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Plasma metabolites, systolic blood pressure, lifestyle, and stroke risk: A prospective cohort study. 血浆代谢物、收缩压、生活方式和中风风险:基于英国生物库的队列研究。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-07 DOI: 10.1177/17474930241293408
Canjia Zhang, Mingxiao Li, Miaomiao Yang, Jiaqi Lin, Jinyao Huang, Ying Lin, Xi Chen, Yongqiang Liang, Yuanhai Yang, Ziyuan Yu, Dongsheng Hu, Ming Zhang, Fulan Hu

Background: To estimate the associations of stroke risk with plasma metabolites, metabolic risk score (MRS), the combinations of MRS with hypertension or lifestyle, and lifestyle-related metabolic signature. To assess the improvement of the stroke risk prediction model through the incorporation of MRS.

Methods: A total of 77,315 participants from the UK Biobank were included in this study. Xgboost and LASSO-Cox regression were used to select metabolites and construct MRS. Elastic net regression was utilized to construct the lifestyle-related metabolic signature. Multivariate Cox regression was used to estimate the associations between metabolites, MRS, the combinations of MRS with hypertension or lifestyle, lifestyle-related metabolic signature, and stroke risk.

Results: We identified 48, 63, 39, and 4 metabolites associated with the risk of stroke, ischemic stroke (IS), subarachnoid hemorrhage (SAH), and intracerebral hemorrhage (ICH), respectively. High MRS significantly increased the risk of stroke (HR = 2.65 (95% confidence interval (CI): 2.09-3.35)), IS (HR = 2.45 (95% CI: 1.89-3.17)), ICH (HR = 2.74 (95% CI: 1.55-4.85)), and SAH (HR = 4.64 (95% CI: 2.25-9.56)). In the combination analyses, compared with normal systolic blood pressure (SBP) and low MRS, normal/high SBP, and high MRS significantly increased stroke risk (HR = 5.80 (95% CI: 2.75-12.27)/6.37 (95% CI: 3.22-12.62)). A favorable/unfavorable lifestyle and high MRS also significantly increased stroke risk (HR = 2.38 (95% CI: 1.73-3.28)/3.86 (95% CI: 2.63-5.67)) compared with a favorable lifestyle and low MRS. Incorporating MRS into the 15-year stroke and IS risk prediction model increased the areas under the curves (AUCs) from 0.746 to 0.766 and from 0.771 to 0.811, respectively. The metabolic signature was correlated with adherence to a healthy lifestyle (r = 0.414; P = 2.22e-16) and inversely associated with stroke risk (HR = 0.80 (95% CI: 0.73-0.86)).

Conclusions: Various metabolites and MRS were significantly associated with the risk of stroke, IS, ICH, and SAH. Individuals with a high MRS may face an elevated stroke risk among populations with high SBP or unhealthy lifestyle, even those with normal SBP or healthy lifestyle. MRS provided modest improvement to the stroke risk prediction model. The lifestyle-related metabolic signature could reduce 20% stroke risk.

背景 估计中风风险与血浆代谢物、代谢风险评分(MRS)、MRS 与高血压或生活方式的组合以及与生活方式相关的代谢特征之间的关联。评估纳入 MRS 后中风风险预测模型的改进情况。方法 本研究共纳入了英国生物库中的 77315 名参与者。使用 Xgboost 和 LASSO-COX 回归选择代谢物并构建 MRS。弹性网回归用于构建与生活方式相关的代谢特征。多变量 Cox 回归用于估计代谢物、MRS、MRS 与高血压或生活方式的组合、生活方式相关代谢特征和中风风险之间的关联。结果 我们发现分别有 48、63、39 和 4 种代谢物与中风、缺血性中风(IS)、蛛网膜下腔出血(SAH)和脑内出血(ICH)的风险有关。高 MRS 会明显增加中风(HR= 2.65 [95%CI 2.09-3.35])、IS(HR= 2.45 [95%CI 1.89-3.17])、ICH(HR= 2.74 [95%CI 1.55-4.85])和 SAH(HR= 4.64 [95%CI 2.25-9.56])的风险。在组合分析中,与正常 SBP 和低 MRS 相比,正常/高 SBP 和高 MRS 会显著增加卒中风险(HR= 5.80 [95%CI: 2.75-12.27]/6.37 [95%CI 3.22-12.62])。与良好的生活方式和低 MRS 相比,良好/不良好的生活方式和高 MRS 也会显著增加卒中风险(HR= 2.38 [95% CI: 1.73-3.28]/3.86 [95% CI 2.63-5.67])。将 MRS 纳入 15 年中风和 IS 风险预测模型后,AUC 分别从 0.746 增加到 0.766 和从 0.771 增加到 0.811。代谢特征与是否坚持健康的生活方式相关(r = 0.414;P = 2.22e-16),与卒中风险成反比(HR= 0.80 [95% CI 0.73-0.86])。结论 各种代谢物和 MRS 与脑卒中、IS、ICH 和 SAH 风险显著相关。在 SBP 高或生活方式不健康的人群中,MRS 高的人可能面临更高的卒中风险,即使是那些 SBP 正常或生活方式健康的人也是如此。MRS 对中风风险预测模型的改善不大。与生活方式相关的代谢特征可降低 20% 的中风风险。
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引用次数: 0
Detection of atrial fibrillation after stroke due to large or small vessel disease: Systematic review and meta-analysis. 大血管或小血管疾病导致中风后心房颤动的检测:系统回顾和荟萃分析。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-06 DOI: 10.1177/17474930241292988
Matilda Florentin, Dimitrios Sagris, Panagiotis Tasoudis, Eleni Korompoki, Roland Veltkamp, Lucio D'Anna, Rolf Wachter, Haralampos Milionis, George Ntaios

Background: Emerging evidence indicates a frequent occurrence of atrial fibrillation (AF) detection among patients with established causes of ischemic stroke unrelated to AF. This systematic review and meta-analysis aimed to evaluate AF detection rates in stroke patients with large or small vessel disease, considering the AF detection modality and duration of cardiac rhythm monitoring.

Aims: We conducted a comprehensive search of PubMed and Scopus databases up to 2 March 2024, to identify randomized controlled trials, non-randomized prospective studies, and retrospective studies assessing the frequency of AF detection in stroke patients with large or small vessel disease. The primary outcome of interest was the rate of AF detection. We utilized inverse-variance weights to produce the pooled prevalence (effect size (ES)) and 95% confidence interval (CI) of patients diagnosed with post-stroke AF.

Summary of review: In the analysis of 14 eligible studies encompassing 4334 patients, AF was identified in 154 out of 2082 patients with strokes attributed to small or large vessel disease, yielding a pooled prevalence of 6.27% (ES; 95% confidence interval (CI): 3.18-10.17, I2 = 87.83%). Among patients with large vessel disease strokes, AF was diagnosed in 79 out of 1042 patients, accounting for a pooled prevalence of 5.07% (ES; 95% CI: 1.30-10.33, I2 = 77.05%). Similarly, among those with small vessel disease strokes, AF was detected in 75 out of 1040 patients, with a pooled prevalence of 5.03% (ES; 95% CI: 1.96-9.06, I2 = 78.05%).

Conclusions: AF is often found in ischemic stroke patients with large or small vessel disease. Detection rates increase with longer cardiac rhythm monitoring. The safety and benefits of oral anticoagulation for these AF episodes are uncertain.

背景:新的证据表明,与房颤无关的缺血性卒中已有明确病因的患者中经常出现房颤检测。目的:我们对截至 2024 年 3 月 2 日的 PubMed 和 Scopus 数据库进行了全面检索,以确定评估大血管或小血管疾病卒中患者房颤检出率的随机对照试验、非随机前瞻性研究和回顾性研究。我们关注的主要结果是房颤的检出率。我们利用逆方差加权法得出了被诊断为卒中后房颤患者的汇总患病率(效应大小-ES)和 95% 置信区间(CI):在对14项符合条件的研究(包括4334名患者)进行的分析中,在2082名因小血管或大血管疾病导致卒中的患者中,有154人被确诊为房颤,汇总患病率为6.27%(ES;95%置信区间[CI]:3.18-10.17,I2=87.83%)。在大血管疾病脑卒中患者中,1,042 位患者中有 79 位确诊为房颤,汇总患病率为 5.07%(ES;95% 置信区间 [CI]:1.30-10.33,I2=77.05%)。同样,在小血管疾病脑卒中患者中,1,040 位患者中有 75 位检测到房颤,总患病率为 5.03% (ES;95% CI:1.96-9.06,I2=78.05%):结论:心房颤动常出现在患有大血管或小血管疾病的缺血性卒中患者中。结论:心房颤动常在患有大血管或小血管疾病的缺血性卒中患者中发现,随着心律监测时间的延长,发现率也会增加。口服抗凝药对这些房颤发作的安全性和益处尚不确定。
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引用次数: 0
Unveiling connections between venous disruption and cerebral small vessel disease using diffusion tensor image analysis along perivascular space (DTI-ALPS): A 7-T MRI study. 利用沿血管周围空间的弥散张量图像分析(DTI-ALPS)揭示静脉破坏与脑小血管疾病之间的联系:7T 磁共振成像研究。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-06 DOI: 10.1177/17474930241293966
Xue Zhang, Xun Pei, Yulu Shi, Yingying Yang, Xiaoyan Bai, Tong Chen, Yuanbin Zhao, Qianqian Yang, Jinyi Ye, Xinyi Leng, Qi Yang, Ruiliang Bai, Yilong Wang, Binbin Sui

Background: Cerebral venous disruption is one of the characteristic findings in cerebral small vessel disease (CSVD), and its disruption may impede perivascular glymphatic drainage. And lower diffusivity along perivascular space (DTI-ALPS) index has been suggested to be with the presence and severity of CSVD. However, the relationships between venous disruption, DTI-ALPS index, and CSVD neuroimaging features remain unclear.

Aims: To investigate the association between venous integrity and perivascular diffusion activity, and explore the mediating role of DTI-ALPS index between venous disruption and CSVD imaging features.

Methods: In this cross-sectional study, 31 patients (mean age, 59.0 ± 9.9 years) were prospectively enrolled and underwent 7-T magnetic resonance (MR) imaging. DTI-ALPS index was measured to quantify the perivascular diffusivity. The visibility and continuity of deep medullary veins (DMVs) were evaluated based on a brain region-based visual score on high-resolution susceptibility-weighted imaging. White matter hyperintensity (WMH) and perivascular space (PVS) were assessed using qualitative and quantitative methods. Linear regression and mediation analysis were performed to analyze the relationships among DMV scores, DTI-ALPS index, and CSVD features.

Results: The DTI-ALPS index was significantly associated with the parietal DMV score (β = -0.573, p corrected = 0.004). Parietal DMV score was associated with WMH volume (β = 0.463, p corrected = 0.013) and PVS volume in basal ganglia (β = 0.415, p corrected = 0.028). Mediation analyses showed that DTI-ALPS index manifested a full mediating effect on the association between parietal DMV score and WMH (indirect effect = 0.115, Pm = 43.1%), as well as between parietal DMV score and PVS volume in basal ganglia (indirect effect = 0.161, Pm = 42.8%).

Conclusion: Cerebral venous disruption is associated with glymphatic activity, and with WMH and PVS volumes. Our results suggest cerebral venous integrity may play a critical role in preserving perivascular glymphatic activity; while disruption of small veins may impair the perivascular diffusivity, thereby contributing to the development of WMH and PVS enlargement.

背景:脑静脉阻塞是脑小血管病(CSVD)的特征性表现之一,其阻塞可能会阻碍血管周围的甘油引流。而较低的沿血管周围间隙弥散指数(DTI-ALPS)被认为与 CSVD 的存在和严重程度有关。目的:研究静脉完整性与血管周围弥散活动之间的关系,并探讨DTI-ALPS指数在静脉破坏与CSVD影像学特征之间的中介作用:在这项横断面研究中,31 名患者(平均年龄为 59.0 ± 9.9 岁)接受了 7T 磁共振成像检查。通过测量 DTI-ALPS 指数来量化血管周围弥散度。根据基于脑区的高分辨率感性加权成像视觉评分,对髓深静脉(DMV)的可见性和连续性进行了评估。采用定性和定量方法对白质高密度(WMH)和血管周围空间(PVS)进行了评估。对DMV评分、DTI-ALPS指数和CSVD特征之间的关系进行了线性回归和中介分析:结果:DTI-ALPS指数与顶叶DMV得分显著相关[β = -0.573,p校正 = 0.004]。顶叶 DMV 评分与 WMH 体积[β = 0.463,p 校正 = 0.013]和基底节 PVS 体积(β = 0.415,p 校正 = 0.028)相关。中介分析显示,DTI-ALPS指数对顶叶DMV评分与WMH(间接效应=0.115,Pm=43.1%)以及顶叶DMV评分与基底节PVS体积(间接效应=0.161,Pm=42.8%)之间的关联具有完全中介效应:结论:脑静脉破坏与甘油活动、WMH和PVS体积有关。我们的研究结果表明,脑静脉的完整性可能在保持血管周围甘油活性方面起着关键作用;而小静脉的破坏可能会损害血管周围的弥散性,从而导致 WMH 和 PVS 扩大。
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引用次数: 0
Elevated risk of end-stage kidney disease in stroke patients: A population-based observational study. 中风患者罹患终末期肾病的风险升高:一项基于人群的观察研究
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-05 DOI: 10.1177/17474930241295890
Sohyun Chun, Kyungdo Han, Bongseong Kim, Dagyeong Lee, In Young Cho, Hea Lim Choi, Jun Hee Park, Junseok Jeon, Hye Ryoun Jang, Dong Wook Shin

Background: Estimating the incidence of end-stage kidney disease (ESKD) in stroke survivors is important to assess and predict clinical course, improve post-stroke quality of life, and ultimately reduce health burden.

Aim: Our objective was to assess the risk of ESKD in patients compared to a matched stroke-free control cohort.

Methods: A nationwide retrospective cohort study was conducted in 315,326 stroke subjects and 390,781 matched stroke-free control subjects. Health examination results and claims data were collected from the Korean National Health Insurance Service during 2010-2018. Cox proportional hazard models were used to assess the risk of ESKD in the stroke cohort.

Results: During a mean follow-up period of 4.3 years, the incidence of ESKD was 1.83 per 100,000 person-years in the stroke cohort versus 0.57 per 100,000 person-years in the control cohort. The stroke cohort exhibited a significantly higher risk of developing ESKD compared to the matched control, with an adjusted hazard ratio (aHR) of 1.79 (95% confidence interval (CI) = 1.67-1.93). Stroke survivors were associated with a higher risk of developing ESKD, regardless of the severity of disability (aHRs of 1.93, 95% CI = 1.69-2.21 for severe disability; 1.71, 95% CI = 1.41-2.07 for mild disability; and 1.78, 95% CI = 1.65-1.92 for no disability), compared to the matching control cohort. The elevated risk was observed in both hemorrhagic stroke (aHR = 1.96, 95% CI = 1.73-2.23) and ischemic stroke (aHR = 1.75, 95% CI = 1.62-1.89).

Conclusions: This study demonstrates that stroke patients have a significantly higher risk of incident ESKD. This highlights the need for heightened clinical awareness and improved monitoring of kidney function in this population.

背景:目的:我们的目标是评估与匹配的无中风对照组相比,患者发生终末期肾病(ESKD)的风险:方法:对 315 326 名脑卒中受试者和 390 781 名匹配的无脑卒中对照受试者进行了一项全国性的回顾性队列研究。从韩国国民健康保险服务机构收集了 2010-2018 年期间的健康检查结果和理赔数据。研究采用 Cox 比例危险模型评估中风队列中患 ESKD 的风险:结果:在平均 4.3 年的随访期间,脑卒中队列中 ESKD 的发病率为每 10 万人年 1.83 例,而对照队列中为每 10 万人年 0.57 例。与匹配的对照组相比,脑卒中队列患 ESKD 的风险明显更高,调整后的危险比 (aHR) 为 1.79(95% 置信区间 [CI] 1.67-1.93)。与匹配的对照组相比,无论残疾程度如何,中风幸存者患 ESKD 的风险都更高(重度残疾的 aHR 为 1.93,95% 置信区间 [CI] 为 1.69-2.21;轻度残疾的 aHR 为 1.71,95% 置信区间 [CI] 为 1.41-2.07;无残疾的 aHR 为 1.78,95% 置信区间 [CI] 为 1.65-1.92)。出血性中风(aHR 1.96,95% CI 1.73-2.23)和缺血性中风(aHR 1.75,95% CI 1.62-1.89)的风险均有所升高:本研究表明,中风患者发生 ESKD 的风险明显更高。结论:该研究表明,中风患者发生 ESKD 的风险明显升高,因此需要提高临床意识并改善对该人群肾功能的监测。
{"title":"Elevated risk of end-stage kidney disease in stroke patients: A population-based observational study.","authors":"Sohyun Chun, Kyungdo Han, Bongseong Kim, Dagyeong Lee, In Young Cho, Hea Lim Choi, Jun Hee Park, Junseok Jeon, Hye Ryoun Jang, Dong Wook Shin","doi":"10.1177/17474930241295890","DOIUrl":"10.1177/17474930241295890","url":null,"abstract":"<p><strong>Background: </strong>Estimating the incidence of end-stage kidney disease (ESKD) in stroke survivors is important to assess and predict clinical course, improve post-stroke quality of life, and ultimately reduce health burden.</p><p><strong>Aim: </strong>Our objective was to assess the risk of ESKD in patients compared to a matched stroke-free control cohort.</p><p><strong>Methods: </strong>A nationwide retrospective cohort study was conducted in 315,326 stroke subjects and 390,781 matched stroke-free control subjects. Health examination results and claims data were collected from the Korean National Health Insurance Service during 2010-2018. Cox proportional hazard models were used to assess the risk of ESKD in the stroke cohort.</p><p><strong>Results: </strong>During a mean follow-up period of 4.3 years, the incidence of ESKD was 1.83 per 100,000 person-years in the stroke cohort versus 0.57 per 100,000 person-years in the control cohort. The stroke cohort exhibited a significantly higher risk of developing ESKD compared to the matched control, with an adjusted hazard ratio (aHR) of 1.79 (95% confidence interval (CI) = 1.67-1.93). Stroke survivors were associated with a higher risk of developing ESKD, regardless of the severity of disability (aHRs of 1.93, 95% CI = 1.69-2.21 for severe disability; 1.71, 95% CI = 1.41-2.07 for mild disability; and 1.78, 95% CI = 1.65-1.92 for no disability), compared to the matching control cohort. The elevated risk was observed in both hemorrhagic stroke (aHR = 1.96, 95% CI = 1.73-2.23) and ischemic stroke (aHR = 1.75, 95% CI = 1.62-1.89).</p><p><strong>Conclusions: </strong>This study demonstrates that stroke patients have a significantly higher risk of incident ESKD. This highlights the need for heightened clinical awareness and improved monitoring of kidney function in this population.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241295890"},"PeriodicalIF":6.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of time from symptom onset to puncture, and puncture to reperfusion, in endovascular therapy in the late time window (>6 hours). 晚期时间窗(>6 小时)内的血管内治疗中,从症状出现到穿刺的时间以及从穿刺到再灌注的时间的影响。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-05 DOI: 10.1177/17474930241300073
Agathe Sadeler, Stephanos Finitsis, Jean-Marc Olivot, Sebastien Richard, Gaultier Marnat, Igor Sibon, Lionel Calviere, Christophe Cognard, Mikael Mazighi, Jean-Philippe Desilles, Bertrand Lapergue, Ruben Tamazyan, Mathieu Zuber, Benjamin Gory, Benjamin Maier

Background- Increased times from symptom onset to puncture (TSOP) and from puncture to reperfusion (TPTR) are associated with worse outcome in ischemic stroke patients treated with endovascular therapy (EVT) in the early time window (<6 hours). However, these associations are less described in the late window (>6 hours), where patients may benefit from EVT because of a more favorable imaging profile (late window paradox). We sought to compare the effect of these timeframes between these two periods on efficacy and safety outcomes.Methods- The ETIS Registry (Endovascular Treatment in Ischemic Stroke) is an ongoing, prospective, observational study in 21 centers that perform EVT in France. We included adult patients with an anterior occlusion, successfully treated by EVT (mTICI 2b-3) between January 2015 and June 2023, with a known time of stroke onset. The cohort was divided into 2 groups according to the TSOP (≤6h vs >6h). Primary outcome was favorable outcome (modified Rankin Scale 0-2 at 90 days).Results- 7,516 patients were included, with 5,936 patients being treated ≤6h and 1,580 >6h. In the early window, TSOP and TPTR were associated with worse outcomes at 90 days (adjusted OR=0.68 per hour; 95%CI, 0.64-0.73; p<0.001 and aOR=0.92 per 10 minutes increment; 95%CI, 0.90-0.94, p<0.001, respectively). TSOP was not associated with worse outcomes at 90 days in the late window (p=0.955), but TPTR was associated with worse outcomes (aOR=0.91 per 10 minutes increment; 95%CI, 0.86-0.96, p=0.001), every 10 additional minutes in TPTR being associated with a 1.7% (95%CI, 0.6%-2.7%) decreased probability of favorable outcome.Conclusions- Only EVT procedural time is associated to unfavorable outcomes at 90 days in late window patients. These results highlight how the late window paradox may end at the start of EVT and underscore the need for timely management, particularly for the EVT, even for late window patients with a presumed more favorable imaging profile.

背景-缺血性卒中患者从症状出现到穿刺(TSOP)和从穿刺到再灌注(TPTR)的时间延长与早期时间窗(6小时)内接受血管内治疗(EVT)的患者预后较差有关,在早期时间窗内接受EVT治疗的患者可能因更有利的影像学特征而受益(晚期时间窗悖论)。我们试图比较这两个时间段对疗效和安全性结果的影响。方法--ETIS 注册(缺血性脑卒中血管内治疗)是一项正在进行的前瞻性观察研究,在法国 21 个开展 EVT 的中心进行。我们纳入了在2015年1月至2023年6月期间通过EVT(mTICI 2b-3)成功治疗的前部闭塞的成年患者,他们的卒中发病时间都是已知的。根据TSOP(≤6小时 vs >6小时)将患者分为两组。结果 - 共纳入 7516 名患者,其中 5936 名患者接受了≤6 小时的治疗,1580 名患者接受了>6 小时的治疗。在早期窗口期,TSOP 和 TPTR 与 90 天后较差的预后相关(调整后 OR=0.68/h; 95%CI, 0.64-0.73; p
{"title":"Impact of time from symptom onset to puncture, and puncture to reperfusion, in endovascular therapy in the late time window (>6 hours).","authors":"Agathe Sadeler, Stephanos Finitsis, Jean-Marc Olivot, Sebastien Richard, Gaultier Marnat, Igor Sibon, Lionel Calviere, Christophe Cognard, Mikael Mazighi, Jean-Philippe Desilles, Bertrand Lapergue, Ruben Tamazyan, Mathieu Zuber, Benjamin Gory, Benjamin Maier","doi":"10.1177/17474930241300073","DOIUrl":"https://doi.org/10.1177/17474930241300073","url":null,"abstract":"<p><p>Background- Increased times from symptom onset to puncture (TSOP) and from puncture to reperfusion (TPTR) are associated with worse outcome in ischemic stroke patients treated with endovascular therapy (EVT) in the early time window (<6 hours). However, these associations are less described in the late window (>6 hours), where patients may benefit from EVT because of a more favorable imaging profile (late window paradox). We sought to compare the effect of these timeframes between these two periods on efficacy and safety outcomes.Methods- The ETIS Registry (Endovascular Treatment in Ischemic Stroke) is an ongoing, prospective, observational study in 21 centers that perform EVT in France. We included adult patients with an anterior occlusion, successfully treated by EVT (mTICI 2b-3) between January 2015 and June 2023, with a known time of stroke onset. The cohort was divided into 2 groups according to the TSOP (≤6h vs >6h). Primary outcome was favorable outcome (modified Rankin Scale 0-2 at 90 days).Results- 7,516 patients were included, with 5,936 patients being treated ≤6h and 1,580 >6h. In the early window, TSOP and TPTR were associated with worse outcomes at 90 days (adjusted OR=0.68 per hour; 95%CI, 0.64-0.73; p<0.001 and aOR=0.92 per 10 minutes increment; 95%CI, 0.90-0.94, p<0.001, respectively). TSOP was not associated with worse outcomes at 90 days in the late window (p=0.955), but TPTR was associated with worse outcomes (aOR=0.91 per 10 minutes increment; 95%CI, 0.86-0.96, p=0.001), every 10 additional minutes in TPTR being associated with a 1.7% (95%CI, 0.6%-2.7%) decreased probability of favorable outcome.Conclusions- Only EVT procedural time is associated to unfavorable outcomes at 90 days in late window patients. These results highlight how the late window paradox may end at the start of EVT and underscore the need for timely management, particularly for the EVT, even for late window patients with a presumed more favorable imaging profile.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241300073"},"PeriodicalIF":6.3,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142580983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diagnosis and management of adult Moyamoya angiopathy: An overview of guideline recommendations and identification of future research directions. 成人莫亚莫亚血管病变的诊断和管理:指南建议概述及未来研究方向的确定。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-04 DOI: 10.1177/17474930241297031
Nicola Rifino, Dominique Hervè, Francesco Acerbi, Satoshi Kuroda, Giuseppe Lanzino, Peter Vajkoczy, Anna Bersano

Despite the progress made in understanding the management and outcomes of Moyamoya angiopathy (MMA), several aspects of the disease remain largely unknown. In particular, evidence on the disease history and management of MMA is lacking, mainly due to methodological and selection biases in the available studies and the lack of large, randomized prospective studies. Therefore, the care of MMA patients remains limited to a few expert centers worldwide, and management is often based on local expertise and available resources. Over the years, recommendations or expert opinions have been written to provide guidance to physicians in the treatment of this condition with the goal of reducing the risk of stroke recurrence and long-term disability. However, there is no complete agreement between the available guidelines and recommendations due to differences in the articles addressed, methodologies, expertise, and validated approaches to literature review. This lack of consensus on the management of MMA may confuse clinicians and highlight some important issues and points. The aim of this comprehensive review article is to critically examine three recent guidelines and recommendations on MMA, discussing their differences and similarities and highlighting gaps in MMA care that need to be covered.

尽管在了解莫亚莫亚血管病(MMA)的治疗和预后方面取得了进展,但该疾病的几个方面在很大程度上仍不为人所知。特别是缺乏有关 MMA 病史和治疗的证据,这主要是由于现有研究在方法和选择上存在偏差,以及缺乏大型随机前瞻性研究。因此,对 MMA 患者的治疗仍局限于全球少数几个专家中心,而管理往往基于当地的专业知识和可用资源。多年来,人们撰写了一些建议或专家意见,为医生治疗这种疾病提供指导,目的是降低中风复发和长期残疾的风险。然而,由于涉及的文章、方法、专业知识和文献综述的有效方法不同,现有指南和建议之间并不完全一致。对 MMA 的管理缺乏共识可能会使临床医生感到困惑,并突出了一些重要问题和要点。本综合综述论文旨在批判性地研究这三份最新的 MMA 指南,讨论它们之间的异同,并强调 MMA 护理中需要涵盖的空白点。
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引用次数: 0
Significance of cerebral microinfarcts in antiphospholipid syndrome: A population-based study. 抗磷脂综合征中脑微梗塞的重要性
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-31 DOI: 10.1177/17474930241293236
Jonathan Naftali, Rani Barnea, Ruth Eliahou, Walid Saliba, Sivan Bloch, Michael Findler, Ran Brauner, Tzippy Shochat, Avi Leader, Eitan Auriel

Background: Acute ischemic stroke (AIS) or transient ischemic attack (TIA) is the most common neurological manifestations of patients with antiphospholipid syndrome (APS). Incidental diffusion-weighted imaging (DWI) positive subcortical and cortical lesions, or acute incidental cerebral microinfarcts (CMI), are microscopic ischemic lesions, detectable on MRI for 10-14 days only. We aimed to look at the prevalence of acute incidental CMI in a cohort of patients with APS and their association with subsequent AIS or TIA.

Methods: This is a population-based cohort study of adults with APS diagnosis using International Statistical Classification-9 (ICD-9) and supporting laboratory results between January 2014 and April 2020. We included any patient undergoing brain MRI (index event) during the year prior APS diagnosis or at any time point following diagnosis. Age-matched subjects with negative APS laboratory workup were used as a control group. In the first analysis, we compared acute incidental CMI prevalence in both groups. We then performed a second analysis among APS patients only, comparing patients with and without acute incidental CMI for AIS or TIA as the primary outcome. Cox proportional hazards models used to calculate hazards ratio (HR) and 4 years cumulative risk.

Results: 292 patients were included, of which, 207 patients with APS. Thirteen patients with APS had acute incidental CMI on MRI (6.3%), compared with none in the control group (p = 0.013). Following multivariable analysis, APS was the sole factor associated with acute incidental CMI (p = 0.026). During a median follow-up of 4 years (IQR 3.5, 4) in patients with APS, following multivariable analysis, acute incidental CMI was associated with subsequent AIS or TIA (HR 6.73 [(95% CI, 1.96-23.11], p < 0.01).

Conclusion: Acute incidental CMI are more common among patients with APS than in patients with negative APS tests, and are associated with subsequent AIS or TIA. Detecting acute incidental CMI in patients with APS may guide etiological workup and reevaluation of antithrombotic regimen.

背景:急性缺血性卒中(AIS)或短暂性脑缺血发作(TIA)是抗磷脂综合征(APS)患者最常见的神经系统表现。偶然出现的弥散加权成像(DWI)阳性皮质下和皮质病变或急性偶然性脑微梗死(CMI)是微小的缺血性病变,只能在 10-14 天内通过核磁共振成像检测到。我们的目的是研究 APS 患者队列中急性偶发 CMI 的发病率及其与后续 AIS 或 TIA 的关联:这是一项基于人群的队列研究,研究对象是在 2014 年 1 月 1 日至 2020 年 4 月 4 日期间使用国际统计分类-9(ICD-9)诊断出 APS 并提供实验室结果支持的成年人。我们纳入了所有在 APS 诊断前一年或诊断后任何时间点接受脑磁共振成像(指数事件)检查的患者。年龄匹配、APS 实验室检查结果为阴性的患者作为对照组。在第一项分析中,我们比较了两组中急性偶发性 CMI 的发病率。然后,我们仅在 APS 患者中进行了第二项分析,以 AIS 或 TIA 为主要结果,比较了有急性偶发 CMI 和没有急性偶发 CMI 的患者。结果:共纳入 292 例患者,其中 207 例为 APS 患者。13名APS患者在磁共振成像中出现急性偶发性CMI(6.3%),而对照组中没有(P=0.013)。经过多变量分析,APS是与急性偶发CMI相关的唯一因素(P=0.026)。在对 APS 患者进行中位随访 4 年(IQR 3.5,4)期间,经过多变量分析,急性偶发 CMI 与随后的 AIS 或 TIA 相关(HR-6.73[(95% CI 1.96-23.11],p 结论:急性偶发 CMI 在 APS 患者中比在 APS 检测阴性的患者中更为常见,并且与随后的 AIS 或 TIA 相关。在 APS 患者中发现急性偶发 CMI 可为病因检查和重新评估抗血栓治疗方案提供指导。
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引用次数: 0
Early penumbral FLAIR changes predict tissue fate in patients with large vessel occlusions. 早期半影 FLAIR 变化可预测大血管闭塞患者的组织命运。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-21 DOI: 10.1177/17474930241289235
Lauranne Scheldeman, Pierre Seners, Anke Wouters, Patrick Dupont, Soren Christensen, Michael Mlynash, Caroline Arquizan, Adrien Ter Schiphorst, Vincent Costalat, Hilde Henon, Martin Bretzner, Jean-François Albucher, Christophe Cognard, Jean-Marc Olivot, Jeremy J Heit, Gregory W Albers, Maarten G Lansberg, Robin Lemmens

Background: In patients with an acute ischemic stroke, the penumbra is defined as ischemic tissue that remains salvageable when reperfusion occurs. However, the expected clinical recovery congruent with penumbral salvage is not always observed.

Aims: We aimed to determine whether the magnetic resonance imaging (MRI)-defined penumbra includes irreversible neuronal loss that impedes expected clinical recovery after reperfusion.

Methods: In the prospective French Acute Multimodal Imaging Study to Select Patients for Mechanical Thrombectomy (FRAME) and an observational cohort of patients with large vessel occlusions undergoing endovascular treatment, we quantified penumbral integrity by fluid-attenuated inversion recovery (FLAIR) changes. We studied the influence of recanalization status on the evolution of penumbral FLAIR changes and studied penumbral FLAIR changes as predictor of tissue fate and functional outcome on the 90-day modified Rankin Scale (mRS).

Results: Recanalization status did not modify the evolution of rFLAIR signal intensity (SI) over time in the total cohort, but was associated with lower SI in the FRAME subset (b = -0.06, p for interaction = 0.04). Median rFLAIR SI was higher at baseline in the subsequently infarcted penumbra compared to the salvaged (ratio = 1.07, standard deviation (SD) = 0.07 vs 1.03, SD = 0.06 p < 0.0001, n = 150). The severity and extent of rFLAIR SI changes did not predict 90-day functional outcome in univariate (p = 0.09) and multivariate logistic regression (p = 0.4).

Conclusions: Recanalization status did not influence the evolution of penumbral FLAIR changes. FLAIR SI changes in the baseline penumbra were associated with tissue fate, but not functional outcome.

背景:急性缺血性脑卒中患者的半影被定义为再灌注时仍可挽救的缺血组织。目的:我们旨在确定磁共振成像(MRI)定义的半影是否包括阻碍再灌注后预期临床恢复的不可逆神经元损失:在前瞻性的法国急性多模态成像研究(FRAME)和接受血管内治疗的大血管闭塞患者观察队列中,我们通过FLAIR变化量化了半影的完整性。我们研究了再通畅状态对半影FLAIR变化演变的影响,并研究了半影FLAIR变化作为组织命运和90天改良Rankin量表(mRS)功能结果的预测因子:再通畅状态并不改变rFLAIR信号强度(SI)随时间的变化,但在FRAME亚组中与较低的SI相关(b=-0.06,交互作用p=0.04)。随后梗死的半影中位rFLAIR SI基线高于挽救的半影(比值=1.07,标准差[SD] 0.07 vs 1.03,SD 0.06):再通畅状态并不影响半影 FLAIR 变化的演变。基线半影的FLAIR SI变化与组织命运有关,但与功能结果无关:支持本研究的数据可在合理要求下提供,但需签署数据访问协议。
{"title":"Early penumbral FLAIR changes predict tissue fate in patients with large vessel occlusions.","authors":"Lauranne Scheldeman, Pierre Seners, Anke Wouters, Patrick Dupont, Soren Christensen, Michael Mlynash, Caroline Arquizan, Adrien Ter Schiphorst, Vincent Costalat, Hilde Henon, Martin Bretzner, Jean-François Albucher, Christophe Cognard, Jean-Marc Olivot, Jeremy J Heit, Gregory W Albers, Maarten G Lansberg, Robin Lemmens","doi":"10.1177/17474930241289235","DOIUrl":"10.1177/17474930241289235","url":null,"abstract":"<p><strong>Background: </strong>In patients with an acute ischemic stroke, the penumbra is defined as ischemic tissue that remains salvageable when reperfusion occurs. However, the expected clinical recovery congruent with penumbral salvage is not always observed.</p><p><strong>Aims: </strong>We aimed to determine whether the magnetic resonance imaging (MRI)-defined penumbra includes irreversible neuronal loss that impedes expected clinical recovery after reperfusion.</p><p><strong>Methods: </strong>In the prospective French Acute Multimodal Imaging Study to Select Patients for Mechanical Thrombectomy (FRAME) and an observational cohort of patients with large vessel occlusions undergoing endovascular treatment, we quantified penumbral integrity by fluid-attenuated inversion recovery (FLAIR) changes. We studied the influence of recanalization status on the evolution of penumbral FLAIR changes and studied penumbral FLAIR changes as predictor of tissue fate and functional outcome on the 90-day modified Rankin Scale (mRS).</p><p><strong>Results: </strong>Recanalization status did not modify the evolution of rFLAIR signal intensity (SI) over time in the total cohort, but was associated with lower SI in the FRAME subset (b = -0.06, p for interaction = 0.04). Median rFLAIR SI was higher at baseline in the subsequently infarcted penumbra compared to the salvaged (ratio = 1.07, standard deviation (SD) = 0.07 vs 1.03, SD = 0.06 p < 0.0001, n = 150). The severity and extent of rFLAIR SI changes did not predict 90-day functional outcome in univariate (p = 0.09) and multivariate logistic regression (p = 0.4).</p><p><strong>Conclusions: </strong>Recanalization status did not influence the evolution of penumbral FLAIR changes. FLAIR SI changes in the baseline penumbra were associated with tissue fate, but not functional outcome.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241289235"},"PeriodicalIF":6.3,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Stroke severity and outcomes in patients with intracerebral hemorrhage on anticoagulants and antiplatelet agents: An analysis from the Japan Stroke Data Bank. 使用抗凝剂和抗血小板药物的脑内出血患者的中风严重程度和预后:来自日本中风数据库的分析。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-21 DOI: 10.1177/17474930241292022
Yoshito Arakaki, Sohei Yoshimura, Kazunori Toyoda, Kazutaka Sonoda, Shinichi Wada, Michikazu Nakai, Jin Nakahara, Masayuki Shiozawa, Junpei Koge, Akiko Ishigami, Kaori Miwa, Takako Torii-Yoshimura, Junji Miyazaki, Yoshihiro Miyamoto, Kazuo Minematsu, Masatoshi Koga

Background and aim: Some patients with intracerebral hemorrhage are on antithrombotic agents at the time of the event and these may worsen outcome, but the relative risk of different oral anticoagulants and antiplatelet agents is uncertain. We determined associations between pre-onset intake of antithrombotic agents and initial stroke severity, and outcomes, in patients with intracerebral hemorrhage.

Methods: Patients with intracerebral hemorrhage admitted within 24 h after onset between January 2017 and December 2020 and recruited to the Japan Stroke Data Bank, a hospital-based multicenter prospective registry, were included. Enrolled patients were classified into four groups based on the type of antithrombotic agents being used on admission. The outcomes were the National Institutes of Health Stroke Scale (NIHSS) score on admission and modified Rankin Scale (mRS) of 5-6 at discharge.

Results: Of a total 9810 patients with intracerebral hemorrhage (4267 females; mean age = 70 ± 15 years), 77.1% were classified into the no-antithrombotic group, 13.2% into the antiplatelet group, 4.0% into the warfarin group, and 5.8% into the direct oral anticoagulant (DOAC) group. Median (interquartile range) NIHSS score on admission was 12 (5-22), 13 (5-26), 15 (5-30), and 13 (6-24), respectively, in the four groups. In multivariable analysis, the prestroke warfarin use was associated with higher NIHSS score (adjusted incidence rate ratio = 1.09 (95% confidence interval (CI) = 1.06-1.13), with the no-antithrombotic group as the reference), but the antiplatelet group (1.00 (95% CI = 0.98-1.02)) and DOAC group (0.98 (95% CI = 0.95-1.01)) were not. The rate of mRS 5-6 at discharge was 30.8%, 41.9%, 48.6%, and 41.5%, respectively, in the four groups. In multivariable analysis, prestroke warfarin use was associated with mRS 5-6 (adjusted odds ratio = 1.90 (95% CI = 1.28-2.81), with the no-antithrombotic group as the reference), but the antiplatelet group (1.12 (95% CI = 0.91-1.37)) and DOAC group (1.25 (95% CI = 0.88-1.77)) were not.

Conclusion: Patients who were taking warfarin prior to intracerebral hemorrhage onset suffered more severe intracerebral hemorrhage as evidenced by higher admission NIHSS and higher discharge mRS. In contrast, no increase in severity was seen with antiplatelet agents.

背景和目的:一些脑出血患者在发病时服用了抗血栓药物,这些药物可能会恶化预后,但不同口服抗凝剂和抗血小板药物的相对风险尚不确定。我们确定了脑出血患者发病前服用抗血栓药物与最初中风严重程度及预后之间的关系:方法:纳入 2017 年 1 月至 2020 年 12 月间发病后 24 小时内入院的脑出血患者,这些患者被纳入日本卒中数据库(一个基于医院的多中心前瞻性登记系统)。入选患者根据入院时使用的抗血栓药物类型分为四组。结果为入院时美国国立卫生研究院卒中量表(NIHSS)评分和出院时改良Rankin量表(mRS)5-6分:在9810名脑出血患者中(女性4267人,平均年龄(70±15)岁),77.1%的患者属于无抗血栓药物组,13.2%的患者属于抗血小板组,4.0%的患者属于华法林组,5.8%的患者属于直接口服抗凝剂(DOAC)组。四组患者入院时的 NIHSS 评分中位数(四分位数间距)分别为 12(5-22)、13(5-26)、15(5-30)和 13(6-24)。在多变量分析中,卒中前使用华法林与较高的 NIHSS 评分相关(调整后发病率比为 1.09 [95%置信区间 (CI),1.06-1.13],以无抗血栓组为参照),但抗血小板组(1.00 [95%CI,0.98-1.02])和 DOAC 组(0.98 [95%CI,0.95-1.01])则不相关。四组患者出院时 mRS 5-6 的比例分别为 30.8%、41.9%、48.6% 和 41.5%。在多变量分析中,卒中前服用华法林与 mRS 5-6 相关(调整后的比值比:1.90 [95%CI,1.28-2.81],以无抗血栓组为参照),但抗血小板组(1.12 [95%CI,0.91-1.37])和 DOAC 组(1.25 [95%CI,0.88-1.77])与之无关:结论:脑出血发病前服用华法林的患者脑出血更严重,表现为入院时NIHSS更高,出院时mRS更高。相比之下,服用抗血小板药物的患者病情严重程度没有增加。
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引用次数: 0
Investigating undiagnosed Fabry disease in young adults with ischemic stroke: A multicenter cohort study. 调查缺血性中风青年患者中未确诊的法布里病:多中心队列研究
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-18 DOI: 10.1177/17474930241289864
Po-Yu Lin, Tien-Yu Lin, Sheng-Feng Sung, Helen L Po, Li-Chi Hsu, Sung-Chun Tang, Yen-Chu Huang, Cheng-Yang Hsieh, Yung-Chu Hsu, Ren-Ying Wu, Cheng-Chi Hsieh, Pi-Shan Sung, Chih-Hung Chen

Background: The global prevalence of ischemic stroke in young adults is increasing, leading to a significant social impact. Fabry disease is a recognized cause of ischemic stroke in young patients, and although disease-modifying treatments are available, further evidence is needed to confirm their effectiveness in reducing the incidence of ischemic strokes.

Aims: This study aimed to identify undiagnosed Fabry disease in young adult patients with ischemic stroke in a Taiwanese cohort.

Methods: This multicenter, prospective cohort study enrolled patients aged 20-55 years who had experienced an ischemic stroke or transient ischemic attack (TIA) within 10 days, from 1 January 2016 to 31 December 2020. Screening for Fabry disease was performed using a dry blood test to measure α-galactosidase activity in male patients and blood globotriaosylsphingosine (lyso-Gb3) levels in female patients. For patients with positive screen results, genetic diagnosis of Fabry disease was pursued through Sanger sequencing of the GLA gene, covering all exons and a segment of intron 4.

Results: A total of 977 patients (659 male, 68%) were enrolled from seven hospitals across Taiwan. Four patients (0.4%, all male) had positive screening results, and two patients (0.2%) were genetically diagnosed with Fabry disease. Case 1 had the GLA c.658C>T mutation and experienced ischemic stroke in the bilateral occipital regions. Case 2 had the GLA c.640-801G>A mutation and experienced an ischemic stroke in the left superficial watershed area.

Conclusion: The prevalence of undiagnosed Fabry disease in this cohort of Taiwanese young adults with ischemic stroke or TIA was 0.3% among the young male population. Understanding the prevalence of undiagnosed Fabry disease in young adults with ischemic stroke could help shape future Fabry disease screening policies.

Data access statement: The collected data will be available upon reasonable request from the corresponding author.

背景:全球青壮年缺血性中风的发病率正在上升,对社会造成了重大影响。法布里病是年轻患者缺血性脑卒中的公认病因之一,虽然目前已有改变病情的治疗方法,但还需要进一步的证据来证实其在降低缺血性脑卒中发病率方面的有效性:这项多中心、前瞻性队列研究招募了 20 至 55 岁、2016 年 1 月 1 日至 2020 年 12 月 31 日 10 天内经历过缺血性脑卒中或短暂性脑缺血发作 (TIA) 的患者。法布里病筛查采用干血检测法,男性患者检测α-半乳糖苷酶活性,女性患者检测血液中球蛋白鞘氨醇(lyso-Gb3)水平。对筛查结果呈阳性的患者,通过对 GLA 基因进行 Sanger 测序(包括所有外显子和一段 4 号内含子),进行法布里病的基因诊断:结果:共有来自台湾 7 家医院的 977 名患者(659 名男性,占 68%)参与了研究。4名患者(0.4%,均为男性)的筛查结果呈阳性,2名患者(0.2%)被基因诊断为法布里病。病例 1 患有 GLA c.658C>T 突变,双侧枕部缺血性中风。病例 2 患有 GLA c.640-801G>A 突变,左侧浅分水岭区域发生缺血性中风:结论:在这批患有缺血性中风或 TIA 的台湾年轻男性人群中,未确诊法布里病的患病率为 0.3%。了解缺血性中风青壮年中未确诊法布里病的患病率有助于制定未来的法布里病筛查政策。
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引用次数: 0
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International Journal of Stroke
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