Zixiao Li, Xinmiao Zhang, Lingling Ding, Jing Jing, Hong-Qiu Gu, Yong Jiang, Xia Meng, Chunying Du, Chunjuan Wang, Meng Wang, Man Xu, Yanxu Zhang, Meera Hu, Hao Li, Xiping Gong, Kehui Dong, Xingquan Zhao, Yilong Wang, Liping Liu, Ying Xian, Eric Peterson, Gregg C Fonarow, Lee H Schwamm, Yongjun Wang
Background: Given the swift advancements in artificial intelligence (AI), the utilisation of AI-based clinical decision support systems (AI-CDSSs) has become increasingly prevalent in the medical domain, particularly in the management of cerebrovascular disease.
Aims: To describe the design, rationale and methods of a cluster-randomised multifaceted intervention trial aimed at investigating the effect of cerebrovascular disease AI-CDSS on the clinical outcomes of patients who had a stroke and on stroke care quality.
Design: The GOLDEN BRIDGE II trial is a multicentre, open-label, cluster-randomised multifaceted intervention study. A total of 80 hospitals in China were randomly assigned to the AI-CDSS intervention group or the control group. For eligible participants with acute ischaemic stroke in the AI-CDSS intervention group, cerebrovascular disease AI-CDSS will provide AI-assisted imaging analysis, auxiliary stroke aetiology and pathogenesis analysis, and guideline-based treatment recommendations. In the control group, patients will receive the usual care. The primary outcome is the occurrence of new vascular events (composite of ischaemic stroke, haemorrhagic stroke, myocardial infarction or vascular death) at 3 months after stroke onset. The sample size was estimated to be 21 689 with a 26% relative reduction in the incidence of new composite vascular events at 3 months by using multiple quality-improving interventions provided by AI-CDSS. All analyses will be performed according to the intention-to-treat principle and accounted for clustering using generalised estimating equations.
Conclusions: Once the effectiveness is verified, the cerebrovascular disease AI-CDSS could improve stroke care and outcomes in China.
{"title":"Rationale and design of the GOLDEN BRIDGE II: a cluster-randomised multifaceted intervention trial of an artificial intelligence-based cerebrovascular disease clinical decision support system to improve stroke outcomes and care quality in China.","authors":"Zixiao Li, Xinmiao Zhang, Lingling Ding, Jing Jing, Hong-Qiu Gu, Yong Jiang, Xia Meng, Chunying Du, Chunjuan Wang, Meng Wang, Man Xu, Yanxu Zhang, Meera Hu, Hao Li, Xiping Gong, Kehui Dong, Xingquan Zhao, Yilong Wang, Liping Liu, Ying Xian, Eric Peterson, Gregg C Fonarow, Lee H Schwamm, Yongjun Wang","doi":"10.1136/svn-2023-002411","DOIUrl":"10.1136/svn-2023-002411","url":null,"abstract":"<p><strong>Background: </strong>Given the swift advancements in artificial intelligence (AI), the utilisation of AI-based clinical decision support systems (AI-CDSSs) has become increasingly prevalent in the medical domain, particularly in the management of cerebrovascular disease.</p><p><strong>Aims: </strong>To describe the design, rationale and methods of a cluster-randomised multifaceted intervention trial aimed at investigating the effect of cerebrovascular disease AI-CDSS on the clinical outcomes of patients who had a stroke and on stroke care quality.</p><p><strong>Design: </strong>The GOLDEN BRIDGE II trial is a multicentre, open-label, cluster-randomised multifaceted intervention study. A total of 80 hospitals in China were randomly assigned to the AI-CDSS intervention group or the control group. For eligible participants with acute ischaemic stroke in the AI-CDSS intervention group, cerebrovascular disease AI-CDSS will provide AI-assisted imaging analysis, auxiliary stroke aetiology and pathogenesis analysis, and guideline-based treatment recommendations. In the control group, patients will receive the usual care. The primary outcome is the occurrence of new vascular events (composite of ischaemic stroke, haemorrhagic stroke, myocardial infarction or vascular death) at 3 months after stroke onset. The sample size was estimated to be 21 689 with a 26% relative reduction in the incidence of new composite vascular events at 3 months by using multiple quality-improving interventions provided by AI-CDSS. All analyses will be performed according to the intention-to-treat principle and accounted for clustering using generalised estimating equations.</p><p><strong>Conclusions: </strong>Once the effectiveness is verified, the cerebrovascular disease AI-CDSS could improve stroke care and outcomes in China.</p><p><strong>Trial registration number: </strong>NCT04524624.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":" ","pages":"723-729"},"PeriodicalIF":4.4,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10590197","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}
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。
{"title":"Association between stroke subtypes and outcomes of endovascular therapy: a post-hoc analysis of the ANGEL-ASPECT Trial","authors":"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","doi":"10.1136/svn-2024-003115","DOIUrl":"https://doi.org/10.1136/svn-2024-003115","url":null,"abstract":"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.","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"41 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142256916","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}
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.
{"title":"Optimal duration of dual antiplatelet therapy for minor stroke within 72 hours of symptom onset: a prospective cohort study","authors":"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","doi":"10.1136/svn-2023-002933","DOIUrl":"https://doi.org/10.1136/svn-2023-002933","url":null,"abstract":"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.","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"77 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142256917","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}
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 …
{"title":"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","authors":"Shen Li, Peipei Li, Xin Wang, Zongping Xia, Yuming Xu","doi":"10.1136/svn-2024-003528","DOIUrl":"https://doi.org/10.1136/svn-2024-003528","url":null,"abstract":"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 …","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"6 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217586","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}
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.
{"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}
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.
{"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}
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.
{"title":"Sex differences in the epidemiology of spontaneous and traumatic cervical artery dissections","authors":"Elke Schipani, Kim J Griffin, Carlee I Oakley, Zafer Keser","doi":"10.1136/svn-2024-003282","DOIUrl":"https://doi.org/10.1136/svn-2024-003282","url":null,"abstract":"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.","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"10 1","pages":""},"PeriodicalIF":5.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142217583","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}
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}
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.
{"title":"Residual inflammatory risk predicts long-term outcomes following stenting for symptomatic intracranial atherosclerotic stenosis.","authors":"Ying Yu, Yake Lou, Yuesong Pan, Long Yan, Weilun Fu, Zhikai Hou, Rongrong Cui, Zhongrong Miao, Yongjun Wang, Xin Lou, Ning Ma","doi":"10.1136/svn-2023-002421","DOIUrl":"10.1136/svn-2023-002421","url":null,"abstract":"<p><strong>Background and purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>In patients with sICAS, preprocedural RIR may predict long-term recurrent ischaemic stroke, ISR and sISR following intracranial stenting.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":" ","pages":"407-417"},"PeriodicalIF":4.4,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10102267","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}
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。
{"title":"Haemorrhage after thrombectomy with adjuvant thrombolysis in unknown onset stroke depends on high early lesion water uptake.","authors":"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","doi":"10.1136/svn-2022-002264","DOIUrl":"10.1136/svn-2022-002264","url":null,"abstract":"<p><strong>Background and purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":" ","pages":"390-398"},"PeriodicalIF":4.4,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10590198","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}
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