Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Navigating stroke care: Geospatial assessment of regional stroke center accessibility","authors":"Stephen Halada BS ,&nbsp;Kirsten MM Beyer PhD, MPH ,&nbsp;Yuhong Zhou PhD ,&nbsp;Benjamin W Weston MD, MPH","doi":"10.1016/j.jstrokecerebrovasdis.2024.108093","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108093","url":null,"abstract":"<div><h3>Introduction</h3><div>Reducing time between stroke onset and hospital intervention is crucial for positive outcomes in stroke patients. While EMS utilization decreases time to intervention, many US regions are not within timely proximity to an advanced-care-capable stroke center (ASC), defined as a comprehensive or thrombectomy-capable center. This study aims to utilize geographic methodology to identify regions in Wisconsin with both high stroke mortality and low physical accessibility to certified stroke centers (SCs), particularly ASCs.</div></div><div><h3>Methods</h3><div>Geocoded mortality records for stroke death between 2015 and 2020 were accessed from the Wisconsin Department of Health Services. Indirectly age-standardized mortality ratios (SMRs) were estimated continuously across Wisconsin using adaptive spatial filtering and mortality records at the census block group level; the surface was then averaged by census tract for tract level SMRs. Addresses for SC locations within Wisconsin and bordering states were collected, and drive times from Wisconsin census tract centroids to the nearest SC subtypes were estimated. Drive times and mortality ratios were evaluated at the tract level alongside Rural-Urban Commuting Area (RUCA) codes. Spatial error regression modeling was used to determine RUCA classifications with the highest stroke risk independent of accessibility to stroke centers.</div></div><div><h3>Results</h3><div>Approximately 50%, 68%, and 78% of Wisconsin residents resided within 30, 45, and 60 minutes of an ASC, respectively. Median drive time from census tract centroids to the nearest ASC were highest for rural tracts (<em>M=</em>90 minutes, <em>IQR=</em>68-115) compared to small-town (<em>M=</em>82 minutes, <em>IQR=</em>49-113), micropolitan (<em>M=</em>53 minutes, <em>IQR=</em>43-77), and metropolitan tracts (<em>M=</em>19 minutes, <em>IQR=</em>11-35; <em>p&lt;</em>0.001). Clusters of high stroke SMRs were found in urban centers as well as rural areas irrespective of county declinations. Spatial regression modeling suggested small-town census tracts had the highest SMR irrespective of physical accessibility to care and spatial correlation. In small-town census tracts &gt;45 minutes from the nearest ASC, the median stroke SMR was 1.12 (<em>IQR=</em>0.94-1.40) with 226,000 residents and 150 stroke deaths per year.</div></div><div><h3>Conclusion</h3><div>Small-town areas are associated with both long drive distance to ASC locations and high stroke mortality. Geographical analyses reveal apparent stroke care deserts and may inform strategic allocation of emergency medicine resources and coverage.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108093"},"PeriodicalIF":2.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512871","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":"Response to the Letter to the Editor: Prevalence of stroke in Bangladesh: a systematic review and meta-analysis","authors":"Tonmoy Alam Shuvo,&nbsp;Asma-Ul- Hosna,&nbsp;Kabir Hossain,&nbsp;Sorif Hossain","doi":"10.1016/j.jstrokecerebrovasdis.2024.108099","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108099","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108099"},"PeriodicalIF":2.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512873","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":"Study protocol for LOMCAD Trial: Effect of lomerizine hydrochloride to prevent recurrence of cerebral ischemic events in CADASIL patients","authors":"Toshiki Mizuno MD, PhD ,&nbsp;Tomoyuki Ohara MD, PhD ,&nbsp;Ikuko Mizuta MD, PhD ,&nbsp;Akari Naito MS ,&nbsp;Mitsuko Nakata PhD ,&nbsp;Aoi Uno-Kadowaki MS ,&nbsp;Yayoi Iwami BS ,&nbsp;Akiko Watanabe-Hosomi MD, PhD ,&nbsp;Hiraku Matsuura MD ,&nbsp;Daiki Fukunaga MD ,&nbsp;Toshiko Ito-Ihara MD, PhD ,&nbsp;Satoshi Teramukai PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108042","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108042","url":null,"abstract":"<div><h3>Objectives</h3><div>Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is one of the most common monogenic cerebral small vessel diseases. Our previous observational study suggested that lomerizine hydrochloride, a calcium channel blocker approved in Japan in 1999 for the prevention of migraine headaches, is also effective for preventing recurrent ischemic stroke in CADASIL patients. The aim of this study (LOMCAD trial) is to verify the efficacy of lomerizine hydrochloride.</div></div><div><h3>Materials and Methods</h3><div>This is a multicenter, prospective, single-arm trial, using a historical control for comparison. CADASIL patients with a history of two or more cerebral ischemic events within the last two years will be administered lomerizine hydrochloride (5-mg tablet twice daily) for 24 months. The primary endpoint is symptomatic cerebral ischemic events during the 24-month period. Using our historical data and Bayesian sample size calculation based on a prior predictive distribution, the planned sample size was determined as 20 subjects.</div></div><div><h3>Conclusion</h3><div>We have planned a clinical trial to verify the effectiveness of lomerizine hydrochloride as prophylaxis to prevent recurrent cerebral ischemic events in CADASIL patients.</div></div><div><h3>Registration</h3><div>The LOMCAD trial has been registered in the Japan Registry of Clinical Trials (jRCTs051220072, https://jrct.niph.go.jp/latest-detail/jRCTs051220072).</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108042"},"PeriodicalIF":2.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512874","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":"Relationship between socioeconomic status and stroke: An observational and network Mendelian randomization study","authors":"Ruijie Zhang ,&nbsp;Liyuan Han ,&nbsp;Shan Xu ,&nbsp;Guozhi Jiang ,&nbsp;Liyuan Pu ,&nbsp;Huina Liu","doi":"10.1016/j.jstrokecerebrovasdis.2024.108097","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108097","url":null,"abstract":"<div><h3>Background</h3><div>The relationship between socioeconomic status (SES) and stroke remains controversial, and the underlying mediator is unclear. This study aimed to assess the causal relationship of SES with stroke and its subtypes and to identify potential modifiable risk factors responsible for this relationship.</div></div><div><h3>Methods</h3><div>The study included 372,437 participants from the UK Biobank. Over an average period of 12.13 years, 6,457 individuals (2.7 %) were recorded as having experienced a stroke. Cox proportional hazards model was used to determine the relationship between SES (average annual household income before tax and age at the end of full-time education) and stroke, ischemic stroke, and hemorrhagic stroke. Two-sample Mendelian randomization (MR) was employed to assess the causal relationship between SES and stroke and its subtypes. Furthermore, network MR was utilized to evaluate the potential mediating role of modifiable risk factors for stroke in this causal relationship.</div></div><div><h3>Results</h3><div>After adjusting for factors such as sociodemographic characteristics, health behaviors, health status, and past medical history, participants in the second highest income group showed the lowest risk of stroke, with a hazard ratio (HR) of 0.780 (95 % confidence interval [CI]: 0.702–0.866), and for ischemic stroke, the HR was 0.701 (95 % CI: 0.618–0.795). Those who completed full-time education at the latest age group(&gt;18 years) had the lowest risk of stroke (HR: 0.906, 95 % CI: 0.830–0.988) and ischemic stroke (HR: 0.897, 95% CI: 0.811–0.992). MR analysis showed that higher income and education were both associated with a lower risk of stroke (income: inverse-variance-weighted odds ratio [OR_IVW] =0.796, 95 % CI: 0.675–0.940, education: OR_IVW = 0.631, 95 % CI: 0.557–0.716) and ischemic stroke (income: OR_IVW = 0.813, 95 % CI: 0.684–0.966, education: OR_IVW = 0.641, 95 % CI: 0.559–0.735). Additionally, hypertension had the highest mediating effect on this relationship. It accounted for 57.12 % of the effect of income on stroke, 51.24 % on ischemic stroke, and 27 % and 24 % for education.</div></div><div><h3>Conclusion</h3><div>Higher SES was associated with a lower risk of stroke and ischemic stroke, and hypertension had the highest mediating effect on this causal relationship. The results have significant public health implications, emphasizing the importance of early intervention to reduce the risk of stroke in low SES populations.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108097"},"PeriodicalIF":2.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512872","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":"Urinary Microalbumin predicts early neurological deterioration in acute ischemic stroke: A study based on etiological classification","authors":"Huan Huang ,&nbsp;Xuan-Fei Jiang,&nbsp;Xiang-Yan Yang,&nbsp;Ying Liu","doi":"10.1016/j.jstrokecerebrovasdis.2024.108044","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108044","url":null,"abstract":"<div><h3>Introduction</h3><div>To investigate the correlation between urinary microalbumin (U-Alb) levels and early neurological deterioration (END), as well as its predictive ability, in patients with acute ischemic stroke (AIS) under different etiological subtypes.</div></div><div><h3>Materials and methods</h3><div>We consecutively enrolled AIS patients within 72 h of onset, collecting relevant clinical characteristics and baseline laboratory data including U-Alb. END was defined as an increase of ≥4 points in NIHSS score within 72 h of onset, and TOAST criteria were used for stroke etiologic typing. Binary logistic regression analysis was employed to clarify the association between baseline U-Alb and the occurrence of END under different stroke etiological subtypes. ROC analysis was conducted to evaluate its predictive ability under different etiological subtypes.</div></div><div><h3>Results</h3><div>Finally, 615 patients were included, with 104 (16.9 %) developed END. Binary logistic regression analysis revealed that baseline U-Alb was independently associated with END occurrence (OR = 1.009, 95 % CI 1.002-1.016, <em>p</em> = 0.009). ROC analysis revealed that U-Alb had the best predictive ability for patients with small artery occlusion (AUC=0.707, <em>p</em> &lt; 0.001), followed by large artery atherosclerosis (AUC = 0.632, <em>p</em> = 0.006), with corresponding optimal diagnostic cutoff points of 31.11 and 25.71 mg/L, respectively. However, U-Alb was not an independent risk factor for END in cardioembolic stroke patients (OR = 1.011, 95 % CI 0.980-1.043, <em>p</em> = 0.478). MAU was associated with stroke progression(<em>p</em> = 0.023), and U-Alb was positively correlated with increased infarct volume (<em>r</em> = 0.516, <em>p</em> &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>U-Alb is closely associated with END in AIS patients, serving as a potential indicator for predicting END, especially among those with small artery occlusion mechanisms.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108044"},"PeriodicalIF":2.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512875","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":"Intraplaque hemorrhage volume in patients with carotid atherosclerosis: How informative is it?","authors":"Sujin Kim ,&nbsp;Somin Jeong ,&nbsp;Hyo Sung Kwak M.D., Ph.D. ,&nbsp;Dac Hong An Ngo M.D.","doi":"10.1016/j.jstrokecerebrovasdis.2024.108088","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108088","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Intraplaque hemorrhage (IPH) of carotid atherosclerosis is an important feature in complex lesions preceding acute stroke events. The current study aimed to determine the role played by IPH volume compared to that of carotid stenosis or maximal wall thickness in patients with carotid IPH.</div></div><div><h3>Materials and methods</h3><div>This retrospective study included 233 patients who presented with carotid IPH on vessel wall imaging (VWI). We divided the patients into symptomatic or asymptomatic groups based on territorial acute focal infarction. The IPH volume, degree of stenosis, and maximal wall thickness on VWI were analyzed.</div></div><div><h3>Results</h3><div>Of the 233 included patients with carotid IPH, 51 (21.9 %) patients showed initial clinical symptoms and positive territorial findings on diffusion-weighted imaging (DWI). Moreover, 154 (66.1 %) patients had low-grade stenosis below 50 % (n = 19: symptomatic groups). Overall, carotid IPH volume, degree of stenosis, and maximal wall thickness were all significantly higher in the symptomatic groups (<em>p</em> = 0.001). The degree of stenosis, in all patients and especially in those with high-grade stenosis above 50 %, was significantly correlated with territorial acute focal infarction on multivariate analysis (<em>p</em> &lt; 0.01). In patients with low-grade stenosis below 50 %, maximal wall thickness was associated with territorial acute focal infarction (<em>p</em> = 0.48).</div></div><div><h3>Conclusion</h3><div>Carotid IPH volume was a risk factor for territorial acute focal infarction. However, in patients with high-grade stenosis, the degree of stenosis was significantly linked to acute stroke. By contrast, in patients with low-grade stenosis, maximal wall thickness exhibited a significant association with acute stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108088"},"PeriodicalIF":2.0,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480793","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":"IL6 and WNK2 polymorphisms and prognosis in patients with intracerebral hemorrhage receiving edaravone","authors":"Yu-Peng Zhang ,&nbsp;Sai Wang ,&nbsp;Tian-Xing Yao ,&nbsp;Xue-Lun Zou ,&nbsp;Si Li ,&nbsp;Lei Chen ,&nbsp;Xiang-Bin Zhang ,&nbsp;Jun-You Chen ,&nbsp;Yi Zeng ,&nbsp;Le Zhang","doi":"10.1016/j.jstrokecerebrovasdis.2024.108095","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108095","url":null,"abstract":"<div><h3>Objective</h3><div>Edaravone is utilized in intra-cerebral hemorrhage (ICH) patients for years, while personalized variances were observed in clinic. To explore the precision medicine strategy for Edaravone, this study investigated the association between genetic polymorphisms and Edaravone efficacy in ICH patients.</div></div><div><h3>Methods</h3><div>We genotyped 7 SNPs in 4 potential genes, including <em>COL4A2, TNF, WNK2</em> and <em>IL6</em>, from the peripheral blood of 217 ICH patients with or without Edaravone utilizations. PLINK and SPSS were utilized for association tests, <em>Student's t</em> tests, <em>Mann-Whitney U</em> tests and <em>Chi-square</em> tests.</div></div><div><h3>Results</h3><div>Rs1800796 (C&gt;G) in <em>IL6</em> (OR: 0.41, 95 % CI: 0.18-0.94, <em>p</em>-value = 0.03) and rs16936752 (G&gt;T) in <em>WNK2</em> (OR: 0.28, 95 % CI: 0.09-0.88, <em>p</em>-value = 0.02) were found to be significantly associated with Edaravone efficacy. The association of rs1800796 and rs16936752 were found to be different in patients with or without smoking habit, alcohol drinking habit, hypertension history and hyperlipemia history were found to be different. Both of these two SNPs were found to be associated with the concentration of high-density lipoprotein cholesterol (HDL) in ICH patients.</div></div><div><h3>Conclusions</h3><div>The <em>IL6</em> rs1800796 and the <em>WNK2</em> rs16936752 could be useful biomarkers for prognosis prediction during Edaravone treatment. These SNPs should be considered in the personalized medicine strategy for Edaravone in the future.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108095"},"PeriodicalIF":2.0,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480792","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":"Enhancing stroke knowledge among youth: Insights from Stroke Busters","authors":"Clare Lambert MD ,&nbsp;Wayne Chang PhD ,&nbsp;Ranisha Parker MSN ,&nbsp;Kris Allen MHA, MBA, BSN, RN ,&nbsp;Lynn Stevens RN, BSN ,&nbsp;Justin Blood MSN, RN, CEN ,&nbsp;Karin Nystrom MSN, APRN ,&nbsp;Rachel Forman MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108078","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108078","url":null,"abstract":"<div><h3>Introduction</h3><div>Community stroke education has shown promising results with sustained stroke knowledge and behavioral changes; however less is known about the effects of targeted education towards youth. We developed an interactive educational program for high school students, Stroke Busters, that focuses on stroke prevention, recognizing warning signs, and the importance of seeking prompt care.</div></div><div><h3>Methods</h3><div>This is a prospective cohort study where students are offered a stroke education program, ‘Stroke Busters’, through the Yale Pathways to Science Program, a Science, Technology, Engineering and Math (STEM) pipeline program for high school students living near New Haven, Connecticut. Students filled out a stroke knowledge survey before, after, and 8-months-post program. Data from four separate sessions were collected (two 5-day programs and two 1-day programs) and scores were compared. Students who returned to help teach were also evaluated with an additional post-test.</div></div><div><h3>Results</h3><div>The average pre-program score was 36.9% and post-program was 62.5% (N=67, p&lt;0.001) across all sessions. Between sessions, scores were not significantly different. 8-month post-program scores (n=5) were not significantly different from immediate post-program scores. Students in the role of teaching-assistant had post-program scores of 85.7%.</div></div><div><h3>Discussion</h3><div>High school students who participated in Stroke Busters retained stroke knowledge for up to 8 months. The 1-day program showed similar results to the 5-day program, which suggests providing shorter programs to high school students may represent a more feasible opportunity for community stroke prevention. Additionally, including students in a teaching role is a promising way to increase enthusiasm and stroke knowledge for youth.</div></div><div><h3>Conclusion</h3><div>Stroke Busters was successfully able to educate high school youth about stroke and programs of both 1 and 5-day are equally effective.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108078"},"PeriodicalIF":2.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142446177","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":"Carotid artery stenting versus carotid endarterectomy for symptomatic or asymptomatic extracranial carotid stenosis: A national cohort study","authors":"Chayakrit Krittanawong MD, FACC ,&nbsp;Song Peng Ang MD ,&nbsp;Jonathan A Tangsrivimol MD ,&nbsp;Yusuf Kamran Qadeer MD ,&nbsp;Zhen Wang PhD ,&nbsp;Hafeez Ul Hassan Virk MD ,&nbsp;Umair Khalid MD ,&nbsp;Samin K Sharma MD ,&nbsp;Alan Dardik MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108094","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108094","url":null,"abstract":"<div><h3>Introduction</h3><div>Stroke is now the 5th leading cause of death in the United States, and carotid artery stenosis is the cause of about 20% to 25% of strokes. We hypothesized that CAS may be an alternative to CEA in both symptomatic and asymptomatic patients with carotid artery stenosis.</div></div><div><h3>Methods</h3><div>We evaluated the clinical characteristics, adverse events and mortality of patients with carotid artery stenosis comparing CEA vs. CAS using data from a national population-based cohort study from January 1, 2016, to December 30, 2020.</div></div><div><h3>Results</h3><div>We evaluated 374,875 patients with carotid stenosis, of whom 344,020 had asymptomatic carotid stenosis and 30,855 had symptomatic carotid stenosis. CAS was associated with higher mortality in both symptomatic and asymptomatic carotid stenosis, compared to CEA, with the trend slightly decreasing for both interventions from the years 2018-2020. CEA was associated with lower adverse events in both symptomatic and asymptomatic carotid stenosis, compared to CAS.</div></div><div><h3>Conclusions</h3><div>Our current data suggest a benefit of CEA over CAS for both symptomatic and asymptomatic carotid stenosis with lower complications, lower mortality and a higher rate of discharge. However, this is not a head-to-head comparison as it becomes selection bias for this procedure; therefore, further prospective head-to-head comparison between 2 groups in the same patient population is needed.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108094"},"PeriodicalIF":2.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480790","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":"Bilateral bow-hunter's stroke caused by sleeping in prone position: A case of recurrent posterior circulation infarction","authors":"Sawako Sakai MD,&nbsp;Masatoshi Kasuya MD,&nbsp;Yuki Kobayashi MD,&nbsp;Kazuya Nonaka MD,&nbsp;Masashi Suzuki MD,&nbsp;Akira Machida MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108075","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108075","url":null,"abstract":"<div><div>Objectives Bow hunter's stroke (BHS) is a condition characterized by temporary vertebrobasilar insufficiency caused by mechanical compression or occlusion of the vertebral artery when the head is rotated, leading to transient neurological symptoms such as dizziness, vertigo, nystagmus, dysarthria, and potentially stroke. Therefore, a situation in which the head remains rotated for an extended period is a significant risk factor for BHS.</div><div>Materials and Methods We present a case of a 25-year-old woman who experienced three recurrent cerebral infarctions in the posterior circulation area after sleeping in a prone position with her head rotated.</div><div>Results The first infarction occurred in the right thalamus, followed by bilateral cerebellar infarctions, and finally, an infarction in the left cerebellar hemisphere. Carotid Doppler ultrasonography revealed blood flow interruption in the left vertebral artery due to head rotation, and digital subtraction angiography showed that rotation of the head to one side resulted in blood flow disruption of the contralateral vertebral artery in both right and left rotation. A C1-2 posterior fixation surgery was performed to stabilize the atlas and axis using screws and rods, with no recurrence observed thereafter.</div><div>Conclusions When encountering a young patient with recurrent posterior circulation infarctions upon awakening, it is crucial to inquire about the patient's sleeping position, such as prone positioning, to assess for potential vertebral artery stenosis or occlusion due to head rotation.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108075"},"PeriodicalIF":2.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480789","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}