Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"VISIION-L: Viz.ai implementation of stroke augmented intelligence and communications platform to improve indicators and outcomes for a comprehensive stroke center and network – Life Flight. A pilot experience","authors":"Brett C. Meyer MD (Professor Neurosciences),&nbsp;Ben Shifflett (Neurosciences),&nbsp;Dawn M. Meyer PhD,RN,FNP-C,FAHA (Neurosciences),&nbsp;Kunal Agrawal MD (Neurosciences),&nbsp;Reza Bavarsad Shahripour MD (Neurosciences),&nbsp;Royya Modir MD (Neurosciences),&nbsp;Thomas Hemmen MD (Neurosciences),&nbsp;Jeffrey S. Pannell MD (Neurosurgery),&nbsp;David Santiago-Dieppa MD (Neurosurgery),&nbsp;Jeffrey Steinberg MD (Neurosurgery),&nbsp;Emily St.Germain RN (Information Services),&nbsp;Leah Adrid RN (Transfer Center),&nbsp;Melody Dotson RN, MSN (Emergency),&nbsp;Alexander A. Khalessi MD (Neurosurgery)","doi":"10.1016/j.jstrokecerebrovasdis.2026.108581","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108581","url":null,"abstract":"<div><h3>Background</h3><div>Improving Life Flight transfer processes is critical. Our telestroke program utilizes the Viz.ai (AI platform) for hyperacute stroke patients with potential vessel occlusions who could benefit from hyperacute transfer. We hypothesized that early incorporation of Life Flight into the multi-team Viz.ai discussion thread would improve communications and streamline transfer times.</div></div><div><h3>Methods</h3><div>We deployed the Viz-Life Flight software module, enabling Life Flight dispatch and helicopter teams access to specific hyperacute transfer cases. Life Flight dispatch and teams were trained on the module use. Variables of interest were collected from stroke databases and Life Flight run-sheets. Likert scale questions were deployed by survey comparing satisfaction.</div></div><div><h3>Results</h3><div>For this pilot experience, the last 5 pre-period patients were compared to the first 5 post-period cases. Median age was 64yrs vs. 65yrs (<em>p</em> = 0.83). Males were 60% vs. 100% (<em>p</em> = 0.18). Time metrics showed: ‘SpokeArrival to SpokeDoorOut (DIDO)’(146 min,146 min; 0.75), ‘SpokeDoorOut to AdjHubIn (DODI)’(19 min,23 min; 0.21), ‘HubDoorIn to GroinPuncture (DTG)’(38 min,33 min; 0.85), ‘NIR Contact to Life Flight Activation’(15 min,8 min;<em>p</em> = 0.99), ‘SpokeLand to SpokeLift (SpokeDoorOut)’(26 min,24 min; 0.92), and ‘SpokeLand to AdjHubLand (aka: ‘SpokeLand to HubDoorIn’)(45 min,50 min;<em>p</em> = 0.69). In the Post- period, ‘Dispatch Notification to Helicopter Notification via Viz’ was 3 min, and ‘Dispatch Notification via Viz to SpokeLand’ was 17 min. Providers rated the Viz-Life Flight communications process higher for satisfaction (30%,89%;<em>p</em> &lt; 0.001), efficiency (26%,91%;<em>p</em> &lt; 0.001), efficacy (30%,93%;<em>p</em> &lt; 0.001), enthusiasm (27%,93%;<em>p</em> &lt; 0.001), and in total (33%,92%;<em>p</em> &lt; 0.001).</div></div><div><h3>Discussion</h3><div>This VISIION-L initiative, adding the Viz-Life Flight module into the process to enable Life Flight teams to actively participate in hyperacute care discussions early on, resulted in preserved time metrics, and significantly improved satisfaction by approximately 60%. Our aim was to show that the novel deployment of this Viz-Life Flight process into the Life Flight hyperacute transfer process can immediately result in improved multi-team communications with a high degree of satisfaction benefit. Assessing improvement in time-based KPIs will require longer term assessments.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108581"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138092","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":"Fibrinogen replacement to prevent intracranial hemorrhage in ischemic stroke patients after thrombolysis – a prospective randomized open blinded endpoint trial (FibER): rationale and methods","authors":"Andrea Zini ,&nbsp;Laura Vandelli ,&nbsp;Stefano Forlivesi ,&nbsp;Elena Merli ,&nbsp;Ludovica Migliaccio ,&nbsp;Luana Gentile ,&nbsp;Michele Romoli ,&nbsp;Flavia Baccari ,&nbsp;Mario Sebastiani ,&nbsp;Francesco Nonino ,&nbsp;Sabina Cevoli ,&nbsp;Guido Bigliardi","doi":"10.1016/j.jstrokecerebrovasdis.2026.108572","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108572","url":null,"abstract":"<div><h3>Rationale</h3><div>Fibrinogen depletion happens soon after intravenous thrombolysis (IVT) for acute ischemic stroke, in relation to the suboptimal affinity of recombinant tissue plasminogen activator (rtPA) to thrombus fibrin. Fibrinogen depletion carries a 4-fold increase in risk of bleeding after IVT.</div></div><div><h3>Aim</h3><div>FibER will determine if early fibrinogen repletion through intravenous infusion of fibrinogen (2 g) in case of fibrinogen depletion is safe and can prevent bleeding after IVT.</div></div><div><h3>Sample size estimates</h3><div>The sample size was calculated assuming a combined rate of parenchymal hematoma at the CT scan in the treated group of 3% versus a 14% rate in the control group, for an overall absolute difference of 11%. Considering such a difference among groups, a 1:1 allocation of treatment will provide 100 patients per group to reach an 80% power to detect a statistically significant difference (p&lt;0.05).</div></div><div><h3>Methods and design</h3><div>Two-center phase 3 prospective randomized open blinded endpoint (PROBE) trial. Fibrinogen depletion is defined as a decrease of serum fibrinogen level &lt;200 mg/dl and/or a decrease of &gt;50% from baseline level after 2 and/or 6 hours from IVT. Patients will be randomized to receive fibrinogen infusion (2 g) versus no fibrinogen infusion at the moment of fibrinogen depletion identification.</div></div><div><h3>Study outcomes</h3><div>The primary outcome is intracranial hemorrhage, defined as parenchymal hematoma after 24 hours and 7 days from IVT. Subgroup analysis according to the severity of fibrinogen depletion is planned. Secondary outcomes will include: symptomatic intracerebral hemorrhage, extracranial bleeding of any type, NIHSS at baseline and after 7 days, modified Rankin Scale at 3 months, serious thromboembolic adverse events (including deep vein thrombosis, pulmonary embolism, myocardial infarct, recurrence of ischemic stroke, major cardiovascular events), and prevalence of hyperfibrinolysis (ROTEM-based definition).</div></div><div><h3>Discussion</h3><div>FibER will determine if early fibrinogen repletion is safe during acute ischemic stroke and prevent bleeding in patients with fibrinogen depletion after IVT for acute ischemic stroke (registered with US National Library of Medicine NCT05300672 and Eudra-CT 2020-005242-41).</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108572"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047486","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":"The association of lipoprotein-associated phospholipase A2 with cerebral white matter hyperintensity and dizziness in patients with cerebral small vessel disease","authors":"Ju Chen,&nbsp;Lupin He,&nbsp;Xinyao Mu,&nbsp;Liqun Fang","doi":"10.1016/j.jstrokecerebrovasdis.2025.108537","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108537","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to explore the impact of lipoprotein-associated phospholipase A2(LP-PLA2) on cerebral small vessel disease (CSVD), specifically its characteristic imaging marker, white matter hyperintensities (WMH), and to investigate the association between LP-PLA2 and CSVD-related dizziness.</div></div><div><h3>Methods</h3><div>A total of 200 subjects were enrolled, undergoing MRI, correlation scale assays, and continuous monitoring of LP-PLA2 activity. Correlation analyses assessed the relationship between Lp-PLA2, Fazekas scores, and Dizziness Handicap Inventory (DHI) scores. Logistic regression determined if Lp-PLA2 was an independent risk factor for CSVD-associated dizziness and diagnostic value was assessed through ROC analysis.</div></div><div><h3>Results</h3><div>In the CSVD group, age, hypertension history, fasting plasma glucose (FPG), triglycerides (TG), and LP-PLA2 activity levels were elevated compared to the control group (<em>P</em> &lt; 0.05). Correlation analysis revealed positive associations between LP-PLA2 activity and DHI score (<em>r</em> = 0.394, <em>P</em> &lt; 0.001), total Fazekas score (<em>r</em> = 0.386, <em>P</em> &lt; 0.05), and paraventricular Fazekas scores (<em>r</em> = 0.506, <em>P</em> &lt; 0.001). Regression analysis identified female gender, LP-PLA2 activity level, and total Fazekas scores as independent risk factors for CSVD-related dizziness (<em>P</em> &lt; 0.05). LP-PLA2 demonstrated diagnostic value for CSVD-associated dizziness (AUC=0.625, 95% CI: 0.534-0.716).</div></div><div><h3>Conclusions</h3><div>CSVD-related periventricular WMH is closely associated with pro-inflammatory factors and vascular risk factors. LP-PLA2 may induce demyelination changes in the periventricular region by disrupting the blood-brain barrier permeability. Periventricular demyelination affects the neural functional network involved in balance, leading to the occurrence of chronic dizziness. Additionally, LP-PLA2 serves as an adjunctive biomarker for risk stratification, facilitating the prioritization of vestibular evaluations and fall prevention strategies in the CSVD population.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108537"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879828","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":"Rapid enlargement of a pre-existing intracranial aneurysm during infective endocarditis: a case report","authors":"Mamoru Ishida MD, PhD,&nbsp;Ryosuke Nishiwaki MD,&nbsp;Hisashi Mizutani MD,&nbsp;Yuichi Kawasaki MD,&nbsp;Takahiro Oyama MD,&nbsp;Mitsuhiro Yoshida MD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108561","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108561","url":null,"abstract":"<div><h3>Background</h3><div>Infectious intracranial aneurysms (IIAs) are generally thought to develop de novo as a consequence of septic embolization during infective endocarditis (IE). Rapid infection-related enlargement of a pre-existing unruptured aneurysm during IE has not been previously documented. We report a case in which a small middle cerebral artery (MCA) aneurysm, previously identified on imaging, enlarged rapidly in the course of IE.</div></div><div><h3>Case Description</h3><div>A 67-year-old woman with a history of mitral valve repair presented with progressive general malaise and mild left hemiparesis. MRI demonstrated acute infarctions in the right caudate nucleus and putamen, and MRA showed occlusion of the right M2 superior branch. A previously identified 2.2-mm right MCA bifurcation aneurysm was not visualized on admission MRA. Infective endocarditis was subsequently diagnosed, and the aneurysm reappeared on day 9 at 5.5 mm and enlarged further to 9.5 mm by day 15. Endovascular coil embolization was performed on day 16, achieving complete aneurysm occlusion. The patient later underwent mitral valve surgery without complications.</div></div><div><h3>Conclusion</h3><div>This case demonstrates infection-related enlargement of a pre-existing intracranial aneurysm during IE, documented chronologically with serial MRA. These findings highlight the need for careful interval imaging in patients with IE and known aneurysms, and rapid morphological change should prompt urgent aneurysm treatment.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108561"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994753","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":"Corrigendum to “Effectiveness of perception–interaction-enhanced rehabilitation in post-stroke recovery: A real-world propensity-matched cohort study” [Journal of Stroke and Cerebrovascular Diseases 34 (2025) 108491]","authors":"Yan Zhang MM ,&nbsp;Jiumei Zhao MM ,&nbsp;Jun Dong MM ,&nbsp;Shaomin Li MM","doi":"10.1016/j.jstrokecerebrovasdis.2026.108573","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108573","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108573"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146129209","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 neurological deterioration before endovascular treatment in patients with mild stroke. MINORCAT-END-EVT study","authors":"Maria Àngels Font MD ,&nbsp;Sonia María García-Sánchez MD ,&nbsp;Juan José Mengual MD ,&nbsp;Carla Avellaneda MDPhD ,&nbsp;Sandra Boned MDPhD ,&nbsp;Antonio Doncel-Moriano MD ,&nbsp;Xabier Urra MDPhD ,&nbsp;Pol Camps-Renom MDPhD ,&nbsp;Natalia Pérez de la Ossa MDPhD ,&nbsp;Mikel Terceño MDPhD ,&nbsp;Barbara Yugueros MD ,&nbsp;Xavier Ustrell MD ,&nbsp;Francisco Purroy MDPhD ,&nbsp;Ana Rodríguez-Campello MD ,&nbsp;Carlos Molina MDPhD ,&nbsp;Jerzy Krupinski MDPhD ,&nbsp;Georgina Figueras Aguirre MD ,&nbsp;Mariona Baraldes MD ,&nbsp;Xavier Jiménez-Fàbrega MD ,&nbsp;Mercè Salvat-Plana RN ,&nbsp;Manuel Gómez-Choco MDPhD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108584","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108584","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>The management of patients with anterior circulation large vessel occlusion (LVO) presenting with mild neurological symptoms remains a matter of debate. Early neurological deterioration (END) may influence the decision to perform endovascular treatment (EVT); however, evidence regarding its impact on clinical outcomes is limited.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of prospectively collected data from the Catalan Stroke Registry (2016–2021). Patients with anterior circulation LVO, baseline NIHSS ≤5, baseline mRS score 0–1, and treatment with EVT were included. END was defined as an increase of ≥4 NIHSS points from hospital admission to EVT initiation. Proximal occlusion was defined as occlusion of the extracranial or terminal internal carotid artery or the M1 segment of the middle cerebral artery. The primary outcome was excellent functional outcome at 90 days (mRS 0–1). Good functional outcome (mRS 0–2) was considered a secondary outcome. Mortality and symptomatic intracranial hemorrhage were assessed as safety outcomes.</div></div><div><h3>Results</h3><div>Among 244 patients, 58 (23.8%) experienced END before EVT. At 90 days, 131 patients (53.7%) achieved mRS 0–1 and 162 (66.4%) achieved mRS 0–2. Fourteen patients (5.7%) died during follow-up, and 8 (3.3%) experienced symptomatic intracranial hemorrhage. In multivariable analysis, successful recanalization was independently associated with the primary outcome (OR 4.54, 95% CI 1.73–13.83), whereas END before EVT (OR 1.24, 95% CI 0.40–3.98), proximal occlusion (OR 1.37, 95% CI 0.69–2.71), and their interaction (OR 0.42, 95% CI 0.10–1.67) were not independently associated with excellent functional outcome.</div></div><div><h3>Conclusions</h3><div>In this cohort of patients with mild ischemic stroke treated with EVT, END before EVT was not independently associated with functional outcomes, whereas successful recanalization remained the main determinant of excellent recovery. Pending evidence from randomized clinical trials, these findings suggest that close clinical monitoring with rescue EVT may be an appropriate approach in selected patients.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108584"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183960","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":"Methodological contextualization and interpretation of early gastrostomy timing in nontraumatic intracerebral hemorrhage","authors":"Andrea Loggini MD MPH 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;Alejandro Hornik MD ,&nbsp;Christos Lazaridis MD ,&nbsp;Adnan I. Qureshi MD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108558","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108558","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108558"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981132","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":"Aspirin-ticagrelor use after mild acute ischemic stroke: Findings from the get with the guidelines-stroke registry","authors":"Ava L. Liberman MD ,&nbsp;Cenai Zhang BS ,&nbsp;Sara K. Rostanski MD ,&nbsp;Hooman Kamel MD MS ,&nbsp;Babak B. Navi MD MS ,&nbsp;Natalie T. Cheng MD ,&nbsp;Radhika Sundararajan MD PhD ,&nbsp;Steven R. Messe MD ,&nbsp;Gregg C. Fonarow MD ,&nbsp;Shyam Prabhakaran MD MS ,&nbsp;Ying Xian MD PhD","doi":"10.1016/j.jstrokecerebrovasdis.2026.108564","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108564","url":null,"abstract":"<div><h3>Background</h3><div>Recent guidelines suggest that aspirin-ticagrelor may be considered for stroke prevention after mild acute ischemic stroke. However, it is unclear how commonly this dual antiplatelet therapy (DAPT) regimen is used in practice.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional analysis of the Get With The Guidelines-Stroke registry 2017-2023. Patients with a non-cardioembolic mild ischemic stroke (defined as NIHSS &lt;6) who presented within 24 hours of last known well without a contraindication to DAPT were included. The primary study outcome was the proportion of patients prescribed aspirin-ticagrelor at hospital discharge; temporal patterns of prescribing aspirin-ticagrelor and aspirin-clopidogrel over time are also described. In addition to standard tests of comparison, we used multiple logistic regression to evaluate associations between patient and facility factors and aspirin-ticagrelor use reported as odds ratios (OR) with 95% confidence intervals (CI).</div></div><div><h3>Results</h3><div>Among 1,018,736 patients meeting study criteria, 478,049 (46.9%) were female and median age was 68 (IQR: 59, 78) years. A total of 12,845 (1.3%) patients were discharged on aspirin-ticagrelor whereas 448,348 (44.0%) were discharged on aspirin-clopidogrel. Prescriptions for aspirin-ticagrelor and for aspirin-clopidogrel significantly increased over the study time-period. In regression analysis, coronary artery disease/prior myocardial infarction (OR: 2.6 [95% CI: 2.5-2.7]), Asian race (OR: 2.1 [95% CI: 1.9-2.2]), aspirin-clopidogrel prescription upon admission (OR: 2.0 [95% CI:1.9-2.1]), and history of stroke/TIA (OR: 1.98 [95% CI: (1.9-2.1)]), were substantially associated with aspirin-ticagrelor use whereas lacking insurance/self-pay (OR: 0.7 [95% CI: 0.6-0.8]), rural setting (OR: 0.8 [95% 0.7-0.9]), and primary stroke centers (OR: 0.3 [95% CI: 0.3-0.4]) were inversely associated with aspirin-ticagrelor. In the subgroup of 176,897 (17.4%) patients with NIHSS 4-5, 74,912 (50.8%) were discharged on aspirin-clopidogrel and 2,394 (1.4%) on aspirin-ticagrelor.</div></div><div><h3>Conclusion</h3><div>Unlike aspirin-clopidogrel, aspirin-ticagrelor is infrequently administered after mild acute ischemic stroke (NIHSS &lt;6) despite current guidelines, though the use of both DAPT regimens increased over time.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108564"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021149","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":"Triglyceride-glucose index and uric acid associations with cardiovascular disease risk in middle-aged and elderly populations: findings from the China health and retirement longitudinal study","authors":"Kun Wang ,&nbsp;Huan Liu ,&nbsp;Hongpu Hu","doi":"10.1016/j.jstrokecerebrovasdis.2026.108575","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108575","url":null,"abstract":"<div><h3>Background</h3><div>Traditional cardiovascular disease (CVD) risk models may fail to adequately capture the interactions among metabolic factors. We evaluated the combined and mediating associations of the triglyceride-glucose (TyG) index and uric acid (UA) with incident CVD in Chinese adults.</div></div><div><h3>Methods</h3><div>Using data from the nationally representative China Health and Retirement Longitudinal Study, we included 9,353 participants aged ≥ 45 years without baseline CVD or cancer, whose fasting triglycerides, glucose, and UA were measured in 2011, and who were followed up through 2020. TyG was calculated as ln [triglycerides (mg/dL) × glucose (mg/dL)/2]. Incident CVD (including myocardial infarction, coronary heart disease, angina pectoris, congestive heart failure, or stroke) was ascertained via standardized self-reported questionnaires. Cox proportional hazards models were used to quantify the relationship between TyG index/UA level, their combination categories and CVD events. Kaplan-Meier curves were used to illustrate the time-dependent association and synergistic effect of TyG index and UA on CVD-related outcomes. Age subgroup classification was used to analyze the effects of two biomarkers on CVD at different ages. Mediation analysis was conducted to assess the direct and indirect associations between two biomarkers and CVD events.</div></div><div><h3>Results</h3><div>During the 9-year follow-up, 2505 (26.8%) individuals developed CVD, including 1745 (18.7%) cases of CHD and760 (8.1%) cases of stroke. Compared with TyG &lt; median (8.59) and UA 4–5 mg/dL, higher TyG and higher UA were each associated with greater CVD risk (fully adjusted HR = 1.146 for TyG ≥ median and HR = 1.167 for UA &gt; 6 mg/dL, all P &lt; 0.05). The joint category of TyG ≥ median and UA &gt; 6 mg/dL showed the strongest association, especially for stroke (fully adjusted HR = 2.193). Elevated TyG and UA levels jointly increased the cumulative incidence of CVD (41.1%), coronary heart disease (31.5%), and stroke (119.3%) relative to the reference group. Synergy was most evident at ages 45–59 and was not significant at ≥ 70 years. Mediation analyses supported a bidirectional pathway: TyG affected CVD via UA and UA affected CVD via TyG.</div></div><div><h3>Conclusions</h3><div>The TyG index and UA levels independently and synergistically increase CVD risk in middle-aged and elderly Chinese adults, with the strongest synergistic effect observed in middle-aged individuals (45–59 years). A bidirectional mediating relationship exists between the TyG index and UA in their effects on CVD. Combined assessment of the TyG index and UA may improve CVD risk stratification, supporting more refined clinical and public health interventions for CVD prevention.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108575"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146055922","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":"Saphenous vein interposition graft of the carotid artery after endarterectomy: Case report","authors":"Gonzalo Reyes Blanco M.D. ,&nbsp;David Blumenkron Marroquín M.D. ,&nbsp;Luis Angel Haro Santillan MSc. ,&nbsp;Michelle Cedano Silva M.D. ,&nbsp;Diana Elizabeth Bernal Vázquez M.D. ,&nbsp;Dante Bernardo Oropeza Canto M.D. ,&nbsp;Yadira Tiburcio Núñez M.D. ,&nbsp;Maricruz Velázquez Vaquero M.D. ,&nbsp;Eduardo Peña Andrade M.D. ,&nbsp;Armando Romero Pérez M.D. ,&nbsp;Carlos Enrique Chávez Donis M.D.","doi":"10.1016/j.jstrokecerebrovasdis.2025.108531","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108531","url":null,"abstract":"<div><h3>Background</h3><div>Strokes are the second cause of death worldwide, with over 12.2 million new cases per year. Ischemic strokes represent 62% of cases, primarily due to atherothrombotic or cardioembolic mechanisms. Surgical revascularization is often required in severe atherothrombotic cases and includes carotid endarterectomy or vascular endoprosthesis.</div></div><div><h3>Methods</h3><div>A hospital stroke code protocol was activated for a 62 years old female with critical carotid stenosis. Surgical intervention included carotid endarterectomy and interposition of a saphenous vein graft.</div></div><div><h3>Results</h3><div>Patient with history of diabetes mellitus type 2 and hypertension, presented with 90% occlusion of right carotid artery and 85% at the bulb. A right carotid endarterectomy was performed resulting in acute neurological improvement. 24 hours later cranial tomography and magnetic resonance revealed occlusion of the right internal carotid artery and dissection of common carotid artery. A second surgical procedure was performed, involving saphenous vein graft. Postoperative recovery was favorable, with improved neurological function.</div></div><div><h3>Conclusion</h3><div>This case highlights importance of institutional stroke code protocols for rapid identification, etiological classification, and timely surgical management of acute stroke. Structured response systems enhance clinical decision-making and improve patient outcomes in high-risk vascular events.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 3","pages":"Article 108531"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807293","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}