Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Association between blood pressure and outcome in patients with acute ischemic stroke treated with alteplase","authors":"Ole Morten Rønning MD, PhD ,&nbsp;Linn Nordby MD ,&nbsp;Nicola Logallo MD, PhD ,&nbsp;Christopher E Kvistad MD, PhD ,&nbsp;Espen Saxhaug Kristoffersen MD, PhD ,&nbsp;Håkon Ihle-Hansen MD, PhD ,&nbsp;Hege Ihle-Hansen MD, PhD ,&nbsp;Vojtech Novotny MD PhD ,&nbsp;Ulrike Waje-Andreassen MD, PhD ,&nbsp;Halvor Næss MD, PhD ,&nbsp;Lars Thomassen MD, PhD ,&nbsp;Bente Thommessen MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108518","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108518","url":null,"abstract":"<div><h3>Background</h3><div>The role of blood pressure (BP) in acute stroke remains unclear. We investigated the impact of BP trajectories during the first 24 hours (h) after hospital admission on outcomes in acute ischemic stroke patients treated with intravenous alteplase.</div></div><div><h3>Methods</h3><div>In 424 ischemic stroke patients from the NOR-TEST I trial treated with alteplase, we assessed systolic BP (sBP) at baseline, change in sBP between 0 h and 24 h, and increase in sBP over the same period. Outcomes included modified Rankin Scale (mRS) at 3 months, NIHSS at 24 h, and symptomatic intracerebral haemorrhage (sICH) within 48 h.</div><div>Logistic and linear regression analyses were used to explore the association of blood pressure trajectories and outcome adjusted for age, sex, time from onset of symptoms to intravenous thrombolysis (IVT) and NIHSS at admittance (NIHSSadm).</div></div><div><h3>Results</h3><div>Mean sBP at baseline (admittance), 2 h and 24 h were 155, 147 and 142 mmHg, respectively. An increase in sBP from baseline to 24 h was seen in 115 patients (27 %), while 409 showed an overall change. In unadjusted analyses, sBP increase (but not baseline sBP or change in sBP) was associated with worse mRS at 3 months. This remained significant after adjustment (OR 0.933, 95 %CI 0.876 – 0.993). Higher baseline sBP and sBP increase predicted worse NIHSS at 24 h. sBP increase and baseline sBP were also associated with sICH within 48 h, but only baseline sBP remained significant after adjustment (OR 1.022, 95 % CI 1.003–1.042).</div></div><div><h3>Conclusions</h3><div>An increase in sBP within the first 24 h was associated with worse neurological and functional outcomes at 3 months, while higher baseline sBP was linked to worse neurological outcomes and sICH in acute ischemic stroke patients treated with alteplase.</div></div><div><h3>Clinical trial registration</h3><div>NCT01949948.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 1","pages":"Article 108518"},"PeriodicalIF":1.8,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Based on the PINK1/Parkin signaling pathway, the protective effect of salidroside on cerebral ischemia-reperfusion injury in male rats was investigated","authors":"Ting Dong ,&nbsp;Haoyu Wang ,&nbsp;Yanwei Li ,&nbsp;Jun Tan","doi":"10.1016/j.jstrokecerebrovasdis.2025.108519","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108519","url":null,"abstract":"<div><h3>Objective</h3><div>Based on the male Sprague-Dawley rats middle cerebral artery occlusion model and SH-SY5Y hypoxia-reoxygenation model, this study systematically evaluated the neuroprotective effect of salidroside (SAL) on cerebral ischemia/reperfusion injury in rats, and explored its possible protective mechanism through PINK1/Parkin signaling axis regulating mitochondrial autophagy.</div></div><div><h3>Materials and methods</h3><div>Using the middle cerebral artery occlusion (MCAO) model in male Sprague-Dawley rats and the SH-SY5Y cell hypoxia-reoxygenation model, we assessed neurological damage severity through the modified neurological severity scores (NSS). Brain histopathological changes were evaluated using hematoxylin-eosin staining, while the infarct volume in the ischemic brain was assessed with 2,3,5-triphenyltetrazolium chloride (TTC) staining. Transmission electron microscopy was employed to observe mitochondrial ultrastructural alterations in the ischemic brain tissue. Western blotting was used for quantitative analysis of key autophagy-related molecules (PINK1, Parkin), and ROS, MDA, and ferrous ion kit were utilized to evaluate ferroptosis biomarker.</div></div><div><h3>Results</h3><div>The findings indicate that SAL effectively reduces infarction rates and ameliorates histopathological changes. SAL decreases the formation of reactive oxygen species, malondialdehyde, and ferrous ions by upregulating the expression of PINK1 and Parkin proteins, thereby mitigating apoptosis. Furthermore, SAL significantly inhibits ferroptosis in SH-SY5Y neuroblastoma cells subjected to OGD/R and reduces oxidative stress. The application of the mitochondrial autophagy inhibitor Mdivi-1 enhances the protective effect of SAL against ferroptosis in both MCAO and OGD/R models. Therefore, we draw the following conclusions: In the rat cerebral ischemia-reperfusion injury model and the SH-SY5Y cell oxygen-glucose deprivation/reoxygenation (OGD/R) model, iron death was found to be increased. Pre-treatment with salidroside was able to reduce the occurrence of iron death in both the cerebral ischemia-reperfusion injury model and the cellular OGD/R model.</div></div><div><h3>Conclusions</h3><div>Salidroside may inhibit iron death by activating the PINK 1 / Parkin signaling pathway and thereby reduce cerebral ischemia-reperfusion injury. Targeted regulation of this pathway may become an important strategy to interfere with CIRI.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 1","pages":"Article 108519"},"PeriodicalIF":1.8,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative analysis of SCALE-CTP and RAPID in determining the affected brain volumes of patients with ischemic stroke","authors":"Jundong Hwang ,&nbsp;Hyeon Sik Yang ,&nbsp;Gi-Youn Kim ,&nbsp;Regina EY Kim ,&nbsp;Minho Lee ,&nbsp;Donghyeon Kim ,&nbsp;Jin Wook Choi ,&nbsp;Woo Sang Jung ,&nbsp;Kijeong Lee","doi":"10.1016/j.jstrokecerebrovasdis.2025.108517","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108517","url":null,"abstract":"<div><h3>Background</h3><div>Computed tomography perfusion (CTP) is widely used to treat acute strokes. The affected brain volume, measured based on the threshold value in the calculated CTP map, has helped guide treatment decisions. We proposed a new software program developed for CTP analysis, SCALE-CTP, and compared the affected brain volumes estimated using RAPID and SCALE-CTP.</div></div><div><h3>Methods</h3><div>We recruited 362 individuals from the local hospital to evaluate the concordance between SCALE-CTP and RAPID in predicting affected brain volumes, including relative cerebral blood flow (rCBF) &lt;30 % and time-to-maximum concentration (Tmax) &gt; 6 s, and the mismatch volumes. Concordance correlation coefficients (CCC) and Bland–Altman plots were used to assess agreement. Subgroup analyses and comparisons with DWI-derived infarction areas were also performed, along with an evaluation of differences in clinical decision-making.</div></div><div><h3>Results</h3><div>The calculated volumes from two different software showed excellent concordance (rCBF &lt; 30 % volume: 0.91, Tmax &gt; 6s: 0.88 volume, mismatch volume: 0.82). The concordance between the two software programs remains excellent in the subgroup analysis. In the subset of 38 cases, the differences between DWI-derived infarction area and rCBF &lt; 30 % volume from both software were similar, while SCALE-CTP showed more variability. Their differences in clinical decision making were slightly different.</div></div><div><h3>Conclusion</h3><div>SCALE-CTP demonstrated strong agreement with RAPID in predicting affected brain volumes and shows potential as a reliable tool for guiding hyperacute ischemic stroke treatment. Further validation is needed to confirm its clinical utility.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 2","pages":"Article 108517"},"PeriodicalIF":1.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated TyG index and eGDR measure enhances stroke risk stratification in early cardiovascular-kidney-metabolic syndrome: A prospective national cohort analysis","authors":"Xiaolei Wang,&nbsp;Hongfeng Sun,&nbsp;Taojing Zhang,&nbsp;Hui Zhou","doi":"10.1016/j.jstrokecerebrovasdis.2025.108516","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108516","url":null,"abstract":"<div><h3>Background</h3><div>The triglyceride-glucose (TyG) index and estimated glucose disposal rate (eGDR) are established markers of insulin resistance (IR), yet their combined role in predicting stroke among individuals with early-stage cardiovascular-kidney-metabolic (CKM) syndrome remains unclear.</div></div><div><h3>Methods</h3><div>We included 4,414 participants from the China Health and Retirement Longitudinal Study (CHARLS) with baseline (2011) and follow-up (2015) data. TyG-eGDR was calculated at both timepoints, and cumulative exposure was derived. K-means clustering categorized participants into three dynamic trajectory groups. Cox proportional hazards models evaluated stroke risk, restricted cubic splines (RCS) tested nonlinearity, and receiver operating characteristic (ROC) curves assessed predictive performance.</div></div><div><h3>Results</h3><div>Over the follow-up period, 219 stroke events occurred. Compared to the low TyG-eGDR trajectory group, the high-trajectory group had a 2.84-fold increased stroke risk (HR = 2.84, 95 % CI: 1.67–4.81). Participants with the highest cumulative TyG-eGDR exposure exhibited a 4.28-fold increased stroke risk (HR = 4.28, 95 % CI: 2.66–6.89), while those with high baseline levels had a 3.46-fold elevated risk (HR = 3.46, 95 % CI: 1.82–6.58). RCS analyses revealed significant nonlinear relationships between TyG-eGDR indices and stroke (<em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>Sustained high TyG-eGDR levels predict stroke risk in early CKM syndrome, supporting its integration into routine metabolic cerebrovascular risk assessment.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 1","pages":"Article 108516"},"PeriodicalIF":1.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebroprotection in acute ischemic stroke: Perspectives on combining cerebrolysin with recanalization therapy","authors":"Marc Ribó ,&nbsp;Jacek Staszewski ,&nbsp;Steven R. Zeiler ,&nbsp;Sławomir Michalak ,&nbsp;Ahmed El Bassiouny ,&nbsp;Fernando Gongora-Rivera ,&nbsp;Zdravka Poljakovic ,&nbsp;Dina R Khasanova ,&nbsp;Mikhail N Kalinin ,&nbsp;Aurauma Chutinet ,&nbsp;Roni Eichel ,&nbsp;Klaudyna Kojder ,&nbsp;Marissa Ong ,&nbsp;Marina Roje Bedeković ,&nbsp;Chien-Hung Chang ,&nbsp;Minwoo Lee ,&nbsp;Peter Quitasol ,&nbsp;Alexander Tsiskaridse ,&nbsp;Natan M Bornstein","doi":"10.1016/j.jstrokecerebrovasdis.2025.108515","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108515","url":null,"abstract":"<div><div>This article provides perspectives on the use of Cerebrolysin as an adjunct treatment to reperfusion therapy in acute ischemic stroke (AIS). In the evolving landscape of AIS reperfusion therapy, we hypothesize that adjunctive cerebroprotective therapy, such as Cerebrolysin, is likely to further improve patient outcomes. Beyond its established neurorecovery benefits, recent data indicate that Cerebrolysin also offers protection to the neurovascular unit and the blood-brain barrier. This paper introduces the CErebrolysin in RECanalization And Perfusion (CERECAP) program, a collaborative initiative of independent academic investigations exploring the favorable trends of Cerebrolysin in reperfusion. The CERECAP program has generated compelling data demonstrating Cerebrolysin’s alignment with current AIS reperfusion therapy concepts, particularly its role in early intervention targeting multiple pathways. We review these studies and discuss the critical need to clearly define the patient population that benefit most from adjunctive Cerebrolysin therapy in AIS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"35 1","pages":"Article 108515"},"PeriodicalIF":1.8,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved outcome prediction in large vessel occlusion stroke: A comparison of Tmax-based hypoperfusion ratios HIR10/4 and HIR10/6","authors":"Jeewon Chon MA ,&nbsp;Ashley Treanor BS ,&nbsp;Andrew C. Pickles BS ,&nbsp;William Y. Shin BA ,&nbsp;Ronak H. Jani MD ,&nbsp;John T. Tsiang MD ,&nbsp;Amy Wozniak MS ,&nbsp;Anthony W. Kam MD, PhD ,&nbsp;David P. Pasquale MD ,&nbsp;Joseph C. Serrone MD ,&nbsp;Brandon J. Bond MD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108504","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108504","url":null,"abstract":"<div><h3>Background</h3><div>The hypoperfusion intensity ratio (HIR), derived from CT perfusion (CTP), reflects collateral flow quality, but its optimal formulation remains unsettled.</div></div><div><h3>Objective</h3><div>To compare the prognostic utility of conventional HIR_10/6 (time-to-maximum [T_max] &gt;10s / &gt;6 s) with an alternative HIR_10/4 (T_max &gt;10s / &gt;4 s) in patients undergoing endovascular thrombectomy (EVT).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed consecutive large-vessel occlusion (LVO) strokes treated with EVT at our quaternary academic medical center (2015–2024). CTP was processed using RAPID software. Primary outcomes were modified Rankin Scale (mRS) at discharge and at 90 days. Secondary outcomes included National Institutes of Health Stroke Scale (NIHSS) at discharge and hemorrhagic transformation on follow-up imaging. Ordinal and linear regression models were adjusted for age, sex, vascular risk factors, intravenous thrombolysis, presentation window, and transfer status. Receiver operating characteristic (ROC) curves assessed discriminative performance.</div></div><div><h3>Results</h3><div>Among 280 patients (mean age 70 ±15 years; 49 % male), mean HIR_10/6 was 0.418 and HIR_10/4 was 0.241. Each 0.1-unit increase in HIR_10/4 translated to 31 % higher odds of worse mRS at discharge (adjusted odds ratio [aOR] 1.31, 95 % CI 1.12–1.54; <em>p</em>=0.001), 24 % higher odds of worse mRS at 90 days (aOR 1.24, 95 % CI 1.04–1.48; <em>p</em>=0.016), and higher discharge NIHSS (β=0.88, 95 % CI 0.05–1.71; <em>p</em>=0.039). HIR_10/6 showed weaker associations and was not significant for discharge NIHSS. Neither HIR metric demonstrated meaningful discrimination for hemorrhagic transformation or dichotomized outcomes (area under the curve [AUC] 0.50–0.52).</div></div><div><h3>Conclusions</h3><div>Incorporating mildly delayed tissue (T_max &gt;4 s) may enhance the physiologic sensitivity of HIR. HIR_10/4 may be a potential prognostic biomarker; however, prospective validation is needed, and its standalone ability to discriminate binary outcomes remains limited.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108504"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age at natural menopause and stroke: A U-shaped association in the health and retirement study","authors":"QinFeng Zeng ,&nbsp;Wenjia Zhang,&nbsp;Yingzhi Liu,&nbsp;Weijun Yang,&nbsp;XiaoLing Wu,&nbsp;Jieding Li","doi":"10.1016/j.jstrokecerebrovasdis.2025.108497","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108497","url":null,"abstract":"<div><h3>Background</h3><div>The association between age at natural menopause and cerebrovascular risk is unclear. This study investigates non-linear relationships, effect modification, mediation, and long-term stroke-free survival in postmenopausal women.</div></div><div><h3>Methods</h3><div>We analyzed 9,159 postmenopausal women from the Health and Retirement Study. Menopause age was categorized (&lt;40, 40–44, 45–49, 50–55, &gt;55) and modeled continuously. Stroke outcomes were derived from self-reports and linked Medicare claims. We used multivariable logistic regression with restricted cubic splines, interaction terms among hypertension, diabetes, and hypercholesterolemia, structural equation modeling for mediation, and Kaplan-Meier/Cox models for survival analysis.</div></div><div><h3>Results</h3><div>Each additional year of later menopause was linked to lower stroke odds (OR 0.935, 95 % CI 0.922–0.948). Compared to the 50–55 age group, those with menopause &lt;45 years (OR 2.76, 95 % CI 2.09–3.47) and 45–49 years (OR 2.08, 95 % CI 1.72–2.62) had higher risks. Spline analysis indicated a U-shaped curve, with the lowest risk at ages 50–52. Stroke-free survival differed significantly across groups (log-rank <em>p</em> = 0.0017), particularly worse with premature menopause.</div></div><div><h3>Conclusions</h3><div>Age at natural menopause exhibits a U-shaped association with stroke risk, emphasizing the importance of timing in individualized prevention strategies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108497"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of holistic nursing intervention based on harmonious nursing theory on patients in stroke recovery period","authors":"Xiaozhu Yu Master of Nursing (Lecturer) ,&nbsp;Xichao Xia Doctor of Medicine (Professor) ,&nbsp;Yanfang Guo Master of Nursing (Senior Nurse) ,&nbsp;Yuhong Wu Master of Nursing (Chief Nurse)","doi":"10.1016/j.jstrokecerebrovasdis.2025.108507","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108507","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically analyze the application effect of holistic nursing intervention based on Harmonious Nursing Theory in patients during stroke recovery period, and provide evidence-based basis for optimizing clinical nursing programs.</div></div><div><h3>Methods</h3><div>Patients in the stroke recovery period were divided into observation group and control group with 83 cases each by random number table method. The control group received routine nursing intervention, while the observation group received holistic nursing intervention based on Harmonious Nursing Theory. The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Herth Hope Index (HHI), SF-36 Short-Form Health Survey, and nursing satisfaction questionnaire were used to compare the differences in negative emotions, hope level, quality of life, and satisfaction between the two groups of patients before and after intervention.</div></div><div><h3>Results</h3><div>After the intervention, the self-reported anxiety score of the observation group was (42.87±17.32) and the self-reported depression score was (45.28±16.67), both significantly lower than those of the control group [(51.59±15.19) and (50.51±15.52), respectively; all <em>P</em>&lt;0.05]. The total score of hope level in the observation group was (40.87±6.03), which was higher than that in the control group [(34.78±5.93); <em>P</em>&lt;0.05]. The scores of all 8 dimensions of health status in the observation group were higher than those in the control group (all <em>P</em>&lt;0.05). The nursing satisfaction rate of the observation group was 92.77%, which was higher than 78.31% of the control group (<em>P</em>&lt;0.05).</div></div><div><h3>Conclusion</h3><div>Implementing holistic nursing intervention based on Harmonious Nursing Theory for patients in stroke recovery period can effectively alleviate negative emotions, improve hope level and quality of life, as well as enhance nursing satisfaction, which has high clinical promotion value.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108507"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A urine-based point-of-care test for Factor Xa inhibitors in acute stroke management","authors":"Prasen R Marella ,&nbsp;Jacob A Sambursky ,&nbsp;Kriti Bhayana ,&nbsp;Asha P Jacob ,&nbsp;Varsha Muddasani ,&nbsp;Murli Mishra ,&nbsp;Alexandra L Czap ,&nbsp;James C Grotta","doi":"10.1016/j.jstrokecerebrovasdis.2025.108500","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108500","url":null,"abstract":"<div><h3>Background</h3><div>For stroke patients with history of possible Direct Acting Oral Anticoagulant use, clinicians must make treatment decisions without knowledge of whether the patient is therapeutically anticoagulated. A urine-based point-of-care test might help guide these emergency decisions.</div></div><div><h3>Methods</h3><div>We prospectively enrolled patients with suspected recent factor-Xa-inhibitor (Xai) use being evaluated for acute stroke therapy in an urban teaching hospital. We obtained the urine test and plasma anti-Xa level in parallel with usual clinical management; the treating clinician did not use test results for decision-making but recorded treatment they would have given had they known the urine test was accurate. The primary outcome was feasibility. Secondary outcomes were accuracy of the urine test at plasma anti-Xa level &gt;30 ng/mL and consequent change in clinical management.</div></div><div><h3>Results</h3><div>Twenty-one patients were enrolled over 1 year. The urine test was successfully carried out in all patients, median 59 minutes after Emergency Department arrival. Sensitivity and specificity for the urine test to detect threshold anti-Xa activity were 100 % and 87.5 %. Of 20 patients with ischemic stroke, none of whom were treated with thrombolytics, 6 had a negative test which would have resulted in treatment of 4 (66 %).</div></div><div><h3>Conclusion</h3><div>A urine point-of-care test for Xai activity is feasible, accurate, and would likely result in treatment of stroke patients currently excluded from thrombolysis.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108500"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public awareness of stroke risk factors in high-income countries: A systematic review","authors":"Mc Lernon S ,&nbsp;Appiah B ,&nbsp;Moorley C ,&nbsp;Thomas N ,&nbsp;Mussa R ,&nbsp;Gonzales S ,&nbsp;Werring D ,&nbsp;Olawade D․B ,&nbsp;Flood C","doi":"10.1016/j.jstrokecerebrovasdis.2025.108501","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108501","url":null,"abstract":"<div><h3>Purpose</h3><div>Stroke remains a significant health concern in high-income countries (HICs) and is increasing among younger adults. Although largely preventable, public awareness of stroke risk factors in HICs is not well established. We assessed awareness levels in World Bank-classified HICs and identified associated factors.</div></div><div><h3>Methods</h3><div>Systematic searches used Ovid MEDLINE, PsycINFO, Academic Search Complete, CINAHL, Cochrane Review Library, Emcare, and ASSIA. Two authors independently screened studies and extracted data. Risk of bias was assessed using Critical Appraisal Skills Programme checklists. Due to heterogeneity, narrative synthesis was conducted. <strong>Exploratory analyses including visual mapping and descriptive cross-country comparisons were performed despite methodological heterogeneity.</strong> Protocol registered on PROSPERO (CRD42025621931).</div></div><div><h3>Findings</h3><div>Of 2146 papers screened, 23 met inclusion criteria. Most studies reported low stroke risk factor awareness. Hypertension was most frequently identified, followed by smoking, dyslipidaemia, and diabetes. Sedentary lifestyle, alcohol consumption, ethnicity, and atrial fibrillation were least recognised. <strong>Risk of bias assessment revealed sampling and generalisability concerns in most studies. Most reported associations were unadjusted for potential confounders.</strong> Higher education was linked to greater awareness. <strong>Marked geographical clustering occurred, with 65 % of studies from Middle Eastern countries, predominantly Saudi Arabia.</strong></div></div><div><h3>Discussion</h3><div>This review uniquely identifies critical evidence gaps including under-representation of diverse populations, lack of standardised awareness metrics, and predominance of unadjusted analyses in HIC stroke risk factor awareness research.</div></div><div><h3>Conclusion</h3><div>Stroke risk factor awareness gaps are prevalent and may limit prevention efforts. <strong>Large-scale, methodologically robust studies across diverse geographical, socioeconomic, and ethnic populations within HICs are urgently needed, as awareness characteristics may vary dramatically even within high-income settings.</strong> Targeted education is necessary for primary prevention strategies.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 12","pages":"Article 108501"},"PeriodicalIF":1.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145592709","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}