Cerebrovascular Diseases最新文献

{"title":"Rural-Urban Disparities in Acute Stroke Treatments and Outcomes: A Propensity Score-Matched Analysis of a Nationwide Sample.","authors":"Andrea Loggini, Jonatan Hornik, Amber Schwertman, Alejandro Hornik","doi":"10.1159/000546950","DOIUrl":"10.1159/000546950","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of the study was to investigate the rural-urban differences in acute stroke care in a large cohort of patients hospitalized for acute ischemic stroke (AIS), using a nationwide inpatient sample.</p><p><strong>Methods: </strong>In this retrospective cohort study, the National Inpatient Sample database was investigated for patients admitted with AIS from 2016 to 2022. Sociodemographics and comorbidities were reviewed. Interventions (rtPA and thrombectomy) were investigated. Outcome measures were prolonged length of stay (PLOS) and mortality. PLOS was defined as length of stay exceeding the 75th percentile of the entire cohort. The cohort was divided in rural and urban location. Propensity score matching (PSM) was applied to balance demographics and comorbidities between the two groups, and outcomes were analyzed between the two matched groups. Multivariable logistic models were used to determine the association between each intervention and rural location. Risk ratio was calculated for PLOS and mortality. Subgroup analyses were performed by age, race, and income. p value was set at 0.05 for all analyses.</p><p><strong>Results: </strong>Of 897,206 AIS patients, 64,640 (7.2%) were cared for in rural location. Rural group was older (74 [64-83] vs. 71 [60-81], p < 0.01 years). Rural group had higher rate of females (51.8% vs. 49%), white racial group (79.8% vs. 64.5%), lower median household income (54.3% vs. 29.1%), and lower private insurance (14.3% vs. 19.2%), p < 0.01 for all. After PSM 1:1, rural group independently retained lower odds of rtPA (OR: 0.532, 95% CI: 0.505-0.561), lower odds of thrombectomy (OR: 0.074, 95% CI: 0.061-0.089), lower risk of PLOS (RR: 0.887, 95% CI: 0.882-0.892), and higher risk of mortality (RR: 1.149, 95% CI: 1.122-1.177), p < 0.01 for all. Older patients in rural setting had lowest odds of interventions, whereas younger, Black, and Hispanic rural patients had highest risk of mortality after AIS.</p><p><strong>Conclusions: </strong>Sociodemographic differences are present between rural and urban acute stroke care. Profound inequalities exist in the use of reperfusion therapy and outcomes. Great effort is needed by the stroke community to fill this gap and provide equality in acute stroke care.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494892","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":"Effects of Body Mass Index on Functional Outcomes in Patients with Acute Cerebral Large Vessel Occlusion.","authors":"Yu Kinoshita, Fumihiro Sakakibara, Shinichi Yoshimura, Kazutaka Uchida, Nobuyuki Sakai, Hiroshi Yamagami, Takeshi Morimoto","doi":"10.1159/000546728","DOIUrl":"10.1159/000546728","url":null,"abstract":"<p><strong>Introduction: </strong>The effect of body mass index (BMI) on the outcome of acute cerebral large vessel occlusion (LVO) was uncertain in the era of endovascular therapy (EVT). We investigated the association between BMI and functional outcomes in patients with acute cerebral LVO.</p><p><strong>Methods: </strong>We performed a post hoc analysis of the RESCUE-Japan Registry 2 including 2,408 LVO patients among 46 stroke centers in Japan. The patients were categorized into 3 groups depending on their BMI (kg/m2): Low-BMI group: BMI <18.5, Normal-BMI group: 18.5≤ BMI <25, and High-BMI group: BMI ≥25. We estimated the effect of the Low-BMI and High-BMI groups relative to the Normal-BMI group. The primary outcome was a modified Rankin Scale (mRS) score of 5 or 6 at 90 days from the onset. The secondary outcomes consisted of an mRS score of 0-2 at 90 days, symptomatic intracranial hemorrhage (ICH), and any ICH within 72 h from the onset.</p><p><strong>Results: </strong>Among a total of 2,234 analyzed patients, Low-BMI, Normal-BMI, and High-BMI groups accounted for 14.5%, 63.7%, and 21.9%, respectively. The patients in the Low-BMI group were older, more female, poorer premorbid status, severe symptom presentation, and more dominant of occlusion of the internal carotid artery or M1 segment of the middle cerebral artery. The Low-BMI group used less recombinant tissue plasminogen activator and EVT. The primary outcome occurred 46.4%, 31.2%, and 23.7% in the Low-BMI, Normal-BMI, and High-BMI groups, respectively. The adjusted odds ratios (ORs) (95% confidence intervals [CIs]) of the primary outcome of the Low-BMI and High-BMI groups relative to the Normal-BMI group were 1.59 (1.18-2.13) and 0.80 (0.60-1.07), respectively. The mRS score of 0-2 in the Low-BMI, Normal-BMI, and High-BMI groups consisted of 26.3%, 38.8%, and 41.9%, respectively. The adjusted OR (95% CIs) of an mRS score of 0-2 for the Low-BMI and High-BMI groups relative to the Normal-BMI group were 0.72 (0.53-0.99) and 0.83 (0.64-1.06), respectively. The adjusted OR (95% CIs) of symptomatic ICH of the Low-BMI and High-BMI groups relative to the Normal-BMI group were 1.57 (0.84-2.95) and 1.31 (0.75-2.29), respectively.</p><p><strong>Conclusion: </strong>The low BMI was associated with a severity and poorer functional outcomes in patients with acute cerebral LVO.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":1.5,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367966","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":"Diagnostic Values of the \"To and Fro\" Conflict Sign on Intraoperative Indocyanine Green Video Angiography as a Warning Sign of the Focal Cerebral Hyperperfusion and Watershed Shift Phenomenon after Superficial Temporal Artery-Middle Cerebral Artery Bypass for Adult Patients with Moyamoya Disease.","authors":"Ryosuke Tashiro, Miki Fujimura, Taketo Nishizawa, Keita Tominaga, Atushi Kanoke, Hidenori Endo","doi":"10.1159/000546826","DOIUrl":"10.1159/000546826","url":null,"abstract":"<p><strong>Introduction: </strong>The focal cerebral hyperperfusion (CHP) is a potential complication after superficial temporal artery-middle cerebral artery (STA-MCA) bypass for moyamoya disease (MMD) that can result in delayed intracerebral hemorrhage and/or neurological deterioration. The focal CHP could accompany hemodynamic ischemia due to the \"watershed shift (WS) phenomenon.\" Preoperative prediction of the focal CHP and WS phenomenon remains challenging. Here, we aimed to assess the diagnostic value of the \"to and fro\" conflict sign, conflicting blood flow around the vascular territory of the recipient arteries on an indocyanine green video angiography (ICG-VA) for predicting the focal CHP and WS phenomenon.</p><p><strong>Methods: </strong>Ninety-seven consecutive adult patients with MMD, undergoing 106 surgeries, were enrolled. Serial quantitative analysis of cerebral blood flow was routinely conducted using <sc>n</sc>-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography preoperatively and postoperative day 1 and 7 after STA-MCA bypass. The association between the \"to and fro\" conflict sign on ICG-VA and the focal CHP/WS phenomenon incidence was then analyzed.</p><p><strong>Results: </strong>The incidence of the focal CHP and WS phenomenon was 29.2% (31/106) and 10.4% (11/106), respectively. The \"to and fro\" conflict sign was evident in 35.5% (11/31) and 54.5% (6/11) of MMD patients with the focal CHP and WS phenomenon, respectively. The \"to and fro\" conflict sign was significantly associated with both the focal CHP and WS phenomena.</p><p><strong>Conclusion: </strong>The \"to and fro\" conflict sign on ICG-VA may serve as an intraoperative warning sign of the focal CHP and WS phenomenon after STA-MCA bypass in adult patients with MMD, providing neurosurgeons with a valuable tool for early detection.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282549","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":"Impact of Pre-miR-218 rs11134527 Polymorphism on Ischemic Stroke in a Chinese Han Population: A Case-Control Study.","authors":"Kaiyan Jin, Zhiquan Yan, Yuyang Li, Qiujun Lu, Jian Hai","doi":"10.1159/000546143","DOIUrl":"10.1159/000546143","url":null,"abstract":"<p><strong>Introduction: </strong>Ischemic stroke (IS) exhibits a high mortality rate, and its pathogenesis is intricately linked to genetic factors. This study was to examine the association between the precursor microRNA-218 (pre-miR-218) rs11134527 polymorphism and genetic susceptibility to IS in the Han Chinese population.</p><p><strong>Methods: </strong>The study included 320 IS patients and 290 healthy controls. Polymerase chain reaction (PCR) was utilized to identify the pre-miR-218 rs11134527 polymorphism. Quantitative real-time PCR was performed to measure the expression levels of miR-218-5p. Logistic regression analysis was conducted to identify independent risk factors for IS. Furthermore, a receiver operating characteristic (ROC) curve was constructed to evaluate the clinical diagnostic value of serum miR-218-5p levels in IS.</p><p><strong>Results: </strong>This study revealed that compared to the control group, the GG genotype (p < 0.001, OR = 2.277, 95% CI = 1.443-3.593) and AG genotype (p = 0.033, OR = 1.496, 95% CI = 1.032-2.168) at rs11134527 were significantly associated with an increased risk of IS. Individuals carrying the G allele (p < 0.001, OR = 1.526, 95% CI = 1.246-1.914) had an increased risk of developing IS. Furthermore, hypertension, hyperlipidemia, and the rs11134527 polymorphism were identified as independent risk factors for IS. The rs11134527 variation may influence lipid metabolism-related indices, potentially contributing to IS. Additionally, the GG genotype of rs11134527 correlated with a higher National Institutes of Health Stroke Scale (NIHSS) score, suggesting its potential for evaluating IS severity. Moreover, serum miR-218-5p levels were significantly elevated in IS patients. ROC curve analysis suggested that serum miR-218-5p could serve as a potential biomarker for diagnosing IS.</p><p><strong>Conclusion: </strong>The rs11134527 polymorphism in pre-miR-218 was strongly associated with genetic susceptibility to IS.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282550","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":"Asymptomatic Intracranial Vascular Lesions and Cognitive Function in a General Population of Japanese Men: Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA).","authors":"Takahiro Ito, Akira Fujiyoshi, Takayoshi Ohkubo, Akihiko Shiino, Satoshi Shitara, Naoko Miyagawa, Sayuki Torii, Takashi Hisamatsu, Hiroyoshi Segawa, Keiko Kondo, Aya Kadota, Ikuo Tooyama, Yoshiyuki Watanabe, Kazumichi Yoshida, Kazuhiko Nozaki, Katsuyuki Miura","doi":"10.1159/000546882","DOIUrl":"10.1159/000546882","url":null,"abstract":"<p><strong>Introduction: </strong>Intracranial subclinical vessel diseases are considered important indicators of cognitive impairment. However, a comprehensive assessment of various types of vessel disease, particularly in Asian populations, is lacking. We aimed to compare multiple types of intracranial vessel disease in association with cognitive function among a community-based Japanese male population.</p><p><strong>Methods: </strong>The Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA) randomly recruited and examined a community-based cohort of Japanese men from Shiga, Japan. We analyzed those who underwent the Cognitive Abilities Screening Instrument (CASI) assessment and cranial magnetic resonance imaging/angiogram (MRI/MRA) in 2010-2015. Using MRI/MRA, we assessed lacunar infarction, microbleeds, periventricular hyperintensity (PVH), deep subcortical white matter hyperintensity (DSWMH), and intracranial artery stenosis (ICAS). We divided these subclinical cerebrovascular diseases (SCDs) into three categories according to severity. Using linear regression, we calculated the CASI score according to the grade of each vessel disease, adjusted for age and years of education.</p><p><strong>Results: </strong>In the adjusted models, CASI scores were significantly associated with both PVH and DSWMH. Specifically, multivariable-adjusted CASI scores declined across increasing severity categories of DSWMH (91.7, 91.2, and 90.4; p for trend = 0.011) and PVH (91.5, 90.4, and 89.7; p for trend = 0.006). Other SCDs did not show significant associations. In stratified analyses based on the presence or absence of each SCD, both DSWMH and PVH demonstrated significant inverse trends with CASI scores in the absence of lacunar infarcts and microbleeds and in the presence of ICAS. Additionally, among participants with PVH (+), ≥moderate ICAS was significantly associated with lower CASI scores.</p><p><strong>Conclusion: </strong>PVH and DSWMH showed significant dose-response relationships with cognitive function among community-based Japanese men. These findings suggest that white matter lesions may be an important indicator of early cognitive impairment, and severe ICAS may also play a role in those with PVH.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282548","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":"Carotid Atherosclerosis Shows Distinct Patterns of Atheroinflammation and Microcalcification Relating to Frailty and Multimorbidity.","authors":"Nicholas R Evans, Shiv Bhakta, Claudia Zeicu, Jason M Tarkin, Mohammed M Chowdhury, James H F Rudd, Elizabeth A Warburton","doi":"10.1159/000546563","DOIUrl":"10.1159/000546563","url":null,"abstract":"<p><strong>Introduction: </strong>Atherosclerosis involves several important pathophysiological processes, in particular inflammation within the atherosclerotic plaque (atheroinflammation) and microcalcification. Not only do these processes have implications for plaque rupture and consequent thromboembolic events, but the burden of systemic atheroinflammation has also been implicated in downstream organ dysfunction. This study aimed to establish the relationships between different patterns of vascular pathophysiology, frailty, and multimorbidity.</p><p><strong>Methods: </strong>Individuals with ischaemic stroke due to symptomatic carotid atherosclerosis underwent vascular imaging using positron emission tomography with both 18F-fluorodeoxyglucose (FDG, measuring atheroinflammation) and 18F-sodium fluoride (NaF, measuring microcalcification). Pre-morbid frailty was measured using the Clinical Frailty Scale (CFS), and pre-stroke multimorbidity was assessed using the Charlson Co-morbidity Index (CCI).</p><p><strong>Results: </strong>Fifty-two carotids (26 symptomatic culprit atheroma, 26 asymptomatic non-culprit atheroma) were included. On univariable analysis, FDG uptake was associated with CFS (rs = 0.68, p < 0.001 for the non-culprit artery), which remained significant after adjustment for covariables (beta = 1.89, p < 0.001). In contrast, NaF uptake was associated with CCI (rs = 0.54, p < 0.01 for most-diseased segment uptake in the culprit artery), which remained significant on multivariable analysis (beta = 0.81, p < 0.01). There was no association between FDG uptake and CCI, nor between NaF uptake and CFS.</p><p><strong>Conclusion: </strong>We demonstrate that frailty and multimorbidity show different patterns of vascular pathophysiology. In particular, the association between diffuse atheroinflammation and frailty elucidates the inflammatory basis of frailty that may underlie its disease- and treatment-modifying effects in stroke.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233303","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":"Underreporting of Sex-Specific Findings in Risk Factors for Unruptured Intracranial Aneurysms.","authors":"Maaike J A van Eldik, Mariam Ali, Stijn Rietkerken, Sanne A E Peters, Hester M den Ruijter, Ynte M Ruigrok","doi":"10.1159/000546774","DOIUrl":"10.1159/000546774","url":null,"abstract":"<p><strong>Introduction: </strong>Women are overrepresented in the unruptured intracranial aneurysm (UIA) population, with an overall two-thirds of patients being female. The reasons behind this female preponderance are still unclear. Therefore, we performed a systematic review of clinical risk factors for UIA, with a specific aim of assessing whether these risk factor associations are sex-dependent.</p><p><strong>Methods: </strong>We systematically searched 5 electronic medical databases for all relevant literature up to March 2024. Cohort and case-control studies reporting on the lifestyle factors smoking, alcohol use, hypertension, hypercholesterolemia, physical activity, diabetes, and BMI were included.</p><p><strong>Results: </strong>We found a total of 21 studies, reporting on 347,907 participants and 8,698 UIA cases, that met our inclusion criteria. However, only one study provided its results stratified by sex, making it impossible to perform sex-stratified analyses.</p><p><strong>Conclusion: </strong>Our findings illustrate the scarcity of sex-stratified results in studies on risk factors for UIAs. Since knowledge on potential sex differences in UIA could help understand the female predominance, we highlight a need for more sex-stratified research in this field.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-5"},"PeriodicalIF":2.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233304","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":"Osteoporosis after Stroke: Retracted - Are All Retractions the Same? A Short Discussion on Integrity of Papers and Researchers.","authors":"Stefano Carda, Marco Invernizzi","doi":"10.1159/000546595","DOIUrl":"10.1159/000546595","url":null,"abstract":"","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-2"},"PeriodicalIF":2.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172797","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":"Assessing the Quality of Stroke Services in Brazil Using the World Stroke Organization Roadmap.","authors":"Aline Palmeira Pires, Kelin Cristine Martin, Thaís L Secchi, Gisele Sampaio Silva, Letícia Costa Rebello, Daniel da Cruz Bezerra, Gabriel R de Freitas, Jamary Oliveira-Filho, Maramelia Miranda-Alves, Gustavo Wruck Kuster, Rodrigo Bazan, Marcos Christiano Lange, João José Freitas de Carvalho, Francisco Jose Arruda Mont'Alverne, José Antonio Fiorot, Viviane F Zetola, Pedro S C Magalhães, Carlos Roberto M Rieder, Luiz Antonio Nasi, Raul Gomes Nogueira, Carla Cabral Moro, Leandro de Assis Barbosa, Wyllians Vendramini Borelli, Octávio Marques Pontes-Neto, Sheila Cristina Ouriques Martins","doi":"10.1159/000546276","DOIUrl":"10.1159/000546276","url":null,"abstract":"<p><strong>Introduction: </strong>Organizing acute stroke care effectively reduces disability and mortality. Since the Ministry of Health in Brazil established the National Stroke Policy in 2012, stroke care has improved significantly. However, despite the increase in stroke centers, some hospitals have not fully implemented the recommended structure and protocols. This study aims to evaluate the quality of stroke services in Brazil based on the World Stroke Organization (WSO) Roadmap, marking the first step toward the Certification of Stroke Centers in Latin America.</p><p><strong>Method: </strong>From 2020 to 2022, we assessed the structure of stroke centers in Brazil via an online survey based on the WSO Roadmap. When multiple responses came from the same hospital, we checked for consistency and contacted the stroke center coordinator if needed. We then compared these findings to the structure of stroke centers available in 2008, before the national stroke plan began.</p><p><strong>Results: </strong>The number of stroke centers in Brazil increased from 35 in 2008 to 246 in 2022, with 216 centers assessed in this study (102 Essential, 114 Advanced). Advanced centers were mostly private (69%). Of all hospitals, 51% serve public health patients, 75% as Essential centers. The southeast and south region have the highest number of stroke centers (77%). All hospitals provided essential blood tests, CT scans, and thrombolytic therapy, with 97% having pre-hospital emergency services. Neurologists were available 24/7 in 85% of centers (49% on call, 35% on duty, 16% via telemedicine), and 46% of hospitals had stroke units. Nearly 90% had acute neurosurgical care, and 47% offered endovascular thrombectomy 24/7. Advanced centers implemented 85% of the WSO Roadmap items and Essential centers 76%. According to WSO/SIECV Certification, 39 centers were prepared for certification, and 18 were certified (6 private: Advanced, 12 public: 4 Advanced, 8 Essential).</p><p><strong>Conclusion: </strong>Brazil has significantly improved its stroke care structure, but disparities and areas for further enhancement remain, particularly in equity, resource access, and best practices implementation. Certification programs could help address these issues and improve outcomes for stroke patients.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149361","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":"Comment on \"Coexisting Obesity and Malnutrition and Its Impact on Stroke and Brain Structure: Insights from UK Biobank Study\".","authors":"Huicong Niu","doi":"10.1159/000546570","DOIUrl":"10.1159/000546570","url":null,"abstract":"","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-2"},"PeriodicalIF":2.2,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141509","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}