Cerebrovascular Diseases最新文献

Introduction: Health-related information and support is scarcely available to stroke survivors following discharge from hospital, largely due to limited access to health professionals. Digital tools like Virtual Assistants (VAs) can address some of these needs on demand in a home environment, and there already is evidence of their effective deployment in health contexts. However, to maximise how individuals engage with such technological tools in or post development, it is integral that their design be grounded to the needs and associated expectations of the target user population.

Methods: We conducted workshops where stroke survivors roleplayed as VAs and users and fed back on their expectations of a stroke-specific VA. In our one-to-one interviews with stroke survivors, we simulated VA interactions with two functions: administering PROMs and asking questions. Then, in testing sessions, stroke survivors, family, and caregivers responded to PROMs both on the VA and with a human, before sharing their thoughts about the VA.

Results: Our thematic analysis yielded four themes with semantic and latent codes. Aligned with past research, we observed an unmet need for information and support on demand following discharge. Participants expected the VA to on demand provide information not typically available through healthcare interactions. Participants perceived the VA in our study as human or as a personable animate object, and the subsequent anthropomorphic expectations were the least addressable barrier to engaging with the VA.

Conclusion: These qualitative findings validate that common expectations of digital tools in general adult populations extend to stroke survivors, emphasising the importance of participatory design to account for addressable barriers to initially and continuously engaging with a digital health tool.

Introduction: It is unknown if language discordance between patient and provider during telestroke evaluations involves differences in stroke metrics, severity, or outcomes when compared to language concordant (LC) situations. We sought to evaluate differences in patient demographics, stroke severity, and treatment times for patients where intravenous thrombolysis was recommended for suspected acute ischemic stroke (AIS) between LC and language discordant (LD) patient and physician encounters.

Methods: This cross-sectional study was a retrospective analysis of prospectively collected data after recommendation to administer intravenous tissue plasminogen activator (IV tPA) between July 2017 and July 2020. Consecutive patients where thrombolysis was recommended for suspected AIS were included, from a single academic center telestroke network with multiple spoke sites. Primary language, time of telestroke evaluation, time to IV tPA recommendation, initial National Institutes of Health Stroke Scale, and demographic information were abstracted. Data were dichotomized into LC for English-speaking patients and providers vs. LD for non-English-speaking patients with English-speaking providers.

Results: A total of 705 LC patient encounters and 42 LD patient encounters were identified. LD patients were older (70 years versus 65 years, p = 0.04) and had a trend to higher stroke severity (median NIHSS 7 versus 6, p = 0.09) than LC patients. Limited outcome data were available only for patients transferred to the comprehensive stroke center hub for a higher level of care or consideration for endovascular thrombectomy, but no significant outcome findings were seen.

Conclusions: LD patients who are evaluated via telestroke were significantly older and had a trend to higher stroke severity as measured by initial NIHSS. Further dedicated data collection on the effects of language in acute stroke metrics in larger cohorts is necessary.

Introduction: Intracerebral hemorrhage (ICH) is a common complication of reperfusion treatment (thrombolysis and/or thrombectomy) after acute ischemic stroke, which is related to poor outcomes. Recent data suggest that reperfusion-related ICH may be dynamic and experience hemorrhage expansion. However, the underlying pathophysiology, natural history, outcomes, clinical features, and risk factors associated with the dynamic evolution of reperfusion-related ICH remain poorly understood.

Methods: The dynamic evolution after reperfusion-related ICH (DESIRE) is a prospective observational cohort study, which is designed to investigate the natural history of the dynamic evolution after reperfusion-related ICH and its clinical and imaging risk factors related to the evolution and progression. Patients with acute ischemic stroke admitted to the Department of Neurology, West China Hospital, Sichuan University in China and received reperfusion therapy will be included. Baseline data, clinical characteristics, as well as major laboratory measures will be collected after admission. All patients will complete brain CT on admission, at 1 day, 3 days, 7 days, with neurological deterioration during hospitalization. We will assess qualitative imaging markers and radiomic features on non-contrast-enhanced computed tomography imaging brain images. The primary outcome is the dynamic evolution after reperfusion-related ICH, which includes one of the following conditions: (1) hematoma expansion: a 33% increase in the hematoma volume using the (A*B *C)/2 method on follow-up imaging; or (2) hemorrhagic infarction evolving into parenchymal hematoma; or (3) asymptomatic ICH evolving into symptomatic ICH. Patients will be followed up at 3 months, 6 months, and 1 year by phone to investigate their survival status, functional outcomes, and cognitive status assessed by modified Rankin Scale score and the modified Telephone Interview for Cognitive Status.

Conclusion: The dynamic evolution after reperfusion-related ICH is poorly understood, as well as the risk factors that drive this progression. This study investigates the natural history of the dynamic evolution after reperfusion-related ICH, identifies those at high risk of early evolution and progression, and uncovers novel targets for prevention and therapy.

Background: The aim was to identify the clinical, laboratory, and radiological predictors of spontaneous secondary haemorrhagic transformation in acute ischemic stroke and after systemic thrombolytic therapy with rt-PA.

Methods: A total of 909 acutely treated (rt-PA, n=161) and non-treated (No-rt-PA, n=748) patients with ischemic stroke in MRI were investigated regarding the occurrence of haemorrhagic infarction (HI) and parenchymal haemorrhage (PH) within the first 5 days after stroke onset. Clinical, laboratory and radiological data were analysed using a one-way analysis of variance (ANOVA) and univariate and multiple regression analyses.

Results: In the rt-PA group the patients were clinically more severely affected, the infarct lesions were significantly larger, and HI and PH occurred more frequently than in the No-rt-PA group. In the No-rt-PA group the clinical condition of patients with HI and PH was not different. Multiple regression analyses revealed atrial fibrillation, diabetes mellitus, and infarct volume as predictors of HI and of PH.

Conclusions: The results support the association between greater infarct size and an increased risk of secondary haemorrhagic transformation both after systemic thrombolysis with rt-PA as well as in non-treated stroke patients. We hypothesize that risk factor reduction may be beneficial not only for the prevention of ischemic stroke but also for the prevention of secondary haemorrhagic transformation. Pragmatically, the radiological assessment of infarct volume appears as a relevant prognostic factor.

Introduction: In more recent years, stroke survival rates have improved, and hospital stays have shortened, increasing the importance of appropriate referrals to municipal rehabilitation. Therefore, this study aimed to examine patterns of referral to municipal rehabilitation among Danish patients with stroke.

Methods: This population-based nationwide cohort study included all individuals aged ≥18 years discharged alive from hospital with a stroke diagnosis between January 2019 and May 2021, as recorded in the Danish Stroke Registry. Individual-level data were linked with information from the Danish Civil Registration System and Statistics Denmark to describe referral patterns to municipal rehabilitation services. Descriptive statistics were reported using frequencies and percentages, and propensity scores were estimated with a multivariate logistic regression model. Alluvial plots were created to illustrate patient flow.

Results: A total of 26,230 patients were eligible for inclusion. The median age was 74 years (interquartile range: 64-81), 56.8% were male, and 66.4% had mild strokes. Up to 30 days after discharge, 58.5% patients received a referral to municipal rehabilitation services. Patients with referrals were older, had longer hospital stays, and had a lower 30-day mortality rate compared with patients without referrals. Propensity score stratification revealed differences in patient profiles, rehabilitation referrals, and regional patterns.

Conclusion: Over 40% of stroke patients did not receive a referral to municipal rehabilitation post-hospitalisation. While this may reflect a lack of rehabilitation needs in some cases, it could also indicate inconsistencies in referral practices that warrant further attention.

Introduction: Previous studies have shown that residing in more deprived neighbourhoods is associated with an increased risk for stroke and worse health outcomes. We aimed to investigate the association between neighbourhood deprivation and secondary prevention prescribing and all-cause mortality after a stroke in Scotland.

Methods: This retrospective observational study analysed linked data on first-ever stroke patients admitted to hospitals across Scotland between 1 January 2011 and 31 December 2018. Data were obtained from the Scottish Stroke Care Audit (SSCA), hospital admissions dataset, community prescribing and dispensing dataset, and mortality records. Neighbourhood deprivation was assessed using the Scottish Index of Multiple Deprivation (SIMD) quintiles. Study outcomes were 1-year all-cause mortality and secondary prevention prescribing, stratified by stroke type and presence of atrial fibrillation (AF). Findings from Cox regression and logistic regression analyses, with models adjusted for sociodemographic factors, comorbidity burden, stroke severity, and stroke unit admission, are presented.

Results: This study included 47,947 stroke patients, of which 11,752 (24.5%) resided in the most deprived areas (quintile 1) and 7,450 (15.6%) resided in the least deprived areas (quintile 5). Compared with patients from the most deprived areas, patients from the least deprived areas were older {78 (interquartile range [IQR] 68-84) vs. 71 (60-81) years}, experienced more intracerebral haemorrhages (12.1% vs. 9.2%), and more AF (26.5% vs. 20.4%). Among ischaemic stroke patients, residing in less deprived areas was associated with reduced hazard of all-cause mortality at 1 year (adjusted hazard ratio [aHR] 0.97; 95% confidence interval [CI], 0.96-0.99), reduced odds of antiplatelet prescription in patients without AF (adjusted odds ratio (aOR, 0.95; 95% CI, 0.92-0.98), and increased odds of being anticoagulated in patients with AF (aOR, 1.15; 95% CI, 1.09-1.20), compared to patients residing in the most deprived areas. No significant differences in all-cause mortality and secondary prevention prescribing by neighbourhood deprivation were found in intracerebral haemorrhage patients.

Conclusion: In this retrospective observational study, ischaemic stroke patients residing in the least deprived areas had a lower hazard of 1-year all-cause mortality, lower odds of antiplatelet prescription (in the absence of AF), but higher odds of oral anticoagulant prescription (in the presence of AF), compared to those residing in the most deprived areas. These findings suggest that neighbourhood deprivation is independently associated with all-cause mortality and treatment after stroke, highlighting potential interventions for stroke risk factors and poststroke care, particularly in patients from more deprived areas.

Introduction: Recent research has increasingly acknowledged the thalamus's role in the development of neuropsychological deficits, which were previously considered to be primarily related to cortical processes. Among these deficits, neglect is of particular importance in stroke survivors, as it is a predictor of poor functional outcome. This review aimed to clarify the relationship between stroke lateralization and location within the thalamus and the occurrence of neglect.

Methods: In the present study, we performed a systematic review according to the PRISMA guidelines. PubMed, Scopus, CINHAL, and Web of Science were searched for articles published from inception to June 30, 2024. All studies presenting cases of isolated vascular thalamic stroke (hemorrhagic, ischemic) and clinical neglect were included. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist for case reports, case series, and case-control studies. We divided the thalamus into four parts (anterior, lateral, medial, and posterior) based on the four classical vascular territories and performed a qualitative and a simple descriptive statistical analysis using absolute numbers and percentages of the data collected.

Results: A total of 23 articles involving 37 patients were included: 31 cases (84%) with right-sided thalamic stroke and 6 cases (16%) with left-sided thalamic stroke. In the hemorrhagic stroke group (21 cases), there was a clear predominance of localization in the posterior (10 cases; 47%) and entire thalamus (9 cases; 43%), with no cases in the anterior part of the thalamus and only one case (5%) each in the medial and lateral parts. In contrast, ischemic cases were predominantly located in the anterior and lateral parts (6 cases each; 37.5%) with only 3 cases (19%) in the medial part and 1 case (6%) in the posterior part.

Conclusion: Thalamic neglect appears to occur more frequently in right-sided thalamic strokes than in left-sided thalamic strokes. However, the exact neuroanatomical correlates differed between hemorrhagic and ischemic groups and the underlying mechanisms remain unclear due to the heterogeneity and paucity of data. Rather than drawing definitive conclusions, this work synthesizes existing literature and underscores the need for prospective studies with standardized assessments and advanced neuroimaging.

Introduction: Ischemic stroke incidence varies significantly with respect to sex and cardiovascular risk factors (CVRFs), a relationship that it is not well understood. Calcification in carotid atherosclerosis is known to impact plaque stability, potentially linked to ischemic stroke. The objective was to assess the in-depth calcification morphometrics within extracranial carotid atherosclerosis, their temporal changes, and associations with sex and CVRFs.

Methods: Carotid arteries (n = 144) with confirmed atherosclerosis and mild-to-moderate stenosis from 72 symptomatic patients (Plaque-At-Risk study) with recent ischemic event due to ischemia in the territory of a carotid artery were imaged using multidetector computed tomography angiography (MDCTA) at baseline and after 2 years. The lumen, vessel wall, and calcifications were segmented semiautomatically, and the carotid geometries were 3D reconstructed. A comprehensive morphometric assessment of carotid calcifications was performed on the baseline and follow-up scans. We investigated distributions of these metrics and their associations with sex and CVRFs using generalized linear mixed models.

Results: Our findings suggest that women have larger (4.5 mm2 [95% CI: 3.2-6.2] vs. 3.2 mm2 [95% CI: 2.4-4.2]) calcifications, located closer to the lumen (0.6 mm [95% CI: 0.4-0.8] vs. 0.9 mm [95% CI: 0.7-1.2]) in contrast to men at baseline and follow-up, adjusted for baseline measurements. At the baseline, nonsmokers had larger (5.3 mm2 [95% CI: 3.7-7.5] vs. 3.2 mm2 [95% CI: 2.3-4.4]) and longer (5.7 mm [95% CI: 4.1-7.3] vs. 2.4 mm [95% CI: 1.6-3.6]) calcifications than the current smokers. Diabetic patients had thicker (1.1 mm [95% CI: 0.8-1.3] vs. 0.8 mm [95% CI: 0.7-0.9]) carotid calcifications at baseline.

Conclusion: Our in-depth analyses exposed several geometric features of carotid calcifications associated with sex and CVRFs and provided further insight into the pathophysiology of carotid atherosclerosis.

Introduction: This study aimed to investigate the role of novel indicators related to obesity in predicting long-term functional outcomes and the risk of stroke recurrence in participants with first-ever acute ischemic stroke (AIS).

Methods: The area and density of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and skeletal muscle (SM) at the third lumbar level, as well as the VAT area (VATA)-to-SM area (SMA) ratio (VSR) and the SAT area-to-SMA ratio (SSR) were assessed using whole-abdominal computerized tomography upon admission. The primary endpoint was the recurrence of stroke. The secondary outcomes were all-cause mortality and cardio-cerebrovascular origin death (CCVD) specifically due to cardiovascular and cerebrovascular diseases. Cox's proportional hazards regression model was used to examine the associations between the novel indicators of obesity and clinical outcomes.

Results: A total of 1,007 participants were enrolled, with an average follow-up time of 1,445 days. The participants in the high VSR group had a higher rate of stroke recurrence {adjusted hazard ratio, 2.06 (95% confidence interval [CI], 1.35-3.14); p = 0.001}. According to the adjusted analysis, high VSR was significantly associated with an increased risk of all-cause mortality (hazard ratio, 2.26 [95% CI, 1.58-3.24]; p < 0.001) and CCVD (hazard ratio, 2.49 [95% CI, 1.65-3.78]; p < 0.001).

Conclusion: A higher VSR was associated with a higher risk of mortality and stroke recurrence in participants with first-ever AIS.