Cerebrovascular Diseases最新文献

{"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}

{"title":"Complications of Implanted Vagus Nerve Stimulation: A Systematic Review and Meta-Analysis.","authors":"Roshini Kalagara, Susmita Chennareddy, Emma Reford, Abhiraj D Bhimani, Daniel D Cummins, Margaret H Downes, Jenna M Tosto, Joshua B Bederson, Mocco, David Putrino, Christopher P Kellner, Fedor Panov","doi":"10.1159/000536362","DOIUrl":"10.1159/000536362","url":null,"abstract":"<p><strong>Introduction: </strong>Vagus nerve stimulation (VNS) has emerged as a promising tool in ischemic stroke rehabilitation. However, there has been no systematic review summarizing its adverse effects, critical information for patients and providers when obtaining informed consent for this novel treatment. This systematic review and meta-analysis reports the adverse effects of VNS.</p><p><strong>Methods: </strong>A systematic review was performed in accordance with PRISMA guidelines to identify common complications after VNS therapy. The search was executed in Cochrane Central Register of Controlled Trials, Embase, and Ovid MEDLINE. All prospective, randomized controlled trials using implanted VNS therapy in adult patients were eligible for inclusion. Case studies and studies lacking complete complication reports were excluded. Extracted data included technology name, location of implantation, follow-up duration, purpose of VNS, and adverse event rates.</p><p><strong>Results: </strong>After title-and-abstract screening of 4,933 studies, 21 were selected for final inclusion. Across these studies, 1,474 patients received VNS implantation. VNS was used as a potential therapy for epilepsy (9), depression (8), anxiety (1), ischemic stroke (1), chronic heart failure (1), and fibromyalgia (1). The 5 most common post-implant adverse events were voice alteration/hoarseness (n = 671, 45.5%), paresthesia (n = 233, 15.8%), cough (n = 221, 15.0%), dyspnea (n = 211, 14.3%), and pain (n = 170, 11.5%).</p><p><strong>Conclusions: </strong>Complications from VNS are mild and transient, with reduction in severity and number of adverse events with increasing follow-up time. In prior studies, VNS has served as treatment option in several instances of treatment-resistant conditions, such as epilepsy and psychiatric conditions, and its use in stroke recovery and rehabilitation should continue to be explored.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"112-120"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109485","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":"Causal Relationship between Gut Microbiota and Aneurysm: A Mendelian Randomization Study.","authors":"Zhentao Tan, Menghui Mao, Zhe Jiang, Huilin Hu, Chaojie He, Changlin Zhai, Gang Qian","doi":"10.1159/000536177","DOIUrl":"10.1159/000536177","url":null,"abstract":"<p><strong>Introduction: </strong>Observational studies have suggested a possible relationship between gut microbiota (GM) and aneurysm development. However, the nature of this association remains unclear due to the inherent limitations of observational research, such as reverse causation and confounding factors. To address this knowledge deficit, this study aimed to investigate and establish a causal link between GM and aneurysm development.</p><p><strong>Methods: </strong>Summary statistics regarding GM and aneurysms were collected from relevant genome-wide association studies. Two samples were used in mendelian randomization (MR). The principal MR technique utilized was inverse-variance weighting, a technique renowned for producing reliable causal effect estimations. Additional MR methods, including weighted median (WM), MR-Egger, MR-PRESSO, and simple mode methods, were employed to ensure the robustness of the aforementioned association and investigate potential biases. Sensitivity analyses were performed to determine the consistency of the MR findings.</p><p><strong>Results: </strong>Varying associations were observed between specific microbial taxa and the different aneurysms analyzed. A negative correlation was observed between aortic aneurysm (AA) and Lentisphaerae, Lentisphaeria, and Victivallales. Conversely, the genus FamilyXIIIUCG001 exhibited an increased risk association. Regarding abdominal AA, Victivallaceae showed a reduced risk, and Bilophila and Catenibacterium were associated with an increased risk. For thoracic AA, negative and positive correlations were observed with Lentisphaerae and Turicibacter, respectively. Lastly, in the case of cerebral aneurysm (CA), Firmicutes and Haemophilus were associated with a decreased risk, and Lachnoclostridium demonstrated an increased risk of association.</p><p><strong>Conclusion: </strong>Our research has established causal relationships between specific GM components and various aneurysms. The obtained knowledge may aid in the development of microbiome-based interventions and the identification of novel biomarkers for targeted prevention strategies.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"59-69"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139478225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Discrepancies in the Population Incidence of Stroke and Hemorrhage Related to Atrial Fibrillation or Flutter.","authors":"Mihir Khunte, Huanwen Chen, Marco Colasurdo, Seemant Chaturvedi, Ajay Malhotra, Dheeraj Gandhi","doi":"10.1159/000538108","DOIUrl":"10.1159/000538108","url":null,"abstract":"<p><strong>Introduction: </strong>Atrial fibrillation or flutter (AF) is a well-known risk factor for ischemic stroke. While female sex has been associated with higher stroke risk among AF patients, overall sex-specific real-world burdens of AF-related strokes and hemorrhages are unknown.</p><p><strong>Methods: </strong>The 2016-2020 National Inpatient Sample was queried for hospitalizations, morbidity, and mortality due to AF-related ischemic strokes and bleeds. Patient demographic information, vascular risk factors, comorbidities, and stroke characteristics were extracted using ICD-10 codes. Overall incidences were calculated using total population estimates provided by the US Census Bureau, and relative risk was calculated by comparing annual incidences between men and women.</p><p><strong>Results: </strong>2,420,870 ischemic stroke hospitalizations were identified; 542,635 (22.4%) were associated with AF. Overall, women had similar risk of hospitalization due to AF-related ischemic strokes compared to men; however, women had a higher risk of morbidity and mortality (RR 1.13 and 1.17, respectively; both p < 0.001). In contrast, women had lower incidences of hospitalization, morbidity, and mortality due to AF-related bleeds (RR 0.82, 0.94, and 0.74, respectively; all p < 0.001). Among patients with AF-related ischemic strokes, women had lower rates of anticoagulation use, higher rates of large vessel occlusion, and higher stroke severity (all p < 0.001). These trends persisted among patients 80 years or older (all p < 0.001).</p><p><strong>Conclusion: </strong>Women in the USA have higher incidences of morbidity and mortality from AF-related ischemic strokes than men. Future studies should investigate strategies to reduce morbidity and mortality due to AF-related strokes in women.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"53-58"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140020995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors and Prognosis of Early Neurological Outcomes on Patients with Vertebrobasilar Artery Occlusion Undergoing Endovascular Treatment.","authors":"Xinan Ma, Yajun Li, Pan Zhang, Jilong Yi, Yingjie Xu, Miaomiao Hu, Jinjing Wang, Wenya Lan, Guoqiang Xu, Yanan Lu, Pengfei Xu, Feng Feng, Wen Sun, Hao Chen, Zongyi Wu","doi":"10.1159/000536113","DOIUrl":"10.1159/000536113","url":null,"abstract":"<p><strong>Introduction: </strong>This research explored the factors influencing early neurological outcomes (ENO) in patients who had vertebrobasilar artery occlusion (VBAO) and received endovascular treatment (EVT), as well as examining the causal influence of ENO on the prognosis of VBAO patients.</p><p><strong>Methods: </strong>A retrospective review was carried out on patients from 65 Chinese stroke centers, all within 24 h of the estimated occlusion time. ENO includes early neurological improvement (ENI) and early neurological deterioration (END), defined as a decrease or an increase of at least 4 points in NIHSS score between baseline and 24 h after EVT. Death within 24 h after EVT was also considered as END. END was further divided into explained END and unexplained END (unEND). Independent predictors of ENO and the association between ENO and outcomes in patients with VBAO were determined using center-adjusted analyses. The study developed a multivariate logistic regression model to examine the comparative risk of unEND versus explained END on the clinical outcomes in VBAO patients.</p><p><strong>Results: </strong>A total of 2,257 patients were included. Glasgow Coma Scale (GCS) (OR: 1.16, 95% CI: 1.03-1.30) and successful reperfusion (OR: 1.15, 95% CI: 1.02-1.30) were associated with ENI. Baseline NIHSS (OR: 0.60, 95% CI: 0.53-0.68), successful reperfusion (OR: 0.79, 95% CI: 0.71-0.89), and puncture to reperfusion time (OR: 1.17, 95% CI: 1.03-1.33) were associated with END. When examining 3-month prognostic indexes, both END and ENI were found to be linked to the 3-month outcomes, but in opposite directions. A subgroup analysis of END suggested that unEND typically demonstrated a more favorable prognosis compared to explained END, although the prognosis remained generally unfavorable.</p><p><strong>Conclusions: </strong>ENO, whether they manifested as early improvement or deterioration, were linked to the prognosis of VBAO patients undergoing EVT. The outcomes after unEND were more favorable than those following explained END.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"70-80"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139671381","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":"10.1159/000542749","DOIUrl":"10.1159/000542749","url":null,"abstract":"","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"145"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817244","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":"Plasma Soluble Angiotensin-Converting Enzyme 2 and Risk of Recurrent Stroke: A Nested Case-Control Analysis.","authors":"Jing Xue, Mingming Shi, Qin Xu, Anxin Wang, Xue Jiang, Jinxi Lin, Xia Meng, Hao Li, Lemin Zheng, Yongjun Wang, Jie Xu","doi":"10.1159/000538245","DOIUrl":"10.1159/000538245","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The angiotensin-converting enzyme 2 (ACE-2) and its shedding product (soluble ACE-2 [sACE-2]) are implicated in adverse cardiovascular outcomes. However, the relationship between sACE-2 and stroke recurrence is unknown. Herein, we examined the relationship of sACE-2 with stroke recurrence in patients with ischemic stroke or transient ischemic attack.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were obtained from the Third China National Stroke Registry (CNSR-III). Eligible cases consisted of 494 patients who developed recurrent stroke within 1-year follow-up, and 494 controls were selected using age- and sex-matched with a 1:1 case-control ratio. Conditional logistic regressions were used to evaluate the association between sACE-2 and recurrent stroke. The main outcomes were recurrent stroke within 1 year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 988 patients included in this study, the median (interquartile range) of sACE-2 was 25.17 (12.29-45.56) ng/mL. After adjustment for conventional confounding factors, the odds ratio (OR) with 95% confidence interval (CI) in the highest quartile versus the lowest quartile was 1.68 (1.12-2.53) for recurrent stroke within 1-year follow-up. Subgroup analysis showed that the association between elevated plasma level of sACE-2 and stroke recurrence was significant in patients with higher systemic inflammation, as indicated by high-sensitivity C-reactive protein ≥ 2 mg/L (adjusted OR: 2.33 [95% CI, 1.15-4.72]) and neutrophil counts ≥ median (adjusted OR: 2.66 [95% CI, 1.35-5.23]) but not significant in patients with lower systemic inflammation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion/conclusion: &lt;/strong&gt;Elevated plasma sACE-2 concentration was associated with increased risk of recurrent stroke.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The angiotensin-converting enzyme 2 (ACE-2) and its shedding product (soluble ACE-2 [sACE-2]) are implicated in adverse cardiovascular outcomes. However, the relationship between sACE-2 and stroke recurrence is unknown. Herein, we examined the relationship of sACE-2 with stroke recurrence in patients with ischemic stroke or transient ischemic attack.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were obtained from the Third China National Stroke Registry (CNSR-III). Eligible cases consisted of 494 patients who developed recurrent stroke within 1-year follow-up, and 494 controls were selected using age- and sex-matched with a 1:1 case-control ratio. Conditional logistic regressions were used to evaluate the association between sACE-2 and recurrent stroke. The main outcomes were recurrent stroke within 1 year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 988 patients included in this study, the median (interquartile range) of sACE-2 was 25.17 (12.29-45.56) ng/mL. After adjustment for conventional confounding factors, the odds ratio (OR) with 95% confidence interval (CI) in the highest quartile versus the lowest quartile was 1.68 (1.12-2.53) for recurrent stroke within 1-year follow-up. Subgrou","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"105-111"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11793094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140109486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Preoperative Cortical Magnetic Susceptibility and Postoperative Changes in the Cerebral Blood Flow on Cognitive Improvement following Carotid Endarterectomy.","authors":"Masahiro Yabuki, Yosuke Akamatsu, Ikuko Uwano, Futoshi Mori, Makoto Sasaki, Kunihiro Yoshioka, Kohei Chida, Masakazu Kobayashi, Shunrou Fujiwara, Kuniaki Ogasawara","doi":"10.1159/000536547","DOIUrl":"10.1159/000536547","url":null,"abstract":"<p><strong>Introduction: </strong>While patients who experience improved cognition following carotid endarterectomy (CEA) typically demonstrate restored brain perfusion after the procedure, it is worth noting that less than 50% of patients in whom postoperative cerebral blood flow (CBF) restoration is achieved actually show improved cognition after postoperatively. This suggests that factors beyond the mere restoration of CBF may play a role in postoperative cognitive improvement. Increased iron deposition in the cerebral cortex may cause neural damage, and quantitative susceptibility mapping (QSM) obtained using magnetic resonance imaging (MRI) quantifies magnetic susceptibility in the cerebral cortex, allowing for the assessment of iron deposition in vivo. The purpose of the present study was to determine whether preoperative cortical magnetic susceptibility as well as postoperative changes in CBF are associated with cognitive improvement after CEA.</p><p><strong>Methods: </strong>Brain MRI with a three-dimensional gradient echo sequence was preoperatively performed in 53 patients undergoing CEA for ipsilateral internal carotid artery stenosis (≥70%), and QSM with brain surface correction and vein removal was obtained. Cortical magnetic susceptibility was measured in the cerebral hemisphere ipsilateral to surgery on QSM. Preoperatively and at 2 months after the surgery, brain perfusion single-photon emission computed tomography and neuropsychological assessments were conducted. Using these collected data, we evaluated alterations in CBF within the affected hemisphere and assessed cognitive improvements following the operation.</p><p><strong>Results: </strong>A logistic regression analysis showed that a postoperative greater increase in CBF (95% confidence interval [CI], 1.06-1.90; p = 0.0186) and preoperative lower cortical magnetic susceptibility (95% CI, 0.03-0.74; p = 0.0201) were significantly associated with postoperatively improved cognition. Although sensitivity, specificity, and positive and negative predictive values with the cutoff value lying closest to the upper left corner of a receiver operating characteristic curve for the prediction of postoperatively improved cognition did not differ between postoperative changes in CBF and preoperative cortical magnetic susceptibility, the specificity and the positive predictive value were significantly greater for the combination of postoperative changes in CBF and preoperative cortical magnetic susceptibility (specificity, 95% CI, 93-100%; positive predictive value 95% CI, 68-100%) than for the former parameter alone (specificity, 95% CI, 63-88%; positive predictive value 95% CI, 20-64%).</p><p><strong>Conclusion: </strong>Preoperative cortical magnetic susceptibility as well as postoperative changes in CBF are associated with cognitive improvement after CEA.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"20-29"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139680664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Atrial Appendage Occlusion versus Direct Oral Anticoagulants in the Prevention of Ischaemic Stroke in Patients with Atrial Fibrillation.","authors":"Sandra Elsheikh, Muath Alobaida, Tommaso Bucci, Benjamin J R Buckley, Dhiraj Gupta, Greg Irving, Andrew M Hill, Gregory Y H Lip, Azmil H Abdul-Rahim","doi":"10.1159/000536546","DOIUrl":"10.1159/000536546","url":null,"abstract":"<p><strong>Introduction: </strong>Existing randomised controlled trials assessing the safety and efficacy of left atrial appendage occlusion (LAAO) in atrial fibrillation (AF) were of relatively small sample size or included patients who could receive oral anticoagulant treatment after device implantation. We compared the outcomes of patients with newly diagnosed AF who received percutaneous LAAO or direct oral anticoagulant (DOAC) treatment, in a large population from a global federated health network (TriNetX).</p><p><strong>Methods: </strong>Patients with AF treated with percutaneous LAAO were matched with those treated with DOAC between December 1, 2010, and October 1, 2018. Outcomes were all-cause mortality, ischaemic stroke, and intracranial haemorrhage (ICH) at 5 years.</p><p><strong>Results: </strong>We included 200 patients with AF, who received either LAAO or DOAC. The risk of all-cause mortality, ischaemic stroke, and ICH at 5 years was not significantly different between the two groups (risk ratio [RR] for all-cause mortality: 1.52, 95% confidence interval (CI): 0.97-2.38, RR for ischaemic stroke: 1.09, 95% CI: 0.51-2.36, and RR for ICH: 1.0, 95% CI: 0.44-2.30).</p><p><strong>Conclusion: </strong>Patients newly diagnosed with AF, eligible for DOAC, showed similar 5-year risk of death, ischaemic stroke, and ICH when comparing those who underwent percutaneous LAAO to those receiving DOAC. Future randomised controlled trials are needed to confirm the findings and advise changes in guidelines.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"81-88"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139680717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Middle Meningeal Artery Embolization for Patients with Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis.","authors":"Nabihah Kabir, Busmah Owais, Gabriela Trifan, Fernando Testai","doi":"10.1159/000543041","DOIUrl":"10.1159/000543041","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic subdural hematoma (CSDH) is characterized by the collection of blood beneath the dura mater. Traditional treatments involve surgical drainage of the hematoma, but recurrence rates can be high. A highly vascularized neo-membrane irrigated by the middle meningeal artery (MMA) may be involved in CSDH re-accumulation. We conducted a systematic review and meta-analysis of studies that compared the efficacy and safety of MMA embolization to conventional treatment alone for CSDH.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase Ovid, and <ext-link ext-link-type=\"uri\" xlink:href=\"http://ClinicalTrials.gov\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">ClinicalTrials.gov</ext-link> identified observational and randomized clinical studies comparing MMA embolization to conventional treatment for CSDH. The efficacy outcomes were hematoma recurrence and good functional outcome (as defined by a modified Rankin Scale Score [mRS] of 0-2). Safety outcomes were the rate of major complication and mortality. Heterogeneity among studies were evaluated using the I2 statistic. Analyses were conducted using Cochrane Review Manager Software, with risk ratios (RRs) and 95% confidence intervals (95% CI) presented for key outcomes. Absolute risk reduction (95% CI) of 1,000 patients was also calculated using GRADEpro software.</p><p><strong>Results: </strong>The analysis included data from 13 studies (4 randomized clinical trials [RCTs] and 9 observational studies) with a total number of 2,960 patients (35.3% in the MMA group and 64.7% in the conventional treatment group). Compared to conventional treatment, MMA embolization decreased risk of hematoma recurrence by 59% (13 studies, RR = 0.41, 95% CI: 0.26-0.65; I2 = 49%), for an absolute effect of 116 fewer events/1,000 patients (95% CI: 69-145), with similar risk of major complications (13 studies, RR = 0.88, 95% CI: 0.67-1.15; I2 = 43%) and mortality risk (13 studies, RR = 1.05, 95% CI: 0.67-1.65). In subgroup analyses by study type, pooled results from RCTs showed similar direction effects as those from observational studies for both efficacy and safety outcomes.</p><p><strong>Conclusion: </strong>MMA embolization in CSDH management is a safe and effective approach for CSDH.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}