Cerebrovascular Diseases最新文献

{"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}

{"title":"Effect of Statin Therapy following Endovascular Treatment of Intracranial Aneurysms: A Meta-Analysis.","authors":"Mingguo Li, Yuan Yao, Jian Liu, Yuanguang Pang, Qian Wu, Cong Liu","doi":"10.1159/000547504","DOIUrl":"10.1159/000547504","url":null,"abstract":"<p><strong>Introduction: </strong>Endovascular treatment has become one of the standard therapies for intracranial aneurysms (IAs), yet the prognosis remains a persistent clinical challenge. This study aimed to systematically evaluate the efficacy and safety of adjuvant statin therapy following endovascular treatment (EVT) of IAs.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. Cohort studies comparing outcomes between patients with IAs who received statin therapy following EVT and those who did not were included. Efficacy outcomes included retreatment, recurrence, and complete occlusion, whereas safety outcomes included ischemic stroke, intracerebral hemorrhage (ICH), thrombosis, and all-cause mortality. A random-effects model was applied, and subgroup and sensitivity analyses were performed on the basis of treatment modality and adjustment for confounding factors.</p><p><strong>Results: </strong>Six retrospective studies comprising 3,692 patients were analyzed. Sensitivity analysis revealed that statin therapy significantly reduced the risk of retreatment (adjusted odds ratio [aOR] 0.35, 95% CI: 0.15-0.81) and recurrence (aOR 0.29, 95% CI: 0.12-0.65), whereas no significant difference was found in complete occlusion rates (aOR 0.94, 95% CI: 0.52-1.71). Although the unadjusted risk of ischemic stroke was greater in the statin group, this association was not significant after adjustment (aOR 1.04, 95% CI: 0.30-3.60). No significant differences were observed in other safety outcomes, including ICH, thrombosis, or all-cause mortality.</p><p><strong>Conclusion: </strong>Statins may help reduce the risk of recurrence and retreatment of IAs following EVT, suggesting their potential adjunctive role in the management of IAs and providing a rationale for conducting prospective investigations.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-12"},"PeriodicalIF":1.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706334","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":"Long-Term Observational Extension Study of an International Stroke Prevention Clinical Trial: Methods and Opportunities.","authors":"Eldina Stojadinovic, Jenifer Voeks, Kevin M Barrett, Thomas G Brott, George Howard, Virginia J Howard, Robert D Brown, Laura Llull, Brajesh K Lal, Lloyd J Edwards, James F Meschia","doi":"10.1159/000547464","DOIUrl":"10.1159/000547464","url":null,"abstract":"<p><strong>Introduction: </strong>The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis (CREST-2) randomized clinical trial compares the efficacy of revascularization plus intensive medical management (IMM) versus IMM alone for stroke prevention in patients with high-grade asymptomatic carotid stenosis. Innovative strategies are needed to extend clinical follow-up and assess long-term durability of both revascularization and intensive medical therapy. This manuscript describes the methods and early experiences of the Long-Term Observational Extension of Participants in the CREST-2 Randomized Clinical Trial (C2LOE).</p><p><strong>Methods: </strong>C2LOE will extend follow-up in CREST-2 participants for up to 10 years. Patients undergo a scripted, computer-assisted telephone interview every 6 months focused on screening for potential stroke events and any hospitalizations and performing a brief cognitive assessment. If a stroke or transient ischemic attack (TIA) is suspected, or a hospitalization is reported, medical records are retrieved, and vascular neurology video visit assessments are conducted to be used for central adjudication of potential endpoints.</p><p><strong>Conclusion: </strong>We describe an ongoing posttrial follow-up study of stroke prevention following IMM with or without carotid revascularization. The study relies on screening for stroke endpoints through periodic telephonic interviews and validation of endpoints through medical record review and vascular neurology video visits. We demonstrate that this technique can be applied effectively to patients enrolled across more than 50 centers. Further research is needed to determine the optimal approach for long-term follow-up studies in stroke-relevant populations.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-7"},"PeriodicalIF":1.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674000","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":"Rising Trends in Cerebrovascular Disease and Substance Use-Related Mortality in the USA from 1999 to 2020: A Retrospective Analysis Using CDC WONDER.","authors":"Anosh John, Faraz Azhar, Zishan Rahman, Dmitry Abramov","doi":"10.1159/000547512","DOIUrl":"10.1159/000547512","url":null,"abstract":"<p><strong>Introduction: </strong>Substance use (SU) has been linked to cerebrovascular disease due to numerous pathophysiologic alterations. This study discusses the age, race, and demographics-related trends in mortality among US adults (≥25 years) with concomitant SU and cerebrovascular disease.</p><p><strong>Methods: </strong>The CDC WONDER database was used to access the mortality data. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Trends for age, sex, race, state, place of death, census region, and metropolitan status, along with annual percent change (APC) in AAMR, were calculated using the Joinpoint regression analysis.</p><p><strong>Results: </strong>From 1999 to 2020, 57,838 deaths occurred, with an overall AAMR of 1.23. The highest AAMRs were observed in adults aged 45-64 (1.8), men (1.85), the non-Hispanic American Indian/Alaska Native population (3.23), the District of Columbia (2.78), and nonmetropolitan areas (1.35).</p><p><strong>Conclusion: </strong>The rising mortality related to SU and cerebrovascular disease with notable sociodemographic and temporal disparities calls for further research and early interventions.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-5"},"PeriodicalIF":1.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674001","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 Anatomy of Infarcts Causing Hemianopia and Quadrantanopia in Posterior Cerebral Artery Stroke.","authors":"Tharani Thirugnanachandran, Jason Vuong, Yongyao Kong, Jian Chen, Christine Chen, Benjamin Clissold, John Ly, Shaloo Singhal, Richard Beare, Velandai Srikanth, Marcello G P Rosa, Henry Ma, Thanh G Phan","doi":"10.1159/000547444","DOIUrl":"10.1159/000547444","url":null,"abstract":"<p><strong>Introduction: </strong>Following posterior cerebral artery stroke, infarcts causing quadrantanopia are thought to be smaller than those causing homonymous hemianopia. We investigated whether these two presentations were different due to the varying involvement of the striate, extrastriate cortex, or geniculocalcarine tract.</p><p><strong>Methods: </strong>Patients with unilateral posterior cerebral artery infarcts on magnetic resonance imaging and visual field defects, as identified by automated visual field perimetry, were included. Infarcts were manually segmented and registered to a standard brain template to facilitate comparison. Infarct volume and infarct involvement with geniculocalcarine fiber tracts were calculated in patients with hemianopia and quadrantanopia.</p><p><strong>Results: </strong>There were twenty-two patients: 15 patients with homonymous hemianopia (median age 68 [interquartile range, 55-76 years old]) and 7 with superior quadrantanopia (median age 40 [interquartile range, 30-56 years old]). Infarct volume significantly differed between the two groups: hemianopia 34.6 mL (interquartile range, 21.6-56.3 mL) versus superior quadrantanopia 15.5 mL (interquartile range, 7.2-24.1 mL), p = 0.026. There was significantly greater involvement of infarct with the geniculocalcarine tracts in the hemianopia group, 5.7 mL (interquartile range, 2.3-8.2 mL) than the superior quadrantanopia group, 2.0 mL (interquartile range, 1.2-2.7 mL), p = 0.042. Infarct involvement with cuneus and the calcarine cortex also significantly differed between the two groups (p ≤ 0.01).</p><p><strong>Conclusion: </strong>In posterior cerebral artery infarction, sparing of the superior calcarine cortex, cuneus, and superior paraventricular geniculocalcarine tract differentiated superior quadrantanopia from homonymous hemianopia.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-7"},"PeriodicalIF":1.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673934","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":"Half-Dose Anticoagulation versus Antiplatelet Therapy to Reduce Silent Cerebral Embolism after Left Atrial Appendage Occlusion (HALO-SCE Study): Rationale and Design of a Randomized Clinical Trial.","authors":"Kexin Wang, Linsheng Shi, Zhongbao Ruan, Caiyi Jin, Mingfang Li, Hailei Liu, Hongwu Chen, Weizhu Ju, Minglong Chen","doi":"10.1159/000547304","DOIUrl":"10.1159/000547304","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with atrial fibrillation (AF) continue to face thrombotic risks even after the left atrial appendages have been occluded, which may manifest as silent cerebral embolisms (SCEs). Half-dose anticoagulation (Hd-OAC) is a pathophysiologically more reasonable therapy in addressing this issue than antithrombotic therapy, but it still lacks strong evidence.</p><p><strong>Methods: </strong>The trial (NCT05671276) is a multicenter, randomized controlled trial comparing the efficacy of two antithrombotic strategies (Hd-OAC therapy vs. standard antithrombotic therapy) in AF patients after left atrial appendage occlusion (LAAO). The primary endpoint is the incidence of newly detected SCEs on any magnetic resonance imaging conducted during the follow-up period. The secondary endpoints are: (1) more than two new SCEs during the follow-up, their size, and distribution; (2) cognitive function, and (3) a composite endpoint of all-cause mortality, clinical thromboembolic events, and major bleeding events. Follow-up is scheduled at 90 ± 15 days, 180 ± 15 days, and 365 ± 15 days after LAAO.</p><p><strong>Conclusions: </strong>This trial aimed to determine whether Hd-OAC therapy can reduce the incidence of SCE and protect cognitive function in patients who have successfully undergone LAAO, compared to standard antithrombotic therapy.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-6"},"PeriodicalIF":1.5,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641904","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":"A Systematic Review and Meta-Analysis Comparing Mortality between Inhospital versus Community-Onset Acute Ischemic Stroke.","authors":"Katrina Hannah Ignacio, Jotinder K Waraich, Faizan Khan, Umberto Pensato, Jessalyn K Holodinsky, Bijoy Menon, Michael D Hill, Mohammed A Almekhlafi, Alexander A Leung","doi":"10.1159/000546822","DOIUrl":"10.1159/000546822","url":null,"abstract":"<p><strong>Introduction: </strong>Patients who experience inhospital strokes may suffer from delays in stroke recognition, delays to acute treatment and management. We aimed to assess evidence for the difference in mortality between patients with inhospital stroke and those with community-onset stroke.</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, and SCOPUS (from inception to October 8, 2024) to identify studies comparing mortality outcomes for inhospital and community-onset stroke patients. We collected data on study characteristics, summarized the quality of evidence, evaluated risk of bias of studies using the Newcastle-Ottawa Scale, and investigated clinical sources of heterogeneity. We performed a random-effects meta-analysis to estimate the pooled odds of mortality of inhospital stroke versus community-onset stroke patients.</p><p><strong>Results: </strong>Forty-one studies, collectively with 3,038,211 patients, of whom 3% experienced inhospital stroke, were included in the review. Inhospital stroke patients had an approximately 2.3-fold higher odds of inhospital mortality (pooled OR 2.27; 95% CI 1.80-2.86; 32 patient cohorts) and 1.9-fold higher odds of 3-month mortality (pooled OR 1.87; 95% CI 1.43-2.45; 14 patient cohorts) compared to community-onset stroke patients. Meta-analyses stratified by acute treatment received and study characteristics revealed consistently higher odds of death among inhospital stroke patients compared to community-onset stroke patients. Acute treatment received, study setting, geographic region, and components of study quality were significant sources of heterogeneity. Most concerns in study quality were due to potential risks of confounding.</p><p><strong>Conclusion: </strong>There was a consistently higher odds of inhospital and 3-month mortality among inhospital acute ischemic stroke patients compared to their community-onset counterparts, highlighting the need for targeted interventions to reduce this disparity.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-18"},"PeriodicalIF":1.5,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625448","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":"Head Positioning for Stroke Blood Flow Augmentation Assisting Reperfusion Therapies Study.","authors":"Rudy Goh, Edmund Cheong, Lizzie Dodd, Carole Hampton, Lavenia Cagi, Nicholas Hamilton Chia, Jackson Harvey, Rebecca Scroop, Carlos Garcia-Esperon, Chushuang Chen, Andrew Bivard, Bruce Campbell, Timothy John Kleinig","doi":"10.1159/000547306","DOIUrl":"10.1159/000547306","url":null,"abstract":"<p><strong>Introduction: </strong>It is uncertain whether lowered head position meaningfully improves cerebral perfusion in ischaemic stroke. We performed a prospective, single-arm, single-centre, self-controlled, non-randomised, pre-post-intervention study, testing whether 20-degree head-down (Trendelenburg) positioning in patients with acute stroke improves perfusion of ischaemic brain tissue, as measured by automated quantitative computed tomography perfusion (CTP).</p><p><strong>Methods: </strong>We enrolled patients aged ≥60, 0-24 h after acute stroke onset, with ≥30 mL anterior circulation CTP lesion volume (delay time [DT] >3 s, MIStar software). CTP was acutely repeated after 5 min of on-table 20-degree Trendelenburg positioning (achieved by a custom-designed foam wedge). Clinical severity (National Institutes of Health Stroke Scale [NIHSS]) and blood pressure were recorded in routine (30° up) and Trendelenburg position. Trendelenburg positioning was maintained for 24 h if lesion volume significantly decreased (≥5 mL) and stroke reperfusion was suboptimal or undetermined.</p><p><strong>Results: </strong>We enrolled 25 patients {14 (56%) male, age 76 (interquartile range [IQR] 70-85), baseline modified Rankin scale score 0 [IQR 0-0], median pre-CT NIHSS 20 [IQR 13-25]}. All patients had anterior circulation large vessel occlusion (LVO), 15/25 (60%) M1 middle cerebral artery (MCA) occlusion, 6 (24%) proximal M2 MCA, and 4 (16%) ICA. Stroke aetiology was predominantly cardioembolic (15/25 [60%]). Median DT >3 lesion volume was reduced by 18 mL [2-48] following Trendelenburg compared with conventional horizontal CT positioning (114 mL [94-204] vs. 149 mL [76-153]; p = 0.0027). Systolic blood pressure was unaltered (mean 148 mm Hg [±standard deviation 29] vs. 143 [±27]; p = 0.129). Head position did not alter clinical severity (post-CT NIHSS 13 [IQR 9-28] in both positions). A significant lesion volume reduction with Trendelenburg positioning was seen in 15/25 patients (60%); 7 received continued Trendelenburg positioning (6 due to incomplete reperfusion following thrombectomy). Head-down positioning caused no serious adverse events and was mostly well tolerated (6/7 [86%]).</p><p><strong>Conclusion: </strong>Head-down (Trendelenburg) positioning appears to modestly improve penumbral perfusion in acute LVO ischaemic stroke and is generally well tolerated. Clinical benefits of this approach may be best tested in patients for whom reperfusion is delayed or not achieved.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-7"},"PeriodicalIF":1.5,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625451","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":"Ayurvedic Treatment in the Rehabilitation of Ischemic Stroke Patients in India: A Randomized Controlled Trial (RESTORE) - Findings from the Process Evaluation.","authors":"Pheba Susan Raju, Shweta Jain Verma, Aneesh Dhasan, Deepti Arora, Jeyaraj Durai Pandian, Vivek Nambiar, Sunil Narayan, Veena Babu, Meenakshi Sharma, Padmavathy Narayanan Sylaja","doi":"10.1159/000547133","DOIUrl":"10.1159/000547133","url":null,"abstract":"<p><strong>Introduction: </strong>The RESTORE trial was the first randomized controlled trial comparing two systems of medicine in stroke. The trial studied about the safety and efficacy of ayurvedic rehabilitative treatment in comparison with conventional physiotherapy in stroke rehabilitation across North and South India. The results showed that ayurvedic rehabilitative treatment was not superior to conventional physiotherapy for improving sensorimotor recovery in ischemic stroke patients, but it was safe to use. The process evaluation assessed the implementation of the trial and its specific rehabilitation effects.</p><p><strong>Methods: </strong>A mixed methods approach, incorporating qualitative in-depth interviews and quantitative data derived from case report forms and activity logs, was employed. Thirty-eight interviews of patient-caregiver dyads and health professionals were conducted. Thematic analysis of qualitative data was done with RE-AIM and realist models. The RE-AIM model aimed to evaluate the reach, effectiveness, adoption, implementation, and maintenance of the RESTORE trial. The context-mechanism-outcome configuration was used as the main structure for realist analysis.</p><p><strong>Results: </strong>Participants in the intervention (ayurvedic rehabilitative treatment) and control (physiotherapy) groups experienced advantages from the therapy, like improved mobility. In addition, the intervention group reported enhanced emotional stability and pain relief compared to the control group. Participants, particularly from South India, found ayurveda therapies more acceptable. In this study, three key reasons were identified for ayurvedic rehabilitative therapy not outperforming conventional physiotherapy. First, a standard ayurveda treatment protocol may not suit every patient as ayurveda emphasizes individualized care. Second, certain treatments like nasya were excluded due to safety concerns for stroke patients, likely affecting outcomes. Lastly, a 1-month duration of ayurveda treatment may be too short to enhance stroke recovery.</p><p><strong>Conclusion: </strong>This process evaluation suggests the need for further studies with a revised protocol that may lead to an important step in integrating ayurveda and physiotherapy in stroke rehabilitation in India.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":1.5,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625449","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":"Cortical Vein Opacification Score Predicts Stroke Outcomes after Thrombectomy: A Frequentist and Bayesian Meta-Analysis.","authors":"Wei-Zhen Lu, Sen-Kuang Hou, Hui-An Lin, Peter C Hou, Chyi-Huey Bai, Sheng-Feng Lin","doi":"10.1159/000547357","DOIUrl":"10.1159/000547357","url":null,"abstract":"<p><strong>Introduction: </strong>Good cortical venous outflow has been considered in association with favorable functional outcomes (FFOs) for large vessel occlusion-related stroke patients treated after an intra-arterial endovascular thrombectomy (IA-EVT).</p><p><strong>Methods: </strong>A diagnostic meta-analysis was performed using the index test of cortical vein opacification score (COVES) on computed tomographic angiography for prediction of 3-month FFOs (reference standard). Literature search for relevant articles was conducted in PubMed, Embase, and Scopus databases from January 1, 2014, to July 8, 2024. The Bayesian analyses were conducted to estimate posttest probabilities (PTPs).</p><p><strong>Results: </strong>Ten studies and 2,238 patients were enrolled. While excluding studies conducted in duplicated cohorts, four studies defined a favorable COVES as ≥1 and another four studies defined a favorable COVES as ≥3. In studies using a favorable COVES of ≥1, the COVES showed a sensitivity of 0.86 (95% confidence interval [CI], 0.48-0.97), a specificity of 0.47 (95% CI, 0.31-0.64) for predicting 3-month FFOs. With a pretest probability of an FFO of 0.19, the COVES increased the PTP to 0.28. In studies using a favorable COVES of ≥3, the COVES showed a sensitivity of 0.76 (95% CI, 0.58-0.88), a specificity of 0.71 (95% CI, 0.65-0.76) for predicting 3-month FFOs. On a pretest probability of an FFO by 0.19, the COVES increased the PTP to 0.37.</p><p><strong>Conclusion: </strong>This meta-analysis showed the high sensitivity and moderate specificity of a COVES of ≥3 to select patients who can benefit from an IA-EVT.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-13"},"PeriodicalIF":1.5,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625450","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}