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Recombinant Human Tissue Kallikrein-1 for Treating Acute Ischemic Stroke and Preventing Recurrence. 重组人组织钾化钾素-1治疗急性缺血性脑卒中及预防复发。
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2025-01-06 DOI: 10.1161/STROKEAHA.124.048858
Scott E Kasner, Philip M Bath, Michael D Hill, John J Volpi, Michael Giuffre, Lorianne Masuoka, David Wambeke, Paolo R Madeddu

Novel strategies are needed for the treatment of acute ischemic stroke when revascularization therapies are not clinically appropriate or are unsuccessful. rKLK1 (recombinant human tissue kallikrein-1), a bradykinin-producing enzyme, offers a promising potential solution. In animal studies of acute stroke, there is a marked 36-fold increase in bradykinin B2 receptor on brain endothelial cells of the ischemic region. Due to this environment, rKLK1-generated bradykinin will exert a potent local vasodilation and increase brain perfusion via 3 synergistic signaling pathways downstream to the B2 receptor. Because of its preferential effect on ischemic tissue, systemic adverse effects such as hypotension are avoided with proper dosing. In addition, with initial vasodilation through recruitment of preexisting collaterals, rKLK1 promotes long-term benefit of brain perfusion by promoting new collateral formation. With an extended course of therapy for weeks after acute ischemic stroke, these multifaceted effects may also reduce the risk of stroke recurrence. A prior phase II trial demonstrated a favorable impact on clinical outcomes and recurrent strokes, particularly among patients who were not eligible for mechanical thrombectomy. A phase II/III trial has launched in this population, though opportunities for combination revascularization therapies deserve further investigation.

当血运重建治疗在临床上不合适或不成功时,需要新的策略来治疗急性缺血性卒中。rKLK1(重组人组织缓激肽-1)是一种产生缓激肽的酶,提供了一个有希望的潜在解决方案。在急性中风的动物研究中,缺血区脑内皮细胞上的缓激肽B2受体明显增加36倍。由于这种环境,rklk1产生的缓激肽将通过3个协同信号通路下游的B2受体发挥有效的局部血管舒张和增加脑灌注。由于其对缺血组织的优先作用,适当的剂量可避免全身不良反应,如低血压。此外,rKLK1通过招募预先存在的络来初始扩张血管,通过促进新络的形成来促进脑灌注的长期益处。在急性缺血性中风后延长治疗数周,这些多方面的影响也可能降低中风复发的风险。先前的一项II期试验表明,该药物对临床结果和复发性卒中有良好的影响,特别是在不符合机械取栓条件的患者中。一项II/III期临床试验已经在这一人群中启动,但联合血运重建术治疗的机会值得进一步研究。
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引用次数: 0
WMH Contributions to Cognitive Impairment: Rationale and Design of the Diverse VCID Study. WMH 对认知障碍的贡献:多元化 VCID 研究的原理与设计。
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2024-11-15 DOI: 10.1161/STROKEAHA.124.045903
Charles DeCarli, Kumar B Rajan, Lee-Way Jin, Jason Hinman, David K Johnson, Danielle Harvey, Myriam Fornage

As awareness of dementia increases, more individuals with minor cognitive complaints are requesting clinical assessment. Neuroimaging studies frequently identify incidental white matter hyperintensities, raising patient concerns about their brain health and future risk for dementia. Moreover, current US demographics indicate that ≈50% of these individuals will be from diverse backgrounds by 2060. Racial and ethnic minority populations bear a disproportionate burden of vascular risk factors magnifying dementia risk. Despite established associations between white matter hyperintensities and cognitive impairment, including dementia, no study has comprehensively and prospectively examined the impact of individual and combined magnetic resonance imaging measures of white matter injury, their risk factors, and comorbidities on cognitive performance among a diverse, nondemented, stroke-free population with cognitive complaints over an extended period of observation. The Diverse VCID (Diverse Vascular Cognitive Impairment and Dementia) study is designed to fill this knowledge gap through 3 assessments of clinical, behavioral, and risk factors; neurocognitive and magnetic resonance imaging measures; fluid biomarkers of Alzheimer disease, vascular inflammation, angiogenesis, and endothelial dysfunction; and measures of genetic risk collected prospectively over a minimum of 3 years in a cohort of 2250 individuals evenly distributed among Americans of Black/African, Latino/Hispanic, and non-Hispanic White backgrounds. The goal of this study is to investigate the basic mechanisms of small vessel cerebrovascular injury, emphasizing clinically relevant assessment tools and developing a risk score that will accurately identify at-risk individuals for possible treatment or clinical therapeutic trials, particularly individuals of diverse backgrounds where vascular risk factors and disease are more prevalent.

随着人们对痴呆症认识的提高,越来越多有轻微认知症状的人要求进行临床评估。神经影像学研究经常会发现偶发的白质高密度,从而引起患者对大脑健康和未来痴呆风险的担忧。此外,目前美国的人口统计数据显示,到 2060 年,这些人中将有≈50% 来自不同的背景。少数种族和少数族裔人口承受着过重的血管风险因素负担,放大了痴呆症的风险。尽管白质高密度与认知功能障碍(包括痴呆症)之间的关系已经确立,但还没有研究全面、前瞻性地考察了白质损伤的单项和组合磁共振成像测量、其风险因素以及合并症对长期观察无痴呆、无中风、有认知投诉的多元化人群认知能力的影响。Diverse VCID(多元化血管性认知损伤和痴呆症)研究旨在通过对临床、行为和风险因素、神经认知和磁共振成像测量的三项评估来填补这一知识空白;在至少 3 年的时间里,对均匀分布在美国黑人/非洲裔、拉丁裔/西班牙裔和非西班牙裔白人中的 2250 人进行了前瞻性的遗传风险测量。这项研究的目标是调查小血管脑血管损伤的基本机制,强调临床相关评估工具,并开发一种风险评分,以准确识别可能接受治疗或临床治疗试验的高危人群,尤其是血管风险因素和疾病更为普遍的不同背景人群。
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引用次数: 0
Case for Establishing a National Stroke Activation Fee in the United States: Learning From Trauma Centers. 在美国建立国家卒中激活费用的案例:从创伤中心学习。
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2025-01-17 DOI: 10.1161/STROKEAHA.124.049151
Paul D Johnson, Jennifer J Majersik

There is a large burden of stroke in the United States, and extensive systems of care have been established to address it. The resources devoted to stroke centers are analogous to those of trauma centers, both sharing many strict requirements for certification, clinical preparedness, quality improvement, data management, and reporting. However, trauma programs partly defray these costs through a trauma activation billing code, a billable fee that is charged for activation of the trauma team under strict criteria. There are potential benefits to establishing an analogous national stroke code activation fee. Although a billable stroke code activation fee may increase financial burden on patients, this may be counterbalanced by the significant potential for individual and societal benefits. Providing additional financial support for stroke systems of care may improve acute stroke treatment, reduce stroke burden and poststroke disability, and reduce inequality by broadening the reach of stroke systems of care to disadvantaged communities. Further evaluation of the costs and benefits of implementing a stroke code activation fee based on that currently used by trauma centers is needed.

在美国,中风是一个很大的负担,并且已经建立了广泛的护理系统来解决这个问题。专门用于中风中心的资源与创伤中心类似,两者在认证、临床准备、质量改进、数据管理和报告方面都有许多严格的要求。然而,创伤项目通过创伤激活账单代码部分支付这些费用,这是一种可计费的费用,根据严格的标准收取创伤团队的激活费用。建立类似的国家中风代码激活费用有潜在的好处。尽管可计费的脑卒中代码激活费用可能会增加患者的经济负担,但这可能会被个人和社会利益的巨大潜力所抵消。为卒中护理系统提供额外的财政支持可以改善急性卒中治疗,减少卒中负担和卒中后残疾,并通过将卒中护理系统扩大到弱势社区来减少不平等现象。需要在目前创伤中心使用的基础上进一步评估实施中风代码激活费用的成本和收益。
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引用次数: 0
Requiring an Interpreter Influences Stroke Care and Outcomes for People With Aphasia During Inpatient Rehabilitation.
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-05 DOI: 10.1161/STROKEAHA.124.047893
Kathleen Mellahn, Monique F Kilkenny, Samantha Siyambalapitiya, Ali Lakhani, Catherine Burns, Tara Purvis, Dominique A Cadilhac, Miranda L Rose

Background: Communicative ability after stroke influences patient outcomes. Limited research has explored the impact of aphasia when it intersects with cultural or linguistic differences on receiving stroke care and patient outcomes. We investigated associations between requiring an interpreter and the provision of evidence-based stroke care and outcomes for people with aphasia in the inpatient rehabilitation setting.

Methods: Retrospective patient-level data from people with aphasia were aggregated from the Australian Stroke Foundation National Stroke Audit-Rehabilitation Services (2016-2020). Multivariable regression models compared adherence to processes of care (eg, home assessment complete, type of aphasia management) and in-hospital outcomes (eg, length of stay, discharge destination) by the requirement of an interpreter. Outcome models were adjusted for sex, stroke type, hospital size, year, and stroke severity factors.

Results: Among 3160 people with aphasia (median age, 76 years; 56% male), 208 (7%) required an interpreter (median age, 77 years; 52% male). The interpreter group had a more severe disability on admission, reflected by reduced cognitive (6% versus 12%, P=0.009) and motor Functional Independence Measure scores (6% versus 12%, P=0.010). The interpreter group were less likely to have phonological and semantic interventions for their aphasia (odds ratio, 0.57 [95% CI, 0.40-0.80]) compared with people not requiring an interpreter. They more often had a carer (68% versus 48%, P<0.001) and were more likely to be discharged home with supports (odds ratio, 1.48 [95% CI, 1.08-2.04]). The interpreter group had longer lengths of stay (median 31 versus 26 days, P=0.005).

Conclusions: Some processes of care and outcomes differed in inpatient rehabilitation for people with poststroke aphasia who required an interpreter compared with those who did not. Equitable access to therapy is imperative and greater support for cultural/linguistic minorities during rehabilitation is indicated.

背景:中风后的交流能力影响患者的预后。当失语症与文化或语言差异交织在一起时,对接受中风护理和患者预后的影响的研究十分有限。我们调查了在住院康复环境中,需要翻译人员与提供循证中风护理及失语症患者预后之间的关系:从澳大利亚卒中基金会全国卒中审计-康复服务(2016-2020 年)中汇总了失语症患者的回顾性患者层面数据。多变量回归模型比较了护理流程(如完成家庭评估、失语症管理类型)的遵守情况和院内结果(如住院时间、出院目的地)对翻译的要求。结果模型根据性别、中风类型、医院规模、年份和中风严重程度等因素进行了调整:在 3160 名失语症患者(中位年龄 76 岁;56% 为男性)中,有 208 人(7%)需要翻译(中位年龄 77 岁;52% 为男性)。口译组患者入院时的残疾程度更严重,表现为认知能力(6% 对 12%,P=0.009)和运动功能独立性测量评分(6% 对 12%,P=0.010)降低。与不需要口译员的患者相比,口译员组患者接受语音和语义干预治疗失语症的可能性较低(几率比为 0.57 [95% CI, 0.40-0.80])。他们更经常有一名照护者(68% 对 48%,PP=0.005):结论:与不需要翻译的患者相比,需要翻译的脑卒中后失语症患者在住院康复治疗过程中的一些护理流程和治疗效果存在差异。平等地获得治疗是当务之急,在康复过程中为文化/语言上的少数群体提供更多支持也很有必要。
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引用次数: 0
Impact of Conventional Stroke Risk Factors on Early- and Late-Onset Ischemic Stroke: A Mendelian Randomization Study.
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-24 DOI: 10.1161/STROKEAHA.124.048015
Kevin T K Nguyen, Huichun Xu, Brady J Gaynor, Patrick F McArdle, Timothy D O'Connor, James A Perry, Bradford B Worrall, Rainer Malik, Giorgio B Boncoraglio, Sally N Adebamowo, Ramin Zand, John W Cole, Steven J Kittner, Braxton D Mitchell

Background: Stroke incidence is decreasing in older ages but increasing in young adults. These divergent trends are at least partially attributable not only to diverging trends in stroke risk factors but may also be due to differences in the impact of stroke risk factors at different ages. To address this latter possibility, we used Mendelian randomization to assess differences in the association of stroke risk factors between early-onset ischemic stroke ([EOS]; onset 18-59 years) and late-onset ischemic stroke ([LOS]; onset ≥60 years).

Methods: We identified genetic variants from the GWAS Catalog for use as instrumental variables to proxy conventional stroke risk factors and then estimated the effects of these variants on risk factors in younger and older individuals in the UK Biobank. We then used these estimates to estimate the causal effects of stroke risk factors on EOS (n=6728 cases) and LOS (n=9272) cases from SiGN (Stroke Genetic Network) and the EOSC (Early-Onset Stroke Consortium). Lastly, we compared odds ratios between EOS and LOS, stratified by TOAST (Trial of ORG 10172 in Acute Stroke Treatment) subtypes, to determine if differences between estimates could be attributed to differences in stroke subtype distributions.

Results: EOS was associated with higher levels of body mass index, blood pressure, type 2 diabetes, and lower levels of HDL (high-density lipoprotein) cholesterol (all P≤0.002), whereas LOS was associated with higher levels of systolic blood pressure (P=0.0001). The causal effect of body mass index on stroke was significantly stronger for EOS than for LOS (odds ratio, 1.26 versus 1.03; P=0.008). After the subtype-stratified analysis, the difference in causal effect sizes between EOS and LOS for body mass index diminished and was no longer significant.

Conclusions: These results support a causal relationship between body mass index, blood pressure, type 2 diabetes, and HDL cholesterol levels with EOS and blood pressure levels in LOS. Interventions that target these traits may reduce stroke risk.

{"title":"Impact of Conventional Stroke Risk Factors on Early- and Late-Onset Ischemic Stroke: A Mendelian Randomization Study.","authors":"Kevin T K Nguyen, Huichun Xu, Brady J Gaynor, Patrick F McArdle, Timothy D O'Connor, James A Perry, Bradford B Worrall, Rainer Malik, Giorgio B Boncoraglio, Sally N Adebamowo, Ramin Zand, John W Cole, Steven J Kittner, Braxton D Mitchell","doi":"10.1161/STROKEAHA.124.048015","DOIUrl":"10.1161/STROKEAHA.124.048015","url":null,"abstract":"<p><strong>Background: </strong>Stroke incidence is decreasing in older ages but increasing in young adults. These divergent trends are at least partially attributable not only to diverging trends in stroke risk factors but may also be due to differences in the impact of stroke risk factors at different ages. To address this latter possibility, we used Mendelian randomization to assess differences in the association of stroke risk factors between early-onset ischemic stroke ([EOS]; onset 18-59 years) and late-onset ischemic stroke ([LOS]; onset ≥60 years).</p><p><strong>Methods: </strong>We identified genetic variants from the GWAS Catalog for use as instrumental variables to proxy conventional stroke risk factors and then estimated the effects of these variants on risk factors in younger and older individuals in the UK Biobank. We then used these estimates to estimate the causal effects of stroke risk factors on EOS (n=6728 cases) and LOS (n=9272) cases from SiGN (Stroke Genetic Network) and the EOSC (Early-Onset Stroke Consortium). Lastly, we compared odds ratios between EOS and LOS, stratified by TOAST (Trial of ORG 10172 in Acute Stroke Treatment) subtypes, to determine if differences between estimates could be attributed to differences in stroke subtype distributions.</p><p><strong>Results: </strong>EOS was associated with higher levels of body mass index, blood pressure, type 2 diabetes, and lower levels of HDL (high-density lipoprotein) cholesterol (all <i>P</i>≤0.002), whereas LOS was associated with higher levels of systolic blood pressure (<i>P</i>=0.0001). The causal effect of body mass index on stroke was significantly stronger for EOS than for LOS (odds ratio, 1.26 versus 1.03; <i>P</i>=0.008). After the subtype-stratified analysis, the difference in causal effect sizes between EOS and LOS for body mass index diminished and was no longer significant.</p><p><strong>Conclusions: </strong>These results support a causal relationship between body mass index, blood pressure, type 2 diabetes, and HDL cholesterol levels with EOS and blood pressure levels in LOS. Interventions that target these traits may reduce stroke risk.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 3","pages":"640-648"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11856430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of Remote Ischemic Conditioning on the Form and Function of Red Blood Cells in Patients With Acute Ischemic Stroke.
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2025-01-30 DOI: 10.1161/STROKEAHA.124.048976
Rolf Ankerlund Blauenfeldt, Jennifer Waller, Kim Ryun Drasbek, Jesper Nørgaard Bech, Anne-Mette Hvas, Julie Brogaard Larsen, Morten Nørgaard Andersen, Marlene Christina Nielsen, Maria Kjølhede, Mathilde Kjeldsen, Martin Faurholdt Gude, Mohammad Badruzzaman Khan, Babak Baban, Grethe Andersen, David Charles Hess

Background: Remote ischemic conditioning (RIC) is a simple and low-cost intervention that is thought to increase collateral blood flow through the vasodilatory effects of nitric oxide (NO) produced by the endothelium and red blood cells (RBCs). This study aims to investigate whether RIC affects RBC deformability and levels of NO and nitrite in patients with ischemic stroke.

Methods: This is a predefined substudy to the RESIST (Remote Ischemic Conditioning in Patients With Acute Stroke Trial) randomized clinical trial conducted in Denmark. RIC was started in the ambulance and continued at the hospital for seven days. Blood samples were collected at different time points: prehospital in the ambulance, in-hospital upon arrival, 2 hours postadmission, and 24 hours postadmission. RBC deformability and erythrocyte aggregation rate were assessed using ektacytometry, NO using flowcytometry, and nitrite content using ozone chemiluminescence.

Results: Of 1500 prehospital randomized patients, 486 patients were included in this study between July 28, 2020, and November 11, 2023, and had blood samples taken. Of these, 249 (51%) had AIS, and here RIC treatment was not associated with increased RBC maximal deformability (RIC, 0.549; sham, 0.548; P=0.31), RBC NO (RIC, 35 301 median fluorescence intensity; sham, 34979 median fluorescence intensity; P=0.89), or nitrite (RIC, 0.036 µmol/L; sham, 0.034 µmol/L; P=0.38), but RIC treatment was associated with a significantly reduced aggregation pressure and a slower erythrocyte aggregation rate (RIC, 323.76 millipascal; sham, 352.74 millipascal; P=0.0113).

Conclusions: Prehospital and in-hospital RIC significantly reduced erythrocyte aggregation rate in patients with acute ischemic stroke, while there was no change in RBC deformability, NO content, or whole blood nitrite levels.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03481777.

{"title":"Effect of Remote Ischemic Conditioning on the Form and Function of Red Blood Cells in Patients With Acute Ischemic Stroke.","authors":"Rolf Ankerlund Blauenfeldt, Jennifer Waller, Kim Ryun Drasbek, Jesper Nørgaard Bech, Anne-Mette Hvas, Julie Brogaard Larsen, Morten Nørgaard Andersen, Marlene Christina Nielsen, Maria Kjølhede, Mathilde Kjeldsen, Martin Faurholdt Gude, Mohammad Badruzzaman Khan, Babak Baban, Grethe Andersen, David Charles Hess","doi":"10.1161/STROKEAHA.124.048976","DOIUrl":"10.1161/STROKEAHA.124.048976","url":null,"abstract":"<p><strong>Background: </strong>Remote ischemic conditioning (RIC) is a simple and low-cost intervention that is thought to increase collateral blood flow through the vasodilatory effects of nitric oxide (NO) produced by the endothelium and red blood cells (RBCs). This study aims to investigate whether RIC affects RBC deformability and levels of NO and nitrite in patients with ischemic stroke.</p><p><strong>Methods: </strong>This is a predefined substudy to the RESIST (Remote Ischemic Conditioning in Patients With Acute Stroke Trial) randomized clinical trial conducted in Denmark. RIC was started in the ambulance and continued at the hospital for seven days. Blood samples were collected at different time points: prehospital in the ambulance, in-hospital upon arrival, 2 hours postadmission, and 24 hours postadmission. RBC deformability and erythrocyte aggregation rate were assessed using ektacytometry, NO using flowcytometry, and nitrite content using ozone chemiluminescence.</p><p><strong>Results: </strong>Of 1500 prehospital randomized patients, 486 patients were included in this study between July 28, 2020, and November 11, 2023, and had blood samples taken. Of these, 249 (51%) had AIS, and here RIC treatment was not associated with increased RBC maximal deformability (RIC, 0.549; sham, 0.548; <i>P</i>=0.31), RBC NO (RIC, 35 301 median fluorescence intensity; sham, 34979 median fluorescence intensity; <i>P</i>=0.89), or nitrite (RIC, 0.036 µmol/L; sham, 0.034 µmol/L; <i>P</i>=0.38), but RIC treatment was associated with a significantly reduced aggregation pressure and a slower erythrocyte aggregation rate (RIC, 323.76 millipascal; sham, 352.74 millipascal; <i>P</i>=0.0113).</p><p><strong>Conclusions: </strong>Prehospital and in-hospital RIC significantly reduced erythrocyte aggregation rate in patients with acute ischemic stroke, while there was no change in RBC deformability, NO content, or whole blood nitrite levels.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03481777.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"603-612"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Flipping the Script: Early Neurological Gains May Redefine Recovery Prognostication After Intracerebral Hemorrhage.
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-03 DOI: 10.1161/STROKEAHA.124.050306
Miriam Quinlan, Susanne Muehlschlegel
{"title":"Flipping the Script: Early Neurological Gains May Redefine Recovery Prognostication After Intracerebral Hemorrhage.","authors":"Miriam Quinlan, Susanne Muehlschlegel","doi":"10.1161/STROKEAHA.124.050306","DOIUrl":"10.1161/STROKEAHA.124.050306","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"628-630"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
March 2025 Stroke Highlights.
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2025-02-24 DOI: 10.1161/STROKEAHA.125.050778
José Rafael Romero
{"title":"March 2025 <i>Stroke</i> Highlights.","authors":"José Rafael Romero","doi":"10.1161/STROKEAHA.125.050778","DOIUrl":"https://doi.org/10.1161/STROKEAHA.125.050778","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":"56 3","pages":"579"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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
Building Academic Comprehensive Stroke Program in Ethiopia: A Model for Lower-Middle-Income Countries. 在埃塞俄比亚建立脑卒中综合学术项目:中低收入国家的典范。
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2024-10-31 DOI: 10.1161/STROKEAHA.123.041392
Wondwossen G Tekle, Tariku A Soboka, Fasika A Yohannes, Ameer E Hassan, Akeza Teame
{"title":"Building Academic Comprehensive Stroke Program in Ethiopia: A Model for Lower-Middle-Income Countries.","authors":"Wondwossen G Tekle, Tariku A Soboka, Fasika A Yohannes, Ameer E Hassan, Akeza Teame","doi":"10.1161/STROKEAHA.123.041392","DOIUrl":"10.1161/STROKEAHA.123.041392","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"e104-e107"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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
Pathophysiology of Intracerebral Hemorrhage: Recovery Trajectories. 脑出血的病理生理学:恢复轨迹。
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-03-01 Epub Date: 2024-12-16 DOI: 10.1161/STROKEAHA.124.046130
Lauren M Mai, Raed A Joundi, Aristeidis H Katsanos, Magdy Selim, Ashkan Shoamanesh

Recovery trajectories in intracerebral hemorrhage (ICH) are recognized as distinct from those observed in ischemic stroke. This narrative review aims to clarify the pathophysiology underlying ICH recovery patterns, highlighting the unique timeline and nature of functional improvements seen in ICH survivors. Population-based cohort studies tracking functional outcomes in a longitudinal fashion, along with randomized clinical trial data with standardized outcome assessments, have demonstrated that ICH recovery generally has a delayed onset in the first weeks, followed by a steep early subacute stage recovery (typically up to 3 months) continuing in protracted, gradual improvements beyond 3 to 6 months. Understanding these recovery patterns, and how these differ from ischemic stroke, is crucial for providing accurate prognostic information, facilitating targeted health care delivery, and optimizing therapeutic interventions and the design of ICH randomized trials. This article synthesizes current evidence on early- and late-stage functional recovery trajectories in primary, spontaneous ICH and cognitive outcomes, emphasizing the clinical and research implications of these recovery patterns.

脑出血(ICH)的恢复轨迹被认为与缺血性中风的恢复轨迹不同。这篇叙述性综述旨在阐明脑出血恢复模式的病理生理学基础,强调脑出血幸存者功能改善的独特时间和性质。以人群为基础的队列研究以纵向方式跟踪功能结果,以及具有标准化结果评估的随机临床试验数据表明,脑出血恢复通常在最初几周延迟发作,随后是急剧的早期亚急性期恢复(通常长达3个月),持续时间延长,3至6个月后逐渐改善。了解这些恢复模式,以及它们与缺血性中风的不同之处,对于提供准确的预后信息、促进有针对性的医疗服务、优化治疗干预措施和设计脑出血随机试验至关重要。本文综合了目前关于原发性、自发性脑出血和认知结果的早期和晚期功能恢复轨迹的证据,强调了这些恢复模式的临床和研究意义。
{"title":"Pathophysiology of Intracerebral Hemorrhage: Recovery Trajectories.","authors":"Lauren M Mai, Raed A Joundi, Aristeidis H Katsanos, Magdy Selim, Ashkan Shoamanesh","doi":"10.1161/STROKEAHA.124.046130","DOIUrl":"10.1161/STROKEAHA.124.046130","url":null,"abstract":"<p><p>Recovery trajectories in intracerebral hemorrhage (ICH) are recognized as distinct from those observed in ischemic stroke. This narrative review aims to clarify the pathophysiology underlying ICH recovery patterns, highlighting the unique timeline and nature of functional improvements seen in ICH survivors. Population-based cohort studies tracking functional outcomes in a longitudinal fashion, along with randomized clinical trial data with standardized outcome assessments, have demonstrated that ICH recovery generally has a delayed onset in the first weeks, followed by a steep early subacute stage recovery (typically up to 3 months) continuing in protracted, gradual improvements beyond 3 to 6 months. Understanding these recovery patterns, and how these differ from ischemic stroke, is crucial for providing accurate prognostic information, facilitating targeted health care delivery, and optimizing therapeutic interventions and the design of ICH randomized trials. This article synthesizes current evidence on early- and late-stage functional recovery trajectories in primary, spontaneous ICH and cognitive outcomes, emphasizing the clinical and research implications of these recovery patterns.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"783-793"},"PeriodicalIF":7.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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
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Stroke
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