International Journal of Stroke最新文献

Background: For neurodegenerative diseases, the inter-individual variability in the functional response to pathology is explained by the construct of cognitive reserve (CR). We aimed to evaluate the association of CR with stroke outcome to improve the understanding of its inter-individual variability and prediction.

Methods: The peer-reviewed protocol was preregistered on PROSPERO (CRD42021256175). The systematic review and meta-analysis followed PRISMA, MOOSE and CHARMS reporting guidelines. Original studies reporting the association between CR-proxies (e.g. level or years of education, occupational attainment) and measures of non-cognitive stroke outcome (e.g. NIHSS, modified Rankin Scale, Barthel Index, Functional Independence Measure) were selected. Risk of bias was assessed using QUIPS. Estimates were pooled using a random-effects model.

Results: Of 4129 studies identified, 17 were included in the systematic review. Based on quality check, ten of them involving 19308 patients were included in the meta-analysis, whereby only five studies directly addressed the association of CR-proxies with stroke outcome. Pooled standardized mean differences (SMD) showed evidence for the association of low CR with poor stroke outcome (SMD, 0.23; 95% CI, 0.04-0.42 corresponding to OR 1.52; 95% CI 1.08-2.14). Subgroup analysis showed a greater association of level of education (SMD, 0.37; 95% CI, 0.12-0.62) and occupational attainment (SMD, 0.34; 95% CI, 0.10-0.57) with stroke outcome, as compared to years of education (SMD, 0.01; 95% CI, -0.06-0.08). The effect of CR was greater in the acute-subacute stroke phase (≤3 months post-stroke, SMD, 0.28; 95% CI, 0.04-0.52) than in the chronic phase (SMD, 0.01; 95% CI, -0.06-0.08).

Conclusion: We found evidence that CR explains inter-individual variability in stroke outcome and thus may improve its prediction. Low CR increases the risk of poor stroke outcome, and its proxies should be considered in both clinical and research settings. However, we observed high heterogeneity across studies, and further research with specific focus on this topic and CR-proxies extending beyond educational and occupational attainment is needed.

Background: The risk of recurrent ischemic stroke during pregnancy or postpartum period in women with a history of ischemic stroke is unclear.

Aims: To determine the risk of incident ischemic stroke during pregnancy or early postpartum period (within 6 weeks) among women with and without a prior history of ischemic stroke.

Methods: We conducted a retrospective cohort study using Oracle Health Real-World Data (January 2015-February 2025). We identified 220,479 completed pregnancies; prior ischemic stroke by the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) I69.3x/Z86.73; and incident ischemic stroke by I63 during pregnancy or ⩽ 42 days postpartum. Odds ratios (ORs) with 95% CIs were estimated using multivariable logistic regression after 1:10 propensity-score matching based on demographics and comorbidities.

Results: The incident ischemic stroke rates were 415 out of 1192 pregnancies (34.82%, 95% confidence interval [CI] = 32.16%-37.56%) among pregnant women with a prior history of ischemic stroke and 737 out of 219,287 pregnancies (0.34%, 95% CI = 0.31%-0.36%) among pregnant women without a history of ischemic stroke. In the multivariate analysis, the risk of ischemic stroke during pregnancy or early postpartum period was significantly higher among pregnancies in women with a prior history of ischemic stroke compared with those in women without a history of ischemic stroke (OR = 2.37, 95% CI = 1.97-2.87, p < 0.0001). Previous myocardial infarction (OR = 1.82, 95% CI = 1.38-2.39, p < 0.0001) and obesity (OR = 1.25, 95% CI = 1.07-1.47, p < 0.01) were also associated with recurrent ischemic stroke during pregnancy or early postpartum period. The odds of experiencing an incident ischemic stroke among women with a prior history of ischemic stroke was significantly higher in women during pregnancy or early postpartum period compared with those with neither of the two conditions (OR = 3.35, 95% CI = 2.67-4.22, p < 0.0001).

Conclusion: Women with a prior history of ischemic stroke had two times higher odds of having another ischemic stroke during pregnancy or postpartum period. Our findings have implications for counseling, surveillance, and enhanced recurrent stroke prevention in this high-risk group.

Background: India is facing a growing burden of stroke due to population aging, lifestyle changes, and increased exposure to risk factors. However, longitudinal data on stroke patterns and outcomes in India are limited.

Objectives: This study assessed stroke patterns, risk factors, management practices, and outcomes using data from the Hospital-Based Stroke Registries (HBSRs) in India.

Methods: This prospective hospital-based registry included 34,792 stroke cases from 30 centers across India, recorded between 2020 and 2022. Data on demographics, clinical features, risk factors, diagnostics, treatments, and outcomes were collected, with follow-up at 28 days and 3 months. Functional outcome was assessed using the modified Rankin Scale (mRS), along with data on recurrence.

Results: The mean age was 59.4 years; 13.8% were aged under 45, 63.4% were male, and 72.1% were from rural areas. Hypertension (74.5%) was the most common risk factor, followed by smokeless tobacco use (28.5%) and diabetes mellitus (27.3%). Ischemic stroke accounted for 60% of cases. Only 20.1% were presented within 4.5 h of symptom onset, while 37.8% of cases presented after 24 h. Motor impairment (74.8%) followed by speech disturbance (51.2%) were the commonest symptoms at onset. Thrombolysis was given in 4.6%, and thrombectomy in 0.7%, of ischemic strokes. At 3 months, 27.8% had died, 29.7% had significant disability (mRS 3-5), and 1.1% had a recurrent stroke.

Conclusion: In this study, one in 7 stroke were in the young, 2 in 5 patients arrived after 24 h of symptom onset, and thrombolysis and mechanical thrombectomy were underutilized. Over half had poor 3-month outcomes, highlighting the need for improving comprehensive stroke care across India.

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.