Journal of Stroke & Cerebrovascular Diseases最新文献

Background: An incomplete circle of Willis (CoW) is associated with ischemic stroke severity and patient prognosis. However, the clinical significance of an incomplete CoW in healthy adults remains unclear. We examined the association between incomplete CoW and cognitive decline in community-dwelling, apparently healthy, older adults.

Methods: A cross sectional study in 829 community-dwelling, functionally independent ≥50 years older adults (mean age: 67.4 ± 8.2 years) who voluntarily participated in the health checkup program provided by the Anti-Aging Center of Ehime University Hospital. Variations in CoW and the degree of cerebral small vessel diseases by Fazekas grading scale were assessed using magnetic resonance imaging. Cognitive function was assessed using a computer-based questionnaire.

Results: A total of 317 participants had complete CoW. Cognitive impairment was frequently observed in participants with absent CoW vessels (complete CoW: 5.7%, absent 1 vessel: 9.0%, absent ≥2 vessels: 12.2%; P = 0.023). Grade 2 or higher white matter lesions in subcortical and periventricular regions were frequent in participants without multiple vessels. However, the association between incomplete CoW and cognitive impairment was independent of white matter lesions and conventional risk factors (absent 1 vessel: odds ratio = 1.76, P = 0.09; absent ≥2 vessels: odds ratio = 2.21, P = 0.014).

Conclusion: The absence of 2 or more vessels was independently associated with cognitive impairment in a general population, which suggests that CoW variation is a risk factor for cognitive decline.

Funding: This work was supported by a Grant-in-Aid for Scientific Research (20390185, 21H04850, 25293141) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan.

Background: Menopausal hormone therapy (HT) alleviates menopause symptoms but may alter stroke risk and migraines. Concerns of compounding risk in patients with CADASIL may deter physicians from prescribing HT. We aimed to describe HT use patterns in women with CADASIL.

Methods: We reviewed women ≥45 years with genetically or dermato-pathologically confirmed CADASIL. Clinical features, menopause symptoms, and HT use were collected from the electronic health record across Mayo Clinic. Characteristics were compared between non-HT users and HT users using the Wilcoxon rank-sum test for continuous variables and Fisher's exact test for categorical variables.

Results: Among 89 CADASIL patients, 45 met demographic criteria. Of these, 10 (22.2%) ever received HT and 35 (77.8%) did not. There was no significant age difference between HT and non-HT users (53.3±11.8 vs. 54.1±8.3 years; P ≥0.05). Migraine history was more common in HT users (100.0% vs. 51.4%; P = 0.007). Menopause symptoms were documented in 48.6% of non-HT users, but HT use was discussed in only 23.5%. Among HT users, non-systemic local vaginal formulations were most common (60.0%), followed by the systemic transdermal (30.0%). In follow-up, 50% of patients either changed formulations or stopped HT. CADASIL was noted as a reason for the change in 40%.

Conclusions: Many CADASIL patients experiencing menopause symptoms did not receive HT. About one-fourth of women received HT, most commonly with non-oral formulations. Transdermal and vaginal formulations and other non-hormonal medications used to treat vasomotor symptoms may be safer than oral HT for women with CADASIL.

Background: The carotid web (CaW) is considered a rare source of cerebral embolism. The aim of this study is to determine the prevalence of CaW, clinical data of CaW cases, risk factors, morphological features of CaW and its relationship with cerebrovascular disease and to contribute to the classification of CaW and the most appropriate treatment approaches in the future.

Methods: Angiographic images of 1,520 patients who were evaluated with a preliminary diagnosis of cerebrovascular disease and underwent carotid computed tomographic angiography (CTA) and/or digital subtraction angiography (DSA) at Süleyman Demirel University Medical Faculty Hospital and Isparta City Hospital between 2016 and 2022 were examined. 31 CaW patients were included in the study. Radiological imaging, laboratory findings and clinical information of the patients were evaluated retrospectively.

Results: The prevalence of CaW was found to be 2.03%. 35.5% of CaW cases were symptomatic and the most common risk factor in these patients were hypertension. The optimum threshold value for CaW length in symptomatic patients was ≥ 2.86 mm. There was a moderate positive linear relationship between CaW length and the degree of CaW stenosis. The optimum threshold value for the degree of web stenosis in symptomatic patients was determined as ≥ 31.33%.

Conclusion: This study showed that some morphological features of CaW increase the risk of stroke. These findings suggest that the evaluation and classification of the morphological features of CaW and the development of risk scoring systems based on these features may be effective in estimating the risk of stroke and planning treatment.

Introduction: Parent large brain arteries are intimately related to their offspring's small arteries. Whether the CADASIL phenotype is confined to small vessels is unclear, and the involvement of large arteries in CADASIL has not been systematically studied.

Methods: We conducted a retrospective observational study with patients with CADASIL and randomly selected controls with acute lacunar stroke from the New York-Presbyterian Hospital/Columbia University Irving Medical Center Stroke Registry. We measured the diameters of both groups' basilar artery (BA) and intracranial internal carotid artery (ICA) on T2-weighted images. Z-scores of the arteries were calculated to derive a Brain Arterial Remodeling (BAR) score. We rated cervical ICA tortuosity as 0=no tortuosity, 1 = 45-90° deviation, and 2= >90°. Generalized linear models compared large artery characteristics, adjusting for demographics and clinical variables.

Results: We matched 37 patients with CADASIL with 104 controls. Patients with CADASIL were less likely to be Hispanic/Latino (p < 0.001), hypertensive (p < 0.001), or current smokers (p = 0.02) but more likely to have a prior stroke (p < 0.001) than controls. In adjusted models, patients with CADASIL had larger BA diameters than controls (p = 0.002), but there were no differences in the right and left ICA diameters (p = 0.73, p = 0.88). There was a statistical trend for higher cervical ICA tortuosity in patients with CADASIL compared to controls (p = 0.08).

Conclusions: Traditionally considered a small-vessel disease, patients with CADASIL have larger BA diameters and possibly higher cervical ICA tortuosity than controls. Whether these changes are part of the NOTCH-3 mutation phenotype or influence the clinical course is uncertain but should be further investigated.

Introduction: Physicians aim to provide optimal care, considering patient experiences and satisfaction. Traditional in-clinic surveys assessing surgical experiences face numerous limitations, including response bias, and inadequate inclusion of diverse demographics. Social media is an emerging platform for patients to share their healthcare experiences, providing an alternative method for gathering patient feedback. This study explores the prevalent themes of moyamoya disease experiences shared on social media.

Methods: Posts containing "#moyamoya" and "#moyamoyawarrior" from Instagram, TikTok, and Twitter were analyzed. Posts unrelated to direct patient experiences were excluded. Relevant posts were categorized by themes and analyzed based on the platform, gender, and identity of the poster (patient or someone else). Chi-squared tests were used to determined significance of theme prevalence.

Results: Of the 1,005 social media posts analyzed, 63.8 % were by patients, and 75.0 % were by females. Most patients (83.0 %) had undergone one surgery. Instagram posts most often focused on Recovery/Rehabilitation (69.7 %), Survival (66.7 %), and Spreading Positivity (45.8 %), while TikTok posts more frequently discussed Survival (97.2 %), Recovery/Rehabilitation (81.3 %), and Spreading Positivity (84.1 %) (p < 0.001). Females were less likely to post on these themes than males, who discussed religious topics more frequently (p = 0.029). Patients discussed appearance (p < 0.001), resiliency (p = 0.002), and quality of life (p = 0.014) more than their loved ones.

Conclusion: This study demonstrates social media's use among moyamoya patients, and can supplement traditional methods of obtaining patient feedback. Despite limitations, leveraging social media can enhance understanding patient needs, ultimately improving care quality for Moyamoya disease patients.

Background: Cerebral venous thrombosis (CVT), a rare stroke variant, poses treatment challenges, especially in young individuals. While guidelines recommend heparin followed by warfarin, warfarin has limitations. Direct oral anticoagulants (DOACs) offer a potential alternative, but evidence on their use in CVT management is limited. The TriNetX study aimed to provide real-world insights into DOAC efficacy and safety for CVT.

Methods: We conducted a retrospective cohort study utilizing data from TriNetX to identify patients with CVT. Propensity score matching (PSM) was used to balance the covariates between patients receiving DOACs and those receiving warfarin. The primary outcome was recurrent CVT, with secondary outcomes including intracerebral hemorrhage and all-cause mortality.

Results: Among 1,507 patients with CVT, PSM generated 551 matched individuals in both the study and control groups. The study group that received DOACs exhibited a lower risk of CVT recurrence (Hazard Ratio [HR], 0.77; 95% Confidence Interval [CI], 0.628-0.97) and a higher 360-day event-free survival rate (p < 0.001). Subgroup analyses revealed significantly reduced recurrent CVT risk in the study group, particularly among females (HR, 0.67; 95% CI, 0.50-0.89), individuals aged 41-64 years (HR, 0.52; 95% CI, 0.35-0.75), and patients with normal weight (HR, 0.65; 95% CI, 0.50-0.84). Moreover, recipients of DOACs had a lower risk of intracerebral hemorrhage (HR, 0.62; 95% CI, 0.43-0.91) and comparable all-cause mortality (HR, 1.03; 95% CI, 0.67-1.59).

Conclusions: This study underscores the potential of DOACs as a promising treatment for CVT, demonstrating reduced recurrence and intracerebral hemorrhage risks with comparable all-cause mortality.

Objectives: To investigate the effect of IRE1α/TRAF2/NF-κB pathway on early brain injury.

Methods: An endovascular puncture model of subarachnoid hemorrhage (SAH) was developed and SAH grading was performed. The following groups of experimental animals were randomly assigned: Blank group, Sham group, SAH+ DMSO group, SAH+STF-083010(IRE1α inhibitor) group, and SAH+BAY11-7082(NF-κB inhibitor) group. Neurological deficits were assessed in the animal models using a modified Garcia score. The expression of IRE1α, GRP78, TRAF2, NF-κB, and caspase3 was measured using western blot analysis. The concentrations of TNF-α, IL-1β and IL-6 were evaluated with ELISA kits. An analysis of neuronal apoptosis was performed using TUNEL staining.

Results: The neurological deficits, expression of IRE1α/TRAF2/NF-κB axis and its related proteins, inflammatory cytokines and apoptosis were increased after SAH, whereas their expressions were suppressed since the inhibition of the IRE1α/TRAF2/NF-κB signal pathway. Moreover, correlation analysis showed that TNF-α, IL-1β and IL-6 were positively correlated with apoptosis.

Conclusions: The IRE1α/TRAF2/NF-κB signal pathway was activated and promoted apoptosis by promoting the expression of inflammatory cytokines after SAH.

Background: Stroke is a major cause of mortality and permanent disability worldwide. Precise prediction of post-stroke mortality is essential for guiding treatment decisions and rehabilitation planning. The ability of Machine learning models to process large amounts of data, offer a promising alternative for improving mortality prediction in stroke patients. In this review, we aim to evaluate the risk of bias in different machine learning models used for predicting post-stroke mortality.

Methods: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). Relevant articles were retrieved from Cochrane Library, Scopus, PubMed, and Web of Science databases.

Results: A total of 9 studies were included, with an aggregate patient population of 669,424. Six studies used publicly available datasets, and four used hospital data with a follow up duration ranging from 7 days to 18 months. The range of area under the curve (AUC) for mortality prediction across the studies ranged from 0.81 to 0.95. All studies were determined to have a high overall risk of bias.

Conclusion: Machine learning models demonstrated great potential in predicting post-stroke mortality. However, implementation of these models in clinical practice is limited by high risk of bias. Future studies should focus on reducing this bias and enhancing the applicability of these models to improve the reliability of stroke mortality predictions.

Background: Stroke is a leading cause of death and disability globally, with significant public health implications. In Latin America, while mortality rates have declined, the number of stroke cases has increased due to prevalent risk factors like high blood pressure and obesity. Unlike Europe, recent trends in stroke mortality in this region remain underreported.

Objective: This study evaluates stroke mortality rates in Latin America Latin American and Caribbean (LAC) countries from 1997 to 2020 and predictions to 2035.

Methods: This ecological observational study utilized mortality data from the World Health Organization database. Trends were analyzed using Joinpoint regression to evaluate the annual percent change (APC) by sex and country. Predicted mortality rates through 2035 were calculated using the Nordpred package in R. Changes in stroke mortality were assessed by disentangling the effects of population growth, aging, and risk factor modifications, based on age-specific rates and projections. Results were presented as absolute case numbers and relative percentages.

Results: From 1997 to 2020, twelve countries presented significant reductions in stroke mortality rates for men in LAC, the main ones being Chile (-4.2 %), El Salvador (-4.2 %), and Puerto Rico (-4.0 %). Thirteen countries reported a reduction in their mortality for women, mainly in Puerto Rico (-4.3 %), Chile (-3.7 %), Argentina, El Salvador, and Uruguay (-3.5 %). By 2035, an increase in deaths among men and women is expected, mainly due to the increase in population structure and size. However, a decrease in the mortality rate will be reported, mainly due to the reduction of risk factors.

Conclusion: Our final findings show a reduction in stroke mortality trends in LAC countries between 1997 and 2020, due to creating public awareness about vascular risk factors by authorities and the implementation of effective health policies. By 2035, an overall increase in mortality is expected, mainly due to population change in each country.