Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"LDL-cholesterol lowering agents (statins and PCSK9 inhibitors) and the risk of intracerebral hemorrhage: A network meta-analysis","authors":"Wangwen Li M.M. ,&nbsp;Chuyue Wu M.D, Ph.D. ,&nbsp;Wenkui Li M.M. ,&nbsp;Li Li M.M.","doi":"10.1016/j.jstrokecerebrovasdis.2025.108224","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108224","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Statin therapy reduces the risk of ischemic stroke; however, certain studies have observed an increased incidence of intracerebral hemorrhage (ICH). Moreover, proprotein convertase subtilisin/kexin type 9(PCSK-9) inhibitors have emerged as a powerful class of lipid-lowering medications, potentially with a lower propensity for causing hemorrhagic events. To investigate this matter further, we conducted a network meta-analysis of randomized controlled trials (RCTs) involving statins and PCSK-9 inhibitors that reported occurrences of ICH.</div></div><div><h3>Methods</h3><div>We performed a literature search of Medline, Web of Science, and The Cochrane Library from database inception until August 2023. All randomized controlled trials of statin therapy and PCSK-9 inhibitors that reported ICH or hemorrhagic stroke were included. The primary outcome variable was ICH. The risk of bias of each included study was assessed by using the Cochrane Handbook for Systematic Reviews of Interventions. We performed network meta-analysis to compare and rank statin and PCSK-9 inhibitors therapies. This study is registered (2023110026. <span><span>inplasy.com</span><svg><path></path></svg></span>).</div></div><div><h3>Results</h3><div>A total of 26251 citations were identified by the search, and 38 potentially eligible articles were included. In total, data from 271411 individuals were analyzed. The data showed that there was not a significant increased risk of intracerebral hemorrhage for all statins and PCSK-9 inhibitors compared with placebo. atorvastatin and rosuvastatin were associated with a lower risk of death than placebo (ORs ranging between 0.79 and 0.82). For risk of intracerebral hemorrhage and mortality. there was not a significant increased risk among all drugs.</div></div><div><h3>Conclusions</h3><div>LDL-Cholesterol lowering agents (statins and PCSK-9 inhibitors) was not associated with a significant increased risk of ICH. Our network meta-analysis provides strong evidence for the safety of statins and PCSK-9 inhibitors, but more studies are needed to further validate this conclusion.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108224"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers for the detection of covert atrial fibrillation after ischemic stroke: NT-proBNP or BNP.","authors":"Hiroshi Shiroto, Joji Hagii","doi":"10.1016/j.jstrokecerebrovasdis.2025.108239","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2025.108239","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation often leads to ischemic stroke. For secondary prevention, clinicians typically switch from antiplatelet to anticoagulant therapy for patients with confirmed atrial fibrillation. This study examined the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and BNP for detecting covert paroxysmal atrial fibrillation (PAF) in patients with ischemic stroke (PWIS).</p><p><strong>Methods: </strong>We enrolled 438 patients with acute stroke in sinus rhythm on admission from July 2021 to March 2023 and measured their NT-proBNP and BNP levels to evaluate their association with PAF detection. Data analysis included logistic regression, receiver operating characteristics curves, and integrated discrimination improvement (IDI).</p><p><strong>Results: </strong>Among our 438 enrolled participants, 43 (9.8%) were in the PAF group and the remaining were in the non-PAF group. PAF group patients were older than those in the non-PAF group (PAF group vs. non-PAF group; 84 [78-89] vs. 79 [71-85] years) and had higher levels of both NT-proBNP (581.0 [264.5-1234.5] vs. 168.0 [76.0-412.5] pg/mL]) and BNP (186.0 [100.4-313.0] vs. 56.4 [26.9-118.0] pg/mL). The PAF group also had a higher prevalence of chronic heart failure (30% vs. 10%). Both biomarkers were independent predictors of PAF detection, and there was no significant difference in their predictive accuracy for PAF. However, BNP had a slight advantage in IDI scores over NT-proBNP (-0.03 [-0.05 to -0.01]).</p><p><strong>Conclusion: </strong>NT-proBNP and BNP can both effectively predict covert PAF in PWIS in sinus rhythm. Thus, either biomarker should be incorporated into treatment planning strategies for these patients.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108239"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124017","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":"Stimulant use disorder and the likelihood of stroke: Analysis of a national database in the United States","authors":"Akash Venkataramanan MD ,&nbsp;Divya Nayar MD ,&nbsp;Sama Almasri MD ,&nbsp;Thirumalaivasan Dhasakeerthi MD ,&nbsp;Sowmya Jayachandran MD ,&nbsp;Suryansh Bajaj MD ,&nbsp;Cheran Elangovan MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108178","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108178","url":null,"abstract":"<div><h3>Background</h3><div>Stimulant use has been associated with an increased risk of stroke, though data on clinical characteristics and exact risk are limited. This retrospective case-control study examines stroke risk in individuals with stimulant use disorder using data from a national U.S. database.</div></div><div><h3>Methods</h3><div>Data was obtained from the 2019 National Readmission Database (NRD) using ICD-10 codes to identify relevant diagnoses. A multivariate logistic regression analyzed the impact of stimulant use disorder on stroke admission odds, adjusting for alcohol use disorder, tobacco use, diabetes, hypertension, dyslipidemia, age, insurance status, and median income. Outcomes like total hospitalization charge, length of stay, and in-hospital mortality were assessed with multivariate regression. Gender-specific analyses were also conducted. Statistical significance was set at p &lt; 0.05.</div></div><div><h3>Results</h3><div>A total of 4,821 adults with stimulant use disorder and stroke were compared to 542,618 stroke patients without stimulant use disorder. Patients with stimulant use disorder (PWSU) had significantly higher odds of hemorrhagic and ischemic stroke admissions, especially hemorrhagic strokes in women. PWSU with hemorrhagic strokes also had higher odds of in-hospital mortality.</div></div><div><h3>Conclusions</h3><div>Stimulant use disorder is associated with higher odds of admission for stroke, especially in women with an overall elevated mortality from hemorrhagic strokes. These findings underscore the need for further research and emphasize the importance of stroke prevention and treatment in individuals with stimulant use disorder.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108178"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular thrombectomy for acute ischemic stroke complicated with systemic light chain amyloidosis: Two case reports","authors":"Yongjie Bai,&nbsp;Bingjie Sun,&nbsp;Jiahui Su","doi":"10.1016/j.jstrokecerebrovasdis.2024.108181","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108181","url":null,"abstract":"<div><div>Systemic light chain amyloidosis (AL) is a non-proliferative plasma cell disease characterized by the deposition of fragments of immunoglobulin light or heavy chain in tissues. There has been no relevant report on the treatment of vascularization during the acute stage of acute ischemic stroke (AIS) complicated with AL. This paper presented two cases of AIS complicated with AL that were treated with intravenous thrombolysis (IVT) and mechanical thrombectomy (MT). The combination of aspiration thrombectomy and IVT might be feasible for patients with AIS complicated with AL.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108181"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke recurrence and all-cause mortality in CPAP-treated sleep-disordered-breathing patients","authors":"Jeppe Suusgaard MD ,&nbsp;Anders Sode West PhD, MD ,&nbsp;Laura B. Ponsaing PhD, MD ,&nbsp;Helle Klingenberg Iversen DMSC (Associate Professor) ,&nbsp;Katrin Rauen DMSC ,&nbsp;Poul Jørgen Jennum DMSC (Professor)","doi":"10.1016/j.jstrokecerebrovasdis.2024.108204","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108204","url":null,"abstract":"<div><h3>Background</h3><div>Obstructive sleep apnea (OSA) affects about 70 % of stroke patients and is closely linked to stroke development. It is unclear whether treatment with continuous positive airway pressure (CPAP) reduces the risk of stroke recurrence or mortality in post-stroke patients, partly due to limited follow-up time and small sample sizes of previous studies. To close this knowledge gap, this study investigated changes in stroke recurrence and mortality among CPAP-treated post-stroke patients with sleep-disordered breathing.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using data from the Danish National Patient Registry covering the period from 2003 to 2016, involving 1821 patients diagnosed with sleep-disordered breathing and a prior ischemic stroke or transient ischemic attack (TIA). Patients were categorized into three groups: CPAP users, CPAP-non-users, and no CPAP treatment. We used Cox hazard regression to assess the risk of recurrent stroke or TIA over a 5-year follow-up period, and all-cause mortality over a 14-year follow-up period.</div></div><div><h3>Results</h3><div>CPAP treatment improved survival rate in CPAP users compared to patients categorized as no CPAP treatment (hazard ratio 0.75, 95 % CI [0.60;0.92], p = 0.007). This effect persisted after adjusting for age, sex, and pre-existing comorbidities within three years (the Quan-updated Charlson Comorbidity Index). There was no difference in recurrence of stroke/TIA among the three CPAP groups.</div></div><div><h3>Conclusions</h3><div>In this registry-based study, we found that CPAP was associated with a reduction in all-cause mortality in post-stroke/TIA patients with sleep-disordered breathing. CPAP treatment did not seem to affect the risk of re-stroke/TIA during the five years of follow-up.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108204"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of multicomponent rehabilitation exercise plus soymilk on cognitive impairment and ischemic lesion growth in stroke patients: A randomized controlled trial","authors":"Babak Esmealy ,&nbsp;Leyla Esmealy ,&nbsp;Leila Gholizadeh ,&nbsp;Saeid Nikookheslat ,&nbsp;Vahid Sari-Sarraf","doi":"10.1016/j.jstrokecerebrovasdis.2024.108207","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108207","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to examine the effects of a multicomponent rehabilitation exercise, coupled with soymilk intake post-exercise, on cognitive impairment and ischemic lesion growth among acute stroke patients.</div></div><div><h3>Methods</h3><div>In a four-arm, single-blind, randomized clinical trial, 120 patients with acute stroke were randomly allocated to one of the following groups: 1) the MRE + soymilk, 2) the MRE, 3) the soymilk, and 4) the control group. Each group underwent their respective intervention for a continuous duration of 20 days. Cognitive impairment was assessed using the Montreal Cognitive Assessment, and the growth of ischemic lesions was evaluated through CT scans.</div></div><div><h3>Results</h3><div>The MRE combined with soymilk intervention demonstrated statistically significant improvements in cognitive impairment among acute stroke patients (χ² = 51.055, <em>p</em> = 0.000). Group differences began to emerge from Week, with improvements observed across all dimensions of cognitive function, except for abstraction. No significant differences were observed between groups in terms of ischemic lesion growth (χ² =0.934, <em>p</em> = 0.810).</div></div><div><h3>Conclusion</h3><div>The incorporation of a multicomponent rehabilitation exercise combined with soymilk ingestion demonstrated effectiveness in alleviating cognitive impairment among acute stroke patients. Nevertheless, it did not influence the growth of ischemic lesions.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108207"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut microbiota and hemorrhagic stroke: Emerging insights and future perspectives","authors":"Chenyang Zang MD ,&nbsp;Zheng Xiao MD ,&nbsp;Luo Zhou MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108212","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108212","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108212"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnesium sulfate in the management of acute ischemic stroke: A review of the literature and future directions","authors":"Maximillian S. Feygin BS,&nbsp;Alex Brenner MD,&nbsp;Omar Tanweer MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108188","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108188","url":null,"abstract":"<div><h3>Background</h3><div>The management of acute ischemic stroke (AIS) was revolutionized within the last 15 years with the introduction of mechanical thrombectomy (MT) to standard of care. Despite the success of mechanical thrombectomy (MT) in achieving high recanalization rates for large vessel occlusion, functional independence post-treatment remains suboptimal. The current limitations of MT prompt evaluation of the role of adjunctive pharmacologic neuroprotective therapies to prevent excitotoxicity, cellular apoptosis, and inflammation that cause irreversible neuronal damage during AIS. Magnesium (MgSO₄) provides an attractive neuroprotectant profile, having many different effects, and is inexpensive, readily available, and has a long-established safety and tolerability profile in the management of myocardial infarction and eclampsia.</div></div><div><h3>Observations</h3><div>This gap between technical success and patient outcomes is largely due to the inability to fully protect brain tissue from infarction during ischemia. MgSO₄ has shown promise in preclinical studies for its neuroprotective properties, including blocking NMDA receptors, increasing cerebral blood flow, and stabilizing ion channels. However, clinical trials, such as FAST-MAG and IMAGES, failed to demonstrate significant benefits when MgSO₄ was administered intravenously, due to delayed drug administration or delivery to target tissue. These trials highlighted the need for faster, more targeted drug delivery. Intra-arterial (IA) administration of MgSO₄ via the catheter used in MT could address these limitations by delivering high doses directly to ischemic brain tissue, potentially enhancing neuroprotection while reducing systemic exposure. Preclinical studies and some clinical trials have demonstrated the safety and feasibility of IA, but not IA MgSO₄. Further investigation is needed to assess its efficacy.</div></div><div><h3>Conclusions</h3><div>While past trials have not succeeded, IA administration of neuroprotective agents like MgSO₄ may improve functional outcomes in stroke patients post-MT. Ongoing and future studies will determine if this approach can effectively complement reperfusion strategies, potentially ushering in a new era of stroke care.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108188"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral collateral flow state in acute ischemic stroke correlates with clinical functional outcomes in non-thrombectomy patients","authors":"Smit Shah MD,&nbsp;Stefanie Wood BS,&nbsp;Lawson Logue BS,&nbsp;Jaclyn Meyer BS,&nbsp;Karly Pikel BS,&nbsp;Matthew Germroth BS,&nbsp;Gowri Peethamber MD,&nbsp;Nishanth Kodumuri MD,&nbsp;Forrest Justin Lowe MD,&nbsp;Ravish Kothari MD,&nbsp;Line Rahman MD,&nbsp;Swamy Venkatesh MD, DM,&nbsp;Souvik Sen MD, MS, MPH","doi":"10.1016/j.jstrokecerebrovasdis.2024.108211","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108211","url":null,"abstract":"<div><h3>Introduction</h3><div>Hypoperfusion index ratio (HIR) measured by computerized tomography perfusion (CTP) has been shown to predict collateral flow state in acute ischemic stroke (AIS). Low HIR (&lt;0.4) is indicative of good collateral flow state. This study tested the association between good collateral flow state and stroke severity and clinical outcome at discharge.</div></div><div><h3>Methods</h3><div>Data from AIS patients who underwent CTP during initial stroke evaluation were linked with Get With the Guideline database between 2018 and 2020. Patients with good collateral flow (HIR &lt; 0.4) were compared to those with poor collateral flow (≥0.4). They were stratified based on modified Rankin Score (mRS) at discharge into good (mRS 0-2) or poor (mRS 3-6) outcomes. A collateral score of 0-3 was assigned using CTA's obtained at the time of AIS presentation. We used univariate and multivariable logistic regression analyses to test the association between good collateral flow state and good discharge outcome.</div></div><div><h3>Results</h3><div>CT perfusion data was obtained in 1442 patients. After exclusions, 391 patients (age 69 ± 14, 54% male, 48% white, 52% black/others) remained, of whom 295 (75%) demonstrated good collateral flow and 96 (25%) showed poor collateral flow. Those with good collateral flow were younger (69 ± 14 vs. 71 ± 15, p = 0.25) and lower median NIHSS [7 (25-75%ile 3-13) vs. 14 (25-75%ile 8-20), p &lt; 0.001]. CTA collateral scores demonstrated a significant inverse correlation to HIR. Good collateral flow was associated with good outcome on discharge (OR 2.7, 95% CI 1.4-5.1). The association remained significant after adjustment for demographics and comorbidities (adjusted OR 3.2 (1.7-6.4).</div></div><div><h3>Conclusions</h3><div>In patients presenting with AIS who were non-thrombectomy candidates, good collateral flow state measured by HIR on CTP was associated with good functional outcome at discharge after adjustment for comorbidities.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108211"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential outcomes and treatment in non-traumatic carotid versus vertebral cervical artery dissection: A national inpatient sample study","authors":"Elizabeth Lee ,&nbsp;Liqi Shu MD ,&nbsp;Setareh Salehi Omran MD ,&nbsp;Eric D. Goldstein MD ,&nbsp;Nils Henninger MD, PhD, Dr. Med ,&nbsp;Thanh N. Nguyen MD FRCP FSVIN FAHA ,&nbsp;James E. Siegler MD ,&nbsp;Lukas Strelecky ,&nbsp;Farhan Khan MD ,&nbsp;Christoph Stretz MD FAAN ,&nbsp;Karen L. Furie MD MPH ,&nbsp;Shadi Yaghi MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108170","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108170","url":null,"abstract":"<div><h3>Introduction</h3><div>Cervical artery dissection (CAD) involves the carotid or vertebral artery. However, limited studies have compared their clinical features and outcomes.</div></div><div><h3>Methods</h3><div>We examined non-traumatic CAD patients from the National Inpatient Sample (2005-2019). Those diagnosed with both carotid and vertebral artery dissections were excluded. The evaluation included patient demographics, comorbidities, and treatment. Differences between carotid and vertebral dissections were assessed using survey-weighted stepwise backward logistic regression, followed by adjusted multivariable regressions for the primary outcomes of in-hospital mortality and routine discharge (to home or self-care).</div></div><div><h3>Results</h3><div>From 2005 to 2019, we included 123,224 non-traumatic CAD admissions without concurrent vertebral and carotid dissections. There were more carotid dissections than vertebral dissections (67,533 vs. 55,691). Compared to vertebral dissection, carotid dissection was associated with older age (54 [44-66] years vs. 49 [37-62] years, <em>P</em>&lt;0.001), Black race (12.6% vs. 8.8%, <em>P</em>&lt;0.001), White race (73.5% vs. 72.0%, <em>P</em> = 0.024), atrial fibrillation (10.8% vs. 6.3%, <em>P</em>&lt;0.001), aortic dissection (7.7% vs. 0.3%, <em>P</em>&lt;0.001), and fewer concurrent acute ischemic strokes (AIS) (47.8% vs. 56.7%, <em>P</em>&lt;0.001).Within the concurrent AIS group, carotid CAD patients exhibited higher NIHSS (8 [2-17] vs. 2 [0-5], <em>P</em>&lt;0.001), an increased utilization of intravenous thrombolysis (6.7% vs. 2.7% <em>P</em>&lt;0.001), endovascular therapy (13.3% vs. 3.3%, <em>P</em>&lt;0.001), and angioplasties (9.8% vs. 0.3%, <em>P</em>&lt;0.001). Overall, carotid CAD was associated with more inpatient deaths (aOR 1.30, 95% CI 1.04-1.62, <em>P</em>=0.023) and less routine discharges (aOR 0.88, 95% CI 0.79-0.97, <em>P</em>=0.014) than vertebral CAD.</div></div><div><h3>Conclusion</h3><div>Our study underscores distinct comorbidity profiles and treatment patterns between non-traumatic carotid dissection and vertebral dissection groups. These findings advocate for tailored treatment strategies based on dissection type to optimize patient outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108170"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}