Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Access to neighborhood destinations that offer opportunities for physical activity and socialization is associated with favorable post-stroke outcomes","authors":"Leanna M Delhey PhD ,&nbsp;Jon Zelner PhD ,&nbsp;Xu Shi PhD ,&nbsp;Lewis B Morgenstern MD ,&nbsp;Devin L Brown MD ,&nbsp;Melinda A Smith DrPH ,&nbsp;Erin C Case BA ,&nbsp;Lynda D Lisabeth PhD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108545","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108545","url":null,"abstract":"<div><h3>Objective</h3><div><strong>:</strong> Assess associations between destinations near stroke survivor's residence – places like restaurants, recreation centers, and stores that offer opportunities for physical activity and socialization outside of the home and work – and their poststroke outcomes.</div></div><div><h3>Methods</h3><div><strong>:</strong> We included non-Hispanic white and Mexican American incident stroke survivors enrolled in the Brain Attack Surveillance in Corpus Christi project (2009-19), a population-based cohort in Texas. Exposure: count of destinations within 0.5-miles around survivors’ residences. Outcomes assessed at approximately 3-, 6-, and 12-months poststroke: cognition (Modified Mini-Mental State Examination), functioning (activities of daily living (ADL)/instrumental ADL), health-related quality of life (abbreviated Stroke-Specific Quality of Life scale), and depression (Patient Health Questionnaire-8). We fit adjusted linear mixed models and considered interactions with follow-up time and stroke severity (NIH stroke scale - mild (&lt;5), moderate-severe (≥5)).</div></div><div><h3>Results</h3><div><strong>:</strong> We included 1,786 survivors who completed 3 (<em>N</em> = 1,321), 6 (<em>N</em> = 677), or 12-month interviews (<em>N</em> = 652). Median age was 64 years, 55% male, and 74% mild stroke. Stroke severity modified associations with functioning (<em>p</em> = 0.09) and quality of life (<em>p</em> = 0.05), follow-up time did not (<em>p</em> &gt; 0.25). Among moderate-severe stroke survivors, more destinations were associated with more favorable functioning (mean difference=-0.12, 95% CI=-0.22, -0.01) and quality of life (mean difference=0.16, 95% CI=0.03, 0.30). No associations were observed among mild stroke survivors or with cognition or depression (<em>p</em> &gt; 0.05).</div></div><div><h3>Interpretation</h3><div><strong>:</strong> Among moderate-severe stroke survivors, more nearby destinations were associated with more favorable functioning and quality of life in the first year. Future research is needed to explore if specific types of destinations may support more favorable outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108545"},"PeriodicalIF":1.8,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902082","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}

{"title":"Post-stroke epilepsy in revascularized versus not revascularized stroke patients: A prospective cohort study","authors":"Stefania Lazzari ,&nbsp;Carlotta Mutti ,&nbsp;Francesca Bozzetti ,&nbsp;Antonio Genovese ,&nbsp;Maddalena Frapporti ,&nbsp;Francesca Badini ,&nbsp;Carmine Siniscalchi ,&nbsp;Andrea Becciolini ,&nbsp;Valentina Tontini ,&nbsp;Elisa Mannini ,&nbsp;Irene Florindo ,&nbsp;Francesco Misirocchi ,&nbsp;Francesca Iuculano ,&nbsp;Liborio Parrino ,&nbsp;Lucia Zinno","doi":"10.1016/j.jstrokecerebrovasdis.2026.108544","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108544","url":null,"abstract":"<div><h3>Objective</h3><div>The association between post stroke epilepsy (PSE) and revascularization therapy in stroke patients remains controversial. The prognostic significance of other supportive techniques such as Computed Tomography (CT) brain data and electroencephalograph (EEG) in PSE prediction is poorly understood.</div></div><div><h3>Methods</h3><div>We performed a single-center prospective observational study to evaluate the incidence of acute symptomatic seizures (ASS) and PSE in adult patients affected by acute ischaemic stroke undergoing reperfusional approaches compared to non-revascularized patients, with a 30-months follow-up.</div></div><div><h3>Results</h3><div>We enrolled 258 patients with stroke: 155 cases (treated with intravenous tissue plasminogen activator (IV-tPA)) and/or endovascular thrombectomy (ET) and 103 controls (non-revascularized). The global incidence of ASS was 3.4%, while PSE was diagnosed in 5% of patients. Reperfusion treatments were not associated with increased risk of ASS or PSE. Hemorrhagic infarction was found as the only independent risk factor for PSE development (HR 5.33, (95% CI, 1.69 – 16.82), p=0.004). In parallel, we analyzed the relationship between ASS and hemorrhagic infarction using the chi-square test (OR 8.59 (95% CI, 2.19 - 33.7), p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Reperfusion therapies for acute ischemic stroke do not increase the risk of epilepsy during the first 30 months after stroke. Hemorrhagic infarction was the main risk for epilepsy after stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108544"},"PeriodicalIF":1.8,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902055","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}

{"title":"Management of intracranial aneurysms: a 2024 nationwide study from China","authors":"Yu Gao MS ,&nbsp;Meihua Huyan MD ,&nbsp;Yina Wu MD ,&nbsp;Zhao Dai MS ,&nbsp;Yongwei Zhang MD ,&nbsp;Jianmin Liu MD ,&nbsp;Pengfei Yang MD ,&nbsp;Rui Zhao MD ,&nbsp;Qiang Li MD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108546","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108546","url":null,"abstract":"<div><h3>Background</h3><div>Rising detection of unruptured intracranial aneurysms (UIAs) in China, driven by an aging population and increased neuroimaging utilization, coincides with significant regional disparities in neurointerventional resources. This study characterizes contemporary management practices nationwide.</div></div><div><h3>Methods</h3><div>A WeChat-based survey distributed to cerebrovascular specialists in 2024 assessed clinical decision-making, resource availability, and case-based preferences.</div></div><div><h3>Results</h3><div>Resource disparities were pronounced: while computed tomography angiography (CTA) was widely accessible (82.4%), dual-arm digital subtraction angiography (DSA=32.4%) and hybrid operating rooms (36.4%) remained limited. Domestic flow diverters surpassed international devices (47.1% vs. 31.4%). Clinician experience significantly influenced management: physicians with &gt;10 years’ experience intervened at smaller UIA sizes (&gt;5 mm; 55.5% vs. 40.1% in &lt;2-year cohort, p=0.03) and preferred flow diverters for incidental aneurysms (80.7% vs. 38.3%, p&lt;0.001). Coiling dominated acute aneurysmal subarachnoid hemorrhage (SAH) management, but senior neurosurgeons favored clipping with hematoma evacuation (66.5% vs. 35.3%, p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>Significant practice variations persist in China, driven by experience gaps and regional resource inequities. Standardized training and equitable resource allocation are urgently needed to optimize aneurysm care.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108546"},"PeriodicalIF":1.8,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902070","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}

{"title":"An evaluation of Stroke Neurology fellowship websites: Incomplete and inconsistent information","authors":"Milan Sivakumar BS ,&nbsp;Nathan Degen BS ,&nbsp;Thomas C. Varkey MD, MBA, MEd ,&nbsp;Judy Dawod MD ,&nbsp;Andrei V. Alexandrov MD ,&nbsp;Savdeep Singh MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108539","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108539","url":null,"abstract":"<div><h3>Introduction</h3><div>Prospective applicants for neurology stroke fellowship programs often rely on online resources to make informed decisions. Access to comprehensive and accurate program information is essential for making application and attendance decisions. This study aimed to assess the availability of critical application and program information on websites of neurology stroke fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and participating in the National Residency Matching Program (NRMP).</div></div><div><h3>Methods</h3><div>Using the Electronic Residency Application Services (ERAS), a list of websites for 112 ACGME-accredited neurology stroke fellowship programs was compiled. Each website was evaluated for 7 components of application information, including deadlines and contact details, and 17 components of program information, such as compensation, rotation schedule, and faculty listings.</div></div><div><h3>Results</h3><div>Of the 112 programs, only 5.1% of websites contained all 7 components of application information, while none (0%) provided all 17 components of program information. This gap in online data availability suggests that prospective fellows may struggle to find essential information to guide their application process.</div></div><div><h3>Conclusion</h3><div>The lack of comprehensive online information poses a challenge for applicants and may hinder the recruitment of qualified candidates. Improving the accessibility and completeness of information on neurology stroke fellowship websites could facilitate better decision-making and ultimately enhance program participation.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108539"},"PeriodicalIF":1.8,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879784","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}

{"title":"Temporal trends in heart failure and stroke-related mortality in the United States, 1999–2023","authors":"Abdur Rafay Bilal MBBS ,&nbsp;Maryam Sajid MBBS ,&nbsp;Shaheer Qureshi MBBS ,&nbsp;Hateem Gaba MBBS ,&nbsp;Reja Ahmad MBBS ,&nbsp;Malik Alta’amreh MD ,&nbsp;Raheel Ahmed PhD,MRCP ,&nbsp;Mohammed Hammad Jaber Amin MBBS ,&nbsp;Gregg C Fonarow MD ,&nbsp;Saad Ahmed Waqas MBBS","doi":"10.1016/j.jstrokecerebrovasdis.2025.108538","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108538","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) and stroke remain among the leading causes of cardiovascular mortality in the U.S. However, the intersection of these two conditions has been underexplored in national mortality data. This study investigates temporal, demographic, and geographic trends in stroke-related deaths among individuals with HF from 1999 to 2023.</div></div><div><h3>Methods</h3><div>Using the CDC WONDER database, we extracted multiple cause-of-death records for adults ≥25 years where both HF and stroke were listed. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Joinpoint regression identified significant trends and calculated average annual percent changes (AAPCs).</div></div><div><h3>Results</h3><div>From 1999 to 2023, 465,695 deaths were attributed to both HF and stroke. AAMRs declined steadily from 13.46 in 1999 to a low of 7.19 in 2019 (AAPC: –3.2%; 95% CI: –3.3 to –3.0; <em>p</em> &lt; 0.001) but then increased to 8.69 by 2023. Men had consistently higher AAMRs than women (2023: 9.88 vs. 7.71). NH Black individuals experienced the highest AAMRs (13.79 in 2023), slower declines, and an earlier mortality crossover compared to other groups. Adults aged 25–44 exhibited the steepest increase. Geographically, the South and rural counties bore the highest burden.</div></div><div><h3>Conclusion</h3><div>Despite long-term mortality declines, recent reversals—especially post-pandemic and among younger, male, and racially minoritized populations—signal urgent gaps in equity and access.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108538"},"PeriodicalIF":1.8,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879870","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}

{"title":"Early gastrostomy is associated with more efficient healthcare resource utilization in nontraumatic intracerebral hemorrhage patients","authors":"Andrea Loggini MD, MBA ,&nbsp;Victor J. Del Brutto MD ,&nbsp;Faddi G. Saleh Velez MD ,&nbsp;Jonatan Hornik MD ,&nbsp;Awni D. Shahait MD ,&nbsp;Denise Battaglini MD, PhD ,&nbsp;Shawn S. Wallery MD ,&nbsp;Amber Schwertman MD ,&nbsp;Alejandro Hornik MD ,&nbsp;Christos Lazaridis MD ,&nbsp;Adnan I. Qureshi MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108536","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108536","url":null,"abstract":"<div><h3>Purpose</h3><div>We investigated the trends and outcomes of early gastrostomy tube placement in patients with nontraumatic intracerebral hemorrhage (ICH).</div></div><div><h3>Methods</h3><div>We analyzed the National Inpatient Sample (NIS) database from 2002 to 2022 for adult hospitalized ICH patients who underwent gastrostomy. Variables included age, sex, race, income, hospital location and region, comorbidities, ICH severity indicators (coma, cerebral edema, brain compression, hydrocephalus), neurosurgical procedures, in-hospital complications (deep vein thrombosis (DVT), pulmonary embolism (PE), acute kidney injury, aspiration pneumonia), and in-hospital outcomes (length of stay, cost, medical complications, and discharge disposition). Early gastrostomy (EG) was defined as below the 25th percentile of median time interval from admission to gastrostomy (&lt; 7 days). Trends were assessed using linear regression of log-transformed yearly proportions. Propensity-score matching (PSM) was applied to balance comorbidities and severity between EG and nEG groups. Binary logistic regression was used to analyze in-hospital outcomes. Subgroups analyses were conducted for medically and surgically managed ICHs.</div></div><div><h3>Results</h3><div>Of 36776 ICH patients who received gastrostomy, 9484 (26%) underwent EG. The rate of EG increased significantly from 23.6% in 2002 to 29.5% in 2022 (β:0.004, <em>p</em> = 0.002). The increase was consistent across sex, ages ≥60 years, and racial groups, greater among Asians (β:0.007, <em>p</em> = 0.008) and patients aged ≥80 years (β:0.006, <em>p</em> = 0.002). Regional analyses showed the fastest growth in the Northeast (β:0.010, <em>p</em> &lt; 0.001). However, overall median time to gastrostomy did not significantly change during the study period (β:0.013, <em>p</em> = 0.495). EG placement occurred more frequently in older patients IQR (71 [59-81] vs. 66 [55-76]), women (47.7% vs. 44.3%), and Whites (57.6% vs. 50.6%). EG was associated with lower rate of in-hospital complications, including DVT/PE (6.6% vs. 11.4%), acute kidney injury (22.6% vs. 28.3%), and aspiration pneumonia (21.4% vs. 28.8%), <em>p</em> &lt; 0.001 for all. After 1:1 PSM, EG was independently associated with decreased odds of greater length of hospitalization (OR:0.388, 95%CI: 0.357-0.421, <em>p</em> &lt; 0.001) and reduced hospitalization costs (OR:0.583, 95%CI:0.538-0.631, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>EG placement among ICH patients has increased over the past two decades. Notable variability in these trends exists across age, racial groups, and geographical regions. Consistent with this trend, EG is associated with lower in-hospital complications, and more efficient healthcare resource utilization.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108536"},"PeriodicalIF":1.8,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835828","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}

{"title":"Integration of genetic risk, cardiometabolic diseases, and cognitive impairment among African American adults","authors":"Chaitali Dagli ,&nbsp;Nicole D. Armstrong ,&nbsp;Daeeun Kim ,&nbsp;Laura M. Raffield ,&nbsp;Hemant K. Tiwari ,&nbsp;Mary Cushman ,&nbsp;Suzanne E. Judd ,&nbsp;Michael Crowe ,&nbsp;Virginia J. Howard ,&nbsp;Marguerite R. Irvin","doi":"10.1016/j.jstrokecerebrovasdis.2025.108535","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108535","url":null,"abstract":"<div><h3>Background</h3><div>African American (AA) adults have a high burden of late-life cognitive impairment (CI) and dementia but remain underrepresented in genetic epidemiology studies. Genetic risk and cardiometabolic diseases (CMDs) contribute to dementia risk. This study investigated whether genetic susceptibility and CMDs were associated with a composite CI outcome and whether CMDs modified these associations.</div></div><div><h3>Methods</h3><div>In AA participants within the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, we assessed the association of a dementia polygenic risk score (PRS), <em>APOE</em> ε4 carrier status, and three prevalent CMDs: stroke, coronary artery disease (CAD), and type 2 diabetes (T2D) with a composite outcome of CI and dementia as a contributing cause of death (DCCD).</div><div>We used logistic regression adjusted for age, sex, education, income, body mass index, smoking status, alcohol intake, physical activity, hypertension, low-density lipoprotein, and C-reactive protein. Interaction terms were included to assess whether CMDs modified the associations between genetic risk and the composite outcome.</div></div><div><h3>Results</h3><div>Of 8,838 participants, 516 (5.84 %) developed CI or had DCCD. In fully adjusted models, high polygenic risk (highest vs lowest PRS tertile) was associated with increased odds of the composite outcome [odds ratio (OR): 1.42; 95 % confidence interval (CI): 1.12-1.78], as was <em>APOE</em> ε4 carrier status (OR: 1.46; 95% CI: 1.21-1.78). Among CMDs, stroke (OR: 1.45; 95% CI: 1.04-2.02) and T2D (OR: 1.31; 95% CI: 1.06-1.61) were significantly associated with increased odds of the composite outcome. However, the association between genetic risk and the composite outcome did not significantly differ by CMD status.</div></div><div><h3>Conclusion</h3><div>Genetic risk and CMDs independently contributed to dementia-related outcomes, indicating their relevance in understanding dementia risk among AA adults.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108535"},"PeriodicalIF":1.8,"publicationDate":"2025-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822637","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}

{"title":"Comment on “Association between biological aging and stroke and all-cause mortality: A population-based cross-sectional study and Mendelian randomization analysis”","authors":"Pankaj Bansal M.D ,&nbsp;Prashant Ramdas Kokiwar M.D ,&nbsp;A. Kavya M.D ,&nbsp;Archana Dhyani M.D","doi":"10.1016/j.jstrokecerebrovasdis.2025.108534","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108534","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108534"},"PeriodicalIF":1.8,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812632","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}

{"title":"Trajectory of longitudinal lending discrimination modifies the efficacy of a skills-based intervention in stroke survivors","authors":"Jeffrey J. Wing ,&nbsp;Helen C.S. Meier ,&nbsp;Jenna I. Rajczyk ,&nbsp;Gia E. Barboza-Salerno ,&nbsp;Jonathan R. Powell ,&nbsp;Bernadette Boden-Albala","doi":"10.1016/j.jstrokecerebrovasdis.2025.108533","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108533","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>The Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study found that a skills-based intervention on systolic blood pressure (SBP) reduction in a cohort of mild/moderate strokes/transient ischemic attacks (TIA) was only effective at reducing SBP among Hispanics. We sought to better understand the differential ethnic success of DESERVE and determine if the efficacy of the intervention varied by longitudinal mortgage lending discrimination, measured by where they lived and home lending practices.</div></div><div><h3>Methods</h3><div>We conducted a post hoc analysis using DESERVE, which randomized 552 stroke/TIA survivors to skills-based intervention or usual care for secondary stroke prevention. We geocoded participant addresses to census tract-level historic and present-day lending discrimination. We used a four-level neighborhood longitudinal lending discrimination variable from Home Owners’ Loan Corporation redlining data and 2018 Home Mortgage Disclosure Act reports: no discrimination, growing investment, declining investment, and persistent discrimination. We modeled change in SBP by intervention status stratified by longitudinal lending discrimination category linearly with generalized estimating equations, clustering by site with inverse probability weights.</div></div><div><h3>Results</h3><div>In unweighted models, the intervention was most efficacious in growing investment areas (8.65 mmHg reduction; 95 % CI: 0.48, 16.82) vs. usual care and least efficacious in declining investment areas (9.69 mmHg increase; 95 % CI:15.04, -4.34). After weighting to account for selection biases and duration of time lived in the community, conclusions were unchanged.</div></div><div><h3>Conclusion</h3><div>The intervention efficacy was impacted by underlying systems of persistent disadvantage, emphasizing the need for contextual factor consideration when designing stroke recovery trials.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108533"},"PeriodicalIF":1.8,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812677","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}

{"title":"Cervicocerebral atherosclerosis and atrial fibrillation increase long-term mortality in patients with ischemic stroke","authors":"Kati Lainelehto MD ,&nbsp;Juha-Pekka Pienimäki MD, PhD ,&nbsp;Sirpa Savilahti MD, PhD ,&nbsp;Heini Huhtala MSc ,&nbsp;Tomi Sarkanen MD, PhD ,&nbsp;Heikki Numminen MD, PhD ,&nbsp;Jukka Putaala MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108532","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108532","url":null,"abstract":"<div><h3>Background and aims</h3><div>Atrial fibrillation (AF) and atherosclerosis in the arteries supplying the brain are both strong risk factors of ischemic cerebrovascular events. However, the effect of their concurrent presence on long-term mortality in patients with acute ischemic stroke or transient ischemic attack (TIA) has gone little studied.</div></div><div><h3>Methods</h3><div>A total of 406 patients with acute ischemic stroke or TIA were enrolled in a tertiary university center and their cervicocerebral arteries imaged with computed tomography angiography (CTA). The extent of atherosclerosis in the carotid, vertebral and intracranial arteries were rated as Cervicocerebral Atherosclerotic Burden (CAB) score. Furthermore, we assessed the combined effect of atherosclerosis and AF with a variable including AF status and CAB score in quartiles.</div></div><div><h3>Results</h3><div>After a median follow-up of 7.3 years (interquartile range 5.7-7.6), 62 of the 121 patients with AF had died, compared to 74 of 285 patients without AF (cumulative mortality rate 52.0 %, 95 % CI 47.1-56.9 % vs. 27.0 %, 24.7-29.3 %, respectively). In adjusted Cox regression, the two highest CAB score quartiles were associated with mortality in AF patients with hazard ratios of 12.7 (1.6-99.7) and 15.8 (2.0-126.4), respectively. Furthermore, with combined variable of AF and CAB score the risk of death was 3-fold in AF patients with two highest quartiles of CAB score compared to those without AF in the two lowest CAB score quartiles.</div></div><div><h3>Conclusions</h3><div>The total atherosclerotic burden in arteries supplying the brain appears as a strong independent factor increasing long-term mortality in patients with acute ischemic stroke or TIA and concurrent AF.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108532"},"PeriodicalIF":1.8,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807294","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}