Frontiers in stroke最新文献

Background: Mechanical thrombectomy is the standard of care for Acute Ischemic Stroke caused by proximal large-vessel occlusion in the anterior circulation. In the stent retriever approach, a nitinol stent engages the clot via outward radial force to enable removal. However, current procedures lack direct clot visualization under fluoroscopy, which can reduce retrieval efficacy and often require multiple passes. Improving first-pass success is critical given the time-sensitive nature of stroke intervention.

Methods: This study presents a clot visualization method using the spatial arrangement of radio-opaque markers on the Medtronic Solitaire™ stent. A deep learning model, Clot[U]-Net, based on the U-Net architecture, was trained on 800 anteroposterior and lateral in-vitro images and evaluated on a separate test set.

Results: The Clot[U]-Net model achieved strong performance in clot boundary prediction, with a mean Intersection over Union (IOU) of 87.9% and an AUROC of 89.9%, and standard deviations of 2.2 and 3.16, respectively.

Conclusion: The proposed method enables clot visualization during stent retriever thrombectomy without altering existing clinical workflows. With further pre-clinical and clinical validation, this approach may support real-time decision-making and improve procedural outcomes.

Introduction: Female stroke survivors experience considerable vulnerabilities and existential concerns, shaped by sociocultural factors and gender roles, which heighten stroke morbidity and limit community reintegration. Yet, the existential concerns of female stroke survivors in Nigeria, and their relationships with psychological depression and community reintegration have not been explored.

Methods: A mixed-methods study was conducted among female stroke survivors recruited from selected hospitals in South-west, Nigeria. Community integration questionnaire, Existential concerns questionnaire, and the depression subscale of the Hospital anxiety and depression scale were used to assess community reintegration, existential concerns, and psychological depression, respectively. Six purposively selected female stroke survivors participated in a focus group discussion (FGD). Quantitative data were analyzed using Chi-square test at p < 0.05, while qualitative data were thematically analyzed.

Results: Seventy-five female stroke survivors aged 64.07 ± 14.03 years participated in the survey. The mean community reintegration, existential concerns and psychological depression scores were 12.24 ± 2.95, 9.77 ± 5.52, and 13.84 ± 4.71, respectively. The majority (n = 61; 81.3%) of the participants had a low level of community integration. Forty-seven (62.7%) reported a moderate level of existential concerns, while 32(42.7%) had psychological depression. There was a significant association between community reintegration and psychological depression (p = 0.02), and between existential concerns and psychological depression (p < 0.01). However, there was no association between community reintegration and existential concerns (p = 0.08). The five emergent themes from the FGD were: perception of stroke as a devastating condition; role disruption and loss of autonomy in the home, isolation and stigmatization in society, inadequate spousal support and sexual intimacy, work-related and financial concerns.

Conclusion: Existential concerns among participants were mostly related to social and family roles and were associated with poor emotional and mental wellbeing. Addressing these concerns through integrated care, delivered by a coordinated multidisciplinary team, could enhance emotional and mental wellbeing, and promote community reintegration among female stroke survivors.

Heart disease (HD) and stroke risk can be reduced with adequate cardiovascular disease (CVD) disease prevention as outlined in the American Heart Association's Life's Essential 8 guidelines for modifiable health behaviors. This scoping review examines the roles of community health workers (CHWs) in CVD prevention trials across the United States. In the 24 clinical trials identified, our review emphasizes the effectiveness of CHWs in improving health behaviors and outcomes, particularly for underserved populations with limited access to health care. CHWs were actively engaged in implementing interventions, providing culturally sensitive education, offering health coaching, and supporting lifestyle modifications, such as increased physical activity and medication compliance. Notably, while most studies focused on HD, only three specifically targeted secondary stroke prevention. Beyond their role of delivering behavioral interventions, CHWs supported research efforts by collecting data and maintaining participant involvement. However, their integration into academic teams was inconsistent in terms of scope of practice and level of interprofessional engagement. Furthermore, CHW research contributions were rarely recognized, with a handful acknowledged in publications. Training for CHWs generally included disease-specific knowledge and communication skills. CHW training programs varied considerably in their scope and standards, with unclear role definitions and insufficient collaboration with academic institutions. To enhance CHW-led preventive health care, developing standardized training frameworks, defining CHW responsibilities in clinical and research collaborations and building sustainable community-academic partnerships are suggested. These actions could significantly increase CHWs' role in reducing CVD disparities, thereby promoting more equitable health care across the United States.

Introduction: Dysphagia or disordered swallowing is a post-stroke condition that requires early intervention to improve stroke recovery. Individuals with dysphagia require specialized services to support nutrition and reduce the likelihood of pneumonia after stroke. This study was designed to utilize Medicare claims data to better understand the acute and post-acute pathways of stroke patients with dysphagia.

Methods: Data included 100% of fee-for-service (FFS) Medicare claims for home health agency (HHA), skilled nursing facility (SNF), inpatient, outpatient, and carrier files. The sample included Medicare beneficiaries who incurred an inpatient claim between January 1, 2016, and October 1, 2019, with ischemic or hemorrhagic stroke as the primary diagnosis.

Results: We identified 745,917 unique FFS Medicare beneficiaries with a primary stroke diagnosis; 90% were over age 65. Approximately 79% were non-Hispanic White, 12% were Black/African American, and 6% were Hispanic. Among those identified stroke survivors, 32.5% were diagnosed with dysphagia within 90 days, with slight racial/ethnic variations. Between 68% and 73% of people with dysphagia (PWD) had their initial service encounter in an inpatient hospital facility, 15%-16% in an SNF, and 4%-5% in an outpatient facility, and there was little variation across race/ethnicity. Approximately 10%-12% of PWD were discharged directly home, 32%-36% were discharged to an SNF, and 33%-36% were discharged to a long-term care or rehabilitation facility.

Discussion: In this study of Medicare data, the rate of dysphagia after stroke among Medicare beneficiaries was ~33%. This rate showed only slight variation across racial and ethnic groups. Approximately 70% of PWD were identified in inpatient settings. Only a small percentage (10%) were discharged home, with ~80% moving to facilities offering rehabilitative services (SNF, long-term care, or rehabilitation facility).

Background: The prevalence of stroke is increasing in Africa, yet resources remain limited in managing the disease. Whilst there are international guidelines on how to set up and manage stroke services, even in resource-limited settings, the uptake remains low. We describe here the opportunities and challenges we faced whilst setting up a stroke care pathway of international standards in a regional referral hospital in East Africa.

Methods: We describe how we adapted international stroke care guidelines for acute primary stroke (including both ischemic and hemorrhagic stroke), and used these to inform our stroke care pathway. We highlight opportunities of leveraging on multi-disciplinary involvement, as well as challenges of implementing the pathway.

Results: Our hospital was accredited by the Joint Commission International with a Clinical Care Programme Certification in May 2021. However, there were strategic improvement plans recommended that needed to be addressed for future re-accreditations, including having a dedicated stroke unit and addressing shortfalls in thrombolysis and thrombectomy timelines. We discuss the challenges faced with these and other relevant findings from the accreditation process.

Conclusion: International accreditation of our hospital provides an example of how to adapt international guidelines to local contexts. The description of our experience may be useful for other healthcare institutions from resource-limited settings who strive to improve the quality of stroke care they provide.

The 2024 ICORR-SASNET Ghana Neurorehabilitation Robotics workshop, convened on March 15-16, 2024, in Accra, Ghana, brought together 22 speakers and 27 attendees from nine countries to address the pressing need for enhanced access to neurorehabilitation services and rehabilitation robotics in Africa. Low- and Middle-Income Countries (LMICs) face substantial challenges in providing adequate rehabilitation services. This exacerbates the burden of disability and impedes the recovery and quality of life of individuals with stroke and other neurological conditions. The workshop aimed to: (1) discuss current trends, challenges in neurorehabilitation services and rehabilitation robotics in Africa; (2) identify gaps in access to rehabilitation services and assistive technologies in LMICs; (3) develop strategies for improving access to these services; and (4) promote collaborative efforts and knowledge sharing among health professionals and stakeholders. A purposive sampling method was employed to recruit a diverse cohort of practicing health professionals, policy makers, and a stroke survivor/advocate. The workshop featured expert presentations and discussions centered on three key questions: (1) the current status of stroke rehabilitation in Africa and driving policies, (2) the role of assistive technology and rehabilitation devices in Africa, and (3) strategies for inclusive implementation culminated into 10 targeted recommendations for integrating rehabilitation robotics into conventional therapies. A roadmap was developed, featuring future initiatives, awareness campaigns, and technology transfer programs, with a planned second workshop in 2026, aiming to enhance access and promote sustainable solutions.

Introduction: Carotid atherosclerotic disease (CAD) is a major cause of stroke, often requiring a combination of medical and surgical interventions. Current guidelines have established well the role of interventions such as carotid endarterectomy and carotid artery stenting (CAS) for unilateral carotid disease. However, there is still a paucity of evidence on the timing, procedural order, and complication rate of these procedures when there is bilateral carotid involvement. Hyperperfusion syndrome (HPS), with or without associated intracerebral hemorrhage, although rare, is a major source of morbidity and mortality after carotid interventions, especially in the setting of bilateral CAD. In select cases, staged bilateral CAS (BCAS) appears to attenuate periprocedural risks, including HPS.

Case report: A 62-year-old male presented with acute dysarthria and right-sided face and upper extremity weakness, amounting to an initial National Institutes of Health Stroke Scale (NIHSS) score of 6. Emergent neuroimaging revealed a dense left MCA sign, complete occlusion of the left proximal internal carotid artery (ICA), and severe stenosis of the contralateral ICA. The patient received intravenous thrombolysis and underwent perfusion imaging for possible mechanical thrombectomy. Although the imaging was favorable for endovascular recanalization, the patient continued to clinically improve to an NIHSS score of 3 during angiography, which showed interval recanalization of left proximal ICA, so the procedure was aborted in favor of a delayed staged BCAS. On the day of the first procedure, angiography revealed interval recanalization of the distal ICA and collateral flow to the middle cerebral artery territory associated with early hyperemia. The risks of symptomatic CAS in light of these findings were discussed with the patient, and a shared decision was made to first pursue endovascular treatment of the asymptomatic severe right CAD, followed by treatment of the symptomatic left CAD, to avoid periprocedural complications such as HPS. The patient continued to improve clinically after both procedures and was able to attain functional independence and resume all previous activities following interventions.

Conclusion: This case and literature review suggest that, although both simultaneous and staged BCAS may be feasible treatment options for bilateral CAD, staged BCAS appears to have fewer periprocedural complications such as HPS.

Background: Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke that is more common in young, especially female, adults and can be challenging to diagnose due to its frequently non-specific presentation and diverse risk factors. Most cases are idiopathic, and international guidelines do not recommend routine investigations for underlying thrombophilia. Timely diagnosis, with prompt neuroimaging and guideline-based treatment, leads to good outcomes. However, in the literature on CVST from sub-Saharan Africa, the gap is substantial, with the few cases described as being related to systemic and/or brain infections. We describe here the largest cohort of CVST from the region with novel findings that may be relevant to everyday clinical practice.

Methods: We conducted a retrospective cross-sectional study of patients diagnosed with CVST from 2010 to 2022 at our tertiary regional neurology referral center in Nairobi, Kenya.

Results: We identified 122 cases: 67.2% (82/122) were female, 80.3% (98/122) were Black African, and the median (interquartile range) age was 36.8 (31.5-45.7) years. Apart from headaches (86.9%, 106/122), the most common presenting symptoms were visual disturbance (26.2%, 32/122) and seizures (23.8%, 29/122); 11 patients developed seizures later. Intracranial hemorrhage with and without venous infarction occurred in 27.9% (34/122) of patients. New diagnoses of thrombophilia were made in 30.3% (37/122). Other causes were HIV, hepatitis B/C, or other brain infections (18.0%, 22/118); pregnancy, including postpartum (14.6%, 12/82); contraceptive use (8.5%, 7/82); and malignancy (8.1%, 10/122). The most common treatment was with warfarin in 50% (61/122), followed by rivaroxaban (29.5%, 36/122) and dabigatran [14.8% (18/122)]. Complete thrombus resolution occurred in only 53.9% (55/102) at follow-up scanning (at a median of 178 days). In terms of outcomes (modified Rankin Score [mRS]), 32.8% (40/122) had an mRS score = 0, 59.9% (73/122) had an mRS score = 1-2, and there was one fatality who also had concurrent systemic malignancy.

Conclusion: Thrombophilia was more prevalent in our cohort of CVST than infections, which is a novel finding compared to what has been published about CVST from sub-Saharan Africa. Most patients were managed with appropriate anticoagulants, but only about half the patients had complete resolution of the CVST at last follow-up. We therefore recommend that thrombophilia should be routinely investigated in all patients with CVST in our setting.

Background and aims: Cognitive impairment (CI) after stroke is still a neglected consequence compared to other neurological deficits for which rehabilitation pathways are routinely available. Cognitive teleRehabilitation (CTR) represents an emerging approach that has the potential to reduce healthcare costs and potentially reaching many patients. By means of a randomized controlled trial, the aims are to investigate the prevalence of cognitive impairment after stroke and the efficacy of a CTR program in: (a) reducing the risk of CI 6 months after stroke; (b) generalizability of the cognitive training to real life; (c) impact on cognitive performances. In the treated group, feasibility, adherence and appreciation of the CTR will also be evaluated.

Methods and outcomes: The CIPS-TER study is a 2-year prospective, single-blind, randomized clinical trial. One hundred patients with ischemic or hemorrhagic stroke will be enrolled in the study, within 5-21 days after onset, and randomized to treatment or standard care. The CTR program will consist of up to 40 h (8 weeks) of individual treatment based on memory, attention, executive functions, and visuospatial tasks to be autonomously performed with a tablet. The study outcomes will be evaluated at 6-month follow-up visit and will include the diagnosis of cognitive impairment, activities of daily living, quality of life, changes in frailty status and cognitive efficiency.

Conclusions: CIPS-TER study will expand our knowledge on the potential effect of cognitive rehabilitation on future cognitive and functional decline after stroke.