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

Methodological concerns undermining causal interpretation in early gastrostomy timing after intracerebral hemorrhage 脑出血后早期胃造口时机的方法学问题削弱了因果解释。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2026-01-06 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108551

Ahmad Shafi Antar

引用次数: 0

Safety and efficacy of adjunctive tirofiban and eptifibatide in acute ischemic stroke: A systematic review and meta-analysis 替罗非班和依替巴肽辅助治疗急性缺血性卒中的安全性和有效性：一项系统综述和荟萃分析。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2026-01-05 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108550

Hameer Ali , Rida Shehzad , Usama Ahmed , Yahya Abualown , Wajida Perveen , Junaid Gulzar , Saad Azam , Zain ul Abideen , Shah e Zaman , Umair Hayat , Uzair Jafar , Muhammad Ehsan , Bilawal Nadeem , Ankit Agrawal , Raheel Ahmed

Introduction and Objective

Acute ischemic stroke (AIS) is one of the most common cerebrovascular diseases, posing a substantial burden on public health systems and individuals. Tirofiban and eptifibatide are used alongside intravenous thrombolysis (IVT) in patients with AIS, as they are believed to improve clinical outcomes. We aimed to investigate the efficacy and safety of IV tirofiban or eptifibatide as adjunctive therapy versus using IVT alone in patients with AIS.

Methods

We conducted a systematic search using PubMed, Embase, and Clinicaltrials.gov to retrieve randomized controlled trials and observational studies comparing adjunctive tirofiban or eptifibatide to IVT alone in patients with AIS. The quality of included RCTs and observational studies was assessed using the revised Cochrane “Risk of Bias” tool (RoB 2.0) and Newcastle– Ottawa Scale (NOS), respectively. All statistical analyses were performed using RevMan 5.4, using the random effects model with Risk Ratio (RR) and Mean difference (MD) as effect measures.

Results

Our meta-analysis included eleven studies, including seven RCTs and four observational studies, involving 1,796 patients. Our results showed that the number of patients with functional independence in the adjunctive therapy group (mRS score 0–2 at 90 days) was comparable to IVT alone (11 studies; n = 1686; RR 1.10; 95% CI, 0.90 - 1.36). There was no evidence of publication bias. Sensitivity analysis with evidence from RCTs showed that adjunctive Tirofiban may improve functional independence at 90 days. The incidence of symptomatic intracranial hemorrhage (ICH) (8 studies; n = 1234; RR 0.74; 95% CI, 0.37 - 1.48) and mortality (11 studies; n = 1686; RR=1.18; 95% CI, 0.82-1.70) was also found to be comparable between the two groups. There was no significant difference between the two groups when assessing the risk of any ICH, asymptomatic ICH, major hemorrhage or systemic bleeding, and fatal ICH. The incidence of early neurologic deterioration and mean change in mRS score remained comparable between the two groups.

Conclusion

Our meta-analysis suggests that while adjunctive tirofiban or eptifibatide with IVT do not yield benefits in terms of reducing mortality or improving functional independence at 90 days in AIS, emerging evidence from RCTs indicates that tirofiban may offer functional benefits, though this remains uncertain. Importantly, adjunctive therapy did not demonstrate a significant increase in bleeding risk in the analyzed studies. . These findings support the need for further large-scale, high-quality randomized controlled trials to explain the role of tirofiban in the management of AIS.

简介和目的：急性缺血性卒中（AIS）是最常见的脑血管疾病之一，对公共卫生系统和个人造成了重大负担。替罗非班和依替巴肽与静脉溶栓（IVT）一起用于AIS患者，因为它们被认为可以改善临床结果。我们的目的是研究静脉滴注替罗非班或依替巴肽作为辅助治疗与单独静脉滴注治疗在AIS患者中的疗效和安全性。方法：我们通过PubMed、Embase和Clinicaltrials.gov进行了系统检索，检索比较辅助替罗非班或依替巴肽与单独IVT治疗AIS患者的随机对照试验和观察性研究。纳入的随机对照试验和观察性研究的质量分别使用修订后的Cochrane“偏倚风险”工具（RoB 2.0）和Newcastle- Ottawa量表（NOS）进行评估。所有统计分析均采用RevMan 5.4软件，采用随机效应模型，以风险比（Risk Ratio， RR）和平均差异（Mean difference， MD）为效应测度。结果：我们的荟萃分析包括11项研究，包括7项随机对照试验和4项观察性研究，涉及1796名患者。我们的结果显示，辅助治疗组功能独立的患者数量（90天mRS评分0-2）与单独IVT相当（11项研究；n= 1686; RR 1.10; 95% CI, 0.90 - 1.36）。没有证据表明存在发表偏倚。基于随机对照试验证据的敏感性分析显示，辅助替罗非班可改善90天的功能独立性。症状性颅内出血（ICH）发生率（8项研究，n=1234； RR= 0.74; 95% CI, 0.37 - 1.48）和死亡率（11项研究，n=1686； RR=1.18; 95% CI, 0.82-1.70）也发现两组之间具有可比性。在评估任何脑出血、无症状脑出血、大出血或全身性出血和致死性脑出血的风险时，两组之间没有显著差异。两组间早期神经功能恶化的发生率和mRS评分的平均变化保持可比性。结论：我们的荟萃分析表明，虽然辅助替罗非班或依替巴肽与IVT在降低AIS患者90天死亡率或改善功能独立性方面没有益处，但来自随机对照试验的新证据表明，替罗非班可能提供功能益处，尽管这仍不确定。重要的是，在分析的研究中，辅助治疗并没有显示出出血风险的显著增加。这些发现支持需要进一步进行大规模、高质量的随机对照试验来解释替罗非班在AIS管理中的作用。

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引用次数: 0

Quality of life after decompressive surgery for severe cerebral venous thrombosis 重度脑静脉血栓形成减压手术后的生活质量。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2026-01-05 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108549

Mayte Sanchez van Kammen MD, PhD , Sanjit Aaron MD , Jorge M Ferreira MD , Patrícia Canhão MD, PhD , Adriana B. Conforto MD , Antonio Arauz , Marta Carvalho MD , Jaime Masjuan MD , Vijay K Sharma MD , Jukka Putaala MD, PhD , Maarten Uyttenboogaart MD , Rodrigo Bazan MD , Bert A Coert MD , Prabhu Kirubakaran MD , Pankaj Singh MD , Diana Aguiar de Sousa MD, PhD , Jonathan M Coutinho MD, PhD , José M Ferro MD, PhD , the DECOMPRESS 2 study group

Background

Decompressive surgery can be lifesaving in patients with severe cerebral venous thrombosis (CVT) and impending brain herniation. However, data on health-related quality of life (HRQoL) after surgery are limited.

Methods

DECOMPRESS-2 was a prospective cohort study including adult patients with CVT from 15 centers in 10 countries who underwent decompressive surgery (2011–2019). HRQoL was assessed using EQ5D-3 L utility scores, subdomains, and a visual analogue scale (VAS) at 6 and 12 months post-surgery. Complete case analysis, multiple imputation, best- and worst-case analyses were performed. Predictors of EQ5D-score (Tobit regression) and VAS (linear regression) at 12 months were analyzed.

Results

Of 118 patients, 112 were included (median age 38 years [IQR 27–46], 68% female). At 12-months, EQ5D-3 L and VAS were available for 89% and 90% of survivors, respectively. Median EQ5D-3L-score was 0.70 (IQR 0.52–0.85, mean 0.59 [SD 0.38]) and median VAS was 70 (IQR 56–80, mean 69 [SD 18]). Overall, 84% of patients reported problems in ≥1 subdomain of the EQ5D-3L: 68% with usual activities, 59% pain/discomfort, 58% anxiety/depression, 47% with self-care, 43% with mobility. Higher age and residence in a middle-income country (vs. high-income) predicted poorer EQ5D-3 L and VAS. Preoperative coma predicted worse EQ5D-3 L only.

Conclusions

Twelve months after decompressive surgery for CVT, over 4 out of 5 survivors reported problems in at least one subdomain of the EQ5D-3 L. Higher age, middle-income country status and preoperative coma were negative predictors of quality of life.

背景：减压手术可以挽救严重脑静脉血栓形成（CVT）和即将发生的脑疝患者的生命。然而，手术后与健康相关的生活质量（HRQoL）数据有限。方法：DECOMPRESS-2是一项前瞻性队列研究，包括来自10个国家15个中心接受减压手术的成年CVT患者（2011-2019）。HRQoL在术后6个月和12个月采用EQ5D-3L效用评分、子域和视觉模拟量表（VAS）进行评估。完整的案例分析，多重归算，最佳和最坏情况分析进行。分析12个月eq5d评分（Tobit回归）和VAS（线性回归）的预测因子。结果：118例患者中，纳入112例（中位年龄38岁[IQR 27-46]， 68%为女性）。12个月时，89%和90%的幸存者分别获得EQ5D-3L和VAS。eq5d - 3l评分中位数为0.70 (IQR为0.52 ~ 0.85，平均0.59 [SD 0.38])， VAS中位数为70 （IQR为56 ~ 80，平均69 [SD 18]）。总体而言，84%的患者报告了EQ5D-3L≥1个亚域的问题：68%的患者有正常活动，59%的患者有疼痛/不适，58%的患者有焦虑/抑郁，47%的患者有自我护理，43%的患者有活动能力。中等收入国家的年龄和居住地越高（与高收入国家相比），EQ5D-3L和VAS越差。术前昏迷仅预测EQ5D-3L加重。结论：CVT减压手术12个月后，超过4 / 5的幸存者报告了至少一个EQ5D-3L亚域的问题。较高的年龄、中等收入国家和术前昏迷是生活质量的负向预测因子。

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引用次数: 0

Outcomes of low-dose versus standard-dose alteplase in acute ischemic stroke patients aged over 80 years: A real-world propensity score-matched study from China 低剂量与标准剂量阿替普酶治疗80岁以上急性缺血性卒中患者的结果：一项来自中国的真实世界倾向评分匹配研究

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2026-01-04 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108548

Chang-sheng Li MD , Hong-Qiu Gu MD , Kai-xuan Yang MS , Zi-mo Chen MD , Xia Meng MD , Chun-juan Wang MD , Zi-xiao Li MD

Background

Optimal alteplase dosing for intravenous thrombolysis in stroke patients aged >80 years remains debated due to underrepresentation in pivotal trials. This study evaluates the relative effectiveness and safety of low-dose (0.6 mg/kg) versus standard-dose (0.9 mg/kg) alteplase in elderly patients treated within 4.5 hours of onset.

Methods

Utilizing the China Stroke Center Alliance registry database (2018-2022), we conducted a propensity score-matched analysis encompassing 6,522 patients over 80 years of age, ultimately generating 2,050 matched pairs. The primary outcome was functional dependence or death at discharge (mRS 2–6). Secondary measures included major disability (mRS 3–6), in-hospital mortality, and symptomatic intracranial hemorrhage (sICH).

Results

The primary outcome showed no statistical difference between low-dose (81.6 %) and standard-dose (81.8 %) groups (OR 0.99; 95 % CI 0.84-1.16; P=0.871). Rates of major disability (56.0 % vs. 57.7 %; OR 1.02; P=0.730), mortality (15.6 % vs. 14.4 %; OR 1.10; P=0.294), and sICH (4.4 % vs. 5.2 %; OR 0.85; P=0.274) were broadly alike. Low-dose alteplase showed a numerical decline in bleeding events. Subgroup analysis found no modifying factors.

Conclusions

In octogenarian stroke patients, low-dose alteplase offers parallel efficacy and safety to standard therapy, with a possible reduction in hemorrhagic complications. These results support low-dose regimens as a reasonable option for elderly patients, particularly when minimizing bleeding risk is a clinical priority.

背景：由于关键试验中代表性不足，80岁中风患者静脉溶栓的最佳阿替普酶剂量仍存在争议。本研究评估了低剂量（0.6 mg/kg）与标准剂量（0.9 mg/kg）阿替普酶在发病4.5小时内治疗的老年患者的相对有效性和安全性。方法：利用中国脑卒中中心联盟注册数据库（2018-2022），对6522例80岁以上患者进行倾向评分匹配分析，最终生成2050对匹配。主要结局是功能依赖或出院时死亡（mRS 2-6）。次要测量包括主要残疾（mRS 3-6）、住院死亡率和症状性颅内出血（siich）。结果：低剂量组（81.6%）与标准剂量组（81.8%）的主要结局无统计学差异（OR 0.99; 95% CI 0.84 ~ 1.16； P=0.871）。主要致残率（56.0% vs. 57.7%; OR 1.02； P=0.730）、死亡率（15.6% vs. 14.4%; OR 1.10； P=0.294）和脑出血（4.4% vs. 5.2%; OR 0.85； P=0.274）大致相似。低剂量阿替普酶显示出血事件的数量下降。亚组分析未发现影响因素。结论：在80多岁的脑卒中患者中，低剂量阿替普酶与标准治疗具有同等的疗效和安全性，并可能减少出血性并发症。这些结果支持低剂量方案作为老年患者的合理选择，特别是当最小化出血风险是临床优先考虑的时候。

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引用次数: 0

Association between cumulative changes of the triglyceride glucose index and incidence of Cardio-cerebral vascular diseases in a population with cardiovascular-kidney-metabolic syndrome stage 0–3: a nationwide prospective cohort study 心血管-肾-代谢综合征0-3期人群中甘油三酯葡萄糖指数累积变化与心脑血管疾病发病率的关系：一项全国前瞻性队列研究

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2026-01-03 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108540

Li Hou , Jing Tang , Lei Zhang , Yanhong Li , Yao Niu

Objective

To evaluate the relationship between the longitudinal changes of the triglyceride-glucose (TyG) index and the incidence of cardio-cerebral vascular diseases (CCVD) among individuals with CKM syndrome stages 0-3.

Methods

Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS), this longitudinal study included 3,416 participants aged 45 and above. Participants were categorized into different TyG trajectory groups using k-means clustering analysis. Logistic regression and restricted cubic spline (RCS) models were employed to assess the associations between cumTyG and TyG changes with CCVD incidence.

Results

Over a median follow-up of 5 years, 698 participants developed CCVD. The relationship between cumTyG and CCVD risk was linear in RCS regression. After adjusting for potential confounders, the risk of CCVD was found to be significantly higher for participants in Class 2, Class 4, and Class 5 compared to those in Class 1. Specifically, Class 2 had an odds ratio (OR) of 1.45 (95% confidence interval [CI]: 1.14, 1.84), Class 4 had an OR of 1.42 (95% CI: 1.09, 1.86), and Class 5 had an OR of 1.64 (95% CI: 1.14, 2.34). Additionally, an elevated cumTyG index was associated with an increased risk of CCVD, with an OR of 1.13 (95% CI: 1.05, 1.22, P=0.002).

Conclusion

CumTyG and its longitudinal trend are independent and potent predictors of CCVD in patients with stage 1–3 CKM syndrome. Dynamic monitoring of the TyG trajectory can enable the early identification of high-risk individuals, providing reliable evidence for individualized and cost-effective prevention.

目的：探讨CKM综合征0 ~ 3期患者甘油三酯-葡萄糖（TyG）指数纵向变化与心脑血管病（CCVD）发病率的关系。方法：利用中国健康与退休纵向研究（CHARLS）的数据，对3416名年龄在45岁及以上的参与者进行纵向研究。使用k-均值聚类分析将参与者分为不同的TyG轨迹组。采用Logistic回归和限制性三次样条（RCS）模型来评估cumTyG和TyG变化与CCVD发病率之间的关系。结果：在中位5年的随访中，698名参与者发展为CCVD。在RCS回归中，cumTyG与CCVD风险呈线性关系。在对潜在混杂因素进行调整后，发现2类、4类和5类受试者的CCVD风险明显高于1类受试者。具体来说，2级的比值比（OR）为1.45(95%可信区间[CI]: 1.14, 1.84)， 4级的OR为1.42 (95% CI: 1.09, 1.86)， 5级的OR为1.64 （95% CI: 1.14, 2.34）。此外，cumTyG指数升高与CCVD风险增加相关，OR为1.13 （95% CI: 1.05, 1.22， P=0.002）。结论：CumTyG及其纵向趋势是1-3期CKM综合征患者CCVD的独立且有效的预测因子。动态监测TyG轨迹可以早期识别高危个体，为个性化和高性价比的预防提供可靠证据。

{"title":"Association between cumulative changes of the triglyceride glucose index and incidence of Cardio-cerebral vascular diseases in a population with cardiovascular-kidney-metabolic syndrome stage 0–3: a nationwide prospective cohort study","authors":"Li Hou , Jing Tang , Lei Zhang , Yanhong Li , Yao Niu","doi":"10.1016/j.jstrokecerebrovasdis.2026.108540","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108540","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the relationship between the longitudinal changes of the triglyceride-glucose (TyG) index and the incidence of cardio-cerebral vascular diseases (CCVD) among individuals with CKM syndrome stages 0-3.</div></div><div><h3>Methods</h3><div>Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS), this longitudinal study included 3,416 participants aged 45 and above. Participants were categorized into different TyG trajectory groups using k-means clustering analysis. Logistic regression and restricted cubic spline (RCS) models were employed to assess the associations between cumTyG and TyG changes with CCVD incidence.</div></div><div><h3>Results</h3><div>Over a median follow-up of 5 years, 698 participants developed CCVD. The relationship between cumTyG and CCVD risk was linear in RCS regression. After adjusting for potential confounders, the risk of CCVD was found to be significantly higher for participants in Class 2, Class 4, and Class 5 compared to those in Class 1. Specifically, Class 2 had an odds ratio (OR) of 1.45 (95% confidence interval [CI]: 1.14, 1.84), Class 4 had an OR of 1.42 (95% CI: 1.09, 1.86), and Class 5 had an OR of 1.64 (95% CI: 1.14, 2.34). Additionally, an elevated cumTyG index was associated with an increased risk of CCVD, with an OR of 1.13 (95% CI: 1.05, 1.22, P=0.002).</div></div><div><h3>Conclusion</h3><div>CumTyG and its longitudinal trend are independent and potent predictors of CCVD in patients with stage 1–3 CKM syndrome. Dynamic monitoring of the TyG trajectory can enable the early identification of high-risk individuals, providing reliable evidence for individualized and cost-effective prevention.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108540"},"PeriodicalIF":1.8,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Global and regional burden of ischemic stroke attributable to smoking and high alcohol use from 1990 to 2021, with projections to 2050 1990年至2021年吸烟和高酒精使用导致的全球和区域缺血性卒中负担，并预测到2050年。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2026-01-02 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108543

Sijia Guo , Bo Qu , Qiqi Wang , Yan Sun

Objective

This study employs data from the Global Burden of Disease Study (GBD) 2021 to analyze the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) of ischemic stroke (IS) attributable to smoking and high alcohol use from 1990 to 2021 across 204 countries and territories, stratified by Socio-demographic Index (SDI), region, sex, and age. Trends are assessed using estimated annual percentage change (EAPC), and future burdens are projected to 2050 using an autoregressive integrated moving average (ARIMA) model.

Results

Globally, the burden of IS attributable to both risk factors declined, with smoking consistently associated with higher ASMR and ASDR than high alcohol use. High-SDI regions showed the most substantial reductions, whereas low-SDI regions experienced stagnant or slightly increasing burdens. Southeast Asia was the only region with a rising trend in smoking-related IS, while Tropical Latin America achieved remarkable success in alcohol control. The burden was higher among males and older age groups for smoking, and more prominent in young and middle-aged adults for alcohol use. Projections suggested a continuing decline in high-SDI regions but limited improvement in low-SDI areas by 2050.

Conclusion

Significant geographic and demographic disparities persist in the IS burden attributable to smoking and high alcohol use. Targeted policy interventions—especially enhanced tobacco and alcohol control in low- and middle-SDI regions, along with focused strategies for males and high-risk age groups—are urgently needed to reduce the global burden of ischemic stroke.

目的：本研究采用2021年全球疾病负担研究（GBD）的数据，分析1990年至2021年204个国家和地区因吸烟和高酒精使用导致的缺血性卒中（IS）的年龄标准化死亡率（ASMR）和年龄标准化DALY率（ASDR），并按社会人口指数（SDI）、地区、性别和年龄分层。使用估计的年百分比变化（EAPC）评估趋势，并使用自回归综合移动平均（ARIMA）模型预测到2050年的未来负担。结果：在全球范围内，可归因于这两种风险因素的IS负担下降，吸烟始终与较高的ASMR和ASDR相关。高sdi地区的负担减少幅度最大，而低sdi地区的负担停滞不前或略有增加。东南亚是唯一一个与吸烟有关的IS呈上升趋势的地区，而热带拉丁美洲在控制酒精方面取得了显著成功。男性和老年人吸烟的负担更高，而年轻人和中年人饮酒的负担更突出。预测表明，到2050年，高sdi地区将继续下降，而低sdi地区的改善有限。结论：吸烟和酗酒导致的IS负担存在显著的地理和人口差异。迫切需要有针对性的政策干预，特别是在低和中等sdi地区加强烟草和酒精控制，以及针对男性和高危年龄组的重点战略，以减轻缺血性卒中的全球负担。

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引用次数: 0

Access to neighborhood destinations that offer opportunities for physical activity and socialization is associated with favorable post-stroke outcomes 能够前往提供体育活动和社交机会的社区目的地与卒中后的良好预后相关。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2026-01-02 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108545

Leanna M Delhey PhD , Jon Zelner PhD , Xu Shi PhD , Lewis B Morgenstern MD , Devin L Brown MD , Melinda A Smith DrPH , Erin C Case BA , Lynda D Lisabeth PhD

Objective

: 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.

Methods

: 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 (<5), moderate-severe (≥5)).

Results

: We included 1,786 survivors who completed 3 (N = 1,321), 6 (N = 677), or 12-month interviews (N = 652). Median age was 64 years, 55% male, and 74% mild stroke. Stroke severity modified associations with functioning (p = 0.09) and quality of life (p = 0.05), follow-up time did not (p > 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 (p > 0.05).

Interpretation

: 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.

目的：评估中风幸存者住所附近的目的地（如餐馆、娱乐中心和商店等提供家庭和工作之外的体育活动和社交机会的地方）与他们中风后的结果之间的联系。方法：我们纳入了非西班牙裔白人和墨西哥裔美国人突发中风幸存者，他们参加了科珀斯克里斯蒂脑梗死监测项目（2009-19），这是一个基于德克萨斯州人群的队列。暴露：幸存者住所周围0.5英里范围内的目的地数量。卒中后大约3、6和12个月评估的结果：认知（修改后的迷你精神状态检查）、功能（日常生活活动(ADL)/工具性ADL）、健康相关生活质量（卒中特异性生活质量量表）和抑郁（患者健康问卷-8）。我们拟合调整后的线性混合模型，并考虑随访时间和中风严重程度（NIH中风量表-轻度）之间的相互作用(结果：我们纳入了1786名幸存者，他们完成了3个月（N= 1321）、6个月（N=677）或12个月的访谈（N=652）。中位年龄为64岁，55%为男性，74%为轻度中风。脑卒中严重程度与功能（p=0.09）和生活质量（p=0.05）相关，随访时间无相关性（p < 0.05）。在中重度中风幸存者中，更多的目的地与更有利的功能（平均差异=-0.12,95% CI=-0.22, -0.01）和生活质量（平均差异=0.16,95% CI=0.03, 0.30）相关。轻度脑卒中幸存者或与认知或抑郁无关联（p < 0.05）。解释：在中重度中风幸存者中，更近的目的地与第一年更有利的功能和生活质量相关。未来的研究需要探索特定类型的目的地是否可能支持更有利的结果。

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引用次数: 0

The role of artificial intelligence in estimating stroke events in Moyamoya patients: A systematic review and meta-analysis of diagnostic test accuracy 人工智能在估计烟雾病患者脑卒中事件中的作用：诊断测试准确性的系统回顾和meta分析。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2026-01-02 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108542

Jeremiah Hilkiah Wijaya , Miguel Quintero Consuegra , Daniela A Perez-Chadid , Aafreen Azmi , Juan Pablo Avila Madrigal , Shane Shahrestani , Sofia Ramirez-Guerrero , Anil Nanda , Abdelrahman Ramadan Elashry , Nestor R. Gonzalez

Introduction

Moyamoya disease (MMD) and syndrome (MMS) are rare cerebrovascular arteriopathies marked by progressive internal carotid stenosis, fragile collateral networks, and a five-year stroke risk near 10% despite optimal care. Artificial-intelligence (AI) models integrating angiographic, perfusion, and clinical data show promise for risk stratification, but their diagnostic accuracy and clinical readiness remain uncertain.

Method

We conducted a systematic review of AI algorithms for predicting ischemic or hemorrhagic stroke events in angiographically or magnetic resonance imaging (MRI)-confirmed MMD/MMS. PubMed, EMBASE, and Scopus were searched through September 3, 2025, for English-language studies employing machine-learning, deep-learning, or radiomics models. We extracted sensitivity, specificity, and area under the curve (AUC) metrics and assessed study quality with Radiomics Quality Score and CLEAR checklists. Pooled estimates and summary receiver-operating characteristic curves were generated; decision-curve analysis evaluated clinical net benefit.

Results

Seven retrospective cohorts (n = 4,795) met inclusion criteria. The pooled sensitivity was 0.65 (95% CI 0.50–0.79) and specificity 0.85 (95% CI 0.82–0.89). The summary AUC was 0.85. Decision-curve analysis demonstrated that AI predictions improved net benefit over “treat-all” or “treat-none” strategies across relevant risk thresholds. Tree-based classifiers (XGBoost, random forest) showed more stable external performance than deep-learning networks. Explainability tools enhanced model interpretability.

Conclusion

AI models achieve moderate-to-high accuracy for stroke prediction in MMD/MMS and offer potential for individualized risk stratification. However, small single-center datasets, heterogeneous imaging protocols, and opaque modeling limit clinical adoption. Prospective multicenter validation, standardized data pipelines, and robust explainability frameworks are essential for integrating AI into routine neurovascular care.

烟雾病（MMD）和综合征（MMS）是一种罕见的脑血管动脉病变，其特征是进行性颈内动脉狭窄，侧枝网络脆弱，尽管采取了最佳治疗，但5年卒中风险仍接近10%。整合血管造影、灌注和临床数据的人工智能（AI）模型显示出风险分层的希望，但其诊断准确性和临床准备程度仍不确定。方法：我们对人工智能算法在血管造影或磁共振成像（MRI）证实的烟雾病/MMS中预测缺血性或出血性卒中事件进行了系统回顾。PubMed、EMBASE和Scopus检索了截至2025年9月3日使用机器学习、深度学习或放射组学模型的英语研究。我们提取敏感性、特异性和曲线下面积（AUC）指标，并使用放射组学质量评分和CLEAR检查表评估研究质量。生成汇总估计和汇总接收者工作特征曲线；决策曲线分析评估临床净收益。结果：7个回顾性队列（n = 4,795）符合纳入标准。合并敏感性为0.65 (95% CI 0.50-0.79)，特异性为0.85 （95% CI 0.82-0.89）。总AUC为0.85。决策曲线分析表明，在相关风险阈值上，人工智能预测比“治疗所有”或“不治疗”策略提高了净效益。基于树的分类器（XGBoost、随机森林）表现出比深度学习网络更稳定的外部性能。可解释性工具增强了模型的可解释性。结论：人工智能模型对烟雾病/MMS的脑卒中预测达到了中至高精度，并提供了个性化风险分层的潜力。然而，小的单中心数据集、异构的成像方案和不透明的建模限制了临床应用。前瞻性多中心验证、标准化数据管道和强大的可解释性框架对于将人工智能整合到常规神经血管护理中至关重要。

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引用次数: 0

Post-stroke epilepsy in revascularized versus not revascularized stroke patients: A prospective cohort study 血运重建术与非血运重建术的卒中后癫痫患者：一项前瞻性队列研究。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2026-01-02 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108544

Stefania Lazzari , Carlotta Mutti , Francesca Bozzetti , Antonio Genovese , Maddalena Frapporti , Francesca Badini , Carmine Siniscalchi , Andrea Becciolini , Valentina Tontini , Elisa Mannini , Irene Florindo , Francesco Misirocchi , Francesca Iuculano , Liborio Parrino , Lucia Zinno

Objective

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.

Methods

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.

Results

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 < 0.001).

Conclusion

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.

目的：脑卒中后癫痫（PSE）与脑卒中患者血运重建治疗之间的关系仍存在争议。其他辅助技术如计算机断层扫描（CT）脑数据和脑电图（EEG）在PSE预测中的预后意义尚不清楚。方法：我们进行了一项单中心前瞻性观察性研究，以评估急性缺血性卒中成人患者接受再灌注入路与非血运重建患者相比急性症状性癫痫发作（ASS）和PSE的发生率，随访30个月。结果：我们纳入258例卒中患者：155例（静脉注射组织型纤溶酶原激活剂（IV-tPA））和/或血管内取栓（ET）治疗，103例对照（非血运重建）。ASS的全球发病率为3.4%，而PSE的诊断率为5%。再灌注治疗与ASS或PSE风险增加无关。出血性梗死是PSE发展的唯一独立危险因素（HR 5.33, (95% CI, 1.69 - 16.82), p=0.004）。同时，我们使用卡方检验分析ASS与出血性梗死之间的关系（OR 8.59 (95% CI, 2.19 - 33.7), p < 0.001）。结论：急性缺血性脑卒中再灌注治疗不会增加脑卒中后30个月内癫痫的发生风险。出血性梗死是卒中后癫痫的主要危险因素。

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引用次数: 0

Management of intracranial aneurysms: a 2024 nationwide study from China 颅内动脉瘤的治疗：中国2024年的一项全国性研究。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases

Pub Date : 2026-01-02 DOI: 10.1016/j.jstrokecerebrovasdis.2026.108546

Yu Gao MS , Meihua Huyan MD , Yina Wu MD , Zhao Dai MS , Yongwei Zhang MD , Jianmin Liu MD , Pengfei Yang MD , Rui Zhao MD , Qiang Li MD

Background

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.

Methods

A WeChat-based survey distributed to cerebrovascular specialists in 2024 assessed clinical decision-making, resource availability, and case-based preferences.

Results

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 >10 years’ experience intervened at smaller UIA sizes (>5 mm; 55.5% vs. 40.1% in <2-year cohort, p=0.03) and preferred flow diverters for incidental aneurysms (80.7% vs. 38.3%, p<0.001). Coiling dominated acute aneurysmal subarachnoid hemorrhage (SAH) management, but senior neurosurgeons favored clipping with hematoma evacuation (66.5% vs. 35.3%, p<0.001).

Conclusions

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.

背景：在人口老龄化和神经影像学应用增加的推动下，中国未破裂颅内动脉瘤（UIAs）的检出率不断上升，与神经介入资源的显著区域差异相吻合。这项研究反映了全国范围内当代管理实践的特点。方法：一项基于微信的调查于2024年分发给脑血管专家，评估临床决策、资源可用性和基于病例的偏好。结果：资源差异明显：计算机断层血管造影（CTA）广泛使用（82.4%），双臂数字减影血管造影(DSA) =32.4%，混合型手术室（36.4%）仍然有限。国内流量分流器超过了国际设备（47.1%对31.4%）。临床医生的经验显著影响管理：具有10年经验的医生干预较小的UIA尺寸（5mm）； 55.5% vs. 40.1%结论：由于经验差距和区域资源不平等，中国的实践差异仍然存在。优化动脉瘤护理迫切需要规范化的培训和公平的资源分配。

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引用次数: 0