Journal of Stroke & Cerebrovascular Diseases最新文献_第4页

Postoperative fragmentation and distal migration of Carotid Stent in vascular Eagle Syndrome 血管性鹰综合征颈动脉支架术后碎裂和远端移位。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108202

Masahiro Nishihori MD, PhD , Takashi Izumi MD, PhD , Shunsaku Goto MD, PhD , Shinsuke Muraoka MD, PhD , Hirotaka Kogame MD, PhD , Ryuta Saito MD, PhD

Objectives

Vascular Eagle syndrome (ES) is a rare condition involving vessel compression by an elongated styloid process, leading to neurologic symptoms. Here, we present the case of a patient with a complication of carotid artery stenting for vascular ES and discuss the implications of treatment of this rare condition.

Case description

A 35-year-old previously healthy male patient presented with transient aphasia and right-sided hemiparesis following ischemic stroke in left frontal lobe. Digital subtraction angiography revealed a large aneurysm with stenosis of the left cervical internal carotid artery, and computed tomography (CT) demonstrated elongated ipsilateral styloid process. Progressive aneurysm enlargement required coil embolization and carotid artery stenting (CAS). Cervical X-ray obtained 1 year later revealed the fracture and fragmentation of the carotid stent. Imaging studies identified multiple stent fragments dispersed in distal arteries and a dissecting aneurysm with an irregular wall at the site of the stent site. Dynamic cone-beam CT scan without contrast performed during neck movement, revealed that the styloid process tip was adjacent to the stent fracture line, confirming vascular ES. The symptomatic left styloid process was resected, followed by repeat CAS. The dissecting aneurysm was thrombosed post-CAS, and the patient remained asymptomatic without complications at 6-month follow-up.

Conclusion

In patients with vascular ES, diagnostic imaging should include dynamic evaluations to assess cervical dynamics and the resection of styloid process is essential to prevent chronic stent fracture.

目的：血管鹰综合征（ES）是一种罕见的疾病，涉及细长茎突压迫血管，导致神经系统症状。在此，我们报告一例颈动脉支架置入治疗血管性ES的并发症，并讨论治疗这种罕见疾病的意义。病例描述：一名35岁的健康男性患者在左额叶缺血性中风后出现一过性失语和右侧偏瘫。数字减影血管造影显示左侧颈内动脉狭窄的大动脉瘤，计算机断层扫描显示同侧茎突拉长。进行性动脉瘤扩大需要线圈栓塞和颈动脉支架置入（CAS）。1年后颈椎x线片显示颈动脉支架骨折和碎裂。影像学检查发现分散在远端动脉的多个支架碎片和支架部位不规则壁的夹层动脉瘤。在颈部运动时进行无对比的动态锥束CT扫描，显示茎突尖端与支架骨折线相邻，证实血管ES。切除有症状的左茎突，然后进行重复CAS。夹层动脉瘤在cas后形成血栓，患者在6个月的随访中无症状，无并发症。结论：在血管性ES患者中，诊断影像学应包括动态评估颈椎动力学，茎突切除对预防慢性支架骨折至关重要。

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引用次数: 0

Global prevalence and risk factors of delirium among patients following acute stroke: A systematic review and meta-analysis 急性脑卒中患者谵妄的全球患病率和危险因素：一项系统回顾和荟萃分析。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108221

Muhammad Amirul Mukminin , Tu-Hsueh Yeh , Hui-Chen Lin , Iftitakhur Rohmah , Hsiao-Yean Chiu

Background and Objective

The exact prevalence and risk factors of delirium following stroke at an acute stage remains unclear. We aimed to determine the global prevalence and risk factors of delirium following acute stroke.

Method

Observational studies reporting the prevalence of or risk factors for delirium following acute stroke published in the PubMed, Embase, and Scopus databases before April 16, 2024, were identified. Data were extracted by two independent reviewers. A random effects model was used for data analysis.

Results

Our meta-analysis included 48 studies on prevalence and 25 studies on risk factors for poststroke delirium. The pooled global prevalence rate of delirium was 24 % (18 %–30 %). Hemorrhagic stroke type, early assessment (within 3 days of stroke onset), older age, and male sex were risk factors for poststroke delirium. Independent factors significantly associated with poststroke delirium (all p < 0.05) were age, dementia, prior stroke, prior total anterior circulation infarct stroke subtype, atrial fibrillation, elevated C-reactive protein levels, aphasia, poor vision, neglect, depression, and the use of urinary catheters and gastric tubes.

Conclusion

Approximately a quarter of the included patients with acute stroke experienced delirium. Our findings regarding the risk factors for poststroke delirium can provide an evidence-based approach for future strategies to prevent delirium.

Fundings

NSTC, Taiwan (MOST 113-2628-B- 038-00-MY3 and 111-2314-B-038-033-MY3).

Protocol

The International Prospective Register of Systematic Reviews (CRD42024518119)

背景与目的：脑卒中急性期谵妄的确切患病率和危险因素尚不清楚。我们的目的是确定急性脑卒中后谵妄的全球患病率和危险因素。方法：选取2024年4月16日前在PubMed、Embase和Scopus数据库中发表的报告急性卒中后谵妄患病率或危险因素的观察性研究。数据由两名独立审稿人提取。采用随机效应模型进行数据分析。结果：我们的荟萃分析包括48项关于卒中后谵妄患病率的研究和25项关于卒中后谵妄危险因素的研究。谵妄的全球总患病率为24%（18%-30%）。出血性卒中类型、早期评估（卒中发作3天内）、年龄和男性是卒中后谵妄的危险因素。与脑卒中后谵妄显著相关的独立因素为年龄、痴呆、既往卒中、既往全前循环梗死卒中亚型、房颤、c反应蛋白水平升高、失语、视力不佳、忽视、抑郁、使用导尿管和胃管。结论：大约四分之一的急性脑卒中患者出现谵妄。我们关于中风后谵妄的危险因素的发现可以为未来预防谵妄的策略提供循证方法。方案：国际前瞻性系统评价注册（CRD42024518119）。

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引用次数: 0

Diagnostic yield and therapeutic implications of vascular imaging in acute ischemic stroke: prospective and consecutive study of small vessel versus large vessel ischemia 血管成像在急性缺血性卒中中的诊断率和治疗意义：小血管与大血管缺血的前瞻性和连续性研究。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108182

Roger E. Kelley M.D. , Prabandh Buchhanolla M.D. , Amrita Pandey M.D. , Monika Thapa M.D. , Md Ismail Hossain M.Sc. , Mohammad Alfrad Nobel Bhuiyan Ph.D

Introduction

To evaluate patients acute cerebral ischemia in order to assess for factors which may help to differentiate patients with small vessel involvement from those with large vessel involvement in an effort to determine diagnostic yield of vascular imaging.

Material and Method

We prospectively and consecutively evaluated all acute ischemic stroke patients at our medical center from May 16, 2021 to December 10, 2021. Distinction between small vessel and large vessel involvement was based upon clinical presentation, the results of brain imaging and either computed tomographic angiography, in the vast majority, or magnetic resonance angiography. Patient demographics and risk factors for stroke as well as therapeutic intervention was assessed.

Conclusion and Result

Of the 90 patients studied, 59 had large vessel ischemia (66%) with 26 (44%) having large vessel occlusion and one had symptomatic high-grade middle cerebral artery stenosis. Conversely, none of the 31 patients with small vessel presentation (34%) had large vessel occlusion or high-grade stenosis. In addition, 19 out of 59 (32%) large vessel patients compared to 2 of 31 (6%) of the small vessel patients had atrial fibrillation identified as a potential mechanism with a p-value of 0.01 by univariate analysis and 0.17 by multivariate analysis. The routine use of vascular imaging in acute ischemic stroke is of very low yield in small vessel presentation with the presence of potential cardiogenic emboli is also relatively low. Efforts at accelerated identification of a small vessel mechanism, to avoid unnecessary testing, should provide significant value from both a patient management and cost standpoint.

目的：评估急性脑缺血患者，以评估可能有助于区分小血管受累患者和大血管受累患者的因素，以确定血管成像的诊断率。材料与方法：对2021年5月16日至2021年12月10日在我中心就诊的所有急性缺血性脑卒中患者进行前瞻性、连续性评价。区分小血管和大血管受累是基于临床表现、脑成像结果和计算机断层血管造影（绝大多数）或磁共振血管造影。评估了患者的人口统计学特征和中风的危险因素以及治疗干预措施。结论与结果：本组90例患者中，大血管缺血59例（66%），大血管闭塞26例（44%），重度脑中动脉狭窄1例。相反，31例小血管患者（34%）均无大血管闭塞或高度狭窄。此外，59例大血管患者中有19例（32%）与31例小血管患者中2例（6%）相比，房颤被确定为潜在的机制，单因素分析的p值为0.01，多因素分析的p值为0.17。在急性缺血性脑卒中中，常规血管成像在存在潜在心源性栓塞的小血管表现中准确率非常低，也相对较低。从患者管理和成本的角度来看，加速识别小血管机制的努力，以避免不必要的检测，应该具有重要的价值。

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引用次数: 0

P2Y12 inhibitors plus aspirin versus aspirin alone in patients with ischemic cerebrovascular events: An updated meta-analysis of randomized controlled trials P2Y12抑制剂联合阿司匹林与单独阿司匹林治疗缺血性脑血管事件：随机对照试验的最新荟萃分析

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108180

Hilária Saugo Faria (medical student) , Rian Barreto Arrais Rodrigues de Morais (medical student) , Elísio Bulhões (medical student) , Lucas Cael Azevedo Bendaham (medical student) , Ocílio Ribeiro Gonçalves (medical student) , João Lucas de Magalhães Leal Moreira (medical student) , Victor Gonçalves Soares (medical student) , Marianna Leite (medical student) , Christian Ferreira (medical doctor) , Márcio Yuri Ferreira (medical doctor) , Yafell Serulle (medical doctor)

Background

The efficacy and safety of P2Y12 inhibitors (P2Y12i) with aspirin in patients with non-cardioembolic ischemic cerebrovascular events remains a topic of ongoing debate. Therefore, we conducted an updated meta-analysis to compare these drugs with aspirin alone.

Methods

We systematically searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing the two treatment regimens in patients with ischemic cerebrovascular events. Primary outcomes were all-cause mortality, severe bleeding, and stroke recurrence. We performed subgroup analyses stratified by National Institutes of Health Stroke Scale (NIHSS). Risk ratios (RRs) with 95 % confidence intervals were calculated using a random effects model. R software (version 4.3.2) was used for statistical analyses.

Results

Fifteen studies were included, comprising 38,851 patients, of whom 19,483 (50.1 %) received P2Y12i plus aspirin. Follow-up ranged from 7 days to 3.4 years. P2Y12i plus aspirin significantly reduced stroke recurrence (RR 0.78; 95 % CI = 0.71-0.87; p < 0.05), but increased the incidence of all-cause mortality (RR 1.38; 95 % CI = 1.11-1.72; p < 0.05) and severe bleeding (RR 2.07; 95 % CI 1.61 to 2.66; p > 0.05) compared with aspirin. There was no significant difference between groups in all-cause mortality in patients with NIHSS ≤3 or ≤10.

Conclusion

P2Y12i plus aspirin reduced stroke recurrence, but increased all-cause mortality and severe bleeding in patients with non-cardioembolic ischemic events. There was no difference between groups in all-cause mortality in patients with NIHSS scores ≤3 or ≤10.

背景：P2Y12抑制剂（P2Y12i）与阿司匹林在非心栓性缺血性脑血管事件患者中的疗效和安全性仍然是一个持续争论的话题。因此，我们进行了一项更新的荟萃分析，将这些药物与阿司匹林单独使用进行比较。方法：我们系统地检索PubMed、Embase和Cochrane Central的随机对照试验（rct），比较两种治疗方案对缺血性脑血管事件患者的影响。主要结局是全因死亡率、严重出血和卒中复发。我们采用美国国立卫生研究院卒中量表（NIHSS）分层进行亚组分析。采用随机效应模型计算95%置信区间的风险比（rr）。采用R软件（4.3.2版）进行统计分析。结果：纳入15项研究，包括38,851例患者，其中19,483例（50.1%）接受P2Y12i加阿司匹林治疗。随访时间从7天到3.4年不等。P2Y12i联合阿司匹林可显著降低卒中复发率(RR 0.78；95% ci = 0.71-0.87；p < 0.05)，但增加了全因死亡率(RR 1.38；95% ci = 1.11-1.72；p < 0.05)和严重出血(RR 2.07；95% CI 1.61 ~ 2.66；P < 0.05)。NIHSS≤3或≤10患者的全因死亡率组间差异无统计学意义。结论：P2Y12i联合阿司匹林降低了卒中复发，但增加了非心栓性缺血性事件患者的全因死亡率和严重出血。NIHSS评分≤3分和≤10分患者的全因死亡率组间无差异。

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引用次数: 0

Compromised cerebrovascular reactivity related to presence of white matter hyperintensities in cryptogenic stroke with right-to-left shunts 伴有右至左分流的隐源性卒中患者存在白质高信号与脑血管反应性受损有关。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2025.108223

Huizhen Song MM , Shuang Zhang MM , Qianqian Xie MD , Zhoujie Zhu MM , Linger Li MM , Hongqin Zhao MD

Objective

This study investigates cerebrovascular reactivity (CVR) changes in cryptogenic stroke (CS) patients with right-to-left shunts (RLS) and evaluates the relationship between CVR and white matter hyperintensities (WMHs).

Methods

The breath-holding index (BHI), representing CVR, was measured from the middle cerebral artery (MCA) using the breath-holding method. WMHs were defined as clearly hyperintense areas on 3T magnetic resonance imaging (MRI), assessed separately as periventricular hyperintensities (PVH) and deep white matter hyperintensities (DWMH). RLS was diagnosed based on a contrast-enhanced transcranial Doppler (c-TCD) examination.

Results

Among 260 CS patients and 128 controls, BHI was significantly lower in CS groups (0.68±0.27 vs. 0.83±0.31, P<0.001), particularly in those with RLS (0.64±0.28 vs. 0.71±0.25,P = 0.030). CS patients with WMHs exhibited lower BHI than those without WMHs (0.50±0.22 vs.0.60±0.35, P = 0.012), and PVH showed lower BHI compared to DWMH (0.45±0.24 vs.0.58±0.16, P = 0.003). A negative correlation was found between WMH severity and BHI (0.60±0.35 vs.0.51±0.21 vs.0.48±0.20 vs.0.38±0.28, P = 0.025). Reduced BHI was an independent risk factor for WMHs (OR = 0.283; 95 % CI = 0.081-0.995, P = 0.049).

Conclusion

CS patients, especially those with RLS, show reduced CVR, which correlates with the location and severity of WMHs. These findings suggest that RLS may significantly contribute to WMH development in CS patients.

目的：探讨隐源性脑卒中（CS）右-左分流（RLS）患者脑血管反应性（CVR）的变化，并探讨CVR与脑白质高信号（WMHs）的关系。方法：采用屏气法测定大脑中动脉（MCA）的屏气指数（BHI）， BHI代表CVR。wmh定义为3T磁共振成像（MRI）上清晰的高信号区，分别评估为心室周围高信号区（PVH）和深部白质高信号区（DWMH）。RLS的诊断是基于经颅多普勒（c-TCD）检查。结果：在260例CS患者和128例对照组中，CS组BHI明显低于对照组（0.68±0.27 vs 0.83±0.31）。结论：CS患者，尤其是RLS患者CVR明显降低，这与WMHs发生部位和严重程度有关。这些发现表明，RLS可能显著促进了CS患者WMH的发展。

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引用次数: 0

Long-term cerebrovascular outcomes of patients undergoing percutaneous patent foramen ovale closure in observational studies: a systematic review and meta-analysis 观察性研究中经皮卵圆孔未闭闭合患者的长期脑血管预后：系统回顾和荟萃分析。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108189

Areeba Asghar MSc , Luxshikka Canthiya BSc , Ani Khachatrian , Varnita Vishwanath BSc , Eduardo Flores-Umanzor MD, PhD , Ashley Farrell MLIS AHIP , Yeva Sahakyan MD MPH MSc , Jonah Himelfarb MD , Eric M. Horlick MDCM , Lusine Abrahamyan MD MPH PhD

Objectives

Patent foramen ovale (PFO) closure is recommended for patients who experience a cryptogenic stroke attributable to PFO. Although few randomized control trials (RCTs) have captured long-term effectiveness of PFO closure, observational data has been abundant. This is the first systematic review of observational studies determining incidence of long-term adverse outcomes in adults who underwent transcatheter PFO closure, with comparisons to findings from RCTs.

Methods

Medline, Cochrane, and Embase databases were searched from inception to October 2023. Only observational studies with ≥4 years of mean or median follow-up were included. A meta-analysis was conducted to calculate the incidence of recurrent stroke after PFO closure.

Results

After reviewing 2,432 records, 13 prospective and 12 retrospective cohort studies were included. Average follow-up lengths ranged from 4 to 12.3 years, and sample sizes from 75 to 1,533 participants. The average age ranged between 43.5-63.0, and 24.0-72.8% patients had an atrial septal aneurysm. The incidence of stroke was 0.34 per 100 person-years (I² = 67%). This was similar to rates from four RCTs that were used for comparison (0.35 per 100 person-years, I²= 51%). There was a significant improvement in heterogeneity once the study with one of the largest follow-up was removed.

Conclusions

Real-world PFO closure studies with long-term follow-up report similar outcomes as RCTs which is important considering the exclusion of several important populations from trials. Future observational studies should include more rigorous reporting of follow-up strategies and explore different long-term adverse outcomes.

目的：卵圆孔未闭（PFO）闭合术推荐用于由PFO引起的隐源性卒中患者。虽然很少有随机对照试验（rct）捕获PFO关闭的长期有效性，但观察数据丰富。这是首次对观察性研究进行系统回顾，确定经导管PFO闭合的成人的长期不良后果发生率，并与随机对照试验的结果进行比较。方法：检索Medline、Cochrane和Embase数据库，检索时间为建库至2023年10月。仅纳入平均或中位随访≥4年的观察性研究。进行了一项荟萃分析，计算PFO关闭后卒中复发的发生率。结果：在回顾了2432项记录后，纳入了13项前瞻性和12项回顾性队列研究。平均随访时间从4年到12.3年不等，样本量从75到1533名参与者不等。房间隔动脉瘤患者的平均年龄为43.5-63.0岁，24.0-72.8%。卒中发生率为0.34 / 100人年（I2 = 67%）。这与用于比较的4个rct的发生率相似（0.35 / 100人-年，I2= 51%）。一旦最大的随访研究之一被移除，异质性就有了显著的改善。结论：长期随访的真实PFO闭合研究报告的结果与随机对照试验相似，考虑到试验排除了几个重要人群，这一点很重要。未来的观察性研究应包括更严格的随访策略报告，并探索不同的长期不良后果。

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引用次数: 0

Knowledge, attitude, and practice of stroke patients' family members towards stroke rehabilitation: A cross-sectional study 脑卒中患者家属脑卒中康复知识、态度与行为的横断面研究

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108177

Dongdong Li , Hui Guo , Yiwen Sun , Zhijun Zhang , Huilin Liu

Background

This study aimed to explore the knowledge, attitude, and practice (KAP) among family members of stroke patients regarding stroke rehabilitation.

Methods

A cross-sectional study was conducted on the family members of stroke patients at the China Rehabilitation Research Center from February 15 to May 2, 2024. This study collected demographic data and KAP scores through a self-designed questionnaire.

Results

The study enrolled 517 family members, of which 344 (66.54%) were male. The mean scores for knowledge, attitude, and practice were 12.01 ± 5.46 (possible range: 0-20), 49.40 ± 4.96 (possible range: 11-55), and 41.93 ± 7.49 (possible range: 10-50), respectively. Correlation analyses demonstrated a significant positive relationship between knowledge and attitude (r = 0.501, P < 0.001), knowledge and practice (r = 0.471, P < 0.001), and attitude and practice (r = 0.441, P < 0.001). Structural Equation Modeling indicated that showed that knowledge directly affected attitude (β = 0.481, P = 0.004) and practice (β = 0.351, P = 0.009), and attitude directly affected practice (β = 0.244, P = 0.007). Additionally, knowledge indirectly affected practice through attitude (β = 0.117, P = 0.006).

Conclusions

This study identified significant gaps in knowledge, despite generally positive attitudes and proactive practices among family members of stroke patients regarding stroke rehabilitation. This highlights the necessity for tailored educational programs for family members to address these knowledge gaps.

背景：本研究旨在了解脑卒中患者家属对脑卒中康复的认知、态度和实践情况。方法：对中国康复研究中心于2024年2月15日至5月2日收治的脑卒中患者家属进行横断面研究。本研究通过自行设计的问卷收集人口统计数据和KAP得分。结果：共纳入517名家庭成员，其中男性344人，占66.54%。知识、态度和实践的平均得分分别为12.01±5.46分（可能范围0 ~ 20）、49.40±4.96分（可能范围11 ~ 55）和41.93±7.49分（可能范围10 ~ 50）。相关分析显示，知识与态度（r = 0.501,P < 0.001）、知识与实践（r = 0.471,P < 0.001）、态度与实践（r = 0.441,P < 0.001）呈正相关。结构方程模型表明,表明知识直接影响态度(β = 0.481,P = 0.004)和实践(β = 0.351,P = 0.009),和态度直接影响实践(β = 0.244,P = 0.007)。知识通过态度间接影响实践（β = 0.117,P = 0.006）。结论：本研究发现，尽管中风患者的家庭成员对中风康复普遍持积极态度和积极主动的做法，但在知识方面存在显著差距。这凸显了为家庭成员量身定制教育方案以解决这些知识差距的必要性。

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引用次数: 0

Quantification of leptomeningeal collateral blood flow in hypertensive rats during ischemic stroke 缺血性脑卒中期间高血压大鼠脑膜侧支血流的定量分析

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108195

Magdalena Litman MPharm , Kristy Martin BSc (Hons) , Neil J Spratt FRACP, PhD , Daniel J Beard PhD

Objectives

There is increasing evidence that poor leptomeningeal collateral blood flow in hypertensive animals is due to increased vascular myogenic tone, indicating that therapies to enhance collateral blood flow during ischemic stroke may be particularly effective. To develop such therapies, we need a greater understanding of the factors that regulate collateral blood flow in the setting of hypertension. Therefore, we aimed to quantify blood flow velocity, diameter and absolute blood flow in individual collateral vessels in an ischemic stroke model in spontaneously hypertensive rats (SHRs) and determine which factors had the greatest influence on blood flow.

Materials and methods

We quantified collateral flow velocity and vessel diameter and calculated absolute collateral blood flow in SHRs (n = 5) during 70 min of middle cerebral artery occlusion (MCAO), using a fluorescent microsphere method.

Results

Average collateral blood flow significantly increased post-occlusion relative to baseline (pre-MCAO: 16.8 ± 7.1nL/min vs. post-MCAO: 146.4 ± 37.7nL/min, p = 0.02). Within animal linear regression analysis showed a strong positive correlation between changes in collateral blood flow versus changes in collateral diameter during stroke (r = 0.7–0.99, p = 0.3–0.002). In contrast, collateral blood flow was only weakly correlated with collateral blood flow velocity during stroke (r = −0.03–0.97, p = 0.9–0.1).

Conclusions

Collateral blood flow and velocity significantly increased post-occlusion. Collateral flow was strongly influenced by vessel diameter, likely because of marked baseline vasoconstriction of collaterals which is flow-limiting.

目的：越来越多的证据表明，高血压动物的小脑膜侧支血流量不足是由于血管肌原性张力增加，这表明在缺血性卒中期间增强侧支血流量的治疗可能特别有效。为了开发这样的治疗方法，我们需要对高血压患者侧支血流量的调节因素有更深入的了解。因此，我们旨在量化自发性高血压大鼠（SHRs）缺血性卒中模型中单个侧支血管的血流速度、直径和绝对血流，并确定哪些因素对血流的影响最大。材料与方法：采用荧光微球法定量测定大脑中动脉闭塞（MCAO） 70 min时SHRs （n = 5）侧支血流速度和血管直径，计算绝对侧支血流。结果：闭塞后平均侧支血流量较基线显著增加（mcao前：16.75±7.1nL/min vs. mcao后：146.4±37.7nL/min, p=0.02）。动物线性回归分析显示卒中时侧支血流量变化与侧支直径变化呈正相关（r = 0.7-0.99,p = 0.3-0.002）。相比之下，卒中时侧支血流量与侧支血流速仅呈弱相关（r = -0.03-0.96,p=0.9-0.1）。结论：闭塞后侧支血流量和血流速度明显增加。侧枝血流受到血管直径的强烈影响，可能是因为侧枝明显的基线血管收缩，这是血流限制。

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引用次数: 0

Mendelian randomization and mediation examination of the immune cell-mediated link between sphingomyelin and stroke 神经鞘磷脂与脑卒中之间免疫细胞介导联系的孟德尔随机化和中介检验。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108205

Cong Xu , Yonghong Xu , Jianglei Ma , Guangming Wang

Objective

The study established a direct link between stroke and sphingomyelin. The precise biology underlying this connection is yet unknown, though. As a result, we decided to investigate the potential causal relationship between Sphingomyelin and genetic vulnerability to stroke, as well as the potential mediating function that immune cells may play in this process, using Mendelian randomization (MR) approaches.

Methods

A published genome-wide association study (GWAS) dataset of European populations served as the foundation for the MR Study. The inverse variance weighting (IVW) model is the main technique. Four additional statistical techniques (MR Egger, Weighted median, Simple mode, and Weighted mode) were also employed to enhance the verification process. Reverse MR Analysis was utilized to reinforce the findings, and heterogeneity and horizontal pleipotency were assessed. Additionally, this study looked into potential immune cell mediating roles in the causal link between sphingomyelin and stroke using two-step MR techniques.

Result

The IVW metod's results indicated that sphingomyelin genetic susceptibility was linked to a high risk of stroke (OR = 1.045 [95 %CI, 1.004–1.087; P = 0.031). Additionally, the statistical result of SSC−A on CD8br and stroke was IVW [P = 0.007, OR(95 % CI) 1.020 (1.005–1.034)], which was proportionate to the increased risk of stroke. A lower incidence of stroke IVW is linked to CD45 on CD8br [P = 0.004, OR(95 % CI) 0.993 (0.988-0.998)]. Furthermore, our results imply that SSC−A on CD8br and CD45 on CD8br contribute to the causative relationship between sphingomyelin and stroke. The percentages of conciliation are 5.38 %, 22.7 %, 33.5 %), and 0.000999, 0.0152, 0.0132, respectively.

Conclusion

We confirmed the effect of sphingomyelin on stroke and conducted in-depth studies. SSC−A on CD8br and CD45 on CD8br is latent stroke mediators associated with sphingomyelin. Through two-step mediated Mendelian randomization analysis, we provide new insights into the etiology and treatment of stroke.

目的：建立脑卒中与鞘磷脂之间的直接联系。然而，这种联系背后的确切生物学原理尚不清楚。因此，我们决定使用孟德尔随机化（MR）方法研究鞘磷脂与中风遗传易感性之间的潜在因果关系，以及免疫细胞在这一过程中可能发挥的潜在介导作用。方法：已发表的欧洲人群全基因组关联研究（GWAS）数据集作为MR研究的基础。反方差加权（IVW）模型是主要的方法。另外四种统计技术（MR Egger，加权中位数，简单模式和加权模式）也被用来加强验证过程。利用反向MR分析来加强研究结果，并评估异质性和水平多能性。此外，本研究利用两步磁共振技术研究了神经鞘磷脂和中风之间因果关系中潜在的免疫细胞介导作用。结果：IVW方法结果显示鞘磷脂遗传易感性与卒中高风险相关(OR = 1.045 [95%CI, 1.004-1.087； = 0.031页)。此外，SSC-A对CD8br和卒中的统计结果为IVW [P = 0.007，OR(95% CI) 1.020(1.005-1.034)]，与卒中风险增加成正比。卒中IVW发生率较低与CD8br上的CD45有关[P=0.004， OR(95% CI) 0.993(0.988-0.998)]。此外，我们的研究结果表明，CD8br上的SSC-A和CD8br上的CD45参与了鞘磷脂和脑卒中之间的因果关系。调解比例分别为5.38%、22.7%、33.5%,0.000999、0.0152、0.0132。结论：我们证实了鞘磷脂对脑卒中的作用，并进行了深入的研究。CD8br上的SSC-A和CD8br上的CD45是与鞘磷脂相关的潜在卒中介质。通过两步介导的孟德尔随机化分析，我们为中风的病因和治疗提供了新的见解。

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引用次数: 0

Screening prediction models using artificial intelligence for moderate-to-severe obstructive sleep apnea in patients with acute ischemic stroke 急性缺血性脑卒中患者中重度阻塞性睡眠呼吸暂停的人工智能筛选预测模型。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2025-02-01 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108214

Huan-Jan Lin MD , Tian-Hsiang Huang PhD , Hui-Ci Huang , Pao-Li Hsiao MD , Wen-Hsien Ho PhD

Background

Obstructive sleep apnea (OSA) is common after stroke. Still, routine screening of OSA with polysomnography (PSG) is often unfeasible in clinical practice, primarily because of how limited resources are and the physical condition of patients. In this study, we used several artificial intelligence techniques to predict moderate-to-severe OSA and identify its features in patients with acute ischemic stroke.

Methods

A total of 146 patients with acute ischemic stroke underwent PSG screening for OSA. Their baseline demographic characteristics, including age, sex, body mass index (BMI), Epworth Sleepiness Scale (ESS) score, and stroke risk factors, were recorded. Logistic regression analysis was conducted to identify significant features associated with moderate-to-severe OSA in patients with stroke. These significant features were used with six machine learning and ensemble learning algorithms, namely decision tree, support vector machine, random forest, extreme gradient boosting (XGBoost), adaptive boosting (AdaBoost), and gradient boosting, to compare the performance of several predictive models.

Results

Multivariate logistic regression analysis revealed that age, sex, BMI, neck circumference, and ESS score were significantly associated with the presence of moderate-to-severe OSA. According to the machine learning and ensemble learning results, the XGBoost model achieved the highest performance, with an area under the receiver operating characteristic curve of 0.89 and an accuracy and F1 score of 0.80.

Conclusion

This study identified key factors contributing to moderate-to-severe OSA in patients with ischemic stroke. The XGBoost model exhibited high predictive performance, indicating it has potential as a supporting tool for decision-making in health-care settings.

背景：阻塞性睡眠呼吸暂停（OSA）在卒中后很常见。然而，在临床实践中，常规的多导睡眠图（PSG）筛查OSA往往是不可行的，主要是因为资源有限和患者的身体状况。在这项研究中，我们使用了几种人工智能技术来预测急性缺血性卒中患者的中重度OSA，并确定其特征。方法：对146例急性缺血性脑卒中患者进行PSG筛查。记录他们的基线人口统计学特征，包括年龄、性别、体重指数（BMI）、爱普沃斯嗜睡量表（ESS）评分和中风危险因素。进行Logistic回归分析，以确定与卒中患者中至重度OSA相关的显著特征。将这些显著特征与六种机器学习和集成学习算法（即决策树、支持向量机、随机森林、极端梯度增强（XGBoost）、自适应增强（AdaBoost）和梯度增强）一起使用，比较几种预测模型的性能。结果：多因素logistic回归分析显示，年龄、性别、BMI、颈围、ESS评分与中重度OSA存在显著相关。从机器学习和集成学习结果来看，XGBoost模型取得了最高的性能，其接收器工作特征曲线下的面积为0.89，精度和F1分数为0.80。结论：本研究确定了缺血性卒中患者中至重度OSA的关键因素。XGBoost模型显示出很高的预测性能，表明它有潜力作为卫生保健机构决策的辅助工具。

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引用次数: 0