Frontiers in stroke最新文献

Introduction: New classes of antidiabetic drugs reportedly lower the risk of cardiovascular events. This review summarizes the evidence for the effects of these drugs on the risk of stroke in diabetic individuals.

Methods: Multiple databases that report stroke outcome data were scrutinized for clinical trials (from inception to June 25, 2023), compared sodium-glucose cotransporter 2 inhibitors (SGLT2-Is), glucagon-like peptide-1 receptor agonists (GLP1-RAs), and dipeptidyl peptidase-4 inhibitors (DPP4-Is), vs. other antidiabetic drugs and placebo.

Results: Among the 960 identified trials, 259 satisfied the eligibility criteria. Among these, 177 and 82 trials reported at least one or no stroke events, respectively. In total, 208, 19, and 32 trials had a low, unclear, and high risk of bias, respectively. SGLT2-Is use did not decrease the risk of non-fatal hemorrhagic or ischemic stroke (risk ratio (RR) 0.96; 95% CI 0.87 to 1.06; P = 0.42) vs. either active comparators or placebo. GLP1-RAs use significantly decreased stroke risk (RR: 0.84, 95% CI [0.77, 0.93], p = 0.0005) and ischemic stroke (RR: 0.85, 95% CI [0.77, 0.94], p = 0.002) vs. placebo. However, GLP1-RAs use did not decrease hemorrhagic events vs. active comparators or placebo. DPP4-Is use did not decrease the risk of non-fatal hemorrhagic or ischemic stroke (RR: 0.91; 95% CI [0.83, 1.01], p = 0.07) vs. active comparators or placebo. For all classes, fatal stroke risk did not decrease vs. active comparators or placebo, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group scores were moderate.

Discussion: The use of GLP1-RAs, but not SGLT2-Is or DPP4-Is, may decrease non-fatal stroke risk. Considering these results, the findings may inform the treatment of diabetic people at risk of stroke and the design of new antidiabetic interventional trials.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017067889, identifier 42017067889.

Sickle cell disease (SCD) is the most common hereditary blood disorder worldwide, and sickle cell anemia (SCA), the homozygous state of SCD, is the most common and severe variant of the disease. Nigeria has the highest burden of SCA in the world. Hemolysis and vaso-occlusion can lead to a wide range of complications, including stroke which is one of the most devastating manifestations of SCA with significant morbidity and mortality. SCA remains the leading cause of stroke in black children. Without any intervention, strokes occur in approximately 11% of children with SCA before their 20th birthday, with the greatest risk in very young children between 2 and 5 years of age. In resource-constrained countries, where the burden of SCA is highest, stroke is underreported, hence the need to develop strategies for stroke prevention and early detection. Improving awareness among healthcare providers and the community can significantly reduce stroke rates and improve stroke detection. The goal of this manuscript is to discuss the progress that has been made in stroke prevention and detection in children with SCA in Nigeria and outline current challenges and future goals. We believe that our experience will be valuable not only in Nigeria which has the highest burden of SCA globally, but also in other low- and middle-income countries.

Background: Telestroke networks aim to address variability in both quality and access to stroke care in rural areas, by providing remote access to expert stroke neurologists. Implementation of telestroke requires adaptation of workflow processes and education. We previously developed virtual reality (VR) workflow training and documented acceptability, utility and feasibility. The effects on acute stroke treatment metrics have not been previously described.

Aims: The overall aim was to improve hyperacute stroke metrics and shorten the time-to-reperfusion therapy administration in rural settings.

Methods: This study applies a natural experiment approach, collecting stroke metric data during transition from a pre-existing pilot to a statewide telestroke service at five rural hospitals. Pre- and post-intervention data included baseline patient demographics and assessment, diagnosis, and treatment delivery metrics. The primary study outcome was door-to-decision time (thrombolysis and endovascular thrombectomy). Secondary outcomes included door-to-computerized tomography time, door-to-thrombolysis time and proportion of patients receiving thrombolysis or thrombectomy treatment. Usage data relating to the VR stroke workflow training of interprofessional healthcare professionals was automatically captured via Wi-Fi. Statistical comparisons of clinical metrics between the pre- and post-intervention time periods, defined as the timeframes before and after VR deployment, were performed.

Results: A total of 2,683 patients were included (April 2013-December 2022); 1910 pre- and 773 post-intervention. All acute stroke time metrics significantly improved post-intervention. The primary outcome, door-to-decision time, decreased from 80 min [56-118] to 54 min [40-76; P < 0.001]. Secondary outcomes also improved, including door-to-thrombolysis time (90 min [68-114] vs. 68.5 min [54-90]; P < 0.001) and proportion of patients thrombolysed (11 vs. 16%; P < 0.001). The proportion of patients transferred for thrombectomy was unchanged (6 vs. 7%; P = 0.69). Seventy VR sessions totaling 15 h 39 min of training time were logged. VR training usage varied across sites (3-31 sessions per site).

Conclusions: Delivery of a multi-factorial intervention including infrastructure, funding, education and training (with VR workflow training) as part of a state-wide telestroke rollout was associated with improved acute stroke treatment metrics. Additional work is required to identify the contribution of each intervention component on clinical outcomes and to increase training uptake and sustainment.