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The Frequency of Carotid Web in Cryptogenic Stroke and Its Association with Stroke Risk Factors.
IF 2 4区 医学 Q3 NEUROSCIENCES Pub Date : 2025-03-15 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108295
Ekin Öykü Baylam Yirmibeş, Nihat Şengeze, Burak Gürel

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.

{"title":"The Frequency of Carotid Web in Cryptogenic Stroke and Its Association with Stroke Risk Factors.","authors":"Ekin Öykü Baylam Yirmibeş, Nihat Şengeze, Burak Gürel","doi":"10.1016/j.jstrokecerebrovasdis.2025.108295","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108295","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108295"},"PeriodicalIF":2.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Assessing Changes on Large Cerebral Arteries in CADASIL: Preliminary Insights from a Case-Control Analysis.
IF 2 4区 医学 Q3 NEUROSCIENCES Pub Date : 2025-03-15 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108294
Edgar R Lopez-Navarro, Silvia V Mayer, Brenno R Barreto, Kevin H Strobino, Antonio Spagnolo-Allende, Pedro G Bueno, Kursat Gurel, Khrystyna Kozii, Salwa Rahman, Farid Khasiyev, Jane S Paulsen, Jose Gutierrez

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.

{"title":"Assessing Changes on Large Cerebral Arteries in CADASIL: Preliminary Insights from a Case-Control Analysis.","authors":"Edgar R Lopez-Navarro, Silvia V Mayer, Brenno R Barreto, Kevin H Strobino, Antonio Spagnolo-Allende, Pedro G Bueno, Kursat Gurel, Khrystyna Kozii, Salwa Rahman, Farid Khasiyev, Jane S Paulsen, Jose Gutierrez","doi":"10.1016/j.jstrokecerebrovasdis.2025.108294","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108294","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108294"},"PeriodicalIF":2.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Moyamoya Disease: Understanding Patient Experiences through Thematic Analysis of Instagram, TikTok, and Twitter Posts.
IF 2 4区 医学 Q3 NEUROSCIENCES Pub Date : 2025-03-15 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108293
Neo Y Hou, Avi A Gajjar, Eli Hou, Arnav Barpujari, Mohamed M Salem, Georgios Sioutas, Visish M Srinivasan, Brian T Jankowitz, Jan-Karl Burkhardt

Introduction: Physicians aim to provide optimal care, considering patient experiences and satisfaction. Traditional in-clinic surveys assessing surgical outcomes face limitations, including 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 "#moyamoya warrior" from Instagram, TikTok, and Twitter were analyzed. Posts unrelated to 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 determined the 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 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 potential to augment traditional methods of obtaining patient feedback, highlighting significant gender- and platform-based differences in shared experiences. Despite limitations, leveraging social media can enhance understanding patient needs, ultimately improving care quality for Moyamoya disease patients.

{"title":"Moyamoya Disease: Understanding Patient Experiences through Thematic Analysis of Instagram, TikTok, and Twitter Posts.","authors":"Neo Y Hou, Avi A Gajjar, Eli Hou, Arnav Barpujari, Mohamed M Salem, Georgios Sioutas, Visish M Srinivasan, Brian T Jankowitz, Jan-Karl Burkhardt","doi":"10.1016/j.jstrokecerebrovasdis.2025.108293","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108293","url":null,"abstract":"<p><strong>Introduction: </strong>Physicians aim to provide optimal care, considering patient experiences and satisfaction. Traditional in-clinic surveys assessing surgical outcomes face limitations, including 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.</p><p><strong>Methods: </strong>Posts containing \"#moyamoya\" and \"#moyamoya warrior\" from Instagram, TikTok, and Twitter were analyzed. Posts unrelated to 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 determined the significance of theme prevalence.</p><p><strong>Results: </strong>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 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.</p><p><strong>Conclusion: </strong>This study demonstrates social media's potential to augment traditional methods of obtaining patient feedback, highlighting significant gender- and platform-based differences in shared experiences. Despite limitations, leveraging social media can enhance understanding patient needs, ultimately improving care quality for Moyamoya disease patients.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108293"},"PeriodicalIF":2.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparing the Effectiveness and Safety of Direct Oral Anticoagulants and Warfarin in Patients with Cerebral Venous Thrombosis: A Real-World Study.
IF 2 4区 医学 Q3 NEUROSCIENCES Pub Date : 2025-03-14 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108290
Jheng-Yan Wu, Chih-Cheng Lai, Huey-Juan Lin, Kuan-Hsien Lu, Wan-Hsuan Hsu, Ting-Ying Chu

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.

{"title":"Comparing the Effectiveness and Safety of Direct Oral Anticoagulants and Warfarin in Patients with Cerebral Venous Thrombosis: A Real-World Study.","authors":"Jheng-Yan Wu, Chih-Cheng Lai, Huey-Juan Lin, Kuan-Hsien Lu, Wan-Hsuan Hsu, Ting-Ying Chu","doi":"10.1016/j.jstrokecerebrovasdis.2025.108290","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108290","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108290"},"PeriodicalIF":2.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
IRE1α/TRAF2/NF-κB pathway promotes apoptosis via regulating inflammatory cytokines and aggravates brain injury after SAH. IRE1α/TRAF2/NF-κB 通路通过调节炎症细胞因子促进细胞凋亡,加重 SAH 后的脑损伤。
IF 2 4区 医学 Q3 NEUROSCIENCES Pub Date : 2025-03-13 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108288
Bin Liu, Chao Zhu, Linzhi Dai, Lei Zhang, Hui Xu, Kunhao Ren, Hao Zhang, Ganggang Wang, Weidong Tian, Dong Zhao

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.

{"title":"IRE1α/TRAF2/NF-κB pathway promotes apoptosis via regulating inflammatory cytokines and aggravates brain injury after SAH.","authors":"Bin Liu, Chao Zhu, Linzhi Dai, Lei Zhang, Hui Xu, Kunhao Ren, Hao Zhang, Ganggang Wang, Weidong Tian, Dong Zhao","doi":"10.1016/j.jstrokecerebrovasdis.2025.108288","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108288","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the effect of IRE1α/TRAF2/NF-κB pathway on early brain injury.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>The IRE1α/TRAF2/NF-κB signal pathway was activated and promoted apoptosis by promoting the expression of inflammatory cytokines after SAH.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108288"},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Risk of bias assessment of post-stroke mortality machine learning predictive models: Systematic review.
IF 2 4区 医学 Q3 NEUROSCIENCES Pub Date : 2025-03-13 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108291
Nicole Maria Radley, Ian Soh, Abdelrahman M Saad, Milindu Wickramarachchi, Amelia Dawson, Jeremy Ng Chieng Hin, Asad Ali, Abhrajit Giri, Alicia Kwan, Osama Elzankaly, Mariam Tarek Desouki, Mohamed S Jabal, Abdelrahman M Hamouda, Sherief Gozy, David F Kallmes

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.

{"title":"Risk of bias assessment of post-stroke mortality machine learning predictive models: Systematic review.","authors":"Nicole Maria Radley, Ian Soh, Abdelrahman M Saad, Milindu Wickramarachchi, Amelia Dawson, Jeremy Ng Chieng Hin, Asad Ali, Abhrajit Giri, Alicia Kwan, Osama Elzankaly, Mariam Tarek Desouki, Mohamed S Jabal, Abdelrahman M Hamouda, Sherief Gozy, David F Kallmes","doi":"10.1016/j.jstrokecerebrovasdis.2025.108291","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108291","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108291"},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Trends in stroke mortality in Latin America and the Caribbean from 1997 to 2020 and predictions to 2035: An analysis of gender, and geographical disparities.
IF 2 4区 医学 Q3 NEUROSCIENCES Pub Date : 2025-03-13 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108286
J Smith Torres-Roman, Carlos Quispe-Vicuña, Alexandra Benavente-Casas, Dante Julca-Marin, Wagner Rios-Garcia, Mabel R Challapa-Mamani, Lita Del Rio-Muñiz, Jorge Ybaseta-Medina

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.

{"title":"Trends in stroke mortality in Latin America and the Caribbean from 1997 to 2020 and predictions to 2035: An analysis of gender, and geographical disparities.","authors":"J Smith Torres-Roman, Carlos Quispe-Vicuña, Alexandra Benavente-Casas, Dante Julca-Marin, Wagner Rios-Garcia, Mabel R Challapa-Mamani, Lita Del Rio-Muñiz, Jorge Ybaseta-Medina","doi":"10.1016/j.jstrokecerebrovasdis.2025.108286","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108286","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>This study evaluates stroke mortality rates in Latin America Latin American and Caribbean (LAC) countries from 1997 to 2020 and predictions to 2035.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108286"},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Differences in door-to-device times in a retrospective cohort of patients with ischemic stroke who received CTA only or CTA and CTP imaging
IF 2 4区 医学 Q3 NEUROSCIENCES Pub Date : 2025-03-13 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108272
Jason W. Tarpley MD, PhD , Horia Marginean MD, MS , Weston Anderson BA , Kamila Szweda , Reza Bavarsad Shahripour , Tamela Stuchiner MA
Background: In the treatment of acute ischemic stroke, there are differing views about the utility of computerized tomography perfusion (CTP). Two approaches are employed depending on hospital preference. The first approach is to perform non-contrast computed tomography (CT) scans followed by vascular imaging with computed tomography angiography (CTA) for patients arriving within 6 h of last known well. In the first approach, CTP is reserved for patients who arrive 6-24 h after last known well. The second approach is to utilize both CTA and CTP regardless of the time window in which the patient presents. In this study, we sought to answer whether patients triaged with CTP and CTA had increased door-to-device times compared to those only triaged with CTA.
Methods: We investigated a retrospective cohort of 1,357 patients with ischemic stroke who received endovascular therapy (EVT) and were triaged with CTA only or CTA and CTP. Patients were stratified by when they arrived at the hospital (<6 h and 6-24 h from last known well). Linear mixed-effects models (LMM) were used to investigate the association between door-to-device times and CTA/CTP usage.
Results: Our results showed that using CTP and CTA was not associated with increased time to treat compared to CTA alone. There was no increase in time from door to device in patients presenting within 6 h. Furthermore, for patients who arrived 6-24 h of last known well, the use of CTP and CTA was associated with an accelerated time to treatment with EVT.
Conclusions: CTA and CTP usage was not associated with added time costs with respect to door-to-device in this patient cohort. Our results are consistent with other data showing that radiologists have faster read times when given both CTP and CTA. It is noteworthy that the majority of EVT patients in our dataset (70.6 %) presented in the <6-hour time window.
{"title":"Differences in door-to-device times in a retrospective cohort of patients with ischemic stroke who received CTA only or CTA and CTP imaging","authors":"Jason W. Tarpley MD, PhD ,&nbsp;Horia Marginean MD, MS ,&nbsp;Weston Anderson BA ,&nbsp;Kamila Szweda ,&nbsp;Reza Bavarsad Shahripour ,&nbsp;Tamela Stuchiner MA","doi":"10.1016/j.jstrokecerebrovasdis.2025.108272","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108272","url":null,"abstract":"<div><div>Background: In the treatment of acute ischemic stroke, there are differing views about the utility of computerized tomography perfusion (CTP). Two approaches are employed depending on hospital preference. The first approach is to perform non-contrast computed tomography (CT) scans followed by vascular imaging with computed tomography angiography (CTA) for patients arriving within 6 h of last known well. In the first approach, CTP is reserved for patients who arrive 6-24 h after last known well. The second approach is to utilize both CTA and CTP regardless of the time window in which the patient presents. In this study, we sought to answer whether patients triaged with CTP and CTA had increased door-to-device times compared to those only triaged with CTA.</div><div>Methods: We investigated a retrospective cohort of 1,357 patients with ischemic stroke who received endovascular therapy (EVT) and were triaged with CTA only or CTA and CTP. Patients were stratified by when they arrived at the hospital (&lt;6 h and 6-24 h from last known well). Linear mixed-effects models (LMM) were used to investigate the association between door-to-device times and CTA/CTP usage.</div><div>Results: Our results showed that using CTP and CTA was not associated with increased time to treat compared to CTA alone. There was no increase in time from door to device in patients presenting within 6 h. Furthermore, for patients who arrived 6-24 h of last known well, the use of CTP and CTA was associated with an accelerated time to treatment with EVT.</div><div>Conclusions: CTA and CTP usage was not associated with added time costs with respect to door-to-device in this patient cohort. Our results are consistent with other data showing that radiologists have faster read times when given both CTP and CTA. It is noteworthy that the majority of EVT patients in our dataset (70.6 %) presented in the &lt;6-hour time window.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108272"},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Corrigendum to "ROTEM and von Willebrand Factor in COVID patients presenting with acute ischemic stroke: A case series: ROTEM and von Willebrand Factor in COVID-19 Related Stroke" [Journal of Stroke and Cerebrovascular Diseases, Volume 33 (11), 2024 Nov 1, p.107894]. 对 "COVID 患者急性缺血性中风时的 ROTEM 和 von Willebrand 因子 "的更正:病例系列:ROTEM和von Willebrand因子在COVID-19相关中风中的应用"[《中风和脑血管疾病杂志》,第33卷(11),2024年11月1日,第107894页]。
IF 2 4区 医学 Q3 NEUROSCIENCES Pub Date : 2025-03-13 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108275
Tamara Strohm
{"title":"Corrigendum to \"ROTEM and von Willebrand Factor in COVID patients presenting with acute ischemic stroke: A case series: ROTEM and von Willebrand Factor in COVID-19 Related Stroke\" [Journal of Stroke and Cerebrovascular Diseases, Volume 33 (11), 2024 Nov 1, p.107894].","authors":"Tamara Strohm","doi":"10.1016/j.jstrokecerebrovasdis.2025.108275","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108275","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108275"},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The relationship between fibrous cap status or plaque surface morphology and intraplaque hemorrhage volume over time: The PARISK Study
IF 2 4区 医学 Q3 NEUROSCIENCES Pub Date : 2025-03-12 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108283
Mohamed Kassem , Tahnee Gorissen , Mohammad Albenwan , Juul Bierens , Dianne H.K. van Dam-Nolen , Madieke I. Liem , Paul A.M. Hofman , Joachim E Wildberger , Jeroen Hendrikse , Werner Mess , Paul J. Nederkoorn , Daniel Bos , Patty Nelemans , Robert J. van Oostenbrugge , M. Eline Kooi

Background

Carotid intraplaque hemorrhage (IPH) is a strong predictor of stroke, but factors contributing to IPH development are incompletely understood. Therefore, we investigate the longitudinal relationship between a thin/ruptured fibrous cap (TRFC)/disrupted plaque surface and IPH volume.

Methods

116 ischemic TIA/stroke patients with ipsilateral carotid plaques underwent baseline and two-year follow-up MRI. IPH and fibrous cap status (thick versus TRFC) on MRI and disruption of the plaque surface (smooth versus fissure/ulceration) on CTA were assessed.

Results

In the TRFC and disrupted plaque surface groups, the median IPH volume (tended) to decrease during follow-up (baseline: 97.3 IQR: [3.2-193.3] mm3 versus follow-up: 29.7 [0.0-115.1] mm3, p = 0.09, and baseline: 25.1 [0.0-166.2] mm3 versus follow-up: 11.2 [0.0-68.3] mm3, p = 0.04, respectively). In the group with a thick fibrous cap/smooth plaque surface, the median IPH volumes were zero at baseline and follow-up. The risk of IPH progression was higher in the TRFC/disrupted plaque groups (risk ratio (RR): 2.9 and 2.0, respectively) than in patients with a thick fibrous cap/smooth plaque surface.

Conclusion

TIA/stroke patients with a TRFC/disrupted plaque showed a net decrease in IPH volume over time, indicating plaque healing in some patients, but patients with a TRFC/disrupted plaque are still at increased risk for IPH progression.

Trial registration

ClinicalTrials.gov NCT01208025.
{"title":"The relationship between fibrous cap status or plaque surface morphology and intraplaque hemorrhage volume over time: The PARISK Study","authors":"Mohamed Kassem ,&nbsp;Tahnee Gorissen ,&nbsp;Mohammad Albenwan ,&nbsp;Juul Bierens ,&nbsp;Dianne H.K. van Dam-Nolen ,&nbsp;Madieke I. Liem ,&nbsp;Paul A.M. Hofman ,&nbsp;Joachim E Wildberger ,&nbsp;Jeroen Hendrikse ,&nbsp;Werner Mess ,&nbsp;Paul J. Nederkoorn ,&nbsp;Daniel Bos ,&nbsp;Patty Nelemans ,&nbsp;Robert J. van Oostenbrugge ,&nbsp;M. Eline Kooi","doi":"10.1016/j.jstrokecerebrovasdis.2025.108283","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108283","url":null,"abstract":"<div><h3>Background</h3><div>Carotid intraplaque hemorrhage (IPH) is a strong predictor of stroke, but factors contributing to IPH development are incompletely understood. Therefore, we investigate the longitudinal relationship between a thin/ruptured fibrous cap (TRFC)/disrupted plaque surface and IPH volume.</div></div><div><h3>Methods</h3><div>116 ischemic TIA/stroke patients with ipsilateral carotid plaques underwent baseline and two-year follow-up MRI. IPH and fibrous cap status (thick versus TRFC) on MRI and disruption of the plaque surface (smooth versus fissure/ulceration) on CTA were assessed.</div></div><div><h3>Results</h3><div>In the TRFC and disrupted plaque surface groups, the median IPH volume (tended) to decrease during follow-up (baseline: 97.3 IQR: [3.2-193.3] mm<sup>3</sup> versus follow-up: 29.7 [0.0-115.1] mm<sup>3</sup>, <em>p</em> = 0.09, and baseline: 25.1 [0.0-166.2] mm<sup>3</sup> versus follow-up: 11.2 [0.0-68.3] mm<sup>3</sup>, <em>p</em> = 0.04, respectively). In the group with a thick fibrous cap/smooth plaque surface, the median IPH volumes were zero at baseline and follow-up. The risk of IPH progression was higher in the TRFC/disrupted plaque groups (risk ratio (RR): 2.9 and 2.0, respectively) than in patients with a thick fibrous cap/smooth plaque surface.</div></div><div><h3>Conclusion</h3><div>TIA/stroke patients with a TRFC/disrupted plaque showed a net decrease in IPH volume over time, indicating plaque healing in some patients, but patients with a TRFC/disrupted plaque are still at increased risk for IPH progression.</div></div><div><h3>Trial registration</h3><div>ClinicalTrials.gov NCT01208025.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 5","pages":"Article 108283"},"PeriodicalIF":2.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Stroke & Cerebrovascular Diseases
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