Cerebrovascular Diseases最新文献

{"title":"Comparing Stroke Profiles and Outcomes between Urban and Rural India: A Secondary Analysis of the SPRINT INDIA Trial.","authors":"Shweta Jain Verma, Arya Devi Karuthedathu Mana Sanal Kumar, Deepti Arora, Aneesh Dhasan, Padmavathyamma Narayanapillai Sylaja, Dheeraj Khurana, Pamidimukkala Vijaya, Biman Kanti Ray, Vivek Nambiar, Sanjith Aaron, Gaurav Kumar Mittal, Aparna R Pai, Somasundaram Kumaravelu, Yerasu Muralidhar Reddy, Sunil Narayan, Nomal Chandra Borah, Rupjyoti Das, Girish Baburao Kulkarni, Vikram Huded, Thomas Mathew, Padma Srivastava, Rohit Bhatia, Pawan Kumar Ojha, Jayanta Roy, Sherly Mary Abraham, Anand Vaishnav, Arvind Sharma, Abhishek Pathak, Sanjeev Kumar Bhoi, Sudhir Sharma, Sulena Sulena, Aralikatte Onkarappa Saroja, Neetu Ramrakhiani, Madhusudhan Byadarahalli Kempegowda, Shankar Prasad Gorthi, Mahesh Pundlik Kate, Tina George, Ivy Anne Sebastian, Meenakshi Sharma, Rupinder Dhaliwal, Rahul Huilgol, Jeyaraj Durai Pandian","doi":"10.1159/000545675","DOIUrl":"10.1159/000545675","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke causes significant death and disability, with urban-rural disparities in healthcare and limited studies in India, despite its rural majority of 70%. The post hoc study aimed to explore differences in stroke profiles, risk factors, and outcomes between urban and rural participants using data from the Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA) trial.</p><p><strong>Methods: </strong>The SPRINT INDIA trial was a multi-center randomized clinical trial across 31 Indian sites. Data were collected between April 28, 2018, and November 30, 2021. Index stroke patients, aged 18 and older, presenting within 2 days to 3 months of symptom onset, were randomized using a centralized web-based system into intervention or control groups. The intervention included SMS, videos, and an interactive educational workbook for secondary stroke prevention in 11 Indian languages. Baseline data captured in a case report form included participants' urban or rural locations. The primary outcome was a composite endpoint that included recurrent stroke, high-risk transient ischemic attack (TIA), acute coronary syndrome (ACS), and all-cause mortality within 1 year after randomization. The trial is registered by <ext-link ext-link-type=\"uri\" xlink:href=\"http://Clinicaltrials.gov\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">Clinicaltrials.gov</ext-link> (NCT03228979) and Clinical Trials Registry-India (CTRI/2017/09/009600).</p><p><strong>Results: </strong>The trial enrolled 4,298 sub-acute stroke patients, out of which 3,038 (70.68%) were followed up, of which 1,620 (53.32%) were urban and 1,418 (46.68%) were rural. The primary composite outcome (recurrent stroke, high-risk TIA, ACS, and mortality) was higher in urban areas compared to rural areas (61 [3.8%] vs. 34 [2.4%]; p = 0.018) at 1-year follow-up. All cases of high-risk TIA occurred in urban participants (p < 0.001). Urban participants were more educated (795 [49.1%] vs. rural 394 [27.8%]; p < 0.001), with higher rates of dyslipidemia (335 [20.7%] vs. 247 [17.4%]; p = 0.023), and higher body mass index (25.17 ± 4.31 vs. 24.76 ± 4.23; p = 0.008). Behavioral risk factors of alcohol intake and smoking tobacco were higher in rural patients compared to urban patients (65 [4.6%] vs. 73 [4.5%]; p < 0.001 and 59 [4.2%] vs. 65 [4.0%]; p < 0.001, respectively).</p><p><strong>Conclusion: </strong>Urban patients show higher stroke recurrence and lifestyle-related conditions, while rural patients face more behavioral risks like smoking and alcohol use. To address these disparities, requires targeted interventions; urban patients would benefit from lifestyle-focused programs, such as dietary improvements and stress management. For rural patients, programs should focus on reducing behavioral risks like smoking and alcohol use through community-based education and accessible cessation support services.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968709","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":"Rationale and Design of the Efficacy and Safety of a Patch-Type Cardiac Monitor for Diagnosing Paroxysmal Atrial Fibrillation in Embolic Stroke of Undetermined Source Patients with Left Atrial Enlargement (SOLO-ESUS): A Randomized Controlled Trial.","authors":"Kwanju Song, Tae Jin Song, Ho Geol Woo, Beom Joon Kim, Woo-Keun Seo, Hyun Goo Kang, Chi Kyung Kim, Hong-Kyun Park, Yo Han Jung, Kang-Ho Choi, Bum Joon Kim","doi":"10.1159/000545883","DOIUrl":"10.1159/000545883","url":null,"abstract":"<p><strong>Introduction: </strong>Detecting atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS) is crucial for effective secondary stroke prevention, particularly in those with left atrial enlargement (LAE), as they have a higher risk of subclinical AF. This study aimed to evaluate and compare the efficacy and safety of a patch-type cardiac monitoring device (PCM) in detecting AF in ESUS patients with LAE.</p><p><strong>Methods: </strong>This prospective, multicenter, open-label, randomized, controlled, investigator-initiated trial will recruit a total of 370 ESUS patients with LAE and randomize them in a 1:1 ratio into two groups: the intervention group, which will receive continuous monitoring with the PCM for 1 week, and the control group, which will undergo a single 12-lead electrocardiogram. LAE will be defined as a left atrial diameter greater than 40 mm in males and greater than 38 mm in females or a left atrial volume index exceeding 35. The primary endpoint is the proportion of participants with detected AF. Secondary endpoints include AF burden, detection of other arrhythmias, and the incidence of tachycardia, bradycardia, premature atrial contractions, and atrial flutter. A post hoc analysis will explore factors influencing AF detection and aim to develop a predictive model based on clinical and imaging data.</p><p><strong>Conclusion: </strong>This trial is expected to provide valuable insights into the safety and efficacy of PCM in detecting AF, potentially influencing clinical strategies for AF detection and management in ESUS patients with LAE.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955150","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":"Vascular Smooth Muscle Cell Dysfunction in Cerebral Small Vessel Disease: Mechanisms and Therapeutic Potential.","authors":"Daichao Ma, Qing Li, Hui Zhang","doi":"10.1159/000545796","DOIUrl":"10.1159/000545796","url":null,"abstract":"<p><strong>Background: </strong>Cerebral small vessel disease (CSVD) is closely linked to stroke and dementia, marked by structural and functional impairments of small blood vessels in the brain.</p><p><strong>Summary: </strong>This review focuses on how vascular smooth muscle cells (SMCs) contribute to CSVD progression. SMCs regulate cerebral blood flow, maintain vascular structure, and support glymphatic waste clearance under physiological conditions. However, in the context of CSVD, these cells undergo pathological alterations, such as hypertrophy, degeneration, phenotypic switching, and extracellular matrix abnormalities. These dysregulations are associated with malfunctions in multiple signaling pathways or disrupted mechanical cellular responses. Emerging treatments, such as drugs targeting cyclic nucleotide pathways, show promise in improving blood flow and vascular stability.</p><p><strong>Key messages: </strong>Despite progress, the molecular mechanisms underlying SMC dysfunction in CSVD remain incompletely understood. A deeper exploration of SMC biology, coupled with clinical translation of preclinical findings, is critical for developing effective therapies to address the escalating burden of CSVD.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986960","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":"Decreased Lactococcus lactis and Propionic Acid in Feces of Patients with Moyamoya Disease: Possible Implications of Immune Dysregulation.","authors":"Mayuko Otomo, Ryosuke Tashiro, Hidetaka Tokuno, Atsushi Kanoke, Keita Tominaga, Arata Nagai, Takashi Aikawa, Daisuke Ando, Hiroyuki Sakata, Takeya Sato, Takaaki Abe, Hidenori Endo, Kuniyasu Niizuma, Teiji Tominaga","doi":"10.1159/000545478","DOIUrl":"10.1159/000545478","url":null,"abstract":"<p><strong>Introduction: </strong>Moyamoya disease (MMD) is a cerebrovascular disease characterized by progressive steno-occlusive lesions in the terminal portion of the internal carotid artery. Despite its unknown etiology, immune dysregulation is regarded as a critical trigger for delineating the pathophysiology of MMD. The gut microbiota produces short-chain fatty (SCFA) and organic acids, influencing immune regulation and vascular remodeling. We aimed to characterize the gut microbiota in patients with MMD.</p><p><strong>Methods: </strong>Sixteen patients with MMD and sixteen healthy controls (CON) were included in this study. We performed 16S rRNA sequencing of fecal samples, analyzed microbiome diversity and composition, and quantified SCFA and organic acid levels using liquid chromatography.</p><p><strong>Results: </strong>There were no significant differences in α- and β-diversities among feces from the MMD patients and CON. However, 16S rRNA sequencing identified defective Lactococcus lactis (0 ± 0 in the MMD patients vs. 0.026 ± 0.084 in healthy CON, p = 0.0181) and abundant Gordinobacter pamelaeae (0.030 ± 0.039 in the patients vs. 0.001 ± 0.005 in healthy CON, p = 0.003) are strongly linked to MMD. Propionic acid levels were significantly lower in feces of the MMD patients compared to healthy CON (0.83 ± 0.34 mg/g in the MMD patients vs. 1.20 ± 0.55 mg/g in healthy CON, p = 0.028).</p><p><strong>Conclusion: </strong>Decreased L. lactis can result in reduced lactic acid and propionic acid levels in the feces of the patients. This imbalance in the gut microbiome and SCFA/organic acid levels could contribute to immune dysregulation underlying the vascular remodeling seen in MMD.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728848","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":"Intraoperative Cortical Indocyanine Green Extravasation as a Predictor of Cerebral Hyperperfusion following Direct Revascularization for Moyamoya Disease: Impact of Prolonged Observations of Indocyanine Green Videoangiography.","authors":"Masaki Ito, Haruto Uchino, Miki Fujimura","doi":"10.1159/000545333","DOIUrl":"10.1159/000545333","url":null,"abstract":"<p><strong>Introduction: </strong>Local vasogenic edema following direct revascularization for moyamoya disease (MMD) is considered to result from an intrinsic vulnerability of blood-brain barrier (BBB) and is consequently associated with transient focal cerebral hyperperfusion (CHP). However, intraoperative identification of the local vasogenic edema remains challenging. To address this, we implemented a prolonged observation of indocyanine green videoangiography (ICG-VAG) as an extension of routine clinical practice. This approach aimed to investigate intraoperative cortical ICG extravasation following direct revascularization, as an indicator of BBB dysfunction in patients with MMD, providing real-time intraoperative evidence of compromised vascular integrity.</p><p><strong>Methods: </strong>This prospective observational study included 50 consecutive combined direct/indirect revascularization surgeries performed for MMD at our institution between December 2022 and February 2025. After confirming the patency of the direct anastomosis using ICG-VAG in the early phase, we conducted an additional observation of ICG-VAG in the late phase, approximately 5 min after the initial assessment, to evaluate cortical changes around the anastomotic site. We analyzed the correlation between intraoperative cortical ICG extravasation observed in the late phase of ICG-VAG and postoperative complications, including CHP.</p><p><strong>Results: </strong>ICG-VAG confirmed patent direct anastomoses in all 50 revascularizations, and postoperative CHP occurred in 16 surgeries (32%) between postoperative days 1 and 7. Among these cases, intraoperative cortical ICG extravasation was detected in the late phase of ICG-VAG in nine of 50 surgeries (18%). This extravasation presented as focal or patchy leakage of ICG dye near the anastomotic site and/or flow-augmented cortical areas without evident cortical contusion or subarachnoid hemorrhage under the light-field surgical microscope. There were no significant differences in preoperative baseline clinical characteristics between patients with and without cortical ICG extravasation. However, intraoperative cortical ICG extravasation was significantly correlated with postoperative CHP (odds ratio: 12; 95% confidence interval: 2.5-94; p = 0.0044) and local vasogenic edema on magnetic resonance imaging (odds ratio: 20; 95% confidence interval: 2.2-444; p = 0.015).</p><p><strong>Conclusion: </strong>Intraoperative cortical ICG extravasation, observed in the late phase of ICG-VAG, may serve as a direct indicator of the intrinsic vulnerability of BBB in patients with MMD. Prolonged ICG-VAG observation could be a simple and effective intraoperative tool to predict postoperative CHP and local vasogenic edema in patients undergoing direct revascularization for MMD, thereby enabling intensive postoperative monitoring for high-risk cases.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669219","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":"Posterior Cerebral Artery Involvement in Paediatric Moyamoya: Angiographic Patterns and Stroke Burden.","authors":"Salvatore Mazzotta, Gerasimos Baltsavias, Monika Hebeisen, Nadia Khan","doi":"10.1159/000545320","DOIUrl":"10.1159/000545320","url":null,"abstract":"<p><strong>Introduction: </strong>The posterior circulation is frequently overlooked when managing patients with moyamoya angiopathy, particularly the non-Asian population. This study aimed to identify the presence of angiopathy in the posterior cerebral artery (PCA), its patterns, and the consequences thereof in a paediatric cohort.</p><p><strong>Methods: </strong>Retrospective clinical data, MRI scans, and cerebral angiograms of all patients referred to a single centre for cerebral revascularization were analysed for PCA involvement. Angiographic patterns of PCA involvement were defined. Associated stroke burden was evaluated using general estimation equation regression models adjusting for prespecified potential confounder age at onset, right or left laterality, and involvement of anterior circulation.</p><p><strong>Results: </strong>PCA involvement was observed in 37% of 122 patients and was identified to be either proximal (proximal P1 segment, P1-posterior communicating artery [Pcomm] segment) or distal (Pcomm-P2 segment and distal P2 segment and beyond). Distal P2 (32%) and involvement of the entire PCA (26%) were most frequently observed. The odds of having any stroke (anterior distribution, i.e., anterior cerebral artery, middle cerebral artery, or posterior distribution, i.e., PCA) was five times higher (odds ratio [OR] 5.0, 95% CI [2.3, 10.9], p < 0.0001) when PCA was involved compared to without PCA involvement. Distal PCA involvement was observed in 59% of children <2 years of age. The OR of stroke in the PCA distribution with distal PCA involvement compared to proximal involvement was 4.1 (95% CI [0.9, 19.0], p = 0.07). The OR of anterior distribution stroke with Pcomm involvement versus no Pcomm involvement was 6.2 (95% CI [1.0, 37.2], p = 0.05).</p><p><strong>Conclusion: </strong>Involvement of the PCA in moyamoya children is highlighted. This may be proximal, distal, or along the entire course of the PCA and is strongly associated with overall stroke. The odds of PCA territory strokes is higher with distal PCA involvement, while involvement of the Pcomm plays a more important role in anterior stroke. Younger children are at higher risk of PCA stroke.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669221","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":"The Impact of Abnormal Distribution of Abdominal Adiposity and Skeletal Muscle on the Prognosis of Ischemic Stroke.","authors":"Chengcheng Cui, Zhiwen Geng, Haotao Li, Rui Li, Mengxia Lu, Yuqiao Wang, Lulu Xiao, Xinfeng Liu","doi":"10.1159/000545334","DOIUrl":"10.1159/000545334","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to investigate the role of novel indicators related to obesity in predicting long-term functional outcomes and the risk of stroke recurrence in participants with first-ever acute ischemic stroke (AIS).</p><p><strong>Methods: </strong>The area and density of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and skeletal muscle (SM) at the third lumbar level, as well as the VAT area (VATA)-to-SM area (SMA) ratio (VSR) and the SAT area-to-SMA ratio (SSR) were assessed using whole-abdominal computerized tomography upon admission. The primary endpoint was the recurrence of stroke. The secondary outcomes were all-cause mortality and cardio-cerebrovascular origin death (CCVD) specifically due to cardiovascular and cerebrovascular diseases. Cox's proportional hazards regression model was used to examine the associations between the novel indicators of obesity and clinical outcomes.</p><p><strong>Results: </strong>A total of 1,007 participants were enrolled, with an average follow-up time of 1,445 days. The participants in the high VSR group had a higher rate of stroke recurrence {adjusted hazard ratio, 2.06 (95% confidence interval [CI], 1.35-3.14); p = 0.001}. According to the adjusted analysis, high VSR was significantly associated with an increased risk of all-cause mortality (hazard ratio, 2.26 [95% CI, 1.58-3.24]; p < 0.001) and CCVD (hazard ratio, 2.49 [95% CI, 1.65-3.78]; p < 0.001).</p><p><strong>Conclusion: </strong>A higher VSR was associated with a higher risk of mortality and stroke recurrence in participants with first-ever AIS.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-12"},"PeriodicalIF":2.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662305","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":"Clinical Outcomes following Acute Ischaemic Stroke in Patients with Comorbid Cancer.","authors":"Noriko Sato, Fumi Kiyuna, Kayo Wakisaka, Yuichiro Ohya, Kana Ueki, Sohei Yoshimura, Kuniyuki Nakamura, Jun Hata, Yoshinobu Wakisaka, Tetsuro Ago, Masahiro Kamouchi, Takanari Kitazono, Ryu Matsuo","doi":"10.1159/000544700","DOIUrl":"10.1159/000544700","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of comorbid cancer is higher in patients with ischaemic stroke than in the general population, and recent studies have attempted to clarify the relationship between the two. We observed that the evidence for the impact of comorbid cancer on post-stroke clinical outcomes was not established and aimed to investigate it among patients with new-onset acute ischaemic stroke.</p><p><strong>Methods: </strong>We evaluated 13,345 patients with acute ischaemic stroke who were functionally independent before onset (modified Rankin Scale [mRS] score of 0-2) and admitted to one of the seven stroke centres in Fukuoka, Japan, between June 2007 and September 2019. A total of 13,047 patients were included in the analyses after excluding those with missing potential confounders (n = 13) or loss to follow-up (n = 298). Comorbid cancer was diagnosed based on previous history or newly identified cancer during hospitalisation for the index stroke. Multivariable-adjusted Poisson regression analyses were conducted to assess the association of comorbid cancer with post-stroke outcomes: clinically assessed poor functional outcomes (mRS score, 3-6), functional dependency (mRS score, 3-5), and mortality (mRS score, 6) at 3 months after stroke onset.</p><p><strong>Results: </strong>Of 13,047 patients (aged 71.1 ± 12.3 years, 62.8% men) with acute ischaemic stroke, 2,027 (15.6%) had comorbid cancer. Among those with no cancer, 24.0% recorded poor functional outcomes; with non-active cancer, 30.7%; and with active cancer, 46.1%. The risk ratios (95% confidence interval) for poor functional outcome at 3 months increased with active cancer (1.50 [1.37-1.65] vs. no cancer) and recently diagnosed cancer (7 months-4 years: 1.43 [1.28-1.59], ≤6 months: 1.53 [1.36-1.72]) after adjusting for potential confounders. These associations were observed for both 3-month functional dependency and mortality. No significant heterogeneity was observed in these associations across sex, nutritional status, inflammatory status, or coagulation status, except for age and stroke severity. The strongest association with 3-month poor functional outcome was observed for pancreatic cancer, followed by gallbladder and biliary tract, liver, and colon cancers.</p><p><strong>Conclusions: </strong>Comorbid cancer is likely to be independently associated with unfavourable outcomes in patients with acute ischaemic stroke.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662298","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":"Stroke Medicine Is Frailty Medicine: Clinical and Research Priorities for Frailty in Stroke.","authors":"Nicholas R Evans, Jatinder S Minhas, Lucy C Beishon, Terence J Quinn","doi":"10.1159/000545288","DOIUrl":"10.1159/000545288","url":null,"abstract":"","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639561","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":"Impact of Body Mass Index on Outcome of Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke in China: A Post Hoc Analysis of DIRECT-MT Trial.","authors":"Qingyuan Wu, Xiangyu Chen, Yina Wu, Limin Ma, Yongpin Chen, Wenqing Zhang, Rong Deng, Jin Liu, Lei Zhang, Zifu Li, Pengfei Xing, Yongwei Zhang, Pengfei Yang, Yue Liu, Peng Xie, Lijun Wang, Shengli Chen, Jianmin Liu","doi":"10.1159/000544907","DOIUrl":"10.1159/000544907","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The impact of body mass index (BMI) on outcomes after mechanical thrombectomy (MT) for large vessel occlusion acute ischemic stroke (LVOS) has been a subject of controversy, mainly due to the so-called obesity paradox. The obesity paradox refers to the phenomenon where, contrary to expectations, overweight or obese individuals seem to have better clinical outcomes in certain disease states. This study aimed to investigate the relationship between BMI and the clinical prognosis of patients with LVOS treated with endovascular thrombectomy (EVT) combined with or without intravenous alteplase in DIRECT-MT (Direct Intra-arterial Thrombectomy to Revascularize Acute Ischemic Stroke Patients with Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals: A Multicenter Randomized Clinical Trial).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a post hoc analysis of the DIRECT-MT randomized trial. Patients were randomly allocated to undergo EVT after alteplase intravenous thrombolysis (IVT) (IVT+EVT group) or EVT alone (EVT group) at a 1:1 ratio. Among 656 randomized patients, 645 with baseline BMI information were included. The BMI was analyzed as a categorical variable, and all patients were categorized according to their BMI into 3 groups: 18.5 ≤ BMI &lt;24 kg/m2 (normal weight), 24 ≤ BMI &lt;28 kg/m2 (overweight), and BMI ≥28 kg/m2 (obese). The primary outcome was the 90-day modified Rankin Scale (mRS) score analyzed as a continuous variable. Multivariable ordinal logistic regression with an interaction term was used to estimate treatment allocation and the BMI subgroups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 645 patients were enrolled in this study, 373 (57.8%) were normal weight, 208 (32.2%) were overweight, and 64 (10.0%) were obese. In all, 175 (46.9%) normal-weight patients, 114 (54.8%) overweight patients, and 31 (48.4%) obese patients underwent direct EVT. Patients in the three groups were statistically different in age (71 versus 68, 66), time from randomization to groin puncture (31 versus 32, 39.5), time from randomization to revascularization (101.5 versus 92, 116), and time from admission to groin puncture (84 versus 83, 98.5). Other baseline and procedural characteristics were comparable. No significant difference for the ordinal mRS or 90-day mortality was observed by BMI (adjusted common odds ratio [acOR] was 0.92 [95% CI 0.64 to 1.32] for normal weight, 1.36 [95% CI 0.83 to 2.22] for overweight, and 1.09 [95% CI 0.45 to 2.64] for obese) and treatment allocation interaction (the adjusted p value for interaction was 0.335 [normal weight versus overweight], 0.761 [normal weight versus obese], and 0.733 [overweight versus obese]). For the procedural complications and other clinical and imaging outcomes, no significant differences were observed between the BMI and treatment allocation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The results demonstrated that BMI had no association with the final outcome whether the pa","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-12"},"PeriodicalIF":2.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540366","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}