Pub Date : 2024-10-16DOI: 10.1016/j.jstrokecerebrovasdis.2024.108047
Arevik Abramyan MD, PhD , Gaurav Gupta MD , Sanjeev Sreenivasan MCh , Jonathan Lowenthal MD , Mena Samaan BA , Priyank Khandelwal MD , Srihari Sundararajan MD , Hai Sun MD , Emad Nourollah-Zadeh MD , Sudipta Roychowdhury MD
Objective
Carotid-cavernous fistulas (CCFs) are rare arteriovenous communications allowing blood to flow from the carotid artery into the cavernous sinus. Although currently coil and/or liquid embolization remain the preferred treatment methods for CCFs, flow diverters (FD) stents represent a viable alternative to traditional embolization techniques. This study explores both the technical aspects and rationale behind using FD stents as a stand-alone treatment approach for CCFs.
Methods
The study includes records of 7 patients with CCFs treated at two comprehensive stroke centers from 2019 to 2023. Patients treated with FD stenting in conjunction with coil and/or liquid embolization were excluded from the study.
Results
Five patients were diagnosed with direct CCFs and 2 patients with indirect CCFs. Six patients were treated with the Surpass Evolve FD stent and 1 patient with the Pipeline FD stent. DSA follow-up was performed for an average duration of 14.4 months following FD placement. Complete fistula obliteration with no residual shunting was observed in all patients. Furthermore, all patients experienced a complete resolution of symptoms following treatment.
Conclusions
The authors’ experiences suggest the efficacy and safety of FD stenting as a stand-alone treatment option for CCFs. Compared to embolization, FD stents can better preserve the parent vessel and promote healing with less associated mass effect. Despite being a retrospective self-assessment with a relatively small sample size, to the authors’ knowledge, this study represents the largest individual case series of patients with CCF treated with stand-alone FD stenting.
{"title":"Stand-alone transarterial flow diversion for treatment of carotid cavernous fistulas","authors":"Arevik Abramyan MD, PhD , Gaurav Gupta MD , Sanjeev Sreenivasan MCh , Jonathan Lowenthal MD , Mena Samaan BA , Priyank Khandelwal MD , Srihari Sundararajan MD , Hai Sun MD , Emad Nourollah-Zadeh MD , Sudipta Roychowdhury MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108047","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108047","url":null,"abstract":"<div><h3>Objective</h3><div>Carotid-cavernous fistulas (CCFs) are rare arteriovenous communications allowing blood to flow from the carotid artery into the cavernous sinus. Although currently coil and/or liquid embolization remain the preferred treatment methods for CCFs, flow diverters (FD) stents represent a viable alternative to traditional embolization techniques. This study explores both the technical aspects and rationale behind using FD stents as a stand-alone treatment approach for CCFs.</div></div><div><h3>Methods</h3><div>The study includes records of 7 patients with CCFs treated at two comprehensive stroke centers from 2019 to 2023. Patients treated with FD stenting in conjunction with coil and/or liquid embolization were excluded from the study.</div></div><div><h3>Results</h3><div>Five patients were diagnosed with direct CCFs and 2 patients with indirect CCFs. Six patients were treated with the Surpass Evolve FD stent and 1 patient with the Pipeline FD stent. DSA follow-up was performed for an average duration of 14.4 months following FD placement. Complete fistula obliteration with no residual shunting was observed in all patients. Furthermore, all patients experienced a complete resolution of symptoms following treatment.</div></div><div><h3>Conclusions</h3><div>The authors’ experiences suggest the efficacy and safety of FD stenting as a stand-alone treatment option for CCFs. Compared to embolization, FD stents can better preserve the parent vessel and promote healing with less associated mass effect. Despite being a retrospective self-assessment with a relatively small sample size, to the authors’ knowledge, this study represents the largest individual case series of patients with CCF treated with stand-alone FD stenting.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108047"},"PeriodicalIF":2.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480795","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}
Pub Date : 2024-10-16DOI: 10.1016/j.jstrokecerebrovasdis.2024.108092
Yanjin Huang Ph.D. , Jiachun You MSN(c) , Qi Wang MSN , Wen Wen Ph.D.(c) , Changrong Yuan Ph.D., FAAN
Background
Post-stroke depression (PSD) is the most prevalent neuropsychological disorder among stroke patients, affecting approximately one-third of stroke survivors at any one time after a stroke. We identified between-person associations between post-stroke depression trajectories across 3 timepoints and predictors affecting trajectory classification among stroke patients.
Methods
This is a prospective longitudinal study using a convenience sample of 119 participants from 2 tertiary hospitals from March 2022 to September 2022. Clinical assessments and data collection were performed at diagnosis (T1), 3 months (T2), and 6 months (T3) after diagnosis. The instruments were Demographic and Disease Information Sheet and PROMIS-Depression 8a. Data were analyzed using SPSS 27.0 for descriptive statistics, logistic regression, and the Mplus program for growth mixture model analysis.
Results
Two stroke survivors depression trajectory classes (Class 1, moderate level decreasing- [37.8 %], and Class 2, high level increasing- [62.2%]) were delineated. Class 1 experienced moderate depression post-stroke, with a smooth diminishing pattern at T2 and T3, while Class 2 had a higher baseline depressive score and a significant increase at T2 and T3. The best growth mixture model was Class 2 model (LMR, p=0.010, BLRT, p≤0.01, AIC=2611.934, BIC=2650.842, aBIC=2606.583, Entropy= 0.944). The logistic regression results revealed that Class 2 of depression trajectory had a significant association with a lower score on cognitive function (B=-5.29, 95%CI: -8.80, -1.78, p <0.05) compared with Class 1. The stroke type, marital status, and monthly income were predictors of the Class 2 depression trajectory group among stroke patients. Precisely, ischemic stroke is associated with lower risk of class 2 trajectory.
Conclusion
The trajectory of post-stroke depression changes over time. This research has the potential to serve as a foundation for the assessment of high-risk stroke patients, the development of precise management programs, the implementation of risk stratification, and the enhancement of prognosis.
{"title":"Trajectory and predictors of post-stroke depression among patients with newly diagnosed stroke: A prospective longitudinal study","authors":"Yanjin Huang Ph.D. , Jiachun You MSN(c) , Qi Wang MSN , Wen Wen Ph.D.(c) , Changrong Yuan Ph.D., FAAN","doi":"10.1016/j.jstrokecerebrovasdis.2024.108092","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108092","url":null,"abstract":"<div><h3>Background</h3><div>Post-stroke depression (PSD) is the most prevalent neuropsychological disorder among stroke patients, affecting approximately one-third of stroke survivors at any one time after a stroke. We identified between-person associations between post-stroke depression trajectories across 3 timepoints and predictors affecting trajectory classification among stroke patients.</div></div><div><h3>Methods</h3><div>This is a prospective longitudinal study using a convenience sample of 119 participants from 2 tertiary hospitals from March 2022 to September 2022. Clinical assessments and data collection were performed at diagnosis (T1), 3 months (T2), and 6 months (T3) after diagnosis. The instruments were Demographic and Disease Information Sheet and PROMIS-Depression 8a. Data were analyzed using SPSS 27.0 for descriptive statistics, logistic regression, and the Mplus program for growth mixture model analysis.</div></div><div><h3>Results</h3><div>Two stroke survivors depression trajectory classes (Class 1, moderate level decreasing- [37.8 %], and Class 2, high level increasing- [62.2%]) were delineated. Class 1 experienced moderate depression post-stroke, with a smooth diminishing pattern at T2 and T3, while Class 2 had a higher baseline depressive score and a significant increase at T2 and T3. The best growth mixture model was Class 2 model (LMR, <em>p</em>=0.010, BLRT, <em>p</em>≤0.01, AIC=2611.934, BIC=2650.842, aBIC=2606.583, Entropy= 0.944). The logistic regression results revealed that Class 2 of depression trajectory had a significant association with a lower score on cognitive function (B=-5.29, 95%CI: -8.80, -1.78, <em>p</em> <0.05) compared with Class 1. The stroke type, marital status, and monthly income were predictors of the Class 2 depression trajectory group among stroke patients. Precisely, ischemic stroke is associated with lower risk of class 2 trajectory.</div></div><div><h3>Conclusion</h3><div>The trajectory of post-stroke depression changes over time. This research has the potential to serve as a foundation for the assessment of high-risk stroke patients, the development of precise management programs, the implementation of risk stratification, and the enhancement of prognosis.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108092"},"PeriodicalIF":2.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480808","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}
Pub Date : 2024-10-15DOI: 10.1016/j.jstrokecerebrovasdis.2024.108091
Lauren E Mamer MD, PhD , Phillip A Scott MD, MBA
Objectives
Since the introduction of thrombolytics, stroke teams evolved to improve thrombolytic care delivery. The impact of the advent of endovascular therapy on the composition of acute stroke teams is unknown.
Materials and Methods
A two-part pilot-tested survey was deployed to site-Principal Investigators (PIs) of the 27 StrokeNet Regional Coordinating Centers (RCCs) regarding institutional acute stroke teams. Part A inquired about the participation of personnel in each type of stroke response. Part B identified stroke team physicians and the types of responses in which they participate to assess training background of stroke team members.
Results
Response rates for Part A and B were 66% and 48%, respectively. In Part A, 67% (12/18) of sites reported trainees always responded to ED stroke activations with significant autonomy. 44% (7/16) and 27% (4/15) of sites reported NP and PA response to ED stroke alerts, respectively, but with limited autonomy. In Part B, 124 physicians involved in ED stroke alerts were identified, the large majority of whom (79%, 95% CI: 71-85) were vascular neurology trained. The 39 (23%) stroke team members involved in endovascular therapy had the following training: 49% (34-64) neurosurgery, 28% (17-44) radiology, 18% (9-33) vascular neurology 5% (1-16) neurology.
Conclusions
We identified modest heterogeneity in the composition of acute stroke team members across StrokeNet RCCs. Individuals performing endovascular therapy had a variety of clinical specializations, reflecting the evolving multidisciplinary nature of interventional acute stroke care. At StrokeNet RCCs, teams have significant trainee involvement in both ED and inpatient acute stroke responses.
目的：自溶栓药物问世以来，卒中团队不断发展，以改善溶栓治疗服务。目前尚不清楚血管内治疗的出现对急性卒中团队组成的影响：向 27 个 StrokeNet 区域协调中心 (RCC) 的现场首席研究员 (PI) 发送了一份由两部分组成的试点调查，内容涉及机构急性卒中团队。A 部分调查人员参与各类卒中响应的情况。B 部分确定了卒中团队医生及其参与的应对类型，以评估卒中团队成员的培训背景：A 部分和 B 部分的回复率分别为 66% 和 48%。在 A 部分中，67%（12/18）的医疗点报告说，受训人员总是以极大的自主权对急诊室卒中启动做出响应。44%（7/16）和 27%（4/15）的医疗点报告 NP 和 PA 对急诊室卒中警报做出响应，但自主权有限。B 部分确定了 124 名参与 ED 卒中警报的医生，其中绝大多数 79% （95% CI：71-85）接受过血管神经科培训。参与血管内治疗的 39 名卒中团队成员（23%）接受过以下培训：49%（34-64）神经外科、28%（17-44）放射科、18%（9-33）血管神经科、5%（1-16）神经内科：我们发现，StrokeNet 区域协调中心的急性卒中团队成员组成存在一定的异质性。进行血管内治疗的人员具有不同的临床专业，这反映了急性卒中介入治疗的多学科性质在不断发展。在 StrokeNet 区域协调中心，团队中有大量受训人员参与急诊室和住院部的急性卒中救治。
{"title":"National assessment of clinicians participating in stroke treatment decisions at strokenet regional coordinating centers","authors":"Lauren E Mamer MD, PhD , Phillip A Scott MD, MBA","doi":"10.1016/j.jstrokecerebrovasdis.2024.108091","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108091","url":null,"abstract":"<div><h3>Objectives</h3><div>Since the introduction of thrombolytics, stroke teams evolved to improve thrombolytic care delivery. The impact of the advent of endovascular therapy on the composition of acute stroke teams is unknown.</div></div><div><h3>Materials and Methods</h3><div>A two-part pilot-tested survey was deployed to site-Principal Investigators (PIs) of the 27 StrokeNet Regional Coordinating Centers (RCCs) regarding institutional acute stroke teams. Part A inquired about the participation of personnel in each type of stroke response. Part B identified stroke team physicians and the types of responses in which they participate to assess training background of stroke team members.</div></div><div><h3>Results</h3><div>Response rates for Part A and B were 66% and 48%, respectively. In Part A, 67% (12/18) of sites reported trainees always responded to ED stroke activations with significant autonomy. 44% (7/16) and 27% (4/15) of sites reported NP and PA response to ED stroke alerts, respectively, but with limited autonomy. In Part B, 124 physicians involved in ED stroke alerts were identified, the large majority of whom (79%, 95% CI: 71-85) were vascular neurology trained. The 39 (23%) stroke team members involved in endovascular therapy had the following training: 49% (34-64) neurosurgery, 28% (17-44) radiology, 18% (9-33) vascular neurology 5% (1-16) neurology.</div></div><div><h3>Conclusions</h3><div>We identified modest heterogeneity in the composition of acute stroke team members across StrokeNet RCCs. Individuals performing endovascular therapy had a variety of clinical specializations, reflecting the evolving multidisciplinary nature of interventional acute stroke care. At StrokeNet RCCs, teams have significant trainee involvement in both ED and inpatient acute stroke responses.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108091"},"PeriodicalIF":2.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480794","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}
Pub Date : 2024-10-15DOI: 10.1016/j.jstrokecerebrovasdis.2024.108090
Braydon Dymm MD , Carmelo Graffagnino MD , Gabriel Torrealba Acosta MD , Matthew E Ehrlich MD, MPH , Lisa Monk MSN , Shreyansh Shah MBBS , Edwin Iversen PhD , Brad J Kolls MD, PhD , IMPROVE stroke consortium
Background
Oral anticoagulation (OAC) is a risk factor for intracerebral hemorrhage (ICH) which is an important source of disability and mortality. OAC-associated ICH (OAC-ICH) patients have worse outcomes as compared to ICH patients not on OAC, likely because of the associated larger stroke volumes, higher propensity to intraventricular hemorrhage, and a higher risk of rebleeding. Although current guidelines recommend that OAC should be reversed quickly, many health care systems have not developed a process for optimizing that aspect of care.
Methods
Through the IMPROVE Stroke Care Consortium, a group of nine Hub hospitals and their 57 regional community hospitals, a systems of care improvement project was implemented. Performance reviews identified best practices which were disseminated throughout all centers. We compared the median door-to-reversal (DTR) time before and after an institutional campaign to speed the process with a target time of 60 min.
Results
Over two years of the study, there were 6,699 ischemic strokes, 152 subarachnoid hemorrhages, and 889 intracerebral hemorrhages. During that time, 73 ICH patients received reversal agents emergently. The overall baseline median DTR time was 123 min (IQR 99, 361 minutes). By the end of the program, the median DTR time had trended down to 84 min (IQR 58.5, 151 min) which is a 31.7 % reduction of DTR from baseline, though times remained somewhat variable (p=0.08).
Conclusions
An integrated stroke systems of care approach was associated with a reduction in DTR times for patients presenting with acute ICH and concurrent use of anticoagulants despite lack of definitive guidelines around targets for OAC reversal times or operational guidance on protocols and agents.
{"title":"Improve time to anti-coagulation reversal for hemorrhagic strokes","authors":"Braydon Dymm MD , Carmelo Graffagnino MD , Gabriel Torrealba Acosta MD , Matthew E Ehrlich MD, MPH , Lisa Monk MSN , Shreyansh Shah MBBS , Edwin Iversen PhD , Brad J Kolls MD, PhD , IMPROVE stroke consortium","doi":"10.1016/j.jstrokecerebrovasdis.2024.108090","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108090","url":null,"abstract":"<div><h3>Background</h3><div>Oral anticoagulation (OAC) is a risk factor for intracerebral hemorrhage (ICH) which is an important source of disability and mortality. OAC-associated ICH (OAC-ICH) patients have worse outcomes as compared to ICH patients not on OAC, likely because of the associated larger stroke volumes, higher propensity to intraventricular hemorrhage, and a higher risk of rebleeding. Although current guidelines recommend that OAC should be reversed quickly, many health care systems have not developed a process for optimizing that aspect of care.</div></div><div><h3>Methods</h3><div>Through the IMPROVE Stroke Care Consortium, a group of nine Hub hospitals and their 57 regional community hospitals, a systems of care improvement project was implemented. Performance reviews identified best practices which were disseminated throughout all centers. We compared the median door-to-reversal (DTR) time before and after an institutional campaign to speed the process with a target time of 60 min.</div></div><div><h3>Results</h3><div>Over two years of the study, there were 6,699 ischemic strokes, 152 subarachnoid hemorrhages, and 889 intracerebral hemorrhages. During that time, 73 ICH patients received reversal agents emergently. The overall baseline median DTR time was 123 min (IQR 99, 361 minutes). By the end of the program, the median DTR time had trended down to 84 min (IQR 58.5, 151 min) which is a 31.7 % reduction of DTR from baseline, though times remained somewhat variable (p=0.08).</div></div><div><h3>Conclusions</h3><div>An integrated stroke systems of care approach was associated with a reduction in DTR times for patients presenting with acute ICH and concurrent use of anticoagulants despite lack of definitive guidelines around targets for OAC reversal times or operational guidance on protocols and agents.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108090"},"PeriodicalIF":2.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480811","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}
Symptomatic carotid web is an increasingly recognized cause of acute ischemic stroke with a high risk of recurrent ischemic events despite aggressive medical interventions. Surgical interventions including transfemoral carotid artery stenting (TFCAS) and carotid endarterectomy have been described to reduce this risk, but transcarotid arterial revascularization (TCAR) has not been evaluated for this purpose.
Materials and methods
Patients with cerebral ischemia from carotid web underwent TCAR with flow reversal. Patients were monitored for periprocedural complications and assessed at follow-up for clinical evidence of recurrent ischemia.
Results
Six cases over the course of 21 months were identified, 2 males and 4 females with a median age of 59.5 (interquartile range of 39). All underwent technically successful TCAR without periprocedural complications no post-procedural cerebral ischemia over a median follow-up time of 21 months.
Conclusions
In this small series of patients, TCAR provided a safe and effective treatment of carotid webs that had previously caused cerebral ischemia.
{"title":"Transcarotid arterial revascularization for symptomatic carotid web","authors":"Cameron Ayala BS , Patrick Barhouse BS , Radmehr Torabi MD , Joshua Feler MD, MS , Curtis Doberstein MD , Krisztina Moldovan MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108089","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108089","url":null,"abstract":"<div><h3>Objectives</h3><div>Symptomatic carotid web is an increasingly recognized cause of acute ischemic stroke with a high risk of recurrent ischemic events despite aggressive medical interventions. Surgical interventions including transfemoral carotid artery stenting (TFCAS) and carotid endarterectomy have been described to reduce this risk, but transcarotid arterial revascularization (TCAR) has not been evaluated for this purpose.</div></div><div><h3>Materials and methods</h3><div>Patients with cerebral ischemia from carotid web underwent TCAR with flow reversal. Patients were monitored for periprocedural complications and assessed at follow-up for clinical evidence of recurrent ischemia.</div></div><div><h3>Results</h3><div>Six cases over the course of 21 months were identified, 2 males and 4 females with a median age of 59.5 (interquartile range of 39). All underwent technically successful TCAR without periprocedural complications no post-procedural cerebral ischemia over a median follow-up time of 21 months.</div></div><div><h3>Conclusions</h3><div>In this small series of patients, TCAR provided a safe and effective treatment of carotid webs that had previously caused cerebral ischemia.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108089"},"PeriodicalIF":2.0,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480814","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}
Pub Date : 2024-10-12DOI: 10.1016/j.jstrokecerebrovasdis.2024.108087
Mellanie V. Springer MD, MS , Bingxin Chen MA , Rachael T. Whitney PhD , Emily M. Briceño PhD , Alden L. Gross PhD , Hugo J. Aparicio MD, MPH , Alexa S. Beiser PhD , James F. Burke MD, MS , Bruno Giordani PhD , Rebecca F. Gottesman MD, PhD , Rodney A. Hayward MD , Virginia J. Howard PhD , Silvia Koton PhD, RN , Ronald M. Lazar PhD , Jeremy B. Sussman MD, MS , Wen Ye PhD , Deborah A. Levine MD, MPH
Objective
To compare changes in cognitive trajectories after stroke between younger (18-64) and older (65+) adults, accounting for pre-stroke cognitive trajectories.
Materials and methods
Pooled cohort study using individual participant data from 3 US cohorts (1971-2019), the Atherosclerosis Risk In Communities Study (ARIC), Framingham Offspring Study (FOS), and REasons for Geographic And Racial Differences in Stroke Study (REGARDS). Linear mixed effect models evaluated the association between age and the initial change (intercept) and rate of change (slope) in cognition after compared to before stroke. Outcomes were global cognition (primary), memory and executive function.
Results
We included 1,292 participants with stroke; 197 younger (47.2 % female, 32.5 % Black race) and 1,095 older (50.2 % female, 46.4 % Black race). Median (IQR) age at stroke was 59.7 (56.6-61.7) (younger group) and 75.2 (70.5-80.2) years (older group). Compared to the young, older participants had greater declines in global cognition (-1.69 point [95 % CI, -2.82 to -0.55] greater), memory (-1.05 point [95 % CI, -1.92 to -0.17] greater), and executive function (-3.72 point [95 % CI, -5.23 to -2.21] greater) initially after stroke. Older age was associated with faster declines in global cognition (-0.18 points per year [95 % CI, -0.36 to -0.01] faster) and executive function (-0.16 [95 % CI, -0.26 to -0.06] points per year for every 10 years of higher age), but not memory (-0.006 [95 % CI, -0.15 to 0.14]), after compared to before stroke.
Conclusion
Older age was associated with greater post-stroke cognitive declines, accounting for differences in pre-stroke cognitive trajectories between the old and the young.
{"title":"Age differences in the change in cognition after stroke","authors":"Mellanie V. Springer MD, MS , Bingxin Chen MA , Rachael T. Whitney PhD , Emily M. Briceño PhD , Alden L. Gross PhD , Hugo J. Aparicio MD, MPH , Alexa S. Beiser PhD , James F. Burke MD, MS , Bruno Giordani PhD , Rebecca F. Gottesman MD, PhD , Rodney A. Hayward MD , Virginia J. Howard PhD , Silvia Koton PhD, RN , Ronald M. Lazar PhD , Jeremy B. Sussman MD, MS , Wen Ye PhD , Deborah A. Levine MD, MPH","doi":"10.1016/j.jstrokecerebrovasdis.2024.108087","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108087","url":null,"abstract":"<div><h3>Objective</h3><div>To compare changes in cognitive trajectories after stroke between younger (18-64) and older (65+) adults, accounting for pre-stroke cognitive trajectories.</div></div><div><h3>Materials and methods</h3><div>Pooled cohort study using individual participant data from 3 US cohorts (1971-2019), the Atherosclerosis Risk In Communities Study (ARIC), Framingham Offspring Study (FOS), and REasons for Geographic And Racial Differences in Stroke Study (REGARDS). Linear mixed effect models evaluated the association between age and the initial change (intercept) and rate of change (slope) in cognition after compared to before stroke. Outcomes were global cognition (primary), memory and executive function.</div></div><div><h3>Results</h3><div>We included 1,292 participants with stroke; 197 younger (47.2 % female, 32.5 % Black race) and 1,095 older (50.2 % female, 46.4 % Black race). Median (IQR) age at stroke was 59.7 (56.6-61.7) (younger group) and 75.2 (70.5-80.2) years (older group). Compared to the young, older participants had greater declines in global cognition (-1.69 point [95 % CI, -2.82 to -0.55] greater), memory (-1.05 point [95 % CI, -1.92 to -0.17] greater), and executive function (-3.72 point [95 % CI, -5.23 to -2.21] greater) initially after stroke. Older age was associated with faster declines in global cognition (-0.18 points per year [95 % CI, -0.36 to -0.01] faster) and executive function (-0.16 [95 % CI, -0.26 to -0.06] points per year for every 10 years of higher age), but not memory (-0.006 [95 % CI, -0.15 to 0.14]), after compared to before stroke.</div></div><div><h3>Conclusion</h3><div>Older age was associated with greater post-stroke cognitive declines, accounting for differences in pre-stroke cognitive trajectories between the old and the young.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108087"},"PeriodicalIF":2.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480810","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}
Pub Date : 2024-10-12DOI: 10.1016/j.jstrokecerebrovasdis.2024.108072
Emma M. Federico BS , Kate Carroll MD , Margaret McGrath MD , Melanie Walker MD , Isaac Stafstrom MD , Erica Skinner BS , Margot Maraghe BS , Michael R. Levitt MD
Background
Post-stroke seizure (PSS) increases morbidity and mortality after ischemic stroke, but a comprehensive understanding of its incidence and risk factors is lacking. We report the rate and risk factors of PSS at a single institution.
Methods
A retrospective cohort study of adult acute ischemic stroke patients between 2018 and 2022 at a comprehensive stroke center was conducted. Patients with a history of seizures, additional stroke during index admission, or death within 7 days of stroke onset were excluded. Early PSS was defined as a new seizure occurring ≤7 days after stroke onset, while late PSS occurred >7 days after stroke onset. Multivariable logistic regression and cox proportional hazard analysis was conducted.
Results
1211 participants met inclusion criteria. Patients were a mean age of 67.82 and were primarily male (58.7 %), white (72.6 %), and non-Hispanic (91.9 %). Incidence of PSS was 8.8 % (n = 106), of which 53.8 % (n = 57) were early and 46.2 % (n = 49) were late. Bivariate analysis identified younger age, diabetes, baseline National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early Computed Tomography Score ≤5, cortical involvement, and hemorrhagic transformation as significant in the development of PSS. Multivariable cox proportional hazard analysis identified cortical involvement (hazard ratio [HR]: 2.31, 95 % confidence interval [CI] [1,29, 4.14]), NIHSS ≥ 21 (HR: 1.82, 95 % CI [1.02, 3.22]),and younger age (HR: 0.97, 95 % CI [0.96, 0.98]) as significant PSS predictors.
Conclusion
PSS occurred in 8.8 % of patients presenting with ischemic stroke. Hemorrhagic transformation, cortical involvement, high NIHSS, and younger age were significant predictors of PSS.
{"title":"Incidence and risk factors of post-stroke seizure among ischemic stroke patients","authors":"Emma M. Federico BS , Kate Carroll MD , Margaret McGrath MD , Melanie Walker MD , Isaac Stafstrom MD , Erica Skinner BS , Margot Maraghe BS , Michael R. Levitt MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108072","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108072","url":null,"abstract":"<div><h3>Background</h3><div>Post-stroke seizure (PSS) increases morbidity and mortality after ischemic stroke, but a comprehensive understanding of its incidence and risk factors is lacking. We report the rate and risk factors of PSS at a single institution.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of adult acute ischemic stroke patients between 2018 and 2022 at a comprehensive stroke center was conducted. Patients with a history of seizures, additional stroke during index admission, or death within 7 days of stroke onset were excluded. Early PSS was defined as a new seizure occurring ≤7 days after stroke onset, while late PSS occurred >7 days after stroke onset. Multivariable logistic regression and cox proportional hazard analysis was conducted.</div></div><div><h3>Results</h3><div>1211 participants met inclusion criteria. Patients were a mean age of 67.82 and were primarily male (58.7 %), white (72.6 %), and non-Hispanic (91.9 %). Incidence of PSS was 8.8 % (<em>n</em> = 106), of which 53.8 % (<em>n</em> = 57) were early and 46.2 % (<em>n</em> = 49) were late. Bivariate analysis identified younger age, diabetes, baseline National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early Computed Tomography Score ≤5, cortical involvement, and hemorrhagic transformation as significant in the development of PSS. Multivariable cox proportional hazard analysis identified cortical involvement (hazard ratio [HR]: 2.31, 95 % confidence interval [CI] [1,29, 4.14]), NIHSS ≥ 21 (HR: 1.82, 95 % CI [1.02, 3.22]),and younger age (HR: 0.97, 95 % CI [0.96, 0.98]) as significant PSS predictors.</div></div><div><h3>Conclusion</h3><div>PSS occurred in 8.8 % of patients presenting with ischemic stroke. Hemorrhagic transformation, cortical involvement, high NIHSS, and younger age were significant predictors of PSS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108072"},"PeriodicalIF":2.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142446178","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}
Pub Date : 2024-10-12DOI: 10.1016/j.jstrokecerebrovasdis.2024.108069
Leonor Ribeiro Dias MD , João Pedro Ramalho Gonçalves BSc , Juliana Patrícia Figueiras Ferreira MSc , Luísa Fonseca MD , Goreti Moreira MD , Pedro Miguel Araújo Campos Castro MD, PhD
Introduction
Several biomarkers have proven prognostic value for acute ischemic stroke (AIS) patients. Red cell distribution width (RDW) has been associated with several diseases and all-cause mortality and suggested as an independent predictor of Ischemic Stroke severity and outcome. This study aimed to investigate RDW as an independent predictor of functional outcome and death in the 3 months following AIS.
Methods
Patients with AIS were divided in four groups according to the quartile of the RDW value at admission. Baseline characteristics of patients in each RDW quartile were compared by Chi-square or Kruskal-Wallis tests, as applicable. We prospectively analyzed the patients for functional outcome in the 3 months following the event. Functional outcome (dichotomized as independent [0-2] or dependent [>2] according to the modified Rankin Scale score) and 90-day mortality was compared between the 4 groups. To conduct this evaluation, univariable and multivariable binary logistic regression analysis for functional independence and mortality at 3 months was conducted, considering the variables previously identified as potential confounders.
Results
The study's final population was of 416 patients. The patients in higher RDW quartiles were older (p<0.001), had lower blood hemoglobin (p<0.001), higher C reactive protein levels (p=0.017), higher BNP values (p<0.001) and more frequently suffered from atrial fibrillation (p=0.015) and heart failure (p=0.004). Univariate analysis showed a negative association between RDW-Q4 and independence at 3 months (p=0.024), which wasn't verified in the multivariate analysis (p=0.871). Univariate analysis also identified a positive association between RDW-Q4 and 90-day mortality (p=0.049), which was not confirmed in the multivariate analysis (p=0.289).
Conclusions
When adjusted to potential confounders, RDW does not predict functional outcome or death in the 90 days after acute ischemic stroke.
{"title":"Red cell distribution width and outcome in acute ischemic stroke patients","authors":"Leonor Ribeiro Dias MD , João Pedro Ramalho Gonçalves BSc , Juliana Patrícia Figueiras Ferreira MSc , Luísa Fonseca MD , Goreti Moreira MD , Pedro Miguel Araújo Campos Castro MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108069","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108069","url":null,"abstract":"<div><h3>Introduction</h3><div>Several biomarkers have proven prognostic value for acute ischemic stroke (AIS) patients. Red cell distribution width (RDW) has been associated with several diseases and all-cause mortality and suggested as an independent predictor of Ischemic Stroke severity and outcome. This study aimed to investigate RDW as an independent predictor of functional outcome and death in the 3 months following AIS.</div></div><div><h3>Methods</h3><div>Patients with AIS were divided in four groups according to the quartile of the RDW value at admission. Baseline characteristics of patients in each RDW quartile were compared by Chi-square or Kruskal-Wallis tests, as applicable. We prospectively analyzed the patients for functional outcome in the 3 months following the event. Functional outcome (dichotomized as independent [0-2] or dependent [>2] according to the modified Rankin Scale score) and 90-day mortality was compared between the 4 groups. To conduct this evaluation, univariable and multivariable binary logistic regression analysis for functional independence and mortality at 3 months was conducted, considering the variables previously identified as potential confounders.</div></div><div><h3>Results</h3><div>The study's final population was of 416 patients. The patients in higher RDW quartiles were older (p<0.001), had lower blood hemoglobin (p<0.001), higher C reactive protein levels (p=0.017), higher BNP values (p<0.001) and more frequently suffered from atrial fibrillation (p=0.015) and heart failure (p=0.004). Univariate analysis showed a negative association between RDW-Q4 and independence at 3 months (p=0.024), which wasn't verified in the multivariate analysis (p=0.871). Univariate analysis also identified a positive association between RDW-Q4 and 90-day mortality (p=0.049), which was not confirmed in the multivariate analysis (p=0.289).</div></div><div><h3>Conclusions</h3><div>When adjusted to potential confounders, RDW does not predict functional outcome or death in the 90 days after acute ischemic stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108069"},"PeriodicalIF":2.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142446723","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}
Pub Date : 2024-10-11DOI: 10.1016/j.jstrokecerebrovasdis.2024.108025
Seemant Chaturvedi MD , Tanya N Turan MD , Jenifer H Voeks PhD , Maria Lopes-Virella MD , Jeffrey Goldstein MD , Philip A. Teal MD , Malcolm Foster MD , Virginia Howard PhD , James F. Meschia MD , Brajesh Lal MD , George Howard DrPH , Robert D. Brown Jr. MD , Thomas G. Brott MD
Background
Data from the Centers for Disease Control show that approximately one-quarter of adults have elevated triglyceride (TG) levels. Some clinical trials, but not all, have demonstrated that pharmacologic treatment of high TG levels in patients already on statin therapy reduces the rate of major vascular events such as myocardial infarction and stroke. We assessed the prevalence of elevated TG levels in patients with asymptomatic carotid stenosis (CS), and medical conditions associated with high TG.
Methods
Baseline lipid profiles from patients enrolled in the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST 2) were analyzed. to determine treatment eligibility for high TG levels using the criteria established by the REDUCE-IT trial (triglyceride levels ≥150 mg/dL with LDL managed by a statin to <100 mg/dL). Equally assessed was the percentage of patients who were using pharmacologic treatment for high TG levels at study entry. Demographic factors and baseline medical conditions associated with high (>150 mg/dl) TG values were also analyzed. Chi-square and t=tests were used to assess baseline factors and abnormal TG values.
Results
As of October 2023, of 2377 randomized CREST-2 patients, 2328 (98 %) (mean age 70.0 years, 63 % men) had baseline lipid profiles suitable for analysis. Among 1961 (84 %) patients who met REDUCE-IT criteria, analysis of lipid profiles revealed that 20.5 % of the patients were eligible for treatment of high triglycerides. Of the 1464 patients with fasting lipid profiles, 17.8 % were eligible for treatment. The median TG value was 205 (IQR 91) mg/dl in the total population. TG levels of 150 mg/dl or higher were strongly associated with hypertension, diabetes, obesity, high hemoglobin A1c, and reduced physical activity (all p<0.0001).
Conclusions
Elevated TG levels are strongly associated with diabetes, hypertension, obesity, and reduced physical activity. Further research is needed on whether treatment of elevated TG levels in patients with asymptomatic carotid stenosis confers benefit.
{"title":"Elevated triglycerides and treatment eligibility in patients with severe, asymptomatic carotid stenosis: CREST 2 Trials","authors":"Seemant Chaturvedi MD , Tanya N Turan MD , Jenifer H Voeks PhD , Maria Lopes-Virella MD , Jeffrey Goldstein MD , Philip A. Teal MD , Malcolm Foster MD , Virginia Howard PhD , James F. Meschia MD , Brajesh Lal MD , George Howard DrPH , Robert D. Brown Jr. MD , Thomas G. Brott MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108025","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108025","url":null,"abstract":"<div><h3>Background</h3><div>Data from the Centers for Disease Control show that approximately one-quarter of adults have elevated triglyceride (TG) levels. Some clinical trials, but not all, have demonstrated that pharmacologic treatment of high TG levels in patients already on statin therapy reduces the rate of major vascular events such as myocardial infarction and stroke. We assessed the prevalence of elevated TG levels in patients with asymptomatic carotid stenosis (CS), and medical conditions associated with high TG.</div></div><div><h3>Methods</h3><div>Baseline lipid profiles from patients enrolled in the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST 2) were analyzed. to determine treatment eligibility for high TG levels using the criteria established by the REDUCE-IT trial (triglyceride levels ≥150 mg/dL with LDL managed by a statin to <100 mg/dL). Equally assessed was the percentage of patients who were using pharmacologic treatment for high TG levels at study entry. Demographic factors and baseline medical conditions associated with high (>150 mg/dl) TG values were also analyzed. Chi-square and t=tests were used to assess baseline factors and abnormal TG values.</div></div><div><h3>Results</h3><div>As of October 2023, of 2377 randomized CREST-2 patients, 2328 (98 %) (mean age 70.0 years, 63 % men) had baseline lipid profiles suitable for analysis. Among 1961 (84 %) patients who met REDUCE-IT criteria, analysis of lipid profiles revealed that 20.5 % of the patients were eligible for treatment of high triglycerides. Of the 1464 patients with fasting lipid profiles, 17.8 % were eligible for treatment. The median TG value was 205 (IQR 91) mg/dl in the total population. TG levels of 150 mg/dl or higher were strongly associated with hypertension, diabetes, obesity, high hemoglobin A1c, and reduced physical activity (all p<0.0001).</div></div><div><h3>Conclusions</h3><div>Elevated TG levels are strongly associated with diabetes, hypertension, obesity, and reduced physical activity. Further research is needed on whether treatment of elevated TG levels in patients with asymptomatic carotid stenosis confers benefit.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108025"},"PeriodicalIF":2.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142446179","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}
Pub Date : 2024-10-11DOI: 10.1016/j.jstrokecerebrovasdis.2024.108081
Brent A. Williams PhD , James C. Blankenship MD , Stephen Voyce MD , Alexander R. Chang MD
Objectives
Over the last decade, direct oral anticoagulants (DOAC) have become preferred over warfarin for stroke prevention in atrial fibrillation (AF). The objectives of this study were to quantify the shift over time from warfarin to DOACs and parallel changes in ischemic and hemorrhagic stroke rates in AF.
Materials and methods
This community-based retrospective study was undertaken within a single integrated health care network from 2011 to 2021. Changes over time in warfarin and DOAC use were quantified by year, both overall and stratified by CHA2DS2-VASc score. Ischemic and hemorrhagic stroke rate changes over time were evaluated by Poisson regression. Stroke rates were evaluated in different time eras: 2011–2015 and 2016–2021.
Results
Among 31,978 AF patients followed an average of 5.5 years, any OAC use increased from 50.2 % (2011) to 59.4 % (2020) (p < 0.001). Warfarin use decreased from 49.3 % to 30.8 %, while DOAC use increased from 2.0 % to 30.8 % (both p < 0.001). In 2020, patients with CHA2DS2-VASc 0–1 and 2–5 were more likely to use DOACs than warfarin (18.6 % vs. 6.7 %; 33.0 % vs. 28.2 %), whereas in CHA2DS2-VASc 6–9 DOACs were used less frequently (30.0 % vs. 40.8 %). Ischemic stroke rates significantly increased by 19 % (95 % CI: 7 %, 32 %) from 2011 to 2015, but significantly decreased by 18 % (10 %, 26 %) from 2016 to 2021. Hemorrhagic stroke rates stabilized in 2016–2021 (+3 %; −18 %, 30 %) after increasing in 2011–2015 (+36 %; 4 %, 78 %).
Conclusion
Improvements in ischemic and hemorrhagic stroke rates coincided temporally with increased uptake of OACs and a shift toward increased uptake of DOACs relative to warfarin.
{"title":"Trends over time in oral anticoagulation and stroke rates in atrial fibrillation: A community-based study","authors":"Brent A. Williams PhD , James C. Blankenship MD , Stephen Voyce MD , Alexander R. Chang MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108081","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108081","url":null,"abstract":"<div><h3>Objectives</h3><div>Over the last decade, direct oral anticoagulants (DOAC) have become preferred over warfarin for stroke prevention in atrial fibrillation (AF). The objectives of this study were to quantify the shift over time from warfarin to DOACs and parallel changes in ischemic and hemorrhagic stroke rates in AF.</div></div><div><h3>Materials and methods</h3><div>This community-based retrospective study was undertaken within a single integrated health care network from 2011 to 2021. Changes over time in warfarin and DOAC use were quantified by year, both overall and stratified by CHA<sub>2</sub>DS<sub>2</sub>-VASc score. Ischemic and hemorrhagic stroke rate changes over time were evaluated by Poisson regression. Stroke rates were evaluated in different time eras: 2011–2015 and 2016–2021.</div></div><div><h3>Results</h3><div>Among 31,978 AF patients followed an average of 5.5 years, any OAC use increased from 50.2 % (2011) to 59.4 % (2020) (<em>p</em> < 0.001). Warfarin use decreased from 49.3 % to 30.8 %, while DOAC use increased from 2.0 % to 30.8 % (both <em>p <</em> 0.001). In 2020, patients with CHA<sub>2</sub>DS<sub>2</sub>-VASc 0–1 and 2–5 were more likely to use DOACs than warfarin (18.6 % vs. 6.7 %; 33.0 % vs. 28.2 %), whereas in CHA<sub>2</sub>DS<sub>2</sub>-VASc 6–9 DOACs were used less frequently (30.0 % vs. 40.8 %). Ischemic stroke rates significantly increased by 19 % (95 % CI: 7 %, 32 %) from 2011 to 2015, but significantly decreased by 18 % (10 %, 26 %) from 2016 to 2021. Hemorrhagic stroke rates stabilized in 2016–2021 (+3 %; −18 %, 30 %) after increasing in 2011–2015 (+36 %; 4 %, 78 %).</div></div><div><h3>Conclusion</h3><div>Improvements in ischemic and hemorrhagic stroke rates coincided temporally with increased uptake of OACs and a shift toward increased uptake of DOACs relative to warfarin.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108081"},"PeriodicalIF":2.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480809","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}
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