Matthew M Smith, James R Brorson, Elena Badillo Goicoechea, Mary Penckofer, Kelsey Eklund, Christoph Stretz, Christina M Lineback, Farid Khasiyev, Deborah Kerrigan, Skylar Lewis, Hamid Ali, Hassan Aboul-Nour, Adam de Havenon, Collin J Culbertson, Emiliya Melkumova, Dinesh Jillella, Oana M Dumitrascu, Parth Parikh, Charles Doolittle, Ian Yahnke, Anvitha Sathya, Samantha Brown, Jieun Kang, Anna Bowman, Mahan Shahrivari, Cheran Elangovan, Siddharth Sehgal, Kelly L Sloane, Muhammad Alvi, Balaji Krishnaiah, Wayneho Kam, Sachin Kothari, Ahmad Abu Qdais, Mudassir Farooqui, Fadi Nahab, Gustavo Antezana Quintela, Richa Sharma, Neeharika Thottempudi, Simona Nedelcu, Franziska Herpich, Patrick Glover, Dalia Chahien, David S Liebeskind, Guillermo Linares, Jean-Philippe Daniel, Sami Al Kasab, Eesha Singh, Marissa D'Souza, Elizabeth Gaudio, Yasmin Aziz, Shadi Yaghi, Narendra Kala, Monica Sarkar, Eric D Goldstein, Lucia Chen, Russel Van Coevering, Jesse M Thon, Brian Stamm, Sean L Thompson, James E Siegler
{"title":"隐源性卒中颅内闭塞不能预测缺血性卒中复发：卒中预防和复发风险研究中心脏异常的倾向评分匹配分析","authors":"Matthew M Smith, James R Brorson, Elena Badillo Goicoechea, Mary Penckofer, Kelsey Eklund, Christoph Stretz, Christina M Lineback, Farid Khasiyev, Deborah Kerrigan, Skylar Lewis, Hamid Ali, Hassan Aboul-Nour, Adam de Havenon, Collin J Culbertson, Emiliya Melkumova, Dinesh Jillella, Oana M Dumitrascu, Parth Parikh, Charles Doolittle, Ian Yahnke, Anvitha Sathya, Samantha Brown, Jieun Kang, Anna Bowman, Mahan Shahrivari, Cheran Elangovan, Siddharth Sehgal, Kelly L Sloane, Muhammad Alvi, Balaji Krishnaiah, Wayneho Kam, Sachin Kothari, Ahmad Abu Qdais, Mudassir Farooqui, Fadi Nahab, Gustavo Antezana Quintela, Richa Sharma, Neeharika Thottempudi, Simona Nedelcu, Franziska Herpich, Patrick Glover, Dalia Chahien, David S Liebeskind, Guillermo Linares, Jean-Philippe Daniel, Sami Al Kasab, Eesha Singh, Marissa D'Souza, Elizabeth Gaudio, Yasmin Aziz, Shadi Yaghi, Narendra Kala, Monica Sarkar, Eric D Goldstein, Lucia Chen, Russel Van Coevering, Jesse M Thon, Brian Stamm, Sean L Thompson, James E Siegler","doi":"10.1161/JAHA.125.041500","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Intracranial occlusions in embolic stroke of undetermined source are histopathologically similar to cardiac sources of embolism. Whether patients with embolic stroke of undetermined source and intracranial occlusion benefit from anticoagulation is unknown.</p><p><strong>Methods: </strong>A multicenter retrospective cohort of adults with cryptogenic stroke was queried for patients with proximal or medium/distal vessel occlusion. The primary outcome was recurrent ischemic stroke, which was assessed in unadjusted and adjusted Cox proportional hazards models and repeated following 1:1 propensity score matching and biweight kernel density matching.</p><p><strong>Results: </strong>Of the 2328 patients who were followed over a median of 1.31 years (interquartile range, 0.34-2.85), 999 (42.6%) had an intracranial occlusion. When compared with patients without an intracranial occlusion, those with an occlusion had fewer atherosclerotic vascular risk factors, more severe symptoms, and less severe cerebral microvascular disease. The rate of recurrent stroke was similar between patients with versus without an intracranial occlusion (6.8%/year [95% CI, 5.7-8.2] versus 7.0%/year [95% CI 6.0-8.1]; adjusted hazard ratio [HR], 1.09 [95% CI, 0.77-1.55]). There was no association between occlusion and recurrent stroke in the adjusted propensity score matching (HR, 1.01 [95% CI, 0.64-1.59]) or kernel density models (HR, 0.95 [95% CI, 0.62-1.45]). There was no interaction between occlusion and treatment with anticoagulation, sex, age, or high-risk sources of embolism for the primary outcome in the unmatched and matched analyses.</p><p><strong>Conclusions: </strong>Intracranial occlusion in patients with embolic stroke of undetermined source is not associated with a greater risk of recurrence when compared with patients without an intracranial occlusion. There was no difference in rate of recurrent stroke with anticoagulation when stratified by presence or absence of occlusion.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e041500"},"PeriodicalIF":5.3000,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Intracranial Occlusion in Cryptogenic Stroke Is Not Predictive of Recurrent Ischemic Stroke: A Propensity-Score Matched Analysis of the Cardiac Abnormalities in Stroke Prevention and Risk of Recurrence Study.\",\"authors\":\"Matthew M Smith, James R Brorson, Elena Badillo Goicoechea, Mary Penckofer, Kelsey Eklund, Christoph Stretz, Christina M Lineback, Farid Khasiyev, Deborah Kerrigan, Skylar Lewis, Hamid Ali, Hassan Aboul-Nour, Adam de Havenon, Collin J Culbertson, Emiliya Melkumova, Dinesh Jillella, Oana M Dumitrascu, Parth Parikh, Charles Doolittle, Ian Yahnke, Anvitha Sathya, Samantha Brown, Jieun Kang, Anna Bowman, Mahan Shahrivari, Cheran Elangovan, Siddharth Sehgal, Kelly L Sloane, Muhammad Alvi, Balaji Krishnaiah, Wayneho Kam, Sachin Kothari, Ahmad Abu Qdais, Mudassir Farooqui, Fadi Nahab, Gustavo Antezana Quintela, Richa Sharma, Neeharika Thottempudi, Simona Nedelcu, Franziska Herpich, Patrick Glover, Dalia Chahien, David S Liebeskind, Guillermo Linares, Jean-Philippe Daniel, Sami Al Kasab, Eesha Singh, Marissa D'Souza, Elizabeth Gaudio, Yasmin Aziz, Shadi Yaghi, Narendra Kala, Monica Sarkar, Eric D Goldstein, Lucia Chen, Russel Van Coevering, Jesse M Thon, Brian Stamm, Sean L Thompson, James E Siegler\",\"doi\":\"10.1161/JAHA.125.041500\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Intracranial occlusions in embolic stroke of undetermined source are histopathologically similar to cardiac sources of embolism. Whether patients with embolic stroke of undetermined source and intracranial occlusion benefit from anticoagulation is unknown.</p><p><strong>Methods: </strong>A multicenter retrospective cohort of adults with cryptogenic stroke was queried for patients with proximal or medium/distal vessel occlusion. The primary outcome was recurrent ischemic stroke, which was assessed in unadjusted and adjusted Cox proportional hazards models and repeated following 1:1 propensity score matching and biweight kernel density matching.</p><p><strong>Results: </strong>Of the 2328 patients who were followed over a median of 1.31 years (interquartile range, 0.34-2.85), 999 (42.6%) had an intracranial occlusion. When compared with patients without an intracranial occlusion, those with an occlusion had fewer atherosclerotic vascular risk factors, more severe symptoms, and less severe cerebral microvascular disease. The rate of recurrent stroke was similar between patients with versus without an intracranial occlusion (6.8%/year [95% CI, 5.7-8.2] versus 7.0%/year [95% CI 6.0-8.1]; adjusted hazard ratio [HR], 1.09 [95% CI, 0.77-1.55]). There was no association between occlusion and recurrent stroke in the adjusted propensity score matching (HR, 1.01 [95% CI, 0.64-1.59]) or kernel density models (HR, 0.95 [95% CI, 0.62-1.45]). There was no interaction between occlusion and treatment with anticoagulation, sex, age, or high-risk sources of embolism for the primary outcome in the unmatched and matched analyses.</p><p><strong>Conclusions: </strong>Intracranial occlusion in patients with embolic stroke of undetermined source is not associated with a greater risk of recurrence when compared with patients without an intracranial occlusion. There was no difference in rate of recurrent stroke with anticoagulation when stratified by presence or absence of occlusion.</p>\",\"PeriodicalId\":54370,\"journal\":{\"name\":\"Journal of the American Heart Association\",\"volume\":\" \",\"pages\":\"e041500\"},\"PeriodicalIF\":5.3000,\"publicationDate\":\"2025-10-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Heart Association\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/JAHA.125.041500\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/9/25 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Heart Association","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/JAHA.125.041500","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/25 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Intracranial Occlusion in Cryptogenic Stroke Is Not Predictive of Recurrent Ischemic Stroke: A Propensity-Score Matched Analysis of the Cardiac Abnormalities in Stroke Prevention and Risk of Recurrence Study.
Background: Intracranial occlusions in embolic stroke of undetermined source are histopathologically similar to cardiac sources of embolism. Whether patients with embolic stroke of undetermined source and intracranial occlusion benefit from anticoagulation is unknown.
Methods: A multicenter retrospective cohort of adults with cryptogenic stroke was queried for patients with proximal or medium/distal vessel occlusion. The primary outcome was recurrent ischemic stroke, which was assessed in unadjusted and adjusted Cox proportional hazards models and repeated following 1:1 propensity score matching and biweight kernel density matching.
Results: Of the 2328 patients who were followed over a median of 1.31 years (interquartile range, 0.34-2.85), 999 (42.6%) had an intracranial occlusion. When compared with patients without an intracranial occlusion, those with an occlusion had fewer atherosclerotic vascular risk factors, more severe symptoms, and less severe cerebral microvascular disease. The rate of recurrent stroke was similar between patients with versus without an intracranial occlusion (6.8%/year [95% CI, 5.7-8.2] versus 7.0%/year [95% CI 6.0-8.1]; adjusted hazard ratio [HR], 1.09 [95% CI, 0.77-1.55]). There was no association between occlusion and recurrent stroke in the adjusted propensity score matching (HR, 1.01 [95% CI, 0.64-1.59]) or kernel density models (HR, 0.95 [95% CI, 0.62-1.45]). There was no interaction between occlusion and treatment with anticoagulation, sex, age, or high-risk sources of embolism for the primary outcome in the unmatched and matched analyses.
Conclusions: Intracranial occlusion in patients with embolic stroke of undetermined source is not associated with a greater risk of recurrence when compared with patients without an intracranial occlusion. There was no difference in rate of recurrent stroke with anticoagulation when stratified by presence or absence of occlusion.
期刊介绍：
As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice.
JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.
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