Thrombolysis in Mechanical Thrombectomy: A Systematic Review and Meta-Analysis.","authors":"Lue Chen, Qiqi Huo, Qi Wei, Thanh N Nguyen, Mohamad K Abdalkader, Shunfu Jiang, Min Luo, Yu Jing, Lanlan Yang, Shuang Wang, Huiping Jiang, Shiyu Wen, Minyue Sun, Wei Huang, Shaotong Chen, Jian Yi, Guangxiong Yuan, Hongfei Sang, QingWu Yang, Nongyan Wang, Zhongming Qiu, Duolao Wang, Bruce C V Campbell, Yufeng Tang","doi":"10.1159/000547442","DOIUrl":"10.1159/000547442","url":null,"abstract":"<p><strong>Introduction: </strong>Intra-arterial thrombolysis (IAT) after mechanical thrombectomy (MT) may improve microvascular reperfusion and reduce disability in patients with ischemic stroke. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational cohort studies to investigate the efficacy and safety of MT combined with IAT for the treatment of acute ischemic stroke.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Cochrane Library, and Web of Science databases in all languages published from inception to May 30, 2025, using the search terms \"stroke\", \"thrombectomy\", \"intra-arterial thrombolysis\". The primary efficacy outcome was excellent functional outcome (modified Rankin scale 0-1) at 90 days and the key safety outcomes were death and symptomatic intracerebral hemorrhage. Effect sizes were computed as risk ratio (RR) with random-effect or fixed-effect models.</p><p><strong>Results: </strong>Seven RCTs and 9 cohort studies with a total of 6,258 patients met the inclusion criteria. The results of the RCTs indicated that for patients with large vessel occlusion stroke who were treated with MT and achieved successful recanalization, the subsequent administration of IAT significantly increased the chances of excellent functional outcome (mRS 0-1, RR: 1.24, 95% CI: 1.12-1.37, p < 0.0001) without increasing the risk of sICH or death. While cohort studies lacked excellent functional outcome rates, other endpoints were consistent with RCTs. The results of subgroup analysis suggested that, in patients who did not receive IVT before MT, the combination of MT and IAT significantly improved the likelihood of achieving excellent functional outcomes (RR: 1.17, 95% CI: 1.04-1.32).</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis indicated that MT combined with IAT could lead to a higher opportunity of excellent functional outcome (mRS 0-1) than MT alone in acute stroke. Importantly, adding IAT was safe and did not increase the risk of symptomatic intracranial hemorrhage and death.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-13"},"PeriodicalIF":1.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741307","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}