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Accurate Detection of Spinal Dural Arteriovenous Fistula With Spinal Photon-Counting Computed Tomography Angiography: A Report of Two Cases. 利用脊髓光子计数计算机断层扫描血管造影准确检测脊髓硬脑膜动静脉瘘:两个病例的报告
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-02-01 Epub Date: 2024-12-16 DOI: 10.1161/STROKEAHA.124.049475
Naying He, Haiying Lyu, Yong Lu, Fuhua Yan, Hong Jiang
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引用次数: 0
Bilateral Basal Ganglia Region Infarction After Trauma in a Patient With Bilateral Basal Ganglia Calcification. 一名双侧基底节钙化患者外伤后双侧基底节区域梗死。
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-02-01 Epub Date: 2024-12-16 DOI: 10.1161/STROKEAHA.124.049509
Qian Zhang, Qian Jia, Yue Suo, Xingquan Zhao, Yi Ju
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引用次数: 0
Tenecteplase Thrombolysis for Stroke up to 24 Hours After Onset With Perfusion Imaging Selection: The CHABLIS-T II Randomized Clinical Trial. 替奈普酶溶栓治疗卒中24小时后灌注成像选择:CHABLIS-T II随机临床试验
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-02-01 Epub Date: 2025-01-02 DOI: 10.1161/STROKEAHA.124.048375
Xin Cheng, Lan Hong, Longting Lin, Leonid Churilov, Yifeng Ling, Nan Yang, Jianliang Fu, Guozhi Lu, Yunhua Yue, Jin Zhang, Feng Wang, Ziran Wang, Yanxin Zhao, Xiaoyu Zhou, Zhaolong Peng, Danhong Wu, Liandong Zhao, Qijin Zhai, Xiaofei Yu, Qi Fang, Xiangzhong Shao, Ying Tang, Diwen Zhang, Yu Geng, Yue Zhang, Bosheng Fan, Bing Zhang, Congguo Yin, Yangmei Chen, Yiran Zhang, Xinyu Liu, Siyuan Li, Lumeng Yang, Mark Parsons, Qiang Dong
<p><strong>Background: </strong>Whether it is effective and safe to extend the time window of intravenous thrombolysis up to 24 hours after the last known well is unknown. We aimed to determine the efficacy and safety of tenecteplase in Chinese patients with acute ischemic stroke due to large/medium vessel occlusion within an extended time window.</p><p><strong>Methods: </strong>Patients with ischemic stroke presenting 4.5 to 24 hours from the last known well, with a favorable penumbral profile and an associated large/medium vessel occlusion, were randomized 1:1 to either 0.25 mg/kg tenecteplase or the best medical treatment. A favorable penumbral profile was defined as a hypoperfusion lesion volume to infarct core volume ratio >1.2, with an absolute volume difference >10 mL, and an ischemic core volume <70 mL. The primary outcome was the achievement of major reperfusion without symptomatic intracranial hemorrhage within 24 to 48 hours post-randomization. Major reperfusion was defined as the restoration of blood flow of >50% of the involved ischemic territory. Secondary outcomes included recanalization, infarct growth, major neurological improvements, change in the National Institutes of Health Stroke Scale score, hemorrhagic transformation within 24 to 48 hours, systemic bleeding at discharge, and modified Rankin Scale (score 0-1, score 0-2, score 5-6, and modified Rankin Scale distribution) at 90 days. The comparison of the primary outcome between groups was conducted using modified Poisson regression with a log-link function and robust error variance, adjusted for time from the last known well to randomization, the site of vessel occlusion, and planned endovascular treatment.</p><p><strong>Results: </strong>Among 224 enrolled patients, 111 were assigned to receive tenecteplase and 113 to receive the best medical treatment (including 23% [n=26] of participants who received intravenous tissue-type plasminogen activator). The mean (SD) age of the tenecteplase group and the best medical treatment group was 64.2 (10.4) and 63.6 (11.0) years old, with 72.1% (n=80) and 70.8% (n=80) male enrolled, respectively. A proportion of 54.9% (n=123) of patients were transferred to the catheter room for preplanned endovascular treatment. The primary outcome occurred in 33.3% (n=37) of the tenecteplase group versus 10.8% (n=12) in the best medical treatment group (adjusted relative risk, 3.0 [95% CI, 1.6-5.7]; <i>P</i>=0.001). Tenecteplase significantly increased the recanalization rate compared with the best medical treatment (35.8% [n=39] versus 14.3% [n=16], adjusted relative risk, 2.5 [95% CI, 1.4-4.4]; <i>P</i>=0.002). There were no significant differences in clinical efficacy outcomes or rates of hemorrhagic transformation between the groups.</p><p><strong>Conclusions: </strong>Administered at a dose of 0.25 mg/kg intravenously, tenecteplase increased reperfusion without symptomatic intracranial hemorrhage in patients with ischemic stroke selected by imagi
背景:将静脉溶栓时间窗口延长至最后一次已知井后24小时是否有效和安全尚不清楚。我们的目的是在延长的时间窗内确定替奈普酶在中国因大/中血管闭塞而急性缺血性脑卒中患者中的疗效和安全性。方法:缺血性脑卒中患者离最后一个已知的病灶时间为4.5 ~ 24小时,具有良好的半影轮廓和相关的大/中型血管闭塞,1:1随机分配至0.25 mg/kg替奈普酶或最佳药物治疗组。良好的半影区定义为低灌注病灶体积与梗死核体积之比>.2,绝对体积差>10ml,缺血核体积占受病灶缺血区域的50%。次要结局包括再通、梗死生长、主要神经系统改善、美国国立卫生研究院卒中量表评分的变化、24至48小时内出血转化、出院时全身出血,以及90天的修正兰金量表(评分0-1、评分0-2、评分5-6和修正兰金量表分布)。各组间主要结局的比较采用带有log-link函数和稳健误差方差的修正泊松回归进行,并根据从最后已知井到随机化的时间、血管闭塞部位和计划的血管内治疗进行调整。结果:224例入组患者中,111例患者接受替奈普酶治疗,113例患者接受最佳药物治疗(其中23% [n=26]的患者接受静脉注射组织型纤溶酶原激活剂)。替尼替普酶组和最佳药物治疗组的平均(SD)年龄分别为64.2(10.4)岁和63.6(11.0)岁,其中72.1% (n=80)和70.8% (n=80)为男性。54.9% (n=123)的患者被转移到导管室进行预先计划的血管内治疗。替奈普酶组出现主要结局的比例为33.3% (n=37),而最佳药物治疗组为10.8% (n=12)(校正相对危险度,3.0 [95% CI, 1.6-5.7];P = 0.001)。与最佳药物治疗相比,替奈普酶显著提高再通率(35.8% [n=39]对14.3% [n=16]),调整后相对危险度为2.5 [95% CI, 1.4 ~ 4.4];P = 0.002)。两组之间的临床疗效、结果或出血转化率无显著差异。结论:静脉给药0.25 mg/kg的替奈普酶可增加晚期窗期影像学选择的缺血性脑卒中患者的再灌注,且无症状性颅内出血,但90天未改变临床结果。注册:网址:https://www.clinicaltrials.gov;唯一标识符:NCT04516993。
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引用次数: 0
Novel Vascular Territory Mapping Algorithm as a Predictive Tool for Identification of Antegrade Flow in Middle Cerebral Artery Occlusion. 一种新的血管区域映射算法作为大脑中动脉闭塞时顺行血流的预测工具。
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-02-01 Epub Date: 2025-01-06 DOI: 10.1161/STROKEAHA.124.048892
Michael Valente, Andrew Bivard, Bernard Yan, Chushuang Chen, Milanka Visser, Henry Ma, Longting Lin, Mark Parsons

Background: Vascular territory mapping (VTM) software estimates which intracerebral vessel provides predominant arterial flow to a brain voxel. The presence of antegrade flow in the setting of acute middle cerebral artery (MCA) occlusion is associated with improved outcomes. We identify whether VTM software is a determinant of antegrade flow in patients with proximal MCA occlusion.

Methods: Consecutive patients with the first branch of MCA (M1) occlusion were analyzed from the International Stroke Perfusion Imaging Registry with their computed tomography perfusion reprocessed through VTM software. Authors reviewed dynamic 4-dimensional computed tomography angiography for the presence of an acute M1 thrombus and also for the presence of residual antegrade flow. The VTM software assigned regions of the brain to an estimated feeding vessel (anterior cerebral artery, MCA, and posterior cerebral artery). A binomial logistic regression was performed to determine the effects of VTM, ischemic core (cerebral blood flow <30), and perfusion lesion (delay time >3) on the likelihood that patients had the presence of any antegrade flow in the MCA territory. A secondary analysis was performed to assess the relationship between imaging variables and 3-month modified Rankin Scale outcomes.

Results: The final data set included 130 patients with M1 occlusion. The median age of participants was 74 years (interquartile range, 62-81) with an onset-to-scan time of 2.1 hours (interquartile range, 1.4-3.8) and a National Institutes of Health Stroke Scale score of 15 (interquartile range, 12-20). Eighteen patients were identified with antegrade flow on 4-dimensional digital subtraction angiography. Patients with antegrade flow had significantly larger VTM volume normal side MCA, 101 (72-180) mL, compared with those with complete occlusion, 41 (21-71) mL. VTM volume normal side MCA volume significantly predicted antegrade flow and outcome, and 1 mL VTM volume normal side MCA volume increased odds of antegrade flow by 1.024 (95% CI, 1.013-1.036). Ischemic core and the perfusion lesion volumes did not predict antegrade flow.

Conclusions: VTM software was more effective than traditional perfusion parameters in the detection of antegrade flow. The results demonstrate a potential clinical utility for VTM; however, larger cohorts will be required to detect whether VTM can predict clinical outcome after reperfusion treatment.

背景:血管区域映射(VTM)软件估计哪条脑内血管为脑体素提供主要的动脉流量。急性大脑中动脉(MCA)闭塞时出现顺行血流与改善预后相关。我们确定VTM软件是否是MCA近端闭塞患者顺行血流的决定因素。方法:对国际脑卒中灌注成像注册表中连续出现的MCA (M1)第一支闭塞的患者进行分析,并通过VTM软件对其ct灌注进行再处理。作者回顾了动态四维计算机断层血管成像的存在急性M1血栓,也存在残余的顺行血流。VTM软件将大脑区域分配给估计的供血血管(大脑前动脉、MCA和大脑后动脉)。采用二项逻辑回归来确定VTM、缺血性核心(脑血流量3)对患者在MCA区域存在任何顺行血流的可能性的影响。进行二次分析以评估影像学变量与3个月修正兰金量表结果之间的关系。结果:最终数据集包括130例M1闭塞患者。参与者的中位年龄为74岁(四分位数范围为62-81),从发病到扫描时间为2.1小时(四分位数范围为1.4-3.8),美国国立卫生研究院卒中量表评分为15分(四分位数范围为12-20)。18例患者在4维数字减影血管造影中发现顺行血流。正常侧MCA的VTM体积为101 (72-180)mL,而完全闭塞的患者为41 (21-71)mL。VTM体积正常侧MCA的体积显著预测顺行血流和结局,1ml VTM体积正常侧MCA的体积使顺行血流的几率增加1.024 (95% CI, 1.013-1.036)。缺血核心和灌注病变体积不能预测顺行血流。结论:VTM软件检测血管顺行性血流比传统灌注参数更有效。结果表明,VTM具有潜在的临床应用价值;然而,需要更大的队列来检测VTM是否可以预测再灌注治疗后的临床结果。
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引用次数: 0
Thrombectomy for Artery of Percheron Occlusion. 动脉闭塞的取栓术。
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-02-01 Epub Date: 2025-01-09 DOI: 10.1161/STROKEAHA.124.049043
He Li, Jinping Zhang
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引用次数: 0
Combination Antithrombotic Therapy for Reduction of Recurrent Ischemic Stroke in Intracranial Atherosclerotic Disease. 联合抗栓治疗减少颅内动脉粥样硬化性疾病缺血性卒中复发。
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-02-01 Epub Date: 2025-01-09 DOI: 10.1161/STROKEAHA.124.047715
Kanjana S Perera, Mukul A Sharma, John W Eikelboom, Kelvin Kuan Huei Ng, Thalia S Field, Brian H Buck, Michael D Hill, Grant Stotts, Leanne K Casaubon, Jennifer Mandzia, Aristeidis H Katsanos, Samuel Yip, Ashkan Shoamanesh, G Bryan Young, Ramana Appireddy, Sumiti Nayar, Rick Swartz, Amanda Taylor, Alexandra Carrier, Abhilekh Srivastava, Aviraj S Deshmukh, Robin Zhao, Robert G Hart

Background: Stroke secondary to intracranial atherosclerotic disease (ICAD) is associated with high recurrence risk despite currently available secondary prevention strategies. In patients with systemic atherosclerosis, a significant reduction of stroke risk with no increase in intracranial or fatal hemorrhage was seen when rivaroxaban 2.5 mg twice daily was added to aspirin. However, there are no trials in ICAD using this combination. To facilitate the design of future ICAD trials, the CATIS-ICAD study (Combination Antithrombotic Treatment for Prevention of Recurrent Ischemic Stroke in Intracranial Atherosclerotic Disease) assessed (1) the feasibility of recruitment, (2) the safety of low-dose rivaroxaban plus aspirin compared with standard-of-care antiplatelet therapy, and (3) trends toward efficacy.

Methods: This was a prospective, randomized, open-label, blinded end point pilot trial conducted in 10 Canadian centers. Eligible participants aged ≥40 years, with acute ischemic stroke or high-risk transient ischemic attack, were randomly assigned in a 1:1 ratio to receive low-dose rivaroxaban plus aspirin or aspirin alone within 7 to 100 days of their index event. The primary safety outcome was hemorrhagic stroke. The main efficacy end point was the composite of ischemic stroke or covert brain infarct on magnetic resonance imaging at the end of the study.

Results: A total of 101 participants were randomized. Average enrollment was 10 participants/site per year. Average follow-up was 20 months. Median time from index stroke to randomization was 67 days. The median age of participants was 67 years (±10.94), and 29% of participants were women. There was no hemorrhagic stroke in either arm. The composite efficacy outcome was less frequent in the combination arm (15.7%) compared with the aspirin arm (24.0%), with a hazard ratio of 0.78 ([95% CI, 0.32-1.93]; P=0.59) favoring the intervention.

Conclusions: A multicenter randomized trial comparing the combination of low-dose rivaroxaban and aspirin in patients with recent ischemic stroke or transient ischemic attack due to ICAD is feasible and appears safe without an increased risk of hemorrhagic stroke. A numerical trend toward efficacy for the composite primary end point of symptomatic ischemic stroke and covert infarcts was observed. These findings will inform the design of a phase III trial.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04142125.

背景:颅内动脉粥样硬化性疾病(ICAD)继发卒中与高复发风险相关,尽管目前有二级预防策略。在系统性动脉粥样硬化患者中,当利伐沙班2.5 mg每日两次加入阿司匹林时,卒中风险显著降低,颅内出血或致死性出血未增加。然而,在ICAD中没有使用这种组合的试验。为了便于未来ICAD试验的设计,CATIS-ICAD研究(联合抗血栓治疗预防颅内动脉粥样硬化性疾病缺血性卒中复发)评估了(1)招募的可行性,(2)与标准治疗抗血小板治疗相比,低剂量利伐沙班加阿司匹林的安全性,以及(3)疗效趋势。方法:这是一项前瞻性、随机、开放标签、盲法终点试验,在加拿大10个中心进行。年龄≥40岁、急性缺血性卒中或高风险短暂性缺血性发作的受试者,在指标事件发生后7 - 100天内,按1:1的比例随机分配低剂量利伐沙班加阿司匹林或单独服用阿司匹林。主要安全性指标为出血性卒中。主要疗效终点为研究结束时磁共振成像显示的缺血性脑卒中或隐蔽性脑梗死的综合情况。结果:共有101名参与者被随机化。平均报名人数为每年10名参与者/站点。平均随访时间为20个月。从指标卒中到随机化的中位时间为67天。参与者的中位年龄为67岁(±10.94),29%的参与者为女性。两臂均无出血性中风。联合用药组的综合疗效结局发生率(15.7%)低于阿司匹林组(24.0%),风险比为0.78 ([95% CI, 0.32-1.93];P=0.59)支持干预。结论:一项多中心随机试验比较了低剂量利伐沙班和阿司匹林联合治疗近期缺血性卒中或因ICAD引起的短暂性脑缺血发作的患者是可行的,并且似乎是安全的,没有增加出血性卒中的风险。观察到对症状性缺血性卒中和隐蔽性梗死的复合主要终点的疗效的数值趋势。这些发现将为III期试验的设计提供信息。注册:网址:https://www.clinicaltrials.gov;唯一标识符:NCT04142125。
{"title":"Combination Antithrombotic Therapy for Reduction of Recurrent Ischemic Stroke in Intracranial Atherosclerotic Disease.","authors":"Kanjana S Perera, Mukul A Sharma, John W Eikelboom, Kelvin Kuan Huei Ng, Thalia S Field, Brian H Buck, Michael D Hill, Grant Stotts, Leanne K Casaubon, Jennifer Mandzia, Aristeidis H Katsanos, Samuel Yip, Ashkan Shoamanesh, G Bryan Young, Ramana Appireddy, Sumiti Nayar, Rick Swartz, Amanda Taylor, Alexandra Carrier, Abhilekh Srivastava, Aviraj S Deshmukh, Robin Zhao, Robert G Hart","doi":"10.1161/STROKEAHA.124.047715","DOIUrl":"10.1161/STROKEAHA.124.047715","url":null,"abstract":"<p><strong>Background: </strong>Stroke secondary to intracranial atherosclerotic disease (ICAD) is associated with high recurrence risk despite currently available secondary prevention strategies. In patients with systemic atherosclerosis, a significant reduction of stroke risk with no increase in intracranial or fatal hemorrhage was seen when rivaroxaban 2.5 mg twice daily was added to aspirin. However, there are no trials in ICAD using this combination. To facilitate the design of future ICAD trials, the CATIS-ICAD study (Combination Antithrombotic Treatment for Prevention of Recurrent Ischemic Stroke in Intracranial Atherosclerotic Disease) assessed (1) the feasibility of recruitment, (2) the safety of low-dose rivaroxaban plus aspirin compared with standard-of-care antiplatelet therapy, and (3) trends toward efficacy.</p><p><strong>Methods: </strong>This was a prospective, randomized, open-label, blinded end point pilot trial conducted in 10 Canadian centers. Eligible participants aged ≥40 years, with acute ischemic stroke or high-risk transient ischemic attack, were randomly assigned in a 1:1 ratio to receive low-dose rivaroxaban plus aspirin or aspirin alone within 7 to 100 days of their index event. The primary safety outcome was hemorrhagic stroke. The main efficacy end point was the composite of ischemic stroke or covert brain infarct on magnetic resonance imaging at the end of the study.</p><p><strong>Results: </strong>A total of 101 participants were randomized. Average enrollment was 10 participants/site per year. Average follow-up was 20 months. Median time from index stroke to randomization was 67 days. The median age of participants was 67 years (±10.94), and 29% of participants were women. There was no hemorrhagic stroke in either arm. The composite efficacy outcome was less frequent in the combination arm (15.7%) compared with the aspirin arm (24.0%), with a hazard ratio of 0.78 ([95% CI, 0.32-1.93]; <i>P</i>=0.59) favoring the intervention.</p><p><strong>Conclusions: </strong>A multicenter randomized trial comparing the combination of low-dose rivaroxaban and aspirin in patients with recent ischemic stroke or transient ischemic attack due to ICAD is feasible and appears safe without an increased risk of hemorrhagic stroke. A numerical trend toward efficacy for the composite primary end point of symptomatic ischemic stroke and covert infarcts was observed. These findings will inform the design of a phase III trial.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04142125.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":" ","pages":"380-389"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955444","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
Cerebral Microbleeds and Their Association With Inflammation and Blood-Brain Barrier Leakage in Small Vessel Disease. 脑血管疾病的脑微出血及其与炎症和血脑屏障渗漏的关系
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-02-01 Epub Date: 2025-01-02 DOI: 10.1161/STROKEAHA.124.048974
Lupei Cai, Daniel J Tozer, Hugh S Markus

Background: How cerebral microbleeds (CMBs) are formed, and how they cause tissue damage is not fully understood, but it has been suggested they are associated with inflammation, and they could also be related to increased blood-brain barrier (BBB) leakage. We investigated the relationship of CMBs with inflammation and BBB leakage in cerebral small vessel disease, and in particular, whether these 2 processes were increased in the vicinity of CMBs.

Methods: In 54 patients with sporadic cerebral small vessel disease presenting with lacunar stroke, we simultaneously assessed microglial activation using the positron emission tomography ligand [11C]PK11195 and BBB leakage using dynamic contrast enhanced magnetic resonance imaging, on a positron emission tomography-magnetic resonance imaging system. To assess local inflammation and BBB leakage, 3 one-voxel concentric shells were generated around each CMB on susceptibility-weighted imaging and resampled to positron emission tomography and T1 mapping images, respectively. In these 3 shells, we calculated the mean of PK11195 nondisplaceable binding potential (BPND) as a marker of microglial activation, as well as the mean influx rate as a marker of BBB leakage. In addition, 93 blood biomarkers related to cardiovascular disease, inflammation, and endothelial activation were measured to quantify systemic inflammation.

Results: No significant associations were found between the number of CMBs and the measures for microglial activation (β=2.6×10-5, P=0.050) and BBB leakage (β=-0.0001, P=0.400) in the white matter. There was no difference in measures of microglial activation (P=0.403) or BBB leakage (P=0.423) across the 3 shells surrounding the CMBs. Furthermore, after correcting for multiple comparisons, no associations were observed between systemic inflammation biomarkers and the number of CMBs.

Conclusions: We found no evidence that CMBs are associated with either microglial activation assessed by [11]CPK11195 positron emission tomography or BBB leakage assessed by dynamic contrast enhanced magnetic resonance imaging, either globally or locally, in sporadic cerebral small vessel disease. There was also no association with markers of systemic inflammation.

背景:脑微出血(CMBs)是如何形成的,以及它们是如何引起组织损伤的尚不完全清楚,但已有研究表明它们与炎症有关,也可能与血脑屏障(BBB)渗漏增加有关。我们研究了CMBs与脑血管病炎症和血脑屏障渗漏的关系,特别是这两个过程是否在CMBs附近增加。方法:在54例以腔隙性卒中为表现的散发性脑血管疾病患者中,我们在正电子发射断层扫描配体[11C]PK11195上同时评估了小胶质细胞的激活,并在正电子发射断层扫描-磁共振成像系统上使用动态对比增强磁共振成像评估了血脑屏障泄漏。为了评估局部炎症和血脑屏障渗漏,在敏感性加权成像上在每个CMB周围生成3个一体素同心壳,并分别重新采样到正电子发射断层扫描和T1映射图像上。在这3个壳中,我们计算了PK11195不可置换结合电位(BPND)的平均值,作为小胶质细胞激活的标志,以及平均内流率,作为血脑屏障渗漏的标志。此外,研究人员还测量了93种与心血管疾病、炎症和内皮细胞活化相关的血液生物标志物,以量化全身炎症。结果:CMBs数量与脑白质小胶质细胞活化(β=2.6×10-5, P=0.050)和血脑屏障渗漏(β=-0.0001, P=0.400)无显著相关性。小胶质细胞激活(P=0.403)或血脑屏障泄漏(P=0.423)在CMBs周围的3个外壳上没有差异。此外,在校正多重比较后,未观察到全身炎症生物标志物与CMBs数量之间的关联。结论:我们没有发现证据表明,在散发性脑血管病中,CMBs与[11]CPK11195正电子发射断层扫描评估的小胶质细胞激活或动态对比增强磁共振成像评估的BBB泄漏有关,无论是整体还是局部。也与全身性炎症标志物无关联。
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引用次数: 0
Identifying Best Practices for Improving the Evaluation and Management of Stroke in Rural Lower-Resourced Settings: A Scientific Statement From the American Heart Association. 确定改善农村低资源环境中风评估和管理的最佳实践:美国心脏协会的科学声明。
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-02-01 Epub Date: 2024-12-12 DOI: 10.1161/STR.0000000000000478
Kori S Zachrison, Kaiz S Asif, Sherita Chapman, Karen E Joynt Maddox, Enrique C Leira, Susan Maynard, Christa O'Hana S Nobleza, Charles R Wira

Considerable variation exists in the delivery of acute stroke care and stroke outcomes across settings and population groups. This is attributable in part to variation in resources among emergency departments in the United States, most notably in rural regions. Structural constraints of the US health care system, including the geographic distribution of where patients live relative to the location of hospitals and certified stroke centers, will continue to mean that many patients with stroke initially present to community emergency departments that have fewer stroke-related resources. These sites also tend to serve populations in rural areas who experience disparities in care and outcomes. Reducing health disparities related to stroke for populations in rural areas requires investment in these more remote community settings as the anchor of the stroke chain of survival for their respective communities. This scientific statement performs a critical appraisal examining challenges in rural stroke care related to access and variation in stroke-related capabilities for the acute phase of care to inform strategies and propose solutions. The scientific statement considers the value of expansion of Acute Stroke Ready Hospital and Primary Stroke Center certification in rural areas, the role of telehealth and improved transfer processes, as well as increased engagement and mentorship from larger, comprehensive centers to the rural hospitals to which they are connected. Multistakeholder collaboration and policy interventions need to be directed to enhance public awareness, impart staff training, grow infrastructure, enhance access to clinical expertise, streamline data management, and implement quality assessment and improvement programs.

在不同的环境和人群中,急性卒中护理和卒中结果的提供存在相当大的差异。这在一定程度上可归因于美国急诊部门资源的差异,尤其是在农村地区。美国医疗保健系统的结构性限制,包括患者居住的地理分布相对于医院和认证卒中中心的位置,将继续意味着许多卒中患者最初出现在卒中相关资源较少的社区急诊科。这些网站也倾向于为农村地区的人口提供服务,他们在护理和结果方面存在差异。减少农村地区人口与中风相关的健康差距需要在这些更偏远的社区环境中进行投资,作为各自社区中风生存链的支柱。本科学声明对农村卒中护理面临的挑战进行了批判性评估,这些挑战涉及急性期卒中相关能力的可及性和变化,从而为策略提供信息并提出解决方案。科学声明考虑了在农村地区扩大急性卒中准备医院和初级卒中中心认证的价值,远程医疗的作用和改进的转诊流程,以及从大型综合中心到与其连接的农村医院的更多参与和指导。多利益攸关方合作和政策干预需要以提高公众意识、提供工作人员培训、发展基础设施、增加获得临床专业知识的机会、简化数据管理以及实施质量评估和改进计划为导向。
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引用次数: 0
Preparing for (and Making the Most of) Your Next Scientific Conference. 准备(并充分利用)下一次科学会议。
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-02-01 Epub Date: 2024-10-09 DOI: 10.1161/STROKEAHA.124.045905
Yohane Gadama, Hannah Simba, Hatice Ozkan, Eitzaz Sadiq
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引用次数: 0
Menstruation: An Important Indicator for Assessing Stroke Risk and Its Outcomes. 月经:评估中风风险及其后果的重要指标。
IF 7.8 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-02-01 Epub Date: 2024-11-07 DOI: 10.1161/STROKEAHA.124.048869
Alison Seitz, Ami P Raval

In recent years, stroke incidence in older adults has declined strikingly, but stroke in younger women has become more common. Abnormalities of menstruation, the shedding of the uterine lining at the beginning of each menstrual cycle, may offer clues about stroke risk in young and midlife women. Endometrial and structural uterine abnormalities are associated with anemia and may be associated with hypercoagulability, possibly increasing stroke risk. Patient factors that influence both menstruation and stroke risk include coagulopathies, polycystic ovarian syndrome, endometriosis, migraine, and other systemic disorders, in addition to menopause. Environmental and iatrogenic factors that influence both menstruation and stroke risk include hormonal contraceptives, nicotine, xenoestrogens, phytoestrogens, oophorectomy, and hysterectomy. Importantly, secondary stroke prevention can affect menstruation. Our current review presents literature supporting the idea that abnormal menstruation may indicate elevated stroke risk in premenopausal women.

近年来,老年人的中风发病率显著下降,但年轻女性的中风发病率却越来越高。月经异常,即每个月经周期开始时子宫内膜脱落,可能为中青年女性的中风风险提供线索。子宫内膜和子宫结构异常与贫血有关,也可能与高凝状态有关,从而可能增加中风风险。影响月经和中风风险的患者因素包括凝血功能障碍、多囊卵巢综合征、子宫内膜异位症、偏头痛和其他系统性疾病,以及更年期。影响月经和中风风险的环境因素和先天性因素包括激素避孕药、尼古丁、异雌激素、植物雌激素、输卵管切除术和子宫切除术。重要的是,中风的二级预防会影响月经。我们目前的综述介绍了支持月经异常可能预示绝经前女性中风风险升高这一观点的文献。
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引用次数: 0
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Stroke
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