Pub Date : 2024-11-02DOI: 10.1177/23969873241293573
Tommaso Bucci, Sylvia E Choi, Christopher Tw Tsang, Kai-Hang Yiu, Benjamin Jr Buckley, Pasquale Pignatelli, Jan F Scheitz, Gregory Yh Lip, Azmil H Abdul-Rahim
Introduction: The risk of dementia in patients with stroke-heart syndrome (SHS) remains unexplored.
Patients and methods: Retrospective analysis using the TriNetX network, including patients with ischaemic stroke from 2010 to 2020. These patients were categorised into two groups: those with SHS (heart failure, myocardial infarction, ventricular fibrillation, or Takotsubo cardiomyopathy within 30 days post-stroke) and those without SHS. The primary outcome was the 1-year risk of dementia (vascular dementia, dementia in other disease, unspecified dementia, or Alzheimer's disease). The secondary outcome was the 1-year risk of all-cause death. Cox regression analysis after 1:1 propensity score matching (PSM) was performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the outcomes.
Results: We included 52,971 patients with SHS (66.6 ± 14.6 years, 42.2% females) and 854,232 patients without SHS (64.7 ± 15.4 years, 48.2% females). Following PSM, 52,970 well-balanced patients were considered in each group. Patients with SHS had a higher risk of incident dementia compared to those without SHS (HR 1.28, 95%CI 1.20-1.36). The risk was the highest during the first 31 days of follow-up (HR 1.51, 95%CI 1.31-1.74) and was mainly driven by vascular and mixed forms. The increased risk of dementia in patients with SHS, was independent of oral anticoagulant use, sex and age but it was the highest in those aged <75 years compared to ⩾75 years.
Discussion and conclusion: SHS is associated with increased risk of dementia. Future studies are needed to develop innovative strategies for preventing complications associated with stroke-heart syndrome and improving the long-term prognosis of these patients.
{"title":"Incident dementia in ischaemic stroke patients with early cardiac complications: A propensity-score matched cohort study.","authors":"Tommaso Bucci, Sylvia E Choi, Christopher Tw Tsang, Kai-Hang Yiu, Benjamin Jr Buckley, Pasquale Pignatelli, Jan F Scheitz, Gregory Yh Lip, Azmil H Abdul-Rahim","doi":"10.1177/23969873241293573","DOIUrl":"https://doi.org/10.1177/23969873241293573","url":null,"abstract":"<p><strong>Introduction: </strong>The risk of dementia in patients with stroke-heart syndrome (SHS) remains unexplored.</p><p><strong>Patients and methods: </strong>Retrospective analysis using the TriNetX network, including patients with ischaemic stroke from 2010 to 2020. These patients were categorised into two groups: those with SHS (heart failure, myocardial infarction, ventricular fibrillation, or Takotsubo cardiomyopathy within 30 days post-stroke) and those without SHS. The primary outcome was the 1-year risk of dementia (vascular dementia, dementia in other disease, unspecified dementia, or Alzheimer's disease). The secondary outcome was the 1-year risk of all-cause death. Cox regression analysis after 1:1 propensity score matching (PSM) was performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the outcomes.</p><p><strong>Results: </strong>We included 52,971 patients with SHS (66.6 ± 14.6 years, 42.2% females) and 854,232 patients without SHS (64.7 ± 15.4 years, 48.2% females). Following PSM, 52,970 well-balanced patients were considered in each group. Patients with SHS had a higher risk of incident dementia compared to those without SHS (HR 1.28, 95%CI 1.20-1.36). The risk was the highest during the first 31 days of follow-up (HR 1.51, 95%CI 1.31-1.74) and was mainly driven by vascular and mixed forms. The increased risk of dementia in patients with SHS, was independent of oral anticoagulant use, sex and age but it was the highest in those aged <75 years compared to ⩾75 years.</p><p><strong>Discussion and conclusion: </strong>SHS is associated with increased risk of dementia. Future studies are needed to develop innovative strategies for preventing complications associated with stroke-heart syndrome and improving the long-term prognosis of these patients.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1177/23969873241293009
Viva Levee, Mariarosaria Valente, Francesco Bax, Liqun Zhang, Simona Sacco, Matteo Foschi, Raffaele Ornello, Katherine Chulack, Emma Marchong, Fahad Sheikh, Feras Fayez, Caterina Del Regno, Mohammed Aggour, Massimo Sponza, Francesco Toraldo, Razan Algazlan, Kyriakos Lobotesis, Daniele Bagatto, Nina Mansoor, Dheeraj Kalladka, Vladimir Gavrilovic, Cristian Deana, Flavio Bassi, Berry Stewart, Gian Luigi Gigli, Soma Banerjee, Giovanni Merlino, Lucio D'Anna
Introduction: There is a lack of evidence for the optimal type of anesthesia technique in patients ⩾ 90 years with acute ischemic stroke undergoing mechanical thrombectomy (MT) as this subgroup of patients was often excluded or under-represented in previous trials. We aimed to compare outcomes between general anesthesia (GA) and non-GA techniques in patients ⩾ 90 years with large vessel occlusion (LVO) undergoing MT.
Patients and methods: Our study included patients ⩾ 90 years with anterior circulation LVO, NIHSS ⩾ 6, ASPECTS ⩾ 5 consecutively treated with MT within 6 h after stroke onset in three thrombectomy capable centers between January 1st, 2016 and March 30th, 2023. Inverse probability weighting (IPW) was used to reduce bias by indication of the anesthesia type on study outcomes. We used a weighted ordinal robust logistic regression analysis to explore the primary outcome of modified Rankin Scale (mRS) shift at 90 days in GA versus non-GA treated patients. Secondary outcomes included 90-day mortality, symptomatic intracranial hemorrhage (sICH) and TICI score of 2b, 2c, or 3.
Results: We included 139 patients ⩾ 90 years treated with MT, 62 were in GA group and 77 in non-GA group. There was a significant shift for worse mRS scores at 90-day in non-GA treated patients (cOR 3.65, 95% CI 1.77-7.77, p = 0.001). The weighted logistic regression showed that non-GA technique was an independent predictor of 90-day mortality (OR 7.49, 95% CI 2.00-28.09; p = 0.003).
Conclusion: Our study indicated that nonagenarians with acute ischemic stroke treated with MT without GA have a worse prognosis than their counterparts undergoing MT with GA. Further studies in larger cohorts are warranted to evaluate the optimal type of anesthesia in this patient population.
导言:对于接受机械性血栓切除术(MT)的 90 岁以上急性缺血性卒中患者,目前尚缺乏最佳麻醉技术类型的证据,因为在之前的试验中,该亚组患者往往被排除在外或代表性不足。我们的目的是比较全身麻醉(GA)和非GA技术对接受机械取栓术的⩾90岁大血管闭塞(LVO)患者的治疗效果:我们的研究纳入了2016年1月1日至2023年3月30日期间在三家血栓切除术中心连续接受MT治疗的前循环LVO患者,年龄⩾90岁,NIHSS ⩾6,ASPECTS ⩾5,卒中发生后6小时内接受MT治疗。我们采用了反概率加权法(IPW)来减少麻醉类型对研究结果的影响。我们采用加权顺序稳健逻辑回归分析来探讨GA与非GA治疗患者90天后的改良Rankin量表(mRS)变化这一主要结果。次要结果包括 90 天死亡率、症状性颅内出血(sICH)和 TICI 评分 2b、2c 或 3:我们纳入了 139 名接受 MT 治疗的 90 岁以上患者,其中 62 人属于 GA 组,77 人属于非 GA 组。非GA治疗患者90天后的mRS评分明显变差(cOR 3.65,95% CI 1.77-7.77,p = 0.001)。加权逻辑回归显示,非 GA 技术是 90 天死亡率的独立预测因素(OR 7.49,95% CI 2.00-28.09;P = 0.003):我们的研究表明,与接受MT治疗的非老年急性缺血性卒中患者相比,接受MT治疗的非老年急性缺血性卒中患者的预后较差。有必要在更大的群体中开展进一步研究,以评估这一患者群体的最佳麻醉类型。
{"title":"Outcomes of different anesthesia techniques in nonagenarians treated with mechanical thrombectomy for anterior circulation large vessel occlusion: An inverse probability weighting analysis.","authors":"Viva Levee, Mariarosaria Valente, Francesco Bax, Liqun Zhang, Simona Sacco, Matteo Foschi, Raffaele Ornello, Katherine Chulack, Emma Marchong, Fahad Sheikh, Feras Fayez, Caterina Del Regno, Mohammed Aggour, Massimo Sponza, Francesco Toraldo, Razan Algazlan, Kyriakos Lobotesis, Daniele Bagatto, Nina Mansoor, Dheeraj Kalladka, Vladimir Gavrilovic, Cristian Deana, Flavio Bassi, Berry Stewart, Gian Luigi Gigli, Soma Banerjee, Giovanni Merlino, Lucio D'Anna","doi":"10.1177/23969873241293009","DOIUrl":"https://doi.org/10.1177/23969873241293009","url":null,"abstract":"<p><strong>Introduction: </strong>There is a lack of evidence for the optimal type of anesthesia technique in patients ⩾ 90 years with acute ischemic stroke undergoing mechanical thrombectomy (MT) as this subgroup of patients was often excluded or under-represented in previous trials. We aimed to compare outcomes between general anesthesia (GA) and non-GA techniques in patients ⩾ 90 years with large vessel occlusion (LVO) undergoing MT.</p><p><strong>Patients and methods: </strong>Our study included patients ⩾ 90 years with anterior circulation LVO, NIHSS ⩾ 6, ASPECTS ⩾ 5 consecutively treated with MT within 6 h after stroke onset in three thrombectomy capable centers between January 1st, 2016 and March 30th, 2023. Inverse probability weighting (IPW) was used to reduce bias by indication of the anesthesia type on study outcomes. We used a weighted ordinal robust logistic regression analysis to explore the primary outcome of modified Rankin Scale (mRS) shift at 90 days in GA versus non-GA treated patients. Secondary outcomes included 90-day mortality, symptomatic intracranial hemorrhage (sICH) and TICI score of 2b, 2c, or 3.</p><p><strong>Results: </strong>We included 139 patients ⩾ 90 years treated with MT, 62 were in GA group and 77 in non-GA group. There was a significant shift for worse mRS scores at 90-day in non-GA treated patients (cOR 3.65, 95% CI 1.77-7.77, <i>p</i> = 0.001). The weighted logistic regression showed that non-GA technique was an independent predictor of 90-day mortality (OR 7.49, 95% CI 2.00-28.09; <i>p</i> = 0.003).</p><p><strong>Conclusion: </strong>Our study indicated that nonagenarians with acute ischemic stroke treated with MT without GA have a worse prognosis than their counterparts undergoing MT with GA. Further studies in larger cohorts are warranted to evaluate the optimal type of anesthesia in this patient population.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1177/23969873241293566
Zhuo Xun Chua, Chern Yeh Lai Amanda, Timothy Jia Rong Lam, Jamie Si Pin Ong, Shermane Yun Wei Lim, Shivaram Kumar, Mervyn Jun Rui Lim, Benjamin Yong Qiang Tan, Joel Aik, Andrew Fu Wah Ho
Purpose: Secondhand smoke significantly increases the risk of cerebrovascular diseases, prompting recent public smoking bans. We aimed to ascertain the effects of smoke-free legislation on stroke incidence and mortality.
Methods: We systematically searched Medline, Embase, Cochrane Library, and Scopus up to August 13, 2023, for studies reporting changes in stroke incidence following partial or comprehensive smoking bans. A random-effects meta-analysis was conducted on hospital admissions and mortality for stroke, stratified based on comprehensiveness of the ban ((i) workplaces-only, (ii) workplaces and restaurants, (iii) workplaces, restaurants and bars). The effect of post-ban follow-up duration was assessed visually by a forest plot, while meta-regression was employed to evaluate for any dose-response relationship between ban comprehensiveness and stroke risk.
Findings: Of 3987 records identified, 15 studies analysing bans across a median follow-up time of 24 months (range: 3-67) were included. WRB bans were associated with reductions in the rates of hospital admissions for stroke (nine studies; RR, 0.918; 95% CI, 0.872-0.967) and stroke mortality (three studies; RR, 0.987; 95% CI, 0.952-1.022), although the latter did not reach statistical significance. There was no significant difference in the risk of stroke admissions for studies with increased ban comprehensiveness and no minimum duration for significant post-ban effects to be observed.
Discussion and conclusion: Legislative smoking bans were associated with significant reductions in stroke-related hospital admissions, providing evidence for its utility as a public health intervention.
{"title":"Impact of smoke-free legislation on stroke risk: A systematic review and meta-analysis.","authors":"Zhuo Xun Chua, Chern Yeh Lai Amanda, Timothy Jia Rong Lam, Jamie Si Pin Ong, Shermane Yun Wei Lim, Shivaram Kumar, Mervyn Jun Rui Lim, Benjamin Yong Qiang Tan, Joel Aik, Andrew Fu Wah Ho","doi":"10.1177/23969873241293566","DOIUrl":"https://doi.org/10.1177/23969873241293566","url":null,"abstract":"<p><strong>Purpose: </strong>Secondhand smoke significantly increases the risk of cerebrovascular diseases, prompting recent public smoking bans. We aimed to ascertain the effects of smoke-free legislation on stroke incidence and mortality.</p><p><strong>Methods: </strong>We systematically searched Medline, Embase, Cochrane Library, and Scopus up to August 13, 2023, for studies reporting changes in stroke incidence following partial or comprehensive smoking bans. A random-effects meta-analysis was conducted on hospital admissions and mortality for stroke, stratified based on comprehensiveness of the ban ((i) workplaces-only, (ii) workplaces and restaurants, (iii) workplaces, restaurants and bars). The effect of post-ban follow-up duration was assessed visually by a forest plot, while meta-regression was employed to evaluate for any dose-response relationship between ban comprehensiveness and stroke risk.</p><p><strong>Findings: </strong>Of 3987 records identified, 15 studies analysing bans across a median follow-up time of 24 months (range: 3-67) were included. WRB bans were associated with reductions in the rates of hospital admissions for stroke (nine studies; RR, 0.918; 95% CI, 0.872-0.967) and stroke mortality (three studies; RR, 0.987; 95% CI, 0.952-1.022), although the latter did not reach statistical significance. There was no significant difference in the risk of stroke admissions for studies with increased ban comprehensiveness and no minimum duration for significant post-ban effects to be observed.</p><p><strong>Discussion and conclusion: </strong>Legislative smoking bans were associated with significant reductions in stroke-related hospital admissions, providing evidence for its utility as a public health intervention.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1177/23969873241293569
Lucie Tvrda, Kalliopi Mavromati, Martin Taylor-Rowan, Terence J Quinn
Introduction: The Modified Rankin Scale (mRS) is the most commonly used functional measure in stroke research but is limited by inter-rater reliability (IRR). Various interventions to improve mRS application have been described. We aimed to compare properties of differing approaches to mRS assessment.
Patients and methods: Multidisciplinary databases (MEDLINE, EMBASE, Health and Psychosocial Instruments [OVID], CINAHL, PsycINFO [EBSCO]) were searched for adult human stroke studies describing psychometric properties of mRS. Two researchers independently screened 20% titles and abstracts, reviewed all full studies, extracted data, and conducted risk of bias (ROB) analysis. Primary outcomes for random-effects meta-analysis were IRR measured by kappa (K) and weighted kappa (KW). Validity and inter-modality reliability measures (Spearman's rho, KW) were also summarised.
Results: From 897 titles, 46 studies were eligible, including twelve differing approaches to mRS, 8608 participants. There was high ROB in 14 (30.4%) studies. Overall, reliability was substantial (n = 29 studies, K = 0.65, 95% CI: 0.58-0.71) but IRR was higher for novel approaches to mRS, for example, the Rankin Focussed Assessment (n = 2 studies, K = 0.94, 95% CI: 0.90-0.98) than standard mRS (n = 13 studies, K = 0.55, 95%CI:0.46-0.64). Reliability improved following the introduction of mRS training (K = 0.56, 95% CI: 0.44-0.67; vs K = 0.69, 95% CI: 0.62-0.77). Validity ranged from poor to excellent, with an excellent overall concurrent validity of novel scales (n = 6 studies, KW = 0.86, 95% CI: 0.75-0.97). The agreement between face-to-face and telephone administration was substantial (n = 5 studies, KW = 0.80, 95% CI: 0.74-0.87).
Discussion: The mRS is a valid measure of function but IRR remains an issue. The present findings are limited by a high ROB and possible publication bias.
Conclusion: Interventions to improve mRS reliability (training, structured interview, adjudication) seem to be beneficial, but single interventions do not completely remove reliability concerns.
{"title":"Comparing the properties of traditional and novel approaches to the modified Rankin scale: Systematic review and meta-analysis.","authors":"Lucie Tvrda, Kalliopi Mavromati, Martin Taylor-Rowan, Terence J Quinn","doi":"10.1177/23969873241293569","DOIUrl":"https://doi.org/10.1177/23969873241293569","url":null,"abstract":"<p><strong>Introduction: </strong>The Modified Rankin Scale (mRS) is the most commonly used functional measure in stroke research but is limited by inter-rater reliability (IRR). Various interventions to improve mRS application have been described. We aimed to compare properties of differing approaches to mRS assessment.</p><p><strong>Patients and methods: </strong>Multidisciplinary databases (MEDLINE, EMBASE, Health and Psychosocial Instruments [OVID], CINAHL, PsycINFO [EBSCO]) were searched for adult human stroke studies describing psychometric properties of mRS. Two researchers independently screened 20% titles and abstracts, reviewed all full studies, extracted data, and conducted risk of bias (ROB) analysis. Primary outcomes for random-effects meta-analysis were IRR measured by kappa (K) and weighted kappa (KW). Validity and inter-modality reliability measures (Spearman's rho, KW) were also summarised.</p><p><strong>Results: </strong>From 897 titles, 46 studies were eligible, including twelve differing approaches to mRS, 8608 participants. There was high ROB in 14 (30.4%) studies. Overall, reliability was substantial (<i>n</i> = 29 studies, <i>K</i> = 0.65, 95% CI: 0.58-0.71) but IRR was higher for novel approaches to mRS, for example, the Rankin Focussed Assessment (<i>n</i> = 2 studies, <i>K</i> = 0.94, 95% CI: 0.90-0.98) than standard mRS (<i>n</i> = 13 studies, <i>K</i> = 0.55, 95%CI:0.46-0.64). Reliability improved following the introduction of mRS training (<i>K</i> = 0.56, 95% CI: 0.44-0.67; vs <i>K</i> = 0.69, 95% CI: 0.62-0.77). Validity ranged from poor to excellent, with an excellent overall concurrent validity of novel scales (<i>n</i> = 6 studies, KW = 0.86, 95% CI: 0.75-0.97). The agreement between face-to-face and telephone administration was substantial (<i>n</i> = 5 studies, KW = 0.80, 95% CI: 0.74-0.87).</p><p><strong>Discussion: </strong>The mRS is a valid measure of function but IRR remains an issue. The present findings are limited by a high ROB and possible publication bias.</p><p><strong>Conclusion: </strong>Interventions to improve mRS reliability (training, structured interview, adjudication) seem to be beneficial, but single interventions do not completely remove reliability concerns.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Prediction scores for hematoma expansion in spontaneous intracerebral hemorrhage (ICH), such as the 9-point and BRAIN scores, were developed predominantly using planimetry to measure hematoma volume. In this study, we aim to investigate whether the ABC/2 formula, which is known to overestimate hematoma volume, can be reliably used as a substitute for planimetry in these prediction scores.
Patients and methods: A total of 429 patients from four hospitals were retrospectively enrolled. CT scan and clinical data at admission and follow-up CT scan were collected. The 9-point and BRAIN scores were calculated using hematoma volume from ABC/2 and planimetry. Hematoma expansion was assessed using hematoma volume from planimetry.
Results: The median hematoma volume measured by ABC/2 was 11.97 ml (interquartile range [IQR], 4.8-30.0), whereas the volume measured by planimetry was 11.70 ml (IQR, 4.9-26.6). The median measurement error between ABC/2 and planimetry was 0.30 ml (IQR, -0.72-2.87). ABC/2 overestimated hematoma volume in 244 patients (56.9%) compared to planimetry. In the 9-point score, the area under the curves (AUCs) for predicting hematoma expansion were 0.735 (95% confidence interval [CI], 0.675-0.796) with ABC/2 and 0.732 (95% CI, 0.672-0.793) with planimetry. In the BRAIN score, the AUCs were 0.753 (95% CI, 0.693-0.813) with ABC/2 and 0.745 (95% CI, 0.688-0.803) with planimetry.
Discussion and conclusion: The 9-point and BRAIN scores using hematoma volume measured by ABC/2 and planimetry showed good performance in predicting hematoma expansion in ICH. ABC/2 volumetric estimation proved to be reliable for these scores.
{"title":"Reliability of ABC/2 volumetric estimation in spontaneous intracerebral hemorrhage for hematoma expansion prediction scores.","authors":"Satoru Tanioka, Orhun Utku Aydin, Adam Hilbert, Yotaro Kitano, Fujimaro Ishida, Kazuhiko Tsuda, Tomohiro Araki, Yoshinari Nakatsuka, Tetsushi Yago, Tomoyuki Kishimoto, Munenari Ikezawa, Hidenori Suzuki, Dietmar Frey","doi":"10.1177/23969873241293572","DOIUrl":"https://doi.org/10.1177/23969873241293572","url":null,"abstract":"<p><strong>Introduction: </strong>Prediction scores for hematoma expansion in spontaneous intracerebral hemorrhage (ICH), such as the 9-point and BRAIN scores, were developed predominantly using planimetry to measure hematoma volume. In this study, we aim to investigate whether the ABC/2 formula, which is known to overestimate hematoma volume, can be reliably used as a substitute for planimetry in these prediction scores.</p><p><strong>Patients and methods: </strong>A total of 429 patients from four hospitals were retrospectively enrolled. CT scan and clinical data at admission and follow-up CT scan were collected. The 9-point and BRAIN scores were calculated using hematoma volume from ABC/2 and planimetry. Hematoma expansion was assessed using hematoma volume from planimetry.</p><p><strong>Results: </strong>The median hematoma volume measured by ABC/2 was 11.97 ml (interquartile range [IQR], 4.8-30.0), whereas the volume measured by planimetry was 11.70 ml (IQR, 4.9-26.6). The median measurement error between ABC/2 and planimetry was 0.30 ml (IQR, -0.72-2.87). ABC/2 overestimated hematoma volume in 244 patients (56.9%) compared to planimetry. In the 9-point score, the area under the curves (AUCs) for predicting hematoma expansion were 0.735 (95% confidence interval [CI], 0.675-0.796) with ABC/2 and 0.732 (95% CI, 0.672-0.793) with planimetry. In the BRAIN score, the AUCs were 0.753 (95% CI, 0.693-0.813) with ABC/2 and 0.745 (95% CI, 0.688-0.803) with planimetry.</p><p><strong>Discussion and conclusion: </strong>The 9-point and BRAIN scores using hematoma volume measured by ABC/2 and planimetry showed good performance in predicting hematoma expansion in ICH. ABC/2 volumetric estimation proved to be reliable for these scores.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1177/23969873241296391
Hironori Ishiguchi, Bi Huang, Wahbi K El-Bouri, Jesse Dawson, Gregory Y H Lip, Azmil H Abdul-Rahim
Background: Adverse cardiac events following ischaemic stroke (stroke-heart syndrome, SHS) pose a clinical challenge. We investigated the association between initial blood pressure at stroke presentation and the risk of SHS.
Methods: We utilised data from the Virtual International Stroke Trials Archive (VISTA). We defined SHS as the incidence of cardiac complications within 30 days post-ischaemic stroke. These presentations included acute coronary syndrome encompassing myocardial injury, heart failure/left ventricular dysfunction, atrial fibrillation/flutter, other arrhythmia/electrocardiogram abnormalities, and cardiorespiratory arrest. Using Cox proportional hazards models, we assessed the risk trajectories for developing SHS and its presentations associated with initial blood pressure. We also explored the risk trajectories for 90-day mortality related to initial blood pressure.
Results: From 16,095 patients with acute ischaemic stroke, 14,965 (mean age 69 ± 12 years; 55% male) were analysed. Of these, 1774 (11.8%) developed SHS. The risk of SHS and initial blood pressure showed a U-shaped relationship. The lowest blood pressures (⩽130 mmHg systolic and ⩽55 mmHg diastolic) were associated with the highest risks (adjusted hazard ratio [95%confidence interval]: 1.40 [1.21-1.63]; p < 0.001, 1.71 [1.39-2.10]; p < 0.001, respectively, compared to referential blood pressure range).Cardiorespiratory arrest posed the greatest risk at higher blood pressure levels (2.34 [1.16-4.73]; p = 0.017 for systolic blood pressure >190 mmHg), whereas other presentations exhibited the highest risk at lower pressures. The 90-day mortality risk also followed a U-shaped distribution, with greater risks observed at high blood pressure thresholds.
Conclusions: There is a U-shaped relationship between initial blood pressure at ischaemic stroke presentation and the risk of subsequent SHS.
背景:缺血性卒中后的不良心脏事件(卒中-心脏综合征,SHS)是一项临床挑战。我们研究了中风发病时的初始血压与 SHS 风险之间的关系:我们利用了虚拟国际卒中试验档案(VISTA)中的数据。我们将 SHS 定义为缺血性卒中后 30 天内心脏并发症的发生率。这些并发症包括急性冠状动脉综合征,包括心肌损伤、心力衰竭/左心室功能障碍、心房颤动/扑动、其他心律失常/心电图异常和心肺骤停。我们使用 Cox 比例危险模型评估了罹患 SHS 的风险轨迹及其与初始血压相关的表现。我们还探讨了与初始血压相关的 90 天死亡率风险轨迹:对 16095 名急性缺血性脑卒中患者中的 14965 人(平均年龄 69 ± 12 岁;55% 为男性)进行了分析。其中,1774 人(11.8%)出现 SHS。SHS 风险与初始血压呈 U 型关系。最低血压(收缩压 ⩽130 mmHg 和舒张压 ⩽55 mmHg)与最高风险相关(调整后危险比[95%置信区间]:1.40 [1.21-1.21] ):1.40 [1.21-1.63] ;收缩压大于 190 mmHg 时 p p = 0.017),而其他表现形式的患者在较低血压时风险最高。90 天死亡率风险也呈 U 型分布,血压阈值越高,风险越大:结论:缺血性卒中发病时的初始血压与随后的 SHS 风险之间存在 U 型关系。
{"title":"Initial blood pressure and adverse cardiac events following acute ischaemic stroke: An individual patient data pooled analysis from the VISTA database.","authors":"Hironori Ishiguchi, Bi Huang, Wahbi K El-Bouri, Jesse Dawson, Gregory Y H Lip, Azmil H Abdul-Rahim","doi":"10.1177/23969873241296391","DOIUrl":"https://doi.org/10.1177/23969873241296391","url":null,"abstract":"<p><strong>Background: </strong>Adverse cardiac events following ischaemic stroke (stroke-heart syndrome, SHS) pose a clinical challenge. We investigated the association between initial blood pressure at stroke presentation and the risk of SHS.</p><p><strong>Methods: </strong>We utilised data from the Virtual International Stroke Trials Archive (VISTA). We defined SHS as the incidence of cardiac complications within 30 days post-ischaemic stroke. These presentations included acute coronary syndrome encompassing myocardial injury, heart failure/left ventricular dysfunction, atrial fibrillation/flutter, other arrhythmia/electrocardiogram abnormalities, and cardiorespiratory arrest. Using Cox proportional hazards models, we assessed the risk trajectories for developing SHS and its presentations associated with initial blood pressure. We also explored the risk trajectories for 90-day mortality related to initial blood pressure.</p><p><strong>Results: </strong>From 16,095 patients with acute ischaemic stroke, 14,965 (mean age 69 ± 12 years; 55% male) were analysed. Of these, 1774 (11.8%) developed SHS. The risk of SHS and initial blood pressure showed a U-shaped relationship. The lowest blood pressures (⩽130 mmHg systolic and ⩽55 mmHg diastolic) were associated with the highest risks (adjusted hazard ratio [95%confidence interval]: 1.40 [1.21-1.63]; <i>p</i> < 0.001, 1.71 [1.39-2.10]; <i>p</i> < 0.001, respectively, compared to referential blood pressure range).Cardiorespiratory arrest posed the greatest risk at higher blood pressure levels (2.34 [1.16-4.73]; <i>p</i> = 0.017 for systolic blood pressure >190 mmHg), whereas other presentations exhibited the highest risk at lower pressures. The 90-day mortality risk also followed a U-shaped distribution, with greater risks observed at high blood pressure thresholds.</p><p><strong>Conclusions: </strong>There is a U-shaped relationship between initial blood pressure at ischaemic stroke presentation and the risk of subsequent SHS.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1177/23969873241278948
Christoph Riegler, Regina von Rennenberg, Kerstin Bollweg, Eberhard Siebert, Gian Marco de Marchis, Georg Kägi, Pasquale Mordasini, Mirjam R Heldner, Mauro Magoni, Alessandro Pezzini, Alexander Salerno, Patrik Michel, Christoph Globas, Susanne Wegener, Nicolas Martinez-Majander, Sami Curtze, Maria Luisa Dell'Acqua, Guido Bigliardi, Nabila Wali, Paul J Nederkoorn, Dejana R Jovanovic, Visnja Padjen, Issa Metanis, Ronen R Leker, Giovanni Bianco, Carlo W Cereda, Rosario Pascarella, Marialuisa Zedde, Maria Maddalena Viola, Andrea Zini, João Nuno Ramos, João Pedro Marto, Heinrich J Audebert, Simon Trüssel, Henrik Gensicke, Stefan T Engelter, Christian H Nolte
Background: Acute intracranial occlusion of the internal carotid artery (ICA) can be distinguished into (a) occlusion of the terminal ICA, involving the proximal segments of the middle or anterior cerebral artery (ICA-L/-T) and (b) non-terminal intracranial occlusions of the ICA with patent circle of Willis (ICA-I). While patients with ICA-L/-T occlusion were included in all randomized controlled trials on endovascular therapy (EVT) in anterior large vessel occlusion, data on EVT in ICA-I occlusion is scarce. We thus aimed to evaluate effectiveness and safety of EVT in ICA-I occlusions in comparison to ICA-L/-T occlusions.
Methods: A large international multicentre cohort was searched for patients with intracranial ICA occlusion treated with EVT between 2014 and 2023. Patients were stratified by ICA occlusion pattern, differentiating ICA-I and ICA-L/-T occlusions. Baseline factors, technical (modified thrombolysis in cerebral infarction (mTICI) scale) and functional outcomes (modified Rankin scale [mRS] at 3 months) as well as rates of (symptomatic) intracranial hemorrhage ([s]ICH) were analyzed.
Results: Of 13,453 patients, 1825 (13.6%) had isolated ICA occlusion. ICA-occlusion pattern was ICA-I in 559 (4.2%) and ICA-L/-T in 1266 (9.4%) patients. Age (years: 74 vs 73), sex (female: 45.8% vs 49.0%) and pre-stroke functional independency (pre-mRS ⩽ 2: 89.9% vs 92.2%) did not differ between the groups. Stroke severity was lower in ICA-I patients (NIHSS at admission: 14 [7-19] vs 17 [13-21] points). EVT was similarly successful with respect to technical (mTICI2b/3: 76.1% (ICA-I) vs 76.6% (ICA-L/-T); aOR 1.01 [0.76-1.35]) and functional outcome (mRS ordinal shift cOR 1.01 [0.83-1.23] in adjusted analyses. Rates of ICH (18.9% vs 34.5%; aOR 0.47 [0.36-0.62] and sICH (4.7% vs 7.3%; aOR 0.58 [0.35-0.97] were lower in ICA-I patients.
Conclusion: EVT might be performed safely and similarly successful in patients with ICA-I occlusions as in patients with ICA-L/-T occlusions.
背景:颈内动脉(ICA)急性颅内闭塞可分为:(a) 涉及大脑中动脉或大脑前动脉近段的终末ICA闭塞(ICA-L/-T)和(b) 非终末ICA颅内闭塞伴Willis环通畅(ICA-I)。所有关于前方大血管闭塞的血管内治疗(EVT)随机对照试验都包括了 ICA-L/-T 闭塞患者,但关于 ICA-I 闭塞的 EVT 数据却很少。因此,我们的目的是评估与ICA-L/-T闭塞相比,EVT治疗ICA-I闭塞的有效性和安全性:方法:我们在一个大型国际多中心队列中搜索了2014年至2023年间接受EVT治疗的颅内ICA闭塞患者。根据ICA闭塞模式对患者进行分层,区分ICA-I和ICA-L/-T闭塞。分析了基线因素、技术(改良脑梗塞溶栓治疗量表(mTICI))和功能结果(3个月时的改良Rankin量表[mRS])以及(无症状)颅内出血([s]ICH)的发生率:在13453名患者中,有1825人(13.6%)患有孤立的ICA闭塞。559例(4.2%)患者的ICA闭塞模式为ICA-I型,1266例(9.4%)患者的ICA-L/-T型。两组患者的年龄(74 岁 vs 73 岁)、性别(女性:45.8% vs 49.0%)和卒中前功能独立性(mRS ⩽ 2 前:89.9% vs 92.2%)均无差异。ICA-I患者的卒中严重程度较低(入院时NIHSS:14 [7-19] 分 vs 17 [13-21] 分)。EVT在技术(mTICI2b/3:76.1%(ICA-I)vs 76.6%(ICA-L/-T);aOR 1.01 [0.76-1.35])和功能结果(调整分析中,mRS顺序移动cOR 1.01 [0.83-1.23])方面同样成功。ICA-I患者的ICH(18.9% vs 34.5%;aOR 0.47 [0.36-0.62])和sICH(4.7% vs 7.3%;aOR 0.58 [0.35-0.97])发生率较低:结论:ICA-I型闭塞患者与ICA-L/-T型闭塞患者一样,可以安全、成功地进行EVT。
{"title":"Endovascular therapy in patients with acute intracranial non-terminal internal carotid artery occlusion (ICA-I).","authors":"Christoph Riegler, Regina von Rennenberg, Kerstin Bollweg, Eberhard Siebert, Gian Marco de Marchis, Georg Kägi, Pasquale Mordasini, Mirjam R Heldner, Mauro Magoni, Alessandro Pezzini, Alexander Salerno, Patrik Michel, Christoph Globas, Susanne Wegener, Nicolas Martinez-Majander, Sami Curtze, Maria Luisa Dell'Acqua, Guido Bigliardi, Nabila Wali, Paul J Nederkoorn, Dejana R Jovanovic, Visnja Padjen, Issa Metanis, Ronen R Leker, Giovanni Bianco, Carlo W Cereda, Rosario Pascarella, Marialuisa Zedde, Maria Maddalena Viola, Andrea Zini, João Nuno Ramos, João Pedro Marto, Heinrich J Audebert, Simon Trüssel, Henrik Gensicke, Stefan T Engelter, Christian H Nolte","doi":"10.1177/23969873241278948","DOIUrl":"https://doi.org/10.1177/23969873241278948","url":null,"abstract":"<p><strong>Background: </strong>Acute intracranial occlusion of the internal carotid artery (ICA) can be distinguished into (a) occlusion of the terminal ICA, involving the proximal segments of the middle or anterior cerebral artery (ICA-L/-T) and (b) non-terminal intracranial occlusions of the ICA with patent circle of Willis (ICA-I). While patients with ICA-L/-T occlusion were included in all randomized controlled trials on endovascular therapy (EVT) in anterior large vessel occlusion, data on EVT in ICA-I occlusion is scarce. We thus aimed to evaluate effectiveness and safety of EVT in ICA-I occlusions in comparison to ICA-L/-T occlusions.</p><p><strong>Methods: </strong>A large international multicentre cohort was searched for patients with intracranial ICA occlusion treated with EVT between 2014 and 2023. Patients were stratified by ICA occlusion pattern, differentiating ICA-I and ICA-L/-T occlusions. Baseline factors, technical (modified thrombolysis in cerebral infarction (mTICI) scale) and functional outcomes (modified Rankin scale [mRS] at 3 months) as well as rates of (symptomatic) intracranial hemorrhage ([s]ICH) were analyzed.</p><p><strong>Results: </strong>Of 13,453 patients, 1825 (13.6%) had isolated ICA occlusion. ICA-occlusion pattern was ICA-I in 559 (4.2%) and ICA-L/-T in 1266 (9.4%) patients. Age (years: 74 vs 73), sex (female: 45.8% vs 49.0%) and pre-stroke functional independency (pre-mRS ⩽ 2: 89.9% vs 92.2%) did not differ between the groups. Stroke severity was lower in ICA-I patients (NIHSS at admission: 14 [7-19] vs 17 [13-21] points). EVT was similarly successful with respect to technical (mTICI2b/3: 76.1% (ICA-I) vs 76.6% (ICA-L/-T); aOR 1.01 [0.76-1.35]) and functional outcome (mRS ordinal shift cOR 1.01 [0.83-1.23] in adjusted analyses. Rates of ICH (18.9% vs 34.5%; aOR 0.47 [0.36-0.62] and sICH (4.7% vs 7.3%; aOR 0.58 [0.35-0.97] were lower in ICA-I patients.</p><p><strong>Conclusion: </strong>EVT might be performed safely and similarly successful in patients with ICA-I occlusions as in patients with ICA-L/-T occlusions.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-26DOI: 10.1177/23969873241292278
Nikolaos S Avramiotis, Fabian Schaub, Sebastian Thilemann, Philippe Lyrer, Stefan T Engelter
Introduction: Extracranial internal carotid artery dissection (eICAD) is a leading cause of stroke in younger patients. In this Cochrane Review update we compared benefits and harms of eICAD-patients treated with either antiplatelets or anticoagulants.
Patients and methods: Eligible studies were identified through Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, and EMBASE and personal search until December 2023. We included randomized-controlled trials (RCTs) and non-randomized studies comparing anticoagulants with antiplatelets in eICAD-patients. Co-primary outcomes were (i) death (all causes) and (ii) death or disability. Secondary outcomes were ischemic stroke, symptomatic intracranial hemorrhage, and major extracranial hemorrhage. Odds ratios (OR) with 95% CIs were calculated for (i) all studies and (ii) separately for RCTs and non-randomized studies.
Results: We meta-analyzed a total of 42 studies (2624 patients) including 2 RCTs (213 patients) for the primary outcome of death and 31 studies (1953 patients) including 1 RCT (115 patients) for the primary outcome of death or disability. Antiplatelet-treated patients had higher odds for death (ORall-studies 2.70, 95% CI 1.27-5.72; ORRTCs 6.80, 95% CI 0.14-345; ORnon-randomized studies 2.60, 95% CI 1.20-5.60) and death or disability (ORall-studies 2.1, 95% CI 1.58-2.66; ORRTCs 2.2, 95% CI 0.29-16.05; ORnon-randomized studies 2.1, 95% CI 1.58-2.66) than anticoagulated patients. Antiplatelet-treated patients had also higher odds for ischemic stroke, though this reached statistical significance only in the subgroup of RCTs (ORRTC 4.60, 95% CI 1.36-15.51). In turn, antiplatelet-treated patients had less symptomatic intracranial hemorrhage (ORall-studies 0.25, 95% CI 0.07-0.86) and a tendency toward less major extracranial hemorrhage (ORall-studies 0.17, 95% CI 0.03-1.03).
Discussion and conclusion: The evidence considering antiplatelets as standard of care in eICAD is weak. Individualized treatment decisions balancing risks versus harms seem recommendable.
简介:颅外颈内动脉夹层(eICAD)是年轻患者中风的主要原因:颅外颈内动脉夹层(eICAD)是年轻患者中风的主要原因。在本 Cochrane 综述更新中,我们比较了 eICAD 患者接受抗血小板或抗凝剂治疗的益处和危害:通过 Cochrane Stroke Group Trials Register、CENTRAL、MEDLINE 和 EMBASE 以及截至 2023 年 12 月的个人检索确定了符合条件的研究。我们纳入了随机对照试验(RCT)和非随机研究,这些研究比较了抗凝药物和抗血小板药物在 eICAD 患者中的应用。共同主要结局为:(i) 死亡(所有原因);(ii) 死亡或残疾。次要结局为缺血性中风、症状性颅内出血和颅外大出血。计算了(i)所有研究和(ii)随机对照研究与非随机对照研究的患病率比(OR)及 95% CI:我们对包括 2 项研究(213 名患者)在内的 42 项研究(2624 名患者)的主要死亡结果进行了荟萃分析,对包括 1 项研究(115 名患者)在内的 31 项研究(1953 名患者)的主要死亡或残疾结果进行了荟萃分析。抗血小板治疗患者的死亡几率更高(所有研究的 OR 为 2.70,95% CI 为 1.27-5.72;ORRTCs 为 6.80,95% CI 为 0.14-345;非随机研究的 OR 为 2.60,95% CI 为 1.20-5.60),死亡或残疾的几率也更高(所有研究的 OR 为 2.70,95% CI 为 1.27-5.72;ORRTCs 为 6.80,95% CI 为 0.14-345;非随机研究的 OR 为 2.60,95% CI 为 1.20-5.6060)和死亡或残疾(ORall-studies 2.1,95% CI 1.58-2.66;ORRTCs 2.2,95% CI 0.29-16.05;ORnon-randomized studies 2.1,95% CI 1.58-2.66)。抗血小板治疗的患者发生缺血性中风的几率也较高,但只有在 RCTs 亚组中才有统计学意义(ORRTC 4.60,95% CI 1.36-15.51)。反过来,抗血小板治疗的患者症状性颅内出血较少(ORall-studies 0.25,95% CI 0.07-0.86),颅外大出血也有减少的趋势(ORall-studies 0.17,95% CI 0.03-1.03):将抗血小板作为eICAD标准治疗的证据不足。平衡风险与危害的个体化治疗决策似乎值得推荐。
{"title":"Antithrombotic drugs for carotid artery dissection: Updated systematic review.","authors":"Nikolaos S Avramiotis, Fabian Schaub, Sebastian Thilemann, Philippe Lyrer, Stefan T Engelter","doi":"10.1177/23969873241292278","DOIUrl":"10.1177/23969873241292278","url":null,"abstract":"<p><strong>Introduction: </strong>Extracranial internal carotid artery dissection (eICAD) is a leading cause of stroke in younger patients. In this Cochrane Review update we compared benefits and harms of eICAD-patients treated with either antiplatelets or anticoagulants.</p><p><strong>Patients and methods: </strong>Eligible studies were identified through Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, and EMBASE and personal search until December 2023. We included randomized-controlled trials (RCTs) and non-randomized studies comparing anticoagulants with antiplatelets in eICAD-patients. Co-primary outcomes were (i) death (all causes) and (ii) death or disability. Secondary outcomes were ischemic stroke, symptomatic intracranial hemorrhage, and major extracranial hemorrhage. Odds ratios (OR) with 95% CIs were calculated for (i) all studies and (ii) separately for RCTs and non-randomized studies.</p><p><strong>Results: </strong>We meta-analyzed a total of 42 studies (2624 patients) including 2 RCTs (213 patients) for the primary outcome of death and 31 studies (1953 patients) including 1 RCT (115 patients) for the primary outcome of death or disability. Antiplatelet-treated patients had higher odds for death (OR<sub>all-studies</sub> 2.70, 95% CI 1.27-5.72; OR<sub>RTCs</sub> 6.80, 95% CI 0.14-345; OR<sub>non-randomized studies</sub> 2.60, 95% CI 1.20-5.60) and death or disability (OR<sub>all-studies</sub> 2.1, 95% CI 1.58-2.66; OR<sub>RTCs</sub> 2.2, 95% CI 0.29-16.05; OR<sub>non-randomized studies</sub> 2.1, 95% CI 1.58-2.66) than anticoagulated patients. Antiplatelet-treated patients had also higher odds for ischemic stroke, though this reached statistical significance only in the subgroup of RCTs (OR<sub>RTC</sub> 4.60, 95% CI 1.36-15.51). In turn, antiplatelet-treated patients had less symptomatic intracranial hemorrhage (OR<sub>all-studies</sub> 0.25, 95% CI 0.07-0.86) and a tendency toward less major extracranial hemorrhage (OR<sub>all-studies</sub> 0.17, 95% CI 0.03-1.03).</p><p><strong>Discussion and conclusion: </strong>The evidence considering antiplatelets as standard of care in eICAD is weak. Individualized treatment decisions balancing risks versus harms seem recommendable.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-26DOI: 10.1177/23969873241293323
François Lun, Lina Palaiodimou, Aristeidis H Katsanos, Georgios Tsivgoulis, Guillaume Turc
Purpose: Uncertainties remain on the optimal treatment for acute minor stroke with nondisabling symptoms. The two most common therapeutic approaches are intravenous thrombolysis (IVT) and antiplatelet therapy, notably dual antiplatelet therapy (DAPT). We synthesized data from the literature to compare IVT to DAPT and identify the best treatment for this population.
Method: We systematically searched Pubmed, Web of Science and the Cochrane Library for randomized trials and observational studies comparing IVT, aspirin, and/or DAPT, started within 24 h of symptom onset in patients with minor stroke (NIHSS ⩽ 5) and nondisabling symptoms. Random-effects Bayesian network meta-analysis was conducted. The primary outcome was excellent functional outcome at 3 months (mRS 0-1). Secondary outcomes included mRS 0-2, symptomatic intracranial hemorrhage, mortality, and recurrent stroke.
Findings: Four randomized trials and 2 observational studies (5897 patients for the analysis of the primary outcome) were included. Compared with IVT (alteplase), DAPT (clopidogrel + aspirin) was significantly associated with higher odds of mRS 0-1 (OR = 1.52, 95% CrI, 1.09-2.35), but aspirin alone was not (OR = 1.36, 95% CrI, 0.87-2.30). DAPT was also associated with lower odds of symptomatic intracranial hemorrhage than alteplase (OR = 0.14, 95% CrI, 0.03-0.91). There were no significant differences between treatment groups regarding the other outcomes. For each outcome, the ranking for the best treatment was DAPT, then aspirin, and then IVT.
Discussion/conclusion: This network meta-analysis suggests that DAPT may be the optimal treatment for acute nondisabling stroke, with higher odds of excellent functional outcome compared with IVT.Registration: PROSPERO ID: CRD42024522038.
{"title":"Intravenous thrombolysis or antiplatelet therapy for acute nondisabling ischemic stroke: A systematic review and network meta-analysis.","authors":"François Lun, Lina Palaiodimou, Aristeidis H Katsanos, Georgios Tsivgoulis, Guillaume Turc","doi":"10.1177/23969873241293323","DOIUrl":"https://doi.org/10.1177/23969873241293323","url":null,"abstract":"<p><strong>Purpose: </strong>Uncertainties remain on the optimal treatment for acute minor stroke with nondisabling symptoms. The two most common therapeutic approaches are intravenous thrombolysis (IVT) and antiplatelet therapy, notably dual antiplatelet therapy (DAPT). We synthesized data from the literature to compare IVT to DAPT and identify the best treatment for this population.</p><p><strong>Method: </strong>We systematically searched Pubmed, Web of Science and the Cochrane Library for randomized trials and observational studies comparing IVT, aspirin, and/or DAPT, started within 24 h of symptom onset in patients with minor stroke (NIHSS ⩽ 5) and nondisabling symptoms. Random-effects Bayesian network meta-analysis was conducted. The primary outcome was excellent functional outcome at 3 months (mRS 0-1). Secondary outcomes included mRS 0-2, symptomatic intracranial hemorrhage, mortality, and recurrent stroke.</p><p><strong>Findings: </strong>Four randomized trials and 2 observational studies (5897 patients for the analysis of the primary outcome) were included. Compared with IVT (alteplase), DAPT (clopidogrel + aspirin) was significantly associated with higher odds of mRS 0-1 (OR = 1.52, 95% CrI, 1.09-2.35), but aspirin alone was not (OR = 1.36, 95% CrI, 0.87-2.30). DAPT was also associated with lower odds of symptomatic intracranial hemorrhage than alteplase (OR = 0.14, 95% CrI, 0.03-0.91). There were no significant differences between treatment groups regarding the other outcomes. For each outcome, the ranking for the best treatment was DAPT, then aspirin, and then IVT.</p><p><strong>Discussion/conclusion: </strong>This network meta-analysis suggests that DAPT may be the optimal treatment for acute nondisabling stroke, with higher odds of excellent functional outcome compared with IVT.Registration: PROSPERO ID: CRD42024522038.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-21DOI: 10.1177/23969873241291465
Hamza Adel Salim, Benjamin Pulli, Vivek Yedavalli, Basel Musmar, Nimer Adeeb, Dhairya Lakhani, Muhammed Amir Essibayi, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Inayat Grewal, Benjamin Yq Tan, Robert W Regenhardt, Jeremy J Heit, Nicole M Cancelliere, Joshua D Bernstock, Aymeric Rouchaud, Jens Fiehler, Sunil Sheth, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Xavier Barreau, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Thomas R Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, James E Siegler, Thanh N Nguyen, Ricardo Varela, Amanda Baker, David Altschul, Nestor R Gonzalez, Markus A Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Paul Stracke, Mohammad Ali Aziz-Sultan, Constantin Hecker, Hamza Shaikh, Christoph J Griessenauer, David S Liebeskind, Alessandro Pedicelli, Andrea M Alexandre, Illario Tancredi, Tobias D Faizy, Erwah Kalsoum, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Max Wintermark, Adrien Guenego, Adam A Dmytriw
Background: Despite the proven effectiveness of endovascular therapy (EVT) in acute ischemic strokes (AIS) involving anterior circulation large vessel occlusions, isolated posterior cerebral artery (PCA) occlusions (iPCAo) remain underexplored in clinical trials. This study investigates the comparative effectiveness and safety of EVT against medical management (MM) in patients with iPCAo.
Methods: This multinational, multicenter propensity score-weighted study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe. We included iPCAo patients treated with either EVT or MM. The primary outcome was the modified Rankin Scale (mRS) at 90 days, with secondary outcomes including functional independence, mortality, and safety profiles such as hemorrhagic complications.
Results: A total of 177 patients were analyzed (88 MM and 89 EVT). EVT showed a statistically significant improvement in 90-day mRS scores (OR = 0.55, 95% CI = 0.30-1.00, p = 0.048), functional independence (OR = 2.52, 95% CI = 1.02-6.20, p = 0.045), and a reduction in 90-day mortality (OR = 0.12, 95% CI = 0.03-0.54, p = 0.006) compared to MM. Hemorrhagic complications were not significantly different between the groups.
Conclusion: EVT for iPCAo is associated with better neurological outcomes and lower mortality compared to MM, without an increased risk of hemorrhagic complications. Nevertheless, these results should be interpreted with caution due to the study's observational design. The findings are hypothesis-generating and highlight the need for future randomized controlled trials to confirm these observations and establish definitive treatment guidelines for this patient population.
背景:尽管血管内治疗(EVT)对涉及前循环大血管闭塞的急性缺血性脑卒中(AIS)的有效性已得到证实,但孤立性大脑后动脉(PCA)闭塞(iPCAo)在临床试验中仍未得到充分探讨。本研究调查了EVT与药物治疗(MM)在iPCAo患者中的有效性和安全性比较:这项跨国多中心倾向得分加权研究分析了原发性远端中血管闭塞多中心分析:机械取栓术(MAD-MT)效果登记的数据,北美、亚洲和欧洲的 37 个中心参与了这项研究。我们纳入了接受EVT或MM治疗的iPCAo患者。主要结果是90天后的改良Rankin量表(mRS),次要结果包括功能独立性、死亡率和出血并发症等安全性:共分析了177名患者(88名MM和89名EVT)。与 MM 相比,EVT 在 90 天 mRS 评分(OR = 0.55,95% CI = 0.30-1.00,p = 0.048)、功能独立性(OR = 2.52,95% CI = 1.02-6.20,p = 0.045)和 90 天死亡率(OR = 0.12,95% CI = 0.03-0.54,p = 0.006)方面均有显著改善。出血性并发症在两组间无明显差异:结论:与MM相比,EVT治疗iPCAo具有更好的神经功能预后和更低的死亡率,且不会增加出血并发症的风险。结论:与 MM 相比,EVT 治疗 iPCAo 有更好的神经功能预后和更低的死亡率,但出血并发症的风险并未增加。这些研究结果是假设性的,并强调今后需要进行随机对照试验来证实这些观察结果,并为这一患者群体制定明确的治疗指南。
{"title":"Endovascular therapy versus medical management in isolated posterior cerebral artery acute ischemic stroke: A multinational multicenter propensity score-weighted study.","authors":"Hamza Adel Salim, Benjamin Pulli, Vivek Yedavalli, Basel Musmar, Nimer Adeeb, Dhairya Lakhani, Muhammed Amir Essibayi, Kareem El Naamani, Nils Henninger, Sri Hari Sundararajan, Anna Luisa Kühn, Jane Khalife, Sherief Ghozy, Luca Scarcia, Inayat Grewal, Benjamin Yq Tan, Robert W Regenhardt, Jeremy J Heit, Nicole M Cancelliere, Joshua D Bernstock, Aymeric Rouchaud, Jens Fiehler, Sunil Sheth, Ajit S Puri, Christian Dyzmann, Marco Colasurdo, Xavier Barreau, Leonardo Renieri, João Pedro Filipe, Pablo Harker, Răzvan Alexandru Radu, Mohamad Abdalkader, Piers Klein, Thomas R Marotta, Julian Spears, Takahiro Ota, Ashkan Mowla, Pascal Jabbour, Arundhati Biswas, Frédéric Clarençon, James E Siegler, Thanh N Nguyen, Ricardo Varela, Amanda Baker, David Altschul, Nestor R Gonzalez, Markus A Möhlenbruch, Vincent Costalat, Benjamin Gory, Christian Paul Stracke, Mohammad Ali Aziz-Sultan, Constantin Hecker, Hamza Shaikh, Christoph J Griessenauer, David S Liebeskind, Alessandro Pedicelli, Andrea M Alexandre, Illario Tancredi, Tobias D Faizy, Erwah Kalsoum, Boris Lubicz, Aman B Patel, Vitor Mendes Pereira, Max Wintermark, Adrien Guenego, Adam A Dmytriw","doi":"10.1177/23969873241291465","DOIUrl":"https://doi.org/10.1177/23969873241291465","url":null,"abstract":"<p><strong>Background: </strong>Despite the proven effectiveness of endovascular therapy (EVT) in acute ischemic strokes (AIS) involving anterior circulation large vessel occlusions, isolated posterior cerebral artery (PCA) occlusions (iPCAo) remain underexplored in clinical trials. This study investigates the comparative effectiveness and safety of EVT against medical management (MM) in patients with iPCAo.</p><p><strong>Methods: </strong>This multinational, multicenter propensity score-weighted study analyzed data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry, involving 37 centers across North America, Asia, and Europe. We included iPCAo patients treated with either EVT or MM. The primary outcome was the modified Rankin Scale (mRS) at 90 days, with secondary outcomes including functional independence, mortality, and safety profiles such as hemorrhagic complications.</p><p><strong>Results: </strong>A total of 177 patients were analyzed (88 MM and 89 EVT). EVT showed a statistically significant improvement in 90-day mRS scores (OR = 0.55, 95% CI = 0.30-1.00, <i>p</i> = 0.048), functional independence (OR = 2.52, 95% CI = 1.02-6.20, <i>p</i> = 0.045), and a reduction in 90-day mortality (OR = 0.12, 95% CI = 0.03-0.54, <i>p</i> = 0.006) compared to MM. Hemorrhagic complications were not significantly different between the groups.</p><p><strong>Conclusion: </strong>EVT for iPCAo is associated with better neurological outcomes and lower mortality compared to MM, without an increased risk of hemorrhagic complications. Nevertheless, these results should be interpreted with caution due to the study's observational design. The findings are hypothesis-generating and highlight the need for future randomized controlled trials to confirm these observations and establish definitive treatment guidelines for this patient population.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}