Cerebrovascular Diseases最新文献

Introduction： The role of endovascular thrombectomy (EVT) for acute extra-large ischemic stroke patients with large vessel occlusion (LVO) is uncertain. We aimed to explore the clinical and safety outcomes of medical management (MM) plus EVT (EVT group) versus MM alone (MM group) among acute extra-large ischemic stroke patients with LVO within 24 hours of last known well. Methods： XL STROKE (endovascular thrombectomy for extra-large ischemic stroke) is an investigator-initiated, nationwide, prospective registry with blinded end point assessment performed at approximately 60 sites in China, and will enroll up to 990 acute ischemic stroke patients within 24 hours of last known well. Imaging inclusion criteria are occlusion of the internal carotid artery, or the middle cerebral artery M1 or M2 segments, and Alberta Stroke Program Early Computed Tomography Score of 0 to 2 or an ischemic-core volume ≥85ml. All patients will be dichotomized into EVT group and MM group according to whether they received EVT or not. The primary outcome is the level of disability on the modified Rankin Scale at 90±14 days. Safety outcomes include symptomatic intracranial hemorrhage within 48 hours, and mortality at 90±14 days. Conclusion： Results from XL STROKE registry will provide constructive evidence of improved disability outcomes and safety with EVT for acute extra-large ischemic stroke patients with LVO within 24 hours of last known well. Trial registrations: ClinicalTrials.gov, NCT06210633.

Introduction: The relationship between the 3-dimensional morphological features of hematoma and hematoma growth (HG) remains unclear. We aim to quantitatively assess the predictive value of 3-dimensional hematoma morphology for HG among patients with intracerebral hemorrhage (ICH).

Methods: Our study comprised 312 consecutive ICH patients. Using semi-automated volumetric analysis software, we measured hematoma volumes and delineated the region of interest. We employed Python software to extract shape features, and receiver operating characteristic curve analysis to assess the predictive performance of hematoma morphology for HG. P value < 0.05 was considered statistically significant.

Results: Sphericity and SurfaceArea emerged as the most effective 3-dimensional hematoma morphological predictors for HG. Optimal cutoff points relating to HG were Sphericity ≤ 0.56 and SurfaceArea > 55 cm2. We subsequently constructed the 3-dimensional morphology models, including the probability of hematoma morphology (PHM) and the probability of comprehensive model (PCM), to predict HG. The PHM model outperformed the irregular hematoma (p = 0.007), island sign (p = 0.032), and satellite sign (p < 0.001) in predictive accuracy for HG. Amongst all prediction models, the PCM presented the highest predictive value for active bleeding.

Conclusions: The Sphericity≤0.56 and SurfaceArea >55 cm2 could represent the optimal threshold for HG prediction. PHM was considered a reliable 3-dimensional morphology model for HG prediction. PCM tended to be a better model for risk stratification of active bleeding in acute ICH patients.

Introduction: Post-stroke dysphagia (PSD) is a highly prevalent dysfunction after stroke, characterized by high mortality and seriously affecting the quality of life of patients. Previous studies have shown that acupuncture improves symptoms of PSD. However, repeated tests of significance may exaggerate Type I errors. To update the evidence on the effectiveness and safety of acupuncture for PSD using a meta-analysis and trial sequential analysis (TSA).

Methods: A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science was conducted to identify randomized controlled trials evaluating the effects of acupuncture on PSD. Trials published up to September 15, 2024, meeting the predetermined inclusion criteria, were included.

Results: Twenty studies involving 1,718 participants were included. Combined acupuncture with rehabilitation therapies significantly improved the Standard Swallowing Assessment (mean difference [MD] = -3.64, 95% confidence interval (CI): -4.72 to -2.56, p < 0.0001), Videofluoroscopic Swallowing Study scale (MD = 1.49, 95% CI: 0.89 to 2.09, p < 0.0001), Water Swallow Test (MD = -0.72, 95% CI: -0.96 to -0.47, p < 0.0001), and Swallowing Quality of Life Questionnaire (MD = 16.56, 95% CI: 9.94 to 23.18, p < 0.0001). TSA indicated that the sample size exceeded the required information size. In addition, acupuncture showed safety for PSD treatment (relative ratio [RR] = 1.23, 95% CI: 0.70 to 2.17, p = 0.48); however, the sample size was insufficient.

Conclusions: TSA demonstrated the positive effects of acupuncture on swallowing function in patients with PSD. Nonetheless, high-quality trials are needed to validate the safety of acupuncture.

Introduction: Stroke etiology could influence treatment decisions. This study aims to evaluate the efficacy and safety of bridging thrombolysis (BT) compared to direct endovascular treatment (EVT) in patients with basilar artery occlusion (BAO), stratified by stroke subtype.

Methods: Data were collected from the PERSIST multicenter retrospective registry, enrolling patients with acute symptomatic BAO treated with EVT. Stroke subtypes were classified based on the TOAST criteria into large-artery atherosclerosis (LAA), cardioembolism (CE), and Others causes. A propensity score-matched analysis was performed to compare outcomes between patients receiving BT and those undergoing direct EVT. The primary outcome was a favorable functional outcome (mRS 0-3) at 90 days. Secondary outcomes included functional independence (mRS 0-2), 90-day mortality, and symptomatic intracranial hemorrhage (sICH).

Results: A total of 577 BAO patients were included, with 376 patients classified as LAA, 119 as CE, and 82 as other causes. In the LAA subgroup, BT was associated with a higher likelihood of favorable outcomes compared to EVT (53.8% vs. 34.4%; OR 1.29; 95% CI 1.02-1.65). In the CE subgroup, BT was associated with an increased likelihood of functional independence (mRS 0-2) at 90 days (OR 1.57; 95% CI 1.01-2.51). No significant increase in the risk of sICH or 90-day mortality was observed in any of the subgroups following BT.

Conclusion: BT appears to be an effective and safe treatment strategy in patients with BAO, particularly in those with LAA and CE etiologies. BT was associated with better functional outcomes compared to direct EVT without increasing the risk of hemorrhagic complications. These findings suggest that stroke subtype should be considered when tailoring treatment strategies for BAO patients. Further prospective randomized trials are needed to confirm these results.

Background Diagnosis of occult atrial fibrillation (AF) is difficult as it is often asymptomatic, leading to under detection. Current diagnostic tests have variable limitations in feasibility and accuracy. Machine learning is gaining greater traction for clinical decision making and may help facilitate the detection of undiagnosed AF when applied to magnetic resonance imaging (MRI). We hypothesise that machine learning algorithm increases the accurate classification of MRIs of stroke patients into those due to AF vs large artery atherosclerosis. Methods Stroke aetiology for each patient was determined by a review of medical records and investigations. Patients with either AF or large artery atherosclerosis were included. Patients were randomly divided into the training and validation groups (4:1). A 3D convolutional neural network (ConvNeXt) was developed to train and validate the algorithm. After training, the models were evaluated using common metrics for binary classification. Results A total of 235 patients were analysed (97 with AF, 138 without AF). The mean age of the sample was 71.1 (SD 14.2) and 35% percent were female. The best discriminative performance was obtained in the 5th fold of cross-validation (AUC-ROC 0.88) and the overall model performance was 0.81. The best performing metrics were precision (0.84) and the F1-score (0.77). Conclusion Our machine learning algorithm has reasonable classification power in categorizing stroke patients into those with and without underlying AF. Testing in external validation data sets are critical to confirm these results.

Introduction: Approximately 20% of strokes in the United States are preceded by either a stroke or transient ischemic attack (TIA). Determining which stroke patients are at higher risk for recurrence allows for individualized, aggressive secondary stroke prevention. A comprehensive clinical decision tool, considering the full spectrum of radiological brain health" including small vessel disease parameters, is currently lacking. Furthermore, large-scale characterization of pre-existing radiological brain health may elucidate novel phenotypes. This study aims (1) to characterize imaging manifestations of brain health at a population level, and associated demographic and clinical risk factors at the time of index stroke and (2) to create a 90-day and three-year prediction models of cerebrovascular disease recurrence (ischemic or hemorrhagic stroke) incorporating comprehensive parameters from routine clinical imaging.

Methods: Our overall cohort was estimated to consist of 4250 patients hospitalized with stroke, including 525 with hemorrhagic and 3725 with ischemic/TIA subtypes, ascertained in the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) population of 1.4 million residents from January 1, 2015 through December 31, 2015. Among 3725 ischemic stroke/TIA patients, based on published and ongoing data collection, we estimated that approximately 16% will have a recurrent ischemic or hemorrhagic stroke over the subsequent three years. Among these, 80% were estimated to have MR imaging for review. Leveraging extensive clinical and demographic data already collected in the 2015 NIH-funded GCKNSS study, we will have obtained and centrally characterized magnetic resonance imaging (MRI), acute CT, and vascular data in patients with hospitalized stroke/TIAs. We will determine if and how pre-existing imaging parameters cluster using factor analysis, and identify associated demographic and clinical risk factors in multivariable modeling. We will develop short term (90-day) and long term (three-year) risk prediction models using the machine learning approach of random survival forest with internal validation, and perform Cox regression models as a sensitivity analysis.

Conclusion: The primary outcome is recurrence defined as any stroke (ischemic or hemorrhagic) occurring after index ischemic stroke or TIA event. For index ischemic strokes, the second event must within a different vascular territory if <14 days from the index event.

Introduction Current studies on the relationship between periodontitis and carotid atherosclerosis (CAS) remain inconclusive. This updated meta-analysis was conducted to evaluate the relevant observational studies to drive a definite conclusion. Methods Four major databases were searched for observational studies regarding the relationship between periodontitis and CAS published up to 14 December 2023. Software STATA 14.0 was used to calculate pooled odds ratios (OR) and 95% confidence interval (CI) in random effects model. Results Twenty-six articles were finally included. Periodontitis was significantly associated with CAS (OR = 1.97, 95% CI = 1.64 - 2.36; p = 0.000)，however, statistical heterogeneity among studies. Sensitivity analysis indicated our results were robust. Although publication bias was observed, odds ratio corrected by the trim-and-fill method was still increased (OR = 1.30, 95% CI = 1.06 - 1.58; p = 0.000). Conclusion The findings revealed a significant association between periodontitis and CAS. However, long-term randomized controlled trials should be conducted to identify the causality.

Background: A significant proportion of stroke survivors, ranging from 50% to 88%, experience upper limb motor impairments. Traditional upper limb assessments in clinical settings rely on subjective observations, leading to inconsistencies. Motion capture (MoCap) systems offer objective, precise assessments of kinematics. This review aims to systematically evaluate emergent MoCap technologies for upper limb assessment in stroke patients.

Methods: This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and the Cochrane Handbook for Systematic Reviews of Interventions version 6.4. The review is registered with the Open Science Framework (OSF). Searches will be conducted in PubMed, MEDLINE, CINAHL, CENTRAL, and IEEE Xplore. We will include peer-reviewed studies from 2014 to 2024, in English, focusing on adults (≥18 years) post-stroke using MoCap technologies for upper limb assessment. Two or more reviewers will independently screen, select, and extract data. A narrative synthesis will describe the evidence's quality and content.

Discussion: This review will enhance our understanding of MoCap technologies for upper limb assessment post-stroke, identifying strengths, limitations, and providing evidence-based recommendations for clinical practice and future research. It aims to bridge the gap by capturing and analysing the latest advancements and their clinical applications.

Background: The dual burden of malnutrition, characterized by the coexistence of malnutrition and obesity, represents a growing concern in global health. This study examines the association of combined effects of obesity and malnutrition with the risk of stroke and brain structure.

Methods: Data from the UK Biobank, a large-scale population-based cohort study, were analyzed. Patients were stratified into nourished nonobese, malnourished nonobese, nourished obese, and malnourished obese. Malnutrition risk using objective scores, including the controlling nutritional status score (CONUT), nutritional risk index (NRI), and prognostic nutritional index (PNI). Obesity was defined as BMI ≥30. Cox proportional hazard models were used to assess the association between combined obesity and nutritional status and incident stroke. Kaplan-Meier curves for incident stroke were constructed. Linear regression models were used to evaluate the associations between combined obesity and nutritional status and brain structure.

Results: A total of 409,694 participants were included in the analysis. Among them, 37930 participants had imaging data. Kaplan-Meier curves illustrated a higher incidence of stroke in the malnourished obese group. Malnourished obese was found to increase the risk of stroke (HRCONUT 1.27, 95%CI [1.09 - 1.48]; HRNRI 2.61, 95%CI [2.03 - 3.36]; HRPNI 7.9, 95%CI [1.11 - 56.07]) , ischemic stroke (HRCONUT 1.29, 95%CI [1.08 - 1.54]; HRNRI 2.8, 95%CI [2.09 - 3.76]; HRPNI 8.43, 95%CI [1.19 - 59.83]) and hemorrhagic stroke (HRNRI 2.53, 95%CI [1.57 - 4.09]). Brain imaging analysis revealed associations between malnourished obese and certain structural parameters. Cerebral white matter hyperintensities may be associated with the occurrence of stroke.

Conclusion: Malnourished obese is associated with the risk of stroke and brain structure parameters. Further research is needed to better understand the underlying mechanisms and develop targeted interventions for individuals with combined effects of obesity and malnutrition.

Background: Neurological deterioration following acute ischemic stroke (AIS) is a common clinical phenomenon associated with poor clinical outcomes. However, neurological deterioration can be attributed to diverse mechanisms in different clinical contexts. Further, there is still a lack of standard and well-recognized definitions of neurological deterioration, which compounds the complexities and challenges of its early identification and management of neurological deterioration. As AIS becomes increasingly common, the need to address neurological deterioration after AIS in clinical practice and further improve functional outcomes is becoming more urgent.

Summary: To facilitate earlier recognition and more precise interventions, in this review, we comprehensively outline the evolution of the definition of neurological deterioration, its incidence in various patient groups, and the potential underlying causes rooted in multiple pathophysiological mechanisms. We further highlight the diverse risk factors associated with neurological deterioration and provide an overview of the scientific basis and practical applications of preventative and therapeutic strategies.

Key messages: Early identification and management of neurological deterioration in AIS patients is crucial but challenging due to lack of unified assessment criteria and diverse mechanisms. Standardizing definitions and developing targeted strategies based on pathological mechanisms and pharmacological profiles are needed to improve outcomes.