Stroke and Vascular Neurology最新文献

Association between stroke subtypes and outcomes of endovascular therapy: a post-hoc analysis of the ANGEL-ASPECT Trial 中风亚型与血管内治疗效果之间的关系：ANGEL-ASPECT 试验的事后分析

IF 5.9 1区医学 Q1 CLINICAL NEUROLOGY

Stroke and Vascular Neurology

Pub Date : 2024-09-17 DOI: 10.1136/svn-2024-003115

Da Lu, Raynald , Dapeng Sun, Na Zheng, Bohao Zhang, Leilei Luo, Sifei Wang, Sihu Pan, Yuchao Dou, Mengxing Wang, Yuesong Pan, Xiaochuan Huo, Zhongrong Miao, Ming Wei

Objectives Our study aims to examine the value of endovascular therapy (EVT) and its comparison to medical management (MM) in ischaemic stroke patients accompanied by large artery atherosclerosis (LAA) and non-LAA Methods modified Rankin scale score (mRS) was evaluated at 90 days post the stroke attack and was considered as the primary outcome. Other outcomes measured in this study included score changes of 0–2 and 0–3 on the mRS. The occurrence of symptomatic intracranial haemorrhage at 24 hours after EVT was also measured as a safety endpoint. Logistic regression analysis was used to determine the associations. Results In the LAA group, no significant difference in mRS at 90-day (median IQR 3 (2–5) vs 4 (3–4), 95% CI 0.53 to 2.00, p=0.924), mRS 0–2 and mRS 0–3 was observed between EVT and MM groups. However, in the non-LAA group, patients who underwent EVT had lower 90-day mRS scores (4 (2–5) vs 4 (3–5), generalised OR 1.47, 95% CI 1.14 to 1.88, p<0.001). No interaction effect on the primary outcomes between treatment options and aetiology. More intracranial haemorrhage events within 48 hours were identified in the EVT group for both LAA and non-LAA cohorts (LAA: 40.98% vs 9.62%, relative risk (RR) 4.26, 95% CI 1.76 to 10.34, p<0.001; non-LAA, 52.07% vs 19.65%, RR 2.65, 95% CI 1.90 to 3.70, respectively). Conclusions For large infarcts, EVT may be more effective than MM for patients with non-LAA aetiology, but not for those with LAA stroke. As no interaction effect was found, the benefit of EVT compared with MM did not vary by stroke subtypes. Data are available on reasonable request.

目的我们的研究旨在探讨血管内治疗（EVT）的价值，以及它与药物治疗（MM）在伴有大动脉粥样硬化（LAA）和非大动脉粥样硬化的缺血性中风患者中的比较方法。本研究测量的其他结果包括 mRS 评分 0-2 分和 0-3 分的变化。EVT术后24小时内出现无症状颅内出血的情况也作为安全终点进行测量。采用逻辑回归分析确定相关性。结果在LAA组中，EVT组和MM组在90天时的mRS（中位数IQR 3 (2-5) vs 4 (3-4)，95% CI 0.53 to 2.00，p=0.924）、mRS 0-2和mRS 0-3方面无明显差异。然而，在非LAA组中，接受EVT的患者90天mRS评分较低（4 (2-5) vs 4 (3-5)，广义OR 1.47，95% CI 1.14 to 1.88，p<0.001）。治疗方案与病因对主要结果无交互影响。在LAA和非LAA队列中，EVT组在48小时内发现了更多的颅内出血事件（LAA：40.98% vs 9.62%，相对风险（RR）4.26，95% CI 1.76至10.34，p<0.001；非LAA：52.07% vs 19.65%，RR 2.65，95% CI 1.90至3.70）。结论对于大面积脑梗死，对于非LAA病因的患者，EVT可能比MM更有效，但对于LAA脑卒中患者则不然。由于未发现交互效应，EVT 与 MM 相比的获益并不因卒中亚型而异。如有合理要求，可提供相关数据。

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引用次数: 0

Optimal duration of dual antiplatelet therapy for minor stroke within 72 hours of symptom onset: a prospective cohort study 前瞻性队列研究：轻微中风患者在症状出现后 72 小时内接受双重抗血小板疗法的最佳疗程

IF 5.9 1区医学 Q1 CLINICAL NEUROLOGY

Stroke and Vascular Neurology

Pub Date : 2024-09-13 DOI: 10.1136/svn-2023-002933

Tingting Liu, Yongle Wang, Kaili Zhang, Haimei Fan, Yanan Li, Jing Ren, Juan Li, Yali Li, Xinyi Li, Wu Xuemei, Junhui Wang, Lixi Xue, Xiaolei Gao, Yuping Yan, Gaimei Li, Qingping Liu, Wenhua Niu, Wenxian Du, Yuting Liu, Xiaoyuan Niu

Objectives Despite the potential spillover effect, the optimal duration of dual antiplatelet therapy for minor stroke within 72 hours of symptom onset is still uncertain. Methods Safety and Efficacy of Aspirin-Clopidogrel in Acute Noncardiogenic Minor Ischemic Stroke (National Institutes of Health Stroke Scale (NIHSS) score≤5) is a prospective cohort study involving patients with minor ischaemic stroke within 72 hours of symptom onset. The DAPT group was further categorised into three subgroups: shorter duration (<10 days), short duration (10–21 days) and long duration (>21 days). The primary efficacy and safety outcomes were composite vascular event and severe bleeding during 90 days. Results Among 3061 eligible patients (age was 61.7±12.0 years, 73.3% were men, median (IQR) NIHSS score, 2 (1–3)), 2977 (97.4%) completed the follow-up. Dual antiplatelet therapy (DAPT) and single antiplatelet therapy (SAPT) were administered in 61.0% and 39.0% of patients. Among them, 305 patients (16.8%) received a shorter duration of DAPT, 937 patients (51.7%) received a short duration and 572 patients (31.5%) received a long duration. In the propensity-weighted Cox proportional hazards regression analysis, the use of DAPT in the short-duration group was associated with a lower risk of the primary vascular event outcome (HR (HR)=0.66, 95% CI 0.46 to 0.94, p=0.02) compared with SAPT group. The incidence of severe bleeding events at 90 days was similar. Similar findings were obtained from the propensity score-matching analysis. Conclusion Short duration of DAPT (10–21 days) is superior to SAPT in minor stroke within 72 hours, reducing 90-day composite vascular events without increasing bleeding risk. The data that support the findings of this study are available from the corresponding author upon reasonable request. The corresponding author is responsible for the data in this study.

目的尽管存在潜在的溢出效应，但在症状出现 72 小时内对轻微卒中进行双联抗血小板治疗的最佳持续时间仍不确定。方法阿司匹林-氯吡格雷治疗急性非心源性轻微缺血性卒中（美国国立卫生研究院卒中量表（NIHSS）评分≤5 分）的安全性和有效性是一项前瞻性队列研究，涉及症状出现 72 小时内的轻微缺血性卒中患者。DAPT 组又分为三个亚组：持续时间较短（21 天）。主要疗效和安全性结果为 90 天内的复合血管事件和严重出血。结果在3061名符合条件的患者中（年龄为61.7±12.0岁，73.3%为男性，NIHSS评分中位数（IQR）为2（1-3）），2977人（97.4%）完成了随访。61.0%的患者接受了双联抗血小板疗法（DAPT），39.0%的患者接受了单联抗血小板疗法（SAPT）。其中，305 名患者（16.8%）接受了时间较短的 DAPT，937 名患者（51.7%）接受了时间较短的 DAPT，572 名患者（31.5%）接受了时间较长的 DAPT。在倾向加权 Cox 比例危险回归分析中，与 SAPT 组相比，短时段组使用 DAPT 与较低的主要血管事件结局风险相关（HR (HR)=0.66, 95% CI 0.46 to 0.94, p=0.02）。90天严重出血事件的发生率相似。倾向评分匹配分析也得出了类似的结果。结论对于 72 小时内的轻微卒中，短程 DAPT（10-21 天）优于 SAPT，可在不增加出血风险的情况下减少 90 天的复合血管事件。支持本研究结果的数据可向通讯作者索取。通讯作者对本研究数据负责。

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引用次数: 0

Pictures of stroke and cerebral vasculature: novel insights and detailed visualisation of U-shaped elastin distribution and disorganised fibre arrangement at carotid bifurcations by advanced techniques 中风和脑血管的图像：通过先进技术对颈动脉分叉处 U 形弹性蛋白分布和无序纤维排列的新见解和详细可视化分析

IF 5.9 1区医学 Q1 CLINICAL NEUROLOGY

Stroke and Vascular Neurology

Pub Date : 2024-09-11 DOI: 10.1136/svn-2024-003528

Shen Li, Peipei Li, Xin Wang, Zongping Xia, Yuming Xu

The bifurcation regions of intracranial and extracranial arteries are common sites for atherosclerosis, predisposing to ischaemic stroke.1 Previous studies have shown that the unique haemodynamics at the bifurcation may lead to alterations in genes and proteins in this region.2 Elastin is closely associated with the progression of atherosclerosis.3 However, under physiological conditions, the expression and distribution of elastin in bifurcation regions have not yet been elucidated. Mice are the most frequently used animal model for studying atherosclerosis. This study focuses on carotid bifurcation, optimising the iDISCO (immunolabeling-enabled three-dimensional imaging of solvent-cleared organs) technique for whole tissue clearing and staining of the carotid …

颅内动脉和颅外动脉的分叉区是动脉粥样硬化的常见部位，容易导致缺血性中风1 。先前的研究表明，分叉区独特的血液动力学可能导致该区域基因和蛋白质的改变2 。小鼠是研究动脉粥样硬化最常用的动物模型。本研究以颈动脉分叉为研究对象，优化了 iDISCO（溶剂清除器官免疫标记三维成像）技术，对颈动脉进行全组织清除和染色。

引用次数: 0

miR-19-3p/GRSF1/COX1 axis attenuates early brain injury via maintaining mitochondrial function after subarachnoid haemorrhage miR-19-3p/GRSF1/COX1 轴通过维持蛛网膜下腔出血后的线粒体功能减轻早期脑损伤

IF 5.9 1区医学 Q1 CLINICAL NEUROLOGY

Stroke and Vascular Neurology

Pub Date : 2024-09-11 DOI: 10.1136/svn-2024-003099

Ge Gao, Xiaoyu Sun, Jiajia Xu, Jian Yu, Yang Wang

Background Guanine-rich RNA sequence binding factor 1 (GRSF1) is an RNA-binding protein, which is eventually localised to mitochondria and promotes the translation of cytochrome C oxidase 1 (COX1) mRNA. However, the role of the miR-19-3 p/GRSF1/COX1 axis has not been investigated in an experimental subarachnoid haemorrhage (SAH) model. Thus, we investigated the role of the miR-19-3 p/GRSF1/COX1 axis in a SAH-induced early brain injury (EBI) course. Methods Primary neurons were treated with oxyhaemoglobin (OxyHb) to simulate in vitro SAH. The rat SAH model was established by injecting autologous arterial blood into the optic chiasma cisterna. The GRSF1 level was downregulated or upregulated by treating the rats and neurons with lentivirus- GRSF1 shRNA (Lenti- GRSF1 shRNA) or lentivirus- GRSF1 (Lenti- GRSF1 ). Results The miR-19-3 p level was upregulated and the protein levels of GRSF1 and COX1 were both downregulated in SAH brain tissue. GRSF1 silence decreased and GRSF1 overexpression increased the protein levels of GRSF1 and COX1 in primary neurons and brain tissue, respectively. Lenti- GRSF1 shRNA aggravated, but Lenti- GRSF1 alleviated, the indicators of neuronal injury and neurological impairment in both in vitro and in vivo SAH conditions. In addition, miR-19-3 p mimic reduced the protein levels of GRSF1 and COX1 in cultured neurons while miR-19-3 p inhibitor increased them. More importantly, Lenti- GRSF1 significantly relieved mitochondrial damage of neurons exposed to OxyHb or induced by SAH and was beneficial to maintaining mitochondrial integrity. Lenti- GRSF1 shRNA treatment, conversely, aggravated mitochondrial damage in neurons. Conclusion The miR-19-3 p/GRSF1/COX1 axis may serve as an underlying target for inhibiting SAH-induced EBI by maintaining mitochondrial integrity. Data are available on reasonable request.

背景富含鸟嘌呤的 RNA 序列结合因子 1（GRSF1）是一种 RNA 结合蛋白，它最终定位于线粒体并促进细胞色素 C 氧化酶 1（COX1）mRNA 的翻译。然而，miR-19-3 p/GRSF1/COX1 轴的作用尚未在实验性蛛网膜下腔出血（SAH）模型中进行研究。因此，我们研究了 miR-19-3 p/GRSF1/COX1 轴在 SAH 诱导的早期脑损伤（EBI）过程中的作用。方法用氧血红蛋白（OxyHb）处理原始神经元以模拟体外 SAH。将自体动脉血注入视神经驰管，建立大鼠 SAH 模型。用慢病毒-GRSF1 shRNA（Lenti- GRSF1 shRNA）或慢病毒-GRSF1（Lenti- GRSF1 ）处理大鼠和神经元，下调或上调GRSF1水平。结果 SAH 脑组织中 miR-19-3 p 水平上调，GRSF1 和 COX1 蛋白水平下调。在原代神经元和脑组织中，GRSF1沉默会降低GRSF1和COX1的蛋白水平，而GRSF1过表达则会提高GRSF1和COX1的蛋白水平。Lenti- GRSF1 shRNA 会加重体外和体内 SAH 条件下神经元损伤和神经功能损害的指标，而 Lenti- GRSF1 则会减轻神经元损伤和神经功能损害的指标。此外，miR-19-3 p 模拟物降低了培养神经元中 GRSF1 和 COX1 的蛋白水平，而 miR-19-3 p 抑制剂则提高了它们的蛋白水平。更重要的是，Lenti-GRSF1 能明显缓解暴露于 OxyHb 或 SAH 诱导的神经元线粒体损伤，有利于维持线粒体的完整性。相反，Lenti-GRSF1 shRNA 处理会加重神经元线粒体损伤。结论 miR-19-3 p/GRSF1/COX1 轴可能是通过维持线粒体完整性来抑制 SAH 诱导的 EBI 的潜在靶点。如有合理要求，可提供相关数据。

{"title":"miR-19-3p/GRSF1/COX1 axis attenuates early brain injury via maintaining mitochondrial function after subarachnoid haemorrhage","authors":"Ge Gao, Xiaoyu Sun, Jiajia Xu, Jian Yu, Yang Wang","doi":"10.1136/svn-2024-003099","DOIUrl":"https://doi.org/10.1136/svn-2024-003099","url":null,"abstract":"Background Guanine-rich RNA sequence binding factor 1 (GRSF1) is an RNA-binding protein, which is eventually localised to mitochondria and promotes the translation of cytochrome C oxidase 1 (COX1) mRNA. However, the role of the miR-19-3 p/GRSF1/COX1 axis has not been investigated in an experimental subarachnoid haemorrhage (SAH) model. Thus, we investigated the role of the miR-19-3 p/GRSF1/COX1 axis in a SAH-induced early brain injury (EBI) course. Methods Primary neurons were treated with oxyhaemoglobin (OxyHb) to simulate in vitro SAH. The rat SAH model was established by injecting autologous arterial blood into the optic chiasma cisterna. The GRSF1 level was downregulated or upregulated by treating the rats and neurons with lentivirus- GRSF1 shRNA (Lenti- GRSF1 shRNA) or lentivirus- GRSF1 (Lenti- GRSF1 ). Results The miR-19-3 p level was upregulated and the protein levels of GRSF1 and COX1 were both downregulated in SAH brain tissue. GRSF1 silence decreased and GRSF1 overexpression increased the protein levels of GRSF1 and COX1 in primary neurons and brain tissue, respectively. Lenti- GRSF1 shRNA aggravated, but Lenti- GRSF1 alleviated, the indicators of neuronal injury and neurological impairment in both in vitro and in vivo SAH conditions. In addition, miR-19-3 p mimic reduced the protein levels of GRSF1 and COX1 in cultured neurons while miR-19-3 p inhibitor increased them. More importantly, Lenti- GRSF1 significantly relieved mitochondrial damage of neurons exposed to OxyHb or induced by SAH and was beneficial to maintaining mitochondrial integrity. Lenti- GRSF1 shRNA treatment, conversely, aggravated mitochondrial damage in neurons. Conclusion The miR-19-3 p/GRSF1/COX1 axis may serve as an underlying target for inhibiting SAH-induced EBI by maintaining mitochondrial integrity. Data are available on reasonable request.","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"421 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217584","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

Association between ASPECTS region of infarction and clinical outcome in non-acute large vessel occlusion ischaemic stroke after endovascular recanalisation 血管内再通术后非急性大血管闭塞缺血性卒中患者 ASPECTS 梗死区域与临床预后的关系

IF 5.9 1区医学 Q1 CLINICAL NEUROLOGY

Stroke and Vascular Neurology

Pub Date : 2024-09-11 DOI: 10.1136/svn-2024-003355

Jialiang Lu, Ziwei Lu, Ye Li, Fangcun Li, Yuxuan Feng, Meijuan Dang, Yang Yang, Fan Tang, Tao Li, Lili Zhao, Yating Jian, Xiaoya Wang, Lei Zhang, Hong Fan, Guilian Zhang

Purpose This study retrospectively investigated whether infarction in specific Alberta Stroke Program Early CT Score (ASPECTS) regions is associated with clinical outcome in patients with symptomatic non-acute internal carotid or middle cerebral artery occlusion who underwent endovascular recanalisation (ER). Methods Preoperative ASPECTS and region of infarction were recorded before recanalisation. Clinical outcome was evaluated 90 days after the procedure using the modified Rankin Scale; a score>2 was defined as poor outcome. Secondary outcomes included postprocedural cerebral oedema, intracranial haemorrhage (ICH) and symptomatic ICH. Results Among the 86 patients included, 90-day outcome was poor in 30 (34.9%) and 40 experienced cerebral oedema (46.5%). Multivariate logistic regression models showed that lenticular nucleus infarction (OR 19.61–26.00, p<0.05), admission diastolic blood pressure (OR 1.07–1.08, p<0.05), preprocedural National Institutes of Health Stroke Scale (OR 1.96–2.05, p<0.001) and haemorrhagic transformation (OR 14.99–18.81, p<0.05) were independent predictors of poor 90-day outcome. The area under the receiver operating characteristic curve for lenticular nucleus infarction as a predictor of poor outcome was 0.73. M2 region infarction (OR 26.07, p<0.001) and low American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral circulation grade (OR 0.16, p=0.001) were independent predictors of postprocedural cerebral oedema. The area under the receiver operating characteristic curve for M2 region infarction as a predictor of cerebral oedema was 0.64. Region of infarction did not significantly differ between patients with and without postprocedural ICH or symptomatic ICH. Conclusions Lenticular nucleus and M2 region infarction were independent predictors of poor 90-day outcome and postprocedural cerebral oedema, respectively, in patients with non-acute anterior circulation large artery occlusion who underwent ER. Data are available on reasonable request. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

目的本研究回顾性调查了接受血管内再通术（ER）的无症状非急性颈内动脉或大脑中动脉闭塞患者，其特定阿尔伯塔卒中计划早期 CT 评分（ASPECTS）区域的梗死是否与临床预后有关。方法在血管再通手术前记录术前 ASPECTS 和梗死区域。术后90天采用改良Rankin量表评估临床疗效；评分大于2分为疗效不佳。次要结果包括术后脑水肿、颅内出血（ICH）和无症状 ICH。结果在纳入的 86 名患者中，30 人（34.9%）90 天预后不良，40 人（46.5%）出现脑水肿。多变量逻辑回归模型显示，晶状体核梗死（OR 19.61-26.00，P<0.05）、入院舒张压（OR 1.07-1.08，P<0.05）、术前美国国立卫生研究院卒中量表（OR 1.96-2.05，P<0.001）和出血转化（OR 14.99-18.81，P<0.05）是不良 90 天预后的独立预测因素。光栅核梗死作为不良预后预测因子的接收者操作特征曲线下面积为 0.73。M2区域梗死（OR 26.07，p<0.001）和美国介入与治疗神经放射学会/介入放射学会侧支循环分级低（OR 0.16，p=0.001）是预测术后脑水肿的独立指标。M2区域梗死预测脑水肿的接收器操作特征曲线下面积为0.64。术后 ICH 或无症状 ICH 患者的梗死区域无明显差异。结论在接受急诊室手术的非急性前循环大动脉闭塞患者中，晶状体核和M2区域梗死分别是90天不良预后和术后脑水肿的独立预测因子。如有合理要求，可提供相关数据。本研究中生成和/或分析的数据集可向通讯作者索取。

{"title":"Association between ASPECTS region of infarction and clinical outcome in non-acute large vessel occlusion ischaemic stroke after endovascular recanalisation","authors":"Jialiang Lu, Ziwei Lu, Ye Li, Fangcun Li, Yuxuan Feng, Meijuan Dang, Yang Yang, Fan Tang, Tao Li, Lili Zhao, Yating Jian, Xiaoya Wang, Lei Zhang, Hong Fan, Guilian Zhang","doi":"10.1136/svn-2024-003355","DOIUrl":"https://doi.org/10.1136/svn-2024-003355","url":null,"abstract":"Purpose This study retrospectively investigated whether infarction in specific Alberta Stroke Program Early CT Score (ASPECTS) regions is associated with clinical outcome in patients with symptomatic non-acute internal carotid or middle cerebral artery occlusion who underwent endovascular recanalisation (ER). Methods Preoperative ASPECTS and region of infarction were recorded before recanalisation. Clinical outcome was evaluated 90 days after the procedure using the modified Rankin Scale; a score>2 was defined as poor outcome. Secondary outcomes included postprocedural cerebral oedema, intracranial haemorrhage (ICH) and symptomatic ICH. Results Among the 86 patients included, 90-day outcome was poor in 30 (34.9%) and 40 experienced cerebral oedema (46.5%). Multivariate logistic regression models showed that lenticular nucleus infarction (OR 19.61–26.00, p<0.05), admission diastolic blood pressure (OR 1.07–1.08, p<0.05), preprocedural National Institutes of Health Stroke Scale (OR 1.96–2.05, p<0.001) and haemorrhagic transformation (OR 14.99–18.81, p<0.05) were independent predictors of poor 90-day outcome. The area under the receiver operating characteristic curve for lenticular nucleus infarction as a predictor of poor outcome was 0.73. M2 region infarction (OR 26.07, p<0.001) and low American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral circulation grade (OR 0.16, p=0.001) were independent predictors of postprocedural cerebral oedema. The area under the receiver operating characteristic curve for M2 region infarction as a predictor of cerebral oedema was 0.64. Region of infarction did not significantly differ between patients with and without postprocedural ICH or symptomatic ICH. Conclusions Lenticular nucleus and M2 region infarction were independent predictors of poor 90-day outcome and postprocedural cerebral oedema, respectively, in patients with non-acute anterior circulation large artery occlusion who underwent ER. Data are available on reasonable request. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"36 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217582","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

Sex differences in the epidemiology of spontaneous and traumatic cervical artery dissections 自发性和外伤性颈动脉离断流行病学中的性别差异

IF 5.9 1区医学 Q1 CLINICAL NEUROLOGY

Stroke and Vascular Neurology

Pub Date : 2024-09-11 DOI: 10.1136/svn-2024-003282

Elke Schipani, Kim J Griffin, Carlee I Oakley, Zafer Keser

Background Recent studies show cervical artery dissection (CeAD) is equally common between sexes, and that the incidence of CeAD has risen at a greater rate in females than males. In this population-based study, we identify sex differences in patients diagnosed with spontaneous and traumatic CeAD. Methods 144 patients with spontaneous or traumatic CeAD were studied for sex differences in medical comorbidities, presenting symptoms and outcomes. Results Females were more likely to carry a diagnosis of migraine, while males were more likely to have hyperlipidaemia. Females were more likely to present with neck pain, males with stroke. Females were significantly more likely to develop recurrent dissections in the study period. Conclusions These findings underscore the importance of understanding CeAD through the lens of sex differences and may explain the significant rise in the diagnosis of CeAD in females. These findings support the importance of considering sex-specific risk factors and medical comorbidities with sex predilection in the diagnosis and management of CeAD. Furthermore, it emphasises the importance of female patients understanding risk factors and presenting signs that should prompt evaluation for CeAD.

背景最近的研究表明，颈动脉夹层（CeAD）在两性之间同样常见，而且女性的发病率比男性上升得更快。在这项基于人群的研究中，我们确定了自发性和外伤性 CeAD 患者的性别差异。方法我们对 144 名自发性或外伤性 CeAD 患者进行了研究，以了解他们在并发症、症状和预后方面的性别差异。结果女性更有可能被诊断为偏头痛，而男性则更有可能患有高脂血症。女性更容易出现颈部疼痛，男性则更容易中风。在研究期间，女性更有可能出现复发性血管断裂。结论这些发现强调了从性别差异的角度来理解 CeAD 的重要性，这也可能解释了女性 CeAD 诊断率大幅上升的原因。这些发现支持了在诊断和管理 CeAD 时考虑性别特异性风险因素和具有性别偏好的并发症的重要性。此外，研究还强调了女性患者了解风险因素和症状的重要性，这些因素和症状应促使对 CeAD 进行评估。

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引用次数: 0

Asymptomatic carotid artery stenosis is associated with increased Alzheimer’s disease and non-Alzheimer’s disease dementia risk 无症状颈动脉狭窄与阿尔茨海默氏症和非阿尔茨海默氏症痴呆风险增加有关

IF 5.9 1区医学 Q1 CLINICAL NEUROLOGY

Stroke and Vascular Neurology

Pub Date : 2024-09-11 DOI: 10.1136/svn-2024-003164

Francesca Vitali, Georgina Torrandell-Haro, Gregory Branigan, Juan Arias Aristizabal, Eric Reiman, Edward J Bedrick, Roberta Diaz Brinton, Craig Weinkauf

Background In the absence of a cerebrovascular accident, whether asymptomatic extracranial carotid atherosclerotic disease (aECAD) affects Alzheimer’s disease (AD) and non-AD dementia risk is not clear. Understanding whether aECAD is associated with an increased risk for AD is important as it is present in roughly 10% of the population over 60 and could represent a modifiable risk factor for AD and non-AD dementia. Methods This retrospective cohort study analysed Mariner insurance claims. Enrolment criteria included patients aged 55 years or older with at least 5 years of data and no initial dementia diagnosis. Subjects with and without aECAD were evaluated for subsequent AD and non-AD dementia diagnoses. Propensity score matching was performed using confounding factors identified by logistic regression. χ2 tests and Kaplan-Meier survival curves were used to evaluate the impact of aECAD diagnosis on AD and non-AD dementia risk over time. Results 767 354 patients met enrolment criteria. After propensity score matching, 62 963 subjects with aECAD and 62 963 subjects without ECAD were followed through data records. The aECAD cohort exhibited an increased relative risk of 1.22 (95% CI 1.15 to 1.29, p<0.001) for AD and 1.48 (95% CI 1.38 to 1.59, p<0.001) for non-AD dementias compared with the propensity score-matched cohort without aECAD. The increased AD risk associated with aECAD was evident in patients younger than 75 years old and was less apparent in patients over 75 years of age. Conclusions aECAD is associated with an increased risk of developing AD and non-AD dementias. These findings underscore the need for further prospective evaluation of interactions between aECAD and dementia, with potential implications for change of clinical care in both of these large patient populations. Data are available on reasonable request.

背景在没有发生脑血管意外的情况下，无症状颅外颈动脉粥样硬化性疾病（aECAD）是否会影响阿尔茨海默病（AD）和非 AD 痴呆症的风险尚不清楚。了解颈动脉粥样硬化性疾病是否与阿尔茨海默病风险的增加有关非常重要，因为60岁以上的人群中约有10%患有这种疾病，而且这种疾病可能是阿尔茨海默病和非阿尔茨海默病痴呆症的一个可改变的风险因素。方法这项回顾性队列研究分析了 Mariner 保险索赔。入组标准包括年龄在 55 岁或以上、至少有 5 年数据且未被初步诊断为痴呆症的患者。对患有和未患有先天性痴呆症的受试者进行了后续先天性痴呆症和非先天性痴呆症诊断评估。利用逻辑回归确定的混杂因素进行倾向评分匹配。采用χ2检验和Kaplan-Meier生存曲线来评估随着时间的推移，AECAD诊断对AD和非AD痴呆症风险的影响。结果 767 354 名患者符合入组标准。经过倾向得分匹配后，62 963 名患有 aECAD 的受试者和 62 963 名未患有 aECAD 的受试者通过数据记录得到了跟踪调查。与倾向得分匹配的无艾氏痴呆症患者队列相比，艾氏痴呆症患者队列的艾氏痴呆症相对风险增加了1.22（95% CI 1.15至1.29，p<0.001），非艾氏痴呆症相对风险增加了1.48（95% CI 1.38至1.59，p<0.001）。与aECAD相关的AD风险增加在75岁以下的患者中很明显，而在75岁以上的患者中则不那么明显。结论 aECAD 与罹患 AD 和非 AD 痴呆症的风险增加有关。这些发现强调了进一步前瞻性评估 aECAD 与痴呆症之间相互作用的必要性，这对改变这两个庞大患者群体的临床护理具有潜在影响。如有合理要求，可提供相关数据。

{"title":"Asymptomatic carotid artery stenosis is associated with increased Alzheimer’s disease and non-Alzheimer’s disease dementia risk","authors":"Francesca Vitali, Georgina Torrandell-Haro, Gregory Branigan, Juan Arias Aristizabal, Eric Reiman, Edward J Bedrick, Roberta Diaz Brinton, Craig Weinkauf","doi":"10.1136/svn-2024-003164","DOIUrl":"https://doi.org/10.1136/svn-2024-003164","url":null,"abstract":"Background In the absence of a cerebrovascular accident, whether asymptomatic extracranial carotid atherosclerotic disease (aECAD) affects Alzheimer’s disease (AD) and non-AD dementia risk is not clear. Understanding whether aECAD is associated with an increased risk for AD is important as it is present in roughly 10% of the population over 60 and could represent a modifiable risk factor for AD and non-AD dementia. Methods This retrospective cohort study analysed Mariner insurance claims. Enrolment criteria included patients aged 55 years or older with at least 5 years of data and no initial dementia diagnosis. Subjects with and without aECAD were evaluated for subsequent AD and non-AD dementia diagnoses. Propensity score matching was performed using confounding factors identified by logistic regression. χ2 tests and Kaplan-Meier survival curves were used to evaluate the impact of aECAD diagnosis on AD and non-AD dementia risk over time. Results 767 354 patients met enrolment criteria. After propensity score matching, 62 963 subjects with aECAD and 62 963 subjects without ECAD were followed through data records. The aECAD cohort exhibited an increased relative risk of 1.22 (95% CI 1.15 to 1.29, p<0.001) for AD and 1.48 (95% CI 1.38 to 1.59, p<0.001) for non-AD dementias compared with the propensity score-matched cohort without aECAD. The increased AD risk associated with aECAD was evident in patients younger than 75 years old and was less apparent in patients over 75 years of age. Conclusions aECAD is associated with an increased risk of developing AD and non-AD dementias. These findings underscore the need for further prospective evaluation of interactions between aECAD and dementia, with potential implications for change of clinical care in both of these large patient populations. Data are available on reasonable request.","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"59 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217585","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

Residual inflammatory risk predicts long-term outcomes following stenting for symptomatic intracranial atherosclerotic stenosis. 残留炎症风险可预测无症状颅内动脉粥样硬化狭窄支架置入术后的长期疗效。

IF 4.4 1区医学 Q1 CLINICAL NEUROLOGY

Stroke and Vascular Neurology

Pub Date : 2024-08-27 DOI: 10.1136/svn-2023-002421

Ying Yu, Yake Lou, Yuesong Pan, Long Yan, Weilun Fu, Zhikai Hou, Rongrong Cui, Zhongrong Miao, Yongjun Wang, Xin Lou, Ning Ma

Background and purpose: Residual inflammatory risk (RIR) can predict the unfavourable outcomes in patients with minor ischaemic stroke. However, the impact of preprocedural RIR on long-term outcomes in patients with symptomatic intracranial atherosclerotic stenosis (sICAS) who underwent stenting remains understudied.

Methods: This retrospective, single-centre cohort study evaluated consecutive patients with severe sICAS who underwent intracranial stenting. Patients were categorised into four groups based on preprocedural high-sensitivity C-reactive protein (hs-CRP) and low-density lipoprotein cholesterol (LDL-C): residual cholesterol inflammatory risk (RCIR, hs-CRP ≥3 mg/L and LDL-C ≥2.6 mmol/L), RIR (hs-CRP ≥3 mg/L and LDL-C <2.6 mmol/L), residual cholesterol risk (RCR, hs-CRP <3 mg/L and LDL-C ≥2.6 mmol/L) and no residual risk (NRR, hs-CRP <3 mg/L and LDL-C <2.6 mmol/L). The long-term clinical outcomes included recurrent ischaemic stroke and death. The long-term imaging outcomes consisted of in-stent restenosis (ISR) and symptomatic ISR (sISR) after stenting.

Results: In this study, 952 patients were included, with 751 (78.9%) being male. Forty-six cases were categorised into the RCIR group, 211 into the RIR group, 107 into the RCR group and 588 into the NRR group. Patients with RCIR (adjusted HR 6.163; 95% CI 2.603 to 14.589; p<0.001) and RIR (adjusted HR 2.205; 95% CI 1.294 to 3.757; p=0.004) had higher risks of recurrent ischaemic stroke than those with NRR during the 54 months of median follow-up time. Patients with RCIR (adjusted HR 3.604; 95% CI 1.431 to 9.072; p=0.007) were more likely to occur ISR, and patients in the RIR group showed a significant increase in the risk of sISR (adjusted HR 2.402; 95% CI 1.078 to 5.351; p=0.032) compared with those in the NRR group with a median follow-up time of 11.9 months.

Conclusions: In patients with sICAS, preprocedural RIR may predict long-term recurrent ischaemic stroke, ISR and sISR following intracranial stenting.

背景和目的：残余炎症风险（RIR）可预测轻微缺血性卒中患者的不良预后。然而，对于接受支架植入术的无症状颅内动脉粥样硬化性狭窄（sICAS）患者，术前残留炎症风险对其长期预后的影响仍未得到充分研究：这项回顾性单中心队列研究对连续接受颅内支架植入术的重度 sICAS 患者进行了评估。根据术前高敏 C 反应蛋白（hs-CRP）和低密度脂蛋白胆固醇（LDL-C）将患者分为四组：残余胆固醇炎症风险组（RCIR，hs-CRP ≥3 mg/L，LDL-C ≥2.6 mmol/L）、RIR（hs-CRP ≥3 mg/L，LDL-C ≥2.6 mmol/L）、RIR（hs-CRP ≥3 mg/L，LDL-C ≥2.6 mmol/L）和 RIR（hs-CRP ≥3 mg/L，LDL-C ≥2.6 mmol/L）：本研究共纳入 952 例患者，其中 751 例（78.9%）为男性。46例被归入RCIR组，211例被归入RIR组，107例被归入RCR组，588例被归入NRR组。RCIR患者（调整后HR为6.163；95% CI为2.603至14.589；P结论：对于 sICAS 患者，术前 RIR 可预测颅内支架置入术后缺血性卒中、ISR 和 sISR 的长期复发情况。

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引用次数: 0

Haemorrhage after thrombectomy with adjuvant thrombolysis in unknown onset stroke depends on high early lesion water uptake. 不明原因脑卒中辅助溶栓的血栓切除术后出血取决于早期病变的高摄水率。

IF 4.4 1区医学 Q1 CLINICAL NEUROLOGY

Stroke and Vascular Neurology

Pub Date : 2024-08-27 DOI: 10.1136/svn-2022-002264

Gabriel Broocks, Lukas Meyer, Uta Hanning, Tobias Djamsched Faizy, Matthias Bechstein, Helge Kniep, Noel Van Horn, Gerhard Schön, Ewgenia Barow, Götz Thomalla, Jens Fiehler, Andre Kemmling

Background and purpose: In wake-up stroke, CT-based quantitative net water uptake (NWU) might serve as an alternative tool to MRI to guide intravenous thrombolysis with alteplase (IVT). An important complication after IVT is symptomatic intracerebral haemorrhage (sICH). As NWU directly implies ischaemic lesion progression, reflecting blood-brain barrier injury, we hypothesised that NWU predicts sICH in patients who had a ischaemic stroke undergoing thrombectomy with unknown onset.

Methods: Consecutive analysis of all patients who had unknown onset anterior circulation ischaemic stroke who underwent CT at baseline and endovascular treatment between December 2016 and October 2020. Quantitative NWU was assessed on baseline CT. The primary endpoint was sICH. The association of NWU and other baseline parameters to sICH was investigated using inverse-probability weighting (IPW) analysis.

Results: A total of 88 patients were included, of which 46 patients (52.3%) received IVT. The median NWU was 10.7% (IQR: 5.1-17.7). The proportion of patients with any haemorrhage and sICH were 35.2% and 13.6%. NWU at baseline was significantly higher in patients with sICH (19.1% vs 9.6%, p<0.0001) and the median Alberta Stroke Program Early CT Score (ASPECTS) was lower (5 vs 8, p<0.0001). Following IPW, there was no association between IVT and sICH in unadjusted analysis. However, after adjusting for ASPECTS and NWU, there was a significant association between IVT administration and sICH (14.6%, 95% CI: 3.3% to 25.6%, p<0.01).

Conclusion: In patients with ischaemic stroke with unknown onset, the combination of high NWU with IVT is directly linked to higher rates of sICH. Besides ASPECTS for evaluating the extent of the early infarct lesion, quantitative NWU could be used as an imaging biomarker to assess the degree of blood-brain barrier damage in order to predict the risk of sICH in patients with wake up stroke.

背景和目的：在脑卒中清醒状态下，基于 CT 的定量净摄取水量（NWU）可作为 MRI 的替代工具，指导阿替普酶静脉溶栓（IVT）。静脉溶栓后的一个重要并发症是无症状性脑内出血（sICH）。由于NWU直接意味着缺血性病变的进展，反映了血脑屏障损伤，因此我们假设NWU能预测接受血栓切除术的缺血性中风患者的sICH：方法：对2016年12月至2020年10月期间接受CT基线检查和血管内治疗的所有发病不明的前循环缺血性卒中患者进行连续分析。基线 CT 评估了定量 NWU。主要终点为 sICH。采用反概率加权（IPW）分析法研究了NWU和其他基线参数与sICH的关系：结果：共纳入88名患者，其中46名患者（52.3%）接受了IVT治疗。NWU中位数为10.7%（IQR：5.1-17.7）。任何出血和 sICH 患者的比例分别为 35.2% 和 13.6%。sICH 患者的基线 NWU 明显更高（19.1% vs 9.6%，p 结论：在发病原因不明的缺血性卒中患者中，高 NWU 与 IVT 的组合与较高的 sICH 发生率直接相关。除了 ASPECTS 可用于评估早期梗死病灶的范围外，定量 NWU 也可作为一种影像生物标志物，用于评估血脑屏障的损伤程度，以预测清醒脑卒中患者发生 sICH 的风险。

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引用次数: 0

Mass effect, aneurysms and flow diverters: Is the pipeline embolization device the Lone Virtuoso? Commentary on 'Pipeline embolization device for intracranial aneurysms presenting with mass effect: a large Chinese cohort' by Zhao et al. 质量效应、动脉瘤和血流分流器：管道栓塞装置是 "独孤求败 "吗？对 Zhao 等人撰写的 "管道栓塞装置治疗出现群体效应的颅内动脉瘤：一个大型中国队列 "的评论。

IF 4.4 1区医学 Q1 CLINICAL NEUROLOGY

Stroke and Vascular Neurology

Pub Date : 2024-08-27 DOI: 10.1136/svn-2023-002783

Alexander Sirakov, Georgi Vladev, Kristina Sirakova, Kristian Ninov, Krasimir Minkin, Vasil Karakostov, Stanimir Sirakov

引用次数: 0