Pub Date : 2025-11-05DOI: 10.1016/j.jstrokecerebrovasdis.2025.108486
Charlotte S. Weyland , Michael Neidlin , Cilli Danker , Linda Puppendahl , Christian Sitzer , Julian Wynhoff , Ulrich Steinseifer , Omid Nikoubashman
Background
Intracranial sinus stenoses (ISS) or sinus occlusions (ISO) can lead to elevated intracranial venous blood pressure. Treatment strategies are advancing, but clinical decision making and the prediction of treatment success is hampered by the variable venous anatomy. We aimed to create a patient-specific computational model that allows for simulating pathologies and their influence on venous flow dynamics and pressure.
Methods
The model was created based on a stroke patient’s CT-angiography using semi-automatic threshold-based segmentation with subsequent flow modeling through computational fluid dynamics. Venous flow velocities were compared to a healthy cohort’s flow encoded magnetic resonance imaging (4D Flow MRI). Nine scenarios, including ISS and ISO at different locations, were simulated and their influence on venous pressure and blood flow was quantified.
Results
In comparison to a healthy cohort’s 4D Flow MRI, the model showed comparable venous velocities at all reference points. Unilateral transverse sinus occlusion or stenosis led to compensatory contralateral flow and elevated pressures up to 12 mmHg. Extensive ISO or bilateral transverse ISS led to markedly increased pressures > 100 mmHg.
Conclusion
Our model depicts realistic venous blood pressures and gradients and could support in identifying patients with intracranial sinus stenosis or sinus occlusions profiting from endovascular treatment strategies.
{"title":"Effect of stenoses and occlusions in the cerebral venous vasculature on intracranial venous hemodynamics - a patient-specific computational model","authors":"Charlotte S. Weyland , Michael Neidlin , Cilli Danker , Linda Puppendahl , Christian Sitzer , Julian Wynhoff , Ulrich Steinseifer , Omid Nikoubashman","doi":"10.1016/j.jstrokecerebrovasdis.2025.108486","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108486","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial sinus stenoses (ISS) or sinus occlusions (ISO) can lead to elevated intracranial venous blood pressure. Treatment strategies are advancing, but clinical decision making and the prediction of treatment success is hampered by the variable venous anatomy. We aimed to create a patient-specific computational model that allows for simulating pathologies and their influence on venous flow dynamics and pressure.</div></div><div><h3>Methods</h3><div>The model was created based on a stroke patient’s CT-angiography using semi-automatic threshold-based segmentation with subsequent flow modeling through computational fluid dynamics. Venous flow velocities were compared to a healthy cohort’s flow encoded magnetic resonance imaging (4D Flow MRI). Nine scenarios, including ISS and ISO at different locations, were simulated and their influence on venous pressure and blood flow was quantified.</div></div><div><h3>Results</h3><div>In comparison to a healthy cohort’s 4D Flow MRI, the model showed comparable venous velocities at all reference points. Unilateral transverse sinus occlusion or stenosis led to compensatory contralateral flow and elevated pressures up to 12 mmHg. Extensive ISO or bilateral transverse ISS led to markedly increased pressures > 100 mmHg.</div></div><div><h3>Conclusion</h3><div>Our model depicts realistic venous blood pressures and gradients and could support in identifying patients with intracranial sinus stenosis or sinus occlusions profiting from endovascular treatment strategies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108486"},"PeriodicalIF":1.8,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472618","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}
Pub Date : 2025-11-05DOI: 10.1016/j.jstrokecerebrovasdis.2025.108482
Yuwhan Chung M.D., Sung Ho Lee M.D., Ph.D., Kangmin Kim M.D., Ph.D., Hyun-Seung Kang M.D., Ph.D., Jeong Eun Kim M.D., Ph.D., Won-Sang Cho M.D., Ph.D.
Objectives
Indirect revascularization after bypass surgery for intracranial atherosclerotic steno-occlusive disease (ICAD) remains controversial. We aimed to evaluate indirect revascularization after direct bypass surgery in patients with ICAD.
Methods
Among 245 patients with ICAD who underwent direct bypass surgery between 2003 and 2022, 191 patients were ultimately enrolled in this study. Treatment outcomes were compared between combined bypass (n = 162 [84.8 %]) and direct bypass alone (n = 29) groups. Multivariable analyses were performed to identify significant predictors of indirect revascularization and favorable clinical outcomes.
Results
There were no significant differences in overall baseline characteristics or treatment outcomes between the two groups. At the last angiographic follow-up at 27.1 ± 27.1 months (range, 5.0–97.3 months), the rate of indirect revascularization was significantly higher in the combined bypass group than in the direct bypass alone group (39.5 % versus 17.2 %, P = .022). Significant predictors of indirect revascularization included combined bypass (OR 3.175, 95 % CI 1.142–8.826; P = .027) rather than direct bypass alone, and significant stenosis and occlusion in the middle cerebral artery rather than the internal carotid artery (OR 1.961, 95 % CI 1.022–3.763; P = .043). An additional analysis revealed that a good preoperative clinical status (OR 0.141, 95 % CI 0.066–0.302, P < .001) and indirect revascularization (OR 5.508, 95 % CI 1.003–30.245, P = .050) were independent predictors of favorable clinical outcomes.
Conclusion
Indirect revascularization was more pronounced after combined bypass than direct bypass alone and was a significant predictor of favorable clinical outcomes.
目的颅内动脉粥样硬化性狭窄闭塞病（ICAD）旁路手术后间接血运重建术仍有争议。我们的目的是评估ICAD患者直接搭桥手术后的间接血运重建。方法在2003年至2022年期间接受直接搭桥手术的245例ICAD患者中，191例患者最终入选本研究。比较联合搭桥组（n = 162[84.8%]）和单纯搭桥组（n = 29）的治疗结果。进行多变量分析以确定间接血运重建的重要预测因素和良好的临床结果。结果两组患者的总体基线特征和治疗结果无显著差异。在最后一次血管造影随访（27.1±27.1个月，范围5.0 ~ 97.3个月）时，联合搭桥组间接血运重建率明显高于单独搭桥组（39.5% vs 17.2%, P = 0.022）。间接血运重建的重要预测因素包括联合搭桥（OR 3.175, 95% CI 1.142-8.826; P = 0.027）而不是单独直接搭桥，以及大脑中动脉明显狭窄和闭塞而不是颈内动脉（OR 1.961, 95% CI 1.022-3.763; P = 0.043）。另一项分析显示，良好的术前临床状态（OR 0.141, 95% CI 0.066-0.302, P < 001）和间接血运重建（OR 5.508, 95% CI 1.003-30.245, P = 0.050）是良好临床结果的独立预测因子。结论联合搭桥术后间接血运重建比单独直接搭桥术后更为明显，是良好临床预后的重要预测指标。
{"title":"Indirect revascularization after bypass surgery for intracranial atherosclerotic steno-occlusive disease","authors":"Yuwhan Chung M.D., Sung Ho Lee M.D., Ph.D., Kangmin Kim M.D., Ph.D., Hyun-Seung Kang M.D., Ph.D., Jeong Eun Kim M.D., Ph.D., Won-Sang Cho M.D., Ph.D.","doi":"10.1016/j.jstrokecerebrovasdis.2025.108482","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108482","url":null,"abstract":"<div><h3>Objectives</h3><div>Indirect revascularization after bypass surgery for intracranial atherosclerotic steno-occlusive disease (ICAD) remains controversial. We aimed to evaluate indirect revascularization after direct bypass surgery in patients with ICAD.</div></div><div><h3>Methods</h3><div>Among 245 patients with ICAD who underwent direct bypass surgery between 2003 and 2022, 191 patients were ultimately enrolled in this study. Treatment outcomes were compared between combined bypass (<em>n</em> = 162 [84.8 %]) and direct bypass alone (<em>n</em> = 29) groups. Multivariable analyses were performed to identify significant predictors of indirect revascularization and favorable clinical outcomes.</div></div><div><h3>Results</h3><div>There were no significant differences in overall baseline characteristics or treatment outcomes between the two groups. At the last angiographic follow-up at 27.1 ± 27.1 months (range, 5.0–97.3 months), the rate of indirect revascularization was significantly higher in the combined bypass group than in the direct bypass alone group (39.5 % versus 17.2 %, <em>P</em> = .022). Significant predictors of indirect revascularization included combined bypass (OR 3.175, 95 % CI 1.142–8.826; <em>P</em> = .027) rather than direct bypass alone, and significant stenosis and occlusion in the middle cerebral artery rather than the internal carotid artery (OR 1.961, 95 % CI 1.022–3.763; <em>P</em> = .043). An additional analysis revealed that a good preoperative clinical status (OR 0.141, 95 % CI 0.066–0.302, <em>P</em> < .001) and indirect revascularization (OR 5.508, 95 % CI 1.003–30.245, <em>P</em> = .050) were independent predictors of favorable clinical outcomes.</div></div><div><h3>Conclusion</h3><div>Indirect revascularization was more pronounced after combined bypass than direct bypass alone and was a significant predictor of favorable clinical outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108482"},"PeriodicalIF":1.8,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466732","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}
Pub Date : 2025-11-05DOI: 10.1016/j.jstrokecerebrovasdis.2025.108488
Yasmin N Aziz MD , Achala Vagal MD, MSc , Heidi Sucharew PhD , Brady J Williamson PhD , Vivek Khandwala PhD , Lily Wang MBBS, MPH , Rebecca Cornelius MD , Mary F Gaskill-Shipley MD , Thomas A Tomsick MD , David T Wang MD , Shantala Gangatirkar , Thomas Maloney , Paul S Horn PhD , Mary Haverbusch RN , Janice A Carrozzella RN , David J Robinson MD , Robert J Stanton MD , Eva A Mistry MBBS, MSCI , Brett Kissela MD, MS , Pooja Khatri MD, MSc
Background
Acute ischemic stroke (AIS) treatment and prognosis depend on the extent of ischemia sustained at time of presentation. The Alberta Stroke Program Early CT Score (ASPECTS) is used for anterior circulation stroke triage and decision making. We sought to determine the distribution of baseline ASPECTS at a population level.
Methods
Clinical imaging was collected from hospitalized AIS patients ascertained in a metropolitan population of 1.3 million as part of the Greater Cincinnati/Northern Kentucky Stroke Study. Patients presenting to an emergency department (ED) in 2015 within 24 hours of anterior circulation ischemic stroke were included. Events were excluded if last known normal (LKN) was unavailable, occurred in the inpatient setting, if CTH was unavailable, or if a previous ischemic event was already adjudicated during the study period. Blinded central neuroradiologists evaluated presenting ASPECTS. National Institutes of Health Stroke Scale (NIHSS) score ≥6 was used as a surrogate for large vessel occlusion, as routine baseline vessel imaging was performed inconsistently during the 2015 study period.
Results
Among 1,518 events of AIS presenting within 24 hours of LKN, 949 were anterior circulation first-time events with baseline ASPECTS status available, of which 520 (55 %) had baseline vessel imaging. Among these 949 patients (mean age 71 [SD 14] years, median ED arrival time 5.2 [IQR 1.3-13.2] hours, median NIHSS 4 [IQR 1-9]), 920 (96.9 %) had an ASPECTS ≥6, of which 844 had ASPECTS 9-10. Of the 373 patients with a NIHSS ≥6 at presentation, 344 (92.2 %) had an ASPECTS ≥6. Of the 150 patients presenting with NIHSS ≥6 beyond 6 hours of LKN time, 129 (86.0 %) had an ASPECTS ≥6.
Conclusions
In our population, most patients presenting within 24 hours of LKN had ASPECTS ≥6. Even in patients with NIHSS ≥6, only 14 % of patients presenting in the extended time window had ASPECTS <6. These results can inform resource utilization and clinical trial design.
{"title":"Extensive ischemic change on stroke presentation is uncommon: A population-based study","authors":"Yasmin N Aziz MD , Achala Vagal MD, MSc , Heidi Sucharew PhD , Brady J Williamson PhD , Vivek Khandwala PhD , Lily Wang MBBS, MPH , Rebecca Cornelius MD , Mary F Gaskill-Shipley MD , Thomas A Tomsick MD , David T Wang MD , Shantala Gangatirkar , Thomas Maloney , Paul S Horn PhD , Mary Haverbusch RN , Janice A Carrozzella RN , David J Robinson MD , Robert J Stanton MD , Eva A Mistry MBBS, MSCI , Brett Kissela MD, MS , Pooja Khatri MD, MSc","doi":"10.1016/j.jstrokecerebrovasdis.2025.108488","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108488","url":null,"abstract":"<div><h3>Background</h3><div>Acute ischemic stroke (AIS) treatment and prognosis depend on the extent of ischemia sustained at time of presentation. The Alberta Stroke Program Early CT Score (ASPECTS) is used for anterior circulation stroke triage and decision making. We sought to determine the distribution of baseline ASPECTS at a population level.</div></div><div><h3>Methods</h3><div>Clinical imaging was collected from hospitalized AIS patients ascertained in a metropolitan population of 1.3 million as part of the Greater Cincinnati/Northern Kentucky Stroke Study. Patients presenting to an emergency department (ED) in 2015 within 24 hours of anterior circulation ischemic stroke were included. Events were excluded if last known normal (LKN) was unavailable, occurred in the inpatient setting, if CTH was unavailable, or if a previous ischemic event was already adjudicated during the study period. Blinded central neuroradiologists evaluated presenting ASPECTS. National Institutes of Health Stroke Scale (NIHSS) score ≥6 was used as a surrogate for large vessel occlusion, as routine baseline vessel imaging was performed inconsistently during the 2015 study period.</div></div><div><h3>Results</h3><div>Among 1,518 events of AIS presenting within 24 hours of LKN, 949 were anterior circulation first-time events with baseline ASPECTS status available, of which 520 (55 %) had baseline vessel imaging. Among these 949 patients (mean age 71 [SD 14] years, median ED arrival time 5.2 [IQR 1.3-13.2] hours, median NIHSS 4 [IQR 1-9]), 920 (96.9 %) had an ASPECTS ≥6, of which 844 had ASPECTS 9-10. Of the 373 patients with a NIHSS ≥6 at presentation, 344 (92.2 %) had an ASPECTS ≥6. Of the 150 patients presenting with NIHSS ≥6 beyond 6 hours of LKN time, 129 (86.0 %) had an ASPECTS ≥6.</div></div><div><h3>Conclusions</h3><div>In our population, most patients presenting within 24 hours of LKN had ASPECTS ≥6. Even in patients with NIHSS ≥6, only 14 % of patients presenting in the extended time window had ASPECTS <6. These results can inform resource utilization and clinical trial design.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108488"},"PeriodicalIF":1.8,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472571","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}
Pub Date : 2025-11-05DOI: 10.1016/j.jstrokecerebrovasdis.2025.108489
Björn Agvall , Junmei Miao Jonasson
Background
Stroke is a leading cause of death and disability worldwide. While personality traits have been associated with various health outcomes, their association with stroke remains underexplored.
Methods
This is a cross-sectional study based on wave 9 data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Individuals aged 50 years or older were included in the study. The Big Five personality traits constituted the main exposure variables and were analyzed separately. The value of each personality trait variable was standardized. The association between each personality trait and stroke was examined by logistic regression models which were used to estimate the odds ratios (ORs) and 95 % Confidence Intervals (CIs).
Results
A total of 2947 participants reported having a stroke in this study. The odds of stroke were higher in individuals with greater neuroticism (OR: 1.28 (95 % CI: 1.18 - 1.40). Higher Openness and Conscientiousness were associated with decreased odds of stroke (OR: 0.90, 95 % CI: [0.82 – 0.98]) and (OR: 0.90, 95 % CI: [0.83 – 0.98]), respectively. There were no significant associations between Extraversion or Agreeableness and the odds of stroke, respectively.
Conclusions
Personality traits, particularly Neuroticism, Openness, and Conscientiousness, were significantly associated with the prevalence of stroke in older European adults. Findings should be interpreted in light of the cross-sectional design.
{"title":"The association between personality traits and stroke - A European cross-sectional study","authors":"Björn Agvall , Junmei Miao Jonasson","doi":"10.1016/j.jstrokecerebrovasdis.2025.108489","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108489","url":null,"abstract":"<div><h3>Background</h3><div>Stroke is a leading cause of death and disability worldwide. While personality traits have been associated with various health outcomes, their association with stroke remains underexplored.</div></div><div><h3>Methods</h3><div>This is a cross-sectional study based on wave 9 data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Individuals aged 50 years or older were included in the study. The Big Five personality traits constituted the main exposure variables and were analyzed separately. The value of each personality trait variable was standardized. The association between each personality trait and stroke was examined by logistic regression models which were used to estimate the odds ratios (ORs) and 95 % Confidence Intervals (CIs).</div></div><div><h3>Results</h3><div>A total of 2947 participants reported having a stroke in this study. The odds of stroke were higher in individuals with greater neuroticism (OR: 1.28 (95 % CI: 1.18 - 1.40). Higher Openness and Conscientiousness were associated with decreased odds of stroke (OR: 0.90, 95 % CI: [0.82 – 0.98]) and (OR: 0.90, 95 % CI: [0.83 – 0.98]), respectively. There were no significant associations between Extraversion or Agreeableness and the odds of stroke, respectively.</div></div><div><h3>Conclusions</h3><div>Personality traits, particularly Neuroticism, Openness, and Conscientiousness, were significantly associated with the prevalence of stroke in older European adults. Findings should be interpreted in light of the cross-sectional design.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108489"},"PeriodicalIF":1.8,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472646","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}
Pub Date : 2025-11-04DOI: 10.1016/j.jstrokecerebrovasdis.2025.108484
Gwenllian Wilkinson BMedSci , Lisa F Everton PhD, MPhil , Kailash Krishnan PhD FRCP , Jacqueline Benfield PhD, MSc , Shaheen Hamdy MD FRCP , Philip M Bath DSc FMedSci
Background
The Feeding Status Scale (FSS) is a 7-point scale based on mode of nutrition in patients with swallowing impairment: normal diet, soft-diet, nasogastric-tube feeding, percutaneous endoscopic gastrostomy tube-feeding, parenteral fluids, no fluids/food and death. We assessed whether the FSS is a valid and reliable scale of feeding status.
Methods
Validation was established through secondary analysis of individual patient data from randomised trials in hospitalised patients with stroke. Validation was assessed as concurrent and predictive validity, intra- and inter-rater reliability, content validity (using untrained assessors) and minimum clinically important difference.
Results
Data were obtained from four trials with total 8435 participants, mean age 70.2 years. In stroke trial populations with or without dysphagia, FSS was associated with other stroke scales (motor impairment, dependency, mood, cognition and quality of life) at baseline (concurrent validity, e.g. motor impairment p < 0.001) and during follow-up (predictive validity, e.g. dependence, cognition, quality of life, all p < 0.001). Both intra- and inter-rater reliability showed excellent agreement (intraclass correlation coefficient ≥0.92). Item level content validity index rating indicated good-excellent (I-CVI 0.63-1.0) relevance of each point of the scale. Scale level content validity index rating was good (S-CVI-Ave 0.83). Within scale minimum clinically important difference (MCID) was found to be 1 point.
Conclusions
Mode of nutrition as assessed using the FSS is closely associated with swallow impairment and produces reliable results without specific training. FSS had good-excellent content validity, can be used with established stroke measures at different time points and is associated with swallowing impairment.
{"title":"Mode of nutrition as a reflection of swallowing ability in acute and sub-acute stroke: Validation of a bedside tool","authors":"Gwenllian Wilkinson BMedSci , Lisa F Everton PhD, MPhil , Kailash Krishnan PhD FRCP , Jacqueline Benfield PhD, MSc , Shaheen Hamdy MD FRCP , Philip M Bath DSc FMedSci","doi":"10.1016/j.jstrokecerebrovasdis.2025.108484","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108484","url":null,"abstract":"<div><h3>Background</h3><div>The Feeding Status Scale (FSS) is a 7-point scale based on mode of nutrition in patients with swallowing impairment: normal diet, soft-diet, nasogastric-tube feeding, percutaneous endoscopic gastrostomy tube-feeding, parenteral fluids, no fluids/food and death. We assessed whether the FSS is a valid and reliable scale of feeding status.</div></div><div><h3>Methods</h3><div>Validation was established through secondary analysis of individual patient data from randomised trials in hospitalised patients with stroke. Validation was assessed as concurrent and predictive validity, intra- and inter-rater reliability, content validity (using untrained assessors) and minimum clinically important difference.</div></div><div><h3>Results</h3><div>Data were obtained from four trials with total 8435 participants, mean age 70.2 years. In stroke trial populations with or without dysphagia, FSS was associated with other stroke scales (motor impairment, dependency, mood, cognition and quality of life) at baseline (concurrent validity, e.g. motor impairment <em>p</em> < 0.001) and during follow-up (predictive validity, e.g. dependence, cognition, quality of life, all <em>p</em> < 0.001). Both intra- and inter-rater reliability showed excellent agreement (intraclass correlation coefficient ≥0.92). Item level content validity index rating indicated good-excellent (I-CVI 0.63-1.0) relevance of each point of the scale. Scale level content validity index rating was good (S-CVI-Ave 0.83). Within scale minimum clinically important difference (MCID) was found to be 1 point.</div></div><div><h3>Conclusions</h3><div>Mode of nutrition as assessed using the FSS is closely associated with swallow impairment and produces reliable results without specific training. FSS had good-excellent content validity, can be used with established stroke measures at different time points and is associated with swallowing impairment.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108484"},"PeriodicalIF":1.8,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461175","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}
Pub Date : 2025-11-03DOI: 10.1016/j.jstrokecerebrovasdis.2025.108485
Lixia Zhu PhD , Zhao Pu , Thomas W. Leung MD , Lawrence Ka Sing Wong MD , Jack Jiaqi Zhang PhD , Li Xiong PhD
Background and Purpose
External counterpulsation (ECP) noninvasively augments cerebral blood flow in patients with ischemic stroke. We investigated whether the cerebral augmentation index (CAI), measured by transcranial Doppler (TCD) during ECP, could predict the functional outcome of ischemic stroke.
Methods
Patients with unilateral ischemic stroke in the anterior circulation territory were enrolled within 7 days of symptom onset. Mean flow velocities in both middle cerebral arteries (MCA) were monitored by TCD before, during and immediately after ECP. CAI was defined as the percentage increase in MCA mean flow velocity during ECP relative to baseline. TCD data from the ipsilateral and contralateral sides of the cerebral infarct were analyzed and compared between patients with good outcomes (modified Rankin Scale (mRS) 0-2) and those with poor outcomes (mRS 3-6) at 3 months post-stroke.
Results
Among 200 recruited patients (mean age, 64.5 ± 8.9 years; 86.5 % men), functional outcomes were good in 148 (74.0 %) and poor in 52 (26.0 %). Admission NIH Stroke Scale, history of ischemic heart disease, and CAI on both the ipsilateral and contralateral sides differed significantly between the two groups (all P < 0.05). In multivariate analysis, NIH Stroke Scale (OR, 1.677 [95 % CI, 1.363-2.064]; P < 0.001), ipsilateral CAI (OR, 1.282 [95 % CI, 1.148-1.646]; P = 0.012), and contralateral CAI (OR, 1.104 [95 % CI, 1.002-1.234]; P = 0.038) independently predicted poor functional outcomes.
Conclusion
CAI, a cerebral hemodynamic index measured over the MCA on either the ipsilateral or contralateral side of an acute cerebral infarct, may predict unfavorable stroke outcomes.
{"title":"Cerebral augmentation index derived from external counterpulsation predicts ischemic stroke outcome: A prospective observational study","authors":"Lixia Zhu PhD , Zhao Pu , Thomas W. Leung MD , Lawrence Ka Sing Wong MD , Jack Jiaqi Zhang PhD , Li Xiong PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108485","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108485","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>External counterpulsation (ECP) noninvasively augments cerebral blood flow in patients with ischemic stroke. We investigated whether the cerebral augmentation index (CAI), measured by transcranial Doppler (TCD) during ECP, could predict the functional outcome of ischemic stroke.</div></div><div><h3>Methods</h3><div>Patients with unilateral ischemic stroke in the anterior circulation territory were enrolled within 7 days of symptom onset. Mean flow velocities in both middle cerebral arteries (MCA) were monitored by TCD before, during and immediately after ECP. CAI was defined as the percentage increase in MCA mean flow velocity during ECP relative to baseline. TCD data from the ipsilateral and contralateral sides of the cerebral infarct were analyzed and compared between patients with good outcomes (modified Rankin Scale (mRS) 0-2) and those with poor outcomes (mRS 3-6) at 3 months post-stroke.</div></div><div><h3>Results</h3><div>Among 200 recruited patients (mean age, 64.5 ± 8.9 years; 86.5 % men), functional outcomes were good in 148 (74.0 %) and poor in 52 (26.0 %). Admission NIH Stroke Scale, history of ischemic heart disease, and CAI on both the ipsilateral and contralateral sides differed significantly between the two groups (all <em>P</em> < 0.05). In multivariate analysis, NIH Stroke Scale (OR, 1.677 [95 % CI, 1.363-2.064]; <em>P</em> < 0.001), ipsilateral CAI (OR, 1.282 [95 % CI, 1.148-1.646]; <em>P</em> = 0.012), and contralateral CAI (OR, 1.104 [95 % CI, 1.002-1.234]; <em>P</em> = 0.038) independently predicted poor functional outcomes.</div></div><div><h3>Conclusion</h3><div>CAI, a cerebral hemodynamic index measured over the MCA on either the ipsilateral or contralateral side of an acute cerebral infarct, may predict unfavorable stroke outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108485"},"PeriodicalIF":1.8,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454474","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}
Pub Date : 2025-11-01DOI: 10.1016/j.jstrokecerebrovasdis.2025.108483
Johanna Seiden MD, MPH , Juan Felipe Daza-Ovalle MD , Zhengrui Xiao MD , Olga Rubalsky MD , Irina Murakhovskaya MD , Ellen Friedman MD , Kathryn Kirchoff-Torres MD , Daniel Labovitz MD, MS , Charles Esenwa MD, MS
Introduction
Cerebral Infarction due to Severe ADAMTS-13 Deficiency (CISAD) remains an underrecognized cause of cryptogenic stroke. Despite the absence of classic hematologic features, CISAD confers a risk of recurrent ischemic events if not promptly identified and treated. Increased clinical awareness is essential to prompt appropriate laboratory testing and reduce stroke recurrence.
Methods
We conducted a retrospective cohort study at Montefiore Medical Center to identify patients with ischemic stroke and severe ADAMTS-13 deficiency from January 2017 to June 2025. Of 235 screened patients, 197 had an acute ischemic stroke. 9 met final inclusion criteria for CISAD: confirmed ischemic stroke, severe ADAMTS-13 deficiency at index event, and absence of microangiopathic hemolytic anemia (MAHA). Clinical, hematologic, and imaging characteristics were analyzed descriptively in the final cohort.
Results
Of 9 patients, 7 were female. Mean age was 51.3 years. Platelet counts were normal in 6 of 9 cases. 4 of 9 patients had large vessel occlusions. 3 patients had multifocal infarcts. 8 of 9 patients met Embolic Stroke of Undetermined Source (ESUS) criteria before ADAMTS-13 testing. 1 had three ESUS events before ADAMTS-13 deficiency was identified. The remaining 6 patients had an established history of thrombotic thrombocytopenic purpura (TTP) and presented with recurrent strokes and severe ADAMTS-13 deficiency. 2 patients had multiple strokes with severe ADAMTS-13 deficiency. All patients were treated with steroids, therapeutic plasma-exchange (TPE), and/or Rituximab.
Conclusion
CISAD may present without hematologic abnormalities and should be considered as a rare cause of stroke. Early ADAMTS-13 activity and inhibitor testing in select patients may allow timely diagnosis, treatment, and prevention of recurrence.
{"title":"Severe ADAMTS-13 deficiency without hemolysis as a cause of cryptogenic stroke: A single center case series","authors":"Johanna Seiden MD, MPH , Juan Felipe Daza-Ovalle MD , Zhengrui Xiao MD , Olga Rubalsky MD , Irina Murakhovskaya MD , Ellen Friedman MD , Kathryn Kirchoff-Torres MD , Daniel Labovitz MD, MS , Charles Esenwa MD, MS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108483","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108483","url":null,"abstract":"<div><h3>Introduction</h3><div>Cerebral Infarction due to Severe ADAMTS-13 Deficiency (CISAD) remains an underrecognized cause of cryptogenic stroke. Despite the absence of classic hematologic features, CISAD confers a risk of recurrent ischemic events if not promptly identified and treated. Increased clinical awareness is essential to prompt appropriate laboratory testing and reduce stroke recurrence.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study at Montefiore Medical Center to identify patients with ischemic stroke and severe ADAMTS-13 deficiency from January 2017 to June 2025. Of 235 screened patients, 197 had an acute ischemic stroke. 9 met final inclusion criteria for CISAD: confirmed ischemic stroke, severe ADAMTS-13 deficiency at index event, and absence of microangiopathic hemolytic anemia (MAHA). Clinical, hematologic, and imaging characteristics were analyzed descriptively in the final cohort.</div></div><div><h3>Results</h3><div>Of 9 patients, 7 were female. Mean age was 51.3 years. Platelet counts were normal in 6 of 9 cases. 4 of 9 patients had large vessel occlusions. 3 patients had multifocal infarcts. 8 of 9 patients met Embolic Stroke of Undetermined Source (ESUS) criteria before ADAMTS-13 testing. 1 had three ESUS events before ADAMTS-13 deficiency was identified. The remaining 6 patients had an established history of thrombotic thrombocytopenic purpura (TTP) and presented with recurrent strokes and severe ADAMTS-13 deficiency. 2 patients had multiple strokes with severe ADAMTS-13 deficiency. All patients were treated with steroids, therapeutic plasma-exchange (TPE), and/or Rituximab.</div></div><div><h3>Conclusion</h3><div>CISAD may present without hematologic abnormalities and should be considered as a rare cause of stroke. Early ADAMTS-13 activity and inhibitor testing in select patients may allow timely diagnosis, treatment, and prevention of recurrence.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108483"},"PeriodicalIF":1.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440473","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}
Pub Date : 2025-10-30DOI: 10.1016/j.jstrokecerebrovasdis.2025.108480
Kimberly Hreha , Marissa C. Ashner , Sarah Peskoe , Timothy Reistetter , Priya Palta , Lisa Wruck , Rebecca Gottesman , B. Gwen Windham , Heather E. Whitson
Vision loss is a risk factor for dementia, but it is unknown whether stroke-related vision impairment is linked to dementia risk in stroke survivors. This secondary analysis aimed to quantify the association between stroke-related vision impairment and time to incident dementia diagnosis, from time of stroke, using the Arthrosclerosis Risk in Communities study dataset. We included participants who sustained a non-fatal probable or definite ischemic, incident stroke captured from hospital surveillance during the study period and excluded those who were diagnosed with incident dementia prior to or less than half a year after the incident stroke. The association between stroke-related vision impairment (binary) and time from incident stroke to dementia diagnosis was analyzed using a Fine-Gray survival model to account for the competing risk of death, adjusting for age at incident stroke, stroke severity, biological sex, education and race-center. Among 787 stroke survivors, 31 % were diagnosed with dementia during the follow-up period and 19.5 % had stroke-related vision impairment. The presence of stroke-related vision impairment was not significantly associated with dementia diagnosis (HR = 1.18; 95 % CI 0.85, 1.63; p = 0.32). While results suggest that stroke-related vision impairment corresponds to a higher cumulative incidence of dementia, the association was not statistically significant.
视力丧失是痴呆症的一个危险因素，但目前尚不清楚中风相关的视力损害是否与中风幸存者患痴呆症的风险有关。这项二级分析旨在利用社区关节硬化风险研究数据集，量化卒中相关视力损害与卒中时间到痴呆诊断之间的关系。我们纳入了在研究期间从医院监测中获得的非致命性的、可能的或明确的缺血性卒中的参与者，排除了那些在卒中发生前或发生后不到半年被诊断为痴呆的参与者。使用Fine-Gray生存模型分析卒中相关视力障碍（二元）与卒中至痴呆诊断时间之间的关联，以考虑卒中发生时的年龄、卒中严重程度、生理性别、教育程度和种族中心等因素的竞争死亡风险。在787名中风幸存者中，31%在随访期间被诊断患有痴呆症，19.5%患有与中风相关的视力障碍。卒中相关视力障碍的存在与痴呆诊断无显著相关性（HR=1.18; 95% CI 0.85, 1.63; p = 0.32）。虽然研究结果表明，中风相关的视力损害与较高的痴呆累积发病率相对应，但这种关联在统计上并不显著。
{"title":"Investigating stroke-related vision impairments and time to incident dementia diagnosis","authors":"Kimberly Hreha , Marissa C. Ashner , Sarah Peskoe , Timothy Reistetter , Priya Palta , Lisa Wruck , Rebecca Gottesman , B. Gwen Windham , Heather E. Whitson","doi":"10.1016/j.jstrokecerebrovasdis.2025.108480","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108480","url":null,"abstract":"<div><div>Vision loss is a risk factor for dementia, but it is unknown whether stroke-related vision impairment is linked to dementia risk in stroke survivors. This secondary analysis aimed to quantify the association between stroke-related vision impairment and time to incident dementia diagnosis, from time of stroke, using the Arthrosclerosis Risk in Communities study dataset. We included participants who sustained a non-fatal probable or definite ischemic, incident stroke captured from hospital surveillance during the study period and excluded those who were diagnosed with incident dementia prior to or less than half a year after the incident stroke. The association between stroke-related vision impairment (binary) and time from incident stroke to dementia diagnosis was analyzed using a Fine-Gray survival model to account for the competing risk of death, adjusting for age at incident stroke, stroke severity, biological sex, education and race-center. Among 787 stroke survivors, 31 % were diagnosed with dementia during the follow-up period and 19.5 % had stroke-related vision impairment. The presence of stroke-related vision impairment was not significantly associated with dementia diagnosis (HR = 1.18; 95 % CI 0.85, 1.63; <em>p</em> = 0.32). While results suggest that stroke-related vision impairment corresponds to a higher cumulative incidence of dementia, the association was not statistically significant.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108480"},"PeriodicalIF":1.8,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426897","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}
Pub Date : 2025-10-30DOI: 10.1016/j.jstrokecerebrovasdis.2025.108481
Chen Yiping MD , Chen Suyu MD , Li Min MD , Li Yongli MD, Zhang Yujing MD, Liu Sihan MD, Xu Chenggui MD, Zhang Tinghui MD, Liao Yong MD, Zhang Ji MD, Zhang Xinghe MD, Tai Xiantao MD
<div><h3>Background</h3><div>Massage is kown to effectively alleviate symptoms of Cerebral Palsy (CP), yet its specific mechanism in CP remains unclear. Cerebral white matter damage is a primary consequence of hypoxia-ischemia (HI) in CP rats. This study aims to explore the potential of massage in facilitating the migration of bone marrow mesenchymal stem cells (BMSCs-Exo) to the brain through the chemokine axis, with the goal of moderating cerebral white matter injury in CP rats.</div></div><div><h3>Method</h3><div>Forty-eight rats were randomized to Sham, Model, Massage, and Inhibition groups. HI injury was induced in 3-day-old rat pups and confirmed through righting reflex assessment and cerebral blood flow imaging. The Massage group received daily massage therapy from postnatal day 5 for 28 days. The Inhibition group was treated with a CXCR4 inhibitor (AMD3100), while the remaining groups were administered saline. Behavioral assessments were conducted at 2 and 4 weeks post-treatment. The homing efficiency of BMSCs-Exo was monitored using small animal live imaging, and cerebral oxygen saturation was measured noninvasively through photoacoustic imaging. Neuronal morphology was evaluated using Nissl staining, and immunofluorescence was employed to co-label oligodendrocytes with CXCR4/SDF-1. SDF-1/CXCR4 expression in bone marrow, serum, and brain white matter was assessed using PCR. In vitro experiments involved co-culturing BMSCs with oligodendrocytes under hypoxic and low glucose conditions. The cell groups included Normal control, DMSO control, Massage, and Massage + GW4869 Group. Viability of BMSCs and oligodendrocytes was determined using CCK-8 assays. Additionally, immunofluorescence staining was performed to visualize exosomes in oligodendrocytes.</div></div><div><h3>Results</h3><div>HI injury prolonged righting reflex latency and decreased cerebral blood flow. Massage intervention was linked to improved blood flow, increased brain homing of BMSCs-Exo, and enhanced limb function, particularly evident after 4 weeks. Histological analysis using Nissl staining and immunofluorescence demonstrated that massage was coincided with reduced neuronal injury and the upregulation of SDF-1/CXCR4 expression in oligodendrocytes. Initially reduced following HI, SDF-1/CXCR4 levels were restored by massage, with the CXCR4 inhibitor significantly abrogating the therapeutic effects of massage. CCK-8 assays indicated that massage was associated with promoted viability of BMSCs and oligodendrocytes, which was attenuated in the presence of exosome inhibition. Furthermore, the uptake capacity of oligodendrocyte cells for exosomes was superior in the Massage group compared to the DMSO control group.</div></div><div><h3>Conclusion</h3><div>Massage is associated with enhanced motor function and white matter restoration in cerebral palsy, potentially through mechanisms involving the SDF-1/CXCR4 axis, increased homing of BMSCs-Exo to the brain, and enhanced oligodendr
{"title":"White matter injury in young rats with cerebral palsy: the role of massage in regulating exosomes via the chemokine axis","authors":"Chen Yiping MD , Chen Suyu MD , Li Min MD , Li Yongli MD, Zhang Yujing MD, Liu Sihan MD, Xu Chenggui MD, Zhang Tinghui MD, Liao Yong MD, Zhang Ji MD, Zhang Xinghe MD, Tai Xiantao MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108481","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108481","url":null,"abstract":"<div><h3>Background</h3><div>Massage is kown to effectively alleviate symptoms of Cerebral Palsy (CP), yet its specific mechanism in CP remains unclear. Cerebral white matter damage is a primary consequence of hypoxia-ischemia (HI) in CP rats. This study aims to explore the potential of massage in facilitating the migration of bone marrow mesenchymal stem cells (BMSCs-Exo) to the brain through the chemokine axis, with the goal of moderating cerebral white matter injury in CP rats.</div></div><div><h3>Method</h3><div>Forty-eight rats were randomized to Sham, Model, Massage, and Inhibition groups. HI injury was induced in 3-day-old rat pups and confirmed through righting reflex assessment and cerebral blood flow imaging. The Massage group received daily massage therapy from postnatal day 5 for 28 days. The Inhibition group was treated with a CXCR4 inhibitor (AMD3100), while the remaining groups were administered saline. Behavioral assessments were conducted at 2 and 4 weeks post-treatment. The homing efficiency of BMSCs-Exo was monitored using small animal live imaging, and cerebral oxygen saturation was measured noninvasively through photoacoustic imaging. Neuronal morphology was evaluated using Nissl staining, and immunofluorescence was employed to co-label oligodendrocytes with CXCR4/SDF-1. SDF-1/CXCR4 expression in bone marrow, serum, and brain white matter was assessed using PCR. In vitro experiments involved co-culturing BMSCs with oligodendrocytes under hypoxic and low glucose conditions. The cell groups included Normal control, DMSO control, Massage, and Massage + GW4869 Group. Viability of BMSCs and oligodendrocytes was determined using CCK-8 assays. Additionally, immunofluorescence staining was performed to visualize exosomes in oligodendrocytes.</div></div><div><h3>Results</h3><div>HI injury prolonged righting reflex latency and decreased cerebral blood flow. Massage intervention was linked to improved blood flow, increased brain homing of BMSCs-Exo, and enhanced limb function, particularly evident after 4 weeks. Histological analysis using Nissl staining and immunofluorescence demonstrated that massage was coincided with reduced neuronal injury and the upregulation of SDF-1/CXCR4 expression in oligodendrocytes. Initially reduced following HI, SDF-1/CXCR4 levels were restored by massage, with the CXCR4 inhibitor significantly abrogating the therapeutic effects of massage. CCK-8 assays indicated that massage was associated with promoted viability of BMSCs and oligodendrocytes, which was attenuated in the presence of exosome inhibition. Furthermore, the uptake capacity of oligodendrocyte cells for exosomes was superior in the Massage group compared to the DMSO control group.</div></div><div><h3>Conclusion</h3><div>Massage is associated with enhanced motor function and white matter restoration in cerebral palsy, potentially through mechanisms involving the SDF-1/CXCR4 axis, increased homing of BMSCs-Exo to the brain, and enhanced oligodendr","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108481"},"PeriodicalIF":1.8,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145427084","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}
Pub Date : 2025-10-28DOI: 10.1016/j.jstrokecerebrovasdis.2025.108478
Tan V. Bui , Yichao A. Sun , Katherine Chappell , Sabah Rehman , Hoang T. Phan , Helen Castley , Lee Nedkoff , Judith M. Katzenellenbogen , Seana L. Gall
Background
Although socio-economic status (SES) is a recognised risk factor for stroke, few studies have examined stroke incidence by SES in Australia. We investigated the incidence of first-ever stroke by SES using state-wide record linkage data.
Methods
This retrospective cohort study used linked Tasmanian Admitted Patient Care and the Death Registry data. Fatal and non-fatal strokes 2007–2020 were identified using ICD-10 codes (8-year clearance period) to identify first-ever strokes 2015–2020. SES was from Index of Relative Socio-economic Advantage and Disadvantage by quintiles (low, low medium, medium, medium high, high). Covariates included sex, age, and remoteness. Population denominators (2016 Australian population) were used to calculate crude and age-standardised incidence rates. Poisson regression models estimated adjusted incidence rate ratios (IRR) for first-ever stroke by SES group.
Results
We identified 4901 first-ever stroke cases (63% ischaemic stroke, mean [SD] age 75 [14] years, 52% female). Ischaemic heart disease (12% lowest vs 7% highest SES), diabetes (26% lowest vs 18% highest SES), and hypertension (48% lowest vs 39% highest SES) were significantly different by SES. The age-standardised rate was 134/100,000 persons (95% CI 130, 138). Compared to the high SES group, the IRR for first-ever stroke was 1.20 (95% CI 1.09, 1.33) for the low medium SES group and 1.33 (95% CI 1.22, 1.46) for the low SES group, adjusting for age, sex, stroke incident year, and remoteness.
Conclusions
Lower SES groups had a higher incidence of first-ever stroke. Public health and primary care strategies targeting stroke risk factors in these groups may reduce stroke incidence.
背景：虽然社会经济地位（SES）是卒中的一个公认的危险因素，但在澳大利亚很少有研究通过社会经济地位来检查卒中的发病率。我们调查了首次中风的发病率SES使用全国范围内的记录联动数据。方法：这项回顾性队列研究使用了塔斯马尼亚住院病人护理和死亡登记的相关数据。使用ICD-10代码（8年清除期）确定2007-2020年的致命性和非致命性中风，以确定2015-2020年的首次中风。SES为相对社会经济优势和劣势指数，分五位数（低、中低、中、中高、高）。协变量包括性别、年龄和偏远地区。人口分母（2016年澳大利亚人口）用于计算粗发病率和年龄标准化发病率。泊松回归模型估计了SES组首次卒中的调整发病率比（IRR）。结果：我们确定了4901例首次卒中病例（63%为缺血性卒中，平均[SD]年龄75岁，52%为女性）。缺血性心脏病（12%最低SES vs 7%最高SES）、糖尿病（26%最低SES vs 18%最高SES）和高血压（48%最低SES vs 39%最高SES）因SES而有显著差异。年龄标准化率为134/100,000人（95% CI 130,138）。与高经济地位组相比，中低经济地位组首次卒中的IRR为1.20 (95% CI 1.09, 1.33)，低经济地位组为1.33 (95% CI 1.22, 1.46)，调整了年龄、性别、卒中发生年份和偏远地区。结论：社会经济地位较低的组首次卒中的发生率较高。针对这些人群卒中危险因素的公共卫生和初级保健策略可能会降低卒中发病率。
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