Cerebrovascular Diseases最新文献

{"title":"Association between Marital/Partner Status and Patient-Reported Outcomes in Stroke Patients: A Systematic Review.","authors":"Cenjing Zhu, Phoebe M Tran, Erica C Leifheit, Erica S Spatz, Rachel P Dreyer, Kate Nyhan, Shi-Yi Wang, Patricia N E Roberson, Larry B Goldstein, Judith H Lichtman","doi":"10.1159/000546413","DOIUrl":"10.1159/000546413","url":null,"abstract":"<p><strong>Introduction: </strong>The extent to which marital/partner status affects patient-reported outcome measures (PROMs) in stroke patients varies among reported studies. We conducted a systematic review and meta-analysis to clarify this relationship.</p><p><strong>Methods: </strong>Five databases (Medline, Web of Science, Scopus, EMBASE, and PsycINFO) were searched from inception to April 15, 2024. Peer-reviewed studies that reported the independent association of marital/partner status with defined PROMs for patients who had a stroke were eligible for inclusion. Results for eligible studies were classified into four predefined outcome domains (health-related quality of life [HRQoL], functional status, symptoms, and personal recovery outcomes). Study quality was appraised using the Newcastle-Ottawa Scale, and data were synthesized by outcome domains.</p><p><strong>Results: </strong>We identified 51 studies (n = 552,943 participants), of which 10 were included in meta-analyses. Being married/partnered was associated with a lower likelihood of poststroke depression (pooled OR, 0.62 [95% CI: 0.43 to 0.89], I2 = 0%), independent of functional outcomes. However, no clear association was found with HRQoL given mixed and insignificant results across physical and mental domains. Qualitative synthesis further suggested that most studies supported better functional and personal recovery outcomes for stroke patients who were married/partnered compared with those who were unpartnered. Data were insufficient to determine whether the association of partner status varied by the sex of the stroke patient.</p><p><strong>Conclusion: </strong>Our findings highlight the importance of the influence of marital/partner status on PROMs among stroke patients for mental health, but not for HRQoL. Future research should aim to harmonize assessments and standardize reporting to enhance further investigation of these associations, determine whether there are differences by sex, and further explore the association between marital/partner status and poststroke functional outcomes.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-21"},"PeriodicalIF":1.5,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092526","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 of Neighbourhood Deprivation with Secondary Prevention Prescribing and All-Cause Mortality among Stroke Patients in Scotland: A Population-Based Study.","authors":"Kadie-Ann Sterling, Melanie Turner, Peter Langhorne, Mary Joan Macleod","doi":"10.1159/000546261","DOIUrl":"10.1159/000546261","url":null,"abstract":"<p><strong>Introduction: </strong>Previous studies have shown that residing in more deprived neighbourhoods is associated with an increased risk for stroke and worse health outcomes. We aimed to investigate the association between neighbourhood deprivation and secondary prevention prescribing and all-cause mortality after a stroke in Scotland.</p><p><strong>Methods: </strong>This retrospective observational study analysed linked data on first-ever stroke patients admitted to hospitals across Scotland between 1 January 2011 and 31 December 2018. Data were obtained from the Scottish Stroke Care Audit (SSCA), hospital admissions dataset, community prescribing and dispensing dataset, and mortality records. Neighbourhood deprivation was assessed using the Scottish Index of Multiple Deprivation (SIMD) quintiles. Study outcomes were 1-year all-cause mortality and secondary prevention prescribing, stratified by stroke type and presence of atrial fibrillation (AF). Findings from Cox regression and logistic regression analyses, with models adjusted for sociodemographic factors, comorbidity burden, stroke severity, and stroke unit admission, are presented.</p><p><strong>Results: </strong>This study included 47,947 stroke patients, of which 11,752 (24.5%) resided in the most deprived areas (quintile 1) and 7,450 (15.6%) resided in the least deprived areas (quintile 5). Compared with patients from the most deprived areas, patients from the least deprived areas were older {78 (interquartile range [IQR] 68-84) vs. 71 (60-81) years}, experienced more intracerebral haemorrhages (12.1% vs. 9.2%), and more AF (26.5% vs. 20.4%). Among ischaemic stroke patients, residing in less deprived areas was associated with reduced hazard of all-cause mortality at 1 year (adjusted hazard ratio [aHR] 0.97; 95% confidence interval [CI], 0.96-0.99), reduced odds of antiplatelet prescription in patients without AF (adjusted odds ratio (aOR, 0.95; 95% CI, 0.92-0.98), and increased odds of being anticoagulated in patients with AF (aOR, 1.15; 95% CI, 1.09-1.20), compared to patients residing in the most deprived areas. No significant differences in all-cause mortality and secondary prevention prescribing by neighbourhood deprivation were found in intracerebral haemorrhage patients.</p><p><strong>Conclusion: </strong>In this retrospective observational study, ischaemic stroke patients residing in the least deprived areas had a lower hazard of 1-year all-cause mortality, lower odds of antiplatelet prescription (in the absence of AF), but higher odds of oral anticoagulant prescription (in the presence of AF), compared to those residing in the most deprived areas. These findings suggest that neighbourhood deprivation is independently associated with all-cause mortality and treatment after stroke, highlighting potential interventions for stroke risk factors and poststroke care, particularly in patients from more deprived areas.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":1.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991185","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":"Stratifying the Utility of Transthoracic Echocardiography for Ischemic Stroke Using a Risk Score.","authors":"Neel D Jani, Haley Basinger, Ann M Jones, Justin A Sattin, Aaron F Struck","doi":"10.1159/000544746","DOIUrl":"10.1159/000544746","url":null,"abstract":"<p><strong>Introduction: </strong>Inpatient transthoracic echocardiography (TTE) is considered to be an important part of secondary prevention in acute ischemic stroke, but can be a barrier to discharge. The goal of the study was to generate a risk score to assess which patients will benefit from a TTE in the inpatient setting.</p><p><strong>Methods: </strong>The training data set consisted of all 874 patients from the UW Health Comprehensive Stroke Registry admitted for acute ischemic stroke/transient ischemic attack (TIA) from 2017 to 2018 that received a TTE. A validation data set of 200 stroke patients was used from the Indiana University Stroke Registry. Using the training data, a modified logistic regression model was developed with simplified coefficients and a limited number of variables. The area under the receiver operator characteristic curve (AUC) was compared between different models and between the training and validation data sets.</p><p><strong>Results: </strong>The training data consisted of 874 patients (52.97% male; median age 64 years). Validation data set consisted of 200 patients (53.5% male; median age, 64 years). For the final model, termed AL2OHA, mean AUC on the training data across five-fold cross validation was 0.78 (95% CI, 0.76-0.80). The model consisted of six variables, and one point was awarded for each: atrial fibrillation, large artery atherosclerosis, large vessel occlusion, obesity, prior antihypertensive medication use, and if the patient's age was 18-39 or ≥70. Risk of positive findings was 6.2% for score of 0, 23.1% for score of 1, 57.4% for score of 2, 85.8% for score of 3, 96.4% for score of 4, and 99.2% for score of 5 or greater. When tested on the external validation data set, AUC was 0.73 and demonstrated to not be significantly different than the AUC for the training data set.</p><p><strong>Conclusions: </strong>The AL2OHA model is a clinical tool which can stratify which patients admitted for acute ischemic stroke/TIA are more likely to benefit from inpatient TTEs.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-7"},"PeriodicalIF":2.2,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971281","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":"Neglect after Isolated Thalamic Stroke: A Systematic Review of the Literature.","authors":"Ariane Dampfhoffer, Dario Cazzoli, Brigitte Charlotte Kaufmann, Thomas Nyffeler","doi":"10.1159/000545473","DOIUrl":"10.1159/000545473","url":null,"abstract":"<p><strong>Introduction: </strong>Recent research has increasingly acknowledged the thalamus's role in the development of neuropsychological deficits, which were previously considered to be primarily related to cortical processes. Among these deficits, neglect is of particular importance in stroke survivors, as it is a predictor of poor functional outcome. This review aimed to clarify the relationship between stroke lateralization and location within the thalamus and the occurrence of neglect.</p><p><strong>Methods: </strong>In the present study, we performed a systematic review according to the PRISMA guidelines. PubMed, Scopus, CINHAL, and Web of Science were searched for articles published from inception to June 30, 2024. All studies presenting cases of isolated vascular thalamic stroke (hemorrhagic, ischemic) and clinical neglect were included. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist for case reports, case series, and case-control studies. We divided the thalamus into four parts (anterior, lateral, medial, and posterior) based on the four classical vascular territories and performed a qualitative and a simple descriptive statistical analysis using absolute numbers and percentages of the data collected.</p><p><strong>Results: </strong>A total of 23 articles involving 37 patients were included: 31 cases (84%) with right-sided thalamic stroke and 6 cases (16%) with left-sided thalamic stroke. In the hemorrhagic stroke group (21 cases), there was a clear predominance of localization in the posterior (10 cases; 47%) and entire thalamus (9 cases; 43%), with no cases in the anterior part of the thalamus and only one case (5%) each in the medial and lateral parts. In contrast, ischemic cases were predominantly located in the anterior and lateral parts (6 cases each; 37.5%) with only 3 cases (19%) in the medial part and 1 case (6%) in the posterior part.</p><p><strong>Conclusion: </strong>Thalamic neglect appears to occur more frequently in right-sided thalamic strokes than in left-sided thalamic strokes. However, the exact neuroanatomical correlates differed between hemorrhagic and ischemic groups and the underlying mechanisms remain unclear due to the heterogeneity and paucity of data. Rather than drawing definitive conclusions, this work synthesizes existing literature and underscores the need for prospective studies with standardized assessments and advanced neuroimaging.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-18"},"PeriodicalIF":2.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960187","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":"In-Depth Carotid Calcification Morphometrics and Their Temporal Changes Are Associated with Cardiovascular Risk Factors in Patients with Recent Ischemic Event: The Plaque At Risk Study.","authors":"Aikaterini Tziotziou, Federica Fontana, Suze-Anne Korteland, Kelly Nies, Paul Nederkoorn, Pim A de Jong, M Eline Kooi, Aad van der Lugt, Anton F W van der Steen, Jolanda J Wentzel, Daniel Bos, Ali C Akyildiz","doi":"10.1159/000546164","DOIUrl":"10.1159/000546164","url":null,"abstract":"<p><strong>Introduction: </strong>Ischemic stroke incidence varies significantly with respect to sex and cardiovascular risk factors (CVRFs), a relationship that it is not well understood. Calcification in carotid atherosclerosis is known to impact plaque stability, potentially linked to ischemic stroke. The objective was to assess the in-depth calcification morphometrics within extracranial carotid atherosclerosis, their temporal changes, and associations with sex and CVRFs.</p><p><strong>Methods: </strong>Carotid arteries (n = 144) with confirmed atherosclerosis and mild-to-moderate stenosis from 72 symptomatic patients (Plaque-At-Risk study) with recent ischemic event due to ischemia in the territory of a carotid artery were imaged using multidetector computed tomography angiography (MDCTA) at baseline and after 2 years. The lumen, vessel wall, and calcifications were segmented semiautomatically, and the carotid geometries were 3D reconstructed. A comprehensive morphometric assessment of carotid calcifications was performed on the baseline and follow-up scans. We investigated distributions of these metrics and their associations with sex and CVRFs using generalized linear mixed models.</p><p><strong>Results: </strong>Our findings suggest that women have larger (4.5 mm2 [95% CI: 3.2-6.2] vs. 3.2 mm2 [95% CI: 2.4-4.2]) calcifications, located closer to the lumen (0.6 mm [95% CI: 0.4-0.8] vs. 0.9 mm [95% CI: 0.7-1.2]) in contrast to men at baseline and follow-up, adjusted for baseline measurements. At the baseline, nonsmokers had larger (5.3 mm2 [95% CI: 3.7-7.5] vs. 3.2 mm2 [95% CI: 2.3-4.4]) and longer (5.7 mm [95% CI: 4.1-7.3] vs. 2.4 mm [95% CI: 1.6-3.6]) calcifications than the current smokers. Diabetic patients had thicker (1.1 mm [95% CI: 0.8-1.3] vs. 0.8 mm [95% CI: 0.7-0.9]) carotid calcifications at baseline.</p><p><strong>Conclusion: </strong>Our in-depth analyses exposed several geometric features of carotid calcifications associated with sex and CVRFs and provided further insight into the pathophysiology of carotid atherosclerosis.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977939","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":"Patient and Caregiver Perspectives on the Design and Execution of ACT-GLOBAL, a Stroke Adaptive Platform Trial: A Focus Group Study.","authors":"Aravind Ganesh, Nora D Cristall, Brian Dewar, Michael D Hill, Carol Kenney, Ivy A Sebastian, Rose Wilson, Craig S Anderson, Xiaoying Chen, Bijoy Menon, Michel C F Shamy, Nishita Singh","doi":"10.1159/000546132","DOIUrl":"10.1159/000546132","url":null,"abstract":"<p><strong>Introduction: </strong>Adaptive platform trials represent a paradigm shift in stroke research. We examined how patient-partners perceived the design and execution of an international platform trial in acute stroke, ACT-GLOBAL (A multi-faCtorial, mulTi-arm, multi-staGe, randomized, gLOBal Adaptive pLatform trial for stroke), through a series of focus groups with process evaluation methodology.</p><p><strong>Methods: </strong>Participants were recruited from two comprehensive stroke centers one in Calgary, Canada and one in Sydney, Australia. Four virtual focus groups were attended by a total of 21 patient-partners and 11 clinician-researchers. One focus group had repeat attendees to review a draft consent form and patient information sheet, and one presented a video describing platform trials. Physician facilitators presented the platform trial concept followed by a facilitated discussion. Audio recordings were transcribed and combined with field notes. Exemplar quotes and themes were identified separately for each group and subsequently across groups.</p><p><strong>Results: </strong>Patients/caregivers perceived acute stroke-focused adaptive platform trials such as ACT-GLOBAL as providing potentially beneficial opportunities to be randomized to multiple treatments, with efficiencies and richer data to improve patient care. Emphasis was given to the importance of gatekeeper processes for the addition of future questions posed by the platform to ensure examined questions would not interfere with routine care, and that safety decisions were ultimately made by nonconflicted parties. They appreciated that deferral of consent would be ideal to allow timely randomization/treatment within the adaptive stroke platform, and for patient safety to be prioritized in enrolment-related decisions with family input whenever feasible. The need to have trial information accessible in digestible chunks, multiple languages, and modalities was emphasized. To facilitate engagement, transparency, trust, and two-way communication was deemed critical to the informed consent process.</p><p><strong>Conclusion: </strong>Patient-partners were supportive of an adaptive platform trial design. However, they expressed important priorities in their execution while safeguarding patient autonomy and safety. Oversight, multiple modes of delivering patient information, and having feedback evaluation and transparency with ongoing participation were identified as valued components. Deferral of consent was recognized as a pragmatic way to enroll patients. Similar considerations may apply to adaptive platform trials in other neurological/medical emergencies.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-10"},"PeriodicalIF":2.2,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961284","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":"Prevalence and Associations of Post-Stroke Frailty: A Cross-Sectional Study.","authors":"Udaya K Ranawaka, Chamila Mettananda, Sithumi Liyanage, Nethra De Silva, Jayalath Chandrasiri, Harsha Dharmasena, Sajeewanie Fernando, Sujeewani Kurukulasuriya, Arunasalam Pathmeswaran","doi":"10.1159/000545884","DOIUrl":"10.1159/000545884","url":null,"abstract":"<p><strong>Introduction: </strong>There is little data on stroke and frailty, especially from South Asia. We aimed to study the prevalence and associations of post-stroke frailty in a cohort of stroke survivors.</p><p><strong>Methods: </strong>We studied all patients attending a tertiary care stroke clinic over 1 year (September 2023-August 2024). Patients with an index stroke event occurring 1 to 5 years earlier were included. Data on demographic features, stroke characteristics, functional outcome, and frailty were studied. Frailty was assessed with the Clinical Frailty Scale (CFS), stroke severity with the National Institute of Neurological Disorders and Stroke scale (NIHSS), and functional status with the modified Rankin Scale (mRS). Frailty was defined by a CFS score of ≥5 and functional dependence by an mRS score of 3-5. Strokes were categorized as mild (NIHSS score of 1-4), moderate (5-14), or severe (>14). Associations of post-stroke frailty were studied using logistic regression.</p><p><strong>Results: </strong>A total of 143 patients with stroke (mean age 58 ± 10 years, male 91 [63.6%]) with a mean follow-up of 2.7 (±1.6) years were studied. Of them, 141 (98%) were functionally independent before stroke onset. The majority (115 [80.4%]) had ischemic strokes, and 106 (74%) patients had moderate to severe strokes (admission NIHSS ≥5). On follow-up, 47 patients (33%) were frail (CFS ≥5), with 13 patients (9.1%) having moderate to severe frailty (CFS 6-9). Functional dependence on follow-up was seen in 33 patients (23%). Post-stroke frailty was independently associated with increasing age (p = 0.012), diabetes (p = 0.039), and admission stroke severity (p = 0.001) in a multivariable analysis. Biological sex, stroke type, other vascular risk factors, and duration of follow-up were not associated with post-stroke frailty.</p><p><strong>Conclusions: </strong>This is the first report on post-stroke frailty in South Asia. One-third of stroke survivors were frail on follow-up. Older age, diabetes and stroke severity were independent predictors of post-stroke frailty.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-7"},"PeriodicalIF":2.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981752","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":"Middle Meningeal Artery Embolization in the Treatment of Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis.","authors":"Shitai Ye, Sixi Zhang, Tianfang Li, Shuchao Wang, Xin Wang, Yong Deng, Longyang Yu, Qi Li, Xinggang Feng, Bingwu Jiang, Zhao Dai, Qifeng Guo, Qin Han, Wei Jin, Shujing Weng, Shunfu Jiang, Zhongming Qiu, Mohamad Abdalkader, Thanh N Nguyen","doi":"10.1159/000546001","DOIUrl":"10.1159/000546001","url":null,"abstract":"<p><strong>Introduction: </strong>There is increasing evidence that middle meningeal artery embolization (MMAE) can be used to treat chronic subdural hematoma (cSDH). The purpose of this study was to demonstrate the efficacy and safety of MMAE treatment through a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>We searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to MMAE from inception to December 3, 2024. The effectiveness outcomes were recurrence, progression, or reoperation of subdural hematoma after treatment, 90-day mRS 0-2, and 90-day mRS 0-3. The safety outcomes were severe deterioration of neurologic function and death within 180 days. The quality of the RCTs was evaluated with the Cochrane risk assessment tool, while the cohort studies were evaluated by the Newcastle-Ottawa Scale (NOS). The random-effect model was used to calculate the effect as risk ratio (RR). The heterogeneity of the results of each study was analyzed by χ2 test.</p><p><strong>Results: </strong>A total of 892 articles are retrieved. Among those, 4 RCTs and 5 cohort studies met the inclusion criteria. The RCT analysis showed that MMAE plus traditional treatment reduced the risk of recurrence or progression of hematoma compared with traditional treatment alone (5.3% vs. 9.1%; RR: 0.58, 95% CI, 0.39-0.86, p = 0.03). The heterogeneity was very low (I2 = 22%). There was no significant difference between the two groups for the 90-day mRS 0-2 and 0-3 scores (p = 0.73/p = 0.71, respectively). In terms of safety outcomes, the 180-day mortality was 3.5% in the MMAE plus traditional treatment group and 5.0% in the traditional treatment group (p = 0.49 > 0.05). Neurological deterioration was present in 4.6% of patients with MMAE plus traditional treatment compared to 3.9% with traditional treatment (p = 0.44 > 0.05). Across the 5 cohort studies, similar results were obtained for the incidence of recurrence, progression or reoperation of subdural hematoma (12.9% vs. 40.6%; RR: 0.26, 95% CI, 0.07-0.95, p = 0.04), but the heterogeneity was very high (I2 = 89%).</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis showed that in cSDH patients, MMAE was associated with a reduced rate of recurrence, progression or reoperation of the subdural hematoma compared to traditional treatment with surgery without increasing the incidence of death or adverse events.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981304","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":"Traditional Lipid Ratios and Carotid Atherosclerosis in Patients with Ischemic Stroke.","authors":"Mengyuan Miao, Chunyue Ye, Ziyi Wang, Jiayi Long, Shoujiang You, Yaming Sun, Yongjun Cao, Chun-Feng Liu, Guojie Zhai, Chongke Zhong","doi":"10.1159/000545676","DOIUrl":"10.1159/000545676","url":null,"abstract":"<p><strong>Introduction: </strong>Traditional lipid ratios were considered as robust predictors of cardiovascular disease risk. However, the relationships between traditional lipid ratios and atherosclerosis in the setting of ischemic stroke remain unclear. We aimed to explore the associations between traditional lipid ratios and carotid atherosclerosis in patients with ischemic stroke.</p><p><strong>Methods: </strong>A total of 1,612 patients with ischemic stroke from 22 hospitals were included in this analysis. Traditional lipid ratios included Castelli's risk index-I (CRI-I), Castelli's risk index-II (CRI-II), and atherogenic coefficient (AC). Logistic regression models were used to assess the relationships between traditional lipid ratios and carotid atherosclerosis.</p><p><strong>Results: </strong>The multivariable-adjusted odds ratios (ORs) (95% confidence intervals [CIs]) in quartile 4 versus quartile 1 of CRI-I, CRI-II, and AC were 1.65 (1.14-2.38), 1.48 (1.03-2.14), and 1.65 (1.14-2.38) for carotid atherosclerosis. Furthermore, the ORs (95% CIs) for the highest quartile of CRI-I, CRI-II, and AC were 1.51 (1.09-2.09), 1.38 (0.99-1.90), and 1.51 (1.09-2.09) for abnormal mean cIMT and were 1.60 (1.17-2.18), 1.59 (1.17-2.16), and 1.60 (1.17-2.18) for abnormal maximum cIMT, respectively. Restricted cubic spline models indicated that there were dose-response relationships between CRI-I, CRI-II, and AC and carotid atherosclerosis and abnormal cIMT (all P for linearity <0.001). Additionally, CRI-I, CRI-II, and AC offered incremental predictive capacity for carotid atherosclerosis beyond established risk factors, shown by increase in net reclassification improvement and integrated discrimination improvement (all p < 0.05).</p><p><strong>Conclusion: </strong>Elevated traditional lipid ratios were positively associated with carotid atherosclerosis in patients with ischemic stroke, supporting that these lipid ratios could be promising atherosclerotic predictors.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968999","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":"Modifiable Factors Are Associated with Frailty in Individuals after Chronic Stroke: A Cross-Sectional Study.","authors":"Ana Luiza Miranda de Oliveira, Julia Mafra Vasconcelos, Vitória Eduarda Alves de Jesus, Aline Alvim Scianni, Christina D C M Faria, Janaine Cunha Polese","doi":"10.1159/000546039","DOIUrl":"10.1159/000546039","url":null,"abstract":"<p><strong>Introduction: </strong>Frailty is increasingly common in individuals after chronic stroke and is associated with poor outcomes. The repercussions of this syndrome on chronic stroke individuals are even worse for physical function. However, it may be reversible, requiring investigations into associated and motor modifiable factors. Thus, this study aimed to investigate whether modifiable variables (level of physical activity and walking speed) are associated with frailty in individuals after chronic stroke, as well as to verify whether these variables contribute to the presence of frailty in these individuals.</p><p><strong>Methods: </strong>This is a cross-sectional study where individuals with chronic stroke, aged over 18 years, with unilateral involvement, and able to walk with or without assistive devices were included. The dependent variable was frailty, measured with the Clinical Frailty Scale (CFS). The modifiable factors (independent variables) were the level of physical activity, expressed through the adjusted activity score measured by the Human Activity Profile, and the habitual walking speed, measured with the 10-meter walk test, in m/s. A multiple linear regression analysis was performed to verify the association between the modifiable variables and frailty.</p><p><strong>Results: </strong>Sixty-one individuals, with a mean age of 62.6 ± 15.7 years, 50.8% men, with a mean time of evolution of 46.4 ± 43.0 months were included. The level of physical activity alone explained 59.2% of the frailty variance (R2 = 59.2%; F = 88.1; p < 0.0). Physical activity and walking speed explained 59.9% of the frailty variance (R2 = 67.1%; F = 62.1; p < 0.0).</p><p><strong>Conclusion: </strong>The level of physical activity and habitual walking speed were significantly associated with the presence of frailty in individuals after chronic stroke. Strategies aiming to increase the level of physical activity and walking speed may be a path to avoid frailty development in these individuals.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-6"},"PeriodicalIF":2.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968723","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}