International Journal of Stroke最新文献

Background: The long-term non-motor outcome of young adults with ischemic stroke (IS) or transient ischemic attack (TIA) is poorly understood.

Aims: Therefore, in this observational cohort study, we explored the prevalence of impairment and factors influencing clinical and neuropsychological outcomes and return-to-work a decade post-stroke.

Methods: After a median follow-up duration of 10.4 years, 163 patients (median age at index event: 46.0 years, 44.8% female, 121 IS and 42 TIA) of the "Stroke in Young Fabry Patients study" attended an in-person follow-up in three European centers. We assessed clinical, neuropsychological, and return-to-work data.

Results: A decade post-stroke, most patients (74.8%) showed excellent outcome, scoring 0-1 on the modified Rankin Scale (mRS) and 68.0% had returned to work. However, at follow-up, 27.2% of patients showed cognitive impairment and 27.6% suffered from fatigue. Anxiety and depression were reported by 38.0% and 18.5%, respectively. Even among patients with excellent functional outcome (mRS 0-1), 24.6% showed cognitive problems, 37.7% suffered from anxiety, 22.1% from fatigue, and 12.4% from depression. Female patients had higher rates of anxiety (52.1% vs. 26.7%), fatigue (37.0% vs. 20.0%), and depression (27.4% vs. 11.2%), compared to male patients.In linear regression, female sex was associated with a higher likelihood for anxiety (odds ratio (OR = 2.89, 95% confidence interval (CI) = 0.62-5.16), fatigue (OR = 3.23, CI = 1.52-4.93), and depression (OR = 2.86, CI = 1.12-4.59). Hypertension at follow-up (52.1%) was associated with worse functional outcome (OR = 3.03, CI = 1.32-6.95), while patients smoking at follow-up (20.2%) had higher rates of anxiety (OR = 4.09, CI = 1.21-6.97) and depression (OR = 3.40, CI = 0.87-5.21).

Conclusions: Despite excellent functional outcome, many young stroke patients experience neuropsychological impairment, highlighting the need for targeted screening and treatment. Particularly young women are at higher risk for post-stroke depression, anxiety, and fatigue. Hypertension and smoking were modifiable risk factors contributing to worse outcomes in this young stroke cohort.

The incidence of ischemic stroke among young adults (aged 18-49 years) has risen over recent decades, particularly in high-income countries, contrasting with the decline seen in older populations. This trend represents a growing public health concern, as stroke at young age often leads to long-term psychosocial consequences and loss of productive life years. The increasing incidence may partly reflect a higher prevalence of traditional vascular risk factors, as well as the identification of non-traditional risk and trigger factors such as air pollution, sleep apnea, long working hours, vigorous exercise, and illicit drug use. Diagnostic evaluation in this young population is typically more extensive than in older patients, given the broad spectrum of potential underlying causes. A structured, multidisciplinary approach integrating vascular, hematologic, and cardiac assessment is essential for accurate etiological classification. Although functional outcomes are generally favorable, many young stroke survivors experience persistent psychosocial sequelae, including cognitive impairment, depression, anxiety, and fatigue, which significantly affect quality of life. Recurrence risk varies according to stroke etiology, with the lowest rates observed in patients with a cryptogenic stroke. These findings highlight the importance of more tailored secondary prevention strategies, as antiplatelet therapy is not without risks. Further research is needed to identify novel risk and trigger factors, refine prognostic tools, optimize secondary prevention, and develop interventions addressing the psychosocial recovery of young stroke survivors.

Background: Despite evidence linking periodontal disease to stroke risk, research investigating the potential mediating role of inflammatory markers and the modifying influence of genetic susceptibility in this relationship remains limited.

Aim: The study aimed to assess the association between self-reported high risk of periodontal disease and stroke, while exploring the potential mediating effects of inflammatory markers and the modifying influence of genetic susceptibility.

Methods: Using UK Biobank data, we investigated the association between high risk of periodontal disease and incident stroke using Cox proportional hazards regression models. Participants were classified as having a high risk of periodontal disease if they reported experiencing any of painful gums, bleeding gums, and/or loose teeth. We explored the potential mediating role of inflammatory markers in the observed association through mediation analyses. For genetic analyses, we calculated a genetic risk score (GRS) for stroke using 32 single nucleotide polymorphisms, stratified participants into tertiles, and conducted interaction analyses between GRS and periodontal disease risk with respect to both all stroke and ischemic stroke.

Results: The study included 442,648 participants, followed up for a median of 13.7 years. Participants with a high risk of periodontal disease showed significantly increased risk of all stroke (HR = 1.11, 95% CI: 1.05-1.16) and ischemic stroke (HR = 1.11, 95% CI: 1.05-1.18) after adjusting for confounders, but no significant associations were found for hemorrhagic stroke (HR = 1.08, 95% CI: 0.98-1.19). Mediation analyses showed that inflammatory markers partially mediated this relationship, with mediation effects ranging from 0.86% to 8.41% for all stroke and 1.03% to 9.58% for ischemic stroke. Genetic analyses revealed no significant interaction between high risk of periodontal disease and stroke GRS concerning the all stroke risk, but a significant interaction was found for ischemic stroke, with participants having both periodontal disease risk and a high GRS showing the highest risk (HR = 1.19, 95% CI: 1.07-1.32).

Conclusions: This study demonstrates a significant association between high periodontal disease risk and increased stroke risk, particularly ischemic stroke, with partial mediation by inflammatory markers and interaction with genetic risk factors.

Background: Patients with acute ischemic stroke and a large vessel occlusion admitted to non-endovascular capable centers frequently require inter-hospital transfer to a comprehensive stroke center (CSC) for thrombectomy. Data regarding arterial recanalization of patients with basilar artery occlusion (BAO) during transfer are lacking.

Methods: We analyzed prospectively collected data of acute stroke patients with BAO transferred for consideration of thrombectomy to three CSCs (Rothschild Hospital, France; Montpellier Hospital, France; Stanford Hospital, USA) between 2016 and 2024, with arterial imaging at the referring hospital and on CSC arrival. Inter-hospital recanalization was assessed by comparison of the baseline and post-transfer arterial imaging and was defined as 2a-3 on the modified Thrombolysis In Cerebral Infarction (mTICI) scale. Independent predictors of inter-hospital recanalization were assessed using multivariable logistic regression analysis.

Results: Overall, 228 patients were included: median age 71 years, the National Institutes of Health Stroke Scale (NIHSS) of 14, transfer time of 3.5 h, and 39% of patients received intravenous thrombolysis (IVT) before transfer. The primary reason for withholding IVT was late presentation. Inter-hospital BAO recanalization occurred in 15% of patients. Variables independently associated with inter-hospital BAO recanalization were IVT use (adjusted odds ratio (aOR) = 24.3, 95% confidence interval (CI) = 6.9-85.5, P < 0.01), distal BAO site (aOR = 2.9, 1.0-8.5, P = 0.05), lack of diabetes (aOR = 11.4, 1.4-93.2, P = 0.02), and non-atheromatous etiology (aOR = 6.6, 1.4-31.4, P = 0.02). BAO recanalization rates ranged from 1% in non-IVT-treated patients with proximal BAO to 45% in IVT-treated patients with distal BAO. Inter-hospital recanalization was associated with an increased odds of good functional outcome (odds ratio (OR) for 3-month modified Rankin Scale (mRS) = 0-2 = 3.3, 95% CI = 1.2-8.8, P = 0.02, adjusted for age, pre-stroke mRS, baseline NIHSS, Posterior Circulation Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS), IVT use, and onset-to-imaging time).

Conclusions: BAO recanalization during inter-hospital transfer for thrombectomy occurred in 15% of patients and was associated with a favorable 3-month outcome. IVT use in the referring center was the primary modifiable factor associated with recanalization, yet its use remains low. Expanding IVT indications in primary stroke centers and developing new therapies that increase recanalization may improve outcomes.

Introduction: Hyperglycemia is common in ischemic stroke. Admission glucose modifies the effect of endovascular therapy (EVT) in patients with ischemic stroke of the anterior circulation, who are treated 0 to 6 hours since onset. Whether this also applies for late-window EVT (6-24 hours since symptom onset or last known well) is unknown. In this study, we assessed whether admission glucose level and/or hyperglycemia modifies the EVT effect in patients with ischemic stroke of the anterior circulation in the late time window.

Methods: We used data from the MR CLEAN LATE trial. The primary outcome measure was the modified Rankin Scale (mRS) score at 90 days. Secondary outcome measures were symptomatic intracranial hemorrhage and mortality at 90 days. Treatment effect modification of EVT by either glucose or hyperglycemia on admission was assessed by multiplicative interaction factors with logistic regression analysis and adjusted for potential confounders. Hyperglycemia was defined as glucose level >7.8 mmol/L on admission.

Results: On admission, median glucose was 7.0 mmol/L (IQR 6.0-8.3 mmol/L), and 147 patients (32%) were hyperglycemic. We found no interaction of either hyperglycemia or serum glucose on admission with treatment effect on functional outcome (p = 0.76 and p = 0.79, respectively), symptomatic intracranial hemorrhage (p = 0.29 for hyperglycemia; p = 0.57 for glucose on admission), and for mortality (p = 0.52 for hyperglycemia; p = 0.69 for glucose on admission).

Conclusion: We found no evidence for effect modification of EVT by admission glucose level or hyperglycemia in patients with acute ischemic stroke and large-vessel occlusion of the anterior circulation in the late treatment window.

Introduction: Perfusion imaging studies show a substantially increased risk of hemorrhagic transformation (HT) in severely hypoperfused tissue. Preclinical evidence indicates that ischemic damage is influenced not only by the degree of hypoperfusion but also by the duration of exposure to that hypoperfused state. We aim to investigate the association of time and severe hypoperfusion with parenchymal hematoma (PH) in ischemic stroke and explore whether there is a combined effect of the two variables on PH.

Methods: Data are from the ESCAPE-NA1 trial, which evaluated the effect of nerinetide in large vessel occlusion patients treated with thrombectomy. This study included patients with some degree of recanalization (expanded Thrombolysis in Cerebral Infarct [eTICI] > 0) and available baseline CT perfusion. Severe hypoperfusion was defined as at least 1 mL volume of relative cerebral blood flow (rCBF) <20%. We assess 24-h imaging for the presence of PH, according to Heidelberg bleeding criteria. Univariable and multivariable logistic regression analyses, including interaction terms, were used to assess the effect of time and severe hypoperfusion on outcomes.

Results: Out of 1105 patients from ESCAPE-NA1, 396 (35.8%) were included. The median age was 70 years (IQR = 59.8-79.2), 202 (51%) were females, and 50 (12.6%) experienced PH. Onset-to-imaging time (adjusted OR 1.04 [95% CI = 1.01-1.06] per 15-min increase) and the presence of severe hypoperfusion (adjusted OR 2.87 [95% CI = 1.47-5.63]) were the only variables associated with PH in multivariable analysis. No significant interaction effect of time and severe hypoperfusion on PH was found. The presence of severe hypoperfusion had a negative predictive value of 98% and a positive predictive value of 39.4% for predicting PH in patients presenting within 3 h and after 6 h from symptom onset, respectively.

Conclusion: Both severe hypoperfusion and time affect the risk of hemorrhagic transformation. However, the interaction between these two variables was not statistically significant, indicating that their effects on hemorrhagic transformation risk are not dependent on each other. Analyzing these variables may help identify patients with a leaky, severely compromised blood-brain barrier in the ischemic core-a "leaky core."

Although reductions in stroke incidence have been reported over recent decades particularly in high-income countries, there has been a worrying trend since the start of the 21st century: stroke incidence in younger individuals (<55 years) has not showed a similar decrease as at older ages. In high-income countries, several population-based studies have found an increase in the incidence of stroke at younger ages since 2000, reaching up to 90% in Oxfordshire, UK (2010-2018 vs 1981-1986) and 97% in Cincinnati, USA (2010 vs 1993-1994). A similar picture has also been documented in low- and middle-income countries, both in population-based studies (Joinville, Brazil, 35% increase in 2012-2013 vs 2005-2006) and in the Global Burden of Disease study. The exact reasons for this very different picture seen in younger individuals are unknown. One possibility is that traditional modifiable risk factors are increasingly prevalent and often undertreated at younger ages. However, studies have also found increases in the incidence of young-onset cryptogenic stroke and in people with no traditional modifiable risk factors, suggesting a role for emerging risk factors. Potential culprits might include air pollution, long working hours, psychosocial stress, prior autoimmune diseases, and illicit drug use, although further research is required to determine whether these emerging risk factors are causally related to stroke at younger ages. Without further intervention, the global burden of stroke at younger ages is projected to increase further in the coming years. Therefore, there is an urgent need to better understand the drivers of these time trends in incidence, to potentially alleviate the individual and societal impacts of stroke in the young. In this narrative review, we examine the recent global changes in stroke epidemiology at younger ages, their potential drivers, and their projected consequences.