{"title":"Letter to the Editor Regarding “Investigating the role of gut microbiota in hemorrhagic stroke: Evidence from causal analysis”","authors":"Rizwan Ahmad MBBS , Saad Khan MBBS , Ayesha Khan MBBS , Faraz Arshad MBBS , Fatima Naveed MBBS","doi":"10.1016/j.jstrokecerebrovasdis.2024.108184","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108184","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108184"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803385","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 : 2025-02-01DOI: 10.1016/j.jstrokecerebrovasdis.2024.108193
Bi Deng MD , Zeyu Liu MD , Qin Huang MD , Xianjing Feng MD , Di Liao MD , Fang Yu MD , Jie Feng MD , Qing Huang MD , Yunhai Liu MD , Jian Xia MD
Objectives
The conicity index (CI), an anthropometric parameter of visceral obesity, has exhibited a strong correlation with the incidence of atherosclerosis and cardiovascular events. This study aimed to explore the relationship between CI and carotid plaque instability, as well as the potential differences between sexes in this context.
Methods
Our cross-sectional study included a total of 44,248 participants from the China Stroke High-risk Population Screening and Intervention Program (CSHPSIP), all of whom underwent carotid ultrasound for the evaluation of carotid plaque. Multivariate logistics regression analysis and restricted cubic spline (RCS) curves were employed to examine the association between CI and the prevalence of carotid plaques and unstable plaques. A subgroup analysis was conducted to account for potential confounding variables.
Results
Patients belonging to the higher CI quartiles had a greater prevalence of carotid plaque and unstable carotid plaque. After adjusting for confounding factors, each standard deviation (SD) increase in CI was associated with an odds ratio (OR) of 1.06 (95% confidence interval: 1.03–1.08) for carotid plaque and 1.03 (95% confidence interval: 1.00–1.05) for unstable carotid plaque. The RCS analysis revealed an escalating trend in the prevalence of unstable carotid plaque with increasing CI values. However, this observed trend was not evident among female participants. Furthermore, subgroup analysis revealed a more pronounced correlation between CI and carotid plaque instability in individuals with a fasting blood glucose (FBG) of ≥ 7 mmol/L and an unhealthy lifestyle characterized by physical inactivity and current smoking.
Conclusions
Our findings demonstrated that CI was significantly associated with carotid plaque and recommend CI as a promising indicator for the initial screening of atherosclerotic plaques in the future.
{"title":"Conicity index and sex differences in relation to carotid plaque instability in Chinese community residents","authors":"Bi Deng MD , Zeyu Liu MD , Qin Huang MD , Xianjing Feng MD , Di Liao MD , Fang Yu MD , Jie Feng MD , Qing Huang MD , Yunhai Liu MD , Jian Xia MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108193","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108193","url":null,"abstract":"<div><h3>Objectives</h3><div>The conicity index (CI), an anthropometric parameter of visceral obesity, has exhibited a strong correlation with the incidence of atherosclerosis and cardiovascular events. This study aimed to explore the relationship between CI and carotid plaque instability, as well as the potential differences between sexes in this context.</div></div><div><h3>Methods</h3><div>Our cross-sectional study included a total of 44,248 participants from the China Stroke High-risk Population Screening and Intervention Program (CSHPSIP), all of whom underwent carotid ultrasound for the evaluation of carotid plaque. Multivariate logistics regression analysis and restricted cubic spline (RCS) curves were employed to examine the association between CI and the prevalence of carotid plaques and unstable plaques. A subgroup analysis was conducted to account for potential confounding variables.</div></div><div><h3>Results</h3><div>Patients belonging to the higher CI quartiles had a greater prevalence of carotid plaque and unstable carotid plaque. After adjusting for confounding factors, each standard deviation (SD) increase in CI was associated with an odds ratio (OR) of 1.06 (95% confidence interval: 1.03–1.08) for carotid plaque and 1.03 (95% confidence interval: 1.00–1.05) for unstable carotid plaque. The RCS analysis revealed an escalating trend in the prevalence of unstable carotid plaque with increasing CI values. However, this observed trend was not evident among female participants. Furthermore, subgroup analysis revealed a more pronounced correlation between CI and carotid plaque instability in individuals with a fasting blood glucose (FBG) of ≥ 7 mmol/L and an unhealthy lifestyle characterized by physical inactivity and current smoking.</div></div><div><h3>Conclusions</h3><div>Our findings demonstrated that CI was significantly associated with carotid plaque and recommend CI as a promising indicator for the initial screening of atherosclerotic plaques in the future.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108193"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824679","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 : 2025-02-01DOI: 10.1016/j.jstrokecerebrovasdis.2024.108203
Jae-Chan Ryu MD , Sang-Hun Lee MD, PhD
Background
Malignant middle cerebral artery (MCA) infarction is one of the most devastating strokes. However, the role of the cerebral venous outflow pattern in malignant MCA infarction is not well established. We investigated the association between the transverse sinus (TS) shape and functional outcomes in patients with malignant MCA infarction.
Methods
This retrospective cohort study included patients with malignant MCA infarction. Baseline characteristics, clinical variables, and cerebral venous outflow patterns (TS shape) were obtained. Incomplete TS shapes are referred to as unilateral TS hypoplasia, TS aplasia, or TS occlusion. We analyzed the effect of an incomplete TS shape on functional outcomes after malignant MCA infarction. The main outcome assessed was the change in ordinal shifts within the modified Rankin Scale score, indicating a deterioration in the outcome at three months.
Results
Among 71 patients with malignant MCA infarction, incomplete TS shapes were observed in 33 (46.5 %). There were no significant differences in the baseline characteristics, vascular risk factors, or factors associated with malignant MCA infarction. Patients with incomplete TS shapes had a higher proportion of unfavorable functional outcomes (5.0 [4.0–5.0] vs. 5.0 [5.0–6.0], P < 0.001). Multivariable ordinal logistic regression analysis showed that patients with incomplete TS shapes (odds ratio = 6.30, 95 % confidence interval = 2.42–17.90, P < 0.001) had a substantial shift towards the unfavorable functional outcome at 3 months.
Conclusions
Among patients diagnosed with malignant MCA infarction, those with incomplete TS shapes had poorer functional outcomes and higher mortality rates. This underscores the significant clinical association between cerebrovenous patterns and functional outcomes.
{"title":"Clinical implications of cerebral venous outflow pattern in malignant middle cerebral artery infarction","authors":"Jae-Chan Ryu MD , Sang-Hun Lee MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108203","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108203","url":null,"abstract":"<div><h3>Background</h3><div>Malignant middle cerebral artery (MCA) infarction is one of the most devastating strokes. However, the role of the cerebral venous outflow pattern in malignant MCA infarction is not well established. We investigated the association between the transverse sinus (TS) shape and functional outcomes in patients with malignant MCA infarction.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients with malignant MCA infarction. Baseline characteristics, clinical variables, and cerebral venous outflow patterns (TS shape) were obtained. Incomplete TS shapes are referred to as unilateral TS hypoplasia, TS aplasia, or TS occlusion. We analyzed the effect of an incomplete TS shape on functional outcomes after malignant MCA infarction. The main outcome assessed was the change in ordinal shifts within the modified Rankin Scale score, indicating a deterioration in the outcome at three months.</div></div><div><h3>Results</h3><div>Among 71 patients with malignant MCA infarction, incomplete TS shapes were observed in 33 (46.5 %). There were no significant differences in the baseline characteristics, vascular risk factors, or factors associated with malignant MCA infarction. Patients with incomplete TS shapes had a higher proportion of unfavorable functional outcomes (5.0 [4.0–5.0] vs. 5.0 [5.0–6.0], P < 0.001). Multivariable ordinal logistic regression analysis showed that patients with incomplete TS shapes (odds ratio = 6.30, 95 % confidence interval = 2.42–17.90, P < 0.001) had a substantial shift towards the unfavorable functional outcome at 3 months.</div></div><div><h3>Conclusions</h3><div>Among patients diagnosed with malignant MCA infarction, those with incomplete TS shapes had poorer functional outcomes and higher mortality rates. This underscores the significant clinical association between cerebrovenous patterns and functional outcomes.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108203"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866322","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 : 2025-02-01DOI: 10.1016/j.jstrokecerebrovasdis.2024.108213
Andy Lim , Grace Phillips , Warren Chan , Shams Albrefkany , Jeniffer Kim-Blackmore , Henry Ma , Thanh Phan
Background
Meta-analysis of clinical trials supports the use of early antithrombotic medication in ischemic stroke and transient ischemic attack. It is not known whether this therapy is delivered within the 85 % threshold that is acceptable in North America's Get With The Guidelines stroke program.
Aim
to investigate the pooled proportion of patients receiving antiplatelet therapy within 48 h of ischemic stroke.
Methods
PubMed to November 2022 was searched for studies reporting “stroke”, “audit”, “antithrombotic”, “national” and “registry”. Multilevel random effects meta-analysis was used to cluster studies by country.
Results
There were 45 studies describing 1,178,595 patients. The pooled proportion of patients receiving antithrombotic therapy within 48 h was 81.1 %, (95 % CI 74.5, 87.8, p < 0.0001, I2=99.99 %). The high heterogeneity was due to within-country (I2Level 3 = 55.4 %) and between-country heterogeneity (I2Level 2 = 44.6 %). There was no statistical significance (p = 0.35) between low- to middle- income countries (LMIC) – 81.8 %, (95 % CI 76.1, 87.4, p < 0.01, I2=100 %) and high-income countries (HIC) – 86.8 %, (95 % CI 81.2, 92.3, p < 0.01, I2=99.7 %) nor any difference between contemporary studies (2008 and later) – 86.5 %, (95 % CI 82.3, 90.8, p < 0.01, I2=100 %) – and studies published before 2008 – 69.9 %, (95 % CI 57.4, 82.4, p < 0.01, I2=99.7 %). Sensitivity analysis showed no difference when excluding single centre studies, observations with n < 500, or both. Meta-regression showed proportion of antiplatelet administration at 48 h to increase significantly with subsequent year of publication (β=0.01, 95 % CI 0.00, 0.02, p < 0.05).
Conclusion
Our key finding is that the majority of countries do not yet provide early antiplatelet therapy at a level acceptable by Get With The Guidelines hospitals.
背景：临床试验荟萃分析支持在缺血性卒中和短暂性缺血性发作中使用早期抗血栓药物。目前尚不清楚这种治疗是否在85%的阈值范围内，这在北美的Get With the Guidelines中风项目中是可以接受的。目的：探讨缺血性脑卒中患者在48小时内接受抗血小板治疗的合并比例。方法：检索PubMed至2022年11月报道“卒中”、“审计”、“抗血栓”、“国家”和“注册”的研究。采用多水平随机效应荟萃分析按国家对研究进行聚类。结果：共纳入45项研究，共1178595例患者。患者在48 h内接受抗栓治疗的合并比例为81.1%,（95% CI 74.5, 87.8, p < 0.0001, I2= 99.99%）。高异质性是由于国家内部（i2水平3 = 55.4%）和国家之间的异质性（i2水平2 = 44.6%）。没有统计学意义(p = 0.35)低收入到中等收入国家(LMIC) - 81.8% (95% CI 76.1, 87.4, p < 0.01, I2 = 100%)和高收入国家(嗝)- 86.8% (95% CI 81.2, 92.3, p < 0.01, I2 = 99.7%)也没有任何区别当代研究(2008年之后)——86.5% (95% CI 82.3, 90.8, p < 0.01, I2 = 100%) - 2008年以前发表研究报告,69.9% (95% CI 57.4, 82.4, p < 0.01, I2 = 99.7%)。当排除单中心研究、n < 500的观察值或两者时，敏感性分析显示无差异。meta回归显示，48 h抗血小板用药比例随发表年份的增加而显著增加（β=0.01, 95% CI 0.00, 0.02, p < 0.05）。结论：我们的主要发现是，大多数国家尚未提供早期抗血小板治疗，其水平尚未达到《指南》医院可接受的水平。
{"title":"Systematic review and meta-analysis of audits measuring antithrombotic therapy within forty-eight hours for ischemic stroke","authors":"Andy Lim , Grace Phillips , Warren Chan , Shams Albrefkany , Jeniffer Kim-Blackmore , Henry Ma , Thanh Phan","doi":"10.1016/j.jstrokecerebrovasdis.2024.108213","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108213","url":null,"abstract":"<div><h3>Background</h3><div>Meta-analysis of clinical trials supports the use of early antithrombotic medication in ischemic stroke and transient ischemic attack. It is not known whether this therapy is delivered within the 85 % threshold that is acceptable in North America's Get With The Guidelines stroke program.</div></div><div><h3>Aim</h3><div>to investigate the pooled proportion of patients receiving antiplatelet therapy within 48 h of ischemic stroke.</div></div><div><h3>Methods</h3><div>PubMed to November 2022 was searched for studies reporting “stroke”, “audit”, “antithrombotic”, “national” and “registry”. Multilevel random effects meta-analysis was used to cluster studies by country.</div></div><div><h3>Results</h3><div>There were 45 studies describing 1,178,595 patients. The pooled proportion of patients receiving antithrombotic therapy within 48 h was 81.1 %, (95 % CI 74.5, 87.8, <em>p</em> < 0.0001, I<sup>2</sup>=99.99 %). The high heterogeneity was due to within-country (I<sup>2</sup><sub>Level 3</sub> = 55.4 %) and between-country heterogeneity (I<sup>2</sup><sub>Level 2</sub> = 44.6 %). There was no statistical significance (<em>p</em> = 0.35) between low- to middle- income countries (LMIC) – 81.8 %, (95 % CI 76.1, 87.4, <em>p</em> < 0.01, I<sup>2</sup>=100 %) and high-income countries (HIC) – 86.8 %, (95 % CI 81.2, 92.3, <em>p</em> < 0.01, I<sup>2</sup>=99.7 %) nor any difference between contemporary studies (2008 and later) – 86.5 %, (95 % CI 82.3, 90.8, <em>p</em> < 0.01, I<sup>2</sup>=100 %) – and studies published before 2008 – 69.9 %, (95 % CI 57.4, 82.4, <em>p</em> < 0.01, I<sup>2</sup>=99.7 %). Sensitivity analysis showed no difference when excluding single centre studies, observations with <em>n</em> < 500, or both. Meta-regression showed proportion of antiplatelet administration at 48 h to increase significantly with subsequent year of publication (β=0.01, 95 % CI 0.00, 0.02, <em>p</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>Our key finding is that the majority of countries do not yet provide early antiplatelet therapy at a level acceptable by Get With The Guidelines hospitals.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108213"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900377","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 : 2025-02-01DOI: 10.1016/j.jstrokecerebrovasdis.2024.108220
Bo Yang , Yanni Wu , Manli Lu , Yongjun Cao , Zhigang Miao , Liuhui Chang , Hui Li , Xia Zhang
Objective
To comprehensively explore the prognostic significance of transthoracic echocardiography (TTE) and three-dimensional speckle-tracking echocardiography (3D STE) parameters in AIS and their role in distinguishing cardioembolic stroke.
Methods
301 acute ischemic stroke (AIS) patients were enrolled. TTE and 3D STE were employed to evaluate cardiac function and structure, also left atrial strain. Patients were categorized into two groups based on functional outcome at discharge and 3 months post-stroke, respectively. Models combining variables related to unfavorable outcome were established, and their predictive efficacy was assessed using receiver operating characteristic (ROC) curves. Additionally, AIS patients were stratified into cardioembolic and non-cardioembolic stroke groups. Logistic regression identified predictors for cardioembolic stroke, and ROC curves assessed their diagnostic performance.
Results
We found that a decrease in early diastolic peak velocity of the mitral valve (E value) was independently associated with adverse outcomes at both discharge (P = 0.014, OR = 0.126, 95% CI 0.024-0.657) and 3 months post-stroke in AIS patients (P = 0.004, OR = 0.054, 95% CI 0.007-0.403). Adding E value significantly improved predictive ability for adverse outcome at discharge and 3 months post-onset (0.807 vs. 0.794; 0.834 vs. 0.815). Moreover, left atrial diameter (LAD) [area under the curve (AUC) = 0.705] was the most valuable TTE parameter, and left atrial reservoir circumferential strain (LASr-c) (AUC = 0.766) was the most valuable STE parameter, even among all echocardiographic parameters for prediction of cardioembolic stroke.
Conclusions
This study indicates reduced E value was associated with unfavorable outcome at discharge and 3 months post-onset of AIS patients. LAD, especially LASr-c exhibited optimal diagnostic performance on cardioembolic stroke.
目的：全面探讨经胸超声心动图（TTE）和三维斑点跟踪超声心动图（3D STE）参数在AIS患者预后中的意义及其在心源性卒中中的鉴别作用。方法：301例急性缺血性脑卒中（AIS）患者入选。采用超声心动图（TTE）和三维超声心动图（3D STE）评价心脏功能和结构及左心房应变。根据出院时和脑卒中后3个月的功能结果将患者分为两组。建立与不良结果相关的变量组合模型，并使用受试者工作特征（ROC）曲线评估其预测效果。此外，AIS患者被分为心栓塞性和非心栓塞性卒中组。Logistic回归确定心栓塞性卒中的预测因子，ROC曲线评估其诊断效果。结果：我们发现，AIS患者在出院时（P = 0.014,OR = 0.126,95% CI 0.024-0.657）和脑卒中后3个月（P = 0.004,OR = 0.054,95% CI 0.007-0.403），二尖瓣早期舒张峰值速度（E值）的降低与不良结局独立相关。添加E值可显著提高出院时和发病后3个月不良结局的预测能力(0.807 vs 0.794；0.834 vs. 0.815)。此外，左心房内径（LAD）[曲线下面积（AUC） = 0.705]是最有价值的TTE参数，左心房储液池周围应变（LASr-c） （AUC = 0.766）是最有价值的STE参数，甚至在所有超声心动图参数中预测心栓塞性卒中。结论：本研究表明，E值降低与AIS患者出院时和发病后3个月的不良预后相关。LAD，尤其是LASr-c对心脏栓塞性卒中的诊断效果最佳。
{"title":"The prognostic and diagnostic significance of echocardiographic parameters on acute ischemic stroke","authors":"Bo Yang , Yanni Wu , Manli Lu , Yongjun Cao , Zhigang Miao , Liuhui Chang , Hui Li , Xia Zhang","doi":"10.1016/j.jstrokecerebrovasdis.2024.108220","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108220","url":null,"abstract":"<div><h3>Objective</h3><div>To comprehensively explore the prognostic significance of transthoracic echocardiography (TTE) and three-dimensional speckle-tracking echocardiography (3D STE) parameters in AIS and their role in distinguishing cardioembolic stroke.</div></div><div><h3>Methods</h3><div>301 acute ischemic stroke (AIS) patients were enrolled. TTE and 3D STE were employed to evaluate cardiac function and structure, also left atrial strain. Patients were categorized into two groups based on functional outcome at discharge and 3 months post-stroke, respectively. Models combining variables related to unfavorable outcome were established, and their predictive efficacy was assessed using receiver operating characteristic (ROC) curves. Additionally, AIS patients were stratified into cardioembolic and non-cardioembolic stroke groups. Logistic regression identified predictors for cardioembolic stroke, and ROC curves assessed their diagnostic performance.</div></div><div><h3>Results</h3><div>We found that a decrease in early diastolic peak velocity of the mitral valve (E value) was independently associated with adverse outcomes at both discharge (<em>P</em> = 0.014, OR = 0.126, 95% CI 0.024-0.657) and 3 months post-stroke in AIS patients (<em>P</em> = 0.004, OR = 0.054, 95% CI 0.007-0.403). Adding E value significantly improved predictive ability for adverse outcome at discharge and 3 months post-onset (0.807 vs. 0.794; 0.834 vs. 0.815). Moreover, left atrial diameter (LAD) [area under the curve (AUC) = 0.705] was the most valuable TTE parameter, and left atrial reservoir circumferential strain (LASr-c) (AUC = 0.766) was the most valuable STE parameter, even among all echocardiographic parameters for prediction of cardioembolic stroke.</div></div><div><h3>Conclusions</h3><div>This study indicates reduced E value was associated with unfavorable outcome at discharge and 3 months post-onset of AIS patients. LAD, especially LASr-c exhibited optimal diagnostic performance on cardioembolic stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108220"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928769","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 : 2025-02-01DOI: 10.1016/j.jstrokecerebrovasdis.2024.108190
FangFang Qian , XiaoHui Du , YouHua He
Background
Emerging evidence underscores a bidirectional relationship between ischemic stroke (IS) and inflammation, yet the causality of this association remains uncertain. We conducted a two-sample bidirectional Mendelian randomization (MR) study aimed at investigating the causal links between inflammation and IS.
Methods
Single nucleotide polymorphism from genome-wide association studies of 112 inflammatory cytokines and IS were chosen as instrumental variables. We evaluated the causal effects of inflammatory factors on IS outcomes and examined the mediating effects of risk factors for IS. Additionally, reverse MR analysis was conducted to determine whether the occurrence of IS influenced levels of inflammatory cytokines. Causal associations were assessed using inverse variance weighting, complemented by sensitivity analyses incorporating weighted median and MR-Egger methods.
Results
We found associations between genetically predicted plasma levels of 25 inflammatory factors and IS along with its subtypes. MR supports smoking, body mass index, atrial fibrillation, coronary artery disease, heart failure, systolic blood pressure, diastolic blood pressure and type 2 diabetes as risk factors for IS. Notably, coronary artery disease and heart failure seemed to mediate the RANTES, HGF, IL-5 associations with IS. In addition, reverse MR analysis suggested a causal relationship between IS and its subtypes and 19 inflammatory factors.
Conclusion
In summary, inflammation was suggestively causally associated with the risk of IS, and inflammatory cytokines had downstream effect on IS. Future studies should explore whether inflammatory factors found to have significant associations with IS risk could be manipulated to reduce IS risk, and the neuroinflammatory mechanisms after IS.
背景：新的证据强调了缺血性中风（IS）与炎症之间的双向关系，但这种关系的因果关系仍不确定。我们进行了一项双样本双向孟德尔随机化（MR）研究，旨在调查炎症与 IS 之间的因果关系：方法：从 112 种炎症细胞因子和 IS 的全基因组关联研究中选择单核苷酸多态性作为工具变量。我们评估了炎症因素对 IS 结果的因果效应，并研究了 IS 风险因素的中介效应。此外，我们还进行了反向 MR 分析，以确定 IS 的发生是否会影响炎性细胞因子的水平。使用反向方差加权法评估了因果关系，并结合加权中位数和 MR-Egger 方法进行了敏感性分析：结果：我们发现 25 种炎症因子的基因预测血浆水平与 IS 及其亚型之间存在关联。MR支持吸烟、体重指数、心房颤动、冠状动脉疾病、心力衰竭、收缩压、舒张压和2型糖尿病为IS的风险因素。值得注意的是，冠状动脉疾病和心力衰竭似乎介导了 RANTES、HGF、IL-5 与 IS 的关联。此外，反向 MR 分析表明，IS 及其亚型与 19 种炎症因素之间存在因果关系：总之，炎症与IS风险存在提示性因果关系，炎性细胞因子对IS有下游影响。未来的研究应探讨是否可以通过控制与 IS 风险有显著关联的炎症因子来降低 IS 风险，以及 IS 后的神经炎症机制。
{"title":"Causal association of inflammation with ischemic stroke and its subtypes: a bidirectional Mendelian randomization study","authors":"FangFang Qian , XiaoHui Du , YouHua He","doi":"10.1016/j.jstrokecerebrovasdis.2024.108190","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108190","url":null,"abstract":"<div><h3>Background</h3><div>Emerging evidence underscores a bidirectional relationship between ischemic stroke (IS) and inflammation, yet the causality of this association remains uncertain. We conducted a two-sample bidirectional Mendelian randomization (MR) study aimed at investigating the causal links between inflammation and IS.</div></div><div><h3>Methods</h3><div>Single nucleotide polymorphism from genome-wide association studies of 112 inflammatory cytokines and IS were chosen as instrumental variables. We evaluated the causal effects of inflammatory factors on IS outcomes and examined the mediating effects of risk factors for IS. Additionally, reverse MR analysis was conducted to determine whether the occurrence of IS influenced levels of inflammatory cytokines. Causal associations were assessed using inverse variance weighting, complemented by sensitivity analyses incorporating weighted median and MR-Egger methods.</div></div><div><h3>Results</h3><div>We found associations between genetically predicted plasma levels of 25 inflammatory factors and IS along with its subtypes. MR supports smoking, body mass index, atrial fibrillation, coronary artery disease, heart failure, systolic blood pressure, diastolic blood pressure and type 2 diabetes as risk factors for IS. Notably, coronary artery disease and heart failure seemed to mediate the RANTES, HGF, IL-5 associations with IS. In addition, reverse MR analysis suggested a causal relationship between IS and its subtypes and 19 inflammatory factors.</div></div><div><h3>Conclusion</h3><div>In summary, inflammation was suggestively causally associated with the risk of IS, and inflammatory cytokines had downstream effect on IS. Future studies should explore whether inflammatory factors found to have significant associations with IS risk could be manipulated to reduce IS risk, and the neuroinflammatory mechanisms after IS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108190"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830832","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 : 2025-02-01DOI: 10.1016/j.jstrokecerebrovasdis.2024.108219
Maria Pereira Coutinho , Sofia Galego , Marta Alves , Ana Papoila , Isabel Fragata , Ana Paiva Nunes
Background
The time frame for mechanical thrombectomy (MT) in acute ischemic stroke (AIS) is enlarging. Guidelines recommend MT until 6 h of symptom onset in M2 segment occlusions (grade IIB). In practice, it is frequently performed later.
Aims
To assess the functional prognosis of AIS patients subjected to M2 segment's MT beyond 6 h, compared to standard intervention.
Methods
Retrospective cohort study including all consecutive AIS patients subjected to MT of M2 occlusions between 1st January 2018 and 31st December 2020 in St Joseph's Local Health Unit, Lisbon, Portugal. Allocation to standard or extended groups was done according to the symptom-to-puncture time, whether within or beyond 6 h after symptom onset, respectively. The primary outcome was the modified Rankin Scale (mRS) at three months. Secondary outcomes were symptomatic intracranial hemorrhage (sICH) at 24 h and three-month mortality.
Results
We included 155 patients, 51.0 % men, median age 76.0 years (P25:69.0;P75:86.0), baseline mRS “0-2” in 84.5 %, mean NIHSS 13.6(6.5). Initial Computed Tomography showed early ischemic changes in 27.1 %. Most patients belonged to the standard group (71.0 %). Groups had similar baseline features. The standard group underwent more frequent (68.2 % vs 44.4 %, p = 0.006) and earlier (2 h02 min, 3 h02 min, p < 0.001) fibrinolysis. Symptom-to-puncture times were 7 h13 min (extended) and 4h01 min (standard), p < 0.001. Outcomes were similar between groups (three months’ mRS [p = 0.578]; sICH [p = 0.720]; three-month mortality [p = 0.422]).
Conclusions
Our study suggests similar outcomes in M2 occlusions performing MT before and beyond 6 h of symptom onset, consistent with previous studies. Patients might benefit from widening inclusion criteria for MT in AIS.
背景：急性缺血性卒中（AIS）机械取栓（MT）的时间框架正在扩大。指南建议在M2段闭塞症状出现6小时前进行MT治疗（IIB级）。在实践中，它经常在稍后执行。目的：与标准干预相比，评估M2段MT超过6小时后AIS患者的功能预后。方法：回顾性队列研究，包括2018年1月1日至2020年12月31日在葡萄牙里斯本圣约瑟夫地方卫生单位接受M2闭塞MT治疗的所有连续AIS患者。根据出现症状至穿刺时间，分别在症状出现后6小时内或6小时以上，将其分配到标准组或扩展组。3个月时的主要指标为改良Rankin量表（mRS）。次要结局是24小时症状性颅内出血（sICH）和3个月死亡率。结果：155例患者，男性51.0%，中位年龄76.0岁（P25:69.0;P75:86.0），基线mRS为0-2的占84.5%，平均NIHSS为13.6（6.5）。初始计算机断层扫描显示27.1%的患者有早期缺血性改变。大多数患者属于标准组（71.0%）。各组具有相似的基线特征。标准组更频繁（68.2% vs. 44.4%, p=0.006）且更早（2h02min, 3h02min, p）。结论：我们的研究表明，在症状出现前和6小时后M2闭塞行MT的结果相似，与先前的研究一致。扩大MT在AIS中的纳入标准可能会使患者受益。
{"title":"“Mechanical thrombectomy beyond 6 hours for acute ischemic strokes due to M2 occlusions”","authors":"Maria Pereira Coutinho , Sofia Galego , Marta Alves , Ana Papoila , Isabel Fragata , Ana Paiva Nunes","doi":"10.1016/j.jstrokecerebrovasdis.2024.108219","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108219","url":null,"abstract":"<div><h3>Background</h3><div>The time frame for mechanical thrombectomy (MT) in acute ischemic stroke (AIS) is enlarging. Guidelines recommend MT until 6 h of symptom onset in M2 segment occlusions (grade IIB). In practice, it is frequently performed later.</div></div><div><h3>Aims</h3><div>To assess the functional prognosis of AIS patients subjected to M2 segment's MT beyond 6 h, compared to standard intervention.</div></div><div><h3>Methods</h3><div>Retrospective cohort study including all consecutive AIS patients subjected to MT of M2 occlusions between 1st January 2018 and 31st December 2020 in St Joseph's Local Health Unit, Lisbon, Portugal. Allocation to standard or extended groups was done according to the symptom-to-puncture time, whether within or beyond 6 h after symptom onset, respectively. The primary outcome was the modified Rankin Scale (mRS) at three months. Secondary outcomes were symptomatic intracranial hemorrhage (sICH) at 24 h and three-month mortality.</div></div><div><h3>Results</h3><div>We included 155 patients, 51.0 % men, median age 76.0 years (P<sub>25</sub>:69.0;P<sub>75</sub>:86.0), baseline mRS “0-2” in 84.5 %, mean NIHSS 13.6(6.5). Initial Computed Tomography showed early ischemic changes in 27.1 %. Most patients belonged to the standard group (71.0 %). Groups had similar baseline features. The standard group underwent more frequent (68.2 % vs 44.4 %, <em>p</em> = 0.006) and earlier (2 h02 min, 3 h02 min, <em>p</em> < 0.001) fibrinolysis. Symptom-to-puncture times were 7 h13 min (extended) and 4h01 min (standard), <em>p</em> < 0.001. Outcomes were similar between groups (three months’ mRS [<em>p</em> = 0.578]; sICH [<em>p</em> = 0.720]; three-month mortality [<em>p</em> = 0.422]).</div></div><div><h3>Conclusions</h3><div>Our study suggests similar outcomes in M2 occlusions performing MT before and beyond 6 h of symptom onset, consistent with previous studies. Patients might benefit from widening inclusion criteria for MT in AIS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108219"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907918","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 : 2025-02-01DOI: 10.1016/j.jstrokecerebrovasdis.2024.108209
Liyan Fu , Qingxuan Xing , Xiaoqian Wang , Yaoyao Chen , Jingjing Kong , Jin Li , Baohong Yue
Background
The TyG index is an emerging low-cost and efficient indicator that is significantly associated with stroke. Multiple studies have confirmed the impact of the TyG index on cerebrovascular diseases. However, the role of indices combining TyG with different obesity factors, such as triglyceride glucose-waist-height ratio (TyG-WHtR) on stroke risk in obese individuals remains unclear. This study utilizes data from the National Health and Nutrition Examination Survey database between 1998 and 2018 to explore the relationship between stroke and the TyG-WHtR index in obese individuals.
Methods
This cross-sectional study analyzed data from 5767 obese individuals from the NHANES database between 1998 and 2018. Univariate and multivariate logistic regression analyses were used to study the association between TyG-WHtR and stroke, utilizing continuous variables or categorizing variables based on quartiles. Propensity score matching (PSM) and subgroup analysis stratifying characteristics of TyG-WHtR and stroke were further conducted to study their relationship. Additionally, restricted cubic spline (RCS) analysis was performed to examine the linear relationship between TyG-WHtR and stroke.
Results
A total of 5767 participants were included in the statistical analysis, comprising 227 stroke patients and 5540 non-stroke participants. Multivariable logistic regression analysis revealed a positive association between TyG-WHtR and stroke both before and after matching (P < 0.001), with statistically significant differences. Subgroup analysis indicated a statistically significant difference among non-Hispanic white individuals, and RCS analysis showed a non-linear relationship between TyG-WHtR and stroke before matching, but a linear relationship after matching.
Conclusion
In obese individuals, a higher TyG-WHtR index is positively associated with stroke risk.
{"title":"Exploring the association between the TyG-WHtR index and the incidence of stroke in the obese population: based on NHANES data from 1998 to 2018","authors":"Liyan Fu , Qingxuan Xing , Xiaoqian Wang , Yaoyao Chen , Jingjing Kong , Jin Li , Baohong Yue","doi":"10.1016/j.jstrokecerebrovasdis.2024.108209","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108209","url":null,"abstract":"<div><h3>Background</h3><div>The TyG index is an emerging low-cost and efficient indicator that is significantly associated with stroke. Multiple studies have confirmed the impact of the TyG index on cerebrovascular diseases. However, the role of indices combining TyG with different obesity factors, such as triglyceride glucose-waist-height ratio (TyG-WHtR) on stroke risk in obese individuals remains unclear. This study utilizes data from the National Health and Nutrition Examination Survey database between 1998 and 2018 to explore the relationship between stroke and the TyG-WHtR index in obese individuals.</div></div><div><h3>Methods</h3><div>This cross-sectional study analyzed data from 5767 obese individuals from the NHANES database between 1998 and 2018. Univariate and multivariate logistic regression analyses were used to study the association between TyG-WHtR and stroke, utilizing continuous variables or categorizing variables based on quartiles. Propensity score matching (PSM) and subgroup analysis stratifying characteristics of TyG-WHtR and stroke were further conducted to study their relationship. Additionally, restricted cubic spline (RCS) analysis was performed to examine the linear relationship between TyG-WHtR and stroke.</div></div><div><h3>Results</h3><div>A total of 5767 participants were included in the statistical analysis, comprising 227 stroke patients and 5540 non-stroke participants. Multivariable logistic regression analysis revealed a positive association between TyG-WHtR and stroke both before and after matching (<em>P</em> < 0.001), with statistically significant differences. Subgroup analysis indicated a statistically significant difference among non-Hispanic white individuals, and RCS analysis showed a non-linear relationship between TyG-WHtR and stroke before matching, but a linear relationship after matching.</div></div><div><h3>Conclusion</h3><div>In obese individuals, a higher TyG-WHtR index is positively associated with stroke risk.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108209"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878447","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 : 2025-02-01DOI: 10.1016/j.jstrokecerebrovasdis.2024.108210
Yang Liu , Lihua Wang , Kuang Fu , Xiaotong Kong , Wenhui Guo , Ning Wang , Xuesong Sun , Hanlu Cai , Yan Yu , Zhaobo Zhang , Xingbang Zou , Ying Cao , Doudou Luo , Peifang Liu
Introduction
Branch atheromatous disease (BAD) is prone to early neurological deterioration (END), leading to a poor prognosis. The most common arteries causing END are the lenticulostriate arteries (LSA) and the paramedian pontine arteries (PPA). To gain insight into the characteristics of symptomatic plaques and their association with poor prognosis in patients with BAD, we conducted a prospective study using high-resolution magnetic resonance imaging (HRMRI).
Methods
A total of 75 patients with BAD in the vascular range of LSA or PPA were recruited for this study. The vascular and plaque features of the carrier middle cerebral artery (MCA) and basilar artery (BA) were evaluated through the application of HRMRI, and the local cerebral blood flow (CBF) of the lesion was assessed through pseudo-continuous arterial spin-labeling (pCASL), and the number and location of cerebral microbleeds (CMBs) were documented by susceptibility-weighted imaging (SWI). Univariable and multivariable logistic regression analyses were performed to analyze the factors that affected the prognosis.
Results
A poor prognosis was observed in 24 patients (32%) with BAD. A total of 28 patients (37%) developed END. Multifactorial analysis showed statistically significant differences in the dorsal plaque of BA (OR: 19.15, 95% CI 1.72–385.37, p=0.028), male (OR: 26.22, 95% CI 3.18–406.31, p=0.007), and NIHSS at 7 days of onset (OR: 2.24, 95% CI 1.4–4.45, p=0.004).
Conclusions
In patients with BAD in LSA and PPA areas, the dorsal plaque of BA, male, and NIHSS at 7 days of onset were independent risk factors for poor prognosis.
分支动脉粥样硬化性疾病（BAD）易发生早期神经功能恶化（END），预后较差。引起END最常见的动脉是透镜状纹状动脉（LSA）和旁脉桥动脉（PPA）。为了深入了解BAD患者症状性斑块的特征及其与不良预后的关系，我们使用高分辨率磁共振成像（HRMRI）进行了一项前瞻性研究。方法：本研究共招募75例LSA或PPA血管范围内的BAD患者。应用HRMRI评估载体大脑中动脉（MCA）和基底动脉（BA）的血管和斑块特征，通过伪连续动脉自旋标记（pCASL）评估病灶局部脑血流量（CBF），通过敏感性加权成像（SWI）记录脑微出血（CMBs）的数量和位置。采用单变量和多变量logistic回归分析影响预后的因素。结果：24例（32%）BAD预后较差。共有28例患者（37%）发生了END。多因素分析显示，发病第7天，BA （OR: 19.15, 95% CI 1.72-385.37, p=0.028）、男性（OR: 26.22, 95% CI 3.18-406.31, p=0.007）和NIHSS （OR: 2.24, 95% CI 1.4-4.45, p=0.004）的背侧斑块差异具有统计学意义。结论：在LSA和PPA区BAD患者中，发病第7天BA、男性和NIHSS的背侧斑块是预后不良的独立危险因素。
{"title":"Prognostic study of intracranial branch atheromatous disease in the blood-supplying areas of the lenticulostriate and paramedian pontine arteries","authors":"Yang Liu , Lihua Wang , Kuang Fu , Xiaotong Kong , Wenhui Guo , Ning Wang , Xuesong Sun , Hanlu Cai , Yan Yu , Zhaobo Zhang , Xingbang Zou , Ying Cao , Doudou Luo , Peifang Liu","doi":"10.1016/j.jstrokecerebrovasdis.2024.108210","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108210","url":null,"abstract":"<div><h3>Introduction</h3><div>Branch atheromatous disease (BAD) is prone to early neurological deterioration (END), leading to a poor prognosis. The most common arteries causing END are the lenticulostriate arteries (LSA) and the paramedian pontine arteries (PPA). To gain insight into the characteristics of symptomatic plaques and their association with poor prognosis in patients with BAD, we conducted a prospective study using high-resolution magnetic resonance imaging (HRMRI).</div></div><div><h3>Methods</h3><div>A total of 75 patients with BAD in the vascular range of LSA or PPA were recruited for this study. The vascular and plaque features of the carrier middle cerebral artery (MCA) and basilar artery (BA) were evaluated through the application of HRMRI, and the local cerebral blood flow (CBF) of the lesion was assessed through pseudo-continuous arterial spin-labeling (pCASL), and the number and location of cerebral microbleeds (CMBs) were documented by susceptibility-weighted imaging (SWI). Univariable and multivariable logistic regression analyses were performed to analyze the factors that affected the prognosis.</div></div><div><h3>Results</h3><div>A poor prognosis was observed in 24 patients (32%) with BAD. A total of 28 patients (37%) developed END. Multifactorial analysis showed statistically significant differences in the dorsal plaque of BA (OR: 19.15, 95% CI 1.72–385.37, <em>p</em>=0.028), male (OR: 26.22, 95% CI 3.18–406.31, <em>p</em>=0.007), and NIHSS at 7 days of onset (OR: 2.24, 95% CI 1.4–4.45, <em>p</em>=0.004).</div></div><div><h3>Conclusions</h3><div>In patients with BAD in LSA and PPA areas, the dorsal plaque of BA, male, and NIHSS at 7 days of onset were independent risk factors for poor prognosis.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108210"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878450","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 : 2025-02-01DOI: 10.1016/j.jstrokecerebrovasdis.2024.108208
Shovan Bhatia BS , Sirisha T. Nouduri BS , Akshay Sankar BS , Michael R. Kann BE , Angela Hardi MS , Joseph S. Hudson MD , Alhamza R. Al-Bayati MD , Raul G. Nogueira , Michael J. Lang MD , Bradley A. Gross MD
Background
Anterior cerebral artery (ACA) occlusions account for up to 4 % of all acute ischemic strokes and may lead to debilitating outcomes. While endovascular thrombectomy (EVT) is a well-established treatment for large vessel occlusions, its efficacy and safety for primary ACA occlusions remains unclear. This systematic review and meta-analysis aims to address this gap by evaluating the clinical outcomes, safety, and efficacy of EVT in the treatment for primary ACA occlusions.
Methods
Following PRISMA guidelines, five databases were queried from database inception until April 2024 for studies describing the use of EVT for acute ischemic primary ACA occlusions. Following abstract, title, and full text-screening, data on patient demographics, clinical presentation, procedural details, and surgical outcomes were extracted from included articles. Primary outcomes were successful reperfusion (modified-Treatment in Cerebral Infarction (mTICI) score 2b-3), and favorable functional outcomes (3-month modified Rankin Scale (mRS) scores 0-2). Secondary outcomes included 3-month mortality rates and procedural complication rates. Meta-analysis was performed using a random-effects model, with heterogeneity assessed by the Higgins index (I²>50 %).
Results
Ten studies met eligibility criteria, encompassing a total of 265 patients with complete clinical and outcome data. Across the pooled meta-analysis, the rate of successful reperfusion (mTICI ≥ 2b) was 0.78 (95 % CI: 0.67-0.86) and the rate of 3-month mRS score 0-2 was 0.41 (95 % CI: 0.33-0.51). Pooled meta-analysis of secondary outcomes analysis revealed a 3-month mortality rate of 0.20 (95 % CI: 0.15-0.26), while the rate of symptomatic intracerebral hemorrhage was 0.04 (95 % CI: 0.02-0.08).
Conclusion
Our findings demonstrate that while successful reperfusion can be achieved with low complication rates, primary ACA occlusions treated with EVT are associated with high morbidity and mortality.
{"title":"Endovascular thrombectomy for acute ischemic stroke with primary occlusion of the anterior cerebral artery: A meta-analysis","authors":"Shovan Bhatia BS , Sirisha T. Nouduri BS , Akshay Sankar BS , Michael R. Kann BE , Angela Hardi MS , Joseph S. Hudson MD , Alhamza R. Al-Bayati MD , Raul G. Nogueira , Michael J. Lang MD , Bradley A. Gross MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108208","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108208","url":null,"abstract":"<div><h3>Background</h3><div>Anterior cerebral artery (ACA) occlusions account for up to 4 % of all acute ischemic strokes and may lead to debilitating outcomes. While endovascular thrombectomy (EVT) is a well-established treatment for large vessel occlusions, its efficacy and safety for primary ACA occlusions remains unclear. This systematic review and meta-analysis aims to address this gap by evaluating the clinical outcomes, safety, and efficacy of EVT in the treatment for primary ACA occlusions.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, five databases were queried from database inception until April 2024 for studies describing the use of EVT for acute ischemic primary ACA occlusions. Following abstract, title, and full text-screening, data on patient demographics, clinical presentation, procedural details, and surgical outcomes were extracted from included articles. Primary outcomes were successful reperfusion (modified-Treatment in Cerebral Infarction (mTICI) score 2b-3), and favorable functional outcomes (3-month modified Rankin Scale (mRS) scores 0-2). Secondary outcomes included 3-month mortality rates and procedural complication rates. Meta-analysis was performed using a random-effects model, with heterogeneity assessed by the Higgins index (I²>50 %).</div></div><div><h3>Results</h3><div>Ten studies met eligibility criteria, encompassing a total of 265 patients with complete clinical and outcome data. Across the pooled meta-analysis, the rate of successful reperfusion (mTICI ≥ 2b) was 0.78 (95 % CI: 0.67-0.86) and the rate of 3-month mRS score 0-2 was 0.41 (95 % CI: 0.33-0.51). Pooled meta-analysis of secondary outcomes analysis revealed a 3-month mortality rate of 0.20 (95 % CI: 0.15-0.26), while the rate of symptomatic intracerebral hemorrhage was 0.04 (95 % CI: 0.02-0.08).</div></div><div><h3>Conclusion</h3><div>Our findings demonstrate that while successful reperfusion can be achieved with low complication rates, primary ACA occlusions treated with EVT are associated with high morbidity and mortality.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108208"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886322","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}
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